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Medical

THURSDAY, APRIL 3, 1884.

A Journal of Medicine, Surgery, and Allied Sciences, published weekly by

HOUGHTON, MIFFLIN AND COMPANY, Boston. Price, 15 cents a number; $5.00

and Surgical Journal. remaining rooms are lighted from the rear and one side.
The middle rooms in two buildings, eight in number,
have one window on each side near the back part, so
that the light practically all comes from the rear, with
reference to the greater number of pupils,
a very ob-
jectionable arrangement. In some school rooms with
side windows the strongest light comes from obliquely
in front of the pupils; as, for instance, in the building on
Baltimore Street, where the light from the windows
near the rear is cut off by trees. This difficulty could
be obviated in a measure by reversing the arrange-
ment of the desks.

a year, including postage.

All communications for the Editors, and all books for review, should be addressed to the Editors of the Boston Medical and Surgical Journal.

Subscriptions received, and single copies always for sale, by the undersigned, to whom remittances by mail should be sent by money-order, draft, or registered letter. HOUGHTON, MIFFLIN AND COMPANY, No. 4 PARK STREET, BOSTON, MASS.

THE SANITARY CONDITION OF THE SCHOOL-
HOUSES OF THE CITY OF LYNN.

WE have before us a report of a special committee, of which Dr. J. G. Pinkham was the chairman, appointed to examine into the sanitary condition of the school-houses of Lynn. The city of Lynn being a place of 44,000 inhabitants, occupied largely in manufactures requiring a considerable degree of intelligence, and having, apart from this, every reason ourselves to believe that it is possessed of at least an equal public spirit and appreciation of the advantages of a public school education as other places of its class in the State of Massachusetts, the results of the committee's investigation should present more than a passing interest for parents and for those concerned with school hygiene, especially as one or two points seem to have been worked out by the committee in their report with more than ordinary care. Moreover, the Hygiene of Study, of which we spoke in our last issue, is a vain problem without hygienic surroundings.

We shall confine our comments to the two important particulars of lighting and ventilation, the defects in which, as shown by the Lynn schools, no doubt exist largely elsewhere in this State, and if in Massachusetts, where so much attention has been given to public schools, then probably in a still greater degree elsewhere.

In the matter of lighting the committtee adopt the usual minimum standard of authorities on this subject, which is, that the size of the windows collectively should equal at least one sixth of the floor space or sixteen per cent. Cohn, in Germany, requires a ratio of at least a fifth or twenty per cent.

In Lynn it was found in ninety-one school rooms that the ratio of window surface to floor space was too small, in some being as low as a twelfth, or eight per cent. only. Of the large grammar school buildings only one is reported as well lighted, the percentage of window to floor space being sixteen; in the other buildings this percentage ranges from ten to thirteen, and, we are told, the evil of insufficient light might easily have been avoided in the construction of these buildings had the architects (or builders?) been reasonably well informed in regard to the amount of light required in school rooms.

"Out of one hundred and twenty rooms visited, only three have light from the front; four have windows at the right only; four at the left only; twenty-eight at both sides, nineteen at the rear and both sides. The

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To the subject of ventilation especial attention was given by the committee, and the report shows a condition needing especial attention. As a standard of purity of air for respiratory purposes, that laid down by Dr. Parkes was adopted, namely, that air containing more than six parts of carbonic acid per 10,000 volumes (.06 per cent.) is unfit to breathe, and that with a ratio of eight, nine, or ten parts per 10,000 the air smells stuffy and close, and beyond this becomes foul and offensive. Accurate analyses of the air of a certain number of school rooms were made by Professor Hills, of the Harvard Medical School, and are given in the following table taken from this report, in which is included an analysis of air from out of doors, It is fair to suppose that in all the instances given the carbonic acid had no other source than the respired air from human lungs, and therefore represented the measure of irrespirability of the atmosphere.

taken at the same time.

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12,
Baltimore Street.. Nov. 28
Primary No. 33,
Chase Avenue.... Dec. 3
Master's Room,
Shep. School.. Dec. 3
Dec. 5
Dec. 5
Dec. 6
Dec. 6

Sils

Nov. 28 11.25 A. M. 11.35 A. M. 11.50 A. M. 3.45 P. M. 4.00 P. M. 10.28 A. M. 11.35 A. M. 11.30 A. M. 11.55 A. M.

72° F.
70° F.

40° F.

18.15

40° F.

17.05

72° F.
68° F.
70° F.
68° F.
68° F.
76° F.

40° F.

12.65

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Primary No. 30,
Primary No. 8, Par-
Master's Room,

Elm Street

rott Street.

Cob'et School..
Out of Doors.
bee Street..

These analyses show the air in some of the rooms to be very bad, much worse in some instances than that of school rooms in Boston as exhibited in the second report of the Massachusetts Board of Health, and these analyses gave far from favorable results, as

may be seen by the following table giving a portion of although the too common condition of school rooms the analyses taken from the report of the Board:

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The Lynn school rooms from which air was taken for analysis are said to be representative of the rest, and the reasons given for the condition found are that (1) the cubic air-space allowed to each scholar is too small, making good ventilation without draught difficult or impossible; (2) the means of ventilation employed are, as a rule, wholly inadequate for their purpose, and would be so, in most instances, even if there were much less crowding of the rooms.

The cubic air-space per scholar in the majority of the rooms is reported at less than 200 feet, in some being but little over 100 feet. The inadequacy of such a provision is readily shown by remembering that with the minimum air-space (220 cubic feet) allowed by authorities on hygiene the air would have to be changed seven times every hour to provide even 1500 cubic feet of fresh air per hour, or half the amount held to be necessary for adults. It is extremely difficult to effect the change of the air of a room as often as seven times in the hour without creating an objectionable draught. From one room, that of the Principal of one of the schools which was tested, air was found to be escaping from the outlets at a rate giving a change of not quite once in two hours, the Scylla of a draught having here been avoided for the Charybdis of impurity, or, as is more probable, very little thought having been given the subject.

Even the American brain is still subject to natural laws, and will not perform its functions, much less develop properly, in an impure or poisonous atmosphere,

and court rooms shows that such expectations are tacitly entertained of it. The Egyptian task-master was far less unreasonable in demanding from bondmen bricks without straw than are our own people in demanding from fellow-citizens and their own offspring sound and invigorating mental labor without a suitable supply of oxygen.

It is hoped by the reporting committee that the evils at Lynn are sufficiently plain to lead to the In these appointment of a supervisory committee. columns we have frequently had occasion to advocate the appointment of health supervisors or instructors in hygiene. We have no prejudices as to the title or composition of the office intrusted with hygienic supervision of schools in cities and large towns, but continue unaltered in the conviction the expression of which has hitherto, it must be confessed, borne but little visible fruit that such supervision should be provided and intrusted to special and qualified officers.

THE FOOT AND MOUTH DISEASE. THE recent introduction of this distemper by means of an importation of some infected cattle into the country at Portland, Maine, its dissemination to a certain extent among neighboring native cattle, its supposed subsequent outbreak first in Kansas, then in Iowa and Illinois, seems to indicate that there exists at this time, among those whose duty it is to prevent just these occurrences, an amount of carelessness or ignorance entirely inexcusable, and which, if continued, will surely lead sooner or later to causes that will in their effects upon our public health and wealth be most disastrous and lasting. To show this let us, very shortly, review facts as reported from various sources.

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During the summer of 1881 "under authority conferred by the sundry civil appropriations bill" the Secretary of the Treasury on July 16th appointed three persons upon a commission to be known as the Treasury Cattle Commission." Of these three, the chairman was a veterinary surgeon, another had practiced as such for a long time, and the third was an editor of a live-stock journal. To this commission, after a time, it came to establish at several of our ports quarantine stations that they might aid the government in preventing the importation and spread of exotic contagious diseases of cattle, two of which, specific pleuro-pneumonia and epizootic aphtha, were well known to exist in Great Britain, from whence we were receiving numbers of animals.

The Board labored with this newly imposed duty, and among other results there was established at Portland a "cattle quarantine," to reach which, as we are informed, cattle landing from the steamers must be driven for a considerable distance over a public highway upon which it is possible for them to meet or be followed by other and native cattle without any restraint whatever; and to the actual occurrence of this chance is due the existence of foot and mouth disease among cattle about Portland. If the statements of competent eye-witnesses concerning the methods, or per

haps it would be better to say the lack of methods, pursued within the "quarantine" are correctly reported, the negligence and stupidity of those in charge of it are almost beyond belief. One instance, as related to us by a person who witnessed the incident, will perhaps suffice to show this sufficiently for present purposes:

are to be "picked up," or even that the science is to be sufficiently mastered by about nine months of special study, what cause of wonder is there that these mistakes occur, for it cannot be a science of any depth or stability. On the other hand, if it is true that there is a real science of the sort, which can, by being allowed to exercise its proper function, be made to do service in protecting public health and domestic industry, then why is it that a government, which should foster the interests of the people, is so unfortunately advised in this matter?

The general public is beginning to realize how important a bearing the diseases of domestic animals and their control by proper measures resulting from their intelligent study is destined to exert upon the material prosperity of the country. People do not yet

Some imported cattle coming to the station a little time after the diseased cargo, were put by themselves in a barn at some little distance away from the sick ones. Upon a certain occasion it became necessary to have for a little time a few extra men in attendance upon them, and one of the members of the commission, who happened to be present, ordered that certain men who were then in attendance upon the diseased animals be called to come directly and give the required assistance. To this the owner promptly objected, referring the matter to his own veterinary sur-appreciate, however, the intimate connection which a geon, there present, who sustained the objection; the order was countermanded, and the blunder prevented. When it is understood, as it is among all properly qualified men, that the contagious principle of foot and mouth disease is surely and easily conveyed by media, as of clothing, ropes, pails, litter, and the like, one is forced to the conclusion that this unqualified member of the commission had better be superseded by a capable man, or else that the government holds itself fairly open to the criticism of keeping an estab-trict. lishment for the propagation of contagious diseases been sufficiently proved before. among cattle.

more exact aetiology and pathology have shown to exist between many of the diseases of domestic animals and of men. This very foot and mouth disease which has of late been occupying so much attention is an excellent illustration of such connection. An extensive epidemic of aphthous sore throat at Dover, England, having its origin in a dairy supplied with milk from infected cattle, is at this very time under investigation by the medical health officer of the disThat man is liable to contract the disease has

Is it that even this service must be We do not know how many epidemics, among aniso strangely mixed up with politics and political ex-mals and human beings, nor how much loss must take pediency in this country that nothing but a show of place before the needed lessons are taken to heart, but action in this direction is tolerated by the authorities fear that the process will be expensive if not slow. at Washington? Or is it, perhaps, that properly qualified men are so few among us that their services for this work cannot be obtained. Let us look at another phase of this same matter.

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During the month just passed we were informed by the daily papers, which had received the news by telegraph, that foot and mouth disease was reported by the United States veterinary surgeon at Fort Leavenworth," who had been detailed to investigate the matter as existing in a certain part of Kansas. In the dispatch there followed such a description of the nature of the outbreak as to lead any one with a knowledge of matters of the sort to decide at once that whatever the disease was it was not "foot and mouth." Rapidly following this outbreaks were reported from at least two other States. Much excitement was worked up, and a large appropriation was obtained to "stamp out" what we were told, a little while after, by another governmental veterinary surgeon, if he is correctly reported, was "ergot in the hay." In view of the rather farcical ending of the whole matter we can this time—if we do not belong to the veterinary profession — afford to smile, but still the more thinking mind will ask itself what the meaning of all this is. In the first place the government has employed an unqualified man; in the second, one who is a graduate of a school in which the total time demanded for professional study is something less than ten months. Perhaps we need look no further. If it is true that the "principles and practice" of veterinary medicine

MEDICAL NOTES.

Dr. D. Humphreys Storer, of Boston, celebrated his eightieth birthday last week, when "honor, love, obedience, troops of friends," found themselves appropriately and happily sheltered beneath his roof.

The Legislature of Connecticut, in session at Hartford, passed a bill recently prohibiting the sale, for hotel or family use, of any ice cut from waters made impure by sewage, mill refuse, etc. There was no objection in the bill to the use of such ice by market men or others for preserving articles. After a very short debate a member rose with an amendment that the bill should not go into effect until next November. He frankly stated that one of his constituents had a lot of impure ice, and as he had expended his money in cutting and housing it it was only fair that he should be permitted to sell it wherever he could. In spite of the whimsical character of this objection the House, to the surprise of everybody, agreed to the amendment. The Senate promptly concurred, but within the next few days so many indignant protests were received that the Senate, last week, recalled the bill, and struck out the obnoxious amendment. - M. Jaccoud, in an analysis of a large number of temperature charts in typhoid fever (Journal de Médecine, February, 1884), shows that the general impression as to the average date of the attainment of the

maximum temperature in that disease is not correct Not the sixth to eighth day, but the fifth represented the maximum; in fact it was not very rare for the maximum to be reached on the second day. In the light of these observations it evidently is unsafe to exclude typhoid on the score of having a temperature of 104° F. on the second or third day. The examination of these charts showed that precocity of the fever constituted a rather unfavorable element of prognosis.

At the "Health Exhibition" to be held in South Kensington, England, in May next, food, dress, the dwelling, and the workshop are to form the staple attractions. The exhibition of food will, we learn from the Lancet, be international, and will embrace raw food substances from all parts of the world, and the different methods of preparing food which are in vogue in different countries will be fully illustrated. The storing, conveying, and preserving of food, as well as its adulteration, and the diseases produced by unwholesome food, will all form the subject of exhibits. Educational machinery and the hygiene of the school-room will also form subjects for illustration. Surgeons J. S. Billings and J. S. Brown, United States Army, have been detailed to attend this exhibition. They will also represent the United States Army Medical Corps at the International Medical Congress, which will convene at Copenhagen in August next.

-The question has been raised as to the frequency of epilepsy in the colored race, by the following remark of Dr. Lawson Tait in a discussion as to deafness in white cats (Nature, xxix., 164): "Every kind of white animal I have kept as a pet has proved to be the subject of epilepsy; and the association is suggestive, when we are told, as I have been frequently, that the disease is unknown among negroes." In Science, February 29, 1884, Alexander Graham Bell, in a communication, denies this assumption regarding the colored race, at least in America. Another writer, in the same periodical, claims that epilepsy is more frequent in negroes than among whites, which claim is apparently borne out by the following table furnished Mr. Bell by General Seaton from the unpublished figures from the tenth census:

Percentage of epileptics in the United States, 1880, by race
and sex.
White male
White female

Black male

Black female

Indian male

Indian female

Chinese male Chinese female

NEW YORK.

.004749 .003751 .005011 .004267

.002942

.003084

.020925

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one of the great needs of the day, and it must be built. We want a cancer hospital on its own foundation, wholly independent of all other hospitals. . . . Its medical board ought to be men who go into it with zeal, determined not only to give temporary relief to human suffering, but to do something toward discovering better methods of treatment. We are now making great progress in every department of medicine. Why should not cancer derive some benefit from this general onward movement? Doubtful points of practice can only be settled in the wards of a great hospital, and success in treatment can only here be demonstrated. We want a medical board of large and liberal views. I would take knowledge. wherever it can be found. I would invite any man who claimed to have a specific to come and try his remedies under the supervision of a committee specially appointed for that purpose. I would offer a large premium for any improvement, whether in constitutional or local treatment. I would do everything to obtain practical knowledge on this subject, regardless of the source from which it emanated. . . . Let me beg you to take steps at once to inaugurate a movement which must culminate in a great work so much needed here and now. The subject of cancer is too large and its interests too great to be lodged in a pavilion subsidiary to any other hospital, whether special or general."

Correspondence.

ARTIFICIAL INFLATION OF THE COLON WITH GAS.

BOSTON, March 20, 1884. MR. EDITOR, In regard to the artificial inflation of the colon with gas, as recommended by Professor von Ziemssen, and mentioned in No. 12 of the JOURNAL, it may not be wholly useless to quote the statement of Austin Flint in his Practice of Medicine,1 who, in treating of Intussusception, says: “I have known rupture to result from the injection successively of an acid and alkaline liquid, giving rise to the evolution of gas by combination within the intestine." It is also on record that injections of water, given to relieve intussusception, have ruptured a portion of normal intestine, below the displaced part, so that it seems clear that, in clinical experiments, we should keep very far on the safe side of an enormous degree of inflation or even "extreme expansion" of the colon. Respectfully yours,

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HERMAN F. VICKERY, M. D.

Dr. Flint gives no particulars as to the condition of the intestine to which he refers, nor do his words indicate whether the accident occurred within the writer's personal knowledge or was merely reported to have happened. On the other hand, V. Ziemssen's language is very explicit, especially in regard to the experiments on intestines immediately after death. We should think by following the suggestion as to introducing the acid and alkali in divided portions any danger of rupture would be easily avoided. Water, from its weight, is probably more dangerous than gas. REP. 1 Fifth edition, 1881, page 490.

1

Miscellany.

patient before it was performed. Regarding the division of the disk of bone before its replacement, it was held by one speaker that it was a decided advantage to di

A CONTRIBUTION TO THE SURGERY OF THE vide the disk of bone into parts, and he was of opinion

1

BRAIN.

A PATIENT was recently exhibited by Dr. Macewen before the Pathological and Clinical Society of Glasgow, whose brain had been operated on for the relief of left hemiplegia, and who has recovered the power of movement to such an extent as to enable her to walk freely about, though with a paraplegic gait, to raise her arm to the level of her shoulder, and to grasp with considerable power, though there is a deficiency in coordination of movement of the hand.

that it would be a still greater if the centre of the disk were perforated before dividing it, so as to admit of the insertion of a small drainage tube. Granulation tissue was apt to block up the spaces between the particles of bone and prevent free drainage. Dr. Macewen in closing the discussion said that on two occasions he had introduced the disk of bone entire: one did well; a small portion of the other necrosed, and the whole had is consequence to be elevated. The advantage of having the bone in small pieces was that you could, under these circumstances, easily remove the affected portion and leave the remainder.

SILVER WIRE.

She had a syphilitic history. The hemiplegia was preceded by a tingling sensation and a numbness of the left arm and leg, which increased until it ended (within six weeks from its commencement) in complete motor paralysis and a deficiency in the perception of touch. The left side of the face was also slightly af- THE SURGICAL ABUSE OF SPONGES AND of fected. This was accompanied by mental confusion and loss of memory. Full antisyphilitic treatment had been tried along with counter-irritation to the head, previous to her coming into the Royal Infirmary, and while she was in the medical wards of that institution. These did not seem to have relieved in the slightest the condition spoken of above.

Trephining was performed over the middle of the ascending frontal and parietal convolutions. The internal table of the disk removed was found softened and thicker than usual, having on its internal surface a series of projections or roughnesses, some protruding for nearly one eighth inch beyond the general level. A second opening was made over the occipital region, and a similar thickening of the internal table was found. Opposite to the first opening the dura mater was paler than normal, and somewhat thickened. It was elevated, and a false membrane of yellow color, and about one sixteenth of an inch in thickness, was removed. An incision was made into the brain in the direction of the paracentral lobule, when a gush of grumous red-colored fluid escaped out of the opening. Its quantity was not measured, as it could not have been collected. Approximately, there would be about a couple of drachms. The brain pulsations previously were not discernible, but, after the escape of this collection of fluid, it was thought that very feeble pulsations were seen. Some of the surgeons standing by doubted the presence of the cerebral pulsation. The disks of bone were carefully divided into segments and replanted, and are now quite firm. Wounds treated without pus production.

The day after the operation the patient expressed herself as very much better. On the third day she moved her toes. Within a week she lifted her leg from the bed and stated that she was so much better that she could turn in bed, and believed she could walk. The fingers were moved within a week. Her mind greatly changed for the better, her memory improving, and her intelligence becoming much brighter. She can now walk freely about, and does a considerable amount of domestic duty in the ward. She lifts her arm to the level of her shoulders, and can grasp with considerable force.

In the discussion which ensued upon the exhibition of the patient the improvement was attributed to the result of the operation by surgeons who had seen the 1 Glasgow Medical Journal, February, 1884.

UNDER the somewhat sensational title of "Seven Surgical Follies," Dr. John B. Roberts (Polyclinic, February 15th) considers what he calls the ether folly (the abandonment of ether for chloroform on account of lack of knowledge of how to secure anesthesia by the former), the incision folly (too short incision), the styptic folly (use of styptics to control hæmorrhage), the adhesive plaster folly (plaster in the place of sutures), the dose folly (inadequately small doses), the sponge folly, and the suture folly. On these last two points he says:

"What I term the sponge folly is the habit of employing sponges for absorbing blood from wounds, when napkins or towels are always obtainable, and are far less liable to introduce septic material into the wound. Sponges, while too expensive to be thrown away after each operation, are cleaned with great difficulty. Servants and nurses, therefore, not appreciating the importance of thorough cleansing and disinfection, often neglect this duty. Hence I prefer towels, and if I do an operation at a patient's house, always use clean towels obtained there. Thus I secure an almost certain immunity from purulent or septic dirt in the articles used for absorbing blood. Perfectly clean surgical sponges are the exception, but clean household towels are the rule. At the polyclinic I use for this purpose, to a considerble extent, Japanese paper napkins, which are thrown away after being once used. Absorbent cotton is too expensive for such uses, except to a limited extent, and besides, has a tendency to leave filaments entangled in the wound.” 1

Regarding the "suture folly," the author says:

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I do not refer to the erroneous opinion, long held, that sutures should not be used in the scalp. This tradition has been disproved so often that few surgeons would now hesitate to use sutures as freely in the scalp as elsewhere. What I call the suture folly is the ad

1 We learn by a note in another part of the same journal that these Japanese napkins are found by Dr. Roberts as efficacious and clean as cotton ones, and are so cheap that they can be thrown away after being used. They cost from $6 to $7.50 a thousand. The cost of washing a large number of ordinary towels is thus avoided. The paper towels are scarcely suitable for drying hands after washing, unless several towels are used at once, because the large amount of moisture on the hands soon saturates a single towel. For removing blood from wounds, a paper towel is crumpled up into a sort of ball and then used as a sponge. Such balls absorb blood rapidly. The crude ornamental pictures, in color, on the towels, are of no advantage, nor are they, as far as is known, any objection.

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