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metropolitan boards with regard to concerted action being taken for the
establishment of special institutions for the treatment of all cases of tuber-
culous disease. A letter was read from Sir Crichton Browne in which he
pointed out our greatly increased knowledge of the nature of tuberculous
disease, and its mode of propagation made it, in his opinion, obligatory upon
those having the control of public institutions into which tuberculous
patients are received to arfange for their complete separation from other
inmates, and such a separation he considered to be especially necessary
where there are other inmates in stages of debility predisposing them to
contract tuberculous disease. It was stated that a third of the patients in
the workhouse infirmaries throughout the kingdom suffered from tubercu-
losis, and that a large number of those cases which were hopeless could be
cured by open-air treatment. The Nordrach system of treating consump-
tion has been introduced into England at the North London Consumption
Hospital at Hampstead. At present only a few beds are set aside for
patients trying the cure, but should this attempt prove satisfactory the
whole establishment will be adapted for the treatment.

Dr. Dyer, at the annual dinner of the Society of Public Analysts, said
a great many people were under the impression that analysts were a
recently established class of public functionaries, but Dr. Dyer pointed out



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230 The American Practitioner and News.

that Shakespeare was one of their remote predecessors. Of course he had
not the elaborate equipment which they have in the present time ; indeed,
his only apparatus was a pair of leather breeches which he used in testing
the quality of the beer vended in Stratford on Avon. The earliest analyst's
methods were as primitive as his time. When he bought a quart of ale in
his capacity as "ale-conner" to test its quality, there was no act of Parlia-
ment obliging him to say he bought it for the purpose of analysis, nor had
he to divide it into three equal portions. He simply took the sample out-
side the inn, and, pouring it on a bench, sat down in the liquor. After
sitting the prescribed period Mr. Shakespeare arose, and if the leather
breeches stuck to the bench with appreciable adhesiveness it was held
evidence of adulteration and the inkeeper was fined accordingly.

The London County Council have determined to provide at a cost of
;^66,ooo a permanent building to accommodate three hundred epileptics in
order to found a working colony for epileptics.

The returns of the health of the Navy for 1897 show a death-rate of
only 5.23 per 1,000 or .05 lower than in the previous ten years. The rate
of invaliding was 4.62 per 1,000 higher than 1896, mainly owing to the
Benin campaign on the west coast of Africa, where much remittent fever
was contracted.

London, February, 1899.



Ctbstracts anb Selections*



Ergot in Chronic Malaria. — A. Jacobi (Medical News, October 22d),
says that in connection with malaria there are two organs which have to be
considered in the administration of medicines : the blood and the spleen,
the former because it contains the sporozoa, the latter because of its sponge-
like mass in which it harbors the infected blood and serves as a receptacle
of dangers. It appears that a direct effect on the blood or on the plasmodia
is not required for a cure, but that gradually the restoration of the spleen to
a fairly normal size, forcing the stagnating blood into a normal circulation
with progressive elimination of the plasmodia, is sufficient to open the gate
to recovery. He gives ergot in the form of fluid extract (Squibb's), one
teaspoonful in whisky and water four times a day. He gives details of
several illustrative cases and formulates the following conclusions: (i)
There are cases of chronic intermittent fevers with large tumefaction of the
spleen that, after having resisted the action of quinine, arsenic, methylene
blue, eucalyptus, and piperine, are benefited by ergot. (2) When enlarge-
ment of the spleen is not old and not firmly established, the contracting
effect of ergot is noticed within a reasonable time. (3) The attacks will
disappear before the diminution in the size of the spleen is very marked.



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The American Practitioner and News. 231

(4) Though temperatures, after the employment of ergot, remain irregular,
and now and then somewhat elevated, rigors, as a rule, are not noticed with
this elevation. (5) Plasmodia do not seem to disappear from the blood so
rapidly as they do after quinine, when the latter is effective. But even
while some are still present, the attacks being more or less under control,
the patient will feel better. (6) Complicating local pain requires additional
treatment with ice, or cold douches, or heat ; chronic hyperplasia calls for
iodide of potassium or iodide of iron. Digestive disorders may indicate, as
they often do when quinine is expected to act, before the employment of
ergot, an emetic, or a purgative, or stomachics. (7) An experience extend-
ing over forty years, in which he has used ergot in many instances, seems
to Jacobi to justify in asserting at least this much : that there are many
cases of chronic malaria, apparently intractable, that will get well with er-
got. (8) There are cases occasionally in which the return of elevations of
temperature after the successful use of ergot makes the combination of
ergot and quinine, or ergot and arsenic, advisable, though quinine and
arsenic had not been successful previously. (9) Ergot, like quinine, proba-
bly by its sudden contracting effect on the spleen, and by the forcing of
large quantities of ^lasmodialaden blood into the circulation, is, in chronic
malaria, when hydremia and spleen tumor are excessive, capable of bringing
on the very first attack of rigors and fever. (10) Recent cases of malaria
have gotten better or were improved under the extensive use of ergot, but
many resisted a long time ; that is why acute cases should rather be treated
with quinine. — British Medical Journal,

Protective Action of the Liver Against Microbes. — Roger {Shn,
Med,, October 19, 1898) describes his recent results on the subject (Paris
Society of Biology). In 1897 he found that certain cultures of anthrax
bacillus introduced into a branch of the portal vein did not kill rabbits,
whereas cultures of the same virulence injected into other blood-vessels did
cause death. He then found that the lungs possessed a protective action
against the streptococcus, while the liver possessed none. The staphylo-
coccus aureus grows rapidly in the brain, but, like the anthrax bacillus, is
destroyed by the liver. The liver seems to be powerless against bacillus
coli, and even to favor the growth of this microbe. Both liver and kidney
arrest the growth of oidium albicans. Recently Roger has made further
experiments on rabbits to determine what conditions modify the protective
action of the liver. This protective action is less marked when the animal
is kept without food, but remains obseri'able even after three days of fast-
ing. If three fourths c. cm. of a sterilized culture of bacillus prodigiosus is
injected into an intestinal vein, the liver loses all its protective power
against staphylococcus aureus. Large doses of glucose — given by the
mouth — weaken the protective power of the liver, whereas small doses
increase it. The effect of ether is most striking; five drops of ether injected
into the portal vein, or two c. cm. given by the mouth, abolish the protect-



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232 The American Practitioner and News.

ive action of the liver, whereas small doses by the mouth — two or three c.
cm. of a solution of ether in alcohol and water — increase it. When the
«ther is injected subcutaneously its effect is much less marked. Perhaps
the beneficial action of potions containing ether, in the case of patients
with infectious diseases, may be explained on the supposition that dilute
<ioses of ether given in this way increase the protective action of the hepatic
<iells against certain microbes. — Ibid.

Bilateral Acute Labyrinthitis.— In the Intercolonial Medical Jour-
nal of Australasia of October 20th Dr. Percy Webster relates a case of this
very rare disease. A healthy lad, aged ten years, one day looked pale and
ill. He vomited, became delirious, and complained of pain in the head;
he had to be held down in the bed. The acute delirium lasted eleven hours,
after which he was quiet but lay muttering. He called out with pain when
touched ; moving the limbs seemed to cause great suffering. At times he
would lie with his back arched and his head retracted. He was ill for about
two months and became very thin. He had giddiness, and after his recovery
staggered at times, especially in the dark. Deafness was noticed before he
recovered from the delirium and remained permanent; it was total both for
bone and aerial conduction. He complained of pain and constant buzzing
in his ears. The fundi were normal, the knee-jerks were active, and
there were neither ankle clonus nor paralysis. As the history was only
obtained from his friends, it was impossible to say whether the labyrinthitis
was primary or associated with meningitis, pneumonia, typhoid fever, or
one of the exanthems, or whether it was secondary to otitis media. —
Lancet,

The Appendages After Vaginal Hysterectomy. — Van der
Hoeven {CeniralbLf. Gyriak,, No. 35, 1898) considers that Brennecke relied
upon pure theory when he asserted that the ovaries of necessity undergo
atrophy after viginal hysterectomy. As a rule, it appears^ the tubes and
ovaries seem to cause no trouble. After Pean's operation for pelvic abscess
fistulous tracts may develop, but they heal spontaneously. Though the
appendages may be absolutely healthy when the hysterectomy is per-
formed, they sometimes become subject afterward to the disease for which
that operation was undertaken. Hematosalpinx may develop, or even, as
in Wendeler's case, tubal pregnancy. Several cases of serous cyst of the
pelvis developing after vaginal hysterectomy or abdominal section have
been reported. These records show, however, that they are not solely the
result of the former operation. Van der Hoeven has described four such
cases, three after vaginal hysterectomy, and these were respectively diag-
nosed as pre-ovarian cysts, ovarian cyst, and hydrosalpinx. The serous
cysts were extirpated successfully. As a rule, operation is best, but hot
irrigations are of benefit. The symptoms are pain and swelling, and also
usually fever. — British Medical Journal.



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The American Practitioner and News

"NEC TENUI PENNA.*'



Vol. 27. MARCH 13, 1899. No. 6.

H. A. COTTBLL, M. D., Editor.

A Journal of Medicine and Surgery, publislied on the first and fifteentli of each
month. Price, $j per year, postage paid.

This joamal 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 American Practitxonbr and News, 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 & COMPANY. Louisville, Ky.



INTRAVENOUS INFUSION IN SHOCK AND HEMORRHAGE.



Dr. Daniel Fiske Jones, of Boston, Surgeon to Out-patients, Carney
Hospital, contributes a valuable paper on this -topic to the Boston Med-
ical and Surgical Journal of February 9, 1899.

The author gives a brief resume of the history of transfusion, which
has been practiced and abandoned from time to time since the time
of Ovid, and shows why this dangerous procedure has been, it is to be
hoped for good and all, set aside. Its place has been taken by the
more recent and practically safe procedure call infusion^ by which is
meant the injection into the blood or subcutaneous cellular tissue of
some fluid other than blood for the support and stimulation of the
almost exsanguined patient.

Intravenous infusion was first practiced, so far as history records i*t, in
1677, when an attempt was made with milk as a medium, the experi-
ment resulting in the death of the patient. While the practice of infu-
sion of normal salt solution into the subcutaneous tissue is and has
been for a decade or two a well established and valuable therapeutic
measure, intravenous infusion has been rarely practiced since the date
of the above fatal experiment. ** If, however, one will read the more
recent literature on the subject, he will be convinced that it is a
measure of the greatest value in saving life.**

" Carefully conducted experiments on dogs by Bosc and Vedel show

18



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234 The American Practitioner and News.

that a solution of sodium chloride, between 0.5 per cent and 0.7 per
cent, is to be preferred for intravenous infusion. A 0.7 per cent solu-
tion has more stimulating power than a 0.5 per cent, or a still weaker
solution, and the beneficial eflFects which it produces are more lasting.
It has also been demonstrated that calcium chloride and potassium
chloride added to the normal salt solution will keep up the action of
the heart longer than normal salt solution alone. Infusions of dis-
tilled water, strong salt solution, and milk have proved fatal in every
case. Ordinary water may be used in case of necessity, but it should
not be used in large quantities, or often.'*

The author's technique is admirably set forth as follows :

The solution used at the Massachusetts General Hospital is a modifica-
tion of Ringer's solution: it is calcium chloride i>^ grains, potassium
chloride i grain, sodium chloride 90 grains, water i quart.

The technique of intravenous infusion is so simple that nobody need
feel that it is necessary to have a surgeon at hand, or even another physician
to assist, for it can be done very easily with the aid of one person. There
are four points which should be noted when infusion is undertaken ; these
are:

(i) Careful asepsis of arm, apparatus, and solution.

(2) Care to get all the tiir out of the tube before introducing the canula.

(3) Care to have the solution free from particles.

(4) The use of a probe-pointed canula, and not a sharp-pointed needle.
With these points in view, there is comparatively little danger in the

proceeding ; in fact, there are in recent literature no reported cases of death
caused by infusion, nor have we been able to learn of any ill effect in about
seventy cases at the Massachusetts General Hospital. In experiments
upon the lower animals unconsciousness is produced when the pressure of
the solution is considerable, but consciousness returns as soon as the
pressure is lowered.

The temperature of the solution, it is generally stated, should be 100^
F.; but we should urge that it be considerably above this point, for the
hotter the solution the greater its value as a stimulant. An initial temper-
ature of 108° F. to no° F. is well borne — the fluid is cooled from one to
two degrees before reaching the circulation.

The amount of the solution to be injected at one time varies with the
rapidity of the injection and with the quality and tension of the pulse. A
thousand cubic centimetres, repeated when necessary, is generally much
better than a larger amount given at one time.

The author reports in detail eight cases in which he practiced intra-
venous infusion. They were all surgical cases, in extremis^ and had,
in addition to the loss of blood, the very dubious qualification of shock



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The American Practitioner and News. 235

to contend with. Nevertheless, four of the eight were saved by the
measure. With these facts in view, the author's conclusions seem well
warranted. He says in his summary :

We have in this list eight cases, with four deaths and four recoveries.
If out of eight desperate cases four can be saved, and if in about seventy
cases there are no ill efiFects, what is there to prevent a more general use
of infusion in severe cases of shock and hemorrhage ? Wiggin reports a
death, but in this case the patient had a weak heart, and three quarts of the
solution were rapidly given. Undoubtedly one reason why this measure is
not more frequently resorted to is the difficulty in always having the solu-
tion and apparatus ready. This, however, is not a valid excuse, for the
canula is very small, and the salts can be carried in vials, in saturated solu-
tion, ready to use in a given quantity of warm water. The tubing and
funnel can be found in almost any household.



KENTUCKY STATE SOCIETY.



Louisville has this year the honor of entertaining the State Soci-
ety. That the compliment is appreciated is evidenced by the unusual
interest shown by the local profession in backing the efforts of those
able and untiring committeemen, Cecil, Vance, Cheatham, Frank, and
Bullock, in their eflForts to make the meeting memorable in the annals
of Kentucky medicine.

The programme is well up in construction, though still open, and
nothing will be left undone in the way of welcome and good cheer.
The meeting will be held on May 17th, i8th, and 19th proximo.



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Hotcs axib Siucrics-



The Relative Importance of Flies and Water Supply in
Spreading Disease. — At a meeting of the Sanitary Club of Buffalo on
December 14th (N. Y. Med. News, December 31, 1898), M. A. Veeder, of
Lyons, N. Y., read a paper on the relative importance of flies and water
supply in spreading disease. From the protracted sanitary standpoint,
he said, camp diseases can be divided into intestinal and malarial, the
former including typhoid and yellow fever, dysentery, and cholera. In
camps malaria is spread almost entirely by water, in intestinal diseases
almost entirely by flies. The failure of measures directed to the water
supply of the Cuban campaign, he ascribed to this fact. Even now
typhoid is rife in Manila and Honolulu. In the recent campaign in
Fashoda, although the climate was especially dry, and general conditions
as to water supply favorable, typhoid was the greatest scourge of the army.
An epidemic of dysentery was cited, taken in hand when forty cases had
developed with ten deaths, the disease having spread from house to house
by short leaps. After measures had been adopted to prevent access of
flies, not a single new case developed. The progress of a camp disease by
short leaps should suggest that it was borne by flies, while a general dis-
semination should call attention to the water supply. Flyborne epidemics
also follow the direction of the wind ; in large cities .with general water
supplies, free drainage, and absence of privy vaults, water is the great
carrier of disease, whereas camps, like small villages, have most to fear
from flies. For this reason typhoid is more or less prevalent at all seasons
in the cities, usually only in the dry and sultry weather of early autumn
in small villages. Veeder strongly condemns the practice of burying
typhoid excrement, citing a series of little epidemics that could be traced
to a nurse who had followed this method. After the nurse had herself
succumbed to the disease, the epidemic ceased. Typhoid bacilli will pen-
etrate to the surface of the soil if buried. Disinfection is necessary, and on
account of its color, its permanence after evaporation and efficiency, copper
sulphate is to be preferred. In camp on account of the practical impos-
sibility of diagnosing incipient typhoid, all excreta should be disinfected.
The coloration of the ground would show just how far the disinfection had
been successful. Volatile disinfectants are not so serviceable as non-
volatile. The United States Government plan of furnishing large, por-
table, water-tight tanks for use as sinks is good in theory, but scarcely prac-
tical. The Indians avoid sickness by frequently moving their camps.
Burial of feces could be relied upon to afford protection against infection by
flies for a few hours. Boiling would render water safe to drink, and, even



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The American Practitioner and News. 237

against malaria, this precaution would afiford almost complete immunity, as
the conveyance of this disease by mosquitos has been greatly exaggerated.
Not only knowledge but discipline is necessary to protect the soldier, and
sanitation under the guns of the enemy is a difficult matter. — British Med-
ical JoumaL

Kentucky State Medical Society.— The Committee of Arrange-
ments has sent out the following stirring appeal : The Kentucky State
Medical Society will hold its next annual meeting at Louisville, Ky., May
17, 18, and 19, 1899. Liederkranz Hall, corner Sixth and Walnut streets,
has been secured for the sessions. This hall is centrally located, quiet and
commodious, and admirably adapted for the meetings of the Society, with
a separate hall conveniently situated for the display of exhibits.

It is the earnest desire of your Committee of Arrangements to make
this meeting of the Society a notable success in every particular. To this
end you ate especially urged to attend. Come the first day and stay
through the last, and bring your neighbor doctor with you. If you are not
a Fellow of the Society, we will welcome you into the membership.

The programme is now being arranged; in order that the scientific
part of this meeting may reach a success never before attained, it is hoped
and expected that every one will take an active part in the proceedings.
You are therefore urgently requested to send at once the title of your
paper to Dr. Steele Bailey, Secretary, Stanford, Ky.

The Committee of Arrangements join with every friend and well-wisher
of the Kentucky State Medical Society in hoping and endeavoring to make
the approaching meeting the beginning of a new era in its existence.

We propose to leave nothing undone that will promote the success of
this meeting, the welfare of the Society, or that will contribute to your
pleasure and profit while with us.

Greatly reduced rates on all railroads will be secured.

JOHN G. CECIL, Chairman,
T. S. BULLOCK,
WM. CHEATHAM,
A. M. VANCE.
LOUIS FRANK.

•'Typhoid Pleurisy." — The Semaine Medicale of October 19th con-
tains a valuable paper by M. Achard on this subject. Pleurisy occurring
in typhoid fever may result from the action of the typhoid bacillus or from
some other infection. Typhoid pleurisy may assume several forms — sero-
fibrinous, hemorrhagic, or purulent. In some cases the pleurisy seems to
have preceded the typhoid fever just as typhoid pneumonia may. The
effusion may also show itself during the course of the disease. Thus a
man, aged twenty-six years, with all the usual symptoms of typhoid fever,
had dyspnea and dullness at the base of the left lung. Puncture showed
the presence of fluid a little cloudy and containing red and white corpuscles.



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On several occasions during a month serous fluid was obtained by puncture,
which always contained the typhoid bacillus in pure culture. The signs
disappeared, and he recovered. In another case, in a young woman, an
empyema formed. At the end of the third week there was a friction sound
at the left base; the temperature fell to normal and convalescence was
apparently insured, but dullness was found at both bases, and pyrexia again
appeared. An empyema formed on the left side. A liter of pus was
evacuated, which contained the typhoid bacillus in pure culture. Resection
of a rib and drainage were carried out and the patient recovered. Why
does the typhoid bacillus produce pus in some cases and not in others? A
categorical answer can not be given, but analogous cases can be cited. The
swellings of osteo-myelitis are sometimes abortive and resolve without
suppuration. The spleen is constantly the seat of bacillary foci in typhoid
fever, but abscess results only exceptionally. In experimental inoculation
of the typhoid bacillus, pus is sometimes produced, sometimes not. The
same is true of the colon bacillus. Again, streptococci and staphylococci,
microbes usually pyogenic, are sometimes present in non-suppurative
lesions. Finally — a very complete analogy — the tubercle bacillus can



Online LibraryUniversidad de Buenos Aires. Facultad de Derecho yThe American practitioner → online text (page 27 of 109)