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HYGIENE AND THE TUBE BOOKING-CLERK.
182 before the age of four years-i.e., before the school age, that it is very rare for the disease to occur in an epidemic form in institutions, and, further, that in hospitals where cases of poliomyelitis are admitted the disease has never been known to spread. Dr. Batten summed up by expressing the opinion that the evidence in favour of the spread of infection by schools is not conclusive, but that it is a possibility which should be borne in mind. He advised that all contacts should be submitted to a period of 14 days’ quarantine before returning to school. In infected cases he suggested that they should not return to school until at least a month after the onset of the illness, and only then if convalescence is complete and there is no discharge from the nose. In severe cases the resultant paralysis by itself prevents a return to school for months. We have also received a copy of a report presented to the Health Committee of the City of Carlisle by Mr. Joseph Beard, medical officer of health, upon an epidemic of the disease which occurred in the late summer and early autumn of 1910. There were 38 cases, with seven deaths. At an early period, on the recommendation of Mr. Beard, the Health Committee adopted a system of voluntary notification, which received the sympathy and cooperation of the local practitioners, with the result that useful information was obtained. Mr. Beard strongly urges the importance of universal notification of this disease.
cases occur
HYGIENE AND THE TUBE
is subject to alteration. The booking-clerk is only human and sometimes he forgets to lick his fingers. Sometimes his occupation is taken from him by an automatic ticket machine or by the system of" strip-tickets " ; but often-very often-the passenger, in return for his pence, may find that be is bearing away on his ticket a generous quantity of the booking-clerk’s saliva. It may at once be granted that, in all probability, not many of these clerks are consumptive 01 are infected with any contagious disease. The practice is insanitary. If, as may be the case, it is the outcome of the contrivance by which the tickets are kept ready to hand in the bookingoffice, and by which an unmoistened finger is placed at a mechanical disadvantage, the difficulty might be met by a damping-pad beside each pigeon-hole. Certainly a pro. gressive and enlightened railway company that not only provides its weary passengers with ozonised air, but exhorts them by public notice and under penalty not to spit, will hardly be backward in putting an end to this gratuitous distribution of their employees’ saliva.
BOOKING-CLERK.
IN the scales of legal justice the question of intent or wilfulness is commonly allowed its full weight either for or against the o:Render, so that, for example, a man charged with inflicting bodily hurt can, if he proves the inadvertence of his act, rely on the leniency of the court. In breaches against the public health, on the other hand, this plea is less satisfying, and rightly so, otherwise the careless householder, for instance, whose insanitary manners have spread an epidemic of infectious disease among his neighbours, might escape the pecuniary responsibility for his sins. Often, moreover, the effects of a dangerously unhygienic act, itself entirely inadvertent, can, if traceable to their origin at all, be linked up to it only with much difficulty, at any rate by Thus a parent may innocently allow a chain of legal proof. his child, while still desquamating from scarlet fever, to attend a gathering of other children many of whom are as As susceptible to the disease as straw to a match. with individuals, so with commercial enterprises. Every year in the London tube railways millions of the public avail themselves of the comforts and conveniences of subterranean travel. Each of these passengers, each time he goes by tube, receives a ticket handed to him by a booking-clerk, whose movements, hidden behind his pigeon-hole, are in most instances not noticed, perhaps not even seen. To the observant, however, the habits of the booking-clerk are of no little hygienic interest. At a first glance it would seem that on the receipt of the appropriate fare he immediately tenders a ticket to the purchaser who carries it in his hand to the liftman to be punched, and then places it safely in his pocket. Looked at more closely, however, the incident gains in significance. It may now be noticed that the clerk, when addressed by the passenger, first inserts one finger (sometimes two) into his mouth, for all the world as though he had burnt his hand, then, withdrawing it rapidly, tenders the requisite ticket. This ticket, now wet with the clerk’s saliva, is picked up by the passenger, to whose fingers a portion of the moisture may adhere, is grasped by the ticketman at the lift, whose fingers may also receive a .portion, and is finally conveyed to the passenger’s pocket, under the warmth of which the remaining portion evaporates, leaving the residual particles to rub against the dark recesses of the lining. This sequence of events, of course,
ACUTE
PHLEGMONOUS GASTRITIS WITH ERYSIPELAS.
ACUTE phlegmonous gastritis is very rare and the number of cases which have been investigated bacteriologically is limited. The organism which has been most often found is the streptococcus, but Mr. J. E. Adams has reported in our columns a case due to the pneumococcus.1 As erysipelas is due to a streptococcus, the suggestion has been made that phlegmonous gastritis is " erysipelas of the stomach." In the American Journal of the Medical Sciences for November last Dr. W. S. Baird has reported a case from the Pathological Laboratory of the Montreal General Hospital in which erysipelas, as well as general infection with the streptococcus, was present. A man, aged 30 years, was admitted
April 26th, 1910, complaining of dyspneea, swelling of the legs, and vomiting. The pulse was 136, irregular, and of small volume. The heart was enlarged, and an apical systolic murmur transmitted to the axilla was present. There were œdema of the legs and thighs and tenderness over the epigastrium. The tongue was coated, and as soon as food was taken it was vomited. The liver was palpable, but the patient stated that he took only one or two glasses of beer or whisky daily. He was discharged improved on May 14th, but he relapsed and was readmitted on June 9th. In addition to the previous symptoms there was evidence of right pleural effusion, and the abdomen was prominent but not tender or dull in the flanks. The oedema disappeared, but he did not improve, and suffered from pain in the epigastrium and prseoordium. Severe hiccough and vomiting developed. On June 16th erysipelas began on the nose and soon spread over the cheeks. The temperature was elevated and the præcordial pain and dyspnœa increased. Delirium followed, and the epigastrium On June 19th he became much became acutely tender. worse and complained of acute sudden pain in the epigastrium; the dyspnoea became much more severe, the pulse failed, and he died. At the necropsy the peritoneum was found covered with a viscid exudate and deeply congested. In the recesses and pelvis were over 300 c.c. of thick, yellowish fluid, smears from which showed Grampositive cocci in chains. The stomach was greatly distended and dark bluish-red. The right pleura was deeply congested and contained 300 c.c. of turbid yellow fluid, smears from which showed Gram-positive cocci in chains. The heart weighed 500 grammes and was much dilated. Shining through the epicardium of the left ventricle were two round, elevated, light yellow cedematous areas, about 1 centimetre on
1
THE LANCET, Jan.
29th, 1910, p. 292.
cases occur
HYGIENE AND THE TUBE
is subject to alteration. The booking-clerk is only human and sometimes he forgets to lick his fingers. Sometimes his occupation is taken from him by an automatic ticket machine or by the system of" strip-tickets " ; but often-very often-the passenger, in return for his pence, may find that be is bearing away on his ticket a generous quantity of the booking-clerk’s saliva. It may at once be granted that, in all probability, not many of these clerks are consumptive 01 are infected with any contagious disease. The practice is insanitary. If, as may be the case, it is the outcome of the contrivance by which the tickets are kept ready to hand in the bookingoffice, and by which an unmoistened finger is placed at a mechanical disadvantage, the difficulty might be met by a damping-pad beside each pigeon-hole. Certainly a pro. gressive and enlightened railway company that not only provides its weary passengers with ozonised air, but exhorts them by public notice and under penalty not to spit, will hardly be backward in putting an end to this gratuitous distribution of their employees’ saliva.
BOOKING-CLERK.
IN the scales of legal justice the question of intent or wilfulness is commonly allowed its full weight either for or against the o:Render, so that, for example, a man charged with inflicting bodily hurt can, if he proves the inadvertence of his act, rely on the leniency of the court. In breaches against the public health, on the other hand, this plea is less satisfying, and rightly so, otherwise the careless householder, for instance, whose insanitary manners have spread an epidemic of infectious disease among his neighbours, might escape the pecuniary responsibility for his sins. Often, moreover, the effects of a dangerously unhygienic act, itself entirely inadvertent, can, if traceable to their origin at all, be linked up to it only with much difficulty, at any rate by Thus a parent may innocently allow a chain of legal proof. his child, while still desquamating from scarlet fever, to attend a gathering of other children many of whom are as As susceptible to the disease as straw to a match. with individuals, so with commercial enterprises. Every year in the London tube railways millions of the public avail themselves of the comforts and conveniences of subterranean travel. Each of these passengers, each time he goes by tube, receives a ticket handed to him by a booking-clerk, whose movements, hidden behind his pigeon-hole, are in most instances not noticed, perhaps not even seen. To the observant, however, the habits of the booking-clerk are of no little hygienic interest. At a first glance it would seem that on the receipt of the appropriate fare he immediately tenders a ticket to the purchaser who carries it in his hand to the liftman to be punched, and then places it safely in his pocket. Looked at more closely, however, the incident gains in significance. It may now be noticed that the clerk, when addressed by the passenger, first inserts one finger (sometimes two) into his mouth, for all the world as though he had burnt his hand, then, withdrawing it rapidly, tenders the requisite ticket. This ticket, now wet with the clerk’s saliva, is picked up by the passenger, to whose fingers a portion of the moisture may adhere, is grasped by the ticketman at the lift, whose fingers may also receive a .portion, and is finally conveyed to the passenger’s pocket, under the warmth of which the remaining portion evaporates, leaving the residual particles to rub against the dark recesses of the lining. This sequence of events, of course,
ACUTE
PHLEGMONOUS GASTRITIS WITH ERYSIPELAS.
ACUTE phlegmonous gastritis is very rare and the number of cases which have been investigated bacteriologically is limited. The organism which has been most often found is the streptococcus, but Mr. J. E. Adams has reported in our columns a case due to the pneumococcus.1 As erysipelas is due to a streptococcus, the suggestion has been made that phlegmonous gastritis is " erysipelas of the stomach." In the American Journal of the Medical Sciences for November last Dr. W. S. Baird has reported a case from the Pathological Laboratory of the Montreal General Hospital in which erysipelas, as well as general infection with the streptococcus, was present. A man, aged 30 years, was admitted
April 26th, 1910, complaining of dyspneea, swelling of the legs, and vomiting. The pulse was 136, irregular, and of small volume. The heart was enlarged, and an apical systolic murmur transmitted to the axilla was present. There were œdema of the legs and thighs and tenderness over the epigastrium. The tongue was coated, and as soon as food was taken it was vomited. The liver was palpable, but the patient stated that he took only one or two glasses of beer or whisky daily. He was discharged improved on May 14th, but he relapsed and was readmitted on June 9th. In addition to the previous symptoms there was evidence of right pleural effusion, and the abdomen was prominent but not tender or dull in the flanks. The oedema disappeared, but he did not improve, and suffered from pain in the epigastrium and prseoordium. Severe hiccough and vomiting developed. On June 16th erysipelas began on the nose and soon spread over the cheeks. The temperature was elevated and the præcordial pain and dyspnœa increased. Delirium followed, and the epigastrium On June 19th he became much became acutely tender. worse and complained of acute sudden pain in the epigastrium; the dyspnoea became much more severe, the pulse failed, and he died. At the necropsy the peritoneum was found covered with a viscid exudate and deeply congested. In the recesses and pelvis were over 300 c.c. of thick, yellowish fluid, smears from which showed Grampositive cocci in chains. The stomach was greatly distended and dark bluish-red. The right pleura was deeply congested and contained 300 c.c. of turbid yellow fluid, smears from which showed Gram-positive cocci in chains. The heart weighed 500 grammes and was much dilated. Shining through the epicardium of the left ventricle were two round, elevated, light yellow cedematous areas, about 1 centimetre on
1
THE LANCET, Jan.
29th, 1910, p. 292.