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The former appear devoid of movement ; the spirochetes twist and turn
with great rapidity. These organisms evidently correspond to those
described by Bernheim, who considers this form of tonsillitis a pathological
entity distinct from diphtheria. If Loeffler's bacillus be present, Bernheim
considers that the disease has been grafted upon a true diphtheria. Stoeck-
lin, in conclusion, puts two questions which further clinical and patholog-



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The American Practitioner and News. 273

ical investigation must answer: (i) Is the co-existence of spirochetes and
fusiform bacilli constant in and pathognomonic of ulcerative membranous
tonsillitis, or are there mixed cases in which the virulent organism of diph-
theria is present? (2) If so, what is the frequency of such mixed cases, and
how does the presence of fusiform bacilli and spirochetes influence the
diphtherial infection, therapeutic measures, and, above all, the prognosis? —
British Medical Journal,

SMA1.LPOX IN A New Light. — The name of M. Drumont, the editor of
the Libre Parole, is chiefly known in this country in connection with that
latest Asian mystery, the Dreyfus case. But he apparently poses as an
authority on other peccant humors besides political passion and religious
rancor. Not long ago he favored the world with his views on smallpox
and vaccination. He holds that Edward Jenner was one of those who have
wrought most mischief to their fellow-men. This, of course, is only what
your common or platform "antivack" is aways telling us. But M. Dru-
mont's charge against the discover of vaccination is not that he introduced
a new disease or a new poison, but that he robbed mankind of a most val-
uable remedial agent, to wit : smallpox ! '* Smallpox," says this new Daniel
of pathology, ** has never been a disease. It is an admirable effort of the
organism, a spontaneous operation of nature, which violently rejects,
expels, and deposits outside the evil principles that are in the body. It is
a flowering, a blowing, a sublime crisis. Consider,*' he adds, " the signs
presented by croup, typhoid fever, pulmonary phthisis, and you will see
that they are only manifestations of smallpox turned inward." We gather
further that the " caustic matter" of smallpox in its travels about the body
produces here a cancer, there meningitis. It is the cause of the increase
of insanity and suicide. We should have thought, in our scientific simplic-
ity, that the mere possibility of such dire consequences from the ** turning
inward " of smallpox afforded some justification for an attempt to keep it
out altogether. But M. Drumont has a logic as well as a pathology of his
own. He accepts modern teaching so far as to admit that there have
always been bacilli ; but his view is that in the good old days before Jenner
smallpox played in regard to these organisms the part which Cromwell
played to the Rump Parliament. Smallpox is, in fact, if we are to believe
the oracle of the Libre Parole, the most useful scavenger of the human
system; beside it as a'* blood purifier" sarsaparilla must hide its dimin-
ished head. M. Drumont will, we are sure, agree with us that if smallpox
is so successful in expelling evil principles. France at the present moment
would be likely to derive considerable benefit from the " sublime crisis"
of a purifying epidemic. It is true that he might not agree with us as to the
evil principles which require to be expelled, but that is a detail. — Ibid,



21



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The American Practitioner and News



NEC TENUI PENNA,'



Vol. 28. OCTOBER 1, 1899. No. 7.

H. A. COTTELU M. D., M. P. COOMES, A. M., M. D., Editors.

A Journal of Medicine and Surgery, pubiisiied on the first and fifteenth of each
month. Ihice, $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 Practitionkr 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 A COMPANY, LonUvllle, Ky.

WHAT TO DO WITH OUR CONSUMPTIVE PATIENTS.



No more important subject confronts us than the disposal of our
patients in the early stages of phthisis. It is certain that there is not
a spot in the Mississippi or Missouri valleys where the climate promises
them any relief, while it is equally certain that to remain in these
localities means a speedy termination in death in the g^eat majority
of cases, under the most favorable circumstances. Medicines may
mitigate the sufferings of this class of patients and prolong their lives
to a very limited degree, but as yet there is no drug which will abso-
lutely arrest the progress of phthisis. Climate is the only thing in the
way of certain relief, and while it is an old song that has been repeated
so often, it will do no harm to hear it again : Sunshine and a temperate,
dry atmosphere are the essentials of an antiphthisical climate. The
United States abounds in such places, and it is useless to indicate any
particular territory ; but in making the selection steer clear of places
where the air suddenly becomes chilled for a few hours, and also of the
places where it is cold in one part of the day and warm the remainder
of the twenty-four hours.

The time to secure the benefits of climate that are lasting is in the
early stages of the disease. This is also the time when the patient is
most likely to refuse to take the advice of his physician.



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The American Practitioner and News. 275

Our knowledge of phthisis and the means of making a diagnosis
of its presence are such that it is always possible to give the patient
timely warning, and thus enable him to take advantage of the only
thing that offers any permanent way of avoiding an early demise.

It is the duty of every doctor to be positive with patients of this
class. Tell them frankly what is expected if they remain, and what is
to be expected by a change of climate. The life of any man or woman
for ten, fifteen, or twenty years is a matter of very great importance,
not only to the individuals, but to those who may be dependent in one
way or another upon them ; hence for this reason, if no other, they
should know every thing.

It is a false notion of withholding the facts from such patients, or
deluding them with the hope of recovery through the aid of drugs.
They pay you for your opinion, and they are just as much entitled to
the facts as they would be if they consulted a lawyer about some com-
mercial transaction, in which his advice would enable them to avoid a
loss of money ; and a great deal more so, for it is life in one instance
and money in the other.

I have seen many a good man go to an untimely grave because he
had not been made acquainted with his exact condition. Do not with-
hold any fact from a patient in the early stages of consumption ; give
him his only chance, a suitable climate.



Hotes anb Queries*



The Standardization op Drugs. — Hitherto the practice has been to
fix a standard of strength only for such drugs as are amenable to chemical
assay. This includes, of course, such drugs as nux vomica, opium, and
cinchona, regarding which standards were formally adopted at the revision
conducted in 1890, and also ipecac and belladonna, which the British
pharmaceutical authorities have since added to the pharmacopeia recog-
nized in the British Isles. The American revisers will no doubt include
the latter drugs in the new pharmacopeia of this country, and it is highly
probable that they will likewise admit and fix standards for the Calabar
bean, gelsemium, hyoscyamus, podophyllum, colchicum, conium, stramo-
nium, and veratrum, all of which lend themselves to chemical analysis.

The question is whether the work of the committee should stop here.
Why, it is asked, should no standards be fixed for such drugs as ergot,
digitalis, strophanthus, aconite, and cannabis indica? They are all drugs
which are in universal use, and their quantitative standard is surely of as



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276 The American Practitioner and News.

much consequence both to the physician who prescribes the remedy and to
the patient who takes it as that of any other medicine. ** It matters little,"
as one authority observes, ** how much crude ergot goes to the fluid pound of
the extract if the fluid fails to produce a characteristic physiologic action."
What, then, is the objection to standardizing these drugs as well as others?
Only this, that the drugs in question are not amenable to chemical assay, or
at all events can not in the present state of chemical knowledge be assayed
chemically with a sufficient degree of accuracy to justify the fixing of a
standard measured quantitatively. But is this any reason why no attempt
should be made to fix a standard by other means? Scientific inquirers
conducting private investigations are not content to rest there, and neither
are the higher class of manufacturing chemists. Acknowledging and mak-
ing use of the chemical test whenever it can be applied with satisfactory
results, they have recourse to physiologic tests, which as regards the
question of potency are for all practical purposes equally reliable. At
present, as has been pointed out, a practitioner who writes a prescription,
say for digitalis, in a dozen diflFerent parts of the same town will find in
some instances that he obtains a drug which exhibits a satisfactory physio-
logic action, and in others no satisfactory action whatever. This is sub-
mitting the drug to a physiologic test when it is too late. If, instead of
leaving the patient to be experimented on, similar tests had previously been
made with the article on some of the lower animals, the potency of the drug
would have been known, and the doctor would be aware of the exact
strength as well as the nature of the remedy he is prescribing. That the
present condition of matters in this respect is recognized by the profession
as eminently unsatisfactory was shown by the discussion which took place
at the recent meeting of the American Medical Association at Columbus,
Ohio, and it is hoped that the Revision Committee will deal' with the sub-
ject in a sufficiently bold manner to provide an adequate remedy. To this
end, however, it is necessary that it should be fortified by expressions of
opinion both from medical men and the manufacturers of drugs, it being to
the interest of none, so far as we can see, except traders in inferior classes
of drugs, to oppose the standardization of as many as possible of the drugs
that are used in the practice of therapeutics. — Medical News,

Diphtheria Antitoxin as a Prophylactic. — In Treatment (Jan.
1 2th) Dr. F. J. Allan, medical officer of health of the Strand District, narrates
a personal experience which illustrates the immunizing action of antitoxin
in an institution accommodating sixty children varying in age from one
and three quarters to seventeen years. Most of them slept in two large,
airy dormitories, and the class-rooms occupied during the day were also
large rooms. Early in February, 1898, one of the children, during a visit to
a friend, was exposed to infection from a case of diphtheria, and on return-
ing home on the same day developed the disease herself and communicated
it to the girls in the beds on each side of her own. These three cases were



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The American Practitioner and News. 277

removed to a hospital, and no further cases appeared until a few days after
their return home in the beginning of March. By March 23d five cases
had occurred in the same dormitory, and a bacteriological examination of
the throats of the three former cases revealed the fact that two of" them
contained typical diphtheria bacilli. Up to April 29th several other children
developed the clinical symptoms of diphtheria, and several more had
inflamed throats without membrane. On April 29th at Dr. Allan's sug-
gestion a protective dose of antitoxin was given all round, and from that
day, although the organisms persisted in the throats, there were no more
cases of diphtheria or of sore-throat. Of the sixty children, nine only
never gave evidence of infection, fourteen were in hospital, leaving thirty-
four children at home in addition to the first three returned from hospital.
As time went on the organisms in these thirty-seven throats became less
and less typical in form, and by June 15th all had disappeared. The im-
munizing dose of antitoxin is from one to three hundred units, according
to age, and the immunity thus produced ordinarily lasts for a period of at
least four weeks. — Lancet.

Report op the International Congress on Tuberculosis. — A
preliminary report of the work of the congress has been issued in England
as a Parliamentary paper. The results of the meeting are interesting and
yet not new. Methods of prophyjaxis are discussed, with special reference
to ventilation, food, and sanitary dwellings. Directions are laid down as to
the disposal of sputum, and considerable stress is put upon the open-air
treatment and the establishment of sanatoria. In general, much hope is
expressed for the future, both as regards prophylaxis and treatment. It is
becoming evident that tuberculosis is gradually losing its terrors as our
knowledge increases. Nothing can do more toward lessening the ravages
of the disease than a widespread recognition among the people of its cause,
of the means of prevention, and of its rational treatment when acquired.
Of interests is the fact that in the abstract before us no mention is made of
tuberculin in treatment ; its one recognized value is as a diagnostic test in
cattle, and even that is not without its drawbacks. — Boston Medical and Sur-
gical Journal,

Accessory Thyroid Bodies at the Base of the Tongue,— At a
recent meeting of the Pathological Society of Philadelphia, Dr. H. L. Will-
iams presented two cases of this rare anomaly. A woman, aged fifty years,
complained of a growth at the base of the tongue, which she had had for
eight or ten years without much inconvenience, but which had begun to
enlarge and to produce dyspnea and diflSculty of speech. It lay in the
median line just above the epiglottis. The growth was about one and a fourth
inches in width and one inch in thickness; oval, rounded, and smooth on
the surface except at the top, where it was superficially ulcerated and cov-
ered with a whitish membrane. A small portion was removed and showed
microscopically in addition to signs of inflammation, typical thyroid struct-



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278 The American Practitioner and News.

ure containing colloid material. In the second case the patient was a young
woman, aged sixteen years, who had a growth at the base of the tongue for
five years, which had recently enlarged, causing some dysphagia. It was
situated in the same position as the growth seen in the first case. On
removal by the wire cautery it measured one and one eighth inch in length,
one inch in width, and three fourths inch in thickness. It was soft and
spongy in appearance, surrounded by a fibrous capsule, and showed a deli-
cate reticulum of fine filaments extending through it in all directions. The
surface was reddish, in some areas whitish, glistening, and resembled the
thyroid gland. Microscopically a meshwork of acini, separated by a deli-
cate reticulum of connective tissue, was seen. The acini were almost inva-
riably dilated and cystic, and filled with colloid material. The diagnosis
of cystic thyroid tissue undergoing colloid degeneration was established.
Thyroid tissue at the base of the tongue is readily explained embryolog-
ically. The middle thyroid area first appears as a ventral outgrowth from
the entodermic lining of the primitive pharynx at a position corresponding
to the second visceral arch. This outgrowth rapidly elongates and gener-
ally loses its attachment with the epithelium of the pharynx, the connection
being represented by a fibrous band (thyroglossal duct) which emerges from
the tongue at the foramen cecum. When thyroid tissue is found in this
locality it is formed from embryological remnants at the upper extremity
of the thyroglossal duct. — Lancet,

Solitary Tubercles of the Heart. — At the recent annual meeting
of the Medical Society of California, Dr. A. W. Hoisholt reported an exten-
sive involvement of the heart in a case of tuberculosis. The writer's state-
ment of the unusual condition found is, in part, as follows: "The tubercu-
losis was evidently primarily located in the left pleura, and from here
extended by contiguity to the pericardium, bronchial glands, ribs, and ster-
num. The tuberculous pericarditis led to the development of subpericar-
dial tubercles, which by conglomeration formed two large, solitary tuber-
cles, one situated about the center of the wall of the left ventricle, the other
in the right auricle below the arch of the aorta, the tuberculous process
burrowing into the myocardium." — Boston Medical and Surgical JaumaL

Hypodermic Feeding with Yolk of Egg in Anemic Children.—
Muggia, of Turin (British Medical Journal), has for some time treated chil-
dren suflFering from anemia and athrepsia by the hypodermic injection of a
preparation of yolk of ^gg. Freshly laid hen*s eggs are taken and carefully
washed before opening. The yolks are received into a sterile glass vessel,
and are weighed and then mixed with one third of their weight of physio-
logical salt solution. The mixture is then thoroughly stirred up with a
glass rod and filtered through aseptic absorbent gauze. The liquid thus ob-
tained is of a bright yellow color and of homogeneous consistency, and can
be used for hypodermic injection. It is well to begin with an injection of
about I c. cm. made into the buttocks or the lumbar region, and, provided



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The American Practitioner and News. 279

asepsis is strictly observed throughout, there is no local or general inflam-
matory reaction. The region of injection should be slightly massaged.
The quantity of hypodermic injection is gradually increased till a limit of
ID c. cm. per injection is reached. The duration of treatment varies accord-
ing to each case, but in any case not less than 100 c. cm. (twenty injections
of at le^st 5 c. cm. per dose) should be administered. According to Mug-
gia*s observations, it appears that both the body weight of the children and
the percentage of hemoglobin in the blood increase in the case of athrepsic
infants. The number of red corpuscles also rises, and this occurs much
more readily than if lecithin were administered in the same way. — Maryland
Medical Journal.

Modes of Infection of Leprosy. — Dr. Prince A. Morrow, of New
York, read a paper on this subject at the recent meeting of the American
Dermatological Association. He stated that very little significance should
be attached to infection through sexual intercourse. It is quite possible
that the mode of salutation of rubbing the noses, which prevails in Iceland
and Hawaii, may have been partly responsible for the spread of the disease
in those countries. The plague of mosquitoes and the plague of leprosy
appeared in the Sandwich Islands about the same time, and a causal rela-
tionship has been claimed. Until recently numerous searches had failed
to reveal the presence of lepra bacilli in mosquitoes. The writer discredits
the part alleged to be played by the mosquito in the production of leprosy.
Leprosy usually occurs first upon the exposed surfaces, face, hands, etc.
Many believe the skin to be the point of entrance of the germs. The prob-
ability is that there are many modes of infection, but the most frequent
channel of infection is, according to the views of most leprologists, through
the upper air-passages. The writer believes inhalation to be a frequent
cause. Blashko collected thousands of lepra bacilli upon plates placed in
the immediate proximity of lepers. Certain conditions predispose to lep-
rosy. Some individuals are absolutely immune. An individual predispo-
sition seems to be the most important favoring factor. Catarrhal conditions
of the upper air-passages are also strong predisposing causes. Nearly all
lepers give a history of a " cold " at the onset of the disease. — Boston Med-
ical and Surgical Journal.

Remarks on the Treatment of Scabies.— Dr. S. Sherwell condemns
the treatment of scabies by irritant ointments of various kinds. He urges
the adoption of a method which he declares is *' better, cleaner, and easier."
The patient is instructed to take a thorough bath, after which sand soap is
to be used upon the tougher portions of the integument. A half teaspoon-
ful of powdered washed sulphur is then rubbed over the entire skin surface.
The same quantity should be placed between the bed sheets and shaken so
as to evenly distribute the powder. This should be repeated for several
nights, a cure being usually effected in a week. The writer has never
seen a dermatitis follow this treatment. He also advises its use as a pro-
phylactic measure whenever an individual is exposed to scabies. — Ibid.



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Special ZToticcs*



Sanmetto in Enuresis Nocturna.— While visiting my nephew in Illinois last
Christmas he told me his little girl, six years of age, had always "wet the bed" at
night, and asked me, " What shall I do for it ? " I procured three ounces of Sanmetto,
all the druggist had at the time; the second night she missed, and has had but three
nightly emissions in two weeks. He wrote me last week, " We consider her cured,
but shall keep an original bottle on hand and use if necessary." I have uniformly
good results from prescribing Sanmetto in kidney and bladder complaints.

Saginaw, Mich. T. T. Hubbard, M. D.

Chemicai« Food is a mixture of Phosphoric Acid and Phosphates, the value of
which physicians seem to have lost sight of to some extent in the past few years.
The Robinson- Pettet Co., to whose advertisement in this issue we refer our readers,
have placed upon the market a much improved form of this compound, " Robinson's
Phosphoric Elixir." Its superiority consists in its uniform composition and high
degree of palatability.

Wm. R. Warner & Co. are calling attention to four of their specialties — Ingluvin,
Lithia Tablets, Tono Sumbul, Elixir Salicyclic Comp. — in the advertising pages of this
issue. They are all first class remedies and should be liberally prescribed by physi-
cians. When we say should be prescribed, we mean that the preparations are so emi-
nent that we can not but recommend them thus strongly. Samples of Ingluvin and
Lithia Tablets will be sent on request,

I HAD rather a queer experience with your sample of Ecthol. I took it twenty
miles north and gave it to Nicholas Diaz. He has had scrofula for four years, and has
paid out in that time over one thousand dollars. He took a teaspoonful every two
hours for four days, after that a teaspoonful every four hours until he had used two
bottles. He walked in here to-day cured. All signs of swelling and those awful
scrofula sores and blotches on his face are gone. Of course, his soft palate was
destroyed by the disease long ago, and he thought I could make him a new one. I
replied, only God can do that. He paid me enough, so I can buy more of your reme-
dies, and I shall keep a supply on hand. I buy of Dr. Barry, of Durango, Mex., who
orders for me from San Antonio, Tex. Chas. A. Baii^ey, M. D.

Canatlan, Durango, Mex., September 29, 1899.

Sanmetto in Anemic, Undevei^oped Young Women.— I have used Sanmetto
with profit in a case of a young woman who was troubled with a very irritable bladder
and urethra, caused from an excess of uric acid crystals in the urine. The Sanmetto
accomplished what I did not expect. The mammae had never developed very much,
nor the chest and shoulders. She was also quite anemic. I gave her a bottle of
Sanmetto with no ?ipparent improvement except toward the last she felt a little more
vitality. I then procured another bottle at the drug store here and gave her about
half of it. There is now a marked improvement in her general health, the mammae



Online LibraryUniversidad de Buenos Aires. Facultad de Derecho yThe American practitioner → online text (page 86 of 109)