« ForrigeFortsett »
may be absent and the fever may not be rapid advances of the disease are pathog. marked until after the patient has become nomcnic. The early recognition of tbe dis. overwhelmed with the septic ptomaines. The ease is quite essential to its successful treat. pulse, which at first is not much quickened, ment. Death is the usual result in from 70 increases in rapidity and decreases in volume to 80 per cent of all patients so afflicted, and as the fover rises; the respirations are shallow more than 90 per cent of those who do not and rapid; the urine shows an increasing die are compelled to undergo bigh amputa. amount of albumin, nausea and vomiting sets tion of the affected limbs to save life. Sta. in, the patient has a very anxious expression tistics on this form of the disease are scarce. of countenance, his face becomes pale, he C. P. Gildersleeve (Medical Record, March grows very restless, delirium appears, and in 4, 1899) reports a series of sixteen cases in short he has all the symptoms of acute viru. which the bacillus aerogenes capsulatus was lent sepsis. Pain in the injured part is fre. found; there were twelve deaths, a mortality quently not severe at first, but as the disease of 75 per cent. This may be considered an advances and the affected part becomes more average mortality in this frightful malady, and more edematous, it increases and becomes even since the time of antiseptics, since quite excruciating. Soon after receiving the which time the disease is not so frequent as injury a slight edema appoars, and the skin formerly; therefore, prophylaxis by means of cbanges its color to a dusky brown hue, thorough surgical cleanliness is the first in. somewhat the color of a rind of bacon, due dication in treatment. All authors advise to the extravasated hemoglobin, and there are prompt and high amputations above the edestreaks of a dark greenish yellow color extend. matous zone as soon as the disease is recog. ing up the limb. The rapidity with which nized; the arm should be taken off at or these obanges takes place is a marked charac. near the shoulder joint and the lower extrem. teristic of this disease; it travels hour by ity bigh up in the thigh. We should always hour and within a day or two from its onset go high enough, if possible, to avoid tissues bas involved the whole limb. The swelling that are swollen and filled with the greenish inoreases rapidly and blebs or bullae filled brown serum above alluded to. No sutures with a dark straw colored fluid form beneath whatever should be put in the flaps, which the epidermis, and the superficial veins of the are to be left wide open to be dressed at fre. limb, especially those on the inner side, stand quent intervals with hot antiseptic (prefera. out in bold relief, showing a very distinct bly bichloride) solutions until the soft tis. and irregular smoky greenish color of the sues become bealthy. It is needless to state skin between them; gaseous emphysema that such operations sbould be done with caused by putrefactive bacteria appears and dispatch, and everything done to sustain the gives a crackling feeling to the tissues be patient already overwhelmed with septic pto. neath tbe skin; putrefaction advances rapid.. maines. Dr. Van Buren Knott (Jour. A. ly along the lymphatics, the tendon sheathes M. A., April 11, 1903) practices somewhat a the connective tissue spaces and beneath the novel procedure in these cases; he estimates fasoiae, and if not promptly arrested by as nearly as possible the line between the high amputation these chemical poisons get healthy and diseased tissues, and after thor. into the patient's general circulation, and he ougbly cleansing the limb and wrapping the soon dies from the invasion of the septic gangrenous parts in sterile towels, amputates ptomaines.
: circulary all the soft tissues and bone at the In this form of gangrene, nature seems to same level, taking particular care to ligate be utterly unable to cope with the invading every bleeding vessel without including any poison, therefore no line of demarcation is perivascular tissue in the bite of the forceps perceivable, and to wait for its appearance is or ligature. The wound is left absolutely to invite death. The wound is usually of an open-not using a single suture-and dressed asben gray indolent appearance with no ten- with gauze saturated in hot saline solution, depoy to heal, and if the limb be cut into a which dressings are changed from two to four greenish purulent serum, with no tendency times a day. After a week or ten days if to localization comes from every direction. the wound is clean, and the patient's condi. It is a mistake to think that gangrenous parts tion is good the flaps, already outlined, are do not bleed freely when incised.
dissected up, the remaining soft tissues out, The diagnosis of this form of gangrene and the bone sawed off at the proper level. is usually not very hard to make, especially The advantages claimed for this procedure in its advanced stages. Some or all of the are that the gangrenous tissues are speedily above symptoms outlined are easily recog. removed from the enfeebled patient rapidly nized; the orackling of the skin on palpation, and with little shook, free drainage is prothe dusky brown bue to the integument with vided, allowing an interval in which to no line of demarcation apparent, and the build up the patient, and the limb is ampu
tated at the lowest point consistent with tion was given intravenously just at the close safety. I have never tried this method, but of the operation; patient's condition was so it seems rational and worthy of considera bad he died at 6:00 p.m., just forty-five hours tion. In a few early cases in which the in. after his admission to the hospital, and six fection is limited free incisions of the afflicted hours after operation. part and afterwards keeping the limb in a continuous hot boric acid or saline, both
CASE II.-W. M. D., male, age 47, a rail. may arrest the disease; but we should be al.
road brakeman, fell from the top of a boxways on the lookout and ready to amputate
car on June 30, 1904, about 11 o'clock p.m., promptly. A few hours delay in this form
and sustained a compound fracture of the
left radius, near the wrist. He was admitted of gangrene may mean the loss of a life. After operation, we should, of course, be very
to St. Vincent's Hospital at 6 o'clook careful to stimulate the patient with alcohol
next morning, July 1st; put under obloroand strychnine, provide good nourishment
form, wound examined and as thoroughly
cleansed as possible, and dressed antisepti. as soon as he is able to take it, and above all see that the stump of the limb is dressed
cally on a splint. The circulation in the often so as to keep it clean and provide as
hand was good and he did rery well until
the fifth day, when evidences of sepsis set in free drainage as possible. My two cases were
about the band, wbich was freely incised are follows:
and dressed in hot bichloride gauze; on the CASE I.-W. P., male, age 35, foreman of
morning of the sixth day the hand looked a a railroad construction gang, on March 29,
little better, but during the next twenty-four 1904, dropped a pistol from his pocket, and
hours bis pulse ran up to 116 and the temthe fall caused the weapon to explode, the
perature to 104 deg. F. The skin on the ball entering the fleshy part of the calf of
arm now began to show the dusky brown the right leg on the inner side four inches
color which was spreading rapidly toward below the knee, passing through the limb
the shoulder, crepitation in the cellular tis. bebind the bones which were not injured,
sues could be felt, tbe patient was flighty, and coming out two inches bigber on the
and gangrene was evident. I advised im. outer surface. The patient, not believing
mediate amputation, but patient's wife dethat his injuries were dangerous, remanied
sired to wait until her family physician, Dr. in his car out on the road two days and con.
John A. Moore, could see her husband. The tinued to superintend the work from his
consultation was held four bours later, dur. bunk; at the end of that time he came to
ing which time patient had grown rapidly St. Vincent's Hospital and was admitted at
worse, and at 1 p. m., July 7, 1904, I ampu. 9 p.m., on March 31.
tated the arm near the shoulder. Patient His condition was fairly.good with a tem.
was under the ether just fifteen minutes and perature of 99 deg. and a pulse of 96. The
1000 c.c. of hot normal salt solution was wounds of entrance and exit looked healthy,
given subcutaneously during the operation. the circulation in the part was good, there
The stump was left wide open, and dressed was very little swelling of the limb, but pa
with hot biobloride gauze, which was tient complained of great pain in the leg. His
obanged twice daily for ten days. His con. injuries were dressed antiseptically and pa.
dition was very precarious for two or three tient put to bed with instructions to nigbt
days after which he began to show some nurse to give a quarter of a grain of mor.
signs of improvement. About this time a phine hypodermically to ease pain. He had
large pectoral abscess, caused from the salt a fairly good night, but next morning the
solution, developed and complicated matters limb was more swollen and circulation was
considerably, this was opened with cocaine not so good, pulse and temperature about
anesthesia, and after a long and stormy con. same as evening before. Hot applications
valescence he made a good recovery.
2218 7th avenue. were applied and frequently changed for the next twenty-four hours, at the end of which time the pain had increased, pulse gone NASAL PAPILLOMA.—Stenosis is generally to 120 and temperature to 102 deg. F., and moderate, the discharge slight and hemormarked gangrene had made its appearance. rhage occasional. The disease appears as I advised immediate amputation. Patient's small, warty growths, near the margin of mother declined this until her family phy. the nostril. When farther back (always sician, Dr. E. M. Robinson, saw him. It arising from lower turbinate), they are was three hours before the consultation was larger, softer and somewhat pendulous, with held, at the end of which the thigh was am. a bright pink, raspberry surface. One putated rapidly at the junction of the middle should remove the swelling with a cold wire and upper third; 1000°c.o. of hot saline solu. snare, then cauterize with the galvanocautery, TUBERCULOSIS, SOCIALLY AND FINAN- plagues and pestilences were expressions of a CIALLY.*
merciful provision on the part of Providence
to lessen the burthen of the poor man's fam. C. A. BOICE, M. D.
ily, and that it was impious and profane to
wrest from the hands of the Almighty these WASHINGTON, IA.
divine dispensations." There are some be. We are told the story of a gentleman wbo lievers in that old superstition living yet. while traveling in Turkey, made inquiries of
Lord · Beaconsfield said that “the public his guide concerning the population and in- beant
health is the foundation upon which reposes dustries of the various cities through which tbe happiness of the people and the power of they passed. The guide informed him that the state, and that the first duty of the states. it was difficult to answer bis questions, and man is tbe care of the public health.” We that the knowledge was useless any way. are only sorry that our present day statesmen
The proper study of the ravages of the do not see their first duty in the proper light. great white plague necessitates very much
Ten per cent of our total death-rate is due work in the collection of statistics. The to tubercular diseases. work is difficult, but it is by no means use
Consumption is the most feared, the most less. It is invaluable.
prevalent, the most fatal of diseases. Other During the past summer we have wit.
diseases have caused more dismay, more panic nessed the general excitement wbich always and occasionally, for short periods, even prevails when a virulent epidemic visits our more destruction, but consumption has been country. A few hundred cases of yellow
the most constant and the most pestilential fever occurred in a Southern state, with a few of all, the worst scourge of mankind.” score deaths. The whole country was intense.
Every community has many cases, rare is ly interested, some men in official position the family which is not directly interested. lost much valuable time in jealous wrangling
No age, nor race, no condition in life or lo. when they should bave stood sboulder to cation of home is exempt. shoulder against the "yellow peril.”
“The continued activity of the prevalence Yellow fever is but an occasional visitor to of this disease is a reflection on the civilizaour country, and its ravages extend over but tion in which we live.” a limited area; wbile consumption is present
Men show a greater mortality rate tban do at all times and in all places.
women, 10.7% of all deaths in men are due to Consumption is carrying away to an un.
tuberculosis, 10.3% in women. The greatest timely grave in this country every year
mortality among men occurs between the ages 110,000 victims, 3,000 every twenty-four
of twenty-five and thirty-four. Thirty-three hours, two every minute, and no very great
per cent of all deaths in men between the exoitement prevails. Why?
ages of twenty and thirty are from preventa. ble diseases. Women show the greatest mor
tality rate between the ages of fifteen and Her strokes are sure, but her advances slow, No loud alarms, no fierce assaults are shown,
Tuberculosis of bones and joints and of That we may know how and when to act, the glandular system occurs with greatest we must learn the social and financial impor. frequency in childhcod - during the milk tance of the captain of the men of death. period of life. The great prevalence of these
The struggle with tuberculosis is intensely forms of tuberculosis at this time of life calls bound up with the solutions of the most for a more careful and thorough study of the complex economic problems, and no plans disease as it occurs in the source of our meat will be complete which do not bave for their and milk supply basis the material and moral improvement of Tuberculosis is widespread among all the the people. The struggle with tuberculosis lower animals—cattle, hogs, horses, chicken, demands the mobilization of the social forces and all wild animals in captivity are affected. -public and private, ocial and voluntary; Of the domesticated animals, those which are and the man behind the gun is the general the basis of our food supply show the great. practitioner who sball, lead and guide and est predisposition. In some countries (Dendirect in the universal campaign.
mark, Belgium, Germany, England) 2 or 3 Osler says that it is not necessary to awak per cent of the hogs, 25 to 33 per cent of the en the public. The public is already awake beef cattle and 50% of the milch cattle and, sitting on the edge of the bed, awaiting are tubercnlar. In the United States further orders.
as a whole, the percent of milch cows An old beathen superstition, "That
affected is about five (Minnesota 7%), but
when left to itself, the disease inoreases so * Read before the Henry County (Iowa) Medical Society, August 10, 1905.
rapidly that it is not an unusual thing to
"Whilst meagre phthisis gives a silent blow,
She starves the fortress first, then takes the town.'
find milob herds where from 50 to 90 per are scavengers. Very rarely is the muscular cent are tubercular.
tissue the seat of this disease. In the interval between 1895 and 1901, the Cattle usually show the infection in the Bureau of Animal Industry examined the lungs, glandular system and udder; hence, carcasses of 30,000,000 beef cattle and of the spreading of the disease through the 120,000,000 hogs. In 1895 the condemnation meat and milk is inevitable. of cattle carcasses for tuberculosis was 407,4 It is a question which deserves far greater per million; in 1901 this bad increased to attention iban it is receiving. 1285.6 per million, a gain of over 300%. In In 1900 the average age of all dying (ex1896 the condemnation of hog carcasses was cept those under fifteen) was 52.8 years; of 29.5 per million; in 1901 the number bad those dying froid consumption the average arisen to 352.8 per million, an increase of over age at death was 37.4 years. At this age 1200%. Some portion of this increase is un. the normal after-life time is thirty-two years, doubtedly due to a more careful inspection, so that the real loss of life covered-measbat the fact remains that tuberculosis among ured in time—is represented by 3,520,000 our domestio animals is on the increase, and years annually. at a very rapid rate.
Death is most common in young men and In 1901, at the Chicago stock yards, 4,000 women at ages when they are just beginning bog carcasses were condemned; in 1904 the to repay the commonwealth the expenses of number was 14,000. Ninety per cent of these education. Again, tuberculosis is more fatal diseased hogs came from the dairy districts
among married people than single, seeming of Iowa, Minnesota and Wisconsin. These to bear out the statement of Robert Louis hogs were fattened on the buttermilk from Stevenson, "that marriage is a field of battle the creameries. Iowa bas 600 creameries and not a bed of roses."
In Massachusetts, from 1856 to 1895, the The mortality from tuberculosis is, there. deaths from tuberculosis (other than pulmon. fore, a problem compared with which all ary) have increased 36%, while the general other social problems of a medical character mortality from consumption has decreased sink into insignificance; and it is safe to 45%. This means that the disease is on the say that the possible prevention of a large increase in those animals wbich serve as the portion of the mortality of this disease is basis of our food supply, and that unless more
justly deserving of the solicitude, the active care is exercised in the selection and care of
personal interest and liberal pecuniary supour dairy berds our boasted sanitary measures port of all who have the real welfare of the will come to naugbt.
people at heart. That it is possible to contract tuberculosis from the milk and meat of diseased animals, Race. The influence of race on any social there can be no doubt. Clinical evidence is phenomenon is hopelessly obscured by the overwhelming in support of the contention. historioil accidents of conquest and migra
In Michigan, where vital statistics are re- tion. We almost feel the truth of the say. liable, in children under five years of ageing, we need not deny that blood tells, but there averaged from 1885 to 1897, 104.3 deaths we must not be prematurely certain that we from tuberculosis not affecting the lungs to can hear what it tells, or that we can distin. every 100 deaths from the pulmonary form. guish the voice of the particular blood that In the period from 1898 to 1900 the ratio bad speaks.” increased to 263.3 to 100. Why this tremend. The registration area of the United States ous increase in the mortality from other includes 38% of the population, and the reforms of tuberculosis as compared with con. ports collected therefrom are a fair repre. sumption at what has well been called the sentation for the whole country. milk-drinking age of life?
Statistics show that the colored races (Afri. A recent epidemic of sickness among the cans, Indians, Chinese and Japanese) bave a students of the U. S. Naval Academy caused general mortality rate of 70% in excess of an investigation of the milk supply to be that for the white race; while the made, with the result that thirty-six out of mortality exceeds that of the whites by over the herd of sixty-two milch cows were found 300%. These colored races show great ten. to be tubercular. One tubercular animal in dencies to crowd together in dirty tenements. a herd is like a rotten apple in a barrel of The ignorance and carelessness of such peogood ones—it is not long until the entire ples provides an ever ready field for the inherd is diseased, then if some of the animals fecting organisms. The death rate among be sold, the infection is carried to other white children (under fifteen years of age) is berds.
31.8 per 100,000; among colored children the Tuberculosis affects hogs almost exclu. rate is 246 per 100,000. Total colored mor. sively through the intestinal tract, hogs tality rate (ages fifteen to forty-four) is 587.4
per 100,000. Next come the Irish with a The following facts must be told again and. rate of 428 per 100,000. Their well known again: habits of overcrowding, carelessness of living, °1. Tuberculosis is infectious. intem perance and poverty.render them very 2 Tuberculosis is preventable. liable to disease. In city tenements the death 3. Tuberculosis is curable in from 80 to rate is lowest among that class of population 90% of the cases when diagnosed early and which is least addicted to drunkenness. In treated correctly. temperance more than trebles the liability. The treatment of tuberculosis has for its to tuberculosis.
basic principle, rest, food and fresh air, all Occupation.— A list has been compiled of
other lines of treatment are but supplemen
tary to these. fifty-three different occupations. Marble and stone-cutters head the list with a rate of Financial Importance.—Maryland statis510.5 per 100,000 engaged in that work. ticians estimate the average individual loss for Tobacco workers hold second place, physi. every wage earning male dying with tubercucians and surgeons rank fortieth, with a losis at $741.64; and the potential loss to rate of 168.8; clergymen rank Sftieth and the community for such death at $8512.52. bankers fifty-third-the healthiest of all, Dr. Homer Thomas, of Chicago, has esti. 42.8 per 100,000.
mated as follows for Illinois: Money loss in Condition in Iowa.-Iowa is essentially
education of those who die before the age of an agricultural or rural community. We
twenty, $1,187,800; loss from inability to have only one city with a population in ex
perform manual labor on the part of those cess of 50,000. Only 16.8% of our people
sick, $30,000,000; loss in savings of those live in cities of over 8,000 inhabitants. Men
wbo die before the end of the producing age, constitute 51.8% of the city population. We
N. $5,139,000; and cost of sickness, $225,000, a have no crowded tenements; no filthy breed.
total for the state of $36,551,000 a year. Illi. ing places of epidemios. Our population is
is nois has about 7,000 deaths in a population 2, 231,853, and we have tuberculosis-lots of
of almost 5,000,000.
Iowa's death rate of 2,000 is two-sevenths The Board of Control, from fairly reliable
that of Illinois. At the same ratio, our statistics, credits the state with 10,000 cases
annual loss for this leader of the preventable, of tuberculosis and a yearly mortality of
and therefore unnecessary, diseases is about 2,000. Iowa's mortality rate from this
$10,443, 142. ope disease is 7.05% of all deaths. Forty
For the United States in the same propor. three of the states exceed us, and we exceed
tion, the arerage yearly contribution to ignor. five-Idaho, Wyoming, Indian Territory,
ance and slothfulness totals the enormous New Mexico and Utah. California leads the
sum of $574,385,420; nearly $8.00 for every Union with a rate of 15.46%
man, woman and child; more than one-half The average length of life after the onset
the value of the entire corn crop, $952, 868,of the disease is two and one-half years. .
000. We certainly have cause for congratulating Signs of Progress.- Massachusetts, New ourselves, not for anything which we have York, Pennsylvania, Indiana, Illinois, New done, but for our natural advantanges, but we Hampshire and Iowa have State Societies for bave room for improvement.
the Study and Prevention of Tuberculosis. Pasteur said that "It is in the power of These societies will accomplish great good man to cause all parasitic diseases to disap- in the systematic study of the disease as it is, pear from the world.”
and in the scientific presentation of the In New York City very reliable statistics learned facts. have been kept since 1885. At that time. The working rule of the average statesman the annual tuberculosis mortality was would seem to have been, “millions for tri. 8,000. The mortality remains the same while bute, but not one cent for defense," but with the population bas doubled in the past the information gathered by these societies twenty years. Preventive measures are sav. we have no doubt but that Daniel Webster's ing for that city 8,000 lives yearly, still the famous remark will find a more widespread city is losing $23,000,000 annually on ac- application. count of the plague. Mortality from con- Masaschusetts and Pennsylvania now have sumption decreased 46% from 1800 to 1900. State sanatoria, and without doubt Iowu and
“We must care for the consumptive in the Illinois will soon be in line. right place, in the right way, and at the right These states have found that the money extime until he is cured; instead of as now, in pended for sanatoria bas been returned many the wrong place, in the wrong way, and at the fold, in increased health and happiness of the wrong time until he is dead.'