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they very dependent on rain, slop water, drains, garden tubs, etc., being
found at all seasons. Now, as Ross has pointed out, malaria is amenable to
drainage, and is largely influenced by the rainfall, while its distribution is
very local and not nearly so general as that of at least the commoner species,
Culex, Hence his inference that malaria depends on a kind of mosquito
which breeds not in pots of water but in puddles on the ground.

"The recent work of the expedition has given ample confirmation of
this view. Culex is essentially a pot-breeding mosquito ; Anopheles, a pud-
dle breeding mosquito— or even a stream-breeding mosquito. Hence the
familiar laws of the prevalence of malaria. But Anopheles not only re-
quires puddles to breed in, but puddles of a certain kind. Hence the prac-
tical importance of the subject.

** Further than this, Anopheles larvae are found in puddles containing
algae. But there is more than a mere association between the larvae and
the algae; the former eat the latter. It has been found that larvae hatched
from the ^%% will not grow unless given large quantities of algae, which
they are seen to devour rapidly, while the crops of the larvae caught in the
puddles are found crammed with the same weed. Hence it would appear
as \i Anopheles is, in the larval stage, essentially an algae-eating insect, and
an insect which generally, if not always, breeds in association with that
vegetable.

** From a theoretical point of view these observations are. of interest,
because they satisfy and explain some long-known laws of the diffusion of
malaria — such as the connection of the disease with rainfall and stagnant
water, its disappearance on drainage of the soil, and so on. The supposed
influence of turning fresh soil may be explained as being due to the forma-
tion of Anopheles puddles. From a practical point of view, however, the
observations just given are still more important, because they enable us to
avoid draining a whole malarious area, a thing which few towns in the



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The American Practitioner and News. 345

tropics can afford ; and by teaching us how to indicate with scientific cer-
tainty the precise foci of malaria enables us to reduce the cost to a mini-
mum by dealing only with the actually dangerous spots. A little considera-
tion will show that level ground is almost a necessity for pools containing
algae, at least in the season of heavy rains. At present when a heavy trop-
ical shower falls almost every six hours all the water courses with any
slope are scoured out so deeply that the bare rock is exposed, while after
the shower, because of the same slope, all the water, except in a few pools
in the rock, drains away almost at once. Mosquito larvae can never live in
5irch places."

Evidently the recognition of the larvae and their habits of life is the first
step toward their extermination. If the researches alluded to above stand
the test of further experience, we may certainly look for positive and
•eflScacious prophylactic measures directed against the spread of malaria. —
Boston Medical and Surgical JournaL

The Increase of Cancer Real, Not Apparent.— Directly after the
publication of Dr. Roswell Park's striking article on the increase of cancer
(Medical News, April i, 1899), there followed quite a discussion in the
medical journals of this country and of England as to whether the increase
of cancer, according to the mortality statistics, was apparent or real. A
number of letters were written by those who could not bring themselves to
believe that cancer is really on the increase, in which they endeavored to
show that the apparent increase is really due to better methods of diagnosis.
A number of obscure internal conditions that were formerly set down in
the mortality statistics under various names, according to the special symp-
tomatic condition that was most prominent in them, are now correctly
diagnosed and reported as cancer.

So great is the tendency to refuse to accept what is new, when it is a
surprise or has been entirely unexpected, that the majority of the profes-
sion have been rather inclined to revert to this explanation of the statistical
increase of cancer. It is undoubtedly true that the gradual evolution
throughout the profession of better diagnostic methods as to internal
cancer has led to the addition to the cancer mortality statistics of a certain
number of deaths that were formerly set down as due to other causes, but
this factor by no means is sufficient to account for the greatly increased
prevalence of the affection that is reported from year to year.

The statistics of the Registrar-General of England for the year 1897
have become available since the discussion in the spring. Dr. Tatham in
the introduction to the Registrar's report does not accept the view that the
increase of cancer in recent years is only apparent, though he admits that
during the decade from 1870 to 1880 this factor probably played an impor-
tant r61e in the increased number of cancer cases reported. Since then the
apparent increase for this reason has been growing steadily less and less,
and at the present day we surely can not say that from year to year there



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34^ The American Practitioner and News.

is such a progressive betterment of methods of diagnosis as would add
markedly to the number of cancer cases reported.

In the London Lancet for September i6, 1899, Dr. Payne makes an
interesting comparison between the death-rate from cancer and from
tuberculosis in the female sex during the two years at the beginning and
end of the last score of years for which we have reports. In 1877 the
death-rate for females from cancer was 636 per 100,000, that from phthisis was
1,967 per 100,000; that is, the cancer death-rate was less than one third that
of tuberculosis. In 1897 the death-rate from cancer was 929, that from
phthisis, 1,162 per 100,000, a ratio of 4 to 5; that is, cancer now causes in
English women lour fifths as many deaths as are caused by phthisis, a condi-
tion of affairs that is certainly very surprising, especially to those who are
prone to think of cancer as a comparatively rare disease.

Some of this approach of the death-rates from the two diseases is due
to the improved methods of dealing with consumption, which has made it
much less fatal. The increment of nearly fifty per cent in the death-rate per
100,000 from cancer is, however, sufficiently startling to make us realize the
importance of the present comparison. This death-rate, it is to be remem-
bered, is among women, while it has been argued that it was especially the
statistics of cancer among; men that showed that the increase was apparent,
not real. We are, then, surely in the presence of a highly-increased mor-
tality from cancer, and this is not due to the lessened number of deaths
from infectious diseases, nor to longer average life, but to actual heightened
incidence of the malignant affection. — Medical News,

Heroin to Relieve Cough and Chest-Pains in Tuberculosis.—
Dr. A. W. Beketoff (Amer. Jour. Med. Sci., August, 1899) has made use of
heroin in the treatment of twenty-five patients suffering from tuberculosis,
in dose of one tenth of a grain in powder or pill. In about fifteen minutes
after its administration cough ceases, and sleep is possible. The respira-
tion, especially when increased by coughing or pleuritic pain, is slower and
deepened. In case of disease of the heart, or oxygen-hunger from en-
croachment upon the respiratory area (large cavities), this remedy is of
little or no value. It has but little influence upon the circulation as regards
either frequency or fullness, further than that respiration is benefited. It
relieves chest-pain, and so favors sleep. Insomnia due to mental excite-
ment is not markedly relieved. It is well borne, even if digestive disturb-
ances exist. It is indicated in the treatment of hemoptysis because of its
beneficial action on cough. Patients do not become readily accustomed to
its action, and it may be administered for a month without necessity arising
for increase of dose. — Virginia Medical Semi- Monthly,

Congenital Cystic Kidneys, with a Report of a Case. — He saw
this baby about twenty minutes after birth. It was well developed but dis-
tinctly cyanotic, breathing feebly, and the cyanosis appeared to be more
marked than the heart's action and feeble breathing should produce. The



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The American Practitioner and News. 347

body was limp, and the child could not be aroused. Death occurred forty-
five minutes after birth. The autopsy made four hours later showed a
normal heart, small areas of lung tissue containing air, liver, spleen, and
mesenteric glands normal, and both kidneys cystic. — Dr, E. E, Graham^ in
American Pediatric Society,

Digestive Value of Hearty Laughter. — Hippocrates recom-
mended eating at table with others and the making of conversation as gay
as possible, since hilarity and laughter are the greatest aids to digestion.
This he believed was a happy and rational application of physiology, of
which the stomach derives the greatest benefits. Not long ago a gentle-
man excused himself at the last moment from attending the theater on the
plea that he had then a violent attack of indigestion. " Go," said his physi-
cian friend, '* by all means go, as nothing will so surely and quickly cure
you as a good hearty laugh." The play was a broad farce, full of ridiculous
situations from start to finish, and the result proved the wisdom of the
doctor's suggestion. Long before the first act was over the patient said he
never felt better in his life. — Virginia Medical Semi-Monthly,

Scurvy in an Infant of Six Weeks.— The patient was born
October 12, 1898. The father was not in good health, having long sufi*ered
from chronic rheumatism, while the mother, who had a valvular cardiac
disease following rheumatism, was anemic and did not recover from the
eflfects of confinement for many weeks. The child was not strong, and
when seen in the sixth week there was a well-marked condition of scurvy.
The child had never taken any thing but breast milk, which was very
abundant but thin and watery. So abundant was the supply that, though
the child nursed frequently, it never emptied the breast, and consequently
only received ** fore-milk," which contains a much smaller amount of fat
than does the later milk. The child was allowed to continue nursing, but
pasteurized cream was given to make up the proper amount of fat, and the
results were prompt and satisfactory so far as the scurvy was concerned, but
the child subsequently died from an attack of pneumonia. — Dr, Floyd N.
Crandall, in American Pediatric Society,

Professor Koch's Report on Malaria. — Professor Koch's first
report on his study of malaria in Italy has been published in the Deutsche
Medicinische Wochenschrift, He stayed in Grosseto, a town situated in
the Tuscan Maremma, from April 25th till August ist, together with his
assistants, Professor Frosch and Dr. OUwig, and the Italian delegate, Pro-
fessor Gosio. It was a remarkable fact that new cases of malaria usually
occurred only in the months of July, August, and September, so that up to
July 23d the commission had the opportunity of observing only fifty-nine
cases, of which five were recent, while from this date till the end of July, 222
cases were examined. In every instance the parasite of malaria was found
in the blood. Apart from human blood, the parasites occurred only in



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348 The American Practitioner and News.

some species of mosquitoes which were met with only in the summer.
The mosquitoes convey the malarial germs from one human being to
another; the infection is especially maintained and propagated by the
relapsing cases which continue all the year round and form the link
between one fever season and the next, so that the mosquitoes in the be-
ginning of summer always find germs. A remedy which destroys the para-
sites was discovered long ago in cinchona bark and quinine; it must be
given not only during a fit but for a very long time, from eight to nine
months, so that relapses may be avoided. If no relapse occurred in any of
the cases of malaria in any given district, the mosquitoes would find no
germs in the beginning of summer, and malaria would become extinct
there. Professor Koch succeeded in recognizing certain species of mos-
quitoes in the dwellings of the population ; this was the more important, as
the mosquitoes of this district did not usually bite during the day, but only
during the night. The inhabitants therefore became infected at night
within their dwellings. In seven cases parasites of malaria were discovered
in insects, especially in anopheles maculipennis. In many dwellings, how-
ever, where patients had contracted malaria, anopheles was not present, but
another insect, culex pipiens, was hardly eyer absent. Professor Koch
ascertained that the so-called estivo-autumnal fevers were identical with
tropical malaria. Professor Grassi, of Rome, has recently charged Professor
Koch with unwarrantably claiming to be the discoverer of the spread of
malaria by mosquitoes, and with ignoring the fact that the propagation of
malaria in this way was made known long ago by the researches of Pro-
fessor Grassi himself and other observers. Professor Koch, being at
present in the Dutch East Indies, is unable to reply to these imputations!
which have been aggravated by publication in a non-medical journal, the
Rome Tribuna. It must, however, be observed that Professor Koch in this
and in other memoirs speaks of the " well known " mosquito theory, so
that obviously be had no intention of giving himself out to be the author
of this theory. — Lancet.

Iodine in Articles of Diet.— Iodine has not hitherto been presumed
to be present in any important quantity in alimentary materials, but accord-
ing to recent researches which have opened up a very delicate process for
the detection and estimation of iodine, this element occurs certainly in the
flesh of fish and shell fish in not a negligible quantity. It is true that
traces of iodine have been found in cod-liver oil, which with other elements,
such as bromine and phosphorus, probably exert a slight specific action
and possibly a favorable influence on the asorption of the oil, thus contrib-
uting in some measure to its tonic effects. The flesh of fish is peculiarly
nutritive though less satisfying and perhaps less stimulating than ordinary
kinds of meat. It is able to be digested more easily and rapidly than is
animal flesh, and on these considerations affords a useful food for invalids.
But most fishes contain iodine, and thus the occurrence of this element



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The American Practitioner and News. 349

may be a factor of importance in the suitability of a fish diet for invalids.
The herring appears to be at the top of the list, containing 2 milligrammes
of iodine per kilogramme. Next come mussels, 19 milligrammes per
kilogramme ; next salmon, % milligramme per kilogramme ; then ling and
cod, % milligramme per kilogramme, and the same amount in oysters.
The salmon trout appear to contain the smallest quantity, which is only
tV milligramme per kilogramme. These results are interesting, and doubt-
less the inquiry will be extended to other articles of diet, though on the
face of it there is more probability of iodine occurring in fish than in mam-
mals or vegetables. — Ibid,

Inoculation op Scarlet Fever.— A remarkable article on the above
subject by the late Mr. Joseph William Stickler, M. S., M. D., of Orange,
New Jersey, U. S. A., is published in the New York Medical Record of
September 9, 1899. A footnote explains that the manuscript was found
among the papers of the deceased physician. The material for inoculation
was obtained from the throat and mouth of a patient who had a mild attack
of scarlet fever. The cases inoculated were ten in all, and all recovered.
The effect of inoculation was generally to produce sickness, diarrhea, rise
of temperature, but not very high, some sore throat, and general desquama-
tion, but intense desquamation and sometimes abscess at the seat of inocu-
lation. The author in a note explains that he had hoped to find a protec-
tive virus in the inoculated muscus, but finding in each case that genuine
scarlet fever developed with, in one or two cases, nephritis, he desisted.
The cases seem to have been of a somewhat less severe type and of shorter
duration than those occurring naturally, but the difference was obviously
not such as to warrant the continuance of the very questionable experi-
ment, to say nothing of the multiplication of cases, each doubtless capable
of conveying the disease. We record the experiments, but we can not
extend to them our approval or understand the principle on which they
could be justified* The average duration of the period of incubation from
the time of inoculation was thirty-two hours and thirteen minutes, but it
varied much, from twelve to seventy-two hours. — Ibid,

The Adulteration op Golden Syrup. — Few articles nowadays seem
to escape the subtleties of the adulterator. Perhaps the latest form of
adulteration brought to light is the addition of glucose syrup to golden
syrup. Glucose syrup is made by the action of acids on maize, starch, or
even wood. It contains the characteristic sugar known as dextrose, and
this is largely used now as a substitute for malt and cane sugar by vinegar
makers, and large quantities of glucose prepared in this way are used by
manufacturers of fancy sugars and sweetmeats, while it is even used to
adulterate honey. We need not urge again the argument which we are
repeatedly bringing forward that the purchaser is entitled to have exactly
the article for which he asks. If he asks for cane sugar he should be sup-



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350 The American Practitioner and News.

plied with cane sugar, and not with a substitute ; for olive oil he should not
be given cottonseed oil ; nor should any other fat be supplied when he dis-
tinctly asks for butter; and so on almost ad infinitum, and, we may add, ad
nauseam. It is pretty certain, moreover, that the dietetic value of substi-
tutes in general is inferior to that of the genuine article, and we have little
doubt that this is so in regard to glucose and true golden syrup. It is
probable that the dietetic qualities of the constituents of golden syrup,
which are all derived from pure cane sugar, are more wholesome than the
sugars chemically derived from starch and woody fiber. Recent revelations
have shown that frequently golden syrup consists of equal amounts of the
two sugars. We trust that a sharp lookout will be kept upon this form of
adulteration, since golden syrup is a favorite adjunct to food among the
poor, and further, it is decidedly nutritive itself, being quite soluble and
giving little trouble to the digestive organs. It is scandalous that a pleas-
ing and cheap article of food should be tampered with in this manner. —
Ibid,

Infantile General Paralysis Simulating iDiocv.—Dr. Toulouse
and Dr. Marchand, in a recent communication to the Soci^t^ M^dicale des
H6pitaux (June 23, 1899), state that the fact that a form of dementia closely
resembling general paralysis may occur in young children is becoming
more and more generally admitted, but according to them one point has not
received sufficient attention ; that is, that many cases of general paralysis
occurring in the very young are often mistaken for cases of idiocy.
They report the case of a child who, after a short period of apparently
normal growth and development, began to manifest signs of progressive
dementia. There were epileptiform convulsions, inequality of the pupils,
disturbances and indistinctness of articulation, and a rapid emaciation fol-
lowed by death. A necropsy was made, and the post-mortem findings
showed the presence of cerebral atrophy of the convolutions, adhesion of
the pia-arachnoid membranes with tearing and decortication on attempts to
strip them ofi*, proliferation of the neuroglia cells, atrophy of the nerve
cells, and other changes known to be characteristic of chronic diffuse
meningo-encephalitis. It is interesting also to observe, as indicating the
syphilitic origin of this disease, that the child's father had died from gen-
eral paralysis with syphilis. — Ibid,

Rare(?) Complications of Typhoid Fever. — In several recent anno-
tations you have called attention to the "rare" complications of typhoid
fever which have been recorded in England and elsewhere. The two most
recent instances are "suppurative orchitis" and "multiple ulcers of the
vulva." With all due deference to the expressions of authorities as to the
respective rarity of the various complications of this disease, I venture to
think that even the rarest are constantly met with by physicians, although
they may not be reported. The result is that a few authorities publish a



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The American Practitioner and News. 351

•series of cases and reckon the rarity of complications by their own series,
taking perhaps into their calculfitions the few cases which from time to
time are reported by others.

In support of my statement, I may mention that within the last two or
three years I myself have attended patients with typhoid fever complicated
with *' suppurative orchitis " (one case), and " hemorrhage under the skin *'
<two cases, while I have lately known of a third). At the present time I
have a young man in the fourth week with hemiplegia (right-sided with
aphasia) from cerebral thrombosis, also a young lady who developed ulcers
on the mucous surfaces of the labia majora, and on the labia minora in the
^second week. Here in a short period and in a comparatively small series
<about sixty cases) are seen some of the supposed rarest complica-
tions.

I could mention other interesting conditions met with in the same period,
such as typhoid fever in a woman seven months pregnant without abortion,
^tc. I may have been fortunate in seeing these ** rarities," but I fancy there
are many others equally fortunate. Most people, especially those who see
most, do not care about rushing into print with every unusual isolated
case, hence the '* rarity " of the unusual. — Dr. W. Blair Bell, in Lancet.



BIOaRAPHICAL SKETCH : DR. OBORQB BEBLBR, DBCBASBD.



Dr. Beeler was born in JeflFerson County, Ky., December 21, 1830,
son of George and Hannah (Stansbury) Beeler. His mother died the
same day he was born, and his father died twenty years later. He
remained on his father's farm until of age, when, under the influence
of a friend of the family, Mr. Simon Snyder, he entered Clinton College,
a noted institution of learning. In January, 1853, the young man com-
menced the study of medicine with Dr. John S. Ray, of Clinton, Ky.,
and after the expiration of one year he went to Louisville and con-
tinued his studies with Dr. Robert Breckinridge, where he attended a
session of the Kentucky School of Medicine. He then went to Lexing-
ton, where he graduated with honor at the Medical Department of the
Transylvania University in March, 1855. He returned to Clinton and
practiced until the following fall, when he went to Philadelphia and
attended a course in the JeflFerson Medical College, also graduating
from that institution. He now located permanently in Clinton, where
he continued to practice the remainder of his days. He became to be
quite a noted physician, and did a large practice. He was kind to the



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352 The American Practitioner and News.

poor, and ever ready to render them medical assistance. The doctor
was a member of the American Medical Association, the State Medical
Society, besides local societies, and was a regular attendant. He
was President of the Southwestern Medical Association several times.
He was elected President of the State Society several years ago at the
meeting at Henderson, and performed the duties of the ofl5ce quite
ably.

''Liberal he was of soul and frank of heart;
And to his dearest friends, who loved him well,
Whate*er he knew or felt he would impart."

The doctor was a prominent member of the Christian Church, and
also a member in full fellowship of the Masonic order.

The doctor was married to Miss Viola Whayne, of Ballard County,
November i8, 1856. Of this union there are left seven children, to wit:
Mrs. Blanche Higbee, Mrs. James L. Moss, Mrs. Jennie Samuels, Mrs.
Jerry M. Porter, Miss Annie Beeler, Dr. Fred Beeler, and Dr. J. Moor-



Online LibraryUniversidad de Buenos Aires. Facultad de Derecho yThe American practitioner → online text (page 94 of 109)