MALARIAL FEVER AT TAI PÓNEW TERRITORY, HONG-KONG.
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273 A strip of endometrium one centimetre wide was intensely bsemorrhagic. The solitary follicles in the ileum and large intestine were swollen and some of them contained hmmor- rhages. Microscopically, the liver cells were swollen and fatt,y, and the renal epithelium was swollen and granular. In the intestinal follicles the lymphoid cells had partly dis- appeared and were replaced by large epithelioid cells ; in stained sections short bacilli were seen. The endometrium showed cell proliferation and haemorrhages. Cultures from the heart’s blood, liver, and kidney were negative ; cultures from the colon, lung, umbilical cord, bile, and spleen yielded the typhoid bacillus. The septicsemic character of the disease is characteristic of congenital cases and basmorrhages are. common in them. ____ A DANGEROUS ECONOMY. A CUSTOM of the City more to be honoured in the breach than in the observance was explained at the Guildhall police-court the other day by a police-inspector and seems to have been new to the presiding alderman. It consists in the police refusing to summon a medical man to examine a prisoner who denies being drunk when charged unless he or she is able to produce 7s. 6d. to pay the necessary fee. In the case in question an inspector explained that the difficulty lay in the fact that if the person desiring to be medically examined did not pay the fee the liability would fall upon the ratepayers. We have no doubt that it would, but the solicitude of the police on behalf of the pockets of the public seems here superfluous. The rate would, we conceive, hardly have to be materially increased even if a large proportion of the drunk and disorderly persons charged in the district insisted upon seeing a medical man. That any large number of them should so insist seems improbable, seeing that it would always be possible to inflict a heavier penalty upon the prisoner who had perversely and out of pure malice chosen to give unnecessary trouble, and we are not without a suspicion that it is the anxiety to avoid extra trouble rather than the dread of falling into extravagance that has caused the restriction to be imposed to which we have called attention. The dangers and hardships arising out of such a restriction fall exclusively upon innocent persons. We confess that we have no great confidence in the diagnosis of a policeman, be he constable, sergeant, or inspector. We do not blame him for it ; his education is not gained in a hospital, and an additional difficulty is thrown in his way by the charity of the man in the street whose first impulse is to administer a stimulant to anyone suddenly afflicted with illness. A person who faints in public may, even though he be a teetotaler, have spirits poured down his throat and spilled over him until he reeks of them. Then he comes into the hands of those who arrive at their conclusions by the simple process of following their noses. They may be right in nine cases out of ten, but in the tenth case the person may die in a police-cell from want of proper attention. MALARIAL FEVER AT TAI PÓ NEW TERRITORY, HONG-KONG. IN November, 1900, His Excellency the Governor of Hong- Kong instructed two medical officers, Dr. T. M. Young and Dr. J. C. Thomson of the Hong-Kong Medical Civil Service, to make an inquiry into the marked prevalence of malarial fever at Tai P6, New Territory. The report of these officers to Mr. John Bell, acting principal civil medical officer, has been published as a Government notification from the Colonial Secretary’s office, Hong-Kong, and bears date Dec. 6th, 1900. From Sept. 4th to Nov. 12th, 1900, there were caught 309 mosquitoes, of which 40 per cent. were anopheletes and 60 per cent. were culices. On Nov. 12th, the day of their arrival, however, the proportions of anopheletes caught had arisen to 60 per cent. But while during October there were 17 cases of fever occurring among the police there was only one in November up to the 15th. Dr. Young and Dr. Thomson attribute the fall in the number of cases which occurred during this period, which coincides with the second rice harvest, to the ’’ adoption of vigorous prophylactic medication with quinine on two days successively at intervals of seven days." A search was made for the larvse of anopheles, and these larvse were found abundantly in the narrow ditches around the upper paddy fields and also in a sluggish stream into which the paddy fields drained. Ten children were brought from the nearest village to the police station who willingly yielded drops of blood at the rate of five cents per drop. In 50 per cent. of these the malaria parasite was found, two cases being of a benign type and three malig- nant, while all five children proved infective to anopheles feeding upon them. With regard to prophylaxis Dr. Young and Dr. Thomson have no alternative but to recommend "the acquirement and reclamation or effi 1ient drainage of all the paddy fields within a radius of 250 yards from the foot of the hills on which the houses (of the police station) stand." Permanent buildings should also replace the mat- sheds at present used by the civil staff. The buildings should be two storeys high, residential quarters to be only on the upper floor, and the site suggested for these build- ings is an island about 900 yards east of the present police station. A MODIFICATION OF FLECHSIG’S METHOD IN THE TREATMENT OF EPILEPSY. Dr. E. Meyer and Dr. C. Wickel have contributed an article on the above subject to a recent number of the Berlinerr Klinische Wochenschrift (No. 48, 1900). The work was carried out at the Psychiatric Klinik of Tubingen under Professor Siemerling, with a view to find, if possible, a more- satisfactory treatment for cases of epilepsy than the method lately proposed by Flechsig. The plan of Dr. Meyer and Dr. Wickel is to begin the treatment with opium alone, com- mencing with small doses—e.g., five centigrammes three times a day, which are gradually increased until in about six or seven weeks the dose is nine centigrammes. This maximum. dose is given only for one day, after which a bromide mixture is substituted for it-viz., potassium bromide one part, sodium and ammonium bromides each one part, the dose of the mixture being six grammes. The doses of the bromide mixture are now steadily increased till in a week they reach nine grammes per dose. This amount is the maximum dose, and it is continued for a long time and until definite improvement occurs. Under this method of treatment it is necessary that the digestive functions and the functions of the skin should be carefully regulated. Thus, during the opium treatment the patient should have cold baths of short duration (10 minutes) daily at a temperature of 240 C. After a day or two the temperature of the bath should be lowered 1° and the duration of the bathing limited to nine minutes, the next day the duration of the bath being eight minutes aDd the temperature 22° C. This process should be continued for a week. When the bromide treatment begins the tempe- rature of the bath and its duration should be the same as at the commencement of the opium treatment. Diet should be carefully regulated so as to be light and easily digestible, all nitrogenous foods or beverages, such a& beef, coffee and tea, meat broths (which generally contain nitrogenous extractives), acids, sauces, and the like, being avoided or reduced to a minimum. Clinical histories are given by the authors of several cases (10 in all) in which the above lines of treatment were carried out for long periods ot
Transcript of MALARIAL FEVER AT TAI PÓNEW TERRITORY, HONG-KONG.
273
A strip of endometrium one centimetre wide was intenselybsemorrhagic. The solitary follicles in the ileum and largeintestine were swollen and some of them contained hmmor-
rhages. Microscopically, the liver cells were swollen and
fatt,y, and the renal epithelium was swollen and granular.In the intestinal follicles the lymphoid cells had partly dis-appeared and were replaced by large epithelioid cells ; in
stained sections short bacilli were seen. The endometriumshowed cell proliferation and haemorrhages. Cultures fromthe heart’s blood, liver, and kidney were negative ; culturesfrom the colon, lung, umbilical cord, bile, and spleen yieldedthe typhoid bacillus. The septicsemic character of the diseaseis characteristic of congenital cases and basmorrhages are.common in them.
____
A DANGEROUS ECONOMY.
A CUSTOM of the City more to be honoured in the breachthan in the observance was explained at the Guildhall
police-court the other day by a police-inspector and seemsto have been new to the presiding alderman. It consists inthe police refusing to summon a medical man to examine aprisoner who denies being drunk when charged unless he orshe is able to produce 7s. 6d. to pay the necessary fee.In the case in question an inspector explained that thedifficulty lay in the fact that if the person desiringto be medically examined did not pay the fee the liabilitywould fall upon the ratepayers. We have no doubt thatit would, but the solicitude of the police on behalf ofthe pockets of the public seems here superfluous. The rate
would, we conceive, hardly have to be materially increasedeven if a large proportion of the drunk and disorderlypersons charged in the district insisted upon seeing a medicalman. That any large number of them should so insist seemsimprobable, seeing that it would always be possible to inflicta heavier penalty upon the prisoner who had perversely and out of pure malice chosen to give unnecessary trouble,and we are not without a suspicion that it is the
anxiety to avoid extra trouble rather than the dreadof falling into extravagance that has caused the restrictionto be imposed to which we have called attention. The
dangers and hardships arising out of such a restriction fallexclusively upon innocent persons. We confess that we haveno great confidence in the diagnosis of a policeman, be heconstable, sergeant, or inspector. We do not blame himfor it ; his education is not gained in a hospital, and anadditional difficulty is thrown in his way by the charityof the man in the street whose first impulse is to administer astimulant to anyone suddenly afflicted with illness. A personwho faints in public may, even though he be a teetotaler,have spirits poured down his throat and spilled over himuntil he reeks of them. Then he comes into the hands ofthose who arrive at their conclusions by the simple processof following their noses. They may be right in nine casesout of ten, but in the tenth case the person may die in a
police-cell from want of proper attention.
MALARIAL FEVER AT TAI PÓ NEW TERRITORY,HONG-KONG.
IN November, 1900, His Excellency the Governor of Hong-Kong instructed two medical officers, Dr. T. M. Young andDr. J. C. Thomson of the Hong-Kong Medical Civil Service,to make an inquiry into the marked prevalence of malarialfever at Tai P6, New Territory. The report of these officersto Mr. John Bell, acting principal civil medical officer, hasbeen published as a Government notification from the
Colonial Secretary’s office, Hong-Kong, and bears dateDec. 6th, 1900. From Sept. 4th to Nov. 12th, 1900, therewere caught 309 mosquitoes, of which 40 per cent. were
anopheletes and 60 per cent. were culices. On Nov. 12th, the
day of their arrival, however, the proportions of anopheletescaught had arisen to 60 per cent. But while duringOctober there were 17 cases of fever occurring amongthe police there was only one in November up to the
15th. Dr. Young and Dr. Thomson attribute the fallin the number of cases which occurred during this
period, which coincides with the second rice harvest, tothe ’’ adoption of vigorous prophylactic medication with
quinine on two days successively at intervals of seven
days." A search was made for the larvse of anopheles,and these larvse were found abundantly in the narrow ditchesaround the upper paddy fields and also in a sluggish streaminto which the paddy fields drained. Ten children were
brought from the nearest village to the police station whowillingly yielded drops of blood at the rate of five cents
per drop. In 50 per cent. of these the malaria parasite wasfound, two cases being of a benign type and three malig-nant, while all five children proved infective to anophelesfeeding upon them. With regard to prophylaxis Dr. Youngand Dr. Thomson have no alternative but to recommend"the acquirement and reclamation or effi 1ient drainage ofall the paddy fields within a radius of 250 yards from thefoot of the hills on which the houses (of the police station)stand." Permanent buildings should also replace the mat-sheds at present used by the civil staff. The buildingsshould be two storeys high, residential quarters to be onlyon the upper floor, and the site suggested for these build-ings is an island about 900 yards east of the present policestation.
____
A MODIFICATION OF FLECHSIG’S METHOD IN
THE TREATMENT OF EPILEPSY.
Dr. E. Meyer and Dr. C. Wickel have contributed an articleon the above subject to a recent number of the BerlinerrKlinische Wochenschrift (No. 48, 1900). The work was
carried out at the Psychiatric Klinik of Tubingen underProfessor Siemerling, with a view to find, if possible, a more-satisfactory treatment for cases of epilepsy than the methodlately proposed by Flechsig. The plan of Dr. Meyer andDr. Wickel is to begin the treatment with opium alone, com-mencing with small doses—e.g., five centigrammes three timesa day, which are gradually increased until in about six orseven weeks the dose is nine centigrammes. This maximum.
dose is given only for one day, after which a bromidemixture is substituted for it-viz., potassium bromideone part, sodium and ammonium bromides each one
part, the dose of the mixture being six grammes.The doses of the bromide mixture are now steadilyincreased till in a week they reach nine grammes perdose. This amount is the maximum dose, and it is
continued for a long time and until definite improvementoccurs. Under this method of treatment it is necessary thatthe digestive functions and the functions of the skin shouldbe carefully regulated. Thus, during the opium treatmentthe patient should have cold baths of short duration (10minutes) daily at a temperature of 240 C. After a day ortwo the temperature of the bath should be lowered 1° andthe duration of the bathing limited to nine minutes, thenext day the duration of the bath being eight minutes aDdthe temperature 22° C. This process should be continuedfor a week. When the bromide treatment begins the tempe-rature of the bath and its duration should be the
same as at the commencement of the opium treatment.
Diet should be carefully regulated so as to be light andeasily digestible, all nitrogenous foods or beverages, such a&
beef, coffee and tea, meat broths (which generally containnitrogenous extractives), acids, sauces, and the like, beingavoided or reduced to a minimum. Clinical histories are
given by the authors of several cases (10 in all) in which theabove lines of treatment were carried out for long periods ot
