« ForrigeFortsett »
not at which he in the
the sclera alone in the palpebral fissure, the ence of contour on the two sides of the neok. size of which has diminished but slightly or On the other hand, when the lines of the planot at all. This is Bell's sign, and it proves tysma stand out markedly on one side, and that the loss of power to close the eye is due on the other side they do not appear at all to an organio nerve-lesion; for this dissocia. or are but slightly marked, we may conclude tion of complete upward movement of the with certainty that there is an organic nerveeye-ball without closure of the eye cannot be lesion that causes the deficienoy on one side; voluntarily or functionally induced. We for this alteration of bilateral simultaneous know without further consideration that there activity of the platysmas cannot be roluntaris an organio element in the case.
ily imitated in the act of forcibly opening the A patient presents the following condi. mouth. In order to prevent any misunder. tions: when the right arm is extended hori. standing, it should be pointed out that unizontally in front of the body, the right scap- lateral contraction of the platsyma is possible ula springs backward very prominently from when the jaws are firmly closed, and that the chest wall, in a manner to suggest a unilateral spasm of this muscle oocurs in wing, while on the other side, in the same some cases of spasmodio wry-neck, and there. movement, the scapula remaios close to the fore it might be imitated voluntarily; but in chest wall. We know immediately that there the presence of such permanent or occasional is paralysis of the right serratus magnus spasmodio contraction of one platysma, if the muscle, due to actual nerve-lesion, because other were not paralyzed it would contraot oontraction of the muscles that elevate and when the mouth were forcibly opened. extend the arm cannot be voluntarily or func The phenomenon just described-contractionally dissociated from contraction of the ture of the platysma on one side with absence serratus magnus.
of contraction of the other, is called the sign When the forearm is forcibly flexed on the of the platysma (Babinski). It is often arm, with prominence of the biceps there is found in organio hemiplegia and unilateral also prominence of the supinator longus facial palsy—and never in hysterio bemi. which forms the firm, rounded contour of the plegia; hence its importance when present as radial side of the forearin. Absence of the an aid in differential diagnosis of these com. prominence of the supinator longus when the mon pathologio states. arm is forcibly flexed proves that there is or. Another sign due to the acute clinical ob. ganio paralysis of that muscle, since in this servations of Babinski, nsually, if not always, act the oontraction of the biceps and supina. indicative of organic hemiplegia, is that tor cannot be voluntarily dissociated (Babin. known as combined flexion of the trunk and ski). Since the supinator is frequently par- thigh. This sign is described by Babinski alyzed with the extensors of the band and fin. as follows: gers, the presence of this peculiarity makes “It is found in the majority of patients it possible to determine the true nature of ex. affected with organio hemiplegia when the tensor paralysis of the band which may be patient lies horizontally on a hard surface like closely imitated by voluntary wrist-drop the floor, with the arms crossed on the chest.
There are also synergic functional associa. and then makes an effort to rise to a sitting tious of corresponding muscles and groups position. The thigh on the paralyzed side of musoles of the two sides of the body, uni. executes a movement of flexion on the pelvis lateral disturbances of which have similar and the beel leaves the floor slightly. On the diagnostic value. A few examples of such opposite side the limb remains immobile or anomalies will emphasize the importance the flexion of the thigh and the elevation of of familiarity with the law of functional the heel ooour later and are very much less synergio association of muscles.
marked than on the side affected with paralyWith the neck and chest exposed, a normal sis; at the same time the shoulder on the subject is made to open the mouth as foroi. normal side is carried forward.” bly and as wide as possible. In this act, if “The movement of combined flexion of the the subject be not too fat, the long fibres of thigh and trunk naturally implies that the the platysma myoides muscle will be seen to limbs are capable of a certain amount of stand out in several lines reaching from the movement; thus, theoretically, it should be lower jaw to the upper portion of the chest, absent when paralysis is complete, and obserand effacing or altering the depressions above vation confirms this. In fact, generally it is the clavicle on each side; and these altera. only some time after the beginning of hemi. tions of the lateral contour of the neck will plegia, when the paralysis is somewhat atten. be practically symmetrical and of equal de- uated, that the phenomenon appears. In the gree. In any event, under normal circum- earliest phase of hemiplegia, since the lack of stances, in this act, whether the platysmas power on the paralyzed side is complete, contract or not, there is no appreciable differ- either the patient is so prostrated that he is not capable of the least effort, or when he tries ing effort will show in more marked elevation to assume a sitting posture he makes a move of the eyebrow. Of course, with practice ment of rotation around the long axis of the these phenomena may be obviated. The exbody toward the paralyzed side; this move. planation of these facts is to be found in the ment seems to me to be the result of the lim. functional relations of the ocular muscles, ited action on one side of the body of the which are yoked together and have an or. muscles which incline the trunk forward.” ganio tendency to act together in the same
In contrast with these positive signs of way; therefore, when the will intervenes to organic nervous disease that form features of prevent this, signs of the automatic involun. paralysis itself, there are others quite as posi. tary tendency are never wanting. tive which form features of some functional 3750 Lindell Boulevard. spasms which simulate paralysis. For example, ptosis, or falling of the eye-lid, may be organic or functional; but functional ptosis is in reality spasmodio or due to vol. untary contraction of the orbicularis of the eye-lids. Falling of the upper eye-lid if due THE HYGIENE AND PREVENTION OF to organio nervous lesion, when the facial
TUBERCULOSIS. * nerve is intact, is always characterized, when tbe patient makes an effort to elevate the lid,
HENRY ALBERT, M. S.. M, D. by elevation of the corresponding eyebrow,
IOWA CITY, IA. and even backward inclination of the head,
Professor of Pathology and Bacteriology, State University of Iowa, College of Medicine : Director of the Iowa
State Board of Health Hygienic Laboratory.
the pupil. This is very apparent in double ptosis, and brought out clearly when the weakness is unilateral, by covering the eye of the unaffected side. Here the elevation of the eyebrow at command to try to open the affected eye is practically demonstrative, like Bell's sign of an organic lesion.
On the other hand, unilateral hysterio or pseudo-ptosis presents a very different pio. ture; the partial or complete closure of one eye is accompanied by lowering of the corresponding eyebrow, and the other eye, like. wise, shows a slight lowering of the upper lid accompanied by elevation of the correspond. ing eyebrow. Such a picture is prcof that the anomaly is functional (hysterio, volun. tary). The truth of this assertion may be readily demonstrated by attention to what takes place when one eye is voluntarily closed and the other is kept open. One may study this act in oneself with a mirror, though better in a normal second person. When one eye is closed and kept closed the eyelid is depressed with contraction of the orbicularis of that eye; the other eye also tends to close, and a forçible effort must be made to keep it open, which results in an initial increase of elevation of the lid which is aided by elevation of the eyebrow. With continuance of this voluntary closure of one eye, the other eye tends more and more to close, and with this the elevation of the corresponding eyebrow is increased to oppose the tendency of the orbicularis to act with its fellow. This fact will be readily apparent to one who be. gins to use a microscope with one eye while closing the other; as the monocular work is continued it will be found increasingly diffi. cult to maintain the eye open and the increas.
We have just listened to a discussion of the causes of consumption and the changes wbich the tissues undergo when affected by this disease process, and we are in a good position to appreciate the importance and the possibility of applying hygienic measures in the stamping out of tbis disease process. Of all diseases common to man, tuberculosis is the most widespread and the most deadly. Other diseases have at times caused more dismay, more panic and for short periods, even wider destruction, but consumption has been the most constant and most pestilental of them all; the worst scourge of mankind. It bas indeed been most properly termed “The Great White Plague.” It spares no nation, no age, no vocation, no class of people.
The following figures may serve to emphasize the importance of considering the subject of tuberculosis. In this country about 1,125,500 people have consumption. It is estimated that the cost of consumption in New York is $1.16 per day per victim. This would mean that consumption is costing the United States $476, 325,000 every year and costing the State of Iowa with its 8,000 consumptives, if the recent estimate made by the Board of Control be correct, $3,387,200 every year.
According to our courts, the value of a human life is placed at $5,000. It is estimated that 150,000 people die from consumption in the Cnited States every year. If we consider the rating of our courts as equitable, tubercu. losis is costing the United States $750,000,
* Read before the second annual meeting of the physicians uary 26, 1906.
of the First Councillor District of Iowa at Fairfield. Ia., Jan
000 a year and the State of Iowa $10,000,000 a year. But you say, that the estimate as to the value of a human life is made too high, not too high when the estimate is made on me, but my neighbor isn't worth quite so much. Let us then make a more conservative estimate. The average age at which con. sumptives die is 35 years. The life expect. ancy of a man of 35 years of age is 32 years. This means that 4,800,000 years of life are lost in the United States by a single year's consumption deatb-list. If we figure that an individual is worth $50 a year to a community, the annual loss to the United States from consumption is $240,000,000, and the the State of Iowa, it is $3,200,000.
How are we to proteot ourselves from tu. berculosis?
Let us first consider measures to avoid the tubercle bacillus. Of prime importance is the subject of
a. Sputum and Expectoration. — The sputum of a consumptive, cougbed up and expectorated, is probably the cause of more than 95% of all cases of tuberculosis. All of us occasionally take cold and phlegm or sputum gathers in the throat. None of us can be absolutely sure that we do not have tuberculosis. Therefore the only safe rule to adopt for all is to stop spitting and expector. ating except into our handkercbiefs, or into vessels provided for that purpose. None of us should ever be guilty of spitting in our homes, or in public places, as public buildings, street cars, railway coaches, etc. If we must expectorate, let us use our bandkerchief or a spittoon (wbich should be frequently cleansed). Let us all join the anti-spitting crusade. Wbat has been said about spitting applies of course with double force to consumptives. If there would be no spit there probably would be no, or very little, tubercu. losis. Every city should bave an antispit. ting ordinance, unless precbance its citizens lead such ideal lives that such an ordinance is unnecessary. I bear some one saying, How, in this land of the free, do you dare to make suggestions that so curb our lib. erty? Let us remember, however, that lib. erty is not license. Liberty has limitations. "A man can say that he has the liberty to swing his arm as far and wide as he pleases. I say, yes, he can swing his arm as far as he pleases, so long as his arm doesn't reach the tip of my nose, or he may find out that the arm of decency and the law can reach the tip of his nose.” Yes, a man can expectorate when and where he pleases, so long as he does'nt expectorate wbere his spu. tum may injure Diy health. Sputum should never be swallowed lest it set up a disease in
the stomach or intestines. When cough. ing, the hand should be held before the mouth. We should turn away from a coughing neighbor.
We should avoid association with tuber. culous individuals, especially if they are of an uncleanly disposition. This does not mean that every consumptive should be de. serted. The consumptive in himself is not necessarily dangerous. He becomes so only by his habits. If he takes the proper care of bis sputum and observes the proper rules of cleanliness, we need bave little fear. The disregard concerning spitting in the past, bas ex. posed every person to the dangers of con. sumption. If all are exposed, why is it that some of us become tuberoular and others do not? Our body when in perfect health is provided with factors which will keep out disease-producing bacteria, and destroy those wbiob occasionally gain entrance before they produce disease. The fleshy frame of every person is some time or other invaded by germs, but unless the soil is favorable, the seed will not grow nor will the plant tbrive. The parable of the sower sets forth in an admirable way tbe story of the disease. The seeds that fall by the wayside are the bacilli that reach our great highways, the air passages and the intestines, in which they are picked up and devoured by the cells and other agents of the budy, representing the birds of the air. The seed that falls on rocky places are the germs that enter the body and pass to the nearest lymph-node by which their activ. ities are checked. They spring up, but having no depth of earth they soon wither away. Those which fall among the thorns are the bacilli which enter the various crgans of the body. The soil is good but the thorns represented by the connective tissue of the system grows up around them and chokes the seed. This represents a ouring of the process. But falling on gcod ground, with conditions fav. orable to growth, the seed springs up, increuses and brings forth fruit, as represented by the sacrifice of human lives, some thirty, some sixty and some a hundred fold. These represent the well marked cases of tuberculosis. A part of the 13th chapter of St. Matthew, slightly modified. “He that hath ears, let him hear." What may we do to maintain that state of health which will suc. cessfully combat the invasion of the germs of consumption, or when entered will remove and destroy them? My answer is, Live up to the best rules of hygiene.
b. We should have plenty of fresh air. Our homes and places of business should be thor. ougby ventilated. We should spend some time in the open air every day, the longer
the better, as a rule. Avoid close, stuffy e. Exercise, especially out of doors rooms, and avoid dust as much as possible, in the open air, is stimulating and invigoratespecially that dust which comes from our ing. It causes the blood to circulate more dwelling places. A study of the distribution actively through every part of the body, and of tuberculosis, indicates that it is present as as it moves through the tissues it brings to a rule in proportion to the housing of indi. them more nourishment and removes the viduals. The Indians of the plains are not tu. waste products. It gives to the tissues more bercular, but bring him into more civilized vigor and with it more resistance to withstand surroundings and he becomes consumptive disease. like the white man. The sorawny, weatherbeaten cattle of the wild west are far less tu..
f. Avoid all excesses. Excesses may destroy bercular than the well housed and well nour.
1 in a few minutes what has been gained in ished stock of our barn-yards. Never permit
years. Our sleep should be regular and of the dust in our homes to be stirred up. The proper length. Eight hours a day is not too feather duster should be abolished, and the
the much for anyone. Intemporance in the use broom should seldom be used in a house.
of alcoholio liquors should be carefully The dust may be removed from furniture by
avoided. Few things reduce the vital resist. means of a piece of cloth slightly dampened
ance more rapidly. with kerosene. Unvarnished wood-ware may
People with a rather weak constitution, esbe cleansed with a cloth moistened with water.
pecially if descended from consumptive If a broom must be used it should be
parents, should seek an out-door occupation. sprinkled with some liquid as kerosene or
Stooped and cramped postures while sitting covered with a piece of cloth which has been
should never be indulged in. moistened. Women should not wear skirts
If these rules of hygiene are carefully cartbat sweep the sidewalk, thereby carrying
ried out the danger of contracting the disinto the house dirt and filth that may pro.
ease become comparatively slight, and if once duce disease. Sunlight should enter wherever
it has been contracted the chances for recov. possible. It kills the germs of disease, and
ery are quite good. Encouraging, too, is that so renders the air more pure. And with the
while all this is being done to fortify the sunshine from the heavens Jet in also a little
system against tuberculosis, it fortifies it suosbine from the soul. Encourage the aga
the against disease of every kind, prepares it to faltering; obeer the discouraged. The pleas. more
1. more effectively discharge the duties of life ant word, the smiling face, the kind act
and overcome the obstacles which more or tells on all our lives.
less beset the path of every one.
These are good instructions you will say, c. Our food should be plain and whole- but what about putting them into practice. some; avoid overeating as well as starvation. Shakespeare in his “Merchant of Venice" Pastries, puddings and too many of the so
causes Portia to say: "If to do were as easy called dainties should seldom if ever be in.
as to know what were as good to do, chapels dulged in. I trust that no one here belongs had been churches, and poor men's cottages to that class called vegetarians. Although it princes' palaces. It is a good divine that is true that most of us eat too much meat, yet follows his own instruction." This statesuch things as eggs, milk and butter with oc.
ment is probably as true now as it was in casionally a piece of good beefsteak are among Shakespeare's time, but why should we not the best things we can use to strengthen our do our best? system. Nor do I believe that there are any
Let us all remember that the cure of tuberhere who fail to eat their breakfast. Eating
oulosis in its early stages is comparatively three times a day, although enough, is not too
es a day, although enough, is not too easy, but once it has advanced to the latter much.
stages, there is little bope for recovery. If d. Our living quarters should not be too you have consumption, follow the golden warm, 60 to 70 deg. F. is sufficient for any rule, “Do unto others as you would that they oue. Overheating causes us to become too should do unto you." Let us see to it that delicate and very susceptible to taking colds. we observe with great care, these rules of hy. Our sleeping room should be more cool, al. giene-proper food, proper clothing, proper though we should be well covered to keep sleep, proper exercise, and moderation in all thoroughly warm. So long as we avoid things, whob are essential to our well being. draughts there is not much danger of taking Let us know that our bomes and public cold. Our clothing should be of such thick buildings are properly heated, thoroughly ness as to keep us comfortably warm. It ventilated and sorupulously cleansed. Let must necessarily vary with the time of year. us ask ourselves to stop spitting and expecWet clothing and wet or cold feet should not torating in our homes and in all public be tolerated.
places. Let us ask our dairymen to keep only
healthy cattle, and to use the utmost care to tines, plainly audible at a distance of twentypreserve the milk which he brings to our five feet. Patient weighed ninety pounds. doors in its original purity and freshness. Through the interpreter I learned she had Let us ask our teachers to inform the pupils been ill for the past six months with periin our public schools concerning the essen- odical vomiting and adominal pains. In the tials of such disease as tuberculosis while last three months patient had been bedridden. teaching them the principle of right living. She has had periodic attacks of diarrhea, Let us beseech our public press, to use their while in the interval of same her stools are weapons to aid in the crusade against con- formed and apparently normal. sumption. Let us request our publio officials On the day of entrance the patient was to pass ordinances and adopt rules aiming at given a saline oatbartio 'that occasioned se. the restriction of this disease process.
vere vomiting and a copious diarrhea. She If all these things are done then the time presented the appearance of extreme sbock by will probably not be far distant wben not only subnormal temperature; cold, clammy perspir. tuberculosis, but many other infectious dis ation and thready, rapid pulse. Stimulants eases will be not only materially diminished and morphia improved the condition and pain number, but entirely disappear. Pasteur tient expressed herself as feeling well again, has truly said, "It is in the power of man to but that she was certain of a recurrence of cause all parasitio diseases to disappear from above, since she had had similar attacks every the face of the earth.”
three days. The vomiting was first stomach contents, later muous, and finally a stercoraceous type. The stools measuring about two
gallons collectively were a pale grayish yel. A CASE OF TUBERCULAR STRICTURE
low in color and composed of mucus and OF THE ILEUM.
pus. No food or other solid particles were found in them, while the odor was very offen.
sive. Microscopic examination showed mucus, JOHN MCHALE DEAN, M. D.
pus cells and coli commun bacilli. During
the above attack, the borberygmus was very WITH PATHOLOGICAL REPORT pronounced as well as the undulatory action
of the intestines. H. P. WELLS, M. D.
Physical examination: Patient pale, ema. A REVIEW of the literature on the subject ciated, skin delicate and fine, the temporal and of tubercular stricture of the bowel will con- superficial veins are plainly visible through vince surgeons that this subject has been it, expression bright but anxious; hair flaxen definitely neglected and they will appreciate and eyebrows long and ourved. Bony prommy incentive to report the following case from inences and tuberosities could be clearly my practice, which is interesting in itself, but studied as the adipose and muscular tissue doubly so because it illustrates a class of were extremely wasted. No enlarged glands cases of which but few are recorded.
palpable except in the inguinal regions where The patient had only recently arrived in a fine chain of small glands could be feli. this cuuntry from Italy, and could, unfortu. Chest parrow, and the fifth left intercostal nately, converse only in the Italian language. space shows the pulsation of heart in normal I was, therefore, compelled to arrive at a his. location. Lungs showed no abnormality either tory through the mediation of an interpreter by auscultation, palpation or percussion, of limited ability. The patient. H. G., was Respiratory sounds consequent to patient's twenty-one years of age; height five feet four debility were feeble. Heart rapid, no murinches; extremely emaciated and very ane. murs elicited and sounds clear and distinct. mic. Previous history showed merely the Peroussion showed normal cardiac area. Res. diseases of childhood-pertussis, measles, etc. piration costo-abdominal. Pulse varied beFamily history: Fatber and inother living tween 100 and 120, and temperature showed and enjoying good health. No history of tu. evening exacerbations from 99.4 to 100 deg. berculosis in her immediate family, except a The spleen normal. younger sister at present suffering from a Blood diminshed red corpuscles and marked well-defined case of cervical tubercular aden- leucocytosis, hemoglobin 50 per cent (Gower). itis. Patient being a daughter of poor parents, Urinalysis: Specific gravity 1012; acid; tbe hygienio surroundings in whion she was faint trace of albumen; no sugar; chlorides compelled to live were extremely poor.
diminished; urea diminished; no bile; Present history: On entrance to the hospi. marked increase in indican. tal the patient complained of vomiting and Microscopic examination negative. colicky pains in the umbilical region. She T he abdomen presented an irregular out. called attention to the noises in the intes. line. Coils of intestines from left to right