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J. A. (Joel Asaph) Allen.

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groaped we nowadays characterize as a typhoid condition. He
lived twenty-eight days, and from this case the fever spread to
other members of Mr. Faller's family and to those living nearest
to his hoase. Seven of Mr. Faller's family had the fever, of whom
three died. Twenty-one other cases occarred in five families, all
being within ten rods of Mr. Faller's house, of whom seven died,
making in all, inclading the stranger, twenty-eight cases and ten
deaths. The whole population of the hamlet amounted to forty-
three persons ; none were attacked who were over tw^ty-three
years old, the youngest was only one year old and a larg^ propor-
tion were children.

Dr. Flint visited the locality of the epidemic, during which
time he made a post-mortem examination of the body of a child
about twelve years old, and took notes at the bedside of the hbtor-
ies of nine cases together with the symptoms presented at the time
of his visits. It was his first distinguished success as an investi-
gator. He found and diagnosticated a fatal disease then unknown
in Western New York, traced it from New England to the hamlet
of North Boston, distinctly established its contagion and found its
focus in a particular well of water which had been poisoned by the
•excreta of an original case. Further use of this well was prohibi-
ted. The cases then existing recovered and no new ones appeared.
The work was done with all the precision and completeness that
characterizes the very best detective work and with all the skill
and acumen of the scientific clinician. Nothing was omitted that
would contribute to the completeness and convincing power of the
evidence adduced, and the published report has become a classic
in this country and in Europe. It also formed the basis of a series
of essays that Dr. Flint subsequently, wrote on typhoid fever, which
were published in this journal.

Thus was established for the first time a direct relationship
between poisoned excreta and the contagion of typhoid fever. I
wish we also could say that there had been established an absolute
knowledge of the contagium of this destructive malady and the
methods of its implantation. Who can say today with absolute
certainty that the infection of typhoid can be prevented in a given
case ? Who has yet been able to solve the subtlety with which
the bacillus of typhoid fastens itself upon the organism, or who
can say what is the most favorable soil for its implantation?
Medical societies are constantly debating these questions and the
pages of medical journals are teeming with learned expositions of



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potter: the prevention of disease. 653

the varioQS and manifold minajbisdof the sabject. I listen to these
debates and am to a certain extent familiar with joamalistio litera-
ture. Yet I fail to find a satisfactory answer to the yarioas ques-
tions bearing on the communicability of typhoid or any final and
determined method of preventing its propagation. There are
nearly as many opinions on these several details as there are par-
ticipants in the debates or writers in periodicals. All this indi-
cates that there is much yet to be done in experimental research,
clinical observation and bacteriological study in relation to typhoid
fever. If a conclusion is ever to be reached thereon that will be
accepted as final by the profession, it must be through the com-
bined efforts of clinicians, pathologists, bacteriologists and sani-
tarians. In the city of Chicago alone, from January 1, 1800, to
November 1, 1893, there have been, according to published re-
ports,^ 5,087 deaths from typhoid fever, an average of 110 a month.
This indicates that during this period there have been between
thirty and forty thousand cases. There are, says Vaughan, annu-
ally 50,000 deaths in this country from typhoid fever, and half a
million sick with it.* If it were possible to estimate the money
lost to the community in salaries, wages and expenses from this
one disease, the sum would be something enormous to contemplate,
and yet there is a great outcry in most cities against the ordinary
expenses of the health department. This embarrasses the officials,
and the evil should be corrected through an enlightenment of the
masses on the subject. If their sympathies cannot be reached from
the humanitarian side of the question, then their interests must be
appealed to from its economic aspects.

DIPHTHERIA.

Similar statements may be offered with reference to diphtheria.
Who can say what is the precise method of the propagation of
this subtle poison ? Who has yet ventured to tell us absolutely
how it enters the system, what is its favorite soil, and why under
apparently like conditions one individual contracts the disease,
while another has only a mild malaise, and still another goes scot
free? Who has told us with absolute certainty what part
mephitic vapors play in the causation of this disease ? In nearly all
the large cities of the world during every month of the year, cases
of diphtheria are reported ranging all the way from a few scatter-
ing victims to many hundreds and even thousands, with a fearful

1. Medical Record, December 30, 1893.
& Medical New$.



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654 potteb: the psevemtion of disease.

percentage of mortality. Here is another field where moot pointi
are many, opinions widely differ and satisfactory conclusions are
still in the air. Shall it be said daring all the f atnre years thai
diphtheria baffles all attempts at prevention ? That it paralyses
the efforts of the medical profession to control it or to fix its
habitat? This would be a sad confession of weakness and a
stigma upon the science of medicine that ought not to be per-
mitted to remain. Let us address ourselves to the study of its
prevention with an assiduity that will at least deserve success.

GONORRHEAL INFECTION IN WOMEN.

But one other example, yet in a most important field, will be
cited at this time. I refer to gonorrheal infection in women. It
is doubtful if any disease is capable of propagating more of sick-
ness, woe and misery than a neglected or unoured gonorrhea. In
view of recent researches, and especially of clinical experiences
evolved at the operating table, it is n<7w admitted that what was
taught and written relating to the treatment of this infection prior
to 1872 was little better than so much chaff ; and this remark
applies with equally cogent force to the acute stage in the male as
to the chronic stage in the female. Though it is true that the
medical profession gave little heed to the notes of warning sounded
by Noeggerath when he published his opuscule in 187 2, now, after
twenty years of continual hammering, the foremost men in medi-
cine have finally become aroused to the dangers that lurk in an
uncured or latent gonorrhea. This is especially true of genito-
urinary surgeons and of those gynecologists who practise pelvic
surgery. Other specialists and clinicians who listen to their
debates and read such convincing expositions of the subject as
have been given on the one hand, for example, by your distin-
guished academician, Brewer, and on the other hand by Gush-
ing, of San Francisco, have accepted in a measure their teach-
ings.

Brewer has conclusively demonstrated in a clinical history that
after six years had elapsed since infection, and where upon exami-
nation no secretion could be pressed from the urethra, yet endo-
scopic examination revealed granular patches and congested areas
in the neighborhood of the bulb and behind a stricture of large
caliber, measuring 33^. In this case the microscope showed several
characteristic colonies of gonococci. Six weeks afterward, con-
trary to advice, this man married, and two weeks later had corn-



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potter: the prevention of disease. 655

manicated the infeotion to his wife, in whom it went throaght he
various stages of inflammation and resulted in abscess.^

Cashing has shown that a woman who had been infected five
years previously, without intermediate exposure, finally married
and infected her husband who had a severe urethritis which
resulted in a perineal abscess. Gushing removed both tubes and
ovaries that were distended with pus in which gonococci were
found. The secretion from the urethra of the husband was
-examined and gonococci demonstrated without difficulty. Here,
then, are two cases — one in which the infection was carried by the
male for six years and then communicated to his newly wedded
wife ; and the other in which it was carried by the patient for
five years and then communicated to her husband, who had all
the symptoms of acute gonorrhea resulting in abscess.''

I have cited these two examples as types of this disease show-
ing its subtlety^ how it lurks in some nook or cranny of the geni-
tal tract for years, thence to be conveyed to an innocent spouse or
-consort in whom it lights up a disease that ravages the entire
pelvic cavity. The list might be prolonged indefinitely, but
this is neither the time nor place to recite lengthy clinical
records.

Only within the last few years have physicians been ^'eady to
admit the terrible destructiveness of this malady. Until lately
most physicians or surgeons who have been called upon to treat
the disease in its acute stages, whether in the male or female, have
generally regarded it in a light or trifling manner, contenting
themselves for the most part with ministering to the first distress,
but paying little heed to its secondary probabilities. The victims
•of this disease, too, have been taught to regard it as a mere trifle
that a few urethral or vaginal injections and a few doses of copaiba
assuredly would cure, without danger of any secondary complica-
tions, and that even a long standing gleet had little or no signifi-
cance beyond the mere personal discomfort that it caused. Only
the few even consulted physicians, while the many borrowed a
syringe and a prescription from a friend or obtained the same from
a kindly and sympathizing druggist who, for a few shekels, is ever
ready to assure the sufferer that his disease is of slight conse-
<)uence, that he will be well of it in a few days, and that all he

1. The Contaeiousness of Chronic Urethral Discharges. Jour, of Cutaneous and
G^nito- Urinary /Hs„ March, 1801.

a. Contribution to the Study of Pelvic Disoase. Trans. Am. Ass'n of Obtt. and Gyn^
Vol. I., 1888, p. 17.



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656 potter: thb pbevention of disease.

needs is a few injections with '* No. 1 " and a few days' dosing
with "No. 2."

The literature of this disease is being almost entirely rewritten^
and the teachings of the schools are recasting in view of the awful
consequences of neglect to cure or prevent the propagation of thi»
subtle, deceptive and virulent infection when once it has been
contracted. It has come to pass that a woman who accepts an offer
of marriage finds herself treading upon dangerous ground — a^
danger far more serious than those contemplated by mother Eve
when she entailed her sex — and it becomes a problem of the most
serious import when her answer may fetch her a spring of woefr
unnumbered. I speak seriously, for it is a subject that demands
our most thoughtful consideration. If we would stamp out the
frightful malady, or even prevent its propagation to innocent per-
sons, we must, as a profession, exert ourselves to the utmost to
bring enlightenment to the people and to enforce an intelligent
application of the laws of prevention. We have been taught to
regard syphilis as the most destructive of the venereal diseases,,
but I believe gonorrhea to be a far more serious disease than
syphilis, and that it plays more dreadful havoc with community.
We are seeing constantly fewer and fewer syphilitics, while gonor-
jheics are increasing in number. Fortunately, though, the secondary
consequences of the disease are becoming better understood. I am
well aware that difficulties surround this subject almost greater than
any other, owing to its extreme delicacy ; nevertheless, the fulness
of time has arrived when action must be taken to arrest a disease
that leaves such horrible consequences in its track, and I appeal to
this Academy to formulate and carry out some plan that shall
have for its purpose the enlightenment of the community, the
education of physicians, and the enactment of such statutes as
shall prevent others than physicians from prescribing or in any
manner giving advice as to the treatment of gonorrhea.

CONCLUSIONS.

In my early youth I learned to look to the New York Academy
of Medicine as the leader of medical thought in this country. My
father, a physician, so taught me, as a child receives impressions
from the horn-book on his mother's knee. It is here that medical
men from all quarters of the globe are received and entertained at
your meetings and go away with new inspirations, renewed energy
and increased intelligence. This academy becomes, perforce, a.



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pottee: the pbevention of disease. 657

mighty instrument for the advancement of medical science and im-
proved methods in medical art. One of the great orators of this
metropolis asseverated in his speech at Chicago on Manhattan day
that the World's Fair had taught us that art is more god-like than
science, for while science discovers, art creates. I believe this
applies as well to medicine as to other arts and sciences. I ask
you to remember that I am not unmindful of the great work this
academy has inaugurated from time to time during its history
with reference to the prevention of disease, nor of the fact that it
is still laboring with might in that field. When this academy
speaks, the world moves. When she asks that certain methods and
certain means be adopted with reference to improvements in quar-
antine, they are done. When she recommends the board of health
to adopt certain measures with reference to the details of preven-
tive medicine, the board at once accepts its conclusions and adopts
them. It has gratified me to observe very recently the splendid
action taken by the academy with reference to the creation of a
National Bureau of Health, and I sincerely hope its recommenda-
tions may be given form and force in the immediate future through
national statutory law.

But it is not as sanitarians, or public health ofiicers, or as
administrators of state medicine, that I now appeal to this academy
of medicine. I beseech you, each and every one, in your capacities
as individual members, to do your parts toward inaugurating a
fashion, that shall have for its purpose discussions relating to the
prevention of disease at the general meetings of this academy to
the exclusion of all other scientific work. The report of these pro-
ceedings given to the medical journals and published as ex cathedra
edicts will arrest the attention of physicians all over the world,
and thus serve to begin a campaign of education on the several
questions to which I have called attention, as well as many others
that for obvious reasons could not be specified on this occasion.
I have merely attempted to accentuate those that seemed to me of
greatest importance. Cholera, smallpox and even yellow fever are
no longer regarded as plagues of humanity, but consumption, diph-
theria, typhoid fever and gonorrhea are slaying or invaliding un-
necessarily hundreds of thousands annually.

The laity must be educated to regard consumption as a com-
municable disease, and to accept laws and regulations calculated to
restrict its propagation and restrain its victims within the limita-
tion of safety so far as uninfected individuals are concerned. But



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658 potter: the prevention op disease.

rales, too, must be formulated for the prevention of the spread of
diphtheria and typhoid, and these mast be insisted upon without
deviation, and the community must learn to yield a hearty sup-
port to such beneficent and humane methods as have for their sole
and distinct object the protection of the individual. Finally, I
hope that this academy will address itself seriously to the
eradication, prevention and cure of that loathsome, subtle and de-
structive dibease, gonorrhea, that is directly and indirectly bring-
ing to invalidism or death so many innocent thousands throughout
the civilized world. I am well aware that all these questions are
as well known to you as to me — perhaps even better ; I am only
attempting to recall them to your minds for the purpose of stimu-
lating or encouraging renewed energy in their consideration.

Pardon me, Mr. President, if I have said more than I ought to
have said, or more than there was occasion to say. I have spoken
from a deep conviction of the importance of the subject, and with
a realizing sense that I am standing in the presence of men
who are doing as much as any other group of equal numbers
toward the prevention of the diseases in question, as well as others
that have not been mentioned. I know, too, that your sections are
made up of recognized men of exceptional skill in their several
departments, and whose work goes out every month to the profes-
sional world in brilliant and well-recorded achievements. Your
orthopedists are restoring hundreds of maimed children to useful-
ness and self-support ; your ophthalmologists are restoring to sight
thousands of eyes in every year, and are preventing the beginning of
destructive processes in many thousands more ; your gynecologists
are restoring to health numberless invalid women — wives, mothers
and sisters — who would otherwise drag through life a miserable
existence or obtain all too early sweet relief in death ; and so on
through the entire list of your splendidly organized sections. But,
in spite of all this, let me implore you to set apart at least one
meeting in every month, if not both, where all the splendid talent
of these sections shall merge itself for the discussion of problems
relating to the prevention of disease ; and I venture to hope that
these discussions may assume that particular form which will
prove valuable to individual physicians who are battling with
disease in the smaller towns, hamlets, and remote points in the
land, and who are known and properly designated as family
doctors. These are the men who need your aid, who deserve the
stimulus of your best thought and the inspiration of your exam-



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WHBBLBB : MABITIMB QUABANTIKB. 650

pie. As a final word, let me enter a plea in their behalf, to the
end that your literature be sent to them with a liberality so char-
acteristic of your organization, and that they be invited, when
practicable, to attend your meetings.

Mr. President, it remains for me to thank you for the distin-
guished honor you have conferred upon me in inviting me to
address this academy at this time. I appreciate it more than mere
words can express, yet I regret that I have so inadequately fulfilled
the responsibilities of the high office you have so kindly thrust
upon me. But I assure you, sir, that I shall carry with me down
to the crack of doom the memory of this pleasant visit to the
New York Academy of Medicine.

284 Franklin Street.



MARITIME QUARANTINE.^

Bt WM. a. wheeler, M. D., U. S. M. H. Surgeon.

I AM DBBPLT conscious of the distinction which an invitation to
appear here has conferred upon me, and doubly pleased to be with
you because of the personal interest I must always feel in the
growth and^^rosperity of your Alma Mater, a feeling natural to
one who was in at the birth, so to speak, as Virgil puts it, " all of
which I saw and part of which I was." Your chairman has asked
me to make a contribution to this annual symposium of yours, and
while I may be surprised at his judgment, you must in no way
relieve him from responsibility as to the character of entertainment
he provides.

It is of Maritime Quarantine in this Country that I propose to
speak for a few moments today, not that I pretend to know so
much about the subject, but because, from what I do know, I have
derived some very positive opinions, which may or may not be
correct, but which, at least, it will relieve my mind to express here
before you. It is of no use for me to tell you that the word quar-
antine does not mean today what it once did. Sanitary inspection
is too long, and we will continue to use the word suggestive of
the Lenten season. This subject has been brought very forcibly
to our minds and, indeed, to all thinking minds, the last two years,
and out of the prominence given the subject some good to the pub-
lic generally ought to come. The public, always ready to criti-
cize, as is right, especially that part of it which gives voice to its

1. Read before the Alumni Association, Niagara University Medical College, Ma jr 0,
ISM.



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660 WHEELER : MARITIME QUARANTINE.

sentimeDts throagh the colomns of the press, is asking the qaestion:
Are we abreast of the times in this matter, or do we not cling to
methods which belong rather to the dark ages ? And England is
quoted as a country which has discarded quarantine as unsuited to
modern needs.

Before we condemn our system, let us first explain what is
meant at the present time by quarantine, and what it is designed
to accomplish. It does not imply necessarily a detention, but
simply a careful examination of persons and their belongings, to
the end that disease may not be brought to us from abroad. There
are two methods of fighting epidemic disease — one by preventing,
if possible, its entrance to your home ; the other by keeping your
house so clean and well ordered that it will not stay with you
when it comes. We are trying the former plan ; England, the
latter. She prefers to try and keep her house clean, having a small
establishment and perfect control of every part of it ; and, depend-
ing for her prosperity, as she does, so largely upon commerce, she
is unwilling to impose any restrictions upon it. We, on the other
hand, have such a large house, or, indeed, so many of them, inhab-
ited by such a variety of tenants, who control their own apart-
ments, that we distrust our ability to keep clean and so bar the
gates that disease may not get a foothold. Consider for a moment
the extent of our territory and the ease and speed with which com-
munication is kept up between all sections. We have a land three
thousand miles in width and two thousand miles deep, if I may be
allowed the expression, with a great variety of climate. It is
possible for an army of people to arrive in one of our Atlantic
ports today, and tomorrow be scattered in fifteen difi^erent states.
It is a common thing for a thousand people to start out by special
train from New York, bound for the West, reaching Chicago in
thirty-six hours, and diverging from there in all directions. Can
we afford to allow these people, fresh from a crowded ship, which
has been their home for the last ten or fifteen days, scatter all over
these fifty states and territories without knowing or caring if they
are free from disease ? Can we keep track of these thousands and
watch them in their wanderings throughout this vast country ?
Now, look at the condition in England. She has, together with
Scotland, an area about equal to. that of Indiana and Illinois, with
a cool temperate climate, all her people under one sanitary system,
which is the growth of centuries and the admiration of those
familiar with it. She has no immigration, as we understand it.



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whbelbb: maritime quabantine. 661

and her commerce is her very life and must be fostered. The
strangers who enter her gates are merely breaking their journey
to other lands, and their movements can be and are accurately
knowa. They are passing through by the shortest and quickest
routes, often not remaining over night on £nglish soil. She does
not need the careful guarding of her gates as with us, and we could
not adopt her close and efficient system of sanitary espionage if
we would. Commerce seeks us of its own accord, and we feel
justified in imposing such slight restrictions as we believe needed
for our protection.

In view of the totally different conditions existing in the two
countries, and also viewed in the light of experience, it would seem
that both countries were wise in their methods. We have a coast
line many thousands of miles in extent, included in the domain of
twenty-one different states. Along this coast line are found scores
of ports through which the foreign commerce of the country is
conducted, and it is at these gates that guards, more or less efficient,



Online LibraryJ. A. (Joel Asaph) AllenBuffalo medical journal → online text (page 66 of 78)