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SOCIETY OF MEDICAL OFFICERS OF HEALTH. (METROPOLITAN BRANCH.)
1581 months later. Mr. Silcock emphasised the utility of the exploratory method pursued in these cases as being efficient to the distended and as obviating injury by bruising, &c., structures. Mr. G. STEVENS showed a specimen of Rupture of the Heart. The patient, a man aged seventy-six, became collapsed after the passage of a stool and died within threequarters of an hour. It was found that the left ventricle was ruptured by a small aperture posteriorly, near the interventricular septum. The loss of blood had evidently been gradual. The heart tissue was fatty, and showed also the microscopic signs of pigmentary infiltration.
baled for the cows, and possibly for washing the cans. The tank was green and the water turbid, the former evidently not having been cleaned for months or years ; and the milk was kept in a cellar under the house, where it was possibly exposed to sewer air. The cows were apparently in good health, and an examination of the milk and of the water in the tank failed to show the presence of the typhoid fever bacillus, though the bacteria in each were identical. Little value, however, could be attached to such purely negative results in the face of the overwhelming evidence of the connexion of the epidemic with the supply of milk. was
LIVERPOOL MEDICAL INSTITUTION. SOCIETY OF MEDICAL OFFICERS OF HEALTH. (METROPOLITAN BRANCH.) Outbreak
of Enteric Fever.
A MEETING of this society was held on Dec. 10th, Dr. YARROW being in the chair. Dr. SIDNEY DAVIES read a report on an Outbreak of Enteric Fever distinctly traceable to a particular milksupply, though the actual cause could not be discovered. Plumstead had been comparatively free from the disease, the number of cases notified in the past three years having been 22, 29, and 26, and up to the beginning of May of the present year there had been 6 scattered cases as regards time and place. Between the 9th and llth of that month 6 cases, all getting their milk from this dairy, had been reported, but he did not apply for a closing order until the number had risen to 25 by the 15th. The milk was nevertheless sold surreptitiously, and on the 29th there had been 92 cases. In the following weeks 47, 21, 7, and 6 and between June 26th and 30th 4 fresh cases were reported, besides 13 in July. Of the 177 cases occurring in the district up to the nd of June 159, or about 90 per cent., were proved to have had their milk directly or indirectly from this dairy--33 of them from a shop in Woolwich which was supplied from the Plumstead dairy. How many cases may have occurred in Woolwich from the same milk could not be ascertained, and the epidemic must have continued to rage there had the dairyman been content to obey the letter of Section 71 of the Public Health (London) Act, selling his milk exclusively in Woolwich, but the notoriety he obtained by defying and evading the magistrate’s order, for which he was again summoned and fined, led to the breaking up of his establishment and the sale of his stock on May 28th. The occurrence within a few weeks, at a time of year at which enteric fever does not usually prevail, of six or seven times as many cases as had previously been known to arise in a whole year, pointed to some extraordinary cause ; and the fact that 90 per cent. of these were proved to have had milk from a single dairy left no room for doubt as to its influence, which was confirmed by the decline of the epidemic following the cessation of the sale of milk after the interval required for incubation ; but had the business not been conducted so irregularly as it was, without books, &c., an even larger percentage of the cases might have been traced to the same source. In 44 of 141 houses regularly supplied by the dairyman’s carts there were 65 cases. Of 49 houses in certain streets supplied by him 29 were invaded, but only 2 of the remaining 150. The 177 cases included 74 males and 103 females ; 23 were under five years of age, 41 from five to ten, 57 from ten to twenty, 45 from twenty to forty, and 6 over forty, one of these, a mild case, being seventy-one years of age. Besides these there were several suspicious cases of diarrhoea among infants. The cases sent to hospital numbered 113, with 13 deaths, and those treated at home 64, with 10 deaths, or 11 and 15 per cent., in marked contrast to the usual mortality of scarlet fever &c., and probably due to the more careful dieting of patients in hospitals. The case mortality in Plumstead had previously been 22 per cent.; possibly the lower rate on the present occasion might have been owing to the larger proportion of children attacked in a milk epidemic. An inspection of the dairy showed the drains to be everywhere unsound, the yard gulleys defective, the rain water pipes connected with the drains, and the cowsheds extremely dirty. The water-supply was that of the Kent Company, and as drawn from the taps was of its well. known purity, but there was a brick tank, lined with cement, from which the water
Endo-laryngeal sponsibility
"Singer’s" Nod2cle.-A ReLying-in Patient from a S’anitary
Removal of to the
Point of View.-Spinal Localisation. A MEETING of this society was held on Dec. 12th, the President, Mr. CHAUNCY PUZEY, being in the chair. Mr. BARK showed two patients after Endo-laryngeal Removal of "Singer’s" Nodule. They were both professional voice users. The first patient had completely lost his singing voice; the growth had been removed in 1892 by another surgeon, but recurred in about a year. In July, 1893, the growth was completely removed by Grant’s guarded laryngeal forceps. Two weeks later he fulfilled a professional engagement and said that his voice had never been better ; there had been no recurrence since. The second patient had suffered from hoarseness and loss of singing voice for over two years ; the growth in this case also was removed by Grant’s forceps ; this was in June, 1894, and the voice had been good ever since.-Mr. BARK also showed a Papilloma removed from the Anterior Commissure of the Larynx by Gibb’s snare and a patient suffering from Trachoma of the Larynx. Dr. STEEVES read a note entitled ‘° A Responsibility to the Lying-in Patient from a Sanitary Point of View." He thought that a variety of puerperal fever existed the result of defective sanitation, and instanced cases where he believed puerperal septicasmia was caused by atmospheric infection by sewer air. He referred to the great benefit that a puerperal fever patient derived from removal to healthy surroundings. In the city of Liverpool one-third of the puerperal fever cases reported were from houses described as insanitary. The prevalence of this disease was no necessary index of the amount of zymotic disease existing. The medical attendant when engaged for a confinement rarely inquired into the sanitary condition of the house, but Dr. Steeves thought that if the physician was not experienced in sanitary details he should not hesitate to obtain a skilled opinion. If the owner of the property refused to abate a nuisance the aid of the sanitary authority should be invoked. A protracted period of ill-health frequently followed confinement, the victim really suffering from chronic sewer air poisoning ; this could only be put an end to by change of residence or an alteration in the sanitary arrangements of the house. Dr. Steeves then moved the following resolution, which was seconded by Dr. Imlach : ’’ That, in the opinion of the members of the Liverpool Medical Institution, it is the duty of every medical practitioner, when engaged to attend a confinement, to forthwith inspect, or cause to be inspected, the premises of the patient, with a view of having any sanitary defects which may exist corrected, and so further the stamping out of puerperal septicaemia by the methods of preventive medicine." Several members spoke on the resolution, some stating that, in their opinion, insanitary conditions had nothing whatever to do with puerperal septicaemia ; others thought that the resolution to be effectual should apply to every kind of illness, and not specially to the puerperal woman. It seemed to be generally agreed that it would be very unwise that any such resolution should go forth to the public from the institution, and on being put to the vote it was rejected by an overwhelming majority. Professor SHERRINGTON drew attention to the Localisation of Function in the Spinal Cord as illustrated by the distribution to the skin of the sensory spinal nerve pairs arising from the cord. He pointed out that experiments show the field of skin supplied by each sensory spinal nerve root to be Where a large area of somewhat simple configuration. simplest-that is, in the trunk and neck-the segmental skin
field is band-like, wrapping transversely round ..
.
B B
3
one
lateral
baled for the cows, and possibly for washing the cans. The tank was green and the water turbid, the former evidently not having been cleaned for months or years ; and the milk was kept in a cellar under the house, where it was possibly exposed to sewer air. The cows were apparently in good health, and an examination of the milk and of the water in the tank failed to show the presence of the typhoid fever bacillus, though the bacteria in each were identical. Little value, however, could be attached to such purely negative results in the face of the overwhelming evidence of the connexion of the epidemic with the supply of milk. was
LIVERPOOL MEDICAL INSTITUTION. SOCIETY OF MEDICAL OFFICERS OF HEALTH. (METROPOLITAN BRANCH.) Outbreak
of Enteric Fever.
A MEETING of this society was held on Dec. 10th, Dr. YARROW being in the chair. Dr. SIDNEY DAVIES read a report on an Outbreak of Enteric Fever distinctly traceable to a particular milksupply, though the actual cause could not be discovered. Plumstead had been comparatively free from the disease, the number of cases notified in the past three years having been 22, 29, and 26, and up to the beginning of May of the present year there had been 6 scattered cases as regards time and place. Between the 9th and llth of that month 6 cases, all getting their milk from this dairy, had been reported, but he did not apply for a closing order until the number had risen to 25 by the 15th. The milk was nevertheless sold surreptitiously, and on the 29th there had been 92 cases. In the following weeks 47, 21, 7, and 6 and between June 26th and 30th 4 fresh cases were reported, besides 13 in July. Of the 177 cases occurring in the district up to the nd of June 159, or about 90 per cent., were proved to have had their milk directly or indirectly from this dairy--33 of them from a shop in Woolwich which was supplied from the Plumstead dairy. How many cases may have occurred in Woolwich from the same milk could not be ascertained, and the epidemic must have continued to rage there had the dairyman been content to obey the letter of Section 71 of the Public Health (London) Act, selling his milk exclusively in Woolwich, but the notoriety he obtained by defying and evading the magistrate’s order, for which he was again summoned and fined, led to the breaking up of his establishment and the sale of his stock on May 28th. The occurrence within a few weeks, at a time of year at which enteric fever does not usually prevail, of six or seven times as many cases as had previously been known to arise in a whole year, pointed to some extraordinary cause ; and the fact that 90 per cent. of these were proved to have had milk from a single dairy left no room for doubt as to its influence, which was confirmed by the decline of the epidemic following the cessation of the sale of milk after the interval required for incubation ; but had the business not been conducted so irregularly as it was, without books, &c., an even larger percentage of the cases might have been traced to the same source. In 44 of 141 houses regularly supplied by the dairyman’s carts there were 65 cases. Of 49 houses in certain streets supplied by him 29 were invaded, but only 2 of the remaining 150. The 177 cases included 74 males and 103 females ; 23 were under five years of age, 41 from five to ten, 57 from ten to twenty, 45 from twenty to forty, and 6 over forty, one of these, a mild case, being seventy-one years of age. Besides these there were several suspicious cases of diarrhoea among infants. The cases sent to hospital numbered 113, with 13 deaths, and those treated at home 64, with 10 deaths, or 11 and 15 per cent., in marked contrast to the usual mortality of scarlet fever &c., and probably due to the more careful dieting of patients in hospitals. The case mortality in Plumstead had previously been 22 per cent.; possibly the lower rate on the present occasion might have been owing to the larger proportion of children attacked in a milk epidemic. An inspection of the dairy showed the drains to be everywhere unsound, the yard gulleys defective, the rain water pipes connected with the drains, and the cowsheds extremely dirty. The water-supply was that of the Kent Company, and as drawn from the taps was of its well. known purity, but there was a brick tank, lined with cement, from which the water
Endo-laryngeal sponsibility
"Singer’s" Nod2cle.-A ReLying-in Patient from a S’anitary
Removal of to the
Point of View.-Spinal Localisation. A MEETING of this society was held on Dec. 12th, the President, Mr. CHAUNCY PUZEY, being in the chair. Mr. BARK showed two patients after Endo-laryngeal Removal of "Singer’s" Nodule. They were both professional voice users. The first patient had completely lost his singing voice; the growth had been removed in 1892 by another surgeon, but recurred in about a year. In July, 1893, the growth was completely removed by Grant’s guarded laryngeal forceps. Two weeks later he fulfilled a professional engagement and said that his voice had never been better ; there had been no recurrence since. The second patient had suffered from hoarseness and loss of singing voice for over two years ; the growth in this case also was removed by Grant’s forceps ; this was in June, 1894, and the voice had been good ever since.-Mr. BARK also showed a Papilloma removed from the Anterior Commissure of the Larynx by Gibb’s snare and a patient suffering from Trachoma of the Larynx. Dr. STEEVES read a note entitled ‘° A Responsibility to the Lying-in Patient from a Sanitary Point of View." He thought that a variety of puerperal fever existed the result of defective sanitation, and instanced cases where he believed puerperal septicasmia was caused by atmospheric infection by sewer air. He referred to the great benefit that a puerperal fever patient derived from removal to healthy surroundings. In the city of Liverpool one-third of the puerperal fever cases reported were from houses described as insanitary. The prevalence of this disease was no necessary index of the amount of zymotic disease existing. The medical attendant when engaged for a confinement rarely inquired into the sanitary condition of the house, but Dr. Steeves thought that if the physician was not experienced in sanitary details he should not hesitate to obtain a skilled opinion. If the owner of the property refused to abate a nuisance the aid of the sanitary authority should be invoked. A protracted period of ill-health frequently followed confinement, the victim really suffering from chronic sewer air poisoning ; this could only be put an end to by change of residence or an alteration in the sanitary arrangements of the house. Dr. Steeves then moved the following resolution, which was seconded by Dr. Imlach : ’’ That, in the opinion of the members of the Liverpool Medical Institution, it is the duty of every medical practitioner, when engaged to attend a confinement, to forthwith inspect, or cause to be inspected, the premises of the patient, with a view of having any sanitary defects which may exist corrected, and so further the stamping out of puerperal septicaemia by the methods of preventive medicine." Several members spoke on the resolution, some stating that, in their opinion, insanitary conditions had nothing whatever to do with puerperal septicaemia ; others thought that the resolution to be effectual should apply to every kind of illness, and not specially to the puerperal woman. It seemed to be generally agreed that it would be very unwise that any such resolution should go forth to the public from the institution, and on being put to the vote it was rejected by an overwhelming majority. Professor SHERRINGTON drew attention to the Localisation of Function in the Spinal Cord as illustrated by the distribution to the skin of the sensory spinal nerve pairs arising from the cord. He pointed out that experiments show the field of skin supplied by each sensory spinal nerve root to be Where a large area of somewhat simple configuration. simplest-that is, in the trunk and neck-the segmental skin
field is band-like, wrapping transversely round ..
.
B B
3
one
lateral