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FIGHTING DIPHTHERIA AT CHICAGO.
1782
completely recovered but only 8 of the women. It is worthy of note that in five of the cases of women the stomach and duodenum appeared normal at operation, and in these the results were almost uniformly unfavourable. We think that Dr. May has done a very useful piece of work much needed at the present time.
the Chicago Health Department examination gratuitously. Further, no less than 28 free antitoxin stations have been established various districts. The remedy, therefore, is close at hand and gratuitous for all. If lives are still lost, it is simply because the persons concerned do not avail themselves with sufficient promptitude of these advantages. According to the PLURALISM AND THE LEEDS GENERAL experience acquired during the last 14 years at Chicago, it is INFIRMARY. stated by the Health Department that recovery is certain if Ox Nov. 18th the weekly board of the General Infirmary antitoxin is given the first day the disease is manifest. Should at Leeds passed the following new rule, which was con- this be delayed to the second day the patient in nearly all sidered and confirmed at a meeting of subscribers held on cases will be saved. Even on the third day most children will recover. But if the antitoxin is not given before the Dec. 8th :After the That from and after Jan. 1st, 1916, members of the full honorary staff fourth day, then there will be many deaths. shall not hold any other honorary hospital appointment than their fourth antitoxin does little or no good. When given on day appointment at the Intirmary. That from and after Jan. lst, 1916, members of the assistant the first day, 2000 units generally suffice. On the third day honorary staff shall not hold more than one honorary hospital or 5000 units are required, and on or after the fourth day dispensary appointment in addition to their appointment at the As all that is Infirmary, and that such additional appointment must not involve the 10,000 units are rarely of any service. charge of beds. Provided that this shall not be held to prevent members of the staff necessary can be obtained gratuitously, poverty is no excuse from holding consulting appointments at other hospitals, appointments for neglect. The State of Illinois supplies all medical at the University of Leedi, or appointments to offices in the Territorial Medical Force, or (so long as they are not elected to a different position practitioners with antitoxin free in exchange for a filled-up from that now held by them) from retaining appointments now held by form to facilitate the furnishing of the demographic them. The penalty for not supplying these details statistics. The question of pluralism in hospital appointments is one the case treated is the refusal to give any more which promises in future to engage the attention of the concerning antitoxin. Culture outfits for collecting samples from medical profession more closely than hitherto. It is a throats to be bacteriologically examined are kept suspected question upon which opposing views are held, not only at all the police stations. Therefore they can be promptly because individual interests clash, but also on the general and there is no loss of time in the analysis when obtained, principles involved. Whether it is better or worse for once the samples are in the hands of the health authorities. particular institutions and for medical science that the Thus, the bacteriological diagnosis is quickly obtained and members of the medical and surgical staffs should also hold the proper life-saving measures can be taken at once. All similar appointments elsewhere, or that their services and that is needed is intelligent action on the part of the parents skill, gratuitously given, should be monopolised by the or guardians of the patient. This organisation and the institutions to which they first become attached, are excellent results attained, even amongst such a mixed questions to which a well-considered answer may be population as that of Chicago, merit to be studied and required. The sweeping away of old institutions is imitated, which is certainly the sincerest form of flattery. liable in most cases to lead to individual hardship, but that the new rule in Leeds will not operate harshly THE SPECIFIC DIAGNOSIS OF PULMONARY is indicated by the provision made in the last paraTUBERCULOSIS. graph to exclude present members of the staff from its scope IT is now a platitude to state that the earlier the stage in so long as they continue to hold their present posts at the which and also the five at pulmonary tuberculosis is diagnosed the greater are which date, infirmary, by years hence, the chances of success in treatment. A large amount has the rule is to become operative. been written in reference to the means at the disposal of the to assist him in a! riving at a conclusion apart from physician FIGHTING DIPHTHERIA AT CHICAGO. actual physical examination of the patient, for in a large THE Department of Health of Chicago has issued an appeal number of the early cases the physical signs are indefinite to the inhabitants of that great city to assist in the preven- and would not by themselves justify a positive diagnosis. tion of diphtheria. It is claimed that during the last It is, therefore, of the highest importance that careful 14 years 25,678 deaths from diphtheria have been prevented, and repeated investigations should be made into the and this is mainly due to the use of antitoxin. The average reliability of the auxiliary methods of diagnosis which annual death-rate from diphtheria before the introduction are employed by the worker in the laboratory in colof antitoxin was 136 per 100,000 of the population. During laboration with the physician at the bedside. We publish the 14 years that antitoxin has been applied the average this week an instructive paper on this subject by Dr. A. C. annual death-rate from diphtheria only amounts to 36 per Inman, the superintendent of the laboratories of the 100,000 inhabitants. Still the sanitary authorities are not Brompton Hospital for Consumption and Diseases of the satisfied. They maintain that practically there should be no Chest. He gives a valuable summary of the work accomdeaths from this cause, as antitoxin, if given in proper doses plished by other observers and adds some interesting results and at the proper time, will cure the disease, while the of his own observations. The value of the detection of immunising dose will prevent its development if taken in tubercle bacilli in the sputum is generally recognised. The time by those exposed to infection. The deaths that still Ziehl-Neelsen is the method that is most usually employed, occur are attributed to ignorance, carelessness, and neglect. but Dr. Inman recommends the antiformin method of Sometimes this may be the fault of the medical attendant, Uhlenhuth and Xylander as being superior to all others. but in the vast majority of cases the parents are the guilty The examination of the blood for tubercle bacilli has not parties. The chief difficulty is to persuade parents not to yielded uniform results in the hands of different observers, neglect what appears to be an ordinary sore-throat. Thus, in and is not likely to be of value in ordinary clinical work. two schools 11 children were found with diphtheria bacilli in Dr. Inman draws attention to the presence of the pathogenic their throats. The bacteriological examination of swabs from bacilli in the stools of tuberculous patients. Of 26 adults the throats should be the common practice; and if the medical 18 had tubercle bacilli in the sputum, and of these 16 had attendant will not do this, or the patient cannot afford to tubercle bacilli in the faeces. He suggests that the -
give the necessary fee, physicians undertake the
in
completely recovered but only 8 of the women. It is worthy of note that in five of the cases of women the stomach and duodenum appeared normal at operation, and in these the results were almost uniformly unfavourable. We think that Dr. May has done a very useful piece of work much needed at the present time.
the Chicago Health Department examination gratuitously. Further, no less than 28 free antitoxin stations have been established various districts. The remedy, therefore, is close at hand and gratuitous for all. If lives are still lost, it is simply because the persons concerned do not avail themselves with sufficient promptitude of these advantages. According to the PLURALISM AND THE LEEDS GENERAL experience acquired during the last 14 years at Chicago, it is INFIRMARY. stated by the Health Department that recovery is certain if Ox Nov. 18th the weekly board of the General Infirmary antitoxin is given the first day the disease is manifest. Should at Leeds passed the following new rule, which was con- this be delayed to the second day the patient in nearly all sidered and confirmed at a meeting of subscribers held on cases will be saved. Even on the third day most children will recover. But if the antitoxin is not given before the Dec. 8th :After the That from and after Jan. 1st, 1916, members of the full honorary staff fourth day, then there will be many deaths. shall not hold any other honorary hospital appointment than their fourth antitoxin does little or no good. When given on day appointment at the Intirmary. That from and after Jan. lst, 1916, members of the assistant the first day, 2000 units generally suffice. On the third day honorary staff shall not hold more than one honorary hospital or 5000 units are required, and on or after the fourth day dispensary appointment in addition to their appointment at the As all that is Infirmary, and that such additional appointment must not involve the 10,000 units are rarely of any service. charge of beds. Provided that this shall not be held to prevent members of the staff necessary can be obtained gratuitously, poverty is no excuse from holding consulting appointments at other hospitals, appointments for neglect. The State of Illinois supplies all medical at the University of Leedi, or appointments to offices in the Territorial Medical Force, or (so long as they are not elected to a different position practitioners with antitoxin free in exchange for a filled-up from that now held by them) from retaining appointments now held by form to facilitate the furnishing of the demographic them. The penalty for not supplying these details statistics. The question of pluralism in hospital appointments is one the case treated is the refusal to give any more which promises in future to engage the attention of the concerning antitoxin. Culture outfits for collecting samples from medical profession more closely than hitherto. It is a throats to be bacteriologically examined are kept suspected question upon which opposing views are held, not only at all the police stations. Therefore they can be promptly because individual interests clash, but also on the general and there is no loss of time in the analysis when obtained, principles involved. Whether it is better or worse for once the samples are in the hands of the health authorities. particular institutions and for medical science that the Thus, the bacteriological diagnosis is quickly obtained and members of the medical and surgical staffs should also hold the proper life-saving measures can be taken at once. All similar appointments elsewhere, or that their services and that is needed is intelligent action on the part of the parents skill, gratuitously given, should be monopolised by the or guardians of the patient. This organisation and the institutions to which they first become attached, are excellent results attained, even amongst such a mixed questions to which a well-considered answer may be population as that of Chicago, merit to be studied and required. The sweeping away of old institutions is imitated, which is certainly the sincerest form of flattery. liable in most cases to lead to individual hardship, but that the new rule in Leeds will not operate harshly THE SPECIFIC DIAGNOSIS OF PULMONARY is indicated by the provision made in the last paraTUBERCULOSIS. graph to exclude present members of the staff from its scope IT is now a platitude to state that the earlier the stage in so long as they continue to hold their present posts at the which and also the five at pulmonary tuberculosis is diagnosed the greater are which date, infirmary, by years hence, the chances of success in treatment. A large amount has the rule is to become operative. been written in reference to the means at the disposal of the to assist him in a! riving at a conclusion apart from physician FIGHTING DIPHTHERIA AT CHICAGO. actual physical examination of the patient, for in a large THE Department of Health of Chicago has issued an appeal number of the early cases the physical signs are indefinite to the inhabitants of that great city to assist in the preven- and would not by themselves justify a positive diagnosis. tion of diphtheria. It is claimed that during the last It is, therefore, of the highest importance that careful 14 years 25,678 deaths from diphtheria have been prevented, and repeated investigations should be made into the and this is mainly due to the use of antitoxin. The average reliability of the auxiliary methods of diagnosis which annual death-rate from diphtheria before the introduction are employed by the worker in the laboratory in colof antitoxin was 136 per 100,000 of the population. During laboration with the physician at the bedside. We publish the 14 years that antitoxin has been applied the average this week an instructive paper on this subject by Dr. A. C. annual death-rate from diphtheria only amounts to 36 per Inman, the superintendent of the laboratories of the 100,000 inhabitants. Still the sanitary authorities are not Brompton Hospital for Consumption and Diseases of the satisfied. They maintain that practically there should be no Chest. He gives a valuable summary of the work accomdeaths from this cause, as antitoxin, if given in proper doses plished by other observers and adds some interesting results and at the proper time, will cure the disease, while the of his own observations. The value of the detection of immunising dose will prevent its development if taken in tubercle bacilli in the sputum is generally recognised. The time by those exposed to infection. The deaths that still Ziehl-Neelsen is the method that is most usually employed, occur are attributed to ignorance, carelessness, and neglect. but Dr. Inman recommends the antiformin method of Sometimes this may be the fault of the medical attendant, Uhlenhuth and Xylander as being superior to all others. but in the vast majority of cases the parents are the guilty The examination of the blood for tubercle bacilli has not parties. The chief difficulty is to persuade parents not to yielded uniform results in the hands of different observers, neglect what appears to be an ordinary sore-throat. Thus, in and is not likely to be of value in ordinary clinical work. two schools 11 children were found with diphtheria bacilli in Dr. Inman draws attention to the presence of the pathogenic their throats. The bacteriological examination of swabs from bacilli in the stools of tuberculous patients. Of 26 adults the throats should be the common practice; and if the medical 18 had tubercle bacilli in the sputum, and of these 16 had attendant will not do this, or the patient cannot afford to tubercle bacilli in the faeces. He suggests that the -
give the necessary fee, physicians undertake the
in