A recent investigation of diphtheria carriers in Detroit is reported by Goldberger, Williams and Hachtel, in Bulletin No. 101, of the Hygienic Laboratories, of the United States Public Health Service. The problem of diphtheria carriers has become one of considerable importance and has been given special prominence of recent years by the studies of von Scholly, Moss, and Nuttall and Graham Smith. The writers of the report mentioned above studied 4,093 people in the city of Detroit, and found that 0.928 per cent harbored bacilli identical morphologically with the Klebs-Loeffler bacillus. This figure is rather lower than those of some otherinvestigators, but would indicate, as stated by the writers, that there were from 5,000 to 6,000 diphtheria carriers in the city of Detroit.
Of nineteen cultures isolated from nineteen of the carriers, only two were virulent, which would indicate that only 0.097 per cent of the people examined carried organisms capable of producing disease. An interesting further point is that the bacillus Hoffmanii was present in at least 41.9 per cent of over 2,000 individuals examined, and that the forty-nine cultures morphologically identified as bacillus Hoffmanii were avirulent. This would confirm the impression gained, we believe, by most experienced laboratory workers, that a true Hoffmanii can be distinguished with considerable certainty from a Klebs-Loeffler bacillus by morphological examination alone, and that its significance is probably that of a frequently present saprophyte of the throat and pharynx. The studies of Goldberger, Williams and Hatchtel also indicate that in examining for diphtheria carriers, it is best not to confine oneself either to the nose or throat, but that cultures should be taken from both places in every case.—The Journal of Laboratory and Clinical Medicine.
In an action against a sanatorium and its superintendent it appeared that the plaintiff had employed the superintendent to perform an operation for hernia. After the operation was performed the doctor carried the plaintiff to the room assigned to him and placed him in bed while still under the influence of an anesthetic. A rubber bottle, filled with very hot water, had been placed in the bed, and the unconscious man was laid upon it, and was burned on his back severely. The witnesses described the wound as being 15 to 18 inches in diameter. He also received a smaller burn on his side; the attendants, believing that his struggles on becoming conscious were due to delirium, having held him down on the bed for a time and then turned him on his side. He wasunder treatment from the burns for a number of months and suffered excruciating pain. The jury found the doctor, but not the sanatorium, guilty, and rendered a verdict for $5,000, which the trial court reduced to $2,500. On appeal, the court said that it did not mean to condemn the doctor, nor even to say that he was in fact negligent; but, taking the situation as it found it, and as the jury observed it, there was evidence to justify them in finding that the doctor had not exercised proper care; and, having so found, the court had no right to dispute the verdict. It also held that the damages awarded were not excessive.—Grosshart v. Shaffer, Oklahoma Supreme Court, 152 Pac. 441.—Medical Record.
Gam says that while experimenting on intrathoracic and intra-abdominal pressures, the blood pressure was observed to fall during vomiting. A series of experiments were performed to determine the cause of this fall. In all experiments the blood pressure, the intrathoracic pressure and the movements of the abdominal wall were recorded. Vomiting was induced in some cases by means of apomorphin; in others by filling the stomach with hot salt solution, hot soap suds, copper sulphate solution, etc. In every case a high negative pressure was observed in the thorax during the act. The pressure would fluctuate rapidly from zero to twenty-five or thirty centimeters (water) of negative pressure. The blood pressure, however, always fell, sometimes to less than half its former level. The fall in blood pressure was found to be due to a vagus inhibition of the heart, for on cutting the vagi while the vomiting was taking place, and while the blood pressure was at its lowest, there was an immediate increase in heart rate and rise to above the normal in blood pressure. Furthermore, when the vomiting was induced after the vagi had been cut, there was a rise instead of a fall in blood pressure.—The Journal of the Amer. Med. Asso.
Home Treatment of Sciatica.
Pœppelmann suggests the following method for the home treatment of sciatica. A pail of boiling water is placed in a tub large enough to permit an old chair to be set in it. A tablespoonful of ol. pini sylvestris is poured into the boiling water, the patient seated on the chair with his feet outside the tub, and two sheets pinned around his neck, so that they reach the floor on all sides, covering him completely but leaving the head free. In this steam bath the patient is allowed to remain for twenty minutes. He is then rubbed briskly with a cold wet cloth, dried and put to bed for an hour. If necessary, especially with elderly people, cold applications may be made to the head during the process of steaming. Internally, iodides are given, preferably iodine-vasogen, 7–8 drops three times daily. The bowels must be kept freely open. The baths are given every other day, and five to fifteen sittings are required for a cure. In the author’s hands a successful outcome has been practically uniform.—Critic and Guide.
In theAmerican Journal of the Medical Sciencesfor September, 1915, Barton asserts that all the irregularities of the heart-beat which are brought about by digitalis tend to be removed by caffeine. Although in many cases digitalis arrhythmia will spontaneously disappear when the drug is stopped, instances arise, unfortunately too common, in which after prolonged digitalis administration the conductive system is so depressed that serious results may arise. Under these circumstances the administration of caffeine will be of service and is therefore strongly indicated. The action appears to be due to the increase in irritability of the conduction system produced by the caffeine, which antagonizes and finally overcomes the depressing effects which digitalisexerts upon the auriculo-ventricular bundle.—The Therapeutic Gazette.
TheJournal of Pharmacology and Experimental Therapeutics, for November, 1915, contains a report of a research by Means and Newburgh in which they report experiments upon the blood-flow of two normal subjects during rest, and of one subject during muscular work.
The action of caffeine on the blood-flow was studied in both subjects while at rest, and in one during work.
The average blood-flow of the two subjects at rest was 4.5 and 4.0 liters per minute; the systolic outputs were 61 and 57 cc.; the coefficients of utilization of the oxygen-carrying capacity of the blood were 31 per cent and 41 per cent.
With increasing work a steady rise in blood-flow, oxygen absorption, and pulmonary ventilation was found. The increase in blood-flow was produced first by an increase in systolic output until a maximum of 118 cc. was reached, beyond that by an increase in pulse-rate. This suggested that the supply of venous blood in this subject becomes “adequate” at about 640 kg. meters of work per minute. The coefficient of utilization showed a slight rise during work, indicating a slightly greater economy of the circulation.
After giving caffeine during rest, or when the supply of venous blood is “inadequate,” evidence of drug action was found with both subjects. This action consisted in an increase in total blood-flow without a corresponding increase in oxygen absorption, and hence a decreased coefficient of utilization of the oxygen-carrying capacity of the blood. The pulse-rate was unchanged. Consequently the systolic output was increased.
During work probably no other action was obtained from caffeine than possibly an increase in pulse-rate, and consequently slight diminution in systolic output.
It is suggested that during rest when the supply of blood to the right heart is “inadequate”, caffeine increases the blood-flow by increasing the venous supply through an action upon some mechanism outside the heart. When the supply becomes “adequate” or approaches adequacy, no such action is obtained.—The Therapeutic Gazette.