753 Dr. W. P. Herringham, of 40, Wimpole-street, London, W., is the secretary of the 1913 Congress.
But for the next week there
carriers, though the
were
new cases were
not
more
nearly
than 150
as numerous-
A week later-that is, the last week of last number of carriers had fallen to 53, and the cases
namely, 224. QUARANTINE FOR DIPHTHERIA CARRIERS. THE energetic measures taken in Chicago to place antitoxin at the disposal of the entire population have already been described. Though last year there was a recrudescence of this disease, it is encouraging to see that the death-rate has on the whole been enormously reduced. Nevertheless, this has not prevented a great increase in the number and the severity of the precautions taken. The statistics of the last five decades have just been published by the Chicago health authorities, and these show that from 1860 to 1869 the average annual death-rate from diphtheria amounted to 159 per 100,000 of the population. From 1870 to 1879 it was 112, from 1880 to 18B9 it was 174, from 1890 to 1899 it was 93, and from 1900 to 1909 there were only 22 deaths per annum due to diphtheria per 100,000 of the population. Undoubtedly this wonderful result is in the main due to the use of antitoxin, and even more lives would have been saved if in all instances the proper measures had been taken as soon as the diagnosis of the disease had been established. With the use of antitoxin must also be associated measures of isolation and disinfection, and these later precautions have now to be applied not only to patients but also to disease carriers.. This latter measure is especially difficult to enforce. But the Chicago Health Department has boldly seized the bull by the horns. The throats of apparently healthy school children have been examined. If a single case of diphtheria occurs in a school cultures are made from samples taken from all the throats of the children attending that school. When it is thus demonstrated that, though a child is apparently in good health, it is a carrier of diphtheria bacilli, the child is at once isolated and kept in quarantine till there are no more pathogenic bacteria in its throat. Outside the door of the room where the child is thus confined a card is suspended, bearing the following
inscription :— CARRIER
OF DIPHTHERIA HERE.
KEEP
OUT.
type there is the following-explanation :— A diphtheria "carrier" may not be sick, but has diphtheria germs in the throat and can spread diphtheria. Such persons will be required to stay in the house until the throats are free from germs. Cultures will
Then in smaller
be taken to determine this. Other persons in the house can go in and out, Neighbours and friends must stay out. Milkmen must take the usual precautions. These rules must be obeyed until this warning card is taken down by the Department of Health.
Naturally not a few parents have rebelled against the severity of such enactments, and in some instances have been supported by local medical practitioners. The latter called in had looked at the child’s throat in the usual way, and had failed to detect that there was anything suspicious. But these practitioners are now realising that such measures are only taken by the authorities after bacteriological analyses. This service entails a very great increase of work. At one moment the Chicago Municipal Laboratory received more than 1000 throat cultures to examine per day. In two schoolrooms, where there had been cases of diphtheria, no less than 25 per cent. of the children, though apparently in good health, were found to be carriers of the diphtheria bacilli. When such a crowd of children had to be put in quarantine it will easily be imagined that these novel and stringent measures caused no small commotion. This new service was first instituted last December, and for the week ending Dec. 16th, 1910, there were 239 new cases of diphtheria notified and 258 carriers. 1
THE LANCET, Dec.
27th, 1910, p. 1782.
year-the
of actual disease were reduced to 146. Only five carriers had been discovered the first week and seven the second week of the new year, so that this source of danger has been largely overcome, and the disease itself seems to be slowly dying out. --
GONORRHŒAL INFLAMMATION OF THE VAS DEFERENS SIMULATING APPENDICITIS. IN the Bulletin de la Soei6te de l’Internat des Hôpitaux de Paris for January M. René le Fur has reported seven cases in which gonorrhoeal inflammation of the vas deferens simulated appendicitis. Statistics have been published to show that in about 40 per cent. of cases of gonorrhceal epididymitis the vas deferen3. prostate, and vesiculse seminales are involved. M. le Fur goes much farther than this, and states that, having systematically examined these parts per rectum in all cases of gonorrhoea, acute or chronic, he has always found them involved in cases of epididymitis. The cases of inflammation of the vas simulating appendicitis may be divided into two classes-those which are accompanied by epididymitis and those which are not. The former cases may clinically take several forms-acute, subacute, or chronic, just as may appendicitis. Cases of very acute epididymitis, with severe pain in the abdomen and right or left iliac fossa, vomiting, obstinate constipation, tympanites, and a temperature of 104° or 105° F., due to an intense peritoneal reaction and exactly simulating the symptoms of acute appendicitis, are well known. These symptoms are due to concomitant inflammation of the vas and vesicula seminalis which has involved the cellular tissue and even the peritoneum covering the pelvic part of the vas and the vesicula seminalis. The following is an example of inflammation of the vas simulating appendicitis. A man, aged 25 years, had slight epididymitis about the fifteenth day of a first attack of gonorrhoea. In the fourth week on returning from a railway journey he was seized with violent pains in the right side of the abdomen, tympanites, vomiting, and a temperature of 105° F. There was absolute constipation and flatus was not passed. He showed the pinched peritoneal face. He and his family were very uneasy, and thought he was suffering from appendicitis. M. le Fur reassured them, though he was himself uneasy, and prescribed opium and the application of ice to the abdomen, which relieved the pain. But on the following day the vomiting and the fever persisted, there was some delirium, the tongue was dry and furred, the pulse was rapid and weak, and the tympanites had increased. M. le Fur then diagnosed appendicitis and called in Professor Berger, who confirmed the diagnosis of appendicitis, but advised against operation, and recommended that the treatment be continued. For two days the condition of the patient was serious. There were a frequent and imperious desire to micturate, and a feeling of weight in the lower abdomen and fundament. On the fifth day the urethral discharge, which had disappeared completely, reappeared in an abundant form. Rectal examination showed that the right vesicula seminalis was much enlarged and painful ; the vas deferens could be followed along the pelvic wall as an elongated painful swelling. On pressure on these organs and on the prostate pus exuded from the urethra. Further, there was in the pouch of Douglas a median swelling of the size of a Tangerine orange, which was painful and soft. The urethral injections were resumed, suppositories of thigenol were inserted, and the bladder was washed out with a 1 in 4000 solution of permanganate of potassium. Rapid improvement took place. The diagnosis