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The history of the yellow fever epidemic in this city in 1878 clearly proved these facts. Large numbers of cases were brought here from the South, were nursed and treated in the fever hospital; not a single physician or nurse contracted the disease from them. The temperature and conditions were not such as to favor the propagation and multiplication of the poison to such a degree as to infect others brought within its influence. In the neighborhood of the Nashville depot all the necessary conditions did exist in the little baggage-room at the end of the platform, which was used as a storeroom for soiled clothing and baggage and blankets taken from the trains bringing in the fever cases. This house was covered with a tin roof, had one window and a door, and was closed most of the time. With the hot sun beating upon the roof the temperature was continually at or above a hundred degrees. The gerins were present, filth abounded, and temperature was maintained as in an incubator. From this as a focal center the poison gradually extended, attacking first the two ticket agents, fifty yards in one direction, then several cases across the street in another direction. In this way twenty-five or thirty cases developed, which were just as genuine cases of yellow fever as those brought from the South. Just as soon as the source of the development of the contagium was recognized and broken up the cases ceased to develop. The conditions existing in the little baggage-room, the filthy soil, the implanted germs, and the incubating temperature were just such as were found in the South, and gave rise to the disease just as it does in the South. If the continuous high temperature is lacking, or the filthy soil is not present, though the germs be numerous, they will not develop nor give rise to an epidemic. The germs or contagium contained in sputum, fecal and urinary secretions, or crusts and scales from the surface conveying the disease, may gain access through the respiratory tract, through the intestinal tract, or by absorption through an abrasion of the surface.
The sputum from a consumptive patient swarms with bacilli in immense numbers. It has been estimated that the expectoration from one well-developed case of pulmonary tuberculosis will contain several millions of bacilli, enough to inoculate every person in this city. This sputum, if allowed to dry, becomes pulverized into a fine dusty powder, so small that each particle containing one or more germs will be caught up by the currents of air and float about in the atmosphere until drawn into the respiratory passages of some luckless victim. Lodging upon the mucous membrane, it forms a colony by self-multiplication, gradu
ally encroaching upon the surrounding tissues, and every now and then implanting new colonies in the immediate neighborhood, involving more and more of the structure, or, by breaking into the blood or lymph channels, distributing germs widely throughout the entire system, resulting in general tuberculosis.
The sputum, instead of being allowed to dry, may be thrown into the vault, and after a time, when this is cleaned, may find its way to the country fields, lodge upon the grass and be devoured by the cows grazing in the meadows. In the system of the beautiful and gentle Jersey cow is a suitable soil for its development, and the milk may carry the germs back to the city to be taken into the stomach of some bottle-fed baby or some lover of milk. Intestinal tuberculosis may be the result. We know that tuberculosis sometimes affects domestic fowls. I have myself seen a consumptive, walking in a barnyard, expectorate upon the ground, the sputum being eagerly devoured by the chickens gathered around it. Who can say that tuberculosis developed in the bodies of these fowls, if they be served as spring chickens at the table, may not carry the germs into the systems of those feasting
The kiss of the consumptive patient impressed upon the lips of the dearly loved one may carry with it the deadly bacillus, as fatal as a draught from a poisoned chalice. No less destructive may be the kiss of a syphilitic subject having a mucous patch upon the lip. I have known an innocent child, carried in the arms of a nurse, infected in this way, the result being a chancre upon the tongue, which in turn inoculated the nipple of the nursing mother. Both mother and child developed constitutional symptoms. All this was traceable to the poisoned kiss of a friend of the nurse. Even the communion cup is not free from the charge of conveying poisonous germs, and one diseased lip may in this way infect scores who sip from the same vessel. To avoid this danger the custom of using small individual cups, however inconvenient, is fast gaining ground, and when thoroughly sterilized before each use safety is assured. Even the apparently innocent custom of shaking hands may convey germs of disease or parasites from one to the other, the communication of scabies being a familiar example.
Contamination of the water supply is a fruitful source of disease. The contagium of typhoid fever, of cholera, and in fact of any infectious disease, may be thus introduced into the system. I well remember, when in attendance upon an epidemic of cholera in Lancaster, Ky.,
some years ago, tracing very clearly the outbreak to the contamination of a well at the foot of the hillside where the discharges from the first case, a refugee from Nashville, were thrown out and washed down by the rain. All the succeeding cases developed among the families supplied by that well.
Rigid sanitary and quarantine regulations are adopted against epidemic diseases, such as yellow fever, cholera, smallpox, scarlet fever, and diphtheria, and yet the disease that destroys one seventh of the human race is allowed to stalk abroad in the land almost without let or hindrance. When we reflect that each case scatters abroad germs enough to inoculate several hundred thousand persons every day, it is a marvel that any one escapes. Not until the public and each individual subject realize fully the danger and adopt stringent measures looking to the thorough destruction by fire or by other potent disinfectant of every morbific material will safety be secured against the spread of contagious and infectious diseases.
BY B. P. EARLE, M. D.
The subject of congenital hydrocephalus is treated very lightly in the text-books I have consulted-only a slight mention. Bedford, in his lectures on midwifery, mentions it and speaks more directly on the danger of rupturing of the uterus, but gives no means of diagnosis or frequency of occurrence or modes of procedure in delivery. On July 28th I was called to see a. lady, thirty-four years old, the mother of four children, the youngest five years old, of a medium stature and with a well-developed and capacious pelvis. On my arrival at 6 P. M., I found her, as she stated, in labor since & A. M. The membranes had ruptured at 2 P, M. She was having some slight pains, which gradually subsided and entirely quit by midnight.
I remained with her until morning, and left, expecting to be recalled at any time. I heard no more of my patient until October 9th, at 4 A. M., I was again called; the distance being eight miles, I did not arrive until half past six. I found the parts well dilated and labor fairly under way. The cord had come down, and a loop about four inches
Read before the Southern Kentucky Medical Association.
long was hanging out. I had her placed in the knee-chest position, and with my hand I replaced the cord, passing it well up into the uterus and above the head. The pains were rather feeble, and I gave
her eight grains of quinine. Kneading the bowels, later on, I gave one dram of Squibb's fluid extract ergot, with no improvement in pains. At eleven I concluded to use the forceps, but after an hour's trial I had to give up the effort, having failed to introduce them. So I then asked for consultation. Dr. C. N. Ferguson was called, who arrived at 3 P. M. After examination he thought it right to give more ergot and quinine and use more kneading after trying for two hours with no advancement. The cord, however, had again come down, and we again, after the same plan, returned it, but it would not stay. We then gave chloroform and attempted to use the forceps.
Dr. Ferguson trying to introduce them, after an effort of twenty minutes succeeded in getting in the first blade, and after a fruitless effort of half an hour at introducing the second blade he gave up, and I undertook the job. After an effort of forty minutes I succeeded in introducing the other blade and locking the forceps, but the handles stood wide apart and could not be closed. I then tried with all my power for considerable time with no progress. Dr. Ferguson, a man of two hundred pounds weight, and very muscular, tried for a while; then we both alternately tried for an hour-still no progress. By this time we knew the child was dead, and we determined to open the head and let out the contents. Wrapping a scalpel to within a fourth of an inch of the point, and introducing it between my fore and middle fingers till I reached the fontanelle, and then with my right hand I inserted it into the head and cut an opening three fourths of an inch long. No sooner had the knife passed into the cavity than the water spurted out over me, the floor, and run down into the chamber until it was most full. I then proceeded to deliver the child, which was accomplished in about five minutes. After waiting a half hour the placenta did not come down, and I introduced my hand and found it firmly adherent to the anterior of the uterus, and was compelled to remove it entirely with my fingers. We had no unusual hemorrhage.
Having seen our patient comfortably placed in bed and for the time being doing well, we turned our attention to the child to see what we had. First filled the head with water as well as we could, but could not make it tense, the scalp remaining in wrinkles. It then measured twenty inches around, occipito-frontal measurement. We agreed that if
we could have filled it full it would have measured at least twenty-three inches. Next we noticed that it was very long, and upon measuring we found that she measured twenty-six inches long, and was more than usually developed. We, however, neglected to weigh it, which I very much regret. The best estimate we could make of the amount of water discharged was seven pints.
The after-treatment consisted of fifteen grains of quinine per day, three days, and the vagina and uterus douched out with hot water, half gallon, carbolic acid, one dram, twice a day, for fifteen days. Her recovery was uneventful.
This case was a very interesting one to us, owing to its many and unusual complications, funis presentation, hydrocephalus, and retained placenta—the membranes rupturing seventy-two days before the fetus was born. I wish to add that the lady—who is one of fair intelligencecontends stoutly that she knows from unmistakable evidence that her time for confinement was fully up when I first called, and that she carried the child for nearly twelve months. I mention this fact for what it may be worth.
THE CONSERVATISM OF MODERN SURGERY.*
BY A. T. M'CORMACK, M. D. ·
Conservatism is probably the most abused term in the vocabulary of the practicing physician. At its doors he lays all his lack of knowledge and progress, and too frequently he uses its soothing syllables to quiet the alarms of an anxious family when active, capable work might relieve his patient. This is true to a certain extent in medicine as well as surgery, but it is in the broad realm of modern surgery that one more often meets this so-called conservatism.
The older men present here realize best what modern surgery is. They remember when a thumb-lancet, an amputating case, a pair of obstetric forceps, and a cystitis-breeding gum catheter constituted a surgeon's armamentarium, when venesections, amputations, and trephinings were the limits of the surgeon's field. They remember, and so do we all, when localized induration was the signal for poultice, foul breeder of germs innumerable, and when timidity, falsely termed conservatism,
*Read before the Southern Kentucky Medical Association.