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Vol. 60, 1909 - University of North Carolina at Chapel Hill

Vol. 60, 1909 - University of North Carolina at Chapel Hill

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165<br />

morbidity from this disease. Everybody much more than the ordinary milk insnect-<br />

*°"^^<br />

alT;be%,W '^H°\Jr''''P''r"''"'^''"^ "°" P"^*'^^d is needed. Tvery<br />

.11 the time, and th<strong>at</strong> even when a c.ty is dairy which is allowed to supply<br />

exempt milk to<br />

from an<br />

a<br />

epidemic there must be city should be under vigorous<br />

many control<br />

sources The<br />

<strong>of</strong> infection. The Yale Med- individuals engaged in trades like baking!<br />

ca] Journal editorially on this subject cites where food is handled freely,<br />

he<br />

should<br />

recent<br />

also<br />

results <strong>of</strong> studies by Kayser in be under sanitary inspection.<br />

erniany. Thorough<br />

1 his investig<strong>at</strong>or has reported disinfection <strong>of</strong> all articles <strong>of</strong> <strong>at</strong>tire<br />

the results which<br />

o several years' investig<strong>at</strong>ions, have been worn bv typhoid fever p<strong>at</strong>ients<br />

-n the city <strong>of</strong> Strasburg, during which pe- before and during their illness should be dg<br />

ri.M hundreds <strong>of</strong> cases were carefully orously carried out. The necessity for rout-<br />

Hieir infection ine examin<strong>at</strong>ion for bacillus carriers is also<br />

t .red Xn ^'^ tiace when •Ki'"'"„''<br />

1 possible. He found th<strong>at</strong> in apparent, as about five per cent, <strong>of</strong> all tv-<br />

Strasburg nearly one per thousand <strong>of</strong> the phoid p<strong>at</strong>ients become chronic carriers uiiniliabitants<br />

(the total popul<strong>at</strong>ion being der existing circumstances. This means<br />

1 ^' I OOO ) contract typhoid fever each year, several hundred carriers in a city <strong>of</strong> 150 f>f 000<br />

the sources <strong>of</strong> infection raw milk is the All <strong>of</strong> these things go to show th<strong>at</strong><br />

most^enous.<br />

the<br />

Over one quarter <strong>of</strong> the cases stamping out <strong>of</strong> typhoid fever, if it is<br />

could<br />

ever<br />

be traced to tlie use <strong>of</strong> uncooked milk, system<strong>at</strong>ically <strong>at</strong>tacked, will be a<br />

cream,<br />

prolonged<br />

or .sour-milk; less frequently to the and expensive process,<br />

use <strong>of</strong> butter-milk. The mixed milk <strong>of</strong><br />

lar-e dairies was found to be <strong>at</strong> fault as « PftTHOOiNOMOMic sign or appeindiwell<br />

as th<strong>at</strong> <strong>of</strong> small concerns, and it was oiTis.<br />

''"''' '^'^''' classical group<br />

an<br />

<strong>of</strong><br />

tliecitvwier<br />

symptoms do not always<br />

B<strong>at</strong>hin'.<br />

n .m!,nf^^ \ ^^th'"8^ or swimming necessarily arise because <strong>of</strong> appendix dis-<br />

'''' s ns!wr<br />

And<br />

llL<br />

much more is this<br />

w''.""''"^';^^"'."''-" Leo^ the<br />

''"" ^'"'^"'^"^ '^'"'^ '"^^'^ cases in<br />

1 . curredi,Ti'"eTr, which<br />

'"f<br />

the<br />

^f ?, ^''"1'^- p<strong>at</strong>ients go about,<br />

t.e N pursue their Comae vShnt/f<br />

voc<strong>at</strong>ions.<br />

"n f<br />

/-^"l^'; t "••"> P<strong>at</strong>ien s was respon- and <strong>at</strong> times complain <strong>of</strong> pain in the rieht<br />

'"'•"/ '''^''''" ^" half <strong>of</strong> the lower<br />

; I "all Ihes^-'T abdomen-over Mc Bur-<br />

^'•^.^^^-^"•- "e.v's point, in the<br />

. M afii<br />

inguinal .'aland region,<br />

1 had'f^h had or<br />

not<br />

even<br />

been diagnosed ly- about the umbilicus. The first and most<br />

ons ve;e uoiiZ \ yu^ "'"'^ '"" ""P"^'^"' ^"^^t'°" ^'^^ -"f"^^ the X'-<br />

'\l.ttle over nine sician<br />

,e X t nf.l.r<br />

when consulted bv a person <strong>of</strong> this<br />

,<br />

l'^'^.*^^^" '"f-/^'l group, or even<br />

•onacfw when called to a hKn case <strong>of</strong> a<br />

\"^^''en<br />

ercL<br />

»-« acute character, is:<br />

letn<br />

Is<br />

per<br />

this<br />

cent, appendi-<br />

<strong>of</strong>^^H^^^^ ot the p<strong>at</strong>ients no definite citis'<br />

"The studv'<strong>of</strong> ule'""''^ '" l'"''^ , ^ '^'^" ^'^''^^ ^^'^ ^"^^ly be called p<strong>at</strong>ho-<br />

"""'^^"°"'^ "f '^' P*- Knomonic would<br />

...<br />

prove <strong>of</strong> inestimable value<br />

ie c 1 ts shied shoued th<strong>at</strong> certam trades were to the diagnostician. Dr. H. Illowav<strong>of</strong><br />

.^''^^ f-" ^'ew York^ has recently described iTi '^Xr-<br />

uen h. ubie Mo i/'^^,/--^'<br />

^f.^^]ff-rthe chives <strong>of</strong> Diagnosis"<br />

^c^ a sign<br />

owed He it. r' which he be-<br />

lieves to be<br />

lem<br />

p<strong>at</strong>hognomonic. It is Icsf elicited<br />

ha^^^<br />

''"^' f"°^.^^'^^ as follows: ', •S<br />

The p<strong>at</strong>ient is<br />

imr liuTr^ placed <strong>at</strong> full<br />

'^^^^^^<br />

; oemlers '""^^^<br />

and H, ,<br />

/"i"""'' °" =^ ^'' ''''^^'^- He is lounakers then in-<br />

and those handling food or structed to flex the leg upon the thigh uid<br />

re olfsr/hamUed " '"' ^'^^ ^'^''^'^ ^P"" ^^^ '"''"^<br />

T't'- 'T "P°" 'he Ixe u<br />

I,""'<br />

V d • IZf !Z Tf 1 \ '" ""''^ V" '°" °f ''^''"^ '' '^ ascertained whether the<br />

"" seae BlrbL f A<br />

'° '^' movement, or r<strong>at</strong>her the<br />

^V'^<br />

upward pressure,<br />

peculiar -ex- causes<br />

eiTtmn' .n Ir T^^tu^ any pain or soreness to be<br />

^}:':\ ," /"'/"^, The investig<strong>at</strong>ion felt in the right half <strong>of</strong> the abdomen, i. e.<br />

lioL- i't m ^^''"f"'^' * the appendicular region. If<br />

'°"f none or very<br />

°' '"'•'''"<br />

'*'''^ '^ f^'* '^^ -<br />

\se nfrn, 1 f r T ^'"Sh is more forcibly flexed<br />

ise through infection from certain either by the p<strong>at</strong>ient's own effort<br />

or<br />

or by<br />

other<br />

the<br />

sources <strong>of</strong> common food physician. Again it is inquired whether<br />

•<br />

.. ,. , any pain or soreness is felt or whether it is<br />

nirs'tlfevrr'r^<br />

gre<strong>at</strong> value, increased. Next the p<strong>at</strong>ient is directed to<br />

extend the leg to full length with a quick<br />

iI ihuidLl^r^ .<br />

,'l>".cl fever in "'rl°^Pu''^"\'°"<br />

cities. They show th<strong>at</strong> and r<strong>at</strong>her sudden movement, care being

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