- Email: [email protected]
TYPHOID FEVER: IS IT OF CATTLE ORIGIN ?
521 i as I had not the materials to make I was to use what was sent. myself, My patient obliged suffered in consequence, and died two days afterwards. I learned that my friend used chloride of calcium instead of chloride of lime, thinking the one identical with the other; the latter he did not have in his stock of chemicals. This is the only death I have had with an experience of over a hundred cases, and the three cases mentioned above require no comment. The mortality in the cases not treated has been very great, especially amongst the natives. In the adjoining district I have heard of nine deaths within a week. In conclusion, I would like to add that where the remedy was given at the very beginning of the illness, immediately after the chill and before the symptoms were fully developed, it appeared to modify and shorten the disease considerably, the cases lasting only about a"fortnight. Niemeyer refers to slight cases, and terms them abortive." If taken in time, I believe every case can be considerably shortened.
odour of
chlorine, but
one
Seymour, Cape Colony. ON A CASE OF
TYPHOID FEVER ASSOCIATED WITH INFLAMMATION OF THE VEINS IN VARIOUS LOCALITIES. BY H. W.
PHILLIPS, M.B., C.M.ED., M.R.C.S.
case came under observation some time ago, when I fortunate enough to be house-physician to the late lamented Dr. Tibbits at the Bradford Infirmary. At that time it excited our united interest and attention, and it was his desire that the case should be put on record as being one of exceptional occurrence. The following is put together from notes then taken with this in view, though the publication has been, till now, unavoidably delayed. Rose G--, housewife, was admitted into the female medical ward of the above hospital on April 10th of last year. The friends, previous to admission, spoke of her as having had bad legs for "years," but as at that time suffering from some "internal inflammation" in addiWhen admitted, the brown tongue, sordes, high tion. temperature, quick pulse, somewhat tympanitic and tender abdomen, and several loose typhoid stools, proclaimed the Thee case to be one of well-advanced typhoid fever. patient’sgeneral state was very low, and had to be sustained by large quantities of stimulants. On the 17th some old varicose veins in both legs, from which, as above stated, she had long suffered, and which had made her more or less of an invalid during that time, were found to be hard, red, and inflamed, the inflammation being in patches and irregularly distributed up and down the legs throughout their course. On the 19th the note was as follows: "General state seems lower, and strength not well maintained. The inflamed veins very distinct, and a large bleb, containing dark blood-stained serum, has formed over the two worst places." On the 21st: "General state even worse; lies per-
Tms
was
seemed to be passing away, and in a day or two after had quite disappeared. It then came to be recognised as another local manifestation of a peculiar constitutional state. Her general condition had considerably improved, and from this time the symptoms gradually subsided ; the temperature and pulse fell, the ulcers on the legs took on a healthy action, strength gathered, and the mind cleared. This improvement merged into convalescence, and convalescence advanced rapidly to full recovery. On June 8th I find the note says: "She gets up every afternoon. Varicose veins of legs gone and apparently quite cured, probably from inflammatory occlusion; patient expresses herself as feeling better than for years previous to the illness." On the 14th of the month she was discharged from the infirmary as cured. It would appear that, in addition to the usual typhoid symptoms, we have here other symptoms pointing to a morbid condition of the venous vascular system, for apparently all the above-noted peculiarities can be accounted for on this supposition, the morbid condition consisting in a tendency to inflammation or phlebitis in its different parts. In the case of the varicose veins of the legs this can be easily understood, for wherever the blood tends to stagnate in diseased vessels, there there will be, at any rate, two most important elements in the production of a coagulation and probably consequent phlebitis. In the increased tendency to clotting, associated with the febrile state, together with the retained waste products and general lowered vitality of that condition, we have further factors predisposing to this morbid process. The tendency, however, did not stop here, but proceeded to produce its effects in other and more important parts of the venous system; the sudden jaundice, tenderness and enlargement of the liver, the enlarging of the superficial veins over it, the rigors and other general symptoms, all pointing to a like obstructive condition taking place in the vessels of the portal system-producing, in fact, the condition known as pylephlebitis. A priori, one would almost expect the tendency to show itself in this situation, as being that part of the venous system most favourable, and, next to the legs, most liable to its development. Even from this the constitution rallied, the morbid process ending in resolution rather than in suppuration. But the tendency, not yet worn out, showed itself finally in the small localised indurations of the skin of the abdomen; these gradually passed away, leaving no trace behind, probably following the same course as in the case of the portal system previously affected. The rapid and satisfactory recovery from a disease in itself serious and attended by complications so grave, the curing of the long pre-existing varicose condition of the legs, form also interesting points in the case, which in its termination was more happy than one would have been justified in anticipating.
marked,
Bolton.
TYPHOID FEVER: IS IT OF CATTLE ORIGIN ? BY JOHN
WARD, M.D.,
fectly quiet, occasionally moaning slightly, and passes all LATE MEDICAL OFFICER OF HEALTH, WEST CUMBERLAND. evacuations involuntarily. The blebs have burst, leaving nasty sloughy condition of underlying sore." In this state THis subject, broached by Mr. Lawrence in THE LANCET she continued till the 26th, when the conjunctive were obof Nov. 15th, it would be interesting to investigate, or to served to have a decided icteric tinge; and during the day thee the inquiry whether there is any marked difference pursue of an hour had three at intervals severe patient very rigors or two, during which the temperature rose to 105° F. On in the type of the disease which we assume to be of cattle the 28th the yellow staining had extended to all the tissues origin and that which we associate in origin with our own of the body; the urine was loaded with urates, and con- race. There are few, it may be supposed, in these days, tained large quantities of bile; and the motions, still loose, who doubt that the disease may be communicated through were perfectly white. The liver was enlarged, tender on the air, or that a filth-contaminated in-door atmosphere is pressure, and in the skin of the abdomen over it were seen veins and venous intimately connected with its causation ; and yet we appear large anastomosing connecting larger trunks above and below. The inflamed patches in the legs to be slow at arriving at a natural corollary of such premiseshad now formed into several small deep ulcers. On May 1st that its intensity, aggravation, and duration, within certain the temperature and other symptoms seemed to point to limits, frequently correspond with the amount of defilement slight improvement; but over the right lumbar and iliac of the air-in other words, with the amount of poison introregions there was found a curious localised inflammatory duced and supplied; or, admitting this, to direct our aims, induration of the skin and underlying tissues, somewhat accordingly,to the securing, at all hazards, as a first necessity, resembling the condition over the varicose veins of the legs. the removal of the patient from influences operating causaThis at the time was taken to be the probable place of tively, and towards procuring for the sufferer an in-door pointing of an hepatic abscess, or other internal suppura- atmosphere reliably free from all filth influences. This is, tion, for which the rigors and other symptoms had prepared no doubt, a matter of great difficulty in some instances, yet us. Ilowever, on the 3rd inst., the condition, though still attainment may well be and pursued. It
its
attempted
:M2
_
522 to allude to the apparent freof the disease in females at the susceptible period of adolescence, except as it may point to a probable causative association from their more constant exposure to the enfeebling influences of an impure in-door atmosphere than the other sex. The following cases easily culled from notes at hand, not to mention others which might be adduced, appear to favour the cattle origin of the disease. In the months of February and March, 1872, I attended Isabella R- - -, aged seventeen years, residing in a country village in North Lancashire, during a severe and protracted illness from typhoid fever. The cottage she occupied was placed immediately adjacent to a barn-like building, in a filthy condition, in which were housed a horse and some pigs. During my attendance 1 had noticed that her symptoms, from day to day, appeared to present a correspondent ratio of intensity with the amount of defilement of the air of the small tenement of which the sick-room formed a considerable portion. When the wind blew in the direction from the stable towards the dwelling-viz., from the norh or east-there appeared an aggravation of symptoms; and, on the other hand, when the wind blew from the opposite quarters, rendering the house freer from the presence of animal filth odour, alleviation of the symptoms seemed apparent, so much so that a corresponding forecast of her state, from day to day, was formed with some approach to accuracy. Her sister, eight years of age, suffered from a somewhat less aggravated form of the disease, and a relative who came from a distance to assist in nursing the sick, on her return home, if my memory serves ,me correctly, communicated the disease to others, or herself suffered from it previously. Here appeared an intensified filth origin of the disease, of the nature under consideration, from cattle. Not from this, but from a sanitary point, it is important to remark that at the cottage adjacent to the stable, on the other side, at or about this time, the children suffered from scarlet fever. The other cases are from notes taken, during an experience of the public health service, on the inspection of houses where fatal cases of the disease had occurred, typical of many other similar cases which are capable of being brought forward. February, 1880.-M. A. H——, aged twenty-three years, female; remittent fever. A byre was found to occupy a position immediately adjacent to the dwelling and to the room in which the deceased had been nursed, which, moreover, was small in size, badly ventilated, and the air redolent of animal ordure. November, 1880.-M. C-, female, aged sixty-one years. Enteric fever; twenty-one days. The deceased was the wife of a farmer, who occupied a house immediately adjacent to a stable, which could not lay claim to special cleanliness, and the bedroom was found to be imperfectly ventilated. The following instances of the disease, occurring under different circumstances, may serve to coroborate the propositional statement that the intensity of the symptoms of the disease, not infrequently, appear to correspond with the amount of the defilement of the atmosphere to which the patient is exposed. 1870.-W---, male, aged four years. A severe and protracted case of typhoid fever. The patient recently occupied an old-fashioned house in the country, with old " pan-container" watercloset appliance communicating, without soilpipe or drain ventilation, with large cesspool, representing very considerable defilement of the house atmosphere. March, 1869.-A-,male, aged three years. Severe and protracted case of the disease. Patient had recently come into lodgings at the house, which was situated at the seaside on the slope of a hill, with its back more or less built up against the soil, in which situation in the rear the watercloset, on the old "container" principle, with unventilated were,
perhaps, inappropriate
quency of the
occurrence
sheltered position in the country, objectionably where a considerable amount of manure accumulated. The house contained an old " container" watercloset appliance, but the connexion with the sewer had been severed and the closet consequently disused. The disease was of the gastrictype of certain authors, very mild, favourable, and of comparatively short duration, corresponding to but a slight defilement of the house atmosphere. February, 1876.-E. B-,female, aged eighteen years, domestic servant at a good modern house at the seaside, in open airy situation; the slopstone waste-pipe had been recently severed from the sewer on the occasion of the family occupying the house as fresh tenants, and the old " container " watercloset, with unventilated drain-pipe leading to a cesspool, had been rendered less objectionable by the ample ventilation of the latter. The symptoms of the disease were mild though decided, and of the " gastric" type, the acuter symptoms not lasting beyond the fortnight, although the patient’s health was not established within the month, corresponding, as it would seem, with a comparatively small amount of filth influence in the atmosphere of the house. These latter cases, presumably arising from a filth contaminated house atmosphere (ex humano genere), could hardly be said to be so modified by treatment or by polypharmacy as to interfere with the inference deduced from the potent and continuously operating influences to which attention has been drawn; and it may, I think, be conceded that the intensity of the symptoms in this as in many other diseases shows a frequent correspondence with the amount of the defilement of the house atmosphere to which the sufferer has been exposed. Whether constitutional tendency, or prior feebleness, or impairment of energy of the affected part or organ, chiefly operates, under ordinary circumstances, in determining whether from apparently similar causes should result typhoid fever, diphtheria, or other zymotic disease, pneumonia, meningitis, peritonitis, nephritis, or even some chronic disease, or, on the other hand, whether a specific virus is causatively present, requires further illustration and research; and to have established the animal origin of the fever in question as distinct from the genus homo, or to have exploded the notion, will have tended in its measure towards that goal of more perfect knowledge to which we advance. Enough appears to have been observed by the careful etiologist to point to the necessity of securing for the sick, under all circumstances, the most favourable conditions for the promotion of recovery, towards which Nature is ever waiting to lend her powerful aid, if but permitted, and amongst which conditions may surely be accounted as second to none in importance a pure and uncontaminated in-door atmosphere to breathe. I might add that the animal origin of the disease, possibly communicated to the human subject through the milk-supply, is well worthy of investigation. Driffold, Sutton Coldfield.
house,
in
near a
farmyard,
a
NOTE ON
ELEVATION OF THE ARMS AS AN INDICATION OF PERITONITIS. BY HENRY A.
LEDIARD, F.R.C.S.ENG.,
SURGEON TO THE CUMBERLAND INFIRMARY.
THERE are various circumstances rendering the attitudes assumed by the sick of great diagnostic value. It may be that extreme restlessness, delirium, or fear, may prevent accurate noting of the pulse, temperature, respiration, or even physical examination of diseased organs. Again, deaf-
mutism, malingering,
foreign language, &c., may further diagnosis which might be in some drain-pipe leading therefrom, was placed, being intimately connected with the house atmosphere, from the drain passing measure overcome by the observance of a well-established under the dwelling. The little patient was removed from position pathognomonic of a disease. I have in this short this house, where a fatal issue seemed imminent, to another note to allude to one disease and one posture only, which at a distance, the sanitary arrangements of which, though seem to be rarely dissociated, at least in the adult, for not perfect, were less objectionable. In this instance the many years have passed since I was first struck with a atmosphere of the house, a comparatively small one, was posture which I have generally found to be a truthful much defiled from excrementitious filth in the manner indicated. December, 1878.-G-,male, aged seven years. Patient had recently come from a healthy house, without sewer influence or objectionable watercloset, to occupy aroomy old
a
entail difficulties in
indication. On Nov. 19th, 1871,
a waiter, aged twenty-two, was Edinburgh Infirmary under the care of the late Professor Spence, whose house-surgeon 1 then was. The patient had been stabbed in the abdomen, and a foot of
brought
into the
odour of
chlorine, but
one
Seymour, Cape Colony. ON A CASE OF
TYPHOID FEVER ASSOCIATED WITH INFLAMMATION OF THE VEINS IN VARIOUS LOCALITIES. BY H. W.
PHILLIPS, M.B., C.M.ED., M.R.C.S.
case came under observation some time ago, when I fortunate enough to be house-physician to the late lamented Dr. Tibbits at the Bradford Infirmary. At that time it excited our united interest and attention, and it was his desire that the case should be put on record as being one of exceptional occurrence. The following is put together from notes then taken with this in view, though the publication has been, till now, unavoidably delayed. Rose G--, housewife, was admitted into the female medical ward of the above hospital on April 10th of last year. The friends, previous to admission, spoke of her as having had bad legs for "years," but as at that time suffering from some "internal inflammation" in addiWhen admitted, the brown tongue, sordes, high tion. temperature, quick pulse, somewhat tympanitic and tender abdomen, and several loose typhoid stools, proclaimed the Thee case to be one of well-advanced typhoid fever. patient’sgeneral state was very low, and had to be sustained by large quantities of stimulants. On the 17th some old varicose veins in both legs, from which, as above stated, she had long suffered, and which had made her more or less of an invalid during that time, were found to be hard, red, and inflamed, the inflammation being in patches and irregularly distributed up and down the legs throughout their course. On the 19th the note was as follows: "General state seems lower, and strength not well maintained. The inflamed veins very distinct, and a large bleb, containing dark blood-stained serum, has formed over the two worst places." On the 21st: "General state even worse; lies per-
Tms
was
seemed to be passing away, and in a day or two after had quite disappeared. It then came to be recognised as another local manifestation of a peculiar constitutional state. Her general condition had considerably improved, and from this time the symptoms gradually subsided ; the temperature and pulse fell, the ulcers on the legs took on a healthy action, strength gathered, and the mind cleared. This improvement merged into convalescence, and convalescence advanced rapidly to full recovery. On June 8th I find the note says: "She gets up every afternoon. Varicose veins of legs gone and apparently quite cured, probably from inflammatory occlusion; patient expresses herself as feeling better than for years previous to the illness." On the 14th of the month she was discharged from the infirmary as cured. It would appear that, in addition to the usual typhoid symptoms, we have here other symptoms pointing to a morbid condition of the venous vascular system, for apparently all the above-noted peculiarities can be accounted for on this supposition, the morbid condition consisting in a tendency to inflammation or phlebitis in its different parts. In the case of the varicose veins of the legs this can be easily understood, for wherever the blood tends to stagnate in diseased vessels, there there will be, at any rate, two most important elements in the production of a coagulation and probably consequent phlebitis. In the increased tendency to clotting, associated with the febrile state, together with the retained waste products and general lowered vitality of that condition, we have further factors predisposing to this morbid process. The tendency, however, did not stop here, but proceeded to produce its effects in other and more important parts of the venous system; the sudden jaundice, tenderness and enlargement of the liver, the enlarging of the superficial veins over it, the rigors and other general symptoms, all pointing to a like obstructive condition taking place in the vessels of the portal system-producing, in fact, the condition known as pylephlebitis. A priori, one would almost expect the tendency to show itself in this situation, as being that part of the venous system most favourable, and, next to the legs, most liable to its development. Even from this the constitution rallied, the morbid process ending in resolution rather than in suppuration. But the tendency, not yet worn out, showed itself finally in the small localised indurations of the skin of the abdomen; these gradually passed away, leaving no trace behind, probably following the same course as in the case of the portal system previously affected. The rapid and satisfactory recovery from a disease in itself serious and attended by complications so grave, the curing of the long pre-existing varicose condition of the legs, form also interesting points in the case, which in its termination was more happy than one would have been justified in anticipating.
marked,
Bolton.
TYPHOID FEVER: IS IT OF CATTLE ORIGIN ? BY JOHN
WARD, M.D.,
fectly quiet, occasionally moaning slightly, and passes all LATE MEDICAL OFFICER OF HEALTH, WEST CUMBERLAND. evacuations involuntarily. The blebs have burst, leaving nasty sloughy condition of underlying sore." In this state THis subject, broached by Mr. Lawrence in THE LANCET she continued till the 26th, when the conjunctive were obof Nov. 15th, it would be interesting to investigate, or to served to have a decided icteric tinge; and during the day thee the inquiry whether there is any marked difference pursue of an hour had three at intervals severe patient very rigors or two, during which the temperature rose to 105° F. On in the type of the disease which we assume to be of cattle the 28th the yellow staining had extended to all the tissues origin and that which we associate in origin with our own of the body; the urine was loaded with urates, and con- race. There are few, it may be supposed, in these days, tained large quantities of bile; and the motions, still loose, who doubt that the disease may be communicated through were perfectly white. The liver was enlarged, tender on the air, or that a filth-contaminated in-door atmosphere is pressure, and in the skin of the abdomen over it were seen veins and venous intimately connected with its causation ; and yet we appear large anastomosing connecting larger trunks above and below. The inflamed patches in the legs to be slow at arriving at a natural corollary of such premiseshad now formed into several small deep ulcers. On May 1st that its intensity, aggravation, and duration, within certain the temperature and other symptoms seemed to point to limits, frequently correspond with the amount of defilement slight improvement; but over the right lumbar and iliac of the air-in other words, with the amount of poison introregions there was found a curious localised inflammatory duced and supplied; or, admitting this, to direct our aims, induration of the skin and underlying tissues, somewhat accordingly,to the securing, at all hazards, as a first necessity, resembling the condition over the varicose veins of the legs. the removal of the patient from influences operating causaThis at the time was taken to be the probable place of tively, and towards procuring for the sufferer an in-door pointing of an hepatic abscess, or other internal suppura- atmosphere reliably free from all filth influences. This is, tion, for which the rigors and other symptoms had prepared no doubt, a matter of great difficulty in some instances, yet us. Ilowever, on the 3rd inst., the condition, though still attainment may well be and pursued. It
its
attempted
:M2
_
522 to allude to the apparent freof the disease in females at the susceptible period of adolescence, except as it may point to a probable causative association from their more constant exposure to the enfeebling influences of an impure in-door atmosphere than the other sex. The following cases easily culled from notes at hand, not to mention others which might be adduced, appear to favour the cattle origin of the disease. In the months of February and March, 1872, I attended Isabella R- - -, aged seventeen years, residing in a country village in North Lancashire, during a severe and protracted illness from typhoid fever. The cottage she occupied was placed immediately adjacent to a barn-like building, in a filthy condition, in which were housed a horse and some pigs. During my attendance 1 had noticed that her symptoms, from day to day, appeared to present a correspondent ratio of intensity with the amount of defilement of the air of the small tenement of which the sick-room formed a considerable portion. When the wind blew in the direction from the stable towards the dwelling-viz., from the norh or east-there appeared an aggravation of symptoms; and, on the other hand, when the wind blew from the opposite quarters, rendering the house freer from the presence of animal filth odour, alleviation of the symptoms seemed apparent, so much so that a corresponding forecast of her state, from day to day, was formed with some approach to accuracy. Her sister, eight years of age, suffered from a somewhat less aggravated form of the disease, and a relative who came from a distance to assist in nursing the sick, on her return home, if my memory serves ,me correctly, communicated the disease to others, or herself suffered from it previously. Here appeared an intensified filth origin of the disease, of the nature under consideration, from cattle. Not from this, but from a sanitary point, it is important to remark that at the cottage adjacent to the stable, on the other side, at or about this time, the children suffered from scarlet fever. The other cases are from notes taken, during an experience of the public health service, on the inspection of houses where fatal cases of the disease had occurred, typical of many other similar cases which are capable of being brought forward. February, 1880.-M. A. H——, aged twenty-three years, female; remittent fever. A byre was found to occupy a position immediately adjacent to the dwelling and to the room in which the deceased had been nursed, which, moreover, was small in size, badly ventilated, and the air redolent of animal ordure. November, 1880.-M. C-, female, aged sixty-one years. Enteric fever; twenty-one days. The deceased was the wife of a farmer, who occupied a house immediately adjacent to a stable, which could not lay claim to special cleanliness, and the bedroom was found to be imperfectly ventilated. The following instances of the disease, occurring under different circumstances, may serve to coroborate the propositional statement that the intensity of the symptoms of the disease, not infrequently, appear to correspond with the amount of the defilement of the atmosphere to which the patient is exposed. 1870.-W---, male, aged four years. A severe and protracted case of typhoid fever. The patient recently occupied an old-fashioned house in the country, with old " pan-container" watercloset appliance communicating, without soilpipe or drain ventilation, with large cesspool, representing very considerable defilement of the house atmosphere. March, 1869.-A-,male, aged three years. Severe and protracted case of the disease. Patient had recently come into lodgings at the house, which was situated at the seaside on the slope of a hill, with its back more or less built up against the soil, in which situation in the rear the watercloset, on the old "container" principle, with unventilated were,
perhaps, inappropriate
quency of the
occurrence
sheltered position in the country, objectionably where a considerable amount of manure accumulated. The house contained an old " container" watercloset appliance, but the connexion with the sewer had been severed and the closet consequently disused. The disease was of the gastrictype of certain authors, very mild, favourable, and of comparatively short duration, corresponding to but a slight defilement of the house atmosphere. February, 1876.-E. B-,female, aged eighteen years, domestic servant at a good modern house at the seaside, in open airy situation; the slopstone waste-pipe had been recently severed from the sewer on the occasion of the family occupying the house as fresh tenants, and the old " container " watercloset, with unventilated drain-pipe leading to a cesspool, had been rendered less objectionable by the ample ventilation of the latter. The symptoms of the disease were mild though decided, and of the " gastric" type, the acuter symptoms not lasting beyond the fortnight, although the patient’s health was not established within the month, corresponding, as it would seem, with a comparatively small amount of filth influence in the atmosphere of the house. These latter cases, presumably arising from a filth contaminated house atmosphere (ex humano genere), could hardly be said to be so modified by treatment or by polypharmacy as to interfere with the inference deduced from the potent and continuously operating influences to which attention has been drawn; and it may, I think, be conceded that the intensity of the symptoms in this as in many other diseases shows a frequent correspondence with the amount of the defilement of the house atmosphere to which the sufferer has been exposed. Whether constitutional tendency, or prior feebleness, or impairment of energy of the affected part or organ, chiefly operates, under ordinary circumstances, in determining whether from apparently similar causes should result typhoid fever, diphtheria, or other zymotic disease, pneumonia, meningitis, peritonitis, nephritis, or even some chronic disease, or, on the other hand, whether a specific virus is causatively present, requires further illustration and research; and to have established the animal origin of the fever in question as distinct from the genus homo, or to have exploded the notion, will have tended in its measure towards that goal of more perfect knowledge to which we advance. Enough appears to have been observed by the careful etiologist to point to the necessity of securing for the sick, under all circumstances, the most favourable conditions for the promotion of recovery, towards which Nature is ever waiting to lend her powerful aid, if but permitted, and amongst which conditions may surely be accounted as second to none in importance a pure and uncontaminated in-door atmosphere to breathe. I might add that the animal origin of the disease, possibly communicated to the human subject through the milk-supply, is well worthy of investigation. Driffold, Sutton Coldfield.
house,
in
near a
farmyard,
a
NOTE ON
ELEVATION OF THE ARMS AS AN INDICATION OF PERITONITIS. BY HENRY A.
LEDIARD, F.R.C.S.ENG.,
SURGEON TO THE CUMBERLAND INFIRMARY.
THERE are various circumstances rendering the attitudes assumed by the sick of great diagnostic value. It may be that extreme restlessness, delirium, or fear, may prevent accurate noting of the pulse, temperature, respiration, or even physical examination of diseased organs. Again, deaf-
mutism, malingering,
foreign language, &c., may further diagnosis which might be in some drain-pipe leading therefrom, was placed, being intimately connected with the house atmosphere, from the drain passing measure overcome by the observance of a well-established under the dwelling. The little patient was removed from position pathognomonic of a disease. I have in this short this house, where a fatal issue seemed imminent, to another note to allude to one disease and one posture only, which at a distance, the sanitary arrangements of which, though seem to be rarely dissociated, at least in the adult, for not perfect, were less objectionable. In this instance the many years have passed since I was first struck with a atmosphere of the house, a comparatively small one, was posture which I have generally found to be a truthful much defiled from excrementitious filth in the manner indicated. December, 1878.-G-,male, aged seven years. Patient had recently come from a healthy house, without sewer influence or objectionable watercloset, to occupy aroomy old
a
entail difficulties in
indication. On Nov. 19th, 1871,
a waiter, aged twenty-two, was Edinburgh Infirmary under the care of the late Professor Spence, whose house-surgeon 1 then was. The patient had been stabbed in the abdomen, and a foot of
brought
into the