Journal of the American Medical Association (JAMA)
number of cases is a great increase in the mortality. In the five years 1901-1905, the total deaths from cerebrospinal fever in England and Wales numbered 395, or an average of 79 annually. In the next five years the annual number of deaths averaged 122. In the three following years the annual deaths averaged 146. In 1914146. In they had increased to 194, in 1915 1,974, and in 1916 they fell to 369. In the recent epidemic, England and Wales suffered much less severely than other countries in
... her countries in which cerebrospinal fever has become epidemic. In 1915, the mortality among the troops occurred earlier in the year than that in the civilian population. The case mor¬ tality was about 53 per cent., both in the civilian and in the military population. But little is known of the conditions under which epidemics arise. In this respect there is some resemblance between influenza and cerebrospinal fever. Both diseases occur at irregular intervals in widespread epidemics, embracing whole continents ; while in the interepidemic periods, sporadic cases, or even small outbreaks occur, which do not appear to possess the power to spread, and con¬ sequently die out. In influenza, however, insusceptibility to attack is unusual; in cerebrospinal fever it is the rule, the difference possibly being bridged over by minor catarrhal or febrile attacks due to the meningococcus, in which meningeal invasion fails to occur. PARIS LETTER Paris, Jan. 10, 1918. Death of Professor Lepage Dr. G. Lepage, 58 years of age, is dead. He was associate professor of obstetrics at the University of Paris and obstet¬ rician to the hospitals. Intern in 1888, he became succes¬ sively chief of the laboratory, chief of the clinic, and répétiteur at the Baudelocque Clinic. In 1894 he was appointed obstetrician to the hospitals, continuing his teach¬ ing work, and in 1898 he was made professeur agrégé of obstetrics. In these two services, which he directed succes¬ sively at the hospitals of the Pitié and Boucicaut, he was given charge of a course in a supplementary clinic. When war was declared he offered his services as a surgeon and has been thus engaged at two of the military hospitals of Paris, besides organizing a maternity service elsewhere. In collaboration with his master, Ribemont-Dessaignes, Lepage published a treatise on obstetrics that was authorita¬ tive. He also published a practical treatise on obstetric anti¬ sepsis, and edited several chapters of the "Medico-Chirurgical Practice." Original articles were published in the Annales de Gynécologie, etc. By numerous communications and actual participation in discussions, besides his scientific publica¬ tions Lepage contributed to the prosperity of the Société d'obstétrique, de gynécologie et de pédiatrie de Paris, of which he was secretary-general from 1902 to 1907. He also was secretary-general of the Association générale des médecins de France from 1906 to 1911. Dressings That Do Not Touch the Wound At a recent meeting of the Société de pathologie comparée, Drs. Polonowski and Durand described their method of wound treatment. In order to avoid contact of the dressings with the wound in cases requiring irrigation, they conceived the idea of isolating the wound from the gauze by a protective apparatus, consisting of a wire netting molded to fit over the wounded area. The edges rest on a small roll of absorbent cotton fastened to the netting. The irrigating tubes do not touch the wound. Compresses placed on the wire netting protect against dust. The fluids run off into a waterproof bag. The apparatus is immobilized with adhesive plaster or a mixture of colophonium, 40 ; ligroin, 5 ; turpentine spirits, 2, and alcohol, 20. This procedure obviates contact of the drainage tubes and wicks with the wound, and adds greatly to the well-being of the patient. Dressings are changed sel¬ dom because the irrigation keeps the wound in good condition and it can be inspected by raising the outer dressings. This method of dressing permits of subjecting the wound alter¬ nately to irrigation and to heliotherapy. It is adaptable to all methods of treatment. Fitted out with this apparatus, the wounded can be evacuated painlessly into the interior. The neutral solution of chlorinated soda can be replaced advan¬ tageously by an isotonic solution of sodium chlorid. The resulting cicatrix is comfortable and supple. Etiology of War Tachycardia Dr. Octave Crouzon, physician to the hospitals, and Dr. Abel Mauger recently demonstrated to the Société médicale des hôpitaux de Paris that a large number of cases of tachy-cardia are caused by an infectious lesion of the heart, organic and latent, existing quite often before the war, and caused to flare up by the war, of which the sole clinical manifesta¬ tion is an acceleration of the pulse, without·any other objec¬ tive sign. Therefore, these cases should not always be regarded as simple functional disturbances, but one must think of an organic basis in those with antecedent rheuma¬ tism, typhoid or other recent severe infection. Consequently, from the military point of view, these cases should be con¬ sidered for service provisionally or at times even definitely, as representing only limited fitness. Treatment of the Itch, Tinea and Vermin in Horses by Sulphuration At a recent meeting of the Academy of Medicine, Mr. T. A. Clayton called attention to the good results obtained in the treatment of the itch, occurring among soldiers, by a gaseous mixture resulting from burning sulphur in a closed oven. The mixture is known as "Clayton's gas" and was employed successfully by the English in the South African War. In April, 1915, the British military authorities called on Mr. Clayton to delouse the soldiers by this method and also to combat the itch in man and beast. The men wear a mask and stay half an hour in the sulphuration room. They are treated with their clothes on. Not only itch mites, lice and nits are destroyed, but also all parasites and vermin affecting the skin. The Bulletin of the academy publishes an illus¬ trated description of the procedure as applied to horses of the French cavalry. The government had a stable built for the purpose with ten stalls, although the apparatus could ster¬ ilize twenty horses at one time. The head of the horse projects, but he wears a hood continuous with the lining of the stall, only the nose being left exposed. Forty horses can thus be freed of itch and external parasites per day with this stable, and the success has been complete with seventy horses to date. None were washed or shaved beforehand, and each wore his harness. Cerebral Tetanus At a recent session of the Academy of Medicine, Dr. Léon Bérard, associate professor on the Faculty of Medicine of Lyons, and Dr. Auguste Lumière called attention to a new form of clinical tetanus, characterized by cerebral symptoms, which had not been observed previously. The case in ques¬ tion was one of late tetanus. The cerebral complication did not appear until a week or two after the onset of the con¬ tractures. The symptoms consisted of hallucinations, delir¬ ium, excitement and phobias, with nocturnal exacerbations, coming on suddenly and with maximum severity, persisting for eight days at least, and then gradually lessening in severity. There was no elevation of temperature. Bérard and Lumière believe that these are wholly toxic manifestations. Marriages Capt.