means of isolation at salford

1
1251 mother should be directed to wash the eyes with a solution of corrosive sublimate (1 to 6000), and to keep small com- presses wet with iced water on them. When the disease appears to be cured it is necessary to be on the look-out for a return; the microscope should therefore be in constant requisition in order to detect microbes, even after all appa- rent discharge has ceased. The most favoured prophylatic measure by Dr. Gayet is the employment of a vaginal douche with a 1 to 6000 corrosive sublimate solution at the com- mencement of all labours, especially when the woman suffers from leucorrhcea, in which case the child should not be allowed to remain too long in the passage. THE NATIONAL MEDICAL CONGRESS OF ITALY. OUR. Rome correspondent writes :-" The Italians are possibly ’over-doing it’ in the matter of congresses, but considering how jealously public meeting used to be restricted even on purely scientific subjects, the error is a venial one and quite on the right side. On the 1st inst. the National Medical Congress opened its sittings here in the great hall of the Senatorial Palace in the Capitol. Three hundred medical men from all parts of the peninsula were present, and on the presidential platform Signor Crispi, Minister of the Interior, represented the Government, the Duke Torlonia the Municipality, and a number of well-known physicians and surgeons the various medico-chirurgical associations of the city and provinces. Tile feature of interest was the eloquent speech of Crispi, who claimed a more than official-a personal-interest in the Sanitary Code of the late Dr. Bertani, brought before Parliament by the Prime Minister, Depretis. Bertaui, the surgeon-in-chief of Garibaldi’s patriotic campaigns, whose premature decease some thirteen months ago was com- mented on in THE LANCET, abandoned a brilliant academic and civic career to minister to the wounded red-shirts, and after their common goal was won devc ted himself heart and soul to a department of medicine con paratively unfamiliar to him-public health-that he might render physically and morally sound and strong the natiana! life he had helped to unify. Crispi’s 916ge of his friend was in his happiest vein, and seemed to infuse a genial spirit into the more formal speeches that came after. The progra nme of the Congress, an extensive one, in harmony with the sentence of Cicero, inscribed in imposing characters ove r the entrance-portal, "Hominum Vitse et Saluti Consuleudum," will doubtless give occasion to discussions of interest, not only for Italian medicine, but for that of other States." EARLY DIAGNOSIS OF PHTHISIS. As an original contribution to the Revue Intei-2zationale des Scierzces Médicales, No.5, Dr. E. Alartel writes on the early diagnosis of pulmonary phthisis by ai examination of the larynx. We cordially concur in the statement that to diagnose pulmonary tuberculosis as soon as possible is of the highest importance in the treatment of this affection, but far more evidence than has yet been adduced will be required to sustain 112. Martel’s principal proposition, to the effect that a " paralysis or a paresis of a vocal cord, with or without derangement of phonation, indicates in nearly all cases an incipient pulmonary phthisis." In other words, the discovery of an imperfection in the action of one vocal cord is equivalent to proving that the patient so affected will eventually develop unmistakable signs of phthisis, and this, too, in the lung of the same side as the impaired vocal cord. The impairment of the action of the vocal cord may precede the development of physical or other certain signs of phthisis, even by as long a period as four years. M. Martel’s own words may be quoted, as they are so very remarkable and emphatic: "I have always examined the larynx even when there were no signs pointing to mischief therein, and I have been surprised at the number of lame’ vocal cords which it has been my lot to examine; but we ought not to say, as soon as the dis- covery of a weakened vocal cord is made, that the apex of the left lung will become tubercular in a nearer or more remote future; there are exceptions, and aneurysm of the aorta, tracheo-bronchial adenopathy, and tumours of the neck may lead to functional troubles of the vocal organ." Never- theless, in the next paragraph, M. Martel avers that in all cases of examination of the thorax or neck we shall find the cause of the vocal paresis; whilst in incipient phthisis the lung will appear to be healthy to physical examination of all kinds, and yet the lameness of the vocal cord alone will suffice for us to assert that something abnormal is taking place on the same side of the respiratory apparatus (lung). __ MEANS OF ISOLATION AT SALFORD. IN view of the contemplated purchase by a railway company of the existing infectious hospital for Salford, Dr. Tatham has submitted to his sanitary authority an able and exhaustive report on the principles which should govern them in the provision of a new hospital. Care has been taken to study the whole subject, and Dr. Tatham has interviewed the depart- ments of the Local Government Board in order to elicit from them any expression of opinion formed since the last official publications were made on the subject. As a result of these steps, Dr. Tatham recommends that 200 beds-at the rate of one bed per 1000 inhabitants-should be provided as the permanent accommodation for the borough, and he enters into details as to the plan on which these should be arranged in different pavilions. The subject of the isolation of small- pox patients in urban communities is for the moment not dealt with, because the Monsall Hospital, affiliated to the Manchester Royal Infirmary, is available for the reception of cases of that disease. But this. it is admitted, is not likely to be a lasting arrangement; and when it comes to an end this very difficult problem will have to be faced in Salford. Dr. Tatham’s report is so complete that its perusal would well repay those authorities and officers who have the provision of infectious hospital accommodation in contemplation. - ACUTE INFECTIOUS MYOSITIS. THE subject of myositis which Mr. Treves brought under the notice of the Clinical Society last year has been farther illustrated in a paper read by Dr. Jackson at a recent meeting of the ialassachusetts Medical Society. The case was that of a woman aged thirty-six, who had been seen by Dr. Jackson when in Strasburg. The illness began with malaise, sore throat, and a red papular eruption on the face, which dis- appeared in a week’s time. Then occurred swelling, accom- panied by pain, in the shoulders, legs, and sacral region. There was moderate fever, except at the close, when the temperature was high and pneumonia occurred. There was slight cedema of the face and extremities, the muscles of the limbs being fixed and rigid, exten- sion causing pain. There was paresis of the soft palate, diminished electrical reaction, and absence of reflexes. The patient died a week after admission. Professor Kussmaul, who had charge of the case, diagnosed a diffused myositis, and said the case reminded him clinically of one in which thousands of miliary aneurysms were found all over the body. Trichinosis was at first thought of, but was eliminated by the history and the absence of gastro-intestinal prodromata. The post-mortem examination was made by Professor von Recklinghausen, and it was found that the muscles through- out the body, especially in the extremities, the trunk, and the face, were pale and moist, maay had small haemorrhages 1 Boston Medical and Surgical Journal, 1887, No. 21.

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Page 1: MEANS OF ISOLATION AT SALFORD

1251

mother should be directed to wash the eyes with a solutionof corrosive sublimate (1 to 6000), and to keep small com-presses wet with iced water on them. When the disease

appears to be cured it is necessary to be on the look-out fora return; the microscope should therefore be in constantrequisition in order to detect microbes, even after all appa-rent discharge has ceased. The most favoured prophylaticmeasure by Dr. Gayet is the employment of a vaginal douchewith a 1 to 6000 corrosive sublimate solution at the com-mencement of all labours, especially when the woman suffersfrom leucorrhcea, in which case the child should not beallowed to remain too long in the passage.

THE NATIONAL MEDICAL CONGRESS OF ITALY.OUR. Rome correspondent writes :-" The Italians are

possibly ’over-doing it’ in the matter of congresses, butconsidering how jealously public meeting used to berestricted even on purely scientific subjects, the error is avenial one and quite on the right side. On the 1st inst.the National Medical Congress opened its sittings herein the great hall of the Senatorial Palace in the

Capitol. Three hundred medical men from all parts of thepeninsula were present, and on the presidential platformSignor Crispi, Minister of the Interior, represented the

Government, the Duke Torlonia the Municipality, and anumber of well-known physicians and surgeons the variousmedico-chirurgical associations of the city and provinces.Tile feature of interest was the eloquent speech of Crispi,who claimed a more than official-a personal-interest inthe Sanitary Code of the late Dr. Bertani, brought beforeParliament by the Prime Minister, Depretis. Bertaui, thesurgeon-in-chief of Garibaldi’s patriotic campaigns, whosepremature decease some thirteen months ago was com-mented on in THE LANCET, abandoned a brilliant academicand civic career to minister to the wounded red-shirts, andafter their common goal was won devc ted himself heart andsoul to a department of medicine con paratively unfamiliarto him-public health-that he might render physically andmorally sound and strong the natiana! life he had helped tounify. Crispi’s 916ge of his friend was in his happiest vein,and seemed to infuse a genial spirit into the more formal

speeches that came after. The progra nme of the Congress,an extensive one, in harmony with the sentence of Cicero,inscribed in imposing characters ove r the entrance-portal,"Hominum Vitse et Saluti Consuleudum," will doubtlessgive occasion to discussions of interest, not only for Italianmedicine, but for that of other States."

EARLY DIAGNOSIS OF PHTHISIS.

As an original contribution to the Revue Intei-2zationaledes Scierzces Médicales, No.5, Dr. E. Alartel writes on theearly diagnosis of pulmonary phthisis by ai examinationof the larynx. We cordially concur in the statement thatto diagnose pulmonary tuberculosis as soon as possible is ofthe highest importance in the treatment of this affection,but far more evidence than has yet been adduced will berequired to sustain 112. Martel’s principal proposition, to

the effect that a " paralysis or a paresis of a vocal cord, withor without derangement of phonation, indicates in nearlyall cases an incipient pulmonary phthisis." In other words,the discovery of an imperfection in the action of one vocalcord is equivalent to proving that the patient so affected willeventually develop unmistakable signs of phthisis, and this,too, in the lung of the same side as the impaired vocal cord.The impairment of the action of the vocal cord may precedethe development of physical or other certain signs of phthisis,even by as long a period as four years. M. Martel’s own wordsmay be quoted, as they are so very remarkable and emphatic:"I have always examined the larynx even when there were no

signs pointing to mischief therein, and I have been surprisedat the number of lame’ vocal cords which it has been my lotto examine; but we ought not to say, as soon as the dis-covery of a weakened vocal cord is made, that the apex ofthe left lung will become tubercular in a nearer or moreremote future; there are exceptions, and aneurysm of theaorta, tracheo-bronchial adenopathy, and tumours of the neckmay lead to functional troubles of the vocal organ." Never-

theless, in the next paragraph, M. Martel avers that in allcases of examination of the thorax or neck we shall findthe cause of the vocal paresis; whilst in incipient phthisisthe lung will appear to be healthy to physical examinationof all kinds, and yet the lameness of the vocal cord alonewill suffice for us to assert that something abnormal istaking place on the same side of the respiratory apparatus(lung).

__

MEANS OF ISOLATION AT SALFORD.

IN view of the contemplated purchase by a railway companyof the existing infectious hospital for Salford, Dr. Tatham hassubmitted to his sanitary authority an able and exhaustivereport on the principles which should govern them in theprovision of a new hospital. Care has been taken to study thewhole subject, and Dr. Tatham has interviewed the depart-ments of the Local Government Board in order to elicit fromthem any expression of opinion formed since the last officialpublications were made on the subject. As a result of these

steps, Dr. Tatham recommends that 200 beds-at the rate ofone bed per 1000 inhabitants-should be provided as thepermanent accommodation for the borough, and he entersinto details as to the plan on which these should be arrangedin different pavilions. The subject of the isolation of small-pox patients in urban communities is for the moment notdealt with, because the Monsall Hospital, affiliated to theManchester Royal Infirmary, is available for the receptionof cases of that disease. But this. it is admitted, is notlikely to be a lasting arrangement; and when it comes to anend this very difficult problem will have to be faced inSalford. Dr. Tatham’s report is so complete that its perusalwould well repay those authorities and officers who havethe provision of infectious hospital accommodation in

contemplation. -

ACUTE INFECTIOUS MYOSITIS.

THE subject of myositis which Mr. Treves brought underthe notice of the Clinical Society last year has been fartherillustrated in a paper read by Dr. Jackson at a recent meetingof the ialassachusetts Medical Society. The case was that ofa woman aged thirty-six, who had been seen by Dr. Jacksonwhen in Strasburg. The illness began with malaise, sorethroat, and a red papular eruption on the face, which dis-appeared in a week’s time. Then occurred swelling, accom-panied by pain, in the shoulders, legs, and sacral region.There was moderate fever, except at the close, when thetemperature was high and pneumonia occurred. Therewas slight cedema of the face and extremities, themuscles of the limbs being fixed and rigid, exten-

sion causing pain. There was paresis of the soft palate,diminished electrical reaction, and absence of reflexes. The

patient died a week after admission. Professor Kussmaul,who had charge of the case, diagnosed a diffused myositis,and said the case reminded him clinically of one in whichthousands of miliary aneurysms were found all over the body.Trichinosis was at first thought of, but was eliminated bythe history and the absence of gastro-intestinal prodromata.The post-mortem examination was made by Professor vonRecklinghausen, and it was found that the muscles through-out the body, especially in the extremities, the trunk, andthe face, were pale and moist, maay had small haemorrhages

1 Boston Medical and Surgical Journal, 1887, No. 21.