- Email: [email protected]
DIPHTHERIA AND THE METROPOLITAN ASYLUMS BOARD.
117
properly, from point of view.
the
meteorological,
and not the medical,
-
WE learn from our own correspondent in Egypt that cholera is still confined to a few villages in the Delta and shows a tendency to die out. However, during the week ending Dec. 24th there were in all thirty-three new cases reported, and there have been altogether thirty-two deaths. H.R.H. THE DUKE OF YORK has consented to preside at dinner in aid of the funds of the Victoria Hospital for Children at a date to be fixed by His Royal Highnessprobably about the third week in February.
a
Pharmacology and Therapeutics. CALAYA IN MALARIA.
DR. MAURAGE of Paris has made use of the extract of Anneslea febrifuga known as Calaya, a leguminous plant, in nine cases of malarial patients from Madagascar and Tonquin. Four doses of about half a drachm each were administered in syrup at intervals of two hours. The first dose always produced a diminution of the temperature varying from 14° to 25° F. After the second dose the temperature fell still further. This antipyretic action was not accompanied by any sweating or by depression. On the contrary, the patients expressed themselves as feeling far better than they had done when they had been given quinine in previous attacks. The temperature, too, never In three of the nine cases fell below normal. In five there were no return of the fever occurred. mild attacks of a character, the temsubsequent very perature never exceeding 1015°, while in one case only there was a somewhat severe attack two days later in which the temperature rose to 104’7°; the treatment was, therefore, repeated, with the result that no further attacks occurred. The same medicine was tried in two cases of phthisis. Here, though the antipyretic effect of the drug was manifested, the fever returned the day following just as before. Dr. Maurage, therefore, thinks that calaya cannot be considered as more than a palliative in non-malarial fevers, but that in malaria it may really be put down as a
apecinc. physician in Jerusalem who has charge of the municipal hospital there has employed with great advantage hypodermic injections of phosphate of soda in two special affections of the nervous system. One patient was a woman who After a month’s treatwas suffering from syringomyelitis. ment, during which fifty injections were administered, the pain completely vanished, and sleep returned. The articular A
also decreased to half their former size.
bacteriological examination. The figures given regarding the different hospitals are unfortunately not exactly comparable, since in many cases the clinical diagnosis does not appear to have been given at the time of bacteriological examination, and it is suggested
in the report that it was afterwards based upon the result thus obtained; still, we can only judge from the figures which have been placed before us. The number of examinations made were 6408, and as these were obtained from 2936 cases it is apparent that a considerable ’, number of re-examinations had been carried out either for the purpose of making absolutely certain of the bacteriological diagnosis where it seemed at variance with the clinical, or for the purpose of determining when a convalescent case might be discharged with safety. It was found that in only eighty-five cases did a re-examination reveal the presence of diphtheria bacilli where a negative diagnosis had been previously recorded, and this may be ascribed to failures in the teelaailz.e, such as to a mis-inoculation or even, perhaps, to the patient having developed the disease while in hospital. The very full and tables which are appended show clearly the trustworthiness of the bacteriological diagnosis, as the percentage of cases in which the original diagnosis had to be reversed was very small; still, no one would seriously contend against the advisability of controlling by re-examination all doubtful cases. The assistance which it gives in confirming or reversing the clinical diagnosis is brought out most clearly where the diagnosis was still in doubt. Thus, out of 451 cases which were as regarded diphtheria in hospital, in 51 the presence of diphtheria bacilli could not be demonstrated, while out of 1763 cases in which the diagnosis was doubtful or was not stated no less than 1112 were found bacteriologically to be true It is interesting to observe how far the cases of diphtheria. clinical diagnosis agreed with the bacteriological in the different hospitals. This will be seen in the following table, in which we have computed the percentages of cases which were recognised bacteriologically as diphtheria from among those which were returned as clinically doubtful or in which no diagnosis was given by the hospital authorities :-
exhaustive
PHOSPHATE OF SODA IN NERVOUS AFFECTIONS.
the individual judgment of the person charged with making the diagnosis. Thus an epidemic of diphtheria which was very virulent in type but restricted in range would, if it occurred at the same time as an epidemic of non-diphtheritic sore-throat prevailed, which was included under the same category, be regarded as a more widespread epidemic of mild diphtheria. In a similar way a hospital which included under the heading of diphtheria other cases of simple non-diphtheritic nature would naturally present a much lower death-rate than those in which these were excluded. Under these circumstances all attempts to compare the relative efficiency of different modes of treatment must fail, and further progress on these lines be greatly impeded. The importance, also, of cases preventing non-diphtheritic being kept apart and thus obviating their exposure to the infection by being placed in the same wards as the diphtheria patients must be quite evident. Perhaps, however, the most important rôle which the bacteriological diagnosis has to play in this relation is in determining when the throat in convalescent cases has become free from diphtheria bacilli, and the patient can be discharged with safety and As it has already no longer be a centre of fresh infection. been established that patients in the convalescent stage can retain for long periods the diphtheria bacilli in an active condition, it is of the utmost practical importance that the best local and general measures of treatment for their removal should be discovered and recognised, and this could only be attempted when the results were controlled by a constant
The other
patient was a man suffering from unilateral astasia-abasia (Charcot’s " neurasth6nie dimidi6e"), and he was discharged Tecovered after twenty-five injections, which were administered once a day. DIPHTHERIA AND THE METROPOLITAN ASYLUMS BOARD. Metropolitan Asylums Board have published a proby Dr. Sims Woodhead on the cases of which were sent to the laboratories of the Con’diphtheria the Board of joint Royal Colleges of Physicians (London) and Surgeons (England) for bacteriological examination from Jan. 1st to Aug. 31st, 1895. The importance of having such a bacteriological examination carried out in hospitals is, of THE
I
visional report
course, once
North-Eastern
Hospital North-Western Hospital South-Eastern Hospital South-Western Hospital
obvious, but if any such doubt existed it would at dispelled on reading this report. So long as the
be
of diphtheria was based on the gross physical signs and symptoms of the disease it is evident that all statistics on the question are subject to most serious error, owing to the inclusion or exclusion of the milder throat cases, according to
- diagnosis
I
... ... ... ...
Per I cent. j
Per cent.
38 71 68 56
69 60
I
Eastern I3ospital ......... 61 Western Hospital......... !Fountain.Hospita.l......... i
The above figures sufficiently clearly indicate the necessity for a bacteriological diagnosis and proves to what an extent the opinions of experts may vary as to what is clinically diphtheria. There are no doubt many other interesting facts which might be deduced from the figures given in this provisional report, and we feel sure that Dr. Sims Woodhead will make full use of the immense collection of material at his disposal in the complete report on the year’s work which is promised.
properly, from point of view.
the
meteorological,
and not the medical,
-
WE learn from our own correspondent in Egypt that cholera is still confined to a few villages in the Delta and shows a tendency to die out. However, during the week ending Dec. 24th there were in all thirty-three new cases reported, and there have been altogether thirty-two deaths. H.R.H. THE DUKE OF YORK has consented to preside at dinner in aid of the funds of the Victoria Hospital for Children at a date to be fixed by His Royal Highnessprobably about the third week in February.
a
Pharmacology and Therapeutics. CALAYA IN MALARIA.
DR. MAURAGE of Paris has made use of the extract of Anneslea febrifuga known as Calaya, a leguminous plant, in nine cases of malarial patients from Madagascar and Tonquin. Four doses of about half a drachm each were administered in syrup at intervals of two hours. The first dose always produced a diminution of the temperature varying from 14° to 25° F. After the second dose the temperature fell still further. This antipyretic action was not accompanied by any sweating or by depression. On the contrary, the patients expressed themselves as feeling far better than they had done when they had been given quinine in previous attacks. The temperature, too, never In three of the nine cases fell below normal. In five there were no return of the fever occurred. mild attacks of a character, the temsubsequent very perature never exceeding 1015°, while in one case only there was a somewhat severe attack two days later in which the temperature rose to 104’7°; the treatment was, therefore, repeated, with the result that no further attacks occurred. The same medicine was tried in two cases of phthisis. Here, though the antipyretic effect of the drug was manifested, the fever returned the day following just as before. Dr. Maurage, therefore, thinks that calaya cannot be considered as more than a palliative in non-malarial fevers, but that in malaria it may really be put down as a
apecinc. physician in Jerusalem who has charge of the municipal hospital there has employed with great advantage hypodermic injections of phosphate of soda in two special affections of the nervous system. One patient was a woman who After a month’s treatwas suffering from syringomyelitis. ment, during which fifty injections were administered, the pain completely vanished, and sleep returned. The articular A
also decreased to half their former size.
bacteriological examination. The figures given regarding the different hospitals are unfortunately not exactly comparable, since in many cases the clinical diagnosis does not appear to have been given at the time of bacteriological examination, and it is suggested
in the report that it was afterwards based upon the result thus obtained; still, we can only judge from the figures which have been placed before us. The number of examinations made were 6408, and as these were obtained from 2936 cases it is apparent that a considerable ’, number of re-examinations had been carried out either for the purpose of making absolutely certain of the bacteriological diagnosis where it seemed at variance with the clinical, or for the purpose of determining when a convalescent case might be discharged with safety. It was found that in only eighty-five cases did a re-examination reveal the presence of diphtheria bacilli where a negative diagnosis had been previously recorded, and this may be ascribed to failures in the teelaailz.e, such as to a mis-inoculation or even, perhaps, to the patient having developed the disease while in hospital. The very full and tables which are appended show clearly the trustworthiness of the bacteriological diagnosis, as the percentage of cases in which the original diagnosis had to be reversed was very small; still, no one would seriously contend against the advisability of controlling by re-examination all doubtful cases. The assistance which it gives in confirming or reversing the clinical diagnosis is brought out most clearly where the diagnosis was still in doubt. Thus, out of 451 cases which were as regarded diphtheria in hospital, in 51 the presence of diphtheria bacilli could not be demonstrated, while out of 1763 cases in which the diagnosis was doubtful or was not stated no less than 1112 were found bacteriologically to be true It is interesting to observe how far the cases of diphtheria. clinical diagnosis agreed with the bacteriological in the different hospitals. This will be seen in the following table, in which we have computed the percentages of cases which were recognised bacteriologically as diphtheria from among those which were returned as clinically doubtful or in which no diagnosis was given by the hospital authorities :-
exhaustive
PHOSPHATE OF SODA IN NERVOUS AFFECTIONS.
the individual judgment of the person charged with making the diagnosis. Thus an epidemic of diphtheria which was very virulent in type but restricted in range would, if it occurred at the same time as an epidemic of non-diphtheritic sore-throat prevailed, which was included under the same category, be regarded as a more widespread epidemic of mild diphtheria. In a similar way a hospital which included under the heading of diphtheria other cases of simple non-diphtheritic nature would naturally present a much lower death-rate than those in which these were excluded. Under these circumstances all attempts to compare the relative efficiency of different modes of treatment must fail, and further progress on these lines be greatly impeded. The importance, also, of cases preventing non-diphtheritic being kept apart and thus obviating their exposure to the infection by being placed in the same wards as the diphtheria patients must be quite evident. Perhaps, however, the most important rôle which the bacteriological diagnosis has to play in this relation is in determining when the throat in convalescent cases has become free from diphtheria bacilli, and the patient can be discharged with safety and As it has already no longer be a centre of fresh infection. been established that patients in the convalescent stage can retain for long periods the diphtheria bacilli in an active condition, it is of the utmost practical importance that the best local and general measures of treatment for their removal should be discovered and recognised, and this could only be attempted when the results were controlled by a constant
The other
patient was a man suffering from unilateral astasia-abasia (Charcot’s " neurasth6nie dimidi6e"), and he was discharged Tecovered after twenty-five injections, which were administered once a day. DIPHTHERIA AND THE METROPOLITAN ASYLUMS BOARD. Metropolitan Asylums Board have published a proby Dr. Sims Woodhead on the cases of which were sent to the laboratories of the Con’diphtheria the Board of joint Royal Colleges of Physicians (London) and Surgeons (England) for bacteriological examination from Jan. 1st to Aug. 31st, 1895. The importance of having such a bacteriological examination carried out in hospitals is, of THE
I
visional report
course, once
North-Eastern
Hospital North-Western Hospital South-Eastern Hospital South-Western Hospital
obvious, but if any such doubt existed it would at dispelled on reading this report. So long as the
be
of diphtheria was based on the gross physical signs and symptoms of the disease it is evident that all statistics on the question are subject to most serious error, owing to the inclusion or exclusion of the milder throat cases, according to
- diagnosis
I
... ... ... ...
Per I cent. j
Per cent.
38 71 68 56
69 60
I
Eastern I3ospital ......... 61 Western Hospital......... !Fountain.Hospita.l......... i
The above figures sufficiently clearly indicate the necessity for a bacteriological diagnosis and proves to what an extent the opinions of experts may vary as to what is clinically diphtheria. There are no doubt many other interesting facts which might be deduced from the figures given in this provisional report, and we feel sure that Dr. Sims Woodhead will make full use of the immense collection of material at his disposal in the complete report on the year’s work which is promised.