Chapter 10

These figures show that great care should be taken in hot weather to prevent diarrhoea, especially among young children; by frequent washing with soap and water to insure cleanliness, and proper action of the skin; by great attention to the food, especially of infants fed from the bottle; free ventilation of living rooms, and especially of bedrooms; and by protection, as far as possible, being afforded from a hot sun, as well as by avoiding excessive exercise. All animal and vegetable matter should be removed from the vicinity of dwelling-houses as quickly as possible (indeed, these should be burnt instead of being put in the dust-bin), the drains should be frequently disinfected and well flushed out, especially when the mean daily temperature of the air is above 60° F.

Time will not admit of more than a mere mention of the relations between meteorological phenomena and the mortality from many other diseases and affections, such as apoplexy from heat, sunstroke, liver diseases, yellow fever, cholera, whooping-cough, measles, etc., especially as the state of our knowledge on the subject is so very limited. A comparison between the mortality from several diseases in this and other countries shows that certain of these do not prevail under closely corresponding conditions. Thus the curves of mortality from whooping-cough, typhoid fever, and scarlet fever do not correspond with the curves of temperature in both London and New York, and the same may be said of diarrhoea in India. It is therefore evident that some other cause or causes than a varying temperature must be concerned in the production of an increased death-rate from these diseases. The subject is of great importance, and I do not despair of our obtaining some day a knowledge of the agents through which meteorological phenomena act in the production of increased and decreased death rates from certain diseases, and the means by which, to a certain extent, these injurious effects on man may be presented.

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P. Rosenbach has found experimentally that potassium bromide diminishes the sensibility of the cortical substance of the cerebrum to electric excitement, while, the excitability of the underlying white substance remains unaltered.

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CONSUMPTION SPREAD BY CHICKENS.

In a village, C., near Weimar, where for many years no case of tubercular phthisis had taken place, two years ago several families suddenly discovered one of their members to be suffering from the disease. After a long inquiry, it was discovered by accident that all these families had been buying their spring chickens from one and the same place, viz., from a private hospital in the neighborhood. A medical student brought the livers of two such chickens to Prof. Johne, in Dresden. The student, whose own sister had become affected with consumption, had lived during his vacation at home with his parents, in C., and he had there at dinner observed the peculiar appearance of the liver of the chickens.

On examination, both organs were found to be full of tubercular bacilli. A thorough investigation was at once instituted, and it was then that the fact came to light that the chickens eaten by the families, members of which had been affected with tuberculosis, had all been brought from the institution mentioned. On further inquiry at the latter place the following facts were elicited:

At about the time when the first case of consumption occurred in the village, an inmate or the hospital, Mrs. R., had died of the disease. Before her death, Mrs. R. used to feed the chickens raised there; she was often seen first to chew the meat before she gave it to the chickens. Further, the spittoons were emptied on a place in the yard where the chickens generally came to pick up any stray corn.

As none of the chickens ever came in contact with any animals in the neighborhood--the hospital being situated at a considerable distance from the village--as no disease had happened among them until the arrival of Mrs. R., when soon after an epidemic seemed to break out among them, and many died, there is no doubt that they contracted the disease from Mrs. R., and in return infected those who ate their flesh.

The case is very interesting, first, as it proves how such animals may become affected, then how they may spread the disease, and lastly, that some kind of a disposition must exist in the person infected; for here, of many who had eaten of the diseased flesh, only a few contracted the malady. The whole report teaches us how careful we have to be, and how necessary is the appointment of skillful experts by the State to inspect all food offered for sale.--_Med. and Surg. Reporter._

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NEW METHOD OF REDUCING FEVER.

For many years eminent medical savants have sought earnestly through the vegetable and mineral worlds for some substance by means of which the high temperature often prevailing in typhoid, malarial, and other fevers might be reduced with rapidity and safety to the patient. A few substances have been found which produce a decline in temperature when administered in enormous and frequently repeated doses; but such administration has often been found to be decidedly detrimental to the patient, producing not infrequently serious injury to the stomach, kidneys, and sometimes the nervous system. So great is the danger of such injurious results, few careful practitioners have cared to adopt the heroic "antipyretic" medication recommended by experimenters, preferring to allow their patients to burn with fever, mitigated only by such simple means as are commonly employed by nurses, than to require them to combat the poisonous influences of a drug in addition to the morbid element of the disease.

Happily, however, it is not necessary to leave the patient to the unaided efforts of nature. By cool sponging of the surface, persistently and thoroughly applied; by large, cool compresses placed over the abdomen and chest, or even the whole front of the body, and changed as often as warm, or every three to five minutes; by frequently repeated cool packs; by cold water drinking; by ice-packs to the spine; by constant application of ice or frozen compresses to the head; by forcing perspiration by copious hot drinks and a warm blanket pack--by any or all of these means the temperature may be reduced with promptness in nearly every case. However, cases will now and then occur in which the temperature remains dangerously high, notwithstanding the thorough application of the above means. What shall be done?

Several years ago our attention was called to a series of experiments made by Dr. Winternitz, Professor of Hydropathy in the Medical University of Vienna, for the purpose of determining the influence upon temperature of enemas of water of different temperature in cases of fever. The results claimed by Prof. Winternitz were so striking that we improved the first opportunity to repeat his experiments, and with such results as have justified the continued use of this means of lowering temperatures in fever, in cases in which the ordinary measures were not efficient. The only objection we have found to the method has been the inconvenience to the patient occasioned by the frequent use of the bed-pan. In a recent case in which we found it necessary to resort to this method, the nurse observed that if the tin can of the fountain syringe used in administering the enema happened to be lowered below the level of the bed on which the patient lay, water which had previously been introduced into the rectum returned readily through the tube into the can. On learning this fact, the attendants were instructed to employ the enema in this way. From one to two pints of water, of 70° or 75° F. temperature, were allowed to pass into the bowels; and after being retained for five or ten minutes, or until the patient experienced uncomfortable sensations, it was made to pass out through the tube by simply lowering the reservoir to the level of the floor. A new supply of water of a proper temperature being introduced into the reservoir, it was again raised to the proper height, and the operation so continued until six quarts of water had been used. Then the patient was allowed to rest half an hour or an hour, according to the height of the fever, and the same process was repeated. Careful record was made of the temperature of the patient just before the treatment and immediately after. It was found to be invariably reduced from one to one and a half degrees by each treatment. The temperature, which had been exceedingly obstinate previous to the employment of this method, ranging from 104° to 105°, during the intervals between the treatments would, of course, rise somewhat; but each time it stopped short of the point reached during the previous interval, so that in the course of a few hours the fever was brought down to very nearly a normal temperature. The temperature of the water, when taken after passing through the bowels, was found to have risen each time from 10° to 13°.

The great capacity of water for absorbing heat renders it one of the most useful of all substances for lowering the temperature; and it is readily apparent that, by the means described, heat may be abstracted from the body almost _ad libitum_, and the temperature may thus be controlled with a rapidity and a degree of certainty which cannot be approached by any other method. In a still more recent case, in which the same treatment was employed, the temperature of the patient had reached 106° F., in spite of the vigorous application of ordinary measures of treatment, such as cold compresses, etc.; but it was, in four or five hours, brought down to nearly 100° by the use of the cold enemas.

The advantages of this method are: 1. It may be employed without wetting or moving the patient; very frequently a patient will sleep continuously during the administration of the treatment. 2. It seldom causes chilliness, which is frequently a disturbing symptom, especially in fevers of a low type, and even, when the temperature is alarmingly high, causing the patient to dread the employment of sponging with cool or tepid water. 3. It is not necessary to employ cold water, a temperature of 80° or even 85° being thoroughly efficient. In the majority of cases, however, water of 70° or even 60° may be employed without danger. The water comes in such immediate contact with surfaces filled with large blood-vessels that a temperature but a few degrees below that of the body is more effective than very much colder water applied to the surface.

In cases in which the use of the cool enema is attended by chilliness, this uncomfortable symptom may usually be relieved by the application of a hot bag or fomentations to the spine or to the pit of the stomach.

The simple measures of treatment we have described will be found more effective in lowering the temperature than any or all other remedies which have ever been recommended for this purpose.--_Good Health._

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THE CROWN DIAMONDS OF FRANCE.

According to a recent law of Parliament, a large part of the crown jewels of France is destined to be sold. The exhibit that has been made of these riches for the last two months at the National Exhibition of the Industrial Arts, in the State Hall of the Louvre, has excited a lively interest among the visitors. Here are to be seen, heaped up in a large octagonal show-case, incomparable treasures, whose value exceeds quite a number of millions. According to the inventory of 1818, the 52,000 precious stones of the crown of France were estimated as worth more than 20 million francs ($4,000,000); but since that epoch the stones have increased in number, and money has singularly diminished in value, so that the total at present would be much less.

In order to publicly exhibit so valuable treasures it was necessary to take precautions against thieves and fire, and this was done in a very sure and ingenious manner. The collection of crown jewels is distributed over the eight faces of an octagonal truncated cone, which is supported by a framework about three feet in height at the lower part. The stand is exhibited every day, at ten o'clock in the morning and six in the evening, under an elegant octagonal show-case surmounted by a high bronze statue of Fortune by Barbedienne. The whole is covered with a canopy, as shown in Fig. 1.

A force of guardians of the Treasury is detailed to watch over the crown jewels, and it is to them that is confided the care of operating in the morning and evening the safety mechanism that we shall describe. The object of this mechanism is to lower into and lift out of the strong-box the entire stand with all its jewels.

A winch, shown at A to the right of the engraving, sets in motion a system of gear wheels keyed at an angle, at B and C, upon intermediate shafts that transmit motion to the four vertical threaded rods of the frame, D. All these shaftings are 1½ inch in diameter, and the cog-wheels, twenty in number, are about 5 inches in diameter.

The well is formed of an octagonal wall of fire-brick, and is 20 inches thick and 6 feet high. In the center of this masonry is embedded very thick iron plate. The bottom of the well is isolated from the flooring of the Exhibition hall by a thickness of boiler plate, by a filling of tire bricks, and finally by a second thickness of boiler plate. The well is closed by means of a large plate of iron 6 inches thick, 10 feet in length, and 88 feet in width. The winch which maneuvers this mass is placed at E. It actuates a system of bevel wheels, keyed at F, which transmit motion to two horizontal screws (hidden under the stage) that actuate the plate, H. This latter is provided with two parallel series of five rollers each that revolve over long and strong pieces of wood covered with rails. Electric alarms are located near the winches.

A fire-engine station is located at within twelve or fifteen feet of the exhibition building.

A committee composed of competent jewelers and mineralogists has been appointed to make an appraisement of the diamonds and to indicate such as should be withheld from sale on account of their scientific, artistic, or historic interest. The members of the committee propose to preserve the following objects:

1. The "Regent" (Fig. 2), by reason of its mineralogical value, the perfection of its cutting, the purity of its water, its incomparable luster, and its great size, it being the largest brilliant as yet known.

2. The military sword of Charles the Tenth's coronation, the hilt of which is entirely of brilliants mounted by Bapst with wonderful art.

3. The jewel called the "Reliquary," of the 15th century.

To these riches must be added the following interesting objects: the Dey of Algiers' watch; the Elephant of Denmark; the decorations, etc., of foreign orders; crowns and diadems of sapphire; rubies; pearls that afford curious specimens of French art at the beginning of our century; one of the Mazarins bequeathed by the celebrated Cardinal; and lots of colored stones destined for our national museums.

The same exhibition alluded to above contains a number of other collections of great interest that it would be unjust to pass over in silence, such as the exhibit of the French diamond mines of the Cape, where one may see all the details of this prosperous exploitation by means of photographs and specimens. The art bronzes, the objects of jewelry, of goldsmith's work, and of morocco work, the music boxes, Trouve's and Aboilard's electric jewelry, and the retrospective art collections especially attracted the attention of the public.--_La Nature._

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A NEW MODE OF TESTING THE ECONOMY OF THE EXPENSES OF MANAGEMENT IN LIFE INSURANCE.

How to determine the general ratios of the expenses of management of life insurance companies has hitherto been an unsettled question, and I think no serious attempt has been made before my own to study this question exhaustively, and reach a scientific conclusion.

Believing that, one is contained in the following statement, I respectfully submit it to the criticism of others.

It has generally been taken for granted that the measure of economy of life insurance expenses may be expressed by the single ratio of expenses to one feature of the business, such as the premium income, or the total income (premium and interest), or the mean amount of all policies outstanding. But this is not the case. No exhaustive reason has been shown for preferring one of these bases of ratio to another, and, indeed, no reason well supported by argument has been shown for employing either. On the other hand, no better evidence is needed of the importance of establishing a uniform and demonstrably sound basis, than the fact that it is common for companies to refute one another's claims to superior economy, and totally confuse the public, by opposing ratios found in one way by ratios found in another--that one of two companies which appears the most economical according to one test being apparently the least so according to another.

The economy of the expense of any transaction, or work, can only be intelligently judged by the value of the _result_. This truth is too well recognized to need illustration, and it only needs to be called to mind, to perceive both the error of ratios of expense based on premium, which is not the result but the _raw material_, so to speak, of insurance transactions; and what, on the contrary, the true basis is.

It is thus clear that in insurance the economy of expense must be judged, not by comparison with the premiums paid, but by comparison specifically with the resulting advantages in fact secured by such payments. Now these are of two kinds: which may be called the _insurance advantage_ and the _investment advantage_.

(1) Each death claim paid is an insurance advantage, though it is so only to the extent of the excess of the amount of the policy which has become a claim over its premium reserve, or value, for the latter being the balance (with interest) of the policy holder's own premium money, could have been left or secured to his representatives without the intervention of the policy and company.

It is true that the advantage or benefit of insurance does not consist in adding anything to the wealth of a company, but only consists in drawing from the premiums paid into its treasury by the policy holders generally, to meet each death claim which arises; or can only be called an _advantage of distribution_, or process of collecting aid from the living members, to assist the representatives or dependents of the deceased ones; but it is not the less on this account an advantage worth _same expense_ in securing.

(2) Interest realized by the investment of premium while it is in the keeping of a company is an advantage; in every sense so, since it comes wholly from outside sources, and accrues proportionally to all members; it may be called, as above, the investment advantage, and of course justifies some _expense_ to secure it.

Hence the expenses incurred by any company in a given; time must be divided into two parts, one being the expense incidental to insurance, and the other that incidental to investment, which parts are to be compared respectively with the insurance claims met, and interest receipts of the company for the same time; or what is equivalent in the latter case, the net rate of interest earned after deducting the incidental investment expense may be found.

When this process shows that one company has earned a higher rate of interest than another, at the same time that its insurance expenses bear a lower ratio to its insurance claims paid, _there is no escape from the conclusion that during the period under observation it has served its policy-holders more economically_, and the test is therefore scientific. Though, if one company shows a higher rate of interest, while the other shows a lower ratio of insurance expense, it will still be necessary, to complete the test, to equate either the rates of interest or the ratios of insurance expense (it does not practically matter which), and note how this affects the relation of the duly corrected ratios on the other score.

To be exact, if the average vitality of the members of the two companies differ (other things being equal, it is always cheapest to belong to that company which has the lowest death rate), the ratios of insurance expense to expected, as well as actual, claims of each must be found, and equated.

The science of this procedure, or mode of testing expenses, and also its practical simplicity, may be more clearly perceived by reference to its practical application in the following table: