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Infectious inflammations of the spine followed attacks of the infectious diseases of childhood. He gave histories of two cases in which wryneck, not differing from that of vertebral caries, had disappeared without sequel after treatment by the application of a brace with a chin-piece.
Dr. Sayre had seen only one case of gonorrheal disease of the spine. The history was clear, and there were pain and disability of the spine, a slight kyphosis, and stiffness in the other joints. He had seen a few cases in which erosion by an aneurism with marked kyphosis had been confounded with Potts' disease. Cases were on record in which suspension for the reduction of the kyphosis had been followed by rupture of the aneurismal sac and death.
The President said that several such cases had come under his observation which had been supposed to be tubercular disease of the spinę. In one the patient suddenly fell back in bed and expired.
Dr. Myers said that traumatic inflammation of the spine was seen in adults more often than in children, and was usually the result of considerable violence. The kyphosis was not often significant. An abscess sometimes followed, and the symptoms might include pain in the spine, not anteriorly, great disability, muscular twitching, and exaggerated knee reflex. The prognosis was good except in severe injuries. Fracture should be carefully protected and for a long time.
Dr. Lloyd said that the violence might cause tearing of the muscles and possibly an infected inflammatory area with rigidity but without kyphosis. There might be paralysis below the point of injury with rectal and vesical symptoms, and in some cases an abscess, with finally good recovery. In other cases a greater degree of violence produced partial dislocation or fracture, with or without kyphosis. In these cases the crepitus was especially important, as symptoms of compression of the cord might not appear till two or three weeks after the injury.
Dr. G. R. Elliott said that when we had a distinct lesion of the spine, such as fracture of the vertebræ, laceration of the ligaments, extra-dural hemorrhage, the cord itself escaping, together with clearly demonstrable objective signs such as possible bony changes, muscular atrophy, some motor paralysis, and distinct electrical degenerative reactions, we had a conditiou far from common, and one very much more valuable in a medico-legal sense than the neurotic symptom called railway spine, which, when standing alone and unsupported by objective signs, admits of endless neurological speculation.
The President recalled the case of a woman who had been shot in the mouth with a blank cartridge. Stiffness of the neck and spinal paralysis developed, and the autopsy showed suppuration running down the cervical vertebræ beneath the periosteum and into the inter-vertebral foramina with a secondary inflammation of the cord. Also the case of a boy who had been kicked over the sacrum and who was suffering from what was supposed to be spinal meningitis. An autopsy showed necrosis of a portion of the inner surface of the sacrum with exudate outside of the dura mater but running along the roots of the nerves, and also an inflammation with exudate intra-dural and subarachnoid.
Dr. Townsend said that instances of non-tubercular inflammation of the spine were extremely rare in comparison with the vast number of tubercular cases which came under observation and treatment.
Dr. A. B. Judson said that when a patient complained of spinal pain and spinal disability, the first thought was to exclude Potts' disease. It was strange that these symptoms were not found in a condition so closely simulating fracture or the worst type of traumatism. On the other hand, in the non-tubercular inflammations as a rule spinal disability and pain were early and prominent symptoins, marking a frank and sometimes alarming onset, very different from the long-continued and insidious approach of vertebral caries.
Dr. Gibney said that we were not apt to look for tuberculous diseases of the spine in adults, while they were very frequent in children.
The President said that the possibility of making a mistake should be borne in mind, for instance in an injury occurring in a man who was both tubercular and syphilitic. The only way was to go over all the points of each disease and exclude as many as possible, not forgetting that two diseases might be present in the same patient.
Dr. Myers said that if a patient were curable within a year the diagnosis of tuberculous spondylitis should be reconsidered. From a medico-legal standpoint it was important to remember that a considerable number of chronic and increasing kyphoses were not tubercular in their origin, and that such disabilities should not be rated so high in awarding damages as those which were tubercular. In life insurance, also, applicants with non-tubercular impairment of the spine should have a more favorable consideration than those whose disability had a tubercular origin.
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THE YELLOW FLAG
The older members of the profession will remember that about a quarter of a century ago smallpox in defiance of vaccination, health board warnings, and minor sanitary restrictions, broke over all bounds, and bade fair to give the enlightened people of the last quarter of the nineteenth century a sample of its power to assume epidemic proportions, and scourge mankind as it was wont to do before the days of Jenner. Nothing but a thorough re-awaking to the efficacy of vaccination, and its forced application to the great unwashed of the villages and cities, saved the country from the horrors of a Medieval epidemic of variola.
The blessing which vaccination has conferred upon mankind will never be appreciated, certainly never heartily received, till smallpox shall have had an opportunity to demonstrate its unspeakable loathsomeness and death-dealing power in full epidemic swing and form. Antivaccination societies still exist in Europe and America, but the bait in converts which the fanatical fools who belong to these orders offer the Gorgon of smallpox is a bagatelle compared with the multitudes who are suffered carelessly to go unvaccinated, through loose sanitary regulations, or who are resting in fancied security given by imperfect vaccinations, or primarily perfect vaccinations whose protective power has been canceled by time.
Vaccination even by the profession is often carelessly administered, while the laity presume to vaccinate without professional advice, and even give judgment upon the genuineness of the vaccine scar with the confidence of experts.
Vaccination should never be done by inexpert hands. The source of the virus should be unquestionable, and the result should be carefully noted in every case. Nobody but an expert can pronounce upon
the genuineness of the vesicle (any kind of sore or inflammatory lesion must not be allowed to pass for a vaccination), and revaccination should be insisted upon in every case after the lapse of five years from the time of the last successful vaccination.
If vaccination and revaccination were made compulsory. by legal enactment, and the above rules were carefully followed, smallpox would be stamped off the face of the earth in a decade. As it is, the disease lies in wait till the careless or unsuspecting victims become sufficiently numerous, and then begins the march of death.
Notes and Queries.
WARNING AGAINST SMALLPOX.
Bowling Green, Ky., March 25, 1898. To the Officials, Fhysicians, and People of Kentucky:
This Board again gives warning that our State is seriously threatened with an epidemic of smallpox. Grave conditions already exist in Bell, Whitley, and Madison counties, and cases are reported in Knox and Mason counties. So far the disease has been almost exclusively confined to negroes, but this exemption of the white race can not long be hoped for if it continues to spread.
In spite of repeated and continued warnings from this and county and municipal boards, each community so far attacked was unprepared, a large per cent of the population was unvaccinated, and dangerous and costly delays occurred before the character of the disease was recognized, and hospital and other provisions could be made for the sick and exposed.
Under our laws this expense must be met by the counties and cities affected, and it can only be made small by proper preparation before a case appears. Had: Middlesborough and Bell county been thus forehanded and ready to care for the first cases, thousands of dollars would have been saved in actual outlay, very many thousands in loss of business, and the
officials and community the mortification of clamoring for outside aid to do what they were amply able to do for themselves.
In view of these facts, the Board advises that each town and city at once pass and enforce a compulsory vaccination ordinance, beginning with the colored race, but reaching everybody; that isolation hospitals or tents, and suitable ground for their location, be secured; that visiting and strange negroes be hunted out, vaccinated and kept under observation, and especially that physicians practicing among negroes be instructed as to the difficulty of recognizing mild cases of smallpox and varioloid in this race, and of the importance of calling in experienced counsel in every doubtful or suspicious case. Those having this work in hand should deal firmly but kindly with every one, advising that this work is being done for their protection as well as that of the community.
Quarantines against infected places, the first resort of unprepared towns, do much actual harm by giving rise to a false sense of security, thus retarding the work of vaccination and preparation, and, if rigidly enforced, are much more expensive than the precautions herein advised, besides causing much financial loss by interference with travel and commerce. No quarantine can be legally established without the consent of this Board, and this will not be given unless the circumstances are very exceptional. Communities maintaining unauthorized quarantines are liable to persons suffering injuries or damages therefrom.
At this time every person in Kentucky should be vaccinated or revaccinated. If properly protected it will not take, and if it takes there is need of it. The vaccination should always be done in three places about an inch apart, by a competent physician with clean hands and instruments upon a well cleaned arm, by scraping off the scarf skin without drawing blood, and should be allowed to dry thoroughly before the sleeve is put down, and should be protected for a few days with a clean cloth or absorbent cotton. This will give the best chance for a successful result, with much less soreness and suffering.
Fresh, reliable virus may always be had from the National Vaccine Establishment, Washington City, or from its agents, the Henry Drug Company, of Louisville. Vaccination from the arm of a child known to be healthy is equally reliable.
This Board holds itself in readiness to aid local boards to the full extent of its powers, but little aid will be needed from it if each community will intelligently prepare to take care of itself. By order of the Board.
J. M. MATHEWS, M. D., President. J. N. McCORMACK, M. D., Secretary.
PRELIMINARY ANNOUNCEMENT OF THE COMMITTEE of ARRANGEMENTS, AMERICAN MEDICAL ASSOCIATION, Denver MEETING, JUNE 7-10, 1898.-The Committee of Arrangements announces that preparations for the coming meeting are well advanced. A large number of prominent