Page images
PDF
EPUB

alæ nasi, pseudo tuberculosis ulcerations of the epiglottis, infiltrations of the palate and ulcerations of the pharynx in which mercury gave excellent results. Syphilis was positively ruled out in each of his

cases. The author believes that in these mercury should be used, and the patient. naturally kept under close observation while undergoing the mercurial treat

ment.

PUBLIC HEALTH AND FORENSIC MEDICINE.

UNDER THE OHARGE OF

F. C. CURTIS, A.M., M.D., of Albany,
Medical Expert, New York State Department of Health.

Study of Ventilation The laboratories are
in Chicago.
making systematic
examinations of the condition of ventila-
tion in all the public schools. All the
newer schools have ventilation systems,
and the results of tests made by the labor-
atory show that these systems are ade-
quate as far as the amount of fresh air
is concerned.

In some of the older schools that have been examined ventilation systems that have been installed supply adequate ventilation. We have not found a single room in any school in which there was not a theoretically proper amount of fresh air being delivered to the pupils. In none of the schools, however, was there any provision made for moistening the air, and the department is now working upon some method whereby this may be remedied, it being a well-recognized fact that dry air is not as wholesome or healthy as that containing the proper amount of moisture.

If some scheme can be worked out whereby the air supplied to the pupils can be sufficiently moistened all of the schools. will be properly ventilated.

An examination is also being made of the ventilation and the air in all of the lodging-houses, public places and the street cars. So far as we have gone, with the examination of the air of street cars, in which the side ventilators were wide open, the air was found to be fairly satisfactory, but, unfortunately, not more

than 20 per cent. of the cars have their ventilators open.

An analysis of the air in some of the cars show it to be polluted to an alarming extent, and an estimation of the ventilation shows that persons in the car were getting only about one-thirtieth of the amount of fresh air required.

This work has only begun. The Department intends to examine the air in cars, lodging-houses and public places, with a view of suggesting proper means for ventilation, and if these are not obtainable by suggestion suit will be entered against the responsible parties.— Bulletin Chicago Dept. of Health.

Dengue Fever.

J. Goldberger and G. W. McCoy, assistant surgeons U. S. Public Health and Marine Hospital Service (Journal A. M. A., December 7), describe the epidemic of dengue as it occurred in Brownsville, Texas, during the summer of 1907. The town is located on the bank of the Rio Grande, about 10 miles from its mouth, and as the water for domestic use is kept in barrels or cisterns, the mosquitoes are very much in evidence. The disease was probably introduced from Mexico, and between the middle of June and the middle of August it was estimated that there were about 1000 cases. The incubation in the one case in which it could be accurately observed was not over six days, the onset was rather abrupt, with general malaise

and aching headache, and ocasionally slight chill or chilliness. Pain, in the form of headache, with or without rachialgia, lumbar pain, aching of the limbs and eyeache was a constant symptom. Severe aching in the scapular regions was complained of in many cases, but no joint pains were noticed. The pains varied in intensity and disappeared as a rule with the fever. In many cases there was an initial flushing of the face for two or three days; the skin was usually warm and moist, and in a little more than one-half of their cases a more or less pronounced eruption appeared, sometime between the third and sixth day, lasting from 12 hours to three days. It varied considerably in character and extent, but in the majority resembled somewhat that of measles. Enlargement of the lymphatic glands was observed in only three cases. The rise of temperature began with the onset of the disease, and was progressive for two, three or four days. When it reached its maximum it began to decline, slowly or rapidly, usually reaching normal on the fifth or sixth day; the highest noted was 104.2 F. The pulse followed the fever; in no case was there typical Paget's sign, a falling pulse rate, with a stationary or rising temperature. In four cases nose bleed occurred, but there were no catarrhal or other respiratory symptoms. Blood examinations revealed no parasites that could be considered as of ætiologic significance. The tongue was usually moist and more or less coated over the dorsum, the appetite dulled and sometimes lost thirst was almost invariably marked. In some cases there was nausea, and in a few instances vomiting, usually watery and sometimes bile-stained, but not severe. Constipation was the rule, but was readily controlled. Albumin was absent. in the urine, at least up to the fourth day, after which it was impracticable to obtain

One pa

specimens, except in one case. tient had a slight catarrhal icterus, antedating, however, the dengue. On the part of the nervous system, aside from pain, insomnia was observed in several instances, frequently as the result of the former. More or less marked adynamia followed the fever as a rule. A number of patients gave histories of previous attacks, and at least two had had yellow fever. The disease corresponded closely with that observed in the Philippines, but there hæmorrhages were not observed and enlargement of the lymphatics was more common. The diagnosis in the presence of an epidemic was not doubtful. Yellow fever, the only disease demanding serious consideration, was readily excluded by the eruption and the absence of albuminuria and jaundice, which would certainly have been present with the fever of such severity and duration.

Too Much Light.

George M. Gould thinks the dangers of too much light should be the subject of more comment than is given to them in current medical literature. The destruction of life, due to concentrated cold rays, should open our eyes to the lesser damage of smaller doses. Nature has heavily pigmented all the races in light countries, and there seems to be no reasonable doubt that its purpose is protection from light. If so, then the blond races are injured if they expose themselves in light climates. Slowly facts are being reported which tend to the view that this is an extremely important practical matter in many directions. We have already called attention to the alleged greater mortality of the tuberculous blonds sent to light climates and their recovery in cloudy ones, and it is now thought that the same rule applies to many other diseases. There is considerable evidence of greater susceptibility

to nervous disorders on the part of blonds in light countries, and the existence of a tropical neurasthenia now seems to be accepted by tropical experts. Its cause must be investigated, for if it is really due to excessive light its prevention is a simple matter. The excessive summer light of our shadeless cities seems to be the fatal factor, and fully accounts for the wonderful change in city children who have a short residence in the country.-Medical Standard.

Hospital Bedding.

There is little doubt that thousands of pounds are wasted annually in the hospitals over new bedding when, with at good system, the old bedding could be restored and cleaned at small cost. The system introduced by Miss Monk at King's College Hospital, London, years ago has never been improved upon, and might with advantage be copied in institutions which show a heavy outlay year by year on repairs and renewals, an item which in many instances is merely bedding in disguise. Under this plan all bedding as it is sent away to be cleaned is weighed,

and each mattress, pillow and bolster is made up to a standard weight, found by long experience to be the most satisfactory. The cleaning process consists of washing the tick and thoroughly pulling, purifying and remaking the hair. Whatever hair is lost in the cleaning or by wear is made good, and the covers are then restuffed. Under this system no new mattresses, bolsters or pillows are ever needed unless the number of beds is added to, the sole outlay being for the labor and for extra hair needed in the process. A competent upholstress is a necessary and most economical adjunct to a large hospital, and even when there is not sufficient work to keep one constantly employed it will be found more economical to engage one by the day to execute work on the premises rather than send such cleaning and repairs as the above to be done at a shop. The reason for this is that the shop has every interest in not making use of old materials, and that the hospital gets the full benefit of such savings when the work can be supervised by those who have a strong motive for economy.--The Hospital.

MATERIA MEDICA AND THERAPEUTICS

UNDER THE CHARGE OF

ALFRED C. PRENTICE, A.M., M.D.,

Assistant in Surgery, College of Physicians and Surgeons; Attending Physician, New York Home for Destitute and Crippled Children.

The Choice of a Vaso- II. W. Cook, Mindilator. neapolis (Journal A. M. A., February 29), calls attention to the advantages of sodium nitrite over nitroglycerin and amyl nitrite as regards stability and permanence and certainty of effect. Its action usually is manifest in from three to five minutes when given by the mouth, and in about two minutes when given hypodermically, and is maintained from one to two and a half hours. Both of the other drugs, while quicker in

action, are less reliable and less lasting in their effects. A great recommendation of sodium nitrite is the almost entire absence of general effects when given in proper doses; the throbbing, dizziness, flushing, etc., often so annoying with amyl nitrite and nitroglycerin, are slight or absent, and Cook has never observed the headaches so common with the continued use of nitroglycerin to follow that of sodium nitrite. He has found it most convenient to give it in triturates of one

half and one grain each. They may be used either by the mouth or hypodermically. He reviews the indications for vasodilatation in conditions of low and high arterial tension, insisting on the necessity for the use of the sphygmomanometer in the treatment of every case of cardiac, renal or arterial disease. Any attempt, he says, to regulate arterial tension without any knowledge of its degree or action under treatment is working in the dark. One-half grain of sodium nitrite is a safe initial dose in an untried case, and a three-hour interval between doses. The adjustment of dose and interval must be regulated by the sphygmomanometer. His conclusions are summarized substantially as follows: 1. Sodium nitrite is the best vasodilator; it has the most enduring effects; is most stable and dependable; gives rise to the fewest unpleasant symptoms. 2. Vasodilatation may be indicated with low or normal tension, i. e., all uncontrollable hæmorrhages, either during operative manipulation, typhoid ulceration, gastric ulcer, pulmonary hæmorrhage, other internal hæmorrhages uncontrollable by surgical methods, aneurism or thrombus. 3. High tension is abnormal, and either accompanies organic disease or else presages its onset; in either case it demands treatment; first, by general hygienic measures; second, when necessary by venesection or vasodilatation with drugs--preferably sodium nitrite.

The Operative Treat M. Woods, Philadelment of Epilepsy. phia (Journal A. M. A., February 29), advocates more frequent resort to surgery for the cure of epilepsy, basing his recommendation on the theory that the disorder is an apyretic paroxysmal neurosis, and that the strong impression made on its neurotic victims.

by surgical procedures will often have a directly curative effect. He reports from his own case records three instances of apparently lasting arrest of the attacks after surgical operations and traumatisms involving surgery, and refers also to the frequently observed fact of the temporary arrest of the paroxysms after almost any kind of an operation. One of his cases is that of a woman, aged 42 years, who had been an epileptic for 20 years, who burned her hand on a red-hot grate in an attack, the hand requiring amputation. She continued free from the disease till her death, eight years later. He refers to other similar cures reported by various authors, and holds that, altogether, they justify a claim for more frequent resort to surgery in this disease.

The Treatment of Ery- Neumann (Berl.
sipelas with Meta- Klin. Wchschrft.,
Kresolanytol.
No. 29, 1907). In

the author's experience, metakresolanytol-a black syrupy fluid, smelling like ichthyol, and readily soluble in waterrendered very good service in a number of severe cases of erysipelas. The remhealthy surroundings of the diseased skin edy was painted, undiluted, upon the

surface to an extent of 10-12 cm.. and then upon the affected area itself. It is applied in rather a thick layer and allowed to dry. The tension of the skin promptly subsides, and finally the epidermis is desquamated in large and small shreds. The most noteworthy action of the remedy is its prompt and reliable effect upon the fever. In those cases where the temperature does not fall after one or two applications, and where the pulse remains frequent, some serious complication, such as phlegmon or sepsis, may be anticipated.

It is advisable to repeat the application of the remedy once daily until the body

warmth becomes normal. Injurious byeffects were not observed in any instance. F. R.

Leukæmia in Children Benjamin Sluka Treated by the X-ray. (Zahrbuch f. Kiederheilkunde, Vol. 65, 1907). The treatment of leukæmia has been started in a new direction by the discovery of the action of X-rays upon the pathological proliferations of lymphatic tissue. After Senn's discovery had been tested in thousands of cases the favorable effect of this treatment upon chronic leukæmia came to be recognized almost universally. Conditions differ for the acute cases, only a few of which seem to have been treated according to this method. Meanwhile, it is of special importance for the pædiatrician, who meets with the acute cases far more often than with chronic conditions, to collect the scanty experiences along these lines in order to gain some sort of an estimate concerning the value of the X-ray treatment. Only four cases of lymphatic leukæmia in children were subjected to the radiation method, according to the authors' compilation from the literature. To these is added a personal observation upon a boy 7 years of age, with a fatal outcome. In all five cases it would seem as if even the duration of the disease had not been prolonged by the treatment. However, a distinct influence upon the course of the process was demonstrable in all these cases, with one exception, in which death followed too promptly. After a latent stage of a few days, during which an irregular rise of temperature is noted, the leukocyte figure unexpectedly and abruptly drops to normal or subnormal values. Cutaneous hæmorrhages are apt to appear during this time, the patient may present a certain euphoria; sometimes the glands, spleen and liver become considerably smaller, and it is even

possible for the blood to approximate the normal percentage as to its composition. Nevertheless, all this does not serve to arrest the fatal outcome, death ensuing under an enormous and sudden rebound of the leukocyte figure, with recurrent glandular enlargement. The authors' personal experience entirely confirms the statements of other observers in regard to acute lymphatic leukæmia. Their compilation shows an essential difference between lymphoid and mycloid cases, with special reference to the X-ray treatment. The results in mycloid leukæmia are far more encouraging, although it should be kept in mind that the mycloid form, as a rule, takes a chronic course. Meanwhile, the brilliant results obtained by the radiation of chronic cases of mycloid leukæmia actually urge the adoption of this method of treatment in every single case. The blood picture approaches the normal, the number of white cells falls, the number of red increases, and the myclocytes diminish. At the same time, the general condition improves, the body weight rises and the spleen becomes smaller. The excellent appearance of the patient is often commented upon. However, it is well to be prepared for unexpected developments, for this welcome change for the better may meet with a sudden and unaccountable interruption. F. R.

[blocks in formation]
« PreviousContinue »