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of the preceding year in another school. But no school can advance a
student or give him credit for attendance upon lectures under any other
conditions.

For the last two years — and we presume during previous years —
several of the Southern schools have admitted students to advanced
standing, allowing them one or more years' credit, who presented no
evidence of attendance upon lectures except matriculation and labora-
tory tickets, which were issued to admit the students to the school and
to the laboratories only, and did not indicate that they had completed
the work in any department, or attended lectures at all. This practice
was not discontinued after official notice that such students were not
entitled to credit for attendance upon lectures. This is a practice that
should not be tolerated by the medical profession, and any school that
will persist in such irregularities should not be recognized as comply-
ing in any sense with the requirements of State Boards of Health or
State Examining Boards, and their graduates should be refused
recognition.

This is a timely warning, especially in the interest of these colleges,
for if they do not take warning very soon it may be too late.



Hotes anb filueries*



LooMis Sanitarium Fire. — Although the administration building of
the Loomis Sanitarium was totally destroyd by fire on October i4tb, the
work of the institution has gone on uninteruptedly, the Casino Building
having been temporarily adapted to the purpose of administration. It is
expected that a new administration building will be completed within a few
months. None of the patients' cottages were at all injured by the fire. —
Medical News.

A Remarkable Yarn about a Jealous Doctor.— On Thursday of
last week the Mail and Express published an account of the case of a blind
man, related by himself, who declared that some years before a certain
physician who was at the time a friend of his had treated him for some eye



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The American Practitioner and News. 437

trouble, but without success, whereupon another physician was called in.
The second doctor was successful for a time, but eventually he, too, failed
in the case, which went on to complete blindness. The first doctor, it is
gravely asserted, confessed on his deathbed that out of jealousy he had
surreptitiously drugged the ailing man in such a manner as to produce
blindness ! What a pity that he did not reveal the name of the drug. — New
York Medical JoumaU

Can White Men Live in the Tropics?— A writer in the British
, Medical Journal is much distressed because Benjamin Kidd, the author of
*' Social Evolution," has recently published a series of articles attempting to
show that it is impossible for white men to become acclimatized in the topics.
So sure is Kidd of his position in the matter that he predicts that ** in the end
there can hardly be room for any important difference of opinion." He also
speaks of the "innate unnaturalness of every attempt to reverse by any effort
within human range the long, slow process of evolution which has produced
such a profound dividing line between the inhabitants of the topics and
those of the temperate regions." This is decidedly dogmatic, and, moreover,
his pessimistic opinions are quite at variance with evidence brought before
the Royal Geographical Society last April by Dr. Sambon to show that the
causes of disease, deterioration, and deaths in the tropics are due to patho-
genic germs, which have their limited and peculiar geographical areas,
and differ greatly in the various tropical regions. If heat were the difl&culty
in the way, of course acclimatization would be altogether hopeless. " There
appear to be good reasons, however, to believe that th^ real enemy is the
microbe; and, if so, we may hope to fight against it in the tropics as success
fully as has already been done in the temperate zones by sanitation and the
gradual acquisition of immunity. This doctrine is strongly supported by
some of the highest authorities in tropical pathology."

Dr. Manson, who has writen a book upon this subject, and Dr. Rho,
director of the Medical Department of the Italian Navy, are also thorough
believers in the possibility of tropical acclimatization. **The death-rate of
European troops in the tropics, which used to be from 100 to 129 per 1,000,
is now as low as 12 per 1,000 in India. In Trinidad and Barbadoes the sick-
ness and mortality among European soldiers are actually less than at home.
The Boers are the finest men in South Africa. The Portuguese under
unfavorable social conditions have been totally absorbed in India, but in
Guiana and Brazil they have thriven remarkably well. Spaniards and Ital-
ians have become completely acclimatized in the tropical parts of both
North and South America. The death-rate of Spaniards at Cuba is less than
in Spain, and their birth-rate is greater." Unfortunately, the question has
heretofore been discussed mostly by geographers, statesmen, and journalists.
Now that the attention of medical men is turned to it, there is every reason
to believe that the conditions for successful life in hot climates will become
more thoroughly understood. It is to the microbe of the topics rather than



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The American Practitioner and News.

jat that attention should be directed. The diflferent experiences of
in ships and the men on land at Santiago proved this beyond ques-
^e have annexed leprosy in Hawaii and yellow fever in Cuba. If
:t to do justice by the tropical islands which have so suddenly come
possession, we must learn to live on them. This is the immediate
of the medical department of the Government. — Medical News,

MPORTANT Legal Decision in Medical Consultations. — The
Medical and Surgical Journal for October 26th says that a case of
able interest to medical men has recently been ordered to be retried'
ppellate term of the supreme court. A bill of- two homeopathic
ns, of seventy dollars for the attendant, and a hundred and seventy-
irs for the consultant (who made six visits), in a case of fractured
ras disputed by the patient, who was left with a stiflf joint and inter-
ith a counterclaim for five hundred dollars damages for malpractice,
xth municipal court the full amount of the bill was awarded to the
ns. In giving his opinion in favor of the reversal, Justice McLean,
ne court, concluded as follows: "There was no justification by custom
vise in plaintiff's epiployment of Dr. Roberts (the consultant) with-
nk and full statement of the situation to the patient and the defend-
patient's husband), and learning their wishes concerning the
)nal persons to be brought in. There can not be properly applied
acts shown here any custom multiplying ordinary professional
five or ten times under the shield of a layman's ignorance, because
irersive of justice that charges should be so largely increased by a
lot made known at all to the patient or to her husband." — New York
/ournaL

Excitability of Motor Nerves. — The excitability of the mo-
es in different segments of their course has just been the subject of
id carefully conducted series of researches by K. Eickhoff, of Mes-
1 the Tiibingen Laboratory, who has published his results in the
)er number of Pfliiger's Archiv fur Physiologie. Many of the older
excellent observers experimenting on the sciatic nerve of the frog
and divided at as high a point as possible have satisfied themselves
; nerve exhibits a greater degree of excitability for electrical stimuli
ime strength in the upper part of its course than below, an effect
eidenhain attributed to the section. More recently, however, those
e made experiments on the completely uninjured sciatic nerve have
at this nerve possesses the same degree of excitability throughout
t course. Those who have experimented on some of the nerves of
Is which pursue a long course, such as the phrenic and the vagus,
ived at the same conclusion, not only where the stimulus applied
•nstant current or a breaking shock of an induction apparatus, but



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The American Practitioner and News. 439

also when it was of a mechanical nature. Eickhoff experimented on the
sciatic nerve of the frog and applied the current of an ordinary induction
apparatus, the uniformity of action of which had been carefully tested. He
also examined the effects of chemical and of mechanical stimuli. The gen-
eral results which he obtained were first in regard to electrical currents —
that when the shock was sharp and sudden the excitability of the nerve in
its proximal and peripheral segments was about the same, but for currents
which slowly rose in intensity the lower segment was much less excitable
than the upper, the strength of the current having, in fact, to be about
doubled to obtain the same result. As to chemical stimuli, on the other
hand, they undoubtedly acted much more strongly below than above; weak
chemical stimuli, indeed, acted inhibitorily upon the muscle when applied
to the upper portion of the nerve, and caused relaxation of the muscle.
Persistent tetanus was rarely seen, and then only after the action had been
long continued. Mechanical stimuli, such, for example, as from 150 to 400
milligrammes falling from different heights, as from one to several hun-
dred millimetres, always acted more stongly when made to stike the nerve
at its upper part than below ; smaller weights falling from correspondingly
greater heights, and hence with considerable velocity, acted more strongly
than heavier weights falling less distances and therefore with less velocity.
What conclusions can be drawn from these results of experiments in regard
to the nature of nerve excitation ? asks Mr. Eickhoff. In a strict sense, he
admits, none; but he points out that if the water from a reservoir passes
through a long tube made of different materials and with walls varying in
thickness though having everywhere the same lumen, the water will flow
equally and continuously ; but if a weight presses on a thin-walled portion
of the tube it will compress it, or, supposing the tube to be very thin-walled,
it may possibly undergo dilatation, as by removal or reduction of the pres-
sure of the atmosphere, and we may consider the action of different stimuli
upon nerves to be explicable in the same way. One stimulus may pro-
mote, another may reduce, the excitability of a nerve, and so, as Gotch and
Macdonald have remarked, ;we can not correctly speak of the varying excita.
bility of one and the same nerve in different parts of its course without
knowing the nature of the stimulus which has been applied, for the part of
the nerve stimulated may react very differently towards different stimuli.
The nerves can no longer be regarded as mere telegraph wires in which
various processes difiering only in regard to their strength originate and
travel ; but, as Hering has quite recently advanced in his ** Theory of Nerve-
activity," they must be considered as fasciculi of living arms which are
extended from the elementary units of the nervous system — that is to say,
the ganglion cells — and are capable of qualitatively different excitation.
Hence our conception of the excitability of a nerye must progressively
widen, and should not be limited to the question of how a nerve reacts to
an opening induction shock. — Lancet,



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The American Practitioner and News.

: Dangers from Infectious Diseases in Public Libraries.
danger of infectious diseases being acquired through the books of
ibraries, especially circulating libraries, has been under consider-
r a number of years. The recent report of the deaths from consump-
jeveral clerks who had been engaged in sorting old files of books and
a practical demonstration that forces upon the guardians of public
J grave responsibilities and additional duties. Experiments have
ide looking to the discovery of the best method of disinfecting books ;
►d that would be efficient and at the same time not injurious to the
5 subjected to the disinfectant. The Medical News, August 8, 1886,
td a series of experiments showing that formalin was the agent par
ice for use in this work. It neither discolors articles subjected to its
lor does it render them more liable to the corrosive action of time,
other hand, it renders articles subjected to treatment entirely clean,
e has come, therefore, for all public libraries to have attached to them
acting plant where all books, pamphlets, magazines, or documents
^e been taken from the library may be thoroughly disinfected before
^turned to their shelves. — Medical News.

Rules and Regulations of the Thirteenth International
CSS of Medicine to be held in Paris. August 2-9, 1900. — All
of medicine may become members of this Congress by making the
application and paying Five Dollars. The Secretary General in
is instructed the American National Committee to receive the appli-
of American physicians and to return a receipt for the amounts sent,
pplications and the money are then to be forwarded to Paris, and in
e cards of admission to the Congress will be distributed to all sub-
Members desiring to present papers will forward them to the
•y of the Section to which they belong, for each Sectional Committee
; the right of drawing up its own working programme. — Ibid.

Es Subsiding about Buffalo.— State Agent M. Quigley, of Buffalo,
n November ist that the cases of rabies in Erie and Niagara coun-
being steadily stamped out. He accords considerable praise to the
f the city of Buffalo for their effective work in capturing and muz-
betic dogs. — Ibid,

:a " has maintained its reputation as a powerful nerve stimulant, being used
d results in nervous debility, opium and alcohol habit, etc. The highly vari-
acter of the commercial drug makes it uncertain, however. Robinson's Wine
\ advertisement in this issue ) we believe to be a uniformly active article, it
epared from assayed leaves, the percentage of Cocaine being always deter-
r careful assay.

lETTo IN Prostatitis, Cystitis, Chronic Gonorrhea, and Vesical Irri-
-I take pleasure in saying that Sanmetto in my hands has proven its superi-
other remedies in prostatitis, cystitis, chronic gonorrhea, and general vesical
I. I prescribe it with confidence every time, and in cases not attributable to
:al causes I feel sure of relief every time. In gleet its action is marvelous,
: cases yielding readily, and I shall continue its use.
:rson, Ind. Oran E. Drui^KY, M. D.



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THE



American Practitioner and News.



'NEC TENUI PENNA."



Vol. XXVIII, LoxnsviLLE, Ky., December 15, 1899. No. 12.

Certainly it is excellent discipline for an author to feel that he must say all he has to say in the
fewest possible words, or his reader is sure to skip them ; and in the plainest possible words, or his
reader will certainly misunderstand them. Generally, also, a downright fact may be told in a plain
way ; and we want downright facts at present more than any thing else.— Ruskin.



©riginal Clrticles.



HYGIENE OF THE NOSE.*

BY W. CHEATHAM, M. D.

The nose is one of the most important organs of the body. By its
exposed position and the offices it has to perform it is rendered one of
the open doors of infection, and yet we hear of but little as to the
importance of keeping it clean. We are taught the importance of
hygiene of the mouth, of the body, and of the hair, but little concern-
ing the nose, which is the " rubber-necker " which is expected to dis-
cover any laxity of cleanliness of other parts of the body or the air
around us. When we consider the offices of the nose, that it is for
olfaction, audition, phonation, respiration, and is much concerned in
taste, sight, and digestion, it will be seen that an obstructed nose will
aflFect almost every organ of the body. All of us know how dull our brains
are if we have nasal stenosis. Hygiene of the nose has much to do with
this. Of course, if the obstruction is from bone, cartilage, or growths,
simple hygiene will not give relief, but it might have prevented much of it,
and after the removal of the cause will prevent recurrences. Unless the
nose is kept well open and clean the olfactory nerves can not do their
work. When smell is destroyed or interfered with it is best not to
follow that advice of old, to " follow your nose," as it might lead you
into trouble. If smell is not correct, taste is much interfered with, and
also digestion. If there is not free nasal respiration, mastication and
deglutition are defective.

* Read before the I«ouisvilIe Medico<<:hirurgical Society, November 3, 1899. For discussion see p. 464.

84



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The American Practitioner and News. 443

lieated to about body heat; that is, in normal respiration. It has been
proven that a normal nasal secretion destroys many bacteria and cocci,
and delays the growth erf many others. This secretion, if not kept
normal, loses this eflfect, and instead becomes a good fluid for their cul-
tivation. Almost all kin,ds of pathogenic germs found in other parts of
the body are found in the nose, many of the most dangerous commonly
so, others more rarely. This being a fact, can any one doubt the impor-
tance of nasal toilet? Can any one state how many cases of diphtheria,
scarlet fever, measles, and other such diseases can be prevented during
epidemics by proper nasal lavage? Epidemic meningitis is another
disease whijch in many cases might be prevented by the use of some
simple nasal spray, say even salt water, and especially DobelPs solution
or fluid. The nose and brain are closely associated. The nerve and
blood-supply are not only quite intimate, but between the two there are
only two membranes and a very thin plate of bone. What might not
proper nasal hygiene prevent? The nose is really one of the filthiest
parts of the body, yet who teaches its cleanliness ? The mother teaches
her child how to keep the body clean, how to attend to the teeth, hair,
and ear, but says little about the nose. Why? Because she is not
taught.

The nose is not an easy organ to clean. - It stands often but little
interference ; the mildest solution often causes bleeding, and produces
soreness about the wings. The turbinal bones are so placed and shaped
that it is very difiScult to reach over and under them ; in fact, there is
but one way to do it thoroughly and safely, and that is from behind
forward. I say safely, and yet that method is not safe, as fluid is liable
to be forced into the ear and the sinuses. This method and the nasal
spray, though, I consider the most thorough ' and safe. The cry
recently, "Down with the spray,*\is, I think, a mistake, because no
better and safer method is offered as a substitute. The douche is
thorough, but, unless the nose is well open and great care exercised,
the fluid used will enter all the sinuses and force the unclean
secretions ahead of it. All of us have seen such results. The oil
sprays are I doubt of much service except in a few cases. The douche,
theoretically and practically, is the best cleanser, but it is, as we
all know, dangerous. The danger is much lessened if it is used
from behind forward. There are but few patients who can use it this
way. I believe the water spray is the best. It is not well to use much
force in cleansing the nose ; the parts are easily bruised. Instead of



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The American Practitioner and News.

I force we must depend, in a majority of cases, upon mild alka-
and saline solutions to dissolve inspissated secretions and to excite
mosis. Whatever method is used, do not let the patient blow the
much immediately after the cleansing ; snuflF back and get all the
ion from the mouths of the eustachian tubes and the openings of
sinuses, then blow. I have seen several cases of "hay fever"
1 benefited by one of the simple solutions used in a spray. I have
many to tell me that, by using the spray all the time, the
ity of the attack was much decreased. Powder insufflations as
Lsers are, I think, of little good. Again I repeat, the spray is the
r for general use. It should be used three times a 4ay at least
• one has been out in the dust a simple spray is of much comfort,
if used properly, may save a great deal of trouble. Nasal hygiene
rly life is much neglected. If properly carried out, much trouble
ter-life can be prevented.

DUISVILI/B.



lALL-STONBS IN THB COMMON DUCT: THEIR DIAGNOSIS
AND TREATMENT.

BY F. WARREN SAMUEL, A. M., M. D.

'ssor of Surgery and Clinic ^ Kentucky School of Medicine ; Surgeon City Hospital: Surgeon to
Kentucky School of Medicine Hospital, etc,

t a meeting of this Society one year ago I presented a paper upon
1-stones : their Etiology, Diagnosis, and Treatment," dealing then
ly with stones in the gall-bladder. This evening I wish to deal
^ with stones as they appear in the common duct. So much
has recently been done upon the common duct, both experi-
ally and at the operating-t^ble, and our knowledge has been
istly added to, that the surgery of the biliary passages has so far
need that the indications for intervention have changed the com-
on of a disease which half a decade ago was considered hopeless,
/"hile gall-stones when located in the common duct are far less
ent than in the gall-bladder or cystic duct, the serious disturb-
5 from obstruction to the flow of bile and the remote consequences
3 great that no comparison can be drawn between surgery of the'
>ladder and common duct as to the gravity of the operation. To
1 my cases to you this evening would be, in a great part, a monot-
s repetition ; therefore I have, on the other hand, decided to pre-



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The American Practitioner and News. 445

sent to you the most notable features in their symptomatology and the
condition found at the time of operation, with a few remarks upon the
surgery of the common duct as a more interesting basis for discussion.

The Frequency of Choledochus Stones. The ratio between gall-stones
observed in the gall-bladder alone and the common duct is a wide one.
Dr. Fenger, quoting Courvoiser, states that Fiedler, in eight hundred
autopsies, only found gall-stones in the common duct in two cases.
Courvoiser, in two hundred and fifty-five cases of cholelithiasis, found
in ten cases alone stones in the common duct. Conradi, in ninety-seven
cases of gall-stone, found common-duct stones only five times. Kehr
of Halverstadt, in one hundred and seventy-four operations for gall-
stone, found common-duct stones in thirty cases, an exceptional expe-
rience. So far as I can ascertain, Fenger, with a vast experience, only
reports six cases. In fifty-four operations upon the gall-bladder and
ducts I have opened the common duct in eight cases for stones. This
extends over a period of eight years and a half. It is evident from the
literature of the subject, taken from the experience of careful observers
with a large field of work, that stones in the common duct bear a small
ratio to those found in the gall-bladder and cystic duct. While com-
mon-duct stones are greatly in the minority, the seriousness of the
symptoms and remote consequences will make themselves felt by reason
of the gravity of the operation, especially at times. I say at times,
because there are cases where pathological conditions contiguous to
the common duct will add danger to the operation when an attempt is
made to isolate the duct and remove the stones. In the cases operated
upon by me the following symptoms were notable, and mostly common
to all. I might add here that in only one did I venture to make the
diagnosis of a choledochus stone.

History. In every case a history of chronic indigestion was given
preceding the so-called gall-stone attack. Colic was a very prominent
symptom ; the location of the pain was far from constant. In the six
cases in which there were associated stones in the gall-bladder it was
referred to the epigastrium, with great tenderness, during an attack, over
the gall-bladder; in the remaining two cases pain was referred to the
epigastrium, or about the umbilicus or the right lumbar region and in
the back. In three of the cases pain and tenderness remained in the epi-
gastrium for a week or more after the colic had subsided, and was present
in a slight degree in all at times. In three cases it had not subsided
before the beginning of another attack. It was always of a severe



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The American Practitioner and News. 447

was noticed, and was dilated in all except one case, where a small float-



Online LibraryUniversidad de Buenos Aires. Facultad de Derecho yThe American practitioner → online text (page 104 of 109)