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testinal and mesenteric tuberculosis in children no doubt finds
here its explanation. As noted in Woodhead's analysis of 137
cases of fatal tuberculosis in children, the mesenteric glands were
involved in 100."

By far the most common method of infection, however, is
through the air by means of the respiratory tract.

<<It has been found that the expired breath of tuberculous
subjects is not infectious," the sputum, however, contains the virus
in enormous amount. If this is kept moist there is no danger of
infection from it, unless it is brought into direct contact with an
open wound, or mucous surface, as in the act of kissing. If, how-
ever, this sputum is allowed to dry, it becomes disseminated
through the air as minute particles of dust, and as such may be
breathed in by a healthy individual, who thus runs the risk of
infection.

All careful investigators agree that this is the most common
mode of entrance of the tubercle bacillus into the economy.



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BUFFALO ACADEMY OF MEDICINE. 593

Osier says in this connection : << Primary tubercolons lesions
are in a majority of all cases connected with the respiratory
system. The frequency with which foci are met with in the lungs
and in the bronchial glands is extraordinary, and the statistics of
the Paris morgue show that a considerable portion of all persons
dying by accidents or by suicide, present evidence of the disease in
these parts. The post-mortem statistics of hospitals show the ,
same widespread prevalence of infection through the air-passages.

Biggs reports that more than sixty per cent, of his post-
mortems showed lesions of pulmonary tuberculosis. In 126 post-
mortems at the Foundling Hospital, New York, the bronchial
glands were tuberculous in every case.

As regards predisposing causes that may render one individual
more Busceptible than another to the disease, all that we can say,
in the light of our present knowledge of the exciting cause, is that
anything that lowers the vitality of the individual renders him
more vulnerable to the onslaught of the bacillus, and that of
especial importance in this respect is the existence of any habit of
life which tends to interfere with proper excretion or proper
digestion.

With the indisputable evidence before us that tuberculosis is a
communicable disease and that every new case is due to infection
from another case existing in a human being, or in one of the
lower animals ; with the knowledge of the habitat of the agent of
infection and of the methods in which, and the various avenues by
which, this organism gains entrance to the economy, and with the
knowledge of methods by which such entrance may be prevented,
it would seem that tuberculosis is a perfectly preventable disease
and that we ought to be able to stamp it entirely out of existence.

This brings us to the consideration of the most important of
th^ subdivisions of the question, and the following suggestions are
made as presenting a practical method to aid in preventing the
spread of tuberculosis.

In the first place, recognizing that tuberculosis may exist in
milk and meat, we should insist that there be competent and
thorough inspection of dairies and meats, and that all diseased
animals should be slaughtered and cremated. For such thorough
work it is necessary that the health department should have a
thoroughly equipped bacteriological laboratory, and that the city
should be willing to pay a sufficiently large salary to insure the
employment of a competent bacteriologist.



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594 SOCIETY PROCEEDINGS.

Id the second place, we must recognize the fact that most of
the laity do not appreciate that consumption is communicable, and
we should lend our energies to the education of the public in thia
respect.

In the third place, as soon as a diagnosis of tuberculosis haa
been made in a given case, the attending physician should inform
either the patient or some responsible member of the family, of
the infectious nature of the disease, and should give explicit direc-
tions as to how to prevent its spread.

In the fourth place, physicians should report all cases of tuber-
culosis to the health department as soon as recognized, just as they
do other infectious diseases, and the health department should
send, either to the patient or to some responsible member of the
family, in the following, or in such form as the health depart-
ment may deem fit, a printed circular containing the following
information :

Tuberculosis, popularly known under the names of consump-
tion, decline, scrofula, marasmus, wasting disease, inanition, lupus^
and white swelling, is a contagious disease ; that is, every new
case is produced by exposure to some other case.

The agent of infection is sometimes found in meat and milk.
Therefore, unless there is competent inspection of foods, and the
sources are known to be free from disease, milk should be boiled^
and meat should be thoroughly cooked before being used as food.

In human beings, the agent of infection exists in the pus (mat-
ter) given off in the discharge from tubercular abscess, or from
lupus ; in the discharge from the bowels in marasmus or tubercu-
losis of the bowels; in the urine in tuberculosis of the kidney^
bladder or other part of the genito-urinary apparatus ; in what-
ever may be vomited, but, most of all, in the material that ia
coughed up and spit out in consumption of the lungs.

' As long as these materials are kept moist there is no danger of
infection, unless they are brought into direct contact with the
mouth, nose, eyes or other mucous surface, or an open wound or
scratch. If they dry on the clothing, on handkerchiefs, in a cup
or spittoon, or other vessel, or on the floor, walls or sidewalk, they
become disseminated through the air as minute particles of dust,
and as such may be breathed in by a healthy person, who thus runs
the risk of infection.

Consequently, the underclothing and bedclothing of the con-
sumptive should be changed at least twice a week (more often



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BUFFALO ACADEMY OF MEDICINE. 595

if the patient sweats much), and those articles of clothing taken
off should be boiled for half an hour before they are washed. The
movements from the bowels shonld be passed into vessels contain-
ing water, and these vessels, as well as those into which the urine
may be passed, should be thoroughly cleaned with boiling water.
The sputum should never be expectorated upon the floor, walls or
sidewalk, or in stores, street cars or other public place, or into a
handkerchief or other cloth upon which it might become dried,
but always into a cup or other suitable vessel containing water,
which is kept covered when not in actual use. If the patient is
walking about, a wide-mouthed bottle, containing some water and
securely corked, can be carried in the pocket and used when neces-
sary. The sputum thus collected should be emptied from the
vessel three or four times in the twenty-four hours, and immedi-
ately burned, boiled or otherwise destroyed. The vessel and its
cover or stopper should each time be thoroughly cleansed with
boiling water. The table utensils, including the napkin of the
patient, should be thoroughly boiled before being otherwise
washed. The mouth, nose and throat of the patient should be
thoroughly cleansed, at least, twice daily with a cleansing solution
made by dissolving one teaspoonf ul of sodium bicarbonate (saler-
atus) in one-half pint of warm water.

No musical instrument or other implement which when in use
is placed to the lips or in the mouth should be used by any well
individual after it has been used by a consumptive, unless it has
been thoroughly cleaned and disinfected. The patient should
not kiss anyone, nor should anyone kiss the patient on the mouth ;
and under no circumstances should anyone sleep in the same bed
with the patient. The patient's room should be thoroughly venti-
lated and should never be tightly shut up. It should be as sunny
a room as possible. It should be thoroughly disinfected, at least,
twice a year during the lifetime of the patient and immediately
after his or her death.

Signed, HENRY R. HOPKINS,

JOHN H. PRYOR,
W. SCOTT RENNER,
ERNEST WENDE,
F. WHITEHILL HINKEL,



DeLANCEY ROCHESTER.



Tuesday, December 12, 1893.



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696 TRANSLATION.

Id submitting this report, your committee recommends that a
sufficient number of copies be printed, and that a copy be sent to
every physician practising in the City of Buffalo, that a copy be
sent to the Health Department of the City of Buffalo, to the State
Board of Health, to the national health authorities at Washington,
to the New York Academy of Medicine and to the medical press
of Buffalo, New York, Boston, Philadelphia and Chicago, and to
the general press of Buffalo.



©fraaAPafioQ*



LATE RESEARCHES IN EPILEPSY.

bt prop. dr. seeligmuller.

(Translated for the Journal from the CerUralblattfur die Qesammte Therapie, March, ISM.)

Bt M. p. CLAUSIUS, M. D.,
First Assistant at the Northern Hospital for the Insane, Winnebago, Wis.

In SPITE of the great number of remedies recommended for the
treatment of epilepsy, the salts of bromine still remain the most
reliable. Gauster comprises his experience in the treatment of
epilepsy with the bromides in the following sentences : <^ The
treatment of epilepsy with the bromides is at present by all means
the most satisfactory, in the various forms and especially in
idiopathic epilepsy." They must, as a rule, be taken for years.

The size of the dose must be regulated according to the indi-
vidual by careful experiments and observations ; either in regard
to the increase or decrease of the dose, after a marked improvement
has taken place. Under careful observation of the condition of the
patient the dose may be increased to twenty grams a day, and
this amount may be given for some time without developing
dangerous symptoms.

The increase of dose is to be discontinued, or gradually dimin-
ished, or a different remedy is to be given temporarily or perman-
ently : (a) if digestion is largely impaired and nutrition dimin-
ished ; {b) if apex catarrh with slight dulness are developed ; (c)
if deep ulcerations of the skin are present.

Retardation of intelligence and development of mental stupor
are generally no cause for discontinuance of the treatment with
bromides, neither do they call for a decrease of the dose. Pulmon-



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LATE RESBARCUES IX EPILEPSY. 597

ary tnbercnlosis, severe chronic diseases of the skin, and profound
impairment of nutrition, contra-indicate the use of the bromides,
providing the epileptic attacks do not directly endanger the life of
the patient. A slight loss of flesh is no oontra-indication, since an
increase of weight may take place during the continuance of the
bromide treatment. During the bromide treatment a nourishing
diet must be given. From time to time the condition of the lungs
and the skin should be examined.

F^r^ gives the following directions for the use of the bromides
in epilepsy : the preparation must be chemically pure and especi-
ally be free from admixture with the salts of iodine, chloride of
sodium and sulphate and carbonate of potassium. Since the
bromides, when taken into an empty stomach, are liable to cause
gastralgia, it is best to administer them at the beginning of the
meal. They are liable to cause dental caries, and, therefore, the
teeth and mouth must be kept clean. Success can only be expected
when the physiological action is manifested — namely, a sense of
weariness, sleepiness, anaphrodisia and suspension of nausea by
means of mechanical irritation of the pharynx and base of the
tongue. This last named sign is, to a certain extent, the criterion
of the saturated condition, the exceeding of which is unnecessary,
but which it is necessary to maintain until certain of a cure, or,
better said, as a cure is never assured, as Voisin expresses himself,
bromide of potassium should be constantly given as a nourish-
ment to the cured epileptic.

If the attacks have ceased for one or two years, we may then
try to gradually discontinue the bromides, as, for instance, give
them every third, or every other, or for only eight days each
month. It is well to be sure in each case that the pharynx
reflexes are absent. The bromide treatment should never be
stopped abruptly, as in such cases nearly always a severe attack
occurs within nine days, which may endanger the life of the
patient; even when no attack occurs within a short time, a fatal
attack may occur even after several months (Le Grand de Saulle).
In regard to the dose, it might be said that in place of continuing
a given dose from day to day, Charcot recommends to begin with
increasing doses, by raising the dose each week by one gram.
For instance, to increase it from four to seven grams within four
weeks and then again to decrease it within the same time to four
grams. In England, a large dose is given every three or four
days — 15, 20 to 25 grams at meal times. Puche has witnessed 40



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698 TRANSLATION.

grams given in one day without any ill effects. F^r^ has, however,
observed bromism after doses of only 20 grams. Farther observa-
tions will have to be awaited.

The bromides act favorably in all forms of epilepsy, either in
the psychical form, or in those accompanied with pain, migraine,
or migraine ophthalmique, and, finally, in those cases that are
complicated with external and internal spasms (spasmus glottidis).
To prevent eruptions of the skin while taking bromides, rigid
cleanliness of the skin and especially frequent bathings are to be
recommended. Against the occasionally occurring salivation,
tannic acid and hyoscyamus are efficacious. To prevent real
ulcerations of the skin, which are apt to appear when very large
doses, about 14 grams per day, are given, F^r^ recommends a
method which he calls intestinal antisepsis. He gives naph-
thol in 4 gram, and salicylate of bismuth in 2 gram doses. With
this treatment the digestive disturbances resulting as consequences
of large doses of bromides are prevented. This medication is
well tolerated for months.

To prevent the general evil actions of the bromide prepara-
tions, free diuresis is to be maintained, eventually by diuretics. If
bromine poisoned epileptics are attacked by an infectious disease,
an adynamic and typhoid condition soon appears. The use of
bromides during pregnancy has no ill effect upon the fetus, but is
likely to leave a salutary influence ; besides, the bromides should
show a prophylactic action, if puerperal eclampsia has been
present in previous pregnancies. They also act favorably in pro-
nounced eclampsia, as well as in status epilepticus. It is well to
consider the warning of Savage in regard to the careless use of
the bromides, as he cites a case that came especially under his
notice, in which the psychical condition became rapidly worse,
seemingly as a consequence of the suppression of the epileptic
attacks by the use of the bromides. Against the psychical symp-
toms of bromide poisoning, Wildermuth recommends, besides the
cessation of the bromides, black coffee, rain douches on the back
in warm baths, and massage of the extremities. Besides the
usually employed bromide salts, such as potassium, sodium and
ammonium, a great many other bromide combinations have been
tried with more or less success. Next to the above mentioned is
the bromide of lithium. Of late, F^re recommended bromide of
strontium in the same small doses as the potassium salt. Confirma-
tion of success by others must be awaited.



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LATE RBSEABOHBS IN EPILEPSY. 599

The obseryation of Doyon, who found deposits of bromides
in the organs of men and animals who had taken the salts for
some time, is interesting. He found them more frequently exist-
ing in the liver than in the brain. The bromide of nickel,
•especially recommended for headache and convulsions by Da Costa,
was tried by Bourneville on eighteen patients, of which seven
were idiopathic and eleven symptomatic epilepsy, but proved effica-
•cious only in a single case, inasmuch as the attacks had nearly
ceased, which result had lasted for three years. In two other
oases a very slight improvement was manifested. The other
fifteen were even aggravated. The usual dose is 3 decigrams,
and the maximum dose 6 decigrams. Stomach difficulties are
readily brought on. The bromide of camphor is said to be quite
efficacious in the vertiginose form of epilepsy. Bromide of
arsenic is recommended by Clement ; bromide of calcium, in doses
of from 5 decigrams to 2 grams, by Hammond ; bromide of zinc,
in the same dose, by Charcot, Rochefontaine, Bourneville ; bromide
of gold, in doses of 8 milligrams, by Bourneville and Goubart.
All three have been tried, occasionally with favorable effect, but
they are by no means as certain as the commonly used bromides.
The bromide of ethel, known as an anesthetic, has been tried by
inhalation several times a day (d'Ollierand Bourneville), apparently
without special influence on the course of the disease. The ethelin
bromide, however, according to observation by Donath, on twenty-
one patients, acted similarly to the commonly used bromides.
Donath recommends the following formula :

R. Ethelin bromide 5,

Emuls. oleos 100,

01. menth. pip., gtt 2,

M.

Of this mixture adults take thirty drops, three times a day, in
one-half glass of sweetened water, adding ten drops every third
day until seventy drops are reached, equal to one teaspoouful.
Children, eight to ten years of age, commence with from ten to
twenty drops. In case the stomach does not tolerate this mixture,
which, however, seldom occurs, a few drops of tincture opium may
be added. Exanthema never appeared on giving these small
doses. This remedy can also be prescribed in gelatine capsules,
each containing three drops, with six drops of oil of sweet almonds,
and from two to four capsules may be given two or three times a
day. Donath observed, besides convulsions, muscular twitching



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600 TRANSLATION.

in the extremities with retained consciousneBS with this treatment
in three patients, which he interpreted abortive attacks. The
rubidium-ammoninm bromide was first recommended by Lanfe-
naner as an anti-epileptic, and tried in seventeen cases. In six of
these it proved more efficacious than the bromide of potassium.
On account of the great price of this preparation — 120 per pound —
and a single dose being from two to five, and the daily dose from
seven to eight grams, extensive experiments can hardly be made
at present. Rottenbiller has treated five epileptics with it, and
has given them a daily dose of six grams. He observed a remark-
able diminution of the attacks. This, however, was not lasting^
and after the discontinuance of the drug the attacks again occurred
with the usual frequency. Hyperosmic acid, in pill-form, daily
dose five milligrams, gradually increased to from ten to fifteen
milligrams, has been tried by Schroeder, on ten epileptics, without
success, excepting in one case in which the attacks were influenced.
Borax, first recommended by Gowers, Folsom and others, has of late
been tried by F^r6 and Lamy and also by Stewart. The daily
dose is from three to six grams. Sherrington calls attention to
the favorable influence on the night attacks and, therefore, advises
to administer the bromides also in cases where attacks occur in
the day time. Gowers, who advised to commence with a daily
dose of one gram, gradually increased to six grams, has called
attention to two deleterious effects produced by borax — namely^
diarrhea and psoriasis.

F^r6, who treated twenty-two epileptics with doses varying
from 1 to 3 grams, has observed momentary improvement only in
three of these cases, and also mentions that the patients complained
of nausea and diarrhea. Besides this, there also appeared eczema
on the lateral surfaces of the body and on the arms of two of the
patients, which did not heal until six weeks after the discontin-
uance of borax. Sclerotic acid, commenced with daily doses of 10
centigrams, and gradually increased to from 25 to 30 centigrams,
may also be administered subcutaneously in doses of from 15
to 36 milligrams, maximum dose, 6 centigrams, was tried by
Bourneville and Bricon on twelve epileptics, and in five of them
produced an insignificant decrease of attacks, but in some an
immediate decrease of bodily weight was observed. Curare, first
recommended by Kunze, and later on by Edlefsen, was tried by
them on twenty-three patients with so little effect, that they recom-
mended to have this not indifferent remedy discarded from the list



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LATE BB8BABCHES IK EPILBPST. 601

of anti-epileptios. The firm of Christy & Co., of London, pre-
pared a tinoture of simalo, from a South American f rait belonging
to the family ysope (the capparis corriacea)^ which is highly
recommended in Peru and Bolivia as an anti-spasmodic. This
tincture was first administered by Rale White, in doses of from
3 to 5 grams, three times daily, to seven patients, with encouraging
success. Eulenburg, who treated four epileptics with this tinc-
ture, commencing with doses of one-half teaspoonful, gradually
increased to 2 teaspoonfuls, two or three times a day, as an
experiment, found it not wholly without effect, but not equal to
the bromide preparations. Osier's experiments with nitro-glycerine
have been accompanied with but little success, and in two cases
the remedy had to be discarded on account of ill effects, such a»
headache and vertigo. It may be said that very little effect has
been produced in the treatment of epilepsy with antifebrin, in
doses of from 25 centigrams to 2 grams per day. Neither have
experiments with antipyrin proved successful. Lemoine, however^
has seen success with antipyrin, firstly, where the attacks occurred
at the time of menstruation ; secondly, in epilepsia larvata ;
and, thirdly, when complicated with migraine. A combination
of bromide of potassium with antipyrin might prove successful.
Amadei claims to have produced a cessation of the attacks for
four months with the above mixture. Finally, amylenhydrate^
first recommended by Wildermuth, has not fulfilled the expecta-
tions of later experiments. The high price of the drug must also
be considered. Naecke, however, observed a marked decrease of
attacks in old cases of epilepsy, often in a remarkable degree^
Later, in another series of observations, with thirty epileptic men,
he observed an increase of the attacks and much mental dulness^
after a use of this remedy for several weeks. Babes injected
the brain and spinal marrow of sheep, from five to six times a
week, and obtained better results than with any other remedy
recommended for epilepsy. Wildermuth recommends wet pack-
ings in cases of status epilepticus, and large doses of bromide of
potassium, given either per clysma or hypodermically. Three
times the amount of the daily dose should be given if the same
is not too large. For cardiac weakness, large doses of camphor
should be administered subcutaneonsly. He found nitrate of
amyl inefficacious, and chloroform proved useful in only a single
case.



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602 SBLBCTIONS.

3efccfionA.



FUNCTIONAL DYSPEPSIA, SO-CALLED.

By R. C. M. page, M. D.,
Professor of General Medicine and Diseases of the Chest in the New York Polyclinic

TuBRB are two principal varieties of the so-called functional dys-
pepsia — irritative and atonic. In both the real pathological ele-
ment we have to deal with is often a subacute or chronic gastro-
intestinal catarrh. In the former class we find patients who are
not infrequently robust and addicted to drink, gluttonous habits,
or the eating of highly seasoned food and the like. In the latter
are found those who suffer with a general lowering of the vital
powers.

But in either case there is a deficiency in quantity and quality
of gastric juice, and an abnormal increase of alkaline mucus
which gives rise to fermentation rather than digestion. The
stomach becomes distended with gas, so that peristalsis is impaired
and there is obstruction to absorption of the stomach contents.
Moreover, the food becomes so enveloped in this alkaline mucus
that the gastric juice fails to penetrate it and reach the food.
Hence, in such cases we would naturally expect to find a tongue
more or less furred, bad taste in the mouth, and that the patient



Online LibraryJ. A. (Joel Asaph) AllenBuffalo medical journal → online text (page 60 of 78)