classes and give them all just the same.
The burden is too heavy, and just
as sure as effect follows cause in natural
law, our generation of children is being
weakened and unbalanced, and still weaker
generations will follow. Our great public
school system, designed to bless the nation,
will become a national curse. This is not
a false alarm or an idle prophecy. Visit
the schools and see the careworn teachers,
always working beyond nature's reasonable
limits, and you can better understand wh}'
she or he seeks your aid before the middle of
the term in order to be able to continue
work. And here in this broken-down con-
dition of the teacher we see an index to the
heavy course and wrong classification."
The health of the young is a matter of
vital importance to a nation. As with in-
dividuals, so it is with races in the struggle
for predominance, the weakest will go to
the wall. To insure the physical and men-
tal well-being of the rising generation con-
siderable modifications in our exising sys-
tem of education will be necessary. Phy-
sical culture is not inconsistent with mental
culture, and when this significant fact is
thoroughly grasped by our boards of educa-
tion, the present faulty methods of training
the young will be changed to those of more
in harmony with the laws of nature.
Koplik's Sign in tlie Diagnosis or Measles.
The diagnosis is important in all diseases,
but an early diagnosis is very important in
some affections. To be compelled to wait
until the disease is full blown is a ^reat
strain on the physician as well as the pa-
tient and relatives.
The Maryland Medical Magazine says
that in measles before the period of erup-
tion one cannot even be sure that an erup-
tive process of invasion, and diagnosis must
be more or less random guess work, while
diagnosis on the appearance of eruption is
sadly belated. These hours and days of con-
jecture are dangerous, and extraordinary
interest attaches to any new means of early
diagnosis.
The appearance of visible mucous mem-
branes in the various eruptive disorders have
been long studied, and are described in all
the text-books. It remained for Henry
Koplik to discover and to describe, in 1896,
a lesion of the buccal mucous membrane,
which is said to be associated only with
measles, and in a majority of instances to
precede the skin eruption by a considerable
interval. It is likely that Flindt made the
same observation some ten years earlier, but
the phenomenon is now properly associated
with the name of the later observer, who,
discovering it independently, has been able
to impress its value upon his contempora-
ries. The results of a special inquiry upon
this subject and a partial analysis, follow-
ing as nearly as possible the language of
the witness, follows.
Of the 20 observers, 6 characterize the
sign by the word "pathognomonic :" Hirsh,
Libman, Lichtenstein, Ross, Sobel, Za-
horsky.
The sign is diagnostic when present, ac-
cording to 17 observers : Adriance, Black-
ader, Blanton, Cheney, de Saussure, Gil-
bert, Hirsh, Libman, Lichtenstein, Mit-
chell, Morse, Ross, Sobel, Taylor, West,
Zabriskie, Zahorsky.
These three doubt its diagnostic value:
Adams, Cameron, Cotton.
Absence of the spots excludes measles,
according to 7 observers : Hirsh, Libman,
Lichtenstein, Ross, vSobel, West, Zabriskie.
Absence of the sign does not exclude
measles, 5 observers : Adams, Cameron,
Cheney, Morse, Zahorsky.
The sign has been observed in advance
of the eruption by 13: Adriance, (20cases
out of 96), Blackader, (in every case),
Cheney ("frequently"), Gilbert, Libman,
Lichtenstein, (as early as 3 days before the
eruption), Morse, Mitchell (48 hours before
the eruption), Ross, Sobel (from a few
hours to 5 days before the eruption) , West,
Zabriskie, Zahorsky.
THE CHARLOTTE MEDICAL JOURNAL.
295
Precautions Against the Plague.
Forewarned is forearmed provided we
heed the warning and set about in a proper
way to meet the expected.
The plague may never become a matter
of widespread concern within our own bor-
ders, but if it should then all our knowl-
edge of the disease would be in vain except
we reduce it to a practical value.
If it were not for wars and rumors of
wars, says the Medical Record, which al-
most monopolize public attention, the
spread of the plague to all quarters of the
globe would give rise to much more alarm
and discussion than are at present the case.
The sinister fact, that the disease has for
the first time gained a footing in the wes-
tern hemisphere, does not appear to be re-
garded as an event of vital importance,
and although the occurrence of plague on a
vessel in New York harbor created a tem-
porary sensation of dread, this feeling was
quickly lulled into one of security, based
chiefly on the widespread opinion that it is
virtually impossible for the malady to make
headway in places where a proper system
of sanitation is carried out.
These optimistic views are certainly to a
large extent justified by the history of the
course of the plague in other parts of the
world. Within recent times proof has con-
stantly been afforded that plague rages most
virulently among dirty surroundings, and
many experts hold that where the environ-
ment is cleanly its ravages are easily con-
trolled. However, this latter conten-
tion is thought by others to be more or less
open to doubt, as there are several instances
on record in which the disease has made
decided progress under conditions presum-
ably unfavorable to its spread. On more
than one occasion after it has been proudly
proclaimed that in a certain city or town
the plague has been wiped out by the en-
ergy displayed in rendering the sanitary
system complete, the news has come that a
recrudescence has occurred on a larger scale
than before. Nevertheless, in the light of
experience during the past decade it may
be said that efficient sanitation is the best
safeguard against plague. In localities
where hygienic arrangement are good the
bacilli of the disease will find no soil suit-
able for its incubation and propagation.
Again, our knowledge as to the best means
of treating the disease has advanced, albeit
but slowly. No absolutely reliable specific
has yet been discovered, but investigation
has demonstrated its cause, and it has been
also shown that when possible isolation of
patients and segregation of those exposed
to infection are among the most prominent
factors in limiting the spread of the plague.
Consequently the enforcement of these
measures, a rigid adherence to the laws of
sanitation, together with the prophylactic
and curative methods now at hand, would
seem to provide sufficrently strong barriers
againsf the plague securing any but a tem-
porary foothold in this country.
There is unfortunately a dark side to the
question. The plague has not only planted
itself in Brazil, but is gradually drawing into
its net aU the islands of the Pacific, and from
these, and especially from the Hawaiian
islands, comes the greatest danger of impor-
tation into the United States.
The disease promises to spread like wild-
fire among the inhabitants of this group,
while our traffic to and from Honolulu is
considerable and frequent. The conditions
prevailing in many of the American towns
on the Pacific coast are not such as to war-
rant the belief that, if the plague were to
obtain an entrance, its extermination would
be a matter of little difficulty. There is a
large Chinese population, and this race is
peculiarly predisposed to plague infection.
In addition, the climate, overcrowding, and
uncleanly habits of the aliens in that part
the United States favor diseases of this de-
scription.
The maritime quarantine regulations con-
tained provisions relating to the plague, but
the Treasury Department has deemed it ex-
pedient under the exceptional circumstances
to supplement these with special regula-
tions, which order that at foreign ports and
places infected or suspected of being in-
fected with plague the United States quar-
antine regulations referring to cholera shall
be observed with regard to vessels and car-
goes bound to the United States. Quaran-
tine regulations relating to cholera are also
to be observed at ports and on the frontiers
of the United States. Dr. Wyman, the
surgeon-general. Marine Hospital service,
in a pamphlet recently published by him,
speaks thus of the quarantine equippment of
this country : "The government is well
equipped with quarantine stations for the
disinfection of infected vessels, and has be-
sides several large stations where immigrants
can be detained in barracks under observa-
tion." Dr. Wyman goes on to say: "It
seems impossible that the plague should
ever again ravage the earth as in previous
centuries.
The modern quarantine is effective to a
degree. Though old-fashioned and absurd
as administered by some of the European
countries, and imperfectly executed in
others, it nevertheless has proven and will
continue to prove a powerful shield against
this Asiatic invasion." The following sug-
gestions with respect to public hygiene are
296
THE CHARLOTTE MEDICAK JOURNAL.
advanced by Dr. Wyman : "The destruc-
tion of rats and other rodent animals ; the
prevention of congregations of individuals,
as fairs, celebrations, and pilgrimages ; the
surveillance and supervision of markets ;
the cleanliness of the soil ; the regular re-
moval of garbage ; the cleanliness of habi-
tations ; the particular supervision of places,
workshops, forges, etc., intended for occu-
pancy by the laboring and industrial classes ;
the cleaning and regular disinfection of la-
trines and cesspools; the care and cleaning
of gutters, etc. Administrative care should
also be brought to bear to improve the sani-
tary condition of notoriously unsanitary
quarters and dwellings."
The primary and principal object in the
fight against the plagne is to keep the dis-
ease out-of the country, and this, according
to tlie views of the most distinguished au-
thorities, can be effected only by a strictly
rigorous system of maritime quarantine.
Our system is undoubtedly a good one, but,
if it requires strengthening, nothing should
be allowed to stand in the way of legisla-
tion tending to the preservation of the
health of the country at large. The next
and scarcely less important aim is to have
our towns in so efficient a state of sanita-
tion that if the disease were to gain an en-
trance it would be given no opportunity to
spread. In this respect many of our sea-
board centres of population will be found
wanting. Therefore it would be well if
the advice proffered by Dr. VVyman regard-
ing public hygiene was taken to heart and
promptly acted upon by the city fathers
throughout the land.
Osteopathy in New York.
It can be almost laid down as a principle
that the greater the fake and the more
stupendous the fraud, the harder it is to
head it off.
The more senseless the imposition the
more difficult is it to protect the people and
safeguard our own interests.
In New York the Empire State of the
nation the regular profession are being wor-
ried by the rediculous pretensions of the
osteopaths.
The Medical Record says that in this and
other states, the medical profession has
none too easy a time in combating fraud
and charlatanism on one hand, and ignor-
ance and stupidity on the other, and the
development of something new under these
headings, called estopathy, has added a
fresh source of difficulty and injustice. The
supreme court of New York, in Smith vs.
Lane, 24 Hun. 633, has decided that a
man who practices massage does not prac-
tice medicine, and prosecutions of ostoe-
paths have therefore been discouraged on
the assumption that osteopathy is massage.
We cannot see the justice or the force of
this form of argument. An osteopath pre-
tends to diagnosticate and treat by manual
means many forms of disease, and does not
limit himself to working under the direc-
tion of some one else, as is almost invariab-
ly the case with the masseur. When the
physician wishes a patient to have massage,
he prescribes it as he would any other form
of treatment, and it is given by an individ-
ual trained for such work, the physician
still being responsible for the wellfar of the
patient.
When the osteopath finds a victim, he
makes his own diagnosis, decides on and
carries out his own treatment, and is
apparently neither legally nor morally res-
ponsible in any way for the outcome of his
ministrations. We cannot see how the
mere fact that the osteopath does not order
any drugs for his victim should relieve him
of the responsibility of practising or attempt-
ing to practice medicine. Does the surgeon
who straps a sprained ankle or a fractured
rib practise a branch of medical science, or
would the law relieve him of responsibility
in case of a bad result from such conditions,
if he should plead that he had used no inter-
nal medication, and was, therefore, not
practising medicine.'' The answer does not
require argument. The important fact is
that the osteopath presumes to make a
diagnosis, and to institute what he dares
»ay is the proper treatment, and this ought
to render him liable to prosecution under
the medical law, without considering the
fact of subsidiary importance that no drug
has been actually given.
If the osteopath cannot be reached under
the present medical law, there ought to be
an amendment, for if something is not done
the regular practitioner will actually have
less protection than the imprudent char-
latan. If a registered physician can be
proven before a jury to have been negli-
gent, the complainant can recover heavy
damages, but it is very doubtful whether
the unregistered and unqualified osteopath
could be reached in this way. It would be
an excellent thing if the County Medical
Society could find out whether, in the eyes
of the law, it is not the making of a diagnosis
and prescribing of treatment which con-
stitutes practising medicine, and not merely
the application of treatment, with a differ-
ence between treatment with or without
internal medication.
We should certainly try to be sure that
any person who pretends to treat or pres-
cribe for the sick or injured in any way, on
THE CHARLOTTE MEDICAL JOURNAL.
his own responsibility and initiative, should
be compelled to come up to a certain stand-
ard of proficiency in such subjects of an-
atomy, physiology, and obstetrics, be his
system of therapeutics what he likes, and
we should be prompt to deny that the osteo-
path is not attempting to practice medicine,
merely because he does not prescribe drugs.
Compensatory Processes in Disease.
By reason of our modern way of living
we have to call out the reserves very fre-
quently and sometimes permanently.
The Medical Record well says that were
not the animal organism endowed with
structure and function in excess of its ordi-
nary needs, disease would obviously be well-
nigh universal. Nature has, however,
been almost prodigal in this respect, so
that destruction of tissue in one situation or
loss of function in one organ mav be com-
pensated for, in whole or in part, by a re-
adjustment to the new conditions. This
result may be brought about in one or more
of three ways, as is pointed out by Leube
[Deutsches Archiv fur kli?iische Medicin,
66 B., p. 80) : (i) Portions of a diseased
organ may remain healthy, and this resi-
duum may assume the increased function ;
or one of azygous organs, as for instance
the kidneys, may take up the work of the
other, if this be diseased or otherwise inca-
pacitated. This form of compensation is
illustrated by the hypertrophy of the heart
that takes place when the circulation is in
any way obstructed, by the hypertrophy of
the muscular coat of the stomach when ob-
struction to the movement of its contents
exists, and by the transformation of yellow
into red bone-marrow in the presence of
anaemic states.
(3) One set of organs or tissues may per-
form the functions of another set of organs
or tissues having a like action. Such reci-
procity of function exists, for instance, be-
tween the skin and the kidneys, and that of
the skin, as pertains to both water and
solids, and this fact is often availed of in
the treatment of nephritis. Only in the
presence of marked cutaneous edema does
Leube consider sweating as contraindicated,
as the excrementitious matters left behind
by the escape of the fluid may be absorbed
and thus give rise to toxic symptoms. In-
stead, he recommends multiple capillary
puncture of the skin. The salivary glands
and the bronchial mucous membrane are al-
so capable in some degree of assuming the
functions of the kidneys, and the gastro-in-
testinal tract also, but only in very small
degree.
There is abundant evidence that the in-
testines are fully capable of replacing the
activity of the stomach if this be diminished
or abolished from any cause, A mutually
reciprocal relation exists between the blood-
forming organs : the bone-marrow, the lym-
phatic glands, and the spleen. In cases of
profound anasmia and in the sequence of
profuse hemorrhage, evidence of increased
haemogenesis in the bone-marrow becomes
appreciable from the change in color from
yellow to red, and in the presence of nu-
cleated red corpuscles. The spleen at
times undergoes hyperplasia under such
conditions, and is often found enlarged.
Leube has observed such enlargement in a
considerable proportion of cases of chlorosis,
and these cases have pursued a more favor-
able course than those unattended with
splenic enlargement. With regard to the
white blood-cells, the spleen and the lym-
phatic glands appear to be concerned
especially in the production of lymphocytes,
and the bone-marrow principally in that of
the granular and amoeboid leucocytes.
Following splenectomy the lymphocytes in
the blood becomes increased.
(3) Organs and tissues may assume the
functions of other organs and tissues having
a different action. Of this fact application
is made therapeutically, diuresis, diaphore-
sis, and catharsis often being induced with
the object of causing absorption of exudates.
Having observed rapid disappearance of an
accumulation of fluid in the abdominal cavi-
ty in the sequence of salivation occurring
spontaneously, Leube suggests that at tiities
ptyalism might be induced artificially with
the same object in view, and he reports four
of five cases of pleurisy with effusion and
one of two cases of ascites in which rapid
absorption of the fluid took place in connec-
tion with profuse salvation excited by the
chewing of gum.
Dietary Studies of Negroes.
The Medical Record says that Dr. Fris-
sell and Miss Isabel Bevier have in connec-
tion with the United States Department of
Agriculture contributed a series of dietary-
studies of negroes living in Eastern Virgin-
ia. The studies made in 1897 were con-
ducted by Dr. Frissell, and the investiga-
tions on the same lines in 189S by Miss
Isabel Bevier. The mode of life and the
quality and quantity of the food of the
colored race in the United vStates is a sub-
ject that has received but little attention.
Some statistics were collected a few years
ago with regard to the food consumption of
negroes residing near Tuskegee, Ala,
These investigations showed that where
negro families had profited by the opportu-
THE CHARLOTTE MEDICAL JOURNAL.
nities for education provided at Tuskegee
Institute, their methods of living had under-
gone a considerable change, approaching
more closely to those of an ordinary Ameri-
can family. Other families who had not
come under such influence might be regard-
ed in the matter of diet as representative of
the uneducated negro type.
The results of the studies in Virginia
coincided in the main with those in Ala-
bama. More protein was found in the die-
taries of negro families in Virginia than the
average amount consumed by white persons
in fairly prosperous circumstances, nearly
as large as that called tor in the tentative
American standarnd — namely, 125 gm, per
man daily. This fact, however, is explain-
ed by the proximity of salt water to the
district in which "the investigations were
conducted in Virginia, which made fish an
important article of diet. The average
fuel value of food consumed per day by the
negro families both in Alabama and Vir-
ginia is as large or larger than that found
in dietary studies made among white fami-
lies. The average fuel value found in nine-
teen studies in Virginia was 3,745 calories;
that found in twenty studies in Alabama,
3,270; the average of ten white families in
New England and New York, 3,515 ; while
the tentative standard for a man at moder-
ate work calls for 3,500 calories per day.
Perhaps the most noteworthy feature re-
vealed in connection with thesa studies was
the small cost of the food. For eleven
cents the families in Virginia obtained
food materials furnishing more protein and
more energy than were obtained for twenty-
eight cents by the families of professional
-men in comfortable circumstances, and for
nineteen cents by families of well-paid me-
chanics. It would appear from a consider-
ation of the dietary studies made in Alaba-
ma and Virginia among negro families that
the character of the food consumed by them
is coarser and less appetizing than would be
tolerated by an ordinary white family.
"Hog and hominy" forms the staple of
their diet.
Scarcely any meat besides pork is eaten,
but where obtainable fish is a favorite arti-
cle as food, while at certain seasons frogs,
turtles, and even snakes are eaten by some
families. The cooking of the negroes is
primitive to a degree, and their drinking-
water is, as a rule, stagnant and brackish,
often muddy. The fact, however, stands
out prominently that notwithstanding the
agricultural negro's careless, unhygienic
methods of living, he is able to do hard
manual labor and enjoys almost if not quite
as good health as his white brother placed
in like circumstances.
Concerning Consultations.
The American Medical Monthly may not I
be dead right in all things but the advice)
in the following editorial is well worth'
reading twice.
Consultations between physicians, in
cases of unusual difficulty, where the diag-
nosis is in doubt or the treatment has been
unsatisfactory, are often productive of the
happiest results, and, in any event, relieve
the minds of relatives, who thus become
more reconciled to the situation. There is
usually, also, a benefit accruing to the
attending physician in the sharing of re-
sponsibility and the bandishment of doubts
and regrets in fatal cases, while in those in
whom result has proved favorable, the
attending physician often turns something
from the consultant.
Wise as we may be. we are constantly
humbled into the dust by failures. At
times we feel like a friend of ours, who
said he had seen every variety of obstetric
case that would be likely to be met with,
and then may be non-plussed by the very
next case that comes under our care. We
then acknowledge that Hippocrates of old
knew what he was talking about in saying
"Life is short and art is long, experience
fallacious and judgment difficult."
However learned we may be, however
great our knowledge of anatomy and path-
ology, however good as a diagnostician,
however great our experience, there is
always something we do not know that
another man may know, and this may be
just what a patient needs for his recovery.
We never know it all.
It would seem to be in accordance with
the natural order that when a physician has
been in general practice for twenty-five
years, he should be in a position to retire
from routine practice and become a con-
sultant, ready to give younger men the
benefit of his larger and varied experience
and observation, and leaving the field of
active labor to them. Such a course would
not only advance the dignity of the profes-
sion, but it would greatly add to the well-
being of our patients, and also relieve the
present congested condition of the profes-
sion, thus giving younger men a better
chance.
Two obstacles stand in the way of this
change, both of them removable. One is
the fact that not many physicians are finan-
cially in condition to give up active practice
after twenty-five years. This objection
will be removed, however, if the increased
frequency of consultations from the end
of the period suggested, will net a suffi-
cietnt income. It is further to be suggest-
led that physicians are extravagant in