CASE OF LIGHTNING-STROKE.

187 Place the patient’s hands together above his head. investiga.tes. and shows in succession that Kneel with patient’s hips between your knees. there was no common water-supply ofthe families infected, Fix your elbows against your hips. in the sense of common well or public system, and no common system of drainage. He ;next examines the question Now, grasping= the. lower part of the patient’s chest, whether there. had been a progressive infection of inde- squeeze the two sides together, pressing gradually forward pendent privies and, by soakage from them, of independent with all your weight, for about three seconds, until your wells; but; although he tfinds some reason to believe that mouth is nearly over the mouth of the patient; then, with such a form of dissemination of infection may have played a push, suddenly jerk yourself backa part in the prevalence, it would not explain the main feaRest about three seconds ; then, begin again. tures. Finally, he proceeds to an examination of the-quesRepeat these bellows-blowing movements, so that air may tion whether the disease might- have been spread over the be drawn into the lungs, about eight or ten times a minute. Remember, the above directions must be used. on the infected-locality by some -particular article of food, and on this line of investigation he ascertained that; among a popur spot, the instant the patient is taken from the water. A lation supplied with milk from three dairies, not less than moment’s delay-and success may be hopeless. As soon as 58 of the cases occurred among the families having milk the water is pressed from the lungs, all clothing should be from one of these dairies only. Not less than 31 per centi ripped away from the chest and throat. In making the of the families habitually using milk from this particular pressure, either for the removal of water or for breathing, dairy suffered from enteric fever. Of the two other milk increase it gradually and thoroughly, and suddenly let go supplies; no cases occurred among the families using one with a jerk. With women and children use less force. Do not stop these movements under an hour, unless patient supply, and but 6’5 per cent. of the families suffered using the other. A close consideration of the cases occurring breathes. Be careful not to interrupt the first short natural among the families using milk from the source first and breaths. If they be long apart, carefully continue between more particularly referred to gave good reason for the belief them the bellows-blowing movements as before. After breathing is regular, keep patient warm with that the relationship of the cases to the milk was not a mere but that they were associated with the milk blankets, rubbing with warm hands, &c. coincidence, Prevent crowding around patient; plenty of fresh air is in some way as a direct result of its use. This conclusion , being arrived at, the question next presented itself for solut all-important. tion as to the manner in which the milk could have Spirits and water only, in occasional small doses, may now become infected, and how its infection could have been so be given ; if, hot the better, After this, encourage quiet sleep. abiding as the succession of cases seemed to showt Previous outbreaks of enteric fever, which have been traced to infected milk, have run comparatively short courses, the CASE OF LIGHTNING-STROKE. development and decline occupying but three or four monthsi To the Editor of THE LANCET. As to the infection of the milk, it is shown that abundant opportunities existed in the suspected dairy-farm for the milk the afternoon of July 14th, after a very severe SIR,—On to become fouled with excremental matters, and although storm of thunder and lightning, I was called to see J. A-, specific infection could not be precisely shown, the possi- who was said to have struck by the electric fluid. bility of such infection could not be excluded. The chief When I saw him-he had been been removed home in a cart, and and abiding source of fouling of the milk was from the water’ supply of the dairy-farm, the well in use there being subject his history and condition were as follows :-He had been to open pollution by soakage from an adjoining privy, and to attending some sheep in the fields, and when the storm was pollution by sundry other sorts of filth, including the effluvium at its height had taken refuge from it under an elm tree. from a cesspool. Assuming that the use of this water in Very soon after he felt strike him behind the left the dairy may have been the source of the infection of the shoulder, seemed to lose the use of his legs, and fell to the milk, Dr. Ballard, from an examination of the geological ground. On my arrival at his home, I found him quite nature of the ground from which the water is obtained, but rather excited in manner; and complaining suggests a mode in which the water may have been inter- principally of numbness in his legs, and a sense-of soreness mittently polluted from the cesspools of the neighbouring over his shoulders and back generally. He was able to houses, which received the dejections of enteric fever patients. stand, though he had taken himself to bed. On. stripIt is impossible to present a summary of this argument, but ping him, I found a very curious condition of affairs on his it deserves close study in the original report. We are not back. From the spine of the left scapula (where he felt the prepared to say that the whole of Dr. Ballard’s conclusions blow that knocked him down) extending downwards and and arguments will be received unquestioned; but there will outwards, and crossing the vertebrae about the middle of be no question as to the value of the report as showing that the dorsal region, over the right buttock; was we are far from having exhausted all the mysteries of the a central stem, from which proceeded various branches, mode of dissemination of enteric fever, and as indicating the as of a tree. These consisted of a raised, oedemateus mode of research by which we can alone penetrate further condition of the skin of a bright scarlet colour, not quite into them. disappearing on firm pressure; the central stem being about The immediate practical lesson of the report is that unless the breadth of three-quarters of an inch, and the various communities will take common action through their local branches gradually thinning off to something like the scratch authorities to obviate the conditions on which diseases like of a pin at their terminals. The general appearance was enteric fever depend, protection from them becomes prac- that of a fern, with the exception that, instead of being one tically hopeless. frond, as in the male fern, there were about from six to eight given off from the central twig. Besides this, there was a distinct impression, over each iliac region, of as-it were "HOW TO RESTORE THE APPARENTLY The whole was most a single frond, each complete in itself. beautiful and regular, just as if one had made the impression DROWNED." of some plant on the man’s back. The man also happened UNDER this heading, and illustrated by the engravings to wear outside his trowsers two small belts, with iron which have already appeared in the pages of THE LANCET, buckles, and on the corresponding parts of his legs were two distinct reddened circles, with the addition on the right leg, May 25th, Dr. Howard has issued the following instructions over where the buckle had been, of a small laceration of the for carrying out what he terms the " Direct Method ":— flesh, which had bled rather profusely for its size. 1st. INSTANTLY (as shown in Fig. 1) turn the patient There was nothing in the man’s clothing to account for the downwards, with a large firm roll of clothing under the erratic impression left by the electric fluid. In about three stomach and chest. days afterwards the whole affair had nearly disappeared. Press with your weight two or three times, for four or five The terminal branches faded first, but on the third day part each time, upon the patient’s back, so that the water of the central stem, and especially towards the left scapula, seconds is pressed out of the lungs and stomach, and drains freely was still raised, and of a bright-red colour. Altogether it downward out of the mouth. Then seemed more like a burnt surface in appearance than anything 2nd. QUICKLY turn the patient (as shown in Fig. 2), face else, only the skin was nowhere broken, and I do Tiot think upwards, the roll of clothing put under his back just below it will leave anv aonreciable mark.-I am, Sir, vours. &c. the shoulder-blades, the head- hanging back as low as GEO. WAUGH, M.B. King’s Sutton, Oxon., July 30th, 1878. possible. cause, Dr. Ballard

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