VETERINARY HEALTH SERVICE IN FRANCE.

1335 of these 13 cases showed that the average duration benefit would accrue from a thorough examination of the disease was only 2-3 years, whereas the average of the supply of eggs to be offered for sale. In duration of the bilateral cases was as great as 4-6 France over 2 million eggs were thrown out by the years. Hence the conclusion that, given time, many, inspectors as unfit for human consumption. The if not all, of these unilateral cases would become shadow test seems to be the one chiefly relied on to bilateral. A third subject to which Prof. Petren discern the quality of the egg. The October supply gives prominence is the remarkable success which can of eggs was the most faulty, because at this time the be achieved by passive movements under skilled preserved eggs are put on to the market. In April supervision. He does not ignore such well-known exotic eggs are rare, and the country supply shows remedies as massage, salicylates by the mouth, and good quality. Apparently but little bad food escapes heat in various forms, but he regards them as the vigilance of the French Veterinary Service, and secondary in importance to passive movements. this important branch of the Public Health Service These should be so powerful as often to cause seems to be very efficiently managed. considerable pain, but this matters little provided it passes off quickly. As judged by the X rays, the results he obtained were not very impresBLOOD TRANSFUSION FOR BURN SHOCK. sive. Very different was the functional improveSEVERE burns occurring in infants and young ment often obtained, and it is obvious that patients children are always apt to terminate fatally from are more interested in improvement they can themselves gauge, than in the cheerless and rigidly objective shock. In the Canadian Medical Association Journal October Dr. Bruce Robertson has reported evidence of skiagrams. Though it is evident that for Prof. Petren has made extensive use of the X rays, encouraging results obtained at the Hospital for Sick he accepts their showings with a healthy modicum of Children, Toronto, from transfusion in the treatment of severe burns in children. The greater number of reserve, and as the records of some of his cases show, he does not abandon all hope of restoring mobility severe burns admitted occurred in children of 4 years mortality has been high (35 per to a joint even when the X rays point to complete and under. so The much from the primary shock as from synostosis." In one such case passive movements cent.), not toxic shock. Weiskotten found in fatal enabled the limb to be flexed about the hip to 20°-30° secondary without the slightest movement of the pelvis ; and cases of superficial burns characteristic lesions in the the patient, a man aged77, was able to walk with suprarenals, lymphatic tissues, and heart muscle indicating the presence of a more or less specific two sticks on his discharge from hospital. It is in the circulating blood" (Jour. Amer. Med. poison arthritis that the immobilisation effected probable by Jan. 25th, 1919, p. 259). It seems that a Assoc., deformans of the hip is not due solely to changes in the bones and articular cartilages, but also to a toxin is produced in the burned tissue and is thrown considerable degree to muscular spasm. And this is into the blood stream. Its action diminishes after It is significant that all the the component of the forces limiting the movements about three days. of the joints which responds so satisfactorily to patients in the hospital who succumbed to shock did so in about 60 hours. Dr. Robertson thinks that skilled, systematic treatment. in this period treatment should be directed towards neutralisation or elimination of the toxin. The injection of saline and glucose solutions, with the idea VETERINARY HEALTH SERVICE IN FRANCE. of diluting the toxin and of hastening elimination of THE diminution of over 50 per cent. in cases of the toxin, has been tried, but in the more severe cases rabies notified in Paris and the Department of the it fails. Treatment by blood transfusion or the more radical Seine for the year 1920 is encouraging, especially as exsanguination-transfusion " was tried at the hospital in the figures for the four quarters of the year were 144, seven cases. The latter is carried out as follows : 108, 47, 34, showing a constant decrease ; the 333 Blood is withdrawn fromoperation the patient until he shows signs 6 included 326 1 cases recorded dogs, cats, and bear. of the loss. In infants it may be withdrawn through the The total number of cases in France has also been fontanelle from the longitudinal sinus. In older children reduced by 1807, giving a diminution of 39 per cent. the external jugular or femoral vein or radial artery may 2136 persons were bitten by be used. It is impossible to obtain much blood from the on the 1919 figures ; other animals in 1919, of whom 6 died ; superficial veins of a child under 5, particularly if the and dogs circulation is sluggish. Transfusion is then commenced only 1403 were bitten in 1920, with 1 death. the great saphenous vein over the internal malleolus The annual report by Prof. H. Martel on the through while further exsanguination is being carried out. In an French Veterinary Service of Paris and the Seine infant only a small amount of blood (up to 120 c.cm.) can be Department shows how vigilantly the public health withdrawn before transfusion is begun. But it seems that is protected also from other diseases of animal origin sufficient blood can be withdrawn until so much toxin is in this district. The incidence of tuberculosis in removed as will turn the scales in the patient’s favour. animals does not decrease, and more efforts should The transfusion is carried out preferably with citrated blood. cases of severe toxic shock from cases of be concentrated on methods of prevention. Prof. Out of seven burns showing symptoms which used to be Martel states that the intra-dermic method of testing superficial considered fatal at the hospital, five terminated in recovery. for tuberculosis is the one most favoured by cow- The following is an example. A boy, aged 2years, was keepers. Tuberculosis has been fairly common in admitted. Six days before he had fallen into a tub of scalding pigs, especially those which have been kept in board- water. He had been treated at home for second and third burns extending over the back from the lower angles ing schools, orphanages, and institutions, and the degree authorities stress the necessity of cooking scraps of of the scapulae to the upper part of the thighs and forward the mid-axillary line on each side. He was desperately human food in order to check the prevalence of to and the extent and severity of the burn were such ill tuberculosis in young pigs. The frequency of tuber- that the prognosis seemed hopeless. He was exceedingly culosis in fowls is a matter of some import ; of 657 restless and toxic. 360 c.cm. of blood were transfused fowls suspected and examined 342, or 52 per cent., were immediately. He showed moderate improvement, but the found to be tuberculous. The incidence of glanders temperature remained high. The restlessness increased and has increased slightly, but it is gratifying to know a severe convulsion occurred. Exsanguination (260 c.cm.) that out of 1165 horses and 119 mules imported not and transfusion (400 c.cm.) were performed. The general of one reacted to the mallein test. Great care is taken condition improved, but there was intermittent twitching was given subto cleanse and disinfect trucks used in animal trans- the arms and legs, for which mag. sulph. cutaneously. Steady improvement followed. But the port by the use of steam and sodium hypochlorite. toxaemia again increased and the circulation failed. As a and carcasses have the been chief last resort blood transfusion (300 c.cm.) was performed. Damaged putrefied causes of seizure and destruction of fowls, geese, The temperature fell, the general condition improved, and ducks, turkeys, lambs, goats, pigeons, and rabbits. recovery ensued. One of the most noteworthy points in Prof. Martel’s Dr. Robertson found that examination of the blood report is the good work done in the inspection of the and urine in these cases did not give any signs to egg supply. It is probable that in this country real indicate transfusion. He had to rely on the clinical "

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