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Buffalo Medical Journal



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BUFFAl^O

Medical ^y?^ Surgical
Journal.

ED^tabUetied 18-46 by AUSTIN KLINT. Nl. D.



THOS. LOTHROP, M. D. WM. WARREN POTTER, M. D.



WILLIAM C. KRAUSS, M. D. JAMES WRIGHT PUTNAM, M. D.

JOHN A. MILLER, Ph. D. JOHN PARMENTER, M. D.

,-.,., VOL. XXXIII.

August, 1893, to July, 1894.




BUFFALO.



1894.



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CONTRIBUTORS TO VOLUME XXXIII.



Abbott, Frank W.. M. D Buffalo.

Angell, Edward B., M. D Rochester.

Bartlett, Frederic W., M. D Buffalo.

Burr, C. B., M. D Pontiac.

Cary, Charles, M. D Buffalo,

Cu^RK, Edward, M. D Buffalo.

Clark, Horace, M. D Buffalo.

Clausius, M. F., M. D Winnebago.

Cott, George F., M. D Buffalo.

Crockett, M. A., M. D Buffalo.

Daggett, Byron H., M. D Buffalo.

Doyle, Gregory, M. D Syracuse,

Fritz, William C, M. D. . . . . Buffalo.

Gram, Franklin C, M. D Buffalo.

Hartwig, Marcell, M. D Buffalo.

Haynes, Francis L., M. D Los Angeles.

HiMMELSBACH, G. A., M. D Buffalo.

Hopkins, Henry Reed, M. D Buffalo.

Howe, Lucien, M. D Buffalo.

HUBBELL, Alvin A , M. D Buffalo.

HURD, A. W., M. D Buffalo.

Hulbert, George F., M. D St. Louis.

INGRAHAM, Henry D., M. D Buffalo.

Jones, Allen A., M. D Buffalo.

JUDSON, A. B., M. D New York.

King, Clarence, M. D Machias.

KiNGSLE\', Mrs. Carlton A Westfield.

Krauss, William C, M. I) Buffalo.

Long, Benj., M D Buffalo.

Long, J. W.. M. D Richmond.

LoTHROP, Thomas, M. D Buffalo.

Love, Isaac N., M. D St. Louis.

Manley, Thomas H., M. D New York.

Mann, Matthew D., M. D Buffalo.

Miller, John A., Fh. D Buffalo..

MiLLiKEN, Samuel E., M. D New York.

Mynter, Herman, M. D Buffalo.

Parmenter, John, M. D Buffalo.

Potter, William Warren, M. D Buffalo.

Putnam, James Wright, M. D Buffalo.

Renner, W. Scott, M. D Buffalo.

Robinson, F. Byron, M. D Chicago.

Rochester, DeLancey, M. D .• Buffalo.

Sellstedt, L. G., Esq Buffalo.

Starr, Elmer, M. D Buffalo.

Tait, Lawson, Esq., M. D Birmingham, Eng.

Thompson, J. C, M. D Buffalo.

Thornbury, Frank J., M. D Buffalo.

Weigel, Louis A., M. D Rochester.

Wende,G. W., M. D Buffalo.

AVheeler, William A., M. D New York.

Whipple, Electa B., M. D Buffalo.

Buffalo Academy of Medicine.
Philadelphia Couniy Medical Society.
Medical Socieiy of the County of Erie.



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ILLUSTRATIONS TO VOLUME XXXIII.



PACE.

Concerning Posture. (B. H. Daggett, M. D.)

Fig. I. — Dorsal Posture — Knees and thighs fiexed 86

Fig. 2. — Knee,-thigh, -chest Posture 88

Radical Cure of Inguinal Hernia. (S. E. Milliken, M. D.)

Fig. 1. — Dissection of Sac and Exposure of Cord 147

Fig. 2. — Suturing of Conjoined Tendon and Poupart's Ligament . I48
Fig. 3. — Suturing of Flaps of External Oblique 149

Hydro-Nephrosis from Valvular Stricture of Ureter. (Herman
Mynter, M. D.)

Fig. I. — Incision through Valvular Stricture and Sac 222

Fig. 2. — Appearance After Operation 222

Laryngeal Tuberculosis. (Horace Clark, M. D.)

View of Larynx in a Typical Case 276

Tricuspid Insufficiency. (F. J. Thornbury, M. D.)

Anadicrotic Wave Synchronous with Auricular Systole 280

A New Method of Artificial Respiration in Asphyxia Neonatorum.
(J. Harvie Dew. M. D.)

Fig. I. — Opening of the Epiglottis by Gravity ... 666

Fig. 2. — Depression of the Pelvis and Lower Extremities 667

Fig. 3.— Forcible Expiration by Arching the Lumbar Region Back-
ward and Bending the Child Upon Itself 668

. Fig. 4.— Expulsion of Mucus by Elevating Buttocks and Depress-
ing Head 672

Hegar*s Sign of Pregnancy. (J. W. Long, M. D.)

Fig. I. — Intra- vaginal Finger in Anterior Vaginal Fornix — Abdominal

Hand Behind Fundus 706

Fig. 2. — Intra- vaginal Finger Behind Cervix, Abdominal Hand

Between Symphysis and Fandus 707

Fig 3. — Hand Between Symphysis and Fundus, Finger in Rectum . . 707

Bladder Gymnastics and Auto-Irrigation. (B. H. Daggett, M. D.)

Fig. I.— The Daggett Canula 714

Fig. 2. — Posture for Auto-irrigation of the Bladder 715

Portrait of Henry Van Aermam. M. D., facing 739



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Buffalo Medical i' Surgical Journal

V0L.XXXIIL AUGUST, 1893. No. 1.

©riginaf ©Kcjcjrex^x^.

THE PREVENTION OF DISEASE.

By DeLANCEY ROCHESTER. M. D.,

Adjunct Professor of Medicine in the University of Buffalo; Assistant Visiting Physician

to the Buffalo General Hospital.

president's address before the buffalo academy of medicine,
annual meeting, june 27, 1893.

A LITTLE over a year ago, at a meeting of physicians called for
the purpose of forming the Clinical Society, some remarks were
made deprecating the formation of another medical society in
Bnfralo,and suggesting that, instead of such action, we concentrate
our energies in the Buffalo Medical and Surgical Association,
dividing it into sections after the manner of the New York Aca-
demy of Medicine. The idea was not new, but that the time was
ripe for its germination was proved by the general favor with
which the suggestion was received. However, after full and free
discassion, it was deemed best not to concentrate in the Buffalo
Medical and Surgical Association, but to invite several other
societies to cooperate in the effort to concentrate the scientific
medical work that was being done in the city, in the manner sug-
gested. Accordingly, a committee was appointed by the newly-
formed Clinical Society to confer with committees which might be
appointed by other societies, as to the advisability and practicabil-
ity of the action suggested. Committees were appointed by the
Buffalo Medical and Surgical Association, by the Pathological
Society, and by the Obstetrical Society, to confer with the com-
mittee of the Clinical Society. These committees had several
meetings, and finally, as a result of these conferences, a joint
meeting of the several societies was held, at which it was decided
to unite in the formation of the Buffalo Academy of Medicine,
a constitution was adopted, and the officers under that constitution
were duly elected. So far all seemed well, but the members of the
varioas societies did not, with alacrity, complete their membership



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2 BOCHESTEB : THE PREVENTION OF DISEASE.

by the payment of initiation fees and annaal dues, seeming to
doubt the virility of the new Academy, and not being willing to
aid in its nurture during its infancy ; so that, at the first stated
meeting of the Buffalo Academy of Medicine, there were but thirty
names enrolled upon the membership list ; to-day there are one
hundred paid-up members! Our first meetings were held in rooms,
hired for the evening,. here and there in different parts of the city;
to-day we have spacious apartments to which we are proud to
invite visitors from out of town ; we have, through the kindness
of Dr. Bartlett, the beginnings of a library, and we are starting a
pathological museum. Truly, I think we may congratulate our-
selves upon the growth of the Academy. Moreover, the stability
of the Academy is assured, from the fact that this growth is in no
respect the result of the energy of any one man, but is the out-
come of the combined energy of all.

Nevertheless, it is but just to say that this energy was fired into
activity by the enthusiasm and self-sacrificing public spirit of Dr.
Herman E. Hayd, who has thrown himself with so much vigor
into the work of increasing the membership and raising money by
subscription for furnishing our apartments, that the rest of us have
been forced for very shame to follow his noble example. No
factional fights have so far disturbed the Academy, and it is to be
sincerely hoped that nothing will ever arise to disturb the harmony
of this new scientific body.

As it fell to my lot to be the lucky one to suggest the forma-
tion of the Academy, you decided to make me its first president,
and thus, to a certain extent, to throw the responsibility for its
success or failure upon my shoulders. I take this opportunity to
thank you all for the aid you have given me to bear this responsi-
bility. Truly, I think we may congratulate each other upon the
bright auspices under which it begins its second year. The consti-
tution requires an annual address from the retiring president ; it
is my desire to inaugurate the custom of making the subject of
that address, one of general medical interest that may cUso be of
value to the community in which we live, and I have accordingly
chosen as the subject of my address this evening Practical
Measures Tending to the Prevention of Disease.

It has been said — and is constantly being re-asserted — that the
medicine of the future is to be preventive medicine. When is the
<< future" to begip ? How much has. any of us done to aid the
advent of that most desirable period ? Moreover, what are we to



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BOCHJESTSR : THE PREVEKTION OF DISEASE. 3

do to accomplish so laudable a purpose ? As far as I can learn
from personal observation and from careful study of the records
of the past, I am sorry to say that most physicians have shamefully
neglected their evident duty to humanity by contenting themselves
with merely aiding in the recovery of a patient from special disease
or condition, and then dismissing the case from further considera-
tion. Now, it seems to me that it is the duty of the physician —
nay, he should esteem it a most blessed privilege — to be more than
a mere healer of the sick, to be an educator of his fellow-men to
such extent that they may learn to so physiologically live as to
avoid disease and postpone death. In order thus to teach, one
must have thorough knowledge one's self. The first requisite, then,
for the much-desired preventive medicine is that all physicians
should be thoroughly educated men or women ; the standard of
medical education must be raised to the highest degree.

While it is undoubtedly true that there have been some excel-
lent physicians who have not received an academic degree before
beginning the study of medicine, I think it is also true that they
have attained their knowledge at great sacrifice after they have
graduated in medicine, and might have attained their eminence at
a much earlier period if their previous education had been broader.

It is generally conceded that a man should not try to become a
specialist in any branch of medicine until he has had a solid foun-
dation of several years of practice in general medicine.

Is it not equally true that no man should devote himself to any
one branch of science, such as medicine, until after he has been
thoroughly founded in general knowledge — arts, sciences, languages,
and philosophy ?

The first step, then, towards the attainment of preventive medi-
cine, is the requirement that all who desire to begin the study of
medicine should possess an academic degree or present proof of
equivalent preliminary education. The next step is the require-
ment of a ninety per cent, standard for graduation.

Some members of some faculties seem not to realize that, when
they allow incompetent or unworthy men to graduate from their
medical schools, by signing the diploma of such a one, they are
making themselves, in fact, if not in law, accessory to any crime or
evil that may be brought about or occur through the wickedness
or ignorance of such a graduate. Let us, then, do all we can to
force tlie medical schools to raise their standard for admission and
for graduation. Then, indeed, we will hear less of exclusive



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4 BOCH ESTER : TBE PREVENTION OF DISEASE.

systems of practice, isecret and patented medicines and other forms
of charlatanry ; and a medical profession, composed of highly edu-
cated members, will be able to truly educate the public as ^o a
mode of life that will tend to prevent the development of disease.

In order to bring about the end desired, every one of us, whose
privilege it is to occupy the position of family physician, should
begin the work of education with the mother of the unborn babe ;
he should carefully watch over her through her pregnancy, advise
her as to every detail of her daily life, especially as to exercise,
diet, and the functions of excretion, encourage her to ask him
about anything on which she wishes enlightenment, and make her
feel that in him she has a friend who will lend a sympathetic ear to
anything she wishes to say, no matter how trivial it may appear.

Thus with a mother in good health through her pregnancy, the
chances that the child born to her will be healthy, and that she will
be able to nurse her child, are proportionately great. It is likewise
our duty to insist on such a mother's nursing her child ; and if we
have done our duty, we will have so impressed the mother with the
beauties and blessings of maternity, that she will rejoice to be able
to nurse her baby. When the mother is up from her confinement,
we should not cease our interest in the welfare of her and her child,
but should give instruction as to when and how to wean, what to
feed the child and how to feed it. Thus the child will be started
on the road to health. •

Now, it is our duty to give instruction, whenever we have the
opportunity in a public way, and to all of our families, in general
hygienic laws, such as proper ventilation, the importance of regu-
larity about meals, defecations and hours of sleep — as regards meals,
we should also give instruction as to what foods are incompatible
and should not be eaten at the same meal, and as to the importance
of the function of proper mastication.

In our system of school education should be included an ele-
mentary course in human physiology, in which every child should
be instructed before he or she has reached the age of fourteen or
fifteen years. The instructor in physiology should always be a
thoroughly educated physician.

So much, then, as regards general instruction for the produc-
tion and maintenance of health.

Let me call your attention for a few minutes to certain measures
for the prevention of special diseases. Although I believe that the
acute infectious diseases, diphtheria, scarlatina, measles, rOtheln



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boohbsteb: the prevention of disease. 5

roseola, varicella, variola, and whooping-cough, could be absolutely
stamped out by the passage of stringent laws and the thorough
enforcement of the same by the municipal authorities against both
physicians and householders, I will not take up that subject this
evening. There is a greater danger than that from all these dis-
eases combined, which has menaced for years, and continues to
menace, the human race ; there are certain diseases which carry off
millions of people and greatly debilitate others, which are gener-
ally incurable when contracted, but could be absolutely avoided if
the people only knew how. It is our duty to instruct the people
how to avoid these diseases, among which tuberculosis \% facile
princeps in the death rate, and the venereal diseases, syphilis and
gonorrhea, are not far behind in the debilitating effect upon the
individual and his progeny. Let me call your attention to some
measures which we might adopt to prevent the spread of these
fearful scourges. For the prevention of a disease by any rational
measures, the cause or causes of such disease must be thoroughly
understood. After Koch had proved that the bacillus tuberculosis
was the cause — the sole active cause — of pulmonary consumption,
our hopes ran high that now that we had a definite foe to attack,
it would not be long before victory should perch upon our stand-
ards and that fell destroyer of the human race would be driven
from the face of the earth forever.

But we have learned that once the bacilli have gained entrance
into an organism, it is seldom that they can be evicted.

** The destruction of organisms outside of the body by disin-
fectants," says Flint, Sr., <' and the removal of all the accessory
conditions necessary to their existence, together with their effectual
exclusion from the body, may, and indeed it is more than probable
will, reduce the fatality from infectious diseases, in the order of
Providence, much sooner than the discovery of effective therapeutic
agents."

Among the "accessory conditions necessary to their existence "
we find that there are certain types of individuals more susceptible
than others to the attacks of the tubercle bacilli. The old writers
laid a great deal of stress upon the recognition of different natural
temperaments in healthy individuals, that modified the course of
disease in such individuals, and upon certain pathological diatheses,
that rendered those possessing them more liable to certain diseases.

It is not my purpose to take up this most interesting subject
further than to call your attention to the fact that there is a cer-



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t$ BOCHE8TER : THE PREVENTION OF DISEASE.

tain physical oondition, that renders its possessor more susceptible
to the onslaught of the tubercle bacillus, that this condition is
marked by certain physical characteristics, and that it is sometimes
inherited and sometimes acquired.

It is not necessary here to enumerate those characteristics ; I
wish merely to point out the fact that they are, almost without
exception, due to malnutrition accompanying or accompanied by
anemia of considerable degree.

If this is so, — and I think the experience of each of you will
bear me out in the statement that it is, — one of the prime factors
to be taken into account in the prevention of consumption, is the
prevention of the preceding anemia. How is this to be done ?
In the first place, as far as in our power lies, we should discourage
the marriage of any who has a hereditary taint.

As regards this, however, the physician is seldom consulted.
Nevertheless, in his public utterances, he should do all he can to
put this matter clearly before the people.

In other respects, the following of the suggestions already made
in regard to general hygienic living will go far towards the pre-
vention of the anemia. One of the great factors in the causation
of anemia is a deficient supply of oxygen ; not that there is not
sttflficient oxygen about us, but a large number of individuals —
especially those who have any hereditary tendency to consump-
tion — do not know how to breathe, and so deprive themselves of
an element that Nature supplies abundantly, which is so necessary
to their welfare. Let us, then, teach people how to breathe, com-
bining with the respiratory exercises the movements of the arms
and legs, and abdominal muscles that will aid in the development,
and expansibility of the chest. No apparatus is necessary for this
Pay great attention to their excretory organs, the bowels, the
liver, the skin, and the kidneys, and to their organs of digestion,
the stomach, and the small intestine.

So much for hints as to how to prevent the anemia. If the
anemia is present, treat it, but treat it intelligently, not by the
mere pouring in of iron, but by careful examination of the patient
in toto and by the combination with the iron of alkalies, oxygen
by inhalation, phosphorus, arsenic, iodine, or cod liver oil, as may
be indicated by the result of your examination.

So much for instruction how to avoid that physical condition
which affords so excellent a culture medium for the development
of tubercle bacilli.



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KOCHBSTEB : THE PRBVlfiNTION OF DISEASE. 7

Now, what can we do to prevent the entrance of the hacillus
into the person of a healthy individual ?

About two months ago, I was called to see a child dying of con-
sumption. She had been under the care of another physician for
several years. He had properly diagnosed her case and realized
her hopeless condition. I confirmed his prognosis, and while giv-
ing the parents the sad information I took occasion to impress
upon them the contagiousness of the disease and wherein the con-
tagion lay, the importance of destruction of sputum, and avoid-
ance of inhaling the child's breath, etc.

The child died that night, and the next day the mother told me
that she had not previously observed much precaution as to the
exhalation, sputum, and excretions of her child, because only the
week before, she had asked the attending physician if there were
any reason why her other child should not sleep in the same bed
with the sick one, as some of her neighbors had warned her in
that regard, and he had told her that there was no harm in it
except that the well one might be disturbed by the restlessness of
the sick one I

Is it not time that the people should be instructed by those
who know, when those who do not know are allowed to practise
medicine ?

What instructions, then, should we give to those who are suf-
fering from phthisis, or to their attendants, to prevent the spread
of the disease from a focus swarming with the deadly germs ?

In the first place, they should all be impressed with the fact
that the disease is infectious, and that the agent of infection is a
germ that is carried from the diseased individual in the breath to
a limited extent, in the excretions from the bowels and sometimes



Online LibraryJ. A. (Joel Asaph) AllenBuffalo medical journal → online text (page 1 of 78)