Page images
PDF
EPUB

pose of it the quickest. If a non-resident they are willing he should return to his home, thereby exposing, perhaps, a hundred people, and carrying it, perhaps, to a community that is perfectly free from it. The duty of every health-officer is well known; they should at once put every one discovered with smallpox in strict quarantine and keep them there the full allotted time. The negligence of a health-officer is the cause of an epidemic in our community. A man came from the northern woods, going freely among his neighbors and attending a free medicine show every night for a week. One day he met the health-officer of his town, and, after showing him his hands, arms and breast, asked what it was. The officer wanted to know if he ever had chicken pox. The patient said he did not know, but they said in camp it was smallpox. Well, said the honorable officer, it is better than being vaccinated, and drove away. From this case we had a large number of cases with four deaths.

In regard to vaccination, it would be far better for each community to pay for the vaccination of all. There would not be half the number who would object to having it done as there is by requiring them to pay for it themselves; so many consider it an outrage to have to pay for the privilege to have a sore arm. Some six years ago there were three towns that paid for the vaccination of the school-children, and I found none who objected to the vaccination of their children; while in the two adjoining towns, where the parents paid, there was only about one-half of the children vaccinated. In this epidemic, there were only a few cases in the towns which vaccinated, while in the towns that did not vaccinate the disease prevailed. The same result is found on the reservation; there the government pays for the vaccination of all the school-children, and requires them to be revaccinated every three years. There they had only a few isolated cases, and not one among the children who had been vaccinated.

There is a fault among the doctors in not being careful enough in securing good vaccine. Many buy the cheapest, and just scarify the arm a little, put on the virus and discharge the patient, perhaps to suffer for weeks with a painful and swollen arm. Perhaps it does not work, though giving the patient an idea they are proof against smallpox. There should be the greatest care used in securing the best vaccine, and the same care in making the arm perfectly aseptic,-also the instrument, then protect the wound after vaccination. Then there would be no trouble in the future. This poor work in vaccinating and the mildness of this epidemic of smallpox, are adding scores to the army of antivaccinationists.

In conclusion, I would say: give us a law requiring districts to pay for the vaccination of all school children. See to it that doctors secure the best vaccine, and use the same care in vaccinating as they do in their surgical work. Require health-officers to do their full duty; then in a few years smallpox will be among the unknown diseases.

Dr. W. C. Bennett: I do not know that I can say anything further unless I give briefly a description of the way smallpox is handled here in Milwaukee. Considering the size of the town, we believe we have had a comparatively small number of cases here, and we attribute it partly to the way in which the cases have been handled and partly to the very efficient vaccination which we had here during the epidemic of 1894, in which probably 150,000 people, or thereabouts, were vaccinated. The way the cases are handled now, as Dr. Boorse has said, is that we have been vaccinating in the schools where the parents would allow their children to be vaccinated. About 18,000 or 20,000 children have been vaccinated since the first of January this year, and I might say that all these vaccinations are at the city's

expense.

Dr. Leith: What is the compensation for vaccinating at the city's expense? What does the city pay for the individual vaccination?

Dr. Bennett: That I don't know. There is no expense at all to the individual.

Q. I know, but what does it cost the city?

A. Well, I do not know what that is.

In addition to this when a case of smallpox is developed the case is immediately taken to the Isolation Hospital. If it is a small child, the mother or some relative is allowed to go along and nurse it, both being cared for at the city's expense. The house where the case developed is thoroughly fumigated, all who have been in contact with the patient vaccinated, and then in case of the head of the family, unless there are some unusual circumstances, he is allowed to go to work at once. School children are not allowed to go to school for two weeks, nor are other members of the family who are working in places where they might have unusual advantages for carrying the contagion, such as clerks in clothing stores, tailor shops, etc., allowed to work, and we have had very few cases, I think, considering the size of the town and the fact that most of the cases that we have had have come in from the outside.

Dr. Leith: I would like to ask Dr. Bennett what he means by "thorough disinfection." There is 'not one of the gentlemen who have spoken that has gone into the detail of the process of disinfecting houses, either as to material or technique. There has been some intimidation of health officers, etc.; now perhaps it might be healthful to the profession generally to particularize what is being done in Milwaukee, and how you disinfect here.

Dr. Bennett: The rooms where the patient has been, if he was sick enough to be in bed, are disinfected by means of formalin.

Q. In what proportion?

A. A 40 per cent. solution, 8 ounces to a thousand cubic feet. Towels, sheets, etc., are suspended in the room and the formalin. thrown on them, and other articles in the room. The bedding, if the case is past the initial stage, is destroyed and new bedding furnished to the patient, and other rooms in the house which may have become infected are also disinfected by the same means, the use of formalin solution.

11-A.

ACUTE ILEUS, WITH ILLUSTRATIVE CASES.

BY ADOLF GUNDERSON, M. D., OF LA CROSSE.

I shall make no attempt to fully describe ileus and its different forms, as we can read it in every textbook, but only refer to some cases observed during the last two years, and add some remarks thereto. Of cases operated earlier, I have no good record.

CASES.

Case 1. Volvulus. Operated after 36 hours. Recovery.

Miss I. J., 22 years old, came to St. Francis Hospital on bed, Nov, 21st, 1900. Got suddenly sick 36 hours before with pain in ileocecal region, soen extending all over abdomen, vomiting off and on, but no fecal vomiting, no movement of the bowels, no flatus passed, patient has had no narcotics. Temp. first evening 100° F., since normal. Has never had any similar attacks, bowels somewhat constipated, menses regular. Patient complains of severe paroxysmal pain in ileocecal region, face has an anxious expression, temp. 99° F., pulse 100. Some meteorismus, abdomen not very tender but more over the right side. Large enemas without result. Moving coils not to be seen. Chloroform, incision over "McBurney's point," appendix is found normal, removed in usual way. Cecum distended, also ileum in less degree. Incision prolonged upwards, cecum and colon ascendens have a very long mesenterium,-are brought out of abdomen. Colon transversum and part of colon ascendens are found twisted 180° around a transverse axis, are replaced. Their mesenterium not shortened, because patient was very poorly. Abdomen closed. Patient recovered fully, is well and working today.

« PreviousContinue »