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REPORTS ON TUBERCULOSIS IN RIO AND ON THE ETIOLOGY OF
By Sanitary Inspector W. HAVELBURG.
PREVALENCE OF TUBERCULOSIS.
Among the diseases which constantly prevail in Rio de Janeiro tuberculosis occupies the first place. It causes the greatest number of deaths, and, therefore, it may be proper to report particularly thereon.
In order to prove the great mortality from tuberculosis I present the following table:
Mortality from tuberculosis.
If we consider that the city of Rio de Janeiro is of large extent, that the people for the most part live in one or two story houses, and spend a great deal of time in the open air on account of the climate; that manufactories here are not yet so much advanced as in many other large cities, so that the air is not so much contaminated by them, in short, that in many respects the natural hygienic conditions of Rio de Janeiro are more favorable than those of other large cities, then the importance of the foregoing figures assumes much greater proportions.
The people of north and central Brazil are in general of low stature and very thin, with tender bones, so that they are inclined to what is called a predisposition to consumptive habits. The constitution of Brazilian women in general is still another cause for suspecting in them a disposition to consumption. The vital resistance is, speaking in general terms, considerably reduced. The damp, warm climate is, as is known, very favorable to the propagation of tuberculosis. Therefore all the circumstances are highly conducive to the development and
increase of the tuberculosis germ, which already exists here and is so wislely prevalent. No precautions whatever for preventing its propagation are used. Tlae sputum is carelessly expectorated by the patients; its danger is riot generally known. Even if it is expectorated into a spittoon it is In ot properly disinfected, and the possibility of the particles being carried by the breeze after drying is not generally realized. In view of the great number of consumptive patients, it is evident that Koch's bacillus of tuberculosis exists to a great extent in the habitations of the people, and we know from scientific investigations how this germ is preserved on the walls and tapestry and in the dust, etc. Climatic treatment, which is much used in Europe, is impractiable here. There are, indeed, some localities (Campos do Jardao, Barbacena, etc.) which are well known for their immunity from consumption. I do not know whether their reputation is well founded. However, patients who repair to those places are unfortunately obliged to deprive themselves of the greater part of the requisites for the proper treatment of the disease, therefore the result of the treatment is very doubtful. In my own medical experience I have seen no real success. The treatment of patients and the means adopted for the extinction of tuberculosis consists merely in administering medicine. But we know how impotent are purely medicinal measures from an etiological point of view. . In regard to the symptoms of consumption we can cer. tainly do something; in regard to the etiological cause nothing. In this country the modern scientific and practical efforts for constructing special sanitary establishments have received hardly any attention. Precautions for protecting children against infection are entirely insufficient. Many children are directly infected from hereditary causes or from close and constant contact with their parents. Another source of infection, principally for children, is the cow's milk with which they are fed. In this country tuberculosis prevails to a great extent among cattle. There is no inspection of the animals by the authorities. In the city and its suburbs it is usual to milk the cows in the presence of the buyer, which is useful for the latter's protection against adulteration. The milking is done in the open streets. No care is taken to insure the cleanliness of the udders or of the hands of the milker. Thus suspicious particles of foreign matter may enter the milk. Other important measures for combating the disposition to tuberculosis, such as hardening the body in different ways, as for instance by gymnastic exercises, which contribute to physical development, and by a strict attention to methodical alimentation, are taken by the public here into little account. I regret to say that, in my opinion, there is little probability of any change in the hygienic conditions relating to tuberculosis. By the
action of the authorities much certainly can be done; but the Inost important part belongs to private initiative and the cooperation of everyone in his own sphere.
RIO DE JANEIRo, June 21, 1898.
ETIOLOGY OF BERIBERI.
In former reports I have laid stress upon the fact that beriberi has become here an endemic sickness and deserves most consideration. In the message, with which the parliament some days ago was opened, the president, speaking about the sanitary conditions of the union, has also designated yellow fever and beriberi as those two diseases whereto the government is obliged to direct its attention.
Some days ago Dr. Francisco Fajardo made to the Academy of Medicine a communication, accompanied by microscopical preparations, and he thinks he is on the track of the cause of beriberi. Dr. Fajardo is a well-prepared and earnest colleague, and I am well acquainted with him. Dr. Fajardo has made his studies in the beriberi hospital on 52 sick persons, including 6 necropsies. He found in the red corpuscles of the blood a form of plasmodium which can be colored highly. With regard to the morphological qualities this haematozoa has great resemblance to the plasmodium malariae. There are also formations of pigment, principally in the liver and spleen; however, in the blood, it is seldom met with. The resemblance to malaria is evidently recognizable.
I beg to observe that I have seen in my practice from time to time persons who are declared by other physicians to be suffering from beriberi, but whose disease I considered as cases of a paludal infection. Of course I only refer to the subacute and chronic forms of beriberi, in which the symptoms of the polyneuritis are not so evident, and the symptoms of a dyscrasia and of the oedema appear more evident. The differential diagnosis is so much more difficult, as the change of the locality or a sea voyage has a good result on both malaria and beriberi, and consequently the logical conclusion “post hoc, ergo propter hoc,” falls short here.
At all events, I thought it convenient to refer you to the above, so that eventually competent examiners, who have the opportunity for such studies, may devote their attention to this important aetiokogical question.
Rio DE JANEIRO, May 10, 1898.
STATISTICS OF THE PASTEUR INSTITUTE AT RIO AND REPORT
ON THE V ACCINATION INSTITUTE IN THAT CITY FOR THE YEAR 1897.
By Sanitary Inspector W. HAvelburg.
From the date on which in Brazil the prophylactical treatment against hydrophobia was commenced up to June 30, 1898, 4,068 persons have applied for the assistance of the Pasteur Institute, here existing under the direction of Prof. Dr. Ferreira dos Santos. Of that number, 2,685 persons have been treated, 172 last year. Treatment has been refused to the persons bitten when it was discovered that the animals were not suffering from lyssa. In two instances it was subsequently discovered that persons rejected on the plea of not having been bitten by rabid animals had actually been so bitten, having shown symptons of hydrophobia. Three other patients were rejected because they had already been attacked by lyssa when they applied for prophylactical vaccinations. Of the 2,695 persons treated, 1,935 had been bitten on uncovered parts of the body and 760 through the clothing. Application was made in 10 instances by employees of the institute on account of accidents occurring during experiments with animals; in three instances sores, resulting from other causes, were contaminated by contact with the saliva of affected persons, and in two instances the patients were bitten by persons suffering from hydrophobia. As for the rest, the wounds were caused in 2,383 instances by dogs, in 287 instances by cats, in 2 instances by mules, in 1 by a cow, in 2 instances by asses, in 1 by a horse, and in 4 instances by monkeys. In 237 animals the existence of rabies was shown by the experiments; 1,196 animals showed undoubted symptoms, and 1,262 animals highly suspicious symptoms of the sickness. The number of persons who did not await the termination of the treatment and that of those in whose cases it was discovered that the animals by which they had been bitten were not suffering from hydrophobia was 99. Among those included in the former class there were 3 who are known to have been taken with hydrophobia after leaving the institute. In 6 cases of patients under treatment the lyssa made its appearance before termination of the treatment. During the treatment 5 patients died of other diseases. Of the 2,585 persons treated, 20 died from hydrophobia, the mortality resulting from this disease being consequently 0.77 per cent. In these 20 cases hydrophobia appeared in 9 instances within fifteen days after the treatment had been completed.
. Before the announcement of Pasteur's discovery the mortality from rabies, according to Leblanc, was 16 per cent.
One thousand five hundred and forty-five persons treated were resi. dents of the city of Rio de Janeiro; the others came from different parts of Brazil.
RIO DE JANEIRO, July 11, 1898.
REPORT OF THE VACCINATION INSTITUTE.
The number of vaccinations in the institute was 2,241; revaccinations, 355; total, 2,596.
The law requires obligatory vaccination till the sixth month of life. Six hundred and fifteen cases are subject to this law. One thousand six hundred and twenty-six vaccinated persons are between 6 months and 40 years old. Of the 2,241 vaccinated, 807 did not return. Without exception, the result was favorable in 1,434 persons. The revaccinated, between 5 and 25 years old, are, for the most part, persons who want for their purposes certificates of vaccination effected.
In houses crowded with people were vaccinated 2,032 persons, and revaccinated 599. In inps and boarding houses of lower class a great number of vaccinations was done; in private houses 100 vaccinations and 249 revaccinations.
During the year 1896, the schools of the city of Rio de Janeiro were revised; during the year 1897, the schools of the suburbs; 68 and 1,330 pupils have been vaccinated and 2,792 revaccinated.
In different establishments and manufactories, 390 vaccinations and 1,015 revaccinations were done.
Three hundred and seventy-three streets with 1,677 houses were revised, and there has been vaccination 4,152 times and revaccination 4,655 times. Altogether were performed 6,393 vaccinations and 5,010 revaccinations; 108,026 tubes of lymph have been distributed.
During the year 1897, were notified 135 cases of smallpox, of which 93 cases were in soldiers. Death occurred in 2 cases. There happened in the month of September, 13 cases; October, 42 cases; November, 36 cases, and December, 15 cases of smallpox.
Since January of last year a “gabinete bacteriologico” exists, joined to the institute. Of 26 cases of diphtheria which were declared to the authorities, the bacteriological examination was executed 14 times, of which 12 times the examination was made in the institute.
Three patients died of diphtheria.
Through the institute were distributed gratuitously 273 boitles of serum, prepared by Roux, and 86 bottles of serum antistreptococcique, prepared by Marmorek.