John Davis Batchelder Collection (Library of Congr.

The Atlantic medical weekly, Volumes 9-10 online

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Online LibraryJohn Davis Batchelder Collection (Library of CongrThe Atlantic medical weekly, Volumes 9-10 → online text (page 33 of 117)
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and it is needless to say that Dr. Mathew-
son*s stay as a member of this Society was
limited.

I was surprised to see no reference in the
records of anything relating to the War of the
Rebellion, except that years after an occasional
report was made of some operation to remove
bullets that had become a souice of trouble.
The Association, however, took action on many
questions of a public nature. In 1849 Dr.
Mauran proposed a law for the registration of
births, marriages and deaths. In 1853 and.
1855 a series of moves were made in refer-
ence to a city hospital and in 1855 the atten-
tion of the Association was (failed to a para-
graph in the Providence Journal reflecting
on " the tardiness of the medical faculty of
the city in moving *' in this matter. In 1849
a committee was appointed to confer with
the Board of Health in regard to the report-
ing of cases of cholera; in 1867 to con-
sider the matter of running cars through the
public streets of the city and to memorialize
the city council if expedient. This was after
the accidental death of Dr, McGregor. It
had reference to the steam cars crossing
the Crawford street bridge, and apparently
the influence of the Association was as great
then as now, for thirty years after the cars are
running just the same.

We are all apt at times to imagine that
there were " no pebbles on the beach " before
our advent. I remember once while visiting
in the country, of getting out of doors at



some unheard-of early hour and finding all
the horses in the barn standing and looking
hungry. I proceeded to give them their
breakfast. I had about half completed my
task when the farmer appeared and in no
gentle terms informed me that he had " fed
them horses two hours ago." And so I sup-
posed that the hue and cry against our
** cove-basin " began during an epidemic of
typhoid fever in 1882, but I find in the
records, as far back as i860, that remarks
were made about the influence of the cove
on the public health. Probably the late Dr.
£. M. Snow was as pugnacious then as in
1882 when he suffered martyrdom for trying
to make the city look to its water supply
rather than to the cove as a source of typhoid.
If I remember truly. Dr. Snow's successor,
Dr. Chapin, promptly proceeded to prove that
Dr. Snow was right.

Dr. Snow's combativeness was also shown
in the records by his frequent avowals that
neither scarlet fever nor cholera were conta-
gious. Apparently the contagiousness of
scarlet fever was a new idea not long before
1871.

So, too, I thought that Listerism was new
in my day, yet I find in these records that Dr.
Snow as far back as 1867 made some remarks
about carbolic acid as an antiseptic. Even
mechanical ingenuity was not neglected in
those days for the records state that, " Dr,
Radeke exhibited a pessary designed for
cases of lacerated perineum, also a new intra-
uterine stem and phial case."

I cannot forbear briefly alluding to some
of the interesting reports and specimens
noticed in the records.

In 1857 Dr. Ely exhibited a specimen of
perforated vermiform appendix and coecum
resulting in death. This is the first reference
to appendicitis that was found.

In 1856 Dr. Collins reported that thirty -
three cases of scarlet fever had been treated
by him during the past two months with thir-
teen deaths. Of these, twenty-six occurred
among the Irish population with twelve
deaths.



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THE ATLANTIC MEDICAL WEEKLY.



[March 19, 1898.



Dr. Mauran reported a case of dropsy
which on his visit at night was very greatly
swollen but in the morning was not swollen
at all. During the night four gallons of fluid
had passed from the kidneys.

Dr. Parsons reported a case of labor in
which the child weighed seventeen pounds
and two ounces.

A case of diabetes was reported in 1852,
as having been successfully treated by the
administration of one pint of New England
rum every twenty-four hours. The treatment
lasted three months.

It is hardly to be expected that any society
should live half a century and not have some
ill turns. Stimulants have been administered



from time to time, as in 1848 a committee was
appointed (so the records say) "to secure in
advance performances of a scientific or prac-
tical character." But not until the annual
meeting in 1886, was the truly rational treat-
ment inaugurated. This treatment was die-
tetic in character and consisted principally
in a collation after each meeting. Its suc-
cess was immediately evident. During the
previous year the average attendance had
been ten or one-eighth the membership,
and only sixteen at the annual meeting.
During the next year the average attendance
was twenty five or nearly one-third the mem-
bership. The health of the society still con-
tinues good.



GONORRHOEA.



By L. E. GRANT, M.D,,*
Somenworth, N* H«



The name gonorrhoea is a misnomer.
The older writers believed the disease to be
a flow of semen ; hence its derivation from
two Greek words ^ovoj, sperm and '/>£w, to
flow.

A better name for the disease would be,
specific urethritis ; but in this paper I shall
use the name gonorrhoea as it is the name
usually applied to the disease under consid-
eration.

Gonorrhcea is a* local, specific inflamma-
tion, usually affecting the urethra of the male
and the urethra and vagina of the female,
ordinarily acute in its course and attended
with systemic poisoning.

While the usual habitat of gonorrhcea is
the urethra of the male and the urethra and
vagina of the female it may affect the con-
junctiva and the mucous membrane of the
rectum. It is somewhat doubtful if the
disease ever attacks the nose or mouth. The
disease also may involve the mucous mem-
brane of the glands and prepuce of the male

*Read before the Somersworth and Berwick Med. Society
October 5, 1897.



and the mucous membrane of the vulva of
the female.

Occasionally it extends to the bladder and
in the female it may extend to the uterus and
through the fallopian tubes to the peritoneum.

While the disease is usually acute in dura-
tion it may, through neglect, improper con-
duct on the part of the patient, or faulty
treatment, become subacute or even chronic.

The cause of gonorrhcea I believe to be a
vegetable micro-organism, usually conveyed
to the part involved by coition.

While coition is the usual way by which
the micro-organism is conveyed, it may be
conveyed in any way by which a part suscep
tible to the disease may come in contact with
the specific virus. Observation teaches the
writer that gonorrhcea is rarely contracted
except by coition. It is said that clergymen
and deacons are the only classes that contract
it from water-closets. '

I am well aware that many writers reject
the spf cific germ theory and teach that gon-
orrhoea is a non specific disease.

Excessive venery, coitus at or near the



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\I\RCH 19, 1898.]



THE ATLANTIC MEDICAL WEEKLY.



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menstrual epoch, the excessive use of
alcoholic stimulants in connection with
venery, leucorrhoea, simple inflammatory
affections of some part of the genital organs.
a purulent or muco-purulent discharge,
intercourse under circumstances of special
excitement and uncleanliness are some of the
causes to which gonorrhoea may be attributed
by these writers.

In those cases in which the disease may
seem to have been contracted in some other
way than by a specific virus, there may be
obtained almost invariably a history ot a
previous attack of the disease, the disease
having become chronic and usually compli-
cated with stricture and thickening of the
mucous membrane.

A chronic gonorrheal inflammation may
take on an acute exacerbation from some of
the causes above stated as many other chronic
diseases may take on acute action from some
exciting cause.

I would as soon expect a case of scarlet
fever from exposure to some other disease
than scarlet fever as to expect a case of gon-
orrhoea to be contracted in some other way
than by exposure to gonorrhoeal virus.

The modus operandi of the micro-organ-
ism of gonorrhoea may be as yet a matter of
speculation. The fact is recognized at the
present time by many writers that germs bear
a casual relation to many diseases ; but how
these organisms produce disease is at present
sub judice.

Some have contended that the bacteria
must enter the circulation in order to produce
the specific result ; and that in order to con-
tract gonorrhoea there must be some abrasion,
perhaps very slight, of the mucous membrane
of some part of the genital tract ; for without
such an abrasion or denuding of epithelium
the gonococcus could not enter the circula-
tion.

The microbes having entered the circula-
tion several theories have been advanced as
to how the disease is produced.

One theory is : — The germs deprive the
blood of oxygen. Another : — The bacilli



accumulate and form mechanical obstruction
in the vital organs. Still another: — The
bacilli consume the protoids of the body.

These theories have been shown to be
defective and unsatisfactory.

If it were a fact that the germs were taken
into the circulation in order to produce
disease, it would naturally follow that the
specific disease would be constitutional or
systemic instead of local as I believe to be
the case.

The theory most generally accepted is the
following: "Bacteria during their growth
elaborate a chemical poison, which is soluble
and which when introduced into the circula-
tion produces fever and the characteristic
symptoms."

A ptomaine is a product of bacterial
decomposition. Vaughan defines a ptomaine
as a chemical compound which is basic in
character and which is formed by the action
of bacteria on organic matter. Only the
poisonous ptomaines produce disease, some
being inert and harmless.

The gonococcus having found lodgement
in its favorite location in some part of the
genital tract, acts as a local irritant producing
inflammation and necrosis of the epithelial
cells.

The further action of the necrosed tissue
and of the gonorrhoeal micro-organisms is to
produce ptomaines which are absorbed into
the circulation producing systemic infection,
and causing the febrile phenomena of this
disease.

It seems to the writer that this same theory
will apply equally as well to all the diseases
which are produced by pathogenic germs.

The time required after exposure for the
development of a case of gonorrhoea is from
a few hours to seven days ; the average time
being from two to five days. Cases in which
the appearance is said to have been delayed
to a longer period are those in which the
first symptoms were so mild as to be over-
looked. •

Gonorrhoea may be divided into three
btages, first or congestive stage which may



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THE ATLANTIC MEDICAL WEEKLY.



[March 19, 1898.



last from one to three days ; second or inflam-
matory stage which may last from one to
three weeks ; third or stage of decline which
may last from one to an indefinite number of
weeks according to the treatment and con
duct of patient. Gonorrhoea, from rnisman-
agement on the part of the physician, or
pat-ent, or both, may become chronic lasting
an indefinite period of time.

A positive diagnosis consists in the discov-
ery of the micrococcus gonorrhoea in the
discharge. Ordinarily it may be diagnosed
from urethritis, from some other cause than a
specific virus, from the characteristic symp-
toms, without the aid of the microscope.

The prognosis is favorable. Only debili-
tated and^cacheciic subjects need suffer long
on account of gonorrhoea if the proper treat-
ment is applied.

During the first or congestive stage there
is more or less heat and itching about the
meatus urethral. The meatus is slightly
reddened and swollen being covered usually
with a small quantity of colorless mucus.
These symptoms gradually become more
marked ; the redness becomes deeper, the
swelling becomes increased, the discharge
becomes milky in appearance and a decided
burning and smarting sensation is experienced
during urination.

During the second or inflammatory stage
there is more or less swelling of the urethra
and glands ; sometimes involving the whole
organ. The lymphatic glands in l^?e groin
nre usually swollen and sensitive. The
mucous membrane of the urethra is swollen,
red and sensitive ; also the raucous mem-
brane of the glands and prepuce are often
involved constituting calanitis. There is
intense burning and smarting during micturi-
tion. The smarting and pain during mictu-
rition is due to the acidity of the urine and
the distention of the inflamed urethra. The
discharge at this stage is very copious, of a
deep green color and sometimes tinged with
blood.

Owing to oedema about the frsenum,
phimosis is often produced in subjects who



have a long prepuce, and paraphimosis in
those who have a short prepuce.

At the commencement of the second stage
there is usually considerable systemic dis-
turbance of a febrile character. This sys-
temic di^tuibance is due to the absorption of
piomaines into the blood from the inflamed
organ and may last to the end of this stage
of the disease, but usually not more than
three or four days.

In the female, the mucous membrane of
the vagina and usually of the vulva becomes
involved.

During this stage, chordee is often a very
distressing symptom. It is due to theoedem-
atous infiltration of the corpus spongiosum,
rendering it less extensible than the cavern-
ous bodies. It is for this reason the penis
assumes a bow shape during erection. The
patient should be warned not to forcibly
straighten the penis, as it might rupture the
spongy body, causing haemorrhage and
stricture.

During this stage of the disease, complica-
tions may arise, such as epididymitis, orchitis,
orchi-epididymitis, adenitis, lymphangitis,
stricture, gonorrhoeal rheumatism, etc.

During the third stage, or stage of decline,
all of the symptoms gradually subside.

There is a tendency in this stage lor the
disease to become seated at the bulbo-mem-
branous portion of the urethra. This condi-
tion of things is often complicated with a
stricture in some part of the urethra, which
tends to perpetuate the gonorrhoeal virus.
This tendency to sub-acute or chronic
gonorrhoea will throw much hght upon those
cases which have been supposed to have
been contracted without exposure to gonor-
rhoeal virus.

If the theory advocated in this paper as to
the nature of gonorrhoea, is correct, prophy-
laxis is of the utmost importance.

If after coitus, the mucous membrane of
the genital organs be thoroughly cleansed
and treated with a i to 10,000 solution of
bichloride of mercury or some other reliable
germicide, gonorrhoea would not develop.



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THE ATLANTIC MEDICAL WEEKLY.



183



even though one of the parties might be
afflicted with the disease at the time of the
sexual act.

Unfortunately, cases of gonorrhoea are not
usually seen by the physician until the
inflammatory stage has developed. Another
unfortunate condition that the physician has
to encounter is the unwillingness or inability
on the part of the patient to properly carry
out his directions.

The treatment of gonorrhoea varies with
the stage of the disease. During the first
stage, the patient should use a very weak
solution of bichloride of mercury — i to
25,000 — as an urethral injection. The injec-
tion should be as hot as the patient will
comfortably bear.

The mucous membrane of the glands and
prepuce should be treated with the same
solution.

The bowels should be kept open. Rochelle
salts is a good cathartic for this purpose.

The urine should be made alkaline as soon
as possible. Bicarbonate of soda in half-
drachm doses, before meals and at bedtime,
acts admirably for this purpose.

The patient should abstain from manual
labor.

During the second stage, if there is much
sensitiveness or swelling of the urethra, the
injection had better be omitted or, if used at
all, should be very weak, i to 40,000, as hot
as can be conveniently borne. The penis
should be immersed in hot water, to which a
little bichloride of mercury has been added
for at least ten n^inutes at a time, every four
hours. The bowels should be kept open
and urine made alkaline, as in the first stage.

Chordee should be prevented as much as
possible with bromide of soda and hyoscya-
mus in full doses. If necessary, an opium
and hyoscyamus suppository may be used.

The diet should be plain and light.

Highly seasoned foods and alcoholic
beverages should be forbidden.

During the third stage, if the discharge is
inclined to remain, an astringent injection
may be used alternately with the bichloride



solution. Borax, sulpho-carbolate of zinc,
acetate of lead, sulphate of zinc or even
nitrate of silver, may be used. The astrin-
gent injections should be weak at first and
gradually increased in strength, if the dis-
charge is obstinate.

Copaiba, cubebs and sandal-wood may
often be used, in this stage of the disease,
with advantage. Strong injections for the
purpose of aborting the disease by setting up
a vicarious inflammation, should never be
resorted to.

In the female, the vagina and vulva should
be treated with the same kind of injections
as the urethra of the male.

If complications arise, they should be met
with appropriate treatment.



The Next Meeting of the American Medical
Association, Denver June 7-10, 1898.

In medical circles, here in Denver, the all-
absorbing topic is, of course, the next meeting
of the American Medical Association, and
naturally the members of the profession are
desirous of knowing what is being done and
what the prospects are. Perhaps no better
answer to these questions can be made than to
give a r6sum6 of the report made to the Com-
mittee on Arrangements, at a recent meeting,
called by the Chairman of the Committee and
embracmg the g^eat variety of interests
involved.

It was then stated that subscriptions to the
amount of $6,000 have been secured from the
medical profession of the city. The Western
Traffic Associa^tion has been asked to furnish
the members of the Association with half rates
and a time limit on all railroad tickets of
thirty days from the date of arrival. While no
definite response has been secured to this
request, it is generally understood that the
railroads view it with favor and there is reason-
able anticipation thatsuch rates will be secured.
Some of the roads have already announced
special trains and there will probably be a
special run out from Louisville; another over
the Missouri Pacific from St. Louis; a jjeneral
train from Chicago; a special is talked of from
St Paul; and even from New York City.

The Committee on Meeting Places for the
several sections gave a favorable report. The
Gulf Railroad has published 20,000 copies of
their pamphlet entitled "Colorado, About its



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THE ATLANTIC MEDICAL WEEKLY.



[March 19, iSgS.



Climate." This pamphlet, originally written
by Mr. J. C. Dana, Librarian of the Public-
Library, has been somewhat revised, with his
consent and co-operation, by Dr. C. E. Edson,
and embraces quotations from Herman Weber,
Knight, J. A. Lindsay, Ruedi, Solly, and others,
in addition to the quotations that it already
contained from the local men. This pam-
phlet bears on its face the indorsement of the
Committee on Arrangements and the fact that
the American Medical Association will hold its
next meetmg in Denver, June 7-10, 1898.
Twenty thousand copies of this have been pub-
lished by the Gulf road, at its own expense,
5,000 of which are being placed in Texas.
Every member of the American Medical Asso-
ication will be furnished a copy, and, in addi-
tion, a copy is being placed in the hands of
every registered member of the six New Eng-
land State Medical Societies.

The Committee on Hotels has done very
effective work and has gotten out an attractive
little leaflet giving the hotels and principal
boarding houses of the city, with their agreed
rates for the meeting and the means of reaching
them by car. One of these leaflets is placed in
■every copy of •• Colorado, About its Climate."
that is being sent out, and we learn that
returns are already coming in to the hotels and
that rooms are being engaged.

The Committee on Souvenir Book also
reported that it was hard at work and hoped to
present an exceedingly attractive Souvenir
volume, giving ample illustrations and also a
statement of the various resources, climatic,
mineral, horticultural, grazing, agricultural,
oil, etc. It is their intention to make this
attractive by drawing upon the numerous
illustrative cuts in possession of the publi.shers
and the railroads, and also to have it replete
with information, furnishing a map of the State
and City, on which will be shown diagramati-
cally, the places of meeting, hotels, etc.

The Committee on Badges reported that they
are in commuuication with the leading hou.ses
in the country, and are making an effort to get
out something unusually attractive and simple,
preferably a button.

It was further reported that our local rail-
roads are very much interested and that it was
confidently expected that we will be furnished
with an excursion " Oyer the Loop,*' and also
one to Colorado Springs and Manitou, with
special rates throughout the entire State. An
effort is being made, and with good prospects
of success, to have the profession and commis-



sioners of Clear Creek County provide the
luncheon for the Loop excursion. Colorado
Springs is raising money, and guarantees to
take care of the members of the Association
after they have landed there. Several of our
more prominent citizens have volunteered to
open their houses for an evening reception, for
one of the evenings of the meeting.

The Ladies' Committee are busily at work
making arrangements for the proper entertain-
ment of the visiting ladies.

It is also stated that the County Commis-
sioners of Arapahoe County and the City
Government have been asked to make appro-
priations toward the expense fund, but that the
question was still undecided in both of these
bodies. It is greatly to be hoped that every
member of the profession, who has subscribed
toward the entertainment, will be prompt in
making payment and that every member of the
profession, in the city and county, will give
some donation, as the expenses are bound to
be heavy and there is a great need of money.
The Committee on State Medical Societies
reported that they had corresjx)nded with the
President and Secretary of every State organi-
zation in the country, and that favorable replies
had been received, many of them stating that
they would come indelegationsof one hundred.
Delaware and Vermont had signified their
intention of sending delegations.

The American Academy of Medicine is to
hold its meeting on Saturday and Monday
preceding the general Association, and the
Chairman of that Committee reported that the
indications were favorable for a large meeting.
He hopes to give the banquet for that Associa-
tion at the University Club, and as it is the
custom of this Academy for each member to
pay for his own plate, this Academy will not be
any drain upon the finances of the General
Committee. The Association of State Boards
of Medical Examiners holds its meeting in
Denver, on Monday preceding the general
meeting as well as the Association of American
Medical Colleges. The proper committee is
arranging to provide a swell banquet for the
Medical Editors, which is planned to be given
on the night preceding the general meeting.
The reports received indicate that many of the
leading men in Medical Journalism, in this
country, will be in attendance upon the meet-
ing, and that this banquet will be a marked
feature and a success. Should the responses
from the Western Traffic Association be as
favorable as it is anticipated, the expectation



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is then to carry the matter before the Eastern
Traffic Association and in that way secure half
rates from all over the country. It is greatly
to be desired that every member of the medical
profession, throughout the Rocky Mountain
region, should identify himself with the Amer-
ican Medical Association, and thus swell the
numbers in attendance upon the meeting and
also increase the circulation of the Journal,
which is sent gratis to each member of the



Online LibraryJohn Davis Batchelder Collection (Library of CongrThe Atlantic medical weekly, Volumes 9-10 → online text (page 33 of 117)