Deep petrissage of the abdomen as an aid to the diagnosis of tapeworm / by Richard J. Cyriax.

  • Cyriax, Richard J.
Date:
1912
Catalogue details

Licence: Public Domain Mark

Credit: Deep petrissage of the abdomen as an aid to the diagnosis of tapeworm / by Richard J. Cyriax. Source: Wellcome Collection.

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    ar A ie at ee ar b iseaAny | AUGUST 7, 1912. ORIGINAL PAPERS. Tue MEDICAL PRESS. 135 pr yy -— ; : ss ” death verified by necropsies performed by compe- tent men. How are they really prepared? Except in cases of violence necropsies are not performed in one per cent. of the cases of death, and the alleged “cause” is merely a wild guess or a con- ventional statement by a practitioner who is not even required to state, or to know, that the patient is dead at all. As an example of prevailing ignorance let me quote my own case. I find that I have certified considerably over a thousand “causes of death.” Out of this thousand there were not ten cases verified by post-mortem examination. Not in 95 per cent. of the cases did I see the patient after death. It is quite possible that in 60 or 70 per cent. of the cases the “cause of death” was either erroneous or so vague as to be scientifically worthless. Now, the Registrar General’s Returns are made up of my thousand cases, and of the thousand cases of other practitioners who are probably not less ignorant than myself. Surely it is a savage farce to draw conclusions from data such as these? In what percentage of cases are proper post- mortem examinations made? No definite figures are available, but the number appears to be less than one per cent. I find that out of about 100,000 deaths there are about 1,600 from violence. These comprise the greater part of those which are the subject of coroners’ inquests. Thus the very cases in which post-mortem examinations are actually held are those from which the least information of any value is derivable—for we do not want to know the cause of death where a man is killed by violence, but when he dies from disease. Out of your 100,000 deaths there will be about 1,500 in lunatic asylums. these will be the subject of necropsies, and we must confess that the yield of information afforded by them is not great; but really if a man be twenty or thirty years in an asylum it does nof so much matter what he died of. Deaths in workhouses and workhouse hospitals comprise a large proportion of every 100,000 deaths. In Ireland they would be about 10,500. The num- ber of necropsies on these is very small indeed. Let us lool at the question in another way. There die in Great Britain about a million people every year. The State proposes to spend some 425,000,000 a year in preventing sickness and death. There are also actively engaged in warding off death some 30,000 doctors, who, at an average salary of £300 a year, receive some £,9,000,000 annually for for their services. And their erdea- vours are largely futile, and all the money spent must be largely wasted. Why? Because really we are working in the dark. We don’t know what people die of. Our opinions as to the disease and the cause of death may be of the most fallacious and misinformed type possible; but instead of cor- recting them by a post-mortem inspection, we are allowed to embalm them in the Registrar General’s Reports, and so lead others into the same morass of ignorance. Death, we are told, comes in through the brain, the lungs, or the heart. It may well be so. If we continue to ascribe death to cardiac failure, dyspnoea, or convulsions, we may, perhaps, be right; but can any man suggest that we shall ever improve the science of medicine, or do anything really helpful to the State so long as we are satis- fied with these vague generalities. Further, I submit that we are led even further astray by those authorities who ought to be in- fallible. Glance at the Registrar General’s ‘‘ New Ne List of Causes of Death.’’? You are begged not to state that your patient died of carbuncle, but you may certify he died of eczema, You are implored not to say that he died of peritonitis, but you may attribute his demise to an ulcer. You must not say a child died from gastric catarrh, but you can state that its fatal trouble was varicose veins. I doubt if caries pure and simple ever killed anyone, but I find I can certify that it did, whereas I cannot say that ‘‘ heart disease ’’ pure and simple killed a man. For the life of me I cannot see why aman should be permitted to state that ‘‘ arthritis ’’ was a cause of death, whilst he is warned off attributing it to “brain tumour.” Why under heaven — should abortion be put as a cause of death? We know, of course, that death will often follow it—just as it may follow the scratch of a pin, but surely it is not the cause—or, if it be, ‘‘ childbirth ’’ is a far commoner cause, and it is not recognised at all. What, then, is the sense of ascribing death, generi- cally, to “Diseases of the Nose,” “Diseases of the Eye”? To cap the climax you are exhorted to state, by the mystic letters P.M., when the cause of death has been verified by fost-mortem, and when you write to the Registrar General for the number of deaths verified by post-mortem you find that no such list is available. It is obvious that the healing art can never advance until we foresee that every blunder of ours will be made manifest at the post-wnortem examina- tion. It is as clear as the sun that medical treat- ment is mere blind muddling in the dark when we never know anything about our patient except that he died. On the other hand, an immense mound of preju- dice must be overcome before the public will submit to universal necropsies. It must be shown that the premature burial. It will gradually be seen that it protects every man from poisoning or foul play, as well as incompetence. We must realise that each of us ought to be proud if by his death he contributes something to a knowledge which may serve posterity. It cannot come to pass in a day, per- haps not even in a generation; but I suggest that if the Berlin Congress of the Royal Institute of Public Health marks the first public insistence on the necessity for necropsies it will have done good work for mankind. DEEP PETRISSAGE OF THE ABDO- MEN AS AN AID TO THE DIAGNOSIS OF TAPEWORM. By RICHARD J. CYRIAX, M.R.C.S., L.R.C.P. LONDig lean As a general rule, a patient is not suspected of having a tapeworm until segments are passed in the stools, which is naturally pathognomonic of the condition, any abdominal symptoms presented by an unsuspected case being ascribed (in the lack of further evidence) to dyspepsia; but there are sometimes sufficient grounds for believing that a tapeworm is present, even when no segments have been passed. In such a case the problem of dia- gnosis is sometimes a difficult one, unless the same measures are resorted to as when a tapeworm is known definitely to be present—namely, dieting and the tadministration of salines, followed by an anthelmintic and a brisk cathartic; thus the dia- gnosis and treatment are often combined. Many authorities hold, however, that these procedures are unjustifiable except in undoubted cases. The administration of a purgative alone, without an anthelmintic, is advised by- some authors, the
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