The latest observations and experiments have been made by Eiselsberg. He has given details of six cases which he has had the opportunity of investigating. The first case was that of a woman with a compound fracture; the wound had been much contaminated by dirt; tetanus occurred on the fourteenth day. Cultures were made from the blood, with negative results. Eiselsberg also inoculated the blood into animals, but no effect followed, nor could any bacilli be found therein; on the other hand, the secretion from the wound contained, with other organisms, the specific bacillus, and from this secretion impure cultures were obtained. A culture of the third generation was injected into three rabbits and four mice; the mice died the following day, one rabbit remained healthy, the second suffered from tetanus and recovered, the third died of tetanus. The second case was that of a man who had a mild attack after an injury to his finger; in this case there was also contamination of the wound by dirt. Experiments gave negative results. The third case was that of a man who died from tetanus. Small pieces of skin taken from near the wound produced tetanus in animals. Impure cultures of the wound-secretion produced the same effects. A fourth case gave very similar results. In this case the man had received his wound in a certain cellar, and experiments were made on the earth of this cellar; tetanus was produced when the wounds of animals were contaminated with it. In the fifth case tetanus had been produced by a splinter of wood. The splinter had been carefully preserved by the man's wife for two and a half years. Small pieces of this splinter were inserted beneath the skin of animals, and tetanus followed. The bacillus was recognized in the secretion. In the sixth case a servant in scrubbing a floor got a splinter of the wood of the floor under her thumb-nail and died of tetanus. Fourteen months after the same splinter produced tetanus in rabbits. So far as to traumatic tetanus. Idiopathic tetanus is rare, and it is not improbable that in reality it does not exist, but is derived from some slight scratch or wound which has passed unnoticed; in other words, so-called idiopathic tetanus has a concealed traumatic origin. 1 Wiener klin. Wochenschrift, 1888. Public Health, vol. i. 117. (309) The Prevention of Tetanus. In view of the modern discovery that tetanus is produced by a micro-organism to be found in dust and dirt and adhering to foreign substances, the surgeon will naturally take the greatest pains not alone to cleanse wounds but to apply to the cut surfaces in cases of foul wounds strong disinfectants, or even where necessary cut clean away the bruised and soiled cut surfaces. It is, however, obvious that save in the way of disseminating information on these points among the public at large, tetanus is a malady against which the Health Officer can do little or nothing. He may however point out that the discharges from such wounds, should be collected on clean rags or similar substances, which can be either disinfected or burned. WHOOPING-COUGH. (310) General Nature of Whooping-Cough. Whooping-cough is believed to be a micro-parasitic disease, the poison of which more especially affects the nervous system. With a few exceptions the sufferers are solely children and persons of tender years. The most prominent symptom is a peculiar expiratory cough, by which the lungs are pretty well emptied of air; following this cough there is a prolonged inspiration with a peculiar crowing sound-the so-called "whoop." (311) Statistics. Whooping-cough kills a large number of children, the mean number of yearly deaths during the twenty-five years ending 1888 was 11,964; the maximum number occurred in 1878, when 17,784 deaths were ascribed to this cause, the minimum in 1864, 8,570 deaths. (312) Etiology. Fatal and common disease as whooping-cough is, there is very little definite knowledge concerning the laws which govern its diffusion. All that is known is that it is excessively infectious, and that once introduced into a house, it is liable to attack all young children not protected by a previous attack. In its seasonal distribution it is most fatal in January, February, and March, up to the second week of April. A curve plotted out for a number of years showing the weekly deaths from whoopingcough shows an inverse relation to the scarlet fever curve; that is to say, the latter curve turned upside down is like that of whooping-cough, the maximum of the one corresponding with the minimum of the other. Whether there is any real antagonism between these two diseases is not known. The disease has a stage of latency, which is generally put at between five or six days. The infecting distance is great. An instance occurred under the writer's own observation in which a tramp brought a child from some distance into a small town in Somersetshire to the workhouse. At the time there was no whooping-cough in town or workhouse. The child had whooping-cough. The woman with her baby was allowed to sit at a table in the open air, at which the workhouse children were having a sort of treat. The woman remained there about an hour. In a few days a third of the workhouse children were simultaneously affected with whoopingcough. The well known St. Helena case may also be cited. The captain of a ship in which there was some children suffering from whooping-cough allowed the linen of the sick to be sent ashore, and shortly afterwards the same disease broke out among the inhabitants. Burger1 has stated that elliptical cocci are constantly present in the sputum of persons affected with whooping-cough, but the bacteriology has not been worked out. (313) Duty of the Medical Officer of Health. In cases of whooping-cough it is certain that on recovery or death the clothing, and the room with its contents, should be properly disinfected. Hitherto it has not been practicable to isolate cases of whooping-cough in special hospitals. 1 Berl. klin. Wochenschrift, 1883. CHAPTER XXVIII. MICRO-PARASITIC DISEASES MAINLY AFFECTING THE RESPIRATORY ORGANS. PNEUMONIA. (314) Epidemic Pneumonia. THERE is abundant evidence that at least the species of pneumonia, known as "croupous or fibrinous pneumonia," is one of the class of maladies produced by a micro-parasite. It is infectious, and not unfrequently prevails in an epidemic form. This is the view generally adopted by hygienists, and one which the writer has held and taught for the last twelve or thirteen years; the profession at large have not yet fully adopted this view, hence few, if any, precautions are taken to prevent the spread of the disease. (315) Evidence of the Infectious Character of Pneumonia. It may be well here to adduce some evidence of the infectious character of pneumonia. In the Akerhus prison1 two outbreaks occurred, one in 1847, another in 1866. In the last epidemic no less than sixty-two cases occurred in six months amongst 360 prisoners. Thoresen, of Eidswold, records an epidemic of croupous pneumonia almost confined to a single row of cottages. The epidemic lasted a month. An epidemic broke out in 1860 in the Mediterranean fleet. Its infective character was very evident, and Dr. Bryson,3 who recorded 1 Norsk. Mag f. Laegevidenskaben, vo'. xxii., P. 2 Ibid. 3rd ser., vol. i., p. 65, 1871. 345. 3 Lancet, January 9, 1862. it, pointed out several characters common to it, and the pleuropneumonia of cattle. Five cases of pneumonia1 occurred almost simultaneously, March 1874, at a school at East Sheen, Mortlake. The time of attack coincided with a large escape of sewer gas into the school, and the boy first attacked slept in one of the rooms most exposed to the effluvium. Mr. Alfred Mayo 2 communicated cases of infectious pneumonia to the author as follows. The first case was that of a bricklayer, aged thirty-five, who was taken ill with pleuro-pneumonia. His mother nursed him and caught the malady and died. A neighbour nursed this last case. She, in her turn, caught the disease and died. Lastly, her child took it but recovered. In the writer's Dictionary of Hygiene, the following additional cases are recorded : A farmer at Bow, Devon, suffered from pneumonia; his niece nursed him; she soon became affected with the same disorder, and, going home, infected her husband. A Dolton farmer became ill with pneumonia on April 16th, 1875, and died on the 18th. The servant girl who nursed him suffered from the same malady, the first symptoms appearing a week after the death. She went whilst ill to her married sister's home, who also contracted the same malady. Another man became ill of pneumonia in April of the same year, and died after ten days' illness. His wife contracted the disease, her first symptoms appearing immediately after his death. About the same date, a farmer's daughter, a mile from the house of the former patient, became ill of pneumonia; five other cases followed, all in the same parish (population, 470), consisting of a small village and a few scattered houses. A clergyman became ill with acute pneumonia. The woman who nursed him in about seven days contracted the same disease. The clergyman's sister, taking the place of the nurse was, in her turn, also seized with pneumonia. A brother of the clergyman now took the place of the last; he, in his turn, also was laid up with the same disease. The nurse and sister both died, the two brothers recovered. 1 "Sewer Gas Pneumonia." Irish Hospital Gazette, Nov. 1, 1874. |