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J. A. (Joel Asaph) Allen.

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and proximate cause, the party responsible for the latter is liable
for such death. In the case of Rettig vs. Fifth Avenue Transpor-
tation Company, recently decided by the Superior Court of New
York City, General Term, which was an action brought to recover
damages for alleged negligent acts causing injuries resulting in
the death of the injured person, the defense was raised that death
was rather caused by a surgical operation than by the injuries com-
plained of. One of the attending physicians at the hospital to
which the injured man was taken, testified that he died from the
result of his injuries, that his condition necessitated a surgical
operation, which was skilfully performed, and that he died of the
shock that followed. This evidence is declared admissible, and
the court holds that the surgical operation and the consequences
flowing from it in no manner relieved the transportation company
from liability for the death as a result of the injuries inflicted by
its negligence. Indeed, the court shows that it has been held that
when a person who, through the negligence of another, has
received an injury which, without a surgical operation, would
cause his death, employs a competent and skilful surgeon, by
whose mistake the operation is not successful, and the patient die,
the wrongdoer is not shielded from liability by the surgeon^s
error ; and this although the operation is the immediate cause of
the death. — Medical JN'ews.



Rectal Affections in Young Children. — It sometimes happens
that a discharge, dysenteric in character, is excited in young children
by the existence of a polyp in the rectum. Whenever a child passes
blood at stool it is well to bear this thought in mind. Internal medi-
cation avails nothing in such cases. It is not essential that a history
of protrusion should be given, for many polyps have their origin high
up the rectum and the pedicle is not of sufficient length to allow the
little tumor to protrude. The growth should then be removed. —
Mathews^s Med, Quarterly,



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STATE EXAMINATION AND PUBLIC HEALTH. ^ 613

• BUFFALO MEDICAL AND SURGICAL JOURNAL

A MONTHLY REVIEW OF MEDICINE AND SURGERY.

EDITORS:
THOMAS LOTHBOP, M. D. - - WM. WARREN POTTER, M. D.

AH oommuiiications, whether of a literary or bnsiness nature, should be addressed
to the managing editor: 284 Fbahklin 8tbkbt, Buffalo, N. Y.

Vol. XXXIII. MAY, 1894. No. 10.

STATE EXAMINATION AND PUBLIC HEALTH.

The friends of higher medical edacation aod of state examina-
tion and license^and the same are rapidly becoming the people —
have frequently been called upon to listen to the managers of our
medical faculties of a too common class, justifying the graduation
of the medical ignoramus upon the plea that he was a good
enough doctor for the country.

Of course, they say, we don't expect him to stay in the city, in
fact, we would not be proud of him as a neighbor, but he will do
for the country. Surely, you do not expect a man with a trained
and cultivated mind, with a full and thorough knowledge of medi-
cine in all its branches, to bury himself in one of our frontier
country villages ? And the speciousness and plausibility of this
pleading prevailed mightily with the more venal and thoughtless
legislator. Hence the prolonged contest that each of our common-
wealths has had to get back the privilege of examining and
licensing their doctors ; and so, for many years, the work of grad-
uating the medical ignoramus for country use went on exaspera-
tingly.

How inimical to public health and how utterly out of place is
the ignorant, careless and incompetent medical man of the country
we are coming to realize, thanks to the converging lights of
bacteriology and sanitary science. In the thorough illumination
of these specialties the harmless and obscure ways of the humble
country practitioner are found to be of vital import to public
health, and too frequently his oversights are fraught with enor-
mous death-dealing potentiality.

We have only to refer to our health reports and to the consen-
sus of intelligent medical opinion the world over, as to the com-



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614 EDITORIAL.

municability and the actual commnnicatioD of tubercnlosis^
typhoid fever, scarlet fever and diphtheria by means of food sup-
plies — water, milk and other foods of habitual and general use —
in order to make clear the vital importance to public health of
having only competent medical men on guard, at least, in thoFe
regions from whence comes these foods so important for the sup-
port of life and the preservation of health, so easy of pollution,
and whcin polluted so destructive of health and life.

Standing at this'point we see the wisdom and the absolute need
of a state examination and license, and that for the most prac-
tical and important reason — the preservation of the public
health.

No more practical questions are before our government — state
or national — and none more vital and of all-embracing interest are
likely to press for answer than the questions : How shall we pre-
serve our springs and other sources of water supply from pollu-
tion ? How shall we keep free from communicable disease our
food-bearing animals ? How shall we prevent the infection of
various food products by the contagia of the zymotic diseases and
thereby limit the spread of these diseases ?

We would observe that no public-spirited citizen, legislator or
sanitary officer will study seriously these practical questions with-
out reaching the conviction that the fundamental requisite of the
case, wanting which progress is impossible, is an efficient medical
profession, and that if there be a suitable place and vocation for
the medical ignoramus, the place is most emphatically not the
country from whence we get our water, our milk and other foods,
and his vocation is not the management of zymotic, infectious,
communicable disease. Public health demands that for these
localities the honor and responsibility of the practice of medicine
shall be given only to those of the most approved competence, and
that this competency be tested by the representatives of the state
— the State Board of Medical Examiners — its object being the
protection of the lives of our people, the defense of the public
health.

The already large and rapidly increasing number of epidemics
of typhoid fever, scarlet fever and diphtheria, directly due to
polluted water and milk, demands the state examination and
license of all practitioners of medicine, and indicates that in such
examinations higher standards and severer tests will be the rule of
the future.



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THB FOO HORN NUISANCE. 615

THE FOG HORN NUISANCE.

With the opening of navigation the citizens of Buffalo are again
tortured by the almost continual sounding of a ponderous fog
horn located within the environs of our harbor. We have here-
tofore, in these columns, called attention to the serious menace to
health that this infernal machine causes. We even go further and
affirm, without reservation, that it is destructive to human life.

In these days of worn and tired nerves, a good night's sleep is
needed to fit'tnen and women for the work of tomorrow. We are
now speaking of those persons who, judged by ordinary standards,
are classified as enjoying good health. Yet, owing to the perplex-
ities of business, with its many cares and anxieties, most of such
^re light sleepers and are easily awakened by undue and unusual
noises. With the first toot of the fog horn they are aroused and
«leep returns to them no more for the night. Hence, they reach
their business offices next day with jaded nerves and tired mus-
•cles, and are wholly unequal to the duties before them.

But, if those in good health are thus disturbed, what shall we
say for the sick ? It requires no longdrawn argument to prove
that these, in innumerable instances, are made infinitely worse by
the unnecessary tootings of the fog horn, and, in some cases, we
-doubt not, they are driven to insanity or death.

It is utterly idle for navigators or vessel owners to contend that
it is necessary to keep a populous city, numbering 300,000 inhabi-
tants, in a state of perturbation that menaces health and life, in
order to preserve the few vessels that may approach Buffalo har-
bor in a fog during the lake season. In most countries, vessels
come to anchor when approaching a harbor during a fog, and here if
a strong search light were properly erected on the site of the fog
horn it would meet every requirement of safety to life and
property.

We speak seriously. This is an important matter to the busi-
ness interests of Buffalo, let alone the questions of life and health,
to which we have before referred. Well-to-do people will leave
Buffalo early in the Spring, and return late in the Fall, thus pro-
longing their outings for the purpose of avoiding this everlasting
fog horn din, hence spend thousands of dollars in other places that
would be used to the benefit of Buffalo. Still others, who reside
here as a matter of pleasure or comfort, will flee from this ter-
rible noise nuisance and seek residences in cities where fog horns,
are unknown.



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616 EDITORIAL.

This is a matter for the Health Department to consider delib-
erately and with great gravity. If the local authorities are not
clothed with adequate power to deal with it, then the offices of the
State Boaid of Health should be invoked, to the end that the
nuisance may be effectively and permanently abated. The United
States Government has no more right to establish and maintain a
nuisance within our borders than has an individual, and it should
be called to account therefor just as summarily, just as certainly »



NATIONAL CONFERENCE OF STATE MEDICAL EXAM-
INING AND LICENSING BOARDS.

The next meeting of this body will be held in San Francisco, June
5, 1894. The important object of this association should com-
mend itself to the friends of higher medical education all over the
land. As the years advance, the number of states that require
separate license is increasing, and we predict that it will not be
long before every commonwealth in the Union will be governed
by such laws.

The object of this national conference, now about to hold its
fourth meeting, is to unify and standardize the methods in vogue
in the several states, and to otherwise improve the service.

The death of Dr. John H. Rauch, president of the conference^
is a sad blow to the cause to which he gave so many years of his
life. The Bulletin of the American Academy of Medicine justly
says that he was one of the best friends the profession of medi-
cine in this country ever had, and that his name will be held in
honor wherever the history of American medicine is studied.

Dr. Charles K. Cole, of Helena, Montana, secretary of the con-
ference, has prepared and sent out a circular containing the follow-
ing inquiries :

How long has your board been organized under your law ?

During that period how many candidates have been examined, and
what percentage of those examined have passed and received license to
practice ? (Note : The above should be separated into years, if possi-
ble.)

How is your board constituted with reference to the various ' ' Schools
of Practice ? "

Do you favor the plan of mixed boards, or three separate boards ?
. How many members should constitute a state board, and what is the
desirable appointing power ?

Should teachers in medical schools be eligible to membership on
state examining boards P



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TOPICS OF THB MONTH. 617

Does your board look with favor upon the Idea of interchange of
certificates between state boards ?

What, in your opinion, are the leading defects in your law, and in
the laws of the various states ?

What should constitute a •* college in good standing ^^ with refer-
ence to number of years of study required and curriculum, for purpose
of registration.

Upon what points in your medical practice act (if any) have you
had litigation in the courts, and what has been the result of such litiga-
tion ?

How many practitioners are there in your state (number in each
school of practice if convenient, number of army and navy surgeons
and surgeons of the Marine Hospital service), and how many are prac-
tising illegally ? (Note : This should include mid wives.)

Will you kindly send the secretary a copy of your law for the use of
the conference ?

The attention of officers and members of the State Medical
Examining and Licensing Boards is called to these qaestions^
and it is requested that answers thereto be sent to Dr. Cole at the
earliest possible day. The facts and answers thus obtained will be
carefally tabalated, and presented to the conference for considera-
tion.



TOPICS OF THE MONTH.

A HOSPITAL CAB has been put into service by the Central railroad
of New Jersey, which is said to be the first of its kind in the
world. It is stationed at Maach Chunk. The car is divided into
two compartments, both of which are fitted ap for hospital use.
There are cots for the patients, seats, a good supply of medicines
and other necessary articles for the care of the injured. The
interior is painted a light cream color, which lends a bright and
cheerful appearance to the car. Next to providing means for the
prevention of accidents, the furnishing of a car specially for the
convenience and treatment of those injured is a praiseworthy idea
for a railway company to carry out.



It is gratifying to know that the Buffalo Health Department has
been doing a satisfactory work in reference to sanitary inspectiona
and other methods of enforcing cleanliness. To show how this work
increases, it may be remarked that as late as 1891 the number of
inspections were less than 1,400, while last year they reached an
aggregate of over 18,000. This has become a necessary part of



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618 BDITORIAL.

the maohinery of the health department, and the CommiBsioner
thinks that it will be equal to all demands in case of a threatened
•epidemic if he is given proper means to work with. It is unfor-
tunate that there is any " if " in the way of ample financial sup-
port to the health department. It should be made responsible
for all outbreaks of epidemic diseases, but it cannot be so held
unless it is voted ample money by the municipal authorities
to meet such outbreaks. Let the Common Council take heed and
give Commissioner Wende all the funds necessary for the prosecu-
tion of his work.



The following group of paragraphs, taken from a recent number
of the PoBtr Graduate^ possess interest to all who favor a separate
State license for the practice of medicine. It is amazing that
^* learned professors" should be found endeavoring to obstruct the
progress making in regard to improved methods of preparation
for the practice of medicine :

The Post- Graduate thinks that some of the learned professors of
the Buffalo Medical College might have been in better business than in
instigating, or at least in heeding, the petition of their students for a
reduction of the fee for the examination required by the State Board.
What a boundless sympathy these Buffalo College doctors have ! We
do not notice that they have reduced any of their own fees, and, dis-
guise their action as we may, it was simply an attempt to belittle the
influence of this beneficent law. Up to this writing, like all their pre-
decessors, who have proposed all kinds of amendments at each session
since the law was enacted, they have failed to convince the Legislature
and the medical profession at large that the law needs any substantial
Amendment.

It is written, "A man's foes shall be those of his own household."
It seems too. bad that the medical profession should be no exception to
this rule, but here also that our own family should be in a state of dls-
•cord. It is beyond endurance that, after these years of struggle to put
New York State abreast of the civilized nations of the old world, cul-
tivated and intelligent practitioners of medicine, who happen to be
professors in medical colleges, should endeavor, as some of them do, to
undo the effects of what is a great advance fpr the State of New York.

We hope we may encourage the Medical Society of the State of
New York to persist in their efforts to defend always the principle
involved in this law, so that it shall not fail to continue to be a barrier
against the foes that spring up on every hand. Under the old system
. the medical colleges, nearly always private institutions, were the eole
arbiters as to who should constitute a medical practitioner in the State.



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TOPICS OP THB HOMTH. 619

It may be as well, first as last, for these medical professors
to understand that students are rapidly gaining knowledge as to
the value of the medical diplomas that faculties issue. They will
soon decline to attend a school that does not properly and ade-
quately prepare them for the State examination.



The advantages of an accurate clinical thermometer are such as
to place any such instrument very high in the estimation of physi-
cians. There are so many inferior thermometers in the market
that are distributed as prizes or sold at low rates, that the effect
often is to bring clinical thermometry into disrepute.

Taylor Brothers Company, of Rochester, N. Y., manufacture a
clinical thermometer which is certified as to accuracy, and experi-
'Cnce has demonstrated that it has no superior in any market in
the world. They reject every imperfect thermometer, which adds
much to the cost of production, hence makes its price higher than
that charged for inferior instruments. If any physician wishes to
obtain an accurate clinical thermometer, he can do so by purchas-
ings Taylor certified instrument.



Montana, though one of the youngest of the states, has shown
herself worthy of taking an advanced position among her older
listers with reference to separate state examination for license to
practise medicine. She is one of the first, if not the very first, to
revoke a license where its holder was proven guilty of unprofes-
sional, immoral and dishonorable conduct. The case is entitled,
The Montana Board of Medical Examiners vs. Dr. E. S. Kellogg,
^nd on appeal to the District court. Judges Hunt and Buck sus-
tained the action of the medical b()ard in revoking Dr. Kellogg's
license. We hope the precedent here established will stimulate
similar action on the part of medical boards in other states in
parallel cases.

Db. J. W. LoNG» of Richmond, Va., professor of diseases of
women and children in the Medical College of Virginia, has
recently made a successful hysterectomy for fibrous tumor, com-
plicated by pregnancy. This was done on December 26, 1893.
The operation consisted in a long abdominal incision ; no adhesions
were found, tumor and uterus were turned out, the ovarian and
uterine arteries ligated and cut, and the whole mass cut away at
the internal os. The blood supply was thoroughly controlled.



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620 EDITORIAL.

hemostatic forceps not even being necessary after severing the
pedicle. The pedicle was trimmed, the canal cauterized with car-
bolic acid, superimposed plains of silk sutures applied, and the
stump dropped. The peritoneum was sutured on either side, the
pelvic cavity made dry with sponges, and the abdominal wound
closed without drainage. She recovered without rise of pulse or
temperature, no nausea, pain or tympany.

The specimens were shown at the Richmond Academy of Medi-
cine in January, 1894, and consisted of a group of five or six
tumors, together with a pregnant uterus in the fourth month*
Pregnancy was diagnosticated beforehand, and the operation was
undertaken with a full knowledge of its existence. This is believed
to be the first hysterectomy done in the South for fibrous tumor
with complicating pregnancy. A full report of this interesting
case is published in the Virginia Medical Monthly/ for April, 1894.



An epidemic of typhoid fever has occurred at Montclair, N. J.,
in which up to this writing seventy cases of the disease have been
reported to the Health Board, and there have been twelve deaths.
It arose from polluted milk sold to some forty or fifty families by a
dairyman, in whose family there occurred a case of typhoid fever.
The sale of the milk was stopped and the epidemic checked, but the
mischief already had been done.

This case strongly emphasizes anew the danger of infection
through milk and the urgent need of the strictest watchfulness to
insure immunity therefrom.

In Sajon's Annual for 1893 it is related that ten years ago the
editor of the British Medical Journal showed that, up to date,,
seventy-one epidemics in England had been traced to milk —
namely, fifty of enteric fever, fifteen of scarlet fever, and six of
diphtheria, the total number of sufferers being 4,800. Since then
a great many milk epidemics have been recorded, probably far
more than during any previous period, and there are the strongest
reasons for believing that various other diseases, especially includ-
ing that most dreaded and fatal of all, tuberculosis, are propagated
in the same way. Milk is largely consumed without cooking or
any process that would destroy noxious bacteria. Nor can it be
cleansed and purified in any way by the consumer who wishes to
use it raw. Full dependence must, therefore, be placed in its
wholesomeness as supplied by the vendor. Hence, the importance
of a careful inspection and a rigid system of internal quar-



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TOPICS OP THB MONTH. 621

antine, ander state or national anthority, is again pointed out, in
the hope that some action may be taken to protect the lives and
health of the people.



The second annual report of the Sheppard Asylum, a hospital for
mental diseases, located at Towson, Baltimore county, Md., has
been published. It is a handsome imperial octavo brochure, beau-
tifully illustrated with photographic reproductions containing
views of the buildings and grounds from various points of view,
as well as numerous photogravures of interior views. This hos-
pital was built and is supported by the munificent benefaction of
the late Moses Sheppard. It is a monument to individual philan-
thropy and is worthy of imitation by wealthy American citizens.
The hospital is presided over by Dr. Edward N. Brush, formerly
of Buffalo, who is well known as one of the most celebrated
alienists in this country. It is a satisfaction to know that he has
attained such conspicuous success as an expert in mental disease,
and that he has succeeded in making the Sheppard Asylum one of
the best hospitals of its kind, even in the short time during which
he has acted as its superintendent.



The twenty-fifth annual report of the New York Physicians'
Mutual Aid Association has been published. It is an excellent
showing of the workings of the association for the year 1893,
and indicates the continued prosperity of this great charity. It
is, however, a charity that renders something in return to the
families of any of its members who may die during the year. Its
assessments are low, and it issues a death certificate of $1,000, and it
pays more promptly than any insurance company doing business in
this state. Dr. Daniel Lewis, of New York, is president, and Dr.
Robert Campbell is treasurer. Application for membership may
be made to Dr. W. G. Gregory, 530 Main street, secretary and
treasurer of the auxiliary committee of Buffalo.



We are indebted to Prof. J. P. Roberts, director of the Cornell
University Agricultural Experiment Station, for Bulletin No. 65 :
a very valuable paper on tuberculosis in relation to animal industry
and public health, by Prof. James Law, a copy of which will be
sent to physicians and members of boards of health on application.
The author first speaks of the prevalence and relative importance



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622 EDITORIAL.

of this dread disease, and says that << the average ratio of deaths
from tabercnlosis to the total mortality is fourteen per cent.''

Its prevalence in lower animals is next treated, in which we
find that tuberculous cattle number in Bavaria 0.225 per cent.; in
France, 0.5 per cent. ; in Belgium, 0.4 per cent.; in Paris, 6 per
cent; in Holland, 20 per cent.; in Edinburgh, 26 per cent; in
Pommeranla and Bomberg, 50 per cent. The American figures
given by the Bureau of Animal Industry are, for Baltimore, from
2.5 to 8.5 per cent

The author then goes on to speak of the contagiousness of



Online LibraryJ. A. (Joel Asaph) AllenBuffalo medical journal → online text (page 62 of 78)