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Intubation in Syphilitic Stenosis of the I^arvnx. — Sargnon
{Arch. Prov. de Chir., August) holds that intubation as practiced by
O'Dwyer is the best method of treating laryngeal stenosis, especially that
of syphilitic origin. Tracheotomy, it is allowed, affords rest to the diseased
larynx, and, when combined with an active specific treatment, may be fol-
lowed by rapid and complete cure. But intubation, the author holds,
when practiced in similar conditions, gives the same results with greater
rapidity by reason of the mechanical dilation effected by the tube ; and,
moreover, it does not leave an external and visible cicatrix. The practice
advocated by Schrotter in chronic cases of stenosis, of performing trache-
otomy and afterwards gradually dilating the strictured larynx by bougies, is
not certain in its results, and in the rare instances in which complete cure
has been effiected this has not resulted until after a very prolonged and
tedious course of treatment. — Ibid.


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The American Practitioner and News.

"nec tenui pennA,"

Vol. 27. MARCH 1, 1899. No. B.

H. A. COTTELL, M. D., Editor.

A Journal of Medidoe and Surgery, published on the first and fifteenth of each
month. Price, $a per year, postage paid.

ThU journal is devoted solely to the advancement of medical science and the promotion of the
interests of the whole profession. Essays, reports of cases, and correspondence upon subjects of pro-
fessional interest are solicited. The editor is not responsible for the views of contributors.

Books for review, and all communications relating to the columns of the journal, should be
addressed to the Editor of Thb Ambucan P&AcnnoxcBK and Nbws, Louisville, Ky.

Subscriptions and advertisements received, specimen copies and bound volumes for sale by the
undersigned, to whom remittances may be sent by postal money order, bank check, or registered
letter. Address jOHN P. MORTON A COMPANY, Louisville. Ky.


** Fill the cup and fill the can,
Give a rouse before the morn ;
Every moment dies a man,
Every moment one is bom."

The pernicious effects upon the economy of the habitual use of
alcohol it would seem have been set forth with suflScient fullness by
the countless writers and speakers who, since Neal Dow " took down
his fire annihilator'* more than half a century ago, have carried on
a ceaseless crusade against this greatest handicap of human develop-

Many of the statements of these temperance reformers were doubt-
less exaggerated ; but not a few of the counter-statements made' by the
topers and their powerful allies — the liquor makers and sellers — have
been quite as much overstated and are more misleading. For instance,
an English authority, some three or four years since, published as truth,
backed by statistics, the statement that longevity in England was con-
ditioned by alcohol, as follows : Longest lived, moderate drinkers ; next
in longevity, liberal drinkers ; next, habitual drunkards ; shortest lived,
total abstainers. This looks like a home thrust for tippling, but, in
fact, can any accurate statistics as to the longevity of alcohol habitues
be obtained ? Since tippling is not an occupation or profession, the
period of drinking by the average tippler can not be fixed. Again,

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The American Practitioner and News, 195

not one in fifty of the cases of death which are indirectly due to alco-
hol are ever returned as such. And lastly, there can be no scientific
fairness in counting against abstinence, and thus enhancing the credit
of tippling, all the deaths due to accident, consumption, typhoid fever,
etc., during adolesence and early manhood. When these errors are elimi-
nated — ^in short, when correct statistics are obtained — there can be no
doubt that total abstinence will distance tippling in the race, for lon-
gevity by figures that will relegate the latter to a low place in the scale.
The following clipping from the New York Medical Journal of the
nth ult. should be carefully read by all who are inclined to hunt for
physiological excuses for drinking liquors :

The Epfbcts op the Habitual Use of Alcohol. — According to
the Dietetic and Hygienic Gazette for January, Dr. Crothers, of Hartford,
Connecticut, in a paper read at the New York County Medical Association,
October 17, 1898, discussed this subject in a very conservative and intelli-
gent way. He stated, among other things, that the ingestion of alcohol
accelerated the heart's action ten or fifteen beats a minute at first, but that
after a while the circulation became slower, so that the pulse-rate dropped
at least as much as fifteen or twenty beats below the normal. Vision, he
said, was always diminished and rendered unreliable by the ingestion of
alcohol. The acuteness of the sense of hearing was likewise impaired.
The increase in the pitch of the voice of persons under the influence of
alcohol was due to impaired hearing. Hallucinations of hearing were fre-
quent under such circumstances. The senses of taste and smell were also
influenced by alcohol. The sense of touch was always exaggerated or
diminished, and careful measurements of muscular force showed that the
muscular system did not escape the deleterious action of this poison. If
the temperate man suffered from the use of one or two ounces of alcohol
in this appreciable way, then the continual or frequent drinking of alcohol
must exert a distinctly deleterious influence. All experimenters agreed
that when alcohol was taken in excess the result was a profound tissue and
cell degeneration and general starvation of the tissues.

Alcohol, by its anesthetic action, soothed the irritable nerve centers,
and the effects were so pleasing that the individual desired to repeat the
experience. Often this desire to seek relief by its anesthetic effect was
really an indication of a diseased condition, which, perhaps, was disclosed
only by a post-mortem examination. A century ago the anesthetic action
of alcohol created dementia and idiocy, but to-day it was more apt to
cause delirium and paralysis. Heredity seemed to be one of the most
prominent causes of inebriety.

The last paragraph is suggestive of one of the most subtle and se-
ductive causes of alcohol addiction — namely, the use of liquor by nervous

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196 The American Practitioner and News.

women as a hypnotic. Every physician has neurasthenic patients who
go to sleep nightly on a large drink, or drinks, of whisky or brandy.
There is, perhaps, no more rapid road to inebriety than this, for to se-
cure the hypnotic effect the dose must be from time to time increased.

A patient who had become an alcohol habitue from this cause
recently consulted the editor. She informed him that she had begun
the use of whisky as a hypnotic some two years ago for the relief of
nervous insomnia, and that to obtain the effect she had been compelled
to increase the quantity until now she was drinking a quart of whisky
a day.

She had the florid, bloated countenance of an inebriate, and exhib-
ited a painful jactitation of body and an irritability of mind that bordered
on insanity, to which she is rapidly tending.

In view of these and many other facts, the same caution should be
exercised by the physician in prescribing liquors as in exhibiting other
enslaving drugs.

Hotes anb £lueries*

Points in the Arsenical Caustic Treatment of Cutaneous Can-
cers. — By William S. Gottheil, M. D. i. The arsenious acid caustic treat-
ment of skin cancers does not contemplate or depend upon the actual
destruction of the new growth by the caustic.

2. The method is based upon the fact that newly formed tissue of all
kinds has less resisting power than the normal structure when exposed to
an irritation and its consequent inflammation. Hence the former breaks
down under an *' insult " which the latter successfully resists.

3. If, therefore, the whole affected area can be subjected to the influ-
ence of an irritant of just sufficient strength to cause a reactive inflamma-
tion intense enough to destroy the vitality of the new cells, the older normal
cells will survive.

4. Arsenious acid of properly mitigated strength is such an agent, and
its application causes an inflammation of the required intensity.

5. It, therefore, exercises a selective influence upon the tissues to which
it is applied, and causes the death of the cancer cells in localities outside
the apparent limits of the new growth, where there is as yet no evidence of

6. It is superior, in suitable cases, to any method, knife or cautery,
which requires the exercise of the surgeon's judgment as to the extent to
which it is to be carried. That that judgment is often wrong, and neces-

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sarily so, is shown by the frequency of recurrence under these methods,
even in the best hands.

7. It is applicable to all cutaneous carcinomata in which the deeper
structures are not involved, and which do not extend far onto the mucous

8. It is easy of application; it is safe; it is only moderately painful,
and its results compare favorably with those obtained with other methods.

The Bacillus in Diphtheria.— Grigorieff(^r^^. de Med, des Enfants,
August, 1898) gives the following as the results of his investigations with
regard to the persistence of the diphtheria bacillus in the mucous mem-
branes of patients convalescent from diphtheria. In four fifths of the
whole number (36 out of 46) the bacilli disappeared very quickly, namely,
not later than a week after the disappearance of the membrane. In a tenth
(5 out of 46) the bacilli disappeared during the second week. In a tenth of
the whole number (5 in 46) the bacilli were found up to the end of the
third week. Bacteriological examination of the nasal cavities showed that
the bacilli disappeared about the same time, or nearly so, as in the throat.
An exception to this rule was when the nose was more severely attacked,
not always with the formation of membrane. The author's conclusion is
that the bacilli disappear or lose their virulence very early — as a rule dur-
ing the first two weeks. It must, however, be borne in mind that in some
patients the bacilli remain much longer than the period mentioned, and the
continued virulence of these has been demonstrated on animals. The
author concludes that the time of isolation must not be regarded as a fixed
period, but must depend entirely on repeated bacteriological examinations
of the nose and throat. These are of the highest importance in children
going to school or otherwise mixing with other children. In hospitals
convalescents should, as much as possible, be kept apart from those
patients who are in the acute stage of the disease. In addition to serum-
therapy it is of the utmost importance to irrigate the throat, mouth, and
nose until the patient can be pronounced cured. — British Medical Journal.

Mississippi Valley Medical Association. — The twenty-fifth annual
meeting of the Mississippi Valley Medical Association will be held in Chi-
cago, Tuesday, Wednesday, Thursday, and Friday, September 12, 13, 14, and

15, 1899-

It has been some twelve years since Chicago entertained a medical body
of national importance, and the profession of the city, under the Chairman-
ship of Dr. Harold N. Moyer, is determined that this shall be a notable gath-
ering in every respect. The Committee of Arrangements has in prepara-
tion a handsome souvenir booklet containing a history of medical Chicago,
which will also be the program of the meeting. In honor of the Associa-
tion there will be given, before and after the meeting, a series of clinics at
the various colleges and hospitals, a full description of which will be con-
tained in the booklet referred to.

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198 The American Practitioner and News.

Admirable arrangements have been made by the local committee for
the places of meeting, both for the general sessions and the medical and
surgical sections. The rooms of the Chicago Medical Society, which mil be
the headquarters before and after the meeting, for those who avail them-
selves of the clinics ofiFered, and the Columbus Medical Library are very
close to the place of meeting.

The annual addresses in Medicine and Surgery will be notable, deliv-
ered by prominent Mississippi Valley doctors, particulars of which will be
announced at a later date.

In order that a place may be secured on the program, titles of papers
must be sent early.

DUNCAN EVE. President, HENRY E. TULEY, Secretary,

Nashvii,i,b,Tenn. l,OUISVII*I,E, Ky.

The Lower Edge of the Liver.— Pichler {CentralbL /. inn. Med,,
September 10, 1898) says that it is recognized that the enlarged liver may
so bulge the abdominal wall as to be distinctly visible. He maintains,
however, that the lower border of the liver, which is not enlarged, may also
at times be seen. In observing Litten*s diaphragm phenomenon, the
author found it possible to see the shadow of the lower hepatic margin
descend with inspiration and ascend with expiration when the individual
was not too fat and the abdominal walls not too distended. The shadow
can be recognized only on deep breathing. It is best seen in the right lobe
of the liver, less clearly in the left. By changing the position of the
patient, different parts may be brought into view. The position adopted
in order to demonstrate Litten's phenomenon is the most suitable. Mete-
orism causes the shadow to disappear. There are two usual methods of
ascertaining the lower border of the liver, the one by palpation, which is
not always available, and the other by percussion, which is sometimes
deceptive. The author says that this simple method of inspection has
often sufficed when palpation was impossible, owing to tenderness. The
limits of other organs may also produce shadows which move with respira-
tion. — British Medical JournaL

A House Epidemic of Syphilis.— William S. Gottheil, M. D. : Thanks
to a better knowledge of the dangers and modes of transmission of sjrph-
ilis, and to superior habits of cleanliness, epidemics of the disease are rare
in America ; yet they occur among the lower classes of our population with
greater frequency than is generally supposed. In the New York Medical
Journal of March 26th the writer records one in which the disease was
introduced into the family, according to the history, by vaccination, and in
which every member of the family of eight was ultimately infected. The
first case was a child of two years; then the mother, aged thirty- four;
then two girls, aged nine and fourteen respectively ; then a boy of four ;
then a girl of seven, and then a nurseling, aged six months. The father

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1 he American Practitioner and News. 199

escaped until the last ; but late in the spring he came to the clinic with a
characteristic eruption, alopecia, etc. The cases were all severe; there
were several irites; all had obstinate and some very extensive mucous
patches ; and the two-year old child had a syphilitic pneumonia. The site
of inoculation was discoverable in two cases only, probably on account of
the lateness and irregularity with which the patients were brought to the
clinic. In the mother it was upon the center of the cheek, and in one girl
it was upon the eyelid. The family was very poor, living in one room, and
their habits were very uncleanly.

Large Families among the Poor. — At an inquest held on Decem-
ber 2d by Dr. Wynn Westcott at Bethnal-green on the body of an infant
found dead in bed, the mother of the deceased mentioned that she had fif-
teen children. The coroner remarked that he could not understand how it
was that the poor managed to keep such large families, whereupon a juror re-
marked : *' One or two don't make no diflFerence. Some grow up and help
to keep the others." After all, there may be more sound sense in this argu-
ment than might at first sight be supposed. Everyone who has any
experience of work among poor people knows how kind the poor are in
taking in an extra child for nothing very often, and sometimes for a small
weekly payment. We do not, of course, refer to baby farmers, but as a
matter of fact the charity of the poor to one another is above all praise, and
so perhaps the large family may not be so undesirable after all. The great
diflSculty in connection with such is not so much clothing or feeding but
proper house-room, and to find this with the exorbitant rents which are
being daily demanded in I^ondon is almost impossible. — Lancet.

Methylene Blue in Epithelioma. — M. I^andrewie {Gazette hebdom.
adaire de medecine et de chirurgie, December 18, 1898), in a thesis before the
faculty of Toulouse, after reviewing the various therapeutic applications of
methylene blue, asserts that it possesses analgetic, antimalarial, and anti-
septic properties. But he considers that it has a special action upon neo-
plastic tissues, which enables it in conjunction with currettage of the dis-
eased parts to give durable cures in cases of cutaneous epithelioma, in
which cases it should be preferred to less active measures. In recent cases
it assures a rapid cure ; in older cases, with extensive destruction, it should
be preferred, he thinks, to extirpation with the knife, for it permits better
limitation ; while, where excision remains the method of election, it can
still render useful aid as a preparatory treatment. — New York Medical

Hemorrhage as a Swn of Congenital Syphilis.— In the course of
the description of a case of hemorrhagic congenital syphilis appearing as a
hemorrhagic vesicular eruption. Dr. William S. Gottheil calls attention to
the importance of otherwise unexplainable bleedings in infants as symp-

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200 The American Practitioner and News.

toms of congenital lues. They may be the only mark of the disease,
especially at first, but they are almost invariably accompanied by a dim-
inution of the coagulability of the blood, similar to that of hemophilia, and
the case usually goes on rapidly to a fatal termination. Disease of the
vesicular walls is one of the commonest and best known eflFects of the
syphilitic poison, leading to hemorrhagic discharges from the mouth, the
bowels, the bladder, or the nose; to blood accumulations under the skin
and mucosae, or in the serous cavities and internal organs ; or finally mak-
ing the syphilitic eruption itself hemorrhagic. The author emphasizes the
importance of remembering these facts in the treatment of infants who
have hemorrhagic discharges or a hemorrhagic eruption, the cause of which
is obscure. — Archives of Pediatrics, June, 1898.

Operative Treatment of Exophthai^mic Goitre. — Schwartz (Bull,
et Mem, de la Soc, de Chir,, de Paris, November 22, 1898) reports two cases
of exophthalmic goitre treated by bilateral resection of the sympathetic
nerve in the neck. In one patient, a woman aged twenty-three, the lower
part of the superior ganglion on the right side, together with about two
inches of the nerve trunk, was excised. This operation was at once
repeated on the right side. In the second case the patient, a woman aged
thirty-one, had sufiFered severely from attacks of angina pectoris. In this
case, as there was considerable difficulty in exposing the sympathetic
nerve on the right side, and the patient was very weak, it was thought well
to defer the operation on the left side for a month. In both cases the
operation, it is stated, gave much relief, and wa^ followed at first by less
marked prominence of the eyeballs and by reduced pulse frequency, and
subsequently by a gradual amelioration of the general symptoms. The
second patient was decidedly more benefited by the operation, as the dis-
tressing attacks of angina suddenly ceased after the sympathetic had been
resected on both sides. — British Medical Journal,

Intussusception Treated by Laparotomy. — On August 13, 1898, a
female infant, five months old, was admitted to the Leeds Infirmary with a
history of pain in the abodmen, vomiting, and of passing blood-stained
motions and some mucus. The child had only been ill for four days. On
admission a sausage-shaped swelling could be felt in the region of the cecum
and extending across the abdomen. On the afternoon of admission ether
was administered and an incision about two and a half inches long was
made in the middle line of the abdomen. On passing the hand into the
abdomen an intussusception was felt and that part of the bowel was brought
outside the abdomen. The intussuscepted part was found to be ileum into
cecum and ascending colon. The intussusception was easily reduced
and was then returned within the abdomen. The abdominal wound was
closed. The patient was discharged well on September 6th. — Dr. W, H,
Brown, in the Lancet,

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Vol. XXVII. Louisville, Ky., March 15, 1899. No. 6

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 Ctrticles*


Professor of Chest Diseases and Physical Diagnosis^ Hospital College of Medicine, Louisville, Ajr.

The paramount importance of detecting the presence of the tubercle
bacillus as soon as possible after its entrance into the system is con-
ceded by all, and the prospect of successfully combating it will be
just in proportion to the promptness and energy with which curative
measures are instituted. Even the merest tyro in medicine can recog-
nize a case of pulmonary tuberculosis in the third stage, when cavities
present unmistakable physical signs. As far as the fate of the patient
is concerned, its recognition makes very little difference. It is a much
more difficult matter to recognize the disease in its very incipiency,
when perhaps there may be so few colonies present, involving so small
an area, as to be scarcely recognizable by the most delicately trained
physical senses. It will make an immense amount of difference in the
results of treatment whether it be commenced in the first few weeks
or months later.

Possibly by a careful study and analysis of the earliest manifesta-
tions of tuberculosis in its effects upon the various functions and
organs of the body we can deduce some rules by which we may recog-
nize the grouping of certain symptoms and signs as indicating the
presence of tubercular deposits.

^Read before the trOuisville Medico-Chinirgical Society, February 24, 1899. For discussion see p. 215.


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202 The American Practitioner and News.

Assuming as a fact now admitted by all that the tubercle bacillus
is the essential cause of tuberculosis, let us study for a moment the
changes and effects wrought by its presence in the tissues.

When the germ is carried by the inspiratory current of air into the
bronchial tubes it lodges upon the walls of some one of the smaller
tubes and at once entrenches itself and commences the development of
a colony, multiplying with great rapidity. Nourishment can only be
secured by absorption from the surrounding tissues, and this is impeded
by the efforts of the defensive cells of the system in their contest with
the invading germs. Every germ originates toxic products which, to
a greater or less extent, poison the system in which it has acquired a
habitat. The effect of this upon the system is to stimulate the multi-
plication of the leucocytes in those cells chargeable with defensive
duties ; and second, to increase the production of a material in the circu-
lation which is antidotal to the poisonous emanation from the germs, and
hence called antitoxin. As long as the production of this keeps pace
with the introduction of the toxic material, the system is protected.
But a limit is soon reached, and then the constitutional effects are
manifested, such as fever, quickened pulse and respiration, loss of
appetite and strength, lassitude, emaciation, nightsweats, etc.

The changes in the constitution of the blood produced by tubercu-
losis are exceedingly interesting. Grawitz noticed in the early stages

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