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Full text of "The Canada lancet and practitioner"

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DOMINION 



MEDICAL MONTHLY 



AND ONTARIO MEDICAL JOURNAL 



Ki)iTr<:D nv 



naediclne: (iraham ('hamlieis. K. J. 
I)\vyer, Gold win HovvlaTiti, Geo. 
\V. Ross, Wm. D. Young. 

Snrg'ery: Walter McKeown, Herbert 
.\. Bruce, W. J. O. Malloch. Wal- 
lace A. Scott, Geo. Ewart Wilson. 

Obstetrics: Arthur C. Hendrick. 

Fathologry and Public Health: John 
A. Aiiiyot, Clia.s. .1. Hastings, O. R. 
•Malic. -. Geo. Xasniith. 

Fbysiolog'ic Therapeutics: J. Harvev 
Todd. 



Ernest .Tones, W. C. Hc-r- 



Psychiatry: 

riinun. 

Ophthalmologry : D. N. Maclennan, W. 
H. I.,o\vry. 

BhiuologT, Iiaryngrolosry and Otologry: 

r;.(,ffrey Boyd, Gilbert Royce. 

Oynecoloffy: F. W. Mario w, W. B. 

H.n.lry. 

Oenito-Urinary Snrg'ery: T. B. Rich- 
ardson, W. Warner Jones. 

Anesthetics: Samuel Johnston. 



aEOBQE £I.I.IOTT. Manag-ing Editor. 



VOLUMES XXXVIIL, XXXIX. 



TORONTO : 

GEORGE ELLIOTT, PUBLISHER 

719 SPADINA RO.\D v V 

I912 




Contents of Volumes XXXVIII. and XXXIX. 



CONTENTS OF VOLUME XXXVIII. 



^^:- 

v.3^ 



II 

1€S 



i Case of 
- Valu-r of a 

■- Oour.t 

Public Health.. 



bronchial . . 
The Plmltary 



13« 
44 

SOX 



Montreal and Mc- 
:v of the Alimen- 



;ess in 

v. Part III. 



.1 Inspec- 

The C^re of Infants and 

i InteraaUonal. VoL IT.. 21st 
y'^ries 

•:;:.iics. International. VoL III.. 21st 
series 

•1'nJcs. IntematioBal. VoL 1_ Series Zt 

^ -press. Seventeenth International 

■"^itcal 

■ -i Resection of the Posterior Roots 
of the Spiaal 

Correspondence — Ont. Medical Associa- 
tion 



102 

29 

21 

28 

10» 

157 

1*4 

S2 

S2 

S4 

248 

87 

>7 

107 



Diabetes 21» 

EHabetes. Oatmeal In 54 

Diagnosis. Principles and Practice of 

Physical 

Dictionary. Borland's American Illus- 
CHctionanr. Webrter's Xew Intema- 

tlora! 28 

tr- -1 «1 

r>;s<- "'.Dst Important 93 

Dise.:. - ^orm 57 

Dtaea&ea, N^r-.oas and Mental 20* 

Dominion Medical Registration 212 

Dominion Re^pistration 172 



105 



Ear. Diseases 



of the 207 

- - — — '*•. Special 

.. l»i 

:al «7 

>." ui. L-.-- insurance. 08 



5lon of Professional . . , 
■ Typhoid 



Fractures. Th* 
laatloti arij 



05 

103 
38 

73 
210 



"^aenc* of 
and Fre- 



r :. > of Raw 

TreatTT.-nt of by Mobil- 
Massage 



12» 
130 
171 

105 



Gastroptosis, The Gastric Contents of. X03 

Goitre. Exophthaimic. in Men 30 

Gonorrhoea 103 

Heart Sounds and Murmurs S8 

Hemorrhage. Central 102 

Hypochlorite. The L'se of Calcium 103 

Infection. Colon B.-»ci!lus 103 

Inoculation. An Introduction to Thera- 
peutic 104 

Intestinal Obstruction. A Report of 
Stx Cases, in the Region of the 
Cecum 1 

Insanity. The Prevention of. 33 

Laryngoscopy, Bronchoscopy and 

Esophagoscopy. Direct 200 

List. The Physician's Visiting — 1912.. 03 

Lister. Lord 137 

Lister. Personal Recollections of Lord. ISl 
LungSw Tuberculous 2w5 

McGill's Work in British Columbia 33 

Medicine. A Manual of the Practice of. 30 
Medicine, A Text-Book of the Practice 

of 29 

Medicine. The Seventeenth Interna- 
tional Congress of 213 

Mouth. Hygiene of the Mouth 171 

Neck. Methods of Diagnosis of the Na- 
ture of Glandular Bnlargments at 
the Root of the Neck 115 

News Items 35. 71. 105. 139. 174. 215 

Ont. Society for the Reformation of 
Inebriates 177 

Pain. The Misinten»re!ta.ti<»n of O&rcliac 94 
Pain. Some General Considerations in 

Regard to Hypochondriac 94 

Papers, Dental Ebcaminatton 207 

Papers. Fellowship Examination 207 

Phenomenon. The Jaw ^Tinking 95 

Policy. No Naval. Yet 102 

Problem. The Midwife 204 

Pyelo - Nephritis. Nephrectomy tor 
Chronic. Probably of Hematogen- 
ous Origin 18 

Record. The Taylor Pocket Case 134 

Registrar-General of Ontario. 1910. 

Synopsis of the Report of the 25 

Reviews. The Medical Review of Re- 
views 104 

Rossv James F. W. 31 



Sajous. Dr. Charles R de M 

Spine. Injuries of the Cervical Region 
of the 

Stomach and Duodenum. Further Ex- 
perience in X-Ray Diagnosis of 
Ulcer of the 

Stomach. Olive Oil in Diseases of the. 



09 
90 



100 
lOS 



Suggestion. One Result of 150 



COXTEXTS OF VOLUME XXXVIII. (Continued) 



Surgery, Minor and Emergency 1« 

Surgery. Text-Book of Gynecoloi^ical . . ti 
Surgery. The Present Status of Abdom- 
inal Delivery in Obstetric S8 

Therapeutics. A Plea for Thorough and 
Systematic Study of the Materia 

Medica. and 124 

Therapeutics. Blair's Pocket 1*5 

Therapy. Practical Eaectro-Therapeu- 

tics and X-Ray 20« 

Therapy. Vaginal Douche *0 

Titanic 211 

Tuberculosis 1*1 

Tumors, The X-Ray as a Curative 

Agent in Malignant 20? 



Tuberculosis 21* 

Typhoid Fever. Safe Water Supplies Ib 

the Control of 21J 

Ulcer, Duodenal *♦ 

Ulcer. Treatment of Gastric, by Len- 

hartx Method UJ 

University. McGfll »» 

Urine. Post Partum and Hjrsterlcal 

Retention of 1<* 

Vaccination, Antitvphoid 5* 

Vivisection. The Report of the Royal 

Commission on !•• 

Vulvae, Purltus IW 

^Toman 1*5 

^Vorld. The Hospital 1#J 



CONTENTS OF VOLUME XXXIX. 



.\bs«>nt Treatment 

Academy of Medicine. Toronto 

Accounts. r*.-.llect'ne 

Action. Method of the Study of Direct 
or Specific Drug 

Address. Presidential. Canadian Medi- 
cal Association 

Address, Presidential — Ontario Medical 
Association 

Alcohol and Insanity 

Amenorrhoea 

Ansemia. Secondary 

Anemia. P'^rnicious 

Ani. Pruritus 

.•\rterirts<^lerosis 

Association. .American Hosoltal 

.Association. .Annual Meeting of the 
Ontario Medical As<!oriatlon 

A^=.-.-'.-irfr,T:. f^r.n^.'ir. >ft=^''--il 

ilth. . 



A.nnual 

n,rp«r: o: 

.Association. T - -.nltarium.. 

.AssociaiTon. r i Medical. 

.Asthma 

Auto-Tntoxicatlon and Disintoxication. 



173 

20> 



143 

1 

172 

«3 

S3 

1*« 

C3 

1»» 

105 

25 
33 

119 
♦'•« 

1«8 
C9 

2«« 
1S3 
201 



Blood. On the. Mononuclear Cells of 

the 73 

Bread. The Proper Handling of 1*3 

Bums 1*4 

C^rs, Ventilation of Sleeping 209 

Catechism Series — Operative Surgery. 

Part 1 198 

Chemistrv. ^ and Bacteri- 

olorr, .A ' Clinical 2'^2 

Children.' Sp-- -*es for Short- 

Siehted «< 

Church. Law and Medicine 32 

Clinics. International. VoL XL. 1912 1«5 

Clinics. Tnternational. Vol. Ill- SeVies 

22. 1912 1** 

Clinic. Skin. In Xew York 171 

Constipation. Chronic, in th<» Aeed 196 

Constipation. Pathology and Diagnosis 

of 159 

Constipation. Seouelse of. Including 

.Auto-Intoxication ISO 

Council, New Dominion Medical 210 



I Birth Rate. Montreal's 143 

r »♦« 

D - - . L.-ills IM 

r>.xt»-rs. .-ihall -A-lvertlse !•• 

Drinking and Smoking Increasing ta 

Canada H2 

Eat. What Shall I *5 

Eclampsia C3 

Education. British Columbia and Medi- 
cal 171 

Enuresis. Nocturnal, in Children 1«1 

Erysii>elas lU 

Exhibition. Child Welfare. pContreal .. . Sit 

Fathers. The Blood of the l»t 

F'^^^linir. Infant 99 

Femur. Cone^nltal Absence of t h e 

Report ^'' r - <7a»es M 

Flatulence ft 

Fly. The < ^ble MS 

Fractures. :>-i.-v .:...,n of §1 

Fun t tn 

Oas-stove, The Hvrtenl'* Claims of the. *** 
German Doctors Visit Toronto 171 

Haschis. -An E«>s«»v on IM 

Health. The Salaries of Officers of 

Health CT 

HosnitaL .A Modem Medical Staff for a 

Modem Medical 1S< 

Hosoital. St. Luke's General. Ottawa. 

Nurse's* Graduation. Dr. R. W. 

Powell's .Ad'iress Ill 

Hospital. The Proposition to Establish 

a Detention in Toronto «9 

Hospital. Wellesley 141 

Hous*-Flies. and How They Spread 

Disease 1 9T 

Hygiene and Demography. Congress on 141 

Impotence. {Sexual !•• 

Insurance, The National 31 

Knee, Hynerextension of the. F^oUowlngr 
Hip Disease !•* 



Leukemia 



19« 



^*) 



('OX'I'KNTS OF VOLUME XXXIX. (Continued) 



Machinery, Periodic Examination of 

Machinery 68 

Man, Man's Inhumanity to 137 

Measles Deadliest of Contagious Dis- 
eases 172 

Medicine an<l Surgery, The rractltion- 

evs" l'>in'yclopedia nf 1!t7 

Medicine, International Congress of... 173 
Medicines, The Trade In Patent and 

Proprietary 31 

Medicine, Seventeenth International 

Congress of . .' 34 

Medicine, Wheelei's Handbook of 65 

Methods, L.aboratory 99 

Milk. Synthetic 20S 

Mortality, The Third Report on Infant. 103 

Nerves 162 

Neurology, Some Aspects of. to General 

Practice 37 

News Items 35, 70, 107, 143, 175 

News Items, vide ante (211). 

Obstetrics and Gynecology, The New 

Professor of 168 

Operations, Surgical 165 

Opthalmology, A Text-Book of 164 

Osteopathy 101 

F'anoreas, Testing the Functions of the 207 

Pharmacology and Therapeutics 199 

Pharmacopoeia, The, of the Toronto 

General Hospital 66 

Phosphaturia 98 

Poisoning, Opium 64 

Poliomyelitis and the Biting Fly 171 

Poliomyelitis in Vancouver 206 

Pregnancy, Toxemia of 162 

Pressure, High Blood 63 



Presentation. Irreducible Shoulder 195 

I'yosalpinx 194 

Remedies, New and Non-Ofticial 66 

Resej-rch, American .\ssociatiun of 

Clinical 106 

Research, Medical, at ITnlver.slly of 

Toronto 208 

Sermon, A Medical — I)eRel)us 81 

Smallpox in Canada 171 

Society. Hamilton Medical 20ti 

Spasm. Muscle, and Deef^nt^ratioii 2fil 

Students' Day, The Medical 169 

Surgery, The Widening of the .'^cope of 
Abdominal, from I^ife-saving to 

Health-iestoring < iperations ISl 

Tea and Coffee 138 

Tetanus 56 

Teeth. The Extraction of 198 

Tonsilitis 9K 

Tonsil, The Massacre of the 123 

Tonsil, The Massacre of the (editorial) 140 

Tourists. Summer 31 

Treatment. Vaccine 195 

Tuberculosis 64 

TTlcers, Gastric 64 

Ulcers, Varicose 163 

University of Toronto, -Medical Depart- 
ment, Opens at 171 

Urethritis, Chronic 162 

Vomiting, Postanesthetic 64 

Whooping Cough 194 

Wright, The Retirement of Dr. Adam 

H 167 






Dominion /Iftebical /Ibontbl^ 



BiiO Ontario /IbeMcal 5ournal 



Vol. XXXVIII. TORONTO, JANUARY, 1912. No. 1 



©rioinal Hiticles 



A REPORT or SIX CASES OP INTESTINAL OBSTRUCTION 
IN THE REGION OF THE CECUM.* 



By W. Gunn, M.D., Clinton, Ont. 



CASE I. 

Intestinal obstruction caused by adhesions between the caput 
cecum and an abscess sac in the broad ligament, complicated by 
uterine fibroids, a pyosalpinx and a cystic ovary. 

Specimen Removed. — Uterus with multiple tibroids, one of 
which protruded from the os as a polypus, a cj'stic ovarj', a Fallop- 
ian tube much thickened and full of pus, a pus sac containing about 
eight ounces of pus, removed from between the layers of broad 
ligament, appendix being still attached, th€ walls of the sac from 
one-fourth to one-third inch in thickness in places. 

Operation, June, 1906. — Result, recovery. Under care of Dr. 
McCrimnion, Kincardine. 

History. — ]\liss M. (aged 34). — For several years had symptoms 
of uterine tumor. For about six weeks previous to operation, there 
were added to the above the physical and local signs and symptoms 
of pelvic inflammation of the right side. Dr. McCrimmon made an 
almost exact diagnosis of the trouble early in the disease and advised 
immediate operation. This was refused till obstruction of the bowels 
became complete. 

Operation. — A long incision through the right rectus muscle, 
appendix amputated and stump inverted. The caput cecum which 
was thickened was carefully separated from the broad ligament and 
the wall of an abscess which it contained. It was also separated 

* Head at the County of Elg^in Medical Association. Nov. 3rd, 19U. 



2 DOMINION MEDICAL MONTHLY 

t'lxtiii llu' jij)i)fiKlix wMrli had hccu a factor in causing' intestinal 
ol)st?-m'ti()ii. Tlio distal end of tlic api)(.'ndix was thus left tii-ndy 
imbedded in the pus wall. A partially huried eystie ovary was sep- 
arated and it, together with the pus tube and uterus, were removed. 
Fresh pacLs were put in j)osition. The line of cleavage being found 
between the abscess and the broad liganent, the wall of the former 
was separated with tingers and gauze. As the sac wall was thin at 
the part to which the appendix was still attached, with the most 
careful dissection a slight leak of pus was unavoidable. 

The adjustment of pelvic peritoneum, toilet of tlie pelvis, an 
abdomino-vaginal drain, and through and through sutuivs of silk 
worm gut to close th€ wound completed the operation. 

Remarks. — Appendicitis is not an uncommon cause of intestinal 
obstruction, but this case, by reason of complications, proliably 
merits a place in our list. The pus tube and cystic ovary might 
well be caused from an infected uterus, but the abscess in the broad 
ligament was evidently secondary to a diseased appendix. 

As a rule, when practical)le, it is safer to drain a pelvic abscess 
per vaginam and to postpone further operations that may be neces- 
sary. The virulency of an abdominal or pelvic abscess diminishes 
in proportion to its age or as the peritoneum becomes immune to the 
infection. As a rule a pelvic or abdominal abscess is virulent in 
proportion to the effort the omentum has made by means of adhe- 
sions to guard the general peritoneal cavity from the infection. 
Suspect an abscess, how^ever small or sweet smelling, if the omentum 
regards it as dangerous. A bad odor does not indicate a virulent 
ab.scess. Tiie i-everse is often the case. 

In removing inflammatory tumore of the pelvis, it is well to 
guard against cutting or ligating the broad ligament transversely 
far out. To do so is seldom necessary. It is often associated with 
troublesome bleeding, and may endanger bowel, mesentery or ureter 
that may have happened to be in the mass. 

The abdominal vaginal drain and through and through sutures 
are often indicated in ])elvic pus cases. 

To have separated the appendix early from the abscess wall 
wo\dd have added very much to the danger of infection in this case. 

CASE II. 

Intestinal ol)struction a.ssociated with displaced right kidney, 
nephritis, septic pyelitis and paranephritis, a large inflannmatory 
mass involving the ascending colon. 

Separation of kidney, decapsulation, neplirotomy, nephropexy 
drainage. 



DOMINION MEDICAL MONTHLY 3 

Result. — Kecov(^ry. ()p(?ration October, 1905. Patient under 
care of Dr. ^leDiarmid of Hensall. 

History. — Mrs S. (about 35 years of age). — Family history 
somewhat tubercular. For several years suffered from severe head- 
aches an^ bladder symptoms. For some time before operation the 
headaches were intens«^ and there were symptoms borderint; on con- 
vulsions. Temp. 100 to 104. There was vomiting, and obstinate 
constipation. Before operation the obstruction was almost (^mplete. 
A tumor could be felt just above the cecum. It was painful and 
t^^nder to pressure, fixed and 'somewhat tympanitic on p^^rcussion. 
The urine (•oiit;iinfd albumin, pus, blood, bladdt-r and kidney epithe- 
lium, casts of different kinds, uric acid and oxalate of lime. Urina- 
tion was frequent and painful. At times there were symptoms of 
nephritic colic. The findings justified the provisional diagnosis of 
displaced kidney nephritis, a septic pyelitis and cystitis. 

Operation. — A retroperitoneal incision revealed a displaced 
kidney, enlarged and firmly fixed. The kidney was separated from 
its suri*oundings with considerable difficulty. A den.se inflammatory 
mass was now observed in front of the kidney, apparently involving 
the ascending colon. No attempt was made to interfere with it and 
the peritoneal cavity was not opened. The kidney was decapsulated 
and split, exposing the pelvis, which contained pus, a bloody gru- 
mous substance and some small calculi. The kidney was fixed by its 
capsule in the normal position, a drain inserted, and a drain and 
some packing put below it. The wound healed in about four weeks 
and the patient has had excellent health ever since. 

Remarks. — In this case, the findings in the urine confirmed the 
diagnosis. Apart from such, the mistake of opening the abdomen 
through the peritoneum might have been made. 

The cystitis was probably kept up by a septic pyelitis and a 
debilitated system, for the condition improved soon after operation. 

The bowels became regular, either from relief of kidney pressure 
or absorption of the inflammatory product, or both combined. 

Jas. ^IcKenzie of London, England, says that all the symptoms 
of acute abdominal obstruction may be caused by a stone in the 
ureter, owing to reflex spasm of the anal sphincters, causing reten~ 
tion of gas, abdominal distension, etc. 

CASE III. *■ 

Intestinal obstruction from an extensive inflammator}- product 
about the lower end of the ascending colon, which looked like a ma- 
lignant growth, causing complete obstruction of the bowels, five 
weeks after an operation for a small cystic ovary, and the removal 
of catarrhal appendix. 



4 DOMINION MEDICAL MONTHLY 

Lateral anastomosis between cecum and colon. 
Resilt. — KecoYiTV. Operation October. 1908. Patient under 
care of Dr. McNaughton, lirusscLs. 

History. — Miss F. (age 32). — Good family history. Had left 
ovary removed by a Toronto surgeon several years ago. An ovarian 
cyst as large as a navel orange and a catarrhal appendi.x were re- 
moved July 10th, 1908, at the Clinton Hospital. The operations 
were of a simple nature and at the time nothing abnormal w-as ob- 
served in the ascending colon. Everything seemed to go well for 
two or three weeks, when obstinah' constipation developed. At 
the end of the fifth week, there was complete obstruction. The 
pains were very severe. 

Operation. — The abdomen was opened, at midnight. Dr. Clark, 
now of PontN-pool. and Dr. Shaw of Clinton, assisting. Everything 
seemed to be normal at the sites of former operations, but there was 
an enormous mass resembling a cancer involving the first six or 
eight inches of the ascending colon. After a difficult dissection, the 
colon was lilxn-ated and found to be very much thickened and indur- 
ated, and its calibre entirely obliterated. As the colon was already 
mobilized, it was not very difficult to approximate and unil^ the 
cecum laterally to the colon, l>eyond the seat of disease. This w^as 
done with Connell suture. The patient made a good recovery, and 
has had very fair health since then, over three yeai'S ago. 

Remarks. — I am aware that it is contrary to the best teaching to 
make a short circuit of the bowel, such as was done in this instance, 
but as the parts came together without much difficulty, I did not 
see the need for a longer circuit. Besides owing to the weakened 
state of the patient, the operation was intended as a temporary- ex- 
pedient, a resection later on being anticipated. 

This inflammatory growth with almost certainty developed with- 
in five weeks. The etiology I make no attempt to explain. I recall 
several instances where chronic inflammatory growths were con- 
fusing at the time of operation. One of these, a case, under the 
care of Dr. Elliott of Lucknow, where an appendectomy was done 
on a man 68 yeare of age. The appendix contained a calculus, but no 
pus. A very large mass resembling a carcinoma involved the region 
of the cecum, which at the time was considered inoperable, l)Ut the 
patieut is well six years after. A patient of Di-. Burrows of Sea- 
forth, had a gastro-enterostomy for pyloric oV)struction. There was 
a tumor in the first part of the duodenum, as large as a small lien's 
egg, and some involvement of adjacent glands. At the time of opera- 
tion we considered the tumor to lie cancerous. It is over six years 
since the operation, and the patient is quite well, having gained fifty 



DOMINION MEDICAL MONTHLY 5 

pounds in flesh. The growth was evidently inflammatory, the result 
of an ulcer of tiie duodenum. 

CASE IV. 

Intestinal obstruction caused by twist of pedicle, left ovary 
(fibro-cystie) pressing on the cecum. 

Specimen Removed. — A fibro-cystie ovary larger than a normal 
kidney, containing blood, left Fallopian tube containing a half 
ounce of blood clot — a c\'st in the broad ligament containing about 
twelve ounces of a sero-saneous fluid. The mass gangrenous. 

Result. — Recovery. Operation, May, 1907. Patient imder care 
of Dr. Campbell, Zurich. 

History. — ]\[rs. P. (age 40). — Mother of five children. Had 
fairly good health till present illness. 

On JNIay 2nd, 1907, felt a very sudden, severe pain on the left 
side of the lower abdomen. The pain was colicky in character, 
micturition became frequent, and with it a scalding sensation. 

When Dr. Campbell saw the patient shortly after, she was in a 
state of collapse. For the present, the symptoms were relieved by 
a hypodermic of morphia and strychnine. About two weeks later, 
when driving to Zurich, there was a second attack. The s.v'mptoms 
were of the same nature as the previous ones, but more severe — the 
shock more pronounced. Partial relief was again olitained by mor- 
phine and strychnine. On ]\Iay 25th, two days later, tiiere were 
severe pains in the region of the appendix. The abdomen was much 
distended and tympanitic, vomiting freciuent. no gas or feces 
passed the lower bowel. Soon after the second attack Dr. Campbell 
detected a tumor, tender and dull to percussion, over the cecum, 
and advised an immediate operation, w^hich was refused. 

On ]\Iay 26th. the fourth day from the onset, when consent to 
operation was granted, the pulse was 130. temperature about nor- 
mal, vomiting persistent, and intestinal obstruction was complete, 
the bowels were much distended, and the gas could be seen to 
accumulate and recede at the point of obstruction. 

Operation. — Tlie abdomen was opene<l through the right rectus. 
A gangrenous mass presented, which, at first sight, gave the im- 
pression of a gangrenous bowel. On lifting the tumor, its pedicle 
could be traced to the left side of the uterus. The diagnosis being 
made, the mass was separated from the uterus, the pelvis cleansed, 
wound closed and a drain inserted which was left for 24 hours. A 
speedy and permanent recovery followed. 

Remarks. — This form of intestinal obstruction is sufficiently rare 



6 DOMINION MEDICAL MONTHLY 

to he incliKlfd in tliis list. It will ho ohsorvt'd tliat the mass that 
pressed ou the eecuni eaiiie from the left side of tlie uterus. 

The fre(iuent and painful micturitions, wliieh were marked 
symptoms, especially in the fii-st attack, were no douht due to trac- 
tion on tile ureter or pressure on the hladder, or to l)otli comhined. 

As the pain radiated to the left kidney, the symptoms altogether 
simulated renal colic, which Dr. Campbell at first thoug'ht it anight 
be. 

The suddenness of the onset, and the absence of fever were 
strongly suggestive of a twisted pedicle, but the cyst in the broad 
ligament, which coula be felt l)ehind the uterus, helped to obscure 
the diagnosis, which in this case, as in some others, was postponed 
till the abdomen was opened. 

CASE V. 

Intestinal olistruction from pressure of a distended gall ])ladder 
on the cecum and ascending colon. (Jail bladder descended to 
the brim of the pelvis and contained pus, mucus, bile and about one 
hundred small gall stones. Cholecystotomy. 

Result. — Recovery. Operation Decem])er 20th, 1908. Patient 
under care of Dr. Campbell of Zurich. 

History. — Mrs. W. (aged 30 years). — The mother of two child- 
ren, and with a good family history. 

P"'or some years had been treated by different physicians for in- 
digestion. On Dec. 17th, or three days prior to operation, patient 
complained of an intense pain just below^ the sternum, which caine 
on suddenly. Dr. Campbell, who saw^ her shortly after, found her 
in a state of collapse. The pain was very severe and vomiting per- 
sistent. Tliere was a slight jaundice and the urine contained some 
bile. 

Dr. Campbell detected a tumor on the right upper quadrant 
on the seconil day, but the rigidity and distension were so great on 
the third day (the day I first saw her) that nothing of the nature 
of a tumor could be outlined. There was marked dullness over the 
whole of the right al)domen, however. The temperature never rose 
above 100, the pulse was fast, and the respiration <|uick and "catch- 
ing" 

Oper.\tiox. — The abdomen was opened by a long vertical incision 
through the rectus muscle. A grayish mass that looked at first 
glance like a greatly distended colon presented which descended 
to Poupart's ligament. The diagnosis of distended gall bladder hav- 
ing been made, the tumor was carefully raised out of the wound and 
the abdominal cavity |)rotected with pads. The gall bladder was 



DOMINION MEDICAL MONTHLY 7 

emptied of its contents, fastened in the upper part of the wound, 
and drained in the usual manner. Several stones were removed 
from the cystic duct, but none were found in the common duct. 

The patient gained rapidly in health and strength soon after the 
operation, but for some reason the wound at times discharged bile 
for three months. The patient became pregnant about this time 
and the fistula healed completely. 

Remarks. — Pressure from distended gall bladder is not a com- 
mon cause of intestinal obstruction. 

Early operation was imperative in this case, for, apart from 
the obstructive symptoms, rupture of the gall bladder apparently 
could not have been long delayed. 

It was nigh impossible from physical signs to make anything 
like a positive diagnosis on the third day on account of the rigidity 
and abdominal distension. Dr. Campbt-ll had mad(» a tentative 
diagnosis of gall bladder distension from the early marked pain and 
tenderness in the region of the gall bladder, the finding of a tumor 
on the .second day, the jaimdice, and the history of indigestion with 
gastrodynia. The enormous distension in so sliort a time would 
seem to be a feature of the case. 

C.VSE VI. 

Intestinal obstruction from cancer of th<' cecum, which was 
mistaken for a movable kidney. Resection — lateral anastomosis. 
Specimen, six inches of the ascending colon, six inches of the ilium, 
the cecum, appendix and adjacent glands. The cecum almost a 
solid mass, with a calibre that would hardly admit a lead pencil. 

Result. — Recovery. Operation August, 1910. Pf^tient under 
the care of Dr. Redmond, of Wiugham. 

History. — Miss G. (age 27). Mother died from cancer of the 
uterus at about the age of 45 — othe^^^^se, family history unimport- 
ant. 

Personal History. — For about a year before operation the pa- 
tient was anemic, lost flesh, and suffered from constipation. Two 
weeks before operation. Dr. Redmond was asked to see Miss G. ou 
account of pains in the right abdomen. These pains were colicky 
in character, and there was an elevation of temperature of 1 to 3 
degrees, lasting several days. The bowels were moved with difficulty 
and vomiting was a pronounced symptom. There was frequent 
micturition and bladder irritability, although the urine showed 
nothing specially pathological. 

Dr. Redmond detected a tumor in the region of the cecum. 
From the feel of the tumor, and the fact that it could be moved to 



8 DOMINION MEDICAL MONTHLY 

the normal position of the kidney, and other syiiijitoiiLs, Dr. Red- 
mond and Dr. ^McDonald were disposed to regard tlie condition as 
one of displaced kidney, and thought nephropexy advisable. 

Oper.\tiox. — A short incision liaving been made, retroperito- 
neal examination .showed the kidney to be normal in size and posi- 
tion. The wound was now extended to tlie inner side of the spine of 
the ilium to near Poupart's ligament. The peritoneiun was opened 
and the diagnosis of tumor of the ilium made. This opening, re- 
sembling the lumbo-ilio-iiiguiiial incision for exposing the ureter, 
gave an admirable worldng space. The outer leaf of the mesentery 
was divided, the mass raised out of the wound, and turned on its 
inner leaf, the vessels were ligated and cut. and pads placed for 
protection. The colon and ilium were doubly clamped six inches 
from the cecum. The parts so isolated, with the adjacent glands, 
were removed. The ends of the colon and ilium were inverted and 
the parts miited laterally. The openings were two and a half inches 
in length, and as near the ends as possible. The union was made 
antiperistalticly, and with the Connell suture. A cigarette drain 
was inserted in the lower part and the wound was united in layers. 
l7nion was somewhat tedious on accoimt of stitch abscesses; other- 
wise recovery was uneventful. 

The patient reports that she feels as well as she ever did. 

Remarks. — This case is interesting from a diagnostic standpoint. 
The size, shape and mobility of the tumor certainly resembled a 
displaced kidney. The colic pains simulated the pains caused by 
an obstructed ureter. The age of the patient was somewhat mis- 
leading. 

While constipation was very obstinate, there was not total ob- 
struction, although the calibre of the gut was so reduced. 

The findings in the urine were against a displaced and affected 
kidney, for a kidney giving a rise of temperature should show some- 
thing pathological in the urine. 

The incision employed was unusual lor such operation, but it 
gave a good working space. 

The last six inches of the ilium has the sanu? blood and lymph 
supply as the cwum and ascending colon, and should always be re- 
moved with them for cancer. W. Mayo removes all of the ascend- 
ing colon with a cancerous cecum and also the last six inches of the 
ilium. 

In uniting the ends of the l>owel laterally, it makes little dif- 
ference in result whether these are joined in an isoperistaltic or 
an antiperistaltic manner. Ease of coaptation is the main thing 
to be considered. 



DOMINION MEDICAL MONTHLY 9 

It is almost a sun^risc how easily the ccc-uiii and ascending 
colon are mobilized by first cutting the outer leaf, and hemorrhage 
is comparatively trrHing when the mesenteric vessels are ligated at 
the beginning of the operation. The glands follow the course of 
the iliocolic vessels whieh .supply this part of the bowel. The ureter 
must be earefully guarded. A .Murphy button should not be used 
in this part of the bowel. 

In conclusion. I would offer the following propositions or sug- 
gestions : — 

It would .seem as if infiammatory products in some subjects have 
a tendency to become excessive as compared with others, or else 
the infection is of such a character that it tends to such result. 
This apparent freak that an inflammatory process takes at times 
is not at all rare, and the condition has cau.stnl confusion many 
times in diagnosis, treatment aiul prognosis for to the naked eye 
these tumors are not distinguishable from cancer. 

I consulted Dr. Primro.se of Toronto regarding ('a.se No. 3, 
where the a.sceiuling colon l)ecame totally occluded, and he informed 
me that he was preparing a paper on the very subject for the 
Ontario Medical A.ssociation, held at Niagara. Dr. Primro.se, in 
his instructive paper, entitled " Infiammatory Tumors Producing 
Intestinal Obstruction," cites four eases which iuul recently come 
under his care. In concluding the paper, he remarks as follows: — 
" My object in recording these cases is to emphasize the fact that 
when such inflammatoiy tumors exist, the operative interference 
should be of the simplest variety, such as tlie creation of a fecal 
fistula or the resection of a damage<l portion of the bowel." In 
case (1) of our list, it is probable that the large abscess in the broad 
ligament, if left for some time longer, would have emptied into 
the cecum and the remaining cavity would become filled with granu- 
lation tissue, whicli, with the thickened sac wall, would result in a 
large inflammatory tumor. It would seem that a pus sac becom- 
ing filled with granulation tissue is the history of some, at least, of 
those tumors, but others have their origin in an ulceration of the 
bowel, acting as a septic focus in producing inflammatory growtlis. 
"When the septic focus is removed, absorption of these growths fol- 
lows, as a rule. 

Purgatives and delay are constantly bringing surgery into disre- 
pute. 

Purgatives should never be given in acute abdominal troubles 
till organic obstruction can be excluded with certainty. 

A case in which tliere is sudden severe abdominal pains with 
vomiting, and neither gas nor feces passing from the bowel, is 



10 DOMINION MEDICAL MONTHLY 

surgical from the start. It is especially so if attended Avith shock. 
Feeal iini>aetion alone rarely if ever pro<luces all the .syniptoins of 
acute or^'anie obstruction, neither does the atlministration of opi- 
ates. They will not cause stercoVaeeous vomiting. 

The long reetal tube hardly ever pa.sses above the rectum. An 
examining tinger will lind tlu' tube eoiled back upon itself in the 
bowel. 

The question is often asked by the friends of the patient, 
" Would the patient have lived if operation had been done early?" 
The surgeon has either to sidetrack the truth, which he often does, 
to save his confrere, or he assumes the resi)onsibility of performing 
a needless operation. 

It follows that in cases of intestinal obstruction the best interests 
of all concerned are served by an early operation before local in- 
flammation, or general infection begins. 

Too many people imagine that a surgeon's motives are not 
wholly disinterested, hence for obvious reasons it is the physician's 
duty and privilege to advise and insist upon early operation when 
such is indicated. 

In deaths associated with acute intestinal obstruction, the ex- 
ploratory incision or operation in competent hands can seldom he 
regarded as a factor bearing on the result. 



Pneumonia. 

James K. ^Mitchell (Medical Record) says that tb.e logical treat- 
ment of pneumonia is rest, support and calcium. He favors cal- 
cium chloride as the ideal heart tonic in pneumonia. Every aspect 
of pneumonia hears testimony to the value of calcium. The pneu- 
mococcus extracts calcium from the medium in which it grows, that 
it extracts calcium from the human culture medium, that convul- 
sions are caused by this calcium poverty, that gray hepatization is 
impossible without the presence of calcium, and that edema of the 
lungs and collapse of the heart occur only when the coagulation 
time of the blood is delayed. He considers that cold air treatment 
and cold sponge baths are harmful and brutal, and that warm air is 
just as fresh as cold air. 



DOMINION MEDICAL MONTHLY 11 

AGNODICL* 



By J. S. Sprague, M.D., Perth, Ont. 



Long ages since when plunged in thickest night of ignorance 
and error lay the world, save where, in one small part called Greece, 
there blazed the noonday sun of learning and of art, destined to 
shed its beams unto all time, in the Athenian tril)unal hall, sum- 
moned for judgment, stood Agnodice. 

A form of noble majesty and strength, such as the genius of 
that ancient's clime has left in priceless legacy of stone, outrival- 
ling in stately, calm repose the sculptured column at whose side 
it stood; serene those features, cast in mould superb, yet fine cut 
as a carven cameo. 

A mouth whose generous curves bespoke a soul large, brave, yet 
tender; prone to sympathy. Eyes like a crystal pool, yet in their 
depths lurked, baffling idle gaze, dark mysteries, all fathoiuless as 
in the deep green sea. 

Then spake the justice: "You are summoned here, a charge 
most grave to meet ; for it is claimed the noble art of medicine 
you've used to cover other base, designing arts against the peace of 
the domestic hearth, corrupting Athens' maids and matrons pure; 
that feigning ailments of the tiesh to heal, that which tenfold more 
precious is. the health of the immortal soul, you undermined. Here 
in the court do your accusers stand, Athenian citizens of high re- 
pute, prepared to prove conclusively their charge. A stranger, 
Athens gave you learning, fame. How ill do you requite her if this 
crime be fastened on you, which by Grecian law must be atoned by 
death! Now, prisoner, the court of Athens will permit your plea." 

The form beside the column raised its head, down bent the 
while the judge's speech was made, and in a voice whose full, rich, 
swelling tones were like unto an organ's, came these words: "0 
righteous judge, and all assembled court, I face you with the truth 
upon my lips. As to the grievous crime upon me charged, a strange 
dilemma I'm compelled to meet. I do avow the practice of deceit 
on my Athenian fellow-citizens. But that I have .seduced their 
wives and maids is fully false, a piece of calumny which in three 
simple words I can refute: yet these of fell import, for Athens 
counts as infamy th' olt'ence I thus avow, no less than that where- 



* These are a few selections from Chapter XXIX. of Dr. James S. Sprague'a proposed 
blication, Ideals in Medicine and Religio Medicorum. 



12 DOMINION MEDICAL MONTHLY 

with 1 ;iiM wnmjrfully cliar^^'d : in citlier case my lit'i' tlu^ forfeit 
pays. IShouUl I keep siU'iiee I mi^ht win release, for of my jrnilt 
there eaii he hroiight no proof; yet foul, unmerited dishonor's 
stain on Athen's blameless matrons there would rest. I cannot 
purchase life at such a price. Know then, citizens, that I who 
stand before you, chartred with this vil<^ crinu', am but a wonuui, 
and my name Agnodiee. " 

Throughout the court at tliis confession strange arose a tumult 
that not soon was (lui'llcd, while motionless aiul calm its subject 
stood, as though the nuitter nothing her concerned. 

"I marvel not that ye should stand amazed to hear the revela- 
tion of my sex. Well have I kept my secret, since not one of the 
wise men of Athens did suspect that underneath the learned doc- 
tor's garb there beat a mere weak, craven, woman's heart. Aud 
now that I am doomed, I pray the court for leniency, while I do 
relate the story of my life, to warn rash youth of Athens, lest they 
follow in my course." 

Consent was granted, and Agnodiee continued her recital: "As 
a child I saw my brothers at their games and books, wherein they 
told me I could have no part, because forsooth, I was a woman- 
child ! That to my sex forever was denied the boon of knowledge, 
for the gods ordained that woman by her nature was but fit for 
household tasks and bearing of the youug. I answered naught, 
but in my heart was born faint stirring of rebellion 'gainst my fate. 
I, mused — 'How strange that these same mighty gods have placed 
such aspirations in my breast that do of right belong to men 
alone ! ' 

"And so apace this knowledge hunger grew until it gnawed 
into my very soul. 

"And when at leiigtii 1 could no longer brook the tornu'iit. did 
I make a la.st resolve to brave the wrath alike of gods and men, 
attain the wisdom I so coveted at any cost. T left my native 
heath, and well disguised in masculine array, journeyed to Athens, 
where I boldly knocked upon her doors of learning; the result you 
know full well. For I bore off the palm from all my ma.sculine 
competitors, although I was a woman. Strange, indeed, if a 
woman's brain is by the gods decreed of poorer 'luality than is 
your own. that I should outstrip all the noble youth of Athens! 
;Mark you then, if this my act has been displeasing to the eternal 
gods, as in the eyes of men. woidd they have shown such favor to 
the maid Agnodiee.' Would th»\v have placed these laurels on 
my brow ? 

"Such wrongs the mighty gods could never do- — endow a woman 



DOMINION MEDICAL MONTHLY 13 

with the attributes tliat to the sex superior belong, i.nd then deny 
her opportunity to exercise these faculties divin-e. And so I rea- 
soned, 'twas a blunder made, for which the gods were not respon- 
sible. Dame Nature 'twas who in erratic mood had linked a man's 
mind to a woman's form. And none suspected, none in all these 
years, the secret of my sex. Oh, strange indeed, the ways of gods 
are — not like those of men' — that by mere change of gr.rb a woman 
is transformed into the semblance of a man, and that great inner 
difference concealed ! 

"The gods were good; they granted me success. My fame 
spread far and wide, and from all parts came the afflict)^, seeking 
for relief. Jiut of all patients did my heart the most incline unto 
my suffering womankind. For I too was a woman, and my heart 
went out to th&se, my sisters, in their woe. For they have trials 
that ye reck not of, oh, men of Athens, following the path of 
glory, wealth and honor in the world, unmindful of the dull and 
thankless lot that falls to them, your mothers and your wives, 
makers and moulders of the race, that bear the burdens of your- 
selves and of your sins before birth, and until your dying hour. 

"So to the mothers and wives of Athens I gave my services and 
sympathy. I .sorrowed in their sorrow, and rejoiced when they 
were glad. In pity for their pain, I wrought appliances for their 
relief: devices crude which science may some day perfect, forget- 
ting that the hand and brain that first did fashion them were 
those but of a simple woman, called Agnodice. 

"Yea, I confers I loved them, and from them won love and 
gratitude. And such as the.se are the base arts ye charge that 
I have used, men of Athens, whom your vices make prone to 
suspicion, these the dealings foul that I have had with your 
chaste wives and maids. Such are the soundless depths of infamy 
to which have slunk these slandered (irecian dames. Ah, now, 
accusers, does the Hush of shame not tinge your brows to hear the 
simple truth .' 

men of Athens, if you could but know what finer forces dwell 
within the frames of your submissive, gentle womankind I These 
are your warriors, doing battle brave with armed hosts of sin and 
suffering ! With smiles that hide the heartbreak giving up the sons 
they've borne to fight their country's foes. ^Mightier in battles 
fought in blood to win a kingdom, and more gloriou< victories, 
these conflicts of the soul from which there come patience, obedi- 
ence and self-sacrifice ! These are your statesmen, teaching to your 
sons — the little lads that cluster round their knees — the love of 
Greece and reverence for her law. These are vour sages who in 



14 DOMINION MEDICAL MONTHLY 

silence learn a tnitn- wisdom of the heart and soul, the Hower of 
their life's (xjx'ricnco! AVhat do ye with tliom ? Slnit them up 
to spin .' 

"O men of Athens, hearken to my plea I Do as you will with 
me, but give to them a larger freedom, standing at your side, as 
equals, and no longer slaves and toys! (Jive all their faculties de- 
velopment : no longer bind their soUls in iron bands of custom, 
forged from superstition's tianie. Then from a fairer Greece shall 
spring a race greater and nobler than ye yet have seen. 

"I would not be so impious as to say the gods have erred. Ye 
have not read aright, men of Greece, their mystical decrees. Lo, 
here I make to you a prophecy : if in your blindness ye shall still 
ignore, and your descendants, this mysterious force, this potent 
energy — the feminine — in the affairs of life, 'twill not be lost. 
Naught in the universe is ever lost! but, beaten back upon itself, 
pent up. mute, motionless, and stifled in the breasts of womanhood, 
a hundred thousand fold it will multiply until long ages hence, 
bursting asunder its fast prison bars, in one tremendous, irresist- 
ible outflow of j)ower, 'twill o'erwhelm the world, triinuphs achieve 
that man has never dreamed ! 

"Thus then will the eternal righteous law be vindicated; so the 
mighty gods avenge the fatal ignorance of man ! 

"!My tale is done. Do with me as ye will!" 

She eea.sed, and for an instant silence fell upon the multitude. 
Then through the court was heard a murmurous undertone that 
swelled in volume, rising ever like the tide, until a very ocean it 
became of .sound tempestuous, upon whose wave, above the mighty 
roar, these words came borne : 

"Well hath she done and spoken. Set her fr(>e! Let all revere 
the brave Agnodice!" — Selina Seixas Solomons, in Aroia. 

A .\ NOTATION.^, SCHOLIA, AND CON'SIOKKATIONS. 

Aguodici. — The name of the earliest midwife mentioned among 
the ( Jreeks. Slie was a native of Athens, where it was f<)rl)idden by 
law for a woman or a slave to study medicine. According to 
Hyginus, however, it would appear that Agnodice di.sguised herself 
in men's clothes, and so contrived to attend the lectures of Uiero- 
philus, devoting herself chiefly to the study of midwifery and the 
disea.ses of woiuen. Afterwards, when she began practice, being 
very successful in these branches- of the profession, .she excited the 
jealou.sy of .several of the other practitioners, by whom she was 
summoned before the Areopagus and accused of corrupting the 
morals of her patients. Upon her refuting the charge by making 



DOMINION MEDICAID MONTHLY 15 

known her sex, she was immediately accused of having violated the 
existing law, which second danger she escaped through the inter- 
vention of the wives of the chief persons of Athens, whom she had 
attended, who came forward in her behalf and succeeded at last in 
getting the obnoxious law abolished. — Smith's "Dictionary of 
Greek and Roman Biography and Mytholog}'." 

They accused her before the Areopagus of corrupt practices and 
conduct, "quod diccerent eum glabrum esse, et corruptorum earum, 
et illas simulare imbecilliatem." — Hyg., Fab. XXIV. 

The Greeks of this historic and heroic period (4(X)— 300 B.C.) 
had their wives to watch their children and the household gods, 
and for their lighter hours the blond-haired hetaerae, attractive 
and beautiful. A query naturally arises, and it is this : Were the 
fountains of her youth — (of Agnodice) — dried up. was the nimble 
spirit of her arteries and of her nerves unstrung? Was this fair 
maid of Athens "blue eyed, and fair of face, but waning fast into 
the sere of virginal deeay?" as Henley would ask. Was she — this 
Doctress Agnodice — (wlio gave draught, counsel, diagnosis, exhor- 
tation) as Henley also says: 

"Frank-faced frank-eyed, frank-hearted; always bright 
And always punctual — morning, noon and night ; 
Bland as a Jesuit, sober as a hymn ; 
Humorous and yet without a touch of whim; 
Gentle and amiable, and full of tight?" — 

Were the golden gleams of her early dreams — the dreams of 
wealth and husband — were they the things of the long ago ? 

Did Dr. Ilerophilus — the dean, (whom Cicero, Plutarch and 
Pliny praise), the most learned in anatomy in Greece, yes, did this 
learned dean say, as William would have said or thought, "Lady, 
you are the cruellest she alive, if you will lead such graces to the 
grave and leave the world no copy." 
Did the learned Dean say : 

« 
"Her soft Avhite hair adorns 
Her withered brows in quaint straight curls like horns, 
And all about her clings an old sweet smell. 
Prim in her gown and quaker-like her shawl. ' ' 

Was she 

. . . "a wee old maid that sweeps the Bridegroom's way, 
Strong in a cheerful trust that never fails"? 



16 DOMINION MEDICAL MONTHLY 

While recalling to memory "The AVeddiiij? of Schon MeClean," 
by Huchauau, the followinjr few lines eame to my ink-horn Was 
her voice "like the wiiistlinjrs of birds, the humming; of bees, like 
the sough of the south winds in the trees; or the singing of angels, 
the playing of shawns; like oci^an itself with its calms and its 
storms; like a thousand laverocks singing in tune; or like countless 
corneraiks under the moon; or a mermaid's harp, or kelpie singing? 
for whom no epitlialamie song was sung? Was this Agnodiee — 
Doctress Agnodiee — whose eyes were filled with "dark m>>iteries," 
yet with "eyes like a crystal pool" and "baffling idle gaze"? — ■ 
yes, was she a bone-punching and rib-adjusting osteopath or a 
spinal column wrcnchcr — chiropractic — an Olympic god scientist, 
or a regular of the Aesclepiadae? Did the Areopagus allow bone- 
punchers, spinal column adjusters, defamers of the gods — called 
scientists, full authority to practice the noble art of medicine — 
and yet arrest the licentiate Agnodiee? Do we not in this civilized 
age allow pernicious and soul and body-destroying cults existence, 
and yet, when one of our own licentiates errs, the whole medical 
Areopagus silences him by fines or imprisonment ? 

"Women who study side by side with men," says Dr. Montra- 
vale Greene, a professor of obstetrics and clinical gynecology. Har- 
vard University, "are injuring themselves in the present and 
■weakening their powers for the future, and the whole theory of 
co-education is doomed to fall of its own weight." 

]Men in medicine often wonder why the opposite sex should 
wish to become "women in medicine." It is true it is an attractive 
study, but the life-work is by no means ideal. Woman, with her 
high and finer sentiments, her spontaneous goodness and afifinity, 
could find a far better calling or profession and a much better life 
even in the church. One fact is, there never was, is not now, or 
ever will be, a demand for "women in medicine," and one fact also 
is that "the pursuit of 'careers' by women is fatiil to domestic 
happiness," and consequently ruinous to the commonwealth. 

If the late distinguished poet-laureate of England could but 
behold the glimpses of the moon and the ])l<)nd-red spots on the 
sun, he would recall his words: 

"That light its rays shall cast 
From portals of the past, 
A lady with the lamp shall stand 
In the great history of the land," 

for, instead of "the lady with the lain])," he would in London see 
the ladv of his dreams with beer l)()ttles and clubs belaboring the 



DOMINION MEDICAL MONTHLY 17 

custodians of tin- peaL-e — cvi'ii polic-oiiK'U — ami iu civilized and 
Christianized America — women as jurors, even as barristers, moim- 
tain climbers, jungle huntresses, doctoi*s and police mistresses or 
rather police madams. "As soon as a man or a people or a litera- 
ture or a period becomes feminine in type it declines in prestige 
and in power." says Amiel, "and as soon as a woman leaves that 
state of subordination in which lier natural merits have full play 
we see a speedy increase in her natural faults. Complete equality 
with man makes her contentious. A position of supremacy makes 
her tyrannical. For a long time the best solution will be foimd in 
honoring her and at the same time in controlling her." 

My apology for this presentation of Affiitxlict is this, that but 
few, a very few of the most scholarly, however well perfected their 
studies in the Inunanities, are able and gifted to "wrestle, wrangle, 
wriggle and writhe" with words and metre and produce such sen- 
tences of flawless and inimitable periods of pleasingly and un- 
erringly controlled rhythm and nuisic in its appeals, and its horta- 
tory apophthegms — and not least, to ascribe to Agncdice the be- 
ginning of many evils with which the worUl is now contending and 
with which and against which the gods or man have no control. 

To the writer of Aguodicc the following classical words do not 
refer : 

"Nam neque chorda sonum reddit quein vult. manus, et mens, 
Posoentique gravem persaepc rcmittit acutum : 
Xec semper feriet quodcunque miuabitur arcus." 

"Alas, but few can touch the magic string, and noisy fame is 
proud to win them ; Alas for those who never sing, and die with all 
the music in them," said Dr. Oliver ^Yendell Holmes. 

"A wife is half the man. his truest friend; 
Source of his virtue, wealth, the root : 
"Whence springs the line of his posterity. 
A wife of gentle speech, a docile dove. 
Sufficient wealth, imbroken health — a friend. 
And learning that subserves some useful end — 
These are a living man's six greatest blessings." 

— Mahabharota, B.C. 200. 

As Milton has it: "He for God only, and she for God in Mm,** 
would save a dying age and bring again those halcyon days "when 
knighthood was in flower," when men were men and the gods 
reverenced. Nee tecum vivere possum, nee sine te. 



18 DOMINION MEDICAL MONTHLY 

NEPHRECTOMY l=OR CHRONIC PYELO-NEPHRITIS PROB- 
ABLY Of HEMATOGENOUS ORIGIN. 



Hv J. 1'. KKNNKnv. M.l). 

>iirm'(Hi to tlic WiiiKliiHii (ifru- iil II()-;|i.tiil. 



Infection of tlic kitliicy juid its pt-lvis coiiics about tlirougli the 
blood stream oi- l)\ dinu't extension from beloV from the bladder 
and prenitals np tiironirh the ureter. We were formerly tauglit that 
all renal suppuration eame fi-om below, but it is now apparent that 
this is not the case; and when one considers the excretory function 
of the kidney, one perceives how inevitably it is subject to damage 
in connection with all sorts of diseases. Patliogeuic bacteria lodge 
in the kidney in the coui-se of measles, smallpox, scarlet fever, 
typhoid fever and tuberculosis; the colon bacillus and pus-produc- 
ing cocci all may pass through it. 

Acute unilateral hematogenous infection of the kidney may be 
mechanical by actual infected tissue carried to the kidney or emboli 
of bacteria themselves may be lodged in the kidney parenchyma. 
"Women are more commonly affected than men. The infection may 
"be rapid and fatal, or, after a rapid onset the symptoms may subside 
and the course become chronic. When it becomes chronic it was 
formerly described under the old fashioned caption "surgical 
kidney."" 

In the case of ".surgical kidney" which I am about to report, 
the infection in all probability was carried to the kidney substance 
bj^ the blood stream and was not of the ascending type which is 
most common, and for this reason I thought the case worth report- 
ing. 

]Mrs. McO., widow, pn'sented herself for examination on May 
13, 1909. 

Family History. — Father died at 68 from pneumonia. Mother 
died at 68 from heart trouble. Brothers, three living and well. 
Sistei-s, none. Husband died at 44 yeai-s of age from cancer of the 
stomach. No history of tuberculosis in the family. Mother's sister 
died with cancer of the uterus at 70 years. No history of kidney or 
mental disease in the family. 

Previous Illnesses. — Measles when a child. 
Menstrual History. — Normal in every way. 
Marital History. — No children, no miscarriages. 



DOMINION MEDICAL MONTHLY 19 

Present Illness. — Sixteen years ago last August and September 
the patient had typhoid fever, was six weeks in bed. Never pro- 
perly regained her strength after the attack. Thirteen years ago 
she began to have frequency of urination. She had no pain, but 
simply the desire to urinate frequently night and day. About 
seven years ago she took a sudden severe pain in the right side, she 
vomited and the pain was so severe that she had to go to bed. This 
attack lasted about two hours. For a time these attacks of pain 
came on about every four to six weeks. About three years ago the 
attacks got furth(>r apart, coming on about every eight or ten weeks 
and with them she had chills and fever. These attacks continued 
up to the time she came to consult me. A year before coming to me 
she consulted a surgeon in Detroit who said that her urinary trouble 
was due to a retro-displaced uterus and advised an operation. This 
she consented to and the surgeon performed an internal shortening 
of the round ligaments. This he followed by local treatments of the 
bladder from December to the following April. The operation and 
treatments were followed by practically no improvement. When 
she consulted me I made a cystoscopic examination of the bladder, 
but could find no local condition to account for her symptoms. 

Urinalysis at this time was as follows : 

Color. — Pale amber, cloudy. 

Reaction. — Sliglitly acid. 

Sp. gr.— 1020. 

Alb.— Slight trace. 

Sug. — Negative. 

^licroscopical. — Many pus cells, much squamous epitiielium and 
a few amorphous urates. Repeated examination of the urine showed 
practically the same condition. It was always found loaded with 
pas. In the meantime I put her on urotropine diuretics and wa.shed 
out the bladder twice a week, although from the first I was con- 
vinced that the primary trouble was higher up. probably in the 
right kidney. 

This treatment producing no amelioration in her symptoms, I 
referred her to Dr. B. R. Schenck of Detroit for ureteral ca'theter- 
ization. Dr. Schenck \s report was as follows: — 

" Mrs. McG. came in the last of last week, and I have seen her 
on four different days. Cultures from the bladder urine show what 
is apparently the colon bacillus in pure culture. I have not yet 
traced it through all of the media, but feel sure that it will prove 
to be B. coli communis. The urine coming from the right kidney 
is heavily loaded with pus. and I think that the source of the trouble 
is in the pelvis of the kidney on that side. One day I thought that 



20 DOMINION MEDICAL MONTHLY 

I could iiuikt' out ail t'lilar^'t'd kidney on the ri^^lit, Imt latci- 1 was 
not sure wlu'tlu'i- it is cnlai'iicd oi- simply niovcal)lc and prolapsed. 
AVhether it is a ease of pyelitis or one of pyeloneplii-osis. I am in- 
clined to the view that it is simply pyelitis." 

Later Di". Schenck wrote me that tlu^ orfjanism obtained from 
the bladder urine turned out to l)e, as exjH'cted. tlie colon l>aeillus. 

I accordingly advised nephrotomy and drainage. It was not, 
however, until April. 11)10, that the patient would consent to opera- 
tion. At the Wingham General Hospital, on April Kith, I opened 
into the loin and brought up the kidney. As far as I could .iudge 
from the macroscopic appearance, the kidney, although small, ap- 
peared healthy on the surface. I split it along Brodel's line down 
to the pelvis. The hemorrhage was ipiite free, but was controlled 
with hot sponges; I then inserted drainage and sewed up. The 
wound heaietl in about four weeks, and for several months my 
patient enjoyed comparative freedom from her distressing urinary 
symptoms. During the winter of 1910 and 1911, however, the fre- 
quency became a.s bad as ever, so bad indeed that her rest at night 
was seriously disturbed by frequert urination. The patient began 
to fail in tlesh and general health. She occasionally had attacks of 
pain in the right side over the region of the kidney, chills, followed 
by some elevation of temperature. In the spring of 1911 I advised 
her to have the kidney removed. To this she consented, and, on 
April 29th last, in the Wingham General Hospital, I again opened 
in the loin, brought up the kidney and removed it. 

The macroscopic appearance of the kidney was as follows: — The 
kidney was small and contracted, and showed evidence of traumatic 
injury, the whole being surrounded by a thick, fibrous capsule. On 
palpation it was hard and firm to the touch. Along the external 
and posterior surface could be felt a hard cord running from the 
inferior to superior pole of the organ. On section there was in- 
^•reased resistance of the cutting instrument. The cut surface shows 
inferiorly that the kidney substance proper is almost wholly dis- 
placed by connective tissues, while superiorly a small amount of 
secreting sul).stance about the size of a walnut but jialer than normal 
could be found, which could be detached from its capsule. The 
microscopic examination of the specimen was made by Professor 
IMcKenzie of Chicago, aiul is as followT?: — 

" Each section examined presented a thick, connective tissue 
capsule, to the outer side of which was attached remnants of kidney 
tissue, in which could be recogtu/ed a few atrophic Malpighian bod- 
ies, as well as a number of tubules which showed marked degenera- 
tion of their ei)ithelial lining. The contents of the connective tissue 



DOMINION MEDICAL MONTHLY 21 

capsule, was simply a network of connective tissue strands, holding 
in their meshes, masses of pus in which no bacteria were demon- 
strable. Owing to the complete disappearance of all normal kidney 
tissue, it is safe to a.ssume that the organ did not functionate for 
some time before removal." 

Diacjnosis — Pyelonephritis. 

The operation was followed by practically no shock, and Mrs. 
McG. made an uninterrupted recovery. I have been surprised in a 
number of instances at the small amount of shock following nephrec- 
tomies. Dr. W. J. Mayo sa.A's there is very little risk about nephrec- 
tomy, even when the other kidney is somewhat diseased. The re- 
maining kidney soon hypertrophies and t-akes on the function of 
both kidneys. Mrs. ^IcG. is now in perfect health, the urine is 
normal, her distressing symptoms have entirely disappeared, and, in 
fact, she savs she never felt so well in her life. 



SUCCESS IN CATARACT OPERATIONS 



By AV. M. Browx, M.D., L.R.C.P. London, Eng., Neustadt, Ont. 



Mr. President and Gentlemen, — The object in offering this 
paper is to induce discussion, elicit opinions, voice mistakes, because 
it is upon th'cse latter circumstances that we can learn and from 
bitter experience, dearly bought, know how, in future, failure may 
be averted. 

I would suggest that at the next meeting of this section, a 
symposium upon the errors, accidents and complications of cataract 
extraction be given. It could not fail to be instructive. 

Genius is said to be "ability to take infinite pains." If this be 
so every good operator must be a genius, for there are a multiplicity 
of minute details, the observance of which means suci^ess to the 
operator. 

The operation for cataract requires more nerve, skill, judgment, 
delicate manipulation, painstaking care before and painstaking 
care after, than any other done upon the human body. A cut a ^ of 
an inch too little, or too much, here means failure or disaster, while 
in other regions of the body has little bearing upon the result. 
The chief aim of the operator is good vision, let the cosmetic re- 
sults be what they niiay. When your hair becomes grey and you are 
a past master in the art of section making, then strive for optical 
appearances. Technique and manipulation may be faultless and 



* Read at Ont^krio Medical Association, 1911. 



22 DOMINION MEDICAL MONTHLY 

results poor — ou the other haiul a badly done operation is often 
followed by excellent vision. 

We liave all been on the "anxious seat" in our first extractions. 
The hopes and fears that tilled our hearts. The anxious friends 
who crowded around and who looked on sceptically and gave but 
doubtful countenance to the proceeding. It tries your heart and 
soul, and when you have successfully passed through it you know 
you have been through the "fire" and that you have sounded every 
depth of surgical terror. It means so much to you, as well as to the 
patient. 

There are a few conditions which contra-indicate operation. 
Dacryocystitis is one of them. The surgeon certainly takes great 
risk in extracting in its presence even with the canaliculus tied 
off. Cough should be cured — a bark cough, after section, tends to 
reopen the wound. Oezena is another contra-indioation. Our pro- 
cedure is as follows: Eyebrows and eyelas'hes having been clipped 
off, sterile towels applied to the head and chest and in a good 
light 

1. "Wash with soap and water. 

2. AVash with sulphuric ether 

3. AYash with bichloride (1-4,000). 

4. Evert the lids, and by undine wash thoroughly with hot 
bichloride (1-4,000). 

5. Add 1 drop eserine (1% solution) half an hour before opera- 
tion. 

6. Repeat this 15 minutes later. 

7. Three drops cocaine (4%) at intervals of 2 minutes before 
operation — begin 10 minutes before section. 

8. Boil instruments and plunge 

9. Into alcohol — then 

10. Into 1% carbolic solution. 

11. Lint wrung out of 1-4,000 bichloride. • 

12. "Withdraw the knife slowly. 

Nothing sJiould be rushed. Plenty of time should be taken. 
Operators at Mooreficlds frequently take two minutes in making 
the seption alone. 

The knife should be extremely sharp, with a tapering point, 
and used only once before resharpening. A good speculum is still 
a desideratum — one which is (luickly and easily removable and 
applies closely to the temple, and is not in the way of the knife. 
In deeply sunken eyes a lid retractor held by an assistant is best. 
In grasping the conjunctiva below, a half turn with the fixation for- 
ceps anchors the eye more securely. 



DOMINION MEDICAL MONTHLY 23 

Half the battle lies in making a good section — if this is properly 
done, everything else is easy. Therefore have conditions such that 
you are at ease, in a sitting position, with the patient's head lying 
not more than 12 inches below the operator's eyes, with perfect 
control over and at ease of your hand. This cannot be secured 
with the patient l>nng in bed and the operator leaning over him 
with every muscle tense. An ordinary table brings the patient 
too high, but a table about 26 inches in height fulfils these conditions 
for the average operator. !Most sections are made too small. The 
accompanying illustrations, from a noted work by a noted operator, 
shows how the counter-puncture should not be done. The latter is 
much higher than the former — the lens will not present and the 
wound must be enlarged by scissors or Graefe knife. Enter the 
knife slightly al)Ove the mid horizontal line of the cornea and make 
the counter-puncture at a corresponding point on the inner side, 
i.e., section, almost one-half the circumference of the cornea. Hold 
the knife like a pen, lying upon the index and middle fingers and 
secured above by the thumb. The ulnar side of the hand should 
rest upon the patient's head, and the section made with a finger and 
not with a hand movement. In this way the point is absolutely 
controlled. The section should, if possible, be done in two move- 
ments — from point to heel and vice versa — cutting out ver>' slowly. 
Sawing movements cause pain and imperfect co-aptation of the lips 
of the wound. 

During the days following the operation, if the patient does not 
complain, rest assured he is doing well — " no news is good news " 
in e}'* surgery. 

A watchful attendant sbould be on every case, day and night, 
for the first ten days. I well remember how this was brought home 
to me upon one of my first extractions. I had operated upon an 
old German lady of 76. She was doting, but her friends, who 
brought her to me, said nothing of the matter. On dressing the eye 
on the third day everything was well and I remarked we would 
soon have her sitting up. The next morning, on returning from a 
distant call, I found my brave German lady up, dressed, downstairs, 
and sitting out in the back>-ard, facing a blazing July sun, on one of 
the hottest and brightest days of a hot summer. I had difficulty in 
restraining myself from slapping her. Her excuse was, " Der 
Dokter hat gestern gesagt leh kann bald aufstehen !! " I rushed 
her back to bed, and' inside of a couple of hours iritis, ^vith intense 
pain, set in, and for the next thirty-six hours I spent my time in 
making hot applications to eye, giving opiates, &c. Finally the eye 
quieted down, and the night following it, whilst watching her, I fell 



24 DOMINION MEDICAL MONTHLY 

asleep in the liall outside' the i-ooin. On awakening from a nap, I 
noticed a disarray in the room, and on cminiry found she had l)een 
out of bed. to use the eliamber. On stooping to open the waslistand 
door, she had struck the eyebrow, immediately above the operated 
eye, a heavy blow against the corner of the waslistand. It was a 
miracle the ball was not emptied of its contents. I then took strong 
measures and tietl her to the bed with ropes, Ndnding them around 
bed and body. She was a constant woriy until her friends removed 
her home. Strange to say, after going through all this her vision 
was 20/50 ! ! 

I have had one death from cataract extraction. It was in an 
aged jNIennonite, in the Canadian Northwest. It occurs rarely and 
is preceded by delirium, and when this occurs, instant action is nec- 
essary, if life is to l>e savo<l. All bandages should be cast off and 
the patient gotten up and out of doorvS at once. Free exposure to 
light and air are imperative. The operative results will be nil but 
life may be saved. 

Cocaine should not l)e used too freely. One of my earlier cases 
had a very patent canaliculus. The cocaine ran down the tear duct 
to the throat, aflfected the palate and caused retching, reopening the 
wound, with infection and suppuration, and the result was a 
shrunken and useless eyeball. I received some of my gray hairs in 
quieting down that eye. 

Long-range doctoring of cataract cases is false economy and bad 
practice. To remove a cataract and leave the care of the eye to an 
inexperienced man is rislcv, and often ends in disaster. 



Whooping Couwii. 

Mehuert {Jak. fur Kinder.) contributes from Cape Colony an 
article on "Intercurrent Vaccination Aborts Whooping Cough in 
Infants." He states it is renuu-kable the way this disea.se disappears 
after an intercurrent vaccination. The effect of the vaccination 
does not seem to be modified by the presence of the pertussis. So 
convinced is ]\Iehnert of its efficacy that he suggests the advis- 
ability of postponing vaccination of infants so as to utilize its dual 
action in case of an epidemic of the disease. 



DOMINION MEDICAL MONTHLY 25 

SYNOPSIS or THE REPORT Of THE REGISTRAR-GENERAL 
or ONTARIO, 1910 



What the frivolous call "The hatches, matches and dispatches 
record" for the Province of Ontario for 1910, which has been com- 
piled by the Registrar-General's Department, contains some in- 
teresting figures with regard to the vital statistics of the Province. 
The Report is in the hands of the printers, and will not be ready 
for the public for some weeks yet. 

During the year tiiere were 55,871 births, 24,036 marriages and 
33,539 deaths, or 24.9, 10.7 and 14 per 1,000 of the estimated popu- 
lation respectively for the county municipalities of the Province 
(including cities and towns). 

For the 18 cities the figures are: Births, 18,767, or 32.2 per 
1,000; marriages, 11,793, or 20.2 per 1.000; and deaths, 12,3(13. or 
21.1 per 1,000. 

Th-e towns of 5,000 population and over are 15 in number, and 
their statistics are as follows: Births, 2,918, ratio 21.6; marriages, 
1,405, ratio 10.4; deaths, 1,109. ratio 14.7. 

Of the 33,539 deaths there were 706 from typlioid fever, 2.287 
from tuberculosis in all forms, as against 2,380 in 1909. Cancer 
was the cause of death in 1,077 cases: 222 died from diabetes, 327 
from anemia, 355 iiicningitLs, 923 apoplexy, 2,240 organic heart 
trouble, 464 broncho-pneumonia, 1,458 pneumonia. 

Diarrhea among infants under two years of age was fatal in 
1,374 cases, while 2,455 died when under four months of age, owing 
to weakness from birth or ignorance on the part of the mothers 
with regard to the care of children. 

In 284 eases women lost their lives in child-birth. 

Of the 1,626 deatlis from affections produced by external 
causes, 91 persons took their lives by various methods, hanging 
being the favorite; 26.3 per cent, of this number selecting this 
means of exit from a weary world. Ninety-five persons were poi- 
soned accidentally; 43 were burned to death; 112 died from burns 
received ; 33 died from gas poisoning ; 266 were drouTied ; 64 shot 
accidentally ; 209 killed by motor cars, landslides, steam and elec- 
tric railways, etc. ; 13 were frozen to death ; 8 died from effects of 
heat — simstroke ; 11 killed by lightning; 18 by electric shock: 17 
homocides took place, and the balance, 645, died from various acci- 
dental causes. 

Old age was the cause of death of 3,429 persons ; 2,207 were 
still-born. 



26 DOMINION MEDICAL MONTHLY 

With regard to mortality ainont; infants, it is found that among 
those under live years of age (),649 died under one year of age; 
917. one y^ar old; 424, two years old; 321, three y€ars old; and 
247. four years old. 

March was the favorite month for births, there being 5,033 in 
that month. Of the children born throughout the year, 28,664 were 
males and 27,207 were females. There were 370 pairs of twins, 264 
boys and 376 girls. Triplets surprised the happy fjither in five 
casas, 9 lx)ys and 6 girls. 

Jime continues to hold favor with the bride. Of the 24,036 
marriages, 3,555 were cel<?brat.ed in the happy month, September 
and December following in the order named with 2. 653 and 2,304 
respectively. 

There are two periods in a woman's life when friends are vastly 
interested in her age ; when she marries and when she dies. 

The Report goes rather deeply into some of these figures, and 
while all the secrets are not disclosed, yet there is some in'teresting 
information in its pages. 

With regard to the age at which pei*sons marry, it is of interest 
to learn that, so far as Ontario is concerned, men do not marry, 
to any great extent, at a later date than women, although it is 
popularly thought otherwise. Last year 8,168 grooms, or about 
one-third of the total number of men, married between the ages of 
20 and 24, while 47 per cent., or nearly one-half, the women who 
entered the bonds of matrimony were between those ages. With 
both sexes the next greater number were in the 25-29 group, and 
then come the 30-34 for the grooms and 15-19 for the brides. 

Tender the age of 20, 453 men were married, one taking a bride 
in the 30-34 group, one selecting a lady who.se age comes in the 
35-39 class ; one married a lady of the discreet age of 70, while two 
grooms showed a predilection for the same maturity of their 
brides. 

P"'ifteen women between the ages of 15 and 19 married men 
between 40-44 ; two became brides of men Ix^tween 45 and 49 ; one 
married a man over 55 ; two, men over 60, and one a man over 70, 
as did also a lady of 25-29. 

Cupid drives his bolt athwart denomination and conventions. 
Just at the present time the question of mixed marriages is holding 
a certain amount of public attention, l)ut many of the good people 
who discuss the matter of persons of different faiths niarrying will 
be surprised to learn to what an extent sucli marriages are con- 
tracted in Ontario. It appears that in one year alone Methodists 
married Roman Catholics, Jews married Gentiles, while in many 
cases May wedded December. 



DOMINION MEDICAL MONTHLY 27 

Out of the total of 7,351 Roman Catholics, no less than 1,509 
married out of their denomination. Of the grooms 665 married 
non-Catholic brides, and 844 professed Catholic girls became brides 
of non-Catholic grooms. Of these marriages, the larger number 
were between Catholics and Anglicans; then came Methodists, Pres- 
byterians, Baptists, Lutherans, in the order named, but, rather 
strangely, no marriage between a Roman Catholic and a member 
of the Salvation Army is recorded, yet two married Jewesses, and 
five brides tlirew in their fate with as many Jews. 

In addition to this, two Jews married Anglicans; two, Presby- 
terians; six, ^Methodists ; two, Baptists; one, a Congregationalist. 
The Jewish ladies did not show such a variety of taste, but exhi- 
bited a strong Anglican leaning, for of the seven who married out 
of their faith five married Anglicans and two Roman Catholic 
husbands. 

Analyzing the table still further, it appears that 631 Presby- 
terian ladies married Anglicans; S41, ^Methodists ; 126, Roman 
Catholics; 41, Congregational ists; 55, Lutherans; and the selection 
of 74 are not classified. 

Of the Methodist ladie.s, 678 married Anglicans; 910, Presby- 
terians ; 157, Roman Catholics ; 290, Baptists ; 57, Congregational- 
ists; 83, Lutherans; and six passed into the care of as many Salva- 
tionlst.s, while 98 of their husbands have yet to be gathered into any 
particular fold which finds a place in the table, 25 frankly con- 
fessing to being of no denomination at all. 

Roman Catholics have already been largely dealt with, and 
coming to the Baptists it is found that 200 chase their husbands 
from the Anglicans, 219 from the Presbyterians; 362 selected 
Methodists; 68, Roman Catholics; 21, Congregational ists; 26, 
Lutherans; 28, from tlie untabulated, and six of the gentlemen were 
unattached denominationally. 

Fifty-seven Lutherans sought and got Anglican husbands; 71, 
Presbyterians; 78, "Methodists; 85, Roman Catholics; one Hebrew 
and one Salvationist. 

Altogether 87 Salvationists found their husbands in "the 
Army"; three married Anglicans; one, a Presbyterian; seven, 
Methodists; five. Baptists; and one is unclaimed. 



28 DOMINION MEDICAL MONTHLY 



IRcviews 



Cafcchism Sirics — Surf/trji. Part TIL Second edition. Kevised 
and enlarged. With plates. Price, 1 shilling. Edinburgh: 
E. & S. Livingstone. 

This booklet enibracts venereal diseases, scalp, cranium, brain, 
spine and spinal cord, face, mouth and tongue, pharynx, neck, 
goitre, oesophagus, larynx and trachea, ear. The questions are set 
out and the answers given in a clear, compact style. Students will 
appreciate going over, amongst themselves, these questions, in grind 
classes and just on the eve of examinations. We heartily recom- 
mend the entire series for this purpose. 



Heart SoidkIs and Miinnurs. Their Causation and Recognition. 
A handbook for students. By E. ]\L Brockbank, M.D. (Vict.), 
F.R.C.P., Senior Hon. Assistant Physician, Royal Infirmary, 
^Manchester. With illustrations. Price 2s. 6d. Ix)ndon, 13fi 
Ciower St., W.C, II. K. Lewis. 

As the title announces, this is a snuUl book of 5-1 pages and 
index on the heart sounds and murmurs. It is designed for the 
use of medical students and, having examined it carefully, we can 
recommend it to them. As a means of gaining a rapid and com- 
pactly accurate Icnowledge of these conditions students will find 
the Ijook of estimable value. 



^Yebsl<r's A Mr J nhrnalional JJicHonanj. liditor-in-chief. Dr. W. 
T. Harris, late United States Commissioner of I^ducation. 
Springfield, !Mass. : O. & C. ^Merriam. 

In this great volume, new from cover to cover a little over a 
year ago, we have developed the Webster tradition by modern 
scientific lexicography. It is the key to the literature of seven 
centuries. In it are defined over -400,000 words and phrases and 
the new information is practically doubled. The pages are divided. 
Thus on the upper three-(|uarters one will find the more important 
words, and the less important below. There are 2,700 pages and 
6,000 illustrations. In scholarship, convenience, authority and util- 



DOMINION MEDICAL MONTHLY 29 

ity it easily stands the best. No college, .school, library, business 
office, commercial house, doctor, lawyer, dentist, drug:gist can afford 
to be without a copy ever ready and handy to refer to on a 
moment's notice. In books it is one of the ^rcat productions of 
the dav. 



The ScnsihiUly of the AUm( ntarij Canal. By Arthur F. Hertz, 
M.A., M.I)., F.R.C.P., Assistant Physician and Pliysician in 
Charge of tlie Department for Nervous Diseases, (iuy's Hospital. 
83 pages. lf)Il. $1.50. London: Oxford Tniversity Press. 
Toronto: D. T. :McAinsh & Co. 

This little volume is another of those modern series, like ''^lac- 
kenzic on the Heart," that is a necessary addition to each physi- 
cian's library. On con.sideration, what do we know on the subject 
of the cause of the gastric sensations our patients call "emptiness," 
"fullness," "burning," and so on? Do we realize that there Ls 
true visceral pain and that it is dependent on the muscle of the 
bowel? And do we know anything about the sensitiveness of the 
rectum and its relation to constipation ? 

Hertz has added a new chapter to the information that makes 
a physician's work the most enthralling profession of all, if he is 
cognisant of the basic laws, which make difficult cases readily 
understood. G. w. h. 



A Text-Book of the Practice of Mcflicinc. By James M. Axders. 
M.D., Ph.D., LL.D., Professor of the Theory and Practice of 
Medicine and of Clinical ^Medicine, ]\Iedico-Chirargical College, 
Philadelphia. Tenth Revised Edition. Octavo of 1,328 pages, 
fully illustrated. Philadelphia and London: W. B. Saunders 
Company, 1911. Cloth, $5.50 net; half morocco, $7.00 net. 
Sole Canadian agents: The J. F. Hartz Co., Ltd., Toronto. 

Dr. James Anders' ninth edition appeared in 1900, and tlie best 
recommendation for his text-book is given by the appearance of a 
new edition in two years. 

There are a number of additions to different articles, including 
some more recent forms of treatment and new physical signs, but 
in the main tlie volume is the exact counterpart of the last edition. 

In reviewing this some time ago the excellence of the lx)ok for 
senior students was emphasized, and one can well regard it as the 
equal of the "^Medicine" it so much resembles, namely. Osier's. 



30 DOMINION MEDICAL MONTHLY 

The American Journal of Svrr/ery, 92 William Street, New York, 
will issue in the early part of lf)12 a speeial edition entitled 
"Special Western Number." This will be an exi-eptionally fine 
number. Our Canadian readers de.siriutr a copy of same should 
enter their orders at an earlv date. 



A Ma)H(aI of the Practice of Medicine. By A. A. Stevens, A.M., 
M.D., Professor of Therapeutics and Clinical ^Medicine in the 
Woman's I\redical College of Pennsylvania. Ninth Edition, 
revised. 12mo of o73 pages, illustrated. Philadelphia and I^on- 
don: W^. B. Saunders Company, 1911. Flexible leather, $2.50 
net. Sole Canadian agents: The J. F. Ilartz Co., Ltd., Toronto. 

This manual of 573 pages is most attractive to the eye, and, in 
addition, is printed in clear, large type on good paper. 

It is naturally only suited to junior students or nur.ses, or as a 
handbook for more advanced but inexperienced workers. 

It fulfils its object as a manual, and its nine editions in nine 
years shows that it is Avell appreciated. 



The Ontario ^Medical Association will meet in Toronto under the 
Presidency of Dr. Herbert A. Bruce, on May 21st, 22nd and 23rd, 
1912. Dr. F. Arnold Clarkson, College and Markham Sts., is the 
General Secretarv. 



H)ominion /ll^ebical /l^ontbl^ 

anD ©ntarto /BeOlcal Journal 

EDITED BY 

Medicine: Graham Chambers, R. J. Poychiatpy : Ernest Jones, W. C. Herri- 

Dwyer, Gold ^^ in Howland, Geo. W. man. 

Ross, W'm. I). Young. Ophthalmology: 1». N. Maclennan, W. 
SuPgrepy : \\ alter .VIcKeown, Herbort A y{ i^owry 

fcot?Geori- Fv^^n^lvu^on'' '"''"'"'' ^^ Rhinology. Lapyngology and Otol- 
ObstetPlCS f*" Chat: '.I C o! Hastin^^s, ogry : Geoffrey Hoyd, Gilbert Koyce. 

Arthur ('. Hendri.k Gynecology: F. W. .Marlow. W. B 
Patholog-y ana Public Health : John Hendr> 

A. .Vinyoi, O. R .M ibee, Geo. N'a- uenito Urinapy Supgepy: T. B. 

smvtli. Kich;irdson, W. Warner Jones. 

Physiolog-lc Thepapeutics : , , , 

J. Harvey Todd Anesthetics: Samuel Johnston. 

GEOBOE EI.i;lOTT, MANAQINO ESITOB. 

Published on the 20th of each month for the .succeeding month. Address 
all Communications and make all Cheque.s, Post Office Orders and Postal 
Notes payable to the Publisher, GBORGE ELLIOTT, 203 Beverley Street, 
Toronto, Canada. 



Vol. XXXVIII. TORONTO, JANUARY, 1912. No. 1 



COMMENT fROM MONTH TO MONTH. 

Dr. James F. W. Ross, one of the leading and distinguished 
surgeons of Canada and America, died the 18th of November, at 
the residence of Dr. R. L. Langstaff. Richmond Hill. Two days 
before he was motoring to an out-of-town call, and while driving 
his own car with the chauffeur by his side the machine was sud- 
denly flung into the ditch and Dr. Ross sustained injuries subse- 
quently resulting in his death. 

"In the midst of life we arc in death" was never before so 
forcibly projected upon the minds of the medical fraternity : To 
some probably more so than others, for it was only a few weeks 
before, Avhen Dr. Ross was temporarily occupying the chair at the 
Aesculapian Club, that deceased had launched a discussion upon 
the rights of the profession exceeding the speed limit in making 
emergency calls. 

To Dr. Ross distinction in medical life came at an early age. 
A son of the late Dr. James Ross, a prominent general practitioner 
and obstetrician in his day, he began his medical studies at the old 
Toronto School of INIedicine, having been gi-aduated in 1886. He 
went abroad after graduation and studied gynecology under the 
celebrated Lawson Tait. In 1891 he returned to Toronto, entered 
practice upon the special branch of g\Tiecology, later adding 
thereto abdominal surgery, and very soon became one of the recog- 
nized leaders in this work in America. 



32 DOMINION MEDICAL MONTHLY 

He took a prorojnent part in medical society work, not only in 
Toronto, Ontario and Canada, but as well in the United States. 
He could always be counted upon for a paper, an address or a dis- 
cussion. He was a prominent member of the Canadian ^ledical 
Association, a past president of the Ontario ^ledical Association, of 
the Academy of IMedicine, Toronto, and of the American Associa- 
tion of Obstetricians and Cijniecologists. 

When the Toronto Academy of ]\Iodicine was being promoted 
Dr. Ross took a leading part therein and did a great deal for the 
Academy at its foundation and subsequently. 

Dr. Ross was well beloved by his iiii mediate confreres in To- 
ronto, scarcely one of whom but had had him either in consulta- 
tion or for operation at some time or other. 

In him Canadian medical journalism loses a generous contri- 
butor. His papers enriched the pages of our medic.il press. 

"Jim" Ross will be remembered as an energetic man, a rapid 
operator, a skilled surgeon, a fluent lecturer, a lover and an ardent 
advocate of every measure tending to promote the welfare of the 
medical profession not only in liis home city and province, but 
across the wide expanses of our great Dominion. 

To the widow and family of deceased the Domixiox Medical 
Monthly extends its heartfelt sympathj'. 



McGill University is to be congratulated upon the energetic and 
spirited campaign friends of that world-famous institution in- 
augurated and conducted during the week ending the 25th of 
November. 

The total sum at first wanted was $L00O,O00. The actual sub- 
scriptions amount to $L540,S73. This amount was received from 
1,404 contributors. 

It must be very gratifying to the promoters of this "whirl- 
wind" campaign that such a large amount was realized. All good 
friends and well-wishers of the University will wish it further luck 
in securing the grant or annual subsidy of .$100,000 requested of 
the Quebec Government. 

Had McGill been forced to close some of its departments or to 
even curtail othei*s, as it was feared, there would have been genuine 
sorrow all over Canada, not alone from graduates, but from many 
Canadians who are entitled to take just and patriotic pride in any 
of the great and famous institutions of our Dominion. 

With two such munificent benefactors as Tvord Strathcona and 
Sir "William Macdonald, with the assurance that there are others 
sensible of their duty and vitally interested, with the prospective 
expression of sympathy on the part of the Provincial Government 



DOMINION MEDICAL MOiSlIiLY 33 

later taking on tangible financial shape, ^IcGill University may 
look forward to a future of almost imperial liberality. 



McGill's work in Brit'sh Columbia has recently been under dis- 
cussion. There has been a great deal of misunderstanding regard- 
ing the part played by McGill University in educational matters 
on the Pacific coast, enough, in fact, to be sufficient to call for wide- 
spread dissemination of the truth. 

At the outset it is necessary for emphasis to state McGill was 
invited to take up work in British Columbia and did not force 
itself upon the people of that province. By special Act of the 
Legislature of British Columbia in the year 1809, the Vancouver 
High School had its name changed to Vancouver College and began 
first year classes in Arts in affiliation with McGill University. So 
successful was this work that in 1002 affiliation was extended to 
embrace the second year. 

Not considering this arrangement to be sufficiently substantial, 
the Legislature in 1906 empowered the ^IcGill authorities to estab- 
lish in that province the McGill University College of British 
Columbia. The same standards were to obtain and like subjects 
taught. The ]\IeGill authorities then took over the Arts work, ex- 
tended the two years to embrace the third year, and added the two 
first years in Applied Science — AFcGill to conduct the examinations. 

This College is entirely undenominational and is self-sustain- 
ing; and, therefore, the charge cannot lie that the College tended to 
financially cripple the home institution in ^fontreal. and must, per- 
force, fall to the ground. 

There is a branch of the College in Victoria. In the- Vancouver 
College there are 9 students in Arts and 33 in Applied Science, 
with a staff of twelve professors and lecturers. In Victoria there 
are 27 students with five "teachers. It is expected that, at no very 
distant date, Vancouver will be in a position to support a complete 
Arts college. As years go on this will likely form the nucleus of 
a Canadian university on the Pacific coast, with Arts, Applied 
Science, Law and ^ledical faculties of its own. "Westward the 
course of empire takes its way." 



The prevention of insanity, all will agree, is of the first magni- 
tude. There is no disease to which the human flesh is heir that can 
compare to any one of those diseases of mentality commonly 
grouped under the single word — insanity. If this be not the age 
of preventive medicine, then we are on the threshold of it. If 
prevention can be applied to insanity, then the sooner there is 



34 DOMINION MEDICAL MONTHLY 

established a special society in this province — The Ontario Society 
for the Prevention of Insanity — the sooner will prevention take 
tangible form and the sooner will educational instnu'tion t:\ke hold. 

In the place of honor in the October issue of The IhiUctin of 
the Ontario Hospitals for the Insane appears an article entitled — 
"AVhy Should Anyone Bceonip Insane?" 

The insane persons of Ontario number 6,803 — one in every 367 
of the population. In 1800 there were 4,210, the increase in the 
two decades being largely due to the de.suctiide of "a.sylum" and 
the ever-growing belief that these institutions are iiospitals in the 
best sense and neither "asylums," placrs of refuge nor houses of 
detention. The misapplied word ''a-sylum" has served its day 
just as surely as "lunatic" has been shoved over into limbo. 

Setting aside all question of expense to the Province in caring 
for these unfortunate patients, and considering only the question 
of prevention of insanity as paramount, the writer of the article, 
we are sure, must have the best and most accurate ground for 
making the statement that fifty per cent, of the patients are so 
from avoidable causes. Then, clearly, there is a great field for 
prevention. 

Syphilis was the cause and the antecedent of 32 male cases of 
paresis, an incurable form of insanity, admitted to the Toronto 
Provincial Hospital for the Insane during the year ending the 30th 
of September, 1911. Syphilis as a disease to be prevented would 
come under the purview of the health officer. Conorrhea, too, in 
its train brings many disasters to innocent lives, but the people, 
especially the moralists, would scarcely consent tp having these 
two diseases classed with other communicable diseases. 

Alcohol and other poisons, physical diseases, worry and other 
mental bad habits, as well as heredity to a limited extent, are 
factors in the cause of insanity about which the people need edu- 
cating. 

TIow this education is to lie brought about would bo one of the 
early problems for an organization to determine. The passing of 
the knowledge from person to person, by teachers, the pulpit, the 
medical profession, the press, combined, would, in time, prove effec- 
tive. The press would no doubt be the best means, as ir.edieal items 
are enticing morsels to most readers; and there is evidence in 
other countries, if not yet in Canada, that the way is being paved 
whereby the public press will be the great medium for the dissemi- 
nation of knowledge of preventive medicine in all its various 
aspects. Of necessitj' this will mean the medical editor on the staff 
of the leading exponents of thought in the country. 



DOMINION MEDICAL MONTHLY 35 



Be\v8 litems 



Dr. Bromley, Pembroke, was visiting in Toronto recently. 

Dr. Hutchison, Winnipeg, has returned from a visit to Europe. 

Dr. Leeming, bacteriologist to tho rity of Winnipeg, has re- 
turned from Europe. 

The medical students of Laval University, ^lontreal, held a 
banquet on the evening of the 14th of Docember. 

Smallpo.x, which h;^s been inoreasincr in the Province of Quebec. 
has appeared in ^lontrcal. 

One woman physician and forty-four men were lic( nsetl by the 
Ontario ^ledical Council as a result of the fall examinations. 

Drs. Lewih ]\If;MuRTKY and Chas. A. L. Reid of Louisville and 
Cincinnati, attended the funeral of the late Dr. J. F. W. Ross on 
the 20th of November. 

St. Luke's Hospital, Montreal, treated -1,351 children in it> 
dental department the past hospital year, and only 26 were found 
to have perfect dentition. 

Dalhousie University, Halifax, has taken over the Halifax Medi- 
cal College. All medical colleges in Canada are now administered 
under the authority of some university. 

Dr. J. E. Dube, ^Montreal, has received a gold medal from the 
International Society Against Tuberculosis for liis work in prose- 
cuting a campaign against the "white plague." 

Dr. J. D. Hei.mcken, Victoria, B.C., has been elected president 
of the British Columbia Medical Association; Dr. Chas. Doherty. 
New Westminster, Treasurer, and Dr. A. S. :Monro, Vancouver, 
General Secretary. 

The :\Iontreal [Maternity Hospital treated 802 patients during 
the past hospital year. The total receipts amoimted to $27,057, 
being $4,000 more than for the preceding year. 

The Quebec Government will give $3,500 annually towards the 
maintenance of a Hospital for Consumptives in that city. The cost 
of the new building will be $60,000, and it will be administered 
under the authority of the medical department of Laval Univer- 
sity, that city. 



36 DOMINION MEDICAL MONTHLY 

Ipublisbers' IDcpartment 



Cough of Phthisis. — In the treatment of pulmonary tubercu- 
losis the mitigation of cougli is fiequently of prime importance, 
since the repeated effort to expel accumulations of perverted secre- 
tions of suppurative materials is often of such degree that pleuritic 
pains are intonsifii'd and the patient is reduced to a state of ex- 
treme weakness. Furthermore, the interruption of sleep caused by 
frequent acts of coughing invarialily brings about a marked depres- 
sion of the vital forces. 

The systematic administration of an agent which exerts a seda- 
tive influence upon the respiratory tract, modifies the pulmonary 
accumulations and invigorates the expulsive act is usually expedi- 
ent, for the reason that tiie comfort and general well-being of the 
patient is substantdally improved by such a course. It is, however, 
judicious to avoid the administration of any drug wnich is capable 
of producing by-efi'ects that are detrimental, in any way, to the 
welfare of the patient. It is particularly important that the use of 
drugs which cause digestive disturbances, constipation or addictions 
should be eschewed, for such drugs always interfere to a very con- 
siderable extent with reparative processes. 

Glyco-Heroin (Smith) is singularly serviceable in the treatment 
of cough of phthisis, since, while possessing extraordinary cough- 
ameliorating, dyspnea-relieving, repair-promoting, sedative and 
expectorant properties, it is completely incapable of producing the 
slightest untoward effects. 



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sale; County of Grey, $3,000 annually.. Price $2,800, small cash 
paj'ment. Unopposed. A good bargain. Apply to us. 



We have pleasure and confidence in recommending the Grove 
Directory for Nurses. Promptitude, reliability and reasonable rates 
assured to all applicants. 



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DOMINION MEDICAL MONTHLY 




Are yo i particular as to the condition of the iron in your 
Blaud preparations? 

Frosst's Perfected Blaud Capsules present True Ferrous 
Carbonate. 

Each 10 grein Capsule contains, approximately, 1 grain of 
Iron. 



xviii DOMINION MEDICAL MONTHLY 

The ]\Iedical Times. — Romaino Pioison, publisher of the Prac- 
fical Druggist, of New York, has purchased from Dr. Alfred Kiin- 
l)all Hills the Medical Timtn, a publicatiou just closing; its fortieth 
year. In the December iiuiiil)er Dr. Hills says editorially: "Mr. 
Pierson lias had lonir and broad tutelage in the production of medi- 
cal and pharmaceutical journals, from the counting room side there- 
of, lie was for yeare an officer in Ihc cor])oration owning and pub- 
lishing the Xcw York Medical Journal, figuring in that joui-nar.-; 
l)urclia.se and incorporation with itself of the I'hiladdphia Midical 
JniinHil and the Medical News. His pharmaceutical journalistic 
experience covers, a quarter of a century with the Pharmaceutical 
Era, I)ru(/(/isls' Circular, American Drufigist, and for two years 
past as owner and publisher of the Practical Druggist, the latter 
having been brought in a brief period to a leading and commanding 
position. The journal will have the assistance of a well-e(!uipped 
and experienced corps for all departments, and it may confidently 
be expected tliat the Medical Time s will renew its youth and render 
even more satisfactory service to its clientele." Mr. Pierson \\a& 
engaged Dr. II. S. Bakelel as editor-in-chief of the Times. 



Prevalent Diseases. — Each change of season brings with it, 
its diseases seemingly peculiar to the time. Summer with its 
intestinal disorders, sunburn, insect bites, ivy poisoning, etc. Fall 
presents for the attention of the physician, its typhoid eases, and 
winter and early spring, its regular quota of pneumonic, bronchial, 
throat and other chest conditions. At this season, when pneumonia 
and bronchitis demand the call of the physician, literature present 
ing the experience of fellow practitioners, in the successful handling 
of these eases, would seem most apropos. The Bloodless Phlehoto- 
mist for January reflects the experience of many physicians upon 
this timely .subject. Dr. Charles liuck, of Cincinnati, presents iiis 
experience in handling cases of pneumonia, also relates some facts 
in the treatment of lumbago, whicli might also be considered as an 
aflliction prominently manifesting itself at this season. "Broncho- 
Pneumonia" witli sup|)ortive as well as local treatment in all its 
details, is tile su])ject of the paper of P. A. Kautz, also of Cincinnati. 
Dr. E. Cliiit(»ii Murray, of Houston. Texas, relates his experience 
and ti'i-atmeiil in a <'ase of i)neumoiiia in an eighteen months old 
baby and Di-. .1. C. Klipi)inger. of Indei)endence, Kansas, presents a 
"Diff'i'rent Techni(|ue in Pneumonia." wliieli is decidedly original. 
In abstract his method is to api)ly the local dressing in a manner 



DOMINION MEDICAL MONTHLY 



XIX 



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XX DOMINIcJ^ MEDICAL MONTHLY 

^vhi(•h jrives the intoreosl il muscles a chance to functionate without 
restriction from handages. This symposium is closed with a paper 
from Dr. AY. A. Kadue, of Union Hill, N. J., upon "Acute Pleurisy 
and a Successful Abortive Treatment." Besides the papers referred 
to upon the subject of chest and throat diseases, much additional 
information is given. The one in particular we would have you note 
is the "Kational Influence of Hot Applications" by tiiat well- 
known Therapeutist, Dr Finley Ellingwood, of Chicago, 111. A 
postal card addressed to the Bloodless Phlchotomist, No. 57 Laight 
Street, New York, will brinj; you a copy of the January- issue. 



A DisTiN'CTiVE Piece of Literature. — "Here is something dif- 
I'crcnt." This is apt to be the firs't thought of the physician upon 
bicakiiig the wrapper of Parke, Davis & Co.'s new brochure on 
bacterial vaccines <Hid tuberculins. And the external appearance of 
the book is in no "^'ise misleading. Tiie "ditference" applies to the 
l>rinted page as well as to the handsome cover in artistically blend- 
ed browns and gold. The brochure contains forty -eight pages in 
addition to the cover and thirteen full-page engravings in colors. 
Tile work is divided into three parts or sections. Some of the sub- 
jects considered in the first section are: ''What is the Difference 
Hctween Bacterial Vaccines (Bacterins), Serums and Toxins?" 
"IIjw are Bacterial Vaccines Prepared?" "Therapeutic Action of 
liacterial Vaccines," "When Should Serums Be Used, and Wlien 
Bacterial Vaccines?" The second section treats of the origin -ind 
nature of the bacterins, the relative merits of "stock" and "auto- 
genous" vaccines, the opsonic index, and the best method of using 
the bacterins, together with a description of each vaccine, including 
references to preparation, therapeutics and dose. The third siHition 
is devoted to a consideration of the tuberculins, with dilution and 
do.se tables, descriptions and illustrations of the various diagnostic 
tests, etc. Briefly stated, the booklet is a concise review of the 
essential facts relating to l)ac'terial-vaccine therapy, containing pre- 
cisely what the seeker after this kind of information wants. It is 
not padded with clinical reports — in fact, it contains none. We 
understand that Parke, Davis & Co. will be pleased to semi a copv 
of this uni(iue and valuable brochure to any physician requesting 
it. Address them at Walkerville, Out., specifying the "new book- 
let on bacterial vaccines," and mention this journal. 



DOMINION MEDICAL MONTHLY 



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xxii DOMINION MEDICAL MONTHLY 

Boiled Milk as a Food for Infants.— The Ivocal » ...v.-nuiK-nt 
Board have done good service in causing an inquiry to be made 
into the relative advantages of l>oile<l and raw milk as a food for 
young children. The investigation was placed in the very capable 
hands of Dr. Janet E. Lane-Claypon, whose report has recently 
been issued in the series of public health reports published by the 
Board. Dr. Lane-Cla.A-pon points out, to begin with, that experi- 
mental e^^denee confirms the conclusion derived from clinical ex- 
perience as to the superior results obtained from feeding infants or 
young animals with the breast milk of an animal of the same species, 
and emphasizes the opinion that infants should be fed on the breast 
unless there is an urgent reason to the contrary. 

In addition to giving the results obtained by a lai^e number of 
other observers, Dr. Lane-Claypon herself conducted an inquiry 
with material obtained personally at the infant consultation of the 
Naunyn Strasse in Berlin, which is under tJie direction of Dr. 
Ballin. The average daily attendance at the consultation is 100. 
The milk supplied for tlie children is produced with great care, and 
is of a high standard of purity, it is delivered cooled, and the 
mother is directed to bring it to the boil and allow it to frotli up 
twace before using it, and is personally instructed in the matter by 
a health visitor. The object of Dr. Lane-Claypon 's investigations 
was to compare the nutrition as measured by weight of infants fed 
on the breast and on boiled cow's milk. For this purpose she dealt 
with two main series of infants. In the first were healthy babies 
of the average artisan class, fed upon milk in various^ forms, in 
order to have a control consisting of the average baby. In the 
second were healthy babies of the same class, but fed only upon 
boiled cow's milk, in order to study the difference, if any, produced 
upon the average baby by feeding it exclusively upon boiled milk, 
as compared with the infant of the first series. The result of her 
investigations, which were characterized by a thoroughness and care 
enhancing their value, is given in a .series of tables and diagrams, 
all of which well repay a close study. The general conclusions 
arrived at are of importance. They are that there is apparently no 
serious loss of nutritive value produced by feeding an animal upon 
boiled milk derived from an animal of the same species; that when 
an animal is fed upon the milk of another species, the milk from 
which has been found to be suitable for this purpose, such small 
differences as have been found in tlie nutritive values of raw and 
ix)ilefl milk have been in favor of boiled milk, and that the milk of 



DOMINION MEDICAL MONTHLY 



xxiii 



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xxiv DOMINION MEDiCAL MONTHLY 

the saino species has a considerably liifrher nutritive value for that 
species tlian the milk of any other species. — The Medical O/Jiccr. 



'PiiK Dios Chemical Co., St. Louis, Mo., announce that tliey arc 
now inaugurating an advertising c,flmpaign to familiarize the pro- 
fession of Candida with their proviucts. For twenty-five years 
Diovihurnia and Neuix)sinc have been prescribed by a largo portion 
of the physicians of the United States, and are considered by many 
to be the standard remedies in the class of cases for which they are 
indicated. Your attention is respectfully directed to the first adver- 
tisement appearing in this journal on upper half-page facing first 
of reading. It is the desire of this company to place samples of 
tlieir preparations in the hands of ever>' doctor who is sufReiently 
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A New Method op Passing the Bronchoscope. — Johnston 
(Maryland Medical Journal, June, 1911) states that his new method 
of pa.ssing the bronchoscope in the straight position has worked 
admirably, and has proven so easy that the work has become a 
pleasure. The method is as follows : 

The patient is placed on the table with the head in the normal 
straight position. A general anesthetic is administered. The 
modified direct laryngoscope is passed straight down between the 
incisor teeth, and when the epiglottis comes into view the spatula 
end of the instrument is hooked behind it. By making slight 
pressure on the upper teeth the epiglottis and base of the tongue 
are pulled up and the larynx opened for inspection. A weak solu- 
tion of cocaine is now applied to the larynx through the tube to 
prevent retlexes. With the laryngoscope in position, the broncho- 
scope is passed through it to the vocal cords. With the eye fixed 
on the end of tlie smaller tube a slight twisting motion is used, 
w^hicli sends the l)ronchoscope between the cords. Tlie breatliing is 
now distinctly tubal in character. The laryngoscope is removed 
and the head of the patient gently lowered over the end of the 
table. The examination is now proceeded with as in the extended 
position. In the above procedure the operator stands to the left 
of tlie patient and uses the laryngoscope in the left hand. Both 
direct laryngoscopy and bronchoscopy are easier because the 
muscles are relaxed. — Therapeutic Gazette. 



■?!. 



2)ominion /II>eMcal /Il^ontbl^ 



auD Ontario /HbciMcal Journal 



Vol. XXXVIII. TORONTO, FEBRUARY, 1912. No. 2 



©rioiiial Hvticlee 



TREATMENT OF TYPHOID EEVER. 



By Graham Chambers, B.A., M.B. 

Associate Profeaaor of Clinical Medicine, University of Toronto; Physician Toronto 

General Hospiial. 



The treatineiit of typhoid fever which is in general use at the 
present time might be designated an expectant and symptomatic 
method. AVe allow, in a way, the disease to "run" its course, but, 
by treating the patient and protecting the various organs and tis- 
sues of the body, hope to mitigate the effect produced by the dis- 
ease process, and to prevent accidents and complications. In carry- 
ing this out one .should keep in mind the nature of the disease, the 
manner in which the bacillus of Eberth produces the various mani- 
festations, and, also, the pathogenesis of the complications. 

Typhoid fever begins as a general infection — bacillemia. In- 
deed, the general infection has been laiown to exist before the inci- 
dence of fever. However, most of the manifestations of the disease 
are not caused directly by the specific bacilli, but by endotoxins 
liberated by their solution. Thus we have two eau.sative agents of 
symptoms, namely, a bacillemia and an endotoxemia. In addition 
one might add a third or rather a group of agents, composed of the 
various bacteria, such as pneumocoecus, streptococcus, etc., which 
cause secondary infections. One might illustrate these relation- 
ships by means of the following table : 

Bacillemia — Roseala, meningitis, cholecystitis, osteomyelitis, 
broncho pneumonia and lobar pneumonia. 

Endotoxemia — Fever, headache, dry tongue, disturbance of 
digestion, diarrhea, meteorism, engorgement and necrosis 
of Peyer's patches and solitary follicles, ulceration of intes- 

• Read at the meeting of the Ontario Medical Association, June, 1911. 



38 DOMINION MEDICAL MONTHLY 

tiii'(\ intestiiial jxrloratioii, low blood pressure, cardiac 
weakness, ilicrotie i)ulsi', arteritis, myocarditis, delirium, 
stupor, tremor and meniuf^ism. 

Secondary Infections — Pneumonia, bi-oucho-pneumouia, sepsis. 

Of course a relationship exists between these frroui)s as the 
bacillemia gives rise to the enclotox<*mia, which, itself, no doubt, 
predisposes the patient to secondary infections. 

The advantages to be gained by keeping this classification in 
mind while determining on the treatment of a case is that our 
methods are likely to l)e more rational. For instance, in fighting 
the bacillemia one can undei-staud the benetit to be derived from 
quietness, fresh air and the selection of a dietary in keeping with 
the assimilative powers of the patient, because these measures 
should tend to increavse the resi.stance of the body against the 
bacilli, but one cannot understand how starvation for a week, as 
advocated by some, can be of service. The giving of any vaccine, 
serum or drug which will increase the antil>odies of the blood is 
rational. 

From theoretical considerations tyi)lu)id vaccine should be of 
value as a preventive measure and clinical observations appear to 
support this view. As a curative agent, however, there does not 
appear to be any evidence to show* that it is of any value. Again, 
the giving of any drug which will increase the antibodies of the 
blood is rational therapy. Smith {Lancet, Nov. 10, 1910) reports 
that the administration of ciuinine increases the opsonic index of 
patients with infectious fevers. If this be true, the giving of 
quinine in typhoid fever would be rational therapy. 

The importance of having a substance which will increase the 
potency of the antibodies in the blood is well illustrated by the 
fact that in cases of relapse, a condition in which one would 
expect the bactericidal substances of the blood to have l)een aug- 
mented by the primary attack, a fatal termimition is uncommon. 
In 1,236 cases of typhoid fever treated at the Toronto General 
Hospital during six years ending September 30th, 1910, there were 
65 relapses, of which only one died. In the fatal case the course 
of the fever was unusual and the temperature was normal for 
barely 24 hours preceding the relapse. 

Again, in the treatment of bacillemia if one had an antiseptic 
which when administered internally would exercise a germicidal 
action in the blood, as mercury and salvarsan do in syphilis, its 
exhibition would be correct, but the principle of giving intestinal 
antiseptics for the same purpose is utterly unsound. 

In the treatment of the endotoxemia of typhoid, if we believe 



DOMINION MEDICAL MONTHLY 39 

that the endotoxins are excreted in the urine, the giving of large 
quantities of water by the mouth or rectum is invariably indicated 
in the early stages of the disease. In the later stages it may also 
be indicated, but there are a number of contraindications, such as 
hemorrhage, early symptoms of perforation, and cardiac weakness. 
The last mentioned ha.s not received the attention it deserves, as it 
is my belief that, frequentl.v, large quantities of water are given in 
a routine manmr throughout the course of the disease, which pro- 
cedure in cardiac weakness might produce pulmonary stasis. This 
I have observed in practice. It should also be remembered that in 
many fevers there is frequently a tendency to retention of water, 
which should be taken into account in determining upon the quan- 
tity of water to give a typhoid patient, especially one suffering 
from cardiac weakness. 

Again, if we believe that endotoxins are excreted into the intes- 
tines, the exhibition of laxatives or possibly mild cathartics is sound 
in principle, especially in the early stage of the disease. Clinical 
experience, I think, supports this view. It is unnece^sarj' for me to 
mention that the profession are not a nnit with regard to the use 
of purgatives in the treatment of typhoid. Some advocate strong 
cathartics producing eight or ten evacuations in twenty-four hours. 
This. I think, is wrong because it disturbs digestion, may depress 
the patient and possibly precipitate hemorrhage or perforation. 
On the other hand, there are others who never use a laxative after 
the ninth or tenth day of the disease for fear of producing hemor- 
rhage or perforation, but make use of a simple enema once a day 
to empty the lower bowel. They believe that a laxative per rectum 
is less dangerous than one per os, although both increase peristalsis 
of the whole intestine. 

For my part, in mild cases, I am accustomed to order an enema 
every morning after the ninth day of the disease, although I believe 
there is practically no danger in administering a laxative to a 
patient who shows no manifestations of hemorrhage or intestinal 
perforation. In highly toxic cases I feel that a laxative or simple 
purgative is preferable because it is more likely to diminish the 
endotoxemia. In my practice I frequently make use of castor oil 
followed in two hours by an enema. Half an ounce of the oil is 
given every morning. This is followed in two hours by an enema of 
2 drachms of turpentine, 4 ounoes of olive oil and 2 ounces of soap 
solution, administered with a barrel syringe. Half an hour later 
a simple enema is given, which, as a rule, produces a free evacua- 
tion with very little disturbance to the patient. The advantage of 
this combined method is that a better cleansing of the whole intes- 



40 DOMINION MEDICAL MONTHLY 

tine takes place, whii'li is essential because we know in typhoid 
fever typhoid haeilli are frequently present in the bile and upper 
intestinal tract. If one uses an enema alone, this cleansing of the 
upper bowel is not obtained to the same extent. In highly toxic 
cases, therefore, I sliould advis(> the giving of castor oil every morn- 
ing as a means of diminishing the end' -toxemia, and, I think, clinical 
experience will support this method. "With regard to the danger 
of hemorrhage and perforation after the administration of a mild 
purgative, I wish to call attention to the fact that both these acci- 
dents are essentially due to ulceration, which itself is the result of 
endotoxemia. I might also mention that with the daily administra- 
tion of a purgative, associated with careful dieting, one is able to 
control ineteorism, a complication which, if associated with 
hemorrhage, frequently makes the treatment of the latter manifes- 
tation very difficult indeed. The explanation of this is probably 
that a contracted intestine tends to stop the bleeding. 

In the consideration of the subject of secondary infections I 
shall limit my remarks to one or two suggestions in the preventing 
of lobar pneumonia and broncho-pneumonia, two of the most serious 
complications. 

Fir.st I should mention that lobar pneumonia occurring in the 
course of tj'phoid fever is generally due to a secondary infection, 
rarely to the typhoid bacillus. Its genesis should therefore be gen- 
erally the same as that lobar pneumonia occurring as a primary 
disease. In pneumonia caused by the pneumococcus we are agreed 
that exposure is a predisposing cause. The question is — does the 
same ever occur in the pneumonia occurring as a complication of 
t>T)hoid? I should not like to make a definite statement in answer 
to this, but I am inclined to the view that exposure is a not uncom- 
mon causative factor. 

The consideration of the prevention of broncho-pneumonia is 
beset with great difficulties. The post-mortem examination of 
typhoid patients shows that broncho-pneumonia is generally asso- 
ciated with hypostatic pneumonia, and clinical experience would 
appear to indicate that the hypostatic is usually the primary affec- 
tion. If this be true then we should pay especial attention to the 
treatment of pulmonary stasis and cardiac weakness. The exhi- 
bition of strj'chnine, camphor and other cardiac stimulants might 
aid in preventing this complication. 

I wish now to call attention to some points in the treatment of 
special .symptoms and manifestations. This is a very important 
part of the therapy of typhoid fever. In the consideration of this 
subject I think one gets considerable benefit from the study of the 



DOMINION MEDICAL MONTHLY 41 

prognostic value of the various manifestations and complications, 
because the knowledge so obtained tends to make one more active in 
the prevention of dangerous conditions and in their treatment at 
their incipiency. The following is a list of some of the manifesta- 
tions and complications which should, I think, be looked upon as 
danger signals: 

High Fever. — The degree of fever is of great importance in 
prognosis. In cases characterized by low or moderate degree of 
fever the prognosis is generally favoral)le. If the temperature does 
not reach the height of 104° F. I should say that the mortality is 
less than 2 per cent. On the other hand, high fever, especially if 
unaccompanied l)y marked remissions and difficult to lower by 
hydrotherapy, is a dangerous sign. 

Dry Tongue. — This should only be considered a danger signal 
when the whole dorsum is dry. 

Diarrhea. — In cases in which care is exercised in the selection 
of a dietary, diarrhea is not a common symptom even in severe 
infections, but when present under such conditions it is always a 
dangerous sign. 

jMeteorivsm. — Distension of the abdomen is generally present in 
tj^phoid fever, being caused partly by fermentation or putrefaction 
of food and partly by disturbance of the neuro-museular apparatus 
of the intestine. The iirst cause can be removed to a great extent 
by treatment, but the second, being due to endotoxemia, cannot be 
influenced by treatment to th-e same extent. ^Meteorism, therefore, 
uninfluenced to any marked extent by treatment should be con- 
sidered a danger signal. I might add that marked meteorism asso- 
ciated with hemorrhage makes a specially dangerous combination 
of symptoms. 

Delirium. — This is a common symptom in severe cases. The 
manifestation becomes more unfavorable if accompanied by in- 
somnia, and especially if uninfluenced by hydrotherapy. 

Spasticity of ^luscles. — This is a very dangerous manifestation. 
It may be due to meningitis, exudation or purulent, caused by the 
typhoid bacillus, but is generally the result of an inflammation of 
the meninges without exudation — meningism. 

High Rate of Pulse. — In typhoid fever the rate of pulse rela- 
tive to the temperature is slow, particularly in the early stages of 
the disease. A high rate, say about 115, indicates a disturbance 
of the nervous mechanism of tlie heart or myocarditis, and should 
be considered a dangerous sign. 

High Rate of Respiration. — This is a danger signal of first-rate 
importance because it suggests the presence of a pneumonia. How- 



42 DOMINION MEDICAL MONTHLY 

ever, a respiration rate of 30 may be due to the fever and endo- 
toxeniia. If pulmonary stasis is also present, then a higher rate is 
not uncommon, but with a remission of the temperature tiie fre- 
quency of the respirations nuiterially diminishes. 

Intestinal Hemorrhage. — The profession are not in accord with 
regard to the prognostic value of this manifestation. In some cas^es 
the condition of the patient improves immediately following a 
hemorrhage, and it has been suggested that this is due to dimin- 
ished endotoxemia caused by the loss of blood. This is observed so 
frequently in practice that there can be no doubt of its truth. In 
many cases, however, hemorrhage produces no appreciable improve- 
ment, and the manifestation is soon followed by others of more 
serious import, such as symptoms of cardiac failure or intestinal 
perforations. 

Pain in Abdomen. — This is a very important symptom of intes- 
tinal perforation. The presence of abdominal pain should, there- 
fore, be a danger signal and an indication for a thorough and pro- 
longed examination of the patient. 

In this paper I shall only consider the treatment of the first- 
mentioned danger signal, namely, high fever. 

The treatment of fever is, I think, an important part of the 
therapy of t>"phoid fever. There are probably two reasons wh}' 
this is the case: Fii-st, high fever is usually a sign of severe infec- 
tion; and .second, a high degree of fever probably caases disturb- 
ances of metabolism, nervous system, etc., irrespective of the origin 
of the fever. In the treatment of the manifestation it is well, 
therefore, to try to diminish the intensity of the endotoxemia and 
to use means to prevent the temperature running at a high level. 
I have already referred to the general principle of treating the 
endotoxemia. These, unfortunately, applied in severe infections, 
have generally very little etTect on the course of the temperature. 
In the.se cases one has to depend upon more direct antipyretic 
methods — such as cold baths, sponges and antipyretic drugs. It is 
not my intention in this paper to consider at length the advantages 
and disadvantages of cold baths or sponges in the treatment of 
fever. I shall merely mention my belief, which I think is that of 
most physicians, that external hydrotherapy is the most valuable 
therapeutic measure "\ve possess in the treatment of typhoid. How- 
ever, there may be a difference of opinion as to the manner in 
which the beneficial effect is brought about. Some contend that a 
reduction of temperature has little to do w'ith it, but the benefit is 
essentially due to the improved state of the nervous, respiratory 
and cardiovascular system and to increased excretion of endo- 
toxins. At the height of the attack, in severe cases, cold baths fre- 



DOMINION MEDICAL MONTHLY 43 

quently have little influence on the temperature, and these physi- 
cians maintain that this is an unimportant consideration My 
belief is that this is incorrect. According to my experience the 
mortality is much higher in cases in which the fever is uninfluenced 
to any extent by cold baths or sponges than in those in which it is 
readily diminished by the same measures; and it is probable that 
the high fever in itself, without considering its origin, is an im- 
portant cause of this difference. In support of this contention I 
wish to call attention to the fact that, although the temperature of 
typhoid fever is frequently high, it is usuallv unstable in character 
being more readily influencwi by cold baths or antipyretic drugs 
than the fevers of most other infections. For instance, 3 to 5 
grains of acetyl-salicylic acid (aspirin) every four hours will in 
most cases produce a marked reduction in the temperature. Is it 
not probable, therefore, that the benefit derived from external 
hydrotherapy in the treatment of typhoid fever is partlv dependent 
upon the readiness of the temperature to be influenced bv such 
treatment? If this is true, it seems to me that it is rational in cases 
characterized by high fever, say above 104° F., in which we are 
unable to influence the temperature by hydrotherapeutie measures 
at our command, to bring to our aid an antipyretic drug. For this 
purpo.se I prefer acetyl-salicylic acid (aspirin) because it is suffi- 
ciently effective in small doses— generally 3 to 5 grains, rarely 6 to 
7, every four hours— and at the same time does not alter the'blood 
pressure and rarely produces any deleterious action. In the ad- 
ministration it is important to limit the quantitv to the minimum 
dosage, associated with sponging the body, which will moderate the 
fever rather than bring it to a low level, because a temperature at 
the height of the di.sea.se, from 102° to 104° F. may be helpful 
rather than harmful. I usually commence by ordering 3 grains 
of the drug to be given every four hours and that each dose be 
followed in half an hour by a cold sponge, as in this wav one com- 
bines the antipyretic agents. If this dosage does not produce the 
desired effect the quantity of drug .should be increased until suffi- 
cient action is obtained. 



44 DOMINION MEDICAL MONTHLY 

^CANADIAN PUBLIC HEALTH ASSOCIATION. 



First Amuial Me^iii«r. :\I()iitreal. Pee. 13th, Utli, 15tli, lOlL 



His Royal Highness, the Duke of Connaught, on the evening of 
December 13th, 1011. inaujrurated the first Congress of the Cana- 
dian Public Health Association, and in the course of a len^tJiy 
speech emphasized the great need for the improvement of the public 
health of the Dominion by the supply of pure water, by proper 
methods of sewage disposal, by lessening infant mortality, and by 
a greater general attention to matters of hygiene. 

Preanier Borden was present, and heartily endorsed the aims of 
the association, saying he did not think the Federal Government 
had done enough in the past to protect the public health. Hon. 
]Mr. ^lartin Burrell, ^Minister of Agriculture, went further, and 
hinted at the early estal)lishment of a department at Ottawa for 
dealing with the public liealth, while Sir Lomer Gouin told of tlie 
project for dividing the Province of Quebec into ten districts, 
which plan was only yesterday adopted by the Provincial Board 
of Health; each in charge of a qualified hygienic expert, and 
another pro.jeet for establishing a provincial hospital for 
consumptives. 

The Duke of Connaught was accompanied by the Duchess, and 
by Princess Patricia, and there was a large gathering of eminent 
physicians and prominent citizens to greet him. The meeting took 
place in the Royal Victoria College. 

Dr. T. Starkcy presided, and those pn^ent included : Premier 
and iMrs. Borden, Sir Thomas and Lady Shaughne.ssy, Sir James 
Grant (Ottawa), Dr. T. Starkey, Sir William and Lady Van Home, 
Hon. Martin Burrell and IMrs. Burrell, Principal and Mis. Peterson, 
Premier and Lady (iouin. Archbishop Bruchesi, Dr. Fi.sher (New 
Brunswick), Dr. Coulter (Toronto), Dr. lliggins (Ottawa), Dr. 
Shepherd. Capt. Worthington, Dr. Johnson. Col. Carlton Jones 
(Ottawa), Lt. Ramsay, Chief Justice Sir ]\rell>ourne Tait and Lady 
Tait, Justice and ]\lrs. Archer, Canon Dauth, IMayor Guorin, Miss 
Guerin, Capt. Gucrin, liishop Farthing and IMrs. Farthing, Arch- 
deacon Norton, Aid. and ]\Irs. Dandurand, Lansing Lewis, Lt.-Col. 
Burland, Dean Adams, Clarence L de Sola and' Mrs. de Sola, 
Dr. A. P. and Mrs. Laberge, Dr. Lachapelle, D. McNichoU and 
Mrs. McNieholl, T. Chase Casgrain and Mrs. Casgrain, Justice and 



• Montreal Star report. 



DOMINION MEDICAL MONTHLY 45 

Mrs. Green.shieldK, Lt.-Col. E. M. and Mrs. Renouf, Dr. T. and :Mrs. 
Starkey, Dr. Adarni, ]\!ilton ITersey, Prof, and Mrs. Porter, Senator 
and Mrs. J. T. B. Casgrain, PI. B. Ames, M.P., and ^Mrs. Ames, 
Aid. and Mrs. Rutherford, Dr. and ]\Irs. BlackadiT, Miss Iliirlbatt, 
Camj^bell Lane, E. Fabre Surveyer and ]\Irs. Surveyer, Dr. 
Louis Laberge, Dr. Duncan Anderson (Toronto), Dr. Monti- 
zambert (Ottawa), ^Mr. Aird Murray (Toronto), Dr. Douglas, Dr. 
Hodgetts (Ottawa), ^lajor Lome Drum (Ottawa), Dr. George 
Porter (Toronto), Dr. ^McCullough (Toronto), and Dr. Adam 
Wright (Toronto). 

Dr. Starker, in opening the proceedings, expressed the gi-eat 
pleasure it gave him to welcome Their Royal ITighnes.ses, in the 
name of Canadian Public Health Association. The Duke of Con- 
naught, he said, would not only be a patron of the Association in 
the usual sense, but intended to take a very active inrterest in 
sanitation, and in the affaii-s of the Association. The first vice- 
president. Lord Strat.heona, also took a practical interest in the 
Association, and had sent, quite unsolicited, a cheque for $2,500 
for its funds, while Premier Borden was the second vice-president, 
and the Coiivmisision on Consiervation gave the Association its mast 
cordial support. 

The primary aim of the Association was the diffusion of sanitary 
knowled^ge. To this end, the^^ mast induce the public to join them, 
and to take an active part in the work, and get the laymen to co- 
operate with t'lie profes.sional men who <rave their lives to the study 
of the problems of sanitation. 

The Duke of Connaught, who had a very cordial reception, 
said: "I desire fii-st of all to express my deep satisfaction at being 
present at this meeting, which has been called to organize the Can- 
adian Public Health Association. Of the many subjects which are 
awaiting solution in Canada, none is so imiwrtant to my mind as 
that of the health of its inhabitants, both adults and infants. It 
is a subject which affects every one of us individually, and we owe 
it to ourselves and to the rising generation to see that conditions are 
improved as far as lies within our power. 

Public health is a question which rises above all politics, and 
it is the duty of the whole nation to join in promoting the objects 
of the Association which is now gathered here. 

The urgent necessity for improvement in existing conditionsi is 
forced on our attention by the reports' of epidemics of tj'phoid, 
diphtheria, and smallpox, which occur all too frequently, in the 
press, and by the study of statistics of infant mortality in your 
great cities. The aims and objects of this Association, as outlined 



46 DOMINION MEDICAL MONTHLY 

by the Pn?sidt'iit, arc most eoniinendal)I(', and the idea of expanding 
tlie inembers'hip so as to include all kinds of workers in the domain 
of sajiitiition is a wise one, because so many of the general public 
outsidie these professional iiien actually engaged in sanitation work 
are Ix^'oining extremely interested, and would ghully welcome any 
means whereby they could learn tlu; hotter to conserve tlie public 
health. 

Such information can only be obtained from experts, and it is 
at congi-esses such as these that opportunities arc given for receiv- 
ing and imparting instruction. Many of the general public are 
laboring under the delusion that to avoid epidemiL-s and to bring 
healtJi into th'eir daily lives they must be e^^juipped with deeip 
scientific knowledge. That is a totally en-oneous idea. Profound 
knowledge and d'cep research on the part of the scientists are 
required in order to arrive at logical and exact results in the field 
of hygiene, hut these results and their application to our daily lives 
are profoundly simple and straightforward. 

As an educational movement, the Association is of paramount 
importance, for what education or knowledge is so important as 
that of learning how to obtain health by avoiding and preventing 
disease, and so obtaining a sound body in which to clothe a sound 
mind? Thus the healthy upl)ringing of children in their homes and 
in the schools is a point of the most vital interest to everjx)ne. 
This question of the education of children in hygienic matters 
has l>een luidertaken more or less in most countries, but a great 
deal still remains to be done in that direction. Attention must be 
given, not so much to the task itself, as to the general routine of 
the daily life. 

Having secured in this Association the moans of tea(-liing the 
public, we have to consifler how best to apply this teaching in order 
to get the best value out of it. Everj-thing seems to point to the 
education of the coming generation as the best field for our ene^g^^ 
"While the yountr are ])cing instructed, thase of their parent.'? who 
are desirous of learning will be able to do so. but we shall not waste 
our time by competing against that obstinacy and apathy which in 
grown people so oft'en takes expression in the familiar saying, 
" Let things alone. What was good enough for our fathers is 
goo<l enough for us." 

"What was good enough for the last generation, is not good 
enough for the present. On the land where Ottawa now stands 
Indians were .scalping one another a hundwd years ago, but who 
would be so rash as to pretend that sanitary conditions have not 
changed since then? In those dav-s pure water and pure air were 



DOMINION MEDICAL MONTHLY 47 

universal in Canada. The growth of the great cities and th^ settle- 
ments has altered this state of things for the agglomeration of 
people is inevitably aeoompanied by the sieedK of disease. 

While on the subject of crowded settlements, let me say how 
glad I am to hear of the garden city movement having been 
started here in Canada, and I trusit it maj'' meet with the success 
it so richly de.serves. To provide decent homes for the people out- 
side the congested districts is a sure step in tlie direction of the 
improvement of the public heaUh, and I have no hesitation in 
recommending the garden city movement most strongly to your 
favorable consideration and support. It will go far towards mini- 
mising the difficulties on the score of health which are met with in 
places where the population is increasing at a rate out of propor- 
tion to the aceomimodation provided for them. 

Speaking of .sanitation in connection with children, the thought 
naturally arises of the movement started in nearly all countries 
to reduce the terrible infant mortality which is so prevalent every- 
where. It is gratifying to know that this topic, as well as those 
relating to the hygienic well-being of children, is going to receive 
the attention of this Congress. 

Again, it is a matter of congratulation that among other very 
important questions relating to the welfare of the people to be 
dLseussed, are such questions as sewage disposal, the supply of 
pure drinking water, the housing of the working classes, etc. All 
these are extremely urgent, and affect the welfare of large masses 
of the population of Canack. The first two have become so urgent 
that action of some kind is contemplated both by the Federal and 
Provincial Goveimments, .iui.lging by the questions brought up in 
the legislatures, and doubtless anything tending to the .solution of 
these problems, that may be brought out of this meeting, will be 
available for the benefit of these legislatures. 

"We must make it an object to impress on the public the neces- 
sity of obtaining health by the prevention of disea.se and' not by 
its cure. Under the heading of preventive medicine conies vaecma- 
tion and other forms of inoculation. I know that vaccination has 
many antagonists, and I have no vr\s\\ to enter into any argument 
on the subject. I will confine myself to the simple statement of 
the fact that in the cemetery of Gloucester, in England (lie the 
bodies of 276 unvaccinated children, who died during the smallpox 
epidemic of sixteen years ago. Only one vaccinated child lost its 
life in the same epidemic. 

It is only when the people have thorouglily grasped the full 
meaning of anv movement that legislative bodies can begriu their 



48 DOMINION MEDICAL MONTHLY 

^vork. Lo«ri.shitioii. without \ho iiitelli{?i'iit support of the public, 
is useless, and it would be wis<' for all of us to appreciate the fact 
that legislation in respect to sanitation is hones-tly intended for the 
benefit of us all, both indiviilually and eolkx'tively. 

Such hemE^ the case, we oujrht to give our full supiwrt to the 
authorities aduninistering the laws. Here, as in most countries, 
there are laws designed to protect the workers in ckngerous trades, 
but tlie vast majority is left to look after its own health. It rests 
with tliem to protect themselves against the ravages of disease. 

1 now have great pleasure in fulfilling the miss.ion with which I 
am ehai-ged this evening, namely, that of inaugurating the Canadian 
Public Health Association, and in deelaring this Congress open. 
In concluding my remarks, I wish you most successful results from 
the work you have undtert<nken, and I trust >'Ou ^nll be able to 
provide the necessary impetus to this movement, which is designed 
to bring about the pernument amelioration of the conditions of 
the public health in this great Dominion." 

Premier Borden, in expressing his entire sympathy with the 
objects of the Association, said that it seemed to him that, under 
present conditions, there was no more worthy work that could 
engage the attention of good citizens than, that of the improvement 
of the public health. He did not think that as much had been done 
in this direction in Canada in the past as ought to have l^een done. 
It was true that a brancli of the Dejiartment of Agriculture was 
organized for the purpose of attending to public health matters, 
but he did not think the Federal .Government had diane so much as 
it should in this direction. In the matter of public health, Canada 
had muddled through somehow, but it ought not to leave the 
question to haphazard miy longer. AVhen it was considered how 
much of the enei'gy of the people and the nation was dissipated 
by disease, simply thorough drinking impure water, and by neglect 
of sanitation, they would realize that, from the standpoint of 
national efficiency, this subject should !>o dealt with in an eft'ective 
way. 

Many phases in connection with those momentous problems of 
town planning and housing were introduced at the afternoon meet- 
ing on December 14th of the Canadian Public Health Association. 

Adequate statutory provision by each province in the Dominion 
to deal with the whole question, was a strong recommendiiition made 
ami endorsed; and to prevent multiplication of (^lovemment officers, 
it was suggested that the powers of the administration of the Act 
be placed under the Department of Health, which must be enlarged 
by the addition of qualified officers to deal with the subject. 



DOMINION MEDICAL MONTHLY 49 

Large apartment liouses and jerry buildings came in for strong 
condemnation. In place of these, garden citie.s and model dwellings, 
situated in the suburbs, were advocated, with cheap andt rapid 
means of transit, preferably underground. The idea of Canadian 
cities trying to convince themselves that they had no slums was 
ridiculed, and the sooner steps w<'re taken to remedij' the evil the 
better it would be for tbe community at large. 

Dr. Charles A. Hodgetts, Medical Adviser of the Commission 
on Conservation, Ottawa, in his paper on " Town Planning and 
Housing," stated that one muvst acknowle<lge that we are behind 
the timesi, and Canadians have made, and continue to make, serious 
mistakes in the la\ing out of cities and towns, and in not planning 
for their development. Acknowledging this fact, it was our duty 
as citizens to learn by the mistiikc^ of the older countri*^ of Europe. 

The lumber town of forty years ago. Dr. Hodgetts said, is still 
a lumber town, overgrown; it has not risen to realization of 
its importance or to the dignity of its position as the Federal 
Capital of a great and growing nation. Xor does the great seaport 
of Canada, its commercial capital, present any outstanding features 
to lead one to eulogise the foresight of its wealthy and intelligent 
citizen.ship, or the sys/tem adopted of convertinig a once fine family 
residence into an apartment house or tenements of the worst t\'pe. 
All the new and older cities are, from the town-planning and hous- 
ing standpoint, monstrosities. 

He noted the tendency, which is in evidence in all these cities, of 
the method of warehousing humanity in apartment houses of all 
grades. 

Posterity would come to curse the day when they were permitted 
to dwell in such places. To attempt to work the remodelling of our 
cities and the planning for the future without first securing proper 
legislation, would, in his opinion, be misspent time. We would also 
require more definite and exact legislation on unsanitary housing 
and unsanitary areas. He concluded by enumerating some of the 
advantages to be derived from to\ATi-planning, among them being 
improvement in general health and morals, reduction of death rate, 
provision of cheaper and more healthy homes, suitably located open 
spaces, and absolute prevention of slums, with all their attendant 
evils. 

Dr. J. E. Laberge, assistant city medical health officer, Mont- 
real, spoke on "Town Planning and Housing." He touched on the 
question mainly from the hygienic point of view. 

Until recently this important matter received little consideration 
from the public authorities, due to the ignorance of the public in 
matters of hygiene. 



50 DOMINION MEDICAL MONTHLY 

Ilnvf wido boult'vai'ds in tlu' plac<>.s to wliicli you tr;iiist\M' the 
pt'opk' from the c'ix)W(leil slums. Let tliese outside surroundiuirs 
be places where the people can obtain air, lijjiit, good and abuuilant 
supply of water, and good housing. This work should not be left 
to outside enterprise, but should be taken up by the miuiicipal 
authorities. To e<lucate tlu^ citizens to see that their city Ix'comes 
large, beautiful, healthful, sound and prasperous. 

Dr. Charles J. C. 0. Hastings, City ^fe^lical OfiKcer of Health, 
Toronto, in a paper on " House Problems," described the im- 
sanitary conditions existing in the shun districts of NeAv York, 
^Milwaukee, and Toronto. Toronto had its slums, the same as other 
cities, and it was no use for people trying to disguise the fact, and 
they musit wake up. like other cities, to the prevailing conditions, 
and not live in a " fool's paradise." In Toronto, he said, there 
were 919 families living under distinctly unsanitary conditions, 
some only in one-room tenements' or in cellars. Sluims were verit- 
able hotbeds of vice and crime, as they are of disease, and cities 
must see to it that they were eradicated. Tenement houses he 
declared to be nothing more or less than mere packing houses — 
human packing houses; and he concluded liy urging the securing of 
transportation to districts on the outside of cities, Avhere people 
could bo properly housed in individiral homes, in beautiful garden 
cities. 

^Ir. Rickson A. Outhet, .Montreal, read a paper on " Munieipal 
powers in dealing with town-planning schemes," which mainly 
dealt with the town-planning in operation in England, and how 
these schemes could be applied to Canadian cities. 

:^Ir. W. D. Lighthall, K.C., speaking on the subject of " Re- 
housing in Canada," dwelt upon the '' jerry-built " tenement 
houses, one-room tenements, and even cellar abodes, prevalent in 
Canadian cities, particularly so in INlontreal. Not far from the 
City Hall, a physician told him, the previous night, that he had 
found sixteen foreigners sleeping in two rooms, only suitable for 
one man in each, and with windows tightly sealed. He urged the 
planning of new districts at once, to relieve the slum districts. He 
knew of only two re-housing instances in Canada, those of Mr. H. B. 
Ames, :M.P., and Lieut.-Col. Carson, both in INTontreal, and they 
have paid well. He thought that the model .suburb and model 
tenement would have to be combined in one company. This was 
done successfully in New York. 

Other papers were read by :Mr. Percy C. No"bbs, Montreal, on 
"Statistics on Housing," and by :\Ir. Colborne Meredith, Ottawa, 
on *' To\\'n Planning." 



DOMINION MEDICAL MONTHLY 51 

The aunnal dinner of the Association wa.s liold at the St. Regis 
Hotel, December 14. 

Many of the problenLs which are confronting the civic authorities 
of ^Montreal at the present moment were dist-nssed at the sessions of 
the Canadian Piil)Ii(' Health Association Cong:ress, in the McOill 
University medical building, prominently among them being the 
questions of food inspection, milk supply and milk depots. Meet- 
ings of four sections, namely, ^Medical Otficers of Health, Dr. I^ouis 
Laberge, convener; Laboratory Workers, Dr. J. A. Amyot, <-on- 
vener; Sanitary Engineers and Aivhitects, Mr. T. Aird Murray, 
convener, and Social Workers, Dr. Grace Ritchie England, convener. 

(jlreat importance was attached to the manner in which milk is 
delivered to the householder, and it was argued that it would be 
more safe for milk to be delivered from the can, as no sj'&tem in 
force can ensure that bottles are properly cleansed and sterilized. 
It was advocated that milk sellers who are personally dirty in their 
habits or are considered otherwise unfit should have tlu-ir lieeiiwes 
cancelled. 

Food inspection was considered a pressing problem of the day, 
owing to the conditions of the hastling modern life necessitating 
hurried meals away from home, and how ueces.sary it was tlmt all 
places where these meals were obtained were properly inspe<'tetl for 
cleanlines.s and sanitary arrangements, as well as the food itself. 

Water supply, sewage systems, removal and disposal of house- 
garbage, town planning from a sanitary standpoint, ventilation in 
private houses, vaccines and the common cold, medical inspe<-tions 
of schools, women as sanitary inspectors, high infantile mortality 
in large cities and the influence exerted by milk depots, what the 
Federal Government might do to assist in the control of tuberculosis, 
and playgrounds were amongst the other important matters dealt 
with. 

Mr. P. B. Tustin, Chief Food Inspector, "Winnipeg, read a paper 
on "]\Iunicipal Food Imspection," which was much discussed, as 
was also a paper by Dr. W. T. ShirrefT, Medical Officer of Health, 
Ottawa, on "Municipal ^lilk Supplies." 

j\Ir. Tustin traced the precautions taken, and the penalties im- 
posed by the ancient EgA'ptians and ancient Romans, in regard to 
food inspection, and he declared that if it was necessary then it Is 
consequently more necessary in these da}"s of refrigerating and v^an- 
ning. 

Present-day rush calls for a strict inspection of all places where 
food is stored', prepared, oflfered for sale and sold. Food inspection, 
to be efficient, should cover the inspection from the raw material to 



52 DOMINION MEDICAL MONTHLY 

the finished jiriMluct, sanitation of preiiiiscs, and the cK'aiilincs.s in 
habits and in j)er.s()n of the pcoph' preparing' the food. 

On taking over tlie dairy inspection in Winnipeg; lie realized that 
the cause of much of the unclean milk was due to igrnoranw on the 
part of the dairymen, rather than their wilful negrlijrenee. 

The cardinal fact to be borne in mind in rejrard to inilk supply, 
Dr. AV. T. Shirreff stated; is that it should be used before it is 
48 hours old. He advocated an educational campaign amongst the 
farmers and dairymen in preference to drastic regulations to secure 
proper sanitary surroundings and to secure a pure milk supply. 

Members of tlie Canadian Public Health Association Congress 
were guests of the Montreal Water and Power Company and were 
shown the sterilization and filtration plants of the company. 

Since sterilization, the Montreal Water and Power Company 
claim that the water drawn and supplied by them from the St, 
Lawrence River has been safely guarded from pollution of any 
hygienic significance. 

In order to meet the spring and late autumn conditions and 
furnish at all times a clear and practically colorless water, the com- 
pany decided to instal the filtration plant presently nearing com- 
pletion. The plant is of the type known as the rapid gravity sand 
filter and depends for its efficiency largely on the use of a coagulant. 
The rate of filtration will be in the neighlwrhood of 125,000,000 
gallons per acre in 24 hours, and the normal aggregate capacity of 
the units being installed at present is 25,000,000 gallons per day. 

The water is fii'st to be drawn from the intake well by low lift 
centrifugal pumps receiving just before entering the pumps the 
necessary coagulating solution. In this case it will be basic alumi- 
num sulphate. On passing through these pumps the coagidant and 
water will become thoroughly mixed, after which it passes through 
the coagulating basin, when by means of suitable baffles, sufficient 
time will be afforded before filtration to render the coagulation of 
the water complete. 

From the coagulating basin the water flows by gravity throngh 
the filter beds to the clear water basin beneath. The rate of filtra- 
tion is governed by automatic controllers placed between the clear 
water basin and filters. From the clear water basin the filtered 
water flows by gravity to the high service pumps and then?e is 
forced into the mains. 

The plant at present is provided with 15 separate filter beds or 
units, which, with the capacity provided in the clear water basin, 
will afford sufficient flexibility to accomplish the necessary washing 
of the sand beds, without interruption to the supply of filtered 



dominioa' medical monthly 53 

water. Provision is being mado for the u-^e of calcium hj-pochlorite 
in the effluent in case this treatment is found desirable. The plant is 
guaranteed to remove 98 per cent, of all bacteria without the hj^po- 
chlorite, and practically all color, sediment and turbidity. 

The walls and floor of the filter units, clear Water basins, coagu- 
lating basins and lower parts of the machinery room, the floor of 
operating room, etc., are all reinforced concrete, and the- superstruc- 
tures are of brick with slate roofs; the buildings throughout are 
lined with bufl: pressed brick. 

The plant has been designed by and is being erected under the 
supervision of Mr. Pitcher, the goneral manager and chief engineer 
of the Montreal "Water and Power Company. 

The plant is to be in charge of Mr. J. O. ^Meadows, at present 
sanitary enfrineer of the Provincial Board of Health. It is expected 
to make preliminary trials of the plant in about ten weeks. 

The sessions of the Canadian Public Health Association came to 
a clo.se with the election of officers and Executive Committee, as 
follows: — President. C. A. Hodgetts, M.D., Ottawa. Vice-Presi- 
dents, Dr. M. ^r. J^eymour, Regina ; Dr. J. W. S. ^[cCullough, 
Toronto; E. B. Fisher, Frederieton. General Secretary, Major 
Lome Drum, M.D., Permanent Army Corps, Otta^^■a• Treasurer, 
G. D. Porter. Toronto. Executive — Drs. P. H. Bryce, Ottawa; F. 
Montizaml>ert, Ottawa: J. D. Page, Quebec; G. P. Lachapelle, ]Mont- 
real; C. J. Hastings. Toronto; J. A. Murray, M. Can. Soc., C. E. ; 
Chas. Douglas, "Winnipeg: P. B. Fuston, M.R.; ^IcKay, Saskatoon; 
T. Clark, Asso. M. Can. Soc, C. E., Saskatoon; C. I. Fagan, 
"^''ictoria, B.C. ; G. E. Duncan, "\"ernon. B.C. : Colonel Carleton 
Jones, ]\I.R.C.S., Department of Militia and Defence, Ottawa; Drs. 
Smith Walker, No^'a Scotia ; E. 0. Stevens, Moncton, N.B. ; G. G. 
Melvin, St. John, N.B.: H. G. Johnson, Prince Edward Island; 
Jas. Warburton, P.E.I. ; T. H. Whitelaw, Alberta. M.H.O., Calgarj'. 

The next place of meeting will be Toronto. 



54 DOMINION MEDICAL MONTHLY 



Graham Chambers, R. J. Dwyer, Goldwin Rowland, 
Geo. W. Ross, Wm. D. Young. 



Oatmeal in Diabetes. 

Of the various dietetic types of treatment suggested for diabetes 
in recent years pro])a})]y none lias aroused an equal degree of inter- 
est or remained in vogue to the same extent as the oatmeal "cure" 
inti-oduoed by von Noorden. Essentially this eonsis'ts in feeding 
daily a mixture of 250 grams of oatmeal, 100 grams of protein, 
preferably of vegetable .source, and 300 gram.s of butter, prepared 
iu the form of a soup or porridge, at frequent intervals, along vvith 
an occasiona/1 allowance of beverages — cognac, -wine, or black coffee. 

Everv'one acquainted with the history of the therapy of diabetes 
mellitus knows hoAv warmly numerous drugs and procedures have 
been recommended and how disai)pointing these have generally 
been. Little reliance can be placed on any reports in 
which, as so often has been the case, the diet factors are 
imperfectly controlled; but aside from this, a marked temporary 
improvement and increased carbohydrate tolerance not in- 
frequently follows the more careful attention to the details 
of diet and the habits of life ; and the benefits are then 
falsely ascribed to some inconsequential accompaniment of the 
new routine. Despite all these considerations, it must be admitted 
at the presient moment that there is a large bodj' of clinical evidence 
indicating that even in severe ca-sies of diabetes a con.siderably larger 
utilization of ingested carbohydrate is observed on an oatmeal re- 
gime than is the case with carbohydrates from other sources. It 
should be clearly emphasized that von Noorden himself pointed out 
that the oatmeal feeding is without influence in very many ca.ses 
and may even be detrimental in some instances. It is more par- 
ticularly indicated in glycosurias of the severe type, with attendant 
acetonuria. 

Granting the validity of some of tlie reported evidence both 
from Europe and this country, the explanation of the good results 
achieved is far from apparent. Why .should the utilization of starch 
by the diabetic become conspicuously favorable when this carbohy- 
drate is derived from a special cereal, tlie oat? This pertinent ques- 
tion was debated by a number of the prominent European clinicians 



DOMINION MEDICAL MONTHLY 55 

at trie last annual meeting of German internists in Wiesbaden. 
Several possibilities have been advanced and experimentally inves- 
tigated. For example, oat starch may possess s-pecial chemical 
structural characteristics which render it unique and specific in 
this direction, in distinction from the starch of wheat or barley. 
This can by no means be regard-ed as evident from comparative 
feeding trials. It should be stated, however, that ^lagnus-Levy, 
among others, believes in a peculiar transformation of oat starch 
by micro-organisms in the alimentary canal, whereby it is converted 
into fermentation products rather than into simple sugars, as is 
ordinarily the case with starches. Xaunj-n early offered a similar 
explanation for the failure of oatmeal feeding to increase the sugar 
output in diabetics, by assuming that it is not utilizeil as sugar. 

Other investigators have attributed the superiority of the oat- 
meal diet to some non-carbohydrate component in the cereal : but 
attempts to extract such an accessory product (perchance some en- 
zyme, hormone, or anti-ketogenic compound) have not been very 
successful. "Without denying for the present some specific virtue of 
the oatmeal itself, it seems as if the preponderance of present 
opinions is in favor of what may be termed the "negative" virtues 
of the dietary. By this we may understand the removal or lack of 
certain objectionable elements pertaining to the usual dietaries 
(meat and fats^ which the oatmeal gruels replace. The latter are 
above all comparatively low in protein, with an abundance of fat 
amounting to as much as 2,500 calories C300 grams of butter). The 
reduction in protein metabolism and the incident replacement of 
animal by vegetable protein are quite in line with current ten- 
dencies and may offer an adequate explanation. It is essentially a 
fat-carbohydrate diet which is thus instituted. 

The complicated nature of the matter is further evidenced by 
^Minkowski's statement that the oatmeal diet is attended by a ten- 
dency towards retention of water and edema formation. Competent 
ob.servers, such as Minkowski and His, incline to the belief that the 
conflicting views can best be reconciled by the assumption of more 
than one eft'ective factor in the problem. It may not be amiss to 
remark that the possibility of a wide-spread emplo>-ment of oatmeal 
in the diabetic dietary through layman's advice or careless adver- 
tising presents a danger which should be strenuously guarded 
against. The proper management of diabetes is characterized by an 
appropriate dietotherapy applied to individual cases. Every patient 
needs the conscientious advice of a competent observer. — Editor 
J. A. M. A. 



56 DOMINION MEDICAL MONTHLY 

Duodenal Ulcer. By J. P. Crozier Griffith, ^LD., Philadelphia, 
Clinical Professor of the Diseases of Children in the University 
of Pennsylvania. 

Duodenal nicer in childhood is rare, although it is a cause of 
melena neonatorum, yet CoUis, of Paris, found 42 occurrences be- 
low 10 yeai"s of age in a collection of 279 collected cases. 

These two cases of Griffith's are, therefore, of interest and may 
'be summarized as follows : 

(1) A boy aged 10 was suddenly seized with faintness and 
dizziness in the morning and could liardly walk liome. He vomited 
his dinner, and on the following day again ejected his stomach 
contents and also passed bloody stools, which recurred for several 
days, but unaccompanied by no abdominal pain, although slight dis- 
tension was present. A relapse of the same condition occurred 
six months later. 

(2) The second case was a baby boy of six months old, who had 
with difficulty been reared on modified milk, but with poor suc- 
cess, as vomiting frequently occurred. Vomiting of blood and 
melena suddenly occurred and the child died, when a post-mortem 
rendered the diagnosis proven. 



Exophthalmic Goitre in Men. Pic and Bonnamour. (Rev. de 
Med.) 

This disease is rare in men, as the statistics collected by the 
authors of this paper show. Of 563 cases collected by Pic and 
Bonnamour from tlie literature, 109 were in men. No mention is 
made by the authors of the monograph by Busehan, who collected 
980 cases from the literature, since which time up to 1903, 229 
other cases had been published, making 1,209 in all, the ratio of 
men to women being as 1 to 4.6 (212 M— 997F.). 

Age.—Ot the 109 cases collected by the authors, it is stated that 
the largest number occurred between 30 and 50 years of age, but 
the figures quoted by them show that the greatest numljer occur 
between 20 and 40, as follows: 24 cases between 20 and 30, 24 
between 30 and 40, and 21 between 40 and 50. This also coincides 
with the 692 cases publislied by Busehan, and since that date by 
various authors, namely, 53 between 21 and 40. The authors state 
that in women, on the contrary, the disease is much more frequent 
in early life; the 692 cases mentioned above do not show this, as 
325 of these occurred between 21 and 40, and the rest of the cases 
were divided over various ages up to 70. The authors only found 



DOMINION MEDICAL MONTHLY 57 

two cases at the extremes of life. Here again, a more extensive 
research into the literature would have found that 5 cases occurred 
before the age of 10, and 1 between 60 and 70. 

Predisposing and exciting causes. — Nervous affections, epilepsy, 
hysteria, neurasthenia, have been frequently noticed in the an- 
cestors. Mental and physical overstrain, emotions, fright have all 
been cited as predisposing causes. Infectious diseases, as rheuma- 
tism, typhoid fever, syphilis, tuberculosis, play the chief part as 
exciting causes. 

Symptoms. — The authors lay stress chiefly on the most im- 
portant symptoms met with in the male sex. The most frequent 
phenomenon is tachycardia. Palpitation is common, and tremors 
nearly always present. Goitre is also very frequent, and if unilat- 
eral, is more common on the right side than the left. The appetite 
is very poor as a rule, but sometimes there is bulimia. Attacks of 
diarrhea are coinnion. Wasting frequently comes on early, and 
may be considerable. The most striking phenomenon in men is 
the presence of nervous s\Txiptoms: there is a marked state of un- 
rest, excitability and irritability, the slightest noise is apt to excite 
him, and the smallest emotion immediately may provoke an out- 
burst of anger. Ideas of persecution, hallucinations or even con- 
vulsions may occur. Exophthalmos may be entirely absent. 

Prognosis. — The disease is much more rapid and the outlook 
much more serious than in women. Pneumonia frequently ushers 
in a fatal termination. The statistics quoted by the authors show 
the gravity of the disease very distinctly. 

Pathogeny. — The authors suggest that, as has been shown, there 
is an antagonism between the ovary and the thyroid body; the 
cause of the gravity of the disease in the male sex is the absence of 
this antagonistic action. 

Treatment. — Remedies appropriate to the disease should be 
employed early and actively, and if powerless for good, the authors 
recommend surgical intervention. — Med. Chron. Abstract. 



Hookworm Disease. H. Gunn, San Francisco (Journal A. M. 
A., September 30), in 1905 called attention to the fact that a large 
number of Porto Ricans were taking up residence in California, 
and that over 50 per cent, of them were hookworm carriers. No 
attention was paid to this at the time, but in 1910 the Public Health 
and Marine Hospital Service began to make examinations for this 
disease in San Francisco, and at the present time the importation 
at this port is prevented, though the country is open to the carriers 



58 DOMINION MEDICAL MONTHLY 

in other places. He refers to his already published article on the 
hookworm disease in mines, and says that during the last year 
several cases have been imported from Hawaii, which is not sur- 
prising, as the plantations there must have been badly infected by 
the numbers of Porto Ricans, Japanese and Chinese immigrant 
laborers. A recently established Bureau of Tropical ^Medicine, of 
which he has charge, has been investigating the matter,, especially 
as regards Hawaii, and the results are given. In 171 cases there 
was found 15 per cent, of .infection ])y hookworms, besides a con- 
siderable proportion of other parasites. He says that prevention 
of hookworm disease in California is a task of considerable magni- 
tude, and will necessitate the examination of certain classes of 
immigrants and of a large proportion of the laborers now in the 
Alaska fisheries, when they return. Compulsory treatment also of 
the infected cases must be provided for. In dealing with the dis- 
ease already existing in the State, the mines are especially import- 
ant, and an examination should be made of every one in order to 
determine the extent of the infection. Mine officials should be 
educated as to the importance of hookworm disease, and mine 
sanitation and regulations should be promulgated and enforced, 
including the examination of employees, the treatment of infected 
persons, and mine sanitation. Mine officials have not given the 
subject their attention, unless it has been called to it, and in only 
one mine has any attempt been made to systematically examine 
the men and treat those needing it, and in this mine only twenty- 
ndne have been examined, and 75 per cent, were found to be 
infected. For the scattered cases through the State, local sanitary 
measures will have to be depended on, but certain regions where 
Hindoos, Chinese, IMexicans, etc., are numerous should be specially 
considered. The only preventive measures mentioned are, as before 
stated, those carried on by the Federal Government, confined to 
San Francisco, and not covering a large class of people liable to 
introduce the disease. 



Chorea. 

Charles (DuUm Jour, of Med. Science) prescribes rest in bed 
and all sensory stimuli excluded; isolation. The free use of trional 
is given to control the movements, and the general health should 
be improved by tonics and nutritious diet. Trional is strongly 
re^^ommended ; it produces sleep, ct)ntrols the movements', and 
effects a rapid cure. He is not in favor of using the salicylate 
coin pounds. 



DOMINION MEDICAL MONTHLY 59 



Suroer\; 



Waltee McKeown, Herbert A. Bruce, W. J. O. Malloch, 
Wallace A. Scott, George Ewart Wilson. 



Antityphoid Vaccination. Surgron J. ^L Phalen. U. S. A., 
New York {Journal A. M. A.. January G). 

Dr. Phalen describes the experience so far with antityphoid in- 
oculation and the methods in use in the United States army. The 
vaccine employt'd is made ])y Dr. F. F. Russell in the laboratory of 
the Surgeon-ljeneral's office in Washington. The organism used is 
from an old culture that has ceased to be pathogenic and is sent out 
in sealed ampules containing 1 to 25 c.c. after having ]>:>en thor- 
oughly tested for bacteria and by inoculation into guinea-pigs. The 
immunizing dose is given in three injections at intervals of U-ix daj's: 
the first of 0.5 c.c, the second and third of 1 c.c. each. The injection 
is given with an ordinary hypodermic s\Tinge into the deltoid mus- 
cle near its insertion. The site may be sterilized in any way, but 
with the large numbers treated at once in the militarj' seniee, it is 
customaiy to paint the skin with tincture of iodine before the opera- 
tion and touch the needle wound with it afterward. The reaction 
is usually not severe, and is comparable with the lighter cases of 
vaccinia following smallpox vaccination. It should not be given to 
persons with any illness or to the aged or debilitated, and a case 
ha.s been reported of latent tuberculosis incited by it. Russell esti- 
mates the percentage of very severe reactions at 0.1 per cent., and 
attributes them to the introduction of the vaccine into a large vein. 
At first a voluntary measure, typhoid immunization has been made 
compulsory in the T^nitetl States army for all officers and men not 
over 45 years of age who have not had an authenticated case of 
typhoid fever. About 60,000 men have completed the three inocu- 
lations. At the barracks where Dr. Phalen has been recently sta- 
tioned, each recruit is vaccinated against smallpox and given the 
first antitj'phoid inoculation on enlistment. At the time of the 
second inoculation many men are suffering from vaccinia, and the 
reactions are frequently more severe, though quite transient. With 
this rather unavoidaitle exception, the inoculations are not given to 
anyone in any way out of health. Phalen gives a history of the u.se 
of antit^•phoid inoculation in armies, and says that nowhere do we 



60 DOMINION MEDICAL MONTHLY 

get so lonviiK'iny: cvideuce as in our owu army experience. In the 
60,(XK) nieu who have been iuoeulated there have been but tweJve 
cases of typhoid and no deaths, and the typhoid-rate is only one- 
sdxth as great in the inoeiihited as in the uninoeulated. One man in 
the (Juantanarao Naval Station died five days after his first inocula- 
tion from a ease of walking typhoid, bat this is the only case of the 
death of an inoculated man from typhoid in the government service. 
Among the nearly 13,000 soldiers near San Antonio there was only 
one mild ease of typhoid, while forty-nine eases with nineteen deaths 
occurred in San Antonio in the city population. As regards para- 
t^T^lioids, these are presumably not aflPeeted by antityphoid inocu- 
lations, though clinically they are similar, and, if the proportion of 
paratA-phoid cases is high, the results may be a little disappointing. 
Possibly a mixed typhoid and paratj'phoid vaccine might be indi- 
cated. The duration of immunitj* is not yet settled, but Firth esti- 
mates it from British data, at thirty months. Ijcishnum thinks the 
reinoculation should be given after two years. In the United States 
army, with its three-year enlistment period, the rule is for inocula- 
tion to be given at each enlistment. Further experience is needed as 
to this point. The treatment of actual typhoid by inoculation is 
still in the experimental stage, but the opinions deduced from ex- 
perience are altogether favorable. It shortens the period of fever 
and total duration of the disease and markedly reduces complica- 
tions and relapses. The mortality, as deduced fronv the reported 
cases available, is found by Phalen to be 4.9 per cent., and all agree 
that it does no harm, even where it does no good. The dosage is 
increasing and the results appear to be better. In the treatm-mt, 
however, the vaeeine has yet to definitely prove its full value. 



Spinal ]\rENiNG0C3:LE. 

J. A. M. A. says Morton's lluid, which was formerly used by 
injection for the cure of spinal meningocele, is made up as follows: 
Iodine, grs. 10; pota.ssium iodide, grs. 30: glycerine, ounce one. 
After the sac was cleaned, chlorofonn w^ls administered, the child 
lying on its .side, a fine trooar was plunged obliquely in at the 
side through sound skin, littl-e or no fluid bring drawn off. Then 
one draehm of the Morton fluid was injeet(Hl. The trocar was with- 
drawn and the puncture sealed with a bit of gauze and iodoform 
collodion. 



DOMINION MEDICAL MONTHLY 61 



IReviews 



Borland's American Illustrated Medical Dictionary. The new 
(6th) edition revised. A new and complete dictionan^ of torms 
used in medicine, surgery, dentistry, pharmacy, chemistry-, vet- 
erinary HKulicine, nursing, biology and kindred branches, with 
new and elaborate tables. Sixth revised edition. Edited by 
W. A. Newman Borland, M.D. Large octavo of 986 pages, with 
323 illustrations, 119 in colors. Containing over 7,000 more 
terms than the previous edition. Philadelphia and London: "W. 
B. Saunders Company, 1911. Sole Canadian agents. The J. P. 
Hartz Co., Ltd., Toronto. Flexible leather, $4.50 net; thumb 
indexed, .$5.00 net. 

This dictionary is quite complete and yet concise, covering thor- 
oughly all branches of the study and practice of medicine and 
surgery. One of the numerous pleasing features is the short biog- 
raphies of "IMasters of Medicine." It is a book well worthy of a 
position in our libraries. j. h. t. 



Special Western Xiimber. 

In furthering the plan of producing special issues of the Ameri- 
can Journal of Surgery, composed of contributions by surgeons re- 
siding within a certain geographical area, yet of intern<ational repu- 
tation, there will be issued, in the early part of 1912, a special 
western number of this magazine. Subjects and those to con- 
tribute : 

"The Operation of Gastroenterostomy," by William J. Mayo, 
Rochester, Minn. 

"The Surgery of Tendons," by John B. ^Furphy, Chicago, 111. 

"Operative Treatment for Graves' Disease," by George "W, 
Crile, Cleveland, Ohio. 

"Colonic Intoxication." by J. E. Binney, Kansas City, Mo. 

"Practical Points in the Surgical Treatment of Exophthalmic 
Goitre," by A. J. Ochsner, Chicago, 111. 

" Treatment of Foreign Bodies in the Esophagus," by E. 
Fletcher Ingals, Chicago, 111. 

• " Brain Surgery Technique," by J. Kilns Eastman, Indian- 
apolis, Ind. 



62 DOMINION MEDICAL MONTHLY 

" Treatment of AbsoesKos and of the Necrotic Foci Resulting 
from the Use of Salvarsan," by A. Ravolgi, Cincinnati, Ohio. 

•' Treatment of Prostatic Obstructions," by E. O. Smith, Cin- 
cinnati, Ohio. 

Subject not announced, H. Tnholske, St. Louis, Mo. 

"Artificial Tendons and Li^anicKts in the Surgical Treatment 
of Paral^-sis," by Nathaniel Alli&on, St. Louis, IMo. 

" Uterine Cancer," by John C. Murphy, St. Ix)uls, Mo. 

"Arthritis Deformans," by fjeonard W. Ely, Denver, Col. 

"Acute Angulation and Flexure of the Sigmoid, as a Causative 
Factor in Epilepsy, with Special Reference to Treatment," by 
W. H. Axtell. Bellingham, Wash. 

The character of coHtril)utions prepared by these well-known 
surgeons arc of such a nature a.s to make this number particularly 
interesting. 



The Care of Infants and Young Children. By A. Dingwall For- 
DYCE, M.D., F.R.C.P. (Ed.)^ Extra Physician, Royal Edinburgh 
Hospital for Sick Children. With thirty-six illustrations. 
Price Is. 6d. net, or in cloth covers 2s. net. Edinburgh: E. & S. 
Livingstone. 

Those responsible for the care of children, or who, like physi- 
cians and nurses, are in the position of advisers, \\\\\ find in these 
compiled lectures a practical handbook which they need have no 
hesitation in recommending to mothers, health students, etc. Nurses 
them.selvas, as well as medical students, may read and study it with 
profit and pass it, or the Ivinowledge gained, along to tho.se in daily 
need of some enlightening information of this character. 



h}frrnntionnJ Clinics. Volume IV. Twenty-first series, 1911. Phila- 
delphia and London : J. B. Lippincott Company. 

Canadian practitioners who recjuiro — and we think all do — a 
practical, useful, modern and up-to-date exposition of the advances 
in all branches of medical science, cannot do better than become 
subscribers to International Clinics. Volume IV. completes the 
twenty-first series, ending the year 1911. The frontispiece isi a 
picture of Edward Jenner. There are five articles on treatment; 
two on geriatrics ; three on diagnasis ; four on medicine ; three on 
surgery; one — otology; one — pediatrics; on(> — ophthalmology; one 
— medico-legal ; two — economics of medicine ; one — history of medi- 



DOMINION MEDICAL MONIHLY 63 

cine. The article on the Successful Practice of Medicine by Thomas 
F. Reilly, Fordhaiii University, New York, is well worth perusal ind 

study by all. Canadians will aLso be interested by the article ''On 

Habit, SjTiiptoms and Disease," by Professor J. George Adami. 
McGill University. Copies and subscriptions can be ordered and 
placed through the Canadian agent of Lippincott's, Mr. Charles 
Roberts, 608 Lindsay Building, Montreal. 



Thf Phsician's Vi.'^itiiuj Lisf—WV2. Piiiladelphia : P. Blackiston's 
Son & Co. 

This is the sixty-first year of this handsome pocket visiting list. 
The contents of the l)ook are: calendar 1912-1013. a new complete 
table for calculating the period of utero-ge.station, table of sign.s, 
incompatibility, poisoning, the metric or French decimal system of 
weights ami mea.sures, table for converting apothecaries' weights 
and measures into grams, dose table, quarantine periods in infec- 
tious diseases, asphyxia and opnoea, comparison of thermometers. 
Then follow the blank pages for accounts, memoranda, etc. 



Text-Book of Gjjnfcolof/ic/il SurffO'y. By Coyn xs Berkelev, M.A., 
M.D., F.K.C.P.. M.R.C.S.. Gynecologist and Obstetrician to the 
^Middlesex Hospital. Tendon, and Victor 1^)nney, M.S., M.D., 
F.R.C.S., M.R.C.P., Assistant G^^lecologist and Assistant 01> 
stetrician to the :\Iiddlesex Hospital. London. 720 pages, 392 
figures in the text from drawings by Victor Bonner, and 16 col- 
ored plate,^?. 1911. .t6.00. London: Cas.^11 & Co. Toronto: 
D. T. McAnish & Co. 

In a review of this work one is at once struck with its essential 
completeness, its simplicity, and accuracy of detail. Dealing. :ts it 
does, with operative g\-necology, and coming from two of London's 
best known and most practical gynecological surgeons, and being 
brief, concise and full of useful information, it cannot fail to arouse 
the interest and enthusiasm of its readers. The plates are of a 
.superior kind, and the illustrative drawings are all that could be 
desired to display very clearly the methods of procedure in various 
operations. During a considerable period from ten to fifteen years 
ago Dr. Berkeley was well known to many Canadian graduates in 
medicine studying abroad as the best "coach'' in London on the 
sub.ie<^ts of gynecology- and obstetrics, and it was due to his untiring 



64 DOMINION MEDICAL MONTHLY 

efforts that many of them were able to pass with credit to them- 
selve.> tne examination of the Ck)n.ioint Board in these subjects. It 
will b' a source of much gratification to his many former students 
to be able to acquire this splendid production. Thiers is no other 
small, readable book that deals more clearly or more usefully vvith 
it.s subject. f. w. m. 



International Climes. Edited by Henry "W. Cattell, A.M., M.D. 
Volume III. Twenty-first series. 1911. Philadelphia and Lon- 
don: J. B. Lippincott Company. 

It is the rule for articles appearing in this well-known quar- 
terly to be the best obtainable from the pens of the very best men 
in all departments of medicine. This volume continues as good as 
any of' its predecessors. Many branches are treated of in the 
twenty-two papers contained in the present volume. Dr. Thomas 
F. Reilly has a splendid article, "The Successful Practice of Medi- 
cine." Another which will appeal to most men is "Economic 
Conditions Affecting Physicians," by H. B. Allyn. Anyone desir- 
ing to subscribe to this quarterly, which is issued four times a 
year, and bound in cloth boards, may do so through the Canadian 
agent of Lippincotts, Mr. Charles Roberts, 60S Lindsay Building, 
Montreal, Canada. The subscription price is $2.00 a volume. Each 
number is far worth the money invested. We heartily recommend 
it to all. 



S)ominion /IfteMcal /llbontbl^ 

Sn£) Ontario /BeDlcal Journal 

EDITED BY 

Medicine: Graham Chambers, K. J. Psychiatry: Ernest Jones, W. C. Herri- 
Dwyer, Gold win Rowland, Geo. W. num. 

o..i^~*^J^ °^v^, J°v."^L' IT K ► * Ophthalmology : D. X. Maclennan. W. 

Supgrepy : v\ alter Mckeown, Herbert A ii i „wrv 

Bruce, \V. J. O. Malloch. Wallace A. „i-. . » . ^ «. . 

Scott, George E wart Wilson. Rhlnolog-y. Laryngrology and Otol- 
ObstetPics : Chas. J C. O. Hastings, °sy Geoffrey Boyd, Gilbert Royce. 

Arthur ('. Hendrick. Gynecolog'y: F. W. Marlow, W. B 
Patholog-y and Public Health : John Hendry. 

A. Amyot. O. It. .Mabee, Geo. Na- Genito Upinapy Supgrepy : T. B. 

imvth. Uiehard.-on. W. Warner Joue>. 

Physiologric Thepapeutics : 

J.Harvey Todd. Anesthetics Samuel Johnston. 

GEORQZ: Z:i.I.IOTT, aiANAQINO EDITOB. 

Published on the 20th of each month for the succeeding month. Address 
all Communications and make all Cheques, Post Offlce Orders and Postal 
Notes payable to the Publisher, GEORGE ELLIOTT, 203 Beverley Street. 
Toronto, Canada. 



Vol. XXXVIII. TORONTO, FEBRUARY, 1912. No. 2 

COMMENT FROM MONTH TO MONTH. 

The division of professional fees, lee-splitting, " dich- 
otomy," or whatt'vor it may he ealled. wa.s an instructive, interest- 
ing and important subJK-t for diseii.stsion at tlie Academy of Medi- 
cine, Toronto, the evening of the 2nd of January. 

Tlie following is the resolution presented : 

(a) That the secret division of a fee, or fees, ^^^th any person, 
or persons, who may be influential in influencing a patient, or 
patients, to apply for operative care or professional advice, is 
unworthy of any member of the medical profession. 

(b) That if such a division of fee is made by a member of 
the Academy of ^fedicine. Toronto, it should be counted' as sufficient 
ground for the expulsion of the member. 

(c) That it shall be the duty of the Council of the Academy to 
investigate charges against members made on the basis of such 
division of fee ; and on proof of offence the Council may either 
permit the resignation of the person or expel him from the 
Academy. 

Before entering upon a discussion of this controversial question, 
one probably of the most momentous importance to the profession 
at large appearing on the medical horizon for years, it will suffice 
for the present to state that the resolution was not finally acted 
upon at the meeting, but that it was referred to a special committee 
for a report, when another discussion will take place. 



66 DOMINION MEDICAL MONTHLY 

Th<? after-effects of the lioliday season may have liad something 
to do with the verj- slim attendance at the meeting, for ainiounee- 
meiits had been sont to members of tlie Academy a week or ten 
days before. Failing this as a reason, is it to be understood that 
the profession as a body is not well seized of the fact that this 
dichotomoiLs practice has invaded, and even gained' considerable 
foothold in, the county, state and national medical life of our 
neighboi-s to the south of us? Or is the profession supine in the 
matter, that is, mentally and morall}- inert? 

Whilst it is understood that the practice has appeared in our 
midst, it cannot be said to have gained any particular headway. 
The discussion, however, proves that there is a feeling of unrest 
and a dissatisfaction witli the present relationship between physi- 
cian and operator. 

It is well to introduce early into the discussions on fee-splitting, 
in order to put special and emphatic stress upon the subject, that 
the monetary consideration, the mere matter of dollai-s and cents, 
is not the totality of the questionable innovation. There is the 
moral side, which may have diversified aspects, and not the lea.s.t 
of these is the right or wrong of paying a secret commission. 

In the sister profession of law, when the solicitor engages 
special counsel, both charge their respective feas to the client — 
and all is open and above board. There is no paying on the part 
of the counsel mone.ys to the solicitor, out of the former's retainer. 
Both stay with tlie ca.se to its finish. And that is exactly where the 
difference lies, for it is not so with the physician and' surgeon. In 
the majority of cases the physician relinrjuishes the patient to his 
brother of the scalpel. 

Life and restored health should be important enough to demand 
that both continue their services hand-in-hand to the close of the 
case. Then the sum total for their services could, and should, be 
amicably adjusted ; twenty per cent., forty per cent., fifty, or what- 
ever it should be. 

Nothing is more evident in life than that there are two sides 
to a que.stion. All history testifies thereto. There is no need of 
cudgelling this into any intelligence, be it never so backward. 
Your enthusiast, who, in this case, may be set down as the surgeon 
fighting vehemently against the introduction of this rash innovation, 
will not see it so; and he will probably din it into our ears that it 
ha.s only one possible solution, namely, thug it to death. In the 
meanwhile, the neophyte in the practice, fjuiet, uninfluential, may 
be steadily at work practising and preaching the gospel of this ne^v 
evangel, — for it may be good news to general practitioner, beginner, 



DOMINION MEDICAL MONTHLY 67 

th^e old man si(lK'-track<xl in the race, and the budding surgeon alike. 

It remains to enumerate some of the causes which have brought 
the question of the division of fees into medical life. The increased 
cost of living: is said to be a potent factor; some one says over- 
crowding is responsible; too many medical schools, cries a third; 
too low standards; too many specialists; the man in general practice 
doing special and other surgical work; the }'oung surgeon fighting 
for his life and his living; the closed hospital; because others are 
doing it. 

Tiie prime question, however, is, is it right or wrong? Because 
it is a secret process between ph3'sician and operator, it is unbecom- 
ing to the ethical profession. Thi.s is the chief condemnatory 
argument. Hut consultations are se<-ret, as all that takes place in 
the consulting-room is not divulged to either patient or friends. 

The whole question is one which demands the most careful and 
serious consideration on the part of the Academy of Medicine, or 
any other medical lK)dy, before any such drastic therapy as expul- 
sion ]ye applied. If perchance a majority of the Academy favored 
the division-of-fee system, and entered a somewhat similar resolu- 
tion calling for the expulsion of those who did not adopt it. what 
would happen ? 



The supervising medical editor on the staffs of the leading 
dailies has eome. Many years ago. and .si-veral tiim-s since, we 
predicted this departure in newspaper work, and. indeed, advocated 
the medical editor in connection with the newspaper, not alone in 
the interests of justice to medical science, but as well to the public, 
who, if they were athirst for information of a scientific character 
of this description, should get it from a competent source, and 
not have it served hot from the juvenile pen of some " kid " 
reporter. 

If the newspaper of the future is to l>e the grt^at metlium for 
the dissemination of knowledge regarding public medicine, which 
more and more is becoming appetizing reading for its patrons, it 
must of necessity recognize the great importance of the medical 
editor to supervise all items of even a medical coloring, as well as 
to edit and prepare such articles as shall correctly impart exact 
knowledge and teach the people aright. 

The Chicago Tribune and the New York 11 1 raid are the two 
foremost pioneers in this new fie^kl, and both have recently engaged 
competent medical editors on their re?;pective staffs. There are 
others which have for some few years emplojied the medical editor 



68 DOMINION MEDICAL MONTHLY 

tentatively, but thes^e are the first to make him a necessary figure 
in the editorial sanctum. 

The advisability of issuing a special journal to the public has 
been undi?r consideration by the Ainerican Medical Association ; 
and in England, a large newspaper syndicate is preparing to issrue 
some such publication, wliicli shall be editinl, and contributed to, by 
mem'bers of the medical profession. 

"We in Canada are a community of excellent copyists; and it 
wild probably not be long before some of our leading dailies will 
be sioized with a d<^ire to follow suit. And, indeed, there is plenty 
of evidence, every now and again, that such a supervising editor 
is urgently demanded. 

The desire to serve the public is generally evidenced by the 
increment of dollars and cents. Once satisfied that there is money 
in the venture; that it is a matter of business as well as one of 
education ; t-hat accurate news of public medicine and. its sub- 
sidiaries, preventive medicine, sanitary science, quarantine, school 
hygiene, the medical supervision of school children, etc., etc., is a 
producer for the newspaper, and effects sales, the ne\\'spaper direc- 
torate will act, and act quickly. 

As we wrote last month, the newspaper is bound to become the 
great medium in educating the people in all which affects the 
conservation of human life and human health. That granted, the 
medical editor is obviouslv and absolutely essential. 



Annual life insurance examinations, according to state- 
ments by tlie officers of some companies, will soon become part of 
the ordinarA' business routine of life insurance work. 

The life insurance companies, from a business standpoint, are 
alive to the gi-eat opportunities for saving, and thus increasing 
dividends, through taking advantage of the teachings of preventive 
medicine. 

With a disinterestedness almost mars-ellous, the medical man 
has always tak(-n keen action in the prevention of disease. 

If annual medical examinations in life insurance, old-line life 
and fraternal, become practice, it will be the first in.sta.nce of the 
profession advocating something in preventive medicine, which w'ill 
redound to their own financial gain. 

It will be in accord and keeping with all the medical profession 
has done in the past in preventing disease, for the profession now 
to as earnestly advocate the annual medical examinations of all 
policy-holders. 



DOMINION MEDICAL MONTHLY 69 

Satisfied that it is iu their own interests, as well as in the 
interests of the insured, and that these examinations are .something 
more than mere mea.sures in preventive medicine, the companies 
may be depended upon to push forward the movement, and. adopted 
by some, it will soon become universal. 

Like as in establisliing sanatoria for disea-sed policy-holders, the 
fraternal societies will follow suit; and alive as is the intelligent 
and educated portion of the community today to the advantages ac- 
cruing from preventive health measures, they will offer little resist- 
ance to these annual examinations, but rather welcome them, r^-cog- 
nizing, as time goes on, the importance of the regularity of being 
reas-sured by a ph^^ician that their physical well-being Is normal. 
So also will they appreciate the fact that it is only by this means 
that insidious disease's may be soon recognized and treated. 

The life insurance medical man is thus destined to fill an ever- 
increasing sphere of usefulness in the community. 



DR. CHARLES E. de M. SAJOUS. 

Supervising Editor of the New York Meilioal Journal. 



We have the honor to announce that beginning with issue of 
December 9, 1911, Dr. Charles E. de M. Sajoiis. of Philadelphia, 
becomes the Supervising Editor of the Xcir York M((lical Journal. 
While Doctor Sajous will give up liis private visiting practice, he 
will continue his work as a consulting physician, investigator, 
teacher, and author, and thus be in a position to keep in the clo<^>^t 
touch with the needs of the medical profession. 

Though born under the American fiag. Doctor Sajoas received 
his preliminary education in France. lie studied medicine in Phila- 
delphia, graduating with honors froii. the Jefferson Medical College 
in 1878. He served for two years as resident physician in the 
Howard Hospital, and in 1881 was appointi-d Professor of Anatomy 
and Physiology' in the Wagner In^^titute of Science, Lecturer in the 
Philadelphia School of .\natomy. and Clinical Assistant in the 
laryngological department of .Teft'er.son ^ledical College, succeeding 
Dr. J. Solis-Cohen. in 18S3, as Clinical Lecturer and chief of that 
department. In 1891 Doctor Sajous went to Paris, where he de- 
voted six years to original research. I'pon his return, he was 
appointed Dean of the Medico-Chirurgical College. At the recent 
reorsranization of the medical department of Temple University 



70 DOMINION MEDICAL MONTHLY 

Doctor Sa.ious ain-optpd the Chair ol" I'liannacolocry and Therapeu- 
tics, which he still holds. 

The immediate outcome of Doctor Sajous's six years of research 
work in Paris was the publication of two volumes on Infernal Secre- 
tions and the Principles of 'Medicine , a work which gave the author 
high standing as an original investigator. 

Doctor Sajous has had a wide editorial experience, having 
founded, in 1888, the Annual of the Universal Medical Sciences, 
which ho conducted with the collaboration of some of t'he most emi- 
nent physicians in America and Europe, until the publication was 
abandoned in 1803 The Annual had a circulation of over 500.000 
volumes and the Cifclopadia of Practical Medicine, founded by Doc- 
tor Sa.ious in 1898, to succeed tJie Annual, and intended more par- 
ticularly for the general practitioner, has attained a circulation of 
240,000 volumes, the seventh edition being now in course of prepara- 
tion. 

The value of Dr. Sajous's services to medical science has been 
recognized in Prance by his being made a member of the Tjegion of 
Honor, while in Belgium he received the Order of Leopold and was 
made a Knight Commander of the Liberator. beside.s receiving other 
titles, both governmental and scientific. In America Doctor Sajous 
has been president and vice-president of many scK-ietics and is a 
Fellow of the College of Ph\-sicians of Philadelphia and of the 
American Philosophical Society. He brings to bear on the editorial 
problems of the New Yorl: Medical Journal a brilliant and well-in- 
formed mind, wide experience, and a thorough knowledge of the 
needs of the American physician. 

The publishers of the Xew Yorl{ Medical Journal feel that they 
as well a.s its readers are to be congratulated uj)on having obtained 
the services of Doctor Sajous. Comprehensive and well-directed 
plans have been formulated for enhancing the vahie and interest of 
the New Yorl- Medical Journal, and in carrying out these plans no 
pains or expense will be spared to give to its readers a medical 
journal of unprecedented authority and interest. 



DOMINION MEDICAL MONTHLY 71 

IRews Jtcms 



Dr. Harry Pearsox has maved L'roiii Stayner, Ont., to Toronto. 

Dr. G. R. McDoxagh, Toronto, left for the South on the 11th of 
January, 

Sarnia, Ontario, has had a small epidemic of typhoid fever, 
there having been upwards of one hundred cases. 

Two good, unopposed medical practices for sale cheap in Al- 
berta. One has a drug store. For further particulars appl}' to us. 

Dr. Bruce IIewson has sold his practice in Colborne, and for 
the last three mouths has been doing special work in New York 
hospitals. 

The Journal of the American Medical Association noted 2,145 
deaths amongst physicians in the Tnited States and Canada during 
1911. 

Dr. Chas H. Mayo was recently operated on in New York for 
appendicitis, and snibsequently for gall stones. He is understood 
to be recovering nicely from both. 

Dr. S. H. Westman, Toronto, died the 30th of December, 1911^ 
of acute Bright 's disease. He was 39 years of age, attached to the 
medical department of Toronto University and also to the Toronto 
Greneral Hospital. Dr. "Westnian was exceedingly well liked by his 
confreres, and his early demise is deplored by all. 

A new private hospital — the Madison — has been established at 
159 Madison Avenue, Toronto. The rooms are sunny and bright, 
the operating room being exceptionally nice and complete. The 
charges are quite moderate. The .Madison is in charge of two ex- 
perienced and capable trained nurses — ^liss Agnes Chishobn and 
Miss Elizabeth F. Sinclair. Telephone College 8599. 

Ontario is to be divided into health districts, the old municipal 
boards of health to the number of 800 are to be abolished, and each 
district is to be placed imder charge of an experienced medical man 
responsible to the chief health officer of the Province. It is not in- 
tended to interfere with the Boards of Health of the larger cities. 

The "Western Hospital, Toronto, held its annual meeting. The 
yearly revenue easily luet the current expenses. Alwut $200,000 is 
needetl for equipment of the new wing nearing completion. Then 
the "Western will be one of the best hospitals in Ontario. 



72 DOMINION MEDICAL MONTHLY 

Ipublisbers' ^Department 



Important New rKEi'AKATiuxs of Pakke, Davis & Co. — General 
practitioners will be interested in the announcement by Parke, Davis 
& Co. of two new products of their chemical hiboratories. Proposote 
and Stearosan are the names chosen to designate the preparations 
in question. Proposote is creosote in combination with phenyl-pro- 
pionic acid. It is a straw-colored, oily liquid, neutral in reaction, 
nearly odorless, and having a slightly bitter taste suggestive of creo- 
sote. It is insoluble in water, but is slowly decomposed by alkaline 
liquids. The indications for it are the same as those for creosote. 
Tubercular cough following pnemnonia, the cough of pulmonary 
tuberculosis, acute and chronic bronchitis, purulent bronchitis, ab- 
.scess of tlie lung, asthma, and bronchitis complicated with Briglit's 
di.sease are among the pathological conditions benefited by itsi ad- 
ministration. Being insoluble in acid media, it passes through the 
stomach unaltered by the gastric juice, to be slowly broken up by 
the alkaline fluids of the small intestine, hence may be given in 
gradaiallj' increasing doses until the desired effect is obtained. Dur- 
ing prolonged administration, as is well kno^vn, creosote disturbs 
digestion, impairs the appetite, and often causes nausc-a and vomit- 
ing. Proposote is free from this objection. Stearosun is santalol 
combined with stearic acid. It is an odorless, tasteless, light-yellow 
oily liquid that is insoluble in water and dilute acids, but is slowly 
l)roken up by alkaline fluids. Tlie pathological conditions in which 
it may be employed with advantage are precisely those in which 
santal oil has long been used — chronic gonorrhea, cystitis, urethritis, 
vaginitis, pulmonary disorders, such as chronic bromehitis. bronclior- 
rhea, etc. It po.ssesses therapeutic properties fully equal to those of 
santal oil, over which it has the important advantage of being prac- 
tically without irritating effect upon the stomach. The explanation 
of the latter fact is that the preparation is not attacked bj-- the acid 
gastric juice, but passes into the small intestine, where it is broken 
up or emulsified by the alkaline fluid and absorbed without diffi- 
culty. The distressing eructations and loss of appetite attendant 
upon the adnninistration of santal oil do not occur when Stearosan 
is given. Both Proposote and Stearosan were thoroughly tested 
clinically before being offered to the medical profession, and prac- 
titioners may be assured of their therapeutic efficacy in all cases in 
which they are indicated. They are supplied in 10-minim elastic 
gelatine capsules, boxes of 12, 24 and 100, and may be obtaimxl 
through retail druggists generally. 



DOMINION MEDICAL MONTHLY xvii 




Are you particular as to the condition of the iron in your 
Blaud preparations ? 

Frosst's Perfected Blaud Capsules present True Ferrous 
Carbonate. 

Each 10 grain Capsule contains, approximately, 1 grain of 
Iron. 



xviii DOMINION MEDICAL MONTHLY 

Progress op Fashion-Craft Clothes in Toronto— Another 
Link in the Dunfield-Bellinoer Chain — Three Progressive 
Men's ^VEAR Stores, the Yoi'ncjer of Which was Opened Re- 
cently. — The opening recently of a third Dimtield & Bellinger store 
in the city of Toronto brings into prominence a notable instance of 
development in men's we.ir merchandising. Whilst to all outward 
appearance the men's furnishing and clothing section in these stores 




appear to be run by one company, such is not the case. Messrs. 
Dunfield & Co. control all that pertains to the haberdashery depart- 
ments, whilst P. Bellinger is pi-oprietor of the three Fashion-Craft 
clothes departments. 

By such means a saving in rent and overhead expenses is made, 
whilst under one roof may be found every requisite for the well- 
dressed man, purchased and displayed by men who thoroughly 



DOMINION MEDICAL MONTHLY 



XIX 



•>^ 



'^1"-^ 








RCQISTCRCO 




FURS 



Seasonable, Appropriate 
and Lasting Gifts 




o 



UR furs perpetuate year 
after year their original 
charm. 

And whether bought as a Xmas 
remembrance to a friend or for 
one's own comfort they afford 
a truly profitable investment. 

PONY COATS 

$50.00 to $175.00 

HUDSON SEAL COATS 

$150.00 to $300.00 

LADIES' FUR-LINED COATS 

$35.00 to $175.00 

MINK SETS 

$55.00 to $350.00 

PERSIAN LAMB SETS 

$25.00 to $125.00 

Write for III usf rated Fur Catalogue 



Fairweathers Limited 



WINNIPEG 



84-86 Yonge Street 
TORONTO 



^^ONTREAL 



XX DOMINION MEDICAL MONTHLY 

uiukTstaml their business in eitlior the clothing or furnisliing de- 
partment. 

A little over one year ago INTcssrs. Diiiifield & Co. oecupicd a 
men's furnisliing store on Yonge Street, \vliilst P. Bellinger owned 
and operated an exclusive shop of Fashion-Craft on King Street. 
By mutual agi-eement ^Me.ssrs. Dunfield & Bellinger erme together 
and the results of placing tlu'ir interests, as far as occupation of 
space being decided upon, and proved so satisfactory that a third 
premises was obtained and opened in September, situated on the 
corner of Buchanan and Yonge Streets. This store is under the 
management of Chas. T. Sargeant for ^Messrs. Dunfi'^ld & Co. and 
Stewart Price for Fashion-Craft. 

The King Street store is managed by ^Tr. Bellinger, with (ilen S. 
Case operating the furnishing department. In the ihird store. No. 
102 Y'ouge Street, Mr. Cordon Dunfield takes the general manager- 
ship of their system, whilst Herb. A. Irving acceptably fills the post 
of manager in the clothing department. 

A proud boast of INIessrs. Dunfield & Co. is that less than twelve 
years ago their sales did not amount to $6,000 for 'he year, while 
to-day thirty times that amount would be more like their annual 
output. 

Mr. Bellinger, who has been connected with Fashion-Craft ever 
since it started, claims that to-day he is doing more business in his 
original store than he ever did before, and yet his second store's 
turnover is larger, whilst his hopes for his third venture, if realized, 
will place him in the enviable position of leading retail clothier in 
Canada. 



]\lEnic.VL practice for sale; fifty miles north from Toronto; rail- 
way station three miles; very nice property and several lots; un- 
opposed; good country and roads. Price $3,000. $500 down, bal- 
ance arranged. Collections about $3,000 per annum. Apply to us. 



The Inteknationat. IIvgiexe ExiiiBrTrox. — firand Prix awarded 
to manufacturers of Sanatogen and Formamint. — The w^orth of a 
" grand prix " depends chiefly upon the character of the exhibition 
which awards it. In the case of the International Hygiene Exhi- 
bition at Dresden — under the patronage of II.M. the King of Sax- 
ony — the honor is a genuine on<', and represents the highest medi- 
cal opinion in Europe. It is interesting to note, therefore, that 
the only Grand Pi-ix awai'ded in the ])liaiiiia('eutical section at this 



DOMINION MEDICAL MONTHLY 



THE 

STEVENS COMPANY 

FOR 

SURGICAL SUPPLIES 

QUALITY AND PRICES RIGHT 




X RAY TUBES 

A complete line of Tubes 
always on hand. 

Write for price list. 



Every Surgeon should use 

STEVENS' KNIVES 

The best material is used. 

All one piece Steel. 
Every Knife guaranteed. 



Lister's Surgical Dressing 

Is put up in all sized packages 
plain and medicated. 

Price List sent on request. 




STEVENS' LINE OF SURGICAL DRESSINGS 

Bandages, Ligatures and Protectives 

AND 

Surgical Instruments can be supplied through 
your Druggist or Supply House. 



THE J. STEVENS ^ SON CO., LTD. 

145 Wellington Street West 



xxii DOMINION MEDICAL MONTHLY 

exhibition has been received, aj,'ain.st innnenms competitors, by 
Messi-s. A. Wulfing & Co., iiianufacturers of tlie well-known pre- 
parations. Sanatogen, Formamint and Albulaetin. The British 
Section, under the patronaf^e of II.R.II. Princess Christian, was 
organized by the Lord ^Mayor of I^ondon, Sir Vesey Strong, and 
played a prominent part at the Exhil.'ition, where all the leading 
nations were ofificially represented. 



P\vCE nias.sage, scalp treatments, body massage, needle sprays, 
colored light baths and electrical massage are now essentially re- 
quired a.s etifieient adjuncts to the medical man's ai-inentarium. 
Where experience and skill in administering such treatments are 
assured, it is very satisfactory to the practitioner who has to refer 
case^ for treatment under special supervision to kno.v such will be 
conducted eflficiently and intelligently. Toronto or out-of-town 
medical men will kno^v that well-appointed parlors and sun room 
have quite recently been opened in this city. The^se are in charge 
of and under the personal supervision of ]\Irs. Neil ^FacKinnon, late 
of Scotland. The institution is conveniently and centrally located 
at 20 Walmer Road. 



James J. Putnam and C. J. Blake, follo\Wng Babinski's obser- 
vations, report favorably upon the withdrawal of from 15 to 22 c.c. 
of cerebral spinal fluid by lumbar puncture in aural vertigo. In 
some cases the results have been immediately favorable, and only 
occasionally has a second puncture been required. No untoward 
results have been observed excepting headache, lasting from a few 
days up to a week. 



Medical practice for sale; Wentworth Comity; established over 
twent}' years; good property; splendid roads and best country. 
Cash collections per annum,' $3,000. Price $:l:^00. about $1,200 
down. Apply to us. 



H. G. Hughes (.V. Y. M. J.) says the urine of a pneumonia pa 
tient shows almost constantly absence of sodium chloride. Potassium 
nitrate in full doses causes the -sodium chloride to reappear in the 
urine within a few hours, and as long as it is given the chloride 
will continue present. He states the effect upon the course of the 
pneumonia is seen in the fall of temperature in a few hours, and 
that it continues to drop until UDnual is reached. The i)liysical 
signs remain for a few days, and resolution ami recovery is 
brought about without crisis. 



DOMINION MEDICAL MONTHLV 



XXI II 



new Vork Polyclinic medical School and Rospital 

The Flr$.t Post -Graduate Medical OrifaDizatlon in America. 
Chartered by the L'uiversity of the State of New York. 



214 - 220 east Tb'rtV'Tcurth Street 



new Vork City 



Post-Graduate Courses for Doctors of Medicine 

Students may matriculate at any lime during the year. The course 
of study may be general or con fined to one or more special subjects 



Departments 



SCRGICAL. 

General. Orthopedic, Rectal.Genito- 
Crlnarj*. 

G.vnecoloery, <)I>»tetricN, Ej-e. Far, 
Nose, Tliroat. 



MEDICAL- 
Clinical Medicine lincludin;? Phy«l- 
oal Oia:;iio8iH\ Di)?estive Svit'em, 
Cliildren, Skin. 
Nervous Sj stem. 

Operative CourseN on file eada \ er In aU Hur^fcai departments. 
Itacteriolo^3 , Pathoioey. Clinical Micro«top>. 

Physicians come in direct personal contact with abundant material'i for 
clinical iiir'trucilon in both hospital and dispensary. 

Special courses, involving individual work, may be arranged for. 
For further information, addiess 

John A. Wyeth, lll.D.. IX.D., Pri-sideiit of the Faculty, or 
John (■iiiin. Superintendent. 




( Linen-Me5hJ 



L 



IVool is a slow absorbent and offers the very best of pn tection — in the 
form of outerclothing: — against rain and culd. 

As underwear it is entirely '* out of place " and most unreliable. 

The Deimel Linen Mesh Fabric, of which the Dr. Deimel Underwear is made, 
is a modified Linen, with the chill of ordinary pure linen removed. It is as 
absorbent as a towel, and as grateful to the touch as a handkerchief, thorough- 
ly invigorating, and the safest and most jirotective undergarment to wear at all 
times. 

DEIMEL LINEN-MESH CO. 

416'St. Catherine St. West :: i Montreal, Canada 

Branches: NEW YORK, SAN FRANCISCO, (WASHINGTON, D.C., BROOKLYN 

BALTIMORE, DETROIT, LONDON, Eng.; 

WE ALSO SELU THE OR. DEIMEL L I N E N • M E S hTS U P P O R T E R S 



xxiv DOMINION MEDICAL MONTHLY 

AViiAT IS Best ix Tonics? — ^lany people, iuid perhaps a few 
physicians, are inclined to consider the terms "tonic" and "stimu- 
lant" as more or less .synonynions and intt^'changeable. This, of 
course, is not the case, altiiough some agents I'.mployed medicinally 
may partake of the properties of both and be properly known as 
"tono-stimulants." Strychnia, for instance, is a heart stimulant, 
but may also be considered as a general nerve and systemic tonic 
when given in small and frequently repeated doses. AVhile a stimu- 
lant alone is sometimes indicated in conditions of emergency, its 
long continuance almost certainly produces an after depression. It 
is sometimes advisable, however, to give stimulant and tonic to- 
getlier in conditions of serious general depression, the first to 
"boost" the vitality and the second to hold it at the point to which 
it has been raised and to restore the general tone of the organism. 
An ideal combination of this nature is Pepto-^Mangan (Gude), to 
which has been added the proper dose of strychnia, according to 
indications. This combination is especially serviceable in the con- 
valescence of exhausting diseases such as typhoid fever, pneumonia, 
la grippe, etc. It is also of much value wTien the lieart needs sup- 
port and the general system requires upbuilding. Pepto-^NIangan 
restores vitality to the blood by increasing the numb.^r of red cells 
and the percentage of hemoglobin, and the strychnia assists in ren- 
dering the combination a peculiarly efficient general bracer and 
permanent reconstituent. 



BRAND'S NUTRIENT POWDER. 



This epnsists of raw, lean meat, dried and dessicated. Can be 
given on thin bread and butter as an ordinary potted meat or mixed 
with milk or any other liquid as the doctor may advise. Valuable 
for children and othere suffering from flaccid muscles, weak diges- 
tion, etc. Is also valuable as a constituent of nutrient enemata. 



7^ 



S)ominion /H^ebical /ihontbl^ 



H^^ Ontario /a^cMcal journal 



Vol. XXXVIII. TORONTO, MARCH, 1912. No. 3 



©rioinal Htticles 



THE FRESHMEN'S flGHT. 



By a. C. E. 



The old medical building of the College of Physicians and Sur- 
geons of T , consisteil of two classrooms, primary and final, a 

faculty room, small museum, and a cloak-room in the basement. 

The freshmen and sophomores together received lectures in the 
primary room; the third and fourth years in the final. The prim- 
ary room was at tlie side of the short main hall; the final at the end. 

At the beginning of term, generally the first Tuesday in 
October, the day was set apart for the opening lecture, after which 
the Dean would give the usual announcement : ' ' The regular lec- 
tures will commence at 8 o'clock to-morrow morning." 

It was always at the close of the first afternoon lecture — i.30 
following the opening day — that the sophomores gathered their 
forces for the freshmen initiation ceremonies in the primary room. 
This was the first haze. 

The janitor had rung the "out" bell, and the professor had 
immediately gathered up his notes and swung out through the 
hall into the faculty room. 

Instantly there was a buzz and a hum. The fun had started. 

The sophomores have doffed their coats, collars, neckties, all. 
anything, everything which is likely to incommode them. Some 
have even stripped to their undershirts. These are passed from 
hand to hand till all have found their way in safety to the quiet 
domain of the final apartment. 

Perched upon the great cross-beams, yelling, cheering, shout- 
ing, in windows, everywhere, to be safe from the terrific avalancho, 
the two final years urge on the battle. 



7t DOMINION MEDICAL MON'iHLV 

The fresliinen, many of tlicin with white faci's, nervous, breaths 
bated, have gathered in groups amongst the upper seats and on 
the upper binding, away up nearly to tlie eeiling of the amphi- 
theatre-like elassroom. All is new to them, so new that they wonder 
to themselves where it will all end. Some stand with hands in 
pockets awaiting for the onslaught. No organization — none; there 
has been no time for anything like that. They have not even made 
acquaintance one with another. All are strangers, but they con- 
gregate now, drawn together by a common s^-mpathy of dread and 
danger. The passageway up the centre between the rows of seats 
is cleared ; so is the space in front and around the dais, for here 
often lies the fun. TTrvf the freshmen very often fight, resisting 
elevation. 

Two sophomores. Jack Felcher and Archibald ^lac^NIahon. are 
rampant. They line a double row up one .side over the seats or 
benches. They muster a force upon the opposite side. One gang 
brings them down ; the other hauls them up. 

John Ditchfield, a third sophomore, stripped to the waist, noth- 
ing upon his powerful frame but under-guernsey and pantaloons, 
stands at the bottom of the elevating detachment. He is supported 
by six or eight stout, burly fellows. These are noted "scrappers," 
and this is the point where fight is always shown. Felcher and 
MacMalion will lead on the first assault. 

Everything is now in readiness. The men are marshalled into 
order. The command is given. Away they go, scrambling up over 
the seats and partitions, some few up the aisle, all the attacking 
party making for the group of freshmen huddled upon the ujiper 
landing. 

Felcher is a little fellow, but he is first. He is met with a rebuff 
which almost completely deprives him of his hazing ardor. A big 
freshman from the Prairie Province, tanned, brown, and rugged 
with his rough, outdoor life and toil, has grabbed the little hazer 
and has literally thrown him in the faces of the advancing party. 
He strikes ^MacMahon, a long, lanky soph., full in the chest, and 
over they both go, all tangled up, between two rows of seats. 

A yell of delight goes up from the jubilant finals at this recep- 
tion. It means there is going to lie some fight and lots of fun for 
them. It is a time-honored custom. The sophomores must fight 
their own battle. They will get no assistance from the finals. Cheer 
upon cheer rises from their throats, and the freshmen are encour- 
aged on, but, timid, the}- hold back from coming up to the support 
of their fellow. The rush is now upon them. Felcher and Mac- 
Mahon have extricated themselves from their ludicrous predica- 



DOxMINION MEDICAL MONTHLY 75 

ment, being uniiiercifully guyed and jeered by the unfeeling finals. 
The small group ol' freshmen on the right are making a good fight. 

"Cross over, 'Freshie,' and help your men!" cry the finals, 
eager now to see the sophs defeated. But the freshmen lack cour- 
age. Tliey have not yet begun 1x) understand the meaning of the 
afi'air, nor what shape it is to take. 

Several of the lines of "elevators" have left their places and 
gone over to the right to reinforce the attacking party. 

Now they come, one by one. By sheer force, each freshman 
is dragged down over tlie partitions f book-rests l)etween the rows of 
seats), by a gang of five or six to the fioor below, where some give 
up and go up on the other side without any fuss or kicking, being 
given a good start by the powerful arms of Jolin Ditdifiehl. 

MacMahon and Felcher are doing very little real fighting. They 
are both standing upon the top of one of the partitions directing 
the manoeuvres. MacMahon, from his height, espies a little, oily, 
Jew freshman, Oliver Oppenlieimer by name, and he leans over 
to reacli him; but that slippery individual eludes his grasp and 
slides away up out of his reach. With a coarse epithet. MacMahon 
dashes after him and catches him as he is about to glide down one 
of the long stovepipes which run, one on either side, up over the 
seats from tlie stoves on the fioor below. Oliver turns and bites 
his fingers as they rest on his forearm. ^lacMahon gives a howl of 
pain and suddenly releases his hold. The Jew, who appears to be 
endowed witli wonderful agility, jumps suddenly upon the shoul- 
der of one of the freshmen, grabs the iron bar which holds the 
south wall of the room from parting with the north, swings him- 
self up, and then shins away up to the ceiling on one of its sup- 
ports, writhing and twisting his body around the rod. looking for all 
the world like a. good-sized monkey. 

This episode amuses the finals immensely, and tliey laugh at 
and joke MacMahon accordingly, daring him to bring the agile 
"freshie" down, as he is elevated altogether too far up. 

The fight still goes on. All are not down. All have not gone 
up over the bar. It has taken no little trouble to bring do^vu the 
strong young man from the West. About a dozen have managed 
at last to land him on the floor below, where he is handed over to 
the tender mercies of John Ditchfield and his gang. He makes a 
little resistance even here, but the brawny arms of big John en- 
circle his waist; his legs are grabbed by four or five others; he is 
lifted bodily off his feet -. a great shove from John, and up he starts. 
Once free of that powerful grasp, he starts at resistance again. He 
kicks out vigorously. Someone gets a stunner in the chest. "Saw 



76 DOMINION MEDICAL MUN I HLY 

him ! Saw him!'' goes the cry. John runs up one or two rows. His 
satellites follow. Three or four are placet! at a leg, the same at 
the other, and at each arm. Then these dozen or mt)re strong fel- 
lows proceed to administer what is very severe punishment. He is 
jerked in one way, then in the opposite direction, alternately arm 
and opposite leg. until the poor fellow has his extremities almost 
evulsed, until he is almost quartered by these fiendish fellows. He 
is then carried up and thrown over the last row to regain his 
breath amongst his freshmen associates, a much sadder and a much 
wiser man. "What availeth one against a dozen ? 

All dripping with perspiration, warm, puffing and blowing, 
tattered and torn, the sophomores stand wiping their necks and 
faces free from the product of their exertions. 

The door suddenly opens and in walks the tall and handsome 
form of George Bolingbrooke, a young man who had' attracted a 
great deal of attention at the opening lecture of the term the day 
previous. 

A small wavering cheer from the freshmen greeted his appear- 
ance, for was not here a champion and a leader for them. 

The finals gave him a hearty reception. Here would be some 
grand sport in elevating this one. Cheer after cheer went up ; 
shout after shout arose. 

The sophs stood looking at Felcher and ]\IacMahon. 

Felcher snd ^lac^Ialion turned their eyes upon Ditchfield. 

"Hurrah, boys!" cry Felcher and MacMahon, as they rush 
for the l)ig fellow. 

Ditchfield and his gang follow. 

The finals shout for the "freshies" to come down^and help 
their man ; but there is no need. 

George Bolingbrooke folds his arms across his expansive lireast 
as he feels John Ditchfield 's arms encircle him. They are lifting 
him bodily. Pie is making not the slightest resistance. Of course 
there can be no scrap when a man will not scrap. Now they have 
him up over .some of the seats, and are lifting liim over the bar. 
Good-humoredly, he takes hold of the bar and thus a.ssists tlieui. 

The finals, not to be wholly outdone of their sport, cry, "Bring 
him down tlie other side. Stand liim on the dais and let's have a 
speech I" 

Away they go across the ai.sle with tlicir man, drag him down, 
and stand him on the dais behind the lecture de.sk, somewhat 
winded, too, even if he did not make a struggle. 

"A speech! A speech!" they cry. 



DOMINION MEDICAL MONTHLY 77 

The giant standing there, six feet four inches tall, is puffing and 
smiling and laughing. 

''Fellow-students," he began, "this is too rich. I am a soph 
myself. I put in my first year at a Philadelphia medical college. 
I have been hazed and elevated before; but I never thought any 
college would ever elevate a sophomore. However, I don't mind 
it at all. I came here because I heard from one of your graduates 
of the splendid course of study imparted in this institution. I am 
not sorry, because I perceive I am in very elevating society." 

The boys cheered him lustily a.s he walked from the dais, and 
voted him a "brick," while many crowded around him to shake 
him by the hand. 

During this change in the proceedings, John Ditchfield had 
been standing, frowning savagely at the newcomer. He had 
measured his man. If this fellow were to remain in tlie college, it 
would surely interfere with his brutal rule. He stood in the front 
row of seats, within arm's reach of where George had stepped 
when he descended from the dais, but he made no attempt to 
welcome the stranger. 

Now occurre<l an episode which ended as a fitting climax to the 
day's proceedings. 

The young Jew, Oliver Oppenheimer, having been forgotten 
during the attention which had been paid to Bolingbrooke, had 
loosened a great chunk of plaster from the ceiling, and, taking aim 
at ]Mac^Iahon, let fly and hit Ditchfield squarely on the back of 
the head. 

Turning with a fierce epitiiet, Ditchfield beheld sitting immedi- 
ately behind him on one of the partitions or book-rests between the 
seats, with his feet resting on the partition immediately in front of 
him, a negro student, George Washington Jones by name. The 
darkey was grinning with delight at the discomfiture of his big 
enemy, as Ditchfield had always bullied him all through tlie first 
term. 

^lany other eyes than the little darkey's had seen whence the 
missile proceeded, amongst them George Bolingbrooke 's. 

"You little nigger!" yelled Ditchfield, boiling over with 

rage and mad with fury. "I'll dash your little brains out." 

He seized the negro boy, and, raising him bodily above his 
head, turned around and was about to put his threat into execution 
before the students actually grasped his intentions, when his thick 
red throat was clutched as if in a vise of iron. He struggled to 
release himself, his hold loosening upon Jones, who frantically 
slipped away out of his reach. 



78 DOMINION MEDICAL MONIHLY 

As soon a.s (li-orge liolingbrookc s.iw Joiics li.-id n-iu-liccl ;i place 
of safety, he suddenly let go his hold, for Ditc-lidfld was almost 
stifled, so strong was the pressure upon tlic cervical poi-tion of his 
respiratory apparatus. 

"What do you mean, you big lout, by interfering with me 
thus'" dark with rage and stagnated blood. 

"Calm yourself, my dear fellow," was (Jeorge Bolingbrooke's 
mild command. "You were going to punish one who had iiotiiing 
to do with your misliap." 

"Anyway, I'll teach you to mind your own business and not 
meddle with my aflTaii-s. " cried Ditchfield, convulsed with jealous 
anger, as the students, seeing there was one who was not afraid of 
the cowardly bully, began jeering and laughing at him dreadfully. 

With a scowl of infinite wrath, John Ditchfield surveyed his 
tormentors, seated high upon the window ledges and side-beams 
and the cross-bar above his head. Then, turning his attention once 
more to his giant rival, he demanded: "Will you fight?" 

"If it so please you," was the quiet rejoinder, "l)ut I don't 
think we have very much to fight over." 

"Come along then to the quad" — the usual place for these meet- 
■ ings. 

"Xo," calmly and firmly. "If I am to fight at all I'll fight it 
out here on the platforui, and the others can look on and see fair 
play. You are acquainted in this college. Y''ou have friends at 
your back. I am a stranger, but I will rely upon the final men to 
see justice and fair play. This space is ample wlien the table is 
removed." 

"Hurrah I" cries little Felciier. "Hooray I Hooray!" whilst 
MacMahon hustles the table and desk out into the hall. 

One of the final men, a very popular young fellow, now de- 
scends from his perch in one of the windows, where lie has been 
enjoying this cowardly ruffianism as much as he could enjoy it, and 
takes his place upon the platform. 

His presence is greeted with prolonged cheering as he is the 
President of the Students' Society, and has therefore the right to 
preside at all entertainments and meetings of tlie student body; 
and is not here an entertainment and a meeting which will eclipse 
any and everytliing yet held within the college halls and under 
their auspices. 

He shoves MacMahon and Felcher off the platform, the boys 
cheering their approval. Then he places the two gladiators at 
either end of this improvised arena. 

One can now study to perfection the chances of the two men. 



DOMINION MEDICAL MONTHLY 79 

Both are of splendid physique and of apparently equal physical 
endurance. Both are trained, tried athletes. George stands calmly, 
with arms folded across his manly breast, clothed in a double- 
breasted sack coat, refusing to cast it aside or strip for the occa- 
sion. Their respective heights are conspicuously unfair. Boling- 
brooke is probably six inches taller than his antagonist; but his 
advantage in heiglit seems to be fully compensated in Ditchfield by 
his almost huge, massive frame and great girth. The man measures 
fully fifty inches around the chest, while his powerful arras and 
strong, thick neck show up well beneath his low-cut guern.sey. 

The .space is now cleared all around the platform, and not one 
is allowed out of the seats, with the single exception of the Presi- 
dent of the Society, now master of ceremonies, Ralph .Meredith. 

Look up I What a swarm of eager, anxious, expectant faces ! 
All are hushed, awaiting with breathless anxiety the outcome of 
this terrific battle. Hazing and elevation are now forgotten, and 
some of the more intrepid newcomers crowd down among the silent 
sophomores. 

It ih to be a figlit to th'. fini.sli — no rounds. From the start, they 
will proceed to hammer and knock each otlier until the end. 

At last President Meredith gives the word. 

With a fearful rush, Ditchfield da.shes pell-mell at his antag- 
onist, all too eager to tear and rend him asunder. He strikes out 
blindly, but only strikes the air, for the nimlile big man from the 
Pliiladelphia medical college has side-stepped quickly ; his right foot 
has been shot out, catching in the in.step of the big bully, who 
goes sprawling headlong over one of the two stoves which stand 
in either corner of the room. Luckily for him there was no fire 
therein — term beginning first week of October — else his hands and 
face must have been assuredly badly burned. He picks himself 
up from his laughable plight and turns upon Bolingbrooke a face 
horrible in its diabolical atrocity. Every pimply point in that 
coarse countenance seems ready to burst, so intensely congested is 
its aspect. 

Again he charges in his blind, headlong fury, and again he 
meets a calm reception. 

George has changed his position. He is crouched this time, 
ready to meet him. As John rushes on at his opponent, he is met 
half-way. Bolingbrooke has rushed, too. but with his eyes on the 
game. Ditchfield feels a pair of strong arms about him. He feels 
them stronger and more powerful than his own. A quick catch 
around his body — the hiplock — and the burly ruffian is sent spin- 
ning* clear over the doubled-up body of his adversary. Bang he 



80 DOMINION MEDICAL MONTHLY 

goes with appalling: momentum agrainst one of the swing doors 
leading out into the hall; and there he lies in a heap, stunned and 
unconscious, a vanquisiied bully, tiie monarch of college rutTianisra 
deposed from his throne. 

While tlie preparations for the fight were being completed, the 
Jew and the little darkey had joined forces and had quietly slipped 
out and away to the Dean's residence, who soon procured a squad 
of police and started for the college. But the alarm had been 
given to the boys, that the Dean and police were marching down 
upon them ; so when the Dean and his officers arrived they found 
no one but the janitor bending over the prostrate form of the 
unconscious bruiser. The good old Dean applied some restoratives 
and in a few minutes Ditchfield gave a sigh as he awakened from 
his letliargic condition. He wiped his hand across his eyes, sat 
up, looked around, realized his utter downfall, and burst into a 
volume of blubbering tears. The Dean dismissed the minions of 
the law, requested the janitor to look to the vanquished gladiator, 
and returned to his home meditating on how this evil business of 
hazing could be trampled out, but inwardly happy because com- 
plaints of Ditchfield 's bullying would now be few and far between. 



VAGINAL DOLCHE TMERAPY 



Dr. W. a. Bryan, Kent, Iowa. 



The use of the vaginal douche as an adjunct to the treatment 
of diseases of women has a well-defined field of usefulness, and is 
indicated in the majority of the pathological lesions of the female 
generative tract. In many of these conditions it will, with due 
regard for proper technique and in conjunction with other mea- 
sures, effect a complete cure. The failure to secure good results 
from this simple remedy arises, in the majority of cases, from the 
lack of care in giving the douche; no regard is paid to posture, 
temperature or amount of the fluid used, or the proper syringe. 
Too often do women, when taking a vaginal douche, stoop over a 
basin, and with a small, hard rubber nozzle, throwing a stream 
the size of a lead pencil, inject a variable quantity of watei; of 



DOMINION MEDICAL MONTHLY 81 

uncertain temperature into the vaginal canal. Douches taken in 
this manner do no good whatever, and in many cases do actual 
harm. The method of giving the vaginal douche requires a certain 
technique which is based upon fundamental laws regulating the 
effect of temperature upon the organism, the action of the sub- 
stances used as remedial agents, and with regard to the anatomical 
structure of the vaginal canal. To attain any success in the treat- 
ment of female diseases by means of the douche, we must be thor- 
oughly conversant with these laws and adapt them to each indi- 
vidual case. To secure the best results from the use of any remedy 
it is necessary that we have a definite knowledge of its action, with 
a clear conception of the benefits or injurious effects which follow 
its use, and without this knowledge we simply work at random and 
without purpose, and in many cases defeat the very object which 
we wish to attain. 

The good effects which follow the use of vaginal douching de- 
pend upon three factors, and we must keep these three constantly 
in mind. First, the mechanical cleansing effect: second, the tem- 
perature of the tiuid; tliird, the medication; and it is upon a proper 
understanding of these that our success or failure with vaginal 
douche therapy rests. In discussing the first factor, the mechan- 
ical effect, it will be wise to review for a moment the anatomy of 
the vagina. It is a muscular canal, lined with mucous membrane, 
and flattened from before backward, so that the anterior and pos- 
terior walls are in contact. It is divided into three portions— the 
orifice, the body, and the vault into which the vaginal portion of 
the cervix projects. The vagina runs upwards and backwards, 
with a slight convexity forward on account of the anterior curva- 
ture of the rectum lying behind. Its axis makes an angle with the 
horizon, from behind, of 65 to 70 degrees. In the middle of the 
anterior and posterior walls there are cord-like thickenings, and 
running laterally from these are well-marked rugae. On either 
side of the vaginal columns, and parallel with them, are deep clefts 
or sulci, so that a transverse section of the vagina is shaped some- 
what like a letter H. It is abundantly supplied with blood-vessels, 
nerves and lymphatics. 

To thoroughly flush the walls of the canal and get the cleansing 
that is essential to the good results of the douche, it is necessary 
that the walls be completely distended. The lateral rugae must 
be straightened out and the sulci obliterated before the fluid can 
reach the entire surface of the mucous membrane. The muco-pus 
must be washed out from between the folds when medicated 



82 DOMINION MEUICATv MONTHLY 

douelies are given, otlierwisc the iiieclicatioii caiinol come in contact 
with the walls. 

Furthermore, as we see by study ing the aiuitomy of the parts, 
the orifice of the vagina is on a lower level than the vault when the 
subject is sitting or standing; therefore tlie force of the stream 
must be sufficient to batlie the upper portion of the canal. Obvi- 
ously, it is impossible to accomplish these requirements if the usual 
methods of douching are carried out. The small stream ordinarily 
employed does not distend the vagina or smooth out the walls 
sufficiently to thoroughly cleanse them, and the pressure necessary 
to force the fluid through the small opening and the entire length 
of the canal may do considerable harm by striking directly against 
the cervix and causing uterine colic or shock. The proper syringe 
to use is one having a nozzle which forces the fluid in a lateral 
direction, completely straightening out the walls of the vagina and 
thoroughly flushing it out, with a minimum amount of force. To 
diminish the force necessary, the dorsal posture should be assumed. 
In this position the orifice of the vagina is raised above the level of 
the vault, and the force of gravity assists in the distril)ution of the 
stream. 

A suitable syringe, with a proper knowledge of its use and mis- 
use, should be a part of the toilet accessories of every woman of 
refinement. When properly used, it is not productive of any harm, 
but when not properly used it may do incalculable damage. It 
must not be employed in any conditions other than that of washing 
out the discharges which are so offensive to all women, except 
under medical supervision, and douches must not be taken for any 
purpose during the menstrual period. To say that a woman should 
take a vaginal douche for any and all conditions, on her own re- 
sponsibility, is wrong; but every woman sliould l)e instructed in 
the proper way to take a douche, both for purposes of cleanliness 
and for such conditions that might arise which would indicate its 
use to her physician. The daily cleansing douche is preferably 
taken, either in the morning, immediately after rising, or in the 
evening when preparing for bed. The time when it is taken is of 
no particular importance. The temperature of the water or salt 
solution used should l)e at least 97 degrees. A cold douche should 
never be taken. To avoid infection of the vagina, a])solute clean- 
liness of the syringe is of great importance. It should be taken 
apart after using, washed carefully and laid away. Just before 
inserting the nozzle into the vagina, plunge the end into boiling 
water for two minutes. 

In considering the second factor upon wliich the success or 



DOMINION MEDICAL MOX'IHLV 83 

failure of vaginal douching depends, we must study the effects of 
temperature upon the tissues of the body, when applied within one 
of its cavities. It is upon this factor that we rely principally for 
the relief of the many conditions of the pelvic organs, associated 
with congestion and intlammatiou. The impressions produced by 
the injection of any fluid into the vagina, depend, in a great 
measure, upon its degree of lieat or cold and the duration of the 
application. M'e may disregard the effect of cold in this connec- 
tion, except to dwell for a moment upon the harm it does. No 
vaginal douclie sliould ever be given at a lower temperature than 
95 degrees. Cold or even cool injections are capable of doing 
irreparable damage, and this fact should be impressed upon every 
woman. 

The effect of a high degree of temperature, wlieu applied to 
the walls of the vagina, is one of decided stimulation. It causes 
a stimulation of the vaso-motor nerves, which, in turn, contracts 
the vessels, and causes tliem to be depleted. Herein lies its value 
in conditions of congestion. This depletion is also due in part to 
its direct action on the muscular fibres in the walls of the vessels. 
Heat, applied to any muscular fibre, causes it to contract, and thus 
we have a narrowing of the lumen of the blood-vessels due both to 
direct and indirect action. This primary stimulation is followed 
in a variable length of time l)y a period of relaxation, during wliich 
the vessels are di.stended. The length of time during which the 
stimulation persists is governed entirely by the rapidity of the 
stimulation and the length of time the beat is applied. The ra- 
pidity of the stimulation depends upon tlie degree of heat. Thus, 
a temperature of Ilo degrees produces a more rapid stimulation 
than a temperature of 95 degrees, while an application lasting 
twenty minutes will produce a longer stimulation than one lasting 
ten minutes. It is evident, then, that we an^ able to regulate the 
time the stimulation lasts, and herein lies the value of suitabh- tem- 
perature in vaginal doucliing. 

^Moderate degrees of heat applied to the vaginal mucous mem- 
brane cause a relaxation of the vaso-motor nerves, with a corre- 
sponding dilatation of the blood-vessels, and are sedative in action. 

It is perfectly plain that such high degrees of heat as are neces- 
sary to secure the desired effect with a douche, would be excessively 
painful when applied to the skin of the thighs and vulva. To 
protect the skin, it should be coated with a thick layer of vaseline. 
or a syringe used with a rubber guard which will prevent the fluid 
from returning and running over the skin. It is best to use such 
a svringe. TIih lluid can be injected, left in the vagina as long as 



84 DOMINION MEDICAL MONTHLY 

necessary, ami tlicn withdrawn into tiio l)ull) of the syrinjje. In 
this way no basin is needed, and the clothing can be protected. 
F'ni'thennore, by using a s>'ringe of this character, and leaving 
the tluid in contact with the vaginal walls as long as we wish, a 
smaller (juantity is needed. As pointed out before, the duration 
of the stimulation is dependent principally upon the length of time 
the heat is applied, and wlien using a nozzle with a small opening, 
wliieh permits tlie tluid to escape as soon as it enters, it is neces- 
sary to use one or two gallons of fluid. Our object is to get the 
permanent stimulation wliieii follows the prolonged application 
of a high degree of temperature, and it is unnecessary to use as 
much fluid, when it is injected and left there the required time, as 
when a small stream is used and successive applications are needed 
to get the required stimulations. Again, when medicated liquids 
are used, we can get the benefits of the medication better by leaving 
the substance in the canal for a time than by allowing it to run out 
immediately. 

In all congestive and inflammatory conditions of the vagina, 
uterus, tubes or ovaries, these hot douches, either with plain water 
or salt solution, are productive of most excellent results. In addi- 
tion to the relief from pain and discomfort that they afford, they 
do much permanent good by driving the blood out of the over- 
loaded blood-vessels, stimulating the muscular fibres of the organs, 
and raising the general tone of the pelvic viscera. All medical 
men have tested the utility of the vaginal douche in displacements 
of the uterus of long standing. Tliey restore the tone of the relaxed 
ligaments, relieve the engorgement of th vessels and diminish the 
suffering of the patient. In many cases, if not too pronounced, 
they will effect a cure. In wearing a pessary for the relief of this 
condition, vaginal douches of hot water, twice a day, are indis- 
pensable, and once a week the vagina sliould be douched with hot 
water and soapsuds. Salt solutions should never be used while a 
pessary is being worn, as they cause incrustations to form on the 
rubber of the pessary, and eventually inflame tlie parts. In 
chronic inversion of the uterus, before replacement can be at- 
tempted, a preparatory treatment of hot vaginal douches tiiree 
times a day is necessary to relieve the congestion and diminish the 
size of the uterus. The pain and liemoiTJiage of cancer can usually 
be controlled by copious vaginal injections, and the patient's life be 
made more comfortable In all infections of the vaginal canal, a 
plain hot water douche twice a day is indicated, in addition to the 
medicated douches used, and for controlling excessive liemorrhage 
in menorrhagia or metorrhagia, whatsoever the cause, it is the best 



DOMINION MEDICAL MONTHLY 85 

means we have. The injections must be given three times a day, 
and the duration of the application depends upon the severity of 
the bleeding. The injections should be continued during the inter- 
menstrual period and discontinued when menstruation begins, 
unless they are needed to prevent an excessive loss of blood. 

Hot water vaginal douches are of the utmost importance in the 
treatment of dysmenorrhea, whether due to neuralgia, diathesis, 
pelvic congestion or inHainmation and .stenosis of the genital tract 
due to uterine lesions. They are useful, not only during the inter- 
menstrual period, but also at the time of the attack, as they lessen 
the severity of the pain and relieve the uterine spasm. 

In discussing the question of medication of vaginal douches, it 
will only be necessary to speak in detail of the more common reme- 
dial agents, out of the great number that can be used. Every 
practitioner will use the drugs that have, in his own experience, 
proven useful in certain conditions, and a complete consideration 
of this question is unnecessary. We are depending more and more 
upon the mechanical cleansing properties and the effects of tem- 
perature to bring results in vaginal douching, and drugs are only 
indicated in selected cases, particularly those of infection of the 
vagina. In conditions where the mucous membrane of the canal 
is diseased, and it is due to micro-organisms, the antiseptic solutions 
are always helpful, if properly used. Medicated douclies should 
always be preceded by a cleansing douche. It is absurd to expect 
any result from the injection of a drug when it does not come into 
direct contact with the mucosa, and this is impossible until the 
muco-pus has been washed out. Always use either plain water or 
salt solution for this cleansing douche. If the muco-pus is par- 
ticularly difificult to dislodge, two ounces of hydrogen peroxide may 
be injected five minutes before the medicated douche is given. 

It is always best to use the weaker solutions of drugs. Many 
discharges are kept up indefinitely by the use of solutions that are 
too strong. If the weaker solution is used at first it can always be 
increased in strength when we find tliat it is not giving the desired 
result. 

The simplest form of medication is the salt solution, made by 
adding a heaping teaspoonful of salt to a pint of hot water. This 
may be used either for daily use, to keep the parts clean, or for its 
antiseptic action. :\Iany physicians use the salt solution for douch- 
ing, almost to the exclusion of all other drugs. It is contraindi- 
cated if a pessary is being worn. Either plain water can be used 
or a solution of potassium permanganate, 5 grains to the pint. 
Bichloride of mercury, of the strength of 1-10,000 or 1-20,000, is a 



86 DCiVilNlON MEDICAL MONTHLY 

favorite solution for vaj2:inal lioiu-liin^', and is especially indicated 
where strong antiseptic (pnUities are needed, as in gonorrheal 
vaginitis. The fact that it is a powerful poison makes it unsafe to 
put into the hands of everyone, and another disailvantage is tliat 
it coagulates albumen, and becomes inert. The compressed tablets 
which are usually used contain tartaric acid to prevent this. Wiien 
it is used, a tiiorough cleansing injection must follow it, otherwise 
some of the drug might be left in the canal. A mild and safe anti- 
septic solution which lias an extensive use for douching is a satur- 
ated solution of boric acid. It is non-irritating, and is particularly 
useful in conditions associated witli an irritating discharge. An 
alkaline douche that can be employed with great bentitit ^vhere 
discharges are irritating is sodium bicarbonate, one dram to a 
pint, and when the discharge causes a pruritis of the vulva, one 
dram of sodium biborate may be added to this solution. The old- 
fashioned prescription of alum and l)orax, 1-2 grain of each to a 
pint of water, is efficacious, and is a favorite with many physicians. 
Sulphoearbolate of zinC; 10 grains to the pint, and permanganate 
of zinc, 5 grains to the pint, are excellent in certain cases. A solu- 
tion of copper sulphate, three grains to the pint, is excellent for its 
astringent qualitie-s, and zinc sulpliate. three grains to the pint, is 
useful in cases of chronic vaginitis. 

The list of drugs that may be used could be continued indefi- 
nitely. The peculiarities of the case and the action of the drug will 
determine which we will select, but do not lose sight of the fact 
that, in the great majority of cases where vaginal douching is 
used, no medication is needed. 



DOMINION MEDICAL MONTHLY 87 



IPvoo:cMiu36 ot Societies 



SEVENTEcNTH INTERNATIONAL MEDICAL CONGRESS. 



The XVIIth International Congress of Medicine will be held 
in London from August (itli to August 12th. 1913, inclusive, under 
the patronage of Ilis Most Gracious Majesty George V., King and 
Emperor, and Presidency of Sir Thomas Barlow. Dr. W. P. Her- 
ringliam, whose visit to this country many will recall with pleasure, 
is the Honorary General Secretary of the Congress. Through his 
courtesy we are able to publish in this issue the rules and regula- 
tions of the r'oiiL'i'fSS. 

Rules of Congress. 

Art. 1. — The Seventeenth International Congress of Medicine 
will be held under the august patronage of His ^ilost Gracious 
Majesty George V., King and Emperor. 

Art. 2. — The Congress will be opened on the 6th August, and 
will close on the 12th of August, 1913. 

At the time of Congress, the Central Bureau will be located in 
the Koyal Albert Hall, Kensington Gore, W., and will be opened 
for the inscription of members on Tuesday, 5th August, at 10 a.m. 

Art. 3. — The object of the Congress is exclusively scientific. 

Art. 4. — The members of the Congress will be: 

(a) Qualified" members of the medical profession, who have 
made formal application, and have paid the subscription here- 
inafter fixed. 

(b) Scientific men wlio have been nominated by a National 
Committee or by the Executive Committee, and have paid the 
same subscription. 

Art. 5. — The subscription is : 

£1 sterling; 25 kroner (Austria); 25 francs; 20 marks; 15 

rupees; 20 kroner (Xorway) ; 5 dollars (United States or 

Canada). 

The wives and daughters of members of Congress desiring to 
profit by the advantages accorded to them must pay half the 
subscription fee. 



88 DOMINION MEDICAL MONTHLY 

ISubscriptioiis should be seut by postal ortler or cheque pay- 
able to: 

The Treasurers, 

Seventeenth International Con{?ress of iNIetlicine, 
U Ilinde St., London. W. 

and the Section in wliicli each member wishes to ])e inscribed must 
be indicated. 

In the ease of any country in which there is no system of inter- 
national postage exchange, the services of a banker must be eni- 
ploj'ed. No one can be enrolled as a member of Congress before the 
receipt of his subscription. 

An applicant when sending his subscription should enclose his 
visiting card indicating his medical qualifications and titles and his 
full i>ostal address. An}- change of address must be immediately 
notified. Cards of Membership will lie sent out from the Central 
Ofifice of the Congress within eight days following the receipt of 
the subscription. 

Art. 6. — Members of Congress will receive the volume of the 
Transactions recording the proceedings at the general sessions, as 
well as the Transactions of the Section in which they have been 
inscribed. 

Art. 7. — The Sections of the Congress are twenty-two in num- 
ber, besides which three sub-sections are established, namely: 

I. Anatomy and Embryology ; IL Physiology ; III. General 
Pathology and Pathological Anatomy; Ilia. (Sub-section) 
Chemical Pathology ; IV. Bacteriology and Immunity ; V. Thera- 
peutics (Pharmacology, Physiotherapy. Balneology) ; VI. ]\Iedi- 
cine; VII. Surgery; Vila. (Sub-section), 'Orthopedics; Vllb. 
(Sub-section) Anesthetics; VIII. Obstetrics and (rynecology; 
IX. Ophthalmology; X. Diseases of Children; XI. Neuropath- 
ology; XII. Psychiatry; XIII. Dermatology and Syphilo- 
graphy; XIV. Urology; XV. Ixiiinoiogy and Laryngology; 
XVI. Otology; XVII. Stomatology; XVIII. Hygiene and Pre- 
ventive Medicine; XIX. Forensic Medicine; XX. Naval and 
Military Medicine; XXI. Tropical Medicine; XXII. Radiology. 
Art. 8. — The organization of the Congress is in the hands of 
the Organizing and Executive Committees. 

Art. 9. — There will be two General Meetings of the Congress, 
the Inaugural Meeting and the Closing ^Meeting. At these meet- 
ings the speakers will be the Government delegates who have been 
invited by the Organizing Committee or designated as such, and 



DOMINION MEDICAL MONTHLY 89 

these alone. At the Closing Meeting the President will announce 
the city in which the next Congress will be held. This will be 
determined by the Permanent Commission, which will sit during 
the Congress. 

Art. 10. — The scientific work of the Congress will consist in: 
(a) general sessions ; (b"^ sectional sessions; Ic) Combined sessions 
of two or more sections. 

Art. 11. — The number of general sessions and the number of 
speakers will be fixed by the Executive Committee. There will be 
no debates in the general sessions. 

Art. 12. — The sessions of the sections will be occupied in for- 
mal di.scussions on the Reports (rapports), also by the reading 
and discussion of papers on subjects chosen by individual members 
of Congress. The work of the Sections is dealt witli in .separate 
regulations. 

Art. 13. — Two or more Sections may hold combined sessions. 

Art. 14. — Members of Congro.ss may take part in the proceedings 
of Sections other than that in which they have been inscribed. 

Art 15. — The speeches delivered at the Opening and Closing 
General [Meetings, as well as tlie Reports opening formal discussions 
will be pulilislied in full. As to communications on subjects se- 
lected by individual members, only those papers will be published 
which the authors have personally presented to the Congress, and 
the Executive Committee, after consultation with the Sectional 
Committees, has decided to publish. 

Art. 16. — The manuscripts of speeches delivered at the General 
Meetings must be sent to the General Secretary. The manuscripts 
of remarks made in discussions, and papers read l)y individual 
members at the Sectional Sessions must be delivered immediately 
(see Art. 14 of the Sectional Rules) to the Secretary of the Section 
concerned. 

Art. 17. — The Central Office of the Congress will use the Eng- 
lish, French and German languages for international business. In 
the General Meetings Italian may be used as well as these lan- 
guages. 

Art. 18. — All correspondence should be addressed to the oflSces 
of the Congress, as follows: 

The Hon. Gen. Secretary, 

Seventeenth International Congress of Medicine, 
13 Hinde Street, London, W. 



90 DOMINION MEDICAL MONTHLY 

On the envelopes of letters relative to the seientitic work of the 
Sections, the Section to which they refer should be specified. 

Art 19. — Information conccrninfr the reductions in fares 
granted by railway companies, hotel and boarding accommodation, 
excursions, etc.. will lu' publisiied before the 30th April, 1913. 

Rules of Sections. 

Art 1. — The Sections will meet at 9.30 a.m. and 3 p.m. 

Art. 2. — The first Session of each Section will be opened on 
Wednesday, 6th of August, at 3 p.m. 

Art. 3. — The President of the Section will be responsible for the 
conduct of the discussions, for the application of the rules, and for 
the punctual accomplishment of the work of the Secretaries. If 
the President is prevented from being present at any Session of 
his Section, his place will be taken by one of the Vice-Presidents 
or by a member of the Council of the Section. 

Art. 4. — There will be no Honorary Presidents of Sections. 

Art. 5. — The Sessions will be conducted according to the parlia- 
mentary regulations in general usage. 

Art. 6. — The Sessions will include discussions on tiie reports 
and the reading and discussion of papers on subjects selected by 
individual members. 

Art. 7. — Reports (rapports). In each Section the morning 
Session will be reserved for the discussion of important questions 
which have been previously selected by the Council of the Section. 
Each discussion will be introduced by one or two reporters chosen 
by the Council of the Section with due regard to the International 
character of the Congress. The defin-ite programme of the dis- 
cussions will be published on September 30th, 1912. The manu- 
scripts of the reports must ])e typewritten, and must be sent to the 
Central Office of the Congress by February 2;Stli, 1913, at the latest. 
The reports of each Section will be printed and distributed three 
months l>efore the opening of the Congress, to all members of the 
Section who have then been enrolled. (See Rules of Congress, 
Articles 4 and 5.) 

The reports will not be read in < xfcnso at the Session. Each 
reporter M'ill, however, be allowed a maximum of fifteen minutes 
for an opening resume, and ten minutes for a reply at the end of 
the di.scu.ssion. Other speakers taking part in the discussion will 
be allowed a maximum of ten minutes only for their remarks. 

Art. 8. — ^Members of Congress who desire to take part in the 



DOMINION MEDICAL MONTHLY 91 

discussion of any report may enter their names before the Congress 
by giving written notice to the General Secretary. During the 
Session they must communicate directly with the Secretary of the 
Section. 

Art. 9. — Speakers wi!l be called upon by the President accord- 
ing to the order of their inscription on the Agenda. 

Art. 10. — Independent Papers. The afternoon Sessions will be 
devoted to the reading and discussion of independent papers. The 
titles of such papers ought to be announced to the Central Office 
of the Congress by the 30th of April, 101:3. The Council of the 
Section has the right of selection from among the papers offered, 
and of declining any tliat they do not consider desirable. The 
Council of the Section will arrange the order in which the selected 
papers shall be read. Any papers offered after the 30th April, 
1913, will only be placed upon the Agenda after the discussion of 
those which have been announced before tliis date, and have been 
chosen by the Council or the Section. No paper will be accepted 
unless the text has been received by the Secretaries of the Section 
before the 1st of July. 1913. 

A maximum of fifteen minutes will be allowed for the reading 
of a paper, and five minutes for each speaker who takes part in the 
discussion. The author of the paper will )»e allowed five minutes 
for a reply. 

Art. 11. — Speakers will receive two intimations from the Presi- 
dent as to their time limit ; notice will be given two minutes before, 
and at the moment of expiry of the period allowed. 

Art. 12. — For certain communications of particular importance 
and general interest, the President may, with the consent of the 
Section, prolong by five or ten minutes the periods already indi- 
cated. 

Art. 13. — If a speaker wanders from the subject undt-r discus- 
sion, or indulges in personalities, the President may call upon him 
to sit down. If several members ask to speak upon a paper, and 
the hour is late, the President may, on his own authority, or upon 
the proposition of a member, defer further discussion upon that 
paper to the end of the Session, if time permit. 

Art. 14. — The text of the remarks made in the course of dis- 
cussions will only be inserted in the Transactions of the Congress 
if the speaker sends it in writing, condensed into twenty lines of 
print, to the Secretary of tlie Section before the end of the Session. 
(Block note-sheets will be placed for this purpose at the disposal 
of members by the Secretaries.) 



92 DOMINION MEDICAL MONTHLY 

Tliose wlio omit to con form to this regulation will lose the right 
to liave their remarks published in the Transactions. 

Art. 15. — The Exwutive Committee reserves to itself the right 
to aln-idge the report of any discussion, and to omit any remarks 
of a personal character. 

Art. 16. — Private resolutions can only be proposed after pre- 
vious notice given to the President, and when the business on the 
Agenda has already been disposed of. For the proposal of any 
special resolution a maximum period of five minutes only will be 
allowed. 

The President will authorize only such resolutions as come 
within the limits of the work of the Section. 

Art. 17. — No vote may be taken, nor any resolutions passed, 
upon questions of science or theory, but only on such questions 
as possess a practical or administrative character. On such ques- 
tions the sense of the meeting will be taken by the majority stand- 
ing or remaining seated. 

The President will transmit such resolutions as shall be passed, 
through the General Secretary, to the Permanent Commission of 
the Congress. The Commission will decide whether the resolutions 
in question ought, or ought not, to be put to the vote at the closing 
meeting of the Congress. 

Art. 18. — The Secretaries of each Section will send an account 
of its transactions for the daily journal. This account will mention 
in chronological order the subject of the reports and discussions, 
the papers read, the names of the speakers, and any resolutions 
submitted to the Section. 



DOMINION MEDICAL MONTHLY 93 



(TDebicine 



Graham Chambers, R. J. Dwyer, Goldwin Howland, 
Geo. W. Ross, Wm. D. Young. 



A Most Important Discovery. By Mary E. Walker, M.D., 

Albanij Mtdual Annals. 

A large number of people have passed away iu recent years 
— suddenly — and "heart failure" has been stated as the immediate 
cause. 

The most of such cases were not known to have had any heart 
ailment previously to their sudden deaths, and had a physician 
chanced to be present, could not have saved life by any known 
method. 

The writer of this has discovered a method by which any person 
with two serviceable hands can save life, and she deems her dis- 
covery one of the most important of the age, since heart-failure is 
no respecter of position or number of years lived, or time, or place. 
Some have been found dead in the street while walking, others in 
bed, others while at the table immediately after having partaken 
of ordinary food ; and many who have coughed spasmodically after 
having suffered from pneumonia or consumption. 

]\Iany who have died from lung troubles, and had passed the 
expectorating period, could have recovered but for the spasmodic 
coughing, when there was nothing more to raise, and the heart in 
an angry mood, so to speak, had rushed the blood out so rapidly 
and in such quantities that the heart failed, because the blood had 
all passed without giving time for replenishing. 

When the heart takes on the mood just stated, it is like all 
moods in this regard, it will spend its force in a little time if placed 
under restraint. 

What to Do. 

Take the extended left hand and place just below the heart, 
with the fingers pointing to the centre of the chest, and place the 
right hand over the left, with the fingers touching the wrist of the 
left hand, and make a hard pressure, and continue the same until 
the heart has assumed normal action. 

The ribs will prevent pressure sufficient to stop the circula- 
tion, but will be sufficient to control the same. 



94 DOMINION MEDICAL MONTHLY 

If the Nol)t'l prize sliould he aeeorded me, I would immediately 
erect a Nohel Sanitarium on my estate at Oswego, N.Y., so that 
the forty-five thousand Swedes in the city of New York could be 
treated and cured hy myself, when treatment for luufj troubles 
should be needed. 

I should be very much pleased to be invited to jrive a lecture in 
Stockholm, Sweden, on luntr troubles. 

(The great importance of the discovery of a method to prevent 
heart failure cannot be overlooked by scientists. — Editor), .v x 



The Misintcrprctatian of Cardiac Pain. By Alexander Lambert, 
M.D., Xi:w York ('ivy. .\ (W York State Journal of Medicine. 

AVe may not all agree Avith the theory that the heart is strug- 
gling to perform its work when cardiac pain is complained of, but 
we will agree that the latter is frequently misinterpreted. 

However, the symptom is of great value in prognosis, as while 
mild and passing distur])ances causing the condition are not often 
serious, yet those leaving superficial i)ain, either over the thoracic 
or other cardiac areas are mucli more important. Aortic valvular 
lesions, associated Avith discomfort, or mitral stenosis, give a more 
unfavorable prognosis than mitral regurgitation. 

Intercostal neuralgia and myalgia are often the mistaken diag- 
nosis when the heart is truly at fault, while occipital localization 
may be the sequence of aortic lesion. 



Some General Considerations in Regard to Right Hypochondriac 

Pain. By James D. Heard, M.D., of Pittsburgh, Associate 
Professor of j\Iedicine, University of Pittsburgh. 

Following Dane's view that neui'otic individuals have a lowered 
threshold of consciousness (which is another manner of stating the 
fact presented by the reviewer in tliis issue that the patient be- 
comes h^^pei-sensitive). Dr. Heard descrilies a case of hypochon- 
driac pain in which the organic disease, probably producing the 
original pain, was rtMuoved, but the area of hypersensitivity re- 
mained; and he contrasts tlie case wnth others where no pain de- 
velojK'd in organic di.sease, and thereby operative relief was re- 
fused; ordinary stimuli ^w\ causing sensation of pain in many vis- 
ceral conditions. 

Heard calls attention to the following causes of right hypo- 
chondriac pain : Enlarged liver from wirdiac weakness, gallstones 



DOMINION MEDICAL MONTHLY 95 

and cholecystitis (Cabot's statistics, while ^Nlayo's favor the epi- 
gastrium), ri»ht pleural eflfusious. Following the contrast referred 
to, one frequently finds a greatly enlarged liver and ii<> trace of 
increased sensitivity occurs. 



The J aw- Winking Phenomenon. Gaultier (R) and Bucquet (A.). 
Gazetlt dis Hoijitatij:. 

The authors record the following case : A man, 55 years of age, 
stated that on waking one morning the left side of the face and 
body felt cold, the former being of a dusky color. He felt giddy, 
and went to work with ditiHculty. At his middle-day meal, it was 
noticed that as soon as he opened his mouth to eat or drink the 
left upper eyelid was forcibly elevated, showing the sclerotic wall 
above the iris. This combination of movements had persisted for 
a fortnight when the patient came under observation. On examina- 
tion, during rest, there was slight drooping of the left upper eye- 
lid, which could be voluntarily overcome, and every attempt to 
depress the lower jaw was accompanied by spasmodic retraction 
of the left upper lid. Contraction of the masseter and lateral 
movements of the jaw produced similar but less-marked spasm. 
The right side of the face was unaffected. 

Cantonnet first drew attention to the occurrence of a group of 
cases, of which the above is an example, and Pontico has collected 
40 published observations. The \\Titers hold tliat there is normally 
an association between the two movements of elevation of the upper 
lid and depression of the lower jaw, and that the phenomenon 
described is to be accounted for by an exaggeration of the associ- 
ation due to a weakness of the opposing muscle. The recorded 
eases show a preponderance in the male sex, and that the condition 
is usually unilateral, generally affecting the left side. A pre- 
existing ptosis, congenital or acquired, seems to be essential for the 
occurrence of the phenomenon. — Med. Chron. Abstract. 



96 DOMINION MEDICAL MON'I HLY 

Suvoer\> 



Walter McKeown, Herbert A. Bruce, W. J. O. Malloch, 
Wallace A. Scott, George Ewart Wilson. 



Injuries of the Cervical Region of the Spine, l^y Luciex Lofton, 
A.B., Ph.D., M.D., Emporia, \'a. International Journ-al of 
Surgery. 

The writer discusses in a very superficial manner certain in- 
juries in the upper vertebrae and reports two cases seen recently. 
So incomplete, however, are the details that the}' are quite worth- 
less. In Case 1, which he saw some three hours after the accident, 
he concludes from manipulation that the "ventrd arch of the 
atlas was resting upon the odontoid process of the axis," and tliis 
was reduced by gentle traction at first, then as motor and sensory 
paralysis "below the chin," and while nothing is said regaixling 
the nature of the sensory disturbances and their recovery, the only 
evidence five and a half mouths alter the accident was an atrophy 
of the deltoid and muscles of the left shoulder, arm and forearm. 
Case II. exhibits the same lack of close observation, and one is left 
with the feeling that \n reality the writer had before him in each 
case an example of haematomyelia. To simply say that there was 
anesthesia below the chin is practically without any value in ac- 
curate diagnosis. g. e. w. 



Resection of the Posterior Roots of the Spinal Cord. By William 

A. .ToxKs. :\r.D. J. A. ^r. a. 

The hi-tnry of a ca.«p of severe painful attacks referred to the 
right hand and shoulder region, extending over a period of about 
16 years, was cited as an introduction. Excision of the posterior 
roots of ;!, fi and 7 cervical was performed, but without relief to 
the paroxysms, nor. as far as could be marie out. were there any 
changes in the sensory supply to the riurht upper extremity. Some 
eight months later Dr. C. IT. Mayo repeated the unilateral lamin- 
ectomy, dividing th<^ post roots of 4 and 8. He was of the opinion 
too that some of the fibres of 5, fi and 7 were still intact when he 
opened the dura. This latter operation did result in sensory loss 



DOMINION MEDICAL MONTHLY 97 

and the spastic condition of the arm disappeared, but it wa.s more 
or less useless, and while the pain \va« distinctly lessened the 
patient felt that he could not recommend the treatment to similar 
sufferers. 

In order that root resection should be of any permanent relief 
It is essential that the seat of the lesion be peripheral to the root, 
and this fact probably explains those cases— and they are numer- 
ous—in which no improvement followed Then too there is alway* 
the possible explanation that the sufferer is aflhcted with memor\ 
P^^- G. E. w. * 



TT^ERcrLosiP OF Rladder.— A. r. Stokes. Omaha, says one verv 
essential point to remember is that tuberculosis of the bladder pives 
rise to a urine which is acid in reaction, as a rule ; on the other 
hand an inflammatory condition of the viscus ffives rise to an 
alkaline urine, and particularly when there is pus" Trine which is 
acid, from a person who has symptoms of cv.stitis. such as pain, 
tenesmus and frequent micturition, would sup^est tuberculosis and 
call for an examination for tubercle bacilli. 



Albi-mix Reaction ix the SpuTi'Af.— Raymond (Puss, M/di- 
cale), according to his experiments, states that the appearance of 
albumin in the sputum whenever there is anv lesion in the paren- 
chyma of the lung, an alveolitis is confirmed. He finds it a con- 
stant accompaniment of sero-fibrinous pleurisy and acute conc^es- 
tions of lung:s and pleura. "^ 



Ixfluexza of the BRAix.-Stepp (Med. hlin.) refers to in- 
fluenza localizing in the brain. He reports three cases, all in the 
forties, and all free from cardio-vascular trouble There was 
gradual development of the disturbances, paralvsis of one cheek 
hemiplegia, after a few days affection of the other side. In most 
cases influenza begins with headache, and in persons with arterio- 
sclerosis, ordinary apoplexy may develop readily. 



98 DOMINION MEDICAL MONTHLY 

©bstctrics 



CiiAs. J. C. O. Hastings, Arthur C. Hendrick. 



The Present Status of Abdominal Delivery in Obstetric Surgery. 

-By Clllin Fkaukkod, .M.D., Am. Jour. Siir!i( ri/. 

The writer very truly states that tlic wliolc d-iinase from 
dragging a head through a contracted pelvis is not oi'ly tlie rup- 
ture of the pelvic floor, but the pulling of a large body through the 
pelvic brim and cervix damages the vault of the vagina and 
ruptures the fascial supports, which "hammock" the uterus to 
the pelvic bonas. This is a very serious damage. 

This consideration influenced the writer to adopt abdominal 
section in all cases in which the child was in good shape, and in 
which, from some disproportion the presenting part failed to 
engage. 

Accurate pelvic measurements are made in order to select the 
doubtful cases and give them the best surroundings when they 
fall in labor, and vaginal examinations are avoided. 

Hence the first indication for abdominal section delivery is a 
contracted pelvis and healthy child. 

The second indication is uterine inertia, which the writer states 
to exist in 75 per cent, of American society girls. Hence a head 
that remains floating after a severe trial of labor by the patient is 
considered a fit subject for section. 

3 — The third indication is a thick, tight cers'ix due either to 
operations of repair or repeated labors. 

4 — After old ventral suspension operations. 

5 — Placenta previa is another indication for celiohysterotomy, 
especially central placenta previa. 

6 — Fibroid tumors complicating pregnancy arc no bar to the 
development of a full-term child, but are best treated by celio- 
hysterectomy at term. But ovarian tumors are best dealt with 
before labor, when they are removed. 

7 — Cancer of the cervix is safely dealt with only ])y hyster- 
otomy. 

8 — Appendicitis. "When ab.scess forms may require removal of 
the child and uterus and drainage of tlic abscess cavity — a most 
serious condition. 



DOMINION MEDICAL MONTHLY 99 

9 — Rupture of the uterus is another indication rarely for hyster- 
otomy. 

1(J — Badly handled cases where there is a chance of saving the 
child may require a Porro Cesarean section. 

11 — Advanced tuberculosis, or cancer of the breast, when the 
patient might not stand the strain of labor, hysterotomy might be 
performed. 

Selected cases of thyroid toxemia. 

Hence summed up the indications for celiohysterotoray are : 
1 — Contracted pelvis, small enough to give failure of delivery. 
2 — Disproportion between head and inlet. 
3 — Floating head for any reason. 
4 — Uterine inertia. 
5 — Cervical repairs. 
6 — Uterine suspensions. 
7 — Central placenta previa. 
8 — Tumors of the uterus or ovaries. 
9 — Cancer of the cervix. 
10 — Badly handled cases. 
11 — Advanced tuberculosis. 
12 — Thyroid toxemias. 

In conclusion the writer states that g>Tiecologists have to admit 
inability to ivpair trauma or tears at the pelvic brim, hence any 
case where the head fails to engage and endangers the ligamenting 
and fibrous support of the uterus should be submitted to section. 

A. c. H. 



Acute Ixti-.^susceptiox in Infants. 

Roughton (Clinical Journal) strongly condemns injections in 
the treatment of acute intussiLsception in infants. Operation should 
be done at once, imm^iately the diagnosis is established. Injections 
lose time, are painful and add to the shock — and, even though the 
tumor has disappeared, it does not prove the injection has been 
beneficial. He advises the right rectus incision and reduces the in- 
tussusception by gently squeezing the rectal end of the tumor. 
Gangrenous cases are beyond hope. lie has had fourteen successive 
cases, all successful by operation. 



100 DOMINION MEDICAL MONTHLY 



Ipb\:8iolooic Tlberapeutlcs 



J. Hahvey Todd. 



Further Experience in X-Ray Diagnosis of Ulcer of the Stomach 
and Ducdenum. H. Ai.dkk. M.l).. H. K. Asiimjuv, .M.D., Balti- 
more. New York Medical Journal, Oct. 7, 1911. 

We have found that under normal conditions tiie .stomach will 
clear itself of 90 grains of bismuth within four hours, and that bis- 
muth retained at the site of an ulcer will be found at this point for 
at le-ast two hours later, so the clearance time has been stated to he 
from four to six hours, as a safe period in which an ulcer can be 
dietected; and if none is present a safe interval to feci sure that all 
the bismuth has been eliminated. 

From these observations one can feel reasonably safe in assum- 
ing that any bismuth which remains in the stomach after normal 
clearance time is held there by some pathological condition which 
interferes with, normal peristalsis or holds the bismuth by the pres^- 
ence of .some ao'glutinant .substiance which prevents the elimination 
of the bi.sTOiith or In- .some permianent obstruction to its outlet. 

Our cases are tabulated and divided into four cla.sses : 

I. Ulcer diagno.sed by *'X" Ray — Group a, ca.ses verified by 
operation, seven; group b, eases substnntir.tcd by presence of cardi- 
nal symptoms, seventeen. 

II. Ca.ses submitted to "X" Ray examination, in which the find- 
ings were negative — Group a, negative findings sul^stantiated by 
operation, twelve; group b, negative findings sul>st.antiated by later 
clinical hi.story, twenty-nine: group c, negative cases sul>stantiated 
by autopsy, two ; group d, negative findings unsubstantiated, six. 

III. Cases in which ''X" Ray dir.gno.sis was incorrect — two 
cases: a, ulcer not detected by "X" Ray; b, ulcer diagnosticated by 
"X" Ray. Operation show<'d gall-stonos. 

IV. Cases clinically: ulcer in which "X" Ray findings were 
negative, two. 

J. H. T. 



2)omiiuon /H^ebical /ll^ontbl^ 

BnCi Ontarto /BeDical journal 

EDITED BY 

Medicine: Graham Chambers, R. J. Psychiatry: Ernest Jone«. W. C. Herri- 

iJwyer, Goldwin Howland, Geo. W. iiiarj. 

Ross, WmD Young Ophthalmolog'y : D. N". Maclennan. W. 
SuPgrepy : \\ alter Mckeown, HerbPrt A jj i owrv 

Bruce. W. J. O. Malloch. Wallace A. _. , ', ' , , . _.,. , 

Scott. George Kwart Wilson. Rhinolog-y. Laryn^ologry and Otol 
Obstetrics : Chas. J C. O. Hastings. og-y : Geoffrey Boyd, Gilbert Royce. 

Arthur (. Hendrick. Gynecolog'y: F. W. Marlow, W. B 
Pathologry and Public Health : John Hei(ir> 

A. Aniyot, O. R Mabee, Geo. Xa- Genito Urlnapy Supg-epy: T. B. 

•mvth. Ri(;-li;iril>oii. W. Warner Jone-. 

Physiolo^ric Thepapeutics : 

J. Harvey Todd. Anesthetics Samuel Johnston. 

GEOBQZ: EZiIiIOTT, MANAQZNQ EDITOR. 

Published on the 20th of each month for the succeeding month. Address 
all Communications and make all Cheques, Post Office Orders and Postal 
Notes payable to the Publisher, GEORGE ELLIOTT, 203 Beverley Street 
Toronto, Canada. 

Vol. XXXVIII. TORONTO, MARCH, 1912. No. 3 



COMMENT FROM MONTH TO MONTH. 

Tuberculosis is e.stimated to be active iu at least 10.000 persons 
in Ontario. Two thousand five hundred die annually in the Pro- 
vince of this disease. But five per cent, of those attacked can have 
institutional treatment at any one time, as there are only about 550 
beds in hospitals and sanatoria set apart for this class of patient. 
Not more than 1,500 can be treated institutionally in any single 
year. 

In connection with the whole sad story of fighting the "white 
plague," private philanthropy has led the way. Neither provincial 
exchequers nor federal revenues have figured to any great extent 
in the campaign, whether in local or national aspects thereof. 

What is being left undone is appalling in its magnitude; for of 
the 13.500 dying annually in Canada from tuberculosis, who is to 
say but that nearly all could be saved. 

"What is true in Ontario is equally true in other provinces, and 
more so in some. 

The Federal Government cannot too soon establish a Depart- 
ment of Health, long hinted at, and truly as long delayed. 

It must be apparent now to even the least among the repre- 
sentatives of the people that private philanthropy cannot grapple 
with this colossal problem. A national campaign, directed and 
financed by the national Government, with the active co-operation 



102 DOMINION MEDICAL MOiMiiiLY 

of each aiul every provincial government, is tlemanded. The cry 
of thousands of atHicted ones calls for action at once. 

Public works, military schemes, immigration expenditure, should 
stand aside for a year at all events, or increased duties on luxuries 
he levied, to provide the initiatory fund. 

The Borden administration has the chance to make the best 
history for itself by inaugurating such a great national movement. 

The nation's power should be exerted against the nation's 
scourge. A national crusade and a natioTial war can only secure 
the victory. 



"N) Naval Policy Yet," says a Toronto morning paper in 
criticism of the present government at Ottawa. And there is no 
public health policy yet cry the thousands of consumptives in Can- 
ada, many of whom will yield up their lives in 1912. 

In the interest of suffering humanity, couldn't the naval policy 
slide or wait? Wouldn't it be far better to have a national health 
policy? Are not the thousands of suffering and dying Canadians 
of infinitely more worth to the nation than any naval policy could 
be? Let the people have the chance by referendum to say which 
policy they will choose — the conservation of human health and 
human life or a Canadian navy. 

If governments will not look alive to human life and human 
health, then tiie people will have to make them do so. In no l)etter 
crusade could a Christiaii power be engaged than in exterminating 
the "white plague.'' Tliere is war cnougli in this for all naval and 
military expenditure and force. 



Canadian Medicine, Montreal and McGil! Universily in par- 
ticular may well I't't'l satisfied with the liiial dc-ision of Professor 
J. George Adami to remain with .McCill and thus refuse the very 
tempting offer recently made him by the Nortliwestern rnivei-sity 
at Evanston, Illinois. 

Professor Adami has been so long and so intimately, associated 
with not only the university and medical life of ]\reGill, but with 
the social life of the metropolis as well, that the offer of the North- 
western University must have been something out of tlie ordinary 
to even tempt him for a moment to consider it. 

With scarcely a doubt that Dr. Adami is Canada's foremost 
medical scientist, his loss would have liceii a distinct one — and 



DOMINION MEDICAL MONTHLY 103 

McGill University and ^lontreal would not liave been the only 
losers. 

Canadian medicine and literature has been enriched by his 
work and writings; and ]\IcGiIl L'niversity is to be warmly con- 
gratulated at his ultimate decision to remain. 



The use of calcium hypcchlorite in the purification of To- 
ronto's drinkiiitr water has pa.ssed tlio e.xperimental stage and may 
now be safely said to liave established itself and proven its worth. 
Even with the completion of the filtration plant, however, it is 
deemed wise and necessary to continue the treatment with bleach. 

The process is not a costly one, and the installation of any such 
plant but a tritling matter. It has been found that pathogenic 
germs are killed by one part per million of available chlorine. 

Objections have been made to a certain disagreeable taste, but 
custom will altogether eliminate that, and even that must be over- 
looked wl^.ere tliere is any ([Ui'stion of the pre\"ention of disea.se and 
the saving of life. 

This hypochlorite treatment has now been in use some months 
in several of the larger cities of the L'nited States and Canada — in 
^Montreal. Ottawa, Minneapolis, Cleveland, etc. 

There seems to be no ground for any such fancied grievances as 
injury to delicate fabrics, bleaching of the hair, injurious effects on 
the .sitomaeh, etc. 

That the treatment of drinking water \nth calcium hypochlorite 
is absolutely harmless, all may be assured, even when sewage con- 
tamination is known or feared. Its advantages are abundantly, 
even brilliantly demonsitrated, in the reduction in typhoid morbid- 
ity and mortality in those cities where it has been employed. 



The Hospital VVtrld marks a new feature in Canadian medical 
journalistic enterprise. It has just been launched in Toronto by 
Dr. W. A. Young, long n medical journalist of the first calibre. It 
purports to be an international publication, as Toronto, Butfab, 
and London, England, appear as the places of its nativity. To- 
ronto, however, will be its abiding place. But may it travel far. 

This city may now be looked upon as the centre of medical jour- 
nalism in Canada, all Englisli Canadian medical journals except- 
ing two being published in Toronto, although a contemporary, of 
the tender age of one year, writing upon "^ledical Journalism in 



104 DOMINION MEDICAL MONTHLY 

Canada." would have the medical public believe our Toronto medi- 
cal journals do not come within the scope of its cate^rory. 

The firet number of Thr JJospitol Vii'nrld is splendid in its 
make-up and material. It will supply an important field. 



The Medical Review of Reviews, whieh includes an Index 
^Icdicus, comes to hand with many new features. 

The frontispiece is a fine four-colored portrait of Louis Pas- 
teur and his grand-daughter. 

A feature is the medical cartoon, the present one being the Doe- 
tor's Dilemma — Tuberculosis and Poverty. 

There is a special article on Louis Pasteur and another on Path- 
finders in Medicine — Paracelsus, Iconoclast of Medicine, with por- 
trait. 

The Index IMedicus embraces, as before, a list of medical jour- 
nals with subscription rates, each assigned a separate number. Then 
follows the month's leading articles of each journal, making these 
departments admirably adapted for reference requirements. 

The Medical Review of Reviews now takes rank as a very in- 
teresting publication ; and the many added and unique features pro- 
mise well for an extremely readable periodical of the medical class. 



DOMINION MEDICAL MONTHLY 105 

IHcws litems 



JoHX D. IvocKEFELLEK lius giveii $11,000 towanls the preserva- 
tiou of the house iu whieli Pasteur was born. 

Dr. Ira S. Wile, New York, has assunuMl the editorial manage- 
ment of the Medical Review of Reviews 

Local Hebrews of ^Icntreal will raise funds to continue their 
sanatorium for consumptives at Ste. Asiatlic, Quebec. 

Dr E. AssELiN has been appointed assistiint to Dr. Coyle in the 
infectious diseases department of the Health Bureau of ]\[outreaL 

Dr Joun G. Cl.vrk, Pliiladelphia, gave an illustrated addres.s 
befoiv the Aca>demy of iNItdicine. Toronto, on the 20th of February. 
The subject was " Tlie Surgical Phases of Enteroptosis. '' 

Western Hospital, Montreal, received 1,:]60 patients in IIHI. 
The death rate was 3.00. In the outdoor departments 11.520 con- 
sultations were given. 

Copper Cliff Hospital was burntn^l to the ground the night 
of the 1 7th of January. The loss is $40,000 on building and $10,000 
on equipment, fully covereil by insurance. Eight patients were re- 
moved safely. 

The Ontario Government will accjuire temporary quarters for 
insane and feeble-minded who have liad to be lodged in Toixuito 
Jail. A building capable of accommodating one hundri'd pctNoiisor 
more will be needed 

Dr. R. a. H. Mackeen, Glace Bay. N.S., died on the 14th of 
January. He was a well known physician in the Maritime Pi-ov- 
inces. He was in his tifty-tifth year and hardening of the arteries 
was the cause of death. 

The Reid Brothers of Newfoundland will erect a $50.(X)0 con- 
sumptive sanatorium in St. John's and the Newfoundland Govern- 
ment will provide a site. They will also ereet-sixteen $3,000 sana- 
toria throughout the Island. 

Dr. a. II. CAUiJ'iFJ-n. Gravenhui-st, read a paper before the 
Toronto Academy of Medicine on the 6th of Fe])ruary on "The 
Etfects of Moiiern Post-Mortem and Lalwratory Data Tpon Our 
Coneeption of the Tr.berculous. " 



106 DOMINION MEDICAL MONTHLY 

IMoNTREAL is being sued for $10,000 damages ou beJiall" of a 
child alleged to have been vaccinated by municipal vaccination with 
vaccine of an inferior quality or infected. The jury will be asked 
to answer these questions: Can vaccine cause infectious neuritis? 
Was the quality of the vaccine used in said case good? 

TffF Board of ^lanagement of tiie Protestant Hospital for the 
Insane, Verdun, Que., is memorializing the Quebec Government, ask- 
ing that the physicians in the service be placed on the same plane 
with others of like rank in the civil service, as regards pensions. 

Dr. Warren P. :\I()rrill, who resigned as superintendent of the 
Sydenham Hospital, has accepted the superintendency of the Winni- 
peg General Hospital, Winnipeg, Manitoba, Canada. The hospital 
contains 850 beds, and is the great general hospital of the Nortiiwest, 
as well as the teaching hospital of the University of Manitoba. We 
extend our cordial good wishes for success to Dr. Morrill in liis new 
field 

Montreal had 9,974 deaths in 1911, 5,110 males and 4,864 
females, giving a death rate of 21.39 per 1,000. This is 1.01 per 
1,000 less than in 1910. The deaths of children under five yeai-s of 
age numbered 5,355, being 53.69 per cent, of the general mortality, 
or a decrease of 0.50 per cent, over the infant mortality in 1910. 
Metisles claimed 74; scarlet fever, 76; diphtheria, 133; typiioid fever, 
124; phthisis, 736, as against 785 in 1910. 

Medical students are occupying the new pathologicfil wing of 
the Toronto General Hospital. TTnit rooms are provided, each with 
accommodation for fifteen students and eacli student lias an electric 
liglit, water tap, gas jet^ microscope and locker. The walls of the 
di'iiionstration room arc white, the floor of red flags ajid skirting the 
walls are marble bases. 

TiiK Hospital for the Insane at London, Ont., admitted five hun- 
(ii-ed patients from January 1st, 1908, to June 6lh, 1910, sixteen of 
tlie.se being twice admitted, 'i'lie males were 251; fenudes 23;i. 
Two hundred and thirty-three, or 48 per cent., were discharged re- 
covered or improved; eight were discharged unimproved; sixty- 
seven, or 13 per cent., died ; five; eloped ; four were ti-ansfen-ed ; five 
were deported, and 162, or 33 j)er cent., remained in residence. 



DOMINION MEDICAL MONTHLY 107 



Corrcepon&cncc 



Ontario Medical Association. 

The next Annual Meeting of the Ontario ^[edical Association 
will ))-• held in Toronto, May 21st, 22nd and 23rd. 

T!u officers of the Association are putting forth their best eflforts 
to make the meeting a success lx)th from a social and educational 
standpoint, and hope that you will l)e able to attend and take part 
in the carrying out of the programme. 

It is the intention of the committee on papers to make the pro- 
gramme more clinical in character than has hitherto been the cus- 
tom. The morning of the second day of the meeting will be devoteil 
to a clinic in the building in which the Association will meet : and 
on the morning of the third day clinics will he held in the various 
hospitals of the city. Programmes of these clinics will l>e dis- 
tributed on the first day of the meeting. 

You are cordially invited to present cases at either of these 
clinics. If you are unable to show a patient we should be pleased to 
have you contribute a clinical report of an interesting case to be 
read at the afternoon or evening sessions. 

F. Arnold Clarkson. Graham Chambers, 

General Secretary. Chairman Committee 

471 College Street. Papers and Business, 

26 Gerrard St. East. 



On Monday evening, the 20th of May, just prior to the annual 
meeting of the Ontario Medical Association, on the three following 
days. May 21st, 22nd and 23rd. in Toronto, the graduates of Trinity 
Medieal College will hold a re-union banquet at some place to be 
designated in a later announcement. A committee is in charge of 
the matter. Dr. Samuel Johnston. 169 Carlton Street. Toronto, Is 
the Secretary of the Committee. Trinity men are urged to attend 
this reunion and to send in notice at an early date of their inten- 
tion to l)e present. 



108 DOMINION MFDICAL MONTHLY 

Ipublishcrs' iDcpartincnt 



Savoury meat lozenges (Brand). — These are composed of the 
Concentrated Beef Tea. and thus contain suhstantial nourislimeiit 
in a simple and easily portable form. A few of these placed by the 
chair or bedside of a convalescent will allay and satisfy the craving 
for food between meals so often noticeable, and relieve the nurse 3f 
a great deal of worry, etc. Their chief value, however, is to tliose 
who from various causes are compelled to go witliout food for a 
length of time The doctors attending a prolonged case of mid- 
wifery, etc., barristers whose raid-day interval is taken up by a 
consultation, cyclists, motorists, yachting people and railway pas- 
.sengers, etc., who have no opportunity, or who may not desire to 
stop to take a meal, will find that a few of these lozenges will keep 
them from all signs of exhaustion or fatigue, from morning until 
night, or longer if necessary. And moreover, wliile allaying the 
pangs of hunger and preventing fatigue, will not vitiate or destroy 
the appetite wlien the time and opportunity to take a solid square 
meal arrives. It may be interesting to state on the authority of this 
Right Hon. "Winston Churchill, who inentions in his book on the 
South African (Boer) War, that at the Battle of Paardeberg, many 
English .soldiers subsisted for three days on these lozenges entirely, 
owing to the ordinary, rations not being available, and suffered no 
ill-effects whatever from the lack of more solid and bulky foods. 
We also hold many letters from soldiers who participated in that 
war, testifying to the value of our meat lozenges when they were 
scouting or otherwise -iway from the main body and from sup- 
plies, many of them saying that they owed theii- lives in a larce 
measure to them, as otherwise they must have starved or beou 
rendered so exhausted as to be unable to re.ioin their regiment. 
Canadian Agent, Nc\\'ton A. Hill, 25 Front Street East. Toronto. 



I RECEivi-:n your sample of Resinol Ointment and Resinol Shav- 
ing Stick, the Ointment is an old friend of mine and I cannot praise 
it too highly. The .shaving stick T have never used before, but T am 
more than pleased ^vith it and shall always keep it on hand. It 
softens the beard better than any shaving soap T have ever used 
and the fa«e seems stimulated and refreshed. — Arthur A. Crawford, 
D.M D., Cambridge, Mass. 



DOMINION MEDICAL MONTHLY xvii 




Are you particular as to the condition of the iron in ^our 
Blaud preparations ? 

Frosst's Perfected Blaud Capsules present True Ferrous 
Carbonate. 

Each 10 grain Capsule contains, approximately, 1 grain of 
Iron. 



xviii DOMINION MEDICAL MONTHLY 

The Ne«le(.ti:i) Tiii;i{.\rv op Convalescence. — The i)liysiiM;in of 
ediu-ation and experience who keeps in touch with the projjress of 
iiiedifiiic jrenerally is well informed as to the treatment of most of 
the "thousand and one" ills that he is called upon to combat. The 
iliafrnosis and treatment of acute conditions, as well as the success- 
ful management of the more chronic affections, are subjects which 
he is constantly investigating and studying. It so happens, how- 
ever, that after the dangerous shoals of medical navigation have 
Ihhmi successfully negotiated and when the crisis or danger point 
has been passed the physician is all too liable to relax his vigilance 
and to allow the patient to convalesce without sufficient attention to 
the therapeutic details of this important period. While tJie feeding 
of the convalescent is of great importance, the medico-tonic treat- 
ment is equally essential, in order to improve the appetite, tone the 
digestive, assimilative, and eliminative functions generally, and to 
hasten the time when the patient shall be once more "upon hLs 
feet." Among all of the general reconstituent and supportive 
measures in the therapy of convalescence, none is more essential 
than the reconstruction of a blood stream of vital integrity and 
sufficiency. Pepto-^Iangan (Gude) is distinctly valuable in this 
special field, as it furnishes to the more or less devitalized blood 
the necessary materials (iron and manganese) in such form as to 
assure their prompt al>sorption and appropriation. One especial 
advantage of administering these hematinics in this form is that 
digestive dif-turbance is avoided and constipation is not induced. 



Baldness and rrs Treatment. — The question of baldness and 
of the chances of its successful treatment is naturally one of ab- 
sorbing interest. In all parts of the civilized world the tendency 
of hair to depart in an untimely manner from the heads of mem- 
bers of the rising generation is becoming more and more evident. 
The sight of a bald young man is so frequent as to give rise to no 
comment, and when a man reaches middle age he is almost expected 
to be bald to some extent. Gottheil. in Progressive Medicine for 
September, 1911, deals with the matter at some length. He depre- 
cates the tendency to treat the subject as a joke and discusses the 
ordinary forms of premature or senile alopecia, commonly asso- 
ciated with or following prevalent scalp affections known as seborr- 
hea or eczema seborrhoicum. In recent years the custom of dis- 
carding head gear in the ])elief that thereby the growth of the hair 
will lie stimulated or that its loss will be stayed, has been widely 
adopted. The fact is, however, pointed out that the skin and its 



DOMINION MEDICAL MONTHLY 



XIX 





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XX DOMINION MEDICAL MONTHLY 

appendages are peculiarly susc'ei)til)le to tlie aetion of the sun's 
rays. Overindulj^enec in sun baths is prejudicial to the human 
orjranism, eansing: irritability and nervousness, cardiac and cir- 
cidatory disturbaju-cs, and dermal lesions, sometimes of a serious 
nature. Well-known authorities on skin diseases state their belief, 
founded on long experience, that extended exposure to the rays of 
the sun finally causes marked baldness. Indeed, the effect of the 
X-rays is similar to that of the actinic rays of the sun in this re- 
spect. Yet the hatless habit must not be wholly condemned offhand, 
rndoubtedly it has its advantages, and it must be noted that sav- 
ages in tropical climates, who wear little or no protection for the 
head, in tlie great majority of cases possess an abundant crop of 
bair. Furthermore, it is a moot question as to wliethcr interfer- 
ence with the cii"culation caused by our modern tight-fitting hat 
bands is not as harmful to the gro^^i:h of the hair as prolonged 
exposure to the actinic rays of tlie sun. Baldness is without doubt 
a disease of civilization and is one of the penalties attached to 
l)eing an inhabitant of a progressive and cultured country. Per- 
haps the more civilized the country the more prevalent will bald- 
ness be, for extreme civilization infers a mode of life furthest re- 
moved from that of nature. Indeed, a lack of hair is almost 
synonymous with the acme of civilization and is one of the most 
annoying of the white man's burdens. As for the treatment of 
baldness, few dermatologists are agreed on a uniform plan. It 
would seem that the most rational and most common-sense remedial 
and preventive means, that is, when no definite disease is present, 
are to stimulate the tissues of the scalp and to increase the blood 
supply of the hair follicles. This may be best done by a second 
jH'rson. Brushing should be proceeded with vigorously and per- 
sistently for months, supplemented with the application of a suit- 
able lotion. Even then no certain results can be guaranteed. Some 
check the loss of hair by the.se methods, others do not attain this 
much-desired end, and some apparently thci-chy liasten tlie deflu- 
vium capillorum. — Medical Record. 



A contemporary pul)lislicd, the other day, an article entitled, 
"Health and the Nose." Which reminds us that one meets not 
infrefjucnlly, especially in cold weather, a nose which, to judge 
l)y its complexion, is obviously enjoying ruder heallli than the face 
to wliich it is attached. — Punch. 



DOMINION MEDICAL MONTHLY 



XXI 



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xxii DOMINION MEDICAL MONTHLY 

Why Digitalis Sumeiimes Fails. — This is the title of a neat 
little broehure purporting to set forth many opinions by eminent 
writers upon the subject of digitalis and its administration. It sets 
forth elearly and eoneiscly the indications and eontra-indications 
for the administration, the conditions where it is not needed, where 
it is, and where it may do harm. These collections from the writ- 
ings of eminent writers can be had by addressing The HotTmann- 
LaRoche Chemical Works. 6.1 Fulton Street, New York. 



Pneumonia, they say in the text books, is a self-limited disease 
and requires no specific medication. Pneumonia, however, is a dis- 
ease which can make and unmake the local reputation of a physician 
and it behooves him to follow his experience rather than theoretical 
instruction. It is well to bear in mind two of the pathological con- 
ditions of this disease — congestion and resolution. The one is pres- 
ent when the doctor arrives, and the other he hopes to produce. 
The relief of the congestion is imperative. It is difficult for the 
blood to pass into the circulation through a congested lung, hence, 
we must make it easier for the blood to pass into the arterial system. 
In sthenic individuals with a full liounding pulse, venesection used 
to be the modus operandi, but nowadays it is far better to " bleed 
but save the blood." Inflammation of the lung is in no wise dif- 
ferent from an inflammation elsewhere, other than that it is perhaps 
more deep seated. Clinical experience has demonstrated that moist 
heat in the form of Antiphlogistine with its hygroscopic and osmotic 
action, properly applied and properly protected, is almost specific 
in pneumonia. When you have bridged over and relieved the con- 
gestion and prevented the occurrence of inliammatory exudates, 
your patient is half way toward resolution and recovery. 



The ^Massage Institution at 20 Walmer Road, Toronto, just 
north of Bloor Street, established only a few months ago, and con- 
ducted and supervi.sed by Mrs. MacKinnon, is now one of the estab- 
lished medical institutions of Toronto. All branches of massage are 
carefully administered, ^li-s. MacKinnon having had considerable 
experience in the Home Country; There are also electrical, electric 
light and needle spray batlis; and the ai)pointments and surround- 
ings are all that could be desired. Male patients are attended by a 
masseur of practical experience. In every way, ]\[rs. MacKinnon 
attends to the comfort and best requirements of all patients. Physi- 
cians are invited to visit and inspect the institution. 



DOMINION MEDICAL MONTHLY 



XXlll 



The Medical Press and Experiments with 

BOVRIL 

The Report on the nutritive value of Bovril read before the Annual Meeting 
of the British Medical Association is attracting wide attention in the medical pro- 
fession. 

The British Afed caZ/oui nu/ of September i6th devoted some six pages to a 
detailed account of the recent experiments, in which it was shown that in the 
case of huiran beings the body building power of Eovril was 
'■even more marked ' than had been previously shown in the experiments 
with animals. ' 

A further article has just appeared in the Meifiai/ Tivies, And \hai journal 
points out that the experiments were originally conducted "with the object of 
ascertaining whether a certain beef extract (Bovril) supplied to the (".overnment 
had any nutritive \alue or not. The ^ults were simply startling." 

"It w^as found that in all cases the administration of the 
extract (Bovril) caused an immediate increase in w^eight 

One important point brought out by these experiments is that this increase in 
weight is in tissue and muscle, and that Bovril must therefore be re- 
garded as a true nutrient. 



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As underwear it is entirely " out of place " and most unreliable. 

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is a modi6ed Linen, with the chill of ordinary pure linen removed. It is as 
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xxiv DOMINION MEDICAL MONTHLY 

What is Best ix Tonics. — Many people, and perhaps a few 
physicians, are inclined to consider the terms " tonic " and " stim- 
ulant" as more or less synonymous and interchangeable. This, of 
course, is not the case, although some agents employed medicinally 
may partake of tlie properties of botli and be properly known as 
" tono-stimulants. " Strychnia, for instance, is a heart stimulant, 
but may also be considered as a general nerve and systemic tonic 
when given in small and frequently repeated doses. While a stimu- 
lant alone is sometimes indicated in conditions of emergency, its 
long continuance almost certainly produces an after depression. 
It is sometimes advisable, however, to give stimulant and tonic to- 
gether in conditions of serious general depression, the first to 
'' boost " the vitality and the second to hold it at the point to 
which it has been raised and to restore the general tone of the 
organism. An ideal combination of this nature is Pepto-Mangan 
(Gude) to which has been added tlie proper dose of strychnia, 
according to indications. This combination is especially serviceable 
in the convalescence of exhausting diseases, such as Typhoid Fever, 
Pneumonia. La Grippe, etc. It is also of much value when the heart 
needs support and the general system requires upbuilding. Pepto- 
:Mangan restores vitality to the blood by increasing the number of 
red cells and the percentage of hemoglobin, and the strychnia assists 
in rendering the combination a peculiarly efficient general bracer 
and permanent reconstituent. 



2)ominion /Ihebical /llbontblip 



HnD Ontario /RcMcal Journal 



Vol. XXXVIII. TORONTO, APRIL, 1912. No. 4 



©riginal Hrticles 



THE CRIME OF THE CENTURY. 



By a. C. E. 



About four a.m. on a ^louda}', Beverle}' Weutwortli. M.D., 
awakened from a troubled sleep. 

He placed his right hand over his heart to quiet its aching — its 
tmnultuoas beating. 

Worry seized hold of him — another attack of the blues. 

To-day the landlord would call for his rent ; to-day tiie furniture 
man for his monthly payment; the grocer, the baker, the milk 
dealer, tlie coal collector, the butcher, proliably the tailor, probably 
others with minor accounts. 

He had had a respite — a feeling of relief when Saturday noon 
came ; no chance of duns for a whole day and a half. 

Restless, anxious, now turning to the prone, in a minute to the 
right, then supine, now to the left, this way and that way he rolled, 
soon awakening his wife. 

''What is the matter, dear? You're so restless." 

"Debts! Debts! Debts!" 

"Never mind, dear; we'll get them paid somehow." 

"Yes," he groaned, "if I could only think so; if people would 
only pay me what they owe me. If the Government would only 
abolish the charge system of doing business and everybody had to 
pay spot cash for everything obtained, for all goods purchased. I 
don't want to be rich; I oulj- want to be out of debt. It is awful 
to be always hovering on the brink of bankruptcy ; going to bed wor- 
rying of debts; awakening worrying of debts. If there was any 
let up to it — a month, three months, a year; but it is always the 
same — the same for ten years. People don't consider us doctors. 



110 DOMINION MEDICAL MONTHLY 

They thiuk we're all making money. Tliey tliink it doesn't make 
any difference when we are paid, how we are paid, or whether we 
are paid at all. They never take into account that our rent has to 
be paid — I owe ten months' rent now — $280." 

"I know it is awful, dear, hut maybe some money will come in 
with the morning mail. Do try to go to sleep again. If the worst 
comes to the wonst, we have the two little kiddies," — and soothingly* 
coaxiugly, his wife lulled him into another slumber. 

Partaking of a very light breakfast of toast and coffee, Dr. 
Weutworth was in his surgery that morning at nine o'clock as 
usual. 

He took up the morning paper and began reading the news of 
the day. He awaited calls. 

It was not long before 'his doorbell rang; the maid soon ushered 
in — the landlord, as he expected. 

"Very sorry, Mr. Brown, but can't do anything to-day — prob- 
ably next Monday. I am promised a good cheque for the last of the 
week, and I think I can safely promise you half of the arrears." 

"Promises don't pay rent, doctor, and you know there is a good 
amount overdue," deprecated the landlord mildly. 

"Yes, I know both too well, but I have to do the best I can: 
people consider I can live on promises^ — wind pudding with imagi- 
nation sauce — a case of 'live, old horse, and you'll get grasps.' " 

'Mr. Brown was a very easy landlord, with a plentiful supply 
of the "milk of human kindness," which was lucky for Dr. Went- 
worth ; so he took his departure, promising to call the followip-? 
IMonday morning. 

The door from the dining-room into the surgery opened and his 
wife stuck her head in : 

"Who was that?" rather anxiously. 

"That was the lamllord. Ciot him staved off for another week, 
until — well, until I get a cheque from — somebody. Run, ]\Iargery ! 
here is someone else," as another ring rang through the house. 

"Good morning!'' and Dr. Went worth aros«^ to meet an expected 
patient. 

"^Morning!" growled, gi-unted and scowled a sturdy coal heaver. 

Dr. Wentworth immediately recognized a man whose Avife he 
had been called to attend one night about eighteen months Ix'fore, 
for a trifling complaint, one of those common disorders of digestion 
not worth bothering a doctor about in the daytime, but at night 
producing such a profound psychological impression that the doctor 
must come at once. Becoming tired of rendering a monthly account 
for $2, he had sent it to a collector. 



DOMINION MEDICAL MONTHLY 111 

''How dare you send a collector after me — and for $2, too. I 
can get any doctor in the city to go out at night for a dollar any 
time — glad to do it. All you doctors think about, anyway, is your 
money. Give me a receipt and I'll give it you, and I won't have 
you any more, not even if the cat was sick." 

' ' Pay me the money, and I '11 give .vou your receipt, ' ' calmly re- 
plied the doctor, though inwardly boiling to kick the dastard out. 
"No one ever gives a receipt until he gets the money." 

The transaction was completed. 

"Haven't you had a job all this time?" queried Dr. Wentwoi-th. 

"What's that to you?" with a snap. 

"Nothing. Only I thought if you could just save two dollars in 
eighteen monflis I would give it back to you," and standing up 
before that begrimed, fat toad, Beverley Wentworth looked him 
squarely in the eye. "Now," he continued, "if you don't want me 
to kick you out you had lietter get out," and the dfiiiiquent debtor, 
looking at his tall, muscular frame, slunk away. 

Again the door opened fi-om the dining-room and iiis wife, 
^largery, poked in her head. 

"Wlio was that?" There was a merry twinkle in her eye. She 
had overheard the conversation. 

"That was a — patient. Here's the two-spot." 

Ring, ring. ring, ring! 

"Kim I Pray for more this time!" 

But the sailing was not so smooth as when the landlord called 

"Good morning!" The doctor thought this miglit be another 
patient, so he was standing ready to greet him. 

"Look liere. Dr. Wentworth! I must have this bill settled. It's 
been running too long altogether — and you haven't been buying 
any meat from me now for over three months. Here it is — ^$28.75 I 
Pay up, or I'll have the law on you! ]\Iy name is Hurry, the 
butcher!" 

Dr. Went^^•o^th reached and took the bill from the excited pur- 
veyor and ran his eye over the items : wing roast, sirloin steak, pork 
chops, lamb chops, round, porterhouse, sausages, brisket, shoulder 
steak, kidneys, liver, bacon, eggs, sweetbreads, with repetitions. He 
was adding the items — thinking, deeply thinking. 

"All I can let you have to-day, 'Sir. Hurry, is the seventy-five." 

"What?" The hands clenched, the fat face got redder, the 
small eyes gleamed, the hair bristled. "What? Do you mean to 
insult me?" 

A weary expression gathered and settled on the Aesculapian's 
countenance. 



112 DOMINION MEDICAL MONTHLY 

"No. -Mr. Hurry, tliat's the honest truth. All the money in the 
house is $2. We have been vegetarians for the past three months, 
and we will have to get some bread and milk for the kiddies and 
some potatoes and a cabbage or two to see us through two or three 
days; but I'm expecting a cheque for sure this week, and I promise 
you that you will be paid as soon as I get it." 

The honest butcher looked at him steadily for a moment. 

"Is that i-eally, honest, all the money you have? And haven't 
3'ou had any meat for three months?" 

"Yes, tliat's honest all right — not a spcH'k." 

"Here," turning over the bill, "write out an order for what you 
want to-day on the back of this account ; telephone when you want 
more, and just pay rae what you can and when you can." 

"^Ir. Hurry, that's vei'y land of you, and I thank you very 
much. Collections have been very poor all winter ; but I '11 pay you 
sure, .just as soon as I can." 

"All right, doctor, all right; good luck! good-bye!" and the 
good-natured butcher hurried away. 

"There, dear, that looks better," and his wife came into the 
surgery and gave him a kiss. "Now you can have a nice wing roa.st 
again with brown potatoes, and a beefsteak and Iddney pie." 

Ring-a-liug, ling, ding, ding! 
I "That's the telephone this time. I'll answer it for you. It 
may bring you luck." 

She came and whispered: "A lady to speak to Dr. Went- 
worth." 

"Hello!" 



'Yes." 



'I'll be in until 10.30." 



"Very well; thank you," and Dr. Wentworfch hung up the ear- 
piece and came back to his surgery. 

"Who was that, Beverley?" ratlier anxiously from his wife. 

"Haven't the remotest idea — a stranger from out-of-to\\Ti, likely. 
She said I didn't know her and that she was at the Royal Alfred." 

"Be very- circumspect then, dear; you never know. Do you wish 
me to remain in the dining-room ? ' ' 

"Yes. And you had better take the key and lock the door on 
that side. It is best to take precautions. As you say, one never 
knows. ' ' 

As Dr. Wentworth 's residence was in the down-town district, it 



DOMINION MEDICAL MONTHLY 113 

was not long before there was another ring at the door and the 
maid presented — the most beautiful voung woman he had ever be- 
held. 

Bowing slightly, he immediately closed the surgery door, open- 
ing into the hall, and with a wave of his hand indicated that his 
fair patient should be seated. 

She glided rather than sank into a chair at the end of his 
desk with her back to the dining-room door, her face paling, her 
hands instantly covering it, sobbing, her whole frame quivering, 
loosening the sluices of a long pent up, nervous flood. 

Dr. Wentworth went to hi.s chair in front of the desk, intensive, 
self-confident, self-reliant. He recognized the symptoms. The diag- 
nosis was easy. He was exceedingly glad he had asked his wife to 
remain in the next room, where she could readily hear all, but see 
nothing. 

Little by little, the nervous agitation subsided, the sobs ceasing, 
the tears drying, the eyes clearing, the color returning; and then 
Dr. Wentworth could see how wonderfully nature had endowed this 
woman with great beauty, exquisite grace and charm, elegance, love- 
liness. 

He saw she was luxuriantly appareled — long Persian laml) coat, 
Alaska sable stole and muff; large, handsome hat with one great, 
drooping, white ostrich plume; black velvet, close-fitting skirt and 
the daintiest patent leather boots just peeping out beneath. Her 
very portmanteau was expensive — all suggestive of wealth and re- 
finement. 

The practised eye of the ph^'siognomist took in the angular arch 
of the delicately traced eyebrow, the anxious, worried expression, 
that look when once seen which denotes the inward harrying of 
conscience and of heArt. 

"You wish to consult me?" asked Dr. Wentworth, sympatheti- 
cally questioning. 

"Yes." And she, with downcast eyes, a hesitating and subdued 
enunciation, told her tale. 

He heard her to the end and quietly replied: "I'm very, very 
sorry, but I can do nothing. Your case is beyond me." 

"How? I do not understand." She leaned forward on the 
desk, and, clasping her two shapely hands, from which the gloves 
had been removed, displaying long, taper, bejeweled fingers, sum- 
moned all the power of her enrapturing hazel eyes, from which the 
high light dazzled like brilliants, pleading, imploring, that he would 
have compassion and yield and comply with her entreaties. 

But, though her beauty dazzled him, mystified him, he only re- 
plied: "I cannot." 



114 DOMINION MEDICAL MONTHLY 

"But, doctor, only think what it nu-ans to nie. I am an only 
daughter. It will kill my poor father; he occupies such a proud 
and distinguished position in society. Thank God, I never knew 
my sainted mother. She died when I was only two years of age. 
Is my whole life to be ruined for such a triviality, I ask of you? 
Am I to be an outcast from my friends — from that society I love 
so \vel\1 Are the gray hairs of my noble father to be bowed in 
shame? Is the even of his life to be embittered as wa-s the mom ? Is 
the seolf of sot'iety to be U'veled at him ? Is the finger of scorn to 
be pointed at him? Is he to suifer all this for my one sin?" 

"I am afraid so, so far as I am concerned. But wait, perhaps I 
can aid you. Nature is unerring in her course. In due time I can 
be a good physician to you." 

"No — not that — never!" she exclainu'd. 

"Then our consultation is at an end," and he quietly arose as 
a signal for her withdrawal. 

"Oh, but doctor! You are a young man, unmarried perhaps, 
perhaps with sisters of your own. Surely you will take pity upon 
me. Surely" — she began opening her portmanteau — "surely money 
— I am wealthy — surely this would be some inducement," — holding 
out a packet of bank notes — "surely for a thousand dollars — there 
are ten one hundred dollar notes in this packet — surely for that you 
will save me." 

He was moved, deeply moved. The hideous spectre of debts 
came before him. He thought of the rent overdue and unpaid; 
of the bills he had to meet — all could ibe more than satisfied with 
this amount. The temptation camo upon him ; it would be so easy 
— a matter of .strict asepsis. 

A slight noise in the dining-ix)om like the clinking of glasses on 
the buffet, called him back to the path of reetitude. His wife had 
saved him. 

Rising up before her, his face paling, his brow contracting, his 
lips tightening, his eyes fixing stwidily uiK)n her, sti"ong, earnest, 
sincere, determined — she saw all rapidly 

"For a thou.sand dollars, doctor!" slic pleadtHl, thrusting the 
packet towards him. 

"Listen!" he said. "Listen! I am a married man. I have a 
loving, a lovely and a well-beloved wife. CJod has blessed our union 
with two, to me, beautiful childn-n. Money I need, but not this 
kind of money. Do you realize what you ask of me? Do you, w*lio 
maj' have already sinned, correctly understand? To your self-con- 
fessed sin, you now wish to add a crime. Thus you are an accom- 
plice before the fact. All my honor, all my manhood and all my 



DOMINION MKDICAL MONTHLY 115 

knowledge of the Cominandmeut, 'Thou slialt not kill,' as well as 
my knowledge of the law of the land and the consequences which 
might ensue, would hold me from ever committing this crime. 
Why do you, a perfect s'tranger to me, \^'ish me such ill will as a 
guilty conscience? Do you not know that upon my head would 
descend the righteous hand of the law in case of accident to your- 
self, whilst you, if you survived, would be privileged to give evi- 
dence against me in the interests of the State ? You are guilty now 
of sin. You are guilty now of exciting me to crime. My profes- 
sional honor holds your trust inviolable. The law looks askance at 
your part in the criminal act, in this, the heinous crime of the cen- 
tury, but deals with my part judicially and unmercifully. I am 
sorry, but I value my conscience, my wife and my family, my honor 
and my hope of the hereafter. No money can purchase them." 

Without a word or even a look she arose and took lier departure. 

As Dr. Wentworth turned from closing the street door after her, 
his wife was beside him, two arms were around him — and "Bever- 
ley!" was the smothered sob on his liosom. 

A few days later the newspapers told the sequel. From the ad- 
vertising columns of one, slie discovered the addresis of a ruffian, a 

villain and a quack who did the deed. Beautiful Estelle G 

lost her life, a victim of blood-poisoning: and the pestiferous beast 
of society yielded his on the gallows. 



METHODS OF DIAGNOSIS OF THE NATURE OF GLANDULAR 
ENLARGEMENTS AT THE ROOT OF THE NECK. 



By 0. C. Gkuner, M.D. 

Pathologist to the Royal Victoria Hospital, Montreal. 



The means which are available for making a diagnosis of the 
nature of glandular enlargements at the root of the neck, other 
than tuberculous and syphilitic, are not called for very infre- 
quently. The advances made during recent years in the study of 
blood cells and tumor cells suggest more satisfactory methods of 
diagnosis b}" the laboratory' worker, though the clinician does not 
have his attention called to them <;o often. 11 is the purpose of the 
present paper to present some data for guidance, with the hope 
that the clinician may derive more benefit from the microscopic 
methods of diagnosis than is usually thought possible. The basis 



116 DOMINION MEDICAL MONTHLY 

of the remarks which t'oHow is the study of several eases whieh 
came to autopsy at the Royal Victoria IJct-pital, Montreal, added 
to a collection of similar eases observed in Pingland. 

The class of case under consideration is one in wliicii there is 
a mass at the root of the neck, associated or not with glandular 
enlargement up the sides of the neck, and with dulness over the 
upper part of the manubrium sterni. It is assumed that tubercle 
and sy]>hilis are excluded by the usual means. There may or may 
not be a slight, possibly periodic, elevation of temperature. 

There are three possible methods of aiding the physician or 
surgeon : 

1. By the histological study of an excised gland. 

2. By the examination of the blood-filiiis. 

3. By the examination of the bone-marrow. 

These three methods each have their peculiar pitfalls, and it 
is proposed to discuss them largely from tliis point of view. The 
interpretation of the histologioal findings ol' excised glands requires 
a pre-formed clear conception of the nature of the changes (other 
than sypliilitic or tuberculous) which mav occur in them. 

1. The liistological study of an excised gland. When glandular 
enlargements of obscure nature have existed for some time it is 
desirable to make a "test-excision" as long as the absence of any 
serious adhesions allows this to be done w^ithout danger. The tissue 
so excised sliould not be subjected to the freezing method of section- 
cutting, but should be very carefully treated, and the sections pre- 
pared slowly and with exact technique. Portions may be placed 
in formalin if a preliminary report (not earlier than 24 hours) be 
really desired, but other portions, as thin as possible, should be 
placed in Zenker's or Orth's tluid. Harris' acid haematein, and 
eosin and methylene blue are useful methods for staining these 
tissues. 

The structural changes Avhich may be met with are : those of 
chronic lymphadenitis of different types (excluded in our imagin- 
ary case) ; those of secondary new-growths (carcinoma of different 
forms, and spindle-celled sarcoma) ; and those associated with 
disease of the blood-forming organs. 

It may be assumed that the ordinary text-book prevents any 
difficulties arising in the diagnosis of the secondary new-growths. 
The problem therefore consists in correctly differentiating certain 
forms of "blood-disease" by the histological clvanges which they 
produce in the lymphatic structures. As regards round-celled sar- 
coma, however, whicli is stated in some text-books to occur pri- 
marily in lymphatic glands, the view may be here expn^sed that 



DOMINION MEDICAL MONTHLY 117 

true round-celled sarcoma is very likely unknown in this situation, 
though the presence, microscopically, of a formless arrangement of 
absolutely similar cells, with scanty supporting tissue and vascular 
clefts, in place of true vessels, would be suggestive of this kind of 
tissue. Careful search would probably reveal the presence of some 
oat-shaped cells amongst the round cells. The cell characters are 
sufficiently definite; a small cell, with abundant cytoplasm, which 
stains rather strongly with acid dyes (eosin, erythrosin), a weU- 
defined central nucleus which stains feebly and shows distinct 
chromatic nodal points. 

There is a form of tubercle in whicii tiie lymph-node presents 
not giant-cell systems, but marked h^^perplasia of the trabecular 
tissue and of the endothelium lining the perifollicular sinuses. It 
is doubtful whether this is not really a form of Ho«igkin's disease, 
and search should be made for other evidence of the latter 
condition. 

We may assume that the true histological picture of Hodgkin's 
disease is fixed at the type described by Andrews and Reed inde- 
pendently in 1902. The presence of many giant-sized cells, of 
eosinophiles, and partial or complete loss of gland structure, are 
the essential points. These cells ire Jirranged almost in a hetero- 
geneous medley, tJiough the difTerent kinds of cells are frequently 
herded together in diflferent fields of the section. This picture, so 
suggestive of a granulation-tissue formation, is better labelled 
"malignant granuloma," the prefix indicating the malignant 
course of tbe disease, and that the progi-osis is more serious than 
is generally supposed. The frequent a.ssociation of fhe condition 
with a mass in the mediastinum would point to the presence of the 
latter, even though it produced only slight physical signs; it would 
also suggest implication of a persistent thymus. The histological 
characters of the form which may be expected to erode the neigh- 
boring bones and produce serious complications will be referred to 
later. 

In a sense, there is nothing to be gained by making a diagnosis 
of "malignant granuloma'' rather than of "sarcoma" or of "Hodg- 
kin's disease, terminating in sarcoma." The gain lies in the more 
correct conception which is obtained by cla.ssifying this type of 
disease with the blastomycoses and other mycoses, and thus separ- 
ating it off from the pseudoleukaemias. The distinction of the two 
varieties of Hodgkin's disease was drawn attention to by Martin 
{Journ. Med. Res., 1901, p. 249), who classified the^i as infectious 
granuloma and lymphosarcoma, respectively. Since the latter con- 
dition is sometimes associated with simultaneous development of 



118 DOMINION MEDICAL MONTHLY 

changes in tlie diffuse adenoid tissues ci' the hody, it sliould be 
subdividetl into lymphoma (pseudoleukaeniia of some authors) and 
lymphosarcoma. 

A few words will suffice to explain tlie features of the pseudo- 
leukaemie enlargements of tlie glands of the neck (which are best 
differentiated entirely from "lymphosiircoma"). The microscopic 
section shows a dense aggregation of small round cells, with very 
little fibrous tissue and entire loss of structure of lymph-node. This 
class of case may be. and has been, incorrectly called small ronnd- 
celled sarcoma. Scrapings of the gland st&ined by blood-staining 
methods demonstrate the real nature of the constituent cells. 

Lymphosarcoma of the glands of the neck. Some of the cases 
60 described in the literature are nothing more than malignant 
granuloma. Others are identical with the pseudoleukaemic type 
already described. Others, however, occur where the tissue is 
almost entirely made up of large multinucleate cells and a sprink- 
ling of lymphocyte-like cells amongst them. The multinucleate 
cells give the tissue an appearance somewhat recalling that of 
myeloid sarcoma, but the nuclei in the giant cells are few in num- 
ber and large in size in the case of lymphosarcoma. 

2. The examination of the blood-film. The red cells show 
changes in number in all the conditions referred to, and the color 
index is lower than unity. The total white cell count varies so 
much that definite rules become impossible. In pseudoleukaemias 
there is a tendency to absolute and relative increase of the neutro- 
phile leucocytes, though the variation of these values with the 
periods of pyrexia, which tend to occur, indicates that the leuco- 
cytosis is of secondary importance. A very decided increase of the 
lymphocj'tes, especially if they were all abnormally large, \\X)uld 
point to lymphemia (lymphatic leukaemia), but this diagnosis 
would have been made before a test-exci^'ion had been undertaken. 
The histological appearances would be identical with those de- 
scribed for pseudo-leukaemia. A moderate grade of lymphocy- 
tosis may be expected in the simple chi-onic inflammatory cases, 
but in lymphosarcomas there is sometimes a relative increase of 
the large mononuclears, as well as of the lymphocjies. The in- 
crease of the lymphocytes and the findina of unusual forms of the 
same (senile types, meso-lymphocytes, lymphocytoid large mono- 
nuclears, etc.) would be expected in the malignant granulomas. 
The details of anal^-sis of blood cell counts on this plan cannot be 
dealt with in the limits of this paper. 

3. The examination of the bone-marrow. This was advocated 
by Ghedini, who performed many exploratory punctures of the 



DOMINIOa^ medical monthly 119 

bone marrow on the living subject. From autopsy experiments 
the writer is able to state that such a procedure, especially while 
the patient is under an anesthetic for the test-excision, would give 
valuable results. The presence of well-marked changes in the bone- 
marrow cell-count would indicate if there were any generalization 
of morbid processes in the blood-forming organs. The presence of 
multitudes of medium and small lympliocyt^ forms rather than of 
members of the nn-eloblast and erythroblast series would furnish 
very valuable information. The examinatior is made by staining 
the carefully prepared smears of the juice obtained ])y trocarizing 
the tibial head, following tlie methods in vogue for blood-cell work. 

Lastly, a few words of comment upon the typical findings to 
be expected in the form of disease labelled malignant granuloma. 
There are three cardinal features: (1^ A special type of giant 
cell, which is present in large numbers. The cell is usually uni- 
nucleate. The nucleus is large, pale, rich in peripherally situated 
chromatin granules. There is an excentric nucleus which stains 
metaehromatically with erythrosin. Sometimes the nucleus becomes 
multiple by budding, and also becomes coiled into a ring form 
exactly comparable to the basket formation of nucleus in normal 
bone-marrow giant cells. In other words, as first pointed out by 
Kurt Ziegler, these cells are exactly like cells which might be 
thought to have wandered from ♦ihe bone marrow into these re- 
moter situations. The absolute size of these cells — some of them 
are truly monstrous — makes it extremely improl>able that such 
migration could have taken place. The writer would sooner sup- 
pose that some stimulus had excited the endothelial cells already 
present to undergo metaplastic transformation into this type of 
cell.* 

(2) The second feature is the occurrence of necroses. These 
phenomena are not pathognomonic of any disease. It is easy to 
understand that from focal thrombotic processes, or superadded 
bacterial infections, necrotic changes ensue here just as elsewhere. 
Where the disease is associated with increase of lymphocytes in the 
blood-stream there is loss of resistance of microbic infection, as is 
so well shown in leukaemias. This is also shown by the fact that 



•It seems to be essentiaUy correct that the various smaU round ceUs 
which we see in chronic inriammations, and in smaU round-ceUed (so-caUed 
"tumor") tissues are not necessarily identical in origin, destiny or function. 
Just as the genealogical table of lymphocytes — lymphoid cells — in inflam- 
matory tissues is coming to be recognized as a complicated one. each mem- 
ber of the chain being capable of reversion of character to that of a previous 
stage, and existing only transitorily in a certain morphological form, so, 
in some of the other small round-celled aggregations, there must be funda- 
mental distinctions between the cell-types. The different cells in a malignant 
granuloma may all have varying life histories and change their type with 
age, and as a result of varying toxic stimuli. 



120 DOMINION MEDICAL MONTHLY 

Coley finds his Huid to give rise to excessive reaction in Ilodgkin's 
disease and leukaenna. 

(3) The character of the eosinopliilo cells. It will sutTfiee to 
draw attention to the difference which these cells exhibit from 
ordinary eosinophile cells. ^Nlany of them seem to be changing 
into plasma cell forms or to be derived from the latter. Tlie evi- 
dence for this view will be presented serarately. 

The tendency to fibrosis of the glands, indicating a later stage 
of the disease, has already been referred to. 

Conclusions: (1) That the word, Hodgkin's disease, requires 
to be replaced by two pathological terms — the malignant granuloma 
and the lymphoma (pseudo-leukaemia). 

(2) This distinction would entirely remove the difficulties of 
diagnosis and the discrepancies between clinician and pathologist. 

(3) That malignant granuloma is not pseudo-leukaemia, but is a 
definite pathological entity, probably of infective origin. 

(4) That the diagnosis can be made during life by test-ex- 
cision, supplemented by study of the l\nnphocyte forms in the 
blood films; the adoption of simultaneous study of the bone-marrow 
cells would materially help. 



REPORT OF A CASE OF ACUTE APPENDICITIS, ILLUSTRATING 
THE VALUE OF A DIFFERENTIAL LEUCOCYTE COUNT. 



By J. P. Kennedy, M.D., 

Surgeon to the Wingham General Hospital. 



In an address, delivered at Rush ^Medical College Commence- 
ment, June 15, 1910, Dr. W. J. Mayo, among other things, gave 
this advice to the graduating class: "Write papers; they will dD 
you much good, although at first they may not Ix-nefit anyone 
else." For a number of years I have been writing occasional 
papers, and have found it very true, that they have been of benefit 
to myself, at least, because, in order to w-rite a paper, one has to 
institute a wider range of reading and investigation than he other- 
wise might do. It has been a stimulus, too, for closer observation 
of my cases, as well as an inducement to visit clinics, laboratories 
and hospital wards, where I could see things for myself. It is now 
well recognized that the leucoc.vte count in itself is of little or no 
value in surgical diseases, as far as diagnosis or prognosis is con- 



DOMINION MEDICAL MONTHLY 121 

cerned, but it is generally believed that the differential count may 
be of the greatest value, particularly, the disproportion between 
the increase in percentage of the polymorphonuclears and the 
actual increase in the leucocyte count itself. Gibson, of New York 
City, who devised a "standard chart" for the visible expression 
of this disproportion, says, in the Annah of Surgery, 1906, page 
485, in speaking of the relative disproportion l)etween the differ- 
ential and total counts, ''Bodily resistance is more clearly defined 
by this disproportion than by any other means at our command, and 
that of all methods of blood examination, this is the most valuable, 
both from the standpoint of diagnosis and prognosis." Dr. H. W. 
Hewitt, in an article in the Annals of Surgery for December, 1911, 
on "The Value of the Leucocyte Count in Acute Inflammatory^ 
Surgical Diseases," among other things, concludes as follows: 
"that in acute inflammatory surgical disea.ses, repeated counts at 
frequent intervals should be made, and if the polymorphonuclear 
percentage rises, while the total number of leucocytes remains 
stationary or falls, immediate operation should be insisted upoH." 
He also says, "No definite percentage of polymorphonuclears can 
be taken to positively indicate infection. If we have a percentage 
of between seventy-five and eighty of polymorphonuclear cells, in- 
fection is probable ; if we have a percentage of between eighty and 
eighty-five, infection is usually found ; if we have a percentage above 
eighty-five, infection is almost invariably encountered." He 
further says, "No one will deny that repeated counts are of much 
greater value in diagnosis than one isolated count." Emphasizing 
this same point, Gibson says, "The importance of a disproportionate 
increase of polymorphonuclear cells, particularly if progressive, 
cannot be overestimated, and those wilfully disregarding such evi- 
dence are perhaps not exhausting all resources available for diag- 
nosis." Herbert French, of Guy's Hospital, says, "If the polymor- 
phonuclear count is high, without a marked leucocyte count, it 
means that the pus is under great pressure." The ease I am about 
to report bears out these conclusions. 

Mr. G., age 33, traveller, presented himself at my office alx)ut 
2.40 p.m. on Noveml>er 28, 1911, with the following history: 

Five weeks ago, he said, he was taken sick with severe abdominal 
pains. His family physician, Dr. Archer, at Port Perry, who was 
called in, diagnosed his condition as appendicitis. He recovered 
in the course of a week, and had been well ever since, until the 
forenoon of the day he consulted me, when he was seized with 
nausea and was unable to eat any dinner. He took the afternoon 
train from Lucknow, intending to go home, but while on the train 



122 DOMINION MEDICAL MONTHLY 

between Lucknow and Wiiiirhani. a distaiict' of tt'ii iiiilcs, was 
attacked with severe pain across the abdomen, and npon reaching 
Wiughani, he came to my office, asking for medicine to relieve this 
pain, so that he could catch a later train and go on to Toronto that 
night. He was a tall, ratlu'r muddy-eomplexioned young man, with 
an anxious facial appearance, and exceeviingly nervous and appre- 
liensive about his condition. Upon examination, I found his tem- 
perature normal, his pulse 62. He had not vomited, but was nau.se- 
ated. A physical examination of the abdomen showed tenderness 
just below the navel, in the hypogastric region, and also a little 
to the right of ^McBurney 's point, in the right inguinal region. There 
was no tenderness in the upper quadrants or left side of the 
abdomen, and even the walls of the lower right quadrant were not 
especially rigid at this time. At 3 p.m. my assistant made a blood 
count, which showed a leucoeytosis of 16,000, the differential count 
showing the polynuclears to be 72 per cent. I diagnosed appendi- 
citis, and advised ]\Ir. G. to enter the hospital here, where we would 
keep him under observation for a few hours to determine whether 
his condition would improve or not. He, however, asked me if I 
could not relieve his pain, as he was anxious to go on to Toronto. 
I told him tliat it w-as easy to relieve his pain, but that did not mean 
his cure, aiul that I thought it very ill-advised to undertake such a 
journey in his present condition. After a short explanation of the 
dangers of appendicitis, he told me tha^ he was quite ready to do 
anything I advised. I accordingly sent him to the hospital, where, 
upon entering at 4 p.m., he had a temperature of 92 2-5 and a pulse 
of 65. Before taking him to the hospital, however, and having 
satisfied myself with my diagnosis, I gave him a quarter of a grain 
of morphine. At 7 p.m. his temperature was 99 4-5, pulse 82, and 
blood count showed a leucoc^'tosis of 17,290, the differential count 
showing polynuclears to be 89 per cent., certainly a very rapid and 
alarming increa.se in the polynuclears. At this time he was not 
complaining unduly of pain, being still under the effects of the 
opiate; l)ut upon abdominal examination tlien^ was increased ten- 
derness over the region of the appendix, and the muscles of the 
right lower quadrant were becoming quite rigid. I now <'xamined 
his heart and chest and found that ii,' had a marked .systolic mur- 
mur at the base of the heart. At 9 p.m. I saw him again, his tem- 
perature now iH'ing 100 ;?-5 and |)uls" 84. As there had been a 
considerable increa.se in the pei-eentage of tlie polynuclears, this 
increase exceeding the corresponding increase in the leucocyte 
count, ins temperature continually rising, and the rigidity in the 
right (piadrant of the abdomen becoming more marked all the time. 



DOMINION MEDICAL MONTHLY 123 

I advised immediate operation. This he at once agreed to, and 
accordingly, without any preparatory- treatment, he was anesthet- 
ized with ether by my assistant. Dr. M. C. Calder. The abdomen 
being prepared by benzine and iodine, according to the Mayo 
method, after etherization I opened the abdomen, using a low 
McBurney incision, and found the omentum presenting. Without 
the slightest diificulty, I pulled out a large, angry, thickened and 
inflamed appendix, whicli was apparently almost ready to rupture. 
Although the omentum presented in the wound, it had formed no 
adhesions to ward off the danger. The appendix was amputated in 
the usual way, the stump being inverted by means of the Gould 
reversed mattress stitch, and the incision was closed in the usual 
manner, using horsehair for the skin. After operation, upon 
taking the clamp off the end of the amputated appendix, the pus 
poured out. He rallied nicely from the anesthetic, and was never 
nauseated after the operation. He made a splendid recovery, with 
the exception of a small hematoma, which formed under the skin 
and delayed union for a few days. Here was a case sick less than 
twelve hours, and yet the "pathology of the living," in this case, 
leads me to believe, if this man had not been operated upon at 
once, that within a very few hours tiiere would have been rupture 
of the appendix, septic peritonitis, and probably death. 

I have frequently seen clinical symptoms just as marked, and 
in fact more so, and yet recovery take plr.ce without operative pro- 
cedure. If the clinical symptoms had not been reinforced by the 
blood examination, his determination to proceed on his journey 
would undoubtedly have overbalanced my insistence on immediate 
operation, and in all probability have led to his death. Accepting 
the findings of well-known laboratory workers, I considered the 
rapid disproportionate increase of the polymorphonuclear cells 
from 72 per cent, to 89 per cent, in a few hours, over the slight 
increase in the leucocyte count, of the gravest significance, and 
acted accordingly. 

The pathological examination was made by Professor McKenzie, 
of Chicago. He states that the case was one of ''acute, exudative, 
fibro-purulent appendicitis." Having given Dr. ^IcKenzie the 
history of this case, he also makes the following observation on it: 

"The differential count, as you have described it, undoubtedly 
indicates a rapid destructive process, actively stimulating the for- 
mation of protective substances. But when we know that the forma- 
tion of protective substances may cease at any time, I do not see 
why operation should not be insisted on and a favorable prognosis 
given. From all our present knowledge on immunit\- and infection, 
the prognosis should be favorable when operation is allowed." 



124 DOMINION MEDICAL MONTHLY 

His pathological report is as follows: 

"Tliere are many disteiuled vessels in tlie serous and outer 
muscular coats, while the inner muscular, submucous and mucous 
layers are infiltrated by an extensive purulent exudate. On tlie 
artery walls may be seen many strands ol" fibrin, which indiiced me 
to call the condition fibro-purulent apoendieitis. Tlie meso-appen- 
dix contains a quantity of fatt^' tissue and distended vessels. I 
was unable to find any pathological condition that might predis- 
pose or in,duce the inflammatory process, except pus infection." 



A PLEA FOR THOROUGH AND SYSTEMATIC STUDY OF THE 
MATERIA MEDICA AND THERAPEUTICS. 



By Fixley Ellixgwood, ]\I.D. 

Editor of EUingwood's Therapeutist, Chicago, Illinois. 



It is a generally accepted fact among those who pay any atten- 
tion to the development of the study of the curriculum demanded of 
medical students that there is altogether too great neglect at the 
present time of the study of the materia medica, and that the study 
that is demanded. is cursory, desultory, and almost entirely devoid 
of attraction to the students. 

The physicians them.selves, being asked to take an introspective 
view of their own knowledge of the Materia Medica, if they are 
honest, in the majority of eases are overwhelmed with their own 
ignorance of the detail of specific or exact action of drugs. ]\Iany 
of them blame their aJma mater, and tliose that should lead in 
medical knowledge, for this ignorance, l)ut I am inclined to tliink 
the individual himself is much to blame, as well. 

Tlie total profession has made marvelous advancement in the 
last three or'four decades in the study of bacteriology, pathology, 
microscopy, in the development of laboratory methods of drug 
study, and in the study of preventive raeddciue and of surgery, but 
in doing this the individual has spent so little time upon the all- 
important subject of Materia Medica and Therapeutics that he 
actually, in many particulars, knows loss of drug action to-day 
than he did thirty years ago. I say this advisedly and regretfully, 
but the individual pliysieian is not as much, a student of Materia 
Medica to-day as he was in the past, because tlie study then of 
Materia ]\Iedica was accounted the most important l)ranch. It was 



DOMINION MEDICAL MONTHLY 125 

not overshad'owed by surgery and the so-called scientific branches. 
To the physician, then, the all-important knowledge was to know 
what medicine to give to his patient when ill, that would cure. 

The study of this subject is ditlficult. It demands concentra- 
tion ; it demands persistency, and unless applied to the immediate 
needs of the patient, unless we can make immediate application of 
the knowledge acquired, it is startlingly devoid of interest. It is 
not exact, and every student delights in exactness. But why is it 
not exact ? It is because our total knowledge of the subject, in the 
first place, is imperfect ; secondly, the study is not conducted in 
systematic, precise, scientific lines. It is not properly cla-ssified or 
arranged ; the study is not made consistent with an exact principle 
of drug action. 

]\Iy object in writing tliis paper for this journal is to attract 
the attention of the readers to a renewed study of the action of 
drugs; to the study of drugs in line with a principle at once exact, 
rational and attractive, and to encourage persistence in this study 
in these lines until the student shall have acquired a knowledge 
and an experience that in itself will stimulate iiim to a most enjoy- 
able persistence in the study, and will enable him to say that there 
is in this stud^', when correctly conducted, a fascination that no 
other study possesses. 

I have been trying to teach for many years the following facts: 
that the reason disease is not cured is btcause ive have the know- 
ledge of drug action necessary with which to cure it, or, conversely, 

That failure to cure disease is due to lack of knowledge; 

That di.sease will ultimately be subdued, in whole or in part, by 
remedial measures; 

That doubt concerning drug action is ?. deadly foe to thera- 
peutic progress; 

That the study of the clinical action of the single drug is the 
only true method of drug study; 

That each drug acts directlj' and invariablj' upon one or more 
exact conditions of disease, and, l>eing so studied and kno^\Ti, an 
exact, reliable knowledge of drug action is obtained; 

That when this knowledge is perfected we will not only pre- 
scribe for known conditions of disease with immediate success, but 
we can prescribe with equal success for conditions we have not 
previously met. 

We begin our study, then, with a perfect analytical study of 
each disease in order to determine those conditions which are in- 
volved, in the patient we are studying at this time. We determine 
a knowledge of these conditions, and an abilitv to recognize them 



126 DOMINION MEDICAL MONTHLY 

whenever we find them, in wliatover disease they may occur. We 
then determine what sinp:le remedy will always meet each one of 
these conditions and correct it. Here is tl'.c whole thing in a nut- 
shell, and really this is all there is to it, as this includes a thorough 
knowledge of the remedies, also, with refererce to their action upon 
exact conditions, as stated above. 

I trust each reader will read and re-read these statements until 
he has them clearly impressed upon his mind, and will weigh them 
fully with reference to his own methods of studying the action 
of drugs, that he may compare the beauty of this method when com- 
pleted, with any other known method. 

It must be accepted at once that thin ?.<; tlie only correct method 
of drug study. If we prescribe compounds because the manufacturer 
has advised them for certain conditions, we acquire no precise 
knowledge of the action of the constituents of that compound, and 
our prescribing is haphazard, uncertain, and largely guesswork. If 
we should, by close study, know the invariable therapeutic pro- 
perties of each one of the constituents of that compound, we are 
enabled to determine whether the total compound is applicable in 
the case required, or whether one or two of its constituents would 
not work even better, or whether it is net totally inapplicable. 

But if we understand drug action as above specified, we will 
seldom, if ever, find an excuse for prescribing a compound, especi- 
ally one prepared for general conditi^^ns, but we will invariably find 
demands in the condition present in the patient we are prescribing 
for, for one, two or three single remedies of which we feel confident, 
and will thus promptly make a perfect adjustment to the case in 
hand. 

This is the course we adopt in every patient, and. this is the 
course we will adopt when we have learned our drugs, and studied 
specific conditions, as above suggest3d, and when we adopt this 
course the results obtained will be so satisfactory the observations 
made will be so rational and consistent, and the confidence we will 
acquire in the knowledge we have so obtained will be so much in 
advance of any knowledge previously accjuired that the real fascina- 
tion of this method will impress itself upon us, and in the future 
we will find ourselves willing students of the specific method of 
drug application. 

Applying tliis method to the study of well-known drugs, everj' 
student is surprised at the amount of kD( wledge thus obtained 
concerning the action of some very common remedies — knowledge 
of actions he had no idea could be present in that drug, materially 
broadening the field of the drug and increasing its value to the 
prescriber, in some cases a thousand-fold. 



DOMINION MEDICAL MONTHLY 127 

Furthermore, those who have been developing this method have 
made observations of a great many drugs that are seldom men- 
tioned by the principal medical journals, or prescribed by the pro- 
fession at large, and which are but little known, or are spoken 
disparagingly of by the Committee on Pharmacy and Chemistry 
of the A.M.A., but which possess values, when studied in this line, 
actually superior to very many drugs upon which volumes have 
been written, as standard drugs, and as those which could not be 
done without. 

'Many of the readers of this journal have learned something in 
an empirical or general way concerning the action of digitalis, or 
aconite, strophantus, or quinine, ergot, nux vomica, belladonna, 
ipecac, geisemium, turpentine, or jaborandi, as common remedies; 
but it is certain that studying these remedies from a specific stand- 
point, we have an entirely different stn<ly. and one wliich brings 
out beauties not before anticipated. 

Added to this, every individual ?hould study from this stand- 
point echinacea, baptisia, berberis, hamameli.c, viburnum, mitehella, 
eollinsonia, dioscorea, colocynth, iris, cb.iouanthus, podophyllum, 
sanguinaria, aselepias, sticta. euphrasia, lobelia, apoc^^lum, cactus, 
crativgus, calil)ar})ean, Pulsatilla, hypscyamus, rhus tox, and per- 
haps one hundred and fifty others that I could mention, and he 
would be surprised beyond measure at the knowledge that would 
develop, and in the ability he would have in the knowledge ac- 
quired, to cope with disease in a satisfactory manner far exceeding 
anything he had ever hoped or known. 

It is to encourage a study, as I have said, in these lines, of both 
the old and the new ^Materia Medica that I am writing this paper. 
It is to disparage the common use of compounds and general phar- 
maceuticals, used with the hope only that they will cure the condi- 
tions for which they are prescribed, when a knowledge of exact 
drug action will enable the prescriber to absolutely know, without 
doubt, what will cure his patient, will make him able to cure the 
condition with positiveness and assurance, thus establishing the 
confidence of his patrons in his ability, first, and secondly, wliich 
is indeed most important, to establish their confidence in the fact 
that disease can he cured with the measures accessible to the 
physician. 

Ignorance of drug action and doubt — therapeutic nihilism— has 
directly undermined the confidence of the people until the drugless 
methods of cure are now sought for and adopted by at least 30 
per cent, of the population of the United States, until the surgeon 
is in demand only to any great extent. Faith in These drugless 



128 DOMINION MEDICAL MONTHLY 

methods cannot endure; they are auxiliar\ only. Let us at once 
re-estal)lish the faith of the masses in correct drug action. 

AVhile I thus ur§re this metliod upon the individual physician, 
this knowledge cannot he ac<iuired at once To hecoiiie an etiHcient 
preseriber, one must be drilled in this study through a long period. 
I think it is necessary, also, that he forget much of the desultory 
knowledge, many of the un.systematic empiiical facts, he has pre- 
viously known. 

To have this method properly woven in with the web and woof 
of his total education, it should be begun with his first day's teach- 
ing in college, and should be continued with every day's instruc- 
tion during the entire course. It is a deplorable fact that so little 
Materia Medica and Therapeutics is systematically, clinically, and 
thus practically, taught in any of the colleges; and I fear there will 
not be much improvement in this cour.se imtil the individual prac- 
titioner and the profession as a body persistently insist upon a more 
thorough teaching of this all-important branch. 

I would be gratified, indeed, and I believe it would result in a 
most valuable discussion, if the reader of tins paper would express 
freely his own opinions on this matter through the pages of this 
journal. All sides of the subject should bo presented. 



DOMINION MEDICAL MONTHLY 129 



flDebicine 



Graham Chambers, R. J. Dwyer, Goldwin Rowland, 
Geo. W. Ross, Wm. D. Young. 



An Inquiry into the Influence of the Menses on the Onset 
and Frequency of Epileptic Fits. By William Alexander, 

M.l)., K.li.C.S. MhHkiI I'nss and Circular. 

The practitioner is constantly being ur^red to sanction pelvic 
operations for tlu' treatment of epilep'^y or to regulate the menses, 
when they tend to be irregular in these patients. 

The feminine mentality considers that epilepsy like nearly all 
other nervous disorders must liave its seat in that chaml)er of 
mysteries, the pelvis, a belief that unfortunately is fostered by many 
physicians. 

Ale.xandei- states that the nurses say that at the periods the 
patients usually are worse and have more numerous and severe 
attacks. 

The principal writers on epilepsy agree that epilepsy often com- 
menced with the onset of menstruation; that delayed or disturbed 
function at puberty may coincide with the appearance of the dis- 
ease, which, if of earlier onset, may then become more severe; that 
the period of menstruation determines the occurrence of the more 
severe or more numerous attacks. 

Alexander 1ms the statistics of 23 yearh. cf the epileptic homes at 
Maghall, and the first fact that he clearly proves is that in the vast 
majority of cases no intlueuce was occasioned by the menstrual 
period on the production of the attacks. (In 666 montlis there were 
no fits in the menstrual fortnight compared with 334 which showed 
them, and in these latter cases many alsa had attacks in the fort- 
night furthest separated from the period.) 

Also statistics showed that during the days immediately pre- 
ceding or following the time of menstruation, there was no relation 
to be deduced relative to its influence on attacks. 

Fifty-two of the cases developed their attacks years before the 
normal age for menstruation and in 17% the fits appeared years 
after its advent, while in only six cases did the two coincide. 

Dr. Alexander can, therefore, lay no stress on any relation 
between the production of epilepsy and the occurrence of men- 



130 DOMINION MEDICAL MONTHLY 

struation. ami in general this function does not in any way influ- 
ence the attacks. 

Surgical interference with the pelvic organs lie strongly depre- 
cates. 



Flatulence. 

Burnet, in the Proctitioucr for October, 1911, .says that in most 
cases the diet will have to be carefully chosen and somewhat re- 
stricted. A rather dry diet will be found to suit best in nearly all 
cases — little liciuid Ix'ing allowed with meals. This excludes all 
soups and brotlis at the beginning of a meal and allows of only a 
small quantity of fluid toward the close of the meal. What the 
special drink should be has to be decided in each particular case. 
Some will do best w'itli plain water, others may require a little 
stimulant — alcohol in some form. 

"We have to consider carefully in thes^ cases whether alcohol is 
necessary, and if so what form is best. If given it should be pre- 
scribed W'ith caution, more especially in the case of women suffering 
from dyspepsia, for oftentimes the temptation to seek temporary 
relief by its means from discomfort and flatulent distention, and 
the lassitude accompanying these conditions, is very great. From 
such beginningK a dependence upon alcoholic stimulants sometimes 
becomes established. If alcohol has to be given the amount should 
be clearly defined and given with or just after meals. Effervescing 
waters are often forbidden, but in the writer's opinion, if taken in 
stricth^ limited amount, they are helpful rather than otherwise, 
owing to the stimulus given by the gas they contain. The light 
white wines and clarets are of doubtful value, but sometimes a glass 
of dry sherry seems to aid digestion. Champagne is rarely re- 
quired, but in some oases where there is much prostration it is 
useful for a time. Ales and stout are not as a rule well borne. No 
alcohol in any form should be given on an empty stomach. 

Tea must' be limited in quantity and must be freshly made. The 
stewed decoction called tea, so dear to the heart of the hospital out- 
patient, is a fruitful source of these digestive troubles and of the 
"spasms" so graphically described by the frequenters of hospital 
out-patient rooms. Distention and disturbances of digestion are 
not, however, by any means confined to the class of persons who 
come under treatment at hospitals, and as a source of flatulence the 
excessive use of tea amongst well-to-do people should be always 
borne in mind. 

Animal food is, as a rule, best digested by tliese patients ; it must 



DOMINION MEDICAL MONTHLY 131 

be carefully selected and well, tliougli plainly, cooked— under, 
rather than overdone ; tender 'beef and mutton, "chicken and other 
birds, game, and fresh white fish. Pork, veal, goose, duck, etc., 
should be forbidden. It will be often found best at first to limit 
the meal meals — luncheon and dinner — to practically one course, 
lig*ht tender meat and a little vegetable with a biscuit and butter 
to follow. Such green vegetable will u-sually not be well borne, and 
what is given should be rubbed through a sieve — cooked as spinach 
is served. Often it is best to forbid potato for a time, and to substi- 
tute toast or second day's bread. Farinaceous foods have to be 
given carefully and the effect watched, but where digestion by the 
stomach is chiefly at fault starchy foods, as they are dealt with 
chiefly in the intestines, may be given in greater amount. The con- 
trary holds good where digestion goes on best in the stoinacii : then 
meats are most satisfactorily digested. Ripe fruits have to be 
taken in great moderation, and raw vegetables, salads, etc. are not 
usually allowable in the earlier stages. 

Whether meat preponderates in the dietary or farinaceous 
foods, the absolute necessity for slow eating and complete mastica- 
tion of all solids should be strongly and repeatedly impressed upon 
the patient. It is always well to a.scertain the condition of the 
teeth, and not infrequently some repairs have to be carried out by 
the dentist }>efore complete and comfortable mastication can he 
attained ])y the patient. 

Nux vomica is one of the most useful remedies in these cases 
and it may be given in tincture, or in pill with a quarter of a grain 
of capsicum and a couple of grains of compound rhubarb pill. Bis- 
muth is of use in many in.stances. with an alkali such as bicarbonate 
of sodium, and calumba or other bitter infusion. Salicin is not used 
so much as we believe it might be, and given in five or ten-grain 
doses in water before meals is often very helpful. Pepsin seems 
distinctly indicated, but it is often disappointing, and at the best 
it must be looked upon more as a palliative than anything else. 
Pancretin, too, does not give the relief in all cases that we should 
expect from it. Salicylate of sodium with liquor pepticus, nux 
vomica and spirits of chloroform seems useful in a certain number 
of eases. Extract of malt given with or just after meals helps in 
those eases in which the digestion of starchy foods is obvioiLsly 
difficult. A few drops of dilute hydrochloric acid in water shortly 
after meals is often decidedly beneficial. In some cases iron and 
quinine seem to be indicated, and in many cases we prescribe them 
only to find how difficult it is to get them to agree, especially in the 
earlier stages. When improvement has set in they may be tried 



132 DOMINION MEDICAL MONTHLY 

witli more confidence. A pill which is often well borne consists of a 
^M-aiii of ivdiu'cd iron, with extract of nnx vomi>'a, quinine and pil. 
rlifi coinp. It acts as a tonic and also as a mild aperient. It may 
be varied hy a grain of pepsin and a twentieth of a grain of ai*sen- 
ous acid in place of the quinine, and it is useful in anemic subjects. 
Calomel in very .small fractional doses, given twice daily for a few 
days at a time, has often a very good effect, and where there is a 
sluggish action of the liver a grain or two of blue pill with the pill 
colocynth and hyoscyamus, or the compound rhubarb pill, should 
be given occasionally and followed, if necessary, by a mild saline 
in the morning, but anything like strong purgation should be 
avoided. 

Where the distention is chiefly in the bowels salicylate of ])is- 
muth, beta-naphthol, and salol, in cachet, give at least temporary 
relief. 

Lavage is not usually needed in the cases we are considering, but 
where there is much accumulation of mucus it is very helpful by 
clearing the stomach and thus giving a fair start to other treat- 
ment. 

In acute attacks of flatulence hot water, with aromatic spirits of 
ammonia and spirits of chloroform with perhaps a teaspoonful of 
brandy, often relieves the tension and spasm. Somi^imes a drop 
or two of oil of cajuput in mucilage has a very good effect. 

In cases in which it is possible for the patient to follow such 
advice we may recommend riding on horseback or traveling, sea- 
bathing for young subjects, or a voyage, as the best means for 
completing the cure and preventing a recurrence of the symptoms. 
— Therapeutic Gazette. 



Dr. Taylor, so aptly called the Canadian doctor's friend, is 
gradually gaining the reputation of one of the most careful and 
pre-eminent neurologists in Great Britain, and Sir William Ciowers 
has wisely selected him as his closest as.sociate. 

Taylor, who is no longer young, states that in his experience 
(which is a vast one) that he each year is inclined to diagnose 
functional nervous disease less frequently, and more often to suspect 
an organic basis. He also states that the disease, dis.seininated 
sclerosis, is becoming in England the dumping ground of indefinite 
diseases (a tendency observed also in Canada). 

Spinal Caries is a disease in which the nervous signs are very 
variable, and it is possible to have complete motor paralysis in the 



DOMINION MEDICAL MONTHLY 133 

legs and yet no curvature visible, and no loss of sensation percept- 
.ible in either extremity. 

Often in these organic diseases which ultimately cripple, such 
as insular sclerosis and that more fatal disease subacute combined 
(which by the way seems fairly common in this country) you will 
find a markedly hypersensitive, even hysterieal mental condition 
associated with spinal symptoms. 

Dr. Taylor describes a case of tabes with gastric crises, and in 
doing so emphasizes the facts that ataxia may not be a cardinal 
sign in this type, and also that they frequently live for many years. 
These cases are mistaken on account of the gastric signs for severe 
abdominal conditions, and in this regard he refers to an American 
who displayed two large scars, from the operations performed on 
erroneous diagnosis. (This recalls to my mind a case seen in my 
student days when a man was operated on for stone in the kidney, 
on alternate sides, without success and where the diagnosis was 
ultimately found to be tabes. Perhaps this is Taylor's case.) 

Retrobull)ar nerve disease causing loss of vision may be the first 
symptom of some diffuse nervous disorder, and in connection with 
ocular conditions it is also necessary to recall the fact that Graves 
disease may be earliest evidenced by the prominence of one eyeball 
only, while in other cases no signs appear but diarrhea, wasting, 
cardiac rapidity and discomfort. 

Taylor adds that he has never yet advised operation for Graves 
disease, and that belladonna is his sheet anchor. 



Treatment of Gastric Ulcer by Lenhartz's Method. By John J. 

GiLBRIDE, A.M., ^I.I)., PlIII.ADKI.I'llI A. 

Lenhartz's treatment takes two weeks — it is essentially a diet- 
etic form. 

He, however, orders four weeks in bed at absolute rest, and 
uses the alxlominal icel)ag. 

Iced milk and eggs, raw and iced, are given every alternate hour 
from an "iced" spoon; and the day's treatment begins at 7 a.m. 
and lasts luitil 9 p.m., with no night treatment. 

About 100 c. of milk and one extra egg is added to the total 
of the preceding day, so that at the end of one week 800 ee. of milk 
and 8 eggs are being taken. Sugar is added to the eggs on the third 
day, but only 35 grammes of raw beef on the sixth day, while 
from the 7th to the 10th 80 gms. are given. 

After 3 — 4 weeks a return to natural diet is allowe<l. Tlie 
cases reported were successfully treated. 



134 DOMINION MEDICAL MONTHLY 



IReviews 



W. B. Saimders Company have just issued a new (16th) edition 
of their Illustrated Catalogue, which deseril^es some forty new books 
and new editions published by them since the issuance of the 
former edition. The books listeil in this e<Ualogue cover every sub- 
ject of interest to the medical man. The descriptions and illustra- 
tions are such as to enable the reader to select easily just the book 
he wishes on any l)ranch. It is really an index to correct medical 
literature — an index by which the practitioner, the surgeon and 
the specialist can acquaint himself with what is new in the litera- 
ture of his subject. This edition also contains an illiLstration and 
description of Saunders' new ])uilding, now being erected on Wash- 
ington Square, Philadelphia's new publisliing centre. Any physi- 
cian wishing a copy of this handsome catalogue can obtain one free 
by addressing W. B. Saunders Company, 925 Walnut Street, Phila- 
delphia. 



The Taylor Pocket Case Record. By J. J. Taylor, :\LD. 252 
pages, tough lx)nd paper; red limp leather. $1.00. Published 
by The ]Medical Council Co., Forty-second and Chestnut Streets, 
Philadelphia, Pa. 

The object of this book is to encourage more accurate observa- 
tion and study of cases by supplying a convenient form for a con- 
densed record of each important case, in pocket size, so that the 
practitioner can have it always with liim, and so arranged that the 
necessary data can be written down in the briefest possible time — 
preferably while the examination is actually being made. 

Thoroughness of examination is encouraged by means of a Sylla- 
bus, detailing all tlie points tliat should be considered in each case. 

The blank for the first thorough examination, diagno.sis and 
treatment is followed by .spaces for sixteen sub.sequent visits. 

The book provides for 120 cases. 



DOMINION MEDICAL MONTHLY 135 

Blair's Pocket Therapeutics. A Practitioner's Handbook of Medi- 
cal Treatment. By Thomas S. Blair, :\I.D., Neurologist to 
Harrisburg, Pa., Hospital; Author of "A System of Public Hy- 
giene," "Blair's Practitioner's Handbook of Materia Medica," 
Member of the Harrisburg Academy of Medicine, American 
^ledical Association, etc.; 373 pages, special Bible paper; bound 
in limp leather; price, $2.00. Published by The Medical Council 
Co., Forty-second and Chestnut Streets, Philadelphia, Pa. 

The physician very frequently needs, for instant reference, a 
book which gives the best methods of treatment in any given case. 
Many Imoks have been offered for this purpose, but they consisted 
only of collections of miscellaneous prescriptions and formulas, 
totally unrelated to each other, with no rules or reasons to guide in 
their use, and almost u.seless to the pliysician with any independ- 
ence of thought or scientific bent of mind. 

This lx)ok gives a condensed intelligent discussion of the best 
methods of treatment, basetl on scientific principles, with a well- 
tried, reliable formula occasionally to illustrate the application of 
the principles. The author gives many modes of treatment far in 
advance of the present text-'books. An ingenious method of in- 
dicating relative dosage is to print tlie name of the drug in CAPI- 
TAL LETTERS for large doses, in ordinary type for medium doses, 
and in italics for small doses. An exhaustive "Table of Large, 
Medium and Small Doses" is given in the book. 

The diseases treated are divided into related groups, each group 
occupying a chapter, according to the following classification (a 
copious alphabetical index provides for instant reference to any 
particular disease) : 

Chapter I. Diseases Incidental to Birth. II. Essential Diseases 
of Childhood. III. Essential Diseases of Environment. IV. Dis- 
eases of Occupation. V. Infectious Diseases. VI. Diseases of the 
Pericardium. VII. Diseases of the Heart. VIII. Diseases of the 
Blood Vessels. IX. Diseases of the Bronchi. X. Diseases of the 
Lungs. XI. Diseases of the Pleura. XII. Diseases of the ^louth. 
Salivary Glands and Esophagus. XIII. Diseases of the Stomach. 
XIV. Diseases of the Pancreas. XV. Diseases of the Intestines. 
XVI. Diseases of the Rectum. XVII. Diseases of the Liver and 
Gall Bladder. XVIII. Diseases of the Spleen. XIX. Diseases of 
the Peritoneum. XX. Diseases of the Uropoietic System. XXI. 
Diseases of the Lymphatic Vessels. XXII. Diseases of the Thyroid 



136 DOMINION MEDICAL MONTHLY 

Cilaiul. XXIII. Nutritive Disorders. XXIV. Diseases of the 
Blood. XXV. ]\Iental Diseases. XXVI. Diseases of the Brain and 
Meninges. XXVII. Diseases of the Spinal Cord. XXVIII. Dis- 
eases of the Periplieral Nerves. XXIX. Disea.ses of the Muscles. 
XXX. Animal Parasites. XXXI. Aleoholisin and Drug Addictions. 
XXXII. Diseases of the Skin. XXXIII. Diseases of the Ilair and 
Nails. XXXIV. The Principal Diseases of the Eye. XXXV. Dis- 
eases of the Ear. XXXVI. Diseases of the Nose. XXXVII. Dis- 
eases of the Tonsils, Pharynx and Larynx. XXXVIII. Obstetrical 
Therapeutics. XXXIX. Non-Surgical Gynecology. XL. Surgical 
Therapeutics. XLI. Essential Diseases of Old Age. XLII. Treat- 
ment of Poisoning (arranged Alphabetically as to the Different 
Poisons). The Appendix gives ver>' many necessary tallies for 
quick reference, followed by an exhaustive Table of Doses, closing 
with a General Index. 

In order to get all this within the compa.ss of a book for the 
pocket, a very thin, tough Bible paper has been used, so that it is 
really a much larger book than it looks. 

This book will be a useful pocket companion to the physician in 
his dailv work. 



2)ominion /Ihebical /Ibontbl^ 

anO ©ntario ^eDical journal 

EDITED BY 

Medicine: Graham Chambers, R. J. Psychiatry: Ernest Jones, W. C. Herri- 

Dwyer, Gold«in Howland, Geo. W. man. 

Koss, VVm. D.Young „ u . » Opiithalmologry : D. N. Maclennan, W. 

Supgrepy : U alter Mckeown, Herbert A | jj i.owry 

Bruce, W. J. O. Malloch, Wallace A. _,, , \ , , , -..^ , 

Scott, George Kwart Wilson. Riiinologry. Lapyngrology and Otol- 

ObstetPics : og-y ; Geoffrey Boyd, Gilbert Rojce. 

Arthur (\ Hendrick. Gynecology: F. W. .Marlow, W. B 

Pathology and Public Health : John Mac, dry. 

^tA^'/^'- f''"^=^- J <-" V*- llastinga, Genito Upinapy Supgepy : T. B. 

O. K. M:ibee Geo. Nasnivth. | Itichard.sou, W. Warner Jones. 
Physiologic Thepapeutics : 

J. Harvry Todd. | Anesthetics: Samuel Johnston. 

GEOBOX: EIiIiIOTT, MAKAOXKO ESITOB. 

Published on the 20th of each month for the succeeding month. Address 
all Communications and make all Cheques, Post Office Orders and Postal 
Notes payable to the Publisher. GEORGE ELLIOTT, 203 Beverley Street, 
Toronto, Canada. 

Vol. XXXVIII. TORONTO, APRIL, 1912. No. 4 



COMMENT FROM MONTH TO MONTH. 

Lord Lister, t)orn on April otii, 1827. died February' 11th, 
1912, in his 85th year. No other medical man in modern times, 
with possibly the single exception of Pasteur, wa.s so universally 
known, respected and beloved. He was, indeed, one of ti\c great 
benefactors of mankind. 

Although Lister's name will be forever inseparably associated 
with the antiseptic theory applied to surgery, paving the way for 
the later asepsis, he simply sharpened the sword. He did not forge 
it. 

"Robert Boyle foresaw that the man who should discover the 
true nature of fermentation would shed light on infective disease." 

Holmes and Seminelweis maintained with regard to puerperal 
fever that certain bodies or organisms were the cause of this dis- 
ease, as it had been suspected they were the cause of pyemia as 
well. The latter, without much theory at all, is said to have saved 
many lives by antiseptic principles. 

.Lister was inevitable after Coginard Latour's discovery that 
yeast consisted of living cells, S'usceptible of reproduction by a sort 
of budding process. 

Pasteur showed that fermentation in beer and wines was due 
to living organisms, and that all putrefaction was due to a similar 
cause. 

When the principle that suppuration was a fermentation of the 
flesh was established, the suggestion was soon evolved that suppura- 



138 DOMINION MEDICAL MONTHLY 

tion could be preventi'd by preventing: access of the ^erin or destroy- 
ing: it when present. 

This proved proposition of the germ theory then led to tiie 
application of antisepsis to surgery. 

Carbolic acid was discovered in 1834 by Lange. Liebig in 1844 
and Calvert in 1851 investigated its disinfectant properties. Le- 
maire made his tirst experiment in a case of gangrene in 1859; and 
published his book on carbolic acid in 1863, the date of the dis- 
covery of the first microl>e of disease. 

The Italian surgeon, Bottini, published an article in 18GG on the 
use of carbolic acid in surgery and taxidermy. 

Lister's work is immortal. Pie began tiiat work in 1865, and the 
place where he conducted his experiments was the Glasgow Royal 
Infirmary. 

Reports of this work were first published in T]ie Lancet of 
March 16th, 23rd and 30th, April 27th and July 27th, 1867. 

The natural heir of Pasteur, in 1874 he acknowledged his in- 
debtedness to that great scientist in these words: "Allow me to 
take this opportunity to tender to you my most cordial tlxanks 
for having, by your brilliant researches, demonstrated to me the 
truth of the germ theory of putrefaction, and tlius furnished me 
with tlie principles upon wliich alone the antiseptic .system can be 
carried out." 

Lister early directed his mind towards science. After having 
been graduated in London in 1852. at the age of twenty-five years, 
he published papers on the muscular tissue of the skin and the 
contractile tissue of the iris. Between the years 1857 and 1862 
his writings, considered remarkable and illuminating, dealt with 
inflammation and coagulation of the blood. 

He was appointed Professor of Surgery in the University of 
Glasgow in 1860, later going to Edinburgh, and then to King's 
College, London. He was knighted in 1883 and raised to the peer- 
age in 1897. 

His claim to fame rests upon his conclusive demonstration, 
founded upon personal observation and application of the anti- 
septic utility of carbolic acid. Medical literature has fairly teemed 
with the brilliant results, the outcome of his life-work Of him 
Henley wrote : 

"TiiK Chief." 
His brow spreads large and placid, and his eye 
Is deep and briglit with steady looks that still; 
Soft lines of tranc[uil tliought his face fulfil — 
His face at once l)enign, and jji-oud, and sliy. 



DOMINION MEDICAL MONTHLY -139 

IHevps Jtems 



Dr. J. C. Alguire, Athens, Ont., died suddenly March 3rd. 

The annual meeting of the Manitoba Medical Association will be 
held in Winnipeg this year. 

The Legislative Committee of the Quebec Legislature has ap- 
proved of the Roddick Bill. 

Dr. R. a. Corbett, Port Hope, died on the 27th of January. He 
was in his 75th year. 

Dr. T.wlor, of St. Catharines, Ont., died the 13th of February, 
of pneumonia. 

Dr. Walter S. Verrali., hite House Physician at the Toronto 
Orthopedic Hospital, has commenced practice in Phoenix, B.C. 

Dr. a. S. ^Foorhead, late House Surgeon Toronto General Hos- 
pital, has been successful in becoming a Fellow of the Royal College 
of Surgeons. 

Dr. J. W. S. ]\rcCuLLOUGn, Secretary of the Ontario Board of 
Health, recently lectured before the medical body of Queen's Uni- 
versity. 

The ]\Iedical Faculty of ^McGill L'niversity will consider the best 
means of perpetuating the memory of the late Lord Lister. The 
matter is in the hands of Drs. T. G. Roddick and F. J. Shepherd. 

Dr. Geo. E. Armstrong, Montreal, was lately operated on by 
Dr. W. J. Mayo, Rochester, Minn. His many friends in the pro- 
fession in Canada will hope for a speedy and complete recovery. 

Dr. C. H. Britton, East Toronto, died recently after a linger- 
ing illness. The late Dr. Britton was highly esteemed in the pro- 
fession. He was a brother of Dr. W^m. Britton. Toronto, a past 
president of the Ontario Medical Association. 

The Ontario Medical Association will meet in Toronto, May 21st, 
22nd and 23rd, 1912, under the presidency of Dr. Herbert A. Bruce. 
Dr. Graham Chambers is Chairman of Committee on Papers and 
Business; Dr. J. T. Fotheringham, Committee on Arrangements; 
Dr. A. Primrose, Chairman of Surgical Section ; Dr. W. P. Caven, 
Chairman of ]\Iedical Section; Dr. Geoffrey Boyd, Eye, Ear, Nose 



140 DOMINION MEDICAL MONTHLY 

and Throat ; Dr. Fred. Fenton, Obstetrics and Diseases of Women. 
The Secretary, Dr. F; Apnold Clarkson, 471 Colk'^re St.. will be 
glad to furnish information of this meeting. 

Montreal Gexkral IIosimtal. — The work in this institution 
increased remarkably during the last yoar, and there was a deficit 
of $25,168.55. The income was .+138,000. The expenditure in- 
creased by $10,000. The salaries paid amounted to $8,600. With 
the new addition it will take .$2()(»,0(H) per annum to run this institu- 
tion. The indoor patients in 1911 totalled 4,146, an increase of 560. 
In the outdoor departments there was an increase of 1,004 consulta- 
tions. The mortality of the hospital was 303. Dr. F. J. Finley 
was re-elected Secretary. 

]\IoxTREAL*s Death Rate ix 1911. — The death rate in Montreal 
has been decreasing in the past three years. In 1911 the rate per 
1,000 of the population was 21.39; in' 1910, 22.40; in 1909, 22.95. 
The death rate amongst infants in 1911 was less than in former 
years, but it still remains high. The rate per 1,000 in 1911 was 
53.69; in 1910, it was 54.19. One-half of the deaths were in chil- 
dren under five years of age. Comparing the death rate with other 
large cities, Montreal is only exceeded by ^Madrid, whose rate was 
27.2. London, Eng.. had a rate of 15.1; Paris, 18.6; New York, 
18.9; Berlin, 14.8. 

Internatioxal ^Medical Congress. — Recent communications 
from London, England, indicate that the XVIIth International 
Congress of Medicine to be held there in August, 1913, is to be of 
great scientific and Imperial importance. We have mentioned 
before that it was the intention of the President to give representa- 
tion of the profession in the Overseas Dominions on the Commit- 
tees of the Congress and the various Sections. We are now in a 
position to state that the President desiring to pay the Canadian 
profession a compliment has alloted two places on the British 
Executive and six places on the British Organizing Committee. 
In addition Canadians have been selected as Vice-Presidents of 
several of the more important sections, as well as placed on the 
councils of the various sections; altogether over fifty members of 
the profession in Canada will be thus officially associated with the 
Congress. There is no doubt that it is owing to the sympathetic 
attitude of the President, Sir Thomas Barlow, the Honorary Sec- 
retary, Dr. W. P. Ilerringham, and the President of the Section 
in Medicine, Sir Wm. Osier, that such representation has been 
given to Canada. The Canadian National Committee is composed 
of the Deans of five medical faculties, namely. Dr. C. K, Clarke, 



DOMINION MEDICAL MONTHLY 141 

Dean of the Medical Faculty, University of Toronto ; Dr. J. C. Coii- 
nell, Dean of the Medical Faculty, Queen's University; Dr. H. H. 
Chown, Dean of the Medical Faculty, Manitoba University; Dr. E. 
P. Lachapelle, Dean of the Medical Faculty, Laval University ; F, 
J. Shepherd, Dean of the Medical Faculty, McGill University, and 
three who have held office in the Canadian Medical Association, Dr. 
George Armstrong, IMontreal, and Drs. A. McPhedran and W. H. 
B. Aikins, Toronto. 

Canadian Hospital Association. — The next meeting of the 
Caiiadian Hospital Association ^^^ll be held in the Parliament Build- 
ings, Toronto, on Tliursday. Frida.v and Saturday, April 4th, 5tl) 
and (itli. Dr. H. A. Boyce, Superintendent of the Ceneral Hospital, 
Kingston, is President, and will deliver the annual address. The 
meeting on Thursday evening, April 4th, 8 p.m., will be open to the 
public, and addressed by Mr. Monro Greer, representing the General 
Hospital, Niagara Falls, Ontario; Dr. Helen ^MacMurchy, of To- 
ronto, and Dr. Edward Stevens, Hospital Architect and Specialist, 
of Boston, Mass. Dr. jMac^Iurchy will deal with the subject, "The 
Relation of the Public to the Hospital." Dr. Stevens will give an 
illustrated address on "What the Home Can Learn from the Hos- 
pital in Regard to Construction." On Good Friday a Round Table 
Conference and Question Drawer will be conducted by Dr. Bruce 
Smith, Inspector of Hospitals for Ontario. A special exhibit of 
hospital apparatus and devices will be made, the uses of which will 
be explained by Dr. W. J. Dobbie, Physician-in-Chief of the Weston 
Sanatorium for Consumptives. Mr. W. W. Kenny, Superintendent 
of the Royal Victoria Hospital, Halifax, will present a paper on 
"Hospital Maintenance." Dr. E. H. Young, Assistant Superin- 
tendent of the Rockwood Hospital for Insane, Kingston, will give 
an address on "The Hospitalization of Asylums." Dr. J. N. E. 
Brown will read a paper on "European and American Hospitals 
Contrasted." Mr. H. E. Webster, Superintendent of the Royal 
Victoria Hospital, ]Montreal, will give a paper on the "Construction 
of Small Hospitals." Mr. J. S. Parke, General ^Manager of the Gen- 
eral Hospital, Montreal, will present a paper on "Hospital Annual 
Reports." Dr. James Third, Professor of Medicine in Queen's L^ni- 
versity, will deal with the question, "The Hospital from the Phy- 
sician's Standpoint." Dr. Theodore ^lacLui-e, Superintendent of 
the Solway Hospital, Michigan, will read a paper, "Problems in the 
Management of Small Hospitals." Dr. C. K. Clarke and other pro- 
minent hospital workers will also present papers, among which will 
be one on "Hospital Housekeeping." Tlie leading feature of the 
Saturday morning session will be an address by Miss Charlotte 



1 12 DOMINION MEDICAL MONTHLY 

Aikfiis, line dl" tile t'orciiKist liospital workrcs on llic coiil iiifiil. Tlic 
subiect of lier address will he *" Hospital Publicity Mrtli(»<|s, \Vis(' 
and I'll wise." Hospital 'Priistet's and Superintendents are eliy:il)le 
for ineinl)orship. Tlie f|iiestion of Amal^Miiiatioii with the Associa- 
tion of Training; School Superintendents will be discussed. Mem- 
bers and all other persons interested in hospital work wishing to 
attend will be able to take advaiitajje of the Easter reduced railway 
rates, and a lari;c attendance is looked for from all parts of the 
Dominion. A number of hospital boards are arran^riui; to |>ay the 
railway expenses of their sui)eriiitendents in orch-r to have their 
hospitals represented at llie nieetiiiir. 

St. John Amhi'L.wck liKiuADK in ( a.nada. --'riiere lias recently 
been foriiutl in Toronto a Division of the St. John Ambulance bri- 
gade, and as the institution of this movement in Canada is of con- 
siderable interest to the membei-s of the medical profession, a few 
words as to the origin of the Brigade will not be out of place. The 
Order of St. John of Jerusalem, to which th(' St. John Ambulance 
Association and lirigade owe their allegiance, is the modern scion 
of the early Knights, who in the days of the pilgrimage to Jeru- 
salem, banded themselves together to relieve the distress and sutfer- 
ing which was rife among>t the religious converts who formed the 
ranks of these pilgrimages. As early as A.D. 1099, the merchants 
of Amalfi organized to relieve vsutferers amongst the pilgrims, and 
for this ])urposc formed hospitals in which to receive and treat these 
ca.ses. In the year A.D. 1118 Baldwin IT, the then King of Jeru- 
salem, gave the members of the original Brotherhood military .sta- 
tus, and under their new name the members were divided into three 
cla.sses, known as Knights of Justice, tlie Conventual Chaplains and 
Priests of Obedience, and tho.sc of the lower grades of society were 
known as the Honorary Serving Brethren. After many struggles, 
in which blood was shed, covering many years, the Order was driven 
from Jerusalem and establisiied themselves in Malta, but were later 
ordered to disband, and their property was coiiH.scated by King 
Henry VIII. later being revived by Queen Mary to be again dis- 
banded by Queen Elizabeth. The Order had, however, continued to 
meet in .secret, and in the reign of Queen Victoria, application was 
made to Parliament for a charter to reorganize the Order, and the 
necessary permis.sion was obtained, the reigning Sovereign to be 
the Sovereign Head of the Order, and the Prince of Wales, the 
(Jrand Prior. From the Order was formed the St. John Andiulance 
Association in the year ISSS, the aim of the Association being to 
give general instruction in the care of the sick and injured, and 
under its banner some hundreds of thousands have taken the course 



DOMINION MEDICAL MONTHLY 143 

of lectures and obtained the certificate of qualification. Some years 
later the St. John Ambulance Brigade was formed to give those who 
had qualified an opportunity to practice their knowledge, and it 
was speedily seen that much good might be derived from having 
these men and women organized into a semi-military body, to give 
assistance wherever their services could be of use. To this end the 
Brigade was uniformed and drilled, and now there is no public 
function in London at which crowds are gathered, wliere there is 
not also detacliments of the Brigade ready to dt'id with any case of 
emergency. On Coronation l*rogress Day, 1911, over 10,000 cases 
were treated along the route of the procession, by memljei-s of the 
Brigade. The work grew in popularity, and as a result, there are 
over 100,000 members within the ranks throughout the British 
Empire. Canada has not, liowever, until recently founded this 
movement, but since its inception in 1911, members have continued 
to pour into the Corps. The arrival of H. R. IL the Duke of Con- 
naught, who is Grand Prior of the Order, should give an immense 
impetus to the work, and it is expected that this year will see a great 
expansion of the knowledge taught. Dr. C. J. Copp is the Honorary 
Secretary of the Ontario Executive Council of the St. John Ambul- 
ance Association, whilst Superintendent G. K. N. Collins, of Or- 
chard View Hospital, is the Organizer and Corps Superintendent of 
the Ambulance Brigade. The work is one in which the medical 
profession may render assistance, by organizing classes for instruc- 
tion in their districts, and for this service, certificates of honor are 
granted, while fees may be collected if so desired. Either of the 
above gentlemen will be glad to furnish details when a.sked, and 
will welcome the assistance of the members of the profession at all 
times. His Majesty King (leorge, has graciously consented to 
review the St. John Amlmlance Brigade at Windsor Park during 
the spring, and for this purpose twenty meml^ers of the Toronto 
Contingent will leave for England to represent Canada in !May. 
His i\Iajesty the King and H. R. H. the Duke of Conuaught both 
take a keen and active interest in the advance of the work, and 
H. R. H. the Duchess of Connauglit is the holder of the five certi- 
ficates issued l)y the Association. 



144 DOMINION MEDiCAI. MONTI IT A' 

Ipubliebcrs' ^Department 



Face massage, scalp treatments, body massage, needle sprays, 
colored light baths and electriL-al massage are now essentially re- 
quired as efficient adjuncts to the medical man's armamentarium. 
Where experience and skill in administering such treatments are 
assured, it is very satisfactory to the practitioner who has to refer 
cases for treatment under special supervision to know such will be 
conducted efficiently and intelligently. Toronto or out-of-town 
medical men will know that well-appointed parlors and sun room 
have quite recently been opened in the city. These are in charge 
of and under the personal supervision of Mrs. Xeil MacKinnon, late 
of Scotland. The institution is conveniently and centrally located 
at 20 Walmer Road. 



A Fixe Line of Steiulized S^HjUtions. — Hermetically sealed 
glass ampoules containing sterilized solutions of important drugs 
for hypodermic use have assumed a commanding place in medicine 
in a comparatively short period of time. Two or three years ago. 
seeing the tendency in this direction. Parke, Davis & Co. brought 
out a modest line of something like a half-dozen formulas, notable 
among them being solutions of Adrenalin, Codrcnin and Cacodj'late 
of Sodium. From this small beginning the line has expanded until 
now the company announces a total of about twenty distinct for- 
mulas. The full list, we understand, is now appearing in display 
advertisements in the leading medical journals of the country. 
Physicians who are interested in this advance in h^-podermic medi- 
cation — and every physician ought to be — will do well to search out 
these advertisements and familiarize themselves with the compre- 
hensive line of solutions therein offered. Solutions provided by the 
glaseptic ampoule, it is obvious, have several advantages over those 
prepared in the ordinary manner. They are ready for immediate 
use : there is no necessity to wait until water can be sterilized and 
cooled. Accuracy of dose is ensured, each ampoule containing a 
definite quantity of medicament. The solutions are aseptic; they 
are permanent. 



Brand's Beef Tea Tabui.es. — Another form of the Concen- 
trated Beef Tea, most valuable to travellers, as they are so easily 
carried and simply need to be dissolved in a breakfast cup with 



DOMINION MEDICAL MONTHLY xvii 




Are you particular as to'the condition of the iron in your 
Blaud preparations ? 

Frosst's Perfected Blaud Capsules present True Ferrous 
Carbonate. 

Each 10 grain Capsule contains, approximately, 1 grain of 
Iron. 



xviii DOMINION MEDICAL MONTHLY 

boiling water to ho ready for immediate use. Doctors and nnpses 
tind tluMu most xisefnl and snstaining wlien retnrning home late 
at night, it may l)e from a trying case, as a cup of nutritious beef 
tea is prepared so easily and relieves the tired energies before 
retiring to rest. District nurses, sick visitoi's and visitors to the 
poor tind them invaluable, as they may be carried so easily in tlieir 
l)ag or reticule and are immediately at hand if coming across a 
child or person whose illness is largely, if not, in some cases, 
entirely due to mal-nutrition, a cup of good beef tea, quickly pre- 
])ared by the aid of one of these tabules, gives tone and nourishment 
to the system, and in some cases will cure what seems to be a likely 
serious case, without the aid of the doctor. They are useful for 
almost any home purpose and should have a place in every store 
cupboard. AVith these tabules a cup of l)eef tea can be made on 
i-eturning home late at night from a concert, theatre or entertain- 
ment, and is most nutritious and valuable. As an addition to 
gravies, stews, etc., the housewife will tind them rendering addi- 
tidiiiil strciiiTtli and I'iclmess and a delightful flavor. 



Pnel'moni.v. — H. A. Hare, in the November number of the 
Therapi uiic Gazette treats of the bearing of pneumonia, considered 
as a terminal infection, upon treatment. In June, 1910, he reported 
his experience as to the importance of studying the relative ratio 
of pulse rate and blood pressure in the course of croupous pneu- 
monia, and expressed the belief that such o])servations were of the 
greatest value in the application of coi'rect treatment. Rince then 
increasing experience with this plan lias convinced him still moi'e 
that it is practically an es.sential factor not only in treatment but 
in pi-ognosis as well. It will be recalled that the favorable ratio 
in croupous pneumonia is one in which the pulse rate per mfnute 
is less than the nund)er of millimeters of mercury as shown by the 
sphygmomanometer. In other words, if the pulse rate be 90 and 
the blood pressure 120, llie patient is doing very well. If the pulse 
rate be 100 and the blood pressure 110 he is not doing as well as 
])efore. If the pulse rate be 110 and the pressure 110 something 
must be done to bring back the normal difFerence referred to, and if 
the pulse rate be 320 and the pres.sui-e 110 he is in grave danger, 
and will probably die unless very active treatment causes him to 
rally before this abnormal ratio has lasted for any length of time. 
The fall of pressure may be considered to be the result of the 
toxemia which directly affects the vasomotor centres or the walls 
of the vessels themselves, or it may be due to a direct etTect on the 



DOMINION MEDICAL MONTHLY 







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XX DOMINION MEDICAL MONTHLY 

lifiirt iiiusclr wlii'i-t'liy tliis oi-jraii is uiiiible to puiu]) stroiii^ly oiinu^h 
t»» iiiaiiitjiiii piTssui-c. 11" the heart be at fault, attention must he 
(lireeted to that orjraii. If tlie vessels be at fault the (litTercnee be- 
tween (liastolie and systolie ])ressure will ])e marked, the lieart, if 
strong, sending out a forcible wave of blood to fill the blood paths. 
On the other hand, if the pressure be low from a failing heart, there 
will be little difference between diastolic and systolic pressure, for 
obvious reasons. Although he is firmly convinced that the ratio of 
pulse rate to pi-essnre is a comparatively new sign of great value, 
he is also equally firmly convinced that it is a fatal error to neglect 
all those j>hysical signs and states on which we have relied hereto- 
I'tire. and any errors in jirognosis or any failure in treatment do 
iiol pi'ove that tlie new sign is useless, ])ut that the liuiti.in iiiiiid is 
not iiifallil)le so far as the physician is concerned, and the ])atient 
is not infallil)le so far as the progress of his disease is concerned. 
There is no treatment of pneumonia, but there is treatment of the 
patient who has pneumonia and this will vary in every case. In 
all cases the physician should be a watchman and a therapeutist in 
the sense of a drug given only when active need ari.ses. — Cleveland 
Mt (Ural Jonrnnl. 



AnoiT fifteen years ago I tried a snudi samjilt- of Resinol Oint- 
iiit'iit on a patient and a persistent .sore healed rapidly. 1 .soon 
found its great use for all eruptions and use it very much to pro- 
mote rapid healing when my work might .strain the epidermis, so 
I feel I owe you thanks. — J. Austin Buchnall, D.D.S., Detroit, Mich. 



Practicai. Points in the TrkatiMEnt of Pnecmonia. — I know 
of 110 drug which is regularly called for in the treatment of pneu- 
monia unless it be calcium chloride (or other calcium salt). The 
indications for calcium in this disease seem analogous to those for 
iron in chlorosis: there is reason to believe that calcium starvation 
exists in pneumonia. ^Mitchell says (M((li(nl lUconl, August 9, 
1911) : "Every aspect of pneumonia beai's testimony to the value 
of calcium. We know that the pneumococcus extracts calcium from 
the medium in which it grows. AVe know that it extracts ealcium 
from the human culture medium, foi- calcium products are in- 
creased in the urine and feces during pneumonia. AVc know that 
convulsions are caused by calcium ]>overt3% and we liave no reason 
to deny that this calcium poverty is the cause of the convulsions in 
pneumonia. AVc know tliat a hyj)rraci(lity is a ciicmical invitation 



DOMINION MEDICAL MONTHLY 



zxi 



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xxii DOMINION MEDICAL MONTHLY 

• 
for alkalis, and we suspect that calcium Ls the l)i(lileu ^ruest iu 
pneuiiumia. We know that ealciuin is absolutely required for the 
aetivation of lysius and opsonins, and all the plienoniena of leuco- 
CN'tosis. We kno\V that gray hepatization is impossible without the 
presence of calcium. We know that edema of the lungs and col- 
lapse of the heart occur only when the coagulation time of the 
blood is delayed." ^Mitchell recommends giving calcium chloride 
in ten grain doses every three hours during the disease. Pneu- 
monia occurring in adults is often attended with cardiac strain so 
severe as to necessitate more or less stimulation of the right heart, 
particularly in the latter part of the course of the disease ; and 
this stimulation should not be delayed too long. A sixtieth of a 
grain of strychnine three times a day, or every four hours, may be 
sutificient ; or the strychnine may be required in as large dose as 
one-thirtieth of a grain every four hours, and tincture of stro- 
phanthus in doses of one and a half to three minims every four 
hours may be needed in addition. Most cases require no more stimu- 
lation than that mentioned, but some do, and additional stimula- 
tion may be provided by catfeine citrate in doses of two or three 
grains every four hours, camphor in doses of two to five grains every 
four hours, aromatic spirits of ammonia in doses of one-half to one 
dram every one or two hours, and digitalin in doses of one one- 
hundredth to one-fiftieth of a grain every four hours. Whisky in 
small or moderate amount should be given to patients who have 
been addicted to alcoholics. In the beginning of the disease a small 
dose of calomel followed by a dose of .jalap or castor oil is usually 
good treatment, and the bowels should be kept open during the dis- 
ease, but at the time of the crisis the patient should not be disturbed 
even for bowel movements. In the first twenty-four or thirty-six 
hours of the disease, if the patient can be seen so early, tincture 
of aconite in small doses may be useful ; it is best given in half or 
quarter minim doses every hour. To secure sleep, especially in the 
early days of the disease, morphine may be necessary. The value 
of fresh air in the treatment of pneumonia has been abundantly 
proven, but not the value of exposure to excessive cold, especially 
at the time of and just after the crisis. Hydrotherapeutic pro- 
cedures to reduce the temperature are of questionable value in this 
disease. In cases which show by a sudden fall in the systemic blood 
pressure, without notable signs of failure of the right heart, that 
vasomotor paralysis is impending, adrenalin and its congeners 
should be given to restore the tone of the dilated arteries ; and nor- 
mal saline solution should be given through the rectum and Iry 
hypodermoclysis. — Medical Kcviciv of Reviews. 



DOMINION MEDICAL MONTHLY 



XXIll 



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All users of Bovril know from experience that 
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See "The British Medical Journal," Sept. 16, 1911, 
"The Medical Times," November 18, 1911, and other 
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XXIV DOMINION MEDICAL MOxNTHV 

THE PKESKNT POSITION OF SPINAL ANALdKSIA. 



In the Birminijham Mnlical Review of October 14, 15)11, McCar- 
die tells us that from an extensive review of all the literature avaii- 
iihle to the autlior on the subject he concludes that spinal analgesia 
is retro^ressiiii; in favoi'. and is fjenerally only used when there are 
marked contraindications to inhalation anesthesia, and local anes- 
thesia is not possible. The exceptions are surjreons who have had a 
special experience of the metliod in a lar«re numl)er of cases of the 
same kind. In (Jermany the method is beiii»r abandoned by 50 per 
cent, of the surgeons wlio liave used it. 

The proportion of deaths, as one would expect from tiie condi- 
tions, is greater than in inhalation anesthesia. 

The immediate dangers are at least as great. The after-effects 
not uncommonly are most severe, affect the nervous system, and on 
the average at least are as frequent as those following inhalation 
anesthesia. ^lany of them are most persistent and disastrous, 
though tlie author asserts that the English results are much better 
in this respect than the foreign. 

In spinal analgesia the chief after-effects are headache, backache, 
and raised temperature. In inhalation anesthesia, vomiting. 

The percentage of failun^ in the former is very high. An 
excessive dose, whether absolute or relative, as in the case of idio- 
syncrasy, is more immediately and hopelessly fatal than is one after 
ether or cldoroform, because it cannot be antagonized by mechanical 
and eliminative means. 

The diffusion of liquid in the spinal canal is very different from 
the difl'usion of vapor in the lungs. 

In the treatment of emergencies from spinal analgesia one does 
Avrong whether one sets up or inverts the patient; in the one case 
he may die of syncope, and in the other of poisoning. 

Keen says that the ideal anesthesia will abolish pain l)y abolish- 
ing consciousness, hut without danger to life. Spinal analgesia, 
states Zachrisson in a review of the subject, does not fuUil either of 
these conditions. 

The author places analgesia, as a method of preventing pain, 
between inhalation and local anesthesia. Generally speaking, he 
thinks it should only be used in certain selected cases. — Therapeutic 
Gazette. 



2)ominion /H^ebical /n^oiubl^ 



an& Ontario /RcOtcal Journal 



Vol. XXXVIII. TORONTO, MAY, 1912. No. 5 



©riginal Hrticles 



WOMAN. 



By James S. Sprague, M.D., Perth, Oxt. 

Tradition says there was a scarcity of solid elements at the 
time of her creation, and from a translation taken from the old 
Sanskrit book, with the title of " The Surging of the Ocean of 
Time," the following is presented : " At the beginning of time, — 
TwMshtri — the \'nk'an of the Hindu mythology — created the 
world. But when he wished to create a woman he found that he 
had employed all his materials in the creation of man. There did 
not remain one element over. Then Twashtri, })er{»lexe<l, fell 
into a profound meditation. He roused himself as follows: He 
took the roundness of the moon, the undulations of the serpent, 
the entwinings of climbing plants, the trembling of the grass, the 
slenderness of the rose vine, and the velvet of the flower, the 
lightness of the leaf and the glances of the fawn, the gayety of 
the sun's rays and tears of the mist, the inconstancy of the wind, 
and the timidity of the hare, the vanity of the peacock and the 
softness of the down on the throat of the swallow, the hardness 
of the diamond, the sweet flavor of honey and the cruelty of the 
tiger, the warmth of the fire, the chill of snow, the chatter of the 
jay and the cooing of the turtle-dove. He united all these and 
formed a woman. Then Ke made a present of her to man. 
Eight days later the man came to Twashtri and said : 
" My Lord, the creature you gave me poisons my existence. 
She chatters without rest, she takes all my time, she laments for 
nothing at all, and is always ill.'' And Twashtri received the 
woman again. But eight days later the man came again to the 
god and said : " My Lord, my life is very solitary since I returned 
this creature. I remember she danced before me, singing. I re- 
call how she glanced at me from the corner of her eye, and she 
played with me, clung to me.'' 



146 DOMINION MEDICAL MONTHLY 

And Twashtri returned the woman to him. Three days only 
passed and Twashtri saw the man coming to him again. 

'* !My Lord," said he, '' I do not understand exactly how, but 
I am sure the woman causes me more annoyance than i)leasure. 
I beg of you to relieve me of her." But Twashtri cried : " Go 
your way and do your best." And the- man cried : " I can not 
live with her!" "Neither can you live without her!" replied 
Twashtri. 

And the man w^as sorro\\'ful, murmuring: "Woe is me! I 
can neither live with nor without her." 

To these classical lines I add classical annotations and scholia 
by an introductory line as confirmatory of the last sentence in the 
above. 

Nee tecum vivere possum nee sine te. From a scriptural 
source I add a few lines expressive of feminine trust, humiliation 
and loyalty, and so charming are the words that you, I'eader, can, 
with me, in our vision behold a Cleopatra or a Lucretia : 

" If I please the king, and if I have found favor in his sight, 
and the thing seem right before the king, and I be pleasing to his 
eyes." Yes, one cannot picture this woman as a sutfragist — a 

P a husbandette — or was she '* like the bird whose 

pinions quake, but cannot fly the gazing snake ?" 

In Marmion, canto vi, you will find : " 0, woman I in our 
hours of ease, uncertain, coy, and hard to please, and variable as 
the shade by the light quivering aspen made — when pain and 
anguish wring the brow, a ministering angel thou !" Yes, truly as 
tlio scholar wrote: " Tu quotics aecjri fronfem dolor emprohus 
angit, fungeris angeUco sola ministerio," — but listen how^ Marie 
Corelli dopes her sisters out, yet not as God has made them : 

"Frizzled, j)add(Hl, shameless creatures I 
Dyed, with painted, powdered features! 
Furbishing your faded faces. 
Covering all hollow places, 
Thin and scraggy, semi-bald, 
' Lovely ' woman, you are called." 

It may be stated that a young ^f.D. should not let his virgin 
youth be captivated by such " store " goods, anyway. Some one 
has said : " A man loves two women in his life — the one he doesn't 
marry breaks his heart ; the one he does marry breaks his pocket- 
book, and still he is not haj)py," and according to the Atchison 
Glohe, " After a woman has been married to a man six months, 
she begins to feel a romantif interest in the man she didn't marry." 



DOMINION MEDICAL MONTHLY 147 

Yes, "' one not learned save in gracious household ways," is the 
ideal of one's visions, and her question is put in these words: 
" I dare not say I take you; hut I give me and my service, ever 
whilst I live, into your guiding power — for this is the man." 

Oar brother, Dr. Oliver Wendell Holmc-s, tells us: ''If the 
good Lord will go on making splendid women He must not blame 
us for thinking too much of his earthly manifestations," and the 
retrospect is: "The hours I spent with thee, dear heart, are as 
a string of pearls to me." As regards marriage, it has been wisely 
defined as an obligation that "owes its institution to nature, its 
perfection to law, and its holiness to religion." Father Vaughan 
tells us the history of woman before the incarnation is a pitiful 
?nd painful proof that when she is not influenced by high ideals, 
instead of exercising her rightful influence of the destiny of man, 
she may incur man's bitterest contempt and scorn. With rare 
exceptions, woman under the Roman Empire kept slipping down 
lower and lower on the incline, till she is spoken of by the historian 
as " La divinite de la corruption." Seneca, too, speaks of woman 
as "a shameless animal," in whom men cannot see anything but 
the savage creature incapable of restraining its passion. We all 
kniow, in the time of Augustus, women became so degraded and 
debased that the very highest and noblest Roman families were 
dying out for want of heirs; while lower down the rounds of the 
social order, woman having lost her place in the family, self- 
inflicted extinction obtained far and wide, desolating whole pro- 
\iucos, and even Rome itself. " Thus were sapped the very founda- 
tions on which an empire re&ts her very life." As confirmation of 
Vaughan's words one can easily refer to the satires of Juvenal, 
who lived during the first century at Rome, and he tells us in 
Satire vi, 3G8 : " Wealth like a leprosy the land has cursed, and 
all the sinews of her strength has burst!" Such are the condi- 
tions which exist in these our days, and he tells us : " Beneath 
tlio sun no daring so sublime as that of woman in the blaze of 
crime." Yes, if a Juvenal or Horace would arise he would notice 
the effects — the degenerating effects wherein " wealth accumulates 
and men decay." 

If one in any sense were interested in the subject of womanly 
virtues and the corrupt tendencies of our age in which the so-called 
leaders of society and fashions are dethroning women in virtuous 
living, no better aids can be afforded than several ladies' journals 
whose pages are designed, apparently, to encourage thoughts and 
morals not conducive to the maintenance of the happy home life 
in which man is to be recognized as the husband and ruler ; in fact, 
"' He for God only, and she for God in him," as Milton writes, is 



148 DOMINION MEDICAL MONTHLY 

repugnant to the niodoni woman of the smart sot, to her of the 
diamond-stntldecl heel, and to her of the slitted skirts. Milton 
also writes : . " Eve, half end)racins2:, leaned on our first father ; 
half her swelling breast, naked, met his under the flowing gold of 
her loose tresses hid," and '* for contemplation he and valour 
formed, for softness she and sweet and attractive grace." 
Kipling's words are none too consoling in these lines: 

" Oh, the toil we lost and the sjioil wc lo^t. 
And the Excellent things we planned, 
Belong to the woman who didn't know why, 

(And now we know that she never knew why) 
And did not understand." 

Was this Avant of understanding referrable to the query: Bridge 
or Babies ? or to those queries : Lives of misery, of barrenness, or 
babies? Unfaithful homes or babies? Unhappy homes or babies? 
Hospital wards or babies, or Asylums or babies, or Suffragettes or 
mothers, or Husbandette or wife, or Courtesan or wife, Murderess 
or mother. Hell or Heaven, a harlot or Cordelia ? 

Had Sir Sidney Smith in view the woman — that art alone 
makes — when he wrote these lines? 

"His heart in nie keeps liini and uic in one. 
My heart in him his thoughts and senses guides ; 
He loves my heart, for once it was his own, 
I cherish his because in me it bides: 
My true love hath my heart and T have his." 

Yes, "a woman's crown of glory should be her family, her 
throne — home ; and her sceptre — affection," yet modern teachings 
as given at many girls' colleges, and by means of literature, so- 
called, of monthly and other widely spread journals for the so- 
called fashionable set, conduce more to sensuality and the develop- 
ment of the manly woman — the athletic woman, to w^honi no man 
of any intelligence wishes to give a home, his heart or his honored 
name. In two periodicals, found in many virtuous families — 
• the names of which publications I need not name, as I am not 
a publisher's agent — one, who is interested in live stock, as is the 
farmer in the best bulls, stallions, rams and boars, the best milkers 
among cows, etc., can find the following description of a typical 
marketable woman in early years: Weight, 118; height, 61% 
(standing), 33l/> sitting; girth of neck, ISV^; of chest, 3lV^ 
of chest (lull), "331/2; of lower chest, 271/0-291/2; waist 231/2 
hips, 351/2 (if not an athlete, 39 in. said Dr. Blanche Denny) 



DOMINION MEDICAL MONTHLY 149 

thigh, 21; calf (right) 13y2; calf (left) 131/2; of ankle, 8; of 
upper arm, 10% ; of forearm, 9^/2 ; of wrist, 6 ; breadth of shoul- 
ders, 15 inches. These are the measurements of the ideal athletic 
girl who is prepared (?) for motherhood, or to be a suffragist 
hammer striker or the man-woman. 

'' Lest the generation fail " I present the following from a 
corset and waist journal: "'Height, 5 ft. 5 inches; weight, 128 
lbs. From tip to tip of each middle finger just five feet and five 
inches, the same as the height. The length of her hand should be 
one-tenth of her height ; her foot one-seventh, and the diameter of 
her chest one-fifth. From her thighs to the ground she should 
measure just the same as from her thighs to the top of her head. 
The knees should come exactly midway between the thigh and the 
heel. The distance from the elbow to the middle finger should be 
the same as from the elbow to the middle of the chest. 

" From the top of the head to the chin should be just the length 
of the foot, and the same distance to the armpits. A woman of 
this height should measure twenty-four inches round the waist, 
thirty-four inches about the bust, if measured under the arms, and 
forty-three if measured over them. The upper arm should measure 
thirteen inches and the wrist six inches. The calf of the leg should 
measure fourteen and onet-half inches ; thigh, twenty-five, and the 
anklo eight." If these measurements had been found in another 
journal, I would not have made this copy or given them to my 
follow subscribers. 

According to Dr. Blanche A. Denny the weight of the perfect 
woman should be 8 stone 3 pounds, her height 5 feet 5 inches. Her 
waist 2'J inches, bust 04 inches, hips o!> inches. "'After all we must 
not consider her as a breeding machine and an adjunct to a 
frying pan," but God's masterpiece, or as our Sir (Dr.) Thomas 
Browne tells us that " man is the whole world, and the breath of 
God ; woman the rib and the crooked piece of man." 

In brief, as Sidney Low in The Standard has it, and which we 
— you and I — will endorse : "' And man knows that woman is not 
fiend nor saint, nor mixture of the two, but an average human 
being — 'most remarkably like you.' 'not half mother-fiend, half 
Maenad, lest the generations fail, armed and engined,' fanged 
and poisoned, for the hunting of the male, Vith the morals of the 
hen coop, with the jungle's code of laws,' as described by Rudyard 
Kipling, after (some way after) Shaw: 

Tis no doubt a graceful fancy. 
But the Woman Time has made 
Doesn't recognize the likefness 
So ingeniously portrayed." 



150 DOMINION MEDICAL MONrHLV 

Tliis presentation from abimtlaut treasures of analecta and 
anthology at^ords many int<:'rpretations and many studies more or 
less directed to the great subject of motherhood — the true woman's 
crown of life and her divine mission from God himself. 

Mother ! is there in any language a sweeter word, or one that 
can more fully awaken our recollections of pleasant days ? Yes, 
'' the mother, in her office, holds the key of the soul, and she it is 
who stamps the coin of character and makes the being who would 
be savage, but for her gentle care-, a Christian man : then crown her 
the queen of the world.'' 

" As unto the bow the cord is 
So unto the man is woman ; 
Though she bends him, she obeys him ; 
Though she draws him, yet she follows ; 
Useless each without the other." 

— Longfellow. 



ONE RESULT OF SUGGESTION. 



By a. C. E. 



"A fee of $10,000 will gladly be paid to any physician who 
will guarantee to cure a young lady of hysterical attacks, it being 
understood that the money wiU not be paid until a year has passed 
and there has been no recurrence of the attacks in that time. Xo 
one but a duly qualified physician need apply. Box 298, Ex- 
press." 

Jerrold Cunningham had just returned to America after doing 
four years' graduate work in continental, English and Scotch hos- 
pitals, rich in neurological knowledge but very poor in financial 
equipment. 

His neat brass door-plate on an up-town fashionable boarding 
house where he was en pension, and where he occupied a suite of 
apartments which would soon land him in the poor house if he 
had to wait long for practice, proclaimed to passers-by and the 
community the particular specialty to which he would confine 
himself. 

lie was glancing casually over the advertising columns of his 
morning Express, when the alx>vo advertisement caught his eye. 

" Would it be professional to answer that advertisement ?" was 
the first thought which flashed through his mind. 



DOMINION MEDICAL MONTHLY 151 

He pondered the thought pro and con. 

" I feel that I am competent to cure this afflicted young lady 
and bring joy and happiness to a worried and anxious household, 
as the knowledge I acquired in the German hospitals where I wit- 
nessed Inindreds of permanent cures of this functional neurosis 
will serve me well now; and then there is not a specialist in dis- 
eases of the nerves in this entire city. Surely this is a case for me." 

Thus he mused, but professional ethics would not down. 

" Well," he conclude<l, "there will be no harm in waiting a day 
or so, and in the meantime I'll think it over. There will be sure 
to be lots of applicants, quacks as well as others. There can't be 
any one here who knows the value of and how to employ suggestion 
in the treatment of these cases. I'll wait." 

So Dr. Cunningham put on his hat, drew on hLs gloves and 
taking up his walking stick sallied out to pay a visit to a case of 
neurasthenia he was then treating in the General Hospital. 

After attending to his professional duties to this case, he betook 
himself to the operating theatre of the hosjiital. where he found 
the leading surgeon of the city performing a delicate operation in 
brain surgery, a branch of surgical science then in its infancy, as 
suggestive treatment was in the sister department of medical 
therapeutics. 

A large concourse of physicians and surgeons were there gath- 
ered to witness this operation and Dr. Cunningham took a place 
fimongst them to watch the outcome of the proceedings. 

He had a few friends amongst the faculty there gathered and 
after the operation was over asked for an introduction to the dis- 
tinguished surgeon. 

The elder man soon engaged him in conversation relative to 
certain diseases of the brain and saw quickly that his younger con- 
frere was a distinct acquisition to their professional ranks. 

"Cunningham," he said on parting, " come over and see me 
to-night after office hours. I have a case I would like to talk over 
with you." 

" Thank you," returned Cunningham, " I shall be delighted." 

That evening found Jerrold Cunningham comfortably en- 
sconsed in one of the surgeon's easy chairs puffing away at a very 
fine " imported.'' 

" Well, how are you getting along on the nerves V' was the 
first sally from the surgeon. 

" Nothing to boast of — you know, doctor, I have got to do a 
little waiting just like every other beginner." 

" Yes, that's true," patronizingly replied the elder — " I had to 
go through the starvation process in this city about seven years 



152 DOMINION MEDICAL MONTHLY 

mjself before I commeuccd to make a dooent living; but never 
mind, it will come to you, my boy. We are hardly yet ripe for a 
specialist on diseases of the nerves here — the people are not yet 
educated to it, thcv still stick to the old family physician — but it 
is coming, and that, I think, shortly." 

A few seconds' pause, the smoke curling above their heads. 
"Xow. I have a young lady patient,'' went on the surgeon, 
'* a beautiful girl, twenty-two years of age, an only daughter of 
one of the oldest and wealthiest families in the city, who for the 
last three years has been simply ostracised from society, and, in- 
deed, from her closest and dearest friends, through a common, 
vet what I consider a terrible, malady, although most physicians 
generally think and write lightly of the atHictiou. I will succinctly 
give you her history; and then, as you have but just returned from 
France, Germany and England, conversant with the latest ideas 
as regards the treatment of functional neuroses, you will no doubt 
be able to help me." 

" Very well, proceed," and Dr. Cunningham settled farther 
down into the comfortable chair. 

" Her father and I were chums at the university together and 
have been bosom friends all our lives. ]My eldest son and Isabel — 
I may as well tell you that her name is Isabel McKinley, the 
only daughter of the prominent wholesale merchant of that name — 
were engaged to be married, but on the eve of the marriage my 
son disgraced us by running away with a nurse who was attending 
on my wife with a very severe attack of typhoid fever. The shock 
was too much for Isabel's nerves, as, indeed, how else could it be ? 
And she has been the subject of hysterical fits ever since, often 
several in a day, although this is not continuous from day to day. 
I have tried all the known remedies with her with no avail, and on 
my advice other physicians have been called in with like result. 
I am afraid now that ^IcKinley has about lost all faith in me — 
and little wonder — and I am just about as distracted over the case 
as he is. Is there anything new for hysteria C 

" Yes, I think it probable that she can be cured entirely." 
" Doubtless you read in this morning's Express," continued 
the surgeon, unheeding the younger man's remark, " an advertise- 
ment which McKinley had inserted contrary to my wishes and 
advice, in which a large reward was oifered to any physician who 
could promise a permanent cure." 

" Yes, I did," replied the young neurologist. 
" Did you answer it ?" queried the surgeon, watching his con- 
frere out of the comer of one eye. 



DOMINION MEDICAL MONTHLY 153 

" Xo," hesitatingly — '*' I was doubtful of it being profes- 
sional." 

" That's right. Kever promise to cure anything either for or 
not for reward. Treat your patient and claim a proper fee. That 
is the pith of honor in the practice of medicine and surgery. Do 
you think there is any possibility of a permanent cure?" 

The specialist sat up and leaned forward, deep earnestness 
marked in his aspect. " I said a moment ago I thought it probable 
— I now say I am almost positively sure of it." 

''What is it?" 

" Suggestion." 

" Suggestion — what's that ? Oh, yes ; I remember now — I think 
I have read of that in The Lancet — but is it STiccessful ?" 

" Quite so. I have seen many cases cured in the French and 
German hospitals. It is used there quite extensively, although it 
has not been tried here in America yet." 

" I will arrange a consultation at the McKinley residence in 
the morning and will send a messenger to you at what time to meet 
me." 

At ten o'clock the following morning Dr. Cunningham was 
ushered into the library of the ^IcKinley mansion to meet the 
father of the beautiful girl, so afflicted, and who was probaldy 
about to become his patient. The family physician was already 
there and came forward to introduce him to Mr. ^[cKinlov. 

" I have a number of letters here — the case of our daughter, my 
doctor informs me, Dr. Cunningham, has already been explained 
to you — which give me hope. Several promise me permanent 
cure and ask for an opportunity to see the i)atient. Xow, the doc- 
tor has informed me that you are a specialist in nervous diseases 
who has been trained in Europe, and who for the past four years 
have been abroad studying diseases of this character and others. 
Will you promise to cure my daughter ? I would rather engage a 
]4iysician on the recommendation of my old friend here, but, in- 
deed, sir, I am almost distracted and have about lost control of 
my judgment in this matter." 

" I cannot promise to cure your daughter, Mr, ^IcKinley, be- 
cause I haven't seen her yet, nor do I know for myself the nature 
of her malady or the cause of it, although your family physician 
here has put me in possession of a good many facts in the case." 
The haughty millionaire was rather rebuffed at this answer, 
but withal rather pleased with the dignified manner of the young 
practitioner. 

" Then there is no use continuing this interview," he said — 



154 DOMINION MEDICAL MONTHLY 

and turninir to the surgeon and haudini!: him a huiidle of letters 
asked: " Which of these do you think we had better engage V 

*' The joung man is right, McKinley, you should have nothing 
to do with any of the^e who claim that they can cure Isabel. All 
that any honest man can do is to treat her and await results. Dr. 
Cunningham says that he has seen many of these patients per- 
manently cured and I believe him. I pray that you will permit 
me to introduce him to the patient." 

'' Very well ! You nuiy have your way once more, but remem- 
ber tliis will be the last time I will take your advice in the matter," 
and Mr. McKinley turned and walked out of the room. 

" You must not mind him, Cunningham, for he is overbur- 
dened with grief at his daughter's condition. Come with me." 

Dr. Cunningham had never seen a more beautiful girl, and 
trained observer as he was he immediately detected marks of great 
mental strain. He saw at once by the action of the grief muscle 
of Darwin that his fair patient was bordering on melancholia. 

He advanced and extended his hand to aeknowledge the in- 
troduction, when the patient promptly fell into a violent spasm to 
all appearances hysterical in character. 

A few drops of restorative and the patient was herself again, 
and the specialist soon engaged her in an animated conversation 
upon various topics. 

It was at length arranged that Isabel should be taken to a 
private ward in the General Hospital, completely isolated from 
all her friends, attended only by her nurse and Dr. Cunningham. 

Two weeks passed and Dr. Cunningham was not able to report 
to Mr. McKinley that his patient had made much progress. 

Another week passed and the parent began to be doubtful. 

A fourth caiiic and went, and the family physician came to see 
Dr. Cunningham. 

" I am afraid you are going to fail," he said. 

" "Wait and see," was the self-satisfied reply. 

" But McKinley is getting very imj)aticnt. He says it is the 
old story — talks of extortion and wasted money. What are you 
doing for her anyway ?" 

" Simply improving her general condition by tonics and diet." 

" Bother ! I've tried that time and again. It's no use. WTbat's 
become of your suggestion ?" 

"All will be in readiness for that next week. Of course, I 
acknowledge if it fails she is done for and so am I — in this city. 
Have a little more patience and bolster up her parent. I am 
sure all will come right in the end." 



DOMINION MEDICAL MONTHLY 155 

Dr. Cunningham saw his patient two, three and sometimes 
four times a day. He was, indeed, vastly interested in both the 
patient and the case. 

Isabel McKinley was very submissive and the nurse reported 
to the doctor that she thought she rather looked for his visits. At 
the same time she would watch his countenance for any tell-tale 
appearance thereon, but the calm exterior of the specialist be- 
trayed nothing. His nerves had been well schooled. To him 
Isabel McKinley was apparently nothing more than any patient 
would be under similar circumstances. 

The day for the application of the suggestive treatment at 
length arrived. 

Dr. Cunningham sent word to Mr. McKinley that on the mor- 
row he would accomplish a cure or return his patient to her home — 
and he a vanquished man. 

Arriving at the hospital at 8 o'clock the following morning, he 
ordered the nurse to prepare the patient as for an anesthetic. 

Her attacks had not been so frequent during the past week 
and the intervals between attacks had been lengthened. 

'* Miss McKinley," addressing her, " I am going to put you to 
sleep and I do not wish you to resist the influence. I wish you to 
aid me all you can, in fact, I wish vou to trv to go to sleep your- 
self." 

A few deft practised passes over the temples and down the 
finely moulded arms to the finger tips — and the patient was in 
the hypnotic trance. 

*' Run, quick, nurse, and bring me a tongue depressor !" 

When the nurse ran out of the room, he stooped down close to 
the ear of the beautiful girl and spoke therein in firm, earnest 
tones : '^ Isabel McKinley, you are cured. You will never have 
any more fits. There has come into your life a man who loves you 
and who is worthy of your love. Love him as he loves you. Your 
life will be forever happy." 

The nurse returned with the instrument. 

" I was afraid," breathed Dr. Cunningham, "' her tongue would 
drop back, so I wanted to be in readiness for any emergency of 
that sort." 

Turning to the patient again : " Miss McKinlev, vou are cured ! 
Awake !" 

A few passes over her eyes and the patient began to come to 
and almost immediately sat up in the bed. 

" Oh, Dr. Cunningham, I have had such a lovely sleep ! I have 
not slept so peacefully in years." 

" You must be quiet now and rest," was all he said. 



156 DOMINION MEDICAL MONTHLY 

The day passed — no attacks. 

A second, a third, and the doctor was satisfied. 

In two weeks Dr. Cunningham returned Isabel McKinley to 
her home and that home was once more a happy one. 

Two years passed away. Dr. Cunningham sent his bill to Mr. 
McKinley in due and proper time for his services, and a check was 
promptly returned together with another for $10,000 as a thank 
offering for the great blessing in returning to her home an afflicted 
child long a source of worry and anxiety to her parents. The cure 
remained complete; and the clever neurologist, now in the enjoy- 
ment of an ever-increasing ])ractice, was often thrown into the 
society of Isabel McKinley, but, remembering her former experi- 
ence, was chary of love-making. 

The surgeon oft^n joked Jerrold about Isabel and said he 
should marry her. 

'* I'll fix it," he said, but not quite in the way probably that 
he had forethought. 

Jerrold fell sick of typhoid fever of a pronounced cerebral type ; 
and the old surgeon was sent for to attend him. He impounded 
Isabel to nurse him ; it was only fair, he said. 

After two weeks' of delirium, Dr. Cunningham came to his 
senses, very weak 'tis true, and found Isabel bending over him. 

" You here, Isabel — I mean Miss McKinley ?" 

'' Yes. There has come into my life a man who loves me, and 
I love him as well as he loves me — but you must rest now — you 
must not get excited" — and she smiled sweetly down upon him and 
then placed her soft hand over his mouth and made him keep 
quiet. 

She had divined it all through his delirium. 



DOMINION MEDICAL MONTHLY 157 

DENTAL PROPHYLAXIS IN CHILDREN.* 



By J. A. BoTHWELL, D.D.S., 

Surgeon to the Hospital for Sick Childrens. 



Prophylaxis is the art of preserving from, or preventing, dis- 
eases. It is not a curative, but a preventive, process. 

From a dental standpoint. Prophylaxis is considered an ele- 
inentary operation, and is necessarily so "because it is the first 
operation when patients place themselves under our care for treat- 
ment — the alleviation of pain only being excepted. It is import- 
ant to make this a very thorough operation. 

Caries or decay is the result of non-prophylactic measures. It 
is caused by the formation of gelatinous plaques on the surfaces of 
the teeth. These plaques protect the bacteria and enable them to 
dissolve out the lime salts (between the enamel rods of the tooth 
and finally break down the enamel rods themselves, producing 
cavities. 

The first requisite to prevention is a healthy, perfectly formed 
organ, one which has all the virtues of good articulation, ample 
blood supply and normal environment. Too little attention has 
been given to the early habits of mastication as well as the charac- 
ter of food which the children receive from the age when perma- 
nent molars begin to erupt. There can be no development without 
a proper and adequate blood supply. This cannot be had without 
proper exercise, and this exercise will not be had until the children 
are taught to thoroughly masticate good hard foods instead of the 
soft preparations usually offered them. 

The immediate eifect of such exercise is to increase the circu- 
lation in all the surrounding tissues, insuring a better growth, a 
more resisting organ, and a healthier action of the salivary and 
mucous glands, the ordinary diet contains a sufficient amount of 
calcium salts and other ingredients to form a perfect set of teeth 
if it could only be properly placed, but how can the child masti- 
cate its food if the deciduous teeth are defective. Xot^only are 
thev unable to do so, but habits are being formed which* cling to 
them long after the loss of the deciduous teeth. This constitutes 
a demand for more careful attention to children's teeth. 

All investigations point to vitiated oral secretions as a prime 

* Read before the Academy of Medicine, Toronto. 



158 DOMINION MEDICAL MONTHLY 

J'lietur in dental carit's — correct the secretions ami preserve the 
teeth. When we are able to determine a normal saliva we will 
l.ave made a big stride forward. 

Frequently we tind cases among children of certain ages with 
a vitiated saliva, where decay is rampant. This condition is 
easily detected by chalky milk-white spots on the enamel and may 
usually be remedied by a })rescription supplemented by Prophy- 
laxis. 

Micro-organisms are to he constantly coml^ated. Can the oral 
cavitv be made sterile ? Most certainly not, but we can reduce the 
numbers and activity of the micro-organisms by limiting their 
food. An intelligent appreciation of this fact will do much to 
establish the daily routine of careful mechanical removal of all 
traces of food with brush, dentifrice, floss, silk, etc. 

Cleanly habits are part of the education of every individual 
and can be found best in early childhood. The mouth is the gate- 
way through which all food must pass on its way to the body, and 
too much stress cannot he bestowed on this important subject of 
oral prophylaxis for the sake of the little ones. A little water used 
frequently for rinsing with a motion of the tongue on all surfaces 
of the teeth and gums, lingual, palatal, labial and buccal, goes a 
long way to as-sisting in this prevention, and this prevention 
should be our highest aim. 

Salivary calculus and green stains, the latter of which is most 
common in children, when the mouth is open, will disgust the be- 
holder, and frequently prevent the formation of a favorable opin- 
ion of the child who is so neglectful of his or her appearance. 
Xothing adds so much to personal appearance as a clean set of 
teeth. As an example to our patients, how necessary it is then for 
a dentist or medical man to present a clean set of teeth at all 
times. 

Germicidal mouth washes are very much estimated because 
they are usually in the mouth such a short time, and so are prac- 
tically useless. Their jirincipal virtue is that they are an in- 
centive to the patient to clean the mouth because of the pleasant 
taste. 

Prom the earliest days down tn the present time in the human 
race, men have searched for the spring of health, hoping thereby 
to find some source of eternal youth. Our patients come in the 
same manner, asking, "Doctor, what can T do to make and keep 
my teeth clean and preserve them from decay ?" This question 
comes over and over again. We would write a prescription if such 
were possible, but there is no specific. 



DOMINION MEDICAL MONTHLY 159 

Sometimes a dentist does prescribe a wash and gives instruc- 
tions with it. What is the result in a large majority of cases ( The 
patient forgets the instructions and uses the wash, thinking he has 
a specific without labor, but in a short time he finds dire results. 
Every Avash should be accompanied by careful instructions as to its 
nse, which should be minutely followed. They are usually pre- 
scribed in cases of inflamed mucous membranes and gum tissues, 
where the inflammation does not recede even after the irritant has 
been removed. They should be used only for a short period, for in 
a few weeks they lose the desired effect on the tissues. 

Tooth pastes and powders are valuable in the cleansing of the 
teeth and mouth, and particularly so if the saliva is inclined to be 
sticky or ropy. They should contain a reasonable amount of fine 
grit— preferably a grit soluble in the fluid of the mouth. A small 
jimount should be jdaced upon the brush in the cleansing process. 
One should see to it that all particles of paste or powder are en- 
tirely eliminated from the mouth by thorough rinsing afterwards 
with pure water. 

Tooth brushes should be of the proper .size and shape, so that 
one may cleanse every surface of every tooth of both jaws. In the 
majority of mouths two brushes at least are necessary, a lafcial and 
a lingual brush. For children under seven or eiglit years of age, a 
small brush with one row of bristles, as the "Hutax" child's brush, 
is strongly recommended. For all over that age, I think there is 
none better than the medium-size Hutax brush for all labial sur- 
faces and the lingual brush for lingual surfaces. I have used a 
great many difteront brushes and have yet to see one that can com- 
pare favorably with the Hutax. They are properly shaped, so that 
every surface of every tooth may be reached. 

I saw" an article on oral conditions read before this society in 
October, in which the writer suggested three ways of remedying 
evils he j>erceived in the use of a tooth brush for many mouths. 

1. All tooth brushes should be boiled before and after use for 
five minutes. 

2. Use a new tooth brush every day. 

3. Rinse brush in trikresol 1 per cent, or stand in formalin 
10 per cent. 

In the first place the boiling of the brush is impracticable or 
would soon destroy it. Secondly, a new brush every day is too 
expensive for the average person, and thirdly, the soaking in solu- 
tions would destroy and soften the bristles to such an extent that 
they would not do their work any great length of time. However, 



160 DOMINION MEDICAL MONTHLY 

as \vi' are immune to our own hactcria, we need not be alarmed, 
and if our brush is given a cliance to dry between usages the 
baoteria do not get much chance to grow, as tliey need moisture, 
and the bristles, being dry, will be stiffer and better able to do 
their work. I strongly recommend the use of three or four brushes 
for each individual to be used consecutively, so that a dry brush 
is always ready for use. They will last longer if so used and so 
ultimately cost less. If only one brush is used, it should be stood 
on end in a good place to dry quickly, so it will be always ready 
to do its work. A soft, flabby bristle cannot do good work. 

The teeth should be brushed from gums down over the crowns 
of the teeth, so that the bristles extend well in between the proxi- 
mate surfaces. If this is done on the labial, buccal and lingual 
f urfaces, together with the thorough rotary 'brushing of the occlusal 
or grinding surface, every surface of every tooth will be pretty 
thoroughly cleansed. This cannot be properly accomplished in 
less than from three to five minutes. 

The teeth should always be brushed upon rising in the morn- 
ing, so that the bacteria that have developed during the night may 
not be taken into the stomach with the breakfast. Brush after each 
meal. It is very important to brush the teeth before retiring, so 
that no particles of food will have a chance to lie around the teeth 
a]?d ferment, thus giving the 'bacteria a good opportunity to set up 
caries. 

The object of all this care is primarily to save the teeth; sec- 
ondly, to prevent infection in the alimentary canal, and, thirdly, 
to prevent the spread of infectious diseases. We are told that 95 
per cent, of all tuberculosis infections take place through diseased 
or ill-kept mouths. The same is true of almost all other contagious 
or infectious diseases. 

Besides these diseases such conditions as enlarged glands, in- 
Mamed tonsils, septic catarrh of the stomach, indigestion, perni- 
cious anemia, deafness and many other serious conditions are 
directly or indirectly traceable to insanitary mouths. 

I have been requested also to say something about the examina- 
tion of children's mouths, but can only lightly to\ich upon it here. 

In the examination of children's mouths, or in fact, any 
mouth, it is well to have a routine to follow. In this connection 
the following order is good : Lips, cheeks, mucous membrane, 
gums, general condition of mouth, clean or unclean, abscesses, 
regular or irregular teeth, num))er of temporary teeth, number of 
permanent teeth, and, finally, cavities in temporary and permanent 
teeth. This becomes a habit with the dentist and he sees practi- 
cally all at a glance. 



DOMINION MEDICAL MONTHLY 161 

Here we might uote that in all children of six years and over 
we are almost sure to find permanent teeth, and these should have 
special care in examination, as they are likely to be on duty a long 
lime. The tooth which is so often lost is the tirst permanent molar. 
It erupts at six years of age, immediately behind all of the tem- 
porary or milk teeth. It has prominent cusps, three in the 
occlusal surface next to the cheek and two on tte occlusal surface 
next the tongue. It has a solid color as compared with the tem- 
porary teeth, which are somewhat of a dead white. 

When one has several patients to examine, it is a good rule 
never to touch the body or face, and particularly the mucous mem- 
brane of the mouth, with the hands, lest infection be transferred 
from one patient to another. Physicians are not always, I fear, as 
l)articular about this matter as they oug^ht to be. I have seen 
physicians on several occasions insert their fingers in the mouths 
of several children and never wash their hands during the whole 
examination. 

To avoid this very bad practice, one can make a very fair 
examination with only a flat wooden tongue depressor, such as used 
in the hospitals. Usually in ward use, where more than one 
patient is examined, I use two mirrors, 10 per cent, formaldehyde, 
sterile water and tongue depressors. One mirror is kept in the 
formaldehyde while the other is being used in the examination of 
one child, about five or six minutes. The water is to wash off the 
formaldehyde before being used again. A tongue depressor is used 
only once and goes to the pus basin to be destroyed. 

Any inflammation of the mucous membrane is quickly noticed. 
Green stains and other stains are easily recognized, and decay in 
tlie teeth is usually marked by a hole in the tooth or dark black 
area on the surface. In closing, I hope that this paper will give 
every man present a few real practical working points. I thank 
you for your kind attention. 



162 DOMINION MEDICAL MONTHLY 

THERAPEUTIC TIPS 



Cekebral Hemorrhage. 

F. X. Callaghan (Medical Press and Circular) says the 
routine treatment of cerebral hemorrhage is absohite rest, deple- 
tion of the circulation by vigorous purgation, and attempting to 
prevent complications, such as bed sores, cystitis, and aspiration 
pneumonia. In cases of marked compression, evidenced by pro- 
longed and deep coma, slow pulse, irregular breathing, the intra- 
cranial tension should be lowered by venesection, lumbar punc- 
ture or decompression, with or without an attempt to remove the 
clot of blood. 



Olive Oil ix Diseases of the Stomach. 

Freeman (American Medicine) reviews the history of the 
treatment of diseases of the stomach with olive oil. This has 
been advocated at times for the past twenty years. Penzolt 
noticed that after drinking coffee with cream gastric acidity was 
lower than Adth coffee alone. Ewald and Boas in 1886 showed 
that when starch oil mixture was introduced into the empty 
stomach there was very little, if any, secretion of hydrochloric 
acid in the first half hour. In 1898, Strauss and Adler used 
liquid fats in patients atHicted with various conditions associated 
with gastric hyperacidity, with satisfactory results. About this 
time Pawlow and his associates showed that fats did not show 
any stimulating effects upon gastric secretion, but had an in- 
hibiting influence on secretory processes excited by other foods. 
Bachmann, in 1900, claimed to reduce free hydrochloric acid 19 
per cent, by butter and as much as 42 per cent, by cream. Then 
Cohnheim employed olive oil with good results in cases of hyper- 
acidity, finding that it fulfilled four conditions: Relief of pain, 
reduction of friction, as a food, for the inhibition of acids. ^loore 
and Ferguson, in 1909, demonstrated fats had a depressing action 
on the activity of the normal flow of gastric juice. Permanent 
cures have been reported from the oil treatment in cases of spastic 
stenosis, fissure and erosion of the pylorus, ulcer, and gastritis. 
Reports of results justify the use of fats, — olive oil, butter, cream, 
in cases of nervous dyspepsia and gastric hyperacidity from many 
causes. It is simple and harmless. 



DOMINION MEDICAL MONTHLY 163 

Post Partum and Hysterical Retention of Urine. 

Edwards (B. M. J.) states tKese cases are very generally re- 
lieved by the administration of an enema. 



Sweating Feet. 

G. Norman :\Ieaehen (Practitioner) says to bathe the feet well 
every night, using a one per cent, solution of pot. permang. warm ; 
then dry thoroughly. The following morning dust in this powder: 
Pot. permang., drachms, two; powdered alunn, grain.s twentj^; tal- 
cum powder, ounce one; precipitaterl zinc carbonate, zinc oxide, 
of each, half a drachm. 



Cotx)N Bacillus Infection. 

Kemp (Bost. Med. and S. J.) gives urotropiu and sodium 
benzoate, of each, ten grains, every three hours, by the mouth. If 
coma is present, or vomiting, he gives it by the rectum. As to diet, 
he gives sour milk and later cereals, etc. No red meats. Calomel 
or blue mass for the bowels. 



Gonorrhea. 

Menzer (Mini. Med. Wocheu.) uses injections of gonococcus 
vaccines in the treatment of acute gonorrhea, together with hot 
sitz baths, and rest in bed for two or three weeks. He particularly 
emphasizes the importance of the latter. 



Pruritus vulv^. 

It. A, Gibbons (B. M. J.) considers the treatment under three 
heads : internal remedies, external remedies, and operation. Under 
the first, regulation of diet, bromides and similar drugs. Exter- 
nally he uses antipruritic lotions or ointments and soothing sitz 
baths, such as bran bath. He has found a five per cent, solution 
often serviceable ; liquor potasse and solutions of either corrosive 
sublimate or subacetate of lead. Menthol, 5 to 20 grs. in solu- 
tion rarely fails. Nitrate of silver, 40 grains to the ounce in long 
standing cases is valuable. Operative measures recommended 
are some form of cautery or division of nerves. 



164 DOMINION MEDICAL MONTHLY 



IRevievps 



Health and Medical Inspection of Sciiool Children. By Walter 
S. Cornell, M.I)., Director of the ^Medical Inspection of 
Public Schools, Philadelphia; Lecturer on Child Hygiene, 
University of Pennsylvania; Director of Division of Medical 
Research, New Jersey Training School for the Feeble- 
blinded, etc. Illustrated with 200 Half-Tone and Line En- 
gravings, many of them original. Philadelphia : F. A. Davis 
Company. 

Medical inspection and medical supervision of school children 
has, within the past few years, attained to such prominence that 
any book of an authoritative nature will be made welcome by the 
medical profession, particularly those intimately associated in 
this laudable work. In a volume of 614 pages one would think 
that at the present time the last word had been written on the 
subject. The experience of the author has been such that he is 
qualified to record his observations and work in book form, and 
it will remain for some time to come tbe best authority in a 
general way on the subject of medical inspection of schools. We 
heartily recommend this book. 



American Journal of Surgery. — Greater New York Numher. 

In June the American Journal of Surgery will issue a num- 
ber composed of original contributions from men of recognized 
prominence in the medical profession residing in Greater New 
York. Among those to contril)ute are: — Herman J. Boldt, C. 
X. Dowd, Meddaugh Dunning, Wm. S. Gottheil, E. L. Keys, 
Jr., Howard Lilienthal, Chas. IL May, Willy ]\Ieyer, Robt. T. 
Morris, S. Lewis Pilcher, John O. Polak, James P. Tuttle, James 
P. Warbasse and others. Contributions from these well-known 
men should make this issue of particular interest and value. 



An Introduction to Therapeutic Inoculaiion. By D. W. Car- 
malt Jones. Toronto: The Macmillan Company of 
Canada. $1.25 net. 

This is an excellent summary of tie principles and practice 
of vaccine-thera])v. based u])()n the large experience of the author 



DOMINION MEDICAL MONTHLY 165 

and that of other investigators, from whose work he has freely 
drawn. Its especial merit, however, is that the author dwells 
particularly upon his own methods and gives succinctly and with- 
(jiit undue enthusiasm the result* of a number of years' experience. 
If any criticism should be offered such an excellent monograph 
it would be that directions for the use of bacterial vaccines that 
should guide the general practitioner are perhaps not sufficiently 
detailed or explicit to meet his needs. g. w. r. 



Principles and Practice of Physical Diagnosis. By Joiix C. 
DaCosta, Jr., M.D., Assistant Professor of Clinical Medi- 
cine, Jefferson Medical College, Philadelphia. Second 
Edition, revised. Octavo of 557 pages, with 225 original 
Illustrations. Philadelphia and London: W. B. Saunders 
Company, 1011. Cloth, $3.50 net. Canadian Agents: J. F. 
Hartz Co., Toronto. 

This Physical Diagnosis of DaCosta is a satisfactory work 
on the physical examination of the chest and abdomen, and it 
may be recommended to those who have a large library of these 
diagnostic methods, but who require a smaller book for quick 
reference and for the few recent additions to this science. 

But while the separation of the physical and chemical methods 
of examining patients has the advantage of pre\'enting the editing 
of a bulky volume, yet it seems hardly wise tx) exclude all men- 
tion of the technique of studying the nervous system, — a physical 
not a chemical examination. 

So that while this book is excellent as regards its contents, 
yet it is not suitable as a text-book for the student, who requires 
to find his library of physical diagnosis in one, not in several 
volumes; nor is it suitable for the general practitioner, who I 
think can invest more satisfactorily in a more complete work. 

(r. W. ]{. t 



The Treatment of Fractures hy Mobilization and Massage. By 

James B. Menxell, M.D., B.C., Cantab., etc. Late resident 

Medical Officer of St. Thomas' Home, etc. With introduction 

by Dr. J. Lucas-Championniere, Honorary Surgeon to Hotel 

Dieu, etc. Price, $3.50 net. St. Martin's Street, London: 

Toronto: The ^lacmillan Co. of Canada. 

This is a very exhaustive work of over 450 pages, profusely 
illustrated, on this, to most of us. new method of treating frac- 
tures. Gentle massage — "' glucokinesis '' — is recommended as pre- 



166 DOMINION MEDICAL MONTHLY 

liininary- and after-treatment, while by mobilization is meant 
gentle movement of the parts. Taking as an examjile, *' a recent 
fracture of the surgical neck of the Humerus, the treatment is lim- 
ited on the iirst day to free movements of the fingers and wrist, 
half movement at the elbow, and only such movement at the 
shoulder as is unavoidable during these manipulations. But in a 
week's time abduction, flexion and extension of the arms should 
reach oO per cent, to 75 per cent, and a minute amount of rota- 
tion may be called for in suitable cases. . . . There is only 
one limit to the amount of this dose ; it must cause no pain. 
The use of splints is not to be altogether abandoned in the treat- 
ment of the majority of fractures. As soon as possible splints 
are discarded, though it is often necessary to leave them in situ 
for a short space." 

The author has naturally had a very wide experience, and a 
careful study of his work will amply repay any practitioner. 

T. B. 11. 



Minor and Emergency Surgery. Ijv Waltkr T. Daxxreuthee, 
M.D., Surgeon to St. Elizabeth's Hospital and to St. Bartholo- 
mew's Clinic, Xew York City. 12mo. volume of 226 pages, 
illustrated. Cloth, $1.25 net. Philadelphia and London : W. 
B. Saunders Company. 1911. Canadian Agents: The J. F. 
Hartz Co., Toi-onto. 

A useful little work, intended more particularly for the hospi- 
tal Interne. t. b. r. 



Principles of Anatomy. The abdomen proper. Described and 
illustrated by text and plates. Bv Wm. Cutiibert Mortox, 
M.A., M.D. (Edin.) Price .$12.'Xew York: Rebman Com- 
pany. 

This work consists of a 175-page book and 27 plates, on 14 
leaves each of 10 by 14 inches. Thirteen of these plates are front- 
and-back plates in which the abdominal organs have been outlined 
x;nd a portion within the outline has been cut out. 

The method of employing these plates is (1) by separate in- 
spection from in front and from l)ehin(l and the relations of the 
various struoturcs seen. (2) By simultaneous inspection, by 
trans-illumination. (3) By correlating the front-and-back plates 
with each other, separately, and by combined inspection by means 
of cut-out leaves, and by simultaneous inspection by trans-illumi- 
nation. In this manner each organ can bo studied completely 



DOMINION MEDICAL MON'IHLY 167 

as regards its surface anatomy, its relations, its blood and nervous 
supplies. 

The object of the work is intended to " stimulate practical 
study, to be used before dissection for a preliminary survey, dur- 
ing dissection for comparison and contrast, after dissection for 
revision, and at all times for reference." 

It is necessary to study the text and the plates in conjunction. 
" Certain changes have been made in treatment and in nomencla- 
ture." These changes only -serve to make some of the more diffi- 
cult parts easier of understanding. 

The whole is most original and will certainly be a great aid 
to all in the studv of the abdomen. w. a. s. 



Fourth Eeport — Wellcome Tropical Research Laboratories. 
Toga Publishing Co., 35 West Thirty-third Street, Xew York 
City, and 101 Coristine Building, St. Nicholas Street, Mont- 
real. 

The. Toga Publishing Company has been authorized, on behalf 
of the Department of Education of the Sudan Government, to 
issue the fourth report of the Wellcome Tropical Research Labora- 
tories at the Gordon Memorial College, Khartoum. 

It is almost impossible to exaggerate the importance of the 
work which is being accomplished by the distinguished group of 
scientific men associated with the Wellcome Tropical Research 
Laboratories, under the leadership of Dr. Andrew Balfour. 

The thorough examination of the conditions of tropical life, 
as they present themselves in men, animals, plants and insects, is 
the task to which this great institution is devoted. 

The Fourth Report of the Laboratories, which is now being 
issued, contains the facts, observations and discoveries brought to 
light during the last few years. LTnlike the. commentaries and 
digests which are so familiar a feature of the scientific press, 
these volumes contain the actual record, at first hand, of new con- 
tributions to the solution of problems of deep and world-wide 
import. 

Their value is further enhanced by the superb manner in 
which the knowledge, so laboriously gained, has been presented 
and illustrated. The expansion of the work of the Laboratories 
and the amount of new material collected during the last few 
years have rendered it impossible to issue the Fourth Report in 
one volume, and the subject matter has, therefore, been divided 
into two parts. The first part. Volume A, of which a compli- 



168 DOMINION MEDICAL MONTHLY 

meutarv review copy is being sent herewith fur vuur accei)tance, 
deals with the medical aspects of the work of research. Volume 
B, which relates to general science, is now in the press, and will 
be issued shortly. Volume A presents the results of the bacterio- 
logical examinations carried out at the Laboratories. Patho- 
logical and other specimens from a wide area, and illustrative of 
many forms of endemic disease, have been the subjects of investi- 
gation. Important papers have also been contributed on the- work 
of the Sleeping Sickness and Kala-azar Commissions. The fal- 
lacies and puzzles met with in the course of blood examination in 
the tropics form the subject of an interesting and well-illustrated 
article. An extended research on fowl spirochii'tosis has demon- 
strated the important role played by the '' infected granule " in 
this disease. Other papers include records of work on trypano- 
somiasis, human spirocha?tosis, kala-azar, forms of cutaneous 
leishmaniasis, veldt sore, diphtheria, human botryomycosis, veter- 
inary diseases, etc. The interesting notes contained in the pre- 
vious reports on sanitation in the Sudan are continued. 

The two volumes of the Report, (A) and (B) together, con- 
tain 738 pages of letterpress and illustrations, many of the latter 
being in natural colors. 

The price fixed for the Reports is as moderate as is consistent 
with the great cost of production, and any profit made will be 
devoted by the Sudan Department of Education to a special fund 
for future publications of the Laboratories. 

In order to place the reader completely in touch with the latest 
phases of the whole subject, a third volume has been added as a 
supplement. It is entitled ''A Second Review of Recent Advances 
in Tropical Medicine, etc." — a title which is am{)ly fulfilled in 
the contents. 

The last Reports were issued in 1908, and the announcement 
that a further instalment of the w^ork was to be expected has 
aroused the keenest interest among students of tropical medicine 
and a very large demand is anticipated. 



dominion /IfteMcal /ll^ontbl^ 

and Ontario /BeOlcal journal 

EDITED BY 

Medicine: Graham Chambers, R. J. Psychiatry: Ernest Jones, W. C. Herri 

Uwyer, Goldwin Howland, Geo. W. | m;in. 

Ross. VV'mD Young „ . , . Ophthalmolofiry : I). X. Maclennan. W. 

SuPS'epy : U alter McKeown, Herbert A u I nwrv 

Bruce. W. J. O. Malloch. Wallace A. „^,V , , . ^ ^ . 

Scott, George Kwart Wilson. RhlnologrV. Lapyngrology and Otol 
ObstetPics : oS'y : Geoffrey Boyd, Gilbert Royce. 

Arthur C. Hendrick. Gynecolog'y : F. W. Marlow. W. B 
Pathologry and Public Health : John Hendry. 

^.tAT/k' ^?^^J ^\?- Hastings, I Genltoljplnapy Supgepy : T. B. 

O. R Mabee Geo. Na«mvtli. Richardson, W. Warner Jone^. 

Physiologric ThepapeutiLS : 

J. Harvey Todd. Anesthetics: Samuel Johnston. 

GEOBQE X:i.I.XOTT, MANAOINa EDXTOB. 

Published on the 20th of each month for the succeeding month. Address 
all Communications and make all Cheques, Po.st Office Orders and Postal 
Notes payable to the Publisher, GEORGE ELLIOTT, 203 Beverley Street, 
Toronto, Canada. 

Vol. XXXVIII. TORONTO, MAY, 1912. No. 5 



COMMENT FROM MONTH TO MONTH. 

The Report of the Royal Commission on Vivisection 

appoiiitt-'d some _vear< ago by the Uritiih rarliainent, has i\eeutlj 
been issued. It is some four years since the evidence was 
concluded before the Coinniission, which time it is understood 
was consumed by the business of agreement among the Commis- 
sioners, illness and even death in the case of two of the Com- 
missioners contributing to the delay. 

That the entire matter has been well gone into and that every 
phase of vivisection has been carefully considered, the evidence 
carefully and judicially sifted and the tindings made com- 
mensurate with all the evidence taken, may well be understood, 
when it is known eighteen months were given over to the hearing 
and that 21,761 questions and answers engaged the attention of 
the Commissioners. 

During these five and one half years medical science, how- 
ever, was not standing still awaiting the verdict. Flexner was 
busily engaged upon spotted fever and infantile paralysis. The 
mortality from sleeping sickness was being cut into by Bruce. 
In India, Leishman was producing good results with antityphoid 
inoculation; and nearer home. Wood of the United States had 
made this protection compulsory in the army upon all under forty- 
five, unless they had previously suffered from typhoid fever. 
France, too, was marching abreast of the times in scientitic attain- 



170 DOMINION MEDICAL MONTHLY 

ments, and had to its credit 401 cases of rabies in 1911 without 
one death, having previously recorded a siniihir history and 
achievement for 1910. Diphtheric antitoxin reduced the death 
rate in England in lar^nigeal diphtheria from 00 to 11.7 per cent. 
None of this coniirmatory evidence ha<l the Commission before it. 
Originally composed of ten members, it is decidedly gratifying 
to the exponents of vivisection that the report is signed unani- 
mously by the surviving eight, and that, therefore, there is no 
minority report. 

Every opportunity was given the opponents of vivisection to 
produce evidence in support of their views and contentions, and 
they made a wholesale failure all along the line. Eighteen of 
these witnesses appeared to give evidence 'antagonistic to the cause, 
and some of them were examined at groat length, one being under 
the limelight three w^hole days and a half. 

One clause in the report is so convincing that it is here set 
forth verbatim et literatim: *' We desire to state that the har- 
1 owing descriptions and illustrations of operations inflicted on 
animals, which are freely circulated by post, advertisement, or 
otherwise, are in many cases calculated to mislead the public, so 
far as they suggest that the animals in question were not under 
an anesthetic. To represent that animals subjected to ex])eri- 
ments in this country are wantonly tortured would, in our opinion. 
be absolutely false." 

The achievements of medical science through animal experi- 
mentation need only to be mentioned in a categorical way: di]ih- 
theria, rabies, malaria, yellow fever, jMalta fever. ]ilague, lock- 
jaw; the work of Lister; in the animal world, anthrax, rinder- 
pest, Texas cattle fever, glanders, swine erysipelas, malignant 
jaundice in dogs, distemper in dogs. 

But to the public apparently the great question is the one 
of pain to the animals experimented upon. With anesthetics 
complete insensibility to pain results. IMorphia, chloral and like 
drugs, when used in heavy doses, produce a similar condition. 
Considering, then, that 95 per cent, of all experiments upon 
animals in Great Britain are inoculation experiments alone, and 
that these are done upon such animals as mice, rats and guinea- 
pigs, the question of pain does not a]i])ear to loom at all large, 
is in fact infinitesimal under the conditions. A great majority 
do not suffer any pain at all. although some inoculations do cause 
some pain. 

The Commissioners have come to the conclusion and are 
unanimously agreed " That experiments ujwni animals. ade(inately 



DOMINION MEDICAL MONTHLY 171 

safeguarded bv law faithfully administered, are morally justi- 
fiable, and should not be prohibited by legislation." 

Surely then, the public, when it comes to humanity against 
mice, rats, guinea-pigs or even dogs, will say humanity overwhelm- 
ingly wins. 



The role of raw foodstuffs, such as garden vegetables and 
fruits, is now having consideration in the dissemination of typhoid 
fever. 

In a recent number of the United States Public Health 
Reports, R. H. Creel records some of his experiences in connec- 
tion with raising radishes and lettuce on soil infected with the 
jiaciUus typhosus. 

His experiments go to show that plants will carry up with 
them in growing, upon the leaves and stems, micro-organisms 
which were in the ?oil subsequent to seeding. 

It was found that the Bacillus tijpliosus, even where the leaves 
and stems were free from all apparent adhering particles of dirt, 
could be recovered from those selfsame leaves and stems ; and 
that neither the natural rainfall nor tap water freed the infected 
plants from the germs. 

Creel draws the conclusion, therefore, that the fertilization 
of garden soil by human excreta is productive of danger, in that 
such vegetables as radishes, celery and lettuce, may carry the in- 
fection direct to the alimentary tract of the human being. 

This will mean additional activities for the health ofiicer and 
his inspectors, or else it is good-bye to our luscious salads, the 
appetizing radish and the palatable celery stalk. We will re- 
quire to know hereafter if these edibles are grown upon ground 
where night-soil figures as a fertilizing substance. 



Hygiene of the mouth, or oral i)rophylaxis, is rapidly be- 
coming a routine practice in the prevention of disease. 

Pharmaceutical houses with keen business instincts are not 
slow in seizing hold of any new idea which can be turned to prac- 
tical account ; and there are already on the drug and medical mar- 
kets numerous solutions, tablets and lozenges adapted to the con- 
servation of health through the medium of the buccal cavity. 

A British physician, William Hunter, has been especially 
prominent in this direction of preaching cleanliness of the mouth, 
and has exhibited a '' sticktoitiveness " which is very commend- 
able. Xeglect of hygiene of the mouth, in his opinion, results in 



172 DOMINION MEDICAL MONTHLY 

uumerous disorders, or at least heljis to oontrihute to them, such 
as gingivitis, dental necrosis, stomatitis, deposition of tartar, sup- 
2)uratiou around decaved teeth, periostitis, alveolar abscess, osteo- 
myelitis, maxillarv abscess, tonsilitis, pharyngitis, otitis and glan- 
dular enlargements. An unclean mouth may also have consider- 
able to do WTtli anemia anil gastric catarrh. 

In mouth hygiene, the dental profession seem to be in advance 
of the medical profession and have blazed the way for the proper 
(■mj>l(»ym('nt of the toi^th brush and intelligent and right, up-and- 
down brushing. 

As the night time, the sleei)ing hours, is known to be the favor- 
able working hours of the little pests, the micro-organisms, the im- 
jjortance of the buccal toilet just prior to retiring cannot be too 
often nor too strongly emphasized. 



Dominion Registration advances apace. The Legislature 
of the Province df (Quebec has passed the necessary measure to 
ratify the Koddick Bill, or the Canada Medical Act, as amended 
at the last session of the Federal Parliament. Ontario has intro- 
duced into its Legislature the ''enabling clause"; and within a 
short time the complete success in rounding out Dominion Regis- 
tration will be accomplished. It is not expected Ontario will 
prove a stumbling block. 

When all the provinces have ratified the Canada Medical Act, 
the Honourable, the Minister of Agriculture will undertake its 
administration. 

An organization meeting will be summoned and convened for 
Ottawa, when the Dominion Medical Council will be organized. 

The much desired end ajiproacheth. Dominion Registration 
was first broached before the Canadian Medical Association, 
shortly after its organization at the time of confederation. As the 
Dominion increased by the acquisition or accession of new pro- 
vinces and new territory the question took on a wider scope. It 
dragged along until Dr. Roddick took it up in real eamest about 
fifteen years ago, and in order to further it before the Canr-dian 
Parliament, sought election to the House of Commons. 

The history of Dominion Registration since that time is familiar 
history. It lapsed for a time after the passing of the original bill 
in 1892, but took on a new lease of life at Winnipeg in 1909. Its 
resuscitation has made it a live question again since 1909. 

Reward for his earnest efforts is soon to perch on the inde- 
fatigable and able shoulders of Dr. Roddick, who may be saluted 
as the Father of Dominion Registration. 



DOMINION MEDICAL MONTHLY 173 

The Seventeenth International Congress of Medicine to 
be held in London, England, August Gth to liith (1912 ), has issued 
its preliminary programme. The subjects for discussion embrace 
Anatomy. Physiology, General Pathology and Pathological Anat- 
omy, Chemical Pathology, Bacteriology and Immunity, Therapeu- 
tics, Medicine, Surgery, Orthopedics, Anesthetics, Obstetrics and 
Gynecology, Ophthalmology, Diseases of Children, Xeuropathol- 
noy, Psychiatry, Dermatology and Syphilography, Urologj', Rhin- 
ology and Laryngology, Otolog;^', Stomatology, Hygiene and Pre- 
ventive Medicine, Forensic Medicine, Naval and Military Medi- 
cine, Tropical Medicine and Hygiene, Radiology. 

A very comprehensive programme is embraced under these 
headings. Canadian practitioners going abroad this simimer 
should remember to time their visit, so as to take in this important 
conference. 



Ontario Medical Association — Toronto, May 21, 22 and 23. 

This meeting i.- to lit- far more clinical and practical than any yet 
held. 



Draft Programme of Ontario Medical Association, to be held 
in Toronto on ^Liy 21. 22 and 2:». 

Tuesday, May 21. — 

9.00. Symposium on Graves* disease. 

9.00. Address in ^ledicine, by Dr. Alden Turner, London, 

Eng. 
3.00. Meeting of Sections. 

8.00. Presi«lent's Address, by Dr. H. A. Bruce. 
9.00. An illustrated lecture on Experimental Medicine, by 
Prof. Carell of the Rockefeller Institute. 

Wednesday, May 22. — 

9.00.' Clinics at the University Buildings. 
1.00 Luncheon in the Quadrangle. 
2.00 Address in Surgery. 
3.00 Meeting of Sections. 
7.00. Dinner at ^IcConkey's. 

Thursday, May 23.— 

9.00. Clinics at the various Hospitals. 
2.00. Woodbine Races and Golf. 



174 DOMINION MEDICAL MONTHLY 

IRews litems 



Dr. S. H. McCoy, of St. Catharines, has moved to Toronto. 

Dr. Clarke, of Diinnville, Ontario, has moved to Toronto. 

Dr. Oliver, of Merlin, Ontario, has moved to Toronto. 

Prof. J. J. ^Mackenzie, of the University of Toronto, has 
gone abroad. 

Dr. G. Stirling Ryerson, Toronto, has returned from Atlan- 
tic Citv. 

Dr. J. W. Daniel, St. John, X.B., has been called to a seat 
in the Senate. 

Hamilton had 100 deaths in February, four being from tuber- 
culosis. 

During the vast year, St. John's, Xewfonndland, became an 
entrance port for Syrians afflicted with trachoma. 

Dr. J. D. McQueen, late Superintendent of the Winnipeg 
General Hospital, is doing graduate work in New York. 

The present Lord Mayor of London is a physician, 81 years 
old. He is the first physician who has ever held this honor. 

Dr. Andrew Croll, Saskatoon, has obtained the qualification 
of F.R.C.S. (Edin.). He is at present in Germany pursuing 
studies in surgery and gjmecology. 

Dr. Geo. H. Field, Cobourg, Ont., was married to Mary, 
daughter of Commander and Mrs. Gearing, Annapolis, Maryland, 
April 18th. Heartiest congratulations. 

St. Michael's Hospital, Toronto, recently formally opened 
a fine new wing. This cost $250,000. One of the features of the 
new wing is a roof-garden. The building is four stories in height. 

When in Vancouver, Dr. Wilfrid T. Grenfell was dined by 
the L'niversity Club, Dr. R. E. ^McKechnie, the President, occupy- 
ing the chair. 

Dr. S. J. S. Pierce, Pathologist to the Winnipeg General 
Hospital, is at present in London, after six months' graduate work 
in Freiburg, Germany. 

Dr. D. N. Maclennan has been appointed chief of the Eye, 
Ear, Nose and Throat Department of the Hospital for Sick Chil- 
dren, Toronto, in succession to Dr. Geoffrey Boyd, resigned. 



DOMINION MEDICAL MONTHLY 175 

Dr. D. a. Stewart, of the Tuberculosis Sanatarium at 
Annette, Manitoba, is on his way to Rome as one of the representa- 
tives of the Dominion Government to the International Tuber- 
culosis Conference. 

The American Practitioner is the title of the amalgamated 
New England Medical Monthly, The American Practitioner and 
News and the Annals of Medical Practice. It is published monthly 
in New York, and Dr. John W. Wainwright is the Editor. 

The fifth annual meeting of the Canadian Military Medical 
Officers was held in Ottawa, February 28th and 29th. Amongst 
others who delivered addresses were the Minister of Militia, Sir 
James Grant, and Major J. T. Clark, Halifax. 

Dr. L. L. Palmer died recently at Grimsby, Ontario. The 
late Dr. Palmer was for many years a prominent specialist in eye, 
ear, nose and throat work, but about two years ago moved to 
Grimsby. He had also taken a leading part in military life. 

Dr. B. E. McKenzie announces that Dr. C. Stewart Wright, 
recent graduate of the Orthopedic Department, Carney Hos^iital, 
Clinical Assistant at Massachusetts General, and Children's Hos- 
pitals, Boston, is now associated in practice with him. Orthopedic 
siirgery exclusively. 72 East Bloor Street, Toronto. 

Dr. James D. Thorburx, Toronto, died at Guelph, Ontario, 
on the 26th of March, following an operation for appendicitis. The 
late Dr. Thorburn was a prominent specialist in nose and throat 
work, and has, since the death of his father, the late Dr. James 
Thorburn, been medical director of the Manufacturers Life Assur- 
ance Company. Dr. Thorburn was a very companionable man 
and was held in high esteem by his fellow practitioners in Toronto. 

The Smallpox Situation ix Caxada. — British Columbia, 
Fernie, Feb. 26-Mar. 2, 2 cases; Xelson, Dee. 24-30, 1; Victoria, 
Feb. 4-10, 1 ; Manitoba, Winnipeg, Jan. 14-20, 1 ; Ontario, Kings- 
ton, Dec. 19-23, 1 ; Ottawa, Dec. 10-Mar. 2, 69 ; Sarnia, Oct. 
17-Dec. 31, 42; Toronto, Jan. 6-Feb. 10, 2; Windsor, Feb. 4-10, 
2; Quebec, Montreal, Dec. 17, Mar. 2, 21; Quebec, Dec. 10-Mar. 
2, 242. There were three deaths, one in Toronto and two in 
Quebec City. 

During 1911 there arrived at the Port of Halifax 119 trans- 
Atlantic passenger steamers, bringing 47,209 passengers, 42,572 
of which were for Canada and the balance, 4,637, for the United 
States. The number of immigrants admitted to the Government 
detention hospital for the year ending June 30th, 1911, for mental 



176 DOMINION MEDICAL MONTHLY 

and physical detVets, was P>')o, of which luuiiher 17!> wore des- 
tined for the United States. The number of immigrants certified 
lor trachoma decreased considerably over the previous fiscal year. 

The Jiseulapian Society, Toronto, held its final meeting for 
the season 1911-1012 in the Albany Club, the evening of March 
14th. Dr. Adam H. Wright, the President, was in the chair. 
President Falconer and Venerable Archdeacon Cody were the 
guests of the evening. The election of officers took place as fol- 
lows: — President, Dr. Albert A. Macdonald; Vice-President, Dr. 
J. Milton Cotton; Secretary, Dr. George Elliott (re-elected); 
Treasurer, Dr. Edmund E. King (re-elected) ; Executive Com- 
mittee, Drs. Walter McKeown, K. W. Bruce Smith, D. J. Gibb 
Wishart and Bruce L. Riordan. 

Canadian Public Health Association. — The second annual 
meeting of the Canadian Public Health Association will be held 
in Toronto some time during the month of September, 1912. The 
officers are : — President, Dr. C. A. Hodgetts, Ottawa ; Vice-Presi- 
dents, Dr. M. M. Seymour, Regina, and Dr. E. B. Fisher, Freder- 
icton; General Secretary, Major. Lome Drum, Ottawa; 
Treasurer, Dr. G. D. Porter, Toronto ; Executive Council, Dr. P. 
H. Bryce, Ottawa ; Dr. F. Montizambert, Ottawa ; Dr. J. D. Page, 
Quebec ; Dr. Lachapelle, Montreal ; Dr. Chas. Hastings, Toronto ; 
T. Aird Murray, C.E., Toronto; Dr. Chas. Hastings, Toronto; 
Mackay, Saskatoon; Dr. Geo. T. Clark, C.E., Saskatoon; Dr. 
C. I. Fagan, Victoria, B.C. ; Dr. G. E. Duncan, Vernon, B.C. ; 
Col. Carleton Jones, M.R.C.S. (Eng.), Ottawa; Dr. Smith Wal- 
ker, Halifax, X.S. ; Dr. E. C. Stevens, Moncton, N.B. ; Dr. G. G. 
Melvin, St. John, !N^.B. ; Dr. H. G. Johnston, and Dr. Jas. War- 
burton, P.E.T. ; Dr. T. H. Whitelaw, Calgary, Alta. The local 
Committee of Arrangements is composed of : — Dr. Chas. Hastings, 
Chairman; Mr. T. Aird Murray, C.E., Secretary; Dr. Duncan 
Anderson, Associate Secretarv; Drs. G. D. Porter, Adam H. 
Wright, A. J. Harrington, J."W. S. McCullough, J. W. Coulter, 
J. A. Amyot, and Helen MacMurchy, with power to add to their 
numbers. 

American Medical Editors' Association. The annual 
meeting of the society will be held at Atlantic City, New 
Jersey, on June 1st and 3rd, with headquarters at the !^^arl- 
borough-Blerdieim Hotel. Dr. Thomas L. Stedman, editor of 
the Medical Record, will preside and an attractive programme is 
being prepared. The annual banquet will be held on the evening 
of June 3rd. Every editor and those associated in medical jour- 
n'alistic work will find this meeting worth attending. 



DOMINION MEDICAL MONTHLY 177 



Corresponbencc 



ONTARIO SOCIETY FOR THE REFORMATION OF INEBRIATES. 

Toronto, Out., March 12, 1912. 
The Dominion Medical Monthly, Toromo, Ont. 

Dear Sirs, — The present seems aii opportune time for calling 
attention to the liberal manner in which the Imperial Government 
favors the reformation of inebriates, — an example which we in 
Canada might follow with profit. 

King George the Fifth, when Prince of Wales, upon his return 
from his first visit to India, is reported to have said : ** Wake up, 
England." When it comes to the knowledge of the Vice Kegent 
in Canada that we have no public institutions here for the reforma- 
tion of the unfortunate inebriate, it is quite conceivable that he 
miglit be impelled to saj, with regard to this sad defect : ** Wake 
up, Canada." 

The Ontario Government has already made an enviable repu- 
tation in the domain of Prison Keform. Its methods of caring for 
destitute and delinquent children is not merely up-to-date, but 
actually leads the world, and the extraordinary success that has 
attended the experiment of exchanging cell-life for farm-life for 
first oftenders is the wonder and admiration of all penologists who 
have visited the Prison Farm at Guelph. Steps are also being 
taken for the custodial care of feeble-minded women and girls. 

Nothing has as yet been done, however, in the direction of fur- 
nishing reformatory treatment for inebriates. 

In the year 1898 an Act was adopted in Great Britain called 
'* The Inebriates Act of 1898." This act provides that when a 
Reformatory for Inebriates is established by a County or a group 
of Counties and certified to by the Government Inspector, it be- 
comes a " Certified Reformatory " under the Act and the entire 
expense of maintenance is assumed by the Government. 

This generosity on the part of the Government has accomplished 
v/hat it was designed to accomplish, namely, it has promoted the 
establishment of Reformatories in the United Kingdom, — in Eng- 
liind alone there being now ten " Certified Reformatories." whereas 
tiiere were two only before the Act came into operation. Xot only 
to, but two Governmental Reformatories have also been established 
■ — one for men and one for women — for the custodial care of in- 



178 DOMINION MKDICAL MONTHLY 

(.orrigible ca:>e6 removed from the C'ertilied lielormalories w'bere 
iLey have failed to respond to reformatory treatment, and have not 
ben amenable to discipline. 

In 1S'.)0 a Prison Keform C^ommission was appointed by the 
Ontario Government, one of the instriictions being to report upon 
tlie question of drunkenness in the Province. In tiie report of the 
Comnnssion it is recommended that two reformatories be estab- 
Jished in Ontario, — one in the eastern part of the Province and one 
ii. the west. In 1892 a Prison Reform Conference was held in 
Toronto, which was attended by certified delegates from thirty dif- 
ferent organizations, including Provincial Church Courts, the On- 
tario Law Society, and the Ontario Medical Association. This 
( '(.inference endorsed most heartily this recommendation with re- 
gard to the establishment of Reformatories for Inebriates. 

In 1894 a deputation from the Ontario Medical Association 
waited upon Sir Oliver Mowatt, who was then the Premier of 
Ontario, urging him to act upon the recommendation of the Prison 
Reform Connnission with respect to the establishment of one or 
two reformatories in the Province. The Premier in reply said, 
in elfect, that he realized fully the great need of reformatory 
treatment for the unfortunate drunkard, but that his Govennuent 
was not prepared to undertake the entire expense involved. In 
case, however, t!he initiative should Ix^ taken by voluntary effort, — 
by municipalities or by the benevolent public, — the Government 
could be relied upon, he affirmed, to give liberal aid thereto. 
When the Hon. Sir G. W. Ross was Premier, he gave a large 
deputation (headed by Medical Associations) practically the same 
iinswer, and, at his request, a bill was drafted, ])rinted and ap- 
proved of by him and his colleagues, in which Government aid 
was provided for — to promote the treatment of inebriates by muni 
I'ipalities or by the benevolent public. The bill was never pre- 
.-ented to the House, however, and, unfortunately, as I think, this 
important matter has never been brought before the Wliitnev 
Government. 

For a number of years the Inspector of Prisons and Charities 
for Ontario has been urging the Toronto city authorities to make 
more adequate provision for gaol prisoners, (irand Juries have also 
reported, from time to time, for several years, against the over- 
crowding in and the faulty construction of the Toronto Gaol. 
After this long delay, however, action has finally been taken in 
the premises by the City Council, and in the right direction. A 
farm of over 400 acres has been purchased, about 14 miles out 
Yonge Street, and will be fitted up as a Reformatory Farm Colony 



DOMLMON MEDICAL MONTHLY 179 

ior Inebriates, — with special arrangements for scientific medical 
treatment. 

This action on the part of the city — though long delayed — is 
most gratifying, as such an institution, properly managed, should 
be the means of restoring to useful citizenship a good percentage 
of the more hopeful class of cases, and moreover, should serve as 
«n object-lesson for other municipalities, and for the Government 
as well. The question arises, however: Should the entire cost of 
a Reformatory for Inebriates fall upon the ratepayers of the muni- 
cipality where it is established i Or shoidd not the Government, 
in this matter, follow the generous example of the Mother Country ? 

When Hon. John Sanfield McDonald took office as the First 
Premier of Ontario, there were but two Poor Houses or Houses 
of Industry in the entire Province. He passed an Act otfering a 
substantial bonus to every County, or United Counties, in the 
Province, to encourage the establishment of such institutions, and 
with such good effect that now, if I mistake not, a Poor House 
is already established, or is being established, in every County or 
group of Counties in Ontario. May we not hope that the Whitney 
Government, following such a wise precedent, will, in like man- 
ner, pass an Act in the very near future, offering, like the Homo 
Government, liberal inducements for the establishment of reforma- 
t(.ry institutions for inebriates in the Province ? 

^lay we not hope that the present session of the Ontario Legis- 
lature will not be allowed to pass without introduction, by the 
Government, of an adequate measure whereby etficient provision 
shall be made with a view to the reformation <»f indigent and police 
court inebriates throughout the entire province. We are also 
desirous that a substantial increase be made to the small grant now 
made to the Ontario Society for the Reformation of Inebriates. 
If you find that you can favor these suggestions we will be much 
gratified. 

On behalf of this Society, 

Yours truly, 

A. M. RosEBRUGii, M.D., Medical Officer. 

Member of Prison Reform Commission appointed by the 
Ontario Government in 1890. 



180 DOMINION MEDiCAL MONllILV 

Ipublisbcrs' IDcpaitmcnt 



Physicians on the lookout for a field for practice can secure 
a short cut thereto by making their wants known to Dr. W. E. 
llamill, medical broker, who conducts the Canadian Medical 
Exchange, at 75 Yonge St., Toronto. The doctor is in touch with 
practically every physician desiring to sell out, and in addition 
iias many vacant fields without a doctor where the residents request 
one and where a practise of at least $3,000 annually is assured. 
Bo7m fdr buyers can get full particulars gratis of any (tifer by 
addressing him as above, or what is still better, call personally 
.11 his office if possible. A partial list of his offers will be found 
each month in our advertising columns, the complexion of which 
necessarily changes each issue. Both vendors and vendees should 
get in touch with 75 Yonge St. to speedily reach the goal desired. 



Never cultivate a grouch, even if in one day you have been 
supplanted on a typhoid case by an unethical practitioner, written 
a death certificate, missed an obstet., and are called to court on a 
day taken up fully by engagements. What's the use ? — Medical 
Review of Reviews. 



Mrs. MacKinnon's ^^ASSAGK Institution, 20 Walmer Road, 
Toronto. Telephone, College 7S95. Mrs. Neil MacKinnon, for 
many years a specialist in all branches of uuissage, having received 
her training in the Old Country, has within the past few months 
opened an institution in this city at the above address. All forms 
of massage, including electrical, electric light, and needle sjiray 
baths, are administered in this institution under her jiei'soual 
supervision. The location of her institution is one of the bcsl that 
could be desired, and there is a beautiful conservatory, with a 
southern exposure. There is a masseur in attendance for male 
patients. The rooms are large and sunny, the appointments beinii 
especially tasty and well adapted for carrying on such work. 
Physicians are invited to visit and inspect for themselves. 



When, ten days after the crisis of pneumonia, you find the 
lung unresolved and unrosolving, maintain a cheerful expectancy. 
When, ten days after this, you find the lung in the same condition, 
look pleased and give an optimistic prognosis. When, ton days 



DOMINION MEDICAL MONTHLY 




Are you particular as to the condition of the iron in your 
Blaud preparations ? 

Frosst's Perfected Blaud Capsules present True Ferrous 
Carbonate. 

Each 10 grain Capsule contains, approximately,^! grain of 
Iron. 



xviii DOMINION MEDICAL MONTHLY 

later again, the liing has not iiuprovod, be phil<jsoj)liic and retlect 
upon the limitations of the physician's art. When, at hist, after 
forty dajs in the wilderness of therap<'ntie nneertainty, the luni: 
clears up, be chastened in spirit and never again talk glibly aneni 
the abortive treatment of pneumonia. — Medical Review of Reviews. 



Ideal Conditions of Serum Manufactukk. — if there is out 
therapeutic agent which, more than another, sliould he i)re})ared 
with scrupulous care, that agent is diphtheria antitoxin. .Its pre- 
paration should never be entrusted to the inexperienced or to those 
who are hani]iered by lack of facilities. It should have its origin 
in the blood of healthy horses — animals whose blood is known to 
be pure. The welfare of the diphtheritic patient demands a serum 
from which every element of conjecture is eliminated. In the 
opinion of many physicians these essentials are best exemplilied 
in the Antidiphtheric Serum of Parke, Davis k Co. Certain it 
is that this antitoxin is manufactured under conditions that are 
ideal. MWes removed from the smoke and dust of Detroit, "hun- 
dreds of feet above the river level, the company maintains a large 
stock farm, equipped with model stable,>5 and supervised by expert 
veterinarians. Here, in the best possible condition, ai^ kept the 
horses employed in serum-production. The laboratories in which 
the antitoxin is prepared, tested and made ready for the market 
are the admiration of scientific men who visit them. 



When, at the close of the year, you look over your accounts 
and ponder on the bad money on your books, representing con- 
scientious effort and often self-sacrifice on your part, and human 
failure on the part of others, there is no regTct that the service was 
rendered, for it was rendored to sick people. Xuf said. — Medicnl 
Review of Reviews. 

A Pleasant. EpFunENT Laxative. — The desirable qualities 
of a first-class laxative are efficiency and fwedom from unpleasant 
taste. The lack of either to just that extent disqualifies the product 
for use in the treatment of chronic constipation. That it is difficult 
to find a palatable and efficient laxative in the same medicament 
is a pretty generally accepted fact. It is possible to do so, how- 
ever, and Cascara Evacuant may be cited as proof of that possi- 
bility. This preparation is pleasant in taste, and in doses of 
15 to 30 minims in water it performs its duty quickly and well. 



DOMINION MEDICAL MONTHLY xix 



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MOTORING 
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experience in selecting qualit}^ 
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Motor Gloves Raincoats 
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Rugs Dusters 

The best goods from the best makers. Practical use 
proves that these lines give the most service. 

Fairweathers Limited 

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TORONTO 
Winnipeg Montreal 

80 J 



XX DOMINION MEDICAL MONTHLY 

without incidental uauseii uv distress. That is why chihlren rarely 
object to taking it, and adults prefer it to other preparations. 
The product is manufactured by Parke, Davis «fc Co., and is pro- 
curable from any well-stocked retail pharmacy. To avoid con- 
fusion with other so-called aromatic cascaras, however, it is well 
to specify clearly *' Cascara Evacuant, P. D. A: ('o." 



Brand's Specialties. — Sir Victor Horsley in his address on 
Surgery before the British Medical Association, in Toronto, in 
1906, said: " For the cardiac failure reliance should be placed on 
nutrient enemata, such as Brand's Essence and pancreatized 
milk. Brand's goods may be had from Newton A. Hill, 25 Front 
St. East, Toronto. 



The Earl of Erroll, K.T., C.B., presiding recently at the 
annual meeting of the shareholders of Bovril, Limited, alluded to 
an article written by a high medical authority in connection with 
the tests made at Trinity College, Dublin, to ascertain the value 
of Bovril. The following is an extract from the article : " As for 
digestion and absorjition of the food constituents of ' Bovril,' they 
have long been known to be of the first order. The action of 
* Bovril ' upon nutrition is that it acts practically as a link be- 
tween the body and the food. It is on such grounds that we are 
entitled to say that ' Bovril ' is more than a food, for it is a / 
feeder. The upshot, one may suppose, must be that ' Bovril,' so 
to say, increases the temperature of the body. Everything must 
be a little quicker, brisker, easier running than before. Digestion 
is hastened, and since it is also more complete, the business of get- 
ting rid of what is not used is reduced to a minimum. That 
means a gain for the temperature of the body. There are con- 
4>tituents of * Bovril ' which greatly stimulate not so much the 
ilow. but the quality that Hows, of the gastric juice." Sir James 
Crichton-Browne, speaking at the same meeting, said : " It is not 
upon medical authority in the ordinary sense — that is to say, on 
the opinion of medical men who have tried it, valuable although 
these opinions are — that Bovril now rests its claims to considera- 
tion, 'but on the far tinner basis of exact scientific experiment. 
Doctors differ, but the scales and the test tube know nothing of 
diagnostic difficulties. The careful observation of Professor W. 
H. Thompson, of Trinity College, Dulilin, assisted l)v ^fr. C^ild- 
well, M.A., an expert chemical physioloeist, and by ^fr. Wallace. 
B.A., have established the unique reputation of Bovril as a food 



DOMINION MEDICAL MONTHLY 



XXI 



THE STEVENS COMPANY 



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xxii nOMTNION MEDICAL MONTHLY 

in itself ana -.s a powerful aider aud abettor of the appropriation 
bv the svsiem of other kinds of food." 



When a gentleman puts before you a proposition to relieve a 
young woman friend of good family who is greatly concerned 
because of the non-appearance of her catamenial flow, and who is 
greatly distressed because of the symptoms which tell her that the 
suppression is doing her much harm, be greatly interested and 
display a hearty sympathy. Also feel flattered, particularly if the 
parties concerned have avoided taking counsel with their regular 
medical advisers, thereby showing their superior faith in your skill 
in difficult cases and their belief in your greater trustworthiness 
as regards professional confidences. — Medical Review of Reviews' 



Copy Letter from E, B. Forbes, Chief of Department of 
Xutrition, Ohio Agricultural Experiment Station, Wooster, Ohio, 
February, 1912. Gentlemen: — In reference to your suggestion 
that I write my experience in the use of whey powder with in- 
fants, I have to submit the following: Very effective use of your 
sweet whey powder was made in my laboratory in the feeding of 
a child who presents a very unusually difficult feeding problem. 
At the age of three weeks the child sufi^ered a complete closure 
(stenosis) of the pyloric opening of the stomach. A successful 
gastroenterotomy was performed. Two days later the stitches 
pulled out and the operation had to be repeated. During this 
second operation an excited nurse put the child onto hot water bags 
that were too hot and its whole back was scalded. The shock was 
so great that it failed to revive and blood transfusion from the 
child's father was resorted to when it was in a moribund condition. 
This operation was successful, but the feeding problem resulting 
from the whole series of calamities was very difficult. The child 
was fed with a tube and funnel for some weeks on modified cow's 
milk, the fat content being gradually increased to 4 per cent, in 
an effort to check the steady loss in weight. At this point the 
child's condition being such as to cause the physicians in attend- 
ance to lose hope in its recovery it came into my hands. It pre- 
sented a typical case of infantile acidosis, caused by the starvation, 
anesthesias, the extensive burns and inability to resorb soaps. 
The fat was now greatly reduced in the milk, sodium citrate added 
and whey used in its modification. The dying child began to gain 
and for the next 13 weeks averaged 8 ozs. per week. Its digestive 



DOMINION MEDICAL MONTHLY 



xxui 



Dietetic Experts and 

BOVRIL 



Tests made recently in Great Britain by W. H. 
Thompson, M.D., Sc.D., assisted by other experts 
in diet, at Trinity College, Dublin, proved that 
when a little Bovril was added to a Standard 
diet it produced a marked increase in weight. 

This increase represented good sound muscle 
and greater available energy. 




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All sorts of material are made into undergarments and much suffer- 
ing and ill-health is caused because of the saying that " any material is 
GOOD ENOUGH for the skin !" 

^^ Really, is the best any too good for occupying the place of honor, 
next to yourself "? 

There is no finer, more cleanly fabric than linen, and since in the 
making of Deimel-Mesh the chill has been removed, there is no safer 
and more protective garment than the Dr. Deimel Underwear. 

DEIMEL LINEN-MESH CO. 

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Branches: NEW YORK, WASHINGTON, D.C., SAN FRANCISCO, BROOKLYN 
BALTIMORE, DETROIT, LONDON, Eng. 

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xxiv DOMINION MEDICAL MONTHLY 

apparatus was verv weak, and we made a chemical study of the 
case, preparing the food in the laboratory every day for months. 
In order to have the proportion of albumen in the milk as high as 
possible in comparison with casein we used your sweet whey 
])Owder with excellent effect. The child is now entirely well, a 
thoroughly normal, hammering, thumping and yelling little boy. 
The fact that he is the only male descendant in his generation of 
jny relationship has given me a great interest in the case. We have 
done some other work with your product, which I shall have to 
report at a later date. Yours very truly, (Signed) E. B. 
Forbes. Canadian Milk Products Co., Mail Building, Toronto. 



After you have treated a case of chronic urethritis for a year, 
during which time you have irrigated the patient regularly, 
stripped his vesicles, massaged his prostate, and his urine still 
resembles a biological aquarium, where would you say you were 
at? We have no message to deliver on this point. — Medical 
Review of Reviews. 



Never, in a moment of forgetfulness, advise the parents of a 
child whom you operated upon a year before for the removal of 
adenoids that the child is suffering from impeded nasal respiration 
and should have its adenoids removed. — Medical Review of Re- 
views. 



When a bore of a detail man (most of them are gentlemen of 
sense and discretion) " presumes " that you are familiar with cer- 
tain details of the digestive process, and then, for fear that they 
may have passed out of your recollection for the nonce, proceeds 
to give you a resume of the latest researches in the field of 
physiology, do not toy restlessly wnth the articles on your desk, 
and do not permit repressed exasperation to send your blood pres- 
sure up to 280. Express your thanks to the messenger of the pro- 
prietary gods, hand him a cigar, and promise to use, and to write 
testimonials, for Bink's Vitalizer and Alterative. — Medical Review 
of Reviews. 



'^ 



2)ominion /IfteMcal /n^ontbl^ 



an5 ©ntarlo /iBcMcal journal 



Vol. XXXVIII. TORONTO, JUNE, 1912. No. 6 



©ricjinal Hrticles 



PERSONAL RECOLLECTIONS OF LORD LISTER. 



By F. Le^I. Gkassett, M.V,.. (Ei.ix.), F.R.C.S. 



On the day that all the papers contained the news of Lord 
Listt-'r's death, your President asked me to give this Academy 
a paper on my personal recollections of Lister and his work. 
This paper, then, is not an account of his life, not a recapitula- 
tion of what all medical men know, viz., the great results that fol- 
lowed the introduction and ])roper use of the system he incul- 
cated, but my personal recollections of his early work and his 
great struggle to convince a doubting medical world of its su- 
preme importance. 

There are others here to-night, who, about the same time 
were, like myself, associated with him. I am sure they feel how 
fortunate we were to be able to see at close range this great 
man; to be very intimately associated with him in early anti- 
septic days, when he was lighting an uphill tight against ignor- 
ance and prejudice. 

When I was a student, Edinburgh University and its medi- 
cal schools were very fortunate in having an unusually large 
number of able and distinguished men : Sir James Simpson, Sir 
Robert Christison, Sir Patrick Heron Watson, Matthews Duncan 
and others, hardly less well known. One was just passing off the 
stage whose name required no hall mark of honor from his 
sovereign to heighten his fame as a surgeon ; James S^nne had 
just given up the chair of Clinical Surgery in the Royal Infirm- 
ary. Lister, his son-in-law, and his most devoted admirer and 
pu])il, succeeded him. As a visitor with Lister. S^Tue went 
round the wards once only when I was with him. Lister showed 

• Read before Academy of Medicine, Toronto. 



182 DOMINION MEDICAL MONTHLY 

liim a compound dislocation, and fracture of the ankle joint 
healing as quietly and as free from all constitutional symptoms 
as a simple fracture and dislocation would. Sjrae said to the 
patient, ''You are fortunate, my man. I lost several out of thir- 
teen in this very ward in cases such as yours." 

I had the good fortune in my first week as a Civis Academiae 
Edinensis, in 1869, to hear two introductory lectures. Prof. 
Playfair, afterwards Lord Playfair, . had al)an<loned chemistry 
to. take up educational work in the political world. His suc- 
cessor, Crum Brown, delivered a scholarly and able lecture. A 
day or two after in the same great chemistry classroom in the 
old University Buildings on the South Bridge, Lister delivered 
his. He had an unusually large audience, various reasons ac- 
counting for it. A Glasgow professor, translated by the Crown 
to Edinburgh, was hardly a persona grata there, yet his work 
in Glasgow had interested them, and they were curious to hear 
about it. The medical students of that year were registered in 
larger numbers than ever before. They were curious to hear 
this new professor who was just beginning to be talked about. 
I remember the lecture as if it were yesterday, — the procession 
into the room ; the marked quiet throughout its delivery. I 
never listened more closely to any lecture, but then it was all 
new to me; all his facts seemed so clear and distinct; so logic- 
ally set out. I could hardly conceive there could be any other 
side to the question ; any ])ossible doubt of all he said. At that 
time he was just over 42 years of age, at his very prime, with 
a commanding figure and a beautiful, thoughtful face, and a 
coniidoxioii which many a woman would like, and which few 
could surpass. 

The intense hold his subject had on him, the earnestness 
with which he spoke heightened his color and accentuated the 
slight hesitancy of speech peciilinr to him. adding, I thought, 
to the force the words carried. A brief resume of this lecture 
I must give you ; it set forth so clearly at that early date what 
he claimed. 

He claimed t<> be practising a system of aniiscptic; surgery, 
— that is, the treating of a surgical case in such a manner as 
shall prevent the occurrence of putrefaction in the part con- 
cerned. If this is really done what a change in behavior do 
many surgical injuries undergo. Injuries formerly regarded 
in the gravest light, become comparatively trifling, and some 
diseases rarely admitting of cure terminate most satisfactorily 
in perfect recovery. 



DOMINION MEDICAL MONTHLY 183 

The guiding principle, the pole star and compass combined 
of all its practical details, was the germ theory of putrefaction. 
This theory declares that putrefaction in organic substances 
under ^atmospheric influences is effected by living organisms, 
developed from germs floating in the atmosphere as constituents 
of its dust and not to the oxygen of the air, as was formerly 
supposed. 

The proofs of the theory were, step by step, traced up, going 
back to Harvey's law, " Omne Vivum Ex Vivo" that all animals 
and plants are derived from eggs and seeds, and vitality is trans- 
mitted, never created. Many scientific people have from time 
to time doubted the truth of this law, and the reasoning deduced 
from it and upheld, — spontaneous generations as opposed to homo 
genesis, or generation from parents. Curiously at that time in 
Edinburgh University, John Hughes Bennett, the able Professor 
of Physiology, was a strong upholder of abiogenesis, as were 
Huxley and Charlton Bastian. But on the other side there was 
a growing weight of evidence from the time of Cogniard La Tour, 
who, in 1836, detected in yeast the Torula Cervisia, which seemed 
to be the essential constituent of the ferment; next came Schwann ; 
lastly, and greatest of all, Pasteur. 

Lister's experiments were very similar to Pasteur's. One only 
I would like to give in his own words, because that experiment 
I am sure clinched in his own mind the basic principle of his 
work, affording as it did the strongest evidence in favor of the 
germ theory. 

Writing in 1869 he says: 

" Two years ago last month I introduced portions of the same 
specimen of fresh urine into four flasks — (urine being a fluid 
combining transparency with a high degree of putreseibility). 
The body of each flask was about one-third filled with the liquid. 
After the introduction of the fluid the necks of three of them 
were drawn out into tubes rather less than a line in diameter, 
and then bent at various acute angles. In the other the neck was 
drawn out to a calibre if anything rather finer, but cut short and 
left vertical. The liquid was then boiled for five minutes, the 
steam issuing freely from the open end of the narrow neck of 
each flask. The lamp being removed, air, of course, passed in to 
take the place of the condensed aqueous vapor, and during the 
two years that have elapsed a considerable portion of a cubic inch 
of fresh air has entered every night into the body of each flask 
to exert its influence on the liquid. In the case of the flasks with 
contorted necks, the air moving to and fro through the tube soon 



184 DOMINION MEDICAL MONTHLY 

dried the moisture whifli was at first deposited within it, makiiic' 
the neck dry as well as open from end to end, so that it could 
present no obstacle to any gaseous constituent of the atmosphere. 
Nevertheless, though thus freely exposed to the action of the 
gases of the air for so long a perioil, including two unusually hot 
summers, the urine still retains its original straw color and per- 
fect transparency, presenting neither cloud, scum, or sediment. 
But very different is the appearance of the urine in this other 
flask whose neck, short and vertical, was calculated to admit par- 
ticles of dust, as well as gaseous materials. (In the case of the 
contorted neck the angles arrested the dust). The transparent 
straw has given place to a muddy brown, with sediment of fungi. 
It is pungently ammoniacal, as can be easily observed by placing 
the warm hand on the flask and a nostril at the orifice. I was not 
content with observing the completely unchanged appearance of 
the bent neck flasks. Half a year after the experiment was begun 
I poured out half an ounce of the clear contents of one of these 
into a wine glass for examination. Its odor was perfectly sweet, 
and its reaction faintly acid. Under the microscope a careful 
search with an excellent glass of high power failed to detect any 
organisms. But exposed to dust, in two days it Avas loaded with 
minute organisms and fungi, visible to the naked eye." 

Some tried these experiments of his and failed to get the same 
results. Lister answered these failures by saying negative results 
are far less strong than positives. It is also easy to understand 
failure in such experiments consistently with the truth of the 
theory ; it is impossible to understand success in any single in- 
stance, consistently with the falsehood of the theory. 

Then he ended the lecture. '' Gentlemen, I commend these 
facts to your candid and impartial judgment, beseeching you to 
form your own opinions regarding them. The minds which you 
bring to bear upon this subject are very much the same as they will 
be throughout your lives, and you are as competent as ever yon 
will be to draw correct inferences from established data. 

"Throughout the course I shall endeavor to place before yon 
simple facts, trusting that in estimating their significance you 
will be guided by what our dear master ( Syme) has so consistently 
striven to inculcate as our leading principle — love of Truth." 

Very similar experiments he later conducted with milk, only 
using superheated wine glasses and covering them with a glass 
cap and shade, purified in the same manner. The milk was not 
Ijoiled, but introduced directlv into the glass as from the cow, whose 



DOMINION MEDICAL MONTHLY 185 

teats and udder, as well as the hands of the milkman, had been 
previously purified by carbolic acid. 

I saw the milk which had been lying in a wine glass, secured 
and treated as I have said, exhibited before the Eoyal Society of 
Edinburgh, by Lister. Although eighteen months had elapsed 
since its introduction into the wine glass, on removal of the shade 
and cap, it was found to be as sweet and pure as the day it came 
from the cow. Watched by the audience with keen interest. Lister 
tasted it, handed it to Tait, the learned Professor of Physics, who 
agreed as to its quality. How many more of the venerable fellows 
tasted it I have forgotten, but I know at the time it seemed to 
impress strongly that learned Society. 

In 1870 Lister gave me a dressershij*. My ajiplication had 
been backed up by an old house surgeon of Syme's, Edward Law- 
rie, whom I knew at that time. Later on Lawrie joined the In- 
dian army, and presided over the Hyderabad Commission investi- 
gating the adniinistration of chloroform. The first cases I was 
allowed to dress were unimportant, chronic ulcers and the like, 
cases in which I could do no harm. I scrupulously washed them in 
1-40 carbolic acid, dressed them with lac plaster, a stump towel 
on the outside, and bandaged rhem as carefully and evenly as if 
much depended upon it. The lac plaster had not long displaced 
the putty, which he had used in Glasgow, and very proud he was 
of his new dressing, frequently describing the gradual improve- 
ments in its manufacture until the perfect stage was reached. 

This was replaced by the gauze. To-day we use a gauze very 
similar to that first made. I rememlx^r well the day Lister dressed 
the first case with gauze. He had finally, after being up nearly all 
night, perfected to his satisfaction a small piece. He came to 
the infirmary, and with his staff went to the laboratory and made 
a larger portion. He went straight back to the theatre and with 
it dressed a compound fracture of both bones of the forearm, then 
made by himself to correct a badly united fracture. This showed 
his confidence in dressing. It was made of cheese cloth impreg- 
nated with carbolic acid, held in resin, the resin having the property 
of holding carbolic acid with great tenacity, but on account of 
its stickiness, required to Ix^ diluted with paraffin — the most satis- 
factory portion being Acid 1, Resin 5, Paraffin 7. By degrees 
the accessories to the dressing were dispensed with as greater 
knowledge came, as the Mackintosh between the seventh and 
eighth layers, the syringe to destroy the germs, the spray — at first 
a hand one and then a steam spray. As one by one was discarded, 
much to the relief of the surgeons, Lister contended that if the 



186 DOMINION MEDICAL MONTHLY 

demaiuls of the theory are met, the means cannot be too sim])le. 

The next year I fortunately received a clinical clerkship. This 
brought increased res])onsibi]ity, — the selecting of instruments 
and dressings for operations, administration of chloroform, and 
taking the notes of cases. Lister had three clerks and 54 beds, 
so it was no light task. At this time surgeons from tbe 
Continent, especially Germans and Danes, followed the daily ward 
^ isit, and Lister, painstaking to a degree, explained over and over 
again the theory and the minutiae of the dressings. His own 
countrymen, and those on the staff of his own hospital, were in- 
frequent visitors. Tn the Royal Tnfirmarv at that time the old 
practice and the new by Lister were both in operation. It was 
easy to see both, to compare the results; but slowly, sometimes it 
seemed very slowly, the new gained more and more confidence in 
men's minds. 

The student body was divided into two camps — those who fol- 
lowed Lister and those who believed him not. I remember a 
dresser of Spence's, the Professor of Surgery, about this time had 
effusion into the knee joint. Tapping was considered advisable. 
At once he became very solicitous that this should be done under 
rigid antiseptic precautions. Tt was, and with a happy result 
and a very rapid conversion of mind. 

I have said that the surgeons of the Infirmary were not frequent 
visitors in Lister's wards. This is correct ; but at least three of 
them were thorough believers in antiseptic surgery. Mr. Annan- 
dale, who succeeded Lister in the chair, was always a warm friend 
and upholder of Lister and his work. I acted in my first year as 
his dresser and once in later years as his house surgeon for a short 
period. Excellent surgeon that Annandale was, he never in my 
time seemed to grasp the necessity of complete attention to details 
which antiseptic surgery re<piired. I su]i]iose it was the old story 
— the difficulty of an old dog acquiring new tricks. Joseph Bell 
was then senior assistant surgeon and later came on as a full 
surgeon. He had, I think, the same difficulties as Annandale in 
adapting himself to the altered needs of surgical work. 

John Chiene, afterwards Professor of Surgery, was always 
a whole-hearted and enthusiastic follower of Lister. Careful, 
thorough, he was a com]>lete master of all detail and demands of 
antiseptic surgery. In Lister's absence during vacation, Chiene 
took charge of his wards. He was then the junior assistant sur- 
geon. I had kiiowni him as the capable demonstrator of anatomy. 
I now found liim the careful surgeon, an excellent teacher and very 
considerate of those under him. For manv vcars Professor of 



DOMINIOr^ MEDICAL MONTHLY 187 

Surgery, he has lately given up the chair and lives, in not very 
robust health, at his country house near Edinburgh. I always 
spend part of a day with him when visiting Edinburgh. A most 
interesting lot of reminiscences he can tell of Goodsir and Turner, 
of Svme and Lister. Some of these he gave to the public in his 
"Looking Back," 1907-1860. The picture in the front of that 
booklet is an excellent one of Lister. 

At the end of my clinical clerkship I asked Lister if later on 
he would make me his house surgeon. This he promised in the 
autumn of 1873, at the same time strongly urging that either before 
or afterwards, if possible first, I should get on in the ^[edical 
House as a house physician. Dr. George Balfour promised me 
his, and in 1873 I went to him and Lister afterwards. 

Lister's wards were the same that Syme had had only not quite 
so many beds. The Trustees had appointed an extra surgeon (Mr. 
Annandale) and about 20 beds had been taken away for him. This 
I know chafed Lister, who felt the loss of them, but there was no 
possibility of altering it. The wards were in the old part of the 
Infirmary, the part that originally had l^een the old High School, 
converted into surgical wards, there was always overcrowding; 
the number of cases seeking admission being largely in excess of 
the accommodation. I have slept 70 patients in 54 beds by putting 
down mattresses between the beds and putting several children in 
one bed. This was exactly the contrary to what prevailed in the 
newer and better ventilated wards of the other surgeons. One 
might have feared at any time an outbreak, such as was not 
unusual at that time. Erysipelas, pyemia, hospital gangerene or 
anv of the forms in which blood poisoning them showed itself, 
with the exception of a few mild cases of erysipelas and one case 
of septicemia following amputation of the breast, I never saw a 
single case of blood poisoning in any shape in Lister's wards dur- 
ing five vears. It was a matter of common report that the surgeons 
who had better wards suffered not infrequently in this way, 
especially in the primary amputation cases. I am sure had Lister 
not had" such confidence in the protective power of his system 
against such calamities he would never have permitted such over- 
crowding. 

Distinguished foreign surgeons were now very numerous in 
the daily visitation. Lister. I think, treated them all with great 
consideration, quite irrespective of their eminence in their own 
country. They wished to see his work — he did his best to show it. 
I remember more than once at his house, in Charlotte Square, 
being the only English-speaking person with the exception of his 



188 DOMINION MEDICAL MONTHLY 

private assistant. John Bishop. One of tlicsi- occasions impressed 
upon njo bow desirable it is, if possible, to know a little of the 
language of the country .you are visiting. Prof. Saxtorph, of 
Copenhagen, and another Danish surgeon were among the guests 
one night at a large dinner party. It ^'/as necessary for the Danish 
surgeon to leave the table early to catch a train. Saxtorph made 
his excuses for him and he left the room with some embarrassment, 
as he spoke not a word of English. 

As his houso surgeon, lie frecpumtly took me to his private 
operations, perhaps because so few outside his actual staff were at 
that period capable of giving efficient aid in antiseptic details. 
While he was as caroful and thorough as he could well be he treated 
always his humblest hos])ital paticiit with the same consideration, 
the almost feminine solicitude, that he gave to the proudest dames 
that sought his care. 

Bear with one illustration. In the treatment of large chronic 
abscesses the then usual practice of surgery was to draw off the 
matter by means of a cannula, and trocar, or some similar manner. 
No surgeon dared to open them in adults at any rate. This man- 
ner of opening was fre(|uently succrssful at the time, the patient 
being relieved from the accumulated fluid ; but pus was almost 
certain to reaccumulate and again tapping must be repeated. 
Sooner or later, inflammation and constitutional symptoms com- 
pelled free incision, when usually fetid pus escaped. Antiseptic 
surgery taught the wisdom and safety of free incision and provided 
careful dressing with drainage was continued in time, even the 
tubercular bone healed and a cure resulted. But sometimes the 
time required was long. Yes, even one or two years. I know in 
my time in Edinburgh the managers of the Infirmary grumbled 
at the length of time that some of Lister's cases of chronic abscess 
of the hip and spine held possession of the beds. On one occasion 
at least. Lister appeared before the managers and by his explana- 
tion prevented them taking any action. 

When Lister left Edin])urgh, in 1877, there were eight cases 
in his wards of psoas and hip abscess — seven men and boys and 
one woman. Lister thought they would remain in the hospital 
under Annandale until they got well. Dr. John Stuart tells me 
that shortly after Lister went to London it was decided to turn 
these patients out. Cair*! wrote to Stuart and asked if the girl, 
a lad^^'s maid from tlic Smiih of T^ngland. would lie taken in at 
Kings. " I shall nevci- forget." he says, " the pained look of sur- 
prise in Lister's face when he heard his patients were to bo turned 
out." I wired Cainl " Yes," and that night she left for London 



DOMINION MEDICAL MONTHLY 189 

under the care of a nurse, transported in one of those long baskets 
which in Edinburgh were used to carry patients to the operatinc: 
theatre, manned bv the dressers of the sur£:eons. She ultimately 
got quite well and the "• Chief,'' writing a year or two later, said 
that he had seen her walking and looking bright and well. Lister 
had the men and boys taken from the Infirmary to a nursing home 
where he used to operate in Edinburgh. He put them under the 
care of his old assistant. John Bishop, and paid all the expenses 
connected therewith, including attendance and dressing. In the 
end all of them got perfectly well. 

Sunday afternoon in the wards was a busy time. Lister, though 
a member of the Society of Frien<ls, went, if I am not mistaken, 
to Trinity Church — a Scotch Episcopal Church of the old-fashioned 
sort, just over the Dean Bridge. At about two o'clock he would 
come to the Infirmary. Any cases that had not been overtaken in 
the pressure of the week-day work were investigated and disposed 
of; minor operations done. Very pleasant were those Sunday 
afternoons. Xo visitors, no strangers ; but often discussion of 
points in the cases given with much more freedom than was usually 
feasible. The bells were ofteii ringing six when I walked out with 
him to Infirmary Street. lie never, I think, took out his horses 
on Sunday. I hardly think any of the clerks or dressers found 
those Sunday afternoons long or wearisome in the very least. 

I cannot remember his ever discussing any aspect of religious 
belief with me; but I have reason to know that neither his scien- 
tific researches nor his ceaseless work nor the high honors heaped 
upon him prevented his having a child-like Christian faith. He 
ever held fast the blessed hope of everlasting life. 

About this time he was summoned to Balmoral to attend Queen 
Victoria. She had an abscess in the axilla whicli required to be 
opened. He did it under the spray with complete antiseptic pre- 
caution. He told us how he had no drainage tube but cut otf a 
portion of the tube of the spray producer to make one; also, that 
the Queen said she liked the smell of the carbolic spray. Carbolic 
acid, as his main antiseptic, had been chosen after considerable 
investigation, ^fany objections had from time to time been raised 
against it, one being its odor. This royal opinion on that head 
gave Lister considerable satisfaction. His selection by Her 
[Majesty showed the estimation in which his work was now being 
held. There were others on the Royal Scottish staff that might, by 
age and experience, have been selected. 

By degrees his old pupils, especially his old house surgeons, 
were helping to spread his views. Cleaver had gone to Liverpool ; 



190 DOMINION MEDICAL MONTHLY 

Fleming to Glasgow ; Knowslev Thornton to be with Sir Spencer 
Wells at the Samaritan for Women, in London; Beatson, after- 
wards Sir George Beatson, to Glasgow ; Malloch, who had been 
his honse surgeon in Glasgow, had already settled in Hamilton, 
Canada. Lister wished me to go to Korwich to take charge of the 
hospital there and help Mr. Cadge, the well-known surgeon in the 
East of England, to become familiar with the practice of antiseptic 
surgery. I had decided to return to Toronto and so, with much 
regret, declined his offer. Baldwin followed me later on to 
Toronto. 

In 1877, Lister left Edinburgh for London, Kings College 
offered him the vacant chair of Sir William Ferguson. I think he 
felt, if he accepted it, he would have greater facility for reaching 
the profession in England. The London men had been slow to 
adopt it ; very sceptical about it. Here was a great chance to let 
the profession see his grand results. Two men went with him 
from Edinburgh, Watson Cheyne and John Stuart, now of Hali- 
fax, both of them loyal, devoted pupils who stand out perhaps 
foremost, among those whom Lister trained. 

In 1879, two years after he went to London, Mr. Savory, after- 
wards Sir Wm. Savory, surgeon to and lecturer on surgery at St. 
BartholomeAv's. delivered the address on surgery before the British 
Medical Association. He chose as his subject the prevention of 
blood poisoning in the practice of surgery; he called it the chief 
evil that waits upon the surgeon's work. He analysed statistics 
of operation cases in his own hospital, showing excellent results as 
to freedom from death from pyemia, erysipelas and the like. 
After covering the subject exhaustively, he contended strongly for 
simple means of dressing and yet he rejoiced in laudible pus. 

Of antiseptic dressings, however, he says : "I say then I cannot 
admit the claim of Lister's method, because though undoubtedly 
good results are to be obtained by this practice — better ones no 
doubt than most of those reached in former years — or are still 
in many places, yet it has not shown results superior or equal to 
those which have been otherwise achieved. Moreover, it has grave 
drawbacks from which simple plans are free; that if it failed it 
is worse than useless by increasing the risk. And, therefore, it 
has not established any title to su|)('rcede all other methods in the 
practice of surgery." Such was the opinion of some at that date. 

In 1880, Professor Spence, of Edinburgh, published his sur- 
gical statistics in reply to those of Lister given at a recent debate 
on antiseptic surgery. He prefaces he is not actuated by any 
such motive as sometimes characterize criticisms of Lister, as due 



DOMINION MEDICAL MONTHLY 191 

to envy, malice and all uncharitableness. Then he produces a 
paper which Lister, the mildest of men, in his answer, says con- 
sists of two elements : " One tending to disparage my character 
as a surgeon, the other calculated to diminish the effect of the 
statistics which I have lately adduced in favor of antiseptic sur- 
gery. The former of these elements I shall beg leave to dismiss 
without further notice than to remark that as Mr. Spence never 
did me the honor to witness the practice which he criticizes, so that 
his knowledge of it must have been derived entirely from hearsay, 
the exercise of a little charity towards a late colleague might have 
induced him in every one of the points to which he refers to accord 
a more generous and at the same time a more just interpretation." 

This called forth from Spence a powerful reply and Mr. Wat- 
son Cheyne furnished full statistics of Lister's results. Mr. 
Spence's replv to this was so severe that the editor of the British 
Medical Journal suppressed parts of it and said his remarks as to 
Cheyne were scarcely worthy of so eminent a surgeon. 

if in the discussion of this momentous question some sharp 
blows were given and taken until conviction gradually became 
universal, yet from time to time Lister received marks of honor 
and ajipreciation that were unusual. 

On leaving Edinburgh, he vacated the office of Surgeon to the 
Queen in Scotland, yet in 1878 he is gazetted as a surgeon extra- 
ordinary to Iler Majesty in the place of ^Ir. Hilton. In June. 
1879, Dublin University gave him the ^Nf.D. honoris causae, and 
in conferring it the Dean of Faculty said: " They might claim 
for him merits equal, if not superior, to the merits of Simpson in 
reference to anesthesia." 

It would be wearisome to give any adequate idea of the d^rees 
and honors conferred on him by countless learned societies the 
world over. One only would I like to refer to, coming as it did 
at the time of these severe criticisms already mentioned. 

In September. 1879, the British Medical Journal says: " The 
enthusiastic ovation with which Prof. List«r has been honored 
this week at the International Congress of Amsterdam by the body 
of surgeons and physicians of all nations who were assembled 
there will cause great joy in Kings College and Hospital, which 
have the advantage of possessing the surgeon whom Europe de- 
lights to honor. The honors which have been heaped upon Lister 
by every country in the world are not perhaps without precedent 
in the history of medicine ; but we know no precedent for the en- 
thusiasm which his presence creates in every assembly of medical 
men in Europe and the almost regal reception everywhere accorded 



192 DOMINION MEDICAL MONTHLY 

to him. It is, as Prolt'ssor Dunders t'Xpressod it, not only a tcsti- 
nionv of admiration to the learned surgeon who has known how to 
draw from the teachings of absolute science the most precious, 
precise and accurate safeguards for practical surgery, and wdio has 
enlarged the bounds of its achievements while he has disarmed it 
of its M'orst terrors an<l anxieties; but it is also an expression of 
gratitude for the multitude of lives already saved throughout 
Europe by the apjdication of his methods and the endless vista of 
benefits to humanity which opens up before the universal adoption 
of antise])tic ])rin('i]iles. Whatever mav be doubted no one will 
deny that Professor Lister has created a revolution in surgerv 
throughout Europe by which every day lives are saved, and it 
cannot be said that the honors thus spontaneously showered upon 
him by the most critical of judges — his foreign contem])oraries 
— are other than well-earned. 

" Few men. if any. however have lived to see themselves so 
quickly hailed by the masters of thir own art in all countries as 
among the greatest benefactors of their kind. And English sur- 
gery may well feel proud of its illustrious professor who has once 
more made the name of English science and Immnnitnrian ]>rogress 
resound with applause in every country," 

After T came to Toronto, in 1875. it was not till 1S8('> T saw 
him again. I visited England in that year and soon went to Kings 
College Hospital, T slipped into the theatre unobserved. T thought. 
while he was ojierating. T found time had changed him a bit. 
His brown hair was heavily tinged with gray, s|)ectacles were 
necessary for operating; but in all other respects he was unchanged, 
T fancied perhaps he would not remember me, but after the opera- 
tion was over he washed his hands in his usual deliberate manner 
and looking round the seats, said : '" Where is that fellow V smiling. 
He warmly shook me by the hand and made me promise to dine 
with him that night. After dinner was over. Tiickman Godlee, his 
nrpliew. and others left the table, but Lister kept me tellinc" me 
all changes and improvements that he had made, the difliculties he 
had overcome, since I had been with him. So keen was he in telling 
me all this and so interested was T in listening, that the time 
passed quickly away and it was eleven o'clock when we went up- 
stairs, to find only his wife and mine in the drawing-room. I think 
the absorbing interest of his work made bini oVilivious to time and 
place, 

^fany of us remt niber him in Toronto at the meeting of the 
British Association. T think he had. in common with many Eng- 
lishmen at that time ftliouiih tiirics have changed since), the idea 



DOMINION MEDICAL MONTHLY 193 

that Canada was an ordinary country and Toronto a commonplace 
city, I called at the Queen's Hotel the first morning of the meet- 
ing early and ])rought him up in my carriage with Sir Wm. 
Turner, the President of my University, who was staying with me. 
It was a lovely August morning as we drove up to the Queen's 
Park, and as the T'nivorsity compound and the park opened be- 
fore them Sir William said to Lister: '' This is a very nice place, 
Lister." " It is, indeed, Turner," said Lister. They were 
charmed with the L'niversity and its surroundings. Further know- 
ledge of Toronto only deepened the pleasing impression they re- 
ceived at first. How much the ])rofession here made of him and 
the pleasure it gave him I can testify; but many remember it well 
no doubt. During that visit T saw much of him as I had known 
him well in the long ago. He seemed to enjoy much speaking of 
the past: of his wife, to whom he was so devotedly attached, and 
of her sad and sudden death when travelling in Italy. I saw him 
only twice afterwards. I find his last letter to me was dated June, 
1007. In it he says that he is in infirm health, but it would give 
him much pleasure to see me at Park Crescent. Unfortunately. I 
did not go to London during that summer. Two years afterwards, 
when in England, I found he had gone to Walmer and his return 
to London was a matter of great uncertainty. Though his niece 
said she thought he would see me, I Ik sitated to intrude u])on him. 

Of the actual results of his work, of the benefits that it has 
conferred on humanity, it is im))ossible to make any estimate. I 
have seen it in ])rint somewhere that in 1000 it was asserted, with 
much appearance of ])robability, that it had already saved more 
human lives than all the wars of the expiring century had sacrificed. 
Well, indeed, did Mr. Bayard, the American Ambassador, sum up 
the matter at a banquet of the Royal Society in proposing Lord 
Lister's health, when he said: ""My Lord, it is not a profession, 
it is not a nation, it is humanity itself which with uncovered head 
salutes you." 

In 1883 the Crown conferred a baronetcy upon him, and Queen 
Victoria later raised him to the peerage; the only one, T believe, 
ever conferred on a surgeon. 

Gratified, no doubt, as he was by these honors, yet I feel sure 
that Jose])h Lister valued the great, the inestimably great, work he 
did for humanity far above any honor that could possibly be 
conferred upon him. 

This Society, I think, does well to honor his memory to-night. 
His life has been written with more or less completeness and 
ability, and no doubt will be done aaain. I have tried to give, not 



104 DOMINION MEDICAL MONTHLY 

an ai>preciatioii of him, not an account of his life, but an outline 
of mj personal knowledge of him. How imperfectly I have suc- 
oeeded in showing uyi some of the characteristics that mark so 
strongly my old teacher — one of the greatest of men — nobody 
knows better than myself, but in loyalty to, in aifection, yes, in 
love for him, I vield to none. 



* REMARKS ON ECZEMA WITH SPECIAL REFERENCE TO ITS 

ETIOLOGY. 



By Graham Chambers, B.A., M.B. 



There are few diseases which are more important to medical 
men than eczema, whether we take into consideration the fre- 
quency of its occurrence, the easiness, as a rule, of its diagnosis or 
the effectiveness of careful treatment. Yet after all this has 
been said we must acknowledge that the etiology is little under- 
stood, and as is necessary under such conditions the treatment 
is more or less empirical. This defect in our knowledge of 
eczema is not due to lack of investigation for there are few 
diseases which have been more closely studied. The investiga- 
tions, however, have not been without value. Observations have 
been recorded which will in time no doubt prove of value in 
elucidating the problem of the disease. 

In studying the disease one of the obstacles met with is the 
difficulty of defining what is meant by eczema. It cannot be 
defined by its pathological characters l)ecause one can produce 
by external irritants such as dyes, flour, sugar, and bichromate of 
jiotassium, d<M-matites indistinguishable as to their gross and 
microscopical appearances, from eczema. This difficulty has been 
recognized ever since physicians began to give special attention 
to the study of cutaneous affections. T^ateman and Willan, who 
classified skin diseases according to their lesional characters 
(papules, vesicles, scales, etc.), restricted the name eczema to 
certain vesicular eruptions and included under this heading not 
only rashes of unknown origin, but also those caused by external 
irritants. For example, in their Atlas of Cutaneous Diseases 
published in 1840 there is a plate designated eczema rubrium 

• Read before the Hamilton Medical Association, February, 1912. 



DOMINION MEDICAL MONTHLY 195 

mcrciiriale, a moist dermatitis caused bv the application of a 
mercurial preparation to the skin. Somewhat later this idea was 
expanded by Hebra, the elder, who stated that eczema was nothing 
more than a superficial inflammation of the skin, dependent on 
some external irritation. Hebra admitted that constitutional con- 
ditions might predispose to eczema, but maintained that local irri- 
tation was essential in the genesis of the disease. He even went 
so far as to include itch with the eczema inasmuch as it is caused 
by an external irritant. 

Nowadays our views with regard to the part played by exter- 
nal irritants in the causation of eczema are quite different from 
those of Hebra. We no longer apply the name eczema to any der- 
matitis produced by chemical or mechanical irritants, but designate 
it, artificial dermatitis. This, however, is open to criticism, 
because in many cases of artificial dermatitis there is a predisposi- 
tion, due probably to constitutional disturbance which renders 
the skin hypersensitive to irritation. For instance, in chocolate 
dippers only about one in ten suffer from an eczematoid eruption 
of the hand, which shows that the predisposition to the dernia- 
titis is of first-rate importance. On the other hand, an artificial 
dermatitis is generally localized to the seat of irritation, which 
shows that the local irritant is an important etiological agent. 
In eczema the lesions appear in parts not subjected to local irrita- 
tion, which character is important in differential diagnosis be- 
tween the two affections. 

If we deny that an eczematoid dermatitis produced by an 
external physical agent is an eczema then naturally one should also 
exclude similar eruptions- caused by local irritation of animate 
agents. This, I may say, is the custom followed. For instance, 
some of the eruptions which are now described under the heading 
of seborrheic dermatitis were formerly clas>ed with the eczemas. 
As soon, however, as the etiology, pathology and symptomatology 
of seborrheic dermatitis was understood the eruptions which were 
formerly classed with the eczemas were given their 
correct nosological position ; and there is no d<jubt that 
as our knowledge of dermatology increases other eruptions 
which are now designated eczema will be separated as distinct 
entities. Eczema at the present should be looked upon as a com- 
posite affection. It would be more correct to speak of the eczema 
group or eczemas than eczema. With this conception of the term 
one might place in the eczema group any superficial inflammation 
of the "skin, originating without visible external irritation and 
exhibiting in some stage of its evolution serious exudation. 



196 DOMINION MEDICAL MONTHLY 

T1[E ETIOLOGY OF ECZEMA. 

There are two theories regarding the origin of eczema. 
According to one, eczema is mierobic in origin; and to the other, 
nmicrobic. 

THE MICROBIC THEORY OF THE ORIGIN OF ECZEMA. 

xVccording to this theory, eczema is an infections inflammation 
of the skin. 

Among those who have strongly supported the mierobic theory 
are Boekhart and Unna. Bockhart, experimenting with virnlent 
staphylococci aureus and albns, found that an inoculation of the 
skin with a filtrate of a culture produced a ])apulo-vesicular erup- 
tion having the gross and microscopical appearance of an eczema. 
Bockhart's observation was confirmed by Bender and Gerlach. 
These investigators looked upon the eruption as due to the irrita- 
tion of the staphylotoxin acting as a serotactic agent, i.e., an agent 
Avhich repels the leucocytes, but attracts the serum. Bockhart 
goes as far as defining an eczema as ''an infection inflammation 
of the epidermis caused by stajjhylococci." lie thinks that staphy- 
lococci, normally present but inactive in the follicles, become from 
some external or internal disturbance active and excrete the staphy- 
lotoxin which passes through the wall of follicle into the inter- 
cellular spaces in the epidermis and there sets up a serotaxis with 
resulting vesication. At first the vesicle is sterile, but soon the 
stapyylococci make their way into it and there exert a positive 
chemotaxic action resulting in a greater or less degree of pustula- 
tion. 

Unna holds a different view from tliat of Bockhart. In 1800 
he reported that he found in largo nunibci-s in the skin in eczema 
a coccus which he named the "morococcus '' from the fact that it 
tended to be arranged in groups like mulberries. His observa- 
tion received little support, ^foreover, it was soon shown that 
the morococcus, was probably the same as the staphylococcus epi- 
dermidis ^bus; and lately Unna has given up the belief that the 
morococcus is tlie cause of eczema. Unna, however, still believes 
in the mierobic theory. lie has isolated twenty-three cocci in a 
case of eczema. Of these twelve are harmless and eleven patho- 
genic. Two of the pathogenie varieties, which he has named 
'• Xeufang" and " Traubclpnas " after the names of patients from 
whom they were taken, are capable of ])roducing an eczematoid 
erujjtion when inoculated on the skin. 



DOMINION MEDICAL AiOiWl HLY 197 

Sabouraud, who may be taken as representing the French 
school, although believing in the amicrobic origin of eczema, holds 
the opinion that several dermatites which are now generally 
described under the heading of eczema are caused by infectious 
agents. He has given the name streptococcic epidermatitis to 
certain of these eruptions. These may be secondary boils, abscesses 
or other pus infection. Frequently they begin as intertrigoes, 
which may become moist, fissured, and spread either by continuity 
or by the formation of new foci on various parts of the skin. The 
eruption which is so frequently seen behind the ears of children 
is frequently a form of the disease. In some cases, especially 
in the anemic and debilitated, the eruption spreads widely and 
may become universal. The character of the eruption is variable. 
It may be characterized by scaly patches, moist surfaces, or ves- 
icles. As a rule itching is not a marked symptom which character 
aids one in distinguishing it from eczema. The distribution is 
somewhat similar to that of seborrheic eczema, but the latter 
disease is generally secondary to a similar aifection of the scalp. 

Perleche is another affection which is classed with the mic- 
robic dermatitis. It is characterized by whitish patches, usually 
fissured, situated at the commissures of the lips. In some cases 
the dermatitis extends on the skin of the cheek, but this is unusual. 
The whitish soddened patch resembles a syphilitic mucous patch. 

The problem which one has to solv^e in these cases is the mode 
of extinction of the dermatitis. How, for instance, a discharging 
abscess produces a dermatitis in the adjacent skin as well as in 
distant parts. The observation of Bockhart, referred to above, that 
a filtered bacterial culture, rubbed on the skin produces an eczema- 
toid dermatitis, affords an explanation of the extension by con- 
tinuity, but does not fully explain the extension to foci in distant 
parts, because it is improbable that sufficient toxin can be carried 
to parts of the skin at a distance from the primary focus to 
produce the irritation. Here one must seek another explanation ; 
and I think the modern theory of anaphylaxis is one at our com- 
mand. I shall refer to this again in the consideration of anaphy- 
laxis and sensitization of the skin. 

THE AMICROBIC THEORY OF THE ORIGIN OF ECZEMA. 

This view is generally accepted by the French and, I think, 
the majority of British and American dermatologists. It is not 
denied by these that bacteria take part in the evolution of the 



198 DOMINION MEDICAL MONTHLY 

eruption, but it is asserted that the primary lesions of eczema 
are at iirst sterile and only become secondarily infected. I shall 
briefly call attention to some data which appear to support this 
theory. This for convenience of description will be considered 
under the following headings: 

(a) The Arithmetic Diathesis as a Predisposing Cause of 
Eczema. 

(b) Disturbances of Metabolism as Causes of Eczema. 

(c) Tlic IntliioiK-e of Anaphylaxis in the Etiology of Eczema. 

(a) THE ARITHMETIC DIATHESIS AS A PREDISPOSING CAUSE OF 

ECZEMA. 

Th& arithmetic diathesis or arthritism is a particular form of 
nutrition which appears to predispose a person in which it exists 
to certain diseases especially eczema, asthma, bronchitis, mi- 
graine, gout, renal calculus and diabetes. Bouchard defines it as 
a sluggishness of nutrition ; Landouzy, bradytrophy. The condi- 
tion appears to develop under the new conditions imposed by 
civilization which tend to develop the cerebral faculties at the 
expense of the bodily. 

The arthritic person may be lean or fat. The lean type, 
according to my experience, is especially liable to eczema, asthma 
and bronchitis ; the fat type, to eczema, bronchitis, gout and 
diabetes. It is unusual to find all these ailments in the same 
individual, but several may be present in the history of a family. 
One member of a family may suffer from asthma ; a second 
from eczema ; a third from migraine ; a fourth from gout or mild 
diabetes. 

The arthritic person is especially predisposed to eczema ; and 
it will be found that if there is marked arthritic diathesis in the 
family history, the eczema is difficult to cure. It would appear, 
therefore, that the metabolic or nervous disturbance which is the 
basic cause of the diseases to which the arthritic person is predis- 
posed is a cause of eczema. The question for us to determine 
is, what is this disturbance? The problem is a very difficult one 
and it is unlikely that it will be solved in the near future. The 
diseases,, (eczema, asthma, migraine, gout, diabetes, etc.), which 



DOMINION MEDICAL MONTHLY 199 

are in some way etiologieally linked together, are so diverse clini- 
cally that one cannot suggest any mechanism by which one agent 
can be an etiological factor in all. 

For instance, eczema and asthma are two diseases, which 
occur so frequently in the same patient, either co-incidentally or at 
different times that there can be no doubt that they are etiologieally 
related. 

JTow in asthma we have spasm of the bronchial tubes brought 
about reflexly by irritation of other parts, especially the mucous 
membrane of the nose ; and in eczema we have a catarrhal inflam- 
mation of the skin. I see no way of linking these together except 
by considering them as both being primarily due to nutritional or 
nervous disturbance which in one case results in a hypersensitive 
condition of the nervous system to reflex action and in the other 
to a hypersensitive condition of the skin which with the least 
possible irritation results in inflammation. 

(b) DISTURBANCES OF METABOLISM AS A CAUSE OF ECZEMA. 

The etiological relationship of disturbances of metabolism to 
eczema has not been definitely determined. Some dermatologists 
who look upon eczema as a local disease believe that metabolic 
disturbances play little or no part in the etiology of the affection. 
There are others who hold the opposite view, asserting that dis- 
turbances of metabolism are very important. T may state that I 
am decidedly in favor of the latter. In the history of patients 
with eczema, one frequently gets a history of excessive eating, but 
a much more important sign showing the relationship is the great 
value of partial or absolute starvation in the treatment, especially 
of acute cases. I know of no measure more valuable than this in 
the treatment of the disease. 

With regard to the question whether the harm results from 
the excessive eating of proteins, fats or carbohydrates. I have not 
formed any definite opinion. In practice I usually blame the 
proteins, order a diet of low protein content, and free from meat 
and fish. I also order that the patient drink no tea or coffee, 
because these beverages contain considerable purin bodies which 
it is reasonable to suppose, might prove harmful especially in an 
arthritic. 

(c) THE INFLUENCE OF ANAPHYLAXIS IN THE ETIOLOGY OF ECZEMA. 

The term anaphylaxis is used to designate a hypersensitive 
condition of the body to foreign substances. It is merely a theory 



200 DOMINION MEDICAL MONTHLY 

or hypotliesis formulated to explain certain facts which have been 
observed in experimenting on lower animals and also in the treat- 
ment of disease. Some of the most important of these observations 
are: 

I. Magendie, in 1837, observed that a rabbit which had re- 
ceived an injection of albumin without ill eifeets might die from 
the second given some days later. 

II. Von Behring, in experimenting on guinea pigs with diph- 
theria antitoxin, found that the second dose given at an interval 
after the first might prove fatal. 

III. Ricliet, in 1902, experimenting with poisons of certain 
actinians in dogs, found that the second dose given after an 
interval of some days invariably* produced a greater effect than the 
first. 

IV. Arthurs, in 1902, found that a single dose of horse serum 
given hypodermically produced no effect, but that relocated doses 
not necessarily in the same place produced edema, sloughing and 
ulceration. He also found that an intravenous injection admin- 
istered some time after a subcutaneous injection caused death. 

V. Theobald Smith found that a single dose of horse serum 
injected into the peritoneal cavity of a guinea pig produced no 
action, but that repeated doses frequently resulted fatally. The 
fatal result only occurred in animals which had been given a dose 
several weeks previously. 

The theory of anaphylaxis was introduced to explain these 
facts. It is thought that tin- introduction of a substance usually 
a protein, and foreign to the tissues, subcutaneously intravenously 
or possibly by the mouth may make the animal hypersensitive to 
a second dose of the same substance given some time later. The 
first is called the soisiti/.ina' and tlic scfond the reacting dose. 

In cxpcrinii nting on iininials there must be at least one week 
after the first dose before the animal becomes sensitized. This 
interval is called the period of incubation of the anajdiylactic 
state. 



DOMINION MEDICAL MONTHLY 201 

In animals the manifestations of anaphylaxis come on almost 
immediately after the giving of the reacting dose. In some cases 
they appear in a few seconds. The length of time depends a 
good deal upon the rapidity of absorption. 

The symptoms of anaphylaxis are variable. In some cases 
there is bronchial spasm; in others cardio-vasciilar disturbance; 
in others again edema and erythema of the skin. It would be 
impossible to mention all the symptoms which may occur. 

The period of duration of the anaphylactic state may vary 
from a few weeks to several years. In rabbits it has been shown 
that the hypersensitive state of the mother rabbit can be trans- 
mitted to its young. 

The theory of anaphylaxis which was first introduced to 
explain the phenomena observed after the injection of albumins 
and serums was later expanded so as to include many other 
phenomena. Rosenan and Anderson showed that the anaphylactic 
state could be produced by the injection of dead bacteria. This, 
at once, suggested that the cutaneous reaction observed by von 
Pirquet in patients with tuberculosis was probably a manifesta- 
tion of anaphylaxis. The fact that von Pirquet's reaction once 
established generally remains through life even in the absence of 
symptoms of tuberculosis in the patient may be explained in this 
way. 

The theory of anaj^hylaxis al?o affords an explanation of the 
appearance of eczematoid eruptions after bacterial infection of 
the skin. It may be supposed that the body becomes sensitized 
by solution of bacteria in an abscess or other primary affection, 
and that a later inoculation produces the eruption. 

An observation which has a very important bearing on prac- 
tical medicine was made by Bruck, who showed that rabbits and 
guinea pigs could be sensitized by feeding crab meat, hog and 
sheep serum per os. 

If an animal can be sensitized by feeding per os, then it is 
quite reasonable to believe that the idiosyncrasies to certain food 
stuffs such as mussels, sausages, strawberries, etc., are due to an 
anaphylactic state. 

Again one may, with reason, suggest that eczema is a mani- 
festation of anaphylactic reaction. It may be supposed that 
a hypersensitive state is inherited or acquired. The arthritic 
diathesis, which we know is so frequently present in patients with 
eczema, may be due to a hypersensitive state of the tissues. The 
excessive eating of meats, which I believe is a cause of eczema, 
may result in the same condition. 



202 DOMINION MEDICAL MONTHLY 

^ebicine 



Graham Chambers, R. J. Dwi'er, GtOldwin Rowland, 
Geo. W. Ross, Wm. D, Young. 



The Gastric Contents in Gastroptosis. By Thomas R. Brown, 
M.D., Baltimore, ^ew York Med. Jour., Sept. 16. 

The digesti\ie signs of gastroptosis are stated by authorities to 
be eitlier superacidity, diminished acidity or motor weakness, that 
is, they vary in ditfei^ent oases. Brown quotes his experience of 
new cases, which shows achylic in 14, diminished acidity in 14, and 
increased in only four. 

The extent of the diminution in acidity depends on the degree 
of prolapse, while cure of the functional disorder is produced by 
the improvement of the prolapse. 



The Pituitary Body. By Charles "W. Hitchcock, M.D., Detroit, 
Mich. 

The pituitary gland is anatomically composed of an anterior 
lobe of nervous origin and a posterior lobe of nervous origin. 

Physiologically it appears to have a marked influence over the 
other duc-tloss glands, and its complete removal leads to death of 
the individnal. 

H\7)eractivity of the non -nervous portion is associated with 
gigantism and acromegalia, Av^hile its atrophy or partial ablation 
leads to a disturbance of adiposity, infantilism and a loss of adult 
sexual characteristics. 

Tlie post part of the gland causes rise in blood pressure, slowing 
of pulse and increased flow of urine, also pupillary dilatation, 
inhibition of pa.ncreatic secretion. Resections into the sexual glands 
are shown by impotence and amenorrhoea, with the pancreas by 
glycosuria, in lesions of the pituitary. 



DOMINION MEDICAL MONTHLY 203 



Ipb^siologic ^berapeutics 



J. Harvey Todd. 



The X-Ray as a Curative Agent in Malignant Tumors. Aspin- 
WALL JuDD, j\LD., New York. Medical Record. 

Two rays are present in a rontpren tube, the X-ray and the 
cathode ray. 

The physiological action of the cathode stream in a low tube is 
of sunlight intensified, producing hyperemia, and in its fullest 
extent, escharosis. The penetration is low (6 m.m.) and only 
valuable in skin lesions. 

The X-ray in a high tube penetrates all substances with a velo- 
city proportional to their density, travels in straight lines, has a 
selective action on diseased tissues, and at first is stimulating. 
"When this effect is intensified it produces overstimulation with 
destruction of the cell through fattj' degeneration. Upon connec- 
tive tissue the stimulation produces an exaggerated adult type of 
connective tissue, i.e., fibrous tissue. Upon connective tissue 
growths, i.e., sarcoma, its effect is to transform the sarcoma to a 
fibromata. L^pon glandular tissue its final action is to produce a 
death of the cell elements. 

About 90% of epitheliomas without metastases or glandular 
involvement can be cured by this means. Malignant angiomata 
react most favorably to the X-ray. 

In deep seated carcinoma rajang is justifiable only when the 
growth is inoperable and is useful only to alienate pain. The 
post-operative raying of malignant conditions. I thoroughly ap- 
prove, and this as soon as healing is complete. 

Sarcoma reacts readily to X-ray treatment, but is very prone 
to recurrence, snch recurrences, however, react as well as the 
original growth. 

In treating a deep-seated tumor of any type we must select a 
tube with the greatest penetration, and the patient should be pro- 
tected carefully. 

In lymphosarcoma we have a type of malignant growth in which 
the X-ray is peculiarly efficacious. Treatment should be early and 
energetic. 

J. H. T. 



204 DOMINION MEDICAL MONTHLY 

®b6tctric8 



Aethur C. Hendrick. 



The Midwife Problem. 

The results of a letter of iniiuiry eoiitaining fifty questions ad- 
dressed to teachers of obstetrics in various medical schools giving 
a four-year course are reported and discussed by J. Wliitridge 
Williams, Baltimore {Journal A. M. A., January 6). He finds the 
condition of affairs unsatisfactory. Forty-three replies in all were 
received to the 120 letters sent out, the answers representing on€- 
half of the acceptable and one-fifth of the non-acceptable medical 
schools. From these answers received, Williams concludes that, 
generally speaking, the medical schools are inadequately equipped 
for teaching obstetrics, one only have an ideal clinic, and that one 
not Johns Hopkins. ]\Iany of the professors are poorly prepared 
for their duties and do not properly appreciate their obligations as 
teachers. Some admit they are not competent to perform the mtijor 
obstetric operations, and con.sequently can be expected to do little 
more than train men-midwives. ]\Iany of them admit their students 
are not prepared to practise obstetrics on their graduation, nor do 
they learn to do so later. One-half the answers .say that ordinary 
pra<'titioners lo.se proportionally as many women from puerperal 
infection as do midwives, and over throe-quarters say that more 
deaths occur from faulty operations than from infection in the 
hand.s of midwives. Refonm is needed, and the following measures 
are, in his opinion, most important : A. Reduction in the number 
of medical schools, with adequate facilities for those f-urviving and 
higher preliminary education on the part of students. B. Insistence 
in imiver.sity medical schools that the head of the department be a 
real professor whose prime object is the care of ho.';pital patients, 
the proper training of a.ssistants and .students and advancemetit of 
knowledge rather than a prosperous medical practice. C. Recogni- 
tion by medical faculties and hof^i^ital.s that obstetrics is one of the 
fundamental branches of imedicine, and that the obstetrician .should 
be a scientific man with a broad grasp of his subject. D. Education 
of the general practitioner to realize that he is competent to conduct 
only normal cases of labor and that major obstetrics is major surg- 
ery, to be undertaken only by .specially trained men in the control 
of abundant hospital facilities. E. The requirement by State exam- 



DOMINION MEDICAL MONTHLY 205 

ining boards that every applicant for license to practice shall show 
that he has had personal experience with at least ten obstetric cases 
under appropriate clinical conditions. F. Education of the laity 
that poorly trained doctors are dangerous and that most of the ills 
of women result from poor obstetrics, and that poor women in fairly 
well-conducted free hospitals iLsually receive better care than well- 
to-do women in their own homes ; that the remedy lies in their hands, 
and that competent obstetricians will be forthcoming as soon as 
they are demanded. G. Extension of obstetric charities — free hos- 
pitals and out-patient servicers for the poor and proper semi-charity 
hospital accommodations for those in moderate circumstances'. He 
would also ad'\asie a greater development of visiting obstetric nurses 
and helpers trained to work under them and the gradual abolition 
of midwives in large cities and their replacement by obstetric chari- 
ties. If midA^ves are to be educated it should be done properly and 
not in a makeshift way, and even then disappointment will probably 
follow. 



Tuberculous Lungs. 

Freidrich (Miiv. mrd. ^yochfn^ tr<^ats tuberculoiLs lungs by 
total mobilization of the chest wall- thoracoplastic pleuro-pneu- 
m'ol>-sis. Fourteen of his patients are in fairly good health up to 
the present time. Fine results have been obtained by him in thus 
immobilizing the lung, inducing a pneumothorax. In 1888 Quincke 
was the pioneer in this line, and the Warburg clinic has a record 
of twenty-eight operations, where resection of more or less ribs 
has been done over the cavity. Patients under 15 and over 40 are 
not accepted. The mortality has been 26 per cent. 



Bronchial AsTinr.\. 

Lemann {Am. Jour. Med. Sciences) states iodide is the sheet 
anchor in the treatment of this distressing condition. By it the 
paroxysms and .severity are diminished. Large doses are not 
needed, so the stomach is saved. From ten to fifteen grains of 
potassium iodide, three times a day, for ses'eral months, and then 
given for periods of ten days with ten days' interval of rest. 
Sometimes he directs the iodide to l)e taken for the first ten days 
of each month. 



206 DOMINION MEDICAL MONTHLY 

IRcviews 



Practical Electro-Therapeutics and X-Ray Therapy. By J. M. 
Martin, M.D., St. Louis, C. V. Mosby Co. 

A well written book for the general practitioner and student, 
giving in a concise manner an excellent introduction to the many 
uses of electricity in therapeutics. 

The chapters on high-frequency currents are particularly inter- 
esting and instructive. Unfortunately, the author has given prac- 
tically no space to an important part of electro-therapeutics, i.e.. 
Phototherapy. 

J. H. T. 



Direct Laryngoscopy, Bronchoscopy and Esophagoscopy. By Dr. 
W. Brunixgs, translated and edited by W. G. Howarth, M.A., 
M.B., Camb. F.R.C.S., Eng. London: Bailliere, Tindall and 
Cox, 1912. ^Medium 8vo., xiv.+370 pages, 114 illustrations, 
including 26 plates, price, 15s. net. 

This book — a standard text-book on the continent — should 
become the same here, since it has been well translated into Eng- 
lish. The author, who by his mechanical ingenuity in the devising 
of instruments has done so much to simplify and render perfect 
the various operative procedures, treats of his subject both from 
the technical and the practical standpoints. "For the skilled 
observer there are many wearisom^e details that might well have 
been omitted, but daily experience in my endoscopic classes has 
convinced me that the written description must include the most 
elementary details, if it is in any way to replace personal instruc- 
tion. Therefore minute details are given as to anesthesia, position, 
to size of tubes, and to the manner of their introduction. Naturally 
the author favors and describes the use of his own set of instru- 
ments, the most satisfactory, in the reviewer's opinion. The 
mirror of the electroscope has been modified, being slotted instead 
of solid, thereby simpliiying the technique. Chapter IV, on the 
trachea and bronchial tree, contains many interesting anatomical 
and physiological data. Chapter VI L is on esophagoscopy in 
which the author says "Its eminent services are so generally recog- 
nized that the unjustified use of esophageal probangs and blind 



DOMINION MEDICAL MONTHLY 207 

•extraction instrumients, as also unjustified delays in the case 
of dangerous disease of the esophagus, must in future be decidedly 
condemned." 

The book can be recommended, and should be in the posses- 
sion of all interested in and practising this branch of work. 

G. B. 



Dental Examination Papers. For the Diplomas of the Royal Col- 
lege of Surgeons, Edinburgh, and the Royal Faculty of Physi- 
cians and Surgeons, Glasgow. Price, I shilling. Edinburgh: 
E. and S. Livingstone. 

This is a paper bound book of GO pages of examination ques- 
tions, well arranged, covering the entire curriculum. They extend 
over several years. 



Fellowship Examination Papers. For the Diplomas of the Royal 
College of Surgeons, Edinburgh. Price, 1 shilling. Edin- 
burgh: E. and S. Livingstone. 

This is a paper bound book of 68 pages of examination ques- 
tions, well-arranged, covering the entire curriculum and running 
from 1906 to 1911. Applicants for the Fellowship Examination 
will find these questions, convenient and handy. 



The C. V. Mosby Company, of St. Louis, has announced the 
publication of a book on Pellagra, to be ready by January 1, 
1912. This book is being prepared by Doctor Stewart R. Roberts, 
of Atlanta, Ga., who has just returned from Italy, where he 
studied the disease in its natural habitat. While in Europe the 
doctor made extensive research regarding the etiology and treat- 
ment of pellagra, and the data contained in the book will retlect 
the latest and best work that has been done in connection with this 
disease, making it a reliable guide to those seeking information on 
the subject. 



Diseases of the Ear. By Milligax and ^VIXGEOVE^ a practical 
handbook for senior students and practitioners. Toronto, The 
MacMillan Company of Canada. 



208 DOMINION MEDICAL MONTHLY 

It is sekloni that one sees in a "liaiuUiook " such a mass of 
detail, such an extensive treatment of thie subject as appears in 
this excellent work. One can gather a good idea of the method 
and the extent of the treatment by a m'ere perusal of the index 
which is most admirably arranged for quick reference. 

The arrangement of the text also is very practical and the 
illustrations, many of which are colored, serve to elucidate the 
surgical and pathological description in a very complete manner. 

We are pleased to make a special chapter upon examination 
of the blood and aural discharges, which have assumed such 
importance in modern otology. 

One of the best portions of the work is that devoted to the 
labyrinth, for in this we have the latest researches, coupled with 
the author's extensive experience. 

There is considerable space devoted to a description of the 
diseases and conditions of the nose and throat, which have direct 
bearing upon the ear. The authors are to be congratulated upon 
the production of what we think is the best and the most compre- 
hensive text-book upon diseases of the ear in the English lan- 
guage, and a work which would be a useful addition to the work- 
ing library of any practitioner. We might also add that the book 
is gotten up with the usual good taste of the publishers, Messrs. 
!Mac]\Iillan and Co. 

a. K. 



Internaf'wnal Clinics. Volume I. Series 22, 1912. Philadelphia,. 
London and ^fontreal. -T. V>. Lippincott rompany. 

Wo]l)arst of Xew York, gives an ext'cHcnt i>aper on the sub- 
ject of the value and methods of using the three or five glass test 
in urethral and bladder disease. He is strongly in favor of the 
catheter glass combination and ho ably describes his own experi- 
ence : — 

Surgeon Taylor, U.S.X. writes on venereal disease in the 
navy, laying stress on his own practice of recommending strict 
prophylaxis. Cyreax, of London, describes manual methods of 
treating facial paralysis, and particularly manual vibrataons, 
resistance exercises and stimulating manipulations. His results 
appear better than electrical methods. 

Hexamethylenamine in aural surgery is not overpraised by 
Hald, the basis for its use is its excretion l)y the meningeal sur- 
faces. 



DOMINION MEDICAL MONTHLY 209 

Finally two papers on dispensing and home sanitariinu 
treatment for tuberculosis close the section on diagnosis and 
treatment. 

Under medicine there is a compact paper by Flexner, col- 
lecting the status of our present knowledge of poliomyelitis. 
Hill writes on diphtheria, particularizing on the use of large 
doses of antitoxin, and Parkes Weber describes two interesting 
cases, one with multiple hemorrhages, the other with antiperi- 
stalsis, both of functional origin. James J. Walsh has probal)l.v 
the most valuable paper in the book, describing the masked 
forms of diabetes, and his article is most instructive in showing 
misleading symptoms. 

An article on jx-llagra and on a new portable water vacuum 
pump appear rather unnecessary. 

Surgical Papers are only three in number, one describing a 
successful transplantation of a testicle which, however, subse- 
quently atrophictl ; the second on tic douloureux operations, alco- 
hol, i>eripheral incision and gasserian ; and a third on inguinal 
hernia. Of the remaining papers, that on the surgical anatomy 
of the female perineum is the most interesting. A review of 
medical progress for 1011. closes the volume and its main interest 
is its section on irregular heart and auricular fibrillation. In 
brief, the volume contains much that is good, some that is indiffer- 
ent and nothing that is useless. 

G. W. 11. 



Nervous and Mental Diseases. By Archibald CHrRCii, ^r.D.. 
Professor of Xervous and Mental Diseases and ^Fedical Jur- 
isprudence in Xorthwestern University ^Medical School, Chi- 
cago; and Frederick Peterson, M.D., Professor of Psychiatry, 
Columbia University. Seventh edition, revised. Octavo volume 
of 932 pages, with 338 illustrations. Philadelphia and London : 
W. B. Saunders Company, 1911. Sole Canadian Agents, The 
J. F. Hartz Co., Ltd., Toronto. Cloth, $5.00, net: half 
morocco, $6.50, net. 

There is no question in my mind to stating this fact, that of 
all the works on nervous and mental diseases that are for sale, 
there is no book on the market which is more valuable than this 
work of Drs. Church and Peterson. 



210 DOMINION MEDICAL MONTHLY 

The volume is not only compact but it is complete aurl it covers 
the whole subject in the most satisfactory manner. The brevity 
of the part allotted to physical diagnosis is expanded under the 
individual diseases. 

The primary chapters on diseases of the nerves are superbly 
written, with excellent plates and references that show wide read- 
ing. 

I know of no more satisfactory volume for a man requiring 
a moderate knowledge of nervous and mental diseases. 

G. w. n . 



Tuberculosis. 

Radcliffe (The Lancet) reviews recorded statistics and esti- 
mates 20 to 25 per cent, of patients cured under sanatorium 
treatment. With a combination of tuberculin and sanatorium 
treatment fifty per cent, of the patients lose their tubercle bacilli. 



Diabetes. 

Oammidge (The Lancet) says, everything depends in the 
treatment of diabetes, upon systematic dietetic measures, early 
employed. This diet should be prescribed quantitatively, as well 
as qualitatively in well-marked, mild or even transient cases of 
glycosuria. The patient needs to be taug^ht how mueii fermented 
food he may, and must take. At first it should all be weighed 
until the eye can estimate the quantity. 



AxAL Fissure. 

T. C. Hill, (Boston Med. and Surgical Jour.) says, palliative 
treatment is all that is required for simple fissure, without hyper- 
trophy. Where there is slight hypertrophy, excision is sufficient. 
If moderate degree only dilatation under anesthesia is the best 
treatment, but if much hypertrophy and spasm excision is the 
only thing to give permanent relief. At the present time it is 
better to divide the fibres of the external sphincter muscle through 
the base of the fissure just to the right or left of the posterior 
median line, without regard to the location of the ulcer. The 
incision is to be made at right angles to the muscle fibres, carried 
outward an inch to secure good drainage. The internal sphincter 
must not be injured. 



2)ominion /n^ebical /Ibontbl^ 

HnD ©ntarto /IbeDlcal journal 

EDITED BY 

Medicine: Graham Chambers, R. J. Psychiatry: ErneBtJone«, W. C. Herri 
Dwyer, Gold«in Rowland, Geo. W. man. , ., „ , txt 

Ross, W'm. D. Young. Ophthalmology: I). N. Maclennan, W. 

Supgepy : Walter McKeown, Herbert A }i, Lowry. 

Bruce. W. J. O. Malloch, Wallace A. Rhlnoio^y, Lapyngology and Otol- 
Scott, George K wart Wilson. Og-y • Geoffrey Boyd, Gilbert Royce. 

°** Arthur°C ^Hendrick. Gynecologry : F. W. Marlow. W. B 
Pathology ikd Public Health: John ; Hendry. 

A Amyot. Chas. J C. O. Hastings. I Qenlto Uplnapy Surgrepy : T. B. 

O R Mabee. Gpo. NaimTth. ' Richardson, W. \\ arner Jonet^. 

***" J.^Har°4!°TTd!r*''*""'''' ' Anesthetics: Samuel Johnston. 

GEOBOX: EI.I.IOTT, MAHAQINO EDITOR. 

Published on the 20th of each month for the succeeding r"0"t^„„ -^^"^'"*^! 

Toronto, Canada. 



Vol. XXXVIII. TORONTO, JUNE, 1912. No. 6 



COMMENT PROM MONTH TO MONTH. 

" T_i_t— a— n— i— c " spelled the last word in naval archi- 
tecture. Giant of the Seas, early on the morning of the 14th of 
April, she went headlong to her destruction, and the whole civil- 
ized world was immediately plunged in overwhelming and stupily- 

ius horror. 

" Philanthropist and millionaire, great railway promoter, and 
distinguished litterateur, financier, physician, law^-er. musician, 
officer, engineer, stoker, sailor, immigrant, men and women in 
every walk of life— dived into eternity with a calmness beyond 

conception. , /. i i i 

Only when the sea gives up its dead will the truth of the whole 
horrible calamity be revealed. 

From out the dark, tragic gloom shines the splendid heroism 
and nobility of soul, ^^ot the least of these is that honored band 
of musicians. . 

For forty years a sailor physician. Dr. William Francis JSor- 
man O'Loughlin, the senior surgeon of the White Star line, died 
a hero's deatb, bravely performing his duties to the last. 

Nor can one fail to admire the unshaken nerves of the fear- 
less and intrepid wireless operators. There were many acts of 
true chivalry. Humanity can but sorrow over the lost, and 
rejoice over the saved. 



2lL> DOMINION MEDICAL MONTHLY 

Dominion Medical Registration we referred to in our last 
issue, l>ut tlirou^li a t_v])ograi>hi<*:il error, the date of passing the 
original Act was given 1S92, when, as is well known, it should 
have been 1002. 

In a letter to the Ottawa Citizen, which we reproduce herewith. 
Dr. K. W. Powell, himself an ardent advocate and earnest worker 
for this cause, suggests what we heartily endorse, namely. Im- 
perial recognition to Dr. Roddick. A referendum to the Canadian 
medical constituency would meet with a unanimity of affirmation ; 
and the entire medical ])rofession throughout Canada would hail 
with infinite gratification and satisfaction due and proper recog- 
nition of Dr. Ivoddick's great services to Canadian medicine, 
along the lines suggested by Dr. Powelh 

Editor Citizen. — It seems only right that credit should be 
given where credit is due and there is no doubt that hearty con- 
gratulations are due over and over again to Dr. T. G. Koddick 
of Montreal for the noble work he has accomplished at last for the 
profession of medicine and surgery in this Dominion. After 
years and years of patient personal labor and the expenditure 
of brains, money and time, which he never spared, he now sees 
the fruits of his work and the session of the Ontario Legislature 
jiist closed witnesses the final act by the passage of an amendment 
to the ^fedical Act, which makes the way plain for the Dominion 
authorities to now^ organize and bring into force a Dominion 
Medical Council, which will be authorized to arrange for the 
granting of licenses to practise medicine and surgery and such 
licenses will henceforth be recognized by every province in Can- 
ada and the holder thereof be entitled to ])ractise his profession 
wherever he chooses within the borders of the Dominion. 

It is too long a story to ]irint in a daily paper, but it will 
suffice to say that this idea has been promiiunt in the minds of 
the ])rofession and has never once been lost sight of since 1867, 
the year of Confederation, when the scheme was first mooted, 
when Sir Charles Tupiicr. ^r.D.. was ])r('sidcnt of the Canada 
^ledical Association. 

Great obstacles had to be overcome, compromises of various 
kinds had to be conceded and much <1i]domacy used. It is well 
known that Dr. Ivoddic-k sought a seat in Parliament for the 
express purpose of being in a iiosition to further this important 
work. What he <lid and how he worked will never be known to 
anybody, but the writci- of this letter is personally aware of a 
great deal of it. Prejudices of all kinds had to l)e overcome, but 



DOMINION MEDICAL MONTHLY 213 

Dr. Roddick's ])lnck never for one instant failed him and in 
1902 he accepted the bill then pnt on tiie statute book, emascu- 
lated as it was, and rendered inoperable, by the insertion of a few 
words that compelled all the provinces [g agree to its provisions 
before it could be brought into forc^. This T say was accepted 
bv Dr. Roddick as a stepping stone and now after ten years 
flirther work he has the satisfaction of knowing that he has 
succeeded in bringing all the provinces into line and the enabling 
clause has been passed by all the legislatures. 

I do hope that Dr. Roddick's work will be duly recognized, 
by the powers that be, because his labors have been truly Imperial 
and will place Canada in the foremost rank as regards medical 
registration.— (Sgd.) R. W. PO\YELL, M.D. 

180 Cooper St., Apl. 27, 1912. 



The Seventeenth International Congress of Medicine will be 
held in LuikIuu, August Gih— U>rh, I'.'i:;. IIil- Canadian represen- 
tatives are : Executive Committee— Dr. W. H. B. Aikins, Toronto ; 
Dr. A. McPhedran, Toronto. Organizing Committee — Dr. George 
Armstrong, Montreal, President of the Canadian Medical Associa- 
tion ; Dr. C. K. Clarke, Dean of the :Medical Faculty, University 
,)f Toronto, Dr. J. C. Connell. Dean of the Medical Faculty^Queen's 
Universitv, Kingston; Dr. H. H. Chown, Dean of the :Medical 
Faculty, Universitv of ^Manitoba, Winnii^eg; Dr. E. P. Lachap- 
elle. Dean of the Medical Faculty, Laval University, Montreal; 
Dr. F. J. Shepherd, Dean of the ^[edical Faculty, McGill Uni- 
versity, Montreal. 



Safe water supplies in the control of typhoid fever are absolutely 
essential. 

As pointed out in a reprint from the Public Health Reports 
,)f the United States, by Allan J. McLaughlin, these must be safe 
for 365 days of the year, as it is not sufficient to have a safe 
suj^ply for 360 days, and boiled water for the other five. 

It is lamentable that the average citizen and even the average 
medical man. takes such scant heed of sanitary problems; and 
even in an altogether preventable disease as typhoid fever, look 
with complacency U]^on a mortality rate of 20 deaths annually 
in 100,000 population. 

In the matter of a low death rate, European cities put Ameri- 
can sanitation to the blush. Ten European cities, representing a 



214 DOMINION MEDICAL MONTHLY 

p(>i)ulation of 15,000.000. show an average death rate for ten 
years of 3.4 i^er 100.000 of the population. For 1910, these 
same 10 cities show a mortality rate in typhoid of 2.5. 

Compare those statistics with the fifty cities of the United 
States having' a i)Ojmlation of over 100,000. One city has a 
•loath rate of 5. Three have rates Ixlow 10 in 100,000. Twenty- 
two other cities have rates from 11 to 20, while the remaining 
24 cities have rates running from 20 to S6. This is astounding. 

On the average then, in every 100,000 of the population of 
the United States there have been 18.5 deaths and 180 cases of 
typhoid fever which should have never occurred ; and a conserva- 
tive estimate for 1910 places the deaths from ty]ihoid fever 
above 25,000. Then when it is remembered that in the smaller 
cities and rural districts the rate is in. general, higher, the con- 
clusion is drawn that the typhoid death rate in the United States 
is not below 25 in 100,000 of the population. 

If these deaths all occurred at one spot at one time the world 
would be as much horrified as by the dreadful maritime disaster 
of the past month, and would awake to the great opportunities 
sanitary science and pul)lic medicine present in the curtailment 
iif all ]»reveutable diseases. 



Under the ])atrouage of Field-Marslial, His iuivit' Highness 
The Governor-General, the Twelfth Annual Meeting of The Cana- 
dian Association for the Prevention of Tuberculosis will be held in 
the ^fargavft Eaton TTall, Toronto, Monday and Tuesday, 20th 
an<l 21st ^Fav. 1012. beainninir on ^fondav at 10 a.m. 



1)U.\11.\10\ MJ::IJ1CAL MONIHLY 215 

IRews litems 



Du. J. W. Stjki.ing.. Montreal, has returned from a trip 
:i broad. 

Du. R. \V. Manx, Toront(j. has gone for graduate work tn 
European hospitals. 

Du. T. G. Roddick has returned to Montreal from Atlantic 
City. 

Dr. C. C. Richardson has sold his practice in Aurnra and 
moved to Toronto. 

Dr. Clemexsha, Port Hope, died recently in the Toronto 
General Hospital. The late Dr. Clemensha was ono- of the most 
prominent practitioners of Eastern Ontario. 

Academy of Medicine, Toronto, has elected the fullowini.' 
officers: President, Dr. R. A. Reeve; VicePresident, Dr. H. .1. 
Hamilton; Secretary, Dr. Harley Smith; Treasurer, Dr. W. A. 
Young. 

Du. A. K. Haywood, Toronto, ha> passed the examinations of 
the conjoint board of the R.>yal College of Physicians and Sur- 
ueons in England. Dr. Haywood will jnirsue graduate work some 
months on the Continent. 

Dr. D. W. Carroll, one of the oMest practitioners in Western 
Ontario, died suddenly in Ingersoll on the ^oth of April. He ha.l 
1 i-actised there over fifty yeai-s, and left hi- n^.b-i, .- ;nid -round- 
:'or a childrens' hospital. 

TiiK Canadian Government spent, in IIJIU. ${77,485 for the 
liiblic health service. The Department of Agriculture spent 
.■rl40,T81; Indian Atfairs, $125,121; Interior, $60,969; Inland 
revenue, $38,613. Greater, efficiency and economy is expected 
when the health services arc all administered under one de}.art- 
ment. 

The Medical Department of the Western University at Lou 
(Ion, Ontario, held its annual convocation on the evening of May 
•2nd'. Dr. W. H. Moorhouse presided. The graduating class num- 
l>ered thirtv-eight, the laraest in the history of the university, and 
ll^e second 'largest in Canada in 1012. Dr. J. Moriarty delivered 
tl'c valedictory, to which Dr. H. A. :MacCallum replied, advocat- 
ii'o- a million dollar en<lowment fund for the :\[edical Department, 
which would begin next season's work with five professors devot- 
ing their w'hole time to medical teaching. 



1210 DOMINION MEDICAL MONTHLY 

Ipublisbcrs' Bcpaitment 



Detroit^ April. Another world's record for automo- 
bile shipmeuts has been broken in Detroit. The Ford Motor 
Company for the past month has exceeded even its own world 
beating records, having shipped 8004 cars in the twenty-seven 
shipping days. This is an output absolutely unprecedented in 
automobile history anywhere in the world — and is a matter of 
much comment among the automobile contingent of Detroit. Mr. 
X. A. Hawkins, commercial manager of the Ford Company, is 
authority for the statement that the tremendous Ford schedule 
of 75,000 cars to be manufactured in 1912, will be produced on 
scheduled time as planned. There are indications, however, that 
the demand will far exceed the supply and that the entire Ford 
output will be sold before the season is much farther advanced. 
The company has not been able to keep pace with its bona fide 
orders. Long ago it made preparations to produce a definite 
allotment of cars each month of 1012, and it will not exceed this 
allotment, even at the determined instance of dealers, because it 
will not run chances of lowering its high standard of production. 
Mr. Hawkins expects, however, in the current month to see 
another record smashed. 



I jiAVE used Resinol Ointment and Resinol Soap in my family 
and also in my practice for over fourteen years and have never 
found anything to equal them. I have also recommended them to 
liuiidreds of my patients suffering from skin diseases, and they arc 
all grateful to Resinol Ointment and Soap wliioli gave them relief 
at once.— B. F. Tillyer. D.D.S., Orange, N. J. 



Pleurisy and Tuberculosis. — Every case of "'cured'' ])leur- 
isy should be closely watched for many months after the ]iatient 
has been actually ill with the disease. Tt is probably correct to 
say that considerably more than half such cases develop tubercu- 
losis years after. Indeed Koster, Landouzy and others consider 
pleurisy with effusion a symptom of existing, though latent tuber- 



DOMINION MEDICAL MONTHLY 




Are you particular as to the condition of the iron in your 
Blaud preparations ? 

Frosst's Perfected Blaud Capsules present True Ferrous 
Carbonate. 

Each 10 grain Capsule contains, approximately, 1 grain of 
Iron. 



xviii DOMINION MEDICAL MONTHLY 

eulosis. Koster states (Zeitschr. fiir Minsche Mcdizin) that in 
persons over fifteen years of age tuberenlosis develops in at least 
one half the cases after the occurrence of idiopathic pleurisy with 
effusion. Tuberculosis develojnnc: after wet pleurisy in older per- 
sons runs an acute course and has a bad prognosis. After idio- 
pathic dry pleurisy (which is rare in children) about 40 per cent, 
of the cases develop manifest tuberculosis. In most cases tuber- 
culosis becomes evident in five years after dry pleurisy or pleurisy 
with effusion. — Ayn. Prnct. 



The Safety of Chloroform in Labor. — It has long beer, 
known that the highest mortality from the administration of 
chloroform as an anesthetic has occurred when this drug was 
employed by dentists, not necessarily because this class of prac- 
titioners is less skilful in its use, but probably because the drug 
was commonly administered when the patient was in the sitting 
rather than in the prone position, and therefore the fall of blood- 
pressure, which is so characteristic of the early influence of 
chloroform, exercised a greater effect upon vital centres. Con- 
versely, it has been universally recognized that the mortality 
rate from the use of chloroform during parturition is extraor- 
dinarily low. Tt has been thought by some that this was due t<t 
the fact that less chloroform was used, and by others that the 
immunity of the parturient woman depended upon the fact that 
hypertrophy of the heart, which is supposed to develop during 
pregnancy, acted as a protective; but these two reasons seem 
hardly adequate, since the chloroform is often given to the par- 
turient female by unskilled hands while the physician is busy with 
the delivery. Further, it is a question whether there is any actual 
hypertrophy of the heart in ])regiiancy which would enal>le it t<> 
resist chloroform. Finally, it has been pretty well proved that, 
except in cases of myocardial disease, chloroform does not pro- 
duce death by its direct action upon the heart. Tt would seem 
that a more reasonable explanation for the imniuuity of this class 
of patients to chloroform depends upon the fact that the patient 
does not take it constantly, and furthermore that each succeeding 
pain acts as a distinct stimulant to the vasomotor centre which 
is ordiuarily iiinch d('])resse<l by this drug, it being well knowu 
to physiologists that pain produces a marked rise in blood-pres- 
sure. That death does occasionally ensue from the use of chloro- 
form in labor, must, of course, be recognized, and a case of this 



DOMINION MEDICAL MONTHLY xix 



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XX DOMINION MEDICAL MONTHLY 

cliarac-ter has been reported in the Atlantn Journal-Record of 
Medicine for November. r.>ll. by Hodgson, who records the case 
of a woman of 24. a priinij»ara. who was delivered by the aid of 
forceps. She had been in hard labor for some time. After what 
was apparently a mo<lerate amonnt of chloroform had been used 
the patient sto])ped breathing, just as tlie head passed over the 
]>erineum, and all efforts at resuscitation failed. There is no 
record of an autopsy to reveal the condition of the heart, but it 
is said that the patient had the appearance of a normal, healthy 
woman, and that at no time was she very deeply under the 
influence of the anesthetic. 



Frequency of Tubeeculous Infection in Children. — Al- 
l!if»Uiih some «^0 year.- have ])assed since the discovery of the bacil- 
lus of tuberculosis, no absolute certainty exists as to the exact 
way in which infection is most commonly produced. Koch's 
nrisrinal opinion, that inhalation of organisms derived from hnman 
disease is the im]iortant factor, still commands pretty general 
assent, but another school has arisen which holds that infection 
ytarts in infanev by consumj)tion of tuberculous milk, the bacilli 
lying latent until some depression of vitality in after life gives 
them a chance to multiply and cause serious disease. Tn view of 
the existing doubt it is im])ortant to obtain trustworthy informa- 
tion as to the frequency of tuberculous infection in infants and 
children and as to the apparent portal of entry of the germs. 
As to the frequent occurrence of tul>erculous foci in children 
authorities are agreed, statistics derived from post-mortem exam- 
inations giving a percentage of infected cases varying from 35 
in London (Still) to 42.5 in Christiana (Harbitz). Attempts 
to obtain further information by the employment of the tuber- 
culin test have also been made, the results confirming the view as 
to the frequency of infection in children. A recent investiga- 
tion on these lines has been carried out by Dr. Charles McNeal 
and recorded in the Edinhurgh Medical Journal for April. The 
investigation concerned a series of 541 cases, 371 of these being 
children in the Hoyal Edinburgh TTospital for Sick Children 
and the others 170 boys in an industrial school. The method of 
employing the tuberculin was a modification of von Pirquet's pro- 
cedure, undiluted "'old" tuberculin being rubbed into an abraded 
point of skin. The results obtained showed, even within the first 
year of life, a percentage of infection of 14.1, the ratio rising till 



DOMINION MEDICAL MONTHLY 



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xxii DOMINION MEDICAL .\l()N IHIA' 

it attaiuod a height of 4:6. G iu the fourth and fifth years of life. 
Among the boys of the industrial school, drawn from the most 
necessitous classes, the percentage of infection actually reached 
a figure of 64.7 in boys aged 15 years. It was remarkable, in 
comparing the figures with those recorded by von Pirquet and 
others in Austria, that whereas the general mortality from tuber- 
culosis in the latter country is much higher than in Scotland 
(36.25 compared witii 12.53), in Edinburgh the j:>ercentage of 
infection among children was actually greater. The more frequent 
occurrence of abdominal tuberculosis among children in Great 
Britain suggests that infection by tuberculous milk may be the 
factor which explains the unfavorable conditions thus revealed. 



A Xew and Promising Agent for the Treatment of 
Rheumatism. — An announcement that is certain to cause wide- 
spread interest among the profession is being made in medical 
journals in behalf of Rheumatism Phylacogen. The new product 
is a bacterial derivative originated by Dr. A. F. Schafer, of 
California. The term '"Phylacogen" (derived from two Greek 
words — the equivalent of "a guard" and "to produce") means 
"phylaxin prod'.icor." phylaxin being a name that is applied to 
a defensive proteid found in animals that have acquired an arti- 
ficial immunity to a given infectious disease. Rheumatism Phy- 
lacogen (Schafer) is a sterile aqueous solution prepared from a 
large variety of pathogenic bacteria, such as the several staphy- 
lococci. Streptococcus pyogenes, Bacillus pyocyaneus, Diplocoecus 
pneumoniae. Bacillus typhosus, Bacillus coli communis, Strepto- 
coccus rheumaticus. Streptococcus erysipelatis, etc. The basic 
Phylacogen is a "polyvalent" preparation, since the organisms are 
obtained from cultures made at frequent intervals and from a 
variety of sources. To this basic material is added an equal 
amount of the filtrate obtained by similarly growing and treat- 
ing the Streptococcus rheumaticus of Poynton and Paine. The 
product is indicated in all cases of rheumatism, acute and chronic, 
not due to gonorrheal infection. It is marketed in sealed glass 
vials of lOcc. capacity and may be administered subcutaneously 
or intravenously, the former method being preferred except in 
cases in which quick results are doujanded. Rheumatism Phy- 
lacogen, which is the first of a series of phylacogens originated by 
Dr. Schafer and about to be ofi^ered to the medical profession, has 
been thoroughly tested clinically iu many of the leading hospi- 



DOMINION MEDICAL MONTHLY 



xxiii 



PHYSICIANS AND NURSES 



ENDORSE 



BOVRIL 

TT is unequalled for its nutri- 
^ live value and for the great 
aid it gives in the digestion and 
assimilation of food. 

Bovril is used for invalids in 
more than 2,000 hospitals. 




( Linen-Me5H) 



All sorts of material are made into undergarments and much suffer- 
ing and ill-health is caused because of the saying that " any material is 
GOOD ENOUGH for the skin!" 

Really, is the best any too good for occupying the place of honor. 
" next to yourself "? 

There is no finer, more cleanly fabric than linen, and since in the 
making of Deimel-Mesh the chill has been removed, there is no safer 
and more protective garment than the Dr. Deimel Underwear. 

DEIMEL LINEN-MESH CO. 

416 St. Catherine St. West :: Montreal, Car ada 

Branches: NEW YORK, WASHINGTON. D.C., SAN FRANCISCO, BROOKLYN 
BALTIMORE, DETROIT, LONDON, Eng. 

WE ALSO SELL THE DR. DEIMEL LINEN-MESH SUPPORTERS 



XXIV 



DOMINION mi:i)u:ai. monihlv 



tals, as well as by (.'Oin})etont specialists and other scientitie men 
in varions ])arts of the country, and is said to have shown brilliant 
results in a large ])ereentage of cases. With the co-oporation of 
Or. Schafer, and in accordance with his methods, it is prejiared 
by Parke, Davis and Co., in whom are vested the sole rights of 
manufacture and sale. Physicians who are interested in this 
new treatment for rheumatism, and every general practitioner 
ought to be, will do well to get descriptive literature on the sub- 
ject. It may be obtained by addressing the manufacturers at their 
l>rincipal laboratories in Walkerville, Out. Ask for the "Rheu- 
matism Phylacogen pamphlets " and mention this journal. 



Repeated Attacks of Appendicitis. — N. "Wolkowitsch {Zfbl. f. 
Chir.), in over 30 cases of recurrent appendicitis, has observed 
more or less marked relaxation of the abdominal niuscles on the 
right side. This is due to a diminution of the muscle tone brought 
al)out through disturbance of the nutrition of the muscle tissue. 
It manifests itself by atrophy in the same manner as the muscular 
atropliy of diseases of the joints. Then, the muscles on the right 
side take part to a less extent in respiration, a contributing factor 
to their atrophic condition. 



THE DR. H. BRUCE COLOSTOMY TRUSS 



MADE OF PURE GUM BY AUTHORS a COX 



135 CHURCH STREET 



TORONTO. CANADA 




BEtT WITHOUT poubi 





CORRECTLY AR^UtD 





Finding it impossible to get a suitable pad to be used 
by patients after colostomy, I asked Messrs. Authors and Cox 
of Church Street to make one for me. They have gone to a 
great deal of trouble in faithfully carrying out my sugges- 
tions in the matter, and have produced a pad or truss for a 
colostomy opening which I believe will prove in every way most 
satisfactory. One of the distressing features of the condi- 
tion 13 the periodic escape of gas, depriving these patients 
of participation in social life. This truss or pad fits 
around the colostomy opening so accurately that it overcomes 
this difficulty, and if properly applied there is no reason 
why the patient should not attend a dinner party in comfort 
and without fear of being objectionable to others. It is 
quite the best colostomy pad I have seen. 



Surgeon to Toronto General 
Hospital . 



/ 



2)ominion /I^ebical /n^oiubl^ 

BtiC) Ontario /IdeMcal journal 



Vol. XXX IX. 



TORONTO, JULY, 191-2. No. 1 



©noinal Hvticlcs 



PRESIDENTIAL ADDRESS. 



By Herbert A. Bruce. >r.D., F.R.C.S.. 

President of the Ontario Medical Association; Associate Pix>fessor of C^^^^^^ 
Surgery, University of Toronto: Surgeon to the Toronto General Hospital. 

Ovvint? to the custom whiL-h has prevailed of electing your 
Prasident at the end of t\\o Annual Meeting, this is the first oppor- 
tunity that has been afforded of thanking you for the distinction 
which you were gooti enough to confer in electing me to fill 
thds very important position. While fully appreciating the honor 
which vou hav<> done me. and for which I am mosft grateful, at the 
same time I ani fully aware that it carries with it ver>- serious 
responsibilities. On looking back over the long list of distinguished 
men who have preceded me. I realize that it is a difficult task to 
maintain the high traditions of this office. I need scarcely say 
that I have done my best to justify the confidence you have placed 
in me, and have been exceedingly fortunate in securing on the 
various committees the assistance of able and energetic men. who 
have devoted a great deal of time and consideration to the working 
out of the details connected with this meeting. 

As you will see from the programme, we have very considerably 
altered the character of the meeting. Realizing the interest and 
value of clinical work, instead of having sessions devoted to the 
reading of papere, Ave have endeavored to make the meeting entirely 
a clinical one, and I trust that the result will justify the experiment. 

In view of the fact that members from a distance could not 
conveniently bring cases to the meeting, and wishing to give them 
an opportunity of taking part in the proc eedings, we have asked 

» Delivered at the Thirty-second Annual MeetTng of the Ontario Medical 
Association, held at Toronto on May 21st. 22nd and 23rd. 1912. 



2 DOMINION MKDICAL .MONTH lA' 

them to pive us short case reports, and have in tliis way seeuivd a 
few short papers. 

Wo felt that the preseutatdou of cliuical eases, with thf i-iisuing 
disonssions. woukl ])e of much frreater interest and advantage to the 
profession tlian listening to a number of lengthy papers. Our 
poliey has been to invite memhers outside the city of Toronto only 
to take part in the symposia and to read papers, and it was only 
because, in some of the sections, we failed to secure a sufficient 
numlier in .spite of repeated appeals, that we have had to fall l)ack 
upon some of the Toronto members. I think the meanders of the 
Association generally do not fully realize the extreme difficulty, 
often amounting to impossibility, of securing papers from members 
in country districts. 

"Whilst we have endeavored to provide a varied and interesting 
clinical programme, we have not l)een unmindful of the social side, 
and I tlierefore liope you will find the meeting both instructive and 
enjoyable. 

I should like to take this opportunity of referring to tlie great 
loss which the profession in the Pmvince of Ontario has sustained 
in the untimely and traffic death of a former President of this 
Associatioai. the late Dr. James F. W. Ross. He always took the 
keenest interest in the affairs of this Association, and wa-s present 
at our last meeting at Niagara Falls. He could always be relied 
upon to do his utmost to further the interests of his beloved pro- 
fession, and it is scarcely necessary for me to say that the pro- 
fession, as a whole, and this Association in particular, has lost a 
very staunch friend, and one whose place it will be difficult or 
impossible to fill. 

I should like also to refer to the loss which the profession 
throughout Canada has siLstained in the death of Dr. James Bell 
of ^fontreal. He was one of our tnily great men, and has done a 
great deal to elevate the standing of the Canadian niedical pro- 
fession. 

As each \i'iii- of iii\- professional life passes, my convictioai 
becomes stronger that an organization of some kind to bind the 
profession together is an absolute necessity, ami that for this 
purpo.se we could have nothing better than our Ontario Medical 
Association, which is a potent inlliience for the good of the nro- 
fe.ssdon and the public. 

When it was first suggested that this Association should become 
a branch of the Dominion Medical Association, many of us feared 
that in this way we might lose our identity. As the scheme has 
eventually materialized, however, I think it a distinct advantage 



DOMIXIOX MEDICAL MONTillA' 3 

to the Ontario Medical Association. Whilst we have retained our 
autonomy, and are thriving and prosperous, we are at the same 
time — I think I may say without lx)asting — the most important 
branch of the Dominion Association, and can feel that our interest 
is not merely provincial, but that we have a larger and wider out- 
look thi-ough our connection with the National Association. 

I think it very desirable that there should be an increase in 
the number of small County ^ledical Societies, and 1 should like to 
suggest that for this purpose the Province be divided into ten 
districts, corresponding to the ten health districts recently estab- 
lished by the provisions of the new Health Bill. As there are forty- 
seven counties in the Province, this would mean that each society 
would include four or five counties, wjiich appears to me to l>e a 
practical arrangement. Then the method of securing membership 
in the Ontario ^Medical Association would be simplified by accept- 
ing the meiubers of these smaller societies, which would ob\-iously 
be in a better position to determine their qualifications. 

When the Ontario :\[edical Council was first established there 
were three Licensing Boards in Canada, in addition to the medical 
schools and universities, namely, the Upper Canada, the Homeo- 
pathic and the Eclectic :\[edical Boards. The universities, in addi- 
tion to conferring degrees, really possessed licensing power, inas- 
much as the holder of a university degree was entitled to practise 
medicine on proving his identity and paxing a small fee. The 
Provincial license enabled the holder of it to practise in the Pro- 
vince conferring it, or, in fact, in any other Pro\ince, so that as a 
matter of fact there were in Upper and Lower Canada, exclusive 
of the other Provincis now constituting the Dominion, seven or 
eight Licensing Boards responsible to no central authority. On the 
establishment of the Ont.ario :Medical Council it became the central 
authority and the only licensing body. 

Before this time the schools and universities fixed their cur- 
ricula, both for matriculation and professional examinations; some 
of the Licensing Boards required no standard of matriculation at 
all, and the professional acquirements necessary to bec-ome a prac- 
titioner of medicine were of a very inferior character. 

The first step taken to remedy this state of things was the 
'"Parker Act," passed in 1865, providing for the formation of a 
Council with power to fix the standard of matriculation and that 
of the medical curriculum, but giving it no power to enforce this 
standard. The Homeopathic and Eclectic Boards were not inter- 
fered with, and the provisions of the Act were found to be very 
defective. An arrangement was then made with the homeopaths 



4 no:\iTXi()\ Arr.DicAi, ^ioxtiily 

and t'clet'tics ajid the various schools ajid universities, whereby the 
whole of the profession be<"anio suliject to tlie Medical Council of 
Ontario, as a central autiiority. This Council Avas made up of 
representatives, elected from and appomted by tlip general profes- 
sion, the medical schools and imiversities, and also from the homeo- 
pathic and eclectic bodies. This Act came into force in 1868, and 
conferred upon the Council power to fix the standard of all 
examinations and appoint examinei's to conduct them. 

Prior to 1867 tihe matriculation examination of our colleges was 
simply a matter of form, and could be passed at any time before 
going up for the degree. Now it is equivalent to a second-class 
teacher's certificate, with compulson" Latin and physics and the 
science course. I believe that at the present time all the colleges 
and universities in the Dominion require four years of sitaidy before 
a student goes up for his degree, and in IMeGrill Univei'sity and the 
University of Toronto five years are required. 

The President of t'he University of Toronto, in his last pub- 
lished report, suggests that the entrance standard for medicine in 
the University of Toronto shall be senior matriculation, which 
really amounts to the first year at the University, and I may say 
that recently the ^Medical Faculty has recommended to the Senate 
that an examination equivalent to that of senior matriculation 
shall be demanded of all s-'tudents entering the ^ledical Faculty 
of the Univei-sity of Toronto in future. 

La.st year the Ontario ^Medical Council very wisely decided to 
discontinue its Primary ajid Tnterinediate Examiiiations. accepting 
the Pi-imai-y and Intermediate Examinations of the Universities, 
and only re<iuiring a Final Examination in ^ledicine. Surgery and 
Obstetrics. As soon as the Dominion ^Medical Council comes into 
operation, it woidd seem unnecessary for the Ontario Medical 
Council to hold even the Final Examination, as a student would 
naturally prefer to take the examinations of the Dominion Medical 
Council, which would entitle him to practise in any part of the 
Dominion. This takes away one of the functions o^f the Ontario 
Medical Council, and while it may have other duties to perform of 
a sTifificiently important character to .iustify its existence, I Ihifuk 
there is a general feeling that its numbers might, with advantage, 
be greatly reduced. 

The number of homeopathic representatives is altogether out of 
proportion. Through the courtesy of the Registrar, Dr. Bray, [ 
have learned that there are 48 homeopaths practising in the Pro- 
vince, and 3,280 regular jiraetitioner-s. These 48 homeopaths have 
f) representatives on the Council, that is to say 1 to al)out every 9.\. 



DOMIXIOX MEDICAL MOXTHLY 5 

The 3,280 regular practitioners have 18 representatives, and if we 
add to these the six representatives from the colleges, making 24 
altogether, we maj' say that they have one to every 136. Amongst 
the members elected from the colleges we find that there is a repre- 
sentative for Victoria University, for Trinity rniversity and for 
Ottawa University, none of which have medical faculties, and I can 
see no reason whatever why they sliould continue to have repre- 
sentatives on the Council. 

I would suggest that the Ontario ^ledical Council consist of ten 
members, one to be elected by the homeopatliic physicians, and 
three to be elect'^d by the universities having medical faculties, 
leaving six to be elected by the general profession. Even this gives 
the homeopaths a predominance in the Council quite unjustified 
by their numbers, and witli the diminished amount of work re- 
quired from the Ontario Medical Council this should be a suffi- 
ciently large l)ody. 

Medk'al Education. 

The question of medical education is at tiie present time 
receiving a considerable amount of attention, and l>oth the teaching 
and praictice of medicine ar<' passing throush a period of evolu- 
tion. In the United States medical education has been a subject 
of discu.ssion for a number of years, and comtiiittees have been 
appointed by various societies, more especially th<> Association of 
American ^Medical Colleges, in conjunction with the Confederation 
of Examining Boards of the United States and the Council of 
Medical Education of the American ^ledical Association, to enquire 
into the e^iuipment, entrance requirements and curricula of the 
medical schools. 

In 190.5 the Carnegie Foundation was established by ^Ir. An- 
drew Carnegie! i^^ investigate the subject of University Education 
in general, and a special committee was appointed to consider 
medical education in the United States and Canada. The report of 
this committee and the recommendations of the Council on Mwlical 
Education of the American ^ledical Association- sihow that the 
most urgent indications are reduction in the number of medical 
schools, elevation and uniformity of entrance requirements, main- 
tenance of well equipped la])oratories with capable teachers, and 
clinical training in a hospital in intimate relationship with the 
medical faculty — that is to say, in a properly constituted teaching 
body, there should be a hospital under the direct control of that 
body. The report of the Carnegie Committee also emphasizes the 
fact that the medical profession, both in the United States and 



6 DOMIMUN MEDICAL MUNTllLY 

Canada, is at i)r(.'seiit overt'n)\V(ltMl by poorly trained pliy&ioians 
and surgeons. 

At the meeting of tlie Council on Medical Education^ held at 
Chicago on Fcljiniary 29th of this year, the Secretary rejwrted that 
^v]lereas in 1906 there were 170 medical schools in the United 
States, constituting half the total number existing in the world, the 
numlx^r had now been reduced to 120. This reduction is due to the 
closing of some badJy conducted and imperfectly equipped schools 
and the amalgamation of others. 

As regards entrance requirements, Dr. Colwell stated at the 
a'lx)ve meeting that 47 of the 120 remaining medical colleges )iow 
rf'(iuire that a year or more should have been devoted to physics, 
chemistn' and biology, together with a four-year Jugh school coui'se. 
Twenty-nine colleges require a minimum of two or more years' 
work in a college of lil)eral arts, with a four-year high school course. 
Nine state examining l)oards have now adopted preliminary re([uire- 
ments in excess of a four-year high school education. Of the 120 
colleges, 79 are connected with liberal arts colleges or universities, 
but of these 33 only are in intimate relationship with universities. 
During the last seven years the college terms have been lengthened, 
new methods of teaching adopted, more salaried teachers employed. 
more endowments secured, new buildings erect-ed, better laboratories 
and lal>oratory equipment, and better clinical facilities provided. 
Several of the larger medical schools have been reorganized, have 
built teaching hospitals and adopted higher standiards of education, 
and the teaching of medicine has now been placed to a great extent 
on a university basis throughout the United States. 

As regards Europe, in London there is more clinical material 
available tlhan in any other city in the world, and the conditions 
for teaching are most favorable: and. in my opinion, there is no 
place at which one can get a better training in the fundamental 
principles miderlying the practice of medieine. This, together 
with the exceptional clinical facilities, makes London the greatest 
medieal centre in the world. In the Univei'sity of Berlin no senior 
professor ])racti.ses medieine. The universities, which are main- 
tained ])y the State, pay salaries to the professors, surgeons and 
phATsdcians, and also all expenses connected with the lalK>ratories. 

I am of opinion that, as education is a matter within the .inris- 
diction of the provinces of this Dominion, it is the imperative duty 
of tlie Provincial Croverninents to see that a certain definite stan- 
dard of medical education is maintained, the individual medical 
colleges retaining thi'ir charters oidy if they continue to provide 
this standard. It will l»e their dutv to see that these colleges are 



DOMINIOX MEDICAL MONTHLY 7 

provided with proper laboratory accommodation and facilities, and 
— what is perhaps equally or more important — a sufficiency of clini- 
cal material in hospitals connected with or under the control of 
the college. 

Medical education attains its maximum efficiency only when it 
it is based upon a good system of general education and Is sup- 
ported by the scientifie and literary atmosphere of a university. 
Three of the greatest advances in modern medicine are due to 
]al)oratory work, namely, the work of Faraday in ph\->sics, of the 
Curies in chemistry, and of Pasteur in biology. Sir William Osier* 
thinks it advisable that this type of university work should be 
extended into our medical schools, and that we need "an active 
invasion of the hospitals by the universities." In the city of 
Toronto we now have what may be described as "an active invasion 
of the hospital by the university-, " in that the University of Toronto 
now has control of the Toronto General Hospital, thus making the 
latter to all intents and purposes the university hospital. We have 
here what is generally recognized as the essential thing in the train- 
ing of medical students, namely, the intimate connection witli and 
active control of the hospital by the universit^i*. When our new 
arrangements are in working order we hope to be able to give our 
stiulents a great deal of clinical work in the hospital, so that they 
may thus have an opportunity of acquiring that familiarity \nth 
disease processes in the living subject which is so essential as a 
qualification for tdie.ir life's work. 

Medical education in Canada has always been up to a high 
standard. But in this connection it should be borne in mind that, 
owing to the developmemt of the preliminarj' sciences, such as 
physiology, pathology and l)iology, the work of the student has 
practically doubled in amount, and is continually increasing. In 
view of this increased demand on the time of the sitndent, a five- 
year course in medicine has now been adopted in all the leading 
Canadian medical schools, the iinal two years being devoted to 
practical work. 

All writers on medical education emphasize the paramount im- 
portaince of thoixjugh training in practical work, with opportunities 
for the students to come into actual contact with patients. The 
efficiency of the practitioner, the welfare of the public generally, 
and the adequacy of the public health serv'ice are all dependent 
upon the quality of the training given in the medical scliools. and 
the ideal at which* we are aiming is uniformity in the requirements 
and standards exacted by all the examining lx>ards throughout the 
country. We trust that this happy result will follow the adoption 



S KOMIXION Ml-:i)lC.\L Mo.Xl'IlLY 

of the "Canada Medical Act," establishing interprwincial regis- 
tration, and a license which ^\'ill enable the holdfr of it to practise 
in any part of the Dominion. 

The "Canada Mehkal Act.'' 

The "Canada ^ledical Act," which has for its object tihe estab- 
lishment of a uniform standard of examinations aaid qualifications 
throughout the Dominion of Canada, was introduced in the Senate 
by Dr. Roddick in 1902. It was passed, but it was found impossible 
to bring the Aot into operation at that time, owing to the fact that 
opposition was made by some of the provinces on the ground that 
their interests had not been sufficiently considered. 

Owing- to Dr. Roddick's perseverance and devotion to the work 
in connection with this bill, and that of a few others who co-oper- 
ated with him, he succeeded in convincing the various provinces 
that it was to their interest to pass this bill, and conse^piently an 
amended bill was passed in the 1911 session of the Dominion Par- 
liament. I wish here to express my sense of the debt of gratitude 
which we owe to Dr. Thomas G. Roddick for the unprecedented 
services which he has rendered to the entire medical profession of 
Canada. 

This amended bill only became operative when a so-called 
"Enabling Clause" had been passed by every provin<?e. All the 
provinces have now passed this "p]nahling Clause," Ontario being 
the last to do so. This means that now the "Canada ^ledical Act" 
is in operation, and it only remains for the Dominion Medical 
Council to be established in accordance with the terms of the bill, 
which are, briefly : That tlie Council shall consist of (a) three mem- 
bei-s, appointed by the Governor-General in Couneil, each residing 
in a different province; (h) two members, representing each of the 
nine provinces, to be elected by the Provincial Medical Council; 
(c) one member from each university or medical college, which has 
power to confer degrees in medicine; and (r/) three members 
elected by the homeopathic physicians in Canada. 

Osteopathy. 

The bill which was recently introduced by Dr. Jamieson, and 
which was withdrawn at the last session, contained a clause defin- 
ing medicine, which, it is to be hoped, will be incorporated in a bill 
which will probably be passed at the next session of the Legisla- 
ture. It is a great pity, as we all knoM% that this was not defined 
by the Legislature many years ago, when the Council was estab- 



DOMIXIOX MEDICAL MOXTllLV 9 

lished in 1867, and it is desirable that the profession should be thor- 
oughly conversant with the terms of this bill. 

The bill provides for the registration of any person who has 
matriculated in accordance \nth the re<iuirements of the College 
of Physicians and Surgeons of Ontario, and holds a diploma 
granted by a school or college of osteopathy recognized by the 
Ameriean Osteopathic Association and has attended such osteo- 
pathic school or college for the time specified in the bill. It also 
provides for the registration of persons who have been practising 
osteopathy in Ontario prior to tlie passing of the bill, provided 
they hold such diplomas. It also provides that any person shall be 
held to practise medicine ^\^thin the meaning of the Act who shall 
by advertisement, sign or statement of any kind allege ability or 
Anllingness to treat diseases, or to prescribe or admini.ster medi- 
cines or treatment of any kind for diseases, defects, deformities or 
injuries, but specifies that this .section does not apply to the prac- 
tice of dentistry, pharmacy, the usual business of opticians, vendors 
of dental or surgical instruments, apparatus and appliances, nui-ses, 
chiropodists, bath attendants or proprietois. Every person regis- 
tered under this Act as a practitioner of osteopathy in the Province 
of Ontario shall be entitled to recover ft^^s for profesional attend- 
ance. 

This amendment to the "Ontario Medical Act," which permits 
of tlie registration of osteopaths, is not such a monstrous thiiii: as 
it seemed at first. I take the view that a man is justified in practis- 
ing any pathy he wishes, provided he has obtainetl a sufficient 
knowledge of the anatomy of the human body, its physiology, and 
the disease processes to which it is liable. It will be obvious to 
every sane man that such a knowledge is al>solutely essential: for 
how can anyone attempt to treat a disease without understanding 
the nature of the disease in question or normal conditions ? 

At the present time the public is at the mercy of a large number 
of uneducatetl cliarlatans, who.se work is not only of no value in 
any real disease, but is often of a liighly dangerous character. We 
have all met with cases in which this lack of knowledge has resulted 
disastrously to the unfortunate patient. 

If, as is proposed in the bill, those ^-ishing to practise osteopathy 
must pass an entrance examination equal to that of any practitioner 
of medicine, and, in addition, pass a primary- and linal examination, 
whic'h would include all the essential subjects, substituting their 
pathy for medicine, we should have no objection to their being 
licensed by the Ontario Medical Council. In this way the public 
would be protected by requiring of osteopaths a sufficient know- 



10 DOMINION -MKDICAl. Mi >N'L" IILV 

letlfre of tliesf fundaiiu'utal subjects, wliieli is al)solutely essential 
before attempting to treat the sick. If, after they have passixi 
tliese exaininatious, they still think there is any value in their par- 
tieular pathy. we have no oli.jeetion to the^ir practising it. I would 
take a similar attitude towards any other pathy. 

When the Ontario Medical Council was organized the homeo- 
paths and eclectics were taken in and the same examinations pre- 
scribed for them as for regular practitioners. What has been the 
result? The eclectics have practically ceased to exist. Very few 
homeopaths have been taking the examinations, as is shown by the 
fact that at the present time only 48 are practising in the Province 
of Ontario; l)ut, unfortunately, I am unal)le to ascertain how many 
there were at the time of the formation of the Ontario ^Medical 
Council. 

The only objection I have to the bill is that it proposes to take 
in a number of graduates of certain American colleges witlioul 
passing any furtlier examination. I think tliat a clause should bo 
added requiring all these men to pass an examination before being 
registered; and although we may, for the time being, have to 
accept qualifications which are decidedly less than those which will 
be exacted from future candidates, we shall certainly have made a 
material advance in securing for the public very valuable protec- 
tive legislation. 

In support of the contention tliat ihose who are practising 
osteopathy at the present time should pass an examination I should 
like to brieHy refer to the Carnegie report : — ^ 

"Amongst medical sectarians the committee includes homeo- 
paths, eclectics and osteopaths, all of whom admit in theory that 
medical education should be based upon the fundamental sciences 
of anatomy, physiolog>% pathology and bacteriology. ' ' 

It is stated that the catalogues of the eight osteopathic schools 
in the United States are a "mass of hysterical exaggerations, and 
fairly reek with commercialism." Entrance standards are con- 
spicuous by their absence. In the catalogue of the parent school 
at Kirksvillc it is stated that an applicant will be accepted if "he 
pass examinations in English, arithmetic, history and geography," 
but he may be admitted even if he fails to do this. The Cambridge 
School (]\Ia.s.sajchusetts) states that "a diploma may be accepted or 
an examination required if deemed advisable by the directors." 

Whatever his opinions may be on the subject of treatment it is 
essential that tlie osteopath should be trained to recognize and to 
differentiate between the diseases he professes to treat, and not one 
of these osteopathic schools is in a po.sition to give the training in 



DOMIXIOX MEDICAL MOXTHLY 11 

phj-siology, pathology, chemistry and bacteriology which "osteo- 
pathy itself demands." In none of them is there any etfort to con- 
nect the "laboratory teaching with clinical osteopathy," and in 
none is there "anything approaching the requisite clinical oppor- 
tunities. ' ' 

In tJie eight osteopathic schools there arc now over 1,-300 stu- 
dents, paying about .t2("HX0O0 annually iii fees, and for this they 
"receive an education which is practically worthless." 

All candidates who intend to practise surgery — whether osteo- 
paths or not — should be required to pass a uniform examination in 
this branch of treatment. It is absolutely essential that all who 
undertake the treatment of disease, irrespective of tiie form of 
treatment they pix>pose to adopt, shall be educated in such a 
manner as to render them capable of distinguishing between the 
various diseases which may come und<*r their observation. 

PiBiJC Health. 

The rapid development of bacteriology and th<^ establishment of 
tlie germ theorA- of infective diseases, due mainly to the scientific 
investigations of Koch and Pasteur, have led to corresponding 
development in practical and preventive medicine. Recognizing 
the importance of this development in relation to public health. 
Senator vOwen, of Oklahoma, introduced a l)ill in Congivss about 
two years ago to provide for the creation of a federal department 
of public health, which was strongly supported l)y the American 
INIedical Association and various other medical societies in the 
Unitetl States. 

The object of this bill was defined to 1)e'' "all matters pertaining 
to the conservation and improvement of public health, and to collect 
and disseminate information relating thereto." It also provided 
that the new Department of Pu])lic Health should include: (1) The 
Public Health and Marine Hospital Sen'iee; (2) foods and drugs, 
from the Bureau of Chemistry, which is now in the Departanent of 
Agriculture; (3) vital statistics, now in the Department of Com- 
merce and Labor. 

An amended draft of the Owen bill has recently been brought 
before the Senate.' which differs from the original Owen bill, in 
that it provides for an independent health service, at tJie head of 
which will be a director appointed by the president, but who is nol 
to have a seat in the Cabinet, whereas the original Owen bill speci- 
fied that the head of the department should be a physician, who 
would also be a member of the President's Cabinet. The amended 



12 lK)Mi:\l(»\ mi; DUAL MON'I'IILV 

bill provides for the appointment by the President, with the 
approval of the Senate, of tiiree commissioners of health, to aet as 
assistants to the director, two of whom shall be skilled sanitarians 
and one a sldlled physician. 

On !Mareh 22nd, of the present year, Senator Smoot brousrht a 
bill before the Senate,^ which contains practically the same pro- 
visions as regards the Federal Government, but varies essentially 
from the Owen bill, in that it arran^ros for the public health s<'rvice 
to be under the control of the Secretary to the Treasury, and to be 
managed by an assistant secretary, who shall devote the whole of 
his time to public health work, thus ensuring representation in the 
Cabinet. The IMedical Bureau, including the present Health and 
^larine Hospital Service, is made the predominating bureau, and 
it is proposed to transfer vital statistics to this department. 

I have referred to this contenipl'ated legislation in the T"'nited 
States in order to show wliat is l)eing done elsewhere in regard to 
public health matter.--, ^[any of us have felt for years that a federal 
department of pul)lic health should be created, with a responsible 
minister at its head, and representations were made to the late 
Government by the Canadian Medical Association along these lines, 
but no action was taken. 

I intend proposing a resolution to this effect during the course 
of the meeting, urging the Dominion Government to give this 
matter early and favora^ble consideration. 

Early in the present year the Academy of Medicine, New York,** 
appointed a committee on public health, hospitals and budget, for 
the purpose of investigating existing conditions, and to give expert 
medical opinion upon various matters, including provision for con- 
tagious diseases, school sanitation and the use of public funds in 
the maintenance of public health, one of the most important being 
the consideration of the healtli of school children. The committee 
is not to interfere in political matters. l)ut to endeavor to give such 
advice as will be serviceable to the coununiiity as a whole. This will 
include attt-mpts to educate the laity to minimize conditions which 
tend to the spread of occupational diseases, and to e<lucate general 
practitioners in matters relating to municipal health, sanitation 
and hygiene. "We might with advantage follow tlieir example. 

Dmsiox OF Fees. 

Considerable attention has rt-cently been directed, more espe- 
cially by the various medical and surgical swieties thix)ugliont the 
United States of America, to the prevalent pra-ctice of fee-splitting, 



DOMIXIOX MEDICAL MOXTHLY IS 

or the division of fees between consulting surgeons aijd physicians, 
or pliysicians and consulting physicians. 

Judging from the papers which liave recently been published, 
and the reports of the committees which have been appointed to 
enquire into the subject, ^'^ this reprehensible practice appears to 
have become exceedingly coimnon. It is increasinif to an alarming 
extent amongst the younger members of the profession, and has 
even been adopted in some cases by men of good standing, owing to 
the fact that it suits their convenience and that they find it profit- 
able. 

The division of the fee is accomplished by various methods, and 
is based on commercialism alone. It means notJiing more or less 
than the payment by the consultant of a commission to the general 
practitioner, with the object of encouraging the latter to continue 
to send his patients where he is most likely to receive a share of the 
money paid for relief or attempted relief, irre.«*pcctive of the skill 
and experience of the consulting surg«^n or physician in question. 
The practice is even more common amonirst surgeons than physi- 
cians, and is carried on without the knowledge of the patient, who 
is ignorant that a portion of the money, amounting, according to the 
report of the committee of the Erie County Medical Society,^ ^ to 
from 25 to oO per cent., goes to the general practitioner who has 
recommended the surgeon. 

There can be no question mat it is a peniieious >ystem. luiida- 
mentally op]>osed to the ethical traditions of the profes.sion, and 
that it cannot be advocated by any honoral)le man. It represents a 
form of colkision between the consultant and the general practi- 
tioner, which is compromising and demoralizing to both parties, in 
tliiat it is invaria'bly practised Anthout the knowledge of the patient, 
and is at the same time disadvantageous to the latter. 

As regards the causes responsible for the prevalence of this evil, 
it is stated in the report referred to above that the committee was 
practically unanimous in the opinion that the principal predispos- 
ing factoi"s in commercialism are the overcrowding of the medical 
profession, a low standard of medical education, and a lack of 
appreciation of professional ethics. The committee also includes 
amongst the contributory causes contract practice and its inade- 
quate remuneration, and the fact that the general practitioner is 
often underpaid. This state of things should be rectified in a 
legitimate manner, by educating the public to understand that, in 
view of the advances in medicine and surgery, and the consequent 
increase in responsibility and work necessitated by modern methods 
of diagnosis, the general practitioner is justified in demanding a 



U DOMIXIOX Mi:i)I(AL MONTHLY 

larger fee in such cases. He frequently has to take his patient to a 
consulting physician or surgeon, and if an operation has to be pcr- 
formeil he has to be present. It goes witliout saying that he siiould 
receive adequate compensation for such services, and it is unr(>ason- 
able to expect him to spend his time in this way witliout remunera- 
tion. In spite of the increased cost of living, and the advances in 
medical and surgical science, the family practitioner is still receiv- 
ing the same compensation as his predecessors of two or three gen- 
erations ago. If the public vnW compensate the family physician 
fairly and promptly for his services, and insist that all transactions 
between the physician and the consultant be carried on with the 
full knowledge of the patient, the cause and tlie possibility of this 
evil will speedily disappear. 

The committee also points out that the prospect of receiving a 
commission sometimes results in exaggeration of the necessity for 
operation, and thus leads to indiscriminate, reckless and useless 
surgery, performed in some instances by • inefficiently trained and 
inexperienced surgeons. Altliough the general practitioner is 
assumed to recommend his patients to consult a competent surgeon, 
the possibility of receiving 50 per cent, of the fee may interfere 
with his discrimination. 

It was suggested at tlie meeting of the Board of Regents of the 
University of New York, held on April 19th, 1911, that the Legis- 
lature be requested to consider the advisability of prohibiting the 
consulting physician or surgeon from paying fees to another prac- 
titioner without making known the fact of such payment to the 
patient or the relative or friend acting on his behalf; and also that 
it might be advisable for the Board of Regents to announce that it 
will revoke tlie licenses of physicians or surgeons determined to 
have been guilty of this practice. 

Dr. A. S. Draper^^ jg ^f opinion that correction of the evil must 
come from within the profession itself by means of the local organ- 
izations, and that if this is not (Unie the public will pix)'l)ably take 
the matter into its own hands with jiainful results. 

The Academy of Medicine, Toronto, appointed a committee to 
consider this question, and the following resolutions were pa.ssed at 
the annual meeting on ]\Iay 7th, of this year: — 

"1. That the payment of a commission to any ])ers()n or ]iersons 
who may be instrumental in influencing a patient or patients to 
apply for professional advice is wrong in principle and detrimental 
to the best interests of our profession. 

"2. That ^'hen t"wo or more practitioners are engaged in a case 



DOMIXIOX MEDICAL MOXTHLY 15 

the disposition of the respective fees shall only be made with the 
knowledge and consent of the patient. 

"3. That we agree that the attending physician has often been 
inadequately paid for his services." 

I would suggest that this matter be dealt with by this associa- 
tion at the present meoting, and that a similar action be taken to 
that of the Toronto Academy of Medicine. 

Progress ix Surgery. 

The last two or three decades have been a periotl of marvellous 
development and evolution as regards surgery-, and there is no 
question that the chief factors to which this evolution is due are the 
discoveries of the bacterial origin of disease, of antiseptics, and 
the more recent development of asepsis. 

I .should like liere to refer to the great loss which the medical 
world has recently sustained in the death of that distinguislied 
scientist. Lord Lister, which o<'curred at Walmer. England, on 
February 10th, of this year. ^lany of you will rememl>er the 
pleasure we had in meeting that kindly and unassuming man at the 
meeting of the British Medical Association in Toronto, with his 
gentle face and wonderful personality. His great achievements in 
the domain of medicine and surgery are well known to everj' mem- 
ber of the profession, and to his practical application of the dis- 
coveries of Pasteur we owe the fact that it has now become possible 
to secure the kindly healing of wounds without the suppuration 
which to the older surgeons seemed a necessary pait of healing, 
and which made any operative measure extremely dangerous. Even 
in the cases in which recovery did ultimately take place it was 
accompanied by such complications as erysipelas, hospital gangrene 
and pyemia, which caii now be avoided in practically all cases. 

Another factor which has contributed to the reduction in the 
mortality of surgical operations is that in the majority of eases the 
surgeon is now consulted at an earlier stage of the disease than 
formerly, when the risk attendant on many operations was so great 
that they were undertaken only as a last resource. "We now recog- 
nize that in many cases delay entails considerably greater risk than 
immediate operation, and that prognosis is often more favorable if 
the latter is undertaken at the earliest possible moment. 

The above remarks apply more especially to what may l>e termed 
acute abdominal emergencies. The degree of perfection to which 
asepsis has now been brought renders it x>ossible to open with 
safetv the cavities of the body, and to expose freely the area of 



l(i DOMINION MKDICAL MONTHLY 

disease, thus oiial^lin^ the sur^oou to operate witli greater confi- 
dence. The knowledge of surgical patholo^gy thus acquired has 
resulted in a coincident development o-f mctliods of diagnosis, and 
we have learnt that peritonitis represents only a late result in 
very various diseases. It lias also led to more intelligent after- 
treatment, and, instead of keeping the intestines at rest as long as 
possihle after an al)dominal operation, as was formerly the custom, 
tlu' aim of the surgeon now is to obtain resumption of normal 
physiological and mechanical intestinal function.s as soon as pos- 
sihle. and thereby to prevent the supervention of peritonitis. 

Appendicitis. 

I should like here to refer very l)rietly to the treatment of acute 
apj)i'ndicitis. For many years this subject has been discussed 
freely in our medical societies, and different opinions held as to the 
proper time for operation, but at the present time surgeons 
throughout the world are practically unanimous in the view that 
the proper time to remove the appendi.x is immediately the diag- 
nosis has l)een made. 

I think it very desirable that the public should be educated to 
appreciate the fact that a diagnosis of acute api)endicitis invari- 
ably calls for immediate 0]>eration ; that no other form of treatment 
is of curative character, and that delay is dangerous. Of course 
all we can do in the matter is to strongly advise operation. AVe 
cannot compel a patient to submit to operation; but. in view of the 
great risk incurred by delay in such cases, it is most important that 
the public s-liould be educated to appreciate the imperative necessity 
for inunediate surgical treatment. 

Ri.oon pjX.vMix.vriox. 

AVithin the last ten or twelve years much has been learnt in 
regard to the value of examination of Ihe blond in acute surgical 
disea.ses, and it has been extensively employed as an aid in the 
diagno.sis of obscure suppurations, and more especially in differ- 
ential diagnosis. The results of experimental and. clinical work 
indicate that investigation of the blood and, above all, determina- 
tion of the percentage of polymorphonuclear leucocytes, although 
not in itself sufficient to definitely establish a diagnosis, may, when 
considered in relation to the clinical symptoms, be an important 
factor in the differentiation ol" various acute surgical diseases. 

Tn addition to the value of blood examination in diagnosis, the 
presence of marked leucocytosis often indicates a hopeful i)rognosis, 



DOMIXIOX MEDICAL MOXTHLY 17 

but the most conclusive results are obtaiued, both in regard to 
diagnosis and prognosis, when the total and differential counts are 
taken together, and considered in relation to each other and the 
clinical findings. The total count may be regarded as an index of 
resistance of the body to the infective agent, whilst the ditt'erential 
count indicates the severity of the infection. 

IxTRAVEXous Anesthesia. 

Improvement in the methods of inducing anesthesia has been an 
important factor in advances in surgery, inasmuch as it now results 
in much less functional disturbance and interference with the 
manipulations of the surgeon. Instead of being obliged to rely 
upon one method only, as was formerly the cast\ we have now a 
choice of many methods of inducing anesthesia, and can select that 
which seems to be most suitable for tlie condition with which we 
are dealing. 

In this connection I may refer to intra-spinal anesthesia, which 
has been practised extensively abroad, and to some extent also in 
this country". A few years ago Bier^^ descrilted the techniqae of 
intravenous local ant^thesia, whicii has been found particularly 
useful in eases with pulmonary and cardiac complications. Bier 
injects novocain into the circulation, and under this method of 
anesthesia has performed various operations on the limbs, inchnliijg 
resection of the ellxiw, resection of the knee-joint, and amputation 
of the lower part of the leg. He thinks there is not the slightest 
doubt that it is suitable for amputations of all kinds. ^lore recently 
a method of intravenous general anesthesia has been suggested by 
Burkhardt of ^liinich,^^ wliich appears to be free from the many 
abjections to inhalation anesthesia, and I believe has a gn-at fniniv 
in store for it. 

At the present moment the .safest all-round anestlietie lor gen- 
eral purposes is undoubtedly ether, given by the open method. I 
may say that for many years I have been in the habit of insisting 
upon the use of ether as an anesthetic, feeling that it is much safer 
than chloroform or chloroform in combination witli ether. I would 
further like to emphasize the very great importance of having the 
ether administered by a skilled anesthetist. 

Brain Surgery. 

The most recent advance in the surgery of the brain consists in 
operations upon the hypophysis cereliri. which have been under- 
taken for the relief of acromegaly, and have in several cases 
resulted in retrogression of the symptoms. 



18 1>(>:\11\1().\ MKDICAI. MONTIILY 

The Roxtgex TJays. 

Kontgenolofry is now lii«?lily developed, and has l)econie one of 
the most valuable adjuncts to surgical diagnosis. It has also 
greatly contributed to render surgery a more exact science, as it 
gives us a clearer understanding of the condition of many of the 
cases which come under our observation, and in many instances also 
gives indications for treatment. 

In fractures the Kontgen rays are of the greatest possil)le ser- 
vice, as we are able to ascertain by means of a skiagram whether or 
not the fractured portions of l3one are properly adjusted. It is also 
most useful in disease of the bones, as it is capable of showing the 
most minute alterations in stiiieture. 

Great advances have recently been made in Rontgenology, as 
applied to the diagnosis of disease of the alimentary canal, and it 
has greatly increased our knowledge of its physiology and path- 
ology. In this region it is second only to an exploratory Laparo- 
tomy, and by enabling the surgeon to make an early diagnosis 
renders it possible to operate at a much earlier and more favorable 
time. The radiograplis are taken after the administration of bis- 
muth subcarbonate, wliicli obstructs the rays, and is considered the 
most suitable preparation. 

By this method displacements of tbe stomach can he deter- 
mined with a greater d^ree of accuracy than l)y any other means, 
with the exception of an exploratory laparotomy'. The more recent 
methods of Rontgenology have rendered it possible to demonstrate 
the site of stenosis of the alimentars" tract ; to distinguish in some 
cases between functional and organic constriction ; to observe the 
peristaltic action of drugs and tlie functioning of intestinal anasto- 
moses; to determine the existence of visceroptoses and of diverti- 
cula. The X-rays have also been used in the diagnosis of pnlmon- 
arj' and other intra-thoracic conditions, and Rosenbaum^'' reports 
a case in which a diagnosis of miliai-y tuberculosis of the lungs was 
made, the skiagram showing iiuiiirrous small tubt-rculous areas in 
both lungs. 

Sehurmayer^^ emphasizes the value of Rontgenopalpation of 
the abdominal vLscera, which is practically manipulation of the 
organs under the guidance of the eye, and lie considers it to "be 
especially useful in the diagnosis of pathological fixation of organs. 

Althoug-h an X-ray examination is of the greatest assistance in 
diagnosis, it should not supersede the older methods of accurate 
clinical investigation, but should bi- used in combination witli them. 



DOMIXIOX :\rEDICAL :\IOXTULY 19 

As a therapeutic agent, however, the X-ray has been very disap- 
pointing, and has frequently been attended with harmful results. 
It has been successful in the treatment of certain superficial forms 
of carcinoma, but in these cases a quicker and more satisfactory 
result would, as a vu\>\ be obtained by tin- ns.- <>f the knife". 

R.\DiL'M Treatment. 

The exact value of radium in the treatment of disease is at 
present complicated by the question of expense, and it is. of course, 
possible that in ca.ses in which small doses fail larger doses would 
be successful. 

Dr. Louis Wickham.^" who has had considerable experience with 
this mode of treatment at the Radium Institute at Paris, has 
recently reported his results. He is of opinion that in the case of 
malignant growths, which are difficult to remove, intense applica- 
tion of radium previous to operation is beneficial, and may facili- 
tate removal of the growth. 

It is sometimes useful in the treatment of superficial lesions, 
such as rodent ulcer and epithelioma, but I have recently seen a 
case of superficial epithelioma in which it was positively in.iurious, 
and, after six months' treatment, it was necessary to remove the 
growth by operation. I have also seen ca.ses of rodent ulcer which 
were in no way benefited by radium treatment, and required sub- 
sequent surgical removal. 

It is of undoubted value in the treatment of certain vascular 
lesions, such as nfevi. port wine stain, etc. Wickham considers it 
also of value in surgical tuberculosis and other skin lesions. 

^ly feeling about it in malignant disease is that it should never 
be used where an operation is possible ; but, after the grov\'th has 
been removed, there can be no objection to its use for a time, in 
the hope that it may prevent recurrence. 

That it should be used as a cure for cancer is an unfortunate 
mist<ike, and has brought radium into disrepute in many quarters. 
It is a great pity that the opinion has got aljout that radium will 
cure cancer, or that anyone should employ radium for a treatment 
of malignant disease where surgery is possible. I have met with a 
number of instances in which a great deal of valuable time has been 
wasted in the use of radium, the delay meaning that the growth 
was becomng inoperable. 

In addition to the therapeutic use of radium, small doses of it 
have been found to stimulate the healinsr of wounds. 



20 DOMLNiUN .MEDICAL MONTHLY 

Thoracic Surgery. 

Ill 190S Saucrlnnu'h dovised a caliinot wliicli rcndort'd it ])(is.siblo 
to open the tliorax freely, whilst respiration was kept ii]i under the 
infiuence of either positive or negative pressure. This led to greiat 
advances in thoracic surgeiy, and many intrathoracic conditions can 
now ))e dealt with in a way that was impossible a few years ago. 
Dr. AVilly ^Meyer^^ subsequently constnieted a cabinet which was 
an improvement on Sauerbruoh's apparatus, in that pressure could 
be changed from positive to negative at the will of the operator, or 
])otli kinds of ])re.ssure could be used simultaneously. lie describes 
tkis cabinet as the "universal pressure chaml)er. " 

In 1909 ]\Ieltzer and Auer^'* suggested a ncAv method of artiiieial 
respiration under positive pressure, which th'ey called intraeheal 
insufflation.- and the very satisfactory results in curarised dogs led 
to its employment for intra tjibracic operations in man. Su'bse- 
quent experience has sho\ra that in the ]\Ieltzer-Auer met'hod we 
havf a simple and apparently s-afe method of producing intra-pul- 
monary pressure, permitting of open operations upon the pleura 
and other intrathoracic structures without the u.se of any cumber- 
some apparatus, and that, owing to these advantages, it is likelv to 
supersede all the more complicated pressure cabinets. 

Dr. p]lsb('rg-o has anesthetized aliout two hundred patients in 
this way at the ]\Iount Sinai Hospital, New York, aiul .states that 
the results are extremely satisfactory. The operations in which he 
has emi)loyed it include craniotomy, thyroidectomy, thoracic empy- 
ema, removal of tuberculi)us cervical glands, pulmonary opera- 
tions, etc. 

Operations upmi the lieart repi-eseiit a comjiiii-atively new field 
of .snirgery, although an attempt was nuul" by Fariiui in lS9fi'-^ to 
suture a wound of the heart. In 1909 Vaugluin-- collected 150 
cases' of suture of the heart, with 85 per cent, cures. Eugene H. 
Pool-^ collected 77 cases, operated upon ])etween 1909 and 1911, 
with 55 per cent, recoveries and 45 per cent, deaths. The use of 
differential pressure methods has greatly impi-oved the prognosis in 
these cases, and recent literature on the su])ject indicates that the 
heart can be manipulated and treated surgically in the same way 
as any otlu-r organ in the liody. 

Amongst the most imi)oi-tant contributions to the surgery of 
the heart and blood-vessels is the work of Professor Carrell, which 
was commenced in lilO'i at the Tniversity of Lyons, France: con- 
tinued at Chicago, and more recently earried on at the Koekefeller 
Institute, New York. lie uses tlie Me]tzei--Auer metliod of insuffla- 
tion anesthesia, and. as you will lieai- fi-oiu his lecture this evening, 



DOMIXIOX MEDICAL MONTHLY 21 

has been able to perform successfully circular suture of arteries or 
veins, arterio-venous anastomosis, transplantation of segments of 
veins into arteries, patching of arteries with pieces taken either 
from veins or the peritoneum, the reversal of circulation in the 
thyroid, transplantation of the kidney from one side to the other in 
the same animal or to anotht-r animal of the same species, and more 
recently the transplantation of entire limbs. The results of his 
experimental researches indicate that we may in future be able to 
cure many diseases of the heart and blood-vessels by means of 
surgical procedures. 

Forster's Operatiox. ' 

Surgery has again come to the relief of what has hitherto been 
regarded as a purely medical condition, namely, tabes dorsalis, arid 
resection of the posterior spinal roots has been performed for the 
relief of the gastric crises met with in this disea.se. 

The rationale of tJie operation is based on the assumption that 
in the various crises which occur in the course of locomotor ataxia, 
affecting the sftomach, intestines, bladder or larynx, there are in- 
variably three cai*dinal signs, namely, symptoms of motor, sensory 
and secretory irritation of the organ involved. In Forster's opinion 
sensory irritation is the primary condition, the other two being 
secondary. Forster and Kiittuer-^ operated on a patient suffering 
from tabes, the seventh to the tenth thoracic roots inclusive being 
divided. Pain and vomiting subsided, the appetite improved, and 
the patient gained in weight. 

It has also been recommendeil for the spasticity which obtains 
in cerebral diplegia, and which is due to loss of inhibition from the 
higher centres, but far better results have been obtained in the 
lower than in the higher extremity. The immediate results are 
great diminution in or disappearance of the spasticity, and of 
spontaneous contractures and cramp, if present. 

Osteoplastic Surgery. 

During the last few years osteoplastic and cosmetic surgery has 
undergone remarkable development, and bone transplantation has 
recently been extensively employed in the correction of congenital 
defects and in replacement of bone which has been destroyed or 
removed by injuries or destructive diseases of various kinds. 

Some surgeons, including Lexer, Enderlen and Konigsberg, 
have successfully transplanted entire joints. Lexer-^ reports four 
functionally successful cases, in which portions of bone and adja- 
cent joints were replaced by bone and cartilage. In two cases of 



22 1H)MIM(».\ .Mi:i)l('.\T> :\I()N'I'IILV 

synostosis of tlie knee, due respectively to suppuration and tuber- 
culosis, the entire knee was resected, and a new knee-joint, with a 
portion of the shaft of the tibia, imidanted. Tliese patients, four 
and seven montlis after the operation, experienced no pain on 
standing or walkijig, and could use tho knee to a slight extent, 
passive movement to an angle of 45 degrees being possible in one 
case. Lexer u.sually proeures his niatei-ial from limbs amputated 
for senile gangixme. 

In a more recent publication Lexer-^ I'eports several cases in 
which he has transplanted bone for cosmetic pui*pbses, including 
formation of a nose or car, correction of defects after operation for 
cancer of the face, transplantation of a portion of the scalp to 
supply a moustache or ])eard, and of a wedge of lx)ne from the 
tibia to form a frame for the nose. 

Kirschnei'-" has had excellent results from transplantation of 
fascia from the iliotil)ial band of the fascia lata. He has us^d i^ 
chietly to wrap around vessels or organs after suture, to close 
defects ajid reinforce hernia operations, to interpose between organs 
which have grown togeflier. to make a sling for suspension of a 
displaced kidney or other organ, and for closing gaps in the dura. 
He also thinks it suitable for a substitute for tendons. 

In the treatment of paralytic deformities of the extremities 
bone transplantation has l>een largely .superseded by periosteal 
implantation of normal tendons, which is based upon the fact that 
normal muscle tendons will continue to functionate normally, even 
if the muscles pull in an altered direction. Lange of Munich 
arrived at the eonelusion that it is inadvisable to impair and pos- 
sibly sacrifice normally functioning tendons when the result is 
problematical, and therefore devised the method of implantation of 
silk, the results of which are the best that have been attained up to 
the present. 

Alcohol Injections in Trigemin.vl NEr'R.\Lr.L\. 

From time to time many experiments liave betMi made with the 
object of relieving the pain of trigeminal neuralgia and preventing 
its recurrence, these experiments consisting chiefly of the injection 
of chemical .solutions and fluids of various kinds into or around the 
affected nerves. The i)roeedure wliieh has, up to the present, had 
the most satisfactory results is that of deep injections of a .solution 
of alcohol into the trunk or tninks of the nerves involved. If tlie 
injection is skilfully performed, and the needle punctures the 
nerve slieatb, the alcobol instantly paralyzes the nerve at the point 
of injection, and destroys the fil)res. Resrvtion of the Gass'M-ian 



DOMIXIOX MEDICAL MOXTHLY 23 

gaii'glion, which is an exceedingly severe operation, is, liowever. the 
only effectual means of obtaining a permanent cure, but the alcohol 
injections may relieve the pain for a period of from six moutl'.s to 
two or three years, and the great advantage of the procedure is the 
possibility of repeating the injections indefinitely at short intervals 
if the pain returns. 

Ehrlich's Salvarsan. 

The last three or four decades have been a period of extraordin- 
ary development in regard to the science of applied bacteriology. 
and more especially with reference to its value in the diagnosis and 
prognosis of infective diseases. 

Syphilis is one of the diseases to which attention has been 
directed in this connection, and the recent advances in its treatment 
date from the researches of Professor ^letehnikoff, who in 1903 suc- 
ceeded in transmitting the disease to apes by inoc-ulation, and thiLS 
proved that it was due to a specific infection, t'urther investiga- 
tion along these lines led to the discovery in 1905 of the spirochete 
pallida as the infective agent, and to that of the AVassermaun serum 
reaction in 1006. 

Early in 1910 Ehrlieh-^ made the assertion that the chemical 
compound dioxy-diamino-arseno-benzol, to which he gave tlie name 
of "606." is capable of producing "sterilization of the system." 
After making a large number of experiments in animals, Ehrlich 
sent samples of the drug to physicians in different parts of the 
world, in order that tliey might make a trial of its efficacy in the 
treatment of human syphilis. The immediate results were brilliant, 
but the intramuscular injections, which were at first used, liad the 
great drawback of causing extreme pain and disability, and this 
method has been discarded. 

Since that time the preparation has been greatly improved, 
chiefiy in the direction of solubility, and it h«s successively become 
"606"ideal," "606 hyperideal," and, lastly, "Salvarsan."' 

Ehrlich sul>sequently recommended that the drug should be 
administered intravenously in small doses, and in some cases in 
combination with mercury. Many writers, including Sir Malcolm 
Morris,-^ employ this combined form of treatment, and are of opin- 
ion that until time has sho\\-n that the effects of salvarsan are 
permanent this is the more prudent course. 

Although Ehrlich s idea that the drug would be capable of 
destroying every spirochete in the body has not been completely 
realized, and although it is no longer considered to be an infallible 
specific which is indicated in eveiy case of syphilis, there is no 



04 DO^IlXrOX MEDICAL MoNl'llI.V 

doubt that it is tlie most powerful antisypliilitie remedy which we 
possess at tJie present time. It was at first feared that the adminis- 
tration of salvarsan might result in injury to the optic nerve, but 
Elirlieh states that he has not heard of a single case of blindness in 
connection with it, and AVeehselniann, who has used it in over 1,200 
cases, has not observed injury to the nerve in any one of them. 

Etiology and Treatment of Cancer. 

During the last few years extensive investigations have been 
undertaken by various scientists, including those carried out by the 
Cancer Research Commission in London, England, and at the 
Rockefeller Institute, New York, but up to the present no definite 
conclusion has been arrived at with regard to the etiology of cancer. 

In this connection I should like to refer to the vers- valuable 
work in regard to cancer which has recently been done by Sir 
Henry Butlin, the great surgeon, and pathologist, who died at Lon- 
don, England, on February 24th, of this year. He had devoted 
special attention to diseases of the throat and tongue, and, strange 
to say, he died of cancer affecting the larynx. 

At the last annual meeting of the Cancer Research Commission, 
held in London in July of last year^^, the Secretary, Dr. Bash ford, 
stated that it has now been proved beyond the possibility of doubt 
that cancer, to begin -Rath, is a local, and not a constitutional, 
disease. This fact contributes to render prognosis comparatively 
favorable, provided operation can bo undertaken at an early stage, 
whilst the disease remains circumscribed. Precise evidence has also 
been secured in regard to tihe existence of hereditary predisposition 
to spontaneous cancer. Its ^nde distribution throughout the entire 
human race and the vertebrates, even when living in a state of 
nature, and the fact that the only way in which it can be trans- 
mitted from one individual to another of the same species is by the 
implantation of living cancer, proves, according to Dr. Bashford, 
that it is not due to a common causal parasite. The almost invari- 
able success of reimplantation into an animal of a portion of its 
own spontaneous tumor, and the almost invariable failure of. im- 
plantation of any spontaneous tumor into other spontaneously 
affected animals, lead him to the conclusion that each tumor is 
individual, and genetically related to the particular organism in 
which it originates.^ ^ 

In his Hunterian Lectures, delivered at the Royal College of 
Surgeons, London. England, about a year ago, the late Sir Henry 
Butlin32 brought forward a theory of the intrinsic, as opposed to 



DOMIXIOX MEDICAL MOXTHLY :>b 

the extrinsic, origin of cancer. According to this theory, each cell 
in the human body is regarded as equivalent t« an entire individual 
amongst th<' protozoa or other unicellular organisms, and the 
cancer parasite is taken to be in etfect simply the cancer cell, which 
by a process of atavism has reverted more or less to the condition 
of the original protozoa, and has become in its relation to the normal 
et'lls in the body the e([uivalent of an intruding protozoan parasite. 
This cancer cell, to which he gives the name of unicdlula cam ri, is 
considered to be a completely independent organism, which has not 
entered the body from without, but has been generated witliin it, 
and wlvich, instead of acting in harmony with the normal cells, acts 
in opposition to them, and thus produces anarchy and destruction. 

Two objections have been made to this view, namely, that in the 
first place the cancer cell, so far as we know, uiuUrgoes no process 
analgous to that of fertilization, and tliat, in the second place, it is 
apparently incapable of growth apart from the organism in which 
it has primarily developed. 

As regards the second of tiiese objections, Dr. Peyton Roils, of 
the Rockefeller Institute, New York,^^ has produced malignant 
sarcoma in fowls by the subcutaneous injection of the filtrate of a 
similar growth olitained from a bird of the same speci<^. Professor 
Alexis Carrel and Dr. Burrows, also of the Rockefeller Institute, 
report a still more conclusive experiment, in so far as the human 
subject is concerned, in that they .have made a successful culture 
from a sarcoma removed by operation from, a female patient, 
although in this instance growth was less luxuriant than that of the 
fowl sarcoma. 

In this connection it may be mentioned that Dr. Simon Flex- 
nei.3 4 (]raws attention to the fact that it has recently been discovered 
that a number of diseases occurring in man and the higher animals 
are due to microscopic parasites, epidemic poliomyelitis being an 
instance of this. 

Sir Jonathan Hutchinson^^ states that his experience indicates 
that the administration of arsenic, even if only for a short period, 
may result in predisposition to cancer, more especially epithelioma, 
and he thinks that it is probablj'^ also responsible for some cases of 
endothelioma and sarcoma. He suggests that the drug may act as 
a depressant to growth, and thus allow of the appearance, after a 
short interval, of degenerate forms of growth nearly allied to those 
of vegetation. 

From time to time a large number of remedies have been sug- 
gested for the treatment of cancer, and some of them have been 
used with a certain amount of success. Several writers report cases 



?•; Do^rixiox mkdical monthly 

in which tliey liave employed seriiin prepared fi^oiii canceroiLS 
material, lierkeley and Beebe-^'^ find that autogenous is more effec- 
tive t'lian stock serum, and think that this mode of treatment may 
ho serviceable in the pn'vention of recurrence of malignant tumoi's 
after operation. 

Dr. C'oley, of New York,^' claims to have cured a few eases of 
sarcoma of the femur by injection of the lluid which bears his name. 
Sir Henry Butlin states that the Continental and Engli.sh surgeons 
have not been equally successful in the use of this fluid ; and, 
although we have used Coley's fluid here a nundier of times, we 
have never seen a ease in which it has been of value. 

Acting upon the suggestion of Professor Ehrlich that the cancer 
cell might possibly be iutiuenced by a specific drug, "Wassermann 
ajid otJiers^^ have found that a compound of eosin and selenium, in- 
jected intravenously into mice infected with malignant tumors, 
causes marked softening of the tumor after three injections; after 
four injections absorption of its liquefied contents, and in favor- 
able cases its complete disappearance in about ten days. In the case 
of exceptionally large tumors, which tend to soften rapidly, the 
animals frecjuently succumb to the action of the toxic material 
absorbed from the tumore. Autopsy indicates that the preparation 
has been deposited electively in the tumor, indicating its affinity 
for the cancer cells. It apparently has a destructive action upon 
the nuclei of these cells, whilst it does not atfect the normal cells. 
In animals which ^ave been kept under ol>servatioTi for months 
after disappearance of the tumors no recurrence Ivas been noted, 
but if a tumor is only partially destroyed recurrence is ra])id. 

In the report of the Cancer Research Commission, previously 
referred to. Dr. Bashford emphasizes the fact that nothing but 
harm can arise from the premature application to the treatment of 
human cancer of methods which have been found effective in modi- 
fying inoculation cancer in animals. A method which produced 
active immunity in inoculated cancer was tested in thirty-three 
mice with natural cancer. It resulted in no arrest of growth or 
dissemination, and did not prevent recuri-ence of spontaneous 
cancer after operation. 

During the last thirty years or so there has been marvellous 
improvement in the results of operations for cancer, and extensive 
and early operation, with removal, as far as possible, of all the 
cancer cells in the body, has been attended with great success. In 
view of the fact tliat most of the wri«ters on the snvbjeet agree in 
considering individual resistance an important factor, if not the 
chief factor, in the cure of cancer, it is ol)vioiLs that even when the 



DOMIXIOX MEDICAL MOXTHLY 27 

disease is sufficiently advanced to be no longer localized, and cancer 
cells have already migrated, it is highly desirable to remove the 
chief source of supply of these cancer cells, and thus assi^ the 
defences of the organism in their endeavors to re-establisli normal 
physiological conditions. 

BlBLIOGRAPUY. 

1. Editorial, Joum. Amcr. Mid. Assoc. 1910. LIV, 1949. 

2. Welch, W., Joum. Amcr. Med A.ssoc. 1910. LIV, 2011. 

3. Cohvell, D.-., Journ. Amer. Merl Assoc. 1912. LVIII, fio4. 

4. Osier, Sir W., Jouni. Amcr. As.^or. 1912, LVIII. 654. 

5. Carnegie Report, ''Medical Education in the United States 
and Canada." 1910, 163. 

6. Editorial, Jouni. Amer. Med. Assoc. 1912, LVIII, 134. 

7. Owen Bill, Xcw York Med. Journ., April 20, 1912, 810: and 
Journ. Amer. Med. Assoc. April 20, 1912, 1221. 

8. Smoot Bill, Journ. Amcr. Med. Assor. 1912, LVIII. 1034. 

9. Editorial, Xew York Med. Journ. Jan. 3, 1912. 

10. Lord, J. F., Journ. Amer. Med. Assoc. 1911, LVI, 725. 

11. Report, Erie County Med. Soc. (State of Xew York), Journ. 
Amer. Med. Assoc. 1911, LVI. 59. 

12. Draper, A. S., Journ. Amer. Med. Assoc. 1912. LVIII, .582. 

13. Bier^ A., Arch. f. klin. Chir. 1908, LXXXVI, Xo. 4. 

14. Burkhardt, Miinch. Med. Wochens. Xov. 16, 1909. 

15. Rosenbaum. Xew York Med. Journ. 1911. 1183. 

16. Schurmayer, Med. Klin. 1910, Xo. 26, p. 1017. 

17. Wickham, Louis, "Radium Therapie." Paris, 1912. 

18. :\[eyer, W., Journ. Amer. Med. Assoc. 1909. 1878. 

19. Meltzer and Auer, Journ. Experim. Med. 1909, IX, 622. 

20. Elsberg, C, Annals of Surgery. 1911. LIII, 749. 

21. Farina (cited bv W. Thorburn, Brit. Mid. Journ., 1910, II, 
1029). 

22. Vaughan (cited by W. Thorburn. Ibid). 

23. Pool. Eugene H., Annais of Surgery. April, 1912, 488. 

24. Forster, Journ. Xervous and Mental Diseases. Seot., 1911, 
293. 

25. Lexer. EhrUch. Arch. f. klin. Chir. 1908. LXXXVI. 939. 

26. Lexer, Ehrlich, Arch. f. kJin. Chir. 1910, XCII. 

27. Kirschner, Therapeutische Monatshcfte, Berlin. Dec.. 1911. 

28. Ehrlich and Hata. "Die experimentelle Chemotherapie der 
Spirillosen. 



•>s DUMIMUN MKlJlLAL .MUM'iiLY 

J'J. .Mon-is. Sir M., Brit. .Med. Journ. 1012. T. 712. 
m Bashford, Brit. Med. Jouru. 1911, II, 171. 
:.U. Bashford, Brit. Med. Jouni. 1011, II, 1307. 
.•■12. Butliii, Sir Henry, BriL M(d. Journ. 1011. IT, 1303 and 
1457 ; and 1012, I, 053. 

33. Carrell anil Burrows, Journ. Amvr. Mid. Assoc. 1010. LV, 
1554. 

34. Flexner, Simon (cited by Morton, X(iv York Med. Journ. 
.Alarch 30, 1912). 

35. Hutchinson, Sir J., Brit. Med. Journ. 1911, I, 976. 

36. Berkeh'y and Beehe, Med. Record, New York. ^larch 16, 
1912. 

37. Coh^y (cited by II. T. Butlin. Brit. Med. Journ. 1911, II, 
1457). 

38. Wasserniann. Journ. Amer. Med. Assoc. 1912, 127. 



2)ominion /II>eMcal /Ihontbl^ 

BnO Ontarto /fteiMcal Journal 

EDITED BY 

Medicine: Graham Chambers, K. J Psychiatry: Ernest Jones. W. C Herri 

I)\vyer, Gold win Howland. Geo. W. man. 

Ko8s, Um. D. Young. Ophthalmolog^y : I' N. Maclenmin. W. 

SuPgrepy : W alter .McKeown, Herbert A jj j^owrv 

Bruce. W. J. O. Malloch. Wallace A. _. , ', " w „„.,^„„i^„„ „„j rt*^i 

Srotr fiportre Kwa-t Wilson Rhinolog^y. Laryngolog^y and Otol- 

ObstetPlcs !^ K« a. t w ilson. ^^^ . ^^.^^^^j. g^j.^, ouhert Royce. 

Arthur C. Hendrick. Gynecology: F. W. Marlow. W. B 
Pathologry and Public Health : John Hei.dr.v 

A. Aniyot, thas. J C. O. Hastings, Genlto Uplnapy Surgery: T. B. 

O. I'v Mnbee. (Jco. Nasmvth. Ri.-hard-on. W. Warntr Jone^. 

Physlologrlc Thepapeutics : 

.1. Harvey Todd. Anesthetics: SamuclJobnston. 

GEOBGZ: i:i.IiZOTT, MANAOXHa EDZTOB. 

Published on the 20th of each month for the succeeding month. Address 
all Communications and make all Cheques. Post Office Orders and Postal 
Notes payable to the Publisher, GEORGE ELLIOTT, 203 Beverley Street 
Toronto, Canada. 

Vol. XXXIX. TORONTO, JULY, 1912. No. 1 



COMMENT rROM MONTH TO MONTH. 

The Annual Meeting of the Ontario Medical Association, 
liekl in Toronto. May L'lst to L*orci. was one ot Tiie i>cst. il not the 
best, in a dozen yeai-s. 

Dr. Herbert A. Hnice made an admirable presiding officer, was 
at all times attentive to his duties, courteous, solicitous for the 
en.io^^nent of tlie meml)ers of the Association, had a keen edge on 
Ids authority as chairman, clear-cut. incisiv** in liis presidential 
address, a.s well as happy as host at the various functions. 

The outstanding features of the meeting were the President's 
address, the most interesting a<ldress in surgery by Dr. Crile, the 
epoch-malving demonstration )iy Dr. Caller, the admirable paper 
by Dr. Turner, read by Dr. Fotheringham. and the annual ban- 
quet. 

"Without the shadoAv of a doubt, the character of the speeches 
at the banquet on the evening of the second day were by far the 
best heard in a long time at any medical banquet ; and the address 
of Yen. Archdeacon Cody was one which will not soon be for- 
gotten. A polished, graceful and forcible speaker, it was said by 
those who knew that the Rev. Arcluleacon surpassed himself. 

Amongsft others who contributed to the success of this evening 
were President Falconer. Mr. Justice Riddell. Hon. Adam Beck, 
Dr. 'SI. SI. Seymour, Regina ; Dr. H. G. ^McKid. Calgary. President 



30 DOMIMCX MKDUAL .M( ).\'l"ll LY 

of the Caiiadiaii -Mcilical AsscK-ia-lioii ; Mio Supi'i-intemlont of the 
Toixjiito Cioneral Hospital, Drs. Bingrhiani and Fotheriiighain. The 
spivc'ho.s wore of a hifxli ordor of cxc'cHcnci^ and this function alone 
woukl have amply repaid anyone for his attendance. 

Two mild mictions occurred at the meeting. One was over the 
so-ealkHi "fee-splitting" bu.^dncss; the other over tiie so-called 
"wanton" di'strnetion of cultures, patiiological specimen.s, et-c., at 
the lalwratories at Gravenhurst. 

Of the former nothing definite was done except to place the 
matttn' m the hands of a special committee to report a year hence. 
The discussion brought out the fact that there is no inconMderable 
unrest OA'er the pi*esent financial arrangements as regards the gen- 
eral praiotrtioner and operator. The sentinienit seemed to be unani- 
mous that "fee-splitting" was dishonorable per sc- If so, we saib- 
mit, it is something for the ]\Iedical (.'ouncil to deal with, as not 
through tine medium of the Ontario AEedical Association can any- 
tliing be done to otfset it. As it is a question which affects the 
entire pi'ofession of the province, it thus comes within the purview 
of the IMedical Council, as it cannot possibly be rightly nor cor- 
rectly adjudged by any local association in which the memljership 
is volimtary. It A\X)uld seem to be no good for the one thousand or 
more meml>ers of the Ontario ^Fedical Association to condemn it 
and osftracize their guilty associates, when two thousand practi- 
tioners beyond the pale of the Ontario ^Medical Association could 
hew wood and draw water as they wished. 

The "wanton" desti-uetion of s»pecimens, the result of pains- 
talcing research work, wherever it takes plaee is to be thoi"ouglily 
condemned ; and the medical profession in Canada is entitled to 
know the w'hole tnith of this matter and to have }x)th sides of the 
story. Acts of vandalism can never l)e condoned. Accidents, w« 
k^low, may occur in the best of regulated households; and the 
profession will read with intense interest the presentment of the 
parties thereto. 

The suggestion of the jPresident to round out afliliation with the 
Canadiaai ^ledical Association by the organization of districit asso- 
ciations Iwis often before been advocated in these pages, and it is 
a scheme which meets with our hearty endorsiation. We are not 
in a position to say just how many or wiiat provincial associations 
are properly atlKliatcd with the national medical body, nor what 
provinces have county or di.strict me'dical astsociations in close touch 
with the provincial associations. Tliis was the purport of the re- 
organization scheme of the Canadian Medical Association some 
yeara ago, but it looks a.s though there lia<l been tardiness in the 



DOMTNIOX MEDICAL MOXTHLY 31 

completion of the reorgauization ami that there still existed a belief 
that, "half a loaf was better than no bread." 



The trade in patent and proprietary medicines is to be imesti- 
gated by a select committee in Great Britain under the chairman- 
ship of Sir Henry Norman. 

This committee is the re.siilt of generations of protest on the 
pajrt of the medical profession of the Uniteil Kingdom, and will be 
sure to bring more prominently Ix-fore the eyes of the public the 
many dangers incident to the promiscuous ajid indiscriminate 
drugging with "patent medicines." 

It is (luite certain that an exhaustive examination of the whole 
question ^^^ll be made, and that it will l>e conducted vrith the sole 
object in view of the public good. 

The Canadian Me<lical Association might weU interes^t itself in 
promoting a similar committee for the Dominion of Canada. 



Summer tourists would do well to consult their family pliysi- 
cians or at best the health officer of the district into which they 
are going before deciding definitely upon their summer retreat- 

The anticipation of a summer holiday is sometimes as replete 
in happiness as the full fruition of it. but oft.-n the happiness is 
cut short by a hasty return to the cit\- and some weeks of sick-bed 
or hosipital life through an ill-advised selection of tHie holiday 
resort. 

Particularly is this the case where tA-pl^oi^^l ^^^'""'^ ^^^^ ^^^ ^^^' 
tracted; and it is of first importance to the holiday »^ker after 
rest and recreation that he should satisfy' himself that there is no 
chance of being contaminated by this disease in any community 
in which the sojourner elects to stay for a period. 

People should 'be satisfied as to the quality of the water they 
are going to drink, the source and handling of the milk supply, 
location and sanitaiy conditions of privies, drainage, and that 
screens are employed towards protection and comfort from flies, 
insects, mosquitoes, etc. 

The question of the sanitary- en\'ironment of the summer resort 
in which one is going to spend three or four weeks or a couple of 
months does not often enter into the plans and deliberations of 
the summer tourist, but it will always be found a wise and safe 
procedure to consider at least whether typhoid has or has not made 
its appearance. 



3-? |)(^:\I1M()N MKDiCAL ^[OXTHLY 

Church, law and medicine imist act in unison, said Venerable 
Aivluloac'on Cody, in liis address at the Ontario Medieal Associa- 
tion baiuinet, in buildinj; up a tine nationhood for Canada. 

Someone lias said eugenics and modern civilization are incom- 
patible. This forces the necessiity for co-opeivitioii of the learned 
pix>fessions. 

We must look to the legal professiion in framing wise and judi- 
cious legislia'tion, to the medicail profession to determine tilie physi- 
cally and mentally normal, and to the clerical ])rofession to aljstaiu 
fi-om Ivinding in the holy Iwnds of niiatriinony the physically, ment- 
ally and morally unfit. 

Under the admimatration of the pn^ent Government of tliis 
Pro\'inee of Ontario health matters, ho.-^pitial expansion and adimin- 
istration, prison reform, stiaml in an advanced position. A decided 
step forward will be taken when, as we luave advocated iK^fore, the 
issuing of marriage licenses is placed in the hands of properly 
qualified medical men. 

There is at least one cliurch in the United States wliose clergy 
will liereafter require certificates froin i^eputable physicians that 
the contracting parties are ph.meally and mentally normal before 
solemnizing t'he marriage ceremony. It were well if all marriages 
were consumnmted by the clergj' and that such were the basis of 
all marriage contracts. 

The Ontario ^ledical Association might well take up with the 
Government the (piestion of making medical men the issuei"s of 
marriage licenses, and the clergy that they, alone, perform the 
marriage ceremony. 



The National Insurance scheme o^ ^Ir. Lloyd George has now 
been Ixfore the English public for one year, yet success for the 
measure is not in sight.. 

That the medical profession is not treated fairly by this measure 
there are many evidences otlu'r than those set forth in the medical 
press. 

The new move liy the profession, designed to bring 'Mr. Lloyd 
George to his senses, is for the doctors to cut off all their contract 
rel-ations ^^^th friendly societies. This step luas been forced upon 
the profession ))y the Chancellor of the Exchefiuer, whb for the 
past twelve months has not ee.as<Kl in ever>' way to bring the medi- 
cal profession in line \rith the proposals of his bill. 

It seeiiLs that tlie profession mistrust the insurance committees 
of the friendly societies, for on these committees the doctors will 



DOMINIOX MEDICAL MO?sTHLY 33 

be in the minority, and tiiey mistrust the undiluted societi«'s still 
more. 

The British ]\Iedical Association, through its State Sickness 
InsRirance Committee, is now pledgriug members to resign from 
club and lodge practice and not to accept appointments under 
this Act. The>' are tiakm^r this step to ofTset Mr. Lloyd George, 
who hias practically used all soi-t^ of threats, as well us tiatterj' and 
invective, to bring the medical profession to his feet, and thus to 
the feet of the friendly societies. 

This, of eoui"se, is very serious busini^ss. It is practically the 
employment of the trade union boycott, and is forced upon the 
profession by a man who will go the whole length in seeing his ends 
accomplished. 

This bill degrades the hoiiorablo status of the medical profes- 
sion, does away witli the inilepend<Mit imvlical man in part, and 
makes many the mere hired employe of tJie Staite. 

Tlic Bill and the trouble therewith directs attention to tiie evils 
of lodge practice more tlian anything occurring in the last (piarter 
of a century. 



CANADIAN MKDK AL ASSOCIATION. 



The forty-fifth annual meeting of the Canadian Medical Asso- 
ciation will l)e held at Edmonton August lOtli to 14th. It is ex- 
pected that the first day, being Saturday, will be devoted to Imsi- 
ness. The scientific part of the prograunne will begin on ^Fourlay 
and occupy the three days, ^londay, Tuesday and Wednesday. At 
the conclusion of tbe meeting the G. T. P. offers an excursion to the 
famous Yellow Head Pass. 

Whil^it was at first thought that one day of the meeting should 
l>e spent in Calgary, that idea has been almndoned. A visit to 
Calgary may precetle or follow the meeting in Edmonton. Every- 
thing goes to show that a splendid programme of papers vriU l>e 
ready, and the pi*overbial hosi>itality of the West is shown in the 
numerous arramgements already made for the amusement and the 
comfort of th(^ visiting members. 

As to railway rates, the standard convention certiticarte plan 
will be in force from all points in Canada, that is, the rate will be 
single fare plus 25c. for the return trip, ilembers are urged to ask 
from their local station agent for the standard convention certifi- 
cate, which \^-ill be honored for ticket for return trip. It is neces- 



31 DOMINION MEDICAL MONTHLY 

sary tliat a eortiain muiilxn* of cortificates bo secured before tbe rate 
can bo valid. It would bo wiso also to soonro slt>oping car reserva- 
tions early. 

Those meinbore who desiro to '^o on to the coast, or return by 
ono of the United States routes, can secure summer tourist rates 
whifh are very low. 

The meetiaig in Edmonton otVor.s an excoMent opportunity to 
men in the East of seeing the West economdcaily and at one of 
the most favorable tiiii(\s of the vear. 



XVII. INTERNATIONAL CONGRESS OF MEDICINE. 



The second official cireulaj- of the Seventeen^th International 
Medical Congress to be hold in London, England, August Gth to 
]2th, lOl.'rJ, has i-ocently been issued. 

The Address in Medicine is l)y Profes.sor Chauffard, the Ad- 
dres.s in Surgery by Prof. Harvey Cushing, while Prof. Paul Ehr- 
lich is to deliver the Address in Pathology. 

The circular eoutains the Provisional Programme of subjects 
for discussion in the 23 sections c<uistituting the Congress. 

It is hoped that the profession in Canada will take full advan- 
tage of au event of such groat importance in the medical world in 
particular, as the profession in Canada has been accorded such 
recognition by the British authorities in charge of the Congress. 

Dr. W. H. B. Aikins, who is Secretary of the Canadian Com- 
mittee, will be pleased to send these circulars or furnish other in- 
formation to anyone interested. The Secretary's address is 134 
Bloor St. AVest. Toronto. ' 



DOMINIOX MEDICAL MONTHLY 35 



IRews Jtcnis 



Dr. J. M. Lane, Mallorytown, Out., died on the 0th of June. 

Dr. A. n. Caulfiehl ha.s resigned as pathologist at tlie Sana- 
torium at GravenJiurst. 

Dr. Colin Canipboll, Toronto, is on a motor trip through Eng- 
hmd and Germany. 

Dr. Clias. McGillivray, Whitby, Ont., has been elected President 
of the Ontario Medical Association. 

The Hon. Adam Reek lias been eh'cted President of the Cana- 
dian Association for the Prevention of Tuberculosis. 

Dr. Fred. Parker, Milverton, Out., has gone on a tAvo months' 
trip to Western Canada and the Western States. 

Drs. W. J. Wil.son <uid W. A. Young, Toi-onto, have returned 
from the meeting of the American Medical Association at Artlantic 
City. 

Drs. Simpson, Halpenny and Gorrell, Winnipeg, ilan., announce 
that ^Fay L5th new offices will be occupied in the new Sterling Bank 
Building, corner Portage and Smith Street. The number of the 
office phone will still be ]\[ain 272. 

Th(3 following have been appointed District ^Medical Health 
Officers: Dr. D. B. Bentley. Samia, headquarters at London: Dr. 
T. J. :McNally, Owen Sound, at Palmer.^ton ; Dr. D. A. McClena- 
han, Waterdown, at Hamilton; Dr. Paul J. ^Moloney, Cornwall, at 
Kingston; Dr. R. E. Wodehouse, Fort William, at Fort William: 
North Bay to be appointed. 



3G DOMINION MEDICAL MONTHLY 

Ipublisbcrs' 2)cpavtincnt 



The Massagk iNSTiTrxiox at '.^n Walmcr I'oad, Toiouto, just 
nortli of Bloor Street, establislied only a few months ago, and con- 
diu-ted and supervised hy Mrs. MacKinnon, is now one of tlie estab- 
lislied medical institutions of Toronto. All branches of massage are 
carefully administered, Mrs. MacTviiiiion having had considerable 
experience in the Home Country. There are also electrical, electric 
light and needle spray baths: and the ai)pointments and surround- 
ings are all that could be desired. Male patients are attended by a 
masseur of ])ractical experience. In every way, Mrs. MacKinnon 
attends to the comfort and best requirements of all patients. Physi- 
cians are invited to visit and inspect the institution. 



Physicians desiring to secure a location for practice in Ontario, 
]\ranitoba. Sa.skatche\van, Alberta or British Columbia, can secure a 
list of from 25 to 35 openings in these Provinces, some with and 
some without property, by apphing to Dr. Hamill, who conducts 
the Canadian Medical Exchange, 75 Yonge Street, Toronto, for the 
purcha.se and sale of medical practices and property. Bona fide 
pro.spective buyers can get particulars free of any offer simply by 
applying therefor and agreeing in writing that all information re- 
ceived is confidential and that they ^^■ill not offer opposition for a 
reasonable time to any physician whose offer is submitted to them. 
A partial list of such practices for sale will be found among our 
advertising columns each month, the comjdction of which naturally 
changes with each issue. 



Prepare the Babies for Hot AVeattier.- -During the month of 
June it is not a bad plan for the physician to take mental "stock'' 
of the l)abies under his care, especially such as are bottle-fed, with 
the general idea of recommending such treatment as will tone up 
and vitalize those whose nutrition may be below par, so that they 
may enter the trying summer months in the best, possible condition 
to ward off or ^^'^thstand the depressing inliuences of extreme heat 
or the prostrating effects of the diarrheal disorders of the heated 
term. Careful attention to feeding is, of coui*se, a sine qua non, and 
the details of the infant's nourishnu'nt should be carefully investi- 
gated and regulated. But this is not all. IMany bottle-fed babies 



DOMINION MEDICAL MONTHLY 




Are yo 1 particular as to the condition of the iron in ; our 
Blaud preparation? ? 

Frosst's Perfected Blaud Capsules present True Ferrous 
Carbonate. 

Each 10 grain Capsule contains, approximately, 1 grain , of 
Iron. 



xviii DOIillNION MEDICAL MONTHLY 

HIV ht'low standard from a honiatolog'ic standpoint. The marasinic 
anemic ])al)y deservt^s spooial attention in tihe way of l)uildinir np 
and restorin^r a circnlating fluid which is deficient in red cells and 
hemoglobin. In the entire Materia Medica there can be found no 
direct hematic quite a.s suitable for infants and younger children as 
Pepto-^rangan (Gude). In addition to its distinctly pleasant taste, 
this her.iie tonic is entirely devoid of irritant properties and never 
disturbs the digestion of the most feeble infant. Being free from 
astringent action, it does not induce con.s/tipation. A few weeks' 
treatnunit witli appi-opriate doses of Pepto-Mangan very frequentl\' 
establishes sufficient resisting power to enable the baby to pass 
through tlie hot summer without serious trouble, gastro-intestinal 
or otherwise. 



After ]More Records. — The prize list of the Canadian National 
Exhibition, Toronto, August. 24th to September 9th, has been issued. 
It shows the usual liberal prizes in all departments of live stock, 
agriculture and home work, amountinsg to a total of $55,000. It is 
also evident that the list has been carefully revised to have it in 
keeping with up-to-date conditions. A few of the innovations that 
might be noticed are provision for competition in breeding hoi-ses 
for strings of five horses ; a number of sections added to provide for 
the newer breeds of poultry- ; $100 in prizes for onions, tomatoes and 
celery in baskets. The last named is a government suggestion meant 
to encourage export of these commodities. On the whole, the list 
shows a distinct advance on its predecessors, and, as the attractions 
will include a review of c<adets from all the overseas dominions of tlie 
Empire, tiie Scots Guards Band and a brilliant historical spectacle, 
the Siege of Dellii, it is safe to predict anotlier record year for the 
Canadian National. 



Every physician kn<nvs that Modified Milk is the bes* infant 
food. But what alwut the method by which it is modified? The 
nsnal way is to cut downi the casein content by dilution with water, 
to restore the a.sh by the additi<in of lime water, and then to add 
cream and commercial milk sugar. Bnt this dilution, while i^ 
decreases the too-abundant casein of co^\'s' milk, further decreases 
the already insnfficicMit and e(|ually important milk albumen. 
Also lime water is only a Tnakoshift to restore part of the natural 
salts in the ash, and commercial milk sugar lacks the properties 
of the unrefined lactose present in fresh milk. 



DOMINION MEDICAL MONTHLY 



XIX 




(Rtoimata) 



Early Buyers 
of Furs 



Earlv selection and purchase of your 
Furs is next in importance to the choice 
of your Furrier. Our stock of furs are 
now at their best and an early selection . 
will result in permanent satisfaction. 

Fur and Fur-Lined Coats 

for Men and Women 

Sets and Single Pieces 

Coats in plain and fancy styles in Alaska 
Seal, Persian Lamb, Caracul Broadtail, Hudson 
Seal! Moleskin, Canadi.in Mink, Ermine and Seal. 
Leopard, Black and Natural I'ony, etc. 

Sets in Black Fox, Fisher, Canadian Mink, 
Ermine, Skunk, Black Lynx, Pointed Fox, 
Persian Lamb, etc. 



Our New Illustrated Fur Catalogue 
will be mailed on receipt of a postal 
with your name and address. 



Fairweathers Limited 

84'S6 Yonge Street 



Montreal 



TORONTO 



Winnipeg 



XX DOMINION MEDICAL MONTHLY 

How THE Men on the Prison Farm Spend Their Day. — 
lliore are no bolts or bars on the Hon. W. J. Ilanna's Prison 
Farm, at Guelph, says Ilobson Black, writing inNoveniber Canada 
Monthh/ under the title of " Making a Man of a Convict." On the 
day I visited at the farm, one man was assigned to work on a new 
concrete bridge over the Ivivcr S])eed, built entirely by the prison- 
ers and much admired by Earl Grey and the Duke of Connaught 
on their visit. lie applied himself with diligence and intelligence 
to his new duty. His surroundings were practically identical with 
those of the freest man in Canada. A " foreman " instructed him 
in the mixing of concrete and the manipulation of tools. It was 
perspiring, back-bending work, but conducted with the camaraderie 
that helps the hours pass like lightning. Twelve o'clock brought 
the signal for luncheon. The men formed in line and marched 
off to the dining hall, where they feasted as well as the best fed 
farm-laborer in the land. Then a group of four, unattended, 
shouldered their axes and struck off for a patch of w^oods half a 
mile distant, where post cutting was in progress. Five others 
found a new assignment in straightening out a bend in the river 
regarded as unconducive to the esthetic standards of the farm. 
Many were needed for the quarry and a corporal's guard manned 
the lime kiln. A good-tempered fraternity departed for some 
newly-jdanned highway. The fine Ilolstein herds required atten- 
tion. The dairy took a foreman and five. Two were sent with 
horse and wagon to repair some broken fencing, and gave a lift 
to a comrade bound for town to replace a piece of damaged mach- 
inery. Such a disposition of two hundred men would read in the 
annals of twenty-five years ago as the order of a public maniac. 
Were the Provincial Secretary of Ontario inclined to boast, he 
might very easily offer a substantial reward for th(^ du])lication in 
any old-fashioned prison c»f such occurrences as 1 am al)out to 
relate. A man of thirty years, whose residence in his native town 
had been a source of police wc^rry, fastening upon himself the 
distinction of a professional loafer, took an extra liberty with the 
law and was awarded a two-month sentence. The officer in charge 
of the Prison Farm gave him a special job, beautifying a portion 
of the river bank. Though at first mulish, he quickly evinced a 
curious ])rid(' in his undertaking and when comjx'lled to relinquish 
it by the exi)iration of his term was far from jubilant to regain 
his liberty. Spying Mr. Ilanna coming along a path, he accosted 
him thus: " T hope you'll see that a good man is placed on this 
river job. It has been a tough ]»iece of work, sir, and I wouldn't 
like to hear of it being spoiled." It was probably the first confes- 



DOMINION MEDICAL MONTHLY 



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xxii I M (Ml MOV MIIDICAL MONTH I. ^■ 

sioii ot jiiiv iiitcri'.-l or aiiihitioii that tlic poor fellow h;ul f\cr made. 
The Minititer iiave him a ready assiiraiu'e, for to his keen divina- 
tion the iiicidriit was crammed full of siiniitieanco. 



Ai'iiAsiA AM) A(.KAi'iiiA. — Two cases of motor aphasia and 
a.irraphia, illustrating the types that are suitable for surgical or 
specific treatment, are reported by E. Martin and V. K. Mills. 
Philadeli)hia (Journal A. M. A., October 26), who also discuss 
the questions of localization of brain lesions both in these condi- 
tions and other varieties of aphasie disturbance. The article is 
lengthy and quite fully illustrated. They say that it is no longer 
surticient to give the surgeon indefinite directions. lie should find 
the lesion located by his neurologic confrere occupying the central 
portion of the area exposed. Aphasia and agraphia are not infre- 
([uently the focal symptoms dominating the clinical picture in 
which operation is under discussion, and the symptoms differ so 
much in character and degree and in their symptomatic associa- 
tions that it is possible to designate at least four or five areas for 
election for osteoplastic operations, and four of these are considered 
in the jiaper. The symptoms which are most characteristic as 
indicating each of these are detailed as well as the methods of 
bounding the areas on the external surface of the cranium. It is 
important both to the neurologist and to the surgeon to consider 
whether or not the focal disease of the brain is syphilitic and amen- 
able to constitutional rather than surgical measures. In one of 
the cases reported the presence of positive Wasserinann and Xogu- 
chi reactions, together with the other symptoms, decided the ques- 
tion against ojieration. while the other was diagnosed in the 
absence of such a positive result as non-specific, and in both cases 
the diagnosis was correct, as shown by the final result. Together 
with general remarks on craniometric measurements, the limits 
of the osteo])lastic operation for lesions in Wernicke's zone and for 
lesions in the angulo-occipital region are also given in detail, as 
well as of those causing motor aphasia. For these details the reader 
is referred to the article itself. In certain aphasie and agraphic 
cases in wliicdi the lesion is deep-seated, operation is clearly contra- 
indicated. The characteristic symptoms in such cases are, briefly 
stated, the completeness of the accompanying hemiplegia, together 
with such phenomena as indicate evident involvement of the cap- 
sules, internal and external, the claustrum and the basal aanalia. 



DOMINION MEDICAL MONTHLY xxiii 



BOVRIL 

AND DIGESTION 

TN cases where milk is not tolerated 
^ it has been found that if a small 
cup of Bovril is taken first the milk 
is easily digested. 

I^ovril aids the digestion and assimilation of food. 
See The British Medical fournil, Sept. IB. 1911 . 



They Fail to Understand '' 



u 



The habit of catching coldisacquired by the habit of wearing 
woollen garments next to the skin. Flannels are weakening, 
a weakened skin is like an open door for colds and chills 
to enter. 

All who have worn Dr. Deimel undergarments for one 
winter wonder at the change for t'e better which has taken 
place with them. They fail to understand how they 
could ever have worn wool next to their skin. 

DEIMEL LINEN-MESH CO. 

416 St. Catherine St. West :-: Montreal, Canada 

Branches: 

NEW YORK, WASHINGTON, D.C., SAN FRANCISCO. BROOKLYN 

BALTIMORE, DETROIT. LONDON, Eng. 

We also sell the Dr. Deimel Linen-Mesh Supporters 



xxiv DOMINION MEDICAL MONTHLY 

CoRPis LuTEUM ExTifACT. — ('. F. I)iirnaiii, Baltimore {Journal 
A. M. A.. Aiigiist 31), after reviewing the function of the internal 
secretion of the ovaries and the use of the extract, civt's his personal 
experience in experiiiienting with the extract of the corpus hiteum 
of the pig. Besides the experiments with dogs, which accorded with 
those of other observers, he tells his ox]^erience Avith the use of the 
extract in huuian patients, and concludes his paper with the follow- 
ing summary: "1. When given by the mouth, corpus hiteum tis- 
sue of the sow. even in large doses, has little or no toxic effect on 
women. 2. It affords us a valuable means of controlling the nervous 
symptoms which occur in so many patients at the time of the nat- 
ural or artilicial menopause, giving relief to most sufferers. 3. It is 
a valuable remedy in treating patients with insufficient internal 
ovarian secretion during the menstrual life. This class constitutes a 
very large number of women. 4. It is an excellent remedy to induce 
menstruation in young women suffering from functional amenor- 
rhea. Those who are fat, in addition to regaining menstruatioif, us- 
ually, but not always, lose weight, 5. There would seem to be a pos- 
sibility for the use of drug in cases of unexplained sterility and 
repeati'd abortions. 0. Extensive use should be made of corpora 
lutea from the cow, sheep, and other animals to determine if these 
extracts Avork more successfully than those of the sow. The ideal 
luteuin tissue for any animal is doubtless tissue from its own spec- 
ies. l»ut this cannot be obtained for the woman. 7. So far as it goes, 
my work strengthens my conviction that Fraenkel is correct in at- 
tributing menstruation to the internal secretion of the corpus 
luteum. 8. From clinical experiences I am inclined to believe that 
the corjjus luteum possesses different properties due to different 
chemicals. One of these substances causes hyperemia of the pelvic 
organs ; another relieves nervous symptoms of a toxic character, as 
at the menopause. It would seem that this product acts as a neutral- 
izer, since even large doses of the luteum cause no disturbance of a 
toxic nature. On the other hand, the toxic results of intravenous 
injections of the luteum extracts, as well as the nervous phenomena 
of menstruation, .show that there must also be some toxic material 
present which is not absorbed from the stomach or intestines. All 
of these various substances may in the future be separated." 



-27- 



dominion /Iftebical /n^oiubl^ 



SnO Ontario /iRcMcal Journal 



Vol. XXXIX. TORONTO, AUGUST, 1912. No. 2 



©lioinal Hrticlee 



SOME ASPECTS OF NEUROLOGY TO GENERAL PRACTICE* 

By William Aldrex Turner. M.D., of London. 



]Mr. President and Gentlemen : — 

]\Iy fir.st duty, a most agreeable one, is to express to you, sir, my 
cordial thanks for the invitation which you have given me to deliver 
the address in ^Medicine before the Ontario ^ledical Association at 
its thirty-second Annual ^Meeting. 

In selecting a subject on which to address you, it has seemed, to 
me that some of the aspects of Neurology to general practice would 
not be considered out of place. This choice has in consequence per- 
mitted me, among other matters, to make a few remarks upon 
psycho-therapeutics, a subject which is claiming much attention at 
the present time, especially on this side. 

Dr. Hughlings Jackson. 

I cannot, however, pass to the subject of my address without 
paying my tribute to the loss which clinical medicine, and more 
especially that branch of it which claims my attention, namely, the 
Diseases of the Nervous System, has sustained in the death of Dr. 
Hughlings Jackson, which took place last autumn. 

He was the father of British Neurology', and all those whose 
activities are devoted towards this subject, whether as phj'siolo- 
gists, pathologists or practitioners, claim him as their Master. His 
influence with his colleagues and upon his pupils was great, but his 
studious nature and retiring habits rendered him little kno\vn in 
the public life of the profession in London. 

* Address in Medicine, Ontario Medical Association, Toronto, May, 1913. 



38 DOMIXIOX AIKl^K'AT/ :\lO\'r]ll.Y 

He possessed a rare combination of mental qualities, keen clinical 
instinct with a strong philosophic bent. His teaching illumined 
many dark places and obscure corners of the Nervous System, and 
his original views upon the "levels" into which he theoretically 
divided that System, did much to clarify the >,tudy of its discas«?s. 
His name \xi\l long be perpetuated in that variety of localised con- 
vulsion which he described, and which is known as Jacksonian 
Epilepsy. 

The Clinical Laboratory. 

AA'hcn a comparison is made between the practice of twelve or 
fifteen years ago and that of to-day, the most striking feature of 
ditTerence will be found in the assistance which various auxiliary 
methods, more especially the clinical laboratory and tli»> Rontgen 
Rays, have rendered to botli the diagnosis and the trcatniont of 
disease. 

The introduction of laboratory methods upon modern lines may 
be said to date from the investigations of Pasteur upon rabies and 
Koch upon the tubercle bacillus, and more particularly from the 
introduction by the latter of tuberculin injections. 

It is only, however, within comparatively recent years that 
these methods have been so developed and extended as to form 
almost a separate department of practical medicine. So extensive, 
in-deed, has been their application and so efficacious the uses of the 
laboratory in clinical work, that a new class of highly-trained and 
specialized practitioners has been solved. 

There are many who think that clinical medicine is becoming too 
dependent upon the observations made in the laboratory, and that 
the old time method of studying the patient as the soil in which 
disease takes root and growth, is being too often replaced by exam- 
ination upon disease in test-tubes. It will, I think, be generally 
admitted that the laboratory investigation is in many cases a most 
useful aid to the bedside examination, but sliould never be allowed 
to replace it. 

In my own branch of clinical medicine, much useful informa- 
tion may be obtained ■with the co-operation of the clinical patho- 
logist, but there are very few organic diseases of the nervous sys- 
tem, even in the early stages, a diagnosis of which cannot be made 
by a careful bedside examination along well-recognized lines. The 
readiness and completeness with which an opinion may be formed 
from an investigation of the cerebro-spinal fluid, should not be 
allowed to replace, but only augment, the usual bedside observa- 
tions. But, notwithstanding, there are many morbid conditions in 



DOMIXIOX :MEDICAL MOXTHLY 39 

which such an examination is desirable, and even essential to com- 
plete the dia^osis. 

Lumbar Puncture, by means of which the cerebro-spinal fluid is 
obtained, was introduced origrinally by Quincke^ in 1S91. In the 
early days following its introduction, the cerebro-spinal fluid was 
examined with a view more especially to the differential diagnosis 
of the various forms of acute meningitis, and it still finds one of its 
most helpful applications in these diseases. 

By its aid the cellular and bacterial elements of the fluid are 
examined and valuable information is obtained as to the precise 
form of meningitis and the nature of the infective agent. 

In cerebro-spinal meningitis. "Weichselbaum demonstrated the 
meningo-coccus in connection with a large polymorpho-nuelear in- 
crease. In tuberculous meningitis Widal and others showed that 
mono-nuclear hinphocj-tes predominate, while in the purulent 
forms of acute meningitis the pohiiiorpho-nuclear cells are in- 
creased, and cultivation reveals the presence of staphylo, strepto 
and pneumococci. 

The presence, however, of pol^-morpho-nuclear cells should not 
be regarded as proving the existence of suppurative meningitis, as 
they may be found in brain abscess, suppurative lab\Tinthiti.s and 
sinus plilebitis, without any direct implication of the cerebral mem- 
branes. 

The bacteriological examination of the fluid also is far-reaching, 
for the absence of bacilli in serous meningitis, cerebral tumor and 
hydiXK^ephalus would sers'e to distinguish these conditions from 
meningitns. notwithstanding the similarity of symptoms in sone 
cases. 

At a later date the investigations of Widal-. Sicard and oth.^rs 
of the French school, demonstrated the almost constant increase of 
the lymphocytes in certain chronic degenerative diseases of s}"phi- 
litic origin, such as parah'tic dementia and tabes dorsalis. Accord- 
ing to Xoune^' a marked lymphocytosis is present in 100 per c-nt. 
of the former and 90 per cent, of the latter. 

The constant increase of the lymphocyte count in these disea-s. 
even in the early stages, was used as a means of diagnosis, when the 
usual clinical s\Tnptoms were not obtrusive. I have seen a few 
cases in which such an examination was necessary- to establisli a 
diagnosis, but in the majority, even in an early stage, some clinical 
signs will be found if carefully looked for. 

The association of a slight increase in the lymphocyte count 
along with Arg^il-Rol>ertson pupils, (or loss of the pupillary light 
reaction "I . in a case presenting neurasthenic or other symptoms of 



40 nOMIXIOX MEDICAL MONTHLY 

lUTVous lireakilowii. but without definite physical signs of tabes 
dorealis, would scarcely be sufficient ^i-ound on which to base a 
diiignosis of tUis disease. Tliis conil)ination of symptoms is not 
uncommon, and considerable ditlficulty may be experienced in form- 
ing a differential diagnosis as to whether the case in question is of 
a functional or organic character. 

Sinve the inti"oduetion of the Wassermann test a further re- 
action of importance has been added to diagnosis; but there are 
some physicians wlio rely upon cyto-diagnosis as of equal value in 
the differentiation of these cases. 

It should, however, be mentioned that a lymphocj'tosis has been 
found in certain diseases of a non-specific character such as herpes 
zoster, Landry's paralysis and enteric fever. 

The observation of ]Mott^ and Ilaliburton that cholin was pres- 
ent in the cerebro-spinal fluid in organic diseases was at one time 
regarded as a possible means of establishing a diagnosis between 
organic and functional disorders of the nervous system. As this 
ol)ser\'ation has not a.ssumed sufficient pathological impoi-tance, and 
as the technique is complicated and difficult, the method has been 
abandoned as a diagnostic resource. 

Kecently the examination of the cerebro-spinal fluid for tiie 
Wassermann reaction has been undertaken, especially in the early 
stages of tho.se diseases in which a specific causation is probable, and 
when the usual physical signs are either not present or only to an 
uncertain or equivocal extent. 

Most practitionei-s see from time to time cases having a definite 
neurological or mental aspect, in which it is difficult to say from 
the physical signs alone, such as Argyll-Robertson pupils and 
alterations in the reflexes, whether the symptoms are functional 
and temporary, or indicate the onset of serious organic disease. 

The cases to which reference is made are usually of adult age 
and commonly of the male sex. They may show signs of neuras- 
thenic breakdown, some degree of mental d'cpre.ssion or excitement, 
or acute iiLSomnia for which no Obvious cause is apparent. On the 
other hand, persistent headache, progressive loss of memory, epi- 
lepsy, and eclamptic convulsions or symi)toms of art<'>rio-scleposis 
may be the outstanding features. 

In this type of case, the examination of the blood and cerebro- 
spinal fluid by the Wassermann test is regarded as being of great 
diagnostic value, and as throwing much light upon the under- 
lying structural changes. It is also a means of differentiating 
between functional and organic nervous conditions, occurring in 
s^-philitic subjects. 



DOMIXIOX MEDICAL MONTHLY 41 

The existence of a positive Wassermauu reaction of the blood 
serum in the type of case just described would be an indication 
merely of the constitutional state, but would not throw any light 
upon the condition of the central nervous system. 

If, however, a positive Wassermann reaction was found in the 
cerebro-spinal fluid as well and if with this there was associated a 
large increase in the lymphocyte count, a diagnosis of parasyphi- 
litic disease, most likely general paralysis, might with confidence 
be made. 

There is also evidence that the reaction of the blood serum may 
be negative while that of the cerebro-spinal fluid may be positive 
in these cases. There are also cases in which the lymphocj-te count 
is above the normal, but does not reach the high number found in 
general paralysis. This latter type is usually associated with a 
positive cerebro-spinal reaction. The significance of this type is 
less certain, but it probably points to a chronic inflammatory condi- 
tion of the central nervous system. 

The proportion of cases of tabes dorsalis which show a positive 
Wassermann reaction of the cerebro-spinal fluid varies from 5 or 10 
per cent, according to Noune up to about 50 p^i-r cent, in Mott's^ 
experience. 

The examination, therefore, of the cerebro-spinal fluid by the 
Wassermann test has come to be of immense practical value in the 
differential diagnosis of functional and organic nervous conditions 
occurring in syphilitic subjects. Many cases occur, however, in 
which such an examination is unnecessary: it should, in fact, be 
reserved for cases in an early or equivocal stage, or for tho.se in 
which the physical signs are not sufficiently characteristic. 

Lumbar puncture has also been adopted as a therapeutic means, 
but its application for this purpose is limited and has been con- 
fined mainly to cerebro-spinal meningitis. The removal of a quan- 
tity of fluid is an operation not unattended by danger, and in dis- 
orders characterized by an increase of the intracranial pressure, 
such as cerebellar tumors, the risk would seem to be great. Removal 
of some fluid, however, is often of advantage in the coma of a cere- 
bral hemorrhage, and in hydrocephalus. Lumbar puncture is also 
used to assist the effects of operation upon meningitis secondary to 
ear disease, when it acts as a temporary drainage for the removal 
of inflammatory products. 

Serotherapy. The diseases of the nervous system do not lend 
themselves, so far as their study has yet gone, to treatment by 
serums and vaccines. There are, however, two maladies — cerebro- 
spinal fever and acute poliomyelitis — whose symptoms indicate 



42 DOMIXION MEDICAL MOX'I'IILV 

nervous deraugenient. l)iit whoso j)a11iol()gy places thein uudor the 
acute iufeetious disorders. 

The infection of the central nervous system through the pos- 
terior nares and uaso-pharynx, the probable similarity of the in- 
fective agent in both diseases, and the fact that they are known to 
occur in epidemic and sporadic forms, have opened the way for a 
better study and have led to the view that they are probably of the 
same or similar pathogenic nature. 

The artificial production of poliomyelitis in monkeys by Flox- 
ner^ and others has thrown fresh light upon its pathogeny, but 
attempts to prevent or cure it after experimental production by 
means of serum or vaccines have not been encouraging. 

For cerebro-spinal meningitis, on the other hand, a number of 
serums have been prepared, and their administration during the 
early days of the fever would appear to be of service. 

Flexner states that he has largely reduced the mortality by the 
use of his serum. 

It is difficult to make any authentic statement upon the use of 
serum and vaccines in the meningitidos secondary to ear disease. 
Their employment, however, would appear to be of some value as 
an auxiliary method in operative treatment. An autogenous vac- 
cine ought to be prepared and employed in all these cases, although 
its direct influence cannot at present be estimated. 

The Rontgen rays find little application for their use on diseases 
of the nervous system. It was at one time thought that they might 
be of value in the location of tumors within the cranial ca\'ity. This 
has not been found of any real value. They are, however, of decided 
value in the diagno.sis of morbid conditions of the bony tissues sur- 
rounding the central nervous system, especially with reference to 
pituitary and other lesions at the base of the skull. 

A minor, but at the same time interesting observation, has been 
made from their universal application in all cases of muscular 
atrophy affecting the small muscles of the hands. It has been 
found by X-ray photographs of the neck in many of these cases, 
occurring especially in young women, how frequently' the presence 
of an additional or cervical rib is the cause of the muscular atrophy, 
and how satisfactory the recover^' may be after the removal of the 
accessory piece of bone. 

In cases of neurasthenia, accompanied by gastro and enterop- 
tosis, the examination of the size, shape, position and motor action 
of the stomach and intestines may bo easily and satisfactorily de- 
termined by tracing the course of a bismuth meal through the 
digestive tract by X-ray examination. 



DOMINION MEDICAL MONTHLY 43 

Too much importance cannot be given to this method of exam- 
ining a portion of the body whose functions have so far not been 
open to a closer examination than could be obtained through ab- 
dominal palpation. 

The Bromides in the Treatment of Epilepsv. 

There exists a strong feeling in the popular mind that the pro- 
longed use of tlie bromides in the treatment of epilepsy is not only 
useless, but actually liannful. One might even say that this feeling 
to some extent has taken hold of the medical mind. There is, in 
fact, in some quarters a reaction against the administration of 
bromides in the treatment of this disease. 

There is no doubt that since the introduction of the bi-omides in 
1857 in the treatment of epilepsy, most epileptics at some i^eriod in 
the course of their malady have been treated by these drugs. The 
almost universal prescribing of the bromides during the past half 
century, with more or less success, has to a large extent deprived 
such patients of the advantages which certainly may be obtained 
from hygienic, dietetic, and disciplinary lines of treatment. 

. The decision as to whether a particular case of epilepsy has 
been cured in the proper sense of that term is difficult to determine, 
as it is well known tliat attacks may recur even after an interval of 
twenty or more years. But it may ])e conceded that arrests of fits 
for a period of from five to ten years in a ease which presents no 
mental stigmata and in which all treatment has be<m suspended 
may be deemed as cured. 

It is just this difficulty in defining a cure which renders the dis- 
cussion of the problem of the value of bromides so difficult. In the 
pre-bromide days — that is, before the year 1857 — quite a number 
of cases of epilepsy were recorded by the French and English 
physicians as cured, the percentage varying from 5 to 13 per cent.' 
These are the results recorded by ph\^icians who used remedies such 
as oxide of zinc, nitrate of silver, and belladonna, some of which 
have largely passed out of common use. 

On the other hand, the statistics of those who have treated 
epilepsy with the bromides do not differ materially from those just 
mentioned. Since the introduction of the bromides the statistics of 
cured cases also vary from 4 or 5 to 12 per cent." Medical writei-s, 
therefore, such as Pierce Clark,^ of New York, and others, who 
favor the abolition of sedative drugs in the treatment of this disease, 
find in the above quoted figures a strong basis for their contention 
that the bromides are neither necessary nor desirable adjuvants to 
ordinary hygienic remedies. 



44 DU.ML\K>N .MKDICAL MONTHLY. 

It is therefore a matter of importance to ascertain whether any 
real bju>is exists for the feeling against the use of the bromides, or 
whether this view is only another instance of popular misconcep- 
tion, of which there are several examples in this disease. 

]\[y experience of the treatment of epilepsy extends over some 
sixteen or eighteen years, during which time I have prescriljed for 
several thousands of epileptics in all stages and varieties of the 
malady. 

I can without hesitation say that the influence of the bromides 
upon epileptic fits is both variable and uncertain. In a certain pro- 
portion of cases, amounting to about 25 per cent., so much benefit 
is derived that the attacks are either permanently or temporarily 
arrested. It is probable that the spontaneously curable cases of the 
disease are found in this group, cases which in the view of some 
writers are arrested not in consequence of, but in spite of. the 
remedy. The curable t>"pes of epilepsy are recognizable early in 
the disease, and in them I consider early and persistent use of small 
doses of the bromides most essential. 

In a second group of cases, amounting to a further 25 per cent., 
some improvement is derived from the administration of the bro- 
mides, mainly in the direction of lessening the frequency and 
severity of the fits. This may be looked upon as the common tem- 
porary result of bromide treatment, and is what may with confi- 
dence be expected in many cases in the early stages of the disease. 

In the remaining group, amounting to about 50 per cent., the 
bromides either have no influence at all upon the fits or are actually 
deleterious. 

It is therefore obvious that about half the number of epileptics 
derive no benefit from the administration of the bromides, from 
which it miglit be argued that these salts are of little, if indeed any, 
use in the treatment of epilepsy. On the other hand, there is the 
25-50 per cent, which derive great benefit from these drugs, includ- 
ing the 10 or 12 per cent, which are cured. 

It is within the experience of most physicians, especially of those 
working amongst the hospital class, that no complete record can be 
obtained either of the numl)er arrested or the duration of the arrest, 
as there is a tendency for the patient to cease attendance once he is 
relieved of his symptoms. 

I hold that it is an error to say that the bromides are of no use 
in the treatment of epilepsy. If 50 per cent, of the cases derive 
some benefit from the administration of these drugs, then all ca.ses 
of recent origin should be given the benefit of the remedy for a time. 



DOMINION MEDICAL MONTHLY 45 

I should, however, be the last person to neglect the value of diet, 
occupation, and general mental and physical hygiene in the sufferer 
from the disease. By these means the dose of the salt is kept at a 
minimum which will produce the desired effect; and the most suc- 
cessful and satisfactory cases of this malady are those in which a 
combination of sedative remedy, diet, and general hygiene are pre- 
scribed and administered under the care of a nurse, attendant, or 
other pei-son, who will enter into every detail of the case and its 
treatment, both in the letter and in the spirit. 

A few remarks upon some popular fallacies in connection with 
epilepsy may not be out of place. 

In the first instance, as to "growing out" of fits. It has long 
been a popular idea that an epileptic on reaching a certain age or 
after a certain number of years of the disease, may outgrow iiis 
attacks. The age is variously stated, but 21 is frequently mentioned 
by the parents as having been the one gi-ven by the doctor. 

There are two age-periods when "growing out" may be looked 
for. The first is the period of childiiood between 4 or 5 and 7 or 8 
years in those whose fits commence in infancy. In addition to 
being a period when fits may with some certainty be expected' to 
cease, at all events for a time, it is also an epoch during which the 
onset of epilepsy is relatively uncommon. 

The second is between the ages of 21 and 25 or 26 (adolescence) 
in those whose fits have commenced during puberty. I have else- 
where^ shown that the quinquennial period,. 21 to 25 years of age, is 
that one which seems most favorable for the arrest of epilepsy in 
those whose fits commenced between 15 and 20. This bears out a 
further observation tliat epileptic fits are more prone to arrest 
during the first three to five years following their onset. If there- 
fore there is another period in which a patient may "outgrow" his 
fits, it is between the ages of 21 and 25 or 26, in those cases in which 
the disease has commenced during puberty. 

There is no evidence that the climacteric period has any influ- 
ence upon the arrest of epilepsy, except perhaps in a few isolated 
cases. 

Secondly, as to the influence of the catamenia. The popular 
belief that the satisfactory and regular establishment of the men- 
strual functions will arrest the disease has no scientific basis. The 
onset of fits in girls is commonly accompanied by irregularity m 
the period, but it is rare to find any amelioration when the periods 
become regularly established. Physiological amenorrhea may or 
may not have a beneficial effect. 



46 DOMINION MEDICAL MONTHLY. 

Tliii\lly, as to marriage. There would appear to be no real 
foundation for the widespread belief, mainly held by the les.s edu- 
cated section of the community, that the marriage of an epileptic 
girl, especially if pregnancy results, favors the cure of the disease. 
On the contrary, although isolated instances of such a cure occur, 
the consequences of matrimony tend to the production of circum- 
stances distinctly unfavorable to the arrest of the disease. That 
there is no certainty in the intiuence of marriage upon epilep.sy is 
the result of the observation of most writers on this subject. 

The intiuence, however, upon the individual is relatively small 
as compared with that upon the offspring, and the consequent 
transmission of the disease. In definitely hereditary cases it is 
probable that one or more children out of several will become epi- 
leptic ; there is no certainty that any of the offspring will suffer, 
although it is unlikely that all will escape. 

Mind and Body — Hysteria. 

It has been the custom in the teaching of the schools largely to 
disregard the mental side of disease, and to consider as altogether a 
special study sj'mptoms and diseases liased upon a psych ieal foun- 
dation. 

Perhaps, under existing arrangements, such a dissociation is 
necessary, but the close inter-relation between mental and physical 
symptoms is all-pervading, and there will be an advance in clinical 
teaching when this aspect is more decidedly brought before the 
attention of students during their hospital career. 

In the first place, there is no physical disorder, however slight, 
which does not produce some effect upon the mind, though varying 
in degree according to the temperament. Every practitioner is 
aware how much the course and treatment of an acute inflamma- 
tory or other malady depends upon the mental attitude of the 
patient, according as he regards his condition from a hopeful or a 
pessimistic aspect. 

There are many persons who consider that the onset of some 
unpleasant or unaccustomed sensation in any part of the body signi- 
fies the development of a serioiLs disease, a form of spurious hypo- 
chondriasis, which only requires the ipse dixit of their physician 
to dispel. But a t^-pe of case is occasionally met with in which the 
commencement of a grave and incurable malady may be preceded 
or accompanied by fears in the patient's mind that such a calamity 
is in store for him. It is, in fact, a presentiment of actual physical 
disorder, and sometimes of dissolution. 



DOMIXIOX MEDICAL MOXTHLY 47 

Then there is the genuine hypochondriasis, a morbid fear of 
■disease affecting one's body, which is a mental disease sui genens. 
It may develop, as Froud^*' has explained, out of an anxiety neur- 
osis, or a more permanent state of hypochondriasis may issue out 
of a temporary neurasthenia or physical breakdown. 

Further, we recognize the influence of nervous and physical 
emotions in the causation of physical symptoms. According as an 
emotion is pleasural)le or painful, we find respectively increase of 
the heart's action, increased muscuhir energy and a sense of well- 
being, or inhibition of the gastro-intestinal functions, a keen sense 
of fatigue, and a decrease of muscular energy. 

The effect of an emotional influence upon the physical condition 
has been ingeniously shown by the experimental researches of Paw- 
low^ ^ on the salivary secretion of dogs. 

In the course of his experiments it appeared that all the phe- 
nomena which were seen in the salivary glands under physiological 
conditions r«'appeared in exactly the same manner under the influ- 
ence of psychological conditions. Thus when he pretended to throw 
pebbles info the dog's mouth or to cast in sand, or to pour in some- 
thing disagreeable, or when it was offered this or that kind of food, 
a secretion either immediately appeared or it did not appear, in 
accordance with the properties of the substance, which he had pre- 
viously seen to regulate the quantity and nature of the juice when 
physiologically excited to Mow. If he pretended to throw in sand a 
watery- saliva escaped from the raucous glands; if food, a .slimy 
saliva; if the food were dry, a large quantity of saliva flowed out, 
even when if excited no special interest on the part of tho dog. 
When a moist food was presented, less saliva appeared, however 
eagerly the dog may have desired the food. 

When this subject is Wewed more especially from the clinico- 
neurological standpoint, it becomes evident that many depressive 
states, characterized by hesitations, doubts, scruples, anxiety, appre- 
hensions, and morbid fears, are associated with derangements of the 
bodily functions, such as dryness of the mouth, furring of the 
tongue, flatulence, constipation, and the like. 

Owing to the lessened vascular tone of the emotional depressive 
states, the body also is more prone to physical disorder and more 
ready to receive the encroachments of infective organisms. 

^lental influeuces may so modify the appearance of disease that 
a wrong impression sometimes may be conveyed to the physician's 
mind. Most of us may recall occasions when it has seemed as if a 
fatal termination were imminent, when in reality the gravity of the 



48 DOMIMOX MEDICAL MONTHLr 

situation was dependent upon a depressive mental state rather than 
upon true physical weakness. 

How far the persistence of emotional and lueutal iuHuenees 
when continued for many years may predispose to organic disease 
by permanently impairing the secretions, and altering the vascular 
tone, is a subject less clearly defined. 

Probably the most characteristic eifect of an acute emotional 
shock, acting upon the mind of a person predisposed to such intiu- 
enees, is the production of those physical and mental symptoms, 
paroxysmal or paralytic, which go towards the make-up of a case of 
acute hysteria. 

Hysteria is a disease which has excited interest and curiosity 
throughout all time. Its nature and causation were as mucli a 
source of speculation to the ancients as to ourselves. As its name 
implies, the disease was supposed to originate in the womb. As a 
later development, this idea was supplanted by the view that the 
sexual organs in general were concerned in the production of hys- 
terical phenomena. The most recent hypothesis, enunciated only 
during the last few years, again places the causation of hysteria in 
sexual disturbances, but based in this case upon a psychical and not 
a physical foundation. 

Our modern conceptions of hysteria, however, are mainly found- 
ed upon the observations and writings of Briquet, Charcot, and the 
Salpetriere School. It was recognized by them that hysteria was 
no privilege of the female sex, but that its origin had to be sought 
for in disturbances of the psychical functions of the brain. Charcot 
expressed his strong belief in the ps^'chical nature of hysteria, and 
demonstrated the possibility of reproducing hysterical symptoms 
by hypnotic suggestion and of effecting their disappearance by a 
similar means. 

Since his time the psychical side of hysteria has been greatly 
developed, and this a.spect of the subject is tlie one which now com- 
mands the most respect. 

The theories of "Nervous Mimicry" (Paget) or of "Paralysis 
from Idea" (Reynolds) have been displaced, and replaced, by the 
broader view of the subeon.scious mind and of the dissociation of 
the personality. 

I shall now refer very briefly to the three chief theories of hys- 
teria, which at the present time attract most attention. They all 
view the malady from the p.sychical side, two of them make use of 
the theory of the subconscious mind (Janet, Freud), and the third 
emphasizes the cardinal importance of suggestion (Babinski). 



DOMINION MEDICAL MONTHLY 49 

Let us look first at the theory of Janet,^- the distinguished 
psychologist of the College de France. His theory is based on the 
view that just as a normal person sees objects in the peripheral 
portions of his field of vision, as well as in the centre, so the normal 
mind can take in and arrange sensations, memories, ideas, and emo- 
tions, the comprehensiveness of his perception being the field of 
normal consciousness. 

Janet's definition of hysteria implies a retraction or limitation 
of this field of personal consciousness, and a tendency to the dis- 
sociation and emaxicipation of the systems of ideas and functions 
that constitute personality. In other words, "in proportion as the 
field of personal consciousness diminishes so do the subconscious 
mental conditions t^nd to flourish and abound." (Ormerod.i^^ 

By this means Janet explains most of the characteristic symp- 
toms of hysteria. ' ' The crises or fits of hysteria are somnambulistic 
states in which the patient lives some scene over again, goes through 
some action, or gives himself over to some idea and obeys it to the 
exclusion of all others. He is in a dream, living for the moment in 
a small world of his own. All this is foi-gotteu when the attack is 
over, and he returns to normal consciousness." (Wilson.) ^^ 

Such is the explanation of those cases of hysterical fugue or 
lapse of memory which are met with from tame to time. It would 
also appear to offer an explanation of the classical hysterical fit 
which is more commonly seen amongst the Latin peoples, a fit char- 
acterized by much display of pantomime and histrionic effort. On 
the other hand, as suggested by Ormerod, it hanlly offers a sufficient 
explanation of the simple hysterical fit or "attack of hysterics "" 
which forms the common type of the seizure in our patients. 

The same idea may be traced in the motor and sensory symp- 
tom.s — the paralyses and the anesthesias. In the former, the mem- 
orj-, the idea, or the function of movement, may be lost; in the lat- 
ter, the systems of sensations, or some of them coming from the 
anesthetic area are no longer connected with the main conscious- 
ness. ' ' 

According to many writers, Janet 's view of hysteria, thus briefly 
and imperfectly mentioned, is the most satisfying, and that one 
which harmonizes the varied and multiform symptoms of the 
disease. But even those who support it most warmly feel that it 
does not explain everj^ varietv' of the malady. 

The second theory is that associated with the name of Babin- 
ski,i5 tlie physician of La Pitie. who has done more than any living 
clinician, by his observation on the plantar reflex and by other 
tests, to assist us to distinguish between functional and organic 



50 DOMINION MEDICAL :M0NTIILY 

paralysis. He holds that hysteria is a special psychical state, giving 
rise to certain symptoms, which can be reproduced by suggestion 
with rigorous exactness in certain subjects and be made to disap- 
pear under the sole inHuenee of persuasion. 

By this means Babinski confines ihe symptoms of classical 
hysteria to those which can be reproduced by suggestion. These are 
the convulsions, paralyses, contractures, tremors, and anesthesias, 
and to them he has given the term "pithiatic. " He has, in fact, 
taken one of Charcot's main contentions, that to be hypnotisable is 
to be hysterical, and that exaltation of suggestibility is common to 
hypnosis and hysteria, and made it his criterion of hysteria. 

One of the most interesting deductions from the Babinski view 
is that hysterical hemi-anesthesia does not really exist, but that 
when present it has been suggested to the patient by maladroit 
examination on the part of the physician. 

In one hundred consecutive cases of hysteria Babinski failed to 
discover a single instaoiee of hemi-anesthesia. There is, however, a 
general consensus of opinion that this explanation is only true for a 
limited number of cases. 

Babinski 'g views have been strongly criticized, chie% in the 
direction of the value of suggestibility as a crucial test of hysteria. 
It has been stated that the majority of normal persons are sug- 
gestible. "To be suggestible and to be hysterical are not synony- 
mous. It is generally' agreed that suggestibility cannot be utilized 
to descriibe sufificiently and exclusively the hysterical mind. Hence 
w^e are led to consider hyper-suggestibility as a symptom and eflFect 
rather than a cause of the mental state associated with hysteria." 
(Wilson.) 

The third theory of hysteria to which reference is made is that 
elaborated by Freud, ^^ the Viennese psychologist. His view is 
based on the acceptance of certain doctrines — the determination of 
mental processes by unconscious pliysical factors, the existence of 
what he calls emotional "complexes" which are often in antagon- 
ism with each other, and the causation of many mental phenomena 
as a result of repression. In this, as in Janet's view, there is a 
recognition of the sub-conscious mind. 

Freud's psychology of hysteria is, briefly, as follows: If in a 
person two sets of mental or emotional "complexes" are present in 
opposition to each other, or a mental, or moral, or emotional shock 
is received, for example, a physical trauma, a painful impression is 
made upon the mind. If relief is not obtained in an ordinary way, 
as by giving vent to the feelings, or forgetting, the painful emotion 
is repressed into the sub-conscious strata of the mind. There it is 



DOMINION' MEDICAL MONTHLY 51 

kept and prevented from returning to consciousness by the action of 
a resisting force, which is the same as tliat which originally brought 
about the repression. The repressed complex remains in the sub- 
conscious mind behaving somewhat in the nature of a foreign body, 
capable of influencing consciou^n«->s, but in a distorted or indirect 
way. In hysteria it is converted into the physical manifestations of 
the disease', such as the paralyses and the anesthesias. How this 
"conversion" is produced is a complicated and elaborate subject, 
which cannot be entered into here. 

The outstanding feature of Freud's hypothesis is that the 
repressed complexes are invariably of a sexual character. In his 
own words : "He who can interpret the language of hysteria can 
understand that the neurosis deals only with repressed sexuality." 
"In a normal vita sexualis no neurosis is possible. "^^ 

"In the hysterical we find all sex components which exist in the 
undeveloped sexual con.stitution of the child in a state of repression. 
The essential basis of hysteria is thus the preservation of an infan- 
tile form of sexuality and the failure of the latter to develop into the 
normal adult type. The hysterical symptom is produced as a com- 
promise between the normal outlet, the abnormal outlet, and the 
repressing forces exerted by education and environment." 
(Hart.) is" 

It is diflBcult at the pr.s4'nt time to express an opinion upon 
the value of Freud's views upon liysteria. He has re\-ive<l the old- 
est doctrine of the disease (its sexual origin), but upon a ps>cho- 
logical basis. In reintroducing the sexual element as the sole factor 
in hysteria and allied neuroses he has opened the floodgates for a 
veritable torrent of criticism. He has been attacked vigorously by 
his opponents and as strenuously supported by his disciples and 

admirers. 

Any criticism, however, of Freud's \iew ought to separate the 
hvpotliesis which he has enunciated, such as his conceptions of con- 
flict, repression, and the influence of the sub-conscious mind from 
the method of psycho-analysis, by which he has arrived at his con- 
clusions. There is a strong body of opinion against the universal 
application and acceptance of the sexual origin of hysterical symp- 
toms. Moreover, his vie^^-s upon the "conversion" of a repressed 
idea into the physical symptoms of hysteria would require some 
further explanation than has .vet been given. 

Psycho-therapeutics. 

In view of the generally accepted psychical origin of all hys- 
terical symptoms, as well as those of the closely allied psycho- 



52 DOMINJON MEDICAL ^[(n'TTTT.Y 

neuroses, such as the mental symptoms of neurastlienia, morbid 
feare, dreads, obsessions, and the like, it is not unnatural that the 
present-day methods of treating those conditions should consist in 
the main of psychical meaijures. 

The intiuence of some kind of suggestion in the treatment of 
functional nervous disorders has been admitted from time immem- 
orial; witness the influence of religious faitli. But apart from this, 
have we not the cures attected by charlatans, hy the pseudo-scien- 
tific methods of metallo-therapy and the like, and by tlie wonder- 
workers in all countries. 

The moral intlueuce of medical men over their patients has, of 
course, been long recognized, but there would seem to be something 
more than verbal encouragement or reassurance necessary in the 
psj'cho-therapeuties of to-day. 

As Mills^^ says: "In a sense, mystic medicine is psychical medi- 
cine, though the converse is not true. In the incantation of medi- 
cine men, in the appeals to omens and oracles, in the resort to heal- 
ing shrines, and in the ministrations of the Christian Scientist, the 
psychical element is discoverable. The psychical medicine of to- 
day, however, is that in which the use of mental influence is resorted 
to on the same scientific lines, as is the use of water, medicines, 
electricity, or the surgeon's knife." 

The modern methods of psycho-therapeutics are limited to the 
following : 

First, direct suggestion. Of this there are two kinds, in one of 
which suggestion is effected during hypnotic sleep, in the other 
during tlie waking state. During liypnosis the jihysiciaii introduces 
new ideas into the patient's consciousness or effects the destruction 
of existing ideas without the consent or judgment of the sufferer. 
In suggestion during the waking state the patient voluntarily places 
liimself in a receptive condition to receiv(» and accept suggestions 
made to him by tlie i)hysician without argument or reason. 

Suggestion during the waking state was introduced as a thera- 
peutic method by Bernheim of Nancy, as a development out of 
hj'pnotic suggestion. According to Dejerine,-^ its good effects are 
based partly on wonder-working and partly on auto-suggestion. In 
most cases, however, it is really a form of persuasion. Dubois^i 
holds that between suggestion and persuasion there is the same 
difference as exists between a piece of good advice and a practical 
joke. "Both may produce the desired result. Suggestion acts like 
a draught which is merely capable of producing an effect on the 
imagination. It is sometimes excusable, but it is not con.scientious. " 
(Dubois.) 



DOMINIOX MEDICAL MONTHLY 53 

There is no doubt, however, that iu practice suggestion during 
the waking state may be of distinct value in certain early and mild 
cases of psychical upset. 

Secondly, posuasion. This implies the re-education of the 
patient's mind by reasoning and argument. This method was intro- 
duced by Dubois of Berne, and in various modified ways is the 
remedy applied by many physicians who work along psycho-thera- 
peutic lines. The physician endeavors to reason with and educate 
his patient in the causation and production of his symptoms. It is, 
in fact, what may be called the method of therapeutic conversation. 
Its object is to teach and convince the patient "what he has, what 
he has not, what he seems to have, what he can do. what he cannot 
do, and what he simply believes he cannot do." (Mills.) 

But there would appear to be something more in the method 
than mere verbal explanation. In Dejerine's words, persuasion 
reasserts the patient's confidence in himself, and revives those ele- 
ments which make him master of himself. The physician's part 
lies in redirecting the patient's thoughts; there is nothing border- 
ing on suggestion and nothing to clash with his convictions and 
reason. Its good effects are due to tlie confidence which the physi- 
cian inspires in his patient. 

It is therefore obvious that it can only be effective in sane per- 
sons, and is of no value in severe obsessional conditions or melan- 
cholia. 

Thirdly, psycho-analnsis. Re-education of the patient, in the 
meaning and significance of his symptoms implies some degree of 
psycho-analysis on the part of the physician. In a general sense, it 
is nothing more than a careful and exhaustive investigation into the 
origin, relation, and importance of existing symptoms. 

In the sense employed by Freud,-- however, psycho-analysis is 
a more elaborate proceeding, and requires skill, patience, and per- 
severance. It is not my intention to describe the method, but merely 
to point out that its object is to get behind the "censure," or 
repressing force which originally repressed and keeps suppressed 
the pathogenic idea in the sub-conscious strata of the mind. This 
pathogenic idea, it will be remembered, is that which gives rise, in 
Freud 's view, to the symptoms of hysteria and the psycho-neuroses. 
Having by psycho-analysis overcome this resistance and given the 
"affect" an opportunity of tiowing out through speech, the re- 
pressed idea is "brought into associative correction by drawing it 
into normal consciousness through the suggestion of the physician." 
(Freud.) 



a4 DoMIMdN MKHirAL MnXTIlT.Y 

111 the liancls of Freud liiinself and of his disciples, both in 
Europe and on this side, the method is stated to be of practical 
value. l)ut one cannot help feelins: that, owiuof to the prominence 
given to the sexnal side in the causation of hysterical symptoms, 
harm may accrue by recalling sexual memories, in themselves per- 
haps harmless, which had long been forgotten. 

During the analysis it is not unlikely that the physician may 
unwittingly suggest to his patient, and in turn may himself be 
misled. 

In Freud's sense, therefore, psycho-analysis is the evacuation of 
a repressed idea by a form of confession, and the re-conduction to 
the patient's consciousness of the thoughts underlying the symp- 
toms. It would appear to be of great use in hysteria and some of 
the psycho-neuroses, but to be of little value in neurasthenia and 
states of anxiety. 

I do not think that it requires much experience of the practical 
application of these methods of psycho-therapy to realize that they 
have their limitations. There are some psycho-neuroses of short 
duration and slight degree, which are readily cured by a little 
reasoning and convincing on the part of the physician ; but there 
are many instances of obsessions, hesitations, doubts, anxiety, and 
morbid fears, which are difficult to cure by ps;\'chical meaiLS alone. 
On the part of the physician a Icnowledge of the causes and symp- 
toms of hj'steria and allied neuroses is essential, as well as a clear 
insight into the temperament of the patient. On the patient 's part, 
faith in the method and in the man behind the method are essential 
to .success. 

I do not imply that it is not in the power of every earnest 
physician to so intluence the mind of his patient by dissipating 
pes.S'imism and by encouraging a healthy outlook to materially aid 
a cure. 

But for the successful treatment of the psycho-neuroses by 
psychical means, a thorough knowledge both of the diseases and of 
the means of treatment is essential. A special class of practitiouer 
has, in consequence, arisen; but it would seem to me as if those who 
give their attention to mental and nervous diseases are those best 
qualified to undertake this work. 

I am, therefore, in complete agreement with those who advocate 
the necessity of physical means in conjunction with psycho-thera- 
peutic efforts. The isolation of the patient in a home, institution, or 
special ward, the deprivation of visits from relatives and friends 
during the course of treatment, the cutting off of correspondence 
and the like, are all essential adjuvants to a successful issue. Rest 



DOMINIOX MEDICAL MONTHLY 55 

in bed, either indoors or in the open air, abundance of milk, mas- 
sage, and regulated exercises are desirable in the majority of cases. 

References. 

1. Quincke. Berlin. Klinisch. Wochenschrift. 1891. 

2. Widal. Bcv. Ncurolog. 1903. 

3. Noune. Refd. by Stertz. Wien. Med. Klinic, No. 4. 1912. 

4. Mott and Haliburton. Brit. Med. Journ. 1904. 

5. Mott. Brit. Med. Journ. Nov. 8, 1911. 

6. Floxner and Lewis. Journ. Amer. Med. Assoc. 1909. 
T.Turner. "Epilepsy-," p. 212. 1907. 

8. P. Clark. Archiv. of Inf. Medicine. 1912. 

9. Turner. "Epilepsy." 1907. 

10. Freud. Selected Papers; trans, by Dr. Brill. New York. 
1909. 

11. Pawlow. Refd. by :Morton Prince. Journ. of Abnormal 
Psychology. 1907. 

12. Janet. "^Nlajor Symptoms of Hysteria." 1906. 

13. Ormerod. Brain, 1911. 

14. Wilson. Brain, 1911, to whoso critdc-al digest on Hystuiu I 
am inde'bted for much information. 

15. Babinski. Soc. de Xeurol 1901. 

16. Freud. Selected Papers. Dr. Brill's translation. 1909. 

17. Dr. Brill's trans., p. 188. 

18. Hart. Brain. 1911. 

19. Mills. Monthly Cyclopedia. July, 1908. 

20. Dejerine. "Les Psyeho-Nevroses. " 1911. 

21. Dubois. " Psychical Treatment of Nen^ous Disorders. " 1909. 

22. Freud. Selected Papers. Op. cit. Chap. 4. 



Cardiac Asthma. 

Rosin (Deutsch. med. VCoch.) says treatment must be rapid and 
heart tonics should be given by subcutaneous, intramuscular or 
intravenous injection, as drugs given by the mouth disturb respira- 
tion and are defectively absorbed. Camphor in a 10 per cent, oil 
solution is \^v\ useful and indispensable during attacks. The in- 
jections can be repeated every fifteen minutes. 



56 DOMINION MKDICAL MONTHLY 

TETANUS* 



A. MoiR, M.R.C>5 (ExG.). L.K.C.P. vLond->, Dunnville, Oxt. 



It is not my intfiition to enter into a comprehensive discussion 
of tetanus, but merely to report a case which occurred in my own 
practice a few months ago. 

On December 28th. 1911, I was called out to see G. S., a farmer, 
fifty years of age, who had got his left thumb crushed in the gear- 
ing of a gasoline engine, which he used for cutting feed for his 
stock, and also for sawing wooil. The engine was therefore used 
around tlie barn or in the woodyard, two very likely places to find 
the tetanus bacillus. 

As he lived a considerable distance out in the country, and at 
the time the i-oads were bad, it was about two hours aftor the acci- 
dent before I was able to see him. In the meantime tJiey liad 
■wrapped the injured part up in some old cotton, which, thoug-h not 
sterilized, had been recently washed. As the bleeding was very 
profuse, they made no attempt to cleanse the wound, but merely 
wrapped it up in the oil and dirt, of which there was a liberal 
supply. On examination I found the terminal phalanx and about 
^ inch of the distal end of the first phalanx ground to a pulp. The 
fleshy part of the thumb was very badly mangled a.nd a large 
amount of oil and dust was ground into it. The lx)ue was a]>so- 
lutely bare as far as the metacarpo-phalangeal joint. 

I cleansed the wound first with gjisoliae, to remove as much of 
the oil as possibk% then scrubbed it witli a sterile nail brush and 
1-60 carbolic acid solution until all dirt was apparently removed. I 
then rounded otf the distal end of the remaining part of the first 
phalanx with l>one forceps and succeeded in getting enough tissue 
to cover it very nieely. I dressed it with bismuth formic iodide and 
plain sterile gauze, applied a splint, and kept the hand in a sling. 

I saw him on th€ following day and he was quite comfortable. 
Had rested well all night without an opiate, and his temperature 
and pulse wcrt' Iwitli normal. I saw him again on the second day. 
His temperature was then 100°, pulse 80. I removed the dressing, 
but the woujid was perfectly drv ; there was no swelling or pain, so 
I simply put on a fresh dressing similar to the previous one, and 
as his lx)weLs had not moved since the accident I gave him a laxa- 
tive, and the following day he reported that he was feeling much 
better. 



' Read at Ontario Medical Asaociation, Toronto, May, 1912. 



DOMIXIOX MEDICAL MONTHLY 57 

I did not see him again until the fifth day. HLs temperature was 
then 100°, puke 96, and he complained of sli^'ht darting pains in 
the thumb, but more especially in the back of his neck. I removed 
the dressing, but the wound was apparently healing by first int<ni- 
tion, so I simply dressed it again in the same manner as before. 
The following day his brother telephoned me that his jaws were 
stiif, was more or less chilly, and felt rather miserable in a general 
way. I went up immediately and found his jaws locked to such an 
extent that it was impossible to insert the handle of a spoon be- 
tween his teeth. The muscles of his back and back of the neck were 
quite rigid. The muscles of the trunk were also involved to quite an 
extent and, to use his owti expression, "He felt as if there were 
tight bands around him." The movements of the chest were cer- 
tainly considerably restricted and the abdominal muscles were so 
rigid that it required ciuite hea\y pressure to make any indentation 
in the abdomen. The muscles of the extremities were not much 
affected, although he said they felt stiff and he could use them 
only \nth diificulty. The muscles of expression were ver>' markedly 
affected. The comers of the mouth were drawn back: the alae nasi 
were drawn out and more or less fixed ; the eyes were widely open, 
the eyebrows archetl and the forehead wrinkled, giving a fairly 
well-marked sardonic grin. The pulse at this time was 110 and the 
temperature 101°. On examining the wound I found a few drops 
of pius at the l>ase of the stump on the palmar a.spect ; otherwise the 
wound looked perfectly healthy and had apparently healed 
throughout. 

I told the patient's friends that he undoubtedly had tetanus 
and advised the use of anti-tetanic serum; but owing to the fact 
that the incubation period had only been six days and that tliere 
would necessarily be 24 to 30 houi-s more elapse before I could get 
the serum, I gave rather a gloomy prognosis. The patient's 
brother then informed me that the patient had a horse die of 
tetanus only a few weeks previously. 

Though tetanus had been known to physicians since the time of 
Hippocrates, and the development of the disease in comiection with 
wounds was well known, it was not until Xicolaier discovered the 
specific bacillus in 1884 that its infective nature was established. 
And it was not until Ehrlich, about 1890. showed experimentally 
that tetanus was an intoxication, and that the bacillus remained 
locailized in the wound, tliat it began to be treated on a rational 
basis. Prior to Ehrlich 's discovery it was considered necessary 
to excise the wound or amputate the infected part, but since it 
has been shown that tlie symptoms are due to tlie toxin absorbed 



58 DOMINION .M KI >K'AI. MONTHLY 

it has been fomul tliat strict autdseptic treatment af tlic wound is 
followed by as «rood i-esnlts as tlie jnore heroic measures of exeisioii 
or amputation. 

For oonvenieuoe I may take up tin- tn-ntmcnt under the four 
folloAnng heads: 

1. Local treatment of tlie wound. 

12. General treatment. 

3. Specific or serum treatment. 

•1. Medicinal. 

1. Local Trcatmcni. 

I removed all t<lie stitches and freely opened up the wound at 
the point where suppuration was occurring, and thorousrhly cauter- 
ized it witli pure car])olic, ajid left the wound exposed to the air 
without any dressing. I also left a solution of carbolic acid 1-40 
^^^th the patient, with instructions to moisten fihe wound with it 
♦■very two liours, but twice daily throughout the acute st-age T 
swabbed the wound out tihoroughly with hydrogen peroxide an.d 
then cauterized with pure carliolic acid. 

2. General. 

For the first day or two {\\v patient was rather restU'SS and 
irritable, but he occupied a room which was rather noisy. I had 
him removed to a quiet room, partially darkened, and excluded all 
except those wlio were actually nursing him. lie seemed to appre- 
ciate the change very much, and when we remember that tihc tetanus 
toxin has a selective action on ner^'ous tissue, and greatly increases 
its excitability, one of the first principh's of treatment ought to be 
to avoid as far as possible all external stimuli. Some claim tluit blue 
light is much more sootlidng to these cases than ordinary light, but 
I found tliat modification of the light by drawing the ordinary- 
blind was just as effectual in tliis case. Feeding is sometimes a 
matter of difficulty. In tliis case, liowever, he was able to ta1<e 
enough milk tiirough his teeth to make rectal or iiasal feeding un- 
nec€S.sary. 

3. Specific or Sirum Therapy. 

It has been shown beyond doubt tliat the presence of pyogenic 
organisuLs greatly increases tihe virulence of the tetanus bacillus. 
It has aLso been sho\vTi that the toxins produced by the tetanus 
bacillus are absorbed largely along the nerve trunks and by them 
are conveyed to the spinal cord. Only comparatively small quanti- 
ties of the toxin pass into the general circulation thi'ough the lymph 



DOMIXIOX MEDICAL MONTHLY 59 

channels. And Avliile it has been demonstrated be>'ond doubt that 
the tetanus antitoxin can neutralize absolutely the tetanus toxin 
outside the body or in the circulating tluids of the body, yet, un- 
fortunately, it has been as clearly proven that the antitoxin in the 
blood or lymph stream can oidy neutralize in a very slight degree 
the toxiii passing along the axis cylinder or in the nerve cell. These 
facts have a ver>' important bearing on treatment, and undoubtedly 
go to show that the sooner the serum is given in a suspected ca.se 
the l>etter. Some claiiu tliat when the specific s>'mptoms by which 
the disease is n^'Ognized have appeared it is already too late for tlie 
antitoxin to have any good effect, and while all are willing to admit 
that its efficiency is lessened the more advamced the case, it does not 
follow that it is* of no effect at all. It is impossible to know in any 
given case whether the amount of toxin takeJi up by the nerves is 
sufficient to cause a fatal termination. Even in advanced cases, 
therefore, we may so limit further al>sorption by use of the s-enim 
that the balance would Ik- turned in the patient's favor, whereas if 
it were not given sufficient further aljsorption might take place to 
cause death. 

It is largt'ly to show that t-ven late administration of anti-tetanic 
serum is not without effect tliat I thought this cas«' wortli reporting. 
When I saAV liim on the sixth day after tlie in.iiir>- tlie symptoiiLS 
of tetanus were well marked and developing rapidly. There being 
no serum obtainabh' in to^\-n. a furtlier delay of 'Mi hours was neces- 
sary. In tJie meantime, however, I gave him a 2^; solution of 
car'lx)lic acid hj-podermically, which no doubt helped to hold the 
disease in check. Of tliis solution I gave him 2 drams hx-poder- 
mieally to start with and i dram every two liours until the serum 
arrived. It was alwut 2^ day.s. therefore, after the onset of the 
characteristic symptoms of tetanus before the serum was obtained. 
1 used the serum put up by Parke, Davis & Co., and administered 
6,000 units eveiy six hours for the first thr.^e dos<-s. then 6.000 units 
every twelve hours. There was no appreciable change until the 
fourth day of the serum treatment, when the spasm of the muscles 
of mastication was c(»rtainly considerably relaxed and I could get 
the end of my thermometer case lietAveen liis teeth. From the second 
day after the appearance of the sAmptouLs up to the fourth day of 
the serum treatment, the temperature ran from 102 to 103 , and 
the pulse the greater part of the time was in the neighborhooti of 
120. The temperature on the fourth day of serum treatment came 
down to 100° and the pulse alwut 105. I continued the serum 
treatment for five days, until a very irritating rash appeared and 
covered the whole lx)dy. It was a mixture of the scarlatiniform 



60 DOMINIOX MEDICAL MONTHLY 

ajul urticarial types, and for two clays the patient was in a very 
distressfiiig condition on account of the intense itching:. xVs soon as 
tlie ra.sh appeared, however, I ddseontinuod the serum and, though 
it cause<l a good deal of distress at the time, it began to disappear 
on the third day, and by tlie fifth day was practically gone. Re- 
gai-ding the method of administration of tJie serum, there are, as 
you are all aware, five different methods of giving it, viz. : 

1. Subcutaneous. 

2. IntravenoiLs. 

3. Intraneural. 

4. Subdural. 

5. Intracei^bral. 

I started witli the subcutaneous method, giving the serum into 
tilie subcut^ineous tissue of the abdomen, and as the patient's condi- 
tion did not grow any worse I continued to the end ^^'ith the sub- 
cutaneous method. Every method of administration has its own 
supportei-s, but in whatever way it may l>e given I think it is pretty 
generally conceded that its chief influence is exerted on tJiat part of 
the toxin which is in the circulation. The affinity of the toxin for 
the nerve cells is so great that, unfortunately, the serum has not 
much effect on this part, irrespective of the method of administra- 
tion. Had the patient grown worse under the subcutaneous method 
I would have given it subdurally. 

4. Medical Treatment. 

During the acute st.age of the disease, when the nervous excita- 
bility was marked, I gave him 30 grs, oif chloral hydrate three times 
a day. This constituted the only medical treatment until after the 
serum was stopped. Though at tliat time tliere was still marked 
spasm of nearly all the muscles of the body, the muscles of masti- 
cation liad relaxed sufficiently to get a small ta])let in his mouth, 
and, aecording to the suggestion of Sajous in his work on the in- 
ternal secretions, I gave five grains of thyroid extract three times a 
day, and I believe it had some effect, for when the patient was 
\nthout it for a couple of days he complained more of the stiffness 
and seemed more comfortable after giving it again. I continued the 
thyroid extract for ten days, and by that time he could eat solid 
food and could walk about a little. 

I saw the patient again a week ago, i.e., about four and one-half 
months after the injurv% and though he is quite well and does Light 
Avork around the farm, he says there is still a slight sense of stiffness 
in all the muscles of the body, but not sufficient to interfere with his 
comfort to any extent. 



DOMIXIOX :\rEDICAL MONTHLY 61 

Surgery 



Walteb McKeown, Herbert A. Bruce, W. J. O. Malloch, 

Wallace A. Scott, George Ewart Wilson. 



Non-Union of Fractures J- S Horsley. Richmond, Va. {Jour- 

mil A. M. A., Fibniary 3). 

The fault in true non-union of fractures is due to the failure of 
the tissues to deposit lime salts, and after excluding all local 
and constitutional causes there still remains a group of eases in 
whie'i this condition seems to occur and the bones fail to unite. 
There are two indications for the treatment of these cases, namely, 
to increa.se the quantity of lime salts in the blood and, second, to 
induce a larger quantity- of l)lo<3d-tlow tlirough the affected bone. 
The first indication is met by tlie administration of calcium salts, 
usually in the form of hypophosphates. Thyroid extract lias been 
recommended, but its methoil of action is uncertain and reports are 
contlicting as regards its etlicacy. It may. however, act as a hor- 
mone. The diet and personal hygiene must, of course, be carefully 
attended to. The second indication, increasing the circulation, must 
be carried out by local measures, and Horsley recommends the intro- 
duction of a sterile foreign body into the tissues to induce h^-peremia. 
This idea was suggested to Dr. Charles Mayo by the fact that a 
sequestrum or a clot induces a growth of new bone around it. He 
therefore uses a sterile ivory pin in the medulla of the bone in cases 
of ununited fracture. It does not fit tightly, is unabsorbable, and 
instead of the ends being smooth they should be a little jagged, so 
as to induce blood-clots and h>-peremia. Another useful measure is 
Bier's hyperemia, obstructing the venous circulation for from ten 
to forty minutes. Frequently in these cases the ends of the bone are 
one solid mass, which exhausts and blocks off the nutrition. Hence 
it is advisable to drill out the end of the bone and expose the medul- 
lary cavity, which is best done with a burr, though a small chisel 
may be gently used to enlarge the opening. Horsley reports a case, 
sho^^^ne the difficulty of nutrition in these cases. The matter of 
fixation of the fracture is probably the lea.st important matter. 
With good personal hygiene, absence of constitutional trouble and 
observance of the local indications, such as cleaning out the ends of 
the bone and roughening them and inserting an ivorj' pin inside, it 
matters little what method of fixation is used so the limb is put in 



G2 DOMIMOX :\Ii:i)ir.\L :\[()XTTTT.Y 

its proper axis. He uses a silver plate fastened by one or two screws 
in each end of the fraetnro. This is best placed on t'lie periosteum, 
or. if that has been denndcd, il should bo sutured arounil the plate. 
The wound is closed without drainagre and a plaster-of-Paris cast or 
some other splint applied. The retentive apparatus should be used 
for several months, changing it every few weeks. After three or 
four weeks it is best to l>egin the use of the limb very gradually, in- 
creasinsr it each day. The article is illustrated. 



Chest Traumata. — F. T. ]\Iurphy {Boston Med. and Sur. 
Jour.), writing of stab or gunshot vvounds of chest wall, refers to 
42 cases treated at the jNIassachusetts General Hospital in the past 
30 years, and analyses the symptoms, giving these points: 1. The 
very frequent complaint of abdominal pain, even though the peri- 
toneum was not alTected. 2. The possibility of serious hemorrhage 
from a wound of the intercostal artery. 3. The great power of 
accommodation of the lungs to hemorrhage or pneumothorax, if 
the change comes slowly on. 4. Relatively slight danger of fatal 
hemorrhage because of the collapse of the lung and the adherence 
of the pleura. 



An outbreak of measles in the vicinity of Ro.syth, where many 
naval ba.se employes reside, is causing some anxiety. According to 
one account the epidemic is German measles, and the microbes have 
been deliberately let loose l)y an emissary of the German Govern- 
ment. — Punch. 



DOMIXIOX MEDICAL MOXTHLY C/.i 

THERAPEUTIC NOTES 



High Blood Pressure. 

Eustis {South. Med. Jour.) advises in cases of high blood pres- 
sure elimination by catharsis and copious administration of water 
if the heart muscle is functionating properly. The diet should be 
of substances which yield little or no tyrosin. 



Pruritus Ani. 

Wallis {rracHHoncr^ says: The following formula will be 
found useful : Chloretone, one drachm ; extract of eonium, one 
drachm ; euthymol cream, two ounces. The local skin area should be 
well washed with soap and water and the above applied. 



ECL.VMPSIA. 



Lichtenstein (Zcuts. fur Gyn., Leipsic^ says eighteen German 
physicians have reported a total of 4,585 cases of eclampsia, of 
which over 20 per cent.. 955 cases, occurred post partum. He con- 
siders this an argument against premature delivery and supports 
the expectant treatment. 



Secondary Anemia. 

J. H. Musser {Boston- Med. and Surg. Jour.) used ferric citrate 
prepared locally. Of the iron preparation .06 gm. ; of the arsenic 
.06 gm. : of sodium glycerophosphate. .10 gm. dissolved in 1 e.c. 
distilled water. Treatments were given twice a week. Fourteen 
cases were treated, only one failing to respond. 



Amenorrhea. 

Rigamonti (Gas. deg. oapedali dcUc clinche, Milan^ has had 
effectual results in three cases of amenorrhea with one pole of 
the galvanic current to the sacrum and the other over the hypo- 
gastrium. He administered the treatment daily for thirty or forty 
sittings, and then at longer intervals. 



64 DOMINION .MEDICAL MONTHLY 

Opium Poisoning. 

F. Taylor {The Lancet) tliiuks the faradic current should be 
applied persistently iu those eases where coma has reached the 
stage threatening life. Even if there is no response after tliirty or 
forty minutes, but the contraction of the muscles, it should be con- 
tinued. The portable faradic battery is all that is required. 



Postanesthetic Vomiting, 

The Therapeutic Gazette says, quoting Halperin : "How 
many of our surgeons or anesthetists would like to have their stom- 
aclis washed out just after a laparotomy?" Absolute rest in a 
quiet room, small swallows of hot water at frequent intervals, the 
application of an old-fashioned mustard plaster over the pit of the 
stomach, the use of one or two grains of acetanilide placed dry on 
the tongue or dissolved in a little brandy, or the use of from three 
to five grains of chloretx)ne in a similar manner, will usually produce 
the results which are required. 



Ga.?tric Ulcer. 

John J. Gilbride describes Lenhartz's method of treating gastric 
ulcer as follows : Put the patient to bed and administer a concen- 
trated albuminous diet. This keeps the excessive acid secretion in 
the .stomach, permitting the ulcer to heal. Absolute rest in bed for 
four weeks is esstntial. An icebag is applied to the epigastrium 
to prevent distension of the stomach and to favor contraction of 
the ulcer, as well as to relieve pain. If medication is indicated, — 
bismuth : Raw beef, if tolerated by the patient. 



FURUNCULOSIS. 

Henry K. Gaskell, speaking in a discussion on furunculosis be- 
fore the Philadelphia County ^Medical Society, stated that the 
staphylococcic vaccine was especially valuable in furunculosis. In 
his eases the beneficial results have been .seen in eighty to ninety 
per cent, of cures; the balance greatly improved. The majority of 
the cases were cured after the fourth injwtiou. Begin with a dose 
of 250,000 to one c.c, increased, if necessary, to a billion. The 
furuncle he opened with the caustic stick for cosmetic purposes. 
Externally he employed from five to seven per cent, salicylic acid 
ointment. Not for the single boil, but for crops — furunculosis — 
s'hould this treatment be employed. 



DOMIXIOX :MEr)ICAL MONTHLY 65 



TReviews 



New and Xono/Jicial Remedies. Price, Cloth, 50e.; Paper, 25e. ; pp. 
298. Chicago: American ]\redieal Assi>.?iation, 1912. 

Tliis lxK)k contains descriptions and a statement of the actions 
and uses of all articles whieli liave Iieen examined and accepted by 
the Council on Pharmacy and Chemistry prior to Jan. 1, 1912, for 
inclusion in the list of New and* Nonotlficial Remedies. 

The book is unique. The work of the Council during its seven 
years of existence and the reports of the Propaganda Department of 
Tite Journal A. M. A. have convinced the pli>"sician that in the pre- 
scribing of proprietary remedies he must be more careful in his 
selection of those which he directs for his patients. Nowhere else 
can the ph>Tsician or the pharmacist turn for reliable, unbiased infor- 
mation concerning the new remedies. This book enables the physi- 
cian to make such selection and the careful pharmacist to know the 
character of the remedies lie disponsos. It should Iv in the hands 
of everv one of them. 



What Shall I Eat? A :\ranual of Rational Fe.xling. By Dr. F. X. 
Grourand, formerly Chief of the Lalwratory of the Medical Fac- 
ulty of Paris. Only Authorized Translation into the English 
Language. Price, -tl. 50. New York: Rebman Company. 1123 
Broadway. 

It is essential for the medical man to know a good deal as to 
what people should eat both in liealth and in disea.se, for it is a very 
common question for the doctor to be asked: "What shall I eat?" 
Again, he is often asked: "Is this good for me?" or again: "TVill 
this do me liarm?" This book is set out in a clear, .snccinct and 
practical way, is verv interestingly written, and gives just wliat 
practical information the physician wants to know of the subject. 
Our readers ^^"ill find it a very satisfaetory mainial on tlie subject. 



'Wheeler's Handbook of Medieine. By AYilliam R. Jack. B.Sc, 
:\r.D., F.R.F.P.S.G.. Assistant Ph^-siciaji to the Western Infinn- 
ar\' of Glasgow. Fourth Edition. Price, 8 shillings. Edin- 
burgh: E. & S. Livingstone. 

IVIedical science adA'ances so rapidly these days that publishers 
are kept busy getting out new editions in order that their text- 



G6 DOMINION .MKDK'AL MoN'I'Ill.V 

books, as well as lx)oks of reference, are kept well up-to-date. Books 
of this character especially, as they are quite appareutly of more 
value to the student of medicine, espwiaJly alx)ut examination time, 
need, therefore, to be brimful of the latest and best, suoeinctly set 
out. Tills is one of the bt-st haudlwoks on the medical Iwok market, 
if! so complete, and withal so splendidly arranged, that we can 
heartily recommend it. Indeed, we consider that the busy general 
practitioner will be benefited by it, as its close and careful perusal 
will afford a rapid and practical means of renewing old knowledge 
and acquii-ing the new. 



Tlic Pharmacopoeia of Ihc Toroito General Hospital. Including 
Preseriptions for Use in the Vaidous Departments, an Epitome 
of Surgical and Obstetrical Technique, and Tables of Foods, 
Doses and Poisons. Price, limp leather, 75c. ; cloth, 50c. Toronto: 
University Press. 

This is a neatly-gotten-up book of 142 pages, and will not fail 
of appreciation by all who have received their clinical training, or a 
part of it, in the Toronto General Hcspital. It ^^•ill also l)e intensely 
interesting aaid instnicting to those who have received their training 
in other hospitals. The value of the book would be enhanced, espe- 
cially to the recent graduate if, instead of grouping the prescrip- 
tions under general headings, some particular theraipeutic indica- 
tions were inserted after each pi'escription. 



Special Classes for t^hort-ISiijhlcd Children. 

Since the year 1908 the London County Council liave had a 
special cla.ss for children affected with high myopia in a blind 
school at Camberwell. It is now found that additional accommo- 
dation is necessary for about one hundred children. The Camber- 
well experiment is declared to have been so successful that the 
Council are agreed to invite the assent of the Board of Education 
toward in.stituting special classes for this particular kind of scholar. 

Could not Toronto profit by this experience? Since the recent 
.system of school inspection has been inaugurated a number of 
highly myopic children have been discovered, who are quite unfit 
to compete with or be wlucated by the .same methods as ordinary 
children. In the absence of facilities for instructing these chil- 
dren, I have had to recommend their admission to the Brantford 
Institution. 



H)ominion /Iftebical /Ibontbl^ 

anD Ontario AeOlcal Journal 

EDITED BY 

„, , i^ T Psvehlatpy: Erneel Jones, W. C. Herr 

Medicine: Graham Chambers K. J ^^^^"^ '^'^^ ' 

Dwyer..GoUlvvin Howland. Geo. \\ . ^ ";'^" .„ .q_„ . i,. N. Maclennan. W. 

Ross, \Vm. 1^ \oung. „ u . a Ophthalmology. 

Supjrenv Walter MoKeown, Herbert A ; H. Lowry. 

fifuce"^ W. J. O. Malloch. Wallace A. , phlnology. Laryngology and Otol 

Scott, George Kwart Wilson. ogy : Geoffrey Boyd, Gilbert Koyce. 

Obstetrics : . Gynecology: F. W. Marlow. W. B 

P.t1.o\'ogya"nd Public Health: John "^Heruiry. «.v • T B 

A \m?^.tcra" J C. O. Hastings, GenltoUPinapy Surgery : T. B. 

O' li Mabee, Geo. Na.mytb. Kichard.on. \N . %\ arner Jone.. 

Physiologic Thepapeutics: Anesthetics: Samuel Johnston. 

J. Harvey 1 od<l. 

GEOBOE EI.I.IOTT, MANAOINO EDITOB. 

Published on the 20th of each month for the s.c^:^ed in g month. ^^Ad^dres, 
Site?^aTa"r';rthe^"^ub"Jlfh^er^"aSl.^GT'Eri!lOTT. 203 Beverley Street. 
Toronto, Canada. 



Vol. XXXIX. TORONTO. AUGUST, 1912. 



No. 



COMMENT PROM MONTH TO MONTH. 

The salaries of Officers of Health do not appear to he any- 
thing nearlv adequate for the sen'iecs rendered to the eommnmty. 

A fi*st-class clerk in a department at Ottawa gets as much or 
more than the average health officer. 

When a corporation counsel is sought or a chairman to some 
special commission wanted the salary buys the man. Our medical 
health officers must be considered a poor lot by the powers that l>e, 
to judge by the salaries attached. 

In a large city where the corporation counsel gets $10,000 a year, 
the health officer is considered abundantly paid with half that 
amount. 

In national, provincial, civic and municipal service the health 
officer is one of the outstanding and best of pubUc. officials. His 
work cannot be measured in dollars and cents, but it is there .iust 
the same and should be recognized by the authorities. The value of 
his services to the eommimity cannot be balanced up with cold 
coin ; but the commanding pasition public medicine is' taking to- 



68 DOMINION MEDICAL MoXTITLY 

tlay deniauds competent ineu and adequate compensation. It has 
come from the last place in medicine to run neck and neck with sur- 
gery and the best of the specialties. Indeed, in a few years it may 
be the most important branch of medicine. 

No position in the medical public service known pays more than 
$5,000 per annum, in Canada, and these could be counted upon the 
digits of both hands. 

The authorities must understand that officials who are of such 
prime importance to the community and w"ho are unselfishly spread- 
ing abroad the propaganda, "cleanliness is next to Godliness," are 
doing a great good work which should be awarded by remuneration 
commensurate with its importance. 



Periodic examination of machinery is an essential part of any 
going concern. It has always been a well-recognized part of any 
business where the machinery is "inanimate." "What, however, has 
been the policy as regards the "human machinery"? Neglect. 

The worker must l3e in the best of health to rise to the maximum 
of efficiency. "Breaks" in this machinery have never been con- 
sidered so costly by employers. But where "breaks" do occur 
there is more necessity for "timely repairs." 

"Breaks" can only safely be detected by periodic medftal exam- 
inations. Repairs can then be timely. 

Life insurance corporations are beginning to realize that the 
"timely repair" of the policy-holder produces efficiency, economy, 
and dividends. Hence the annual medical examination has ap- 
peared. Employers of labor must soon realize the nocossity for 
such medical examinations of employees. 

In this way the health of employees will be conserved, the work- 
ing force rendered efficient ; and the worker, the cmployei*, and the 
public will all gain thereby. 

]\Iost important will be the systematic examination of employees 
to discover incipient tuberculosis. As the appreciation of health 
grows industrial concerns will ultimately adopt the policy of these 
systematic medical examinations; for it is only by these that 
"early" cases will be discovered or "closed" cases transformed into 
"open" ones detected. It is only by some such .systematic method 



DOMINION MEDICAL MONTHLY 69 

that "cure" or "arrest" and restoration to working capacity can 
be established. 

Wliat are public health authorities doing in this direction? And 
who will finance it — the employers or the municipality or the state? 



The National Sanitarium"^ Association proposes to erect and 
iiiciintain in Toronto a Free DisjK'nsary for Tuberculosis. 

Towards this end a friend of the association offers to donate 
$50,000 ; and the association has asked the city for a central site on 
College Street, not far west of the new Toronto General Hospital, 
and equally contiguous to the University of Toronto. 

The great good work done by the National Sanitarium Associa- 
tion commends itself to all, and the city should not long wait to 
grant their request. 

Some may think, however, Toronto should erect and maintain a 
free dispensary of its own ; but the National Association is well 
established in this business and has demonstrated its ability to con- 
duct institutions of this character successfully. 



The proposition to establish a detention hospital in Toronto 
is a wise one, and the sooner the city takes steps in that direction 
the better. 

Now that the Ontario Government is moving the Toronto Hos- 
pital for the Insane to a location some twentj' miles east of the city, 
the need for such an institution as a detention hospital will be more 
urgent. 

The failure to provide proper accommodation for .some of the 
insane, leaving them to be housed in the jail, is a sad blot upon 
administration of some sort. 

Lack of funds is generally given as the reason, but it looks a 
great deal like listless inattention. 

Now that the city of Toronto proposes to give $100,000 for the 
purpose, the jail may be fully reserved for its proper inmates. 



70 DOMINION MEPTCAL MONTTTTT 

IRewe Jtcins 



Dr. l?AT.vir ITooPKi}, Tdroiitn. has irhinicd from B.-iltiiiion'. 

Dr. Embree, Toronto, is nioviiig to 108 Avenue Road. 

Dr. Grant Stewart, Montreal, has returned from Atlantic 
City. 

Hon. John Henry Wilson, M.D., St. Tliomas, Ont., is dead at 
the age of 79 years. 

By the will of tlie late H. Marklnnd Molson, IMontreal. tlio :\ront- 
real General Hospital gets ij^l 0,000. 

Dr. S. M. Hay begs to announce to the medical profession that 
in future he will limit his pi-acticc to surgery and consultations. 

Dr. Graham Chambers has purchased the residence at the 
soutli-west corner of St. George and Bloor Sts., Toronto. 

Dr. Daniel Clark, for many years Superintendent of the To- 
ronto Hospital for the Insane, died the 3rd of June in his 78th 
year. 

At the eighty-first annual commencement of Wesleyan Univer- 
sity at Middh'town, Conn., held on June 19th, the degree of dootor 
of laws was conferred upon Dr. Amos J. Givens, proprietor of 
Givens' Sanitarium for Nervous Diseases, at Stamford, Conn. 

Amongst Canadian visitors in London are noticed the names of 
"Sh. Irving II. Cameron, Toronto; Dr. J. 0. Orr, Toronto; Dr. Jas. 
Third, Kingston; Dr. II. E. Cowper, Owen Sound; Dr. J. A. Dickson, 
Hamilton; Dr. E. B. Orr, Toronto, and Dr. E. E. Blanchard, P.E.I. : 
Dr. J. Parry Harrison, Uunnville, Ont.; Dr. L. G. Powaitree, Ijondon, 
Ont. 

Dr. Charles Ferdinand Durand, late Proctologist to the Ger- 
man Hospital, Buffalo, N.Y., begs to announce to the profession that 
he has opened an office at No. 590 Huron St., Toronto. Tel. Hill- 
crest 2173. Office hours, 9 a.m. to 1 p.m. and 7 p.m. and by appoint- 
ment. Practice limited to diseases of the rectum. 



DOMINION MEDICAL MONTHLY 71 

Ipublisbers' department 



Mus Mv(Ki\N..Ns Massage Institution, 20 Walmer Road, 
Toronto. T.-l.'pliono, Collogo 7895. Mrs. Neil MaxjKinnon, for 
many yeare a speciali-st i)i all branches of luassa-e, having received 
her traiaiing in the Old Country, has within the pa^st few months 
opened an institution in this city at the above address. All torms 
of massage, including; eh-etrical, electric light, and needle spray 
baths are administered in tliis institution under her personal supeT- 
vision The location of her institution Is one of the best that could 
l>e desired, and there is a beautiful conservator^' with a southern 
exposure There is a masseur in attendance for male patients, ihe 
rooms are large and sunny, the appointments being especially ta.stA- 
and weU adapted for carrying on such work. Physicians arc in- 
vited to visit and inspect for themselves. 



To cure practically any cas.' of bed sores: wash frequently with 
a solution consisting of two drams of ammonium chloride, 4 ounces 
of water and 12 ounces of alcoliol. Dry gently and powder witl. 
stearate of zinc. Of cours.' the patient's position sliould ])e chang.-d 
frequently and rubber air cushions should be used whenever re- 
quired.— Med. Rev. of Revs. 



Painting with iodine as a means of sterilization of the skin 
prior to operation has now Ix'C^me a regular procedure. This same 
method is now applied successfully to the vagina prior to vagina 
operations. Bv the aid of two specula the vaginal walls are held 
apart and thoroughly swabl>cd with ether, and then with tincture 
of iodine. The cervix is included in the operation. Care must be 
taken not to leave any iodine in the vagina. The results are sa.l 
to be much superior to the ordinary methods of donehmg.-Mcd. 
Rev. of Revs. 

IvY PoisoNiNG.-Dermatitis venenata, always very unpleasant 
and occasionally dangerous, presents as long a list ^^ Possible med^ 
caments as is claimed for pertussis or pneumonia. Recent studies 
liave demonstrated the cause of the irritation, and it is now known 



72 DOMINION MEDICAL MONTHLY 

that the imtatin.ix ajrent may be neutralized by permaiijranate of 
potash solution. The ai>plieation of the perniansjanate solution 
gives great relief, aaid when used soon after exposure or as soon as 
the first vesieles appear, ^\^ll avert the distressing itching. Treat- 
ment should ])e as follows: Fii-st thoroughly wash the part or parts 
witli warm water and soap: th(Mi use an alkaline wash, as, for exam- 
ple, a teasiX)onful of bicarbonate of soda to one i>int of water. Fol- 
lowing this should come several washings in warm 2 per cent, to 4 
per cent, solution of permanganate of potash. The strength of the 
permanganate solution sliould vary according to the severity of the 
attack. — Mccl. R< v. of Eev. 



"The ]\rEDiCAT. Science." — Early one crisp ]\Iarch morning, 
D. K., unkempt and greasy, accepted my invitation to have a ride. 
For a few moments he scanned me in silence; then in Highland 
accents, difficult of reproduction, remarked, ''You are a stranger 
in these parts?" I assented. 

"Anyhow, I have not seen you before. Anyhow, you are a very 
ordinary-looking fellow. I mean, you are a very common-looking 
fellow. I — I — I mean to say, you have no big nose, or big mouth 
one would know you by." 

Having thus mollified me, he assumed the role of chief spokes- 
man. "I used to sell the electric batteries; then I tried the patent 
medicines ; and now I practise the Medical Science. Do you know 
what the ^Fedical Science is?" 

I pleaded ignorance. 

He proceeded: "I will tell you of a particular case. Mr. H., 
of S., told me his back was very bad. I said, 'I can cure it.' So 
I looked him in the eyes until a film came over them — and they 
went shut. Then I stood at his side and stroked him up and down 
the back. Then I asked him if the pain was better. He said it 
was some better.' I repeated the treatment, keeping up a stream of 
talk the whole time. He now said that he was well. l)ut that he 
could not open his eyes. So I opened them for him. Now, that 
is the Medical Science." 

At this juncture we overtook a well-known farmer, who called 
out, "Good morning. Doctor." Somewhat aghast, my companion 
exclaimed, "And are you a doctor!" 

A few moments' drive brought us to the corner hotel, where the 
old man wished to alight. As I drew up, he inquired, "And will 
you be having something?" R. H. 



DOMINION MEDICAL MONTHLY xvii 




Are you particular as to the condition of the iron in your 
Blaud preparations ? 

Frosst's Perfected Blaud Capsules present True Ferrous 
Carbonate. 

Each 10 grain Capsule contains, approximately, 1 grain of 
Iron. 



xviii DOMINION MEDICAL MONTHLY 



0>ubUeher8 IDcpnvtnicnt 



I'nYsiriAXs' Ai'i'KovAi. To I 'ki:('i:;>i: Mauijiack. — Doaii Walter T. 
Siiiiiiicr of the ( "atlic(]i'al of SS. I'clir mul Paul. Cliicaijo, rwcntly 
ilrlivcred a sei-nion upon tlic '■Saci-aiiicnt of Man-iao:!'." in wliidi lie 
takes advaiiccil iri'ouud in I'cjrai'd to marital relations. His position 
will meet the hearty approl)ation of the medical profession. Dean 
Sumner issued the followinuf edict : "Beirinninir with Ea.ster, no per- 
sons will l>e married at the cathedral- i^nless they present a certificate 
of health from a repntahle physician, to the effect that they are 
normal, physically and mentally, and have neither an incurahle or 
connnuiiicahle disease." "This- step is taken only after mouths of 
study of the situation and d'eli^er,ation as to its advisability. H is 
believed that this stand will meet with the immediate sympathy of 
the clergy in the churches at largfe, all of whom have long felt the 
undesirability of being party to tT\e marriage of persons who, be- 
cause of their physical condition j,»liould never be allowed to enter 
into the marriage state and propagati^ their species." This is cer- 
tainly a step in the right direction, and we sincer«?l3' hope to see 
Dean Sumner'.^ excellent example emulated' by others in. Church 
authoi'ity, and may his sane and sensible policy act as a stimulus to 
physicians and legislatoi-s to continue the good work by introducing 
and enacting stringent laws in every State, for the purpose of re- 
strictjing the marriage of the unfit. The attitude of the Dean of 
Saints Peter and Paul is right. The "Sacrament of jNFarriage" 
5-hould not ])e disease polluted and eugenics slu)uld stand guai-d be- 
fore the matrimonial altar. Matrimony should be no melting pot for 
vicioas morbidity. The salvation of the race and the longevity of 
humanity is concerned in tlie matter. — Alitiiisl and \< \irt>h)i]isl . 



Vaccination Exemptions. — I^Ir. Crawshay-William.s asked the 
President of the Local Covernment Hoard if he would itate the total 
num'lx'r of declarations of cons-cientious objection to vaccination 
made in the years 1907, 11K>8, 1009, 1910 and 1911. and the percent- 
ages of these declarations to the births? 

Mr. Burns: The total number of certificates or declarations of 
conscientious objection to vaccination receivwl ))y vaccination ofTi- 
eers during the calendar years Ifin? to 1011, inclusive, and the per- 



DOMINIDX MEDICAL MOXTHLY 



XIX 




(Resistxrco) 



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XX DOMINION MEDICAL MONTHLY 

c(Mitag:es of siK'h objtH'tioiis to hirtlis rcfjistcrcd (luriii<r those years, 
were as fullo^^•s, namely: — 

Pfreentage 
01).)eetioiis. of Births. 

liK)7 57,675 6.3 

1908 162.799 17.3 

1!)09 1110.689 20.9 

1910 230,947 25.7 

1911 248.483 28.2 

Those who advoeated the enaetiiieiit atfordini; facilities for ex- 
emption did not anticipate svu-h a laru:e proportion of neglei't of 
vaccination. It is now generally admitted that very large numbers 
are exemtpted' by parents who have no conscientious objection what- 
ever to vaccination and whose decision would invmeddately l)e re- 
versed in the presence of small-pox. — M((l. Officer. 

AuTrMN.\L Augments. — The Autumn months constitute the sea- 
sou during which the average practising physician is called upon to 
treat the following conditions: 1. Typhoid fever, which is, more 
often than not, contracted at some unhygienic Sununer resort. The 
patient may return home during the first week or so, with headiache, 
malaise, etc., or the premonitory or primary symptoms may appear 
after reaching home. 2. Malarial infection, in certain sections, 
which is more than usually rife in the Spring and Fall seasons. 
3. The after results of the gastro-intestinal disorders of infantsi and 
young children, due to improper fcixling, etc., during the heated 
term. In almost every instance, when the acute symptoms have 
subsided, a condition of anemia and general devitalization is the 
final result that constitutes the e-svsential indication for treatment. 
In convales<'c!i('e from all forms of illness resulting in general 
de'bility, Pepto-Mangan ((iude) i.s the one ideal tonic and recon- 
structive. It not only revitalizes the blood, but also tones up every 
|)hysiologic function. It stimulates the appetite, improves the a'b- 
sori)tive capacity, increases energ>' and' ambition and restores the 
hl<M)(l to its normal condition. It is. thus, a general tonic and rccon- 
stitucnt of mark<'(1 and certain value. 



The Vai.I'e ok Kadh'M. — There are no very exact statistics of 
radium availa'ble, but awording to the United States (Jeological Sur- 
vey- the whole quantity in the world is probably not over two or 
three ounces, and its value, like that of the big diatnonds of the 
world, is purely nominal. It is worth whatever tlic possessors can 
get for it. The head of the English corporation producing radium 
claims that it is worth approximately $100,(M)0,000 a pound. A 
year ago this same person ha<l estimated the value of radium at one- 



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xxii DOMINION MEDICAL MON'THI.Y 

third more. However, a little variation of $50,(XH),000 is not thought 
to matter where there is no appre<'iable fraction of a poimd of the 
precious stuff in sight. The fact that has more than an\-thing else 
to do with iixing: the price is the existence of several radium banks 
in the world where tubes containing a microscopic speck of radium 
are rented out to doctors at something like $50 a day. AYhile it is 
laio\\ii to be of some value in treating lupus, which is a form of 
tuberculosis attacking the tissues, usually of the face, there is little 
else known about its medical value. It has been claimed on several 
occasions that radium was valuable in the treatment of cancer, but 
experiments have not proved this to be an absolute fact. A short 
time ago it was reported that the Austrian government had pur- 
chased the only two mines under private o\\Tiership producing the 
ores from- which radium is made, and thereby gained a monopoly in 
its manufacture. This report, however, turned out inaccurate. It 
is true that the Austrian mines and the Austrian government here- 
tofore have supplied the bulk of the radium salts existing in the 
Avorld, but at the present time radium is l^eing manufactured' in 
three other countries, the United Stiites included. Sweden is pro- 
ducing radium from kolm, the English are getting it from mines in 
Wales, while we get it from western Colorado, where there is a 
large deposit of radium-producing ore. These deposits produce also 
uranium and vanadium, the latter being used for making some of 
the high-grade steel alloys. While the mining pays in vanadium 
alone, the ore produces a certain per cent, of radium. Ten tons of 
it procure only between twenty and thirty milligrammes of radium. 
—Sc. Am. 



The Ice Bag in Appendicitis. — In a most interesting article by 
A. ]\r. Fauntleroy, Surgeon of the United' States Navy, Medical Bec- 
ord, Aug. 3, 1912, the fact is brought out, basing the same upon a 
large number of cases of appendicitis operated, that the ice bag is 
pos-itivcly harmful in this condition. In 507r of the cases operated, 
where the ice bag was used, the condition seemed to indicate that 
there was a notieeiible lack of effort on the part of nature to wall off, 
from the rest of the abdominal cavity, the appendix, which was fre- 
quently very much congested, gangrenous or perforated'. He also 
observed that in the ice bag cases there was a surprisingly low white 
cell count when one took into consideration the condition foimd in 
the abdomen at the time of the ox>eration. From 8,000 to 11,000 
•white cells was the rule in these ice bag cases when one would be 
justified in saying that the pathological condition warranted a con- 



DOMINION MEDICAL MONTHLY 



XXlll 



Nutrition Depends Upon Small Matters 

It is beginning to be recognised that it is a mistake to force 
hysterical, emaciated or tuberculous patients to take large 
quantities of " nutritious food," and that course will pro- 
bably soon become as antiquated as the copious drugging of 
the past. 

BOVRIL 

in small quantities, taken as part of the daily diet, has been 
proved to increase the power of digestion and assimilation, 
for the series of tests made by Professor Thompson, M.D., 
Sc.D., at the Dublin School of Physiology showed con- 
clusively that while Bovril was taken with ordinary diet 
the weight of the subject of the test was increased as much 
as from ten to twenty times that of the weight of Bovril 
taken. 




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stitutional roaition of from 20,000 to 30,000 leucocytes, or even, 
liigher. On the other hand, in those eases in which the hot water 
bag or niorpliine had been used' prior to operation (the ice bag not 
being used at all), the white count corresponded to what one would 
expect. Dr. Fauntlei-oy advances from his findings the logic that 
while the ice bag cau.ses numbness, practically the same as, in the 
condition of frostbitten ear or toe, it also decreases hyperemia, leu- 
cocj'tosis and stasis in the part to which it is applied. That heat is 
the direct antithesis of cold in encouraging favorable physiological 
action in inflammatory processes, whether superficial or peritoneal, 
seems to be from his report most logically and conclusively proven. 
In applying heat whether it be for peritoneal or inflammatory con- 
ditions of a more superficial character, the most rational method is 
to use that which is not only sanitary, but, for the comfort of the 
patient does not require frequent changes. In this respect, anti- 
phlogistine, on accoimt of its heat retentive properties., its cleanli- 
ness, and its ease of application, .s^hould appeal to the professional 
mind. That antiphlogistine has proven of great therapeutic value 
as a thermic agent is best indicated by its extensive professional 
employment and its many advantages over the hot water bottle and 
other methods of application of heat is readily discernible. 



CnROXic Articular Eiteumatism. — Edward B. Richey (Ken- 
tucky Medical Journal) records in detail a case of twelve years' 
standing treated with intravenous injections of phylacogen. The 
treatment began February 8th, 1912, and by end of the month 
patient was free from all pain, had free motion and could extend 
limbs several inches more than before treatment. 



Occiput Po.stehior Positions. — F. AV. Rice (Am. Jour. Ohs. and 
Diseases of W. and C.) says early rupture of the membranes is the 
principal cause of prolonged labor in primipara'. Relaxed pelvic 
floor i.s often a frequent cause of delayed rotation in multiparae. 
The best method of delivery where the head is high in the pelvis is 
double application of the forceps. Where the head is floating, in 
a flat pelvis, version offers the be.st solution, if not contra-indicated. 
Partial rotation by the blades is the best method, where the head 
is low in the pelvis. 



1 



2)ominion /llbeMcal /in>oiubli2 

HnD Ontario /nbcMcal journal 



Vol. XXXI X. TORONTO, SEPTEMBER, 1912. No. 3 



©rioinal Hrticles 



ON THE MONONUCLEAR CELLS OF THE BLOOD 



By 0. C. GRrxER, M.D., Montreal. 

Pathologist. Royal Victoria Hospital. 



Enumeration of the white c«lls of the blood by recording the 
different varietie.s as they pass before the obsen'er's eye in a nnero- 
scopie preparation is a well-recoornized procedure in clinical raicro- 
scopv Tlio classification usually adopted is. in its main features, 
that' originallv put forward by Ehrlieh in 1891, althougli 
Arneth'si work was published in 1904, in which an attempt was 
made to demonstrate the utility of subdividing tlie white cells into 
further groups than those referred to. That tliis new classification 
has been adopted in so few centres appears to be due to the in- 
creased attention whicli is needed in carrying out a given differ- 
ential count. Experience has nevertheless demonstrated the utility 
of the system in deciding on the reactive powers of a patient's 
tissues to different infections. Just as the great, majority of cases 
reported in the present-day literature, in which a differential blood 
count has been made, give the reader extremely little information 
about the polvmorphonuclear cells, so it is a conspicuous fact that 
a distinction between "small lymphocytes," "large lymphocytes"' 
and "hyaline" cells appears to be considered a satisfactory limit 
in the case of the mononuclear cells. It is the main object of the 
present paper to sliow that this limitation should not be accepted 

as final. 

Some years ago the writer endeavored to divide up the lympho- 
cyte forms into several varieties, according to morphological char- 
acters, with the object of ascertaining if any rules lay at the root 
of the distribution 'of the different cells in the blood stream, from 



74 DOMINION MKhlCAL MoNTIlLV 

wliifli (liay:noslit' or jirogncstie iiulieations ooukl l)o formulated. 
During the earlier years the principle was carried out by the aid 
of certain arbitrary' symbols which were employed to represent 
these various forms; subsequently, liowever, the general recognition 
of Pappenheim's nomenclature- rendered it more convenient to 
replace the symbols by names which had a meaning to the ln'ina- 
t«>logist. A description of the various forms familiarly lalH-lbnl 
"lymphocytes" may serve the useful purpose of rendering a search 
for finer distinctions more fre(iuent among hospital laboratory 
workere, and an attempt will be made to demonstratf the practical 
value of greater care in this direction. 

The panoptic method of staining introtluced by the author 
named-^ has also proved of so great value that it may be said to 
be essential that blood films should l>e studied by its aid in all 
cases. The remarks which follow depend entirely upon the appli- 
cation of this met'hod of staining. 

It will be convenient to discuss these cells nnder three headings: 

(1) The source of the mononuclear cells of the blood. 

(2) The special morphological characters of each cell- form. 

(3) The applic^ition of these obserA-ations to routine clinical 
pathological work. 

(1) The different sources of the rnononuelear cells of the l)1ood 
stream. 

While the old problem as to whether these cells cO'ine from the 
lymplioid follicles or from the spleen, or from both, i-^maiiis only 
partially solved, we find the following sources to be possible: The 
Innphoid follicles of the lymph nodes and of the mucous mem- 
branes; the ^lalpighian bodies of the spleen; the connective tissue 
spaces. Some of the cells may enter the blood directly ; others may 
pass in via the thoracic duct. The wandering cells of the connec- 
tive tissue spaces, whatever be their origin, may be supposed to be 
able to enter the blood stream eventually by passing along 1>tu- 
phatic cliannels. It is questionable whether such cells could be 
identitieil again in a blood smear. The cells of the pulp of the 
spleen, and those in the "pulpar" tissue of the lymph-no<les and 
the endothelial cells lining the blood-va.scular channels are cer- 
tainly able to make their way into the blood stream, either under 
normal or under catarrhal conditions. It may, therefore, be as- 
sumed that aai attempt to identify such cells in the circulating 
blood might be instructive. According to Patella*, the endo- 
thelial cells are to be recognized under the form of the familiar 
"large mononuclear leucocyte," but such an interpretation is not 
generally placed upon this form of cell. 



DOMIXIOX MEDICAL MOXTMLY 75 

Even though it be not possible at present to identify the lym- 
phoeytt' coming from a lymph-node, that from the spleen, that from 
the endothelium of the capillaries of any part of the circulation, it 
will be the aim of the clinical pathologist to rectify this defect of 
knowledge so that he can recognize other lymphoid cells, including 
those liberated into the blood stream during the metastatic cycle of 
tumors. Furthermore, the recognition of abnormal or degenerat- 
ing cells may prove of profound value to the clinician'. 

(2) The special morphological characters of each cell-form. 

The means of identification of a cell are: size of cell compared 
with red blood cells; the shape; the relative proportions e.xisting 
between the cell-body and the nucleus; reaction of each to staining 
reagents; the structure of each; the presence of nucleoli and their 
characters. The characters which go to indicate the age of a cell 
have alsx> to be borne in mind — degree of basicity of nucleus, in- 
creasing amount of cell-body as oompareil with the nucleus as age 
advances. 

The lymphocyte forms unth-r cousich^ration all agree in liaving 
simple nuclei and in having a basophile cell-body withoirt a granu- 
lation visible by the use of stains in vogue previous to the Romau- 
ows-ky age. The cells have had the following SA*nonymous terms 
applied to them : mononuclear leucoc}i:es, agranulocytes, spongio- 
c>"tes. 

(a) Small lymphocytes: This is a small round cell with a dark 
reddish- violet nucleus enclosed in a conc-entric film of non^granular 
pale-blue cytoplasm. "Within the nucleus is a nucleolus which is 
eccentric in position. There are sometimes a few azure granules 
visible, es^jecially at one spot. The cell is of about the size of a red 
blood-eell, but never larger. 

(b) Leucocytoid lymphocyte: This cell resembles the preceding 
save that the cell-lx)dy is decidedly more conspicuous, but the 
nucleus is eccentric. The nucleiLs is not as large as in tlie preced- 
ing ease, but the cell as a whole is larger. This cell is an older form, 

(c) Lymphoc\'te with reniform nucleus: This cell is exactly 
similar to the type (a), but the nucleus shows a slight dimple on 
one side, the cytoplasm against which is decidedly paler in staining 
power. 

(d) Meso-lymphocyte : The characters are similar to those of 
(a), but the cell is distinctly larger, though smaller than type (e). 
The nuclear character of dense structure and deep staining power 
is present here also. The markings within the nucleus are charac- 
teristie — ^polygonal masses drawn out at their angles into filament- 
ous structures which join ^^'ith those of their fellows. 



7(; DOMINION MKDlCAL MoNTIII-V 

(e) Large iiiononuelear knicoc.vt<*s (nioiiocytcs) : The cell is 
2-3 times as large as (a). The cytoplasm stains feebly and lias a 
faint retiform striieture. Azure granules of small size are scattered 
ilifFusely tlirougli the cell-))ody. The nucleus is relatively medium 
in size, oval in shape, with a slightly irregular contour (lobate or 
indent) and a delicate nuclear structure. There are no nucleoli 
\nthin it. 

(f) Leucocytoid monocyli': Thf cell is similar to (e) save for a 
relatively larger cell-lx>dy. 

(g) Tra.nsitional cell of Ehrlieh : This form is similar to (e), 
but the nucleus is deeply indented, simila.r to that in a metamye- 
locyte. 

(h) Juvenile monocyt4?s: Cells with a nucleus similar to the 
prece<ling, but with a narrow cytoplasmic zone. The latter may 
have a lilac tint from the presence of slight oxyphilia. 

(i) Juvenile Ivmphocytes : These forms are similar to (al. but 
the nucleus is void of reeogniza;ble cell-body. 

(j) Dwarf lymphocytes: These correspond in all characters 
\nth t>pe (a), but are of much smaller size. Tlie.se are classed as 
at.vpical immature forms. 

(k) Lymphocytes with nuclei in a state of amitotic division. It 
is questionable where these should be placed in tlie genealogical tree. 

(1) Myeloic monoc.ytes, or leucoblasts: These are presumably 
bone-marrow cells, which only occur in the blood in pathological 
conditions. The distinctive feature is the structure of the nucleus, 
which stains less intensely than that of an ordinary large mono- 
nuclear leucocji;e, and is marked by delicate shadowy lines run- 
ning at right angles to the long axis of the nucleus. The cell-body 
is ba.sophile and may contain azure granules of larger size than 
tho.se of (e). There is no nucleolus. 

(m) Myeloic monocyte without azure granules: This form is 
identical with (1) .save for the ab.sence of azure granules. 

(n) Leucocytoid myeloic monocyte: This foi-m is similar to (1), 
but the size of the cell-body relative to the nucleus is increased. 

(o) ^lyeloic monocyte with indenti'd nucleus: This form is 
.comparable with (c). 

(p) Lymphoblastic macrolymphocyte: This cell is of the same 
size as (d), but the nucleus is relatively larger than in that form of 
cell, and nucleoli may \)e noticed. The nuclear structure differs in 
that the markings are similar to those of (r) intermingled with 
coarse flakes of chromatin of the form descrihed under (d). This 
cell is pathological and represents an earlier stage in genealogj'. 



DOMINIOX MEDICAL MONTHLY 77 

(q) Leucocytoid lymphoblastic maerolyraphocyte : This cell has 
similar characters to the precediiifi:, but the cell-body is larger. 

(r) Lyiiiphoidocyte: This form is characterized by the peculiar 
structure of the nucleus. The cell itself is much larger than (d) 
and may be larger than (1). The nucleus appears to be made up 
of a very fine network, whose meshes are circular in shape. The 
staining power is relatively feeble. There may be two or three 
nucleoli presejit whicii are eccentric and relatively large. There 
is a slight increase in the density of the chromatin structure 
airound them. The cell-body is rather strongly basophile. 

(s) Microlymplioidoeyte: This cell lias similar characters to 
the preceding, but the cell is decidedly smaller, being equal to or 
less than (d). 

(t) Leucocytoid lyniphoidoc.vte : This is similar to fp), but 
with relatively larger cjioplasmic zone. 

(u) Leucocytoid microlymphoidocyte : This cell is exactly 
analogous to the preceding. 

(v) Rieder cell: This is a lymphoidocyte whose nucleus is in- 
dented at one or more places. Its appearance is quite characteristic 
and is definitely pathological. 

(w) Dwarf lymphoidocytes: Cells similar in type, but still 
smaller. Their identification and significance must remain doubtful. 

(x) Lymphoid erA'throiblast : This belongs to the hemoglobin- 
bearing series, and comes to appear like a lympliocyte form because 
of the al)sence of hemoglobin. The cell-body is rather strongly 
basophile and contains no granules of any kind. The nucleus is 
relatively large, and its structure is quite characteristic — the chro- 
matin lies towards the periphery in the form of a wheel. 

(y) Plasma cells or irritation cells: These may be di^vided up 
into almost as many groups as have been already- mentioned ac- 
coniing to the form of the nucleus and the relative proportions of 
the cell-])ody. Th<' staining reaction of the latter is always in- 
tensely basophile, and a retiform structure is alwa^'s well marked 
in it. Vacuolar spaces may be noted among the meshes. Azure 
granules are not to be expected, though forms do occur in whicli 
such granules can be made out scattered through the cell-body. 

Simulating these forms are the foUowing abnormal cells: 

(i) The pVomyelocyte, wliieh has a basophile cell-body, but may 
present a few neutrophile granules. Azure granules are scanty. 

(ii) ^Myelocytes and metamyelocytes without granules. The 
oxyphile reaetion of the cell-body enables the cells to be placed 
correctly. Polynuclear leucocytes may occur in similar gnise. 



78 DOMINION MKDICAI. MoNI'lILV 

(iii) Leueosarconia colls of different forms ^.iuvenilc, senile, 
Riedor-like). These may simnlate any' of the preceding types as 
reyrai'ds nuclear characters. 

Finally, indications of degenerative changes in any of tlie above- 
named cells require to be noted. The presence of vacuoles in the 
eell-bodies, feebleness in staining of nucleus, ill-definition of out- 
line of the cell (indicative of cytolysis), or the presence of foreign 
bodit^ witliin the cells, should all Ix' noted. Tlie "shadow" forms 
were first nanwd a'fter Klein and Guitipreclit. 

The evid^ice afford(»d by the study of blood-films and of films 
from the various hemotopoietic tissues fully bears out the .iusti- 
fication for Pappenjieim 's terminology. The introduction of 
such a word as "lymphoidocyte" proves a great boon wh'en we 
consider the confusion that has arisen from the use of such in- 
definite woi-ds as "large lymphocyte" or "large mononuclear leuco- 
cyte." The term "large lymphoc^-te, " for instance, is frequently 
employed in modern clinical work to represent an inh'aibitant of 
normal blood, but in technical literature the term is found to be 
applied to a parent cell normally residing only in the ])one-marrow 
or other blood-forming centres. Tiie term "monocyte." again, as 
applied to a definite cell-entity, has found wide application since 
the researches of Pappeidu'iin and Ferrata in 1010'' and should 1)6 
widely adopted as a decided advance on previous nomenclature. 

As ^nll be readily uiulei-stood, the distinction l>etween such cells 
as (a) and (s), (p)'and (r), (f) and (h), (1) and (m), is difficult 
to make out, but is possible l)y making a rule of firet noting the 
nucleus and then the cell-l)ody. Intermediate forms between the 
different cell series arre not distinguished with enough certainty to 
justify a separate nomenclature. 

The habitual cla.ssification of the mononuclear elements into 
small and large lymphocytes and hyaline cells throws together the 
following cell forms : The small lymphocytes include (a), (b), (c), 
(d), (h), (i), (j), (k), (s), (w),"(x) and (iii). The large lympho- 
cj-tes include (e), (1), (m), (o), (p) and (v). The hyaline cells 
include (b), (g), (n), (q). (u) and (v). and po.ssibly (e), (1), 
(m), (o), (p) and (y). 

In spite of the fact that normal blood does not contain more 
than (a), (b), (c), (d), (e), (f), (g) — (a) and (e) 'representing 
by far the majority — the "plea is that any of the serious diseases 
wliich come into a hospital ward may furnish examples in which 
the other forms occur in varying number. A .search for an ade- 
quate explanation for the latter finding will afford a clue to the 



DOMINION MEDICAL MOXTHLY 79 

meaning of lymphocyte forms in their relation to imnmnity and 

infection. , , 

(3) The application of the above data to routine clinical putl.o- 

logical work : „ , i . ^ 

The full value to be derived from a careful study of the lymp o- 
evtJ'roup of cells cannot be defined until the prec.se ^^^ 
of eidi varietv is determined. Such questions as the follo™g arise. 

rrv ;V4t^;a"TnX';i;c«la«:;blood :„aer any co.KUjioos, 
^t -is t "dTation of life of each main type -thmtte Wood- 
stream ' eto On tlie other hand, even in the absence of such knowl 
X a studv of n«n,erons careful differential counts may be ex- 

'"DLna;"ra„.es in the hloo.,-picture.-The collection of blood 
at a "ven . : of day will avoid nnsmterpn-tations of d,anges n 
rbWp.ture;.,icharerea^^^^^^^^^ 

;™;Z;t:":;%-r ;u.'.C .. da. the resuUs of snch 
olJrvations are conveniently recorded m the or 

su m of small and medium torms per c. nun. ^^ 
- sum of large forms 

It is fot,nd that this adymphoid-cell index falls trom .6 (m^d- 
nigh,,) to 5 during the forenoon, and nses tron, o to ';! '"* P^^.; 
f»llin^ aeain to 3 5 at the time of. the evening meal. -Whether this 

fndiriduals) or not, it is the ol,.ject of further study to d«ide The 
*s™a.ions of Fr„n,bin« show that the P-P-'--/ ,^^'^ 
different cell-forms are different in healthy and di,e.i.ed >tates^ 
rsiii- his fi-nres to construct an index as suggested above, we fid 
h t intn healthy young adults the index -- -' -^^^^ "^^ 
reaches 5 in 80 per cent, of eases. In nephritis, 1"'*«"T^' "' 
T ■ „f .!„> liver svuhilis and med astinal sarcoma, on the other 
hrraie i d X varw' r^ 1.3 to 1.6, while in chronic heart cases 
ft ran-ed from 2 to 15. In a case of septic sore-throat with qumsv 
tl Met r 3 iKfore operative interference and rose to 9 -thin 
five days. 



80 DOMINION MEDICAL AIOXTIILV 

A .««'n*>.s of counts published by Houston" was used as a 
basis for calculations in this manner.* The index was less than '■] or 
4 in lIod«rl<ins' disease, lyniphosiUX'Oina (not constant), and iiiahiria. 
Similarly, from a nuinl)er of counts on eases o-f Hodgkin's disease 
by Bunting^ the index was almost constantly less tlian 2. and 
in one instance was as low as 0.4. 

The presence of abnormal lymphoid cells in the blood-film. — 
The presence of lymphoidocytes of different types would indicate 
some participation of the bone-marrow in t'he morbid process. 
Under this heading the question of subleukemic states would be 
considered. Again, the preponderance of the monocytes charac- 
teristic of malaria would be of significance in the diagnosis of cer- 
tain ti"opical fevers (Robertson)^. The investigations of Pare- 
musoff^^ demonstrate them to be of a peculiar and characteristic 
form, different from that of the ordinary well-knoA\ni large mono- 
nuclear leucocyte. 

Other Indices. — Other indices can be constructed by calculating 
the relations between any of two or moi'e Ijinplioid cell types th«n 
those named in the "a-lymphoid-cell index." Such additional in- 
dices may be given ai>propriate terms, though the most satisfactory 
nomenclature is difficult to decide upon. 

Variations of the various indices are not characteristic of any 
given disease. It is essential to realize that variations in differen- 
tial counts represent variations of reaction to morbific agents. The 
blood is a tran.s^1ort agent and not a factory. If the proportions of 
material tran.sported vary at different times they will reflect 
changes in supply or demand in otiier regions of the lx>dy. It does 
not follow that these changes are peculiar to one or other disease 
to the exclusion of all others. 

Should a certain agent act chiefly or entirely on the myeloid tis- 
sues, an absence of abnormal mononuclear types would be antici- 
I)a.te<l ; on the other hand, the presence of such types would be indi- 
cative of changes in Ipnphadenoid tissues, regardless of evidence 
or not of associated leucol)lastic reaction in the marrow. The care- 
ful weighing-up of the total figures presejited by each type of cell, 
as well as of the relative figures betAveen them and the granular 
cells, is bound to furnish valuable conclu.sions for the guidance of 
diagnosis, prognosis or treatment. 



•There is some uncertainty as to the correct position of the lymphoid cell forms n 
th^-se counts, because of lack of data for cytolOKical diagnosis. 



DOMIXIOX MEDICAL MONTHLY 81 

References. 

(1) Arneth, Deutsche med. Woclienschr., 190-4. 

(2) Pappenheim, Fol. haeni.. XII., i., p. 26. 

(3) Pappenheim, Medizin. Klinik, 1908, 32. 

(4) Patella, Gaz. deeji. osped., 1911, 94. 

(5) Pappenheim and Ferrata, Fol harm-, X., p. 78. 

(6) Frumkin, Fol. harm., XII., 1, p. 50. 

(7) Houston, Bnt. Med. Journal, 1904, Sopt. 10. 

(8) Bunting, Johns Hop. Hosp. Bull, Oct., 1911. 

(9) Ro]>ertson, Indian M<d. Gazette, 1911, p. 161. 
(10) ParemusoiT, Fol haeyn., XTL, p. 236. 



A MEDICAL SERMON-DE REBUS 



By James S. Sprague, M.D., Perth. Ont. 

Examiner Materia Medica, etc.. College of Physicians and Surgeons. 1903-7. 



"Nothing extenuate nor set down aught in malice. 
It is said Tertullian's every word was a sentence and his every 
sentence was a sermon. In this it is the intention to name fifty or 
more interests more or less in unison which, separately, aflford texts 
capable of much expansion, and all ethical; fully believing you 
my brother, if learned and in love with our profession, will hnd 
herein much diversified delight ; if you are, as many are, in pos- 
session of indolence that is warping your usefulness and very lite, 
herein is a brief solace for you ; but to the uninformed and indiffer- 
ent, yet seekers of truth and ideals, much encouragement, cheer 
and a refuge, if you can be aroused. 

It is well and warrantly becoming for us to believe that our 
lives are more infiuenced by ideals than by ideas, and that more 
to examples, and less to precepts, our movements to higher studies 
are directed. It, too, is a duty, and one very obligatory, that you 
and I follow the teachings of Bacon, who tells us: "I do hold 
everj' man a debtor to his profession from the which as men of 
couiie do seek to receive countenance and profit, as they of duty 
to endeavor themselves by way of amends, to be a help and orna- 
ment thereto," and if vou and I fully endorse these words, can we 
say '-'These words do not refer to me or to us?" I leave this 



82 DOM IX 10. \ :\1F.I)I('AL MONTHLY 

siin]>lt' (|iu ry for you to solve or to answer in your (|uiet hours, 
for your own ami true answer after careful retrospect of your 
doings in the jirofession, for you either honoivd it or (lis^rraced it, 
or have l)ccn a neutral. 

Wlieii I find that of my fellow-graduates in medicine — more 
than forty-three yeans since — more than one-half the numher 
are dea<l : that hut few continued in practice and relied on it 
through life; that several died through excessive stimulation that 
"stingeth like an adder," aud, too, that those engaged in politics 
were under tiie fatal delusion tliat medicine was not a jealous mis- 
tress, it appears no Avonder that our temples contain no reeoixls — 
save the fact that they lived — and they died, for they said no word 
of cheer; they told nothing of their successes, or failures, and few 
of them experienced the fulness of the great and national move- 
ments, interests and prospects, and in the belief that this is the 
age of "reason in religion and reason in medicine," and though 
our foundations are well established, yet the most pernicious cults, 
even encouraged by the church and upheld by the indiflferents. the 
weaklings, the ignorant and unthinking among our legislators, are 
seeking recognition of their baseless cults in tiiis, our province — 
the most enlightened in our Dominion — especially in this our 
native province — the burial place of our fathers and mothers for 
several generations. 

This prologue will sutfice, and as all sermons have a wide range 
and depart very much from the text, it, too, will serve as apoloqia 
pro m(a ct verba oliorum. 

'Sir. John S. Collins, 253 Broadway. New York, some few yeai-s 
since sent to me "Mrs. O'Malley's Advice to Her Son Upon Re- 
ceiving His Diploma." When the doctor received his dijiloma he 
said his mother advised him always to look after the pooi-, saying 
in quaint Irish humor: "If health was a thing money could buy, 
the rich would all live and the poor would all die." It may be said 
and very truthfully, that every God-fearing and intelligent mother 
has prayed her hopeful .son shouhl )>e either a minister of Clirist 
or a doctor — but no prayer tliat be Iteeoint* a lawyer. No! 

"So you are a doctor, witli papers to sliuw; 
Of your great deeds in medicine the world will soon know. 
All our pains and our aches now like magic will go. 
From the top of our head to the tip of our toe. 
Now, don't be like Dinny, your brother, who iuvs taken to law: 
All the big words he used would break a man's jaw. 
He argues to-day that black must l>e white. 



DOMIXIOX MEDICAL MOXTHLY 83 

And to-morrow he swears it's as black as the night. 

Sure the Divil himself couldn't argue with Dinny; 

Only last night he told me the judge was a ninny, 

And the jurors themselves hadn't brains for to see 

That all their great talking was only for fee. ^ 

Now the ladies will call on you morning aijd night, 

Whenever they get the least bit of fright, 

Saj'ing, 'If the doctor is in, I would see him, if you please, 

For I'm after contracting a painful disease.' 

Then you'll run to the cuplward and take out your pills 

And say, 'My dear madam, they are good for all ills; 

Take one in the morning and one in the night. 

And in forty-eight hours you'll be feeling all right.' 

With a smile on her face and your fee in your hand. 

You'll take it by saying, 'I'm at your command.' 

And be at her command, if she has only a .smile, 

For healing the sick is always worth while. 

Don't bother too much about getting your fee, 

For to-morrow the Ix>rd only knows where you'll be, 

For if health was a thing that money could buy. 

Sure, the rich would all live and the poor would all die." 

It is well that we console ourselves with the words of Horace, 
who in his Carm. IV. 4-33 tells us the effects of culture: ''Docirina 
sed vim promovit itisitam, rectiquc cult us pectora rohorant." 

In the Canons of Ethics of the American Bar Association, 
George Sharswood writes: "There is certainly, without any excep- 
tion, no profession in whicli .so many temptations beset the path 
to swerve from the line of strict integrity, in which so many deli- 
cate and diiferent (piestions of duty are continually arising. There 
are pitfalls and man-traps at ever>' step, and mere youth at the 
very outset of his career needs often the prudence and self-denial 
as well as the moral courage which belong commonly to riper years. 
High moral principle is the only safe guide, the only torch tO light 
his way amidst darkness and destruction." The high moral prin- 
ciple torch is very seldO'm lighted ; if so, it is justly considered as a 
mask, for "nowadays a religious lawyer is regarded with wonder 
and susj)icion." Yes, the same accusation in a few instances may 
be applied, justly or unjustly, yet rarely, to a few widely scattered 
ones in our ranks. 

There are those — and many they are — in whom we trust, and 
are compelled by law to trust in legal interests, and it is often a 
querj' whe-ther to term them barristers or l)arrators. Yes, there arc 



84 DOMINION ^[EDICAL :\inN'|'IILY 

otht^r than sea piratt-s. and under commission, who are in our midst, 
and of whom someone had in consideration whm lie thoujrht of 
money shi^jrei's and fee exacters. Ilis solilo(|uy is: 

"Full many rofrues have honest faces. 
And lightly trip their Sunday paces; 
But yet these pious broadcloth types 
Full oft should wear a garb O'f stripes, 
And, heavy fettered, trip as well 
The lock-step to a prison cell." 

There are too many of whom it can ])e well said: "Gentler 
pirates never scuttled ships" or more stealthily threw the grap- 
pling irons around our money-bags, or tlaslied false liglits to treach- 
erous shoals, or sang more alluring somgs than the sirens, daughters 
of the river-god Achelous. 

'Be not the first by whom the new is tried, 
Nor yet the last, to lay the old aside,' 

A few extracts from "LaAv and ^Medicine" by ^Iv. Justice 
William Renwick Riddell may be presented, which, althouffli un- 
challenged and apparently accepted, save by Dr. Clark of Toronto, 
have statements which reflect no merit or advantage in experience 
and research: "But while our law is thus in a state of flux, it must 
not be forgotten that immensely the greater portion of it is in 
principle the same as it has been for centuries. While in medicine, 
in not one case out of twenty, can a physician gain any practical 
advantage by consulting an authority twenty years old, in law 
there is not one case in twenty in which authorities much more 
tlian twvnty years will, or may not be — if not conclusive, at 
least of advantage. A physician who has been in practice twenty 
years will have twenty times as much to unlearn as his brother jf 
the same age in the legal profession. The former must be, 
but with the latter 'novum ft ad hanc dirm non audit iitu' is ana- 
thema as Cicero, one of the greatest of his tribe; and his rule must 
be 'what is new is seldom true, and what is true is seldom new.' 

Immrr etivas Xrues, sclfrn ctwas Gutes/' 

Cicero in De Henectate did say: ''Discc a experientia quoniam 
qui i)i viam o-rahant — qui rruditi sunt." 

In some, and a few most worthy respects 



DOMIXIOX MEDICAL ]k[ONTHLY 85 

'"Outworn itU'als are fading fast away, 
Beyond its buried past the world lias ranged, 
And new intiuences shape its trend to-day." 

However, it is well for us, many of us, to comfort ourselves with 
the prophet's words: "Thus saith the Lord, Stand ye in the ways, 
and see, and ask for the old paths where is the good way, and walk 
therein, and ye shall find rest for your souls." — Jer. vi., 16. 

It may be justly mentioned that Justinian in his Pandicts and 
Institutes or Code, formulated decisions from the Roman law, and 
from his time as Emperor of Constantinople, one thousand and 
more years and B.C. the great Hippocrates — Princeps Medicorum — 
Auxiliator Maxiuius Aegris, who was born at Cos, was the 
disciple of Heraclites and Deinocritus, and Iiis researches were the 
full principles of the Baconian philosophy. It may be said that 
his treatment of acute diseases may be instanced as being so com- 
plete that the experience of more than two thousand years has 
scarcely improved upon it. Celsus, a contemporary of Trajan, in 
his treatment of phthisis pulmonalis advised his patient to flee to 
highest mountains, there to live, and his nourishment to be the 
fruit of the cow. The query is, has medical science done other than 
adopt this treatment? 

Plato's year but repeats itself in due season, and the thouiriits 
we are thinking on life's serious problems our fathei-s have thought. 
Our literature ^v^thout that of before the Saviour of men would be 
sterile, and what is extant has formed the basis of our modern 
classics and inspirations. 

The present time is suflficieut for our labors, however. Cicero 
tells us tria esse omnino genera quae in diseeptioncm eadera pos- 
sinf : (juid fiat, faetum, fxiiurnmve sif," that is: tJie past, the 
present and the future of all considerations should, if worthy, 
occupy our studies. However, let us, with Hesiod, a contemporai-y 
with Homer, but study our future and keep in memory his wise 
instruction: "That man's with wisdom duly blest, who of himself 
can judge what's best, and scan with penetrating eye what's had 
in dark futurity." The church, law, and medicine are the con- 
servators, have been and ever will be of our civilization, and without 
a highly educated number it will cease and heavens will peal their 
last thunders to mark the end of time, and it is our hope that the 
old saying, "That a three- fold cord is seldom broken," \vill apply 
until time shall cease and be no more, and the trinity ever exist. 

Yet, why this dissertation? — for it is only imagination rears 
imperishable monuments ; for the gods will ever return and forever 



8G l)().MiM(»\ MKDICAr. MOXTHIA' 

will remain — and tlio Divine cannot be razed in the Churcli, in Law 
or in Medicine, and if united, we stand, and if divided, we fall. 

The pa^es of RcU<jio Medici tell nie, what time has forcibly 
told me, that "it is better to sit down in a moilest itrnoranee and 
rest contented with the natural l)le.ssinii:s of our own reasons than 
buy tlie uncertain knowledge of thy life \\-\\\\ swc^at and vexation 
which death gives every fool gratis, and is an accessory to our own 
gloritication." 

In the words of Horace: "Jam satis est, verljion non ampUus 
aeldani," and with this belief: 

"Optimi coHsiliarii mortui." 

SOLILOQUIUM. 

It may be advisable in medicine, as in religion — in these days of 
very bewildering and unsettled (|uestious under that designation 
falsely termed "higher criticism'' — to console ourselves, and very 
wisely too, with the thought that there is "more wisdom in doubt 
than in half the creeds," which because they for centuries have 
been invariable, displace our rea.son with entanglements, and 
falsely claim divine origin; })ut for whicli selfish and ungodlike 
aims and ends too often are sought. If Bishop Whately did say 
of us: "i7&i tres mcdici, ihi duo althei," yet the daily prayer of 
every ]\I.D. is this, and which moves his soul: 

"Live I, so live I, 
To my Lord heartily. 

To my prince faithfully, 

To my neiglilior lionestly; 

Die I, so die I," 

said Longfellow. 



DOMIXIOX MEDICAL MOXTIILY 87 

METHOD OF THE STUDY OF DIRECT OR SPECIFIC DRUG ACTION 



3y Finley Ellixgwood, M.D., Chicago, Illinois. 

Editor Ellingwood's Therapeutist. 



In a recent niunber of this journal, an article of mine ^\as pub- 
lished in which 1 called the attention of the reader.-^ to the im- 
portance of the study of the Materia Medica and Therapeutics, 
and to some faults, in my opinion, in the present method of study, 
and I undertook to urge upon the readers the necessity of study- 
ing each indiridual remedy, with reference to its most direct action 
ui)on exact conditions of disease. 

It is plain to any reader that if we prescribe the proprietary 
])reparations, or the manufactured ])harmaceutical compounds 
that are being put out more and more extensively every year, we 
can never know- what the individual drugs will do, and the darkness 
and doubt that, have settled down upon the knowledge of the exact 
action of drugs, will be intensified. 

In the study of drug action each remedy must positively be 
studied alone, but in order that we know to what exact condition 
we may apply a remedy, we must begin our study with an analyti- 
cal examination of each disease, in the patient under considera- 
tion, in order that we may determine the conditions that we have 
to contend with in that patient. By so doing we thus familiarize 
ourselves with these conditions, and we become enabled to recog- 
nize them whenever we find them, as we will find that they may 
occur in given diseases other than the one under consideration. 

Determining then, in each case the exact conditions jiresent, 
we apply to one or two of each of the leading conditions a single 
remedy which will meet each condition and correct the disorder. 
Manv years' close observation has convinced us, that in each 
remedy there is an inherent and very definite medicinal influence, 
which produces a corrective effect upon some given condition of 
disease, and, influencing that condition at one time, we find that' 
whenever so administered, and whatever the general disease in 
which the condition is found, it will exercise the same influence. 
This certainly is the study of the exact adaptation of each remedy 
to certain specific conditions of disease, and when we have these 
conditions and a remedy that can be relied upon for this specific 
action whenever that action is demanded, we define the remedy 



.sc> Dominion .mkdral MoMiiLV 

as speeitic in that action — specific to that given condition. 77/ /.s 
is tlif nwi<t direct action of a drug jwssihle to olitain. 

There is no more fascinating study — nothing that offers 
greater attraction nor more beneficial .results to the sudent than 
thi> study i»f the direct action of drugs on exact conditions, and 
as first stated it will be at once seen that no other method of study 
can be depended upon to be so absolutely accurate. 

This study opens up an enormous field. It is not necessary 
that we' study many hundred remedies, but by taking the con- 
ditions with one or two of the remedies tluit will directly influence 
them, when the field of the diseased conditions is covered, we can 
take these remedies and by a thorough, persistent and careful 
study of the fact* concerning their action, we may equip our- 
selves with sufficient remedies to combat all diseases in a positive 
and most reliable manner. 

To illustrate the exact conditions in which certain remedies 
act. or to which drugs must be ap])lied, I would call attention to 
the fact that in acute disease we find in one patient with a high 
temperature that the tongue and mucous membranes of the mouth 
are red. or deep red, that the tongue is elongated and thin and 
covered with a dark coat, while with the same temperature in the 
same disease with another patient, the mucous membranes and 
tongue are pale, the tongue is coated with a pasty white coat, with 
a dirty grayish or yellow centre. 

If we were to say hydrochloric acid was a good remedy for 
such a disease and would give that remedy in both cases, the latter 
condition would be most seriously increased and intensified, and 
the temperature would increase, and be very difficult to control, 
while in the former case the whole train of symptoms would yield 
in ii most satisfactory manner to that one remedy. 

The reason for this is that in the former named condition 
there is a deficiency of the acids in the system, there is an in- 
efficient secretion of acids in the gastro-intestinal tract, and acids 
are positively demanded. In the latter case the acids are all 
in excess, and not alone must neutralization be effected, but it is 
necessary to administer alkaline remedies often to go back of the 
simple neutralization of the acids, and to create in the system 
a larger outj)Ut of the alkaline elements. 

This one illustration may be ajiplied, as follows, whatever 
the acute febrile condition present, after determining the tem- 
j)erature we must determine whether the course of treatment 
should be alkaline in character or acid, and this condition must 
be kept in mind until (•orrecte<l. administering other remedies as 



DOMIXIOX JIEDICAL MOXTHLY 89 

indicated Take for instance an extreme typhoid case with 
_ tembranes dark, .nou.h and tongne dr^ P"hap. sordes 
r.u the teeth. We will presume this patient to haie de irinm, 
low mu terii .^ stupor increasing to cotna. If we were to give 
aTaS ine mi'iedv'in this case with sodium or potassium bromide^ 
?^stuor%vould' increase; the deficiency in secretion would be 
enified, and the entire group of symptoms would - -■endered 
still more difficult of control. By administering to Aat^ patient 
noi^toline or neutral or acid laxative if needed, with hydro- 
rom c ac d ;„ fifteen minim doses every two hours, with perhaps 
ten -twelve drops of ergot to relieve the cerebral conges loi. the 
change hat would take place for good would be so marked and 
•an d as to be at times almost astonishing as the acids are needed 
ositivelv. Yet these conditions are seldom considered, 
'"might go on from this and mention very many conditions 
that can be met with a single remedy, that usually have no atten- 
tion whateve in the treatment of disease in general, and yet f 
he dItaU remedy was applied to the exact conditions, the symp- 
oL would'Xatl the thVeatening factors would ^^^J^^'iZi 
the temperature would drop in febrile diseases, and the whole 
disease would take on a more favorable aspect. 

For the further consideration of the readers. ,n his line a 
this time I will present onlv the conditio,, of i>a,„, with some o 
the e™t cllitious under which pain is found and as reluved 
bv that particular remedy which experience has P^ven , s 
si")ecifical V adapted to that exact condition of pam. In a future 
a Hcle in till Lirnal I hope to bring out some specific remedies 
with the exa^t^daptations of these remedies n a way that will 
«bow the beautv of this method of drug study. 

To be brief-, but vet definite, supraorbital pain, "n. latera or 
bilatera acute' and 'sharp, from acute cold, is -trolled on 
bv a sin-le dose of fifteen grains of sodium saliey ate. Ihi, pain 
if also controlled by five drops of specific gelsemuim, one or two 

doses an hour apart. . i „. i-f 

Muscular pains-general aching-pains in '"^^ "u.scle a. 
bruised-as if overworked-indicate maorotys. .F'""' ^^.f'" 
fZf,« five drops of a good fluid extract may be given exei.^ hour 
or ™- the miller doJes in sensitive patients, the large doses in 
fiillTlethoric™ es. The action of macrotys is enhanced by suffi- 
cient dose" of atonte if there be any elevation of the temperatt.re^ 
The above condition is also relieved by twenty drops oi a mca 
in a fou ounce mixture, a teaspoonful every hour, especiaUy if 



90 DOMINION MEDICAL MONTHLY 

the soreness, bruised eoiulition or achine: is (.luc to aetiial innsciilar 
strain or overwork, as in labor. 

For muscular pains as above, caused by exposure to cold, with 
local or general aching', give sodium salicylate, from five to fifteen 
grains every two hours. 

For muscular pains in the deep muscles of the neck or back, 
acute, as in tic, or lumbago, give gelsemium, from two to five 
drops, combined with macrotys, every hour or two. Muscular 
soreness or pain in the deep muscles from cold is materially bene- 
fited by applications of dry heat, often effected by ironing the 
part over flannel with a hot flat iron, or the applications of a 
rubber water bag, hot. This assists the indicated medicines. 

For pain in the face, neuralgic in character, with nervous 
irritation, give gelsemium, from one to five drops every hour or 
two; especially effective if the skin be warm, the eyes bright and 
pupils contracted. 

Pain in the face, neck or shoulders; sharji, persistent, patient 
chilly, skin and extremities cool or cold — belladonna, one or two 
drops of the tincture every hour. This influence is materially 
enhanced by from two to five grains of ammonium chloride, or 
one-half grain of camphor with each dose of belladonna in per- 
sistent neuralgia of the head or up])er extremities. 

Shooting pain under the right shoulder blade, as from the 
liver, with dull ache in the shoulders and across the back — sticta, 
twenty drops in four ounces of water, a teaspoonful every hour. 

Pain through the lungs, or in the pleura; acute, cutting; 
increased by motion or by deep breathing — bryonia, twenty drops ; 
water, four ounces; a teaspoonful every hour with adults; in 
smaller proportion, half a teasj^oonful every half hour with infants. 

The pain of acute i)leurisy, very severe, sometimes agonizing, 
should be at once relieved by a large, efiicient hot mustard poul- 
tice, applied short of blistering, for from four to eight minutes. 
This relieves until the effect of bryonia is ap])arent, which re- 
quires a little time. 

In acute pleuritic pains, asclepits, in from five to thirty dro])s 
every two hours, acts very similarly to bryonia. and, when exactly 
indicated, this remedy is as relial)lo. 

For pain in the heart — angina jjcctoris — give a hypodermic 
of lobelia from twenty to forty drops. Relief is usually imme- 
diate from one dose. The same dose may be repeated, however, 
in one or two hours if relief is not complete. 

Angina is relieved also by macrotys in from two to five drop 
doses every hour or two; also by gelsemium in from five to ten 



DOMTXIOX MEDICAL MOXTHLY 91 

drop closes where there is nervous excitability. The two latter 
remedies are indicated especially if there be a rheumatic diathesis. 

For pain in the heart, persistently recurrent, not severe but 
distressing — give cactus, from one to two drops, five or six times 
a day. If muscular soreness he present in the chest, shoulders 
and left arm, combine with macrotys. 

Pain in the stomach, acute from indigestion, give a mild but 
efficient emetic — a teaspoonful of mustard in a quart of warm 
water — to induce vomiting, or sufficient ipecac, with a large quan- 
tity of warm watel-, to induce vomiting. In many cases the warm 
water alone will be sufficient to wash out the stomach. Treat 
subactute pain then, if any, as then indicated. 

Pain in the stomach after each meal from indigestion; give 
a digestive always while the food is taken. Pawpaw in some 
form covers most of these cases. Institute general treatment for 
the restoration of the normal action of the stomach. 

Pain from indigestion, from deficient hydrochloric acid, give 
hydrochloric acid in water, with from five to ten drops of fluid 
hydrastis. Exercise extreme care as to food in these cases. In 
fact in the acute cases a period of fasting is essential. 

Pain in the stomach, with extreme acidity — tongue broad, 
pale and thick, coated white; one-half of a teaspoonful of bicar- 
bonate of soda in half of a glass of water will often at once control 
the pain, but continued treatment to neutralize excess of acidity 
and to change the habit of the system must be instituted. When 
this condition is present at the beginning of any acute disease, it 
must be overcome first, or the specific action of the other remedies 
will be interfered with. 

Pain in the stomach, severe, agonizing, spasmodic — give 
twenty drops of dioscorea in half of a cupful of hoi water, drunk 
at once. 

Pain always after eating, with extreme gastric acidity, prob- 
ably due to gastric ulcer — avoid solid food, neutralize acidity if 
indicated, give from ten to fifteen drops of geranium every two 
hours. Flush the colon, and in-emaciated cases resort to rectal 
feeding for a few days. Milk of bismuth, or a solution of cal- 
cined magnesium in regular sufficient doses, will assist in the 
neutralization of the acidity. 

Pain in the stomach walls, ditfuse<l tenderness on pressure, 
the pain acute or slightly cutting, not infiuenced by food ; — tender- 
ness, persistent and aggravating — give bryonia, twenty drops; 



92 J>(>MINIOX MKDICAL :\rOXTIILV 

water, four ounces; a teaspoonful cvcrv hour or two. May apply 
a hot solution of magnesium sulphate externally. 

Pain in the region of the liver, miklly acute, little sluxiting 
pains, no great disturbance, tenderness on pressure or hy motion 
— give bryonia as above. Violent, agonizing pain in the liver, 
probably from gall stones, or the i)ain known as bilious colic, give 
half of a teaspoonful of dioseorea in a cu])ful of hot water, re- 
peated in from twenty to forty minutes. If not from obstructive 
causes, this will control the pain. If the pain is not aifected by 
the second dose, institute other measures as the administration of 
half of a dram of hypodermic lobelia. 

Pain within the abdomen, diffused, with soreness on ])ri'ssure; 
pains shifting, small, acute and cutting — apply heat and give 
bryonia persistently, as if peritonitis were present. 

Pain in the abdomen, extreme, cause indeterminate, difficult 
to locate, griping in character, very severe — give hypodermic of 
lobelia. This should relieve promptly. If it recurs after a short 
period repeat the dose. 

Pain in the abdomen radiating toward the umbilicus — nnx 
vomica, twenty drops ; water, four ounces ; a teaspoonful every 
half hour or hour. 

Colic pains in infants, no apparent disturbance otherwise — 
lobelia, five drops ; water, two ounces, a teaspoonf Jil every ten 
minutes. Colic in infants, with mild diarrhea or greenish par- 
ticles with the feces, colocynth tincture, five drops; water, two 
ounces; half of a teas]>oonful every five to ten minutes. A few^ 
doses will usually rclic\c. 

Colic in infants, with mure protracted diarrhea, greenish dis- 
charges, discharges induced by taking food — tincture of chamo- 
mile, ten drops; water, two ounces; a teaspoonful every hour. 

C<dic in infants, with large, watery, bowel movements, ex- 
hausting in character; skin inclined to be cool, patient feeble — 
arsenite of copper, one or two one-one hundredth grain tablets 
in four ounces of water; a teaspoonful every ten minutes. The 
effect of this remedy is very reliable and prompt. 

Pain in the liver of a very tensive character, dull, jjcrsistent, 
dragging — chelidonium, one to two drams; water, four ounces; 
a teaspoonful every two hours. If accompanied with tenderness 
on ])ressure add bryonia. If there be shooting ]>ains under the 
right shoulder blade also, add sticta. Chionantlius is especially 
indicated if jaundice be present, with or without ]iain. 



DOMIXIOX MEDICAL MOXTHLY 93 

Pain in the kidneys, dull, dragging, constant, with backache 
and soreness through the muscles of the lumbar region — gelse- 
niium and macrotys, from two to five drops of each, every hour 
or two, with hot applications. 

Persistent backache from the kidneys, the urine of high 
specific gravity, give these same remedies as above, with ten drops 
of hydrangea at each dose. 

Kidney colic from the jiassage of stone — give a full hypo- 
dermic of lobelia, repeated if necessary, without fail, two or three 
times an hour apart. 

For bearing down or dragging pains in the lower hypogas- 
trium — give helionias, two to four drams ; water, four ounces ; a 
teaspoonful every two hours. 

Painful menstruation, skin cold. i)atient chilly, extremities 
cold, pain at the beginning of the fiow or just before — belladonna 
in full doses; patient in a hot bath (with much care as to length 
of time). To equalize the circulation is a desirable thing. If 
the pains are spasmodic, with cold skin, as above, give hypodermic 
injections of lobelia. The tendency to this should be overcome 
by proper intramenstrual medication. 

For pain in the urethra on urinating, if following labor, give 
hydrangea, a dram in four ounces of water, a teaspoonful every 
hour. If accompanied with cystitis, in mild cases give gelse- 
juium and macrotys, one or two drops of each every two hours. 
If with chronic cystitis in the aged, severe, give thuja, eight drops ; 
chimaphila, ten drops ; in a teaspoonful of water every two hours. 

Pain with chronic cystitis in the aged, the urine very irrita- 
ting, alkaline in reaction, giving off an animoniaeal odor — dis- 
solve four grains of benzoic acid and six grains of borate of 
sodium in half an ounce of cinnamon water, and give this as a 
dose every two hours. The effect is almost immediate and highly 
satisfactory. 

Pain from spasmodic contraction of the urethra, acute, severe 
— give five to ten drops of gelsemium ; repeat in an hour, or 
inject a dram of specific lobelia deep in the urethra, allowing 
it to remain a short time. 

Pain in general should be relieved by a hypodermic of mor- 
phine after injury or after severe burns when the pain is likely 
to induce shock. 

Pain or any distress after surgical operations can often be 
relieved without inducing any discomfort or other unpleasant con- 
ditions, often controlling the post-anesthetic vomiting, by using 
the following simple combinations : 



9i DOMINIOX MEDICAL MOXTHLY 

R/ 

!Mori>hino grain 1. 

Sodium or strontium bromidt' drams ll/> to 2. 

Tr. hyoscyamus drops 10 to 20. 

Tr. capsicum drops a to 10. 

Svrup of tolu or simple elixir q.s ounces 2. 

!M. Sig. — A teaspoonful ewvy tifteen to twenty minutes to 
effect. 

I think this combination acts very similarly to very small 
rej)eated doses of H.M.C. I used it twenty years before H.M.C. 
was suggested, and have recommended it in hundreds of cases, 
and its influence is highly satisfactory, as it is difficult to get 
too much of a morphine influence or any other unpleasant effect 
upon the stomach. Those who cannot otherwise take morphine 
can take it with only goodly resnlts in this combination. 

General pain or local pain, either of uncertain cause, is greatly 
benefited by hot applications, if the surfaces are cold and the 
temperature of the body is low. This should always be borne 
in mind. Intense and persisted heat w^ill not only help restore 
normal conditions and relieve ]iain. but will ])ri'V('nt its recurrence. 



Acute Poliomyelitis. 

According to Dr. Schreiben (French correspondence. Medical 
Press and Circular) the prophylactic treatment consists in isola- 
tion of all contaminated ]iatients; and in times of e]">idemic, every 
jierson in touch with the patient should lie isolated. As the 
olfactive mucous membrane is loaded with the medullo virus, 
this region should be disinfected l)v the introduction into each 
naris of a pomade such as: — Solol, ^ dr.; menthol, 5 grs. ; vaseline, 
1 oz. Rest in bed, quinine for fever, aspirin or salicylate of soda 
for jiain, calomel, and hot baths. Tn the meningitic form, lumbar 
puncture may be useful. When the case enters on the period of 
repression, vicious attitudes must be corrected, and massage — at 
first very light rubbing — as the muscles are often sensitive; later 
on heavier pressure, the muscles com])letely relaxed by flexion. 
Gymnastic movements are good against ankylosis and muscular 
atony. Later the galvanic current will often be found useful, 
the negative pole being moved over the different paralyzed mus- 
cles. General treatment salt baths, friction, and geniral tonics. 



DOMIXIOX MEDICAL MONTHLY 95 

CONGENITAL ABSENCE OF THE FEMUR : REPORT OF FIVE 

CASES 



B. E. ^rcKENZiE, B.A.. M.D., Toronto. 



Bone defect, or actual absence of an entire bone, or of bones, at 
birth, is not very uncommon. Because the condition greatly dis- 
ables' the patient in some instances it is one of great importance. 
The etiology is shroudetl in mystery-. Nothing satisfactory by way 
of explanation is known to the writer. Four causes have been 
assigned with more or less coloring of satisfaction. 

1. Maternal impressions. 

2. Intra-uterine constriction by uterine bands, or from the cord. 

3. Local arterial disease ; or 

4 Some deficiency in the germ. 

From tlie point of view of a practical or clinical paper these may 
be passed ^vithout comment. Of the various long bones the radius 
is most frequently absent. Next in order of frequency are the fibula, 
tibia, uln-a, femur and humerus. 

Iloflfa in his Orfhopadisclu Chirurgh, published 1894, found ot 
the radius, 53 ; of the fibula, 45 ; of the tibia, 38 : of the ulna, 6, cases. 
He makes no mention of the congenital absence of the humeriLs or 
femur. Other writers on orthopedic surgery make but slight ref- 
erence to the subject, the literature being found only in scattered 
articles in medical journals. In the Xeic York Medical J o.u rnal oi 
Feb 20th, 1897, the writer published the reports of ten cases {vnth 
dissections) comprising absence of the following bones^radius, 
ulna, tibia, fibula, ribs and metacarpal Iwnes. At that time he had 
not seen anv cases of absence of the femur. 

In such* cases treatment naturally falls to the lot of the ortho- 
pedic surgeon. The fact, which is generally true, is manifest here, 
that very "little relatively can be done to l>enefit the upper extremity 
by surgical intervention, but the lower is quite amenable to treat- 
ment. 

\Vhen the defect in the upper extremity is such as to greatly dis- 
able a member it is possible in some instances for art to improve the 
condition, but seeing that the kind of action called for pertains to 
the finer and more delicate movements, artificial aids must be dis- 
appointing. In the lower extremity, however, a useful member in 
most cases can be secured by the aid of prothetic appliances. 



96 noMlNloN Mi:i>ir.\i. MnxrilLV 

AVlien the fibula is only defective and not entirely absent it is 
coiujuouly the lower part which is lacking, the leg thus failing to 
have its outer guard — the external malleolus — to keep the foot up- 
right in its place. This lack is readily supplied by a simple boot 
and brace. 

When only the lower portion of the tibia is lacking the knee joint 
is likely to be normal or nearly so. In these cases the deformed foot 
may be brought to a normal position and a boot and brac^e made to 
supplement the defective limb. If the entire tibia be absent the dis- 
ability is much greater. It will be recalled that of the tibia and 
fibula the former only takes part in the formation of the knee joint ; 
hence, in its absence there is no knee joint proper. Ii> such cases 
the femur has a poorly developed lower extremity, so that sometimes 
instead of the well expanded articular surface made up of the con- 
dyles it terminates in a pointed extremity. If the end of the femur 
presents a fairly expanded surface the upper end of the fibula may 
be removed from its position, and either the ends of the bones may 
be excised and by s^'nostosis a continuous bone from hip to ankle be 
substituted or by implantation the fibula may be brought into line 
with the femur. If now by correction of the deformity of the foot 
and the fibula, a correct alignment can be secured, and whatever lack 
there is be supplied by a brace, it is surprising how greatly the 
parts will develop so as to assume a function approaching the nor- 
mal. 

When the tibia is entirely absent, however, the remaining parts 
are usually so defective as to render ineflficient any effort to secure 
a weight-bearing extremity. In such a case it is better to remove 
by amputation the portion below the femur and pci-iuit art to sup- 
ply the lack. 

The femur may be altogether absent; commonly there is a ves- 
tige intervening between the acetabulum and the tibia. In such 
cases the gluteal and thigh muscles are bunched so as to present the 
appearance of a ball. If a portion of the femur be present it is 
directed nearly horizontally outward from the acetabulum and is 
not well under muscular contix)l ; there are two joints instead of one 
in the immediate vicinity of the pelvis and when the limb assumes 
the weight of the body there is a yielding similar to that seen in con- 
genital dislocation of the hip. Owing to this fact a prothetic appli- 
ance should be brought well undci- the ischium so as to carry the 
body weight more securely. 

In one of the cases shown here, not only is the femur absent, but 
the fibula also. The radiograph shows n rudimental bone above "the 



DOMIXIOX MEDICAL MONTHLY 97 

end of the tibia, which is probably a vestige of the femur and after 
further development it Anil probably establish a more intimate re- 
lationship with the acetabulum. In this case, although the fibula 
is absent tihe foot is complete in all its parts, but is strongly ab- 
ducted, so that if weight be borne upon it the inner border of the 
foot is brought into contact with the ground. 

In such cases a prothetic appliance can readily be made so as to 
render walking quite comfortable, and sueh as to avoid any very 
noticeable limp. In the case of children where growth is pretty 
rapid and where it is necessary to avoid any considerable expense a 
Thomas knee brace can be employed to meet all the requirements. 
The boy whose condition and brace is mentioned here It^arned to 
walk very readily almost immediately after putting the appliance 
on. In the ca.se of an adult where appearance is of greater 
importance and where growth does not render necessary so 
frequent a change of the appliance, an artificial limb can readily 
be adapted to tJie defective portion. The foot can be so directed as 
to bring its long axis into line with the tibia and the socket which 
is made in the artificial limb can be exactly adapted to the shape of 
the foot .so that the heel in this position can bear a very consider- 
able portion of the weight. If, in addition to this weight-bearing 
point, the ring of a Thomas braice comes into fairly close apposition 
with the tuberischii the weight of the body is very efficiently borne. 

Two of the cases seen were in yoimg infants and before the time 
when I could secure satisfactory radiographs. One is a boy of five 
years. A fourth was a boy about eight years of age whose condi- 
tion was very similar to No. 3 and was treated in a similar manner. 
The fifth here referreti to is that of a young man about twenty-five 
years of age, for whom an appliance was made which enables him to 
stand and walk without a limp which attracts much attention. 



Pneumonia. 

James Mitchell {Medical Record) treats pneumonia a> fol- 
lows, rest, support, and calcium chloride. With equal parts of 
milk and lime water, he gives 10 grains of calcium chloride every 
three hours. 



98 DOMiMOX :NrEmrAL :mo\tttta' 

THERAPEUTIC NOTES 

PlIOSPIIATURIA. 

Umber {Therapic des Gegen.) says that in tlie majority 
of patients suffering from phosphaturia, that hyperchlorhydria is 
present with general neurasthenia. Atropine has a pronounced 
action in increasing the acidity of the urine, and thus keeping the 
phosphates in solution. It reduces the elimination of the calcium. 
lie orders foods as free from lime as possible. The dose is from 
10 to 20 drops of a 1 per thousand aqueous solution of atropine 
sulphate after meals. This maximum dose he keeps up for two 
weeks, then gradually reducing it. The course of treatment ex- 
tends over three or four weeks. 



Gastric Flatulexce. 

Prof. A. Hirschler (Hungary correspondence Medical Press 
and Circular) reeonnnends the following for severe gastric flatu- 
lence, the treatment consisting in antiseptics, absorbent powders 
and laxatives: — Peroxide of manganese. grs. For one wafer; 
to be taken half an hour after meals. After the repast: — Pre- 
pared chalk, 15 grs. ; carbonate of soda, 8 grs. ; calcined magnesia, 
8 grs. For one powder ; to be taken in water or aniseed tea. 
In case of pain or burning in the stomach, opium and belladonna 
might be associated with the powders: — Prepared chalk of bis- 
muth, 15 grs.; calcined magnesia, 12 grs.; powdered opium, 1-5 
gr. ; powdered belladonna, l/£> gr. 



Tonsillitis. 

A. E. Buchanan (Medical Council) has had good success in 
the treatment of tonsillitis witli the following prescription : — Sodii 
salicylatis, grs. 10 to 15; tincture ferri chloridi, gtt., 10; 
glycerini, gtt., 15; aqua\ q. s., ad oz. 1, M. Sig. One such dose 
every two to four hours. To this he adds now one or two drachms 
of bicarbonate of jiotash, which gives a bettor color and enhances 
its medicinal value. Patients first drink half a tumbler of 
water, then the iron mixture, allowing the medicine to coat over 
the throat and remain there as a topical aj^plication, as well as 
an internal treatment. He also uses asjurin as a topical applica- 
tion, carefully aji})lied on a swab. 



DOMIXIOX MEDICAL MOXTHLY 99 

TRevievps 



Infant Feeding. By Clifford G. Grl-lee, A.:M., :\r.D., Assistant 
Professor of Pediatrics at Rush Medical College; Attending 
Pediatrician to Cook County Hospital. Octavo of 295 pages, 
illustrated. Philadelphia and London: TV. B. Saunders Com- 
pany, 1912. Cloth, $3.00 net. Sole Canadian Agents: The J. 
F. Hartz Co., Ltd., Toronto. 

One can quite agree with the author of this book that in com- 
bating infant mortality by infant feeding the most simple 
laws are the best, that each child is a law unto itself, and that the 
education of mothers is essential. The problem of proper infant 
feeding is apparently a great one when it takes a book of 295 pages 
to set it forth, and the physician must realize what he has got to 
knoAv in order to be able to Iwil it down for adaptation to each 
individual ca.se. There are chapters relating to the anatomy and 
ph.vsiology of the gastro-intestinal tract, the metalx)lism of the 
infant, tlie bacteriological tlora, breast feeding, artificial feeding 
in health and gastro-intestinal disturbances and nutrition in other 
than these disturbances. Li the book the scientific and the practical 
are combined. 



Laboratory Methods. With Special Reference to the Needs of the 
General Practitioner. By B. G. R. Willi.vms, :M.D., assisted by 
E. G. C. Williams, M.D., with an introduction by Victor C. 
Vaughan, M.D. Illustrated with forty-tiiree engravings. St. 
Louis : C. V. Mosby Co. 

A book on laboratory methods for the general practitioner, dedi- 
cated to the general practitioner and stamped with the approval of 
Victor C. Vaughan scarcely needs commendation from the medical 
press. 

An examination of this book, however, leads us to recommend it 
highly to our readers. It is neither an elaborate encyclopedia nor 
a concise and limited compend. It strikes rather the happy medium 
of full practicability. ^len in general work will find it just what they 
require for doing their work in a small, well-equipped home labora- 



100 i)():\ii\io\ :\iKi)U'AL .month i.v 

tory. There are exeelK'iit ehaptei-s ou simple water aualyses, every- 
day stool t<?sts aud laboratory prophylaxis, while that on private 
post-mortems is well worth the price of the book alone. It isi a 
volume of 204 pages. 



An Essai/ on Hashish. Inoludino: Observations and Experiments. 
By Victor Robinson, Contributing Editor Medical Review of 
Hi views, ete., Price, 50 cents. New York: Medical Ecinew of 
Be views. 

This little volume of 83 pages shows painstaking lalwr and re- 
search on the history, pharmacology and therapeutics of cainiabis 
itidica. Dr. Robinson's experiments and observations upon friends 
and himself are interestingly told. He does not tell us. however, 
why he gave thirty and forty minims to his friends, but only took 
twenty himself. Possibly he anticipated the more joyful delights of 
the smaller dose. 



Sexual 1 input tiui. By Victor G. Vecki, ]\[.D., Consulting Genito- 
urinary Surgeon to the Mount Zion Hospital, Sau Francisco. 
Fourth Edition. Philadelphia and London: W. B. Saunders 
Co. Canadian Agents: The J. F. Hartz Company. 

The ever-increasing interest manifested by the profession in the 
study of the normal functions and pathological conditions of the 
sexual organs necessitates the re-appearance at prompt intervals 
of the newest theories and ideas in regard thereto. Hence the 
present edition of this good book is timely. The book goes closely 
into the forms of impotence, diagnosis, prophylaxis and treatment. 



H)ominion /ll^eMcal /Ihontbl^ 



BnD Ontario fbcOical Journal 

EDITED BY 

Medicine: Graham Chambers, R. J. Psycliiatpy : Ernest Jone=, W. C. Hcrr 

Dwyer, Gold ^^ in Howland, Geo. W. man. 

lioss, \Vm. D. Yonng. Ophtiialmolog^y : I) N. Maclennan, W. 
Supgrepy : V\ alter McKeown, Herbert A }{ i owry 

icot?Geor/e E^waalnison'''*"*"" ^^ Rhinology. Lapynsology *nd Otol- 
Obst^tPics f °Sy ■■ Geoffrey Hoyd. Gilbert Royce. 

Arthur C.Hendrick. Gynecologry: F. W. Marlow, W. B 
Pathologry and Public Health : John Hei.dry. 

A. Amyot, Chas. J C. (J. Hastings, Genito Upinapy Supgrery : T. B. 

O. R M ibee. Geo. .Va«mvtli. Richardson, W. Warner Jones. 

Physiologrlc Thepapeutics : ^ ^ 

J. Harvey Todd. Anesthetics: SamuelJobnston. 

GEOBOX: EI.I.IOTT, MANAGING EDITOB. 

Published on the 20th of each month for the succeeding month. Address 
all Communications and make all Cheques, Post Office Orders and Postal 
Notes payable to the Publisher, GEORGE ELLIOTT, 203 Beverley Street 
Toronto, Canada. 



Vol. XXXIX. TORONTO, SEPTEMBER, 1912. No. 3 



COMMENT PROM MONTH TO MONTH. 

Osteopathy wa.s a .subji^ct dealt with in a comprehensivo man- 
ner by Dr. Bruce, President of tlit^ Ontario Medical As.sociation, in 
his address which we published in full in our July issue. It is 
quite true to assert that his remarks concerning osteopaths and 
osteopatliy in Ontario will be endorsed l)y the medical fraternity. 

Embodying the views of the medical profession a.s they do, they 
should command respect from the Legislature and should carry 
great weight with that body. 

The representatives of the people put the Ontario Medical Act 
upon the statute books in the interests of the public, but failed to 
define the practice of medicine. This error will be .sure to be 
remedied when the subject comes before the Legislature for final 
adjustment. 

At the last session. Dr. Jamieson introduced a bill which appar- 
ently has been misunderstood by many members of the medical 
profession, and as it was being promoted by the Ontario ^ledical 
Council, that body came in for criticism, as it was believed they 
wished to license the osteopaths already' practising irregularly and 
contrary to the law of the province. 



102 DOMIXIOX MEDICAL :\rOXTHLY 

How any iiu*mber of the medical profession can believe that the 
representatives of that profession seek to do injury to the profes- 
sion is beyond compreliension. The Medical Council is just as 
desirous as anybody else, yes, even as desirous as the university 
men, to conduct its affairs and the affairs of the profession to the 
best possible degree of perfection, and those who are continually 
and incessantly decrying its efforts do more than they may be aware 
of in bringing the Council and the profession into disrespect with 
the public. 

So far as legalizing osteopathy, or any system of healing, there 
is only one simple, safe rule to follow, namely, the same standard 
of matriculation, study, examination, and license for all. When 
that is carried out to the letter, the.y can practice osteopathy, homeo- 
pathy, musculopathy, arteriopathy, venopathy, or confine them- 
selves to diseases of the top of the head or the last joint of the 
big toe. 

No man should be licensed to practice medicine simply because 
he has been for a few years establislied in illegitimate practice. 
There should Ik* backbone enough in the man wlio gets liis l>ack to 
the wall and who is "honest enough to be bold and lK)ld enough to 
be honest" to hand out the square deal to a profession which all its 
livelong day has fought the battles of the people against the design- 
ing charlatan whose sole aim is to make money. 

From whence do all these cults come ? "Where is tlieir great 
breeding ground? The neighboring republic. It is the birthplace 
of Christian Scientists, Divine Healers, Eclectics, Homeopaths, 
Vitopaths, Chiropractors, Phy.sio-^NIeds. What not? Is it not sur- 
prising then that a stolid British-American would be led astray by 
one of such faddists? 

If osteopaths are to be licensed l)y Act of Parliament under the 
Ontario ^ledical Avt, why not the chiropractors et al? Why not 
the masseurs ? 

And then what alx)ut the other fads which are yet to come? 
Sojne one A\ili discover that stagnation in the veins and tlie deposit 
of silt is the true cause of all disease : then the venopathist will 
appear in the land. Tliis will prove to be another epoch-making 
discovery and will make for bleeding in a double sense. Fads will 
not cease to appear, for a fool and a faddist are born every minute. 

The people, however, will hope that their legislators will re- 
member the maxim: "One law for all." 

It is just about time the medical profession stood bj' its repre- 
sentatives with unanimous voice. 



DOMINIOX MEDICAL MONTHLY 103 

The third report on infant mortality, prepared by Dr. 

Helen MacMurchy for the Outario (iovcrniiient, is undoubtedly the 
Ijest upon the subject extant. Its prime object is to lessen or wipe 
out infant mortality, in so far as that can be done. 

This can best be brought about by the proper education of the 
mothers and a full realization of the fact that each child is a law 
unto itself. 

It cannot too strongly be pointed out that the most simple laws 
and rules are the best, for the multiplication o-f rules and direc- 
tions will only tend to confuse and discourage. 

Dr. Mac^Furchy says in this report a great deal of good may be 
done by giving the mother a leatlet. It would be far better to have 
large cards printed in bold type, which could be framed and hung 
up in some convenient place. These should state the simplest rules 
of guidance, and, of cour.se, must be in the language the mother 
can read or understand. Then they will be kept; leaHots are ea.sily 
lost or misplaced. 

As infant mortality occurs to a greater extent amongst the poorer 
and foreign classes, the necessity for printed rules in different 
languages is apparent. 

It would be a wise proceeding on the part of the Provincial 
Health Department to send a copy of Dr. MacMurchy 's report into 
at least every Englis-h-speaking family where a child is born. 



The proper handling of bread, advocated in these pages on 
several former occasions, has not so far a.s can be learned appealed 
to health oiificers. 

Bread is a universal article of diet, but more attention seems to 
be paid towards enfonnng the laws to protect fruits and other like 
food stuffs in shop windows from flies, dirt and dust. These are not 
the household articles that bread is. especially amongst the poorer 
classes. 

It is a nice point of table etiquette that no one .shall touch a 
slice of bread except for his own personal and immediate use. Bread 
comes to the table as an article of diet, unwashed, subjected to no 
cooldng in the household, after passing through many hands. 

Although contamination is abundant, public opinion has not yet 
demanded the .sanitary delivery of the staff of life. 

That bacterial contamination of bread has an element of danger 
there can now be no longer any doubt, for typhoid fever has been 
proven to have been carried by a bread-handler. 



lul DOMIMOX MEDICAL MONTHLY 

If oue can be satisfied tliat the haiuUers of bread are non-tuber- 
culaiu<. that they are not in. coutaet with any eomnumieable disease, 
that they are always free from any venereal disease, eleauily, scrupu- 
lous in their private hygiene, all danger could be considered as re- 
duceil to the minimum and the sanitary handling of bread a mere 
bugbear. This, however, cannot be guaranteed. Therefore, it must 
be worth while when so much is being done for the preventtion of 
disease thi-ough contaminated food stuff.s that the most universal of 
all be properly pi'otected. 

Each loaf should be completely wrapped, bagged or boxed. Un- 
wrapped bread carries countless bacteria ; wrapped bread, few. 

It is the plain duty of health officers to see that all bread is 
properly handled. 



Brill's disease, the new name for typhus fever, health officers 
and physicians .should he on the look out for, as it has' apparently 
been epidemic in many places of the United States, and the Chicago 
Health Department has recently issued a warning to physicians to 
be on their guard. 

This disease, the old famine or ship fever, typhus, is said to be 
of a mild type, and becf^use it has been investigated and re- 
ported upon by Dr. V. E. Brill, of Xew York, carries his name. He 
has observed 255 ca.ses in his vicinity Mnthout a single death. 

Being transmitted by the body louse, the disease necessarily ap- 
pears amongst the poorer classes, unlike typhoid which is no re- 
specter of the I'ich or the poor. 

The t^-phus virus is extracellular and free in the circulating 
plasma: while the serum of virulent typhus blood is constantly 
infective. 

The onset of the disease is sudden with chill or chilly sensations, 
body pains, increasing headache, the temperature reaching its maxi- 
mum on the third day. Here it remains between 103 and 104, 
sometimes as high as lOG. lasting foi- 12 to 14 days, falling mostly by 
crisis. 

On the 5tji or 6th day a maculo-papular rash appears, dull red 
in color, irregular in outline, usually ovoid, 2 to 4 in.m. in diameter. 
It is erythematous in character. 

The rash appears on the extremities and trunk, rarely on the 
palms and soles. The eruption is permanent until the end of the 
disease. 

With defervescence, the spots fade rapidly, leaving brownish- 
yellow stains often gone in 24 hours. 



DOMINION MEDICAL MONTHLY 105 

The age of most common occurrence is between 20 and 40 years, 
children being rarely affected. In the sexes it is about evenly 
divided. 

Practitioners noticing the appearance of this disease should re- 
port immediately to the health authorities. 



EDITORIAL NOTES 



AMERICAN TTOS;PITAL ASSOCIATION. 

At Hotel Ponchartrain, Detroit, Sept. 24-27, the American Hos- 
pital Association wiU hold its fourteenth annual meeting and present 
indications point to one of the most helpful and largely attended 
gatherings in the existence of the organization. The presidential 
address will bp delivered by Dr. Henry M. Hurd, Secretary, board 
of trustees, Johns Hopkins Hospital, Baltimore. 

Various reports will be presented by Dr. C. R. Holmes, Trustee, 
City Hospital. Cincinnati: Dr. Thos. Howoll. Superintendent New 
Yoi-k Hosjiital ; Dr. Wayne Smith, Superintendent City Hospital, 
St. Louis; Mr. J. R. Draper, Superintendent I^niversity Hospital, 
Ann Arbor, ]\rich. ; Dr. R. 0. Beard, Tniversity of Minnesota, Minne- 
apolis; Dr. S. S. (ioldwater. Superintendent ^It. Sinai Hospital, 
New York City; Rev. 0. F. Clover, Superintendent St. Luke's Hos- 
pital, New York City, and Dr. Frederick A. Wa.shbum, Superin- 
tendent ]\ra.ssachusetts Oeneral Hospital, Boston. 

The prograjnme is unusually good. It will include these papers 
among others : 

The Economic Features and Feeding of Hospital Employees and 
Patients. Dr. II. T. Suminei'sgill, Supt. Post-Graduate Hospital, 
New York City. 

Hospitals and their Duty in Relation to the Prevention of Dis- 
ease. Dr. Chas. P. Emerson, Dean of the Medical Department, Uni- 
versity of Indiana, Indianapolis. 

The Hospital lyaundry. Dr. AVinford H. Smith, Supt. Johns 
Hopkins Hospital, Baltimore. 

A Contribution' to the Problem of Convalescence. Dr. Frederick 
Brush. Supt. Burke Relief Foundation, New York City. 

The Use of Salvarsan (606) in Hospitals. Dr. R. R. Ross, Supt. 
General Hospital, Buffalo, N. Y. 

The Co.st of Infectious Diseases. Prof. Jas. W. Glover, Univer- 
sity of Michigan, Ann Arbor. 



106 iHtMIXInN Mi:ii|('.\L Mti.XI'llLV 

Tlie Keliitioii of tlic (Iciici-.il aiul S]i(N'iiil ll<)si)il;ils in the Care 
cf the Insane. Dr. C'has. K. Clarke, Siij)!. Cciieral Hospital, To- 
ronto. Canada. 

Hospital Orfraiii/.ation with Special Keferenoe to that of the 
Detroit General. Dr. W. F. ^Fetealf, Detroit, Mieh. 

The Qni>stion Drawei-. Dr. Alice Seabrook, Supt. Woman's Hos- 
pital, Philadelphia, Pa. 

Konnd Table Confti-eiice for Workei-s in Smaller Hospitals. ^liss 
Ix)nise lirent. Snpt. Hospital for Sick Childi'en, Toronto. Canada, 
and Miss Amv Armonr. Supt. New Ixochelle Hospital, New Rochelle, 
X. Y. 

The Grading of Nurses. INIrs. E. (J. Fonrnier, Supt. Minnewaska 
Sanitarium, Gravennur.st, Out., Canada. 

Dr. J. N. E. Brown, Supt. of the Detroit General Hospital, is 
the General Secretary. 



A:\rERICAX ASSOCIATION OF CLINICAL RESEARCH. 

The fourth annual nieetinsrof the American Association of Clini- 
cal Research will be held in New York City, at the Academy of 
]\Iedicine, on November 9, 1912. 

The sessions will be held from 9 a.m. to 1 p.m., from 3 p.m. to 
6 p.m., and from 8 p.m. to 10 p.m. The evening session will be open 
to the public. 

Notable contributions on the Negri Bodies, on certain Fluids for 
Tubeivle Bacilli in the Urine, on Ad.justment and Function, on 
Psychoanalysis and Traumbedeutung, on a Pandeanic of Malignant 
Encapsulated Throat Coccus, on the Single Remedy, on Indicanuria 
and (ilycosuria, on Disease Conditions expressive of Correct Diag- 
nosis, on Biochemic Problems, on the Two Most Far-Reaching Dis- 
coveries in Medicine, and others are to be given. Every member of 
the A.s.sociation is cordially invited to contribute a paper. The title 
should be semt at once to the Permanent Secretary, so that the pro- 
gramme may be completed. 

As soon as completed, the programme will be mailed to you. 
Plea.se make an effort not only to contril)ute a paper, but to be 
present at the coming meeting, to bring your friends, and to assist 
in the most important movement of medicine as repre-sented in the 
aim of our As.sociation, the systematic, scientific investigation and 
advancement of medicine by conclusive clinical and clinically-allied 
methods. 

Please invite your friends to become members. Your support 
and that of your friends will be cordially appreciated. 



DOMINION MEDICAL MONTHLY 107 

lRevv>8 Jtenis 



Sir William Osier will visit Toronto in September. 

Dr. Herbert J. Hamilton, Toronto, lia.s sailed for Europe. 

Dr. Samuel Johnston, Toronto, luus returned from New York. 

Dr. Charles E. Secord, New York, is visitinir in St. John, N.B. 

Dr. Wm. Arrell, formerly of Dunnville, is praeti.sing in Ham- 
ilton. 

l)i-. Ileihert W. Naneekivel, formerly of Ini^'ersoll. has moved 
to Foxl)ui'y, Sask. 

Dr. B. S. Elliott, Toronto '07, has moved from White Plain.s, 
N. J., to Vancouver. 

Dr. Frank Duston, of the Sprintitiijd, .Mass., IIos])ital, i.s visit- 
\u<x ill St. Steplien, N.E. 

Montreal is promotiiii? a new hospital for sick hahies under two 
years of a.ir''. It will have 200 beds. 

Dr. E. E. King, Toronto, will spend his holidays in August at 
his .summer home in Ha-slings C<i. 

Dr. C. F. Moore, Spadina Rd., Toronto, has moved to the house 
of his brother-in-law. Dr. Wm. Britton. 

Dr. A. C. Heiulriek and Dr. A. W. Maybury, Toronto, have 
returned fi-om a tri]) to the Old Country. 

llie Montreal Star has conducted a tiy campaign which resulted 
in tli(^ death of 25,000,000 of these pests. 

Dr. Charles G. Sutherland, South Porcupine, has been appointed 
Medical Superintendent of ]\Ioose Jaw Hospital. 

Professor James Playfair McMurrich, of the University of To- 
ronto, has been made Doctor of Laws by the University of Michi- 
gan. 

Drs. A. A. Weagaut, Ottawa, H. R. Casgrain, Windsor, and 
T. E. Kaiser, Osliawa. have been appointed members of the On- 
tario Board of Health. 

Dr. Sloan, Surgeon to the Central Prison, Toronto, has resigned 
after fifteen years' service. Dr. Jas. Algie, Toronto^ has been ap- 
pointed to the position. 



108 DOl^IINION MEDICAL MONTHLY 

Dr. A. T. Stanton, who has been doing research work on tro- 
pical diseases in the INIalay Islands in tlie interests of the British 
Medical Association, is visiting at his home in Newcastle, Ontario. 

AVe rearret to announce that Dr. Wm. Britton, Toronto, a phy- 
sician well-beloved by his confreres, ha.s retired from practice owing 
to ill-h'calth. lie is .spending tlie summer in Brantford and in the 
Autumn will tour the West. 

The American Medicine Gold I\ledal for 1912 has been awarded 
Dr. "Wm. C. (iorgas, Panama, whose public health work has been the 
most conspicuous of any work in the domain of medicine in- that 
country during the past year. 

The meeting of the Canadian Public Health Association will be 
held in Toronto, September IGtli, ITtli and 18th, and an interesting 
pi-ogramme will be presented. At the same time the Annual Con- 
ference of Medical Officers of Ontario 'wall be held. 

Dr. John N. E. Brown, Secretary of the American Hospital 
Association and formerly Superintendent of the Toronto (ieneral 
Hospital, has been appointed Superintendent of the Detroit Gen- 
eral Hospital. Congratulations to the D. G. II. 

Canadian physicians visiting in Ijondon, England, are : Dr. B. 
E. I\IcKen7Je, Toronto; Dr. J. A. Tanner, Vancouver; Dr. T. Shaw 
Webster, Toi-onto; Dr. W. L. Hatman, Montreal; Dr. E. Jones, 
A. C. Ilendrick, and F. W. Rolph, Toronto; Dr. Han ford McKee, 
Montreal; Dr. E. Pelletier, iMantrcal ; Dr. J. George Adami, Mont- 
real. 

Dr. Wm. C. Barber, for twenty-three years in the Ontario Hos- 
pital tor the Insane service, has established a new sanitarium at 
Barric, Out., to be known as "Siincoc Hall." This institution is 
beautifully situated close to Lake Simcoe, 175 feet al)ove its level 
and about 800 feet above that of Lake Ontario. Simcoe Hall was 
formally opened (ui the Gth of July. We wish Dr. Barber the full- 
est success in this new enterprise. 

The work of Dr. Alexis Cai-rell, of the Rockefeller In.stitute, New 
York, which Dr. Carrell recently presented before the Ontario 
Medical As.sociation, has attracted great attention from medical 
scientists in France. Leading biologists say that if the results are 
authentic, they form the greatest scientific advances of the genera- 
tion. It is proj)ose<l that a deputation of Freiieh biologists visit the 
institute in New York and determine tlial Di-. Cai-i-ell's claims are 
founded upon fact. . 



DOMINION MEDICAL MONTHLY 




Are you particular as to the condition of the iron in your 
Blaud preparations? 

Frosst's Perfected Blaud Capsules present True Ferrous 
Carbonate. 

Each 10 grain Capsule contains, approximately, 1 grain of 
Iron. 



xviii DOMINION MEDICAL MONTHLY 

Ipublishcrs' Bcpavtincnt 



The New Compound Terpene Peroxihe (CjoHioO.,.). — Every 
iiH'tliocI or rt'inedy before it is aeceptml l)y the medical profession, 
must withstand tlie battle of eriticism due to the skepticism of the 
ph.meian. One cannot help but feel that skepticism and thorough 
investigation aid in establishing the merits of a method or remedy. 
We need but (piote from medical history such men as Harvey, whose 
theory regarding the circulation of the blood was laughed at for 
years. Pasteur met opposition of the most pronounced type. Jen- 
ner did not have an easy tim*?. It took Laveran over fifteen years 
to get his ideas recognized concerning the transmission of malaria. 
Xot until Wright was collecting the left-overs from every clinic in 
the city of Ixmdon did the profession realize what an important 
stride he had hcli)ed them to make in the treatment of disea.ses when 
he announced the vaccine therapy. 

Dr. William Xeel, of Chicago, after years of imtiring labor, pre- 
siMited to the public an apparatus whereby the oxygen of the air 
could be concentrated and passed through the hydrocarbon oils of 
the Terpene group forming terpene peroxide. We are also glad to 
announce that the Xeel-Ai'iiistrong method of treatment for diseases 
of the raspiratory tract and wherever suboxidation is a prominent 
factor has withstood the battle of criticism and skepticism and has 
come out victoi-ious in tlii' end. The prudent physician will go by 
the law of cause and effect when he administers a medication, need- 
less to say if the active principles are not present the medicine is 
useless, but where the active principles are present the result of the 
medication must corres'pond. 

Teri)ene Peroxide is a new compound so far as tlmt a lucthoil of 
coml)ining the terpeiies. the active principles of llie .iiitiseptic oils, 
have never been put in combination with a surplus amount of oxygen 
in such a form that the patient enjoys the healing aiitis<'ptic (puili- 
ties of the terpenes on the inflamed or otherwise diseased parts with 
a surplus amount of na.scent oxygen, which is dire<'tly assimilated by 
the blood. There is no remedy analogous to tei-pene peroxide enjoy- 
ing that scope of medication. 

The Neel-Ann.strong Company, Limited, of Orillia. Ontario, asks 
that every physician acquaint himself with tlie method, and a.sk for 
further demonstrations, so that he can judge its merits for his own 
interest. 



DOMINION MEDKAL MONTHLY 



XIX 




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XX J)0MIN10N MEDICAL MONTHLY 

Mhs. ^LvcKiNNox's ]\L\SSAGE Institl'tiox, 20 Waliner Koad, 
Tonmto. Tolophone, CoUoge 7895. Mrs. Neil MacKinnon, for 
many yi-ai's a specialist in all branches of inassajje, having received 
lier training in the Old Country, has within the past few months 
opened an institution in this city at the above address. AJl forms 
of massage, including electrical, electric light, and needle spray 
l)aths are administered in this iiistitution under her personal super- 
vision. The location of her institution is one of the best that could 
be desired, and there is a beautiful conservatory with a southern 
exposure. There is a masseur in attendance for male patients. The 
rooms are large and sunny, the appointments being especially tasty 
and well adapted for carrying on such work. Physicians are in- 
vited to visit and inspect for themselves. 



The Hay-Fever Kiddle. — Despite the many therapeutic ad- 
vances of recent years, "what to do for the hay-fever patient" con- 
tinues to be something of a puzzle. Tlie long-.sought specific still 
eludes us. Nevertlieless, the malady is not (luite the enigma that it 
once was. Medic<ition, if still empiric, is not ineffective. The 
.symptoms of the disorder can be controlled or minimized; relief, 
tliough temporary in many cases, may ])e obtained, and for these 
blessings the afflicted patient and the sympathetic physician may 
well be thankful. For use in the treatment of hay fever there is, of 
course, a long line of so-called available medicaments. One depend- 
able agent whicli comes naturally to mind in this conneetion is 
Adrenalin. Indeed, it is doubtful if any other single medicinal 
.substance has been so largely and successfully employed in the 
treatment of vasomotor rhinitis. As adapted to the needs of the 
hay-fever sufferer the product is available in a number of con- 
venient forms, as Adrenalin Chloride Solution, Adrenalin Inhalant, 
Anesthone Cream, Anesthone Inhalant, Anesthone Tape, etc. The 
various solutions are used in spraying the nares and pharynx, the 
cream for snuffing into the nostrils, the tape for packing the nos- 
trils. All cases of hay fever, of course, are not amenable to the 
same form of treatment. It is a logical presumption, however, that 
a vast majority of them ought to yield to one or more of the 
preparations above referred to. The Adrenalin products, as is well 
known to most physicians, are maim fad ured l)y Parke, Davis & 
Co., who will doubtless be glad to send literature regarding them 
to any practitioner. Requests for printed matter may be addressed 
to the company at its otHces and laboratories in Walker\'il]e. Out. 



DOMINION MEDICAL MONTHLY 



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xxii DOMLNION MEDICAL MONTHLY 

Famol's Paintincs. — This yoar's display at the C. X. E. is iu ad- 
vance of other years. The list of paintings coming from Europe 
for this year's Canadian National Exhibition fairly bristles with 
famous names. There are forty paintinirs loaned by tlie French 
Government, while such names as Lord Leighton, Sir John ]\Iillais, 
Orpen, etc., make the British collection even more interesting than 
usual. The display of art on the whole promises to be well in ad- 
vance of any previous exhibits. 



Poultices Should Be Sterile. — Prof. George Howard Iloxie, 
of the University of Kansas, in his most excellent book on "Symp- 
tomatic and Regional Therapeutics," states under the heading of 
localized intlammation that "the danger of infection should ever 
be in mind in applying a poultice, for the maceration incident to 
the poultice favor.s infection, even if in ordinary circumstances one 
might consider the area germ proof." Again he refers under the 
chapter on Pain, to the dangers from using dirty poultices and that 
skin affections have been added to the ordinary disorder when 
bread-and-milk or lin.seed poultices have been used to relieve pain. 
It is thus noted how important then, it is, in the employment of a 
poultice for the relief of pain and intlammation, that a sterile and 
trustworthy product be applied. Inasmuch as poultices are a 
means of producing Hyperemia by the use of heat and insofar as 
they do this better than by other means, it is interesting to oljserA'e 
that in the belief of Prof. Hoxie "the clay poultices, known 
best in the form of Antiphlogistine, are the best to employ, as they 
are sterile and clean." Antiphlogistine affords not only a safe but 
clean method of utilizing the advantages of hot moist heat in the 
treatment of pain or intiammatory conditions. It maintains heat 
in contact with the part for hours and its adaptability is only 
secondary to its therapeutic value. 



Wonderful Programme. — Great List of Special Attractions for 
the C. N. E. The programme of special attractions for the Cana- 
dian National Exhibition has just been issued. It is featured by 
the Imperial Cadet Review and Competitions with representative 
corps from all parts of the Empire, and the two famous liands from 
England, the Scots Guards Band and the Besses 0' Th' Barn Band, 
but these are a small part of the programme. There Is enough 



DOMINION MEDICAL MONTHLY 



xxui 



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BOVRIL renders valuable aid in the digestion 
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Really, is the best any too good for occupying the place of honor 
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There is no finer, more cleanly fabric than linen, and since in the 
making of Deimel-Mesh the chill has been removed, there is no safer 
and more protective garment than the Dr. Deimel Underwear. 

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xxiv DOMINION MEDICAL MONTHLY 

vaudevilli' for Imlf a dozen ordinary sliows, a liistorieal spectacle, 
the Siege of Delhi, sixty nunihers of Imperial fireworks nightly, 
Wellintrton's Zouaves, tlie Cadet Tattoo, Motor P>oat Races, Swim- 
ming Races. War Canoe Races, At'detie ]\Ieet. Baby Show, etc. It 
is a truly wonderful programme. 



LiMK Water vs. Phillips' ^Iilk of ]\I.vgxesia. — Lime water, 
according to the 8tli decennial revision of the U. S. Pharmacopeia, 
should contain not less than 0.14% of pure Calcium Hydroxide ca 
(OH) 2, about 10 grains to the pint. The percentage of Calcium 
Hydroxide varies with the temperature at which the saturated solu- 
tion is prepared, being 0.17%, ahout 12 grains to the pint at 15°C. 
(59°F.), and diminishes as the temperature rises. 

In over 100 samples of lime water obtained from reputable phar- 
macists the amount of Calcium Hydroxide varied from 1 to 11 grains 
to the pint, 75% examined was below standard strength and in sev- 
eral the percentage of lime was so low as to make the preparation 
practically worthless. 

Phillips' ]Milk of Magnesia is a hydrate containing not less than 
24 grains of pure ^Magnesium Hydroxide (Mg 11, Co), to the otmce. 
A tea.spoonful is eciuivalent in acid neutralizing power to about 
6 ounces of lime water of standard strength. 

"50 e.c. of lime Avater require for complete neutralization not 
less than 19 e.c of tenth-normal Sulphuric Aeid V. S. (correspond- 
ing to alxtut 0.14% of Calcium Hydroxide), phenolphthalein T. S. 
being used as indicator" U. S. P. 

50 CO. of Phillips' Milk of ^Magnesia require for complete neu- 
tralization not less than 900 e.c. of tenth-normal Sulphuric Acid V. 
S. (corresponding to about 5% ^Magnesium Hydroxide), phenolph- 
thalein T. S. being used as indicator. 



Ei^CTRiciTv ON THE Fahm. — Hydro-Electric will demonstrate at 
the C. N. E. Just how electricity can be utilized on the farm will 
he fully shown at the Canadian National Exhibition. The Hydro- 
Electric Commission have taken a large space in the Process build- 
ing where all kinds of farm machinery will be run by the white 
juice from Niagara. It will be a demonstration no up-date farmer 
can afford to miss. 



1 1^- 

iDominion /Iftebical /Il^oiubl^ 



anD Ontario /IBeDical journal 



Vol. XXX fX TORONTO, OCTOBER, 1912. No. 4 



Qrioinal Hvticlcs 



HfPEREXTENSION OF THE KNEE FOLLOWING HIP DISEASE* 



By B. E. McKexzie, B.A., M.D. 

Senior Surgeon, Toronto Orthopedic Hospital. 



Hyperextension of the knee .ioint, or, as it is called, genu re- 
C'lirvatum, is seen not infrequently in persons who have been con- 
fined to bed in the supine position for a considerable lenorth of time. 
Examination of t'his young woman's condition and enquiry into 
her history reveals interesting causes as explanatory of her 
condition. 

H. J., fourteen years of age, had scarlet fever five years ago, 
followed by disease of the right hip. She was treated \yy recum- 
bency in hospital for nine weeks, followed by a brace, which was 
worn for a year. The hip now presents no evidence of present 
disease. The thigh and leg show a moderate degree of atrophy. The 
right femur is one-half inch .shorter than the left, and the tibia 
slightly shorter than its fellow. The proximal articular surface 
of this tibia is shown in a radiograph as altered in direction. If a 
normal tibia be held vertical it will lie seen that its upper articular 
surface slopes backward and downward, whereas the corresponding 
surface in this bone slopes downward and forward. The radio- 
graph shows also an area of increased density at the anterior portion 
of the bone, just below the tubercle, at which point the tibia is bent 
so that its anterior surface recedes and is concave, whereas in the 
normal bone the anterior border of the bone here presents a con- 
vexity forward. 

A probable explanation of the altered direction of the superior 
articular surface is afforded if we assume that the kiiee was allowed 

♦Note. — Interesting case shown at the Saturday clinic at the Toronto 
Orthopedic Hospital. 



11(1 DOMINION Mi:iMl'AL MoNIIILV 

to heeomo hyperextendiHl wiiiJe tin- patient was i-t'cunilx'iit in the 
supiiit' jiositioji miller treatment for liip ilisease. 

1. Tliereby inereased pressure wlu'ii \\eiirlit-l>eai-iii;r was re- 
sunu-il would come upon the anterior part of the articular surface 
of the tiliia. 

2. This iiu-reased pressure would tend to depress the anterior 
portion of the enlarged extremity of the tibia and alter the dire<'- 
lion of the articular surface. 

3. It would also cause greater compactness, and pr()l)al)ly early 
synostosis at the anterior part of the epiphyseal junction. 

4. It would thus cause .shortening of the tibia, especially at this 
anterior part. 

During the course of disease at the knee it is well known that 
the increa.sed congestion of the part bringing more pabulum to the 
chief growing areas of both tibia and femur, causes relatively 
increased length, so that the affected liml) in sucli a case is usually 
longer than its fellow. Disease at the hip .joint, however, on the 
other hand, causes so much interference with the nutrition of the 
entire lindj that growth, both in circumference of the bones and in 
their length, i.s retarded. The continuance of the hip disease during 
some years of the actively growing period of life has so interfered 
with the growth of the limb as to make this one about an inch and 
a half shorter than its fellow. 

The disal)ility of the lind) in this palieiit resulting from hyi)er- 
extension. from atrophy, from shortening and from disease, wa-; 
very marked, and it was on this account tliat advice was sought. 
The girl's general condition was fairly good, thougii she was not 
robust. She used a crutdi in walking, and could accomplish but 
little without its aid. 

Tiu:atmknt. 

The method of treatment adopted was to i)erform ostL'Otomy of 
the tibia innuediately below the tubercle, and so alter the align- 
ment of the tibia at this point a.s to make a considerable ellww 
there, the .salient angle pointing forward, thus restoring the nornud 
convexity. This was made sufficient to fully overcomv the degree 
of hyperextension. During the weeks while laid up with a fixation 
dressing applied, tiie knee was kept flexed at an angle of about 
thirty degrees. I have no doubt that tihe ligaments and other 
structures of the posterior a-spwt of the joint shortened somewhat 
during this period. These causes, together with the change in 



DOMINION MEDICAL MONTHLY 111 

alignment of the tibia, proved sufficient to over-correct slightly the 
genu reeurvatum, and a few months later she was waUcing with a 
consciousness of increased power, and control was gradually 
returning. 

Disability at the knee joint when there has bt-cn no disease affect- 
ing the part is due occasionally to laxity of the ligaments and other 
structures which should keep the bones which enter into its forma- 
tion in close and firm apposition. The causes doubtless are varied. 
One of the most frequent, however, is faulty nursing while con- 
fined to bed supine. It has often been stated that extension 
applied to the lower extremity in .such a way that the femur is not 
grasped is responsible for this relaxed condition of the knee joint. 
For several years, however, the writer has so applied the power, 
when extension is required, as to grasp the leg only at a point 
just above the ankle joint by means of an anklet or gaiter fitting 
comfortably that part and forming the fixation to the limb for the 
traction force. As a result, disability has never been seen at the 
knee joint. While thus recumbent a small pillow or pad should be 
placed under the knee, so that a slight degree of flexion should be 
constantly maintained. The disability and laxity of the joint is a 
result of hyperexten.sion rather than of direct traction made upon 
the joint. 



ST. LUKE'S GENERAL HOSPITAL, OTTAWA, NURSES' 
GRADUATION, MAY, 1912 

Address by Dr. K. W. INavell. 



The graduation exercises at St. Luke's General Hospital this 
year took place in the hospital on ^lay the loth, and were honored 
by the presence of Her Royal Highness the Duchess of Connaught, 
who presented each candidate with her diploma and medal. 

The chair was taken by Sir Louis Davies. in the absence of ^Ir. 
J. R. Booth, the President of the hospital, and the proceedings 
were opened by Sir Jjouis with a few words of welcome to Her Royal 
Highness. 

Dr. W. C. Cousens, Chairman of the ^Medical Board, then read 
the official returns of the standing of the nurses, and administered 
the Florence Nightingale pledge to the graduates. 

The nurses presented Her Royal Highness with a handsome 
bouquet of roses, and this was followed by the presentation of the 
lecturer's prize to Miss Edith Extou, of Leeds, England. 



IIV DOMINION MKDICAL MONTHLY' 

The names of the graduates were: ^liss P. ^lott, Ayliner, Que.; 
^fiss M. ^FeKinnon. :\Iiss F. Vance, Miss F. :\IeConnell. Miss M. 
Owen. Miss C. Latimer, Miss L. ^NfeDermott, Miss F. Sheridan, Miss 
F. West, and ]\Iis8 E. p]xton. 

The Chairman then failed upon Dr. Robert W. Powell to ad- 
(Ire.ss the nurses in valedictory. 

Dr. Powell, on risiuja:, said: 

May it please Your Royal Highness, ^Ir. Chairman, Ladies and 
Gentlemen, — 

Like others who luvve preceded me on this interesting oei-asion, it 
seems incumbent upon me to offer an apology for my appearance 
to-day to say a few words of encouragement and of farewell to the 
graduating class. 

The Board of Governors and the Medical Board, whicii, 1 may 
say, has some administrative functions in this institution, have 
thought it a great pity that this present class of young ladies should 
be allowed to escape from the hospital without a few words of 
advice and farewell from the Secretary of the Board, and one who 
has taken in the past a deep interest in all that concerned the 
education of the nurses. 

My colleagues on the Medical Board are by nature a retiring 
body of men when such fuiK'tions as the present have to be under- 
taken ; but in some other walks of life, when they appear dressed 
in oflficial garb, with white operating gowns and rubber gloves, they 
are not so retiring in disjiosition. Then again my enforced alisenee 
from the graduating exercises for the past two years gave them 
an opportunity to do me a favor and good turn, from their point 
of view, and to allow me to take advantage of this occasion to blow 
off some bottled steam. 

This class of 1912 graduates are particularly to be congratulated 
that the gracious lady occupying the most exalted position in Can- 
ada now has so generously consented to be present to-day to deliviT 
personally to the members of the class their diplomas and medals, 
and I am sure no one who thinks on the subject at all can fail to 
realize what an occasion such as this must mean to the young ladies 
before us, and how it must be a stimulus to them, accentuated as 
the day is l)y the presence of royalty and by the countenance of all 
the friends whom they most value, to so fashion their future con- 
duct and career that none of us will ever regret having been present 
on this interesting, and more or b^s solemn, occasion. This present 
class have not had the opportunity of listening to me from the 
lecture platform, as has been my custom, and that is a still further 



DOMTXIOX MEDICAL MONTHLY 113 

reason why I may be pardoned if I speak a little at length to them 
to-day. 

My first duty, of course, is to congratulate you, and I do so 
from the bottom of my heart, on having to-day attained the goal of 
your hopes and aspirations. It has been a long and weary fight, 
accoiiiplihhed under all sorts of disadvantages, but you have con- 
quered all obstacles and have come forth with flying colors. We 
realize only too well what these di.sadvantages have been, but we 
have been powerless to avoid the conditions. We are a modest 
institution, in size ?nd ecjuipment, and we have not been able to 
offer certain advantages attainable in other larger and more 
favored 'hospitals. Your accommodation here is unsuitable and 
cramped, and your opportunities for rest and recreation very 
limited, but you have accepted the situation loyally, and have sur- 
mounted the disadvantages of the situation, and have realized, I am 
sure, that we have given you in your education the best that we had. 

Coming to closer ciuarters, it seems opportune to say that the 
cross words and black looks and irritability of temper shown at 
times towards you have been a necessity. In the first place, it is 
inseparable from your training, and while many a night you have 
laid down your aching head on your pillow, almost determined to 
retire from the tight, yet other occasions of triumph and well-doing 
have been accomplished by light hearts and glistening eyes when 
you were connmended. This adverse criticism has been primarily 
done for the benefit of the sick under your care at the time, and for 
those who may hereafter ])e under your care, because it is esential 
that orders must be faithfully obeyed and executed, and firm dis- 
cipline maintained. If it were otherwise, the whole hospital machin- 
ery, often very delicate, would absolutely run riot. Recollect that 
you are not singular in the making of errors; it happens to all of 
us; it is a necessity of our human nature. There is a well-authenti- 
cated record, buried, I hope, deep down in the archives of St. Luke's 
Hospital, that our present estimable Lady Superintendent once 
made a mistake. Is not that wonderful ? Is it not a source of 
encouragement to us all .' I fancy, if the truth were only known, 
the same might be said of her capable assistant in the work. They 
are none the worse for it, and neither are we. When a vacancy 
was created in the office of Lady Superintendent of this training 
school, owing to the lamented death of ]\Iiss Chesley, we chose one 
of our distinguisihed graduates, whom we knew so well, and one 
who had filled the position of Assistant Superintendent so satisfac- 
torily, and offered her the position at once. His Grace the Arch- 
bishop, here with us to-day, will be able to tell you officially what 



114 nOMlMo.N MKDICAI. .Mt ).\lll LV 

I am only able to tell yon as a layman, that mistakes in administra- 
tion ooeur to all of us, and that "angels once fell." So there is 
hope for us all. and irreat eiu-onratrement. Positions whieh others 
have secured by honest, painstaking devotion to duty are attainable 
by any one of you here before me to-day; but remember, only by 
the sanu^ process and thron<rh similar channels. 

The grate of the pasture has been unlocked for you to-day l)y 
Iler Royal Higrhuess, and it is for you now to enter the field and 
so perform your daily tasks that your good labor will be recoirni/.i^l 
by its fruit. A great many thoughts arise in my mind that I would 
like to emphasize, but I must be content with a few salient points, 
and some that I hope you will remember. 

This is a solemn occasion. The pledge that you have just volun- 
tarily taken places the seal of solemnity on the whole proceedings. 
You have undertaken before (Jod and before this as.sembly that you 
will fashion your practice and your lives on certain well-recognized 
high principles; .see that you have not taken this pledge lightly or 
wantonly. I well renu^mber the day, many years ago — I won't tell 
you how long — that I stood up before my teachers and solemn Dons, 
Fellows and Professors, and took the Ilippocratic Oath preparatory 
to receiving my degree, I felt it to be a very solemn moment, and 
I there and then determined that I would, to the l^.st of my al)ility 
and powers, so conduct my life in matters professional that I would 
not bring the blush of shame on my teachers or my college, who had 
given me of their best, and T would wish you to adopt the sanu^ atti- 
tude now to-day. and take your life, as regards your chosen calling, 
seriously. 

There is a snuil! part of your amitoiiiy situated in a cavity 
between your nose and your chin, called the tongue, and while it 
has been called l)y the Psalmi.st of old "the pen of a ready writer," 
I think St. Paul's definition is more to the point as regards the 
human race, and he indeed must have had great powers as a diag- 
nostician of rare perception when he termed it "the unruly uumu- 
ber. " It is capable of getting us all into more trouble in a .short 
time than any other oiu^ organ we possess, and its powers for evil do 
not stop there, but it gets other people into trouble as well. Keep 
strict guard over it and see that when occasion requires it is well 
in harness behind your teeth and the reins drawn tight. If it ever 
gets loose it is apt to wag incessantly, and nearly alwa^is at the 
wrong time, and, moreover, what it utters cannot as a rule be 
amended. 

When on business, stick closely to what you have on hand, and 
if your eyes see, or your eai-s hear, matters not intended for you, 



DOMIXIOX MEDICAL .MUXTHLY 11^ 

i)iit whieli you cannot help observing, be careful that you keep the " 
information strictly to those organs, and do not pass it on to your 
voice apparatus, over which your "unruly member" presides with 
so much power. Xo matter what your other qualifications are — 
your physiciue, your carefulness, your endurance, your watchful- 
ness, your wide sympathy, your tenderness, or your devotion to 
duty — you will be useless as a trained nurse and absolutely un- 
fitted for private practice if your tontrue rims away with your 
judgment, or your discretion, and you will at once lose your intiu- 
ence and your power for good, and confidence in you will be 
destro\-ed. 

Besides all this, remember that a talkative, parrot-like nurse is 
abhorrent to most patients who, when ill, as a rule, care not to be 
entertained in this way, especially if the subject of conversation is 
other people's affairs. Tale-bearing and chattering about what you 
see in other people's houses, while it may tickle the ears and 
imagination of a certain class of people, is an abomination that 
ought not to be tolerated for a moment as part of the make-up of 
the trained nurse. In fact, to do these things is at once to adver- 
tise your.self a.s quite untrained. 

You nuiy rest assured that medical men will not befriend you, or 
employ you, if they once realize that you are of this type of dan- 
gerous citizen. The devil — I apologize — I did not mean to even 
mention the gentleman's name — but let us call him the captain 
of the lower regions. Well, the great trouble with him is that he 
is not domesticated ; he will not stay at home. 

I presume, if all reports are true, that home is not too attrac- 
tive a place for him ; the atmosphere is close and sticky, and even 
in winter it is apt to be sultry, and the eon-secjuence is that he is 
constantly leaving his abode and putting in an appearance on this 
Fair world, and poking his nose into other people's business, and 
buzzing about, making him.self very objectionable. He ought to 
be kept in his place, and each time he shows himself above ground 
he ought to be cracked on the head and made keep quiet, and be 
told politely, but firmly, that he is ''dc trop."' If all the human 
race would adopt this attitude he would soon tire out and sink to 
his own level, and finally be annihilated and suffocated in his own 
en\-ironment. It is the encouragement he receives by our mis- 
doings that gives him pabulum for existence. He is frightened at 
anything .savoring of a reversal of his schemes. This is the idea 
underlying the two lines of Cowper's beautiful h\nun : 
"And Satan trembles when he sees 
The weakest saint upon his knees." 



IIG DOMINION Mi:i»l('.\L MoN'l'lll.Y 

This ustil to be rendered "sinner," hut we are getting better 
now. jind we are termed "saints." I liear someone say: "What is 
Powell drivini^ at?" It ou^'lit to be manifest. 

If you were a elass of graduates in Arts, or Science, or Domestic 
Economy my mind would in all probability be drifting in another 
iliriH'tion ; Init it is because you are a clas'S of graduate nurse's that 
I am talking on these lines. Do not imagine for a moment that 
your Creator will place you on a pedestal, safe from temptation to 
do wrong; not at all. The time may be short or long, but come it 
will, and that sooner than you possibly dream of; and be saire that 
you make up your mind now, at once, firmly and boldly, that the 
very first suggestion will be tlirown ])ack with the scorn it de- 
serves, and that you will luirl tlic tempter from you. Each re- 
versal for him weakens his power and reads victory for you. and. 
iiioreover, the victory is easier on each successive occasion. 

Your conscience comes to your rescue and strengthens you for 
the next battle. The temptation may assume many a subtle form — 
at one time financial, another time enhanced worldly power or posi- 
tion, and next some other insidious suggestion of advancement in 
what you most prize and value. Always adopt the same attitude ; 
tell the approacher, who is an emis«ary for the special occasion, and 
often chosen with intelligent discrimination to soften the blow, that 
the application has come to the wrong door; that he or she must 
descend a bit lower down the avenue of life and keep on descending 
till one is found on a level equal to tlie proposer of ill deeds: that 
you are trained on different lines and do not consort with sordiil 
creatures, or low and vulgar people. 

The Florence Nightingale lamp must be ever well oiled and ke])t 
lighted in your hearts and homes, and with her, the earliest lady 
nurse whose works have followed her, and whose name will go down 
to posterity as a shining example of a stirring devotion to duty, 
and a life budding and then blossoming with shining crystals of 
fortitude and Christian excellence, as your guide and beacon, and 
with the memory of to-d«y kept bright and bui-nislu'd. and the glad 
faces enjoying your happiness and extending to you tlieir sym- 
pathy, and above all with the recollection of tlie gracious royal lady 
who, at personal inconvenience, has come to-day to preside at your 
graduation and speak her personal congratulations, surely you must 
be termed fortunate graduates of St. Luke's, and such a day must 
strengthen and fortify you for your life's work. 

You have to-day placed your foot on the first rung of the ladder 
that leads to success or failure, and I want you to determine well 
that you will work with all your might and main to achieve success 



DOMIXIOX MEDICAL MOXTHLY IH 

in vour noble calling. Take hold of the ladder with both hands 
and never let go as voii proceed to climb upwards. Be caretul you 
don't slip You are not likely to do so from the first rung, as there 
is not uLuch space below; but as you go on you will find some of 
the rungs thornv and slippery— yes, and some even slimy— and 
thev become difficult to negotiate. The lower rungs, also, are 
crowded, and you are liable to be pushed off to one sid^ or the 
other in the scramble. 

If vou come down a rung or two through carelessness or inat- 
tention, or, what is worse, by doing that I hinted at a Avhile ago, you 
will find it difficult to recover the lost ground, and more than that, 
the wav becomes even more beset with ditHeulties than it ever was 
before' Keep vour eve always on the top rung. What others have 
attained to you can accomplish. Your motto must be "Onward 
and ever onward; upward and ever upward." There is always 
plenty of room at the top for all of us. The lower and middle rungs 
of life are crowded, but as you pass the rubicon the atmosphere is 
dearer; the air is lighter; breathing becomes easier. So much is 
this the case that the remark has become a truism. When we get 
over a difficultv or surmount an obstacle that was causing anxiety 
we sky, "I breathe more freely now." We have an example of the 
top rung here with us to-day, and the head of the Anglican Church 
in Canada has not attained to his lofty and dignified position with- 
out much patient care and laborious, persistent effort. He can show 
forth personally to-day in our midst what I can so feebly put into 
words, viz., that there are plenty of priests and deacons, but very 
few archbishops. 

Finally, voung ladies, let me beg of you to keep a warm place 
in your hearts for your Alma Mater, she who has given you birth 
to-dav ; she needs vour a.ssistance and your sympathy. She rejoices 
with Vour triumphs ami your successes and grieves over your down- 
falls 'and your failures; she feels her responsibility more keenly 
than vou imagine; she is anxious for your welfare, but is also 
jealous of her own reputation ; she is the one, you graduates are the 
manv ; she has not been in a position to do all for you that she would 
have wished, but she has done what she could %nth the opportmuties 
she possessed, and what she has done she has done ungrudgmg-ly. 
She expects in return your loyal attachment and real support ; not 
only a lip support, which is easy to give and costs nothing, but a 
support from your heart and your brains that may cost you some 
small sacrifice at times. 

You will have in life no better friends than the authorities of 
this hospital, who will now watch your e-areer with eager hope and 



lis DOMIXION MIllHCAI. MOX'I'III.V 

high expectations. Don't rewjird us tlie wronu: ^vay; don't sully 
the name of St. Luke's, but uphold the institution in every possible 
way and advance her interests whenever opportunity offers; don't 
brincT the blush of shame to our faces by unladylike actions, loose, 
wanton conversation, or grievous misdemeanor; but conduct your- 
selves after the pattern O'f those good women of old and also of 
those of modern days, who never weary of well-doing, and who keep 
themselves spotless and untarnished in their character. The world 
knows nothing finer than a kind, sympathetic, good-looking, modest 
and chaste woman. 

]\ry last word is on my tongue, and I am done. If you find 
yourselves, soon or late, in trouble or distress of any kind, be it of 
mind or body, be it moral or physical, or financial, the hand of 
fellowship will be held out to you here and always and forever. 

Where can you turn for succor in time of anxiety and need if 
not to her who gave you birth? And if this is true of your human 
frame, and applies to your nature as woman, it is equally true and 
forcible that your scholastic mother, St. Luke's Hospital, in its 
corporate capacity, as well as individually by its members, will ever 
lie faithful to its responsibilities for you and proud and glad to 
have the privilege of helping you in time of need. 

Young ladies, farewell. 



DOMTXTOX :NrEDICAL MOXTHLY 119 

CANADIAN PUBLIC HEALTH ASSOCIATION 



The second annual meeting of this Association was held in 
Toronto od ^londay, Tuesday and Wednesday, the 16th. 17th and 
18th of September. 

The public address was given on the evening of ^londay, Sep- 
tember 16th, by Dr. W. A. Evans, of Chicago, who is recognized 
as one of the foremost public health authorities in America. The 
President, Dr. Charles A. Hodgetts, ^Medical Adviser to the Com- 
mission of Conservation, Ottawa, delivered his address on Tuesday. 

The meetings were held in the Medical Buildings of the Uni- 
versity of Toronto. 

The Annual Conference of Medical Officers of Health of On- 
tario was held in connection with this meeting. 

1. — Sectiox of Military IIvgiexe. 

J. T. Fotheringham, Lt.-Col. P.M.O., A. M.S.. Chairman. 

Paper — G. Carleton Jones, Col. A. M.S., D.G.M.S., Canada. 

"The Sanitation of the Bivouac."— D. B. Bentley. Lt.-Col. 
A.M.C., District Officer of Health. Ontario. 

"Simple Means for En.suring Supply of Drinking Water on 
Active Service" — Campbell Laidlaw, Lt. A.M.C. 

"Some Ob.servations on Sanitation for the Soldier" — T. B. Rich- 
ardson, Major A.M.C. 

"The Militia as a Factor in Public Health" — Lome Drum. Ma- 
jor A. M.S. 

2. — Section of Mii.k Inspection. 

Andtrew R. B. Richmond, V.S., B.V.Sc.. Chairman. 

"Municipal ]Milk Inspection in Toronto" — O. G. X'^asmith. Di- 
rector of Laboratories, City of Toronto. 

"Municipal Food Inspection" — Robert Awde. Chief Food In- 
spector. Toronto. 

"Dominion ^leat Inspection" — L. A. Wilson, in Charge of Do- 
minion Meat In.spection Staff, Toronto. 

"^Municipal Meat Inspection" — Andrew R. B. Richmond. Chief 
of Staff of Veterinary Inspectors, Toronto. 

3. — Section of Sanitary Engineers. 

T. Aird Murray, C.E., Chairman. 
"Toronto Filtration Plant"— F. F. Longley. C.E.. Toronto. 
"A Complete Sewage Disposal Plant for a Public Institution" — 
T. Lowes. C.E., Toronto. 



l-.^O DO^IIXloX MKDICAL Mo.X'llI L^■ 

"Filtration of Water, from an Engineeriuir INtiiit of View" — 
T. Aii-(1 Murray, (\E., Toronto. 

■"How to Obtain ?]t!iL'iency from i'rt'ssurc Filters" II. W. 

Cowan, C.E., Toronto. 

4. — Secti(»n (»k MKDir.M, Officers of Hkai.tii. 

James Kol)ert-s, M.I).. M,.,li,-al Oflficer of Health, Hamilton, 

Chairman. 

"A Moilern Hospital for Commnuieable Diseases" — Dr. Chas. . 
J Hastings, Medical Oflfieer of Health, Toronto. 

"The International Hynfjene Exhibition. Dresden" — Dr. J. F. 
Honsberger, Berlin. 

'\Arunicipal Control of :\rilk Supplies"— Dr. Whitelaw, Medical 
Officer of Health, Edmonton, Alta. 

"The Importance of Trained Sanitary Inspectors" — Dr. A. J. 
Douglas, .Medical Offii-er of llealtli. Winnipeg, Man. 

5. — Section op Medical Inspection of Schools. 

Dr. W. E. Struthers, ^ledical Inspector of Schools, Toronto, 

Chairman. 

"Tuberculosis in Children" — Dr. J. H. Elliott, Toronto. 

"Xursing Side of Medical Inspection of Schools" — ]Mi.ss L. L. 
Rogers, R.X., Toronto. 

Lantern Slide.? of the Work of Medical Inspection of Schools in 
Toronto— W. E. Struthers, B.A., M.D., Toronto. 

"The Feeble-Minded Child"— 

6. — Section of Soci.m. Workers. 

Joint Secretaries — Vincent Basevi, Editorial Staff, ''The News," 
Toronto; Dr. W. A. Whyte, [Medical Superintendent Riverdale 
Hospital, Toronto. 

Convener — Plelen MacMurchy, M.D. 
"Prevention of Social Misery" — 1. Howard T. Falk. General 
Secretary, Associated Charities. Wiinii|)(u. 

Disctission. 
Dr. J. A. Pa^'e, Medical Superintendent. The Immiirration Hos- 
pital, Quebec, P.Q. 

Dr. MacAuley, Chairman Board of Health, Halifax, X.S. 

•Mr. J. W. Smith, President Children's Home, Regina, Sask. 

Dr. W. E. Home, Victoria, B.C. 

RufiLS D. Smith, Secretary Charity Organization, .Moiiti-t-al. P.Q. 

Mrs. Smillie, Women's Club, [Montreal, P.Q. 

Dr. Huerner [Mullin. Hamilton. Out. 



DOMTXIOX MKDICAL MOXTHLY Vil 

]\Ir. Edward Gurney, Toronto. 

]\rr. Joseph W. Bonnier, Recorder of Vital Statistics to the 
Quebec Government, Quebec, P.Q. 

Mr. Rowland Dixon, Clerk of Statistics to the ]\Ianito'ba Govern- 
ment, Winnipeo;, ]Man. 

Miss Alice Ravenhill, Shawnegan Lake-, Vancouver Island, B.C. 

Mr. G. A. Smith, General Supervisor Toronto Playgrounds As- 
sociation, Toronto. 

]\Ir. G. Frank Beer, President of the Toronto Iloasing Co. 

"The Dentist 'as a Social Worker"— Dr. A. W. Thornton, 
Toronto. 

Discussion. 

Mrs. Adam Shortt, M.D., Ottawa. 

Dr. Albert E. Webster, Toronto. 

'Sir. Josep^h Likely, St. John, X.B. 

Dr. W. IT. Delaney, D.P.TI.. Quebec, P.Q. 

A Symposium — "The Scientific ^Management of Household 
Work and Workers." 

From the Vie\\"]ioint of tlic Mistr(\s.s — Mrs. L. A. Hamilton, 
Lome Park, Ont. 

From the Viewpoint of the Maid — Miss Yates, O.A.C., (Juelph. 

From the Viewpoint of the Physician — Dr. T. F. McMahon, 
Toronto. 

From the Viewpoint of the Church — Rev. Daniel Strachan, 
Toronto. 

From the Viewpoint of the Settlement — Miss Helm, I'niversity 
Settlement, Montreal, P.Q. 

From the Viewpoint of tlie rniversity — Miss Cartwright, Lady 
Principal, St. Hilda's College, Toronto. 

(Ten minutes for each speaker.) 
Discussion. 

Dr. Grace Ritchie England, Montreal. 

Professor Stevenson, I'niversity of Toronto. 

7. — Section of L.vborat(jry Workers. 
John A. Amyot, ]M.D., Toronto, Convener. 
8. — General Section. 
"Diet in Relation to Disease"— Dr. H. B. Anderson, Toronto 
Professor V. E. Henderson, Toronto, and Professor Fothering- 
ham, Toronto, will open discussion. 

"How Shall Canada Save Her People from the Phy.dcal and 
]\Iental Degeneracv Due to Industrialism as Seen in the Great 



\-!-i iMiMlMoN \|i:i»lr.\L .MdNTIII.V 

Cities of OUk'r Civilization.''"- — I)i-. I'. II. Ui-yec, Siiperiiilcndiiit 
of Iimuitrration, Ottawa. 

Syiiipo^ium — "'rnl)or('ulo.sis" — Dt*. .1. II. I-'lliott, Toronto. 

Discussion. 

Dr. (i. D. I'orti'i-, Toronto. 

Dr. Harold Parsons, Toronto. 

Dr. W. R. Kendall. Mnskoka Sanatorinni. 

Dr. C. I), l^arfitt, (iravenhnrst. 

Mi.>s Dyke, Toronto, and others. 

"Prevention of Tnherenlo.sis in the Conntry" — Di-. TI. (I. J\ob- 
erts. (Juelph. 

"Of What Value Are Sanatoria as a Public Health Pleasure?"— 
Dr. W. R. Kendall. 

"Open Air Schools for Children" — Dr. J. TI. Holbrook, 
Hamilton. 

"The Feeble-Minded" — ]Mr. .1. P. Downey, Superintendent 
Asylum for Insane. Orillia. 

Paper— Dr. W. T. Shirreff. .Medical Officer of Health. Ottawa, 
Ont. 

"A Threatened Outbreak of Tj-phoid Fever in Fort William, 
and INIean.s Taken to Successfully Abort It"— Dr. R. E. Wode- 
house. District Officer of Health. Ontario. 

Paper— Dr. II. AV. Hill. Director Institute of Public Health, 
London, Ont. 

".Medical Inspection of Public Schools" — Dr. A. 1*. Rcid, Pro- 
vincial Health Officer of Nova Scotia. 

S^nnposium — "Communicable Disease." 



IKIMIXIDN MKDICAL MnXTllLV l-'S 



Geoffrey Bovu, Gilbert Royce. 

The Massacre of the Tonsil. By Johr N. Mackenzie. M^D. Clinical 

l^rofessui' of Laryngology and Khinology in the Johns Hopkins 

University and Laryngologi.t to the Johns Hopkins Hospital. 

Thp. Mnri/land Jfi^dical .lournni 

During the past few years I have been repeatedly urged by 

medieal friends to give some public utterance by way o formal 

protest against the indiscriminate and wholesale destruction and 

removal of the tonsils, which, far above all others, is the chief 

and most glaring abuse in the laryngolog>' of the present day. Hiey 

have been good enough to say that a word might not be ami.ss from 

on<^ who has been through the dust and heat of the conflict that has 

raged around this and other fancies in surgical larNiigology which 

have risen and fallen during the quarter of a .Tntury that has .lUst 

pa.ssed away. 

One of these friends, a distinguisht^l general surgeon of wide 
experience, large practice and exceptionally high professional skill, 
in insisting that I say something on the subjeot, gave me as his 
deliberate opinion that of all the surgical insanities within hLS recol- 
lection this onslaught on the tonsils was the worst, not excepting 
the operation on the appendix. And, indeed, when I look baek 
through an experience of over thirty years, in which I have seen 
theory after theory, for some of which I have been partially, if not 
wholly, responsible myself, come and go, materialize and dissolve, I 
feel that, notwithstanding the fact that I approach the subject with 
reluctance, with diffidence, with hesitancy— A\ith even timidity-— 
and fully mindful of the truth that we are all liable to error, even 
the youngest of us, and that nowadays in some quarters apparently 
age and experience count for nothing, I feel I may be pardoned for 
saying a few words in what I consider to be the interest of the pub- 
lic health, and, therefore, of the public safety. 

Let me at the outset be not misimderstood. It is not my object 
to stir up strife, to impute unworthy motives to anyone, or to arro- 
gate to myself any superior wisdom in the surgical management of 
tonsil disease. 

Nor do I wish to shift to other shoulders all the blame. I, too, in 
my earlier days, have fallen by the way. Indeed, it was once face- 



r.M DOMINION MKIHCAL MoNlHI.V 

tiously said that the street in front of my oltice \va» paved witli the 
turbinated bones of my victims. 

That there are a liost of conditions tliat call for more or less 
complete destruction of the tonsil is an axiomatic proposition which 
is not open to discussion. We have all been takinj^ out tonsils for 
innumerable reasons ever since we entered our special field of work, 
and we will continue to do so when proper occasion demands it. ]\Iy 
contention is simply this, that in selecting our cases for operation we 
should be guided by a sane and safe conservatism and coinmon sense, 
and not be carried away by those who, by their precept and example, 
are fast bringing our specialty into disrepute in the eyes of thought- 
ful and lionorable men. 

^lany years ago Austin Flint was conducting an examination in 
physiology at the Belle^aie Hospital Medical School in New York. 
Among the students who came up for graduation was a bright young 
fellow to whom Flint propounded the following conundrum : "What 
is the function of the spleen?" And the lad replied that the func- 
tion of the spleen was to enlarge in malarial fever. To the next 
question. "What is the function of the tonsil?" the boy declared 
that the mission of the tonsil was to swell and suppurate in (juin.sy. 
"That will do," said Flint, "you have passed a perfect examina- 
tion, for you know as much about the subject as I do myself." Long 
before, a distinguished medical luminary on the other side of the 
Atlantic had said that were he, like Frankenstein, to attempt the 
artificial construction of a man, he would leave the tonsils out. In 
other words, at that period, or, as a matter of fact, from a period as 
long back as memory can run, the tonsil was regarded as a per- 
fectly u.seless appendage which cumbered the throat, and which, 
therefore, ought to be gotten rid of. Like its little neighbor, the 
uvula, it was sacrificed on every possible pretext or wlien the sur- 
geon did not know what else to do. T ivmember, a long tinie ago. in 
i. discussion on hemorrhage after tonsillotomy before a New York 
society, a distinguished lar\-ngologist made the statement that he 
had removed without accident many thousands (I have forgotten the 
exact number) of tonsils — to which declaration an in(|uisitive, in- 
credulous individual present, with a mathematical turn of mind, 
said he had made a calculation which showed that in order to have 
removed that many tonsils within the limit of an ordinary lifetime 
the operator would have to average a bushel a day. 

This general extirpation of the tonsils that obtained in the early 
days of laryngology received a rude and jarring jolt when, in the 
last century, it was proclaimed that the tonsil was physiologically 
direetlv related to the virilitv of the male. According to this 



DOMTXIOX MEDICAL MOXTIILV 125 

luminous conception, Avhich owed it.s popularity chiefly to the 
teachings of no less a personage than Chas&aignac, destruction or 
extirpation of the tonsil meant impairment or extinction of pro- 
creative power. This doctrine at once made tonsillotomy ver\' un- 
popular among the male laity; but when the Homeric shock of the 
battle that raged around this burning question had subsided, and it 
had been found that there were no facts to support the alleged 
relationship, then the work of slaughtering the tonsils again went 
merrily on. 

But never in the history of medicine has the lust for operation 
on the tonsils been as passionate as it is at the present time. It is 
not simply the surgical thirst from which we have all .suffered in our 
earlier days, ju.vt as at a still earlier period we suffered from the 
measles; it is a mania, a madness, an obsession. It has infected not 
only the general profession, but also the laity. A leading laryugo- 
logist in one of our largest cities came to me with the humiliating 
confes.^ion that, although holding views hostile to its performance, 
he had been forced to do a tonsillectomy in every case in order to 
satisfy the popular craze and to save his practice from destruction. 

To-day the laity, with or without medical advice, insist on entire 
removal of the tonsil for almost every conceivable infinnity. If I 
had time to do so. I could tell you some, if they were not so serious, 
amusing .stories in this connection. 

I will only relate one. A few days ago a woman l)rought her 
little six-year-old daughter to me to know whether her tonsils ought 
to come out. Her nasal and throat passages were normal. 

The child was in perfect physical condition and complained of 
nothing. I said to the mother: "Your baby is perfectly well; why 
do you want her tonsils out?" "Because slie sometimes wets the 
bed." 

In the annual reports of nearly all the special hospitals for dis- 
eases of the nose and throat the number of tonsil removals, as com- 
pared with all other operations on the upper air tract and its appen- 
dages, is simply appalling. In conspicuous and refreshing contrast 
to the usual narrative of these productions let me quote from the 
last report of a well-known children's hospital in this city these 
words of sanity and wisdom : 

"A large and annually increasing number of cases apply for 
operation for hypertrophied tonsils, or for adenoids. Of these the 
adenoids practically all need and receive operation with benefit and 
without injury. 

"The recent universal inspection of the throats of school children 



T?(; DOMINION MI-.DICAL MoN'illLV 

il.l^ i.'xi-akxl llu* fact that nearly all childrt'ii at soino time of hlV 
have more or less enlarged tonsils. 

"That most of this is harmless if not actually physiological, and 
that their removal in these cases is not only unnecessary but in- 
jurioiw to the proper development of the child is our conviction. 

"The rarity of rheumatism or endocarditis in children, while 
nearly every child has enlarged tonsils, would indicate that their 
removal is only exceptionally advisable unless they mechanically 
interfere witli respiration, deglutition, or speech. When this is the 
case they are still best removed with the tonsillotome unles.s radical 
extirpation is necessary for other reasons." 

I cannot more correctly express the general attitude on the mat- 
ter than by cjuoting the words of Professor Swain of Yale Univer- 
.sity, in the admirable paper with which he opened the debate on the 
subject at the last meeting of the American Lars'ngological Associa- 
tion in Philadelphia :* 

''When an author speaks of his experience in upwards of 9,0('0 
eases, mentioning especially 8,000 removed within the cap.sule with- 
in the last six or seven years, the only method which he Ihinks is 
really worth the while — he certainly has a right to speak as an 
expert in regard, at least, to methods. Also, it will be readily de- 
duced that he felt in removing ton.sils thus wholly he was not 
depriving the patients of anything important. When it is the prac- 
tice in recent years of many operators all over the country to ahvays 
enucleate the tonsils as completely as possible in all cases, either 
children or adults, as a routine procedure, it would certainly seem 
to argue that in general tonsils are better out than in. The question 
of relative size, appearance, healthiness of structure or any such 
matter is apparently never thought of. Remove, anyway, and dis- 
miss the matter as not worthy of further consideration. And, again, 
it is a most excellent condition of things to be operating laryn- 
gologist to a busy internist, who takes the entire responsibility of 
removal. Failure and success are alike credited against hiiu. but it 
is a case of blissful inexactness which I consider deploral)le." 

]\ruch wild and incontinent talk, for which their teachers are 
•sometimes largely to blame, has poisoned the minds of the younger 
generation of op>erator.s and thrown the public into hysteria. Ton- 
s'illectomy, for example, is held out to them, not only as a sure cure 
for, but as an absolute prophylactic against rheumatism and heart 
disease. They are told that with the disappearance of the tonsil in 
man these diseases will cease to exist. Parents bring nowadays their 
perfectly sound children to the lar\Tigologi.st for ton.sil removal in 



•See Transaftixii.' 



DO.MIXIOX MEDICAL MOXTiiLV l-.'7 

order to head off these affections. Tonsillectomy is recommend'ed 
as a curative during the agony of acute articular rheumatism. 

But the origin of the latter disease ha.s recently been traced to 
an infection of the nasal muc-osa following operation. To-morrow 
it will come from somewhere else. Those of us who are old enough 
to remember will recall the story of chorea. Years ago we found 
the cause of this affection in the nasal passages. When this view, 
after the usual .struggle, had to be abandoned, it was suddenly dis- 
covered that the eye was the portal of entrance. To-day it has been 
caught in the tonsil. If we exercise a little patience it will turn up 
soon in some other organ. 

In considering the (|uestion of operation on the tonsil, and espe- 
cially complete removal, we must face the following facts: 

I. The fimctions of the tonsil are, in the present state of our 
knowledge, unknown. 

Whether they are portals of entrance or avenues of exit for 
infection, whether they protect the organism from danger or invite 
the presence of disease, whether the pathogenic bacteria sometimes 
found in them are coming out or going in, whether they are manu- 
facturers or storehouses of leuco — or lymph ocA'tes, whether they 
represent the extreme outlying protective ramparts and that, there- 
fore, their destruction would mean the removal of the battle-line 
against infection from the throat to the neck hinphatics, whether 
the efferent current of lymph exceeds the afferent in volume or 
velocity, whether, which .seems probable, there is an endless flow 
of l>nnph from their interior to the free surface, which, unchecked, 
prevents the entrance of germs from the surface and washes out 
impurities from within, whether the organ possesses an internal 
secretion, sui (jencris, or whether, in fine, the tonsil structure is in 
any way e-ssential to the well-being of the individual, are questions 
wVeh have as yet received no definite solution, but which are full 
of intere.st and furnish material for instructive discussion and de- 
bate. Until the functions of the tonsil are known the final word on 
its removal cannot be spoken. 

II. Whatever its functions may be, and the production of leuco- 
c>-tes is undoubtedly one of them, the tonsil is not, as is generally 
taught and believed, a lymphatic gland. 

The general ignorance of this fact had led to the useless sacrifice 
of thousands of tonsils, on the fallacious assumption that their func- 
tional acti\'ity may easily be replaced by the mwiads of other 
lymphatic glands in the body. The physiological integrity of the 
tonsil is of the utmost importance in infant and child life. The 
gland appears early in embryonic life (fourth months, att-^.ms 



138 DOMTNIOX :\1 KDICAL :^I()N"ril F.V 

maturity at tlio end of tlie first year of infancy, and at or ahi)ut 
puberty tends to diminish in size. It does not develop as a \ym- 
phatic prland from a plexus of pre-existinsf lymph vessels in the 
mesothelium, but as an injrrowth of endothelium from the second 
brancliial pouch, and, therefore, in its orijjin must be classed Avith 
the thymus and the thyroid, the former originating from the third, 
the latter from the fourth, while the parathyroid takes its origin 
from the third and fourth branchial pouches, all by inbudding of 
the endothelial lining of the primitive pharynx. These anatomical 
facts have been recently emphasized by Gordon Wilson,* of Chicago, 
who, in a careful study in comparative anatomy, has shown from 
various relations which the tonsil shows to the pharynx that the 
tonsil secretes or excretes a substance into the pharynx. The tonsil 
is present in all mammals, with a few exceptions, notably the white 
rat, and its anatomical arrangement is such that no matter how con- 
cealed it may be by folds of membrane it always retains commiini- 
eation with the pharynx. Observations nrade in his laboratory on 
the earnivora show that in this genus the tonsil is often so protected 
by folds as to be invisible from the mouth; but there always exi.sts 
a channel of communication. This is well shown in the lion, where 
the tonsil lies in an elliptical sac of considerable size, which is so 
placed that during certain ihovements of the pharynx the contents 
may be expelled into the back of the mouth. In other words, we 
have here a structure which plays a role of importance in early life, 
in addition to its production of lymphocytes, and which necessitates 
a clos€ relation to the phar>nix. This role may be of infinite value 
to the infant in his earliest days of life, but which, as he grows 
through childhood into manhood, he is able to dispense with. 

Xow, the first organ to manufacture or store leucocytes in em- 
bryonic life is the thymus gland (fJacobi).t In view of the origin 
of the tonsil from the branchial pouch, is it not conceivable, as 
Jacobi suggests, that it may as.snme the role of the thymus after 
birth, or when the latter gland ceases to functionate or (lisap]iears? 

III. It is rarel}^ possible to separate the tonsil from its neighbor- 
hood during the acute invasion or rapid progress of a inicrobic or 
toxic poi.son (Jacobi). 

Years ago Jacobi called att<'ntion to the fact that in cases of 
membranous throat disease, whenever the menvbrane is limited to 
the tonsil, there is little or no glandular swelling in the neighbor- 
hood. If the membrane extends from the tonsiil to its neighborhood, 
or starts at a distance from the tonsil, neiglvboring lymphatics swell 
at once. 



*Trans;ictions of the American Laryn go logical Association. 19)1. p. 2C3. 
^Archives of Pediatrics, July, 1906. 



DOMINION MEDICAL MONTHLY 1?0 

Again, the treatment of this neighborhood shows its effect ahiiost 
immediately in the swollen glands. This is especially true of diph- 
theria, which, when limited to the tonsil, produces less adenitis and 
constitutional symptoms, and, therefore, is less dangerous. We all 
remember, too, in the days before antitoxin, how much graver the 
prognosis was when the membrane appeared in the nose and upper 
pharynx than when it appeared on the tonsils. Nearly every case 
died. 

IV. The role of the tonsils as portals of infection, like all new 
doctrines in medicine, has been greatly exaggerated. To state that 
they are, in certain cas<^, the avenues through which pathogenic 
organi.sms reach other organs is simply to .state an incontrovertible 
proposition, in the light of present-day research. But to make them 
responsible for the long Iliad of woes which has been laid to their 
account is to remove the whole question from its legitimate plac€ 
in the region of cold clinical fact into the atmo.sphere of fads and 
fancies. Some absorption takes place in and from the tonsil, but 
it is far less than that which occurs in the more abundant and 
receptive lymphatic structures of the nose and nasal phar\iix. The 
tonsil, moreover, is not built anatomically as a gateway of infet-tion. 
I have not time to go into a review of this interesting subject, but 
will simply quote, with some modification, from a summary by 
Faulkner, of Pittsburgh (Mrdical Rec&rd, July 9, 1910), based on 
an analN-sis of observations made by Most, Retterer, Labbe, Hoden- 
pyl, Jacobi, Grober and others, and also refer you to a sjnnposium 
on the subject of the naso-pharyngeal lymphatics and their relation 
to other parts of the body, by Ilartz, Poli, Logan Turner and 
Broeekart :* 

"The faucial tonsils are peculiar organs. They possess an ana- 
tomical character different from other tonsils and other lymphatic 
tissues. They are innocent organs with functions chiefly confused 
by medical literature. Their blood supply is scant and they have 
almost no communication with the Ipnphatic system. • • * 
Their crypts are lined by mucous membranes having the ordinary 
function of other mucous membranes, so far as known. They are 
distinctly separated from the very active absorptive and bacterio- 
Mic sitructures of the fauces, pharynx and nose. Their position 
is a segregated one. Their external deep surface is covered by a 
dense fibrous capsule which sometimes sends a network of fibrous 
tissue as outrunners along the tonsillar blood vessels (HodenpyD, 
the tonsil contains a system of closed lymph canals in the follicles 

♦These papers have been collected, the foreign ones translated into English, 
and published in the Laryngoscope, March, 1912. 



]3i) noMlNION MKDICAL MoNI'IILV 

wliifli do not opi'ii into tlie coniiectivi' tissue i-t-tii-iiliiiii (HctttTcr, 
confinmd by Hodcnpyl), diphtheritic luemhrane confined to the ton- 
sil is relatively innocent (Jacobi). There are no lymphatic sinuses 
around tlie tonsil, and the nearby lymph current is less active than 
that of the pharynx at some distance (Labbe), and, finally, injec- 
tions made into the region of the tonsil (not even into the tonsil 
itself) do not spread like those made into other parts of the naso- 
pharynx (Labbe, Eetterer, Tlodenpyl, ^Fost and Jacobi)." 

Ilartz,* in reviewing the important expi^rimtMits of Lenliardt, 
says: "These experiments would lead to the assumption that the 
tonsils are frequently infected secondiarily to acute infection of the 
nose and the accessory cavities and the nasopharynx. * * * * 
It is probable that every inflammation of the mucosa induces a 
.swelling, often imperceptible, of the neighboring lymphatic glands 
of greater or less extent, which, acting as a protective mechanism, 
inhibits the development of the germ. To the tonsils, which have 
the function of an open lymphatic gland, may be a.scribed a protect- 
ing influence against the micro-organisms wiiich are ever present 
in the mouth and nasopharynx, acting, also, as a barrier against 
their invasion into the trachea and esophagus. On the other hand, 
it must be admitted that the tonsils are frequently the seat of pri- 
mary inflammation, and that they are more susceptible to disease 
than other membranous structures in this region!" 

The question has two sides — a purely bacteriological and a purely 
clinical one. If we consider the vast extent of the area through 
which infection can possibly take place, and if we follow the lead 
of experiment and that of the pure bacteriologist to its extreme 
limit and logical end, we may find that nothing short of the guillo- 
tine or the axe will insure the patient against absolute and certain 
immunity from infection through the throat. 

On the other hand, when we consider the fact that there are 
constantly loitering around the oro and nasal pharynx — this region 
is the clubhouse of the strei)tococcus — a miscellaneous crowd of 
pathogenic bacteria, and when we consider the further fact that 
thousands of operations are done in these regions every day, and 
necessarily without antiseptic precaution.s. is it not significant at 
least that we meet with so little sepsis following their performance? 

V. The chief practical les.son to be drawn from the foregoing 
facts is that in cases in which the throat, and particularly the ton- 
sils, is apparently the starting point of infection, it is mandatory 
to examine the entire upper air tract and not be content with ap- 
pearances that are visible to the eye through the open mouth alone. 
IIow many stop their search for the cause at the tonsil and fail to 

• \ar\ingoscove, March. 1912, p. 180. 



DOMTxiox :\rT':r)iC'AL moxtuli' i3i 

explore the deeper parts of the pharAnx, the retro-nasal space, to say 
nothing of the nasal passages and accessory sinuses'/ This entire 
region must be reckoned with, and failure to do so has probably 
sent more than one to his grave. I know of a number of cases of 
fruitless removal of the tonsil which have only gotten relief when 
treatment was subsequently diret-ted to the nasal cavities and post- 
nasal space. Not to mention many others. I am forcibly reminded 
of a case of general poisoning and wrecked health in a young woman 
in whom I had thought I had traced the .source of infection to an 
antrum maxilla" empyema. As there was no escaping pus. my diag- 
no.sis was not accepted by the family and attendant, and I was not 
even permitted to m«ke an exploratory puncture. I am unable to 
.•ay what operation, if any, was done, as she naturally pa.ssed' out 
of niy hands. But as .she grew rapidly worse, and as the futility of 
the treatment be<-anip apparent, my advice was finally reluctantly 
and doubtfully taken, the antrum was opened, the fetid contents 
evacuated, and the patient, under appropriate treatment, went on 
to speedy and complete recovery. 

I could tell you, also, of ca.ses in which the tonsil has been held 
responsible for the morbid condition, and has been partially or com- 
pletely removed, in which relic^f has only been secured by the dis- 
covery and treatment of di.sease in the nose and retro-nasal space. 
And of far graver, far-reaching and deeper significance are cases 
of inftction in wliicli life has doubtlessly been sacrificed by clinging 
to the lazy and stupefying delusion that the tonsil is the sole portal 
of poisoning. 

VI. The In-pertrophied lymphatic tissue of the vault of the 
phar^nix (adenoids) does harm chiefly through obstruction. Re- 
store normal respiration in the child, and in a large number of 
oases the tonsils will take care of themselves. Even if the glands 
should remain large, if they are gi\ing no trouble, they may be 
safely left in situ, for as their growth doe.s not go on pari passu 
with the growth of the rest of the pharxTix, the time soon comes 
when they become inconspicuoiLS in the fully developed fauces. 

The mere size of the tonsil is of itself no indication for removal 
except it be large enough or diseased Siuflficiently to interfere Anth 
respiration, speech or deglutition, in which case it, or a sufficiemt 
portion, should be taken away without delay. A large tonsil does 
not mean neces.sarily a disea.sed tonsil, nor does a small tonsil always 
indicate a healthy organ. Tonsils apparently diseased may consist 
of normal tissue, and, on the other hand, perfectly normal-looking 
glands may be found pathological microscopically. The tonsil may 
be greatly enlarged, may extend far down into the phar^Tix or be 



vvi Dominion miiimcal ^roxTin.v 

buried deeply in the palatine arcade, and yet not interfere with the 
well-being of the individual. Such tonsils are the special prey of 
the tonsillectoniist. If they are not interrupting function, they had 
best be left alone, for they are doing no harm. The change in ana- 
tondcal relations after operation is often so great that function is 
crippled more after their complete removal tliaii it was before. 
^Moreover, it occasionally happens that the resurrection of a 
"buried" tonsil is followed by the burial of the patient. 

A most interesting and instructive part of this subject is the 
occurrence of tonsil disease, with or without cervical adenitis, from 
infection from the nasal passages (from pus cavities, operations, 
etc.) and the improper care of the teeth during dentition. AVright* 
of Boston reports a remarkable series of 150 cases in which operation 
on the tonsils was deferred until after the eruption of the molars, 
not only in the six, but in the twelve-year period, and when denti- 
tion had been completely accomplished the enlarged cervical lym- 
phatic glands disappeared, together with the swelling of the tonsils. 

Tonsillitis not infrequently follows operations on the nasal cav- 
ities, especially if pus be present, or even after a cold in the head. 
Experimental work along this line would seem to indicate that 
infection takes place through the lymphatics. Thus, in the carefully 
conducted experiments of Lenhardtt it was foimd, among other 
things, that foreign matter, even when injected into the mucous 
membranes of one nasal passage, was found in both tonsils a short 
time after the injection. 

The practical illuminating lesson of these observations is that 
if, in infancy and childhood, we pay more attention to the neglected 
nasal cavities and to the hygiene of the mouth and teeth, we will 
have less tonsil disease and fewer tonsil operations. 

VII. In the permanent removal of tonsil disease ecjually good, 
and in the long run even better, results may be obtained in a large 
percentage of cases by measures less radical than those usually 
employed at the present time. Out of a multitude of examples, take 
the ca.sc of recurring quinsy, for which complete enucleation is done. 
In this condition it has been found that it is frequently only neces- 
sary to thoroughly slit up and shrink the upper lobe of the tonsil. 
Most quinsies occur in this situation, and the destruction of that 
part of the tonsil is all-sufficient to prevent recurrence. Hy this 
method enough of the organ is left to entirely perform its function, 
and the ultimate development of quinsy of the lateral columns of the 
pharynx, which follows sometimes complete removal, is avoided. 



* Boston Medical and Surgical Journal, May 20. 1909. 
^Archiv f Laryngologie, 1909, Bd. XXI. 



DOMINION MEDICAL MONTHLY L'-i 

VIIL I do not propose to enter the perennial and monotonous 
controversy of tonsillotomy versus tonsillectomy. Each operation 
has its legitimate indications and aims. I do not intend to discuss 
them. I will only say, in passing, that enucleation of the tonsil, 
with even the removal of its capsule, if so desired, complete enough 
for all practical purposes, and this fact should be generally known, 
practically free from danger and \nth equally, and in some in- 
.stances better results, can be done with the guillotine or one of its 
modifications. In the majority of ca.ses this procedure will be all- 
sufficient. It is a :nuch simpler method, e.specially in children, and 
it is not handicapped by the danger of complete enucleation, with 
its many accidents and complications, to say nothing of its long roll 
of unrecord^^d deaths. To subject a child to the latter operation, 
with all that it entails, when we have very much safer and prac- 
tically jusft as efficient measures at hand, is, to say the least, bad 
judgment and unnecessary surgery. 

As I see this part of the subject in the light of my own experi- 
ence, and in the experience and observation of others, the truth is 
slowly but surely dawning, and at no distant day will irresistibly 
emerge- into recognition that the so<'alled complete enucleation — 
the chief objection to which is that it can never be made complete— 
except in individuals in whom the organ is totally diseased, is an 
luinecessary operation in the great majority of cases in which it is 
at present done, and may be supplanted by many other methods 
which are perfectly safe and efficient and not open to its many 
serious objections. That the tonsil has some important mission to 
fulfil is furthermore shown from its frcfiuent reappearance after 
enucleation— a protest, as it were, on the part of nature against 
the total destruction of its functions, a.ud the vicarious activity 
of the neighboring lymphatic tis-sues when its physiological pro- 
perties cease to exist. This is strikingly shown in the cas« of quinsy 
of the lateral columns of the pharynx, before referred' to. when the 
tonsil is rudimentary or gone. In the case, too, of infectious dis- 
ease, whose poison is eliminated by the throat, this compensatory 
action is most marked. Thus, in the malignant epidemic of tonsillitis 
whicli occurred last year in Boston, in which the disease was not 
contagious, did not start from a septic foeus in the throat, but was 
introduced through the food supply (milk), after much constitu- 
tional disturbance, the whole tonsillar ring, as Coolidge* expres.ses 
it, broke into flame at once. The patients whose tonsils had been 
removed did not escape the process in the pharyngeal lymphoid 
tissue, the constitutional symptoms or the cervical adenitis. 

•Tranaiotions .American Laryn gological Association. 1911. p. 272. 



]:]\ nOMlXloN MKhlCAI. :^I( t.\ Til I.V 

IX. The tonsils are phonatory organs and play an important 
part in the meehanisni of speech and sonir. Tlioy influence the 
action of the surrounding muscles amd modify the resonance of the 
mouth. On the otlicr hand, tliey may hi* so enlarged as to cripple 
botli these functions, and sliould, therefore, be removed, such re- 
moval being sometimes a gain to the voice of one or more octaves. 
In tonsillectomy no one can foretell the amount and character of 
change in the anatomical relations of the parts, no matter how 
skilful the surgeon is or how skilfully the operation is performed. 
The adJiesions and contractions left after this operation, even in the 
best of hands, lead often to deplorable changes in the qu:ility and 
ruin of the singing voice. I should certainly iiesitate long before 
advising such an operation in a great singer or anyone dependent 
upon the voice as a means of livelihood. The operation of tonsil- 
lectomy is a capital operation, a dangerous operation, and should 
only be done in a hospital or other place where every facility is at 
hand to meet the gravest possible emergency. It sliould only be 
done by a surgeoai skilled in its performance and thoroughly 
equipped for every accident, and with a mind fully awake to the 
possible fatality which has so often followed as its result. 

X. One word, again, to those who will fail to grasp the meaning 
of these remarks. It is not my object to decry in the least degree 
the many excellent measures which modem ingenuity has devised 
for the surgical treatment of tonsil affections. No one resorts to 
them with more alacrity than myself when the necessity for their 
adoption is apparent. 

It is not my purpose to assail operatit)n for delinitc and le-jiti- 
mate cause, but to warn against the "busy internist," as Swain so 
aptly terms him, who is too busy to waste his time with such trifles 
as differontial diagnosis or diagnosis by exelusion, and his accom- 
modating tonsillectomist, who, whether he admits it to himself or 
not, cares less about the cause of the 1 rouble, as he is in the business 
for revenue only. 

We who are teachers of laryngology' slunild wake \i\) to the re- 
sponsibilities of our position and see to it that our pupils shall not 
leave our institutions or post-graduate schools until they are taught, 
on the one hand, conservatism and moderation in the surgical treat- 
ment of the simpler affections of the upper air tract, and, on the 
other hand, thoroughness and completeness wlien brought into the 
presence of situations of graver emergency. The problem, though 
difficult, is not impossible of solution. The cure for the evils I have 
been di.scussing is largely educational. While impressing upon our 
students the a'bsolute necessity for surgical measures in proper cases, 



DOMINION' MEDICAL. MOXTHLY lo'o 

we slioulcl at the same time make the danofers of their indiscriminate 
performance fully appan-nt. In this way only can we be reasonably 
sure of accomplishing the desired result. The error of first im- 
pression derived from teacher and text-book is often difficult of 
eradication. In the lecture-room, in the clinic, in our daily walks 
with the student, let u.s make that first impression a good one. 

But eciually, if not more, responsible for the deplorable state of 
affairs which exists to-day in the matter under discussion are the 
teacher of internal medicine and the general surgeon. "When pre- 
eminent authority proclaims in lecture-room and text-book as in- 
di.sputable truth the relationship between a host of diseases and the 
tonsil of the child, and advises the removal of the glands as a 
routine method of procedure, what can we expect of the student 
whose mind is thus poisoned at the very fountainhead of his med- 
ical education by ephemeral theory that masquerades so cheerily in 
the garb of indestructit)le fact ? How are we to offset the irrespon- 
sibility of the responsible.' But we hear on all sides, "Look at the 
results." Results.' Here is a partial list from the practice, not of 
the ignorant, but of the most experienced and skilled : Deatli from 
hemorrhage and shock, development of latent tuberculosis in lungs 
and adjacent glands, laceration and other serious injuries of the 
palate and pharyngeal muscles, great contraction of the parts, re- 
moval of one barrier of infei-tion, severe infection of the wound, 
septicemia, troublesome cicatrices, suppurative otitis media and 
other ear affections, troubles of \ision and voice, ruin of the singing 
voice, emphysema, septic infarct, pneumonia, increased suscepti- 
bility to throat disea.^-e at the seat of operation, pharyngeal quinsy, 
and last, l)ut not least, tonsillitis! 

Who. may I ask, is in the better position to advise, the surgeon 
or practitioner who. without .sufficient knowledge, lightly recom- 
mends complete enucleation of the tonsils, or those who have devoted 
their lives to the study of throat conditions, and who come in daily 
contact with its disastrous and often fatal end results? Formerly 
i* was the nasal septum ; now it is the tonsil that is the surgical 
objective of every beginner in laryngology, and a tonsillectomy is 
usually his first baptism of blood. This operation is done all over 
the land by operators of all kinds, and, if the truth were known, 
with great mortality. The amount of reckless surgery done in this 
field will never be known or chronicled in the pages of medical liter- 
ature, but it may be found in its abiding-place in the book of the 
recording angel. 

Let us hope that the day is not far distant when not only the 
profession, but the public, shall demand that this senseless slaughter 



13(; 1M)M1M(»N" MKDICAL MoXTIILV 

ho stoppiil. Is not this day of nit'ilit-al moral pn^achinir and nplift- 
in«? a fittingr ono to lift the public out of the atmosphere in whit-li 
it has been drnjrfred, and for the reckless tonsillectoniist a proper 
timi^ to apply the remedy of the referendum and recall ? 

We are iroin^r through to-day in laryngology what the gyne- 
cologist went through years ago. The ovaries were removed then 
under as little provocation as the tonsils are being tak^n out to-day. 
The so-called "tonsil question" is one of simplicity and compara- 
tively small dimensions when viewed in the light of sanity and 
common sense, but it has been made to assume formidable propor- 
tions by unsound observation and reckless surgery. It has come to 
a point when it is not only a burning question to the profession, but 
also to the public. This senseless, ruthless destruction of the tonsil 
is often so far-reaching and enduring in its evil results that it is 
becoming' each day a greater menace to the public good. Until we 
have more definite knowledge concerning the use of the tonsils no 
one can tell the damage done to the children of the present genera- 
tion or the influence of wholesale tonsil removal on the children of 
the next. Whatever a more exact examination of the tonsil may 
reveal as to its function, I believe it was placed in the throat, not 
with evil, but with good intent ; to serve a teleological rather than 
a pathological purpose ; that its mission is physiological, and that it 
was not designed by Nature as a natural, easy and convenient 
avenue of infection. It is, of course, not open to debate that there 
are a multitude of conditions that call for partial destruction or 
more or less complete removal of the tonsils, but radical operation 
should not be done without definite and sufficient reason. The 
tonsil should not be sacrificed any more than any other organ with- 
out convincing evidence that it is tiie cause of the disease to be 
removed. 

Hasty theory, which sees in destruction of the tonsil the only 
means of treatment, and which, unmindful of the lymphatic and 
ether anatomical arrangement of the neiglvlwring structures, and 
their physiology, and which, losing sight of the further fact that it 
is hard, if not impossible, to determine during life that the tonsil 
is the only avenue of entrance in a given infection, throws ditTeren- 
tial diagnosis to the winds, should have no part in modern scientific 
laryngology. When we shall clarify the atmosphere of our ideas in 
this matter, and when sane authority shall demand a halt, then we 
will hear less of the massacre of innocent organs a)id have less fren- 
zied literature on the subject. 



2)ominion /ll^eMcal /Ihontbl^ 



Bn& Ontario ^eOical journal 



EDITED BY 



Medicine: Graham Chamber*, R. J. Psychiatry: ErncFtJorep. W. C. Herr 



Dwj-er, Gold«in Howland, Geo. W. 



rn;iri. 



lios-, Wm. D. Young. Ophthalmology: D. N. Maclennan. W. 
Surgery: Walter McKeown, Herbert A H Lowrv 

Hruce. W. J. O. Malloch, Wallace A. Rhinoloev Larvngology and Otol- 

.^cott, George Ewart Wilson. ^^ogy^.T/r^n ^^Hfv° "^IberPRo" ^ 

Arthur C.Hendrick. Gynecologry: !■'• ^^' Marlow. W. B 

Pathology and Public Health : John Hei.drs 

A. Amyot, Chas. J C. O. Hastings, Genito Urinary Surgery: T. B. 

O. II M.ibee. Geo. Nasmytli. Ki< hard-on, W. Warner Jone?. 

Physiologic Therapeutics : , , ,, u . 

.1. Harvey Todd. Anesthetics: bamuel Johnston. 

GEOBGi: EIiIiIOTT, MANAOIKO EDITOB. 

Published on the 20th of each month for the succeeding month. Address 

all Communications and make all Cheque=!. Post Office Orders and Postal 

Notes payable to the Publisher, GEoRGE ELLMtTT, 215* Spadina Road. 
Toronto, Canada. 



Vol. XXXIX. TORONTO, OCTOBER, 1912. No. 4 



COMMENT FROM MONTH TO MONTH 

Man's Inhumanity to Man is not to be compared to man's 
iuhuiuanity to uoniaii. Hurn.s had in mind mankind in general when 
he conceived this phra.se. Had he known of a specific ca.se where a 
man had neglected to engage professional attendance for his wife 
in her approaching confinement, or could he have conceived of a 
man failing to provide for the profes.sional fee in an emergency call 
upon that wife, especially at night time, he might have written 
man's inhumanity to woman. 

Each man's humanity is a nature and a law unto itself: and the 
man who fails to provide against emergency sickne.ss in hi.si house- 
hoki is not deserving of a very great deal of .sympathy from the 
general public. 

It is easy to cry ''close corporation" and point the finger of 
scorn at the entire medical profession when one member thereof 
seems to fall from the pedestal of professional ethics and follo\\-s the 
dictates of his own human nature. 

Practically all the members of the medical profession are sym- 
pathetic and true. Their deeds speak far louder than any mere, 
written words. They are not given as a class to advertising their 
good deeds from the hou.se tops. They are the pioneers and ardent 
workers in the causae of preventive medicine which slashes into and 
cuts out chunks from their professional incomes. They never pause 
to think of the reason of it. They simply work away and do it. 



i;!s hoMixKiN Mi;i>ic.\L M(l^■|■|lI.^■ 

W'vy few fail to rcsjieiul to a call wiun they arc i)laiiily and simply 
told the ease is one of charity. This is their humanity. 

As to "close corporation" — where is it.' Snrely not in a pro- 
fe.>sional field which is the .stamping sfronnd for charlatans, fakirs 
and cults of every variety and description. It is a joke to call the 
medical profession a "dosi' corporation." when that profession is 
parasitized as it is. 



Are Tea and Coffee Harmful? This is tiic title of a sym- 
posium in the Medical limes for Septeml)er. li)12. All have been 
of the opinion' that if these beverages, same a.s alcohol, were abused, 
they were harmful. Most of us consider them harmless in modera- 
tion. 

Caffeine is the principal alkaloid in both tea and coffee. There- 
fore, exact studies of the amount of caffeine in a cup of tea or coffee 
are of interest as well as important. 

Prof. J. W. Wallet, of the Tniversity of Virginia, who has re- 
cently mad'e exhaustive studies says that in one cupful of hot, black 
tea there are 1.54 grain of caffeine ; green tea, cold — a glassful — 2.02 
grains; coffee — cupful — witb hot milk,' three-fifths coffee, 2.61 
grains; coffee, "black," demitasse, 1.74 grains. 

This woukl prove that black tea and coffee ^vitb milk would be 
the safer beverages to drink. It can readily be computed just how 
much caffeine i.s taken into the system with two or three cups of 
either at a meal or in tbe course of twenty-four hours ; and it will 
be worth while to know what is the maximum amount of either that 
can he drunk safely daily and what effects ujion various organs of 
the body exces.sive do.-:es of caffeine have. 

Pilcher has found that therapeutic doses increase cardiac tone, 
the va.somotor centre stimulated, va.scular relaxation, sometimes 
raised blood pressure, usually a more rapid blood How. Witb larger 
doses there is decrease of cardiac tone, va.s^cular relaxation and a 
lowering of blood pressure. In excessive doses death takes place 
by cardiac dilatation. 

The abu.se of tea or coffee, therefore, will prove harmful to the 
normal heart, whilst small (puintities may j)rove helpful when the 
heart is dilated. 

In severe intoxication frcmi alcohol Pildu r finds caffeine of no 
value, but helpful in mild intoxication. 

Some of the disorders following in the train of caffeine are ner- 
vou.sness, feverishness, headache, irritability, dyspepsia and disturb- 
ance of sleep. One writer considers it an etiological factor in chronic 
nephritis. 



DOMIXIOX MEDICAL MOXTHLY 13!) 

One to four grains of caffeine per diem does not appear to cause 
any appreciable alteration in the quality or quantity of sleep, but 
above this the sleep is neither so sound or refreshing as it should 
be. So the person drinking more than two cups of coffee or three 
of black tea is verging on the border line of abuse. 

As caffeine is not a food to nerve or muscle tissue, but a stimulant 
pure and simple, demands upon reserve force by repeated stimu- 
lation will tend to exhaustion and perversion of function. It is 
well, therefore, not to use tea or coffee regularly day in and day 
out, but to allow time for its elimination. This offsets its cumulative 
action in the tissues. 

Individual opinion is botli valuable and interesting. 

Harvey W. Wiley believes that all caffeine beverages are harmful 
in varying degrees, depending upon the age and physical condition 
of the drinker, idios.^^lcratic tendencies, and the manner and cjuan- 
tity in which they are used, but the almost universal use of these 
beverages shows they do not produce very serious lesions. Caffeine, 
nicotine and alcohol has had much to do in creating the large number 
of neurotics found in the world to-day. E.xcessive drinking of tea 
and coffee, especially upon an empty stomach, is to be condenuied. 

Tom A Williams says special susceptibility is sometimes very 
great and instances cases where caffeine has proven poisonous even 
in small doses. People early learn, however, of this spe^'ial suscepti- 
bility. 

F. H. Barnes, of the Dr. Barnes Sanitarium, does not consider 
tea and coffee harmful if used in reasonable quantities; nor can he 
remember a case where they have been the cause of a neurosis or a 
psychosis. He believes there are too many extremists and alarm- 
ists in the medical profession. 

On the other hand Solomon Solis Cohen, whose opinion must also 
carry weight, state?' they are harmful except when prescribed for 
definite purposes in the treatment of the sick. ]Most ph>Tsicians cut 
them off in the case of the sick, even though the sick often crave for 
a cup of tea. Cohen believes one will escape serious injury-, how- 
ever, if he controls his appetite and keeps his d'aily allowance down 
to one cup of moderately weak coft'ee, diluted one-half with hot 
milk, in the morning, and one-half cup of black coffee — but a weak 
decoction — after dinner. 

J. H. Kellogg, of the Battle Creek Sanatorium, answers the ques- 
tion of harmlfulness by saying, "Yes, decidedly so." Tea and coffee 
are poisonous drugs. They are, in his opinion, the "cause of, or lead 
to hardening of the arteries, among the results of which are Bright 's 
disea.-e, heart failure, apoplexy and premature old age. The mis- 



140 DOMINION MKDICAL MoN'nIL^■ 

diief done by tea and eoffee i.s exeeeded only by the iiarni caused by 
alcohol and tobacco. Tea and coffee are baneful dTugs and their 
sale and use ought to be prohibited by law. 

Su]HM-intendent Harnes and Superintendent Kellogg have very 
divergent views. Perhaps " There 's-a-Reason." 

What the people want to know from the medical profession aliout 
coffee, tea, alcohol and tobacco i.s the maximum quantity which can 
be partaken of daily without injury to their economics. There will 
always l)e some who will abstain from one, two. three or the whole 
all the time; and it is equally true there will alwaj'^ be some who 
will partake of one, two, three or four for all time. The total ab- 
stainers want no scientitic knowledge upon the subject. The others 
want to know what ((uantity can be consumed without danger to 
themselves or their progeny. 



The Massacre of the Tonsii, publislied in full on other pages 
of tills i.ssne, is so sane, so timely, and so important in its pronounce- 
ments that it is adjudged worthy of reproduction so as to give it as 
wide circulation as possible. 

Coming from an undoubted, authoritative source at a time when 
medical inspectors, many practitioners and others have gone mad 
with an insane desire to rip the tonsil up the back, no nuUter what 
the cost, it cannot fail to make a profound impression upon all, and, 
indeed, upon those even who would harass, fine and imprison people 
who would fail to bow downi and worship this golden calf of latter- 
<lay surgery. 

Whilst laying no claim to any extended or far-reaching oibserva- 
tions upon tonsil disease, there must be many practitioners of medi- 
cine who have, time and again, seen many tonsils right themselves 
as time went by under simple treatment. There must be many, too, 
who have often treated diseased tonsils successfully without hasty 
reference to the surgeon's hands, and liad the joy of seeing them re- 
stored to their natural functions, whatever they may be, without 
running the danger to life and other diseases which these operations 
assuredly entail. 

It was high time someone called a halt, and it is exceedingly 
satisfactory that the call has issued from one .so eminently qualitied 
])y knowledge, experienee and position. 

The pronouncement has been deemed so imi)()rtant 1)\' the Editor 
of the Maryland Medical .hmnial as to call for rei^roductioii in its 
September issue, an almost unheard-of proceeding in Ihc history 
of medical journalism. 



DOMINION .MKDllAL .MONTHLY Ul 

EDITORIAL NOTES 



WELLESLEY HOSPITAL. 

The new Wellesley Hospital, erected on the site of the welL 
known "Ilomewood" property of Mr. Fn-derick Xieholl at the head 
of Plotnewood Avenue; was formally declan-d open for public ser- 
vice on the morning of the 27th of August 1»y II. R. 11. the Governor- 
General. 

II. R. n., accompanied by Princess Patricia, Mi-> Pelly, CoL 
Lowther and Capt. Long, drove up to the entrance to the hospital 
shortly before 12 o'cloi-k and were received by Lieut.-(Jovernor Sir 
John Gihson, with whom were Bishop Sweeny, Bishop Reeve, Canon 
Dixon, Sir William Mulock, Presid.MU of the new institution, ^Ir. 
E. B. Osier and other disting-uished gentlemen. 

Following an address by the Lieutenant-Governor, in which hv. 
explained the objects of the hospital, H. R. II. said: 

"Sir William Mulock. ladies and ^'ent'enien, when yoii and Dr. 
Bruce asked me last May to open this hospital in August it gav.- me 
great pleasure to accede to your invitation, and I congratulate you 
on being ready for the opening to-day. 

"As you have justly remark(-<l — In EntrlaiuL Europe and the 
United States, they have many private hospitals for the accommo- 
diition of people whom it is inadvisable to treat in their homes. This 
hospital should be of great advantage to people in that condition 
who can afford to pay for medical attention. They can get here just 
as efficient treatment as could l>e obtained in any public hospital 
with the added advantage of absolute privacy. 

"The Dm-he.ss obtained great benefit in a private ward in the 
Royal Victoria Hospital at Montreal, and it is my sincere wish 
that all who come to this institution may receive as good treatment 
and may make as good a reeovery." 

The Lieut. -(Governor explained that the hospital was to be d»>- 
voted exclusively to tlie care of paying patients. 

"It is furnished with all the accessories and equipment of a mod- 
ern hospital," he s'aid, "but vcith the privacy and comforts of a 
home. On the top of the building is a roof garden, sufficiently large 
to accommodate all the patients. Nearly all the rooms have a south- 
ern aspect, so that even patients who are in bed can be wheeled to 
the \nndows to benefit by the rays of the sun. 

"There is no regular visiting staff, as each patient will be 
attended by his or her own physician or surgeon. The hospital is 



11? DOxMlNION MI'.DKAI. :M(»NrilLY 

<>|>rii to all pliysiriaiis in jrood staM(liM«,' ami siir<;('()iis who t'onliiif 
tlu'ir practice to surgery. 

"AVo aro fortunato in liavin^ sti-urcd the sprvicos of -Miss Eli/.a- 
liftli (1. Flaws as Supoi-iiitcndeiit. ]\Iiss Flaws irradnatcd in the To- 
ronto (loncral Hospital some years ago, subsequently held an im- 
portant post in the Lakeside Hospital, Cleveland, and latent' was 
Superintendent of the Kiii«:r.slon fJeneral Hospital." 

Followinir tile offieial eeremony the royal party were condueted 
tliroujrh the hospital and expressed the hiarhest appi'eeiation of the 
huildintr itself and its splendid equipment. 



MOXTREAL'S DEATH AND BIRTH HATE. 

The animal report of the IMedical Officer of Health of ^lontreal 
shows that the hirth rate in that eity in 1011 was ^7.40 per 1.000 of 
tlie population and' the death rate 21.10 per 1,000. These fifrure.s 
repre>:ent a jrain in births of one per eent. ovm* 1010, and a di'creas'e 
in deaths of one and one-fifth per eent. The total deaths for 1011 
were 9,074. The births numbered 17.(i:>7. whidi places ^lontreal 
very hiffh in natal statistics. 



DRINKING ANT) S^yrOKINCx INCREASINr; IX CANADA. 

For the fi.seal year endings 31st March. 1012, Canada consunuxl 
spirits, beer, wine and tobacco per capita as follows: 1.030 pfals., 
G.oOS gals., .114 gals., 3,670 lbs. This shows a decided increasi\ when 
compared with those of the previous year: Spirits, .041 irals.: beer, 
o.OaO gal.s.: wine, .112 gals.: tobacco, .3.302 lbs. 

How is this to be explained in the face of manv local option 
mnnicipaliti'N nnd a militant temperance movement'? 



COX(iRESS()N IIV(;il-:XK AX!) I)K.M( M ;i;.\l'| I V. 

The Fifteenth Inteniational Congj-ess on Hygiene and Demo- 
graphy will be held in Washington, D.C., September 23rd to 28th, 
1012. The President of the United States is Honorary President of 
the Congress. Dr. Henry P. Walcott of Massachusetts is President, 
and the Secretary-Ceneral. Dr. John S. Fulton, of ^laryland. 

This Congres.s will probably be the largest gathering in the 
interest of pnblic health ever held. It will be the first time in the 
half-<'entury's history of the Congre.^ses that one has ])een held in 
the United States and pro-liably the last for a generation. The fee 
for nuMubership is $r).00 ;iiiil copies of the proceedings are only 
available for members. 



T)OMIXI()X MEDICAL 3I0XTIir.V 143 



IRews litems 



Dr. A. L. Daiiard, Owen Sound, is in London, Entjland. 
Di-. Kaufiiuinii, Mdntri'al, lias sailed for Europo. 

Ke^irina is to have a new isolation hospital. 

Dr. Hill, of the University of Minnesota, has been appointed 
Suiicfintcndent of the TTyfj:ienie Listitute, at Ijondon. Ontario. 

In the past five months there have been fifty-four deaths in 
Toronto from whooiiintr <'Ou^h ; scarlet fevei-, thirty-two deatlis. 

Drs. Ij. S. Harding, ^Montreal ; E. D. Ault, Acton, Ont., and J. 
(I. Hands, Victoria, B.C., are in I^)ndon, Enp;land. 

Dr. Wm. l^urdcn, Trinity '0."), liochester, X.Y.. has been visit- 
iuir in Toronto and othei- points in (Ontario. 

Dr. W. S. Harri.son, will iTpreseni the Toronto Board of Health 
at the Hygienic Congress in Washington. 

Dr. Allan Cameron, Owen Sdinid. Ont.. died on the (Ith of 
Septendier, aged eighty-three. 

Dr. Bruce Hewson, Trinity '95, formerly of Collwrne, Ont., is 
now ])ractising in Peterboro. 

Dr. Tait jMackenzie. Philadelphia, formerly of ]\rontreal, has been 
a guest of Loi'd Aberdeen. 

Drs. W. B. Howell and T. C. Sharp, ^Fontreal, have returned 
from Europe. 

Dr. Geo. AY. l>adgcrow, London, England, is visiting his old liome 
ill Toronto. 

Dr. -J. D. ]\rcDonald, formei-ly of Lion's Head, Out., is located 
in Regina. 

Di". Ceorge Elliott has moved to 219 Spadiua Road. 



lU DOMTXIOX MEDICAL MO.X'rilLY 

A iH'u li()s|Mi.ii i> liciiig erected at ^\^'ybllnl. Sask.. at a cost of 
$r>0.()(M\ 

\)v. I )<ii|._H.iN. M. (). II.. Wiiiiiiiit'jr. lias n'tui-nrd from a trip 
East. 

Dr. ]\. T. Hiilheri"()i-(1, an old Stratford boy, practising at Strath- 
dair, Man., has been appointed Medical Inspector of Immigration 
at the port of New York for the Dominion of Canada. 

AVinnipeir now lia.s a Children's Hospital, the first in Western 
Canada. II. K. H. the Dnke of Connanght opened the hospital on 
the 17th of July. 

Dr. Hugh A. IMacCalluiii. London, Ont., has been elected Presi- 
dent of the Canadian .Medical .V.ssociation, which will meet next 
year in London. 

In August there were 304 deaths in Ontario. Infantile paralysis, 
1.") eases, S deaths; spinal meningitis, 1'A, 13; smallpox, 31, no deaths; 
scarlet fever, 140, 10; diphtheria, 193, 27; measles, 64, 3; whooping 
cough, 348, 30: typlioid fever. 1.022, 04; tuberculo.sis, 179, 119. 

A most successful public health exhibit was that at the Cana- 
dian National p]xhibition this > ear. It was in charge of Dr. J. W. S. 
McCullougli, the Chief Officer of Health of the Province of Ontario, 
and from the vast crowds who inspected it, it may be certain the 
]mlt!ic are taking an exceeding great interest in matters of a public 
health nature. 



Sr.M.MKu i)i.\uuiiE.\. — ^11. Ileiman (Am. Jour. Obs. and Diseases 
iif \V. and C.) advises an initial cathartic of castor oil or milk of 
magnesia in tlie non-inllammatory, milder cases. IVIilk should not 
be given from twenty-four to forty-eight hours. I'pon cessation 
of the diarrhea give diluted skiuinied milk, barley water and .sugar 
in gradually increa.sing (piantities. in mo.st cases astringents are 
uinie<-e.s.sary. If, after the thorough removal of the decomposed 
pnulucts causing the dysjx'p.sia, diarrhea continues, 5 to 10 grains 
of bismuth may be given in mucilage of acacia every one to two 
hours. AVith alKlominal pain, cramps, restlessness and! watery- 
diarrhea, he advises five to ten drops of paregoric. He reports 
favorably upon "Eiwei.ss Milch," which consists of casein and 
buttermilk. 



DOMINION MEDICAL MONTHLY 




Are you particular as to the condition of the iron in your 
Blaud preparations? 

Frosst's Perfected Blaud Capsules present True Ferrous 
Carbonate. 

Each 10 grain Capsule contains, approximately, 1 grain of 
Iron. 



XV ii DOMINIOX MEDICAL MONTHLY 

Ipublisbers' ^Department 



The Pallid School Girl. — In view of tlie iiKMlcrn inethuds 
of echication, which force the scholar at top speed, it is not to be 
wondered at that the strennons courses of study prcscrilu'd for the 
adolescent girl more than frequently result in a general hrcakdown 
of both health and spirits. Each winter the phvsieian is con- 
sulted in such cases and almost always finds the patient anemic, 
nervous and more or less devitalized. In most instances a rest of 
a week or two, together with an efficient tonic, enables the patient 
to take up her school work again with renewed energy, Pepto- 
^langan (Gude) is just the lu'inatiiiic needed, as -it acts promptly 
to increase the red cells and lienioglobin, and to tone u}) the 
organism generally. It is i)articular]y suitable for young girls 
because it never induces or increases constipation. 



The Moderx Treatment of Syphilis. By Dr. ^Martin 
Friedlander, Director of Lassar's Clinic, Berlin. Folia Thera- 
peiillcd, page 89, July, 1908. More recently, as we Avere com- 
])el!ed to make use of the internal treatment in a series of cases, 
our attention was directed towards a new preparation called Mer- 
gal. This substance is a cholic acid-mercury oxide combined with 
tannate of albumen and is dis])eiis(il in small, easily taken cap- 
sules. It has already found numerous advocates, and we have 
ourselves used it in appropriate cases. We are able to state that 
it is well li(>'ii(>, has proved itself powerfully active against 
syphilis, although the inunction and injection methods remain the 
r(»ntiiie ]>ractiee. This organic mercury ])r(']iaratioii, ^Mergal, has 
Ivtwever, llie advantage over the other and inorganic mercury 
ju-eparations, that it is easily assimilai)le, and in no way irritates 
the aliiiieiitary canal. Patients can remain long under this method 
of treatment quite comfortably, and do not suffer from the dis- 
agreeable inconvenience attending ()ther methods, and this, in the 
case of better-class patients, is a matter of the highest importance. 
^NFergal is supplied by TIenrv A. Jvowland, Toronto, Ontario. 
Canada Agent for Kiedel cV Co., of London, England, and Berlin, 
Germany, and who will be pleased to submit samples of their 
products for clinical tests. 



DOMINION MEDICAL MONTHLY 



XIX 




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XX DOMINION .MKDICAL MoNTIIL^- 

The modification of the milk from which MODIFIED MILK 
POWDER (CM. P.) is mauufaetured consists of dilution with 
unfermented whey. This contains all the milk solids otlier thaji 
fat ajid caisiMn, and, instead of decreasing the milk albumen content, 
largely increases it to correspond wiih mothers' milk. The natural 
milk salts and milk sugar are likewise supplied 

The practical results of MODIFIED :^iILK POWDER (C.M.P.) 
juid SWEET WIIEY POWDER (C.M.P.) are what we should 
expect fi-om the scientific way they are made, whereiby the albu- 
mens and milk sugare remain unaltered and the enzymes un- 
desti\)yed. These foods have saved the lives of hundreds of infants. 
This summer will see these foods saving the lives of hundreds more. 



PiTUiTRiN IN Diffici:lt P.vktukition. — ^luch attention is being 
given by the medical press of Germany and other European coun- 
tries to the importance of Pituitrin as an oxytocic. The drug has 
been somewhat extensively used for the past two or three years, 
lx>th here and abroad, chiefly, perhaps, as a hemostatic and heart 
stimulant. Now it is known to be of great value in uterine inertia, 
obsdetrieians in many of thf Germain hospitals and elsewhere who 
have thoroughly tested it clinically pronoun.-ing it a tinily remark- 
al)le oxytocic. For the licnefit of practitioners who may not be 
familiar with its origin and nature, it may be explained that Pitui- 
trin is an extract of the posterior or infundil)ular portion of the 
pituitary' gland. Although the psysiology of this gland is as yet 
largely speculative, there seems to be no doubt that it contains a 
substance or .substances that exert a considerable influence over the 
metabolism and on the cardio-vascular srv'stem. As bearing upon 
the value of Pituitrin in pai'turition, this expression from Dr. Emil 
Vogt, of the Royal Gynecological Clinic at Dresden, is significant: 
"The oxytocic action of Pituitrin at this clinic was obsei'ved in 
over one hundred cases. After the rupture of the fetal mem- 
branes, in the .second stage of labor, the physiologic efTeet of Pitui- 
trin is the most pronounced; tiie contractions of the uterus follow 
each other much more rapidly and energetically, and the intervals 
between jiains are decreased. Individually the pains are not more 
severe, so far as sulfei-ing is concerned, even in the case of sensitive 
women^ than they would be in a normal delivery. In half of the 
cases the Pituitrin Wfus administrated in the second stage of lal)or. 
It failed only once; in all other instances its action was very pro- 
nounced. An<l altliough we encounter a great many eas'^s of nar- 
i"ow ])elvis in Dresden, fi'om 40 to 50 per cent., it was not necessary 



DOMINION MEDICAL MONTHLY 



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sxii Do.MIMoX .MKDiC'AL .MONTHLY 

to liavt> rix'oui'so to t'oi-ops ilolivcry in a single instance in which 
Pituitrin was employed. . . . According to our experience, 
Pituitrin is the ideal oxytocic." Pituitrin i.«: manufactured by 
Parke, Davis & Co. It is supplied in one-ounce Ixtttles and in 
glaseptic ampoules (for convenient hypodermic injection), each 
ampoule coiitaininjr one cubic centimeter, or IH minims, the usual 
dose. Parke, Davis & Co. have just issued a pamphlet on Pituitrin 
as an oxytocic, in which is reprinted not only the extract from 
Dr. Vo^rt which appears in this article, but also a nunvber of others 
from prominent German specialists and practitionere, in which 
Pituitrin is highly extolled as a corrective of uterine inertia. 
Physicians will do well to write the company, addressing them ast 
the home ofifice in Detroit, for a copy of the pamphlet. 



A MEDICAL MAX'S DRESS. 



The days when the physician made an open parade of his call- 
ing by appearing in public places in full-blown academicals, or, 
upon more private occasions, attired in silk coat, wig, stockings and 
cane, are now over, and few thoughtful persons would desire to 
return to such con>spicuous constume. The nearest approach to 
this affectation is the traditional academic dress, worn on special 
occasions only, but this is invested with all the mediaeval dignity 
inseparably connected with the ancient seats of learning. Apart 
from the go\\Ti and hood, however, the ordinary everyday attire 
of the medical practitioner is still governed, almost subconsciously, 
by the dictates of conventionality. As a lecturer remarked at the 
rect')it Nursing Conference, held at AYestminster, no class is so 
punctilious as medical men in being correctly clothed in "regula- 
tion dress," presumably, the orthodox silk hat and frock coat. 
"A doctor otlierwise than conventionally attired for whatever oc- 
casion presents itself would soon be looked upon by his < onfreres 
as something of an eccentricity, if not worse." Nevertheless, we 
have come across many menrbers of the craft in full swing of work 
who are bold enough to throw conventionality to the four winds, 
and who appear quite unconcerned upon the most professional 
occasions in a get-up that is, to say the least, distinctly original. 
The strange thing is that their practices do not appear to suffer at 
all from this departure from the normal. Suitability to any 
occasion is, of coui-se, in much better taste than merely trying to 
look impressive. — Medical Press and Circular. 



DOMINION MEDICAL MONTHLY 



XXlll 



Nutrition Depends Upon Small Matters 

It is beginning to be recognised that it is a mistake to force 
hystericaL emaciated or tuberculous patients to take large 
quantities of " nutritious food," and that course will pro- 
bably soon become as antiquated as the copious drugging of 
the past. 

BOVRIL 

in small quantities, taken as part of the daily diet, has been 
proved to increase the power of digestion and assimilation, 
for the series of tests made by Professor Thompson, M.D., 
Sc.D., at the Dublin School of Physiology showed con- 
clusively that while Bovril was taken with ordinary diet 
the weight of the subject of the test was increased as much 
as from ten to twenty times that of the weight of Bovril 
taken. 




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There is no finer, more cleanly fabric than linen, and since in the 
making of Deimel-Mesh the chill has been removed, there is no safer 
and more protective garment than the Dr. Deimel Underwear. 

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xxiv DOMINION MEDICAL MONTHLY 

Lime Water vs. Phillips' Milk of Magnesia. — Lime water, 
according to the 8th decennial revision of the U. S. Pharmacopeia, 
shonld contain not less than 0.14% of pure Calcium Hydroxide ca 
(0H)o. about 10 grains to the pint. The percentage of Calcium 
Hydroxide varies with the temperature at which the saturated solu- 
tion is prepared, being 0.17%, about 12 grains to the pint at IS'C. 
(59°F.), and diminishes as the temperature rises. 

In over 100 samples of lime water obtained from reputable phar- 
macists the amount of Calcium Hydroxide varied from 1 to 11 grains 
to the pint, 75% examined was below .standard strength and in sev- 
eral the percentage of lime was so low as to make the preparation 
practically worthless. 

Phillips' Milk of Magnesia is a hydrate containing not less than 
24 grains of pure Magnesium Hydroxide (]\fg H„ 0,), to the ounce. 
A teaspoonful is equivalent in acid neutralizing power to about 
6 ounces of lime water of standard strength. 

"50 c.c. of lime water require for complete neutralization not 
less than 19 c.c of tenth-normal Sulphuric Acid V. S. (correspond- 
ing to about 0.14% of Calcium Hydroxide), phenolphthalein T. S. 
being used as indicator" U. S. P. 

50 c.c. of Phillips' Milk of INIagnesia require for complete neu- 
tralization not less than 900 c.c. of tenth-normal Sulphuric Acid V. 
S. (corresponding to about 5% Magnesium Hydroxide), phenolph- 
thalein T. S. being used as indicator. 



IH 



2)ominion /n^ebical /Ihoiubl^ 



HnD Ontario /iBeOical Journal 



Vol. XXXIX. TORONTO, NOVEMBER, 1912. No. 5 



©rioinal Hrticles 



TRESIDENTIAL ADDRESS, CANADIAN MEDICAL ASSOCIATION 



By H. G. [NIacKid. :\r.D.. Calgary, Alta. 



If, in rising to address this national association as its president 
for the year, I confess to some small feeling of pride, I have 
little doubt you will forgive me for it. It is a feeling born, 
and legitimately born, of a deep sense of the honor you have laid 
upon me ; and I trust you will accept the assurance of my heartfelt 
thanks. 

Yet, deeply as I have appreciated the honor, I have felt the 
responsibilities of the office in an equal, or even a greater, degree. 
At times during the past year, let it be confessed, the work and 
worries incident to preparing for this meeting have almost made 
me regret my election. We all owe a debt of gratitude to the medi- 
cal men in Edmonton and the city authorities for the arduous work 
they have done and the excellent help tliey have rendered. 

Gentlemen, I do not propose in this presidential address to take 
up any one aspect of medicine in particular, as is done in many 
addresses of this character; nor to give a general review of the 
progress of medicine during the past year, with which many of you 
are better acquainted than I am. What I have set before myself 
is rather to review briefly the work of the association in the past 
two or three years: to point out the lines along which progress has 
been made, and along which, as I take it. progress lias still to be 
made ; to estimate what part in it all the West has taken and may 
take, and, finally, to make an appeal for greater unity in thought 



'Reprinted from Canadian Medical Association Journal. 



146 DOillNlON MEDICAL :\IOXTHLY 

aud ill aim among: the profession in Canada for the advancement 
of this association. If what I have to say sliall render even the 
slightest service to the cause of the association, and through it to 
the cause of medicine in Canada, I shall feel myself amply repaid. 
The selection of Edmonton for the place of meeting of the 
association this year is significant. It marks the awakening of the 
East to the fact that this AVestern part of the middle West has 
come to man's estate, aud is showing the lustiness of youtii. We 
of Alberta who have grown up, so to speak, with the province, have 
been ourselves amazed at the strength and rapidity of her growth. 
But the East liad not really recognized the fact. The Easterner 
knew much of Vancouver and Winnipeg, but little of Calgary and 
Edmonton. Your selection of Edmonton, therefore, came as a wel- 
come surprise. When it was first suggested, we immediately set 
our hearts on it. We desired greatly to give you a taste of Western 
hospitality, and we desired also that you should see us and observe 
how well we were getting on. Perhaps there is in us some such 
vspirit as that of the boy who insists on his father mea-suring his 
height against the door every month. 

However all this may be, you are eventually here, and in the 
name of Edmonton, and of Alberta, I bid you heartily welcome. 

This is only the second time that the association has held its 
annual meeting in Alberta. In 1889 it met at Banff, and there were 
only eighty-two present. 

Only two meetings in the history of the association have been 
held in the West previous to the present one. Of these, one, as 
I have said, was held at Banff, twenty-three years ago, in the year 
1889. The president was Dr. H. H. Wright, of Ottawa, and the 
general secretary was Dr. James BeU, of Montreal, both of whom 
have since died. The vice-president for the North-West Territories 
at that time was Dr R. G. Brett, of Banff, who is so widely and 
favo'rably known throughout the West. The second of these meet- 
ings was held in Vancouver in August, 1904. The president was 
Dr. Tunstall, of Vancouver, and the secretary Dr. George Elliott, 
of Toronto. Dr. Elliott's annual report gave certain statistics of 
attendance which are interesting. He said that during the first 
decade after the organization of the association in 1867, there was 
an average attendance of seventy-one. In the second decade, from 
1877 to 1887, there was an average attendance of 74.8; during the 
third decade, 107.5; while for the previous seven years, that is 
from 1897 to 1904, the average attendance was 139.1. In the light 
of these figures it is interesting to note that the average attendance 
for the past seven years has been 320, while if we count only the 
last three meetings since the inauguration of the Journal it is 400. 



DOMINION MEDICAL MONTHLY 147 

In reading over the minutes of the Vancouver meeting, I came 
across two resolutions of interest to us. One concerned the question 
of a Public Health Department for the whole country, the other 
that of Dominion Registration. 

At the Vancouver meeting in 190-4, a strong resolution was 
passed, urging the Dominion Qovernment to establish a depart- 
ment of public health under a minister of the crown; a matter 
which the association had been urging for three years. Unfortu- 
nately, tliis resolution, as well as others of a like purport, remained 
without ett'ect. But I am happy to be able to say that matters 
in this direction now look more favorable. At the tirst meeting 
of the Canadian Public Health Association, held last December 
in Montreal, under the presidency of Professor Starkey, Premier 
Borden promised that his government would institute a general 
reform in public health matters, and put that department on a 
sound and modern footing. In this he was supported by the Hon. 
]\Iartin Burrell, Minister of Agriculture. We can 'thus hope that, 
before long, this very important question will be settled in the man- 
ner that this association has been urging for so long. 

At the same meeting there was passed a resolution concerning 
Dominion Registration, to w-hich Dr. Roddick, of Montreal, had 
given so much of his time. Tliis, too. has now come to pass, but 
only this year. During the present spring the so-called "Enabling 
Clause" was finally passed by Ontario, the last of the provinces 
which had previously been afraid that their provincial autonomy 
would be endangered ; and I am glad to be able to say that we are 
finally in a position to begin the detail work of arranging for a 
Dominion Council. 

The Roddick Bill aims at the establishing of one set of exami- 
nations and one standard of qualifications for the practice of 
medicine in Canada, in place of the different examinations and 
varying standards of the individual provinces. It was introduced 
in the House of Commons in 1902 by Dr. Roddick, then represent- 
ing St. Antoiue Division, Montreal. The bill was passed, but 
owing to objections raised to certain features by provinces jealous 
as to their existing rights, it was found impossible to give effect 
to the act. 

About two years ago a meeting of the representatives of the 
provincial medical councils was held in Montreal, when Dr. Roddick 
succeeded in securing the consent of all to certain amendments which 
he proposed to the original Act. These amendments, removing 
earlier objections, were embodied in a bill which was passed at the 
1911 session of the Parliament in Ottawa. It is part of the Act as 



148 DO^IIXION :\IEDICAL MONTHLY 

it now staiuls thill tlu' pi-ovinces give their assent to tlie principle 
of the Act through a hill passed in their own legislatures, ami it is 
this step which has now been taken by all the provinces. 

AVhen the Dominion I\Iodical Couni'il is finally formed it will 
be possible for a physician, having passed the examinations pre- 
scribed by it, to practise in any province of Canada, instead of, 
as at present, only in the province or provinces where he has satis- 
fied the rtMiuirements of the respective provincial medical councils. 
The Dominion Medical Council will have full authority over the 
purel}- professional subjects, while the provinces will probably ex- 
ercise authority over the non-professional subjects of the exami- 
nations. 

I have no doubt that I voice the sentiments of all of you here 
present, and indeed of the whole profession in Canada, when I 
say that we all owe a profound debt of gratitude to Dr. Roddick, 
who has been the direct means, and in a sense the only means, 
by which this beneficent law has been placed on the statute-l)ooks. 
We realize what a vast amount of time and energy he has expended 
on this work : how, indeed, he has given many of the best years of 
his life to it. And in thanking him we desire to record, not alone 
our appreciation of the work he has done, but also of the sacrifice 
it has cost him. If it is, in his eyes, any reward that the profession 
throughout the country feels grateful to him for his work ; if it is 
to him any gratification that the whole of Canada has learned to 
call tills bill the ''Koddick Bill"; if it is any pleasure to him to 
realize that every member of the profession, thinking of this task 
which he has accomplished, looks up to him w'ith respect largely 
mixed with aifection, let him be assured that all this is true. It is 
an achievement which perhaps no other medical man in Canada 
could have brought to pass. The task of reconciling so many 
diverse and even warring interests in the various provinces of the 
Dominion ; of overcoming prejudice, and of bringing together 
those of dissimilar views, was only to be accomplished by a man 
whose professional reputation was high fi-oiii East to West, and 
whose tact had become almost provertii.il from East to W(>st. 
People not only gave him affection: Ihey gave him respect. It 
was the combination of ((ualities of head and heart in liim which 
finally brought this great matter to a successful conclusion. One 
of the chief privileges of my office this year lies in the opportunity 
which it affords me of thus giving public expression, on behalf of 
the association, to the gratitude which we all feel towards Dr. 
Roddick. 

I have thought that this meeting would l)i' interested in a 
short review of the recent work of the association. The associa- 



DOMINION MEDICAL ^[OXTHLY liO 

tioii, it is true, has been in the last ten 3'ears steadily increasing 
in numbers, but the increase up to a recent period has been slow. 
The ostablisliment of the Journal two years ago gave an enormous 
impetus to its growth. With the inception of the Journal, the 
conditions of membership were radically changed. In former 
years a member paid $2.00 annual subscription, and paid it only 
when he attended tlic annual meetings. It is perfectly clear that 
with an annual attendance varying from one to three hundred 
the amount of money in the treasury was rarely sufficient to do 
more than pay ihe ordinary expenses of the secretary's office, 
together with the expenses incident to the annual meeting. The 
activities of the association along general lines were extremely 
hampered. Without an official organ and without money, there 
was very little that could be etificiently done. Now we have changed 
all that. Thanks to the labors of the Finance Committee of the 
past two years, we have established an etificient journal of the 
as.sociation, which, under the able editorship of Dr. Andrew Mac- 
phail, has already won a place for itself in the periodical literature 
of the medical world. We have hopes that within a short time we 
shall be able to make it a weekly instead of a monthly. That will, 
however, depend upon the support given the association by the 
profession at large throughout the country. In the second place, 
the establishment of the Journal enabled tlie association to raise 
the memliership fee to a reasonable amount, and to make member- 
ship in the association and the payment of the annual dues a per- 
manent matter. I am instructed by the secretary and by the 
treasurer to say that this does not mean that the a.ssociation has 
grown suddenly rich. In spite of the increased income, the neces- 
sary expenses connected with the publication of the Journal have 
eaten up nearly all the revenue. But the profession now has an 
organ to represent it in Canada: and while it is yet too soon to 
expect that it can give adequate representation to all the branches 
of the profession, and though it must naturally fall short as yet 
of the standard which many of you hope for it, it has nevertheless 
done extraordinary good work, and is a .iournal of which we all 
feel proud. 

During the last two years a second big piece of work has been 
carried on by your officers. I refer to the affiliation of the various 
Provincial Associations with the Canadian Medical Association. 
At present all of the provinces save one have declared themselves 
in favor of affiliation, and have become affiliated. I am con- 
vinced that this work will be of the greatest benefit to the profession 
in Canada. 



150 DOMINION MEDICAL MONTHLY 

I pass now to a brief consideration of tlie needs of the future. 
Along what lines are advances to be made? To begin with, there 
is one matter, gentlemen, which T think is of paramount importance" 
to tliis association, and it is this: the r-onsolidation of the profession 
in Canada into one strong and united body. Tliat ta-k can be 
accomplished by no other means than by this national association. 
We have already done something towards this end. No longer 
than three years ago we were a very haphazard body. The mem- 
bership was constituted, for all practical purposes, only by those 
who came to the annual meeting — from three hundred to four hun- 
dred men. And these, of course, varied enormously from year to 
year, according to the part of the country in which the meeting 
liappened to be held. With this state of atfairs, there was no pos- 
sibility of concerted action. A great step forward was made in 
the establishment of the Journal of the association, and in making 
membership continuous, and the payment of the fee an annual 
necessity for continued membership. The establishment of the 
Journal involved, as I happen to know, a very great amount of 
labor on the part of the Finance Committee, and the thanks of 
the association are due to the members of the Finance Committee 
for the last three years, as well as to its able and self-sacrificing 
editor. Dr. Andrew Macphail. The Journal has had a very 
excellent start. It had to be begun as a monthly, but we look for- 
ward to its becoming, before long, a weekly. Canada can afford 
plenty of good material for a weekly, if material were all that was 
needed. But, unfortunately, journals cannot live on material alone. 
The financial burden of the undertaking is very great -, and the 
Finance Committee assures me that unless the ineinliership roll of 
the association increases very considerably, it will be impossible to 
stand the expenses of a weekly. Wlien we consider that the 
Journal, as the organ of the Canadian Medical Association, is the 
one great bond which alone can unite the profession from East to 
AVest, we cannot fail to realize the great importance of loyal ad- 
herence to the association. It means so much to the profession 
in Canada as a whole, and to each individual man, that there should 
exist a strong central body, like the Canadian ^Medical Association, 
to look after their interests, that I cannot conceive how any medical 
man .should remain out of it. 

This, then, is the great problem — to get the Canadian Medical 
Association solidly cemented together. Plow is it to be done? To 
my mind, it is to be done by an extension of the principle of atlfilia- 
tion. Two years ago the only province that had declared itself in 
favor of affiliation with the Canadian Medical Association, and 



DOMINIOX MEDICAL .MOXTHLY 151 

that became affiliated, was Ontario. In the last two years all but 
one of the provinces have followed Ontario's lead, and the one 
exception has declared itself unofficially in favor of affiliation at 
an early date. This is the necessary beginning. But what we 
have yet to do towards organization, is to create a properly con- 
stituted body, a sort of parliament, with proportionate representa- 
tion from each province. Hitherto we have had the Executive 
Council, but this body has been chosen in an absolutely casual 
way at the times of the general meetings by members who hap- 
pened to be present at the first meeting of the session. The mem- 
bers of the Executive Council should be properly elected by the 
respective provincial associations, and the council should have 
more work given to it and greater responsibility placed upon it than 
in the past. 

But this affiliation of the provincial associations with the Domin- 
ion Association is only half of what should be done. The prin- 
ciple of affiliation should be extended to embrace the relations of 
the provincial with the county and city societies. At present this 
is practically barren ground. The county societies have no rela- 
tions with the provincial associations. They are casual and in- 
dependent. Yet there can be no doubt that, to cement the pro- 
fession together, the bond between the county and provincial so- 
cieties ought to be quite as close as that between the provincial 
and national as.sociations. 

This then, gentlemen, is what I feel sure we must strive for, 
and what I ask your co-operation in. Let us begin with the county 
societies as the centre of things. Let us group, if necessary, several 
counties into one good district society. Let these elect members 
as delegates or officers to the respective provincial associations. 
Where no county societies exist, let the men of that particular 
region organize one. This has already been proposed for Ontario 
by Dr. Herbert Bruce, in his recent address as President of the 
Ontario Medical Association for this year. He said: "I think 
it very desirable that there should be an increase in the number of 
small county medical societies, and I should like to suggest that, 
for tliis purpose, the province be divided into ten districts corres- 
ponding to the ten health districts recently established by the 
provisions of the new health bill. As there are forty-seven counties 
in the province, this would mean that each society would include 
four or five counties, which appears to me to be a practical arrange- 
ment. Then the method of securing membership in the Ontario 
• Medical Association would be simplified by accepting the members 
of these smaller societies, which would obviously be in a better 



152 DOMINION MKDK'AI. :\IOX'IMILY 

position to dett'i-iuiiu' their tiualilicutiuns. " It socins to me that 
hr. Bruce 's proposal is of the greatest importance, and I would 
urjre that a similar phm be adopted hy the other provinces. In- 
deed. I think, gentlemen, that if this address has any value at all, 
that value lies in the advocacy of the idea just described. This is 
not the place to go into details of organization, which may well be 
left to the Executive Council and the general secretary ; but I am 
convinced that a close union of all the county societies witli their 
provincial association is the great need of the immediate future of 
this association. 

But it may be asked by some of you, what, after all, are the 
advantages to be gained by this scheme of consolidation or affilia- 
tion? Are we going to be any better off for it? Perhaps the best 
reply I can make to such a hypothetical question is to point to the 
extraordinary success of the American Medical Association. I pre- 
sume it can safely be said that no national association in the world 
has accomplished so much in so short a space of time for the gen- 
eral good of the profession as has the American Association. Any- 
one who ha.s followed its work at all closely cannot but admire the 
extraordinary amount of good, both for the profession and for the 
public, which it has accomplished in the last ten to twenty years. 
The .scope of its activities has widened enormously. It would be 
impossible in an address of this nature to refer in detail to all 
these activities, but I cannot avoid calling your attention to a few 
of them. It is well known to you that in the matter of medical 
education, not many years ago, the States, with the exception of a 
few prominent universities, were in a deplorable condition as re- 
gards their medical schools. The proprietary school, and as a more 
or less natural result, the diploma mill, flourished. The American 
Medical Association set itself to clean their Augean stables. Their 
stables were encumbered with such stuff as the diploma mill, a low 
standard of professional conduct, commercialism, quack medicines, 
dislionest proprietary remedies, all sorts of fake cures, and all .sorts 
of patent medicines. They have not rid themselves, by a long way, 
of these matters of reproach, nor indeed has any country anywhere, 
but they have waged a very good war against them, and in that 
tliey serve us as a very good example. What have they done? 
Tliey have established permanent, and active, and hard-working 
committees on medical education, which have reduced the number 
of the low-class medical schools to nearly half what they were ])e- 
fore. They have established a committee on legislation, wliich, in a 
great many ways, has been of the greatest assistance in fighting the 
pas.sage of bills in favor of unqualified sects in medicine, and in 



DOMINJOX MEDICAL ,MOXTHLY 153 

favor of the proprietary interests; they have established committees 
on such subjects of general interest as anesthesia and the newer 
remedies, wliich have given to the profession at large reliable infor- 
mation upon these things. They have organized a very large pro- 
portion of the profession in America into a united body ; they have 
published the fullest and most accurate directory of the medical 
men in the TTnited States and Canada that exists, from which, by 
the way, our own association has derived much benefit. They have 
gradually made of the Journal of the association the best all-round 
weekly in the world ; certainly the best for the general practitioner. 
Now the secret of the whole thing, the key-note of its success, has 
lain in its power to secure the loyal support of the profession 
throughout the country, and this they have done by the plan of 
organization that I have outlined above — county societies uniting to 
form state associations, and state associations uniting to form the 
national association. It means something to a man to be a member 
of a county society, for that is the only gateway to membership in 
the state and national associations. There is no reason why we in 
Canada should not make a like success with our own Association 
and our own Journal. All we need is a good start, and if we can 
arouse the enthusiasm and obtain the loyal support of the majority 
of the profession in Canada, we shall be able to follow out a like 
successful career. If we can only secure a large enough membership 
to justify the expenses of making our monthly into a weekly, we 
can then go ahead at a great pace. . The Journal will attract new 
members; it will pay, and more than pay, its own running expenses; 
it can serve as a medium of publication for the whole profession ; 
it can infiueuce the legislatures to enact good medical laws; it can 
wage effectual war on the nostrum vendors and the quacks of all 
descriptions ; it can furni.sh up-to-date information on all subjects 
of interest to the general practitioner; and it can do a thousand 
other things which I have not space to mention here. Any ten- 
dency to the narrow view, to an exclusive attention to home affairs, 
to provincial chauvinism, to country or city narrowness, to per- 
sonal absorption in one's own practice to the exclusion of a larger 
view of national medical affairs, must be combatted : and I think 
that I strike no false note in appealing to you all who are here 
present to act in your own district as missionaries in this problem, 
to arouse a pride in our association and a willingness to work for it. 
I thnk that I can guarantee that so far as the West is concerned 
that spirit is already strong in us. 

Gentlemen, I know you will forgive me, knowing me as you do 
of old for an enthusiastic Westerner, if I now allow m\^elf. in 



15i DOMIXIOX MEDICAL MONTHLY 

closing, a fe^v words upon what seems to me to be the value of the 
West to the profession of medicine in Canada and to this associa- 
tion, and a few words also upon the future of medicine in the West. 

What is the value of the W^est to medicine? Does not the 
answer lie in the words, energy and newness and opportunity. 
The West is young and lusty, and full of life. It has a love of 
action, and it has a love of newness. It is unhampered by tradi- 
tions, whether of conduct or of science. It will do the things that 
it thinks right, whether in conduct or in science. I really do believe 
that, in medicine as in the rest of human endeavor, the West is 
going to supply that leaven of originality which, after all, is "the 
one thing needful." The AVest thinks boldly and acts boldly, by 
necessity first, then by conviction, and ultimately by habit. Give 
the West a little more time to establish herself soundly in the 
higher education, by means of provincial universities, and she will 
jield a rich harvest of energetic and trained men who will have in 
them that invaluable dash of Western originality which makes for 
really big work. 

And now, what is to be the future of medicine in Alberta and 
the West ? I think it will bo admitted by everybody that the goal 
towards which we must strive in the matter of medical education 
in Canada is the establishment of a first-class medical school in 
each province of the Dominion, as part of a provincial university. 
This does not mean that each province must have a medical school 
as a necessity of itself; it means rather that with the enormous 
gro\vth in population in Canada, it will become inevitable that each 
province shall have a medical school, and that we must see to it 
that that medical school is a first-class one. In Alberta we already 
have, and have had for the past four years, a provincial university 
whch is doing excellent work under the able presidency of Professor 
Tory. We have no doubt that before very long we shall be able 
to establish a good medical faculty. And I would point out that we 
have already in Alberta first-class facilities for the education of 
the medical man. Our hospitals are excellent institutions, and will 
soon be quite large enough to serve efficiently for the teaching of 
medicine. What w<? must aim at is to estal)lish close relations be- 
tween the university and any proposed beginnings of medical teach- 
ing. There is plenty of money in the country with which to endow 
education. It must l)e our ])usiness to show to our wealthy business 
men the advantages which must accrue to the province at large 
from any financial help given to the cause of general education. I 
place my faith in the growing wealth of this new country, and not 
less in the inherent generosity of the Westerner. It seems to me in- 



DOMIXIOX MEDICAL MOXTHLY 155 

evitable that our country will before long, not only have a university 
and a medical school that one maybe proud of, but that these \nll be 
amply endowed with money made in the West, and given by the 
generous men of the West. All this may probably happen in Van- 
couver before it happens in Alberta, but we shall certainly not be 
far behind. 

Looking forward, as I do. in this hopeful way to the future of 
medicine in the West, and anticipating as I do the training of 
medical men in the West, I feel sure that when we do graduate men 
in medicine out here, these men will do us credit. Like all Western- 
ers, our graduates will have the love of travel, perhaps more so than 
have they of the East, and perhaps on the average they will have 
more monej' to do their travelling with. Already our medical men 
are well known in the big clinics in this country and abroad, from 
the mere fact that they visit them so often. This will make for 
liroadness of vicAv. If you get in any man broadness of view com- 
bined with energy and the progressive spirit, you get exactly those 
qualities which make for the advancement of medicine as a whole 
and the welfare of the patient in particular. 

We have, out here, the advantages of a clean slate. We can 
begin rfght. We can begin where others leave off. unhampered by 
conditions that have got set and that are difficult to change. I hail 
the meeting of this national association in Alberta as a great stimu- 
lus. Our own men will be more encouraged to better work and our 
laymen will have an opportunity of seeing what the profession is 
doing for Canada. 

And now, fellow-members of the Canadian Medical Asso