uecessary to repeat this treatment more than
once or twice. The relief experienced in
every instance is prompt, and grateful to
the patient.
There is another class of patients who
are sufferers from a chronic nasal discharge
whose condition is due to the occupation
engaged in, thus those who work in facto-
ries where the air is continually loaded with
dust and debris, being constantly exposed
to the irritating influence of these particles
THE CHARLOTTE MEDICAL JOURNAL.
239
the nasal disturbance is perpetuated. In
this class of cases the same plan of action is
referable, namely, first, thorough cleansing
of the nose with Glyco-Thymoline (Kress)
solution in the same strength as before and
the after application of an unguent.
A very useful remedy that gives well-
marked beneficial results is a four per cent,
menthol and alboline mixture, which is a
very efficient and cooling ointment, that
being liquid can be readily sprayed upon
the nasal mucous membrane.
There is still another class of cases that
are very persistent in resisting different
kinds of treatment. I refer to what is tech-
nically known among the people as chrouic
nasal catarrh. In this class of subjects the
pathological state of the nose is to be care-
fully enquired into, as the catarrhal dis-
charge is only a symptom of something else,
this something else constitutes the disease
to be treated. In one case it will be found
to be an hypertrophic rhinitis, in another
a stenosis of one of the nares from a de-
flected septum, and in a third case, espe-
cially in the case of a child, the presence of
a foreign body, a tumor, or a polypus,
Treatment of the nasal discharge, there-
fore, to be efficacious should consist in
directing attention to which ever one of
these or other conditions are found to be
responsible for the catarrh. In all cases,
however, due to whatever cause, the action
of Glyco-Thymoline (Kress) has impressed
me most favorably. I will outline a half
dozen cases wherein I have derived the most
gratifying results from this remedy.
Case first, — "Acutk Rhinitis."
A lady consulted me with a very bad
cold which had been persisting to her in-
tense annoyance for several days. She
called upon me in the belief that the diffi-
culty was increasing instead of diminish-
ing. Posterior nasal washing was at once
done, using Glyco-Thymoline (Kress) in
warm water, one part to six, and the nasal
fossae sprayed with cocaine solution, patient
was also given a six ounce bottle of Glyco-
Thymoline solution, and advised to apply
with an atomizer three times a day. Re-
covery was prompt and thorough under its
use.
Case second. — "Hypertrophic Rhin-
itis."
This case was in a man who worked out-
doors in all kinds of weather. In addition
he was an inveterate tobacco user, smoking
as many as two dozen pipes of tobacco daily.
He was also subject to great relaxation of
the pharyngeal structures, had a cough,
enlarged tonsils, and was a terrible snorer,
sleeping with his mouth open. This pa-
tient was treated with Glyco-Thymoline
(Kress) in solution, and the throat fre-
quently gargled with a fifty per cent, solu-
tion of the same remedy. Internally, quin-
ine, iron and strychnia were given him,
and he was advised to lessen the amount of
tobacoo he was consuming. He was also
told to dress more warmly. The outcome
of the case was very slow, but an unevent-
ful recovery took place.
Case third. — "Tobacco Pharynx."
This patient came to me for an annoying
cough, which upon inspection I discovered
was due to an intense hyperaemia of the
pharyngeal structures. He was given a
twenty-five per cent, solution of Glyco-
Thymoline (Kress) and instructed to gargle
his throat often with the mediciue. I saw
him a week later, aud he advised me that
very much to his own and his wife's delight
the cough had entirely disappeared.
Case fourth. — "Diphtheria."
I have used Glyco-Thymoline (Kress) in
cases of diphtheria with good results. My
favorite combination is composed of the
following : Glyco-Thymoline, 50 per cent.,
Per Oxide of Hydrogen, 50 percent., for
use in the atomizer every hour or so. Al-
though mentioning this under case fourth,
I will not specify any particular case, as I
employ this prescription in all cases of
diphtheria. Of course, Glyco-Thymoline
(Kress) has no specific influence in diph-
theria other than a strong, reliable and
harmless antiseptic.
Case fifth. — "Chronic Gastritis."
Having satisfied myself of the signal
utility of Glyco-Thymoline in the previous
conditions outlined, determined me to test
its efficacy in the operation of lavage. A
few days ago a conductor on a street rail-
way in St. Louis, came to my office com-
plaining with chronic gastric disease. He
had a foul, coated tongue, and said he al-
ways felt bloated after meals. I employed
lavage, using sodium bicarbonate and
Glyco-Thymoline (Kress), using two table-
spoonfuls of soda and six tablespoonfuls of
Glyco-Thymoline to a quart of hot water.
The patient experienced so much relief from
this remedy that he returned unsolicited
four days later and asked that I repeat the
process, which I did. He sent me several
other railroad men, and the results in each
case were the same.
Case sixth.— "Acute Cystitis."
A gentleman who sustained an injury to
his spinal column, from suddenly alighting
from his bicycle, had as a result paralysis
of his lower extremities in which his blad-
der participated, was troubled with acute
240
THE CHARLOTTE MEDICAL JOURNAL.
cystitis and its concomitant evils. For the
correction of this his bladder was irrigated
with a tablespoonful of Glyco-Thymoline
and a tablespoonful of boracic acid to a
pint of warm water. It was not necessary
to repeat this process more than three times
when the relief was established, frequent
micturition disappeared, and necessity for
the continued use of the catheter was ob-
viated.
These cases demonstrate, beyond a per-
adventure of a doubt, the therapeutic effi-
cacy of Glyco-Thymoline (Kress) as a re-
medial agent.
Some Remarks Concerning the Infectious
Nature of Tuberculoses and Measures
for Prophylaxis.*
By Dr. Chas. L. Pearson, Asheville, N. C.
It is not my purpose to enter into the
pathology of tuberculosis nor attempt to
discuss at length its etiology. The subject
of the Infectious Nature of Tuberculosis has
been suggested to my mind, not only by
personal observation of the great numbers
who visit our city annually suffering from
some form of the disease, and inhabit our
homes and hostelries and visit our public
institutions, but also by the fact that the
laity generally are fully cognizant of its
infectious nature, and are demanding for
their own protection that more vigid meas-
ures for prophylaxis be taken. To substan-
tiate this statement, let me cite to you the
impression which prevails among the visi-
tors who seek the mountains of Western
North Carolina in the summer season not
on account of any pulmonary disease, but
to escape the extreme heat which prevails
in the larger cities and the lowlands especial-
ly of the South. Is it not true that many of
those who formerly came to our city are now
gomg to neighboring towns, and when ask-
ed their reason for so doing their reply is,
"I would not go to Asheville because there
are too many consumptives there. I am
afraid to go into a boarding house or hotel,
which has been occupied during the winter
by people who have some form of tubercu-
losis. My family physician has told me
there is some danger that I may contract the
disease by occupying a room which may be
infected." A fact, which if it has not al-
ready done so, will tend to injure the future
of our city as a place of resort, unless some
active measures be taken by the medical
profession here, to establish most rigid pro-
phylaxis, especially among the boarding
*Read before the Buncombe County, Medical
S) -'ety, .January 5th, 1900.
houses, and thereby place ourselves on re-
cord as being a city where every possible
precaution is taken then we can safely and
conscientiously assure our visitors of a mini-
mum risk of infection as well as that we
possess a climate, equalled by a few and as
we think surpassed by none of the resorts.
That the arguments which I have quoted
are not alone without foundation, but are,
to a certain extent true, it is my purpose to
show by bringing to your attention some
clinical facts which I have collected from
various sources, concerning the infectious
nature of this disease.
Tuberculosis is an infectious disease causes
by the presence of a micro-organism called
the Bacillus Turberculosis. Osier has truly
said, "Although the researches of many
workers in the field of tuberculosis had left
no doubt of the infective nature of the di-
sease, it was not until the discovery of the
bacillus by Koch in 1882 that the true na-
ture of the parasite was known. In the
seventeen years which have elapsed, much
work has been done on the Bacillus Tuber-
culosis in its various relations, and from
varying standpoints but the original work
of Koch was so thorough and far reaching
that our increase of knowledge has consisted
in the elaboration of finer detail the essen-
tial facts remaining unchanged."
One of the most important etiological
facts in connection with this disease is its
wide-spread occurrence in animals from
which man derives a considerable portion
of his food.
Recent studies and improved methods of
inspection have demonstrated the very wide
spread existence of this disease in cattle.
Quoting statistics "of 5297 cattle slaughter-
ed in Maryland, 159 were tuberculous, and
of 15,506 slaughtered at the Brighton abat-
toir near Boston, 29 were tuberculous.
Careful inspection of herds has been made
in some of the states and the tuberculin test
employed to determine the existence of the
disease. For the four years 1890-1893 in-
clusive the per-centage of tuberculous ani-
mals among 132,294 oxen and cows slaugh-
tered in Copenhagen was 17.7. At the Ber-
lin abattoir, in the year 1892-1S93, 21,603
animals out of 141,874 showed evidences of
tuberculosis, In Great Britain, there are
no satisfoctory records to show the exist-
ence of disease in cattle. In sheep the di-
sease is very much less common. The per-
centage at Berlin is about 1.5. Horses are
rarely attacked and dogs and cats are not
very liable to the disease. In other animals
kept as pets such as rabbits and guinea pigs,
the disease is very rare. Among apes and
monkeys kept in confinement, tuberculosis
is the most formidable disease with which
THE CHARLOTTE MEDICAL JOURNAL.
241
these animals have to contend. Tuberculo-
sis is the most universal scourge of the hu-
man race it is estimated that in the civilized
countries 1.7 of the deaths are due to this
disease. Vaughan says "In the U. S. Cen-
sus Report for 1890, 102,188 deaths were
reported to be due to consumption." It is
difficult to get accurate statistics as to the
number of deaths due to other forms of the
disease, but a low estimate one can say that
at least 150 000 persons die annually in the
United States of all forms of tuberculosis.
An estimation based on the Census Report
gives the total number of persons in this
country effected with tuberculosis as 1,050,
000, ro one in every sixty of the population.
"All of which serves to show the wide-
spread existence of the disease among the
lower animals as well as the human race.
The possibility of the direct transmission
of tuberculosis has never been open to much
doubt, but the methods of transmission and
frequency are still under discussion. There
are two opposing schools — the one claiming
that "the disease per se is not inherited but
only a tissue soil favoring development."
Baumgarten and his followers claim that
"in inherited tuberculosis actual tubercle
bacilli have been carried over from parent
and lodged in the tissues of the child, where
under suitable conditions, they multiply
and produce the disease." The followers
of the school also assume that the tubercle
bacilli can be latent in the tissues and subse-
quently develope when the individual resis-
tence is lowered.
The possible methods of transmission of
the germ in direct inheritance are three,
transmission by the sperm, transmission by
the ovum and through the blood by the pla-
centa.
Most of the experiments which have been
conducted upon the lower animals to prove
the spern transmission have been unsuccess-
ful. Wolff conducted a series of experi-
ments by injecting tuberculous sputum into
the testicles of male rabbits and guinea pigs,
and succeeded in obtaining foetuses conceiv-
ed by them, but none of the results gave
evidence of the existence of tuberculosis in
the foetus. Gartner also experimented with
females impregnated by males with tuber-
culous testicles and obtained negative re-
sults, but was able to show the possibility
of germ infection by inoculating into the
peritoneal cavity and causing only two out
of nine canary birds to produce tuberculous
eggs. Experiments by other observers all
tend to show that the animals inheriting tu-
berculosis directly are in great minority.
That occasional transmission can occur
through the sperm seems to be demonstrated
by a case reported by Larney. A woman
of thirty was delivered of a deformed foetus
in whose spinal column a caseous focus con-
taining tubercle bacilli was found. The
woman was in perfect health, but her hus-
band presented signs of tuberculosis. In
order that the disease could be transmitted,
it would-be necessary that the tubercle ba-
cilli should lodge in the individual sperma-
tazoon wliich fecundated the ovum. While
possibilities of transmission in this manner
are extremely small, we know that the tu-
bercle bacilli do occasionally exist in the
semen. But such an occurrence must be the
rarest, and the bacilliary transmission of
tuberculosis by this means plays a most in-
significant part.
The possibility of transmission by the
ovum has been demonstrated. Baumgarten
has in one instance at least been able to de-
tect the presence of the tubercle bacillus in
ovum of a female rabbit which he had arti-
ficially fecundated with tnberculous semen.
The question, however, of what effect such
inoculation would have upon the human
ovum cannot, of course, be answered.
Probably the most constant method of
transmission in congenital tuberculosis is
through the blood current, the tubercle ba-
cillus penetrating by way of the placenta.
Some authors hold that in these cases the
placenta itself is invariably the seat of tu-
berculosis and the presence of tubercle in
the placenta has been demonstrated in sev-
eral instances. But there are undoubtedly
cuses in which, with an apparently sound
placenta, both the placental blood and the
ffctal organs contained tubercle bacilli, not-
withstanding the fact that the organs also
appeared normal.
The opponents of this theory of germinal
transmission hold that in cases of heredi-
tary tuberculosis, a special predisposition
of the tissues exists towards the tuber-
cle bacillus, though just what this predis-
position is cannot be explained in our pre-
sent state of knowledge. Perhaps the
strongest evidence in favor of the predispo-
sition theory is the fact that we know of
instances where children, born of tubercu-
lous parents, when removed from direct
sources of infection have gone through life
without a sign of the disease. An instance
reported by Bernheim, may be interesting
in this connection, of a family of seven
children in which both parents were tuber-
culous. The second and fifth child, who
had never lived with their parents, remain-
ed healthy and had healthy children of their
own, while the children who did live with
their parents died of tuberculosis.
"The question of heredity in tuberculosis
can be summed up in these statements:
that though cases of congenital tuberculo^'s
242
THE CHARLOTTE MEDICAL JOURNAL.
do occur, they are extremely rare, and in
all probability most cases of hereditary tu-
berculosis are due to heredity of the soil and
not to the inheritance of the germ ; that
tuberculosis is much inore frequently trans-
mitted in the maternal than in the paternal
line." — (Osier).
Another source of infection is milk. It
has been shown experimentally that the
disease may be transmitted to young ani-
mals fed upon the milk of tuberculous cows.
The pigs of a tuberculous sow have been
fouiid with intestinal tuberculosis of the
most advanced grade. The prevalence of
intestinal and messenteric tuberculosis in
children should suggest that the food sup-
ply may be the source of infection, hence
the practice of drinking cows milk raw and
feeding it to children without a positive
knowledge of its source is not without
danger.
In man, transmissiou by inoculation is
chiefly met with in persons whose occupa-
tions bring them in contact with dead bodies
or with animal products, butchers, tanners,
demonstrators of morbid anatomy, are liab'e
to a local tubercle of the skin, particularly
of the hands. This form of a local tuber-
culous process should be classified with
lupus, with which, in general character, it
appears to be identical. The disease has
been inoculated in various other ways, local
tubercle has resulted from the perforation
of the lobe of the ear for ear-rings, also
the bite of a tuberculous patient has been
followed by local disease. Inoculation has
also occurred from a cut by a broken spit-
toon of a consumptive patient, and in-
stances of infection have occurred by the
transplantation of skin.
By far the most frequent mode of infec-
tion is by inhalation. It is well remarked
by Cornet that "the consumptive in him-
self is almost harmless, and only becomes
harmful by his bad habits." It has been
fully shown that the expired air of con-
sumptives is not infected. The virus is
contained only in the sputnm, which, when
dried, becomes widely disseminated in the
form of dust, and constitutes the great me-
dium for the transmission of the disease.
It is then that we encounter the great risk
of infection by breathing into the bronchial
tubes and lungs these germs which frequent-
ly find lodgment in a soil fertile for growth
and development. In the last stages of
consumption the patient becomes weak and
it is often the case that the sputum is imper-
fectly expelled — pillows, sheets, and hand-
kerchiefs are soiled, as well as the carpets
or rugs, and, if a male, sometimes the beard
or moustache is smeared. Such circum-
stances all tend to the production around
the patient and attendants of a halo of in-
fection.
Cornet has shown that the dust of rooms,
hospital wards, and other localities frequent-
ed by patients with pulmonary tuberculosis
contains the bacilli and is infective.
The observations of Strauss shows how
these bacilli may be found in the air pas-
sages of perfectly healthy individuals. At-
tached to particles of dust the bacilli gain
entrance to the system through the lungs,
which may be regarded as th*e great portals
of invasion. In institutions such as jails,
barracks, and convents, where the occu-
pants are restricted from that important
element, fresh air, tuberculosis is especially
prevalent. The more perfect the prophy-
laxis and hygienic arrangements of an asy-
lum or institution, the lower the mortality
from tuberculosis.
In the Alabama Insane Asylum, during a
period of three years and nine months, of
395 deaths, 28 per cent, among the whites,
and 42 per cent, among the negroes, were
caused by tuberculosis. — (Bordurant).
In institutions of this sort, in addition to
the presence of bacilli, the lowered vitalitv,
and, in persons, the mental depression, must
lower the resistance. The death rate from
phthisis is estimated at 15 per cent, of the
total mortality, while in prisons it consti-
tutes from 40 to 50 per cent., and in some
countries, as Austria, over 60 per cent. In
a single ward, in the city of Philadelphia,
Flick studied the distribution of deaths from
tuberculosis for) 25 years. He found that
not less than one-third of the houses became
infected during this period, and more than
one-half of all the deaths from this disease
during the year 188S occurred in these in-
fected houses.
Individual predisposition, age, sex. cer-
tain diseases and occupations may be men-
tioned as influencing infection. Hyppocrates
has described the so-called "Habitus Phthi-
sicus"inthe following terms : "The form
of body peculiar to phthisical complaints
was the smooth, the whitish, that resem-
bling the lentil, the reddish, the blue eyed,
the leucophlegmatic. and with the scapulae
having the appearance of rings. ' ' That the
long, narrow chest, with depressed sternum
is commonly seen in tubercular patients is
true, but that there are many individuals
with perfectly well-shaped chests who fall
victims annually to the disease, is also true.
The tuberculous or scrofulous diathesis upon
which formerly so much stress was laid is
now regarded as only a type of conforma-
tion in which the tissues are more vulnera-
ble and less capable of resisting the disease.
The disease occurs, as stated by Hyppocrates
most frequently from the iSth to the 35th
THECHARLOTTE MEDICAL JOURNAL.
243
years, but no age is exempt. It is met with
in the infant, and in the extremely aged.
At diflferent ages, different organs are more
prone to be involved; thus, in the first ten
years of life, the meninges, the bones, and
the lymph glands are more frequently af-
fected than at subsequent periods. That
women are more frequently attacked than
men is due to the fact that they live a more
sendentary in-door life, and pregnancy and
lactation are two conditions which are apt
to lower the resistance of the organism.
Among the local conditions influencing
infection may be mentioned catarrhal dis-
eases of the respiratory tract, certain of the
specific fevers, such as measles or whooping
cough ; typhoid fever is thought by some to
predispose to tuberculosis.
It is a clinical fact that the occurrence of
tuberculosis among the workers in mills,
factories, mines, and among stone-cutters,
glass-blowers, and others, whose occupa-
tions necessitate the inhalation of impure
dust-laden air, which renders the lungs less
capable of resisting infection, is very fre-
quent.
Of the conditions influencing infection, in-
vironment is an all important predisposing
factor. Dwellers in cities are more prone to
the disease than residents of the country.
Not only is the liability to infection greater
but the conditions of life are such that the
powers of resistance are apt to be weakened.
Sunlight is one of the most important ele-
ments in destroying the bacillus, so that, in
imperfectly ventilated dwellings and work-
shops, and in houses in close dark alleys, and
in tenements, the liability to infection is
very much increased The influence of in-
vironment was never better demonstrated
than in the now well-known experiment of
, Trudeau, who found that rabbits, when in-
oculated with tuberculosis, if confined in
dark, damp places, without sunlight, rapid-
ly succumbed, while others, treated in the
same way, but allowed to run wild, either
recovered or showed very light lesions.
I will not go farther into the subject, but
will conclude with a few remarks in regard
to prophylaxis. If the factslwhich I have been
able to collect and so feebly present to your
attention to-night, in regard to the infect-
I ious nature of this disease, prove anything
1 do they not serve to show that the fears of
many of our would be visitors are well
founded, and when we consider the state-
ment made by Nuttall, "that every patient
in the stage of cavity, at a very moderate
estimate will expectorate from two to four
billions of bacilli, in the twenty- four hours
the danger is by no means imaginary."
I The question then arises, should there not
I be some steps taken towards more thorough
inepection of the houses which are occupied
by tuberculous patients, and more rigid pro-
phylaxis enforced to prevent the risk of in-
fection to those who may occupy rooms in
such houses after they have been vacated
by those -afflicted with this disease. In
bringing up this subject, I do not wish to
reflect upon or dictate the duties of the
physician who may be in attendance upon
this class of patients, for it is presumed that
he will give instructions to both the patients
and attendants in regard to the necessity of