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

165
morbidity from this disease. Everybody much more than the ordinary milk insnect-
*°"^^
alT;be%,W '^H°\Jr''''P''r"''"'^''"^ "°" P"^*'^^d is needed. Tvery
.11 the time, and that even when a c.ty is dairy which is allowed to supply
exempt milk to
from an
a
epidemic there must be city should be under vigorous
many control
sources The
of infection. The Yale Med- individuals engaged in trades like baking!
ca] Journal editorially on this subject cites where food is handled freely,
he
should
recent
also
results of studies by Kayser in be under sanitary inspection.
erniany. Thorough
1 his investigator has reported disinfection of all articles of attire
the results which
o several years' investigations, have been worn bv typhoid fever patients
-n the city of Strasburg, during which pe- before and during their illness should be dg
ri.M hundreds of cases were carefully orously carried out. The necessity for rout-
Hieir infection ine examination for bacillus carriers is also
t .red Xn ^'^ tiace when •Ki'"'"„''
1 possible. He found that in apparent, as about five per cent, of all tv-
Strasburg nearly one per thousand of the phoid patients become chronic carriers uiiniliabitants
(the total population being der existing circumstances. This means
1 ^' I OOO ) contract typhoid fever each year, several hundred carriers in a city of 150 f>f 000
the sources of infection raw milk is the All of these things go to show that
most^enous.
the
Over one quarter of the cases stamping out of typhoid fever, if it is
could
ever
be traced to tlie use of uncooked milk, systematically attacked, will be a
cream,
prolonged
or .sour-milk; less frequently to the and expensive process,
use of butter-milk. The mixed milk of
lar-e dairies was found to be at fault as « PftTHOOiNOMOMic sign or appeindiwell
as that of small concerns, and it was oiTis.
''"''' '^'^''' classical group
an
of
tliecitvwier
symptoms do not always
Bathin'.
n .m!,nf^^ \ ^^th'"8^ or swimming necessarily arise because of appendix dis-
'''' s ns!wr
And
llL
much more is this
w''.""''"^';^^"'."''-" Leo^ the
''"" ^'"'^"'^"^ '^'"'^ '"^^'^ cases in
1 . curredi,Ti'"eTr, which
'"f
the
^f ?, ^''"1'^- patients go about,
t.e N pursue their Comae vShnt/f
vocations.
"n f
/-^"l^'; t "••"> Patien s was respon- and at times complain of pain in the rieht
'"'•"/ '''^''''" ^" half of the lower
; I "all Ihes^-'T abdomen-over Mc Bur-
^'•^.^^^-^"•- "e.v's point, in the
. M afii
inguinal .'aland region,
1 had'f^h had or
not
even
been diagnosed ly- about the umbilicus. The first and most
ons ve;e uoiiZ \ yu^ "'"'^ '"" ""P"^'^"' ^"^^t'°" ^'^^ -"f"^^ the X'-
'\l.ttle over nine sician
,e X t nf.l.r
when consulted bv a person of this
,
l'^'^.*^^^" '"f-/^'l group, or even
•onacfw when called to a hKn case of a
\"^^''en
ercL
»-« acute character, is:
letn
Is
per
this
cent, appendi-
of^^H^^^^ ot the patients no definite citis'
"The studv'of ule'""''^ '" l'"''^ , ^ '^'^" ^'^''^^ ^^'^ ^"^^ly be called patho-
"""'^^"°"'^ "f '^' P*- Knomonic would
...
prove of inestimable value
ie c 1 ts shied shoued that certam trades were to the diagnostician. Dr. H. Illowavof
.^''^^ f-" ^'ew York^ has recently described iTi '^Xr-
uen h. ubie Mo i/'^^,/--^'
^f.^^]ff-rthe chives of Diagnosis"
^c^ a sign
owed He it. r' which he be-
lieves to be
lem
pathognomonic. It is Icsf elicited
ha^^^
''"^' f"°^.^^'^^ as follows: ', •S
The patient is
imr liuTr^ placed at full
'^^^^^^
; oemlers '""^^^
and H, ,
/"i"""'' °" =^ ^'' ''''^^'^- He is lounakers then in-
and those handling food or structed to flex the leg upon the thigh uid
re olfsr/hamUed " '"' ^'^^ ^'^''^'^ ^P"" ^^^ '"''"^
T't'- 'T "P°" 'he Ixe u
I,""'
V d • IZf !Z Tf 1 \ '" ""''^ V" '°" °f ''^''"^ '' '^ ascertained whether the
"" seae BlrbL f A
'° '^' movement, or rather the
^V'^
upward pressure,
peculiar -ex- causes
eiTtmn' .n Ir T^^tu^ any pain or soreness to be
^}:':\ ," /"'/"^, The investigation felt in the right half of the abdomen, i. e.
lioL- i't m ^^''"f"'^' * the appendicular region. If
'°"f none or very
°' '"'•'''"
'*'''^ '^ f^'* '^^ -
\se nfrn, 1 f r T ^'"Sh is more forcibly flexed
ise through infection from certain either by the patient's own effort
or
or by
other
the
sources of common food physician. Again it is inquired whether
•
.. ,. , any pain or soreness is felt or whether it is
nirs'tlfevrr'r^
great value, increased. Next the patient is directed to
extend the leg to full length with a quick
iI ihuidLl^r^ .
,'l>".cl fever in "'rl°^Pu''^"\'°"
cities. They show that and rather sudden movement, care being