Copyright
J. A. (Joel Asaph) Allen.

Buffalo medical journal online

. (page 53 of 78)
Online LibraryJ. A. (Joel Asaph) AllenBuffalo medical journal → online text (page 53 of 78)
Font size
QR-code for this ebook


easily fatigued and more easily put on edge than their own. Then
will we help them to realize that marriage is not a failure. With
a view to the building up and maintainment of nerve force and
guarding against nervous bankruptcy, both on the part of parents*
and children, we should teach them the importance of proper food,
proper clothing and a properly opened condition of the animated
system of sewerage. We should impress them with the fact that
the daily visit to the Temple of Cloacus, with satifactory results,
is quite as important as the morning and evening prayer. When
we recall the fact that ninety per cent, of the women of the world
are much more constipated than the traditional owl, we will realize
what room there is for improvement in this direction. A -special
missionary work should be entered into, on the part of the profes-
sion, among the teachers of our schools, for they need not only to
know the importance of the flushing out of the alimentary canal,
so far as they themselves are concerned, but its importance as a



Digitized by



Google



LOVB : NSURASTBSKIA. 525

«timalator of the wit and the ability of the young idea in the
direction of shooting properly. All along the line we are
«afe in keeping in mind the cardinal principles, both as pre-
venters and oarers of the conditions mentioned, — namely, elimi-
nation, disinfection, nutrition, tranquilization and> oxygenation.
Large quantities of pure water serve, whether preceded by
medicament or not, as excellent stimulators of the eliminative
organs*

Food that is easily digested and readily assimilated' is import-
ant, and, in this connection, the fats, hydrocarbons, are more valu-
able even as nerve builders than as enemies to tuberculosis, and
that is saying a great deal. Under this head, butter and milk stand
preeminent. Sleep is, indeed, " tired Nature's sweet restorer," and
it represents the life of the individual. Mothers should be
impressed with the fact that children, who are poor sleepers, run
the chance of growing up with wrecked nervous systems^ The
average mother, as well as the average child, does not sleep-
enough.

The limits of this paper will permit of but few points in the-
way of treatment. As a sleep producer, I believe that trional in
ten, twenty or thirty grain doses is the best remedy we have at
hand. No exaltation, no depression, and no bad effects, follow its
use. I observe, in a recent number of one of my exchanges, a
very pronounced tribute to this remedy by Dr. J. B. Mattison, of
Brooklyn, N. T., a high authority. His experience is entirely in
harmony with my own. •

The digestion should be helped in order to secure nutrition in
better form in every way possible. I have no sympathy with those'
who inveigh against the general aids to digestion. Just as well
say that when a man's leg is broken or injured that he should not*
wear a crutch, as to say that when the digestive powers are
crippled, crutches are not indicated. Pepsin, which assists in the
digestion of albuminous foods, and diastase, which directs its
energies toward the digestion of starchy foods, are of value.
Papoid is also an excellent helper of digestion. Remembering
that we have a condition of general debility all along the line,
tonics are certainly indicated, and there is none better in all the
world as a toner up of digestive and general nerve activity than
strychnia.

For long, arsenic in the form of Fowler's solution has been a
sheet anchor in the treatment of chorea and allied conditions, and



Digitized by



Google



586 LOYS: MXUBASTHSKIA*

believmgr.a8 1 do, Uiat in Bearastbeaia, whidi ia a dkease of adoli
life, Ike oonditiosB are almost identical to those which are
present daring childhood when chorea prevails, (hysteria, chorea
and nearasthenia are all a species of physical insanity,) I consider
arsenic of great value. Within the past few months I have
administered to these cases a preparation which was introduced to
the medical profession hy Dr. Wm. F. Barday^of Pittshurg, ( one
of the most reputable physicians in the State of Pennsylvania, a man
who is an expert chemist and a thoroughly reliable observer ) and
to which has been given the name of arsenauro, which la in fact i^
beautiful and attractive liquor of the bromide of gold and arsenic.
( Every ten drops, the ordinary dose, contains one-thirty-seoond
grain of gold bromide and one-thirty-second grain of arsenic
bromide.) I have a very large number of patients taking this*
compound in ten-drop doses, three or four times a day and
uniformly with good effect. Let us not forget that the majority
of these cases, whether spurious or bona fide neurasthenia, have
usually a rotten, crowded condition of the alimentary canal, a long
history of constipation leading up to leucomaine and ptomaine
poisoning, and that the entire system of secretory glands is
deficient and perverted in activky^ and that flushing out of the
emunctory system is called for. As an all-around excellent stimula-
tor of elimination, tongaline (liq* tong. salicylate-Mellier) is
indicated. Pains which are present are well met by the salicylic
acid contained in the compound and which is of the best form,,
being made from the oil of wintergreen. The pilocarpin, cimi-
cifuga and colchicin which it contains are all stimulators of
elimination. I usually administer from a teaspoonful to a table-
spoonful at bed-time, and oftener if necessary in order to clear
out the bowels thoroughly. In cases of la grippe, which are
accompanied by so-called rheumatic symptoms and great nervous
prostration, the tongaline is particularly indicated as a flnsher of
the sewerage system.

Change of scene and air are often indicated, and, to my mind,,
no better place in all America can present itself than Hot Springs,.
Arkansas. Here we have the elevated mountainous atmosphere,,
the ideal water, and facilities furnished for drinking it in large
quantities, and being hot it is all the more promptly eliminated ;.
and at the same time the bathing in the hot watec is very beneficial
in the direction of relieving the pains which so frequently accom-
pany these conditions.



Digitized by



Google



\

HOPKINS: ASTIFICIAL hcmumitt. 527

The jadiciouB administration of eleotrioity is certainly indi-
cated, but I am strong in the belief that more of these cases ar»
benefited by jadioioas massage, both mannal and mechanical, than
by electricity.

3642 LlKDBLL BOULBYARD.



ARTIFICIAL IMMUNITY.^

By henry reed HOPKINS, M. D., Buffalo. N. Y.

The traditions and the history of the art of medicine have
ever asserted the fact of the remarkable exemption or immunity of
certain races or individuals from attacks of communicable disease
to which their less favored neighbors were liable. The findings
of the science of medicine in her investigations and experiments
apon the reactions of various contagia upon the lower animals
reveals the existence of a similar variation in immunity, proclivity^
susceptibility, and is already well advanced in the most ambitious
and far-reaching of human endeavor, the attempt to discover the
secret of the immune, in order to possess the God-like power of
extending his inestimable blessiqgs and advantages to his less-
favored brother, the susceptible.

With truth and soberness, it may be said that there does jiot
exist, and there never has been, a more attractive, a more poten-
tial scientific investigation, than the study of artificial immu-
nity.

To the elucMation of this problem, medicine is at this moment
devoting her highest art and her most profound science — her most
creative enthusiasm, and her most cautious painstaking and accu-
rate technique.

Let us recall some of the primitive conceptions embraced in
this consideration. The well-attested observation that certain
races, families or individuals possessed a peculiar exemption from
the attacks of a given disease ; for instance, the dark-skinned races
from ague, led our forefathers to recognize the condition which
we know as immunity — that the individual who was immune to a
given disease, was to that form of illness disease-proof. Continu-
ous and contemporaneous with these interesting observations ran
a similar set, resulting in the conclusion that certain individuals
had the misfortune to be the pathological antithesis of the previous
class, differing from the average of their kind in the opposite



L Bead before the Medical Society of the State of New York, Albany, February ((, ISM.



Digitized by



Google



528 HOPKINS: ABTIFICIAL IMMUNITY.

direotioD, and their situation or relation to disease the fathers were
wont to indicate by the terms — procliyity, susceptibility.

Here it is worth noting^ for the obserration may be found of
«ome little significance, that as the fathers recognized instances of
wide variation from the average reaction of individuals to acute
disease, they also noted that individuals frequently reacted sin-
gularly to the operations of certain well-known remedies ; that in
one class the usually efficient dose would be found utterly ineffi-
cient, while in the opposite class extreme or poisonous conditions
or effects would result from the exhibition of what was usually
considered perfectly harmless and suitable doses. These interest-
ing facts are. still grouped about that most fascinating and puz-
zling term, idiosyncrasy.

The prosecution of the theory of the bacterial origin of infec-
tious disease has brought us many important new truths ; not the
least of these in interest and suggestiveness is the fact of the
communicability of many of our infectious diseases to our neigh-
bors, the lower animals. Had the observation not extended
beyond this point, it still must have been regarded as one of the
utmost practical importance and suggestiveness, but already the
party of exploration is sending back news from much higher
altitudes, and we hear from many laboratories that the same veins,
the rich ore-bearing veins — immunity, proclivity, susceptibility —
known for ages to run among the children of men, are ako found,
and in a more marked degree in the lower animals. Moreover,
these veins, as seen in the lower animals, are workable, are being
worked, and the precious metals, the silver and gold of scientific
therapeutics, laid up in these everlasting hills of the bacteriolo-
gist, — the rabbit, the guinea-pig and the mouse, — are now in sight ;
in fact, the metallic bars are now in the assay er's office, or on the
way to the mint, waiting for the final test and stamp as coin of the
realm of scientific medicine.

The questions which the bacteriologist would answer in this
investigation : (1.) What is the nature of the change wrought
in the individual, child or adult, by an attack of disease, — scarlet
fever, small-pox, or vaccinia, — whereby the individual ceases to fur-
nish the requisite culture media for the maintenance and growth
of that particular bacterium known to cause, or to be most inti-
mately associated with the cause, of the particular disease? (2.)
How far does this principle of immunity, natural or acquired,
extend among the infectious diseases? (8.) How far may we



Digitized by



Google



HOPKINS : ARTIFICIAL IMMUNITY. 529

extend the condition of artificial immanity for the cure or preven-
tion of disease ?

A slight knowledge of the rapidly increasing literature of this
subject convinces the writer that satisfactory progress is being
made along the lines of each of these enquiries. Regarding the
character of natural immunity, perhaps the progress has been the
most disappointing, but even in this direction valuable obEerva-
tions or discoveries are reported. We may so consider the obser-
vations of Nuttall, Buchner and others upon the aseptic or anti-
infectious property of the blood serum of the immune animal,
this quality having been found in several instances to be in direct
proportion to the degree of the individual's immunity.

Most intimately related to this thought is the discovery of Koch,
as to the different methods by which bacterial invasion produces
disease, methods which he proposes to recognize and distinguish
by use of the terms, bacterial infection and bacterial intoxication.
In bacterial infection, the microorganism, for instance, the
bacillus of anthrax, gains admission to the body of the susceptible
individual, and very soon rapidly increases in numbers, and liter-
ally swarms throughout the entire body, invading every organ and
tissue. Such microorganisms appear to be inimical to their host
wholly or in the main in a mechanical or negative manner ;
mechanically by blocking the capillaries, and thereby arresting the
circulation of the blood and consequent functional activity, and
negatively by robbing the tissues of nutrition used in their own
upbuilding, particularly of oxygen. The method of attack in
cases of bacterial intoxication is quite different from the f oregoing,
and introduces new and most important characters, ptomaines
and tox-albumins, which may be indicated by the single word tox-
ines. Tetanus, typhoid fever, diphtheria, cholera, and possibly
tuberculosis, are instances of disease produced by bacterial intoxi-
cation.

In these diseases the method of invasion may be the same as be-
fore, but the behavior of the microorganism of the disease, from
the moment of invasion, differs widely in the following respects :
in bacterial infection the microorganisms tend to increase and
multiply rapidly, to go and to grow anywhere and everywhere ;
in bacterial intoxication the microorganisms tend from the first
to grow only on certain tissues and in certain localities, to produce
local disease, but with their growth they elaborate a virulent
poison, which gains admission to the blood, circulates with the



Digitized by VjOOQ IC



530 HOPKINS : ABTIFICIA.L IMMUNITY.

blood, and by doing the work of an irritant poison upon the sensi-
tive and susceptible tissues of the various organs of the body, or
some of them, produces the given disease.

These poisons of bacterial origin are of two kinds, — ptomaines
and toz-albumins ; the former are crystalline, alkaloidal bodies, the
latter are colloidal. The important role these animal poisons are
likely to play in our knowledge of and management of the infec-
tion, the preventable diseases, we may get a hint of when we hear
that although of bacterial origin, they may be produced at will
outside of the body, and yet when introduced into the susceptible
individual, with or without their particular microorganisms, they
invariably produce their specific diseases, each after his kind.

The possession of knowledge of the precise kind, as to the
method of the (>roduction of bacterial disease, as indicated by the
above statement, has resulted in a decided advance of our thought
relating to artificial immunity, and we now know that an animal
may have immunity of two distinct kinds, — namely, from bacterial
infection and from bacterial intoxication ; and our experimenters
seem to have demonstrated that an individual may have one with-
out the other, and that in the near future infectious diseases are
to be treated or prevented by an increase and right use of our
knowledge of both these processes.

Results of experiments bearing upon the condition bacterial
intoxication seem to be the most important and suggestive, and
appear to establish the following facts : that there resides in the
blood serum a chemical substance or substances of vital origin, by
some called defensive proteids or anti-toxines, which substances
possess the power of rendering pathogenically inert and harmless
the ptomaines and tox-albumins, the disease-producing agents, in
all cases of bacterial intoxication. That the organism has the
ability of producing these defensive proteids or anti-toxines, as their
peculiar services are required for the protection of the individual,
as seen in Pasteur's treatment for hydrophobia, until their presence
and protective activity in the blood, in much more than that of
normal ratio, is demonstrable. When an individual is by suitable
treatment brought to such a state as to receive with impunity that
which is ordinarily a fatal dose of a given ptomaine or tox-albu-
min, the individual is said to be poison-proof. And to render the
susceptible poison-proof, whereby he ceases to be susceptible and
becomes immune, is today the highest ambition of the art and the
science of medicine.



Digitized by



Google



HOPKINS: ABTIFICIAL IMMUNITY. 531

Information regarding this most interesting condition of arti-
ficial immunity, — poison-proof, — points to the fact, as we just
observed, that it may be acquired, and that when present, either
by Nature or by acquirement, the fortunate possessor, if a female,
may transmit the same to her offspring, and what seems to be
most fc^rtunate, the milk of the poison-proof mother renders the
young almost equally immune. Experiments also indicate that the .
blood of the poison-proof animal has high Airative powers in cases
of the given disease occurring in his own kind or in man. Observ-
ers also seem to be quite in accord in this testimony, as to the com-
plete individuality of the action of the various toxines. An ani-
mal, poison-proof against a given disease, — tetanus, diphtheria, ery-
sipelas or pneumonia, — has thereby not the slightest protection
against any other disease.

The writer is well aware of the fact that medical enthusiasts
usually have early cause to regret their enthusiasm, and that the
rdle of prophet is not popular in this, the closing years of the
nineteenth century, and yet ventures to proclaim with enthusiasm
the dawn of a new era in medicine, when from a truer knowledge
of temperament, proclivity, susceptibility, idiosyncrasy, immunity
and artificial immunity — the art of the treatment of disease and
the prevention of disease will attain such eminence, and accom-
plish such results, as heretofore have been attained and accom-
plished only in dreams.

433 Franklin Street.



Points for Trained Nurses. — At the training schools for nurses no
applicants are accepted who are under twenty-one years of age or over
thirty-five ; twenty-five is the preferred age. When application is
made by letter it must be addressed to the superintendent of the school.
In reply she will receive a circular stating that a personal interview is
desirable. If that is impossible, the applicant should write again, say-
ing so and asking for an application blank. This blank must be filled
out in the applicant's own handwriting and returned to the superin-
tendent, together with a physician's certificate of health, a letter from
a clergyman and the addresses of three women, not relatives, who have
known the applicant for several years. These applications are filed, and
when a vacancy occurs the most desirable applicant is selected by the
president, and is taken for a month on trial. During this month of
probation, she will, at almost all the training schools, receive her
board and lodging. At the end of the month she may be accepted or
rejected as a pupil nurse, and the decision is final. — February Ladies'*
Borne Journal,



Digitized by



Google



532 CLINICAL RSPOBTS.



(sifimcaP J^eporfA*



CLINICAL MEMORANDA FROM THE SURGICAL CLINIC
AT THE SISTERS OF CHARITY HOSPITAL.*

Bt HERMAN MYNTER, M. D..
Profetsor of Surgery, Niagara University, and Surgeon to the Sisters* Hospital.

During the last two years, I have had occasion to trephine
twenty-seven times. Of these, the majority, fifteen in all, were^
made on account of fractures of the skull. They represent
all forms of lesions, from compound and comminuted fractures
extending into the base, with laceration of membranes and brain,,
to simple depressed fractures of the vertex. Four of these cases
died, all of which had extensive fractures of the base of the skull.

Five cases were operated on account of traumatic epilepsy,,
four of which were greatly improved, although a cure was probably
not obtained in any case.

Five cases were operated by linear craniectomy, for microcepha-
lus with idiocy, without any apparent improvement in any case.
One case was trephined for subdural hemorrhage with aphasia and
hemiplegia, and recovered perfectly, and one case recovered, after
trephining, from a brain abscess. All operations were performed
with the usual precautions in the Sisters' hospital, and all recov-
ered, with the exception of four with necessarily fatal injuries of
the base of the skull. In regard to covering the - bony defect
after trephining, I have tried to implant a layer of leaf-gold
unsuccessfully several times. Eretic granulations occurred on
both sides of the gold, forming a semifluctuating, painful swellings
which necessitated its removal. I have twice successfully implanted
a celluloid plate, covering the defect and inserted beneath the
internal table.

In one case, I reimplanted successfully the whole bony disk
removed by a very large (one and one-quarter inch) trephine.
This is, of course, the ideal proceeding. In several operations for
traumatic epilepsy I covered the dura. Mosaic fashion, with bits
of the bone removed, without paying any particular attention to
whether the internal table of the bits of bone was turned inwards
or not. 1 thereafter closed the wound without drainage. All the
cases, with the exception of one, in which suppuration occurred
and the bone particles had to be removed, recovered without com-

1. Read l^efore the New York State Medical Society, in Albany, February 7, 18(M.



Digitized by



Google



CLINICAL BEFOBTS. 533

plication, and adhesion between the dura and the scalp was most
Boccessfally prevented. Where laceration of dara and brain was
present, this method, of course, cannot be used, and in such cases
I always pack the wound loosely with iodoform-gauze and expect
healing by granulation.

Three of the cases deserve special mention :

TREPHINING FOR SUBDURAL HEMORRHAGE WITH APHASIA AND RIGHT-
SIDED PARESIS — RECOVERY.

Case XII. — Daniel Blackford, 25 years of age, entered the Sisters'
hospital on November 13, 1893, with the following history : Twelve
-days previously, while in a fight, he was struck by his opponent's fist
on the right side of the head and knocked down, striking the left side
of his head on the plank sidewalk. He was able to walk home, but his
face and eyes were swollen, and he complained of severe pain in the
back of the heckd. Nothing further could be learned about his condi-
tion, while at home, except that he, on the day of his admission to the
hospital, had had a fit, with convulsive movements of right side of face
-and arm. While being prepared for bed he had another fit with simi-
lar muscular contractions in face and arm.

On examination, paresis was seen of the right side of the face ;
there was constant twitching of the muscles of the right hand
and arm, tongue drawn toward the left side, left pupil contracted.
He experienced some sensation in the arm and leg, but, apparently,
none in the face. There was some paresis present of the right
arm and leg, which he moved with difilculty. Complete aphasia
present. He could neither articulate nor did he appear to under-
stand what was said to him. Temperature, normal ; pulse, 96.
B. Ice to the head ; iodide potash, gr. x.; fluid ext. ergot, mm. xx.,
«very four hours.

On the following day, November 14th, he appeared somewhat
better, could raise his arm and leg at will, although with difificnlty,
and seemed to understand questions and to make an attempt to
answer, but he was unable to utter a sound. He was restless and
sleepless ; ^ulse, 120. After consultation with Dr. Crego, the
neurologist to this hospital, who concurred in the diagnosis of a
clot on the brain, either extra- or intradural, over the center of
speech, extending upwards and involving the motor area on the
left side, operation was decided upon and performed on the fol-
lowing day, November 16th, after the usual antiseptic precautions
had been taken. A curved incision, convex downwards, was made
from the external lower border of the frontal bone downwards and



Digitized by



Google



534 CLINICAL BEPOBTS.

then upwards, terminating just above the ear. The large winga
of the sphenoid and the temporal bone were exposed, and by aid
of a large trephine — one and one-quarter inches in diameter — a
button of bone removed over the base of the third frontal convo-
lution, involving the center of speech and face. No extradural
bleeding was found. The dura was bluish in color, and bulged



Online LibraryJ. A. (Joel Asaph) AllenBuffalo medical journal → online text (page 53 of 78)