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LOCALISATION OF THE BACILLUS TYPHOID AT THE SITES OF INJURIES DURING RECEIVED TYPHOID FEVER AND AT THE SITES OF PREVIOUSLY EXISTING LESIONS.
’-CHRISTIAN SCIENCE" IN GERMANY.
464
which caused the mischief were said to smell like Indian or China ink ; they were blackened with a composition containing a large proportion (90 per cent.) of ordinary aniline, which served as a vehicle for the black colouring agent. Dr. Landouzy and Dr. Brouardel found that aniline applied to the shaved skin of guinea-pigs and rabbits kept in a warm place produced illness in from three to four hours and death in from 24 to 36 hours.
infant insurance. The history of this system as it is read by the critical onlooker is marked by a degree of mortality which is, at least, suggestive of widely prevalent abuse. Here, if anywhere, we would say, is a point at which legislation should intervene in a manner that it has not done. We have never been able to understand what pecuniary interest a poor parent can be considered to possess in the death of his young child apart from the cost of burial As a matter of fact, the sum insured is often expenses. far in excess of this moderate sum, o far that it bears a dangerous likeness to a premium on mortality. It is to be feared that it is not infrequently so regarded by parents who have more children than they care for and that a child’s life has repeatedly gone in exchange for the insurance money. We believe that the necessity for this kind of insurance even amor g the poor has been overestimated. We are of opinion that it would be fairer to the child, fairer to the parents, and of greater public benefit, that instead of insurance being made for a payment of money it should be limited to providing decent burial in the event death.
I
____
"CHRISTIAN SCIENCE" IN GERMANY. THE German Emperor is stated to have no intention of allowing the mischievous and crack-brained disciples of Mrs. Eddy to have an opportunity of spreading their doctrines in the Fatherland. It will be interesting to see what steps the German authorities will be able to take in the matter, for while it is the duty of a Government to watch over the health of the people it cannot possibly be the province of any Government to decide what is and what is not correct It may be said that such a manifest medical treatment. the as absurdity theory of Christian science cannot possibly to be a pretend system of therapeutics ; but, unfortunately, that is just what it does pretend to be. The German Emperor will earn the gratitude of English and American legislators if he can devise a plan which will stop these silly persons from playing with the lives of their fellow-creatures and which will at the same time give no chance to refractory persons to say that the freedom of the individual is being
BILL
FOR THE
BETTER PROTECTION CHILDREN.
judgment in respect of such matters as occupations or decency we cannot shut our eyes tu the help which can be derived from education or from the It - mure delicate, subtle, and powerful influence of religion. of
Tiousehold
will be for those who have to discuss and to vote upon this Bill to say how far the evils with which it deals are real ,and how much they are to allow to one or the other There is a or to all of these forces in seeking their removal. .related subject which we greatly desire to see taken up by Ethe legislature with more energy than it has been-that of
recently referred to usually present in the blood
WE have
OF
Cruelty
errors
LOCALISATION OF THE BACILLUS TYPHOID AT THE SITES OF INJURIES DURING RECEIVED TYPHOID FEVER AND AT THE SITES OF PREVIOUSLY EXISTING LESIONS.
-
WE are informed that a Bill to amend the Act for the Prevention of to Children will shortly be introduced into the House of Lords. It proposes to restrict the working hours of children employed in domestic work and to prevent their being brought up as tramps. It would also make it illegal to endanger the lives of young children by overlying, by leaving them alone in rooms with an unprotected fire, and by having them carried about by drunken persons, and would seek to protect their moral character by prohibiting promiscuous sleeping arrangements. It may be said that much of the ground occupied by these amendments is covered by the general term " neglect " for which provision is made by the original Act. There can be no reasonable doubt that such is the case with .regard to many so-called accidents due to burning and to overlying. Nor is the case of a child committed to the arms of an incapable drunkard essentially different. It is from our point of view hardly conceivable that a magistrate should be able under these circumstances to interpret the implied neglect as other than a punishable offence. Nevertheless, we should be most unwilling to lose any force derivable from detailed and exact definition which may be needful to strengthen the hands of magistrates in dealing with such As regards the regulation of domestic arrangeoccurrences. ments we are of opinion that makers of law should walk warily. Questions arising in this connexion are best settled When there is proof out of court as far as may be possible. of oppression, orcruelty, or a public nuisance, we naturally .look to the law for justice and reparation. Where we have to do with
-
the fact that typhoid bacilli cases of typhoid fever and to the value of examination of the blood for them as a means of early diagnosis.’ Some cases described at the meetings of the Societe Médicale des Hopitaux of Paris illustrate the ubiquity of the bacilli in cases of typhoid fever in a novel and interesting manner. At the meeting on Jan. 17th M. F. Widal and M. L. Le Sourd jointly described the case of a young woman,’ aged 24 years, in whom during convalescence from a long attack of typhoid fever an abscess and three ’’ oily subcutaneous collections developed in the positions of punctures made in injecting hypodermically caffeine and normal saline solution. In the pus of the abscess which was beneath the skin of the abdomen and in the oily collections which were situated on the left thigh the typhoid bacillus was found. This fact is analogous to the observation of several writers who have found pneumococcic abscesses at the sites at which subcutaneous injections of caffeine had been made in cases of pneumonia. In the abscess the typhoid bacillus and the staphylococcus aureus were found. In the oily collections the typhoid bacillus was found in pure culture. Histological examination showed polynuclear cells mixed with In this case the slight injury produced some lymphocytes. by the needle of the hypodermic syringe evidently localised the typhoid bacillus which must have been present in the blood. At the meeting of the Societe Medicale des Hôpitaux on Jan. 24th M. Widal and M. Ravaut gave examples of the localisation of the typhoid bacillus in the sites of lesions existing before the occurrence of the typhoid fever. A young woman had chronic submaxillary tuberculous adenitis. During convalescence from typhoid fever one of the tuberculous glands enlarged and became red and fluctuating. On incision pus was obtained containing the typhoid bacillus in pure culture. Cicatrisation rapidly occurred. A woman, aged 34 years, had typical typhoid fever which ran the ordinary course until the twentieth day, but there was abdominal pain, especially on the right side. On the twenty-first day vomiting occurred and the abdomen became tympanitic and more painful. The febrile symptoms persisted for three weeks. At the end of this time the abdominal pains returned in a violent form, greenish matter was vomited, and the abdominal facies-pinched noe, hollow eyes, and leaden are
unduly curtailed. A
of
I
in
"
1
THE
LANCET, Feb. 8th, 1901, p. 390.
LAPSES OF MEMORY IN RAILWAY EMPLOYÉS.
tinge—was present : the pulse was 130. These symptoms persisted for a week and then gradually disappeared. On the sixtieth day there was no fever and the general condition
4. As to the workmen, neither the hospital authorities nor anyone else can compel workmen to be vaccinated or to remain within the hospital grounds. Notices are, however, posted forbidding them to have any communication with the convalescents and offering to vaccinate them gratuitously and to disinfect their clothing. Contractors are now to their workmen to requested get comply with these conditions. So far, then, as we can see the statements upon which we commented seem to be. if not without founda-
good. Three weeks after defervescence the patient got up, but the abdominal pain and tympanites at once reappeared, the evening temperature rose to 100-40 F., and a tumour was found in the right iliac fossa. Appendicitis was suspected and laparotomy was performed. A large ovarian cy-t containing 1500 grammes of blackish fluid which yielded the typhoid bacillus in pure culture was found. The patient’s blood had still a high agglutinative power. The cyst and the right Fallopian tube were removed and rapid recovery was
ensued.
RAILWAY
with the single exception that convalescents have been ablb to approach too may possibly A small-pox hospital is, of course, near to the highway. a nece’sary evil, but we earnestly advise all the dwellers in the neighbourhood to get vaccinated without delay. They will then be practically free from all danger ; and it is only fair that if the hospital authorities take precautions the local inhabitants should do so too.
tion, grossly exaggerated,
____
LAPSES OF MEMORY IN
465
EMPLOYÉS.
I
course of a discussion at a meeting of American surgeons held in Chicago and recently reported in the Railway Surgeon, Dr. A. F. Jonas of Omaha, Nebraska, CALEDONIAN MEDICAL SOCIETY. said that as with many other persons so with railroad men THE awards of the Gunning Celtic prizes offered by the there was now and then a mental blank when a man did not Caledonian Medical Society for original work on MedicoThis was the only think or his mind did not operate. Celtic have just been made public. The adjudicators, subjects explanation for the fact that some men ran into an obstrucof Oxford and Professor Mackinnon of EdinPrincipal Rhys tion in broad daylight when it was plainly visible. He then have the first prize of k20 to Dr. H. Cameron awarded burgh, quoted an instance of this kind. Dr. A. T. Eskridge of Gillies of for his paper on a Gaelic Medical MS. Hampstead Denver, Colorado, the next speaker, said that these cases of of This which the author discovered in 1563. manuscript, amnesia were of not infrequent occurrence on railroads and British to the famous Beaton family the Museum, belonged were usually due to definite causes. The greatest cause was who were hereditary physicians to the Kings of Scotland not in the the sense of drunkenness at alcoholism, time, but of drunkenness a day or two before. The brain was from the beginning of the fourteenth century. The second then in an automatic state in which it could not adapt prize of £10 has been awarded to Mrs. K. Whyte Grant, itself to new conditions. Dr. D. S. Fairchild of Clinton, New Zealand, for an essay on the Influence of Scenery and the of the Iowa, president meeting, said that the observa- Climate on the Poetry and Music of the Highlands. Thetions made by Dr. Eskridge struck him very forcibly and in papers will be published in the Caledonian Medical Journal. his opinion accounted satisfactorily for certain inexplicable accidents. He then related a case in which through a THE STEREOTYPED ATTITUDES AND POSTURES OF THE INSANE IN REGARD TO DIAGNOSIS swiLch being turned the wrong way one of the most
Ix the
railway
on a certain railway left the main line and went off on a branch line. The main line was a double track and crossed a bridge, and the branch line was single and passed through a cutting, but the engine was allowed to run for eight miles before the driver discovered his mistake. Fortunately, no accident occurred. The driver when off duty drank freely and occasionally got drunk, but he was always sober when he went on the engine.
important trains
-
AND PROGNOSIS.
DR. ALBERT CAHEN has contributed to the December number of Archives de Neurologie a minute study of the "stereotyped attitudes and postures"characteristic of many forms of insanity, a subject to which much popular clinical interest has been accorded, but which has been little studied as regards diagnostic and prognostic value. At the outset. such conditions as ties, spasms, choreiform movements, and impulsive acts were excluded from the present research, which was limited to stereotyped movements and attitudes SMALL-POX AND ISOLATION. in the strict sense-i. e., such as were marked by automatism, As we surmised the statements made about the Small-pox long duration and persistence of attitude, and by being Hospital at South Mimms before the Barnet Rural District repeated frequently and in the same way. Such acts were, Council on Jan. 23rd were in some cases exaggerated and moreover, stamped by a "I professional appearance in some in others apparently simply untrue. It appears that the cases and had the semblance of being voluntary and intensame statements have been made previously by various tional. They included attitudes, peculiarities of language, people, and the secretary of the hospital has forwarded gestures, and modes of walking. The following were to us letters and copies of his answers which deal illustrative instances : attitudes of crouching like a beast with the points upon which we commented. From these without moving, standing or sitting in fixed poses which documents and letters we learn: 1. That the staff all had an insane or delusional significance, automatic buttoning reside on the premises, with one exception only. She and unbuttoning of the clothes, modes of stamping the floor resides at Clare Hall, an old house in the grounds. She and of walking a few paces forwards and then backwards, never goes to the hospital, and always changes her clothes lispings and utterings of sounds and words which the patient and has a disinfectant bath before leaving. 2. As to con- held to have a spiritual or mystic meaning (neologisms), valescents leaving the grounds and going to the public-house and mutism. When a patient exhibiting any of the above this has not occurred. What did happen was that some peculiarities was examined at the onset of his illness inquiry patients after discharge went to the public-house. 3. With generally revealed that the cause of his actions was a delusion regard to convalescents and the fence, the fence on the east of grandiose, mystic, hypochondriacal, or persecutory nature, side is an oak one more than six feet high. Convalescent provoking reactions and attitudes of a defensive chapatients are only allowed in certain parts of the ground and racter-the attitudes, acts, and postures in question. The an unclimbable iron fence is being erected to keep them patient who acted thus in the early stages of his disorder away from the highway altogether. A further fence is being acted consciously, but later, owing to repetition, the reaction erected on the northern side which will be five feet six inches became automatic and stereotyped and the delusion becamehigh. When this fence is erecte 1 there will be a double barrier. fixed and organised in the brain, so that the circuit.
464
which caused the mischief were said to smell like Indian or China ink ; they were blackened with a composition containing a large proportion (90 per cent.) of ordinary aniline, which served as a vehicle for the black colouring agent. Dr. Landouzy and Dr. Brouardel found that aniline applied to the shaved skin of guinea-pigs and rabbits kept in a warm place produced illness in from three to four hours and death in from 24 to 36 hours.
infant insurance. The history of this system as it is read by the critical onlooker is marked by a degree of mortality which is, at least, suggestive of widely prevalent abuse. Here, if anywhere, we would say, is a point at which legislation should intervene in a manner that it has not done. We have never been able to understand what pecuniary interest a poor parent can be considered to possess in the death of his young child apart from the cost of burial As a matter of fact, the sum insured is often expenses. far in excess of this moderate sum, o far that it bears a dangerous likeness to a premium on mortality. It is to be feared that it is not infrequently so regarded by parents who have more children than they care for and that a child’s life has repeatedly gone in exchange for the insurance money. We believe that the necessity for this kind of insurance even amor g the poor has been overestimated. We are of opinion that it would be fairer to the child, fairer to the parents, and of greater public benefit, that instead of insurance being made for a payment of money it should be limited to providing decent burial in the event death.
I
____
"CHRISTIAN SCIENCE" IN GERMANY. THE German Emperor is stated to have no intention of allowing the mischievous and crack-brained disciples of Mrs. Eddy to have an opportunity of spreading their doctrines in the Fatherland. It will be interesting to see what steps the German authorities will be able to take in the matter, for while it is the duty of a Government to watch over the health of the people it cannot possibly be the province of any Government to decide what is and what is not correct It may be said that such a manifest medical treatment. the as absurdity theory of Christian science cannot possibly to be a pretend system of therapeutics ; but, unfortunately, that is just what it does pretend to be. The German Emperor will earn the gratitude of English and American legislators if he can devise a plan which will stop these silly persons from playing with the lives of their fellow-creatures and which will at the same time give no chance to refractory persons to say that the freedom of the individual is being
BILL
FOR THE
BETTER PROTECTION CHILDREN.
judgment in respect of such matters as occupations or decency we cannot shut our eyes tu the help which can be derived from education or from the It - mure delicate, subtle, and powerful influence of religion. of
Tiousehold
will be for those who have to discuss and to vote upon this Bill to say how far the evils with which it deals are real ,and how much they are to allow to one or the other There is a or to all of these forces in seeking their removal. .related subject which we greatly desire to see taken up by Ethe legislature with more energy than it has been-that of
recently referred to usually present in the blood
WE have
OF
Cruelty
errors
LOCALISATION OF THE BACILLUS TYPHOID AT THE SITES OF INJURIES DURING RECEIVED TYPHOID FEVER AND AT THE SITES OF PREVIOUSLY EXISTING LESIONS.
-
WE are informed that a Bill to amend the Act for the Prevention of to Children will shortly be introduced into the House of Lords. It proposes to restrict the working hours of children employed in domestic work and to prevent their being brought up as tramps. It would also make it illegal to endanger the lives of young children by overlying, by leaving them alone in rooms with an unprotected fire, and by having them carried about by drunken persons, and would seek to protect their moral character by prohibiting promiscuous sleeping arrangements. It may be said that much of the ground occupied by these amendments is covered by the general term " neglect " for which provision is made by the original Act. There can be no reasonable doubt that such is the case with .regard to many so-called accidents due to burning and to overlying. Nor is the case of a child committed to the arms of an incapable drunkard essentially different. It is from our point of view hardly conceivable that a magistrate should be able under these circumstances to interpret the implied neglect as other than a punishable offence. Nevertheless, we should be most unwilling to lose any force derivable from detailed and exact definition which may be needful to strengthen the hands of magistrates in dealing with such As regards the regulation of domestic arrangeoccurrences. ments we are of opinion that makers of law should walk warily. Questions arising in this connexion are best settled When there is proof out of court as far as may be possible. of oppression, orcruelty, or a public nuisance, we naturally .look to the law for justice and reparation. Where we have to do with
-
the fact that typhoid bacilli cases of typhoid fever and to the value of examination of the blood for them as a means of early diagnosis.’ Some cases described at the meetings of the Societe Médicale des Hopitaux of Paris illustrate the ubiquity of the bacilli in cases of typhoid fever in a novel and interesting manner. At the meeting on Jan. 17th M. F. Widal and M. L. Le Sourd jointly described the case of a young woman,’ aged 24 years, in whom during convalescence from a long attack of typhoid fever an abscess and three ’’ oily subcutaneous collections developed in the positions of punctures made in injecting hypodermically caffeine and normal saline solution. In the pus of the abscess which was beneath the skin of the abdomen and in the oily collections which were situated on the left thigh the typhoid bacillus was found. This fact is analogous to the observation of several writers who have found pneumococcic abscesses at the sites at which subcutaneous injections of caffeine had been made in cases of pneumonia. In the abscess the typhoid bacillus and the staphylococcus aureus were found. In the oily collections the typhoid bacillus was found in pure culture. Histological examination showed polynuclear cells mixed with In this case the slight injury produced some lymphocytes. by the needle of the hypodermic syringe evidently localised the typhoid bacillus which must have been present in the blood. At the meeting of the Societe Medicale des Hôpitaux on Jan. 24th M. Widal and M. Ravaut gave examples of the localisation of the typhoid bacillus in the sites of lesions existing before the occurrence of the typhoid fever. A young woman had chronic submaxillary tuberculous adenitis. During convalescence from typhoid fever one of the tuberculous glands enlarged and became red and fluctuating. On incision pus was obtained containing the typhoid bacillus in pure culture. Cicatrisation rapidly occurred. A woman, aged 34 years, had typical typhoid fever which ran the ordinary course until the twentieth day, but there was abdominal pain, especially on the right side. On the twenty-first day vomiting occurred and the abdomen became tympanitic and more painful. The febrile symptoms persisted for three weeks. At the end of this time the abdominal pains returned in a violent form, greenish matter was vomited, and the abdominal facies-pinched noe, hollow eyes, and leaden are
unduly curtailed. A
of
I
in
"
1
THE
LANCET, Feb. 8th, 1901, p. 390.
LAPSES OF MEMORY IN RAILWAY EMPLOYÉS.
tinge—was present : the pulse was 130. These symptoms persisted for a week and then gradually disappeared. On the sixtieth day there was no fever and the general condition
4. As to the workmen, neither the hospital authorities nor anyone else can compel workmen to be vaccinated or to remain within the hospital grounds. Notices are, however, posted forbidding them to have any communication with the convalescents and offering to vaccinate them gratuitously and to disinfect their clothing. Contractors are now to their workmen to requested get comply with these conditions. So far, then, as we can see the statements upon which we commented seem to be. if not without founda-
good. Three weeks after defervescence the patient got up, but the abdominal pain and tympanites at once reappeared, the evening temperature rose to 100-40 F., and a tumour was found in the right iliac fossa. Appendicitis was suspected and laparotomy was performed. A large ovarian cy-t containing 1500 grammes of blackish fluid which yielded the typhoid bacillus in pure culture was found. The patient’s blood had still a high agglutinative power. The cyst and the right Fallopian tube were removed and rapid recovery was
ensued.
RAILWAY
with the single exception that convalescents have been ablb to approach too may possibly A small-pox hospital is, of course, near to the highway. a nece’sary evil, but we earnestly advise all the dwellers in the neighbourhood to get vaccinated without delay. They will then be practically free from all danger ; and it is only fair that if the hospital authorities take precautions the local inhabitants should do so too.
tion, grossly exaggerated,
____
LAPSES OF MEMORY IN
465
EMPLOYÉS.
I
course of a discussion at a meeting of American surgeons held in Chicago and recently reported in the Railway Surgeon, Dr. A. F. Jonas of Omaha, Nebraska, CALEDONIAN MEDICAL SOCIETY. said that as with many other persons so with railroad men THE awards of the Gunning Celtic prizes offered by the there was now and then a mental blank when a man did not Caledonian Medical Society for original work on MedicoThis was the only think or his mind did not operate. Celtic have just been made public. The adjudicators, subjects explanation for the fact that some men ran into an obstrucof Oxford and Professor Mackinnon of EdinPrincipal Rhys tion in broad daylight when it was plainly visible. He then have the first prize of k20 to Dr. H. Cameron awarded burgh, quoted an instance of this kind. Dr. A. T. Eskridge of Gillies of for his paper on a Gaelic Medical MS. Hampstead Denver, Colorado, the next speaker, said that these cases of of This which the author discovered in 1563. manuscript, amnesia were of not infrequent occurrence on railroads and British to the famous Beaton family the Museum, belonged were usually due to definite causes. The greatest cause was who were hereditary physicians to the Kings of Scotland not in the the sense of drunkenness at alcoholism, time, but of drunkenness a day or two before. The brain was from the beginning of the fourteenth century. The second then in an automatic state in which it could not adapt prize of £10 has been awarded to Mrs. K. Whyte Grant, itself to new conditions. Dr. D. S. Fairchild of Clinton, New Zealand, for an essay on the Influence of Scenery and the of the Iowa, president meeting, said that the observa- Climate on the Poetry and Music of the Highlands. Thetions made by Dr. Eskridge struck him very forcibly and in papers will be published in the Caledonian Medical Journal. his opinion accounted satisfactorily for certain inexplicable accidents. He then related a case in which through a THE STEREOTYPED ATTITUDES AND POSTURES OF THE INSANE IN REGARD TO DIAGNOSIS swiLch being turned the wrong way one of the most
Ix the
railway
on a certain railway left the main line and went off on a branch line. The main line was a double track and crossed a bridge, and the branch line was single and passed through a cutting, but the engine was allowed to run for eight miles before the driver discovered his mistake. Fortunately, no accident occurred. The driver when off duty drank freely and occasionally got drunk, but he was always sober when he went on the engine.
important trains
-
AND PROGNOSIS.
DR. ALBERT CAHEN has contributed to the December number of Archives de Neurologie a minute study of the "stereotyped attitudes and postures"characteristic of many forms of insanity, a subject to which much popular clinical interest has been accorded, but which has been little studied as regards diagnostic and prognostic value. At the outset. such conditions as ties, spasms, choreiform movements, and impulsive acts were excluded from the present research, which was limited to stereotyped movements and attitudes SMALL-POX AND ISOLATION. in the strict sense-i. e., such as were marked by automatism, As we surmised the statements made about the Small-pox long duration and persistence of attitude, and by being Hospital at South Mimms before the Barnet Rural District repeated frequently and in the same way. Such acts were, Council on Jan. 23rd were in some cases exaggerated and moreover, stamped by a "I professional appearance in some in others apparently simply untrue. It appears that the cases and had the semblance of being voluntary and intensame statements have been made previously by various tional. They included attitudes, peculiarities of language, people, and the secretary of the hospital has forwarded gestures, and modes of walking. The following were to us letters and copies of his answers which deal illustrative instances : attitudes of crouching like a beast with the points upon which we commented. From these without moving, standing or sitting in fixed poses which documents and letters we learn: 1. That the staff all had an insane or delusional significance, automatic buttoning reside on the premises, with one exception only. She and unbuttoning of the clothes, modes of stamping the floor resides at Clare Hall, an old house in the grounds. She and of walking a few paces forwards and then backwards, never goes to the hospital, and always changes her clothes lispings and utterings of sounds and words which the patient and has a disinfectant bath before leaving. 2. As to con- held to have a spiritual or mystic meaning (neologisms), valescents leaving the grounds and going to the public-house and mutism. When a patient exhibiting any of the above this has not occurred. What did happen was that some peculiarities was examined at the onset of his illness inquiry patients after discharge went to the public-house. 3. With generally revealed that the cause of his actions was a delusion regard to convalescents and the fence, the fence on the east of grandiose, mystic, hypochondriacal, or persecutory nature, side is an oak one more than six feet high. Convalescent provoking reactions and attitudes of a defensive chapatients are only allowed in certain parts of the ground and racter-the attitudes, acts, and postures in question. The an unclimbable iron fence is being erected to keep them patient who acted thus in the early stages of his disorder away from the highway altogether. A further fence is being acted consciously, but later, owing to repetition, the reaction erected on the northern side which will be five feet six inches became automatic and stereotyped and the delusion becamehigh. When this fence is erecte 1 there will be a double barrier. fixed and organised in the brain, so that the circuit.