Reports of Societies

1917 BMJ (Clinical Research Edition)  
2o MNAJ 3R."I THE LOUSE PROBLEM. [MARcH 3, S917 2~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~C I, 3 , 19 V? ;RNKl form of a lon, -narrow kit-bag, wvhicl -ism }ad to reach to the top of the thigii in the case of thle leg, And to the axilla in that of -the arm. It lias a ttibe of exit at tlhe bottomi whichi passes out of tfie bed into a pail or bucket. It mi g ht be argued that iii the case of a leg, woundc the _ v ater w ourd -0 i.w -j1Descape into the !bed throughl the upper end of thie outer bag; if,
more » ... r, two blocks are placed r-G. u.-tpl)r& in olhillg o fl.lnder the legs at iG. 1.-Akpparatuis in working order forth top of' the a w-otijid on thle tliigli. tl o ftl bed, thie water ruus dowii aind the outei ba is' d at 'tlie op with a pair of Spencer Wellsforceps, leaving thie resultiag ll-d' upp?ermilost; thlis 'foul is Atilized as a means of Qntiiande for the supply pipe. As a' supply rescrvoir a'two-gallol 'Lysol jaL 'Is used, which. can be stood besicle the bed on. the Ipatient's locker. Into the lwaXr in the jar is placed an electric lheater, and into the circuit between the electric lheater aud the 'plug in the vwAll is fitted an ordinary 'electric light swvitchi, whilh' the patient.can iold in bed. A ;crewi clip is fied on the * ' upply tube, so that the r&te ofiitflow cin be controlled. Havixg put 'on the bags, and filled 'ite reservoir with4 water, the rest can -safely be' left to -the patient. He can switcl the electric current off and --' -ou as he lilkes, lie can feel the temperature of tlle water by placing -his hand against the glass reservoir, and can regu-FJIG. 2.-Thie bags in position late the inflow by the screw for an amputation stumip. The clip on the pipe. He can roll bags can he easily sterilized about in bed as much as lie by -wiping them down' with ,i nbda uha I bo.leantisenticsol.ition,or by likes, and lie can be entirely descriptio it coyvred up vitlh bedclothes. From this desci il be appaet low eadily ,%e cani give bathi treatment to wounds in such 'avkward pl-aces as the kniee, thiglh, or upper arm. Ampputati'on itumps can be dealt witli in the same way, providing there is sufficient sttumlp. In tlhese cases thle inner cylinder is yeplac d by a small editio -of thio outer bag. The ampu. tation stuimpi) bag is found very iseful, especially foi tile leg, even if bath treatmnenit is onlly employed'to cleain the wounds prior to re-amnputation. T1hle whole apparatus, ineluiding set of bags for arm, leg, lind anb utation stuiiip, is muade by Messrs. Allen and 1falibLi ys.' BAsIL SAMPSON, Captain S.A.M.C. South African Mi\iia-ryIHospital,-Richmoiind Park, Surrey. 'GENERALIZED POST-DIPHITHERIAL PARALYSIS.' A CHiLD, aged 3-1years, was taken ill on November 8th, 1916. The case was diagynosed as diplhtheria and admitted' to the isolatioln hospital onl November .9tl. The symptoms were headaclle, vomiiting, sore tlhroat, anid enlarged cervical gWaiids_ tli teirperatuire -Was 100.20 and the pulse 116. When the child came into hospital -th6 throat was very "'dirty " and antitoxin (4,000 units) was administered. The report of the bacteriologist on the swab was " a very strong growth of B. dip)htheriae." Rectal salines ,5 ounces) were administered for thiree clays. The temperature stayed about 100°for four days, after that it nlever rose above 99'. The pulse went down to 86 on the fifth day. On the nintlh day the patient's voice became very nasal, alid on thle tenithi day slle lhad a very severe attack of vomit ing, alid on the eleventh thle colour became very bad and thle w-as pOorandl thready. Again salines were adminxis. teredl anid shle becanile muchl b)etter. On thle seventeenith day after admnission squinit wXas very nloticeabale. On thi.s day a swvab was takSen and thec result was-" nio B. d7ipht-*kerizae, b-ut st'aphlccocci an1dl streintococci n\iunlerous," On the eighteentlh day paralysis of the muscles-at tlho back of the neck occurred, andif the child was raised up from the -bed by tlho hands tlre--head fell back at olnce almost to iighb6 angles with the body. The paralysis was marked for about four weeks, btt improved on small doses of strychnine and mnassage of the affected part. Tlho patient was for some time unable to turn the head from sidc to side. Comnplete recovery ensued. Medicine of tlie Royal Society of Medicine on F9bruary 23rd, Dr. C. J. MARTIN being in tlhe chair, Mr. A. W. BACOT pointed out that of the thiree varieties of lice parasitic upon man only one, the PedicuNl3 humatnus (clothes louse) was of sufficient impprtance as a disease transmitter to cause serious a4nxiety. Pcdic?,dltscapiti8 was so closely related that It could onily grudgingly be allowied specific rank apart from the latter, and he --did not deal with Phtdhirittl pitbis (ciab louse). He described the life-hiistory anid chiaracte'ristics of PedCioiit'su , nia1is aild' s;uij-marizettI the features of practical impoFtance from tho point df view ofsanitaky precautions. Untdei 'norlual conditions-naniely, in clothling tllat was constintly worin -eggs tool. s6viCn,tb_ ten days to l1teh, if'dl6thing w-as discarded or allowed to cool for a pr each daytha,time mighit be extended to five webks. Active lice eouMid exist without food and apart from-any host for periods uo to nilne days. Yotung lice took from tenr to f6urteen days to attain sexual maturity. Females, after attain ng maturity, required two to four days before they conimenced to oviposit. Egg production could not take place without food or under cool conditions (blow 65°F.). Eggs laid by unpaired females did not lhatch. Impregnatioln was not effective for more than twenty days. As lany as 10 or 12 eggs a day mniglht be laid by each femiale, ancl eacll iniglht lay a total of 300 eggs. After reaclling maturity the female might live for forty-six day,s3 anda before the close of lher life a single female might have 4,160 living offspring. Pediculosis, lhe said, was a signi ofa low standard of life.-Witlh the possession of a; change of garments and the institution of tlle weekly washiing of shirts and underclothing, the number of thee parasites was speedily reduced; whllen sufficient means and leisuro obtained among tlle people to allow of the regular clhange and cleaning of bedding as well as of clotlinLg, Pcdicttlu lumauits must die out. WViththe advent of war arinies were plunged back into a conition of barbarism, inwhlikih +,he washing and changing of garments, not to mention bedding, was erratic, and miiight not take place for weeks or months. The solution of the problem depended eitherupon campaigning under a civilitzed standrd of life Or upon the adoption of efficient remedies for the destruction' of lice. In the WVest tlle stable front had renclered it possible for the troops in the field to enjoy, in large" mieasure, the civilized custom of the washing and chaiiginof clothiing, but in tlle actual fighting line and in other areas this lhad not been found practicable, and dependence upon insecticides was essential. It was necessary to use ielatively stable slow-acting remedi&s, hi 4ddifidn to6 1ne wvith a quick action of short duration. Thlose miost4s'r-v-iceable -in emergencies were imnpracticable for continuous u,se-oWing to tlle large quantity which their rapid evaporationi rendered necessary. The treatment of discarded clotlhing should, wherever possible, depend upon the "ction of dryheat as' more economical than hot fluids' o steami. A chamber for drying clothes once established mighlt be maintained above tlle level of the temperature necessary for the destruction of lice and nits, especially as it was almost certaini that the same temperature would destroy the active females of the sarcoptes whicll caused scabies. The necessary temperature was 520 C. for thirty minutes, and lhence, allowing a margin for contingencies, one of 55' C. for thiis; period would be'ligh enouglh if the garmen'ts' were spread and hung. If great speed and economyy of fu el wee desire d, ttubtilar oven with travellirg l1angers
doi:10.1136/bmj.1.2931.296 fatcat:exvhxwbe7vc65dr3x4cfputkky