Morrill, F. Gordon

Boston Medical and Surgical Journal

English

F. GORDON MORRILL

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Some Diseases Which May Be Merely Symptoms of the Effects of Poisoning by Sewer Gas

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And while we hold fast to well-founded principles oftreatment and to remedies whose adoption has beentried, we give a hearty welcome and testing to everynew measure, to every new mediciue, which has asatisfactory indorsement. We are hampered by nodogma ; so that while we are not seduced by Utopiantheories, while we make no experiments with obviousand gross delusions, and while we set our faces likeflint against fraudulent pretenses and practices, wecarefully consider every promising suggestion, bywhomsoever made, and we gladly adopt every usefuldiscovery, and every tested new application of oldprinciples and remedies.(To be concluded.)Original Articles.SOME DISEASES WHICH MAY BE MERELYSYMPTOMS OF THE EFFECTS OF POISON-ING BY SEWER GAS.BY F. GORDON MORRILL, M. D.Notwithstanding the attention which bad drain-age and defective plumbing with cousequent evils haveattracted of late years, I am quite sure that we areiu the almost daily habit of overlooking the factthat certain diseases are often caused and prolongedby the unsuspected presence of sewer-gas poison. I be-lieve that a considerable percentage of all cases of sorethroat (including both forms which tonsillitis usuallyassumes), trouble of the digestive tract, neuralgia,rheumatism, pneumonia, gout, asthma, and even so-called " nervous prostration," is attributable to thiscause; and I have named these affections in the orderof frequency with which they have occurred under mypersonal observation when good proof of their causa-tion or prolongation by the presence of sewer-gas hasbeen obtained.The cases which I give are merely outlined for thepurpose of illustration (a8 their only claim to interestis based upon their astiology), and are fair samples ofa respectable number of each kind which I have seenduring the past five years.Case I. Gastro-duodenal catarrh. A. B., aged six,had a very severe convulsion December 10, 1883, whichproved to be a manifestation of the above-named dis-order, the symptoms of which had been well-markedfor a month preceding. Under a proper regimen ofdiet and medicinal treatment the case progressed favor-ably for a fortnight, wheu a relapse occurred, and thechild seemed as far from recovery as ever. The pep-permint test revealed trouble in the bath-room adjoin-ing her chamber, which was promptly remedied andspeedy recovery followed. A younger sister, who hadsuffered from nausea and diarrhoea during the forty-eight hours preceding the examination of the drainage,at once got better, and both children have remainedperfectly well ever since.Case II. Diarrhoea of a watery character. C. D.,aged fourteen, was suddenly seized with intense abdom-inal paiu in April, 1879. Numerous watery dischargessoon followed, and persisted in spite of energetic treat-ment until the third day, when the trouble ceased, onlyto return again in a grave form (for now blood waspresent in the discharges) twelve hours later. A breakin the drain under the cellar floor was found and re-paired, and the child at once recovered. This wouldread well if reported in full as a case of " wintercholera."Case III. E. F., aged fourteen, had been under thecare of an eminent practitioner during the four monthspreceding my first visit. Her symptoms were weak-ness, progressive emaciation, and great distress aftertaking food, the cause of which neither physical exami-nations nor the condition of the urine revealed. The lougcontinuance of her trouble, its mysterious nature, andthe fact that previous treatment had obtained no betterresults, led me at once to have the drainage examined,strongly suspecting that something wrong would bediscovered. The result justified my suspicions, for thewaste pipe of the bowl in the adjoining bath-room wasfound uutrapped and leading directly into the soil pipe(which was not continued up through the roof), and abad break was discovered in the main drain. A slowbut steadily progressive recovery followed the neces-sary repairs.Case IV. G. H., aged forty-two ; mother a chronicconsumptive; the lady herself of poor physiqueand wo.mout with family cares, had pneumonia, right apex, front,December 10, 1882, from which she very slowly recov-ered. January 20, 1883, harsh respiration still de-tected over 6eat of trouble. Progressed slowly butfavorably until February 5th, when a sudden attack ofwatery diarrhoea, accompanied by pain and a greatmany discharges, reduced her greatly. This conditionlasted in spite of all remedial measures for five days,when the defects of drainage which had been discov-ered meanwhile were remedied, and the diarrhoea ceasedas quickly as it had begun. The patient's conditionwas such at one time as to excite grave fears, and Ithink a possibly fatal result was avoided by recognizingthe cause of the trouble.Case V. Neuralgia. A young lady, aged twenty-three, who had been subject to paroxysms of intensepain in the hepatic region during the two winters pre-ceding my visit, was seen by me for the first time No-vember 28, 1883, on which occasion the paroxysm wassevere enough to require the hypodermic injection ofone half grain of morphia. A history of her troublerevealed the fact that while absent from the city dur-ing the summer months she never had pain, but thatupon her return to town the paroxysms at once began,and towards midwinter occurred with great frequency.She had been treated homoeopathically for a long timeas a case of congestion of the liver. Examination ofthe plumbing revealed an absence of any trap underthe set bowl—which in this case was placed nearthe patient's bed. This deficiency was supplied, andthe pain has never returned.I can recall a number of neuralgia in which sewergas has played an important part, and mention this onemerely on account of its somewhat rare location.Case VI. Tonsillitis. J. K., aged thirty-seven.Subject for years to inflammation of the tonsils (ac-companied by enlargement, but no deposit of any kind),which would confine him to the bed. In 1880 he cameunder my care twice with this affection.No trap under set bowl. The patient, who is anactive business man, decided to prevent any possiblefurther trouble from this source, so had the pipe cutaud sealed up, and a large jar placed under the bowlto receive the flow off. Siuce that time he has not hada tonsillitis.Cases of follicular tonsillitis are often attributable to The Boston Medical and Surgical Journal as published by The New England Journal of Medicine. Downloaded from nejm.org at UNIV OF MANITOBA LIBRARIES on June 22, 2016.  For personal use only. No other uses without permission. From the NEJM Archive. Copyright © 2010 Massachusetts Medical Society.sewer-gas poison, and numerous instances illustratingthis fact have come under my observation, with thedetails of which I will not trouble my readers, as Ithink most of us realize that both this trouble and theordinary erythematous sore throat may be thus caused.Dr. Langmaid informs me that in cases of public sing-ers sojourning at hotels he has on several occasionsadvised cutting and sealing the waste pipes of setbowls to hasten the cure or prevent the recurrence ofthroat troubles.Case VII. Rheumatism. L. M., aged forty-two,subject to very severe attacks of inflammatory rheu-matism and also gout, the latter being hereditary. Inthe house which he lived in cerebro-spinal meningitis,pneumonia, scarlet fever, and nearly all the other illswhich flesh is heir to held full sway during the twoyears following the introduction of modern conveniencesinto an old-fashioned family mansion. His wife, too,had two severe attacks of rheumatic fever during thisperiod. Competent authorities pronouuced the entirearrangement of plumbing and ventilation to be faultyin the extreme, and L. M. decided to seek anotherresidence, which he speedily found. Results : Iu hiswife's case no more rheumatism. In his own caseneither rheumatism or gout for eighteen months, whenan attack of the former followed long exposure on amarsh during a shooting trip in the West.Case VIII. Pneumonia. An aged lady, the grand-mother of Case II., a monomaniac on the subject ofwarmth, who never ventured out-doors from November1st to the middle of May, had an attack of acute pneu-monia in April, 1879, after a winter passed under theprotecting influences of furnace heat, open fires, wiu-dow strips, and numerous shawls and wraps of allkinds. At the same time another member of the fam-ily had watery diarrhoea (Case II.) and I think bothdiseases may be fairly attributed to the same cause.Case IX. Asthma. A^little girl, aged eight, hadsevere paroxysms of asthma in the winter of 1878.The patient lived in a house where numerous faults indrainage and plumbing were discovered. The familywere in poor circumstances, and the terms of theirlease were such as to render them responsible for allrepairs, while their lack of means prevented their seek-ing another residence until the present lease expired.Up to the time of their removal (October, 1878) thechild continued to suffer from asthma, but the attacksceased immediately after changing her residence to ahouse where the sanitary arrangements were good.Case X. Nervous prostration. Mrs. X., a lady ofrather flighty temperament, but who had enjoyed goodhealth until within two years of her first coming un-der my observation, in December, 1881. During theperiod mentioned she had suffered from intense weak-ness and all sorts of anomalous complaints, in short,her condition seemed composed of equal parts of hys-teria and debility, and her life had become a burden toher family as well as herself. She had been assidu-ously treated by a regular physician during the firsteighteen months, and during the six months precedingmy first visit had been trying the " faith cure," socalled, which iu her case seems to have consisted inhiring a female of unprepossessing exterior and exag-gerated dignity of manner to stare at her steadily foran hour or two every day. I was summoned to adviseregarding an acute rheumatic affection which had re-cently appeared. Her other symptoms, with the myste-rious nature of which she was fully impressed, shepreferred to have remain under the supervision of theexponent of the " faith cure." Salicylate of soda verysoon relieved her rheumatism, and I ventured to sug-gest that it would be well to have the drainage in-spected. To be brief, this was found to be decidedlybad, and the mason and plumber soon brought aboutthe disappearance of the nervous prostration and thedismissal of the exponent of faith.This case has led me to wonder whether oil of pep-permint might not prove indirectly the means of reliev-ing some few of the cases of neurasthenia, with thedetails of which our ears are constantly filled by sym-pathetic friends of the sufferers.The point which I have tried to establish is onewhich is often hinted at but not pressed so strongly asI think it deserves to be. When we are called to acase of typhoid nor diphtheria we at once order an in-spection of the drainage and plumbing, and are seldomdisappointed in finding defects, but I am convincedthat we ought also to do this iu many other cases of dis-eases which are as yet merely suspected of being infec-tious, and in some to which no suspicion is attached.Sewer-gas poison seems to seek out the patient's weakspot, aud often brings discredit upon the physician,whose inability to relieve his patient is due to his fail-ure to appreciate its unlimited powers of mischief.- -THE USE OF MANACA (FRANCISCEA UNI-FLORA) IN THE TREATMENT OF ACUTERHEUMATISM.BY HERBERT C. ROGERS, M. D., BROOKLYN, N. Y.,Adjunct Surgeon Long Island College Hospital.My attention was first called to manaca by a physi-cian practicing in South America. I am in the habitof giving the fluid extract in ten to twenty drops,using the preparation made by Parke, Davis & Co., ofDetroit, Michigan.Case I. March 3, 1883. Was called to see JamesD., aged twenty-one, a native of Ireland, car driver.He had enjoyed good health until three days ago,when he was suddenly seized with a severe chill fol-lowed by fever and sharp pains in his limbs. Thenext morning he was unable to walk. The left kneeand ankle were swollen, red, and painful. The rightknee had been affected, but got better before he sentfor me. He perspires profusely. Suffers most fromhis pain at night. He complains much of headache.Tongue badly coated. Bowels constipated. Urinedeeply colored and free from albumen ; specific gravity1030. Pulse 130. Temperature 104° F. He wasordered five grains of calomel and ten grains of com-pound jalap powder, also ten drops of fluid extract ofmanaca every three hours. The painful joints to becovered with cotton.March 4th, eleven a. m. He has had but little sleepduring the night. The right knee and ankle havebecome inflamed. He suffers a good deal from head-ache. Bowels have moved several times. Examinationof his heart negative. Ordered ten drops of tinctureof opium with the fluid extract manaca every threehours. The paiuful joints to be wrapped in clothswet with liq. plumhi et opii. Temperature 104J° F.Pulse 130.March 5th, 11.30 A. M. Patient passed a betternight. Has been able to sleep three hours. Swelling The Boston Medical and Surgical Journal as published by The New England Journal of Medicine. Downloaded from nejm.org at UNIV OF MANITOBA LIBRARIES on June 22, 2016.  For personal use only. No other uses without permission. From the NEJM Archive. Copyright © 2010 Massachusetts Medical Society.

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Some Diseases Which May Be Merely Symptoms of the Effects of Poisoning by Sewer Gas

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