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would not dare to use the cold bath in scarlet fever, and did not believe in “ reducing the pulse.” – Dr. Manley had given up the quinine treatment, and substituted small doses of calomel, from which he had seen good results in fevers. — Dr. Chase believed in occasionally giving a large antipyretic dose of quinine, say a scruple, in typhoid fever. He had seen the fever heat come down in a few hours from 107° F. to nearly the normal. Dr. E. P. Hurd, in closing, said that one object of his paper had been to inculcate caution in the treatment of fevers, we know so little about the causes of fever and the action of medicines.
OF THE NORFOLK DISTRICT MEDICAL
JANUARY 14, 1879. Vaccination followed by Death. — After the transaction of business, DR. PETERS, of Roxbury, read the case. Virus was bovine, fresh, and of the best quality. Perfectly developed vesicles the eighth day. Next seen the fourteenth day. The space occupied by the three vesicles, with the skin around it, was black and sloughing, forming a deep ulcer two and a half inches long by more than an inch broad. Elsewhere on arm were superficial ulcerations, and three blebs filled with turbid, serous fluid. Arm twice the size of its fellow, boggy and cedematous. At shoulder-joint and half-way to sternum vivid redness of skin. Little constitutional disturbance. Each of the next three succeeding days the constitutional disturbance grew more serious, while the appearance of the arm was steadily improving. The urine became scanty and high colored, the face white and slightly puffy ; but on the morning of the eighteenth day these symptoms were improved, and the child seemed better, while the arm was rapidly healing. A little later in same day bands and feet grew cold, chill crept up the limbs, the skin turned bluish, and the child was soon dead. No urine could be obtained before or after death. DR. S. C. MARTIN said that the fatal result in that case was due to the constitution of the child or to septic influences near its home. Five hundred individuals were successfully vaccinated from the same animal, and probably thirty from the same vesicle. — DR. PETERS replied that he had made no complaint of the virus. He had used the same on other children, and the resulting vesicles had run a regular course. The child that died had had some infantile ailments some time previously, and he had waited until it was in good health before vaccinating. The house was in the neighborhood of a marsh, but the family lived in an upper story. He did not notify Dr. Martin, because he did not hold the virus responsible for the death. — DR. EMERY, of Roxbury, said that he vaccinated a healthy child with fresh animal virus. Immediately the weather became intensely cold. On the eighth day there was a typical vesicle. Sereral days after was called to child, and found a large, deep ulcer where vesicle had been, with redness, swelling, etc. Applied poultices, but abscesses formed in axilla, and above and below the ulcer, and just above the elbow. Child recovered under supporting treatment. Dr. Emery received information from the mother that the child slept in an intensely cold room (he believed thermometer would bave proven temperature to be below zero), and that she found the child one morning sitting up in bed, uncovered, and scratching the vesicle
with its finger nails. He could learn of no other cause for the trouble. — Dr. H. A. Martin thought that if one hundred children after vaccination were exposed to temperature below zero they might all suffer as did the patient of Dr. Emery.
The causes of trouble are almost always connected with morbid atmosphere, irritation of sore, and lack of care. The sleeve becomes glued to the arm, and the scab is torn off. The matter becomes putrescent, and develops intensely septic poison. All cases should be investigated by impartial men. - DR. CUSHING, of Dorchester, expressed doubt whether any one could produce erysipelas at will, and the case of Dr. Peters was undoubtedly one of erysipelas. He thought the lesson to be drawn was that no matter how carefully the virus be selected, or how judiciously the time be chosen, fatal accidents will sometimes occur. All cases of this kind should go on record, to show that the best precautions will not always avail.
Ingrowing Toe Nail and its Treatment. — Dr. H. A. MARTIN read a paper on Ingrowing Toe Nail and its Treatment, Ancient and Modern. (Reserved for publication.) — DR. MECUEN, of Roxbury, had successfully treated two cases (one of which was double) in the following manner: He elevated the edge of the nail, and passed deep through it a needle armed with heavy silk. The silk was then passed through a strip of adhesive plaster, which was drawn over a fulcrum formed of the half of a piece of lead-pencil, round surface down, close to the nail. Thus the nail, which had been first scraped thin, was kept elevated. A dressing of boracic acid and lint was employed.
MACKENZIE ON DIPHTHERIA." In this little book of one hundred pages is contained a very interesting and learned treatise upon the disease in question, and the author has brought to the task not only the results of his large experience, but also a thorough knowledge of the medical literature pertaining to the subject, both modern and historical.
It might reasonably be feared that a special practice in diseases of the throat would lead one to attach too great importance to the local manifestations of so complicated a disease as diphtheria, but no such charge can be made with justice in the present case.
The bibliographical references in the foot-notes are very numerous, extending backwards, in the chapter on the History of Diphtheria, to the work in Sanscrit by D'hamantare, to a time about coeval with Pythagoras. There is claimed to be found in this book a description very suggestive of diphtheria. The Askara, frequently mentioned in the Talmud as a fatal epidemic, is said by Dr. Mackenzie to be supposed to have been diphtheria. It was described by Rashi, the learned commentator of the Talmud and Old Testament, who remarks that “sometimes it breaks out in the mouth of a man, and he dies from it.” He further observes that “sudden death comes from suffocation.”
1 Diphtheria: Its Nature and Treatment, Varieties and Local Expressions. By MORELL MACKENZIE, M. D., London, Senior Physician to the Hospital for Diseases of the Throat and Chest, Consulting Physician to the North Eastern Hospital for Children, and Lecturer on Diseases of the Throat at the London Hospital Medical College. Philadelphia : Lindsay and Blakiston. 1879.
The “Syriac ulcer,” described by Aretæus at the close of the first century after Christ, is considered also to have many points of resemblance to the diphtheria of to-day. Actius of Amidas in the sixth century delineated a disease as presenting white and ash-gray spots in the pharynx, slowly ending in ulceration. From that period there is no record until the sixteenth century, when its occurrence in Holland was described by Peter Forest (1557), and a few years later most accurately by Von Woerd (1585).
The first published description with definite mention of a false membrane was by Baillou, a French physician (1576). The literature since then has been large, at first by Spanish and Italian physicians; and from the middle of the eighteenth century on, the contributions have been abundant, both by English, Continental, and American writers, in the form of monographs upon recorded epidemics.
The ætiology and pathology are ably discussed. In the chapter on pathology we find at the end the following summing up:
“ The most cursory study of the general pathology of diphtheria suffices to assure us that it is an acute general disease, with certain local manifestations. The primary septicæmia is due to the specific poison, but absorption from the decomposing lymph is, no doubt, a cause of secondary infection. In all cases the attack is associated with some degree of constitutional disturbance, while in the severest forms there is extreme disorganization of the blood, and conse quent implication of nearly every tissue in the body. The general infection is shown at a very early stage, as well as at a period when the local manifestations have disappeared. Besides the constitutional disturbance by which the attack is ushered in, there is the frequent derangement of the renal function, the marked prostration of strength, the functional disturbance of the heart, and, at a later period, the extensive implication of the nervo-muscular system. The local symptoms, the false membrane, with its parasitic growths, must be looked upon as the first evidence of constitutional poisoning; in fact, as the first of the secondary phenomena."
The description of the symptoms of the disease is given as they occur in the following six different constitutional forms: (1) the typical form ; (2) the mild or catarrhal form; (3) the inflammatory form; (4) the malignant form; (5) the gangrenous form; (6) the chronic form. Differences dependent on site are described under (a) nasal diphtheria, and (6) laryngeal diphtheria or croupAt the end of this chapter there is a special discussion of some of the most important symptoms of the disease, namely, albuminuria, the false membrane, fever, and cutaneous eruptions. The secondary elevation of temperature described by Faralli as occurring in cases of moderate severity towards the fourth day is referred to, and is explained as due to, the appearance of fresh diphtheritic patches on parts previously healthy; or, more frequently, to the appearance of glandular enlargements, the result of secondary infection. The paralyses are described in a separate chapter.
In the chapter on Diagnosis the rules given are simple and practical, the author frankly acknowledging the frequent difficulty, as well as the impossibility in some cases, of making an absolute diagnosis. The difficulty is generally confined to those cases which deviate from the normal type in the direction either of unusual mildness or of exceptional severity.
The chapter on Prognosis is followed by that on Treatment. This latter is full of interesting and valuable information, and the rules for general and local treatment are based upon sound ideas as to the pathology of the disease.
The author's views on the relation of croup and diphtheria are made manifest by the title to Chapter IX., Laryngo-Tracheal Diphtheria (formerly called Croup); and the arguments in support of them are skillfully presented. The complete identity of all cases of croup with diphtheria, however, is by no means a universally accepted fact; and in view of the question being still a mooted one, the report of the commission of the Royal Medical and Chirurgical Society of London, shortly expected, will be awaited with great interest.
Short chapters on Nasal Diphtheria and Secondary Diphtheria bring the book to a close.
It may be a disappointment to some that the author has not enriched the pages with cases and statistics from his own large practice. The book, however, is modestly claimed in the preface to be " a short sketch of the affection from one who has had considerable opportunities of studying it.” It is certainly a great deal more than that, and will be considered a valuable contribution to the literature of this disease.
PUBLIC HEALTH IN MINNESOTA.
The seventh annual report of the State Board of Health of Minnesota contains, as usual, much that is of great interest and value. The discussion of the appearance of small-pox in that State and its limitation to very narrow areas illustrates well the ease with which a general epidemic of that disease may be prevented by wise and vigorous action. The board prefers fresh animal vaccine matter to the humanized.
The paper by Dr. Staples on diphtheria occupies about one half of the report, embodying the replies to inquiries from thirty-five of the fifty-three physicians to whom circulars were sent, and also the results of microscopical investigations by Dr. Boardman and Professor Danforth. From 1870 to 1877, the deaths in Minnesota from diphtheria were for the several years respectively 63, 62, 41, 236, 226, 379, and 370. Beside the unknown element in the causation of the disease, by virtue of which it appears, disappears, reappears, and prevails for periods of various lengths in different places, damp soil, bad drainage, possibly polluted drinking-water, foul air, filth, damp and cold weather, and debilitated constitutions, one or several, were associated with the cases of diphtheria with greater or less frequency. In some towns the disease appeared to be of spontaneous origin ; commonly it was shown to be contagious and infectious, - good illustrations being given from Rochester, Eyota, and St. Peter. A young man came to work in harvest for Mr. S. from a town ten miles distant, where his sister and brother had died of diphtheria, although he did not have the disease. One week after his arrival, Mrs. S. was taken with diphtheria. The boy did not sleep in the house, but Mrs. S. had handled some of his clothing. She had a comparatively mild run of the disease. Mrs. S. had a nursing infant. One week from the time of the attack of the mother, the babe was taken sick, and died in fourteen days. Its throat was very much swollen, and there was a yellow exudation in it with a bad odor. Within a week of the child's death, two hired men and a servant-girl took the disease, but recovered. They were all well by the 1st of September. Mr. Si's little boy, who had happened to be away at his grandmother's during all the sickness, was brought home on the 20th of October. The child was at home one week, when he was taken with diphtheria, and died in a week from the time of the attack. No other cases occurred in the neighborhood. The S. family was at the time living in a log house. . . . At a time when diphtheria was not prevalent within a radius of ten miles, a lady went to a remote part of the county to attend the funeral of a relative who had died of this disease. She there came in contact with others of the family then sick. In a week she had a severe attack of diphtheria. Her babe took the disease from its mother, and died; the other remaining child had a severe attack, and several cases followed in the neighborhood. As to the question of the virulence of the contagion giving character and severity to the disease, in the above cases, it was found that in this particular family three out of five died. Those taking the disease direct from these malignant cases suffered more severely than in cases where the disease was contracted later in the little epidemic that followed. ... Two cases have occurred where it seemed to have been conveyed by infected clothing a distance of many miles. The first was the case of Mr. S., who visited a family twelve miles from his home, where there was diphtheria. In one room five were sick, and the air was very offensive. Five days after his return home, his daughter fell sick, and on the following day a young man in his employ These were the first and only cases in the neighborhood. The second case was very similar. A mother visited a daughter twenty miles away, whose child was sick of diphtheria, and died during her stay. She returned home, and on the sixth day after one of her children came down with the disease, and in a few days still later two others. There were no other cases in that vicinity. Many other cases pointing toward the infectious nature of the disease have occurred, and the evidence is strong that it is often spread in this way. In pure air, and upon dry, porous soil, even when not always clean, the contagious and infectious element seemed, with a few exceptions, nearly if not quite wanting, and the disease pursued a very mild course; and in the most severe outbreaks the rigid isolation treatment practiced in small-pox was apparently successful in “stamping out ” the disease. There is the common difference of opinion as to the identity of membranous croup and diphtheria. The mortality reported was, from 13.7 to one hundred per cent., no account being given, in that particular, of the mild epidemics and sporadic cases. The measures recommended are general attention to sanitary laws, including cleanliness, isolation, disinfection, and a supporting treatment.
Dr. Peckham's paper on the sanitary water survey of the State shows the constant and increasing danger of contamination of soil and water by the usual methods of constructing and managing privies and cess-pools, and the evils arising from pollution of streams by sewers. Professor Peckham suggests a useful form of lantern devised by him, as a result of experiments, for avoiding the danger of accidents from dust, fires, and explosions in flouring mills. He closes the top and bottom of the lantern by three or more plates of tin placed horizontally about one quarter of an inch apart, and arranged with holes