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twist of iodoform yauze to the fundus. The gauze keeps apart the flabby walls of the uterus, thereby preventing a retention of the infectious secretions in any part of the cavity, and where the uterus and vagina have been thoroughly cleansed, there is no more disturbance of the patient for two or three days. The main point we desire to emphasize is the importance of early resort to the dull curette and gauze for drainage, and not to rely on irrigation alone. The prompt treatment of septic conditions cannot be too highly appreciated. Infection travels rapidly from the uterus to the tubes, ovaries and peritoneum, and time is valuable in bringing to bear all the therapeutic measures at our command. In many cases this can be prevented by early treatment in the manner we have mentioned, and as urged by the author of the paper to which reference has been made.

W. W. T.

TENNESSEE STATE BOARD OF HEALTH.—The full text of Secretary J. Berrien Lindsley's Quarterly Report has just been received, and although a little out of place in the Editorial Department, we will, on account of its interest, give it in full:


NASHVILLE, TENN., July 5, 1892. Dr. James D. Plunket, President State Board of Health :

SIR:-At no period since public attention has been directed to the prevention of epidemics has there been greater need of caution and preparation in Tennessee than at present.

Smallpox, which within the past fifteen years has caused great alarm, much suffering and no little expense in different portions of the State, is now widely diffused throughout the Union. In compliance with the agreement entered into by the State and Provincial Boards of Health in 1886, this office has recently been informed of the existence of smallpox in Pennsylvania, Michigan, Iowa, Ohio and Illinois; also, the daily press and medical journals notice its presence in New Jersey and the city of New York.

It is a very significant fact that ordinarily these cases can be readily traced to importation by travelers from abroad, showing the uncertainty of frontier quarantine, and also the

vigilance of local health officials. Another noteworthy fact is the speedy stamping out of the infection, and thus the prevention of its spread. No better proof can be given of wakefulness and energy on the part of these officials and of the immense value to the public of their labors.

One remarkable result has come about from this new era in the history of smallpox, namely: the indifference of the public to individual protection by means of vaccination. And from this indifference results the very great danger of virulent epidemics if once the disease should get a foothold. The people are quite conscious of this danger, and hence the panic terror which seizes a community or neighborhood when the presence of smallpox is announced.

Formerly everybody was vaccinated and felt comfortable in the idea of safety, and was not afraid if peradventure thrown into the presence of a smallpox patient. Now it is difficult to find nurses, physicians and guards for the proper care and isolation of the afflicted.

These facts must be considered and lead to two practical conclusions of great importance. First, the necessity of a constant outlook against the disease, for virtually it is always in our midst. Secondly, the importance of promptly reporting any case, real or suspected, to the proper authorities, so that the requisite measures may be taken to prevent its spread.

Of late years the efforts of the United States Government, seconding the State Boards of Texas, Louisiana, Mississippi, Alabama, Florida and the Carolinas, have resulted in a feeling of security as to yellow fever among the people of the adjoining States. This may be carried too far. The Gulf and South Atlantic Coasts to be watched are of enormous extent, abounding in inlets favorable for smuggling. The inland Mexican frontier is of great length and is merely a nominal barrier. Yellow fever is always at work in its native habitats, the West Indies and Mexico. Just now it is notably active in the great seaport of Vera Cruz. This year climatic changes will probably be favorable to its spread in those portions of our country hitherto scourged by it. Hence we have a right to demand special vigilance on the part of all those entrusted with frontier posts, at the same time exercising a good com


mon sense in carrying out those principles of every day sanitation which are alike requisite for daily health and are also the best safeguard against the disasters of epidemic diseases.

Just eight years ago, as now, the daily press gave great emphasis to news about cholera in Europe, and no little alarm was felt throughout America, especially in the valley of the St. Lawrence and of the Mississippi. The epidemic did prevail in South France, in Spain and in Italy with its wonted violence. It also crossed the Atlantic and spread dismay in portions of South America. However, contrary to its history from 1832 to 1873, the Union and the Dominion escaped its presence. The only logical and generally admitted explanation of this remarkable fact is that for the first time since its advance from the Orient toward the Occident scientific measures were taken to stay its progress.

The daily newspaper of today, that invaluable medium of universal knowledge, informs us that the Asiatic pest is on its old line of march overland into Europe. From India it has penetrated through Afghanistan and Persia into Russia, where it has aroused and alarmed a great people and a mighty government. Whether this government, as did France in 1884, can check its progress, remains to be seen. At all events, it has entered Southern Russia, and this region is now one of our next-door neighbors, as all America comprehends from the recent outbreak of typhus fever in New York City.

With virulent cholera on our west in China and India, and on our east in the Russian Empire, and on the south in Brazil, we are admonished to be on the alert, ready for any breaks in the long-extended lines of quarantine and for an explosion in any part of our vast Republic.

One thing may be averred with confidence, and it is timely to do so in view of the uneasiness and alarm already manifested in all parts of the land by the news from Russia, France and Italy, towit: that here in Tennessee while we should be on the alert, there is no occasion whatever for panic or scare. Fright is the result of false confidence, or want of preparation, of concealment. Should an immigrant step through into Tennessee with cholera in his system or goods there need be no spread. Isolation and disinfection, with humane treat

ment of the afflicted individual, are the safeguards. And should the danger of such an invasion be imminent there will be no lack of eyes to discover or of tongues to report the first case, real or suspected. The public, no less than the profession, realize the folly and danger of concealment. The scenes of 1833, of 1849, of 1854, of 1866, of 1873, need never be repeated in Tennessee. All these great epidemics entered our country without the least resistance and with no preparation whatever to abate their force. Communities and individuals simply bowed to the storm. It is altogether different now. The Federal Government keeps a sharp eye through its Department of State on all communicable diseases. Information thus gained is at once communicated to the public. Hence, at all seaports a vigilant outlook is maintained and precautions taken against introduction of the same into the interior. The cholera epidemic of 1884 demonstrated the remarkable efficiency of this system. If from any cause whatever these barriers were overlooked, then our State, county and city boards would come forward and doubtless repeat the demonstration of their efficiency given recently in the typhus fever case. All this machinery has been created since 1873, and is the result of biological science.

LEPROSY IN RussIA.—It has been supposed that a commendable amount of care is bestowed upon the sufferers from leprosy in Russia, but this belief has been dispelled by Miss Marsden, who recently visited the Russian settlement at Yakutsk, Siberia. This lady is a member of the Red Cross Sisterhood, and since her return has furnished a graphic description of a visit made under favorable circumstances, being provided with letters of introduction from the Queen and the Princess of Wales to the Czarina, and thereby obtained unusual facilities for making a careful investigation of all the circumstances in connection with the leprosy settlement. Leprosy, Miss Marsden tells us, exists as a disease throughout a district extending over several thousand versts, and no provision whatever is made for the care of the sufferers. As soon as the disease declares itself the unfortunate victim is driven into the forests, where wretched huts are provided, and never allowed to come

again into contact with his fellow-creatures. The sole food of the lepers is the bark of trees, and small quantities of rotten fish, which their relatives from time to time deposit for them at a short distance from the huts. Many were blind, and some insane. They were of all ages and in all stages of disease, but in many instances their condition was such that they had lost all semblance of humanity. Incredible as it may appear, some of them have dragged out a loathsome existence in this state for twenty years. With regard to a plant said to be a remedy for the disease, which was one of the objects of the journey, but little information could be obtained as to its medical properties. It exists, and Miss Marsden was able to bring back a considerable quantity of it with her for examination. Miss Marsden believes from all she heard that leprosy extends much farther than the district visited by her on this occasion. On her return to Siberia, in about twelve or eighteen months, she intends to enter Russia by Kamschatka, and thoroughly investigate the existence and extent of leprosy in these and other regions.-Med. Press.

Fruit EATING.–The value of fruit of various kinds in the dietary of the average healthy individual cannot be overestimated. When it causes indigestion it is usually when taken at wrong times, and not because it is necessarily difficult of digestion. The proper time to partake of fruit, whether cooked or raw, is at meals, and not, as is so frequently done, at odd times throughout the day. At this season of the year most persons are the better for restricting the amount of nitrogenous food and indulging in raw fruit and green vegetables. It must not be lost sight of that fresh, uncooked fruit and vegetables ought to form a substantial part of our daily food. Cooking, though it may facilitate the digestion of fruit, does so at the expense of the peculiar quality of freshness the absence

of which, in the long run, gives rise to serious disturbances of nutrition. A belief has gained ground of late years, based on a misconception of certain general statements, that fruit is harmful to persons with a tendency to gout. No.doubt if cooked and sweetened by the addition of cane sugar, dyspeptic disturbances are not unlikely to occur, but no possible

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