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The paper on “The Water Supply of New Orleans and Its Improvement” was both particular and comprehensive of the peculiarities of the locality with relation to the river and other circumstances and external conditions, rainfall and sources of impurity; the past with regard to cisterns and wells; the present undertaking for the supply and systems of purification, with the conclusion "that the present water supply of New Orleans is neither satisfactory nor abundant, and that sufficient data have been collected during the investigation to allow a system of water purification to be designed which will efficiently and economically purify the Mississippi River at New Orleans. Furthermore, the available evidence shows that the American system of purification is best adapted to local conditions, on account of its low first cost, coupled with adequate efficiency."
Fourth and last day's session was almost wholly devoted to the routine of winding up business and the election of officers for the ensuing year. An animated discussion arose in regard to bubonic plague in San Francisco, but without any practical remedy. Resolutions were adopted favoring a sanitary exhibit at the exposition to take place in St. Louis in 1904; asking that control of illuminating gas be placed in the hands of municipal authorities; asking that railroad and steamship companies be compelled to furnish pure drinking water, and several memorial resolutions.
Officers elected for 1903 were as follows:
President-Walter Wyman, Surgeon-General of the United States Public Health and Marine Hospital Service, Washington, D. C.
First Vice-President-Dr. C. P. Wilkinson, of New Orleans. Second Vice-President-Dr. John L. Leal, of Paterson, N. J. Treasurer-Dr. W. F. Wright, of New Haven, Conn. Secretary-Dr. C. O. Probst, of Columbus, Ohio.
To Fill Vacancies on Executive Committee—Dr. John S. Fulton, of Baltimore, Md.; Dr. John A. Amyot, of Toronto, Can.; Dr. Jose Ramirez, of Mexico.
Place of Meeting in 1903—Washington, D. C.
DISINFECTION OF THE URINE IN TYPHOID FEVER.
If a physician were to neglect disinfection by some simple, recognized method of the stools in typhoid fever, he would be held blamable, and justly so. If he were to omit cautioning the con
sumptive in regard to the dangerously infectious character of the sputum, he would be regarded as careless and negligent. Again, if the physician were to permit his scarlet fever patients to run about in the neighborhood before desquamation is completed, it would spread consternation through the community and the general condemnation of such action would not be slow in making itself effectively heard.
Numerous other instances could be mentioned of equally glaring sins of omission and commission in the preventive treatment of infectious diseases against which the general professional conscience would protest. How is it in the case of the urine in typhoid fever? It is demonstrated beyond doubt that in a considerable percentage of the patients suffering with typhoid fever, typhoid bacilli occur in that urine in large quantities, frequently so numerously that the urine is rendered turbid on that account alone. It is furthermore known that typhoid bacilli may persist in the urine for months and even years after an attack of typhoid fever, such persons being in reality perambulating disseminators of bacilli, which are deposited wherever urine falls. In this way, unless precautions are taken, the cause of typhoid fever may be perpetuated locally and new foci of disease started as the bacillophorous urine finds its way into the sources of water supply. With the springing up of brisk endemics of typhoid here and there the question arises, are physicians using proper precautions in regard to the urine of their typhoid patients? Has the proper care of the urine become a matter of definite routine as is the case with the stools? Probably much more ought to be done than is being done. Certainly a convalescent typhoid patient should not be allowed to leave the hospital or be discharged from supervision before the condition of the urine as to the absence or presence of typhoid bacilli has been established. This would require a bacteriological examination of the urine, at least in many cases, and this the vast majority of private practitioners are unable to do as thoroughly as modern sanitary ideas require. In the case of hospitals, however, such examination ought to be a matter of routine. We are in need of further reports concerning the presence and persistence of typhoid bacilli in urine after attacks of typhoid fever. Careful observations should be made with the view to the establishment of easily practicable methods by means of which the practitioner can determine for himself the condition of the urine of his typhoid patients. In the meantime, it is our plain duty to do all in our power to prevent the spread of typhoid fever by the urine. Much may be done by the systematic use of reliable urinary disinfectants, such as urotropin, which should be administered for a reasonable time to every typhoid convalescent. Patients should be informed of the fact that their urine may be dangerous. No doubt some of them would feel the responsibility thus placed on them and exercise a certain degree of care. · This is another striking example of the direct and real value of bacteriological laboratory methods applied to practical medicine. As the matter now stands it is quite clear that practitioners of medicine, in order to do their full duty in this matter of typhoid fever, must possess or control sufficient bacteriologic skill and apparatus to determine whether or not the urine of their typhoid patients is free from typhoid bacilli before returning to their usual modes of life.-"Journal American Medical Association.”
THE DANGERS OF POPULAR SPORT. The serious and sometimes fatal accidents that occur in popular games are eminently suggestive of greater care by enthusiasts who thus expose themselves to dangerous or fatal injuries. :
Lawn-tennis is not a very dangerous game, but accidents do occur more frequently, perhaps, as played in Europe than in this country.
These accidents have never been described until very recently; they have been brought to the attention of the medical profession by Dr. Clado, whose history has been published in extenso in “Le Progrès Médical,” of November 1, 1902, in its “Clinique Chirurgicale." . . . .
Tennis-arm.—The players of lawn-tennis have given this name to an injury of the arm which oceurs under two different forms; the first as a fatigue, an exhaustion of the muscles of the arm; the second as a material lesion, located in the neighborhood of the elbow of the right arm. The first form is found in players who force the muscles of the arm and shoulder excessively; the second is found more rarely and in conditions extremely well .defined. . .. in fi .' -i ... ......
Through the kindness of one of the ablest players in France, the doctor says: "I have been able to collect twelve cases that have enabled me to describe this form of disease."
The affection is characterized by a sudden pain, located at the external part of the elbow, and above the line of articulation, producing a functional loss of power of the superior part of the right arm, at least for all movements that require a certain amount of muscular strength.
The etiological conditions that give rise to tennis-arm may be easily determined. It is the result of quick and violent movements, causing functional loss of power at the same time or as some extraordinary effort is made in order to gain a definite point. In either of these efforts the violence of the muscular contraction appears to be the immediate cause of the injury.
Players having well-developed muscles are more disposed to an attack of this kind than those of more feeble development. Another important fact to be noted is that strong and well-trained players are more susceptible to an attack than poor players or beginners. Besides, female players are entirely exempt, at least I do not know of a single case. The etiology of tennis-arm may be stated in a few words; it is confined almost exclusively to men, at least I do not know of a single female player who has suffered from it. It always attacks the strong and practiced players, and begins with a violent contraction of the arm.
Three symptoms mark the existence of tennis-arm: First, pain; second, want of power in the arm; third, swelling. The first two of these are always present; the third not very frequently. Pain is the invariable and characteristic symptom of the disease. It comes on suddenly and in consequence of a violent movement of the muscles of the arm. It is characterized by a sensation as of a sudden rupture, which the player compares with that of a violent tearing at the external part of the elbow. The arm falls as if paralyzed. The injury is found to be located along the external lateral ligament of the elbow, not far from the insertion of the supinator brevis muscle.
Swelling is not constant; I have found it in ten cases, present in four; it disappears in from three to eight days. Functional loss of power is a constant symptom. In about half the cases the arm falls as if paralyzed.
The Diagnosis of tennis-arm rests on the presence of three indications. The first indication that offers—and it forms the diagnosis in the greater number of the players who have suffered
is an almost complete loss of power of the muscles of the forearm. The duration of the paralysis varies from two to eight days, and at the end the player may generally resume his practice. In four cases, however, it lasted six months, and in one case a year. In general, active play should not be resumed before the lapse of some months.
Pathogenic Conditions.—There are two ways of returning the ball to the adversary; first, in meeting the ball from above, raquette haute; second, in meeting it from below, raquette basse. The first never causes tennis-arm. This method constitutes a bad or indifferent player. Ladies employ it almost exclusively. The hand holding the raquette is raised as high as the head, the raquette inclined backwards strikes the ball and returns it in a curved line; the muscular effort is moderate, the only strain is on the shoulder. In the second the raquette receives the ball in its course or after it has rebounded, striking it from under and returning it with great violence immediately above the filet, giving it a course as direct as possible, intending that on the side of the opponent it does not rebound from the ground.
(The movements necessary for the skillful returning of the ball are described in detail; they are quite complicated.)
Its COURSE depends on the prudence of the player; if he stops play immediately and takes necessary rest, recovery may be complete within a month. Relapses are frequent.
PROGNOSIS is generally favorable. As all movements are possible, except that which caused the injury, the only permanent result is the necessity of abandoning lawn-tennis.
TREATMENT consists in necessary rest; massage, occasionally the application of a bandage from the wrist to the elbow. None of the severer applications used in surgery are necessary.
FOOTBALL.—A Kentucky clergyman declares that football is worse than prize-fighting, because more men have been killed on the football field in this single season than have died as a result of injuries received in the prize-ring in all the years since such fighting began in this country. Another clergyman, out in Chicago, says that the spectators who thrill with joyful excitement as they watch the gridiron battles are little less bloodthirsty than the wicked Romans who crowded the gladiatorial shows, and with their cruel thumbs signaled death for the vanquished. That football has come to be a disquietingly strenuous game is beyond ques