series of cases, though he is already of
opinion that these drugs may be warmly
recommended for the smaller gynaecological
operations. — Treatment.
The Proper Performance of Vaccination.
For many years the operation of vaccina-
tion has been considered one of the trivia;
things in medicine, which could be per-
formed by undergraduates, or even by lay-
men, as by physicians. Not a few of the
laity are in the habit of vaccinating them-
selves or their families. When points were
used they were easily contaminated; pro-
bably not while in the hands of the pro-
ducers, but as commonly put upon the
market, wrapped in the rubber protective,
they would easily become contaminated as
soon as the wrappings were removed. As
a rule they were retailed in drug stores in
which little care was exercised in their pre-
servation. Even if they did not become
contaminated, there was a liability of their
simple deterioration. The best accepted
methods of the present time require vaccin-
ation to be done with a glycerinated lymph
( protected in sealed tubes. Not only is a
better and more reliable product thus se-
cured, but if properly prepared there is no
danger of contamination and sepsis.
The laity should be taught that the oper-
ation of vaccination, while not a grave and
serious one, should be under careful profes-
I sional supervision. The physician himself
should not perform it in a careless or hur-
ried manner. The site selected for the
THE CHARLOTTE MEDICAL JOURNAL
operation should be carefully cleansed,
using green soap, or failing this ordinary
Castile soap, with a stiff brush. The part
is then cleansed with clean water, and the
virus is best introduced through a number
of superficial para'lel incisions made with a
sharp lancet. The site of the inoculation is
then to be protected by one of the vaccina-
tion protectors commonly sold ; or an ex-
cellent substitute is found in one of the large
bunion plasters. This is to be fastened to
the skin so that the hole in the plaster in-
cludes the site of the inoculation. It ad-
mits of ready inspection, and all such cases
should be seen at least twice after the oper-
ation. Not only is this necessary to ascer-
tain if the vaccination has been successful,
but to early meet any complications which
might develop.
Much of the distress shown by the general
public, and of the belief that diseases are
conveyed in this manner, is due to second-
ary infections from careless vaccinations, or
improper care of the vesicle after it is
formed. The use of glycer.nated virus with
the care indicated will do away with those
occasional secondary infections that have
furnished ammunition for the antivaccina-
tionist . — Medicine.
tubercle bacilli and prevents anything
from reaching the tubercular area itself.
Inhalation in tuberculosis is simply an
adjuvant, its particular value being in
exciting deep breathing which is much
desired "in impaired respiration of tuber-
culosis. — Fort Wayne Medical Journal.
The Value of Inhalation of Antiseptic
Nebulae.
Much has recently been said and written
regarding the effect of the inhalation of
nebulized medicaments in the treatment of
various inflammatory conditions of the
respiratory tract, and some have even con-
tended that nearly all pulmonary affections,
phthisis pulmonalis included, offered special
conditions for treatment by inhalation of
nebulized medicaments and are more quick-
ly amenable to this form of treatment than
any other.
Like many other things, this method of
treating affections of the respiratory tract
has been much over-rated in many parti-
culars so far as its therapeutic efficiency
goes. No one who employs the methods
can doubt its beneficial effects in chronic
bronchitis, where the direct contact of the
medicament seems to lessen the bronchial
secretion much better than any medication
which reaches the eft'ected areas through
the circulation. In pulmonary tuberculosis
neither inhalation of medicated vapors nor
the injection of different oils into the respir-
atory tract have given any definite results
so far as a cure is concerned. It really
could not be expected when we consider
that a collateral zone of congestion sur-
rounds the tuberculous area, as demonstrat-
ed by Councilman, which contains no
The Future of Appendicitis Cases.
E. J. Cottier, (Revue Mensuelle des Ma-
ladies de I'Enfance), in examining the ul-
timate results in 86 appendicitis cases treat-
ed by Broca, ranging in age from a few
months to fifteen years, divides them into
three classes: (i) Patients not operated
on; (3) patients operated on during an
acute attack ; (3) patients operated on in
the afebrile period. Cottier's aim is to
show by analysis of Broca's statistics that
the latter is justified in taking a position
against immediate operation in every case,
and against searching for an appendix
which is at the bottom of a purulent cavitv.
Of these, (a) 19 went out without opera-
tion : of the 19, 5 returned after a fresh at-
tack, and were operated on in the afrebile
period ; 13 had no pain after the operation,
and remained well ; i had slight colicky
pains, [b) 47 were operated on during the
acute attack ; i for general peritonitis. The
appendix was removed from only 3. Of
these 47, 28 had no trouble afterwards and
remained in perfect health ; 4 went out with
a fistula, and were subsequently operated
on, and remained in perfect health, (c) 30
operated on during an interval (8 of them
had been operated on previously during an
acute attack). At the time of writing, all
30 were in perfect health ; 3 showed slight
separation of the muscular walls, and a
slight impulse on coughing. ((/) 3 died of
intestinal obstruction, due to peritoneal
bands, at intervals of eight months, one
month, and seven months after operation ;
one of these was not operated on in the first
place by Broca. Two were suppurative
cases, showing how adhesions were the
cause of accidents : one of these was an
operation in the acute stage for abscess ;
one was operated on in the afrebile period,
but in this the extent of the suppuration
necessitated drainage, and a temporary
foecal fistula occurred. All the patients were
seen again from six months to five years
after they left the hospital. — Treatment
Bigamists in Hungary are compelled to
submit to a queer punishment. The man
who has been foolish enough to marry two
wives is obliged by the law to live with
both of them in the same house. — Med.
Age.
182
THE CHARLOTTE MEDICAL JOURNAL.
Shall We Charge for Medical Advice given
by Telephone.
The telephone is not an unmixed blessing.
Although we hardly see how we ever got
along without it, we are sometimes tempted
to declare we wish there were no such thing
in existence. The interruptions it causes
are innumerable and most exasperating.
The night calls are undoubledly increased
by this convenience for summoning the doc-
tor. Of course the telephone often obviates
the necessity of a trip ; sometimes when
the doctor does not want it and again some-
times when he would rather make it. On
the other hand, it enables people to annoy
the doctor with unnecessary interviews.
Necessary or unnecessary, they take the
physician's time and his knowledge and tax
his nerves, and he sometimes poses himself
with the query whether he ought to charge
for those interviews. With some patrons
such a charge would be paid without a
question. They never ask for an itemized
bill, and the doctor, feeling that he is ab-
solutely trusted, is extremely careful to be
perfectly just or to lean to the side of gen-
erosity in his charges. Other patrons would
not like to be charged for a few minutes'
advice over the wire. Now, there ought
to be a general understanding, and some
kind of a rule to go by in dealing with this
matter. The individual case must be left
to the doctor's knowledge of his people and
their circumstances and the doctor's own
conscience. We believe the profession is
pretty liberal in giving advice in many
cases where it is hardly expedient to charge
a fee. And again, it is sometimes justifia-
ble to charge a fee where it would be hard
to specify the service rendered. We are
told that the account book of the famous
Irish surgeon, Dr. CoUes, showed many
such entries as this :
"For giving ineffectual advice for deaf-
ness, I guinea."
"For telling him that he was no more ill
than I was, i guinea."
"For nothing that I know of except that
he probably thought Jie did not pay me
enough last time, i guinea."
It was not the doctor's fault that the deaf-
ness was found to be incurable ; nor that a
person who was not ill sought his advice
and required him to ascertain that no dis-
ease was present.
Evidently Dr. CoUes thought that who-
ever took his time and attention, and pro-
fessional knowledge should pay for them.
He was right. And that is a good general
rule to go by in this telephone problem.
Another good rule would be that when
advice or a prescription by telephone ob-
viates the necessity of a visit or an office
consultation it should be charged for.
Otherwise the doctor's time and his gray
matter are drawn upon without compensa-
tion, and he is further drained by having
to pay for the very apparatus that is used
to extract them from him. — Clevclafid Med-
ical Gazette.
Would Surgery Suffer if Iodoform was
Abolished?
E. C. Brush, in the Journal of the Amer-
ican Medical Association of December i6,
1899, sets out to answer the above question.
He says the use of iodoform is on the wane,
and he desires to further res-trict its use.
Accordingly a large number of letters were
sent to various surgical clinics asking cer-
tain questions relative to the value of iodo-
form and the frequency of its use. The
first of these was, "What germicidal pow-
der do you prefer?" Of the eighty-four
replying, twenty - seven used iodoform,
twenty-four used no powder of any kind,
twelve used boric acid, and eight used
aristol. The remaining thirteen used ace-
tanilid, nosophen, iodol, etc. To the ques-
tion, "Have you seen any bad eft'ects from
using iodoform.?" seventy-three reported
that they had seen bad effects, and eleven
had not. Four of the eleven had seen no
bad effects because they had not used the
drug. Thirty-seven thought that the drug
could be abolished without any detriment
to surgery, and forty-seven believed that
the detriment would be in a gener^^l way ;
twelve limited the loss to the treatment of
surgical tuberculosis, and eight considered
the loss to be only when it is used, in con-
nection with the manufacture of surgical
dressings and in specific cases. — Medicine.
Mortality in New York State.
The State Board of Health at Albany
reported on February 2nd that the number
of deaths from all causes for 1899 was 121,-
820. This is S20 more than in 1898 and
4740 more than in 1897, which was a year
of unusually low mortality. The death-
rate per 1000 is 17.3, which is the average
death-rate for the past ten years. The
infant mortality was less than the average
by nearly 5000 and is 1800 less than that of
last year, 29 per cent, of the deaths occur-
ring under five years of age against the
average of 35. A point to be noted in
connection with the antitoxin treatment is
that compared with the average of ten
years the deaths from diphtheria are but
little more than half as many, although the
number is 175 greater than in 1898. Diar-
rheal diseases caused 2000 fewer deaths
THE CHARLOTTE MEDICAL JOURNAL.
183
deaths than the average. Whooping-cough,
measles, scarlet fever and malarial diseases
all caused fewer deaths than the average.
Smallpox caused 21 deaths, all save three
of which occurred in New York City. The
outbreak in the western part of the State,
beginning in May, 1898, continued till
midsummer of 1899, reaching forty-five
localities in fourteen counties and attack-
ing 320 individuals and producing but one
death. At the end of the year the State is
believed to be free from smallpox. Grip
is estimated to have caused 7000 deaths
from January to April. An epidemic of
modest severity prevailed at the close of
the year. The deaths from acute respiratory
diseases were excessive on account of it,
18,000 deaths, or nearly 15 per cent, of all
deaths, having been caused by such dis-
eases. — Medical Nexvs.
Treatment of Neurasthenia.
The close contact of physician with pa-
tient is of extreme importance in the cure
of neurasthenia, according to O. Dornbluth
(Munch, med. Woch., January 16, 1900).
A thorough physical examination will
awaken confidence and prevent errors of
diagnosis and the patient should be in-
formed of the true character of his disorder.
The most important rules to keep the
patient in bed and absolutely at rest for
from one to six weeks, depending on the
severity of the case. Where this is im-
possible, the recumbent posture should be
assumed during all leisure moments. Strict
dieting is not necessary; even coffee and
tea may be allowed, but alcohol is to be
strictly interdicted. Even when nervous
dyspepsia is present the regular plan of
feeding five times daily at intervals of two
and a half to three hours is admissable, but
when great irritability of the stomach
dominates the clinical picture, the diet
should be similar to that for gastric ulcer,
or solid and liquid food alternately every
one and a half hours may be given. To
quiet the nervous system the best results
were obtained by applying cloths wrung
out in water at 59 deg. F. to the abodomen
and covering these with flannel, or by giv-
ing a bath at 81-88 deg. F. with the tub
but half filled, for four minutes. Massage
is not to be resorted to, but general faradi-
zation with weak currents is excellent. As
for drugs, a depreciated condition of the
blood demands iron, preferably in organic
form, while, for the severe manifestations
of the disease codeine acts almost as spe-
cific. In selecting sanatoria, especial care
is necessary to choose such which really
meet the indications. — Medical News.
The Danger of Performing Needless Operations
Upon Hysterical Patients.
(.Deutsche Med. Wochenschrit, Sep-
tember 2, 1899), M. .Sander reports two
cases bearing upon this subject. A man of
twenty-three presented the clinical picture
of intestinal occlusion, and a young woman
that of perforating peritonitis. Each was
operated on, and everything found normal,
the first undergoing operation twice and
the second four times, until it was suggested
to tattoo "Beware" on their abdomens.
Sander thinks that such mistakes could be
avoided by more careful search for hysteric
antecedents. In the observations reported,
the lack of proportion between the pulse
and the fever, and also between the general
appearance and the severe symptoms, the
rapid changes in the symptoms, their severi-
ty in the presence of the physician and sub-
sidence in his absence, combined with evi-
dences of hysteria, should have warned
against intervention. He also notes the
"elective" character of the vomiting, and
that meteorism can be caused by voluntary
swallowing of air. He classes hysteria as
a form of degenerative psychosis with
many points in common with the severer
forms. Hospital treatment is directly in-
jurious. The patient should be in a "closed
establisment" and all his complaints syste-
matically ignored and attention diverted,
with general tonic treament, suggestion and
faradization later. — Treattnent.
Contract Surgeons for the Philippines.
The medical department of the army is
now in need of some additional assistance
in the Philippines, and it is desired that
candidates for appointment as acting assis-
tant surgeons will make application to the
surgeon-general of the army. Applicants
must be graduates of reputable medical col-
leges, who have had practical experience,
since graduation, in hospitals or in private
practice. Candidates between the ages of
twenty-five and thirty-five are preferred.
Candidates should forward with their ap-
plication one or more letters from well-
known professional men, giving testimony
as to their character and qualifications. Ap-
pointments will not be made through polit-
ical influence, and letters designed to pro-
duce political effect will injure rather than
benefit the applicant. All applicants will
be examined as to their physical and pro-
fessional qualifications for service in the
Philippines before they are given a contract.
Contracts are made for one year, with the
understanding that the approved candidate
will remain in service for a longer period if
his services are required. — Medical Record.
THE CHARLOTTE MEDICAL JOURNAL.
Treatment of Hasinatemesis by Surgical
Interference.
(British Medical Journal, October- 21,
1899). — G. E. Armstrong, of Montreal,
brings forward two cases of surgical inter-
ference in hasmatemesis, one successful and
one fatal. He further gives an analysis by
Wyatt Johnson of the sources and causes
of bleeding from the gastric mucous mem-
brane.
1. Bleeding from an eroded surface, or
from an eroded vessel in the base or wall
of an ulcer.
2. Bleeding from passive congestion, as
in cirrhosis of the liver or other forms of
portal obstruction, or in heart disease. In
most of these cases the serious hemorrhages
come from oesophageal varices.
3. Abnormal states of the blood, as in
leukaemia (usually associated with the ob-
struction), also rarely in haemophilia, etc.
Besides this, from reflex, 'causes, such as
vicarious menstruation, the blood may
come, not from the stomach or intestine,
but from some adjacent organ, as in aneu-
rysm. Traumatic causes are rare.
Clinically, cases of hsematemesis may
be divided "nto two distinct classes, those
in which occur frequently repeated small
haemorrhages, and those in which the loss
of blood is in larger quantities, and it would
seem that each class has a disticnt patho-
logical lesion, and this should be borne in
mind in the consideration of the treatment
of hgematemesis, medically or surgically ;
and, however efficient hypodermics of mor-
phine and ergotin may be in small haemor-
rhages coming from the capilliaries and
small venules of the surface of the mucosa,
it may not possibly be considered rank
heresy to question their therapeutic value
in the presence of a considerable lesion in
the wall of a considerable artery. It is
also to be noted that the bleeding point in
the case the author reports was in every
instance accessible, situated in a part of the
stomach wall that could be readily reached,
or, if duodenal, in every instance it was
put outside the pyloric ring.
If, then, we can exclude aneurysm, which
should generally be possible, and leukaemia,
which should be possible with the aid of
the microscope, and cirrhosis or other cause
of portal obstruction, it would seem to be
the surgeon's duty to interfere in suitable
cases ; and suitable cases are those first of
frequently repeated small haemorrhages,
which persist in spite of medical and die-
tetic treatment, and which threaten to
destroy the life of the patient ; and, second-
ly, in all cases of a large haemorrhage
which, in spite of medical and dietetic
treatment, recurs. In these cases operation
should be performed after the second
hemorrhage.
For haemorrhage occurring in cirrhosis
and portal obstruction, the surgeon cannot
accomplish any good. In these cases the
haemorrhage is generally from a varicose
oesophageal vein, a part difficult of access,
and secondary to a pathological lesion but
little amenable to any form of treatment.
Treatment.
Marshall Hall and Multiple Sclerosis.
The quickness of perception and the ac-
curacy of observation of the physician of
earlier times has been frequently remarked
by those who have taken the trouble to read
the productions of the older authors. Some
time ago, while the writer was reading the
very enjoyable and lucid "Lectures on the
Nervous System and Diseases" by Dr.
Marshall Hall published in 1836, he found
in the lecture on "Paralysis Agitans, this
very interesting observation : "Of the
hemiplegic paralysis agitans, I have long
had an interesting case under my care :
Macleod, aged 28, is affected by weakness
and agitation of the light arm and leg, aug-
mented on any occasion of agitation, and
on moving; it is observed as he walks, or
when he passes his cane from one hand 'to
the other ; there is, besides, a peculiar late-
ral rocking motion of the eyes, and a degree
of stammering and defective articulation.'"
This very apt and striking clinical pic-
ture of a case of multiple sclerosis is the
earliest of which I have any knowledge.
The conception of the nervous system and
its diseases at the time of Marshall Hall
was not perfect enough for the understand-
ing of the nature of a disseminated sclero-
sis, and it was left for a more recent writer
to discover and make known the relation
between the clinical manifestations and a
pathological basis, but it is of interest to
note this, 'which I believe to be the first de-
scription of a case of this most interesting
disease.
Hall's description of the intention tremor,
the paralysis, speech defect and the nystag-
mus is apt and accurate and when taken
with the age of the patient admits of no
question as to the certainty of its being
other than a classical case of "Scleroses en
Plaques Disseminees. — Bulletin, of the
Cleveland Hospital.
Adhesions after Laparotomies.
(Beitrage zur Klin. Chir., xxiii. 2.) —
Steffens has been making a study of forty-
five individuals on whom laparotomy had
been performed several times at Kummell's
clinic, thus allowing inspection of the con-
THE CHARLOTTE MEDICAL JOURNAL.
185
ditions consecutive to previous operations.
He found that- in every case in which the
operation had been followed by a rise in
temperature attributable to the condition
of the abdomen, adhesions had formed,
while not a trace of adhesions was to be
found in the cases without post-operative
hyperthermia. The conclusion that the
! development of adhesions is chiefly due to
, some slight peritoneal infection, not suffi-
cient to cause a general peritonitis, yet
determining a slight rise of the temperature,
is evident. He also found Jesions of the
I serosa and the lack of peristalic movement
' of the intestines, factors in the production
i of adhesions. On this account Kummell
I tries to obtain an evacuation of gases within
' twelve hours of the intervention, by means
of an injection, or the insertion of a canula
when the intestines have been sutured. —
Treatment.
Collection of Vital Statistics.
Physicians and students of mortality
statistics will be interested in learning of
the work now being accomplished by the
Chief Statistician of Vital Statistics of the
United States Census, by the authority of
the Director, Hon. William R. Merriam.
It is a practical effort, necessarily of limited
scope, to secure the adoption of a uniform
certificate for the return of deaths and
looking toward the establishment of a
common national system of collection of
vital statistics for the purpose, primarily,
of the Census tables and publications.
It has been found that there is much un-
necessary and objectionable variation in
the methods employed to collect and register
death returns. The census office has under-
took to secure a modification or amplifica-
tion of the death certificates so as to have
them include the items necessary to obtain
census data. A model return form has
been prepared and submitted with explana-
tory correspondence to each registration
office or officer controlling the preparation
of the state or local office. The result has
been more gratifying and important than
even the census office expected, as not only
have the items in the specimen form been
very generally adopted, but the registration
officers have abolished many practically
obsolete local variations in their certificates
and the latter have been made to conform
to one standard more nearly than ever
before.
The Director of the Census confidently
expects that physicians everywhere will
appreciate the desirability of the new order
of things, and that they will earnestly and
actively co-operate in securing prompt and
accurate mortality returns of the uniform
character required by Congress and sought
for by statisticians. He recognizes the
fact that failure on the part of physicians
to give vitality to the common standard by
carefully reporting the items that mav be