F. Neugebauer gives an analysis of 50 cases of marriage between persons of the same sex, with several cases of divorce from errors of sex. Injury of Domestic Animals by Sexual Perverts.-A. Guilleheau emphasizes the importance of veterinarians being familiar with the evidence of such acts. In cases of sadism valuable cattle were found to be destroyed. The unnatural sexual acts were, however, fatal only in the case of hens; these showed rupture of the liver and fatal bleeding, and sometimes broken bones. In 1 case human spermatozoa were found in the cloaca, which was unusually widened. Wounds of the vagina, with rectal and peritoneal perforation were met with in cattle subject to sadistic acts. In 1 case a cattle-tender was shown to have introduced a pitchfork handle into the vagina and twisted it round. Case of Precipitate Labor in a Primipara of 43.-Knepper 3 tells of a child that was born with only very short pains, taken for desire for defecation, into a chamber-pot. The escape of the liquor amnii was first noted afterward. The child was a girl, weighing 3000 gm., diameters of the head not given. About 4 months later a slight prolapse of the anterior vaginal wall was noted. 4 Exceptional Cause of Syncope during Accouchement.-P. de la Touche relates the case of a woman, weak and in poor health, who was confined alone. After feeling with her hand the head protruding from the vagina the labor did not advance. She then passed in a pair of scissors between the head and perineum, and divided the perineum. The pain caused her to faint. Subsequently, on coming to, the child lay between her legs. She tied a knot on the cord. On the arrival of the neighbors the child was found to be dead. 5 Self-inflicted Vaginal Injuries by a Fragment of Copper Sulphate.-Kuhn says that a girl of 23 had a discharge of slimy blue fluid from her vagina; the vaginal mucosa was eroded and discolored blue-gray; there was deep-seated corrosion of the posterior vaginal wall, with sloughing of the surface. She had placed a piece of blue vitriol, as large as a plum, in the vagina to relieve constipation. After separation of the sloughs the wound healed rapidly. Coffin-birth.-A case is reported by Langerhans. The body, that of a girl of 16, dead of phthisis, was placed upon the autopsy-table 60 hours after death, in February, with no signs of decomposition. The attendant noticed a prolapse of the uterus, and on his return about 20 minutes later the head of the child was seen to be completely delivered. There were no signs of liquor amnii. Pregnancy had not been diagnosed. The development of the child indicated 7 months. MENTAL. G. Villeneuve and E. P. Chagnon report a number of cases in which lunatics were condemned by mistake by the courts. This subject has also been made the subject of a very full discussion by the French Congress of Alienists in 1899. 1 Rev. de Gyn., Mar. and Apr., 1899. 3 Viertelj, ger. Med., Oct., 1899. Viertelj. ger. Med., July, 1899. 2 Schweizer Arch. f. Thierheilk., i., 1899. L'Union méd. du Canada, June, 1899. PUBLIC HYGIENE AND PREVENTIVE MEDICINE. BY SAMUEL W. ABBOTT, M. D., OF BOSTON, MASS. MANAGEMENT AND CONTROL OF INFECTIOUS DISEASES. Bacteriologic Diagnosis.-J. W. Washbourn discusses "Bacteriologic and Clinical Diagnosis in Relation to some of the Notifiable Infectious Diseases," selecting diphtheria, scarlet fever, and typhoid fever as examples. In discussing the questions "How far can we trust a positive result?" and "Can we absolutely rely upon a report stating that bacilli are present?" he says: "Upon the strictly scientific point of view we cannot, as it is impossible to distinguish the true diphtheria-bacillus from other allied microorganisms by the method of examination adopted; for example, the xerosis bacillus. We must therefore admit that the ordinary method of bacteriologic examination of the throat will not enable us to say for certain that we are dealing with diphtheria-bacilli. Another difficulty consists in the fact that true diphtheria-bacilli are found at times in the throat and nose without giving rise to local or constitutional disturbance. Are persons thus affected capable of conveying the disease to others? As the result of considerable experience I believe that bacilli resembling the diphtheria-bacillus in morphology are seldom found in inflamed throats except in cases of diphtheria. What course should be adopted when diphtheria-bacilli, or bacilli resembling the diphtheriabacillus, are found in the healthy throat? Should the individual be isolated? We are not justified in subjecting the person to the hardship of isolation unless the bacillus has been proved by all the necessary tests to be a true diphtheria-bacillus. I personally believe that all persons with true diphtheria-bacilli in the throat or nose may convey infection, but I think that with care the risk of infection is not very great. We now examine systematically the throats of all the scarlet-fever patients at the London Fever Hospital, and isolate as far as possible those with bacilli resembling the diphtheria-bacillus in their throats. Since this has been adopted we have had no outbreak of postscarlatinal diphtheria." In the case of scarlet fever, dependence must be placed upon the clinical diagnosis. The diseases liable to be mistaken for it, in addition to diphtheria are measles, German measles, erythemas and drug-rashes, septic eruptions, and the initial rashes of variola and other fevers. The difficulty in the diagnosis of this disease will never be overcome till we possess some new method of examination, such as bacteriology may possibly supply. In the case of typhoid fever the important diagnostic symptoms are pyrexia, 1 Jour. Sanitary Institute, vol. xx., part 1, p. 43, 1899. rash, diarrhea, tumefaction of the abdomen, bronchitis, and enlargement of the spleen. The rash is the most pathognomonic symptom. Each case must be judged upon its merits, all symptoms being taken into account. Much may be done by eliminating other diseases; pneumonia and phthisis by careful examination of the lungs, and malaria by examination of the blood. The author also testifies to the great value of the serum-test; if the reaction is absent during the whole course of the disease, typhoid can almost certainly be excluded. Cost of Bacteriologic Examination for Diagnosis.-D. G. Davies' presents a list of the London and Provincial districts to the number of 33 which afford opportunities for bacteriologic diagnosis for diphtheria, tuberculosis, and typhoid fever at a cost ranging from 2s. 6d. to 5 s. (60 cts. to $1.25) for each examination. In some of these districts antitoxin is supplied at cost price. Influence of Elementary Schools in Spreading Scarlet Fever.-Niven, Medical Officer of Health of Manchester, observes a decided drop in the prevalence of the disease in the summer holidays. His observations confirm those of Murphy of London.3 Niven thinks the extreme measure of closing a school for scarlet fever is rarely called for, and is not so likely to be effectual as in the case of measles. Diphtheria in Germany.-The Imperial Board of Health of Germany publishes two maps, colored to show the mortality from diphtheria in the periods 1885-1894 and 1895-1897, these periods representing the mortality before and after the introduction of antitoxin in the treatment of diphtheria. The supply has been unlimited since 1894, and its employment universal both in hospital and in private practice, its use being deemed morally if not legally imperative, with the result that the deathrate has fallen from an average of 15.5 per 10,000 for the whole country to 9.9 in 1895, 7.6 in 1896, and 6.2 in 1897. Typhus Fever.-Littlejohn of Edinburgh reports an epidemic of typhus. The disease was imported in August, 1898, and was spread by means of a "wake." He advises treatment of the disease only in an infectious-disease hospital. Only those in intimate contact with the sick appear to become infected. The disease is now so rare that young medical men do not recognize it, and hence it may spread rapidly at first. Out of 79 cases there were 9 deaths. Diphtheria and School Attendance.-Shirley Murphy's recent report gives prominence to the view that the prevalence of diphtheria is increased by school attendance. The experience of nearly every medical officer of health will furnish instances of this, and Murphy's exhaustive and careful analysis of the metropolitan statistics furnishes statistical support to what has come within the experience of nearly all. The demonstration of the relation between school holidays and a fall in the amount of diphtheria is particularly striking, though it appears to a very unequal extent in different years. In this report Murphy has not only brought this aspect of the question up to date, but has supplied some very interesting additional figures as to the altered age-incidence of fatal diph 1 Public Health, June, 1899, p. 602. 3 Report of London County Council, 1897. 2 Ibid., Sept., 1899, p. 787. Public Health, Sept., 1899. 5 Diphtheria and Elementary Schools. Report by the Medical Officer of the London County Council, 1898, p. 36; also Public Health, Feb., 1899, p. 305. theria plus croup. There has been a noteworthy increase in the relative incidence of diphtheria mortality between the ages of 3 and 15 years which did not appear before the period 1871-1880. Effect of the Use of Antitoxin upon the Death-rate from Diphtheria. The evidence upon this point presented during the past year is chiefly cumulative, and is overwhelmingly in favor of the use of antitoxin as a therapeutic and as a prophylactic measure. The evidence is furnished mainly from its hospital use, but the figures presented by the Board of Health of Massachusetts are those of cases which occurred both in private practice and in hospitals, but chiefly of the former class. The general mortality from diphtheria and croup in the State for the 4 years 1891-1894, prior to the introduction of antitoxin into general practice, was 28.3% of the reported cases during that time, but that of the 4 following years, 1895-1898, was only 15%, while that of the persons reported as having been treated with antitoxin during 3 years was only 10.7%. Murphy, in his report upon the health of the city of London,2 quotes similar figures; so also does the Imperial Board of Health of Germany. On the other hand, Kassowitz of Trieste inveighs against antitoxin in the strongest terms, saying that the results of the use of antitoxin in Trieste furnish "a bloody illustration of Behring's claims with reference to the safe operation of antitoxin." It is interesting to know how an intelligent layman views the subject from a purely statistic standpoint. With this object in view, the greatest living statistician, Körösi of Budapesth (who so very clearly demonstrated the value of vaccination from the statistic standpoint at the International Congress at Washington in 1887), critically reviews the statements of Kassowitz, and shows their illogical character, since the value of the remedy is shown, not by the lessening in the crude mortality (the death-rate of a given population from a given disease), but by the decrease in the lethality, or ratio of deaths to existing cases; and this had happened in Trieste as well as elsewhere. 5 4. The Campaign against Tuberculosis.-The Fourth Congress for the Study of Tuberculosis at Paris passed the following votes: 1. As soon as the notification of tuberculosis has become obligatory in all places, sanitary cuspidors should be placed and placards posted stating that spitting must be allowed only into the cuspidors. 2. The Government should see that this rule is enforced in all public buildings, and especially in schools. 3. Tuberculous persons must not be taken to establishments for convalescence intended for persons sick with other diseases. Special establishments for the cure of children should be erected. committee of physicians should be appointed to have charge of the establishment of free sanitaria. 6. Medical men should urge the establishment of as many small establishments for treatment of phthisis as possible. 7. The educational and sanitary authorities should, by their official patronage, encourage the extension of the work already begun by the League against Tuberculosis in Paris, into other cities of France. 8. A committee of the French Exposition of 1900 is to have general charge 1 Report of Mass. State Board of Health, 1899. 2 P. 39. 3 Arbeiten a. d. Kais. Gesundheitsamte, 13, p. 254, 1897. Der Kinderarzt, 1898, ix., p. 197; also Berlin. klin. Woch., 37, 1898. 5 Therap. Monatsh., Sept., 1898. 6 Presse méd., No. 64, 1898. of the question of giving information to visitors as to the best methods of avoiding infection from tuberculosis. 9. International organizations should make the subject of tuberculosis a subject of study, chiefly with the view of its prevention. 10. The government should adopt measures to prevent the fraudulent use of tuberculin, when employed to avoid the recognition of the disease. 11. The following measures were recommended relative to tuberculosis in cattle: (a) The separation of all diseased animals from the healthy. (6) No sick animals should be sold except for slaughter. (e) All dairies which produce milk for public consumption must be subject to inspection, and every cow suffering with tubercular disease of the udder is to be killed at once. (d) Milk intended for the manufacture of butter and cheese to be sterilized or pasteurized. (e) Inspection of meat in the slaughter-houses to be carried out in the same manner as has been done in Belgium.' Compulsory Notification of Phthisis.-Byrom Bramwell' discusses very fully the propriety of compulsory notification of phthisis. The question resolves itself into the following inquiry: "Will the compulsory notification of phthisis materially aid us in the prevention of phthisis and other forms of tuberculous disease; and, if it will materially aid us toward this end (and in my opinion there is no doubt whatever that it will do so), are the disadvantages which would result from, and the objections to, a system of compulsory notification, specially adapted to the peculiarities of phthisis, sufficiently great and sufficiently well-founded to overbalance the advantages and to negative its adoption? The advocates of the plan have therefore to show: 1. That compulsory notification would be beneficial. 2. That it is possible to formulate a system of compulsory notification which would be both effective and which would work well in practice. 3. That the objections which can be urged against such a system of compulsory notification are less important than the advantages which would result from it. The author favors such notification. In the same journal, July, 1899, the question is further discussed pro and con by many noted English authorities, the weight of argument being in favor. The New York system is pointed out as a model. Newsholme of Brighton, England, advocates a modified system, in which voluntary notification is to be encouraged, and that power be given to local authorities to adopt the compulsory plan as soon as "public opinion is sufficiently ripe for this purpose. Abolition of Tuberculosis in Cattle.-Meredith Young clearly defines from a public health and practical standpoint what measures should be taken to eradicate tuberculosis from cattle. The first step is the appointment of a staff of veterinary inspectors, and the application of the tuberculin-test to all dairy animals. The next thing is to decide what must be done with reacting animals. The inspector should make a clinical examination of any reacting beast, and particularly of the udder. Young divides those which react into three classes: 1. If the udder is affected and the animal is in an advanced stage of disease it should be slaughtered and no compensation given. 2. If the animal is affected slightly and the udder diseased (a combination seldom found) the animal See also the "Present Condition of Bovine Tuberculosis in Europe," by Prof. Conn, in Bulletin No. 19, of Experiment Station of Connecticut, Feb., 1899. 3 Public Health, June, 1899, p. 612. 2 Med. Mag., June, 1899, p. 515. |