ABSTRACTS AND EXTRACTS. SURGERY. Casf of CEsophagotomy.?In the Apri number of The American Journal of the Meaical Sciences, Dr. Louis A. La Grade reports a successful case of this rare operation for the dislodgment of a plate of artificial teeth, and he shows that existing statistics do not support the view of Sir William Fergusson and -Nelaton, that oesophagotomy is a dangerous operation. A
Mastoid
Abscess:
Trephining:
(Zeitchrift fiir Olirenhcilkunde, xiii,
Recovery.?Knapp i) reports in detail
of severe disease of the mastoid process. The first that of a man, aged thirty-nine, with acute purulent otitis in consequence of sea-bathing. The occipital bone became perforated, and the cavity of the skull was drained for thiee consecutive months, but death followed in consequence of The second case occurred in a woman, abscess of the brain. aged forty-tive, who had a chronic internal mastoiditis followin"; purulent otitis media. The bone became sclerosed and No pus was found, and death followed from was trephined. meningitis or abscess. The third case was in a man, aged twenty-five, with acute purulent tympano-mastoiditis, accompanied by violent headache. There was neuritis optica. The mastoid was trephined, and the patient recovered with restoration of normal hearing.
three
cajr face became a little less livid. The attempt at respiration soon failed. A catheter was now passed down the trachea, and attempts made to inllate the lungs?at first with the mouth, then with a bellows?but For a long time the pulse could be f':lt in the all in vain. femoral artery, full and regular at first, then less distinctly, till it ceased, and it became clear at length that all attempts at resuscitation were fruitless. At the post-mortem examination nothing was found to explain the cause of death ; the lungs, heart and kidneys were normal. The goitre, according to Mr. Ilolmes, had no part in the fatal issue. The case appears to be one of direct paralysis of the respiratory centre in the medulla, brought about by the depressant action of the ether. No mention is made of the purity of the sample of the anaesthetic employed, except that it had been used on three previous occasions without giving rise to any untoward symptoms.
1884)
a
case
into bed
an
one
?
is reported of a woman with suicidal impulse, asylum, who was observed, just after getting night, to have become suddenly and violently '
ill, and 'medical aid
was summoned at once. On its arrival she was found to be quite unconscious, very pale, skin cold and clammy, pupils widely dilated, but there was no conjugate deviation present; the features were drawn and altered, and the head was rolled rhythmically from side to side, patient moaning slightly at times. The radial pulse on the right side was very weak, that on the left almost imperceptible ; rate 78 per minute. The left arm and leg were quite paralyzed so far as cuila be made out The right arm was lifted and let fall feebly and aimlessly now and then. She had vomi'ed but no deleterious substance could be detected in the a little, rejected matter by the rough examination possible at the time. On palpation over the prrecordia the cause of this rather puzzling condition was discovered. A knob about the size of a large pea was felt adhering to the chest wall, in the situation of the apex beat, and this proved to be the head of a large steel shawl-pin, about three and three eighths inches long, which the patient had succeeded in secreting, unobserved by the attendant in charge, and which she had thrust right into the chest, at the situation mentioned above, the part imbedded being directed slightly upwards and inwards, and measuring It was at once removed, about two and three fourths inches and stimulants administered, and almost immediately the heart's The pulse became stronger action began to gain in force. and steadier, and consciousness slowly and gradually returned. For some time there was very urgent dyspnoea, and patient complained much of pain in the prcccordia, but the^e unfavorable symptoms diminished as time went on, and after an hour had passed, she was much better; the paralysis of the left side had disappeared ; the pulse was steady, and of fair strength, rate 108 per minute, and she was quite conscious of what transpired around her. Four hours after the occurrence she vomited a little, but this soon passed off, was sick again, and and she fell asleep, and slept at intervals during the rest of the night, stimulants being given frequently in small doses. On the following day she complained of some pain at the site of puncture and of headache, but was otherwise pretty well, and her recovery after this proceeded without interruption. The writer believes, from the point of puncture and the direction of the needle, that the heart was wounded near its apex. Reference is made to a similar case in I lolme's Surgery, and to another author who describes a tigress which lived for some time with seven lead bullets in her heart. The practical applications of these facts to the operation of cardiacentesis are of
interest.
MICRO-ORGANISMS
DENTAL OARIES
IN
:?Al tho
ihe
PRODUCTION
1884
Odontological Society,
PROBABLE TRANSFIXION ok the HEART, with RECOVERS.?In the Edinburgh Medical Journal (March, confined in
[July,
of
April meeting of the London
Mr. A. Underwood referred to a paper read before the Dental Section at the International Medical Congress in i88t, in which he had shown that certain forms of micro-organisms were invariably present in carious dentine ; that no change resembling caries could be produced in the absence of these organisms, i. e., under aseptic conditions ; and that under septic conditions a change could be produced artificially which, if not undistinguishable from ordinary caries, certtinly resembled it. The fact that organisms were invariably present had since been confirmed by numerous observers. It had been stated by one investigator, Dr. Miller, of Berlin, that the dentine was first softened by acid, the invasion of the micro-organisms being only secondary to this, and that a zone of softened dentine not infected with organisms always existed in advance of that which was so infected, lie and his Mr. Milles had on the contrary found that the colleague organisms extended as far as the softening ; they could not find any softened tissue which did not contain micro-organisms, and they were of opinion that the acid which softened the dentine was produced by the organisms, just as occurred in ordinary processes of acid fermentation. They had cultivated the various organisms found in carious dentine in flasks containing purified blood serum, after the method introduced by Professor Koch, and had ascertained that there were several distinct varieties, but experiments made with the view of finding out which of these species were the most active agents Dr. Mi.ler had gave negative results. stated that he had produced artificially out of the mouth caries which he defied ar.y one to distinguish from that which occurred in the mouth. Messrs. Underwood and Milles had repeated his experiments, and had tried several of their own with but very partial success ; the result was that in the absence of germs no change takes place which could be supposed to be caries ; in the presence of germs a change does take place resembling caries, but which invariably became arrested before it had gone very far. This comparative failure was no doubt caused by the difficulty of assembling in a flask or irtcubator experiment various conditions all the which were present in the mouth, instances were and quoted from the experiments of Pasteur and Ntegeli to show that micro-organisms cultivated ui der conditions not altogether favourable became weakened, and even lost their special attributes, so that the bacillus of anthrax, for could be inoculated instance, hnrm'essly. The authors o( the paper claimed to have established that microorganisms of a special form were an essential element in the production of dental caries. Food gets lodged between the teeth, and undergoes fermentation, with formation of acid and bacteria ; the acid destroys the enamel, the micro-organismS invade the dentine, proliferating in the tubes and living at the expense of their organic material, their advance being accompanied by decalcification of the intertubular substance A discussion followed, the tone of which was distinctly favour*. able to the adoption of the views promulgated by Messrs.-, Underwood and Milles. It was remarked that these cleared up some points which the purely chemical theory of caries did not explain, e. g., the fact that the dentine was destioyed more rapidly than the enamel, and a hope was expressed thut the discrepancies at present existing between ;he results arrived at by Messrs. Underwood and Milles and by Mr. Miller might soon be settled by the testimony of independent investigators.
PUERPERAL FEVER IN INDIA. By Norman
Chevers, c. i. Puerperal Fever.
e., m. d.
It was remarked by Lind, in the last century, when Calcutta and the other Presidency towns were very unhealthy, that, in India European women in general enjoyed a much better state of health than the men, but that child-bearing was, in his time, peculiarly fatal to them in Calcutta ; on which account he considered that it would be advisable for them to retire to at the approach of their delivery. a more healthy situation In the absence of more explicit information regarding the prewe may state the probability that postvailing causes of death, partum hrhage destroyed many who were the subjects of neglected malarial cachexia. This dangerous accident is still always so much to be dreaded in India that I never omitted to have a sheet-binder placed under the patient from the first, and to give a full dose of ergot as soon as I knew that the child was descending quickly. Clarke, writing in >770>
ABSTRACTS AND EXTRACTS.
July, 1884.]
mentions putrid puerperal fever as extremely common in Bengal. The Hindoo women, who, at the time of their confinement, are, in many cases, placed apart in small, damp, ill-ventilated rooms, artificially heated, are still very liable to puerperal metritis, pelvic cellulitis, and peritonitis. History contains only too abundant evidence of the fact that, in mediaeval England, the lives of even royal ladies were frequently sacrificed under a similar practice of " lying in" in un ventilated castle chambers, over-heated and scrupulously ciosed against every in-draught of pure air. This was, probably, one of our many customs learnt in the Crusades. In 1836, the surgeon to the Calcutta General Hospital wrote*?" Puerperal Fever, in its severe form, is a rare disease in Bengal." Mackinnon, who, previously to the appearance of his great work, was stationed at Tirhoot, Dinapore, and Cawnpore, spoke of true puerperal fever as rare?he believed totally absent?in India. Until of late years, within my knowledge, Lower Bengal was nearly free from erysipelas, and puerperal fever was not common in the obstetric wards of our hospitals. When erysipelas became very prevalent in Calcutta, in June, 18741 I enquired of Dr. Charles whether there was any puerperal fever in his wards. He replied that they were particularly free from this disease. Shortly afterwards so many cases occurred among his patients, that I had to provide accommodation for him in a separate building. Dr. De Renzy states! that Abbotabad, in the Punjab, has long had i. bad reputation for puerperal fever. lie thinks this may be attributed to the practice of washing the Europeans' clothing in the water-course which is the natural drain of the native town. Malm ions rat-Parturn Fever. At
Chittagong, thirty years ago, and also in Calcutta subsequently, I had in my practice frequent illustrations of the ^act that there, soon after delivery, both European and native women often gel fever, genenlly with arrest of the milk and lochia. At first these symptoms were equally terrifying to the patient and the physician ; but I soon found that no other severe symptoms were developed, and that quinine speedily
restored health. I had many of these cases ; but not one that did badly cr long refused to lie controlled by the specific. I was much interested, in 1S80, by readingf the report of a discussion upon this fever as it occurs in the neighbourhood of New York. Professor Fordyce It is called by Barker " Puerperal Malarious Fever." As in India, it stands quite apart from all the forms of deadly " Puerperal Fever." I prefer my own nomenclature for the Bengal malady. Professor Barker observes that it may occur from twenty-four hours after normal labour up to completion of puerperal recovery. Only one of his seventeen cases was fatal, on the 4.7th day after confinement. He gives half-ounce doses of Warburg's Tincture every four hours until the fever is entirely abated, continuing it, in diminishing doses, until convalescence is perfectly established. He finds it a far more effectual and speedy remedy than the largest doses of quinine. In the discussion which followed the reading of Professor Parker's paper, Dr. Jones, who lives in a malarious district, said that he gives a dose of quinine on the day following confinement. Dr. Lusk considered that it is needful to remove these women from lying-in-hospitals, as puerperal peritonitis and cellulitis begin to appear in other cases. Dr. Barker puts his patients on quinine immediately after confinement, from January to June, and continues it for ten days. Dr. Emmett referred to cases in which there were uterine haemorrhage, sub-involution, cellulitis, &c., in women who hail been living in malarious districts, ar.d which could not be cured except by quinine. Professor Barker does not mention the lochia. Dr. Gillette " " speaks of the purity of the lochial discharges" as a diagnostic point in these cases. In the Bengal disease, as I saw it, the lochial discharge was checked until the fever abated. In 1839, Dr. Duncan Stewart, then of Calcutta, published ?some very important remarks upon the predisposition of pregnant women to fever, and upon the great danger of Bengal fever when occurring late in pregnancy. He shows that it generally happens that, when labour occurs in the course of fever, it is premature. He cites the following striking observation from Twining:?" I hardly deem any part of the ob*
Ittd. Jour, ofMed. ami Phys. Science, vol. iii. /. 117. t Trans, of the Epidemiological Society, 1822-3.3, p. 35. Times and Gazette, March so, 1880, p. 327. Med. { ? Ind. Jour, of Med. and Phys. Sc., vol. iv., p. 587.
211
servations I have
to offer concerning the peculiar nature and of the remittent fever of the rainy season in Uengal of more importance than the caution I have now given respecting the hazard of either bleeding or applying leeches at a late stage of the paroxysm, after the disease has been returning daily above a week, and when the patient is much exhave met I with hausted. several instances where the application of leeches was, from trivial causes, delayed for three after they were ordered, and then put on toor four hours wirds the conclusion of the paroxysm when arterial action was subsiding?the patient being in a state of languor and anxiety, and the skin perspiring freely?and death has been the treatment
consequence. " If," says Dr. Stewart, "such results have followed the loss of a minute quantity cf blood under ordinary circumstances, will it surprise any one that the occurrence of even natural labour at the end of a paroxysm of fever should be matter of more than ordinary anxiety, or that the abstraction of so large the best conmust attend even a portion of blood as ducted delivery should, at such a time, be eminently perilous ?" I have seen grave remittent fever, in Bengal, passed through under quinine, by which a cure was effected some weeks beand fore delivery, with perfect immunity both to mother child, but a more anxious case for the physician it is hardly possible to conceive. Med. Times and Gazette, Mar. 8. The Tubercle Bacillus ; its Diagnostic and ProgValue.?Mackenzie (Ed. Med. Jour., Feb., 1S84), in a paper, distinguished for the conciseness with which he presents results of examination an important series of facts, details the in seventy cases of pulmonary and laryngeal disease. A little were undoubtedly instances of over one half of these cases tuberculous disease, and in all the specific bacilli were present in In the acute cases they were usually from three to the sputum. four times as abundant as in those of chronic course. In laryngeal phthisis the bacilli were usually present in abundance, and taken direct]) from were especially numerous in the muco-pus the larynx by the laryngeal brush. So'marked was this phenomeMackenzie attributes non that great diagnostic value to this mode of examination in doubtful cases of laryngeal inflammation or ulceration. On the other hand, the absence of bacilli in the sputum in suspected cases is at least strong presumptive In evidence against the existence of tuberculous disease. Mackenzie's series of cases bacilli were absent in thirty-three, of which twenty-two were undoubtedly non-tuberculous, and the remainder, although of doubtful character at the time of observation, were proved by their subsequent history not to be cf tubercular origin. Accordingly, he ascribes considerable diagnostic value to the presence or absence of the bacilli in In common doubtful cases, especially in the incipient stages. with other observers, he does not consider that much stress indications afforded should be laid upon the prognostic by the number of bacilli present, since non-febrile cases of slow course of while cases of show an abundance acutc bacilli, may general tuberculosis, in which the lungs arc not greatly affected, few. show very usually nostic
Lurus and its Relation to Tuberculosis.?The controversy over the nature of lupus has been enlivened and in-
fused with a new interest since Koch's discovery of the tubercle bacillus. Friedlander and Volkmann state decidedly that lupus is a local tuberculosis, while Virchow believes it is not. Koch the tubercle bacillus.* regards it as being caused by at his disposal, for lie had placed purposes of examination with regard to the presence of the tubercle bacillus, specimens from seven cases of undoubted lupus. The specimens from four cases consisted of bits of excised skin, and from the other three only the debris resulting from scraping was available. The bits of excised skin could alone be utilized for the purposes of direct microscopical examination. In each one of these four specimens the tubercle bacillus was detected, small in a number of from each preparations although only specimen, and only inside the giant cells. Such is the scarcity of the tubercle bacillus in lupus, that in one instance twentyseven, and in another forty-three sections were examined before It repeatedly happened, that after a the bacillus was detected. number of sections were examined without showing the bacillus a group of successive sections, each containing from was met with. More than one bacillus one to three bacilli, *
page
Mittheilungen 38.
aus
dem
Raiscrlichcu
Gesundheitsamte,
Hand
212
THE INDIAN
1
MEDICAL GAZETTE.
since in any giant cell. From each of the above inoculation of lupus material in the anterior chamber of the eyes of rabbits was made, and tuberculosis of the iris was produced in every instance, resulting in those animals which were allowed to live long enough (not immediately killed) in generalised tuberculosis. From one specimen of lupus the bacillus was calti /ated, and inoculations of this cultivation upon animals were made with success in several instances. was
never
seven
cases
["July
1884-
Mastoid
Abscess:
Trephining:
(Zeitchrift fiir Olirenhcilkunde, xiii,
Recovery.?Knapp i) reports in detail
of severe disease of the mastoid process. The first that of a man, aged thirty-nine, with acute purulent otitis in consequence of sea-bathing. The occipital bone became perforated, and the cavity of the skull was drained for thiee consecutive months, but death followed in consequence of The second case occurred in a woman, abscess of the brain. aged forty-tive, who had a chronic internal mastoiditis followin"; purulent otitis media. The bone became sclerosed and No pus was found, and death followed from was trephined. meningitis or abscess. The third case was in a man, aged twenty-five, with acute purulent tympano-mastoiditis, accompanied by violent headache. There was neuritis optica. The mastoid was trephined, and the patient recovered with restoration of normal hearing.
three
cajr face became a little less livid. The attempt at respiration soon failed. A catheter was now passed down the trachea, and attempts made to inllate the lungs?at first with the mouth, then with a bellows?but For a long time the pulse could be f':lt in the all in vain. femoral artery, full and regular at first, then less distinctly, till it ceased, and it became clear at length that all attempts at resuscitation were fruitless. At the post-mortem examination nothing was found to explain the cause of death ; the lungs, heart and kidneys were normal. The goitre, according to Mr. Ilolmes, had no part in the fatal issue. The case appears to be one of direct paralysis of the respiratory centre in the medulla, brought about by the depressant action of the ether. No mention is made of the purity of the sample of the anaesthetic employed, except that it had been used on three previous occasions without giving rise to any untoward symptoms.
1884)
a
case
into bed
an
one
?
is reported of a woman with suicidal impulse, asylum, who was observed, just after getting night, to have become suddenly and violently '
ill, and 'medical aid
was summoned at once. On its arrival she was found to be quite unconscious, very pale, skin cold and clammy, pupils widely dilated, but there was no conjugate deviation present; the features were drawn and altered, and the head was rolled rhythmically from side to side, patient moaning slightly at times. The radial pulse on the right side was very weak, that on the left almost imperceptible ; rate 78 per minute. The left arm and leg were quite paralyzed so far as cuila be made out The right arm was lifted and let fall feebly and aimlessly now and then. She had vomi'ed but no deleterious substance could be detected in the a little, rejected matter by the rough examination possible at the time. On palpation over the prrecordia the cause of this rather puzzling condition was discovered. A knob about the size of a large pea was felt adhering to the chest wall, in the situation of the apex beat, and this proved to be the head of a large steel shawl-pin, about three and three eighths inches long, which the patient had succeeded in secreting, unobserved by the attendant in charge, and which she had thrust right into the chest, at the situation mentioned above, the part imbedded being directed slightly upwards and inwards, and measuring It was at once removed, about two and three fourths inches and stimulants administered, and almost immediately the heart's The pulse became stronger action began to gain in force. and steadier, and consciousness slowly and gradually returned. For some time there was very urgent dyspnoea, and patient complained much of pain in the prcccordia, but the^e unfavorable symptoms diminished as time went on, and after an hour had passed, she was much better; the paralysis of the left side had disappeared ; the pulse was steady, and of fair strength, rate 108 per minute, and she was quite conscious of what transpired around her. Four hours after the occurrence she vomited a little, but this soon passed off, was sick again, and and she fell asleep, and slept at intervals during the rest of the night, stimulants being given frequently in small doses. On the following day she complained of some pain at the site of puncture and of headache, but was otherwise pretty well, and her recovery after this proceeded without interruption. The writer believes, from the point of puncture and the direction of the needle, that the heart was wounded near its apex. Reference is made to a similar case in I lolme's Surgery, and to another author who describes a tigress which lived for some time with seven lead bullets in her heart. The practical applications of these facts to the operation of cardiacentesis are of
interest.
MICRO-ORGANISMS
DENTAL OARIES
IN
:?Al tho
ihe
PRODUCTION
1884
Odontological Society,
PROBABLE TRANSFIXION ok the HEART, with RECOVERS.?In the Edinburgh Medical Journal (March, confined in
[July,
of
April meeting of the London
Mr. A. Underwood referred to a paper read before the Dental Section at the International Medical Congress in i88t, in which he had shown that certain forms of micro-organisms were invariably present in carious dentine ; that no change resembling caries could be produced in the absence of these organisms, i. e., under aseptic conditions ; and that under septic conditions a change could be produced artificially which, if not undistinguishable from ordinary caries, certtinly resembled it. The fact that organisms were invariably present had since been confirmed by numerous observers. It had been stated by one investigator, Dr. Miller, of Berlin, that the dentine was first softened by acid, the invasion of the micro-organisms being only secondary to this, and that a zone of softened dentine not infected with organisms always existed in advance of that which was so infected, lie and his Mr. Milles had on the contrary found that the colleague organisms extended as far as the softening ; they could not find any softened tissue which did not contain micro-organisms, and they were of opinion that the acid which softened the dentine was produced by the organisms, just as occurred in ordinary processes of acid fermentation. They had cultivated the various organisms found in carious dentine in flasks containing purified blood serum, after the method introduced by Professor Koch, and had ascertained that there were several distinct varieties, but experiments made with the view of finding out which of these species were the most active agents Dr. Mi.ler had gave negative results. stated that he had produced artificially out of the mouth caries which he defied ar.y one to distinguish from that which occurred in the mouth. Messrs. Underwood and Milles had repeated his experiments, and had tried several of their own with but very partial success ; the result was that in the absence of germs no change takes place which could be supposed to be caries ; in the presence of germs a change does take place resembling caries, but which invariably became arrested before it had gone very far. This comparative failure was no doubt caused by the difficulty of assembling in a flask or irtcubator experiment various conditions all the which were present in the mouth, instances were and quoted from the experiments of Pasteur and Ntegeli to show that micro-organisms cultivated ui der conditions not altogether favourable became weakened, and even lost their special attributes, so that the bacillus of anthrax, for could be inoculated instance, hnrm'essly. The authors o( the paper claimed to have established that microorganisms of a special form were an essential element in the production of dental caries. Food gets lodged between the teeth, and undergoes fermentation, with formation of acid and bacteria ; the acid destroys the enamel, the micro-organismS invade the dentine, proliferating in the tubes and living at the expense of their organic material, their advance being accompanied by decalcification of the intertubular substance A discussion followed, the tone of which was distinctly favour*. able to the adoption of the views promulgated by Messrs.-, Underwood and Milles. It was remarked that these cleared up some points which the purely chemical theory of caries did not explain, e. g., the fact that the dentine was destioyed more rapidly than the enamel, and a hope was expressed thut the discrepancies at present existing between ;he results arrived at by Messrs. Underwood and Milles and by Mr. Miller might soon be settled by the testimony of independent investigators.
PUERPERAL FEVER IN INDIA. By Norman
Chevers, c. i. Puerperal Fever.
e., m. d.
It was remarked by Lind, in the last century, when Calcutta and the other Presidency towns were very unhealthy, that, in India European women in general enjoyed a much better state of health than the men, but that child-bearing was, in his time, peculiarly fatal to them in Calcutta ; on which account he considered that it would be advisable for them to retire to at the approach of their delivery. a more healthy situation In the absence of more explicit information regarding the prewe may state the probability that postvailing causes of death, partum hrhage destroyed many who were the subjects of neglected malarial cachexia. This dangerous accident is still always so much to be dreaded in India that I never omitted to have a sheet-binder placed under the patient from the first, and to give a full dose of ergot as soon as I knew that the child was descending quickly. Clarke, writing in >770>
ABSTRACTS AND EXTRACTS.
July, 1884.]
mentions putrid puerperal fever as extremely common in Bengal. The Hindoo women, who, at the time of their confinement, are, in many cases, placed apart in small, damp, ill-ventilated rooms, artificially heated, are still very liable to puerperal metritis, pelvic cellulitis, and peritonitis. History contains only too abundant evidence of the fact that, in mediaeval England, the lives of even royal ladies were frequently sacrificed under a similar practice of " lying in" in un ventilated castle chambers, over-heated and scrupulously ciosed against every in-draught of pure air. This was, probably, one of our many customs learnt in the Crusades. In 1836, the surgeon to the Calcutta General Hospital wrote*?" Puerperal Fever, in its severe form, is a rare disease in Bengal." Mackinnon, who, previously to the appearance of his great work, was stationed at Tirhoot, Dinapore, and Cawnpore, spoke of true puerperal fever as rare?he believed totally absent?in India. Until of late years, within my knowledge, Lower Bengal was nearly free from erysipelas, and puerperal fever was not common in the obstetric wards of our hospitals. When erysipelas became very prevalent in Calcutta, in June, 18741 I enquired of Dr. Charles whether there was any puerperal fever in his wards. He replied that they were particularly free from this disease. Shortly afterwards so many cases occurred among his patients, that I had to provide accommodation for him in a separate building. Dr. De Renzy states! that Abbotabad, in the Punjab, has long had i. bad reputation for puerperal fever. lie thinks this may be attributed to the practice of washing the Europeans' clothing in the water-course which is the natural drain of the native town. Malm ions rat-Parturn Fever. At
Chittagong, thirty years ago, and also in Calcutta subsequently, I had in my practice frequent illustrations of the ^act that there, soon after delivery, both European and native women often gel fever, genenlly with arrest of the milk and lochia. At first these symptoms were equally terrifying to the patient and the physician ; but I soon found that no other severe symptoms were developed, and that quinine speedily
restored health. I had many of these cases ; but not one that did badly cr long refused to lie controlled by the specific. I was much interested, in 1S80, by readingf the report of a discussion upon this fever as it occurs in the neighbourhood of New York. Professor Fordyce It is called by Barker " Puerperal Malarious Fever." As in India, it stands quite apart from all the forms of deadly " Puerperal Fever." I prefer my own nomenclature for the Bengal malady. Professor Barker observes that it may occur from twenty-four hours after normal labour up to completion of puerperal recovery. Only one of his seventeen cases was fatal, on the 4.7th day after confinement. He gives half-ounce doses of Warburg's Tincture every four hours until the fever is entirely abated, continuing it, in diminishing doses, until convalescence is perfectly established. He finds it a far more effectual and speedy remedy than the largest doses of quinine. In the discussion which followed the reading of Professor Parker's paper, Dr. Jones, who lives in a malarious district, said that he gives a dose of quinine on the day following confinement. Dr. Lusk considered that it is needful to remove these women from lying-in-hospitals, as puerperal peritonitis and cellulitis begin to appear in other cases. Dr. Barker puts his patients on quinine immediately after confinement, from January to June, and continues it for ten days. Dr. Emmett referred to cases in which there were uterine haemorrhage, sub-involution, cellulitis, &c., in women who hail been living in malarious districts, ar.d which could not be cured except by quinine. Professor Barker does not mention the lochia. Dr. Gillette " " speaks of the purity of the lochial discharges" as a diagnostic point in these cases. In the Bengal disease, as I saw it, the lochial discharge was checked until the fever abated. In 1839, Dr. Duncan Stewart, then of Calcutta, published ?some very important remarks upon the predisposition of pregnant women to fever, and upon the great danger of Bengal fever when occurring late in pregnancy. He shows that it generally happens that, when labour occurs in the course of fever, it is premature. He cites the following striking observation from Twining:?" I hardly deem any part of the ob*
Ittd. Jour, ofMed. ami Phys. Science, vol. iii. /. 117. t Trans, of the Epidemiological Society, 1822-3.3, p. 35. Times and Gazette, March so, 1880, p. 327. Med. { ? Ind. Jour, of Med. and Phys. Sc., vol. iv., p. 587.
211
servations I have
to offer concerning the peculiar nature and of the remittent fever of the rainy season in Uengal of more importance than the caution I have now given respecting the hazard of either bleeding or applying leeches at a late stage of the paroxysm, after the disease has been returning daily above a week, and when the patient is much exhave met I with hausted. several instances where the application of leeches was, from trivial causes, delayed for three after they were ordered, and then put on toor four hours wirds the conclusion of the paroxysm when arterial action was subsiding?the patient being in a state of languor and anxiety, and the skin perspiring freely?and death has been the treatment
consequence. " If," says Dr. Stewart, "such results have followed the loss of a minute quantity cf blood under ordinary circumstances, will it surprise any one that the occurrence of even natural labour at the end of a paroxysm of fever should be matter of more than ordinary anxiety, or that the abstraction of so large the best conmust attend even a portion of blood as ducted delivery should, at such a time, be eminently perilous ?" I have seen grave remittent fever, in Bengal, passed through under quinine, by which a cure was effected some weeks beand fore delivery, with perfect immunity both to mother child, but a more anxious case for the physician it is hardly possible to conceive. Med. Times and Gazette, Mar. 8. The Tubercle Bacillus ; its Diagnostic and ProgValue.?Mackenzie (Ed. Med. Jour., Feb., 1S84), in a paper, distinguished for the conciseness with which he presents results of examination an important series of facts, details the in seventy cases of pulmonary and laryngeal disease. A little were undoubtedly instances of over one half of these cases tuberculous disease, and in all the specific bacilli were present in In the acute cases they were usually from three to the sputum. four times as abundant as in those of chronic course. In laryngeal phthisis the bacilli were usually present in abundance, and taken direct]) from were especially numerous in the muco-pus the larynx by the laryngeal brush. So'marked was this phenomeMackenzie attributes non that great diagnostic value to this mode of examination in doubtful cases of laryngeal inflammation or ulceration. On the other hand, the absence of bacilli in the sputum in suspected cases is at least strong presumptive In evidence against the existence of tuberculous disease. Mackenzie's series of cases bacilli were absent in thirty-three, of which twenty-two were undoubtedly non-tuberculous, and the remainder, although of doubtful character at the time of observation, were proved by their subsequent history not to be cf tubercular origin. Accordingly, he ascribes considerable diagnostic value to the presence or absence of the bacilli in In common doubtful cases, especially in the incipient stages. with other observers, he does not consider that much stress indications afforded should be laid upon the prognostic by the number of bacilli present, since non-febrile cases of slow course of while cases of show an abundance acutc bacilli, may general tuberculosis, in which the lungs arc not greatly affected, few. show very usually nostic
Lurus and its Relation to Tuberculosis.?The controversy over the nature of lupus has been enlivened and in-
fused with a new interest since Koch's discovery of the tubercle bacillus. Friedlander and Volkmann state decidedly that lupus is a local tuberculosis, while Virchow believes it is not. Koch the tubercle bacillus.* regards it as being caused by at his disposal, for lie had placed purposes of examination with regard to the presence of the tubercle bacillus, specimens from seven cases of undoubted lupus. The specimens from four cases consisted of bits of excised skin, and from the other three only the debris resulting from scraping was available. The bits of excised skin could alone be utilized for the purposes of direct microscopical examination. In each one of these four specimens the tubercle bacillus was detected, small in a number of from each preparations although only specimen, and only inside the giant cells. Such is the scarcity of the tubercle bacillus in lupus, that in one instance twentyseven, and in another forty-three sections were examined before It repeatedly happened, that after a the bacillus was detected. number of sections were examined without showing the bacillus a group of successive sections, each containing from was met with. More than one bacillus one to three bacilli, *
page
Mittheilungen 38.
aus
dem
Raiscrlichcu
Gesundheitsamte,
Hand
212
THE INDIAN
1
MEDICAL GAZETTE.
since in any giant cell. From each of the above inoculation of lupus material in the anterior chamber of the eyes of rabbits was made, and tuberculosis of the iris was produced in every instance, resulting in those animals which were allowed to live long enough (not immediately killed) in generalised tuberculosis. From one specimen of lupus the bacillus was calti /ated, and inoculations of this cultivation upon animals were made with success in several instances. was
never
seven
cases
["July
1884-
