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INFECTIOUS DISEASES IN MACCLESFIELD.
549 venereal disease in the European Army is entirely attributable to the abrogation of the Contagious Diseases Acts in India, and that the first thing to be done is to restore On the other hand, it is this system of legislation. alleged by some of those who have no sympathy with the opponents of the Acts that the system had proved a comparative failure in India and that its reintroduction could not
consequently be recommended on sanitary grounds. While we recognise the practical difficulties attending the application and working of legislative measures in India in this direction we nevertheless believe that the system previously in force was not as efficiently carried out as it might have been. If we are warranted in trying to prevent or limit the spread of such diseases as small-pox or scarlet fever, we are certainly justified in endeavouring to do so in the caseI of syphilitic disease. Every other country has recognised the correctness of this view and adopted repressive measures, and if our previous attempts in India in this respect were inadequate to cope with the evil others must be tried. We repeat that we are therefore glad that the subject is about
by its recent object-lesson, but we await for of this conversion"which shall prove to the overt sign world that the vast majority of its citizens no longer have part or lot with those whose baseless propaganda have been the direct cause of so much misery and death. been converted some
POISONOUS FOOD.
EVERY year presents a more or less alarming tale of obscure cases of poisoning by food, and the present year bids fair to "beat the record." There can be no doubt that in some instances poisoning could have been avoided by taking advantage of the abnormal appearance, taste, or smell frequently evinced by unsound foods, although these characters It is to are not always a certain indication of unfitness. be feared, however, that poor persons, by reason of their impecuniosity, are often led to partake of what they have bought although it may be distinctly objectionable, as from their point of view to reject it would be waste. On the other hand, there is reason for believing that food which is apparently, to the senses of sight, to receive attention. taste, and smell, free from objection, may prove to be injurious. In these cases it is difficult to suggest how the ANOTHER GLOUCESTER OBJECT LESSON. can be avoided. The poison is probably a ptomaine, IN the daily press of last Saturday, which contained danger the product of the action of certain bacteria upon nitrocopious extracts from the report of the majority of the Vac- genous substances. The ptomaines closely resemble the cination Commission, there also appeared an item of news of amines and in this way bear some relation to the poisonous singular significance in face of the conclusions at which the alkaloids. Their action is quite distinct from that of food Commission is said to have arrived. This was a statement such as milk or ice cream which has been exposed to to the effect that on the previous day at Gloucester a public to sewer emanations, or to some demonstration had been held by anti-vaccinationists to unhealthy surroundings, source of other pollution. Fatalities due to the consumption welcome the release from prison of a defaulter under the Acts. of unwholesome ice cream are of comparatively common It is not, perhaps, so much a matter of surprise that this At Bradford last week a number of persons occurrence. should happen in Gloucester, where, after a suspension of were taken ill, all of whom recovered, however, except ten years, the law is now being enforced, for during this in the coroner’s court it a boy. In the evidence period the anti-vaccination crusade has been, as we all appears that the retailer given of the ice cream admitted the know, most vigorously conducted, and there must be cream was but it was also shown by an inspector sour, many in that city to whom compulsory vaccination must that there was a seriously defective drain in the shop. But what is indeed seem a thing to be resisted to the death. Instances of true ptomaine poisoning are afforded in two surprising, nay, more, profoundly disheartening, is the fact cases recently reported, one from Crawley in Sussex and the that those people who have suffered so much from the disease, other from Liverpool, in both of which rabbit - pie was which vaccination prevents and mitigates, should nevertheless the fons et origo niali. Ptomaines were also seize the first opportunity to show that this bitter lesson has undoubtedly for some cases of " poisoning by potted probably responsible been taught them in vain. We are told that the defaulter in meat" also reported from Liverpool on Aug. 14th, in which question was in the service of the Midland Railway Company, severe gastro-enteritis was the principal symptom. A whole and that the crowd which accompanied him in his progress were seriously affected and the eldest child is reported through the streets contained many of the employes of family to be in a critical condition. this company in their uniform. What makes the affair more shameful still is the notorious fact that in this INFECTIOUS DISEASES IN MACCLESFIELD. recent epidemic, of the two great railway companies whose lines converge at Gloucester, the servants of the MACCLESFIELD seems to be rather unfortunate in its Great Western Railway Company hardly suffered at all, methods of dealing with infectious disease. Apparently it whereas the disease was rife amongst the Midland men, possesses only one small hospital for the reception of such the fact being that the former company required their cases, and in this building there is no provision for isolating men to be re-vaccinated, whilst the latter declined to one kind of infectious disease from another. Consequently put any pressure upon them at all. Let us hope, for the majority of cases arising in the town have to be the sake of human nature, as well as our belief in the dealt with in their own homes and many cases have intelligence of such men, that none of those who took part hitherto been attended by the house surgeons of the in this demonstration (which, of course, may have been infirmary. Some doubts of the wisdom of this custom arose largely based on the personal popularity of the offender) in the minds of the governors of the infirmary, and on had suffered in their own families from the visitation of July 6th, 1896, they-or at least the house committee-small-pox. It would, indeed, be incredible if any man, whose appealed to the members of the medical staff for their opinion home had been recently decimated by reason of his own on the subject. On July 16th, 1896, the medical staff replied perversity in failing to secure for his children protection that they saw no reason why the house surgeons should not from the plague which smote them down, could be so wilfully attend infectious cases. At a meeting of the governors on and grossly blinded by unreason as to continue in the delusion Aug. 8th the whole question came up again and it was finally he hitherto held. Have the wives of such men and the decided that the matter should be left in the hands of mothers of those dead children no voice in the matter ; and the house committee, where as a matter of fact it was is there no sense of shame amongst the people of Gloucester before. It was argued at the meeting that the honorary to permit such an exhibition of heartlessness and ignorance medical staff visited infectious cases in their private practice to be made in their midst ?7 It is said that Gloucester has and then saw cases in the infirmary and that, therefore, the ___
550 house surgeons might do the same ; but to our mind the A house surgeon cases stand on a totally different plane. has to inspect all his cases at least once every day-has to do a number of dressings and minor operations with an occasional one of greater gravity, and thus has far greater opportunities of conveying infection. Perhaps the simplest way out of the matter would be to prohibit the house surgeon, or indeed any member of the staff, from visiting in his capacity of infirmary medical officer any patients at their own homes. These might well be left to the ordinary practitioner and the parish medical man. Of course this might send up the rates, but it would be cheaper than an epidemic; and if this " impasse" teaches the Macclesfield authorities the need for a proper isolation hospital good will come out of a seeming evil.
TYPHOID FEVER AND RAIN AT BEYROUT.
Nevertheless, we have inquired fully into the circumstances of the case, and place the more important facts before the profession. The evidence given was that the man the cause of whose death was the question before the court had been taken to St. Thomas’s Hospital early on the morning of July 31st by the police to be treated for a scalp wound caused through falling on Waterloo Bridge. The house surgeon on duty, Mr. Conford, dressed the wound but did not consider it advisable to admit the man. The patient left the hospital in charge of the police, but was brought back to the hospital about two hours later, having been run over in the street. The injuries then received proved fatal. The coroner made some remarks and treated the house surgeon with scant courtesy, saying that the man w01Ûd not have been killed if he had been admitted, and the jury returned a rider to the verdict to the effect : "We con. sider the deceased ought to have been admitted to the hospital, and his death was due to the neglect of the hospital authorities in not admitting him." On the first occasion when he was seen at the hospital there is evidence that the man was partially intoxicated and that the scalp wound was not sufficiently serious to make it necessary or advisable to Our readers will recognise the condition in admit him. which hospital wards would be on a Saturday night if this combination led to admission in all cases. The post-mortem examination subsequently proved that Mr. Conford was quite right in his estimate of the severity of the case. There had been no injury to the skull or its contents. The man left the hospital in the custody of the police, who agreed to He was, however, persecure a night’s lodging for him. mitted to leave their care before being placed in safety, and in crossing a road was run over by a railway van. All these facts ought to have been ascertained during the inquiry. If anyone is to blame it is surely the police, who ought to have taken the man to the station. It is no part of the duty of a hospital to take charge of drunken men who, as in this instance, can walk for a considerable distance without help.. There are persons who apparently go out of their way to cast mud on charitable institutions and hamper them in their work. We cannot understand the spirit which prompts such a proceeding. A public apology should be offered to the house surgeon whose conduct was so wrongfully condemned. occurrence.
BRUN, of the French Faculty of Medicine at issued a report on the serious epidemic of has Beyrout, which has afflicted that town. The epidemic fever typhoid commenced suddenly in October, 1895, and only ceased at the , end of the spring of this year. It appears that during the summer of 1895 numerous cases of typhoid fever were observed in various villages situated in the valley of the Nahr-el-Kelb where flows the river which supplies drinkingwater to the town of Beyrout. On Oct. 14th Dr. de Brun relates that there occurred a remarkable storm. Torrents of rain fell throughout the district. In less than half an hour the streets were converted into rivers and the water rushed by with such force that some children were carried away, thrown into the sewer mouths and drowned. Two men also lost their lives in the flood. From the mountains that surround Beyrout water came sweeping down into the river. The dejecta of the inhabitants of the surrounding villages, which are simply thrown out on the soil, followed the current, and thus brought the germs of typhoid fever from the villages to the river. Ten days after the storm the fever broke out in Beyrout. There were cases in all quarters of the town. By Nov. lst it was estimated that there had been from 6000 to 7000 cases. This is so large a figure that the Beyrout epidemic may be considered as one of the most recent and striking illustrations of the danger that results from the absence of an effective system of drainage. WE congratulate Dr. Francis Richard Cruise upon the The epidemic conveys no new lesson, but it very forcibly conferred upon him by Lord Cadogan last knighthood emphasises what is already known. A similar occurrence in week. Sir Francis Richard Cruise was President of the London would mean something like 50,000 cases of typhoid Royal College of Physicians of Ireland in 1884 and is confever in a week. At Beyrout the cesspools were flooded, and sulting physician to the Mater Misericordise Hospital of their contents, diluted by the rain-water, were conveyed in Dublin and Consulting Visitor in Lunacy in Ireland. all directions. This, together with the specific germs brought down from the outlying villages, where cases of typhoid fever THE Queen has sanctioned the appointment of Surgeonare known to have previously occurred, may account for Major-General James Jameson, M.D., Director-General of the the wide-spread nature of the epidemic. In most Eastern Army Medical Department, to be a Knight of Grace of the villages there is no provision for drainage. The earth is Order of the Hospital of St. John of Jerusalem in England. the usual purifier, and where the population is not large the sunshine, the air, and the earth ultimately render the filth recklessly thrown out quite innocuous. But if there is a sudden down-pour of rain the filth is carried away before it is purified. It may thus contaminate a neighbouring waterEUROPHEN AS A SUBSTITUTE FOR IODOFORM. supply and result in such an epidemic as that which has DR. EDMUND SAALFIELD gives an account in the Tam’arecently affected Beyrout. peutie Gazette of the properties of europhen and its COMPLAINT AGAINST A HOSPITAL AUTHORITY. advantages over iodoform. Europhen is in the form of a fine yellow powder, with a faint, saffron-like odour, and Our attention was drawn to two paragraphs dealing with contains 28’1 per cent. of iodine. In the dry state it is the above subject in our contemporaries the Mog-niiq Post permanent, but on contact with water and alkaline fluids it As a result of his and the Daily Ne7vs of the 12th inst., and we have investi- liberates small quantities of iodine. Saalfield thinks that this drug is to be Dr. thus to the notice of the the experiments gated brought public. charges This was, perhaps, less necessary than usual, as a letter looked upon as the best substitute for iodoform which at exists, for it is neither toxic nor odoriferous, and its from the medical officer (really censured by the jury, with present application to inflamed skin causes no irritation. On account the coroner’s assent) was published on the following day in ot this non-irritating property it is said to be useful in the former journal and put quite a different aspect on the various dermatological conditions, such as varicose ulcers DR.
DE
Pharmacology and Therapeutics.
-
consequently be recommended on sanitary grounds. While we recognise the practical difficulties attending the application and working of legislative measures in India in this direction we nevertheless believe that the system previously in force was not as efficiently carried out as it might have been. If we are warranted in trying to prevent or limit the spread of such diseases as small-pox or scarlet fever, we are certainly justified in endeavouring to do so in the caseI of syphilitic disease. Every other country has recognised the correctness of this view and adopted repressive measures, and if our previous attempts in India in this respect were inadequate to cope with the evil others must be tried. We repeat that we are therefore glad that the subject is about
by its recent object-lesson, but we await for of this conversion"which shall prove to the overt sign world that the vast majority of its citizens no longer have part or lot with those whose baseless propaganda have been the direct cause of so much misery and death. been converted some
POISONOUS FOOD.
EVERY year presents a more or less alarming tale of obscure cases of poisoning by food, and the present year bids fair to "beat the record." There can be no doubt that in some instances poisoning could have been avoided by taking advantage of the abnormal appearance, taste, or smell frequently evinced by unsound foods, although these characters It is to are not always a certain indication of unfitness. be feared, however, that poor persons, by reason of their impecuniosity, are often led to partake of what they have bought although it may be distinctly objectionable, as from their point of view to reject it would be waste. On the other hand, there is reason for believing that food which is apparently, to the senses of sight, to receive attention. taste, and smell, free from objection, may prove to be injurious. In these cases it is difficult to suggest how the ANOTHER GLOUCESTER OBJECT LESSON. can be avoided. The poison is probably a ptomaine, IN the daily press of last Saturday, which contained danger the product of the action of certain bacteria upon nitrocopious extracts from the report of the majority of the Vac- genous substances. The ptomaines closely resemble the cination Commission, there also appeared an item of news of amines and in this way bear some relation to the poisonous singular significance in face of the conclusions at which the alkaloids. Their action is quite distinct from that of food Commission is said to have arrived. This was a statement such as milk or ice cream which has been exposed to to the effect that on the previous day at Gloucester a public to sewer emanations, or to some demonstration had been held by anti-vaccinationists to unhealthy surroundings, source of other pollution. Fatalities due to the consumption welcome the release from prison of a defaulter under the Acts. of unwholesome ice cream are of comparatively common It is not, perhaps, so much a matter of surprise that this At Bradford last week a number of persons occurrence. should happen in Gloucester, where, after a suspension of were taken ill, all of whom recovered, however, except ten years, the law is now being enforced, for during this in the coroner’s court it a boy. In the evidence period the anti-vaccination crusade has been, as we all appears that the retailer given of the ice cream admitted the know, most vigorously conducted, and there must be cream was but it was also shown by an inspector sour, many in that city to whom compulsory vaccination must that there was a seriously defective drain in the shop. But what is indeed seem a thing to be resisted to the death. Instances of true ptomaine poisoning are afforded in two surprising, nay, more, profoundly disheartening, is the fact cases recently reported, one from Crawley in Sussex and the that those people who have suffered so much from the disease, other from Liverpool, in both of which rabbit - pie was which vaccination prevents and mitigates, should nevertheless the fons et origo niali. Ptomaines were also seize the first opportunity to show that this bitter lesson has undoubtedly for some cases of " poisoning by potted probably responsible been taught them in vain. We are told that the defaulter in meat" also reported from Liverpool on Aug. 14th, in which question was in the service of the Midland Railway Company, severe gastro-enteritis was the principal symptom. A whole and that the crowd which accompanied him in his progress were seriously affected and the eldest child is reported through the streets contained many of the employes of family to be in a critical condition. this company in their uniform. What makes the affair more shameful still is the notorious fact that in this INFECTIOUS DISEASES IN MACCLESFIELD. recent epidemic, of the two great railway companies whose lines converge at Gloucester, the servants of the MACCLESFIELD seems to be rather unfortunate in its Great Western Railway Company hardly suffered at all, methods of dealing with infectious disease. Apparently it whereas the disease was rife amongst the Midland men, possesses only one small hospital for the reception of such the fact being that the former company required their cases, and in this building there is no provision for isolating men to be re-vaccinated, whilst the latter declined to one kind of infectious disease from another. Consequently put any pressure upon them at all. Let us hope, for the majority of cases arising in the town have to be the sake of human nature, as well as our belief in the dealt with in their own homes and many cases have intelligence of such men, that none of those who took part hitherto been attended by the house surgeons of the in this demonstration (which, of course, may have been infirmary. Some doubts of the wisdom of this custom arose largely based on the personal popularity of the offender) in the minds of the governors of the infirmary, and on had suffered in their own families from the visitation of July 6th, 1896, they-or at least the house committee-small-pox. It would, indeed, be incredible if any man, whose appealed to the members of the medical staff for their opinion home had been recently decimated by reason of his own on the subject. On July 16th, 1896, the medical staff replied perversity in failing to secure for his children protection that they saw no reason why the house surgeons should not from the plague which smote them down, could be so wilfully attend infectious cases. At a meeting of the governors on and grossly blinded by unreason as to continue in the delusion Aug. 8th the whole question came up again and it was finally he hitherto held. Have the wives of such men and the decided that the matter should be left in the hands of mothers of those dead children no voice in the matter ; and the house committee, where as a matter of fact it was is there no sense of shame amongst the people of Gloucester before. It was argued at the meeting that the honorary to permit such an exhibition of heartlessness and ignorance medical staff visited infectious cases in their private practice to be made in their midst ?7 It is said that Gloucester has and then saw cases in the infirmary and that, therefore, the ___
550 house surgeons might do the same ; but to our mind the A house surgeon cases stand on a totally different plane. has to inspect all his cases at least once every day-has to do a number of dressings and minor operations with an occasional one of greater gravity, and thus has far greater opportunities of conveying infection. Perhaps the simplest way out of the matter would be to prohibit the house surgeon, or indeed any member of the staff, from visiting in his capacity of infirmary medical officer any patients at their own homes. These might well be left to the ordinary practitioner and the parish medical man. Of course this might send up the rates, but it would be cheaper than an epidemic; and if this " impasse" teaches the Macclesfield authorities the need for a proper isolation hospital good will come out of a seeming evil.
TYPHOID FEVER AND RAIN AT BEYROUT.
Nevertheless, we have inquired fully into the circumstances of the case, and place the more important facts before the profession. The evidence given was that the man the cause of whose death was the question before the court had been taken to St. Thomas’s Hospital early on the morning of July 31st by the police to be treated for a scalp wound caused through falling on Waterloo Bridge. The house surgeon on duty, Mr. Conford, dressed the wound but did not consider it advisable to admit the man. The patient left the hospital in charge of the police, but was brought back to the hospital about two hours later, having been run over in the street. The injuries then received proved fatal. The coroner made some remarks and treated the house surgeon with scant courtesy, saying that the man w01Ûd not have been killed if he had been admitted, and the jury returned a rider to the verdict to the effect : "We con. sider the deceased ought to have been admitted to the hospital, and his death was due to the neglect of the hospital authorities in not admitting him." On the first occasion when he was seen at the hospital there is evidence that the man was partially intoxicated and that the scalp wound was not sufficiently serious to make it necessary or advisable to Our readers will recognise the condition in admit him. which hospital wards would be on a Saturday night if this combination led to admission in all cases. The post-mortem examination subsequently proved that Mr. Conford was quite right in his estimate of the severity of the case. There had been no injury to the skull or its contents. The man left the hospital in the custody of the police, who agreed to He was, however, persecure a night’s lodging for him. mitted to leave their care before being placed in safety, and in crossing a road was run over by a railway van. All these facts ought to have been ascertained during the inquiry. If anyone is to blame it is surely the police, who ought to have taken the man to the station. It is no part of the duty of a hospital to take charge of drunken men who, as in this instance, can walk for a considerable distance without help.. There are persons who apparently go out of their way to cast mud on charitable institutions and hamper them in their work. We cannot understand the spirit which prompts such a proceeding. A public apology should be offered to the house surgeon whose conduct was so wrongfully condemned. occurrence.
BRUN, of the French Faculty of Medicine at issued a report on the serious epidemic of has Beyrout, which has afflicted that town. The epidemic fever typhoid commenced suddenly in October, 1895, and only ceased at the , end of the spring of this year. It appears that during the summer of 1895 numerous cases of typhoid fever were observed in various villages situated in the valley of the Nahr-el-Kelb where flows the river which supplies drinkingwater to the town of Beyrout. On Oct. 14th Dr. de Brun relates that there occurred a remarkable storm. Torrents of rain fell throughout the district. In less than half an hour the streets were converted into rivers and the water rushed by with such force that some children were carried away, thrown into the sewer mouths and drowned. Two men also lost their lives in the flood. From the mountains that surround Beyrout water came sweeping down into the river. The dejecta of the inhabitants of the surrounding villages, which are simply thrown out on the soil, followed the current, and thus brought the germs of typhoid fever from the villages to the river. Ten days after the storm the fever broke out in Beyrout. There were cases in all quarters of the town. By Nov. lst it was estimated that there had been from 6000 to 7000 cases. This is so large a figure that the Beyrout epidemic may be considered as one of the most recent and striking illustrations of the danger that results from the absence of an effective system of drainage. WE congratulate Dr. Francis Richard Cruise upon the The epidemic conveys no new lesson, but it very forcibly conferred upon him by Lord Cadogan last knighthood emphasises what is already known. A similar occurrence in week. Sir Francis Richard Cruise was President of the London would mean something like 50,000 cases of typhoid Royal College of Physicians of Ireland in 1884 and is confever in a week. At Beyrout the cesspools were flooded, and sulting physician to the Mater Misericordise Hospital of their contents, diluted by the rain-water, were conveyed in Dublin and Consulting Visitor in Lunacy in Ireland. all directions. This, together with the specific germs brought down from the outlying villages, where cases of typhoid fever THE Queen has sanctioned the appointment of Surgeonare known to have previously occurred, may account for Major-General James Jameson, M.D., Director-General of the the wide-spread nature of the epidemic. In most Eastern Army Medical Department, to be a Knight of Grace of the villages there is no provision for drainage. The earth is Order of the Hospital of St. John of Jerusalem in England. the usual purifier, and where the population is not large the sunshine, the air, and the earth ultimately render the filth recklessly thrown out quite innocuous. But if there is a sudden down-pour of rain the filth is carried away before it is purified. It may thus contaminate a neighbouring waterEUROPHEN AS A SUBSTITUTE FOR IODOFORM. supply and result in such an epidemic as that which has DR. EDMUND SAALFIELD gives an account in the Tam’arecently affected Beyrout. peutie Gazette of the properties of europhen and its COMPLAINT AGAINST A HOSPITAL AUTHORITY. advantages over iodoform. Europhen is in the form of a fine yellow powder, with a faint, saffron-like odour, and Our attention was drawn to two paragraphs dealing with contains 28’1 per cent. of iodine. In the dry state it is the above subject in our contemporaries the Mog-niiq Post permanent, but on contact with water and alkaline fluids it As a result of his and the Daily Ne7vs of the 12th inst., and we have investi- liberates small quantities of iodine. Saalfield thinks that this drug is to be Dr. thus to the notice of the the experiments gated brought public. charges This was, perhaps, less necessary than usual, as a letter looked upon as the best substitute for iodoform which at exists, for it is neither toxic nor odoriferous, and its from the medical officer (really censured by the jury, with present application to inflamed skin causes no irritation. On account the coroner’s assent) was published on the following day in ot this non-irritating property it is said to be useful in the former journal and put quite a different aspect on the various dermatological conditions, such as varicose ulcers DR.
DE
Pharmacology and Therapeutics.
-