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192 The American Practitioner and News.

For the first time in the history of coroner*s inquests in London the
doctor in the case was a lady who was recently appointed second medical
officer to the Bethnal-green Infirmary.

Much interest was shown in the departure from Liverpool for the
Grand Canary and the West Coast of Africa of a number of professional
men for the purpose of making experiments and acquiring information
useful in the treatment of tropical diseases. The party was headed by
Major Ross, of the Liverpool School of Tropical Diseases ; along with him
was Dr. Annett, also of the School of Tropical Diseases, which is connected
with the University College and the Royal Southern Hospital. These two
gentlemen are sent out by the school to which they belong, and it is the
first organized expedition despatched from England. Mr. E. Austen,
another member of the party, belongs to the Natural History Department
of the British Museum, who is being sent out by the British Museum. Dr.
Van Neek, of Belgium, is also with them. Freetown, Sierra Leone, is to
be the center of their experiments on the species of mosquito which is sup-
posed to be the principal agent in the propagation of malaria.

Major Beevor, of the Royal Army Medical Corps, in a discussion upon
the diagnosis and treatment of gunshot wounds of the abdomen, said he
agreed that in all cases abdominal section gave better results than the
expectant method, but went on to point out what difficulties were met with
in the field. He gave as an example that at the action at Dargai in India the
only water available for all surgical purposes was that of a small village
pond into which flowed the liquid excreta of men and animals. The
dressings had to be manipulated by hands which were dirty, and the num-
ber of abdominal cases was so large that only first dressing could be
applied. As to the difficulties of supply, Major Beevor said in that action
the first five transport mules which reached the top of the ridge were shot
dead by some natives, 2,800 yards distant, who were armed with the Lee-
Metford rifle. Irrigation was recommended even before the enlargement
of the external wound, and if collapse came on during the operation, pro-
ceedings should be stopped and irrigation performed.

Few societies with a history which goes back only twelve years can
boast such a rebord as the Royal National Pension Fund for Nurses. Its
invested funds now amount to nearly half a million pounds, and it is stated
by the Council in their annual report that the nurses have paid into the
fund ;^250,ooo since the last reception at Marlborough House four years
ago. The income of the fund at the present time is ;^83,ooo a year. The
scheme is based upon thrift and self-reliance, and it claims to be the
greatest and most successful of insurance and friendly societies for women
workers in the world.

The Government of India has formally sanctioned at the public expense
voluntary inoculation against enteric fever. Many officers at Aldershot
who are under orders for South Africa have already undergone Inoculation,
and any non-commissioned officers and men can, if they wish, be inoculated
free of charge.



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The American Practitioner and News. 193

Vaccination against smallpox is stated to be making most satisfactory
headway throughout the Bombay Presidency, as it appears that during the
five years ending in 1897 the percentage of births successfully vaccinated
was never lower than fifty-five, and on one occasion it rose to fifty-nine.
Unfortunately, in the Bengal Presidency the percentage is as low as
eighteen, and the average number annually vaccinated by each ofl&cer is
650, while in Bombay each operator had an average of i ,690 cases.

Dr. Lambert Lack -will in the autumn publish the results of his careful
investigations into the cause of cancer. .His researches have been on
entirely original lines, and the results have been examined by a select com-
mittee of the Pathological Society. He proves the theory that cancer is
due to injury to the basement membrane of mucous and allied structures.
Dr. Lack states that by causing injury to these structures he has produced
cancer in some of the lower animals.

One small company who some time ago started a sanitarium for tuber-
culous patients in England at the present moment pays ten per cent to its
shareholders, with every likelihood of increased profits.

London, August, 1899.

Ctbstracts anb Selections*



Illinois Society for Prevention of Consumption. — One week ago
there was organized in this city a society having for its object, as its name
indicates, the prevention of tuberculosis. Relative to this topic and
apropos of it is what the Journal of the American Medical Association has
advocated for several years, viz., that the United States Government should
have a department of public health and a competent scientific physician as
medical secretary of the same. In this respect the Government is behind
the times.

At the Columbus meeting of the Association Dr. Joseph M. Mathews, in
his presidential address, among other things stated, ** That it was incumbent
upon the Association as far as scientific investigation can do so, to eliminate
tuberculosis from the land, a disease so dreaded in character that it actually
does remove yearly one seventh of the population of the universe."

I have often thought that statistics are sometimes imaginary, and not
as reliable as we would desire, but Dr. Mathews' statement in this respect
is acknowledged by the scientific world to be approximately correct, so
much so that the international conference which was held in Berlin last
month to consider this topic arrived at the same conclusion, as have other
analogous scientific organizations, etc. ; the result of this latter congress, as
we are all aware, is that much good has already been eff*ected.

We, as scientists, veterinarians, public ofl&cials, lawyers, merchants,
dairymen, and others, who were represented at the meeting organized one
week ago for this cause, should unite and co-operate in stamping out this
dread malady.

15



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1 94 The American Practitioner and News.

The old maxim, ** prevention is better than cure," certainly applies
with equal force and greater efficiency to tuberculosis. I quote again from
Dr. Mathews* address, '' That a committee be appointed from the American
Medical Association to prepare a careful report on this subject and submit
the same to the next session of Congress."

The attention of Congress has been called to this appalling fact year
after year for several years by the physicians throughout the United States i
and particularly by the special committee of the Association, which was
appointed in 1892, whose bill was endorsed by many scientific bodies of our
country, advocating the idea of a department of public health foi* this
nation, having a proper, able, and scientific medical secretary at its head to
rank in dignity with other cabinet officials ; had this been done years ago,
the United States Government, through its department of public health,
would have accomplished incalculable benefit in educating the people in
preventing the disease, and thus would have been the means, possibly, of
saving thousands of precious lives.

All Europe at the present time is on the alert regarding the great
importance of preventing consumption. Throughout England various
scientific associations have awakened to the great importance this subject
deserves. We should not only devise the best methods of prevention, but
our Government, State, and municipal authorities should adopt measures
for the care of this class of its citizens. That pulmonary tuberculosis is
contagious under certain conditions is a well-known fact. Hence it is
necessary to adopt measures to prevent its communicability to the healthy
classes.

As to management and treatment, when tubercle bacilli are discovered
in the sputum of a patient, a change of climate, all other things being
equal, is perhaps the first sine qua nan thought of. To eradicate or kill the
germs is what is most desired. In pursuance of this, we must be careful
not to hasten a patient's death by isolation and other methods. I am a pro-
found Believer that fully twenty per cent of the cases of pulmonary tuber-
culosis are amenable to treatment that will result in recovery under suitable
climatic conditions and the best hygienic environments. This is aside from
any form of scientific treatment with drugs, though thorough and scientific
in every detail, that might aid in increasing the percentage of recoveries.

I am a believer, also, contrary to what we are taught nowadays, that pul-
monary tuberculosis is, or should be, classed as a hereditary disease — not
that I desire to be understood that every case is one of heredity, and even
though a hereditary taint be present in a family, that recovery should not
be anticipated. Physical influence, and an optimistic view, as much as is
consistent, should enter into the cure, probably of every class of patients.
My desire in the near future is to see a national department of public
health, where, in the nation's laboratory, not only tuberculosis but all other
constitutional diseases that are preventable can be studied and investigated ;
indeed, where every thing all along the line can b^ scientifically studied



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The American Practitioner and News. 195

and statistics established irrefutably tending to " build up'* the health, and
thereby promote the longevity of future generations and our citizens. —
Lision H. Montgomery ^ M. D., in tke Journal American Medical Association,

Meat Extracts of Vile Origin. — The Lancet of April 22d com-
ments upon revelations which have recently been made concerning the
preparation of meat extracts from filthy material, such as putrid livers and
offal. Modern chemistry has unwittingly placed at the disposal of those
who prepare meat extracts in this manner deodorizers and subtle flavoring
materials which disguise the substances from which these extracts are
made. The Lancet considers that a system of control should be estab-
lished by the State, so that extracts might from time to tjme be subjected
to chemical and bacteriological examination. Possibly many cases 'Of
gastro-enteric disturbances, the etiology of which has not been discover-
able, may have been due to the ptomaines generated in such preparations.

The Serum Treatment of Pulmonary Tuberculosis. — G. Zanoni
in a recent monograph (Essais de Serumtherapie Antituberculeuse — m6thode
Maragliano — fait h la Clinique M6dicale de rUniversit6 de Genfeve : Geneva
1898) gives full details of a series of twenty-seven cases of pulmonary tuber
culosis treated in Revilliod's clinic at Geneva with Maragliano's "anti-
tuberculous" serum. Among these cases three were in the infiltration
stage, ten in the softening, and fourteen in the cavitation stage. In all the
cases bacilli were present. The duration of treatment varied from a few
weeks to a year and more. Of the cases in the first stage, two were cured,
and one remained stationary. Of those in the second stage, one was on the
way to recovery, six were improved, two remained stationary, and one had
got worse. Of those in the third stage, two were on the way to recovery,
four were improved, two remained stationary, and six died. Of the total
number (27) treated, therefore, there were three ** on the way to recovery,"
twelve improved, five in statu quOy and seven worse ; giving a proportion of
eleven per cent recovering, forty-four per cent improved, nineteen per cent
stationary, while twenty-two per cent got worse or died. Maragliano's own
statistics show in a total of four hundred and twelve cases sixteen per cent
cured, forty-eight per cent improved, twenty-five per cent stationary, and
eight per cent in which the patient got worse. Zanoni states that in forty-
seven per cent of his cases weight increased, in some as much as five or six
kilos. Fever disappeared in fifty-two per cent. Physical signs almost dis-
appeared in twenty-two per cent, diminished in thirty per cent, remained
stationary or got worse in twenty-four per cent. Bacilli disappeared in
twenty-four per cent, diminished in number in forty-one per cent, remained
stationary in thirty-two per cent, Nightsweats in all cases in which dis-
tinct improvement was noted. Zanoni attributes the good results solely to
the sefum ; no other special treatment was employed, and the food was the
same as that given to other patients. — British Medical Journal.



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The American Practitioner and News.

*'nec tenui pennX,"
Vol. 28. SEPTEMBER 1, 1899. No. 8.

H. A.' COTTBLL, M. D., M. P. COOMBS, A. M., M. D., Editors.

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

This 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 Editors are not responsible for the views of contributors.

Books for reviews, and all communications relating to the columns of the journal, should be
addressed to the Editors of The American Practitiohbr and News, Louisville, Ky.

Subscriptions and advertisements received, specimen copies add 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.

PUBLIC NUISANCES, BAD SEWERAQE, AND DEFECTIVE

PLUMBING.



Defective plumbing and bad sewerage are two common enemies of
all large cities, and Louisville is no exception to the rule. Within the
eastern limits of the city is a filthy, sluggish stream into which all
kinds of sewage is constantly pouring. The emanations from this
cesspool are a menance to the health of all who live adjacent to it, and
it is undoubtedly the cause of much sickness. It would cost only a
small amount to grade this stream so as to allow this filth to find its way
directly into the river without delay. It is the accumulation of the
filth in the low places and sluggish parts of this stream that makes
it so obnoxious. As to the plumbing in dwellings, there is but little of
it that is first class, from a sanitary point of view. There are many rea-
sons why this is so.

Much of the present work is old, and the owners are antiquated and
will not make changes unless they are forced to do so, hence the
condition of property in such hands. Secondly, there is no law by
which the constructor of property can be guaranteed that the plumbing
that he contracts for is what he needs, or that he will get what he con-
tracts for, because he must depend on an architect and a plumber, and
it often happens that neither is particular about any part of the con-
tract, save to draw the amount of money agreed upon for the work
to be done.



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The American Practtttoner and News. 197

What Louisville needs is an inspector of plumbing, whose oflSce
shall be combined with that of building inspector, with a salary of five
thousand dollars per annum. This would insure all of the work to be
properly done. The plans for every building could then be submitted
and all defects cured in the beginning, and when the work was com-
pleted the inspector could examine and receive or reject as the case
may be. This would put an end to all defective work, and this most
important part of house construction would be properly executed.



DRUGS AND SUICIDES, CARBOLIC ACID AND MORPHIA.



The promiscuous sale of carbolic acid should be prohibited. Its use
as a medicinal agent should always be directed by a competent phy-
sician. It has become popular as a domestic disinfectant, and in that
way is regarded as a common article of commerce.

It has also become one of the fashionable agents to commit suicide
with, and for that reason alone its promiscuous sale should be prohib-
ited. The great majority of people who attempt suicide, if rescued,
never make a second attempt. This is especially so with women. If
they take carbolic acid there is but little hope of saving their lives,
while if morphine or arsenic is used there is a fair chance of prevent-
ing death.

There is no reason why the sale of carbolic acid should not be
restricted to the doctor's order. It is of no special therapeutic value,
and as a disinfectant permanganate of potash is far its superior and
harmless in every particular.



MORPHIA.



The unrestricted sale of morphia is one of the greatest curses of our
modem civilization. There are to-day hundreds and thousands of our
best men and women in all grades of society who are its slaves. Who
was to blame for the acquirement of the habit by these people is a
question almost as grave as the one under discussion. Many people
become morphine-eaters as the result of a careless or indulgent physi-
cian. There is entirely too much morphia given by the doctors. The



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198 The American Practitioner and News.

ever-ready hypodermic syringe is used too often, and it is by this
means that many persons become addicted to the use of morphia.

As to the promiscuous sale of morphia, there is no excuse. As a rem-
edial agent it should always be given by a physician's order. That of
itself would, to a great extent, put an end to its unnecessary use.

Suicidal doses should not be sold to any person under any circum-
stances.

While there is a law which is supposed to regulate the sale of mor-
phia in this State, there is little or no attention paid to it ; and if the
law was followed out to the letter it would not lessen the sale of the drug,
as the morphine fiend will lie and steal if necessary in order to obtain
the drug.

The law requires that the purchaser of morphia shall register his or
her name and address. This does not deter the confirmed morphine-
eater in the least; in fact, it only enables him to procure it more
readily. The law should be so changed as to make it impossible to
secure it without the order of a physician, and this order should not
exceed over three grains for every twenty-four hours.



TUBERCULOUS COWS.



The following letter has been received from Dr. J. N. McCormack,
Secretary of the State Board of Health :

Bowi^iNG Grbbn, Ky., Sept 10, 1899.
Dear Doctor: Our law in regard to tuberculous cattle is so indefinite
that it has little if any value, especially as we are without funds for
its attempted enforcement. It could only be reached under the general
law as to infectious diseases in domestic animals. Most of the work done in
the State has been under city ordinances. Sincerely,

J. N. McCORMACK, Secretary.

In the issue of August 15, 1899, of the American Practitioner and
News there appeared an editorial on the subject of tuberculous cattle.
It seems that most of the work of the State Board has been done
under city ordinances. It is to be hoped that the next legislature will
take up this very important subject and enact such laws as will give
the State Board of Health power to control all tuberculous cattle.
This would be a long stride in the proper direction, and would do
much to lessen the mortality of human life.



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The American Practitioner and News. 199



Hotes anb filueries*



Human Face and Jaws. — Man is a compound organism made up of
many different organs, structures, and systems which have their own life,
albeit subordinate to the life of the organism as a whole. These structures,
organs, etc., draw on a fixed supply of the nutriment, and unless this nutri-
ment be properly distributed through the system of checks summed up in
the nervous system one organ of structure will receive more than its due
proportion of nutriment. The balance kept up by the checks is distributed
when the organism becomes nervously exhausted, either from nerve-tire,
from general disease, or from other cause. If this exhaustion occurs at
certain periods, called the periods of stress, or of involution and evolution,
certain structures on which is thrown such stress are peculiarly apt to be
affected either in the direction of arrested development or of hypertrophy.
Prominent among the structures which mark these periods are the jaws
and teeth, considered together.

The period of the first dentition is one of these periods of stress during
evolution ; the period of the second dentition is another, and the appearance
of the so-called wisdom-tooth marks a third, while the disappearance of the
teeth from senility is the period of involution. These conditions of nerve-
strain may affect the organism of the individual so that not he but his
descendants show the effects. To this result are often due the irregulari-
ties of the jaws and teeth resulting from the lack of balance of the proper
distribution of nutriment. The defective palates are also an expression
of this strain and not of conditions like mouth-breathing, due, like the
defective palates, to hereditar>' defect evincing itself during the evolu-
tionary periods of stress or at birth. These irregularities are danger-signals
prophesying what may happen to the child of the nervously exhausted
individual unless there be proper training at the periods of stress, training
which will involve brain, nervous system, nutrition, and excretion.

The degeneracy which results from nervous exhaustion is a prophecy
of what may be, rather than a destiny. As the dentist is among the earliest
of the medical specialists to whom application is made, it comes within his
power to outline a course of training and treatment which will prevent the
child evincing irregularities from becoming a moral lunatic, aii imbecile, a
paranoiac, a sexual lunatic, or a victim of lesser forms of degeneracy. Here
is a point at which the dentist is afforded an excellent opportunity to take
part in the beneficent work of the prophylaxis of the medical profession,
which has done so much for the race. The three dentitions, as they are
called appropriately by Dr. Talbot, mark three periods of systemic evolution
when it is possible to affect the mental and physical development favorably.
•^J, G, KiemaHy in the Journal of the American Medical Association,



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200 The American Practitioner and News.

Special XTotices.



The preparations of " Pepsin" made by Robinson-Pettet Co. are endorsed by
many prominent physicians. We recommend a careful perusal of the advertisement
of this well-known manufacturing house in this issue.

Sanmbtto and Imitations. — I gave Sanmetto a trial in a case of gonorrhea]
cystitis where all the usual remedies and Sanmetto imitations had failed, and it gave
the desired result. Will continue to use it. L. H. Sarchbtt, M. D.

Hudson, la.

The Inflammatory Condition in Peritonitis, Etc— An interesting reference
to an extensively prescribed remedy is found in that valuable text-book, "Materia
Medica and Therapeutics," by Finley Ellingwood, A. M., M. D., Chicago. The sub-
stance of the article is to the eflTect that the influence as a pain reliever of the popular
analgesic — antikamnia — is certainly next to morphine, and no untoward results have
obtained from its use, even when given in repeated doses of ten grains (two five-grain
tablets). It is especially valuable during the progress of inflammation, and given in
pleuritis or peritonitis it certainly abates the inflammatory condition, relieves the
pain at once, and the diffused soreness shortly as satisfactorily as opium. It does not
derange the stomach or lock up the secretions. It is also of value in pain of a non-
inflammatory character, and is a convenient and satisfactory remedy in headaches
without regard to cause, if the cerebral circulation be full.

Summer Diarrhea in Infants.— Abroad of late years a good deal has been said
of the value of tannigen in controlling the stools. Dr. Blackader, of Montreal, in the
March number of ** Progressive Medicine," in an excellent review of the recent litera-
ture on summer diarrheas, quotes no less an authority than Escherich, the well-known
Professor of Children's Diseases at the University of Graz in Austria, who speaks very
favorably of tannigen, and claims for it a distinct disinfectant and bactericidal effect.
Kraus and Biedert have also written in its praise, especially for chronic intestinal
catarrh. It is a tasteless powder, therefore easily administered, and is given in doses



Online LibraryUniversidad de Buenos Aires. Facultad de Derecho yThe American practitioner → online text (page 77 of 109)