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theria, never left the premises of their residence led him to think that the disease was idiopathic, and not imported. In the house where the three cases occurred, the odors from a privy vault could be perceived. In the other case there was no malarial cause that could be found, the child not living in a room aljacent to any drainage, nor was any other member of a large family in the same house sick with the same disease. Of course, communication between the sick child and most of the family was prohibited and faithfully prevented.
Dr. Bowditch said that he felt the deepest interest in this paper, and asked why a patient should be admitted into a hospital with a patch in the throat,
DR. SHATTUCK responded that it subsequently proved to be a mistake. He had seen many cases of follicular sore throat which proved not to be diphtheria.
DR. BOWDitch asked what examinations were made of the drains in this case, and how such an examination could be made. He also wanted to know if there was any examination of the soil under the house.
Dr. SHATTUCK stated that there was no examination made under the house. He considered the peppermint test a good one. He had asked Dr. Folsom if he would come and examine the house drains ; but he said it was of no use if the inspector went over the house, which he did, and found the drains in perfect order.
Dr. Bowditch called the society's attention to the condition of the soil found under Marlborough House, the residence of the Prince of Wales. He asked Dr. Shattuck if it would not have been well to have disinfected the wards thoroughly.
DR. SHATTUCK replied that there were pans containing a solution of carbolic acid kept in the wards.
Dr. Bowditch remarked on the local epidemic of diphtheria which occurred at Vergennes, Vt., where for the space of one and a half square miles almost every child had at least sore throat. Sometimes there was no membrane. No child from a house where there is diphtheria should be introduced into another house where there are children. He asked Dr. Shattuck if erysipelas and diphtheria ran together.
Dr. SHATTUCK stated that he could find no statements about this in any authority which he had consulted, but found that erysipelas and diphtheria were classed as filth diseases by some sanitarians.
Dr. Bowbitch wished to know if the same cause produced them.
DR. SHATTUCK replied that in this case the affections seemed to depend on the same or allied causes.
Dr. Bowditch cited the case where the poison was supposed to have been carried in the clothing of a father from the funeral of a case of diphtheria to his own family.
Dr. E. G. CUTLER spoke of a case which occurred under his charge at the Carney Hospital, where a woman having had diphtheria came into the hospital because she could not be taken care of outside, and was convalescent in a short time. In about three weeks a child who had never come in contact with this woman or the nurse who attended her, but who was allowed to play out of the hospital, was taken with diphtheria, and for two or three days before it was isolated was in the general ward with several patients suffering from phthisis and other debilitating diseases, but none of them had a single symptom of the disease. Both the woman and child recovered, and both had paralysis of the soft palate. The drains and traps in the establishment were examined and found in perfect order.
Dr. Knight asked if the period of incubation in the second case of erysipelas in Dr. Shattuck’s' paper was not too short for communication froin the first case.
DR. SHATTUCK replied that perhaps it was too short.
Dr. SHATTUCK stated that the nurses and patients were isolated, and the physician made his visit on those affected last. The soiled linen, etc., was washed separately, and everything was done to prevent the spread of the disease.
DR. Knight and Dr. Williams both said that erysipelas was very readily transmitted in hospitals.
Dr. Bowditch, in answer to Dr. Knight, said that the first case that appeared in the almshouse during the epidemic at Vergennes, above alluded to, came without any warning. The children of three families residing near, and who had helped the patient home from school, where it had been taken ill, had mild sore throat without deaths, and after that in five or six weeks the epidemic burst out suddenly a quarter of a mile away.
Dr. Charles P. Putnam said that while it was our duty to search after the sources of infection, it was also fitting that we should not be too ready to accept theories about it that were not fairly proven. He thought there was but little reason to think diphtheria very contagious, or that it was ever carried in the clothing. He had seen diphtheria in a tenement house, where there were seven cases at the same time in the upper and lower parts of the house, while the middle part had escaped. He had also often been over children affected with diphtheria a large part of the day, and must have had his clothes thoroughly saturated with it, if that be possible, and yet it had never occurred in other children he had seen at the same time. He asked if Dr. Bowditch had not met with cases in Vergennes, in which diphtheria had sprung up at a distance from other cases, when he had not been able to find out its means of conveyance.
Dr. Bowditch thought there were facts enough proved to warrant our saying that diphtheria is contagious, but he was not sure that it could he asserted that it might be carried in one's clothes. Ile thought that with any disease where there is doubt as to infection, the physician should be very careful about going to other patients without taking precautions. Some are not in a condition to take disease, but we should treat all our patients as if they were susceptible. He also spoke of the rules adopted by him over twenty years ago in regard to vaccination, namely, to be very particular not to take any virus from an infant who had or had had any
chronic eruption. DR. AMORY said that in the House of the Good Samaritan, some years ago, there was a case of scarlet fever in ward A. It was moved to ward B, and no other case made its appearance.
DR. RICHARDSON stated that the so-called peppermint test was considered by the Board of Health a very certain method of detecting defects in house drainage. It was very diffusive, and in one case in which he had examined a house the smell from the peppermint put into the basin of an upper watercloset was noticed in half a minute entering a bed-chamber on the same floor through a ventilator. It has been the rule of the Board of Health to have every house carefully examined in which a case of diphtheria is reported. In a very large majority of these houses a defect in the drainage has been discovered. In nearly every house in which a fatal case has occurred a defect has been found.
DR. AMORY and Dr. BUCKINGHAM both had had a case where no defect had been found, and yet a death had taken placc from diphtheria.
Dr. Minot asked if the soil-pipes were open at the roof.
Dr. SHATTUCK replied that the gutters were connected with the drain, but that there was no direct communication between the soil-pipe and the open air.
Hypertrophic Cirrhosis of the Liver. - Dr. O. W. Doe reported the following case of Hypertrophic Cirrhosis of the Liver, and showed the specimen :
The patient, a man thirty-two years of age, entered the City Hospital April 11, 1878, in a semi
moribund condition. His friends gave the following history of his illness so far as they knew: During the past ten years he had drunk freely of liquor, though he had never suffered from delirium tremens. Last summer he began to lose flesh very rapidly, losing fifty pounds in three months. Since then he had complained of feeling very weak, and they noticed about four months before entrance that his skin was becoming jaundiced. On April 7th he was quite “shaky," and had several chills. For a week before this he had been drinking unusually hard, and had taken considerable laudanum in his whisky. On the 8th his mind seemed to be wandering, and two days later he was seized in the morning with active delirium, and in the afternoon became unconscious, and was reported to have had a convulsion, the urine having been very scanty in amount for two days previous. At the time of entrance to the hospital his pulse was 132, easily compressible ; temperature 101° F. He was wholly unconscious ; the pupils were slightly dilated, but responded freely to light. His respiration was 28 in the minute, loud and labored. The abdomen above the umbilicus was occupied by a hard, resisting mass extending to a line drawn vertically through the left nipple. There was no ascites, and no adema of the extremities. The heart sounds were obscured by the loud respiration. Urine drawn by the catheter showed a specific gravity of 1020 ; albumen, one fourth of one per cent. ; a sediment of blood, yellow granular matter, granules, and epithelial and hyaline casts in abundance. He gradually sank, and died twenty-six hours after entrance.
At the autopsy the heart was found to contain numerous ecchymoses under the visceral pericardium. Slight atheromatous degeneration of anterior curtain of mitral valve. Slight stenosis of aortic valves. It weighed one pound six ounces.
The kidneys were large and dense, the cortex being twice the natural size. One weighed eleven and a half ounces, the other ten ounces. The weight of
the spleen was two pounds fourteen ounces. It was dark, congested, dense to the touch, and measured nine inches in length, six inches in width, and two and a half inches in thickness. The liver weighed ten pounds, and measured eighteen inches transversely and seven and a half inches vertically, and on section presented a nodular appearance, with numerous protuberances of greenishyellow color, evidently hypertrophic cirrhosis.
DER ALCOHOLISMUS.I This work, which we have received from the chairman of the State Board of Health, is a valuable contribution to the literature of this subject. Anything which throws light on the many questions involved in its discussion, questions of interest alike to the political economist, to the physician, and in fact to any one who has the interests of his fellow-men at heart, should be welcomed. We are especially glad to find in the work before us such marked evidences of earnest, faithful work.
The author, in his position as physician to one of the largest prisons in Germany, has had abundant opportunity to observe the effects of which he writes, and at the same time his training as a scientific man has preserved him from advancing those extreme, one-sided views which are only too apt to characterize enthusiastic writers on this subject. While recognizing in general the evil effects of the use of alcohol, he is able to judge intelligently of its value under certain conditions. He is in a position, too, to estimate the result of the efforts which have been made to reform the abuses, and to point out which have proved and are proving successful.
The book is a fairly exhaustive treatise on the subject. In the preface the author says: “ This work will present the physiological and pathological effect of alcohol upon the individual economy, and will determine the value of alcohol as a food, as a luxury, and as a medicine ; it will endeavor to show what peculiarities the consumption of alcoholic beverages in the different countries among the various peoples and races presents, and what influence it has upon the social economy, and upon the physical, mental, and moral life of the nations ; finally, it will speak of the means which have been used in the various states for the control of intemperance, and will notice the results which have been obtained with them.” The introduction refers to the almost universal use of some form of stimulant, and mentions some of the questions which are answered by facts derived from statistics and experiments, in the body of the work, which is divided into three parts. The first treats of alcohol, its discovery, its source, and its properties, and its effects upon the individual economy. These last naturally divide themselves into the physiological and pathological, and are fully treated of. The absorption of alcohol, its physiological effect upon the blood, the circulation, respiration, nervous system, digestion, secretion of the kidneys, metamorphosis of tissue, and, finally, its excretion, are
! Der Alcoholismus, seine Verbreitung und seine Wirkung auf den individuellen und socialen Organismus, sowie die Mittel ihn zu bekämpfen. Von Dr. A. Baer, Königlichem SanitätsRath, und Oberarzt an dem Strafgefängniss (Plötzensee) hei Berlin. Berlin. 1878. Ver. lag von A. Hirschwald.
thoroughly worked out, the points of dispute fairly stated, and with constant reference to the literature of the subject the most probable conclusions are given.
Under the pathological effects the author considers the acute fatal alcohol poisoning and the chronic alcoholismus. The changes which occur in the economy from the abuse of alcohol, and which constitute chronic alcoholismus, are general and special. The changes in the blood and the abnormal deposit of fat, so-called "polysarcia potatorum,” are spoken of as examples of the first. Where such general changes occur it is no wonder that of the various organs of the body none seems exempt from the deleterious effects of the long-continued use of alcohol, and that each in its turn is the seat of most serious pathological lesions.
To complete this section of his work the author looks at alcohol in its threefold aspect of food, luxury, and medicine, and in this connection discusses important and interesting questions. Only in the very limited sense that under certain conditions it hinders the destructive metamorphosis of tissue can alcohol be considered as a food.
For its use as a luxury (that is, by persons in health), there is more to be said, though even here the limits within which it may with advantage be used are, according to our author, very narrow. He shows by physiological arguments, by the testimony of those who have had the greatest experience, and by facts of history that its use in cold climates and in warm is contraindicated; farther, that the popular idea that alcohol increases the power for work is wrong, with the important exception of the powerful stimulus it may give for a brief exhibition of energy, that its regular use in the army is prejudicial to health and to discipline, and that at the different stages of life, even in old age, when the powers are failing, it should be used only as a medicine. Here we find its true use, and Dr. Baer shows its value most clearly, especially in lowering the temperature in cases of fever. He completes the first section of the work by considering briefly the three principal forms under which alcohol is consumed, — brandy and other strong liquors, beer, and wine. Only against the first does the author speak as productive to any extent of alcoholismus; the other two, consumed in moderate quantities, not only are healthful, but are the most effectual means of limiting the consumption of the stronger liquors.
The second division of the work, which treats of “the consumption of alcohol and its influence upon the social economy,” is divided into three parts. The first speaks of the spread of drunkenness and of the consumption of alcoholic beverages in the different countries, the second of alcoholismus and its influence on the physical life, and the third of its influence on the national prosperity and morals. The first is a most careful and useful study of the amount of alcoholic drinks produced, the amount exported or imported, number of places where they are sold relative to the population, and the amount of drunkenness. The second part shows in what ways alcoholismus affects the physical welfare of a people ; first, by inducing a degeneration of the race ; second, greater predisposition to disease ; third, greater mortality from alcohol poisoning, delirium tremens, accidents the result of drunkenness, and suicide ; and fourth, a tendency to shorten life. The third part, which treats of alco