1
1203 THE TREATMENT OF DIPHTHERIA. building, was made of light cast iron, and so badly manu- factured that it could not be properly jointed, and that there was no ventilation for the soil pipe. The house was unfit for human habitation. Dr. Llewelyn added that the stench was abominable and that there was leakage from the roof to the kitchen. Some leakage fell into the cistern, and the same cistern supplied the closet and the drinking-water. Samuel Steggall lived here with his wife and eight children. Soon after occupying this flat his wife had sore-throat ; in November she had rheumatic fever, in February typhoid fever, and in April diphtheria. In February five of the children suffered from typhoid fever, and two died after a few days’ illness. After such an experience it n not surprising that the tenement was at last abandoned ; but the tenant now claimed compensation for the loss and trouble he had experienced. The jury returned a verdict in plaintiff’s favour, but allowed only 28 damages. In any case, it is satisfactory that the principle was maintained that damages were due. We confess that we place a higher value on human health and on human life. The worst phase of the question, however, is that unless life is lost, or at least a serious illness endured, it is no easy matter to bring an action. There are an enormous number of houses in a very insanitary condition, but the tenants dare not complain, and it is only when some terrible affliction has occurred that proceedings are taken. The very reverse should be the case ; proceedings should be taken before any injury is sustained. EPILEPSY AND CONTRACTION OF PALMAR FASCIA. IN a recent number of the Edinburgh Medical J01trnal Mr. A. G. Miller records the case of a patient, a joiner aged thirty-two, who had become subject to fits ten months before he came under observation. He is said to have been "nervous" ever since, five years ago, he was arrested in mistake for someone else ; but there were no fits until a dis- pute took place with his parents, after which he left their house, and worked very hard at his "beach. " This, as already said, was about ten months ago, and it was after this spell of hard work that he noticed a contraction in the palm of his right hand, and almost simultaneously the fits began. These were epileptiform in character apparently, commencing with flexion of the fingers of the right hand. Consciousness as a rule was lost, but on one or two occasions the fits had been cut short by forcibly preventing the flexion of the fingers. There was found to be contraction of the palmar fascia of the ring and little fingers of the right hand. The prepuce was also contracted. After the fascia had been stretched, and the prepuce slit up, only one fit occurred during the several months that the patient remained under observation. Mr. Miller regards the case as one of epilepsy, resulting from peri- pheral irritation ; but it is only fair to state that after the operation the patient was under treatment with bromide for some time at least, and the rarity of such a condition arising from such a slight cause makes it very desirable to discover the subsequent history of the patient. THE GRIMSBY MUNICIPALITY. OF the municipal elections that have taken place through- out England none, perhaps, are of more importance than those of Grimsby, so far at least as the public health is concerned. In 1892 the authorities at Grimsby had a fair warning that their town was especially exposed to the risk of a cholera epidemic. They so far realised this position that the town councillors themselves undertook a house-to-house inspec- tion, with the result that something like 600 suggestions were made as to desirable improvements in the sanitary condition of the dwellings, courts, yards, and streets they had visited. We will not stop to inquire why, in spite of these reports and the pressing nature of the danger, little or nothing was done. This year the munici- pality have had more than a warning ; cholera has actually broken out, and Grimsby is the place where it com- menced and where it has had the greatest number of victims. Grimsby became, to employ the term of the Dresden Cholera International Convention, the foye’J’ of the English epidemic. This is not an enviable distinction for the town. Perhaps if more was not done to prevent such a calamity this inactivity was due to the fact that the muni- cipal elections were close at hand and the authorities did not venture to embark on any very bold and sweeping scheme just when their tenure of office was approaching its termination. They, nevertheless, voted for a measure for improving the con- dition of the sewers and engaged six medical men, whose mission it has been, not merely to attend cholera cases, but also to undertake a second house-to-house inspection. This is how matters stood before the elections, and now the same majority has been re-elected. Thus strengthened by the votes of the ratepayers the members of the town council have no longer any excuse for not giving immediate effect to their promises. What will be done with regard to the recommendations contained in the reports on the house-to-house inspections made in 1892 and this year 2 The municipality now in office, having itself ordered and organised these inspections, cannot have taken such a measure for no purpose. Already the first reports-those made last year-have been unheeded too long. There is not a shadow of excuse for any further delay. The cases of cholera that have occurred in so many localities this year are simply a warning of what we may expect next year. There will be time enough, however, to effect great sanitary improvements, and these, if promptly and efficaciously carried out, may save us altogether when the period for the recrudescence of cholera comes round. In any case, with cholera or without cholera, the exceptional prevalence of typhoid fever at Grimsby is a proof of the insanitary condition of the town. All England is interested in seeing this state of things abolished. If the cholera scare has momentarily abated, this does not mean that the danger has passed away. If the present golden opportunity is lost, and the necessary sanitary improvements are not effected this winter, the town council will incur a heavy responsibility. THE TREATMENT OF DIPHTHERIA. AN excellent rés1lmé of our knowledge of the bacteriology of diphtheria is given in the Semaine Médicale of Sept. 30th by Dr. Veillon. He assumes that it is now generally accepted as proved that the bacillus first described by Klebs and Loflier is the main causal agent of diphtheria, although other organisms, such as the streptococcus and staphylococcus pyogenes and one resembling morphologically the pneumo- coccus, are frequently to be found together with the patho- genic bacillus. As a result of his investigations Dr. Veillon maintains that the treatment must necessarily be com- plicated, for we have to deal not only with the local effects of the Klebs-L6ffler bacillus, but also with the constitutional effects produced by the toxines evolved, and the lesions produced by secondary infections. Various antiseptic agents have been proposed in order to destroy the germ-corrosive sublimate, phenic acid, &c. The most successful seems to have been the first mentioned. Great difficulty has always been found in reaching the parasite, as it is protected by the false membrane. Dr. Veillon recom- mends removal of the pseudo-membrane by curved forceps having cotton-wool wrapped round the points. If, however, this should produce much bleeding he would advise sprays and irri- gations only. The applications should be made to the throat very frequently-at least every hour. With regard to the second point-namely, to combat as far as possible the toxic effects- Dr. Veillon is of opinion that swabbing the throat and frequent

EPILEPSY AND CONTRACTION OF PALMAR FASCIA

  • Upload
    duongtu

  • View
    224

  • Download
    7

Embed Size (px)

Citation preview

1203THE TREATMENT OF DIPHTHERIA.

building, was made of light cast iron, and so badly manu-factured that it could not be properly jointed, and that therewas no ventilation for the soil pipe. The house was unfit forhuman habitation. Dr. Llewelyn added that the stench wasabominable and that there was leakage from the roof to thekitchen. Some leakage fell into the cistern, and the samecistern supplied the closet and the drinking-water. Samuel

Steggall lived here with his wife and eight children. Soon

after occupying this flat his wife had sore-throat ; in

November she had rheumatic fever, in February typhoidfever, and in April diphtheria. In February five of the

children suffered from typhoid fever, and two died after afew days’ illness. After such an experience it n not

surprising that the tenement was at last abandoned ; butthe tenant now claimed compensation for the loss and troublehe had experienced. The jury returned a verdict in plaintiff’sfavour, but allowed only 28 damages. In any case, it is

satisfactory that the principle was maintained that damageswere due. We confess that we place a higher value on humanhealth and on human life. The worst phase of the question,however, is that unless life is lost, or at least a serious illnessendured, it is no easy matter to bring an action. There arean enormous number of houses in a very insanitary condition,but the tenants dare not complain, and it is only when someterrible affliction has occurred that proceedings are taken.The very reverse should be the case ; proceedings should betaken before any injury is sustained.

EPILEPSY AND CONTRACTION OF PALMARFASCIA.

IN a recent number of the Edinburgh Medical J01trnalMr. A. G. Miller records the case of a patient, a joiner agedthirty-two, who had become subject to fits ten months beforehe came under observation. He is said to have been"nervous" ever since, five years ago, he was arrested inmistake for someone else ; but there were no fits until a dis-pute took place with his parents, after which he left theirhouse, and worked very hard at his "beach. " This, as alreadysaid, was about ten months ago, and it was after this spell ofhard work that he noticed a contraction in the palm of hisright hand, and almost simultaneously the fits began. These

were epileptiform in character apparently, commencing withflexion of the fingers of the right hand. Consciousness as a

rule was lost, but on one or two occasions the fits had beencut short by forcibly preventing the flexion of the fingers.There was found to be contraction of the palmar fascia of thering and little fingers of the right hand. The prepuce wasalso contracted. After the fascia had been stretched, and theprepuce slit up, only one fit occurred during the severalmonths that the patient remained under observation. Mr.Miller regards the case as one of epilepsy, resulting from peri-pheral irritation ; but it is only fair to state that after theoperation the patient was under treatment with bromide forsome time at least, and the rarity of such a condition arisingfrom such a slight cause makes it very desirable to discoverthe subsequent history of the patient.

THE GRIMSBY MUNICIPALITY.

OF the municipal elections that have taken place through-out England none, perhaps, are of more importance than thoseof Grimsby, so far at least as the public health is concerned.In 1892 the authorities at Grimsby had a fair warning thattheir town was especially exposed to the risk of a choleraepidemic. They so far realised this position that the towncouncillors themselves undertook a house-to-house inspec-tion, with the result that something like 600 suggestionswere made as to desirable improvements in the sanitarycondition of the dwellings, courts, yards, and streets

they had visited. We will not stop to inquire why,in spite of these reports and the pressing nature of the

danger, little or nothing was done. This year the munici-

pality have had more than a warning ; cholera has actuallybroken out, and Grimsby is the place where it com-

menced and where it has had the greatest number ofvictims. Grimsby became, to employ the term of the DresdenCholera International Convention, the foye’J’ of the Englishepidemic. This is not an enviable distinction for thetown. Perhaps if more was not done to prevent such acalamity this inactivity was due to the fact that the muni-cipal elections were close at hand and the authorities did notventure to embark on any very bold and sweeping scheme justwhen their tenure of office was approaching its termination.They, nevertheless, voted for a measure for improving the con-dition of the sewers and engaged six medical men, whosemission it has been, not merely to attend cholera cases,but also to undertake a second house-to-house inspection.This is how matters stood before the elections, and now thesame majority has been re-elected. Thus strengthened by thevotes of the ratepayers the members of the town councilhave no longer any excuse for not giving immediateeffect to their promises. What will be done with regardto the recommendations contained in the reports on thehouse-to-house inspections made in 1892 and this year 2The municipality now in office, having itself ordered and

organised these inspections, cannot have taken such a

measure for no purpose. Already the first reports-thosemade last year-have been unheeded too long. There is not ashadow of excuse for any further delay. The cases of cholerathat have occurred in so many localities this year are simply a

warning of what we may expect next year. There will be

time enough, however, to effect great sanitary improvements,and these, if promptly and efficaciously carried out, may saveus altogether when the period for the recrudescence ofcholera comes round. In any case, with cholera or without

cholera, the exceptional prevalence of typhoid fever at

Grimsby is a proof of the insanitary condition of the town.All England is interested in seeing this state of thingsabolished. If the cholera scare has momentarily abated, thisdoes not mean that the danger has passed away. If the

present golden opportunity is lost, and the necessary sanitaryimprovements are not effected this winter, the town councilwill incur a heavy responsibility.

THE TREATMENT OF DIPHTHERIA.

AN excellent rés1lmé of our knowledge of the bacteriologyof diphtheria is given in the Semaine Médicale of Sept. 30thby Dr. Veillon. He assumes that it is now generally acceptedas proved that the bacillus first described by Klebs andLoflier is the main causal agent of diphtheria, although otherorganisms, such as the streptococcus and staphylococcuspyogenes and one resembling morphologically the pneumo-coccus, are frequently to be found together with the patho-genic bacillus. As a result of his investigations Dr. Veillonmaintains that the treatment must necessarily be com-

plicated, for we have to deal not only with the localeffects of the Klebs-L6ffler bacillus, but also with theconstitutional effects produced by the toxines evolved,and the lesions produced by secondary infections.Various antiseptic agents have been proposed in order to

destroy the germ-corrosive sublimate, phenic acid, &c. The

most successful seems to have been the first mentioned.

Great difficulty has always been found in reaching the parasite,as it is protected by the false membrane. Dr. Veillon recom-mends removal of the pseudo-membrane by curved forcepshaving cotton-wool wrapped round the points. If, however, thisshould produce much bleeding he would advise sprays and irri-gations only. The applications should be made to the throatvery frequently-at least every hour. With regard to the secondpoint-namely, to combat as far as possible the toxic effects-Dr. Veillon is of opinion that swabbing the throat and frequent