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teria until we lose resistance from some
kind of poisoning". Daniel takes the oppo-
site ground that the local aflfection is pri-
mary, and that a cure of the local disease is
followed by the disappearance of the gen-
eral condition. Perhaps both are right — ^at
any rate each is accomplishing phenomenal
results by attacking one cause. Our in-
terest in Daniel's work is due to the fact
that Americans have for many years been
calling attention to the disasters which fol-
low long continued toxemia from such con-
ditions as suppuration in the gums, antrum,
sinuses, vagina, urethra, etc., and it has
been a routine to examine for a local sup-
puration somewhere to clear up obscure
cases. Daniel shows that the British pro-
fession has almost completely ignored these
causes of chronic diseases and that students
are not even made aware of these condi-
tions which do the "spade work" for a later
planting of tubercle or typhoid bacilli. Not
only is the toxemia to blame for all kinds of
after-effects — from arthritis to insanity —
but the organisms themselves migrate and
may lodge almost anywhere, and other in-
vaders may appear in the weakened body.
Darling found that 92 per cent, of persons
dying of pneumonia had an older nasal
sinusitis; Fish found empyema of the an-
trum of Highmore in the majority of those
dying of measles and scarlet fever; and
Weichselbaum found empyema of one or
more of the sinuses in 12 influenza autop-
sies.

The results of sepsis maybe goitre,
neuritis, arthritis, heart disease, general ill
health and hysteria, crises of tabes, Char-
cot's joints, perhaps eclampsia, nephritis,
exophthalmic goitre, Henoch's disease and



certain glandular affections. Even in cancer
it is a factor and this long list does not in-
clude all the things Daniel mentions.
There will be great skepticism as to the
wisdom of making such sweeping general-
izations, but it will be criminal not to act
upon the suggestion and cure up all local
chronic infections even if we must extract
all the teeth in cases of Rigg's disease
which do not respond to treatment. If we
take care of these pennies, the pounds of
ill health will take care of themselves —
that is, the mild and often overlooked
trivial complaints are really destroying lives
of men who do not know that anything is
wrong, and the cure of some minor pus
focus which is industriously poisoning the
whole system, may cure a baffling general
condition in some patient whom we are apt
to condemn to life-long suffering as an in-
curable neurasthenic. Nothing can be more
important, then, than to search for chronic
pus foci and cure them.



Insanitary American dental bridges are

receiving some pretty harsh criticism in
England and have been under the ban for
a year or two because of the revelations as
to the harm done by oral sepsis. It is
claimed that unless the tongue can get under
the bridge freely to dislodge particles of
food, the apparatus becomes a foul culture
tube of about every kind of organism which
can kill us. They set up local disturbances
of a septic nature and give rise to gastro-
intestinal sepsis with all the after effects
of autointoxication. Physicians are now
sending such cases to the dentist to have
the bridges removed, for in no other way
can a cure be obtained. These are all
serious charges, and we would beg our
dental confreres to take up the subject with



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a view of preventing such insanitary work
in' the future. J. P. Colyer (Pro, Roy. Sc,
of Med,, Mar. lo, 1913) goes to the ex-
treme of advising the extraction of all
carious teeth in children, though we pre-
sume he excepts small cavities which can
be properly filled. He says that no doubt
there will be some contraction of the jaws,
and the permanent teeth come in crowded,
but he declares that this can be corrected
later, and even if not corrected it is a very
minor damage compared to the dreadful
systemic results of constant toxemia from
foul teeth. American dentists are inclined
to protest agains the extraction of decid-
uous teeth, but Colyer says that he does
not hesitate to take all out if all are oflFend-
ers, for they may cause permanent destruc-
tion of health or even death from supple-
mentary infections due to lowered resist-
ance.

The decayed teeth of school children

are far more dangerous than we have
formerly believed. Those pioneers who
have been urging dental work in schools
are not officious busy-bodies trying to
create jobs but jare public benefactors de-
serving of commendation. Parents, as a
rule, are horribly negligent of their chil-
dren's teeth, even intelligent ones are ig-
norant of oral hygiene. It would be a wise
move then for the family doctor to look into
the mouths of his little patients as a routine
part pf his examinations. He might find
the cause of many an obscure case. It is a
well known fact that a group of children
whose teeth are kept in good condition, are
far healthier, brighter, and better developed
than an identical group in identical condi-
tions but who are poisoned by discharges
from carious teeth and diseased gums. It
is thus proved that from infancy to old age



we are in constant danger of developing
fatal diseases as a result of toxemia from a
very insignificant pus focus in the mouth.
This is an enormous hygienic field for cul-
tivation, and the family physician will be
miraculously successful if he is on the con-
stant lookout for these minor affections un-
dermining health. If only half is true as
to the statements relative to the develop-
ment of tuberculosis in persons suffering
from chronic poisoning, it would be well
for our antituberculosis societies to include
oral hygiene as a part of their crusade.



Therapy of the colon is destined to loom
up large in the future and we must again
take up the discarded intestinal antiseptics
with the hope of finding some which are as
truly specific for bacteria as emetine has
proved to be for amebae. Vaccines may
solve the problem if we can find the offend-
ing bacterium, but unfortunately the orig-
inal culprit is not infrequently driven out
by later invaders which are not able to start
disease themselves but, like a mob of riotous
looters, become active when defense is
weak. Metschnikoff's Bulgarian lactic acid
bacillus has accomplished phenomenal re-
sults, but is disappointing in certain cases.
Where there is sagging of the intestines
and delay in flow of their contents, Lane
has succeeded marvelously by supporting
the abdomen with a truss and administer-
ing a half ounce of Russian liquid paraffin
a half hour before meals. The oil acts
mechanically as a lubricant, as it cannot be
saponified and undergoes no chemical
change. It passes through with the feces.
The. American mineral oils do not succeed
so well as they contain sulphur — ^particularly
the western product. Hence the fluid
paraffins (white oil, petroleum, etc.) made



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I New Series, Vol. YIII, No. 11.



from them are irritating- to the intestines
and are said to have caused nephritis. They
also contain a high percentage of add and
fluorescent hydrocarbons of the pentane,
hexane series, all of which are also irritat-
ing. For these reasons the Russian oil
must be g^ven as it is free of sulphur and
the undesirable hydrocarbons. Finally, if
the colon is incurable, we must decide
whether to short-circuit it or remove it —
and this must be decided by the surgeon.
All these matters should really be made
known to laymen to popularize the idea that
small illnesses and local suppurations usually
considered trivial, may in fact start a chain
of diseases which bring death several dec-
ades too soon. The dentist alone has be-
come an enormously important factor in
preventing chronic invalidism and in pro-
longing life.



Journalistic responsitaility for honest
advertisements seems to be an accepted
part of the ethics of the profession. The
time has long gone by when the business
office of any periodical would accept an
evidentiy fraudulent advertisement and then
calmly shift responsiblity to the buyer tell-
ing him to look out for himself. The ques-
tion has been carefully studied in the
Columbia School of Journalism, and, ac-
cording to The N. Y. Times: —

"In the course of the discussion, as was
inevitable, the old idea of "caveat emptor"
was brought forward in a way to show that
some of the students had brought with them
into the school vague notions as to the
purchaser's duty to look out for himself —
notions which, though true enough when
properly understood, have been made an
excuse for a vast amount of shabby deal-
ing and hardly less of fraud and theft.
Before the debate ended, however, all the
members of the class had settled on the
commendable view that a newspaf>er is
bound to take reasonable care, with every



advertisement printed, to see that the rep-
resentations in it are made in good faith,
and that it comes from those whose purpose
to tell the truth can fairly be assumed.

That all "doubtful'* advertisements should
be excluded was also decided. Noble
counsel that, but before accepting it as a
rule for practical application one would like
to know a little more as to how the boys
defined the word "doubtful." Is no allow-
ance whatever to be made for the seller's
enthusiasm, and is publicity to be denied to
him on the possibility that a rigid investiga-
tion of his claims in behalf of his wares,
whatever they may be, might disclose that
they are not quite as much better than those
of his competitors as he says? To do that
would be "restriction of trade," indeed,
and might get the meticulous doubter into
trouble with the Interstate Commerce Com-
mission or even the Supreme Court.

"Reasonable care" and "due diligence"
are all that can be expected in the present
state of the world — and both, by the way,
are as much to be expected from the buyer
as from the journalist."

Medical advertisements in medical
jonmals require even greater care and dis-
cretion because of the radical differences
of opinion among therapists. The main
point is not to weed out errors and mistakes
— a matter of a life time even in revising
a dispensatory — ^but to exclude deliberate
fraud and falsehood. What one physician
considers highly valuable, another may de-
nounce as worthless and too often it is
because he gave it in wrong ways and
amounts. The early use of tuberculin was
almost universally fatal, . and if medical
journals had excluded all mention of it
from their columns, the world would have
been deprived of the wonderful good it is
now accomplishing. A small group of
men cannot possibly know enough to ex-
press safe opinions on all the drugs used
throughout the civilized world. The op-
position to the verdicts of self-constituted
judges and councils is due to the fact that
they now and then denounce what others



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EDITORIAL COMMENT



5 AMBBICAM MBDICIKB

( Complete Series, Vol. ZIX.



705



have found to be not only useful but valu-
able.

Neither American Medicine nor any
other journal should care to refuse publicity
to what it considers error but what many
of our best men have found of high value.
Our efforts are consequently directed to de-
tect deliberate attempts to deceive our read-
ers and protect them to the best of our
ability against those whom we find to be
fraudulent and dishonest. We realize that
we are not infallible and in spite of all pos-
sible vigilance will make mistakes from time
to time. We will be grateful to any of our
readers, therefore, who will cooperate with
us by pointing out any advertisements
which may slip in because the fraud is
hidden, or we have been deceived.

As for deciding what to use and what to
avoid in any given case, that is a matter
which the colleges try to teach, and the
medical journals are the mediums for the
discussion of views and the publication of
advances. The family physician must have
brains and use them, for if he takes his
opinions second hand from those who may
not have had his opportunities to observe
cases locally, he is not doing the right
thing by his patients.



The gennicidal power of arsenic and
mercury are far from being understood.
The general impression has always been
that they have a selective action on spiro-
chetae which they poison to death though
the solution is too weak to aflFect the body
cells of the host. Like quinine in the
case of the Plasmodium, they are considered
specific poisons, though all specifics are
poisonous to us if taken in too great a
quantity. There is evidently another fac-
tor according to Dr. A. G. Brown of Rich-
mond, Va., who discussed the matter in
the Virginia Medical Semi-Monthly (Oct.
25, 1912). He calls attention to the fact
that the Wassermann reaction is negative



after mercury is administered and while
spirochetae are still found in the unhealed
lesions. He is inclined to believe that this
is due to the destruction by meVcury of
the bodies causing the Wassermann phe-
nomenon, the mercury being a very feeble
spirjUicide, and requiring several years to
eliminate the parasites. Arsenic on the
other hand in the large doses possible with
salvarsan is much more of a spirillicide as
the spirochetae promptly disappear, but as
the Wassermann reaction continues positive
the arsenic evidently does not aflFect the
syphilitic poisons. Mercury, then, prevents
symptoms from appearing though the case
may be far from cured, while arsenic causes
symptoms to fade from the destruction of
the spirilla, although we now know that
it too does not cure. This is a very inter-
esting hypothesis, and it is mentioned to em-
phasize the fact that we are far from under-
standing why specifics are specifics. There
is still an empirical basis even for the exact
results of laboratory experiments. Brown
quotes Levy-Bing (Oxford System of
Syphilis) as suggesting that mercury
strengthens the system in some way and
enables it to dispose of the spirilla. Many
cases spontaneously recover in spite of this
aid, and indeed there may be a modicum
of reason in the administration of "altera-
tives" by the old physicians. They must
have seen good results now and then, if
these new speculations are correct Per-
haps we may see a return to some dis-
carded drugs as adjuvants in the after-
treatment by mercury when arsenic is the
primary reliance. We have seen just as
remarkable returns of other drugs to favor
and should keep an open mind in this
matter. The new therapy is still a matter
for discussion, and has thus made it neces-
sary to find out why alteratives are al-
teratives. It seems to be a chemical prob-
lem, and is one more link binding the
chemists and therapists together for team-
work.

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infi AMBSicuf Medicine \ irnTTnnTAT r*nitritn?MT J Novembbb, 1913.

«vO Complete Series, Vol. XIX. f editorial comment | ^^^ g^^j^^ y^, vill, No. 11.



Charles McBubney, M. D.,
Died Nov. 7, 1913.



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MEN AND THINGS



( AMBSICAM BiODICINB

) Complete Series, Vol. ZIZ.



707



MEN AND THINGS.



The Staten Island Sea^View Hospital
for Tubercidosis has been opened for the
reception of patients and already is filling
up. It will accommodate i,ioo of the 4,000
consumptives of New York City who are
in urgent need of hospital care, and will
probably have a far greater public benefit in
popularizing knowledge of methods of cure
which will reach the estimated 30,000 New
Yorkers who are in the incipient stage. That
is the problem of the consumptive just
beginning to be solved. Whether the people
can aflford to solve it is a question now giv-
ing serious concern to thoughtful philan-
thropists. This hospital cost thirty-five
hundred dollars per bed, and to reach all the
sufferers, a hundred million dollar plant
would be necessary, not to mention cost of
maintenance, which cannot be much less than
fifteen million dollars a year. This is ap-
palling, of course, but should not discourage
us from doing what we can. Luckily the
number of consumptives has been progress-
ively diminishing for nearly forty years,
and the decline seems destined to continue.
The death rate from tuberculosis of the
lungs in New York City has declined from
341 per 100,000 in 1890 to 190 in 1912, and
may soon be as low as London's 135 or
Hamburg's 120.

The plan of the ISea-View Hospital seems
to be the last word in housing the tubercu-
lous, but there is a well grounded fear that
it has carried one matter to excess. It was
designed years ago when everyone repeated
parrot-like, the alleged necessity for an ex-
cessive amount of light. The best phthis-
iographers now rarely mention it, because
they have found that cures are good and
permanent in places noted for lack of light.
Moreover in all places, the cases improve
most in the dark season, while most if not
all go backward in the light season. The
chief exponent of light baths, RoUier of
Leysin, Switzerland, cannot use them in
summer and finds them injurious to blonds.
Even the brunets do not improve unless
they take on a heavy coat of tan which
keeps out the light. RoUier's critics are
bitter in their denunciation of his methods,



and claim better results without exposing
the naked bodies to the sun. Rollier care-
fully shades the head to prevent pain from
the glar€, while at Sea- View, the face is
the only part which the light reaches. We
are much afraid that the excessive number
of glass windows and partitions without
shade will only give a painful glare and that
the results from March to September will
not be good. With this exception, the de-
tails leave nothing to be desired in the way
of prevention of spread of infection. Still
one cannot help asking why it is necessary
to go to such extremes, if it is true that
no one is ever infected in adult life. The
popular phthisiophobia of the days when the
plans were laid is now a thing of the past.



The sudden death of Dr. Charles
BIcBumey has directed public attention to
the fact that though he was one of the
world's great surgeons, his fame seems to
have centered on the one fact that he helped
to make the diagnosis of appendicitis easier.
Long after the world has forgotten his great
operative achievements, he will be remem-
bered through "McBurney's point" which
every physician now instinctively looks for
in cases of abdominal pain. He deserves
his fame for he was an exceptional man.
Untold thousands of others had found pain
and tenderness located at that spot, but no
one else ever dreamed of making any
special deduction from it. Few of us are
able to see what we look at — a fact noted
by philosophers for thousands of years.
These few attain renown in proportion to
the good to mankind resulting from their
discoveries. Dr. McBurney retired from a
highly successful professional life a few
years ago, and it was hoped that he would
enjoy his honors and fortune in a long
happy leisure. But life seems prolonged in
those who stay in the harness.



Tuberculosis following acute or chronic
enteritis has been discussed by Drs. M.
Loeper and Ch. Esmonet in La Tribune
Medicale of Mar., 1912. This is evidently
an old observation in France, for they men-
tion the theory that the enteritis merely pre-
pares a port of entry for the tubercle
bacillus, but as we are constantly taking in



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MEN AKD THINGS



( NOVBHBBB, 1913.

\ New Series. Vol. VIII. No. 11.



living bacilli, these few extra ones should
not do any appreciable harm. There must
be another reason and the authors think it
is the reduction of resistance from the in-
terference with digestion and assimilation
during the enteritis. Acting upon this idea
they have apparently prevented tuberculosis
after such cases by a liberal diet of fats
and proteins. All this is exceedingly inter-
esting and important from another, point of
view. The recent discovery that typhoid
fever is a frequent precursor of tuberculosis
raises the suspicion that these cases of
acute and chronic enteritis were really ty-
phoid fever. If they were typhoid, then we
have one more reason for dreading that
infection, and also additional proof of the
safety and necessity of liberal feeding in
that wasting disease. Under the classical
milk diet — so contrary to the proud boast
"he fed fevers" — the patient comes out of
the fever pale, thin, weak and thoroughly
exhausted mentally, nervously and physic-
ally. No wonder that in so many of them
a latent tubercular focus lights up and de-
stroys them. This alone is sufficient to ac-
count for the facts not to mention the un-
doubted destruction of tubercular resistance
by the typhoid toxins. If the cases of en-
teritis were not typhoid but due to some
other bacillus, the process is the same. It
is quite essential then in every case of en-
teritis to think of the possibility of a latent
tuberculosis subsequently developing, and
to take dietary and other measures to keep
up the patient's resistance. It would be
well to paste in our hats two big letters
"F. F." and when anyone asks what it
means explain that it means we must "Feed
Fevers."



A decrease of crime in England is now

reported and it is a welcome relief from the
monotonous and dreary wailings of pessi-
mists who have been telling us that mankind
was getting worse and worse and the world
going to the demnition bow-wows generally.
Few have believed it of course, and they
have been deceived by the greater fre-
quency with which crime is detected. There
are little outbreaks here and there, as with
the New York gunmen and the Paris auto-
mobile bandits, but these cases excite atten-
tion by their infrequency, for they were



common occurrences in the slums of all
cities a century ago. The medical interest
in the decrease of crime, is due to the fact
that it is an indication of increasing public
health. We can now accept it as proved
that the great majority of criminals are of
such frail physique and poor nervous sys-
tem that they cannot make a living except
in a parasitic way. Many — ^perhaps most
of them — can be cured if caught young
enough, and even if they are instances of
quite a high grade of arrest of mental de-
velopment, as most young criminals are,
they can be taught how to make an honest
living. We are now told that at least two
per cent, of the children in the graded
schools are mental defectives who cannot
profit by the course of instruction. They
are the ones who furnish the criminals for
the reformatories to cure. It is claimed
that if these defectives are trained in special
schools by special teachers they will be
cured or at least kept out of prison. We
wish we could believe it. Although there
is no question of the necessity of special in-
struction, the main point is wholesome and
ample food, as there is little doubt that the
main reason why they are largely^ devel-
oped in the slums is the poor quantity and
quality of their nourishment. They are
really starved and cannot develop properly
until properly fed. This is perhaps the
main reason for the excellent results of in-
stitutional treatment where the food is not
stinted. "He fed fevers" is a glorious
epitaph for a doctor, but let it be known
that good results of reformatories may also
be largely due to the fact that the inmates
are well fed. To go back to the decrease
of crime then, it is a legitimate conclusion
that the sanitary crusade of the last fifty
years in England is now bearing fruit in the
lessened production of weaklings who exist
as parasites. Not only are people better
fed, but they largely escape other harmful
factors which prevented proper develop-
ment. For every dollar spent on sanita-
tion we may eventually save one now spent
for criminals.



The suffragette mania for violence has

reached a point where it has stirred the
whole British Empire— as the women in-
tended. Unfortunately this stirring up has



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MEN AND THINGS



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Online LibraryNew York (State). Board of Railroad CommissionersAmerican medicine → online text (page 106 of 131)