wound of peritoneum, 2. In 4 cases the victim was under 12 years of age. Two cases were of rape; 5 occurred during the wedding night. Pregnancy existed in one case and hemophilia in one. R. Braun 1 has studied perforation of the uterus during gynecologic operations. The commonest cause is instrumental separation of the placenta. Perforation of the wall by dilators is rare, and by sounds rarer still. With the clamp forceps not only has the uterus been perforated, but even coils of intestine dragged down. The puerperal uterus, especially if septic, is readily perforated. Further predisposing causes are tumors, especially malignant moles, atrophy, and edematous states. L. Lewin and M. Breuning 2 have published a monograph on abortion. Sulphuric Acid as an Abortifacient.-S. Egger 3 reports the case of a girl who died from the effects of a half-cupful of 30% sulphuric acid given to produce abortion. The symptoms of irritant poisoning developed immediately, and were followed by profound emaciation and debility. She was delivered of a dead fetus 2 months later, and died at the end of the third month. The stomach showed extensive cicatrization at the pylorus. Medicolegal Relations of Marriage.-P. Brouardel 4 has issued a further addition to the series of works by him, dealing with hysteria, impotence, sterility, pregnancy, and other sexual medicolegal problems arising in connection with married life. Like the other volumes of the series, it is enriched by a series of illustrative cases. Several of the chapters in the book have been published separately in the "Annales d'Hygiene Publique."5 Nina Rodriguez 6 has given a careful study to the various injuries of the hymen, and is of the opinion that in the majority of instances the condition of the hymen does not permit of an absolutely safe diag nosis. A. Haberda finds that anatomic evidence of rape is often wanting, in spite of the fact that coitus has been completed. The hymen varies greatly in form, elasticity, and size of lumen, and may present appearances liable to lead to confusion. He considers that to be fully characteristic the laceration must extend through the entire hymen and involve, at least slightly, the vaginal wall. Vicarious Hemorrhages.-E. Schaeffer 8 reports a case where a woman of 20 was the victim of a violent assault with attempt at rape. The same evening she began to cough and to spit blood, and this continued for 5 days. This was repeated at intervals of a month for 3 successive months. The apparent cause was the fright received. Calle in speaking of medicolegal relations of forced labor and cesarean section, insists on the uselessness of postmortem cesarean 1 Wien. med. Presse, 6, 1900. Freidreich Bl., No. 4, 1900. 5 Nov., 1899; Dec., 1899; Jan., 1900. 7 Monatsch. f. Geburtsh., Bd. XI. 2 Hirschwald, Berlin, 1899. 4 Le Mariage, Baillieu & Co., Paris, 1900. 9 Bull. de la Soc. de Méd., Nov. 5, 1900. section and lays stress upon the advantages of manual extraction. The cervix of a pregnant woman, he states, is always readily dilated and entered during the agonal period or immediately after death, whether labor has begun or not. MENTAL QUESTIONS. Dupré and Rocher 1 consider that criminality resulting from hypnotic suggestion can easily result in the case of minor offenses and in suitable subjects, but that any departure calculated to shock the moral sense of the individual is unlikely to occur. 1 Thirteenth Internat. Med. Cong., 1900. PUBLIC HYGIENE AND PREVENTIVE MEDICINE. BY SAMUEL W. ABBOTT, M.D., OF BOSTON, MASS. THE MANAGEMENT AND CONTROL OF INFECTIOUS DISEASES. Compulsory Notification of Measles and Infectious Pneumonia. -Vallin1 discusses the propriety of notification of measles and infectious pneumonia. The following figures show the deaths from measles and from scarlet fever, and the number of disinfections practised in each : The total number of disinfections made by the municipal service has increased from 38,000 in 1895 to 64,000 in 1899, and yet the practice of disinfection after measles appears to have diminished in the same time, comparing the results of 1899 with those of 1895. At the advice of Vallin and others the Academy of Medicine adopted a proposal on Feb. 27, 1900, to include measles among the notifiable diseases, under the law of 1892. In military practice the following method of dealing with measles is carried out: The first case is sent to hospital; the sick room and its contents are disinfected the same day; unless lack of space in the barracks prevents, the room is vacated, the floors are washed with cresyl, and the walls are lime-washed or sprayed with an antiseptic. Every morning for a week the bedclothes are carried into the yard and exposed to the open air and sunlight. For at least a fortnight the men who had occupied the same room and come into contact with the patient have to report themselves to the doctor, who examines the skin, mucous membranes, palate, uvula, etc.; every one who comes up to sick call for any illness whatever is subjected to a special examination in view of measles. In this way faint rashes are often detected on men who did not suspect that they could infect their comrades by walking with them. Prompt. diagnosis and isolation lessen at least by one-half the risks of contagion 1 Rev. d'Hyg., April, 1900. and spread of disease. After prolonged discussion, the Academy, at the suggestion of Graucher and Vallin, also adopted the following proposition: "The Academy is of the opinion that infectious pneumonia and infectious bronchopneumonia should be included in the list of compulsorily notifiable diseases." This discussion also brought out some facts with regard to the cost of disinfection in Paris, the charges varying from nothing for dwellings of low rental to a maximum of 100 francs for those of the highest class. The charge for a house renting for about 6000 francs, and for disinfecting all rooms and removal and disinfection of their contents, is only 45 francs. The city of Paris spends annually 600,000 francs for this service, and receives back only 40,000 francs as charges, so that the service is practically gratuitous. Several private concerns have been started to carry on disinfection; some do the work in a shiftless and expensive manner. Diffusion of the Plague.1-The following summary shows briefly that from 1879 to 1898 not a single year has passed without the development of plague in at least one country, and in later years the disease has been present in several countries at one and the same time: In 1880 plague was reported to be present in Mesopotamia; in 1881 it was present in Mesopotamia, Persia, and China; in 1882, in Persia and in China; in 1883, in China; in 1884, in China and in India; in 1885, in Persia; in 1886, in India; in 1887, in India; in 1888, in India; in 1889, in Arabia, Persia, and China; in 1890, in Arabia, Persia, and China; in 1891, in Arabia, China, and India; in 1892, in Mesopotamia, Persia, China, Russia, and Tripoli; in 1893, in Arabia, China, Russia, and India; in 1894, in Arabia, China, and India; in 1895, in Arabia and China; in 1896, in Arabia, Asia Minor, China, Japan, Russia, and India (also 2 suspected cases in the London docks); in 1897, in Arabia, China, Japan, India, Russia, and East Africa; in 1898, in Arabia, Persia, China, Japan, India, Russia, East Africa, and Madagascar (also 3 fatal cases in Vienna). It must also be remembered that since 1890, and probably long before that time, plague has been occurring in Central Africa, whence it might have been carried northward by Arab travelers to Egypt and Tripoli in past years, or eastward toward the ports in communication with Jeddah and the Red Sea coast. Destruction of Rats and Mice for Prevention of the Plague. -Doriga contributes a paper on this subject. He says: "The French Government has charged the Comité Consultatif d'Hygiene with the investigation of this question. Certain navigation companies have also taken measures for the destruction of rats and mice upon their vessels. The Compagnie des Messageries Maritimes offered a bounty to their sailors for every rat caught on board. Instructions have been adopted by the Minister of the Interior. These instructions urge the importance of preventing the access of rats to floating hospitals and ships at the wharves, at sea, and on arrival in port. If the dead bodies of rats are 1 Twenty-eighth Ann. Rep. Local Gov. Board of Eng., p. 202. 2 Rev. d'Hyg., Aug., 1899. found on board, a bacteriologic examination must be made; and if the plague bacillus is found, the ship must be discharged, the cargo and passengers' and crew's baggage disinfected, the vessel fumigated throughout and the dead rats burned." See also articles by Mereshowsky, who studied the question of infecting rats and mice with destructive bacilli other than those of plague, with the purpose of exterminating them. Abel 2 also has experimented in the same direction. It was found necessary to discriminate between wild species and those which live habitually in contact with man. The field-mouse, for example, appears to be endowed with slight susceptibility to infection. per Plague Precautions in English Ports.-The Chief Medical Officer of the Local Government Board of England 3 briefly details the measures adopted in England as follows: "The system adopted in this country in such cases is the medical examination of all persons on board; the removal to hospital of any person either suffering from plague or suspected to be so suffering; the disinfection of articles believed to have had the opportunity of becoming infected, and of those portions of the vessel occupied by the sick; the registering on board of the names and addresses of all the remaining persons, including the crew, such persons being then free to leave the ship and go to the addresses given; and, lastly, the transmission to the sanitary authorities of the names and places of residence of persons leaving the vessel for their respective districts with a view to such sons being maintained under supervision of the medical officer of health during the 10 days which have been determined on as representing, so far as administrative purposes are concerned, the period of incubation of the plague. The system embodied in these measures is that which England has now for a long period adopted with regard to exotic diseases; it aims at arresting at our ports actual cases of foreign disease, plague, cholera, and yellow fever, and of securing the disinfection of articles which may reasonably be held to have incurred risk of infection. For the rest, it imposes no restrictions on either individuals or articles imported; but it relies on the internal sanitary administration of the country to control at the onset any infection which may perchance evade the precautions adopted at our ports. Thus far it has been singularly successful, as regards the 3 diseases to which it has been applied; and the responsibility which devolves under it on local sanitary authorities, to organize their public health departments so that they shall be always prepared effectually to deal with any chance infection which may reach them from abroad, has had the inestimable advantage of helping to secure at the same time a standard of health at home which has resulted in an immense saving of life." With regard to the possibility of the spread of the plague by means of merchandise, he makes the following statements: "Having 1 Centralbl. f. Bakt., XVII, p. 742, and xx, pp. 85 and 176. 2 Centralbl. f. Bakt., XXI, p. 497. Twenty-eighth Ann. Rep., Suppl., 1899, p. xxx. Twenty-eighth Ann. Rep. Local Gov. Board of Eng., Suppl., p. xxxvII. |