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Vol.    XfV  JANUARY,     1899.  No#    u 

The  Charlotte 

Medical  Journal. 

A  MONTHLY  JOURNAL  OF  MEDICINE  AND   SURGERY. 

RY,     %\ 

Edited  by  E.  C.  REGISTER,  M.  D.,  and  J.C.  MONTGOMERY,  M.  D. 


CHARLOTTE,    N.  C. 


PHILLIPS'  EMULSION 


exhibits  the  highest  de- 
gree of  excellence  in 
emulsionizing  Cod  Liver 
Oil.  50  per  cent,  finest 
Norway  Oil— in  minute  sub-division— emulsified  by  Pancreatine — combined  with  the 
Wheat  Phosphates  (Phillips').     Acid  reaction,  precluding  saponification. 

PALATABLE— PERMANENT. 

Miscible  in  Water,  Milk,  Wine,  etc.  Prescribe  PHILLIPS'. 

THE  CUAS.  II.  PHILLIPS  CHEMICAL  CO.,  77  Pine  St.,  New  York. 


EURASTHENIA, 
ERYE  STARVATION 

and  Blood  Poverty 

are  the  conditions  in  which  Mercauro  has  produced 
desired  results ,  never  before  secured  by  me  in  a 
practice  covering  over  twenty  years. 

A; -M; •  Oweri,  &£$vv 

Ex  Member  Judicial  Council  Amer ;Med . Assn. 
Ex  Pres.  Miss.  Valley  Med.   Assn.- 
Treas'.  GteriMv  Pan  toner.' 'JwBdte  Congress. 


^Entered  at  the  Post  Office    in  Charlotte  aa  second    Matter.) 


A*?  85  1900 


Argonin 


Benzosol 


(ARGENTUM-CASEIN) 

Has  conslusively  proven  its  clinical 
value  as  a  non-irritating  and  powerful 
gonococcicide  in  the  local  treatment  of 
acute 

SPECIFIC 

URETHRITIS. 


(GUAIACOL   BENZOATE). 

A  tasteless,  non-irritant  substitute 
for  Creosote,  in  the  form  of  a  granular 
powder.  Of  special  value  in  tubercular 
affections  and 

BRONCHIAL 

CATARRH. 


As  it  splits  up  into  guaiacol  and  benzoic 
acid  in  the  bowels,  it  also  constitutes  a 
valuable  intestinal  antiseptic.  Dose,  5 
grs.,  3  or  4  times  a  day. 


It  is  a  safe  and  efficient  substitute  for 
Silver  Nitrate  in  this  disease  as  well  as 
in  Gonorrheal  Ophthalmia.  Employ- 
ed in  solution  of  from  2  to  10  per  cent. 

Descriptive  literature  and  clinical  reports  sent  upon  request. 
Our  Monthly,    "Therapeutic  Progress,"    can  also  be  had    regularly 
for  the  asking. 

VICTOR  KOECHL  &  CO.,  122  Hudson  St.,  New  York. 


TARRH 


An   Alkaline,    Antiseptic,   Non-Irritating,  Cleansing  Solution  for  the  Treatment  of 
Diseased  Mucous  Membrane,  particularly  Nasal  Catarrh. 

"The  antiseptic  preparations  now  seeking  eminence  and  favoritism  at  the  hands  of 
the  profession  are  many.  The  preparation  that  has  given  me  most  uniform,  excellent 
and  lasting  results  is  Glyco-Thymoline  (Kress).  It  is  a  most  excellent  mixture,  of  a 
beautiful  wine  color,  alkaline  in  reaction,  slightly  pungent  and  very  pleasant  to  take. 
Its  therapeutic  virtues  are  best  shown  in  nasal  and  pharyngeal  troubles,  though  I 
am  now  using  it  with  marked  benefit  in  a  case  of  chronic  cystitis  of  ten  months' 
standing.  I  had  used  the  various  remedies  recommended,  such  as  boric  acid,  sulphate 
of  zinc,  etc.,  with  scarcely  any  improvement;  but  since  I  have  been  using  Glyco-Thy- 
moline  1  see  marked  improvement  in  every  way,  particularly  in  less'frequent  urina- 
tion, and  with  more  ease,  with  also  considerable  improvement  in  general  health."— 
Charlotte  Medical  Journal  for  March,  l§9f..*:    ••;  ... 

SPFn  Al      OFFPH?VA  *ull-size  bottk.ef  Glyco-Th,xmoline  (Kress)  will  be  sent 
v-ri    i-vi/il     vri.F-^IY    to  any  pbysiciajitwho  will  pay'exjpres^  charges. 

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The  Charlotte  Medical  Journal, 


Vol.  XV. 


CHARLOTTE,  N.  C,  JANUARY,    ii 


No.   i 


The  Symptoms  and  Diagnosis  of  Simple 
Glaucoma.* 

By  Gaillard  S.  Tennent,  M.  D..  Asheville,  N.C. 

There  are  some  diseases  which  ought  to 
be  blotted  out  of  existence,  if  for  no  other 
reasons  than  the  trouble  they  give  the  pro- 
fession in  making  an  absolute  diagnosis, 
and  the  danger  arising  from  failure  to  make 
this  diagnosis  early  in  the  disease.  Glau-' 
coma,  which,  according  to  Fuchf ,  'furnishes; 
one  per  cent,  of  all  eye  diseases  "is  ®u6  of.' 
these.  -       '      ' 

The  fact  that  total  .blindness  is  the  Final 
result  in  every  untreated  case  of  chronic 
glaucoma,  as  well1  as  in  the^ majority  of 
cases  receiving  the  best  Ml  rtoeatmc-nt  •  ipja 
sufficient  reason  and  excuse  for  offering  a 
paper  on  the  subject  and  occupying  the 
valuable  time  of  the  society  with  its  dis- 
cussion. 

It  is  true  that  there  is  something  vague 
about  the  term,  and  that  the  highest  author- 
ities still  differ  as  to  the  causes  which  pro- 
duce the  condition  known  as  glaucoma. 
It  is  also  true  that  there  is  a  great  deal  of 
uncertainty  connected  with  the  diagnosis 
of  many  cases  in  their  incipiency ;  still 
early   diagnosis  is  possible   and    important. 

The  subject's  interest  to  the  general  prac- 
titioner centres  around  these  points  :  First, 
glaucoma  in  its  different  forms  closely  re- 
sembles other  ills  of  every-day  occurrence; 
Second,  atropine,  which  is  unfortunately 
looked  upon  as  a  panacea  in  eye  troubles  by 
some  men,  is  decidedly  contraindicated 
where  there  is  even  a  suspicion  of  its  pres- 
ence or  a  tendency  in  that  direction. 

The  symptoms  of  simple  glaucoma  dur- 
ing an  exacerbation  are  very  much  like 
those  of  supra-orbital  neuralgia,  or,  if  the 
attack  be  more  acute,  may  closely  resemble 
those  of  a  bilious  attack,  sick  headache,  or 
facial  erysipelas.  The  appearance  of  the 
eye  may  also  lead  to  the  diagnosis  of  some 
less  serious  eye  trouble,  the  treatment  of 
which,  when  applied  to  a  glaucomatous  eye 
would  be  disastrous. 

If  everyone  were  to  realize  that  the  dis 
ease  is  not  such  a  very  rare  one  and 
that  it  is  as  fatal  to  the  sight  as  it  is  stated 
above,  there  would  be  far  greater  care  exer 


*Read  before  the   Buncombe  County   Medica 
Society,  Nov.  21,  1898. 


cised  in  the  use  of  atropine,  which  often 
brings  into  activity  latent  cases,  often  brings 
on  an  acute  attack  in  those  predisposed  to  it 
and  may,  by  a  single  instillation  produce 
glaucoma  in  a  perfectly  normal  eye  after  the 
age  of  40.  In  a  case  recently  seen  by  the 
author,  atropine  had  been  used  continuously 
for  several  months  before  the  outbreak 
which  resulted  in  permanent  blindness. 
Not  having  the  evidence  of  observation 
during  this  time,  it  cannot  be  said  that  post 
'k^c\  ergo  propter  hoc,  but  it  was  decidedly 
a/s&spi^fous  case,  the  patient  being  over  50 
years  6»P#£ge*;..and  it  is  a  sample  of  many 
instances  iTre^.wfth  in  treating  eye  troubles. 
In  order  todeig&Up  to  the  salient  points  in 
the,  di.agno§is,  it  tnay-.be  necessary  to  enter 
int&i^fm/oal  deta*tfs  of  little  interest  to  the 
bnSy  'medical  man,  but  it  will  be  the  au- 
thor's aim  to  emphasize  and  dwell  upon 
only  those  things  with  which  everyone 
should  be  familiar. 

Juler  defines  glaucoma  as  "the  name 
given  to  the  group  of  symptoms  caused  by 
an  excess  of  intra-ocular  tension."  This 
state  of  abnormal  tension  may  be  caused 
and  kept  up  by  forces  operating  continu- 
ously or  intermittently  through  an  indefi- 
nite period  of  years,  in  which  case  it  is 
termed  simple  glaucoma,  or  it  may  be  pro- 
duced by  certain  conditions  existing  for 
only  a  few  hours  and  acting  more  rapidly, 
in  which  case  it  is  called  acute  glaucoma. 
Between  these  two  extremes  there  are  vari- 
ous shades  of  the  disease,  progressing  with 
more  or  less  rapidity  and  acuity,  and  sepa- 
rated by  no  distinct  lines.  A  strict  defini- 
tion of  the  term  simple  glaucoma  is  "non- 
inflammatory" glaucoma,  which  would  ex- 
clude all  these  cases  presenting  acute  symp- 
toms, but  the  generally  accepted  classifica- 
tion includes  all  the  chronic  cases  like  those 
described  below,  under  the  same  head.  No 
attempt  will  be  made  to  account  for  the 
origin  of  the  different  symptoms,  for  by  so 
doing,  one  of  the  twelve  digerent  theories 
as  to  the  causation  of  the  disease  may  be 
slighted. 

Simple  glaucoma  is  practically  a  disease 
of  the  middle  aged  and  of  those  advanced 
in  years,  though  it  is  sometimes  seen  in  the 
young.  It  presents,  -usually,  four  well 
marked  stages:  1.  The  prodromal,  which 
is  marked  by  occasional  attacks  of  pain, 
dimness  of  vision  and  halos,  with  increas- 
ing presbyopia  in  the  interim  ;   2.  The  stage 


ft!  A  I 


24 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


of  rapid  advance  in  which  the  attacks  are 
more  frequent  and  only  remit  instead  of 
intermitting;  3.  Absolute  glaucoma  which 
is  synonymous  with  blindness;  4.  The 
stage  of  degeneration. 

During  the  prodromal  stage,  which  lasts 
from  several  months  to  many  years,  the 
patient  complains  of  an  increase  in  the 
asthenopic  symptoms  (a  great  majority  of 
cases  occur  in  the  subjects  of  hyperopia  or 
astigmatism)  which  cannot  be  relieved  by 
glasses ;  he  will  be  subject  to  attacks  of 
dimness  of  vision  attended  with  more  or 
less  neuralgic  pain  in  the  frontal  region, 
and  will  state  that  during  the  attack,  arti- 
ficial lights  are  surrounded  by  halos  of  color 
and  that  objects  appear  as  though  seen 
through  a  fog.  If  the  attack  be  a  severe 
one,  the  conjunctiva  becomes  congested, 
the  lids  and  surrounding  tissues##becfeiVi£ 
swollen  and  ocdematous,  the  paiaAa'd 'intol- 
erance of  light  are  acute,  tfnd'^paere  will, 
be  a  feeling  of  tendernV§s.*-6r  soreness 
through  the  frontal  regie*fi.Yor  several  days 
after  its  subsidence.     .  .*  .";  #.#    •;;.•:     : 

After  some  time  the  attacks  betQflie" rrtorS 
frequent  and  the  patient  enters  u'pbn  the 
second  stage,  in  which  the  tension  is  con- 
stantly raised  and  a  certain  degree  of  pain 
and  discomfort  persists  between  seizures. 
The  visual  acuity  may  now  be  permanently 
lowered  and  the  patient  may  be  unable  to 
use  his  eyes  for  near  work,  despite  the  fre- 
quent changes  of  glasses.  The  visual  field 
becomes  canstantly  narrowed  till,  finally, 
the  little  vision  which  has  been  coming 
and  going  for  some  time  past  is  perma- 
nently blotted  out  and  the  third  stage  or 
absolute  glaucoma  is  reached. 

From  this  time  on  there  is  no  perception 
of  light ,  except  occasional  subjective  flashes 
which  delude  the  unfortunate  victim  into 
the  belief  that  sight  is  not  permanently 
destroyed.  The  painful  attacks  continue 
until  the  undue  pressure  has  had  its  effect ; 
degeneration  sets  in,  with  reduction  of  ten- 
sion and  the  eye  becomes  quiet. 

The  physical  signs  or  objective  symptoms, 
which  are  of  more  importance  than  the  sub- 
jective from  a  diagnostic  point  of  view, 
naturally  fall  into  two  classes  :  those  dis- 
cernible by  ordinary  means,  and  those  re- 
quiring the  use  of  special  examinations  for 
their  detection. 

Unless  seen  during  an  exacerbation,  there 
is  nothing  distinctive  in  the  external  ap- 
pearance of  or  feeling  of  the  eye  during 
the  prodromal  stage,  and  it  is  then  that  the 
ophthalmoscope  and  perimeter  are  most 
valuable.  If,  however,  the  patient  be  seen 
in  one  of  his  attacks,  or  if  increased  ten- 
sion becomes  permanent,  it  will  readily  be 
observed  that  the  pupil  is  dilated,    or    very 


sluggish,  the  anterior  chamber  is  shallow, 
and  the  eyeball  distinctly  harder  than  nor- 
mal. 

This  hardness  may  be  detected  very  read- 
ily, as  Schweiger  remarks,  if  one  have  "only 
enough  faith;"  more  readily  still  at  this 
time,  because  one  eye  is  usually  implicated 
long  before  its  fellow,  and  its  hardness  con- 
trasts with  the  feeling  of  the  normal  eye. 
Measuring  the  different  degrees  of  tension  is 
no  harder  than,  and  very  similar  to,  testing 
the  degrees  of  ripeness  of  large  plums  by  their 
feeling.  In  practicing  palpation,  the  pa- 
tient should  be  told  to  close  his  eyes  and 
look  downward,  pressure  should  then  be 
made  and  increased  alternately  with  the 
tips  of  the  forefingers  on  the  opposite  sides 
of  the  ball. 

If  the  onset  be  a  severe  one,  resembling 
acute* '.glaucoma,  in  addition  to  the  signs 
•.notfeVl.'ab'gyfV.  tb.ere  will  be  intense  conges- 
tion of  "  thQ/Zcojijunctiva,  the  cornea 
.v^H*;  be  steamy*,/  o»*  .hazy  looking  and 
antithetic,  and  th*e*.i*id's..and  surrounding 
tissues^  wUl  pra^sent  a'^wdllen,  oedematous 
flfrrdj  te*Qse*jjsM6ct:  so  that  the  brow  cannot 
Toe  wrinU'ed. 

Late  in  the  disease,  the  pupils  are  widely 
and  irregularly  dilated,  showing  in  the  ab- 
solute stage  the  peculiar  green  reflex  from 
which  the  malady  has  derived  its  name. 
The  sclerotic,  at  this  time,  is  of  a  bluish 
tint,  and  several  enlarged,  tortuous  vessels 
may  be  seen  near  the  corneal  margin. 

A  direct  ophthalmoscopic  examination 
reveals  two  very  important  changes  in  the 
fundus:  1st.  Cupping  of  the  disc,  or  push- 
ing back  of  the  yielding  nerve  tissue  at  the 
point  of  least  resistance;  2d.  Pulsation,  or 
permanent  change  in  the  calibre  of  the 
retinal  vessels. 

The  cupping  of  the  disc  is  progressive 
and  goes  hand  in  hand  with  the  other  symp- 
toms, from  a  depression  similar  to  that  of 
early  atrophy,  to  a  condition  in  which  the 
whole  disc  is  deeply  concave,  with  vessels 
disappearing  over  the  edge  of  the  cup  like 
snakes  crawling  into  a  hole.  The  bottom 
of  the  cup  is  formed  of  the  macula  crib- 
rosa,  and  at  first  is  glistening  white  but 
finally  assumes  the  gray  color  of  atrophy. 
Cupping  commences  about  the  time  of  the 
first  noticable  subjective  symptoms,  and  at 
first,  may  only  occupy  the  temporal  half  of 
the  nerve  head,  in  which  case  it  is  hard  to 
differentiate  it  from  physiological  cupping. 

Arterial  pulsation  is  sometimes  sponta- 
neous and  can  always  be  produced  by  slight 
pressure  when  abnormal  tension  exists ; 
the  diagnosis  often  depends  upon  the  facil- 
ity with  which  it  can  be  brought  about. 
Venous  pulsation,  though  generally  present, 
is  a  negative   sign,   it   being  often   seen  in 


THE  CHARLOTTE  MEDICAL  JOCRHAL. 


25 


normal  eyes.  In  addition  to  this,  as  the 
disease  progresses,  the  calibre  of  the  arte- 
ries becomes  smaller  and  the  veins  become 
enlarged  and  tortuous. 

Another  important  symptom  is  the  grad- 
ual limitation  of  the  visual  field,  which, 
though  subjective,  may  be  classed  among 
the  physical  signs,  owing  to  the  process 
that  has  to  be  used  in  measuring  it.  The 
limitation  commences  in  the  upper  nasal 
field,  very  early  in  the  disease,  and  pro- 
gresses gradually  until  there  is  only  a  nar- 
row strip  of  relatively  good  vision  extend- 
ing outward  from  the  centre.  The  disap- 
pearance of  this  strip  in  a  specially  severe 
attack,  ushers  in  complete  blindness.  In 
contrast  with  the  narrowing  of  optic  atro- 
phy the  field  for  white  usually  contracts 
pari  passu    with  that  for  colors. 

Except  in  those  cases  which  simulate  op- 
tic atrophy,  the  diagnosis  is  easily  made,  if 
the  following  points  be  remembered  :  Early 
signs — rapid,  or  premature  presbyopia,  at- 
tacks of  pain,  dimness  of  vision  and  halos. 
In  the  more  severe  attacks — swelling  and 
congestion  with  shallow  anterior  chamber, 
dilated  pupils,  steamy  and  insensible  cor- 
nea; and  recognizable  hardness  of  the  globe. 

Seen  during  an  attack,  there  is  danger 
of  confounding  the  symptoms  with  those 
of  neuralgia,  erysipelas  or  a  bilious  attack, 
and,  in  every  case,  attended  with  frontal 
or  orbital  pain,  close  attention  should  be 
paid  to  the  condition  of  the  pupils,  cornea, 
and  depth  of  the  anterior  chamber. 


tis.  In  conjunctivitis  the  pupils  are  nor- 
mal and  there  is  no  deep-seated  or  severe 
pain.  In  keratitis  the  opacities  are  more 
dense  and  well  marked.  The  iris  is  dis- 
colored and  the  pupils  contracted  in  pain- 
ful iritis.  If,  in  any  of  these  conditions, 
a  mydriatic  has  been  used  before  the  patient 
is  seen,  the  diagnosis  becomes  more  difficult 
and  a  very  careful  examination  has  to  be 
made, 

In  absolute  glaucoma  the  greenish  opac- 
ity of  the  pupils,  arising  from  changes  in 
the  vitrous,  may  be  mistaken  for  cataract, 
unless  attention  be  paid  to  the  dilated  pu- 
pils and  tortuous  vessels  near  the  sclero- 
corneal  junction. 

There  are  some  cases  ef  glaucoma,  espe- 
cially among  myopes,  in  which  the  tension 
is  never  appreciably  increased,  these  and 
some  other  "quiet"  cases  are  hard  to  differ- 
entiate from  optic  atrophy  with  cupping 
of  the  disc  ;  it  is  here  that  the  retinal  pul- 
sation and  the  peculiarities  of  the  visual 
field  assume  special  importance.  It  is  some- 
times necessary  to  examine  the  field  in 
different  degrees  of  light  and  under  differ- 
ent circumstances  to  develop  these  peculiar- 
ities. 

The  four  cases  which  follow  are  pict- 
ures of  the  conditions  described  above,  and 
three  of  them  are  types  of  the  first  three 
stages,  except  in  point  of  age.  The  other 
is  not  glaucoma  at  all,  but  a  semi-patho- 
logical condition  strongly  resembling  it, 
sometimes    termed  false   glaucoma.      Cases 


tfo' 


J.700 


fc*M,i.,  *-4*  ** 


t . 


Locally,    the  appearances   may  lead  to 
diagnosis  of  conjunctivitis,  keratitis  or  ir 


III.  and    III.,  at  the    respective  ages  of  29 
and  30  years,  are  remarkable    as    examples 


THE  CHARLOTTE    MEDICALJOUKNAL. 


of  early  development  of  the  disease,  while 
cases  III.  and  IV.  show  its  well  known 
tendency  to  attack  members  of  the  same 
family. 

Case    i. — False   Glaucoma.     Miss , 

aet.  30.  Seen  October  4th,  1898.  Has 
three  myopic  brothers.  Has  been  suffering 
for  several  years  from  aortic  insufficiency 
which  has  affected   her   health   moderately. 

Has  been  wearing  glasses  for  near  sight 
of  moderate  degree  for  about  sixteen  years. 
Symptoms  of  asthenopia  have  been  persis- 
tent for  past  two  or  three  years,  in  spite  of 
scrupulous  correction  of  the  myopia  and 
astigmatism ;  correction  giving  vision  of 
}  I  plus,  each  eye.  This  asthenopia  is  ac- 
counted for  by  the  fact  that  there  is  marked 
exophoria  at  the  near  point.  Has  never 
had  any  attacks  of  orbital  pain,  dimness  of 
vision  or  halos. 

Examination  of  the  field  shows  that  it  is 
practically  normal  as  far  as  white  is  con- 
cerned and  slightly  contracted  for  colors. 
This  suggests  optic  nerve  trouble. 

With  the  ophthalmoscope  both  optic 
nerve  heads  are  found  to  be  decidedly  cup- 
ped on  the  temporal  sides,  one  side  of  each 
cup  being  precipitous  enough  to  completely 
hide  the  vessels  as  they  dip  down  into  the 
nerve.  Arterial  pulsation  on  the  disc  is 
only  evoked  by  marked  pressure  or  after 
bodily  exertion 


Tension  normal.      Pulsa- 


tion and  tension  tested  negatively  several 
different  days. 

Diagnosis  :  Change  in  head  of  optic  nerve 
from  the  undue  arterial  tension  of  aortic  in- 
sufficiency, which  accounts  for  the  cupping 
and  the  limitation  of  the  color  field. 

Case  II. — Simple  glaucoma.     Mr. , 

aet.  33,  unmarried.  Family  history  nega- 
tive. General  health  has  always  been  good. 
Has  been  a  moderate  smoker  since  he  was 
a  boy,  and  drinks  a  little  beer  occasionally. 
Has  always  suffered  from  asthenopia,  for 
which    he    has    worn   improperly    adjusted 


gl; 


for 


:ral  years.      Vision  is  |~|  plus, 


each  eye,  with  minus  cylinders  of  low  de- 
gree, axes  horizontal. 

Has  had  several  acute,  painful  attacks, 
attended  with  congestion,  photophobia  and 
oedematous  swelling  of  lids  and  brow  over 
one  eye.  During  these  onsets  the  visual 
acuity  was  decidedly  lowered  and  halos 
were  noticed  around  artificial  lights.  The 
last  one  occurred  about  four  years  ago,  but 
there  have  been  times  after  fatigue  or  slight 
dissipation  when  the  halos  appeared  again, 
and  the  vision  became  slightly  foggy. 

The  field  in  each  eye  is  found  to  be  con- 
tracted moderately  for  white  and  decidedly 
for  colors.  The  right  field  is  more  limited 
than  the  left,  and  especially  in  the  upper 
nasal  quadrant.  Ophthalmoscopic  examin- 
ation reveals  decided  cupping  of  both  discs, 


Jfl° 


•    0  • 


XT 


<Loac1£.,  T*i$YA  %j*-- 


very  similar  to  that  observed  in  case  1. 
The  vessels  are  normal  in  calibre,  but  arte- 
rial   pulsation   was  elicited    by  very  slight 


pressure.  Tension  is  normal.  Pulsation 
detected  by  repeated  examinations  at  differ- 
ent intervals. 


THE  CHARLOTTE   MEDICAL  JOURNAL. 


27 


Diagnosis  of  simple  glaucoma  in  the  pro- 
dromal stage  is  made  from  the  fact  that  four 
of  the  principal  signs  are,  or  have  been, 
present,  viz.  :  cupping  of  the  disc,  arterial 
pulsation  on  slight  pressure,  limitation  of 
the  field  and  painful  attacks,  with  dimness 
of  vision,  congestion  and  halos. 

Case     III Simple     glaucoma,     second 

stage.     Mrs.  ,  act.  29.     First    seen  on 

July  2d,  1898.  Has  an  aunt  blind  from 
glaucoma,  and  a  sister  said  to  be  affected 
in  a  manner  similar  to  patient.  General 
health  has  been  fairly  good.  Vision  with 
each  eye  is  }|  with  minus  .75D.  Sph. 

States  that  eyes  have  been  weak  for  sev- 
eral years,  and  that  for  the  last  two  years 
she  has  been  subject  to  attacks  about  twice 
monthly,  during  which  vision  becomes  fog- 
gy, neuralgic  pain  is  felt  in  frontal  region, 
and  the  eyes  become  congested.  She  also 
states  that  at  these  times  artificial  lights  are 
surrounded  by  large  rings  of  colors,  and,  in 
the  worst  seizures,  upon  looking  at  a  lamp, 


cent,  solution,  to  be  instilled  once  daily  for 
two  months,  as  a  test.  Seen  again  four 
months  later,  the  ophthalmoscopic  picture 
was  unchanged,  pulse  could  not  be  elicited 
and  the  tension  was  normal.  The  general 
symptoms  were  better  and  no  exacerbation 
had  occurred  during  the  whole  period,  al- 
though the  eyes  had  been  used  freely  and 
without  much  discomfort. 

The  field  was  then  measured,  showing  a 
very  extensive  concentric  limitation  for  the 
left  eye,  and  a  similar  but  smaller  reduction 
for  the  right. 

When  first  seen,  the  case  had  entered 
upon  the  second  stage  because  of  the  fre- 
quent onsets,  the  serious  symptoms  in  the 
intervals  and  the  extensive  narrowing  of 
the  field. 

Case    IV. — Absolute    glaucoma.       Mrs. 

,  aet.  ^4.     Married;  mother    of    seven 

or  eight  children.  Seen  Aug.  27th,  1898. 
This  patient  is  an  aunt  of  the  one  designat- 
ed, "Case  III." 


Co^^W.,.^^4- 


the  flame  is  invisible,  a  halo  of  brightness 
taking  its  place.  During  the  intermissions, 
there  is  a  constant  feeling  of  uneasiness, 
generally  amounting  to  pain,  which  pre- 
cludes the  use  of  the  eyes  for  near  work. 

The  discs  are  deeply  cupped,  and  the 
nasal  edges,  from  which  the  vessels  spring, 
overhang  the  plainly  visible  macula  cribrosa. 
At  this  time  the  arteries  pulsated  on  slight 
pressure  and  the  tension  was  perceptibly 
above  normal. 

Eserine  was  prescribed  in  one-fourth  per 


States  that  she  has  had  weak  eyes  for 
thirty  years.  Is  uncertain  about  first  seri- 
ous symptoms,  but  consulted  an  oculist  fif- 
teen years  ago,  who  gave  her  large  doses  of 
strych.  Eyes  have  grown  rapidly  worse 
during  past  four  years,  and  typical  glauco- 
matous attacks  have  succeded  each  other 
with  increasing  rapidity.  For  about  eight 
months  there  was  only  a  small  patch  of 
vision  in  each  temporal  field,  which  disap- 
peared permanently  four  months  ago. 

Conditions  present  at  time  of  examina- 


THE    CHARLOTTE  MEDICAL  JOURNAL. 


tion  :  Vision  abolished  ;  both  pupils  fixed 
and  dilated  ;  large,  tortuous  vessels  in  ante- 
rior scleral  region ;  media  clear ;  discs 
gray  and  deeply  cupped  in  their  whole  ex- 
tent;  enlarged  veins  and  threadlike  arteries 
crawl  out  of  sight  over  the  edge  of  the  cup, 
to  reappear  on  the  bottom.  The  eyeballs 
are  decidedly  hard  and  unyielding  and  the 
painful  attacks  continue. 


Hemorrhage  in  the  New-Born. 

By    John  N.   Upshur,    M.  D.,   Richmond,    Va., 

Professor  of  Practice,  Medical  College 

of  Virginia. 

The  successful  termination  of  labor,  the 
mother  and  child  both  doing  svell,  the  strain 
of  anxiety  to  the  family  relieved  and  the 
joy  experienced  that  beside  the  hearthstone 
another  heart  throbs.  When,  in  a  few 
hours  after  the  shadow  of  dire  calamity  to 
the  infant,  caused  by  hemorrhage  from 
some  source,  again  excites  the  gravest  ap- 
prehensions of  parents  and  friends — espe- 
cially as  in  the  presence  of  the  malady  the 
physician  feels  more  or  less  impotent  to 
bring  the  necessary  relief  because  of  the 
difficulty  of  detecting  the  cause.  Nor  do  I 
find  that  much  help  is  given  us  by  authori- 
ties, and  we  fall  back  upon  the  ability  to 
guess  correctly,  and  administer  remedies 
most  empirically  and  usually  with  poor  suc- 
cess. 

I  am  led  to  the  above  preface  by  an  expe- 
rience in  a  case  a  year  ago,  which  has  set  me 
to  thinking  on  this  subject.  Before  relat- 
ing the  case,  however,  I  would  consider  the 
varieties  and  sources  of  hemorrhage  in  the 
newly  born.  Early  in  my  professional  life, 
I  saw  a  case  in  which  the  blood  oozed  from 
the  skin  around  the  umbilicus,  and  could 
not  be  controlled  by  pressure  styptics,  or 
even  the  actual  cautery,  the  infant  dying  in 
a  few  hours.  The  infant  was  about  a  week 
old  when  the  bleeding  came  on  ;  had  seemed 
well,  was  well  nourished,  and  of  parentage 
free,  so  far  as  I  could  learn,  from  all  taint. 
Haemophilia  is  undoubtedly  a  cause,  and 
probably  was  in  the  case  above  related  ;  I 
could  not  learn  of  any  heredity  in  this  fam- 
ily. Comby  (Twentieth  Century  Practice) 
says,  "among  thousands  of  children  seen  by 
me  in  Paris  during  the  past  sixteen  years,  I 
have  observed  but  three  cases  of  haemo- 
philia. This  bleeding  may  come  from 
trauma  of  some  kind,  or  the  mucous  mem- 
brane of  nose,  mouth,  or  gastro-intestinal 
canal.  Pathologically — changes,  fatty,  ul- 
cerative, etc.,  are  found  in  the  capillaries, 
localized  thinning  of  their  walls,  and  thus 
the  bleeding  occurs." 


Jacobi  mentions  the  cases  of  two  infants 
in  which  bleeding  occurred  spontaneously, 
merely  from  excessive  thinness  of  the  walls 
of  the  vessels.  The  blood  would  trickle 
from  the  surface  of  the  lower  extremities 
like  drops  of  perspiration,  from  day  to  day, 
until  the  baby  died  from  exhaustion.  (Cy- 
clopedia, Diseases  of  Children,  Keatinig 
Vol.  2d).  Haemorrhage  from  the  chord,  or 
the  capillaries  of  the  chord  is  extremely  fa- 
tal, the  mortality  being  as  high  as  83  per 
cent.  Dr.  Thayer  refers  to  24,533  births, 
with  only  five  cases  of  haemorrhage.  Vogel 
says  extremely  rare,  once  in  10,000  cases. 
The  haemorrhage  may  take  place  into  the 
brain  and  be  the  initiative  of  some  paraly- 
sis, but  the  following  case  illustrates  a 
source  of  haemorrhage,  gastro-intestinal, 
which  is  usually  intractable  to  treatment, 
and  rapidly  proves   fatal. 

Case.  On  the  19th  of  December,  1897, 
I  delivered,  after  a  satisfactory  labor,  an 
average  female  infant,  of  vigorous  parent- 
age and,  so  far  as  I  could  learn,  free  from 
all  taint  or  heredity.  The  infant  was  well 
nourished,  and  took  the  breast  satisfactorily. 
When  thirty-six  hours  old  it  vomited  some 
blood,  not  much.  This  was  followed  by  a 
bloody  stool  and  in  the  next  twenty-four 
hours  she  had  fifteen  of  this  character  till 
she  was  almost  pulseless,  mucous  mem- 
branes and  skin  blanched  and  fontanelle 
deeply  depressed,  surface  cool.  Prognosis 
very  grave  and  source  of  haemorrhage  very 
obscure.  Remembering  the  disproportion- 
ate size  of  the  liver  in  early  life,  I  concluded 
that  the  cause  of  the  bleeding  was  torpid 
liver  with  consequent  congestion  of  the 
portal  circulation  and  of  the  gastro-intes- 
tinal mucous  membrane.  Acting  upon  this 
theory  I  empirically  gave  grain  ss.  calomel 
every  hour.  So  soon  as  a  characteristic 
calomel  stool  was  obtained  the  bleeding 
ceased.  The  infant  rallied  from  the  de- 
pression and  made  a  satisfactory  recovery. 
Now,  at  one  year  old  she  is  plump,  fairly 
grown,  mucus  membranes  florid,  though 
surface  is  pallid,  teething  backward.  There 
was  no  evidence  of  jaundice  in  this  case, 
at  this  time  or  subsequently.  This  view  is 
sustained  by  the  theory  suggested  by  Gryn- 
feltt  as  the  result  of  the  observations  of 
Billard  and  confirmed  by  personal  studies 
of  the  histology  of  the  digestive  mucus 
membrane  of  newborn  infants  (American 
Text  Book). 

I  note  that  the  therapy  recommended  is 
astringents,  but  this  method  of  treatment  is 
manifestly  not  rational.  I  know  that  calo- 
mel is  said  not  to  act  directly  on  the  liver, 
but  it  does  indirectly,  and  it  is  a  glandular 
stimulant ;  how  much  more  rational  then  to 
administer    an   agent  which  by  clinical  ob- 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


29 


servation  we  know  will  unload  a  congested 
portal  circulation,  and  relieve  the  congested 
gastro-intestinal  mucus  membrane. 

In  conclusion,  a  word  as  to  dietetic  man- 
agement. The  infant  should  be  regularly 
put  to  the  breast,  a  moderate  amount  of 
stimulant,  brandy  or  whisky,  given,  and  it 
should  be  shielded  from  catching  cold  or 
even  becoming  slightly  chilled. 

210  W.  Grace  St. 


A  Case  of    Incontinence  of    Urine   Cured 

by    Anterior  and   Posterior  Colpor- 

rhaphy. 

By  A.  Lapthorn  Smith,  B.  A.,  M.  I)..  M.  R. 
C.  S.,  England.  Fellow  of  the  American 
Gynecological  Society,  Professor  of  Clini- 
cal Gynecology,  Bishops  University;  Gyne- 
cologist to  the  Montreal  Dispensary;  Sur- 
geon-in-chief of  the  Samartian  Hospital  for 
Women;   Surgeon  to  Western  Hospital. 

During  the  last  twenty-four  years  I  have 
been  consulted  by  about  the  same  number 
of  women  for  incontinence  of  urine  follow- 
ing a  very  severe  labor.  A  few  of  these 
were  found  on  close  examination  to  have  a 
vesico-uterinc  or  a  vesico-vaginal  fistula 
which  was  dealt  with  in  the  usual  way 
and  cured  by  operation.  Nearly  all  the 
others  were  treated  for  two  or  three  months 
with  a  mixture  of  iron,  strychnine  and 
phosphoric  acid  in  full  doses  and  were  also 
cured,  the  cause  in  their  cases  being  weak- 
ness of  bruised  and  overstretched  muscu- 
lar fibres.  But  about  six  months  ago  the 
present  case  came  under  my  care  at  the 
Montreal  dispensary  and  proved  an  excep- 
tion to  the  rule  of  my  experience. 

Mrs.  M.,  age  40,  had  a  very  severe  instru- 
mental labor  about  a  year  ago,  ever  since 
which  time  she  has  had  to  wear  large  pads 
to  catch  her  urine.  Her  physician  was 
unable  to  stop  it  in  any  way.  If  she  re- 
mained in  bed  she  could  hold  her  water  for 
an  hour  or  two  and  then  it  would  trickle 
out  if  she  moved  or  took  a  long  breath  and 
when  she  went  about  her  work  it  kept  run- 
ning all  the  time,  keeping  her  clothes  wet, 
and  always  smelling  of  urine.  I  put  her 
on  t lie  above  tonic  treatment,  and  in  order 
to  observe  her  better  took  her  into  the  Sa- 
maritan Hospital  for  a  couple  of  weeks.  A 
careful  examination  failed  to  detect  any  fis- 
tula; in  fact,  in  filling  her  bladder  with 
warm  salt  solution,  the  latter  flowed  out 
beside  the  catheter  ;  there  seemed  to  be  no 
life  in  the  sphincter.  There  was  a  large 
rectocele  and  cystocele  and  lacerated  peri- 
neum.     Although  I  have  seen  a  great  many 


patients  with  this  condition,  and  quite  com- 
monly causing  desire  to  micturate  frequently 
and  also  a  sensation  as  though  some  urine 
still  remained  in  the  bladder,  as  indeed  it 
does,  yet  I  do  not  remember  to  have  had  a 
case  in  which  it  caused  incontinence.  I 
therefore  feared  that  the  cure  of  these  con- 
ditions alone  might  not  suffice  to  cure  her 
of  her  trouble  and  I  had  some  intention  of 
at  the  same  time  shortening  or  taking  a  reef 
so  to  speak  in  the  relaxed  sphincter.  This 
I  found  was  quite  easy  to  do  when  I  had 
removed  the  vaginal  mucous  membrane  to 
the  extent  of  2-|  inches  in  length  and  an 
inch  and  a  half  in  breadth.  In  order  to 
tighten  up  the  sphincter  I  made  the  denu- 
dation further  down  towards  the  meatus 
than  usual  and  indeed  of  drawing  the  edges 
surrounding  the  denuded  area  together  with 
a  purse  string  suture  as  I  usually  do,  I  tight- 
ened up  the  sphincter  by  means  of  a  run- 
ning catgut  suture  which  was  buried  in  the 
muscular  layer  of  the  bladder  right  down  to 
the  urethra.  The  vaginal  mucous  membrane 
was  then  accurately  brought  together  over 
this.  Hegar's  operation  on  the  posterior 
vaginal  wall  was  then  done,  with  a  buried 
and  a  superficial  row  of  catgut.  This  made 
a  good  support  for  the  bladder. 

Fortunately  the  catgut  was  good  and  her 
tissues  were  healthy  so  that  in  both,  primary 
union  was  obtained.  The  result  was  all  that 
could  be  desired.  She  could  cough  and 
turn  in  bed  from  the  first  day  without  wet- 
ting herself,  and  at  the  end  of  two  weeks 
she  could  walk  about  with  comfort  and 
without  a  single  drop  of  urine  passing  in- 
voluntary. Later  reports  state  that  she  is 
completely  cured  of  her  infirmity. 

250  Bishop  St.,  Montreal, 


Head  Injuries. 


By  J.  Herbert  Austin,  M.  D.,   M.  R.  C.  S.,   En- 
gland,   Assistant  in  Surgery,    University 
Medical  College,  Kansas  City,  Missouri. 

In  considering  this  subject  of  injures  to 
the  head  there  are  several  facts  that  at  once 
attract  one's  attention,  and  to  a  greater  or 
lessextent  impress  themselves  on  one's  mind. 
First  we  notice  where  an  injury  may  be 
situated.  It  may  be  purely  external,  a 
scalp  wound  only.  The  bony  skull  may  be 
involved  and  also  the  brain,  or  we  may  have 
a  serious  brain  lesion  and  yet  the  scalp  and 
skull  are  practically  sound  and  normal. 

In  some  cases  the  scalp,  skull  and  brain 
are  all  badly  injured  at  the  time  of  the  ac- 
cident. An  injury  such  as  this,  where  the 
scalp  is  torn,  the  skull  fractured  and  the 
brain  lacerated  is  necessarily    a    very    seri- 


30 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


ous  one.  In  another  class  of  cases  the  bony 
skull  is  the  part  that  has  suffered  most,  the 
skull  may  be  fractured  and  badly  so  and 
yet  the  scalp  has  not  been  divided  and  the 
brain  has  not  been  torn.  Now  let  us  con- 
sider these  various  head  injuries  separately. 

First,  Scalp  wounds.  These  vary 
greatly  in  severity.  A  slight  cut  in  the 
scalp  which  is  not  deep  need  occasion  no 
alarm.  It  will  usually  heal  speedily.  The 
wound  must  be  thoroughly  cleansed,  the 
hair  shaved  away  from  the  track  of  the 
wound,  the  edges  brought  neatly  together 
so  as  to  obtain  union  by  first  intention. 
A  longer,  deeper  wound  of  the  scalp  in- 
volving Treve's  "dangerous  area"  of  the 
scalp  is  a  more  serious  affair. 

This  "dangerous  area"  of  the  scalp  is  the 
layer  of  loose  connective  tissue  just  beneath 
the  aponeurotic  layer  of  the  scalp,  and  just 
above  the  pericranium.  When  this  area  is 
opened  there  is  every  opportunity  for  the 
spread  of  a  suppurative  or  erysipelatous 
process.  So  we  must  make  every  effort  to 
render  this  wound  surgically  clean.  Should 
puffing  occur  the  wound  must  be  opened  so 
as  to  relieve  any  tension  by  giving  free  vent 
to  any  secretions  or  discharges  that  may 
exist.  See  that  free  drainage  is  kept  up. 
Don't  worry  about  sloughing  or  gangrene 
occuring  in  the  scalp  even  in  severe  injuries. 
The  sculp  is  more  prone  to  live  than  to  die, 
on  account  of  its  fine  blood  supply,  even 
when  extensively  separated  and  almost  cut 
off  from  the  rest  of  the  head.  It  is  not 
enough  to  cut  the  hair  as  short  as  possible 
with  scissors  when  treating  a  scalp  wound, 
I  always  insist  on  being  allowed  to  have  the 
parts  thoroughly  shaved  as  well.  The  hair 
will  soon  grow  again,  and  the  part  cannot 
be  rendered  as  clean  as  it  should  be  unless 
the  shaving  is  done. 

Now  as  regards  fractures  of  the  skull,  we 
have  great  variety  here  also.  A  simple 
fracture  of  the  skull,  or  crack  in  it,  may 
exist  and  its  presence  not  be  suspected. 
Given  that  we  know  that  a  fracture  of  this 
nature  exists,  if  there  is  no  depression  and 
no  unfavorable  symptoms  follow,  I  believe 
such  a  case  should  be  left  alone.  I  consider 
it  would  be  bad  surgery  to  operate  on  such 
a  case.  Undoubtedly  such  cases  make 
splendid  recoveries  without  operation.  Of 
course  I  well  know  how  some  surgeons 
would  have  us  trephine  in  all  cases,  once 
the  diagnosis  "fracture  of  the  skull"  has 
been  mad-.  These  gentlemen  gain  nothing 
in  these  cases,  and  the  patient  runs  the  risk 
of  a  serious  operation. 

In  fractures  of  the  skull  with  depression, 
trephine  at  once  and  relieve  that  pressure 
on  the  brain.  Often  brilliant  results  attend 
our  efforts  in  these  cases,  patients    speedily 


regaining  consciousness  and  going  on  to  a 
speedy  recovery.  An  operation  should  be 
done  in  cases  where  unpleasant  symptoms 
occur  later,  some  time  after  the  accident — 
may  be  to  relieve  adhesions,  etc.  In  the 
case  of  a  punctured  fracture  of  the  skull,  an 
operation  should  be  done  at  once  to  remove 
any  foreign  body  from  the  brain,  c.  g.  spi- 
cules of  bone,  and  to  cleanse  the  track  of 
the  wound. 

Fracture  of  the  base  of  the  skull  may  be 
caused  by  a  fall  on  the  feet,  the  force  of  the 
blow  passing  upward  to  the  occipital  bone. 
In  some  cases  a  fall  or  blow  upon  the  top 
of  the  head  causes  a  fracture  which  extends 
to  the  base  of  the  skull.  Oftentimes  we 
find  blood  and  cerebro-spinal  fluid  escaping 
from  the  ear,  nose,  or  mouth.  The  prog- 
nosis in  cases  of  fracture  of  base  of  skull  is 
very  bad  indeed,  patients  generally  but  not 
always  dying.  The  reasons  for  such  bad 
results  are  that  the  brain  is  often  terribly 
injured  at  the  time  of  the  fracture  and  that 
often  septic  inflammation  of  the  brain  and 
membranes  sets  in.  In  the  way  of  treat- 
ment the  patient  must  be  kept  perfectly 
quiet  to  try  and  prevent  inflammation. 
The  ear  should  be  syringed  out  with  car- 
bolic solution  and  dusted  with  iodoform,  an 
antiseptic  dressing  being  applied.  Purga- 
tives should  be  freely  used,  a  fluid  diet  ad- 
hered to.  Injuries  of  the  brain  vary  greatly 
in  severity  also.  Simple  pressure  on  the 
brain  can  often  be  entirely  relieved  by 
trephining. 

Laceration  of  the  brain,  as  has  already 
been  stated,  may  occur  with  or  without 
fracture,  or  other  injury  of  the  skull.  Usu- 
ally the  brain  is  torn  on  the  side  of  the  head 
opposite  to  that  on  which  the  blow  or  injury 
is  received.  In  a  case  where  there  is  an 
open  wound,  and  the  torn  brain  is  protru- 
ding, then  the  contused  and  lacerated  brain 
substance  should  be  removed,  the  wound 
thoroughly  cleansed  and  the  scalp  replaced. 

In  a  case  where  laceration  of  the  brain 
exists  and  yet  there  is  no  external  injury  the 
symptoms  of  paralysis  will  guide  us  as  to  the 
site  of  the  lesion  and  inform  us  whether  the 
hemorrhage  is  spreading  or  not.  Such  a 
case  should  be  kept  perfectly  quiet,  a  very 
light  diet  used,  and  the  bowels  should  be 
kept  quite  active. 

When  we  believe  from  the  symptoms 
that  the  laceration  is  cortical  and  superficial, 
and  quite  localized,  then  trephining  over 
this  area  is  justifiable,  to  remove  hardened 
clots  and  the  torn  brain  tissue.  Every  an- 
tiseptic precaution  must  be  observed.  In 
some  of  these  cases  the  operation  relieves 
completely  the  symptoms  of  cerebral  irri- 
tation and  the  patient    makes    an    uninter- 


THE  CHARLOTTE  MEDICAL  JOURNAL, 


rupted  recovery.    In  others  no  improvement 
follows. 


Anaesthesia  and  Anaesthetics.* 

By  C.  C.  Hersman,  M.  D.,  Physician  to  South 
Side  Hospital  of  Pittsburgh,  Lecturer  on  Ma- 
teria Medical  and  Therapeutics  South  Side 
Hospital  Training  School  for  Nurses,  Past 
Surgeon  P.  R.  R.,  Member  South  Side,  Alle- 
gheny County  and  Pennylvania  State  Midical 
Societies,  W.  Va.  State  Medical  Society  (hon- 
orary), American  Medical  Association,  Ameri- 
can Medical  Temperance  Association,  &c,  &c. 

Much  of  the  surgeon's  success  depends 
upon  the  anaesthetist.  In  administering  an 
anesthetic  there  is  no  such  thing  as  minor 
surgery.  A  strong  person  with  a  full 
stomach  runs  greater  risk  from  a  "whiff" 
of  chloroform  while  under  the  anesthetic 
than  a  weaker  person  properly  prepared, 
who  is  kept  under  it  for  an  hour;  and  if 
the  surgeon  is  inclined  to  look  lightly  on  it, 
the  anesthetist  should  be  all  the  more  care- 
ful. Under  no  circumstances  should  the 
clothes  fit  tightly,  and  this  applies  to  all  an- 
esthetics. The  patient's  meals  should  be  in- 
terfered with  as  little  as  possible,  but  allow 
an  interval  of  four  or  five  hours  between 
the  last  meal  and  t lie  anesthetic.  To  give 
soup  and  light  diets  at  hours  other  than  the 
meal  time  is  a  mistake.  Loose  teeth  should 
be  noted,  false  teeth  and  tobacco  removed, 
and  take  note  whether  the  patient  breathes 
freely  through  the  nose.  A  faulty  position 
of  the  head  is  the  most  frequent  error,  and 
this  applies  particularly  to  dentists  and 
operations  on  the  mouth.  Flexion  on  the 
sternum  or  extension  on  the  spine  should  be 
avoided  during  inhalation.  Extension  upon 
the  spine  brings  the  base  of  the  tongue  and 
epiglottis  away  from  the  opening  of  the 
larynx,  making  swallowing  either  difficult 
or  impossible  and  allowing  saliva  or  other 
foreign  substance  to  enter  it. 

Always  keep  the  head  in  the  long  axis 
of  the  body. 

Idiosyncrasies  are  often  nothing  short  of 
the  fault  or  carelessness  of  the   anesthetist. 

Opinion  is  still  divided  as  to  the  most 
suitable  anesthetic  in  general  surgery.  Of 
course,  statistics  show  that  ether  is  safest. 
But  it  cannot  be  denied  that  ether-bronchitis 
and  ether-pneumonia  may  occur,  and  until 
some  authentic  inquiry  is  made  into  this 
frequency  we  do  not  know  the  precise  com- 
parative risks  of  ether  and  chloroform.  Of 
course,  chloroform  is  safer  in  hot  than  in 
cold  climates,  and    administration  of    ether 

*  Read  at  a  meeting  of  the  Allegheny  County 
Medical  Society,  at  Pittsburgh,  Pa.,  Nov.  15, '98. 


in  high  temperatures  is  difficult  or  impos- 
sible. Taken  all  in  all  ether  is  safer,  but  in 
well  appointed  hospitals,  with  an  expert 
anesthetizer,  I  see  few  contraindications  to 
chloroform.  It  is  well  enough  to  have  other 
anesthetics  at  hand,  as  well  as  tongue  for- 
ceps, gag,  restoratives,  etc.,  but  the  more 
one  sees  of  anesthesia  the  less  need  he  sees 
for  anything  save  proper  position  and  early 
and  efficient  artificial  respiration. 

If  pallor  and  feeble  pulse  occur  from 
chloroform,  ether  is  a  good  restorative,  but 
often,  I  believe,  valuable  time  has  been  lost 
by  resorting  to  these  when  the  anesthetist 
should  have  turned  his  attention  to  the  res- 
piration. Muscular  men  while  passing 
through  the  stage  of  muscular  spasm  just 
prior  to  deep  anesthesia  may  have  their 
breathing  arrested  by  the  muscles  of  the  jaw 
and  neck  becoming  fixed.  In  this  class  of 
men  I  believe  ether  to  be  the  safer. 

Close  attention  should  be  paid  to  the 
brcatliing.  See  that  every  breath  enters 
and  leaves  the  liDigs. 

Too  often  the  anesthetist  has  realized 
nothing  wrong  until  cyanosis,  lividity,  pal- 
lor, or  pulselessness  has  drawn  his  attention 
to  the  condition 

There  is  not  one  student  in  five  who 
graduates  that  can  put  his  theoretical  knowl- 
edge to  practical  test  when  giving  his  first 
anesthetic.  They  should  have  clinical  in- 
struction as  well. 

Keep  the  lower  jaw  well  forward.  In 
laryngeal  spasm  rub  the  lips  briskly  with  a 
dry  towel.  It  is  the  custom  to  rush  to  the 
hypodermic  syringe  in  case  of  weak  pulse, 
when  often  the  correction  of  bad  breathing 
would  right  everything.  It  is  too  much  the 
habit  to  attend  altogether  to  the  circulation. 
There  is  no  better  stimulation  to  the  circu- 
lation than  free  breathing. 

In  collapse  from  surgical  causes  resort  to 
your  strychnia,  etc.,  but  collapse  from  over- 
narcosis  is  to  be  treated  from  the  respira- 
tory side. 

The  following  are    some  of  the  solutions 
used  by  surgeons  : 
200  parts  chloroform,  60    parts    ether,    and 

60  parts  alcohol. 
3  parts    chloroform,    2    parts    ether,    and  1 
part  alcohol. 

1  part  chloroform  and  3  parts  of  ether. 

2  parts  chloroform  and  1  part  alcohol. 

3  parts  of  chloroform  and  1  part  alcohol. 

^  parts    chloroform    and    1  of   oleum    tera- 

bintheni. 
Chloroform  1  lb.  to  amyl    nitrite  1  drachm. 
A.  C.  E.  mixture. 
Chloroform  and  oxygen  safest. 

This  last  mixture,  it  is  said,  anesthetises 
sooner  than  other  mixtures  with  a  smaller 
amount  of  chloroform  ;   the  cheeks  and  lips 


2-2 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


are  rosy  ;  blood  from  the  wound  bright  red  ; 
shock  and  nausea  less,  and  consciousness 
more  quickly  gained. 

This  preparation  is  obtained  by  Oxygen 
passed  under  pressure  through   chloroform. 

Menthol  i  part,  chloroform  10  parts,  and 
ether  15  parts  used  as  a  spray  will  cause 
local  anesthesia. 

The  danger  from  chloroform  is  immediate  ; 
ether,  remote— at  a  later  stage,  days  or  even 
weeks  after,  especially  if  the  kidneys  are 
affected,  or  if  emphysemia,  asthma,  chronic 
bronchitis,  old  pleurisy,  cardiac  hypertro- 
phy, fatty  heart  or  valvular  disease  is  pre- 
sent. Also,  it  may  cause  suppression  of 
urine,  vesicle  irritation,  uremic  symptoms, 
or  bronchitis. 

Chloroform  would  then  be  indicated  in 
chronic  endarteritis  occurring  in  those  in 
advanced  years ;  chronic  inflammations  of 
the  respiratory  tract  and  advanced  pulmon- 
ary affections ;  organic  diseases  of  the  ner- 
vous system ;  operations  about  the  head ; 
renal  diseases ;  when  ether  has  produced 
deleterious  effects  at  a  former  time  ;  chronic 
alcoholism;  in  the  aged  or  very  young 
(children)  or  any  one  with  weakened  or 
undeveloped  muscular  system ;  puerperal 
eclampsia  ;  night  operating  ;  during  second 
stage  of  labor.  In  the  latter,  it  is  said  by 
some,  that  it  prevents  shock,  reduces  liabil- 
ity to  rupture  of  cervix  and  perineum  ;  that 
it  does  not  produce  or  cause  uterine  inertia 
and  postpartum  hemorrhage  ;  that  it  does 
not  affect  the  foetus. 

In  military  surgery  on  the  field  chloroform 
is  indicated. 

The  administration  should  be  begun  slow- 
ly, given  in  small  quantity,  admitting 
plenty  of  air  until  the  suffocating  stage  is 
over. 

Chloroform  has  been  comdemned  possibly 
more  on  theoretical  grounds  than  from  prac- 
tical observation,  and  I  believe  the  greater 
mortality  is  more  the  cause  of  carelessness 
than  otherwise,  as  a  very  great  number  of 
these  cases  have  been  under  the  care  of 
students,  dentists,  or  recent  graduates. 

The  death-rate  in  Berlin  in  about  52,000 
cases  in  1893  from  anesthetics  is  one  in 
2,587  ;  from  chloroform  alone  one  in  1,924. 
Their  mode  of  administration — flat  down 
on  the  face — is  thought  to  have  much  to  do 
with  it.  Also,  most  fatalities  occur  witl 
men  of  little  experience,  one  or  two  years 
after  graduation  (.Silk,  Lancet,  April  28th, 
1894). 

It  is  the  experienced  man  who  knows 
best  how  to  act  in  all  emergencies.  The 
anesthetist  should  be  oblivious  to  all  but  his 
part.  Never  push  in  the  first  stage.  If 
coughing  or  rapid  swallowing  occur  give 
air.     Have    patient     breathe     through    the 


mouth  until  after  spasmodic  stage,  as  breath- 
ing through  the  nose  may  cause  spasm  of 
the  glottis.  This  applies  to  ether  as  well. 
Never  touch  the  eyeball  with  the  finger,  as 
it  is  never  clean,  and  has  caused  severe  con- 
junctivitis and  suppurating  keratitis.  Sim- 
ply press  the  lid  down  over  the  ball  gently. 
If  the  patient  makes  no  attempt  to  close  the 
eye  insensibility  is  complete.  The  con- 
junctiva is  not  the  last  part  to  become  in- 
sensitive. The  anterior  portion  of  the  chest 
is  the  last  part  of  the  body  to  lose  sensation. 

A  wide  pupil  which  does  not  respond  to 
light  signifies  deep  anesthesia.  If  respon- 
sive to  light  that  stage  has  not  been  reached 
or  the  patient  is  returning  to  sensibility. 
A  contracted  pupil  is  a  sign  of  danger, 
however,  some  of  my  own  observations  in 
children  show  a  very  narrow  pupil  just  as 
they  are  returning  to  consciousness.  The 
pupil  in  children  is  an  unsafe  guide,  how- 
ever, as  the  pupilary  reflex  is  not  fully  de- 
veloped. 

Chloroform  is  an  ideal  anesthetic  if  pro- 
perly handled,  and  if  medical  students 
would  pay  more  attention  to  anesthesia, 
chloroform  would  be  more  often  employed. 
Practically  I  see  few  contraindications  It 
is  the  typical  anesthetic  for  children,  the 
aged,  and  in  obstetrics.  Give  but  a  few 
drops  (2  or  3)  at  first,  and  gradually  in- 
crease as  anesthesia  comes  on.  A  few  short 
inhalations  followed  by  a  deep  one  is  dan- 
gerous if  used  in  greater  quantity.  The 
danger  is  an  overdose.  It  is  not  so  much 
the  quantity  taken  that  makes  the  overdose 
as  the  quantity  taken  at  one  inhalation 
many  times. 

Chloroform  is  contraindicated  in  surgical 
shock,  epilepsy,  spinabifida,  when  there  is 
tendency  to  syncope,  fatty  heart  and  chronic 
valvular  disease,  acute  alcoholism,  delirium 
tremens,  fatty  liver,  and  when  under  the 
influence  of  chloral. 

Never  give  chloroform  except  in  recum- 
bent position,  not  even  on  the  side.  Never 
give  it  during  digestion,  and  never  except 
in  company  with  a  third  person.  This  ap- 
plies to  all  anesthetics. 

The  anesthetist  should  pay  no  attention 
to  the  operation.  The  patient  has  a  chance 
from  the  surgeon's  knife,  but  none  from  the 
anesthetic.  Any  feeling  of  apprehension 
on  the  part  of  the  patient  should  be  over- 
come by  a  few  encouraging  words.  It  may 
save  his  life. 

An  intense  fear,  with  the  combined  in- 
fluence of  the  anesthetic,  may  cause  collapse 
and  death  from  heart  failure  or  even  heart 
paralysis.  Haste,  too,  has  had  its  fatali- 
ties. Just  preceding  narcosis  there  is  an 
acceleration  of  the  pulse,  but  during  com- 
plete narcosis  there  is  a  gradual  diminution 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


33 


of  beats.  The  pupil  has  a  regular  cycle, 
first  dilated  and  active,  then  contracted, 
lastly  dilated  and  fixed.  The  first  is  the 
sign  of  incomplete  narcosis,  the  second  com- 
plete and  safe  narcosis  (the  eyes  stare 
straight  ahead.  I  have  observed  marked 
divergent  squint  in  the  aged)  ;  third,  dan- 
ger of  imminent  paralysis  of  respiratory 
center. 

However,  the  pupil  may  be  widely  dilated 
if  operating  in  the  abdominal  cavity  or  rec- 
tum from  sympathetic  irritation  and  the 
anesthetic  may  have  to  be  pushed  somewhat 
to  counteract  it. 

If  the  patient  should  struggle  take  hold 
of  the  wrists  and  allow  free  use  of  the  arms 
and  make  pressure  on  the  shoulders  to  pre- 
vent rising.  If  he  attempts  to  tear  the  ap- 
paratus away  keep  the  hand  in  such  posi- 
tion that  he  may  take  hold  of  it  instead. 
Always  replacing  it  as  soon  as  he  lets  go, 
so  that  he  may  again  remove  the  hand  in- 
stead of  the  inhaler.  If  vomiting  occur 
early,  have  patient  take  deep  breath  and 
hold  it.  The  pupils  dilate  when  vomiting. 
Very  rapid  breathing  is  a  sign  of  danger. 
If  the  heart  stops  place  the  thumb  between 
the  apex  beat  and  the  sternum,  and  make 
quick,  strong  movements  at  the  rate  of  from 
30  to  120  times  per  minute.  This  forces 
heart  contraction.  Force  the  lower  jaw 
forward  and  make  rhythmic  traction  on  the 
tongue.  If  the  pulse  is  small  and  hard,  ad- 
mit air.  If  weak  and  fast,  or  intermittent, 
stop  the  chloroform  and  favor  the  circula- 
tion through  the  cappillaries  by  rubbing. 

Dilate  the  sphincter  ani  and  use  all  other 
methods  needed.  In  the  most  dangerous 
asphyxias  the  heart  stands  still  and  the 
pupils  dilate  without  reaction,  though  res- 
piration may  continue.  This  is  cardiac 
syncope  and  usually  happens  in  the  begin- 
ning. Fear  or  nasal  reflex,  already  men- 
tioned, maybe  the  cause. 

This  dilatation  may  occur  almost  at  once 
in  drunkards  or  very  nervous  persons  from 
too  large  doses. 

If  the  countenance  changes  from  anxious 
to  depressed,  admit  air.  The  color  of  the 
eir  is  said  to  be  a  good  index. 

Methods  of  resuscitation  should  never  be 
stopped  too  soon. 

Allow  the  patient  to  sleep  off  the  narco- 
tic ;  he  is  less  liable  to  vomit.  A  cloth 
moistened  with  vinegar,  placed  in  front  of 
the  nose,  will  many  times  prevent  vomiting. 

Nitrous  oxide  gas  is  possibly  the  safest 
of  all  anesthetics,  and  should  be  used  in 
short  operation*.  Combined  with  oxygen 
makes  a  safe  anesthetic.  In  reducing  dis- 
locations, fractures,  re-opening  the  site  of 
operation,  making  uterine  examinations, 
redressing   wounds,  and    all    short    punish- 


ments if  severe,  should  be  mitigated  by  this 
gas.  To  give  any  other  in  a  dentist's  chair 
seems  to  me  little  short  of  malpractice. 
However,  as  stated  before,  it  should  be 
combined  with  oxygen,  to  be  used  when 
there  is  the  least  sign  of  lividity  or  cyano- 
sis. So  administered  I  believe  the  dangers 
would  be  almost  nil.  The  position  in  a 
dentist's  chair  contraindicates  any  other 
anesthetic. 

Ether  or  ethyl  oxide  is  safer  than  chloro- 
form (methenyl  chloride-terchloride  of  for- 
myl),but  the  bad  odor  is  a  serious  objec- 
tion, and  it  is  more  likely  to  cause  vomit- 
ing. When  first  inhaled  there  is  a  sense # of 
asphyxia  and  a  severe  burning  of  the  air 
passages.  It,  however,  concerns  the  sur- 
geons more  than  the  others  do  from  its  fre- 
quent use.  Erotic  impressions  may  present 
themselves  so  vividly  as  to  leave  the  im- 
pression until  after  anesthesia  is  concluded. 
At  first  respirations  are  increased,  but  as 
anesthesia  increases  they  become  slower  and 
more  shallow. 

Operate  as  soon  as  the  patient  is  com- 
pletely anesthetized.  If  carried  further 
there  may  be  paralysis  of  respiration. 

Ether  should  be  given  by  the  so-called 
closed  method,  but  do  not  rush  it  at  first 
nor  close  off  all  air,  do  so  gradually. 

According  to  some  ether  is  indicated  with 
few  exceptions. 

Marcus,  of  Philadelphia,  who  has  anes- 
thetized several  thousand  patients,  says 
ether  is  never  contraindicated  if  properly 
administered.  Coming  from  him  it  de- 
serves more  than  passing  notice.  However, 
the  following  text  would  indicate  a  differ- 
ence of  opinion  : 

The  investigations  of  H.  A.  Hare,  in  the 
Hyderabad  Commission,  India,  concludes 
that  chloroform  kills  by  vasomotor  paraly- 
sis ;  ether  by  paralysis  of  respiration,  and 
nitrous  oxide  by  asphyxiation. 

No  drug  has  yet  been  used  to  produce 
anesthesia,  says  Frank  C.  Hammond,  of 
Philadelphia,  that  has  not  caused  death. 

No  doubt  the  least  danger  would  be  in 
an  anesthetic  with  a  boiling  point  below 
100  degrees  Fahr. ,  or  at  or  near  the  normal 
temperature  of  the  body.  Many  experi- 
ments based  upon  this  thought  have  been 
tried;  the  latest  by  Schleich.  He  has  pre- 
pared three  formulae ;  the  one  for  general 
use  as  follows:  Chloroform  30  c.c,  petro- 
leum ether  15  c.c,  sulphuric  ether  80  c.c. 
There  is  claimed  for  this  by  Dr.  Meyer,  of 
New  York  : 

1.  During  the  induction  of  anesthesia, 
no  salivation,  rarely  any  accumulation  of 
mucus  in  the  trachea,  and  no  cyanosis. 

2.  During  the  stage  of  anesthesia,  rarely 


THE  CHARLOTTE  MEDICAL  JOURNAL 


any  accumulation  of  mucous  in  the  trachea 
and  no  cyanosis. 

3.  The  patient  awakens  more  rapidly 
with  less  nausea.  One  drawback,  the  chlo- 
rine odor. 

Under  the  head  of  mixed  anesthesia  some 
years  ago  (10  or  12)  much  was  said  about 
a  hypodermic  injection  of  morphia  preced- 
ing the  anesthetic.  I  mention  it  only  to 
condemn  it.  After  a  thorough  trial  of  the 
mixed  anesthetic,  it  was  found  to  be  unsafe 
as  a  routine,  and  was  as  vigorously  con- 
demned as  at  first  advocated. 

In  the  first  place,  to  follow  such  a  method 
is  routine,  and  routinity  is  unscientific.  In 
the  second  place,  it  is  unsafe  in  many  cases 
and  very  unsafe  in  some. 

The  patient,  of  course,  goes  under  the 
anesthetic  much  more  readily,  but  with  a 
complicated  danger.  In  morphia  poison- 
ing death  is  more  likely  to  occur  from  paral- 
ysis of  respiration,  due  to  the  direct  action 
of  the  poison  on  the  respiratory  center  in 
the  medulla.  This  is  proven  by  the  fact 
that  the  breathing  of  dogs  and  rabbits, 
whose  pneumogastrics  have  been  cut,  are 
as  much  affected  by  morphia  as  those  whose 
nerves  are  entire,  says  Wood. 

It  diminishes  the  sensibility  of  the  re- 
spiratory center;  hence  the  involuntary 
breathing  is  less  perfectly  performed  which 
adds  greatly  to  the  dangers  of  an  anesthetic. 

In  opium  poisoning  the  patient  in  some 
cases  will  suspend  all  effort  to  breathe  if 
artificial  respiration  is  performed.  Very 
alarming  effects  have  been  produced  by 
the  injection  of  one-sixth  grain  of  morphia, 
and  the  injection  of  one-half  grain  has 
caused  death.  Hence  it  is  readily  seen  that 
in  any  case  of  idiosyncrasy  such  procedure 
should  not  be  tolerated.  Again  in  many 
others  it  would  be  dangerous  owing  to  some 
idiosyncrasy  to  the  anesthetic. 

Some  other  uses  of  chloroform  are  :  Ten 
to  twenty  drops,  three  or  more  times  a  day, 
in  albuminuria  of  pregnancy ;  applied  on 
lint  it  stays  the  flow  of  blood  without  leav- 
ing a  clot.  Ten  drops  every  half  hour  re- 
lieves lead  colic.  Applied  on  a  folded 
cloth  to  the  skin  acts  in  a  few  minutes  as  a 
mustard  plaster.  Pressed  on  the  seventh 
cervical  vertebra  will  often  check  a  dry 
cough.  Half  a  drachm  of  a  mixture  of  two 
parts  chloroform  and  one  part  alcohol  in- 
haled will  produce  sleep. 

Complete  narcosis  will  cause  spontaneous 
reduction  of  hernia  in  somo  cases. 

BIBLIOGRAPHY. 

Frank  C.  Hammond,  M.D.,   Philadelphia. 
Frederick  W.  Hewitt,  M.  A.,  M.  D.,  Can- 
tab, M.R.C.S.,  Eng.,  London,  Eng. 
Herman    D.Marcus,   M.  D.,   Philadelphia. 
David  R.  Fly,  M.  D.,  Fort  worth,  Tex. 


Abortion  of  Fevers. 

By  T.  Edwards  Converse,  M.  D.,   Adjunct  Pro- 
fessor of  Ophthalmology  and  Otology,  Hos- 
pital College  of  Medicine,  Louisville,  Ky. 

In  taking  up  the  subject  of  abortion  of 
fevers,  I  have  undertaken  the  discussion  of 
some  of  the  oldest,  threadbare  theories  in 
the  science  of  medicine,  for  if  the  oldest 
books  on  the  treatment  of  fever  are  con- 
sulted, and  a  careful  reading  is  made,  there 
will  be  found  a  great  deal  of  literature  on 
this  subject,  which  matter  has  been  care- 
fully argued  from  different  standpoints,  but 
very  few  who  have  written  on  the  subject 
have  attacked  the  matter  from  the  right 
direction,  having  argued  more  from  the 
symptoms  manifested  than  the  cause  of  the 
fever,  having  gone  at  it  from  an  external 
aspect  instead  of  attacking  it  at  the  root. 

In  the  attack  on  fevers  the  treatment  must 
be  similar  to  the  way  a  fireman  attacks  the 
fire,  for  he  sees  the  smoke  and  flame  and 
notices  the  effect  of  the  heat  to  a  great  ex- 
tent, but  in  his  attack  his  first  step  is  to  get 
at  the  seat  of  trouble,  and  to  do  this  he  gets 
rid  of  the  smoke  by  cutting  holes  in  the 
roof  to  allow  the  smoke  to  escape,  and  at 
the  same  time  he  attacks  the  flame  as  ac- 
tively as  possible,  working  towards  the  site 
of  the  conflagration,  but  at  first  he  may  be 
unable  to  locate  it  on  account  of  the  smoke 
and  other  obstacles,  but  whenever  the  exact 
locality  is  located  the  attack  with  the  water 
is  made  vigorously  and  the  fire  is  extin- 
guished. In  the  treatment  of  fevers  the 
first  thing  to  do  is  to  attack  the  fever,  re- 
duce it  if  dangerously  high,  and  at  the  same 
time  locate  the  cause  and  treat  that  prompt- 
ly. In  the  abortion  of  fevers  like  attacks 
are  made,  and  in  a  similar  manner  as  the 
fireman's  tactics  to  prevent  the  spread  of 
the  conflagration.  In  all  fevers,  it  makes 
very  little  difference  what  kind,  the  cause 
must  be  first  located,  and  then  the  treat- 
ment instituted  and  carried  out  which  will 
reduce  it  and  also  cur*  it.  In  typhoid  fever 
there  have  been  a  great  many  abortive  treat- 
ment theories  promulgated,  and  the  amount 
of  scientific  experimentation  in  that  line  of 
original  investigation  has  been  very  great, 
and  to  a  certain  extent  the  results  have  been 
fairly  good,  but  when  the  Peyer's  patches 
have  once  become  thoroughly  infected,  and 
an  acute  inflammation  is  in  progress  and 
ulceration  of  the  patches  well  established, 
there  is  no  aborting  the  fever  and  all  the 
results  which  might  possibly  follow.  True, 
treatment  can  be  used  which  will  ameliorate 
all  the  symptoms  and  modify  the  severity 
of  the  disease.  To  succeed  in  the  abortion 
of  this  fever  it  is  necessary  to  make  a  direct 


THE  CHARLOTTE   MEDICAL  JOURNAL. 


35 


and  early  vigorous  attack  when  the  fever  is 
in  its  infancy  and  before  the  trouble  has 
reached  an  active  stage,  for  the  longer  the 
proper  treatment  is  delayed  the  harder  it  is 
to  get  good  results.  Various  methods  for 
aborting  this  have  been  used,  as  the  use  of 
minute  doses  of  calomel  and  podophyllin, 
etc.,  and  apparently  in  a  great  many  of  the 
cases  there  has  been  a  certain  degree  of  suc- 
cess. In  malarious  fevers  there  also  have 
been  various  treatments  used  to  abort  the 
trouble,  and  large  doses  of  the  sulphate  of 
quinine,  which  is  regarded  as  a  specific  in 
this  trouble,  supplemented  with  calomel, 
arsenic  and  iron,  seem  to  have  been  the 
favorite  medication,  but  often  these  have 
been  found  wanting.  In  the  treatment  of 
these  two  classes  of  fevers,  lately  my  atten- 
tion has  been  called  to  the  properties  of 
Viskolein,  manufactured  after  the  formula 
of  Dr.  Geo.  H.  Rice,  and  this  preparation 
used  in  proper  doses  and  correctly  adminis- 
tered has  on  several  occasions  proven  very 
satisfactory.  This  drug  seems  to  act  by  re- 
ducing the  temperature  and  indirectly  but 
proportionally  reducing  the  pulse,  and  from 
the  results  manifested,  seems  to  circulate  in 
the  blood,  acting  as  a  powerful  and  reliable 
antiseptic,  destroying  all  micro-organism  in 
it.  The  bad  effects  of  it  are  almost  nil,  for 
in  my  hands  as  yet  I  have  not  had  any  bad 
effects  or  dangerous  symptoms,  and  the  ac- 
tion seems  to  be  very  quick.  I  will  report 
a  few  cases  where  I  have  used  it.  the  mode 
of  administration  and  the  results. 

Cask  i. — A.  N.,  female,  white,  single, 
age  20,  robust  in  appearance  and  giving  a 
good  family  history,  but  living  in  a  mala- 
rious district  of  this  city  ;  first  came  to  my 
office  with  a  history  of  general  malaise, 
pain  in  the  small  of  the  back,  headache, 
bowels  constipated,  and  fever.  The  ther- 
mometer showed  a  temperature  of  101  de- 
grees, pulse  90  and  full.  vShe  complained 
of  no  appetite  and  vomited  almost  every 
time  she  took  food.  The  tongue  was  cov- 
ered with  a  thick,  rough,  ugly  coat,  and 
the  breatli  very  offensive.  No  tenderness 
over  the  abdomen,  but  the  spleen  was  slight- 
ly enlarged,  and  on  firm  deep  pressure  was 
tender.  My  diagnosis  was  malaria,  and  as 
she  gave  a  history  of  this  trouble  for  several 
days  before  coming  to  me  I  was  of  the 
opinion  that  she  was  suffering  from  what  is 
called  slow  malarial  fever  in  this  part  of 
the  country.  The  microscope  showed  the 
Plasmodia  in  the  blood  very  plainly,  and  1 
knew  I  was  liable  to  have  a  patient  which 
would  be  sick  several  days  before  conva- 
lescence could  be  established.  I  prescribed 
calomel  in  one-fourth  grain  doses  combined 
with  podophyllin,  one-sixteenth  of  a  grain, 
every    hour    until  eight    doses  were    taken, 


and  then  the  sulphate  of  quinine,  two  grains 
in  solution,  every  two  hours.  The  next 
morning  I  called  at  the  house  and  found 
that  the  bowels  had  moved,  but  the  fever 
was  higher  by  one  degree  and  the  pulse  one 
hundred,  no  appetite  and  steady  pain  in 
the  long  bones.  I  increased  the  dose  of 
quinine  for  three  days,  using  in  conjunction 
with  it  Rochelle's  salts  as  a  laxative  with- 
out improvement.  I  then  determined  to 
use  Viskolein,  but  only  used  it  in  the  pow- 
der, and  not  hypodermically  as  is  recom- 
mended, and  from  the  start  gave  five  grains 
every  four  hours  for  the  first  day,  all  other 
treatment  being  discontinued  except  the 
laxative,  but  with  very  little  improvement, 
when  I  increased  the  dose  to  ten  grains 
every  five  hours,  and  in  twenty-four  hours 
the  temperature  had  fallen  from  the  neigh- 
borhood of  102  degrees  to  99,  and  the  pulse 
had  dropped  in  proportion.  This  dosage 
was  continued  for  another  forty-eight  hours, 
when  the  temperature  was  normal  and  the 
pulse  78,  and  she  was  put  on  a  tonic  and 
was  able  in  a  few  days  to  return  to  her 
work.  This  patient  was  seen  the  first  time 
after  having  the  fever  some  four  or  five 
days,  and  the  sulphate  of  quinine  did  not 
have  any  effect  for  about  five  days,  but 
when  that  drug  was  discontinued,  and  the 
Viskolein  was  used,  in  forty-eight  hours 
the  temperature  was  almost  normal,  and  in 
seventy-two  hours  convalescence  was  well 
established. 

Cask  2. — J.  \\\,  laborer,  white,  single, 
aged  34,  sent  for  me,  and  arriving  at  the 
house  found  him  with  a  fever  of  103^  de- 
grees, pulse  no,  tongue  heavily  furred, 
bowels  loose,  four  and  five  actions  a  day, 
pain  in  the  back  of  the  head  and  a  very  severe 
pain  in  the  small  of  the  back, abdomen  slight- 
ly tender  and  a  little  tympanitic,  urine  high 
colored  and  scanty.  lie  gave  a  history  of 
having  been  sick  four  days,  and  on  each 
succeeding  day  the  fever  appeared  to  get 
higher  and  other  symptoms  increased  in 
severity.  He  had  been  taking  quinine  in 
large  doses,  but  had  not  derived  any  benefit 
from  it.  My  suspicions  were  aroused  in 
the  directions  of  typhoid  fever,  but  I  was 
not  sure  of  it,  but  as  a  precautionary  mea- 
sure I  put  him  on  small  doses  of  calomel, 
and  good  size  doses  of  the  sulphate  of  quin- 
ine in  solution,  but  without  any  reduction 
of  the  symptoms,  as  the  temperature  would 
be  103  at  four  in  the  afternoon  and  101  in 
the  morning;  insomnia  very  marked  and 
some  delirium,  and  the  tympanitis  increas- 
ing. I  then  put  the  patient  on  five  grains 
of  the  Viskolein  every  four  hours,  but  pre- 
ceded this  treatment  by  giving  hypodermi- 
cally ten  minims  of  the  liquid  Viskolein  in 
ten  minims  of  distilled  water,  and  no  other 


36 


THE  CHARLOTTE  MEDICAL   JOURNAL. 


treatment.  The  next  morning  the  nurse's 
report  showed  that  the  temperature  had  not 
gone  as  high  as  in  the  afternoon  previous, 
but  the  morning  temperature  was  the  same. 
I  continued  the  treatment  by  giving  ten 
grains  of  the  Viskolein  every  five  hours, 
night  and  day,  and  this  was  followed  by  a 
diminution  of  the  tympanites,  and  a  check- 
ing of  the  bowels  and  a  steady  decline  in 
temperature,  and  four  days  after  the  Vis- 
kolein was  started  there  was  no  fever,  and 
the  patient  went  on  to  convalescence,  being 
put  on  the  hypophosphites. 

The  first  diagnosis  was  typhoid  fever, 
and  from  all  indications  the  diagnosis  was 
correct.  There  were  no  rose  spots,  and 
tenderness  was  not  sufficient  to  be  really 
diagnostic,  but  if  it  was  a  case  of  typhoid 
fever,  it  was  either  that  the  temperature 
was  normal  in  two  weeks  after  first  symp- 
toms of  the  fever,  or  else  the  treatment  had 
a  great  tendency  to  reduce  or  modify  all  the 
symptoms. 

Case  3. — This  case  is  not  one  of  aborted 
fever,  but  one  where  the  fever  and  all  the 
symptoms  were  very  much  modified  in  ref- 
erence to  severity  and  action,  and  made 
what  appeared  at  first  to  be  a  very  severe 
and  dangerous  condition,  a  very  encoura- 
ging and  easy  one  to  treat,  Mrs.  M.  M., 
white,  married,  aged  30,  large  and  very 
fleshy,  was  taken  on  the  first  of  the  week 
and  I  was  sent  for  on  Wednesday,  and  I 
found  the  patient  in  a  stupor,  temperature 
104!  deg's.,  pulse  120,  weak  and  small, 
the  skin  dry  and  hard,  tongue  heavily  coated 
and  cracked,  the  bowels  very  loose,  the  dis- 
charges being  yellow  and  very  offensive,  a 
slight  rash  on  the  neck  and  face,  but  none 
on  the  body.  The  abdomen  was  tympa- 
nitic and  very  tender,  unusually  so  for  this 
stage  of  typhoid  fever.  The  patient  had 
suffered  from  insomnia  from  the  beginning 
of  the  attack.  I  prescribed  salol  in  small 
doses  and  had  her  given  a  sponge  bath  to 
reduce  the  temperature,  which  it  did  two 
degrees,  when  she  fell  asleep  and  slept  sev- 
eral hours.  Sulphate  of  quinine  with  the 
salol  was  given  for  three  days  to  see  what 
effect  it  had  on  the  range  of  the  fever,  and 
found  that  it  did  not  affect  it  at  all  when  the 
diagnosis  from  the  regular  range  of  the  fe- 
ver was  made  as  typhoid  fever.  I  then 
began  viskolein  in  ten  grain  doses  four  times 
in  twenty-four  hours,  salol  being  used  at 
the  same  time,  and  the  diet  being  regulated 
to  suit  this  trouble.  After  the  administra- 
tion of  the  viskolein  the  abdomen  became 
less  tender  and  the  passages  were  more  nor- 
mal and  only  about  two  a  day,  the  tym- 
panites being  less  marked.  The  fever  drop- 
ped very  much  and  remained  in  the  neigh- 
borhood of     101    or    102    degrees,     at    the 


highest,  for  a  week,  when  it  gradually  and 
regularly  dropped  to  normal  at  least  once  a 
day,  and  the  fever  on  the  twentieth  day  did 
not  get  above  99  deg's.,  and  I  discharged 
her  and  she  regained  her  strength  very  fast. 
She  was  pregnant  (in  her  sixth  month) 
when  taken  sick,  and  since  then  has  been 
delivered,  with  a  fine  baby,  but  some  other 
doctor  was  the  attending  physician  at  the 
event.  The  noticeable  feature  about  this 
case  was  the  profound  condition  on  the 
fourth  day  of  the  fever,  the  alarming  symp- 
toms and  gravity  of  them  from  the  first ; 
and  from  what  I  could  judge  the  treatment 
did  not  abort  the  fever  but  it  did  amelior- 
ate all  of  the  symptoms.  There  were  no 
emorrhages,  either  from  the  bowels  or  nose. 
Case  4. — This  case  is  a  little  different 
from  the  usual  run  of  fever,  as  the  visko- 
lein was  used  in  a  case  of  tonsilitis.  The 
Datient  was  a  young  man  robust  and  strong 
and  by  occupation  a  bookkeeper.  He  gave 
a  history  of  having  suffered  for  the  last  ten 
years  with  a  chronic  suppurative  tonsilitis, 
and  had,  at  different  times,  had  both  tonsils 
clipped,  the  left  being  removed  entirely, 
but  the  right  had  been  only  partially,  and 
the  remaining  portion  gave  him  a  great 
deal  of  trouble,  for  whenever  he  went  out 
in  the  cold,  as  skating  or  hunting,  or  even 
got  wet  on  a  rainy  day,  he  was  sure  to  have 
trouble  which  lasted  generally  for  a  week 
When  he  came  to  my  office  his  right  tonsil 
was  red  and  cedematous  and  the  pain  was 
very  severe,  which  radiated  toward  the  ear, 
but  there  were  no  indications  of  a  suppu- 
rative process  going  on,  and,  as  much  on 
account  of  the  fever  as  anything  else,  I  gave 
him  a  five-minim  injection  of  the  liquid 
viskolein  with  five  minims  of  distilled 
water,  and  ordered  five  grains  of  the  pow- 
der every  four  hours.  In  three  days  he  re- 
ported back  with  the  history  that  his  throat 
was  well  and  that  there  had  not  been  any 
suppuration  and  that  all  the  symptoms 
became  very  much  less  severe  after  taking 
the  powders  one  day,  and  it  was  the  first 
time  out  of  some  half  dozen  attacks  that 
the  tonsils  had  not  gone  on  to  suppuration, 
for  generally  he  would  be  suffering  with  a 
great  deal  of  fever  for  a  week,  but  in  this 
case  the  trouble  was  well  by  the  third  day. 
I  can  not  attribute  it  to  anything  but  the 
action  of  the  drug.  The  cases  cited  are 
only  a  few  of  several  that  I  have  treated 
by  this  drug. 

From  the  cases  cited  the  conclusion  is 
drawn  that  the  viskolein  seems  to  reduce  the 
fever  without  producing  shock  or  depression 
and  that  the  pulse  seems  to  be  very  little 
affected.  In  miasmatic  troubles  the  drug 
seems  to  circulate  in  the  blood  and  attacks 
directly  the  micro-organisms  and    destroys 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


them  there,  and  at  the  same  time  does  not 
seem  to  have  auy  injurious  effect  upon  the 
blood.  It  seems  to  keep  the  bowels  in  an 
antiseptic  condition  as  thoroughly  as  any 
drug  we  have,  and  also  relieves  diarrhoea. 
It  seems  to  have  very  little  effect  on  the 
kidneys  as  far  as  I  was  able  to  observe.  In 
the  use  of  it  as  an  abortive  treatment  in 
fevers  I  believe  that  it  has  a  wide  scope  of 
usefulness  and  the  future  will  show  that 
even  if  it  does  not  directly  abort  fevers  in 
every  case,  it  certainly  has  a  very  beneficial 
effect  upon  them  in  reducing  the  temper- 
ature, regulating  the  bowels,  and  restoring 
the  equilibrium  between  the  temperature 
and  the  pulse. 

4th  and  Chestnut. 


Pernicious   Malarial    Fever  Complicating 

the  Puerperal  State— with  Report  of  a 

Case. 

By  F.  D.  Gray,  M.D.,  Jersey  City,  N.J.,  Attend- 
ing Surgeon  to  Christ  Hospital,  Jersey  City: 
Member  "Practitioners  Club,"   Jersey 
City;    Member   Hudson   County 
Medical  Society. 

There  is  a  strong  tendency  on  the  part  of 
many,  perhaps  the  majority  of  the  medical 
profession,  to  regard  every  febrile  complica- 
tion of  the  puerperium,  as  of  septic  origin, 
and  without  sufficient  investigation  of  all 
the  features  of  the  case,  to  adapt  the  treat- 
ment to  that  diagnosis. 

At  the  outset  we  must  admit  that  if  a 
routine  diagnosis  for  these  cases  is  to  be 
adopted,  that  of  sepsis  will  fit  a  larger  num- 
ber than  any  other,  and  consequently  ;t  fixed 
antiseptic  method  of  treatment  will  be 
more  appropriate  and  will  relieve  more  pa- 
tients than  any  other ;  but  wherefore  is  the 
necessity  of  any  stereotyped  diagnosis  or 
plan  of  treatment  in  any  particular  class  of 
cases?  It  would  be  as  consistent  to  classify 
all  ailments  in  our  changeable  northern  cli- 
mates as  Pneumonia;  all  diseases  in  the 
infected  regions  of  India  as  cholera  ;  and 
all  those  which  come  under  the  care  of  phy- 
sicians in  the  malarial  regions  in  the  south, 
as  intermittent  or  remittent  fever,  as  to 
pronounce  every  fever  occurring  during  the 
puerperium  as    one  depending  upon  sepsis. 

As  a  matter  of  course,  if  we  are  obliged 
to  adhere  to  one  diagnosis,  it  is  much  safer, 
as  a  rule,  to  treat  all  fevers  of  the  puerperal 
state  as  septic,  than  to  loosely  clafs  a  cer- 
tain percentage  of  them  as  malarial ;  but 
with  the  modern  facilities  for  accurate  diag- 
nosis, either  extreme  of  error  is  uncalled  for 
and  reprehensible.  Necessarily  a  certain 
period    must    elapse    between    the  onset  of 


symptoms  and  our  ability  to  reach  a  posi- 
tive diagnosis.  During  that  interval  as  a 
matter  of  course,  when  the  question  lies  be- 
tween sepsis  and  a  malarial  infection,  the 
strictly  safe  plan  would  be  to  give  our  pa- 
tient the  benefit  of  treatment  from  both 
standpoints,  in-as-much  as  this  can  resuk 
in  no  harm  and  whichever  may  prove  to  be 
the  true  cause  of  her  trouble,  we  have  gai?i- 
cd  instead  of  lost  a  valuable  headway  upon 
the  disease.  Referring  now  to  the  methods 
by  which  we  can  discriminate  between 
these  two  types  of  infection,  I  would  say 
briefly,  even  at  the  risk  of  rehearsing  what 
my  readers  may  already  know,  that  a  cul- 
ture, properly  made,  from  both  vaginal  and 
uterine  secretions,  at  the  earliest  possible  mo- 
ment, should  within  twenty-four  to  forty- 
eight  hours,  at  most,  establish  or  disprove 
the  presence  of  septic  infection  of  the  gen- 
ital tract ;  during  this  period  it  is  equally 
practicable,  by  microscopical  examination 
of  the  blood,  to  prove  the  presence  or  ab- 
sence of  malarial  infection  as  indicated  by 
the  plasmodia  which  so  constantly  attend 
malarial  disease. 

Permit  me  again  to  impress  upon  the 
minds  of  my  readers  the  importance  of  vig- 
orously carrying  out  the  accepted  modes  of 
combating  the  presence  either  of  septic 
germs,  on  the  one  hand,  or  of  plasmodia  on 
the  other  :  in  this  connection  let  me  urge 
caution  in  the  use  of  cutting  instruments, 
such  as  the  sharp  curette,  in  favor  of  the 
more  conservative  and  less  harmful  dull  in 
struments,  combined  with  thorough  irriga- 
tion and  the  application  of  such  antiseptic 
preparations  as  Churchill's  Caustic  Tincture 
of  Iodine,  1-5000  solution  of  mercury  bichlo- 
ride or  1 -100  solution  of  carbolic  acid,  ap 
plied  to  the  uterine  canal  and  to  any  abra- 
sions or  lacerations  upon  the  vaginal  surface, 
or  the  vaginal  portion  of  the  cerved  uteri 
and,  in  suitable  cases  the  hypodermatic  use 
of  Marmorek  serum.  By  combining  this 
plan  of  treatment  with  full  doses  of  quinine 
in  solution  or  hypodermatically,  or  with  the 
use  of  Warburg's  Tincture  or  such  other 
anti-malarial  remedies,  as  the  medical  at- 
tendant may  see  fit  to  use,  we  are  giving 
our  patient  the  benefit  of  any  doubt  which 
may  exist,  while  at  the  same  time  we  in  no 
way  prejudice  her  chances  of  recovery, what- 
ever may  prove  to  be  the  true  nature  of  her 
affection. 

To  illustrate  the  significance  of  the  fore 
going  remarks,  allow  me  to  submit  the  his- 
tory of  a  case  occurring  in  my  practice  a 
little  more  than  a  year  ago  : 

Mrs.  T.  F.,  white,  married,  primipara, 
aet.  twenty-two,  was  attended  by  myself 
and  my  associate,  Dr.  T.  H.  Atkinson,  in 
her  confinement,  which  occurred  Nov.  5th, 


38 


THE  CHARLOTTE  MEDICAL  JOURNAL 


1897,  both  of  us  made  use  of  all  the  usual  an- 
tiseptic precautions  in  which  we  were  firm 
believers.  Her  accouchment  was  completed 
without  special  difficulties  other  than  those 
attending  an  ordinary  forceps  delivery; 
there  were  practically  no  lacerations  of  the 
cervix  or  perineum  and  the  entire  period  of 
delivery  did  not  cover  more  than  six  hours. 
The  course  of  her  convalescense  was  une- 
ventful until  the  sixth  day,  beyond  the  fact 
of  slight  mammary  tenderness  due  to  exco- 
riated nipples.  Pulse,  temperature  and  re- 
spirations were  normal ;  abdominal  tender- 
ness absent ;  lochia  normal  as  to  quantity 
and  free  from  odor.  Upon  the  sixth  day, 
however,  I  was  summoned  to  the  patient  in 
consequence  of  a  chill  occurring  at  2  p.  m. 
I  found  the  temperature  per  oram  to  be  102 
deg.,  pulse  96,  respirations  normal,  no  ab- 
dominal tenderness,  no  change  in  the  lochia, 
mammary  tenderness  still  existing.  I  was 
at  loss  to  decide  whether  her  chill  and  ele- 
vation of  temperature  were  due  to  saparemic 
infection  of  the  genital  tract,  a  malarial  in- 
fection of  the  individual,  or  a  beginning 
suppurative  action  in  the  mammary  gland. 
In  consequence  of  this  uncertainty  I  gave 
the  patient  a  very  thorough  and  prolonged 
vaginal  douche  of  carbolic  acid  solution  of 
the  strength  of  1-100;  I  also  ordered  qui- 
nine sulphate  in  acid  solution,  the  dosage 
being  five  grains  every  three  hours,  also  the 
evaporating  lotion  which  had  already  been 
applied  to  the  breast  was  continued.  This 
being  the  first  case  presenting  so  serious  a 
combination  of  symptoms  in  the  puer- 
perium  occurring  in  my  practice  during 
a  period  covering  my  last  four  or  five 
hundred  cases,  and  in  view  of  the  fact  that 
I  had  within  the  previous  week  read  a  paper 
before  the  "Practitioners'  Club"  of  our  city 
on  the  subject  of  "The  Modern  Aspects  of 
Puerperal  Fever,"  and  published  in  the 
New   York    Medical   Record,    Nov.    26th, 

1898,  in  which  I  had  taken  very  strong 
grounds  as  to  the  direct  responsibility  of 
the  accoucheur  in  whose  practice  this  dis- 
ease might  appear — my  feelings  in  the  pre- 
sence of  this  case  can  well  be  imagined  and 
I  feared  that  I  was  about  to  be  confronted 
by  the  "irony  of  fate"  and  compelled  either 
to  confess  myself  guilty  of  the  very  errors  I 
had  so  strongly  condemned,  or  else  recant 
from  the  position  I  had  assumed ;  however, 
as  the  sequel  proved  1,  happily,  was  not 
forced  to  either  alternative. 

To  resume  the  history  of  the  case  :  The 
patient  was  again  seen  by  me  at  10.30  that 
evening  and  I  found,  in  spite  of  the  treat- 
ment established,  her  temperature  had  ad- 
vanced one  degree,  with  a  corresponding  in- 
crease of  pulse,  and  a  coincident  increase 
of  her    general    discomfort.     Feeling  now 


that  in  case  there  were  a  vaginal  or  uterine 
infection  my  preliminary  antiseptic  treat- 
ment may  have  been  insufficient,  I  placed 
the  patient  on  the  table  and  with  the  assist- 
ance of  my  associate,  I  first  secured  a  speci- 
men of  both  vaginal  and  uterine  discharges 
which  were  applied  to  gelatine  in  a  culture 
tube  and  immediately  sent  to  a  competent 
pathologist  for  his  opinion,  after  a  suita- 
ble period  of  incubation.  A  careful  inspec- 
tion of  the  vagina  showed  but  a  few  abra- 
sions which  were  cauterized  with  Church- 
ill's Tincture.  Following  this  the  uterine 
cavity  was  gently  but  thoroughly  cleansed 
by  the  use  of  the  dull  curette,  free  intra- 
uterine irrigation  and  subsequent  applica- 
tion of  Churchill's  Caustic  Tincture  of  Io- 
dine. I  would  state  here  that  the  use  of 
the  curette  and  intra-uterine  irrigation  re- 
vealed the  presence  of  no  retained  clots  or 
secundines.  The  quinine  solution  was  or- 
dered continued  in  the  same  dosage.  Feel- 
ing now  that  I  had  placed  my  patient  on  a 
thorough  preliminary  course  of  treatment 
I  anxiously  awaited  its  results  on  the  mor- 
row. Upon  making  my  morning  call  at  9 
o'clock,  I  learned  that  she  had  had  a  slight 
chill  at  about  4  a.  m.  but  found  the  tempe- 
rature to  register  only  101  degrees,  showing 
a  material  defervescence  over  her  condition 
of  the  previous  afternoon  and  evening;  her 
general  condition  was  also  somewhat  im- 
proved and  I  noticed  that  she  displayed 
a  moderate  degree  of  perspiration.  I 
may  state  here  that  the  urine  had  been 
examined  subsequent  to  the  preliminary 
chill  and  was  found  to  be  negative.  The 
fact  that  the  mammary  tenderness  was 
lessened,  led  me  to  feel  that  that  could 
probably  be  eliminated  as  the  source  of 
the  trouble ;  no  further  antiseptic  mea- 
sures were  used,  and  the  anti-malarial 
treatment  continued  as  before.  On  the  af- 
ternoon of  that  day,  at  about  2  o'clock,  an- 
other chill  occurred  and  circumstances  pre- 
venting my  reaching  her  until  the  evening, 
I  found  her  temperature  entirely  normal, 
but  with  a  history  of  fever  following  the 
chill,  succeeded  by  free  perspiration.  This 
recurrence  of  a  chill  at  practically  the  same 
hour  as  on  the  previous  day,  followed  by 
fever  and  perspiration  and  in  a  few  hours 
by  complete  defervescence,  began  to  clear 
up  my  diagnosis  and  I  felt  that  I  had  to 
deal  in  all  probability  with  a  malarial  infec- 
tion only,  in  spite  of  the  fact  that  the  report 
from  my  bacteriologist  revealed  the  presence 
of  a  few  streptococci  in  the  uterine  culture, 
while  that  from  the  vaginal  remained  en- 
tirely sterile.  Acting  on  my  increased  be- 
lief in  the  malarial  origin  of  this  complica- 
tion, I  ordered  a  double  dose  of  the  quinine 
to   be  given   at   midnight — in   other  words 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


about  four  hours  preceding  an  expected 
morning  chill.  On  calling  the  next  fore 
noon  I  found  that  the  chill  had  not  appear 
ed,  as  previously  at  4  A.  m.,  I  therefore 
ordered  another  double  dose  of  quinine  to 
be  given  at  10  a.  m.,  again  preceding  the 
expected  afternoon  chill  by  a  matter  of  four 
hours,  the  single  doses  being  administered 
as  usual.  To  my  delight  my  patient  had  no 
chill  on  the  afternoon  of  this  day  and  under 
the  same  course  of  medication  escaped  the 
anticipated  seizures  of  the  following  morn- 
ing and  afternoon. 

This  brings  us  up  to  Saturday,  or  the 
ninth  day  of  the  puerperium,  when  the 
patient,  exhibiting  signs  of  cinchonism  and 
having  passed  two  full  days  with  no  mala- 
rial manifestations,  and  a  constant  normal 
temperature,  respiration  and  pulse,  together 
with  a  general  sense  of  well  being,  I  con- 
cluded it  safe  to  omit  the  double  doses 
which  she  had  previously  received  at  10  A. 
M.  and  at  midnight.  On  Sunday  forenoon, 
on  making  my  usual  call,  I  discovered  she 
had  again  experienced  a  slight  chill  at  4 
o'clock  in  the  morning,  and  her  tempera- 
ture registered  101  deg.  Anticipating  a 
return  of  trouble,  in  consequence  of  too 
early  abatement  of  anti-malarial  treatment, 
I  ordered  the  double  doses  to  be  again  re- 
sumed, accompanied  by  the  single  doses  as 
before.  At  about  3  o'clock  of  that  after- 
noon, much  to  my  dismay,  I  received  an 
urgent  call  to  this  case.  It  not  being  con- 
venient for  me  to  respond  immediately  I 
requested  my  associate  to  go  in  my  stead; 
he  had  hardly  had  time,  however,  to  reach 
her  residence  when  I  received  a  still  more 
urgent  message  that  I  '■'■must  come  at  once, 
that  the  patient  had  had  convulsions.''^  Up- 
on arriving  on  the  scene  I  confess  that  my 
heart  sank  within  me.  I  learned  that  Mrs. 
F.  had,  at  about  3  o'clock,  experienced  a 
severe  chill,  followed  by  three  equally 
severe  convulsions.  Her  condition  when  I 
arrived  appeared  most  desperate  ;  she  was 
pulseless,  unconscious,  bathed  in  a  profuse, 
clammy  perspiration  and  presented  a  tem- 
perature of  107  deg.  per  vaginam — in  fact 
she  exhibited  all  the  appearances  of  a  most 
profound  collapse,  and  everything  indicated 
a  speedy  dissolution.  Fortunately,  how- 
ever, my  associate  had  already  administered 
a  full  dose  of  digitalin  hypodermatically, 
together  with  a  quantity  of  brandy  by  the 
same  method.  These  remedies  were  re- 
peated by  us  twice  during  the  succeeding 
hour,  when  her  pulse  began  to  return  and 
her  general  condition  to  improve,  accom- 
panied by  a  material  drop  in  temperature, 
so  that  after  a  time  I  felt  safe  in  leaving 
her  for  a  few  hours.  Upon  visiting  her 
that   evening  I  was   greatly   encouraged  to 


find  that  her  temperature  was  normal,  con- 
sciousness fully  regained  and  pulse  satis- 
factory. Determined  now  to  take  no  fur- 
ther chances  of  a  recurrence  of  this  perni- 
cious malarial  explosion,  I  kept  her,  for  the 
next  succeeding  several  days,  saturated  with 
quinine  to  the  extreme  limit,  both  by  hypo- 
dermatic and  oral  administration — in  fact 
for  a  week  a  most  pronounced  condition  of 
cinchonism  was  maintained,  with  the  result 
that  no  further  malarial  manifestation 
made  its  appearance.  Her  convalescence 
from  this  time  on  was  steady  and  unimpeded. 
At  no  time  in  the  entire  history  of  the  case 
was  there  any  abdominal  tenderness  or 
fetid  condition  of  the  lochia.  After  the 
first  preliminary  cleansing  of  the  genital 
tract  she  received  no  further  antiseptic 
treatment.  I  should  have  mentioned,  that 
coincident  with  the  taking  of  cultures  from 
the  vagina  and  uterus,  I  secured  a  specimen 
of  her  blood  which  showed  the  unmistaka- 
ble presence  of  plasmodia. 

As  a  further  proof  that  the  case  was  in 
nowise  a  septic  one,  I  would  call  attention 
to  the  fact  that  had  it  been  due  to  septic 
infection,  the  preliminary  antiseptic  treat- 
ment, evidently,  did  not  control  the  condi- 
tion, for  we  find  the  patient  suffering  from 
several  recurrences  of  chill,  high  tempera- 
ture, etc.,  terminating  in  the  terrific  explo- 
sion on  the  tenth  day,  and  with  these  per- 
sisting symptoms,  accompanied  as  they  were 
by  the  final  most  formidable  ones,  the  pa- 
tient must  surely  have  succumed  to  so  severe 
a  septic  condition,  which  only  received  the 
one — and  that  somewhat  meagre — antisep- 
tic treatment ;  while  on  the  other  hand  the 
proven  presence  of  the  plasmodia  in  the 
blood  and  the  distinct  periodic  character  of 
the  symptoms,  together  with  the  prompt 
and  efficient  result  of  anti-malarial  treat- 
ment, can  leave  no  doubt  in  any  reasonable 
mind  that  the  only  complication  in  this  case 
was  a  distinctly  malarial  one.  Just  here  it 
is  interesting  to  note  the  occurrence  of  an 
undoubted  pernicious  form  of  the  disease  in 
a  locality  where  it  is  claimed  by  many,  that 
this  form  of  malaria  never  exists. 

A  practical  point  in  passing  is  the  occa- 
sional superiority  of  clinical  evidence  over 
the  results  of  bacteriological  investigation 
or  entire  dependence  on  instruments.of  pre- 
cision, etc. 

It  will  be  noted  that  the  report  from  the 
uterine  culture  showed  the  presence  of  a  few 
streptococci,  and  to  one  who  follows  abso- 
lutely the  most  modern  methods  of  diagno- 
sis, would  indicate  sepsis  as  the  etiology  in 
this  case. 

On  the  other  hand  the  clinical  aspects  of 
the  case,  viz  :  pronounced  periodicity,  ab- 
sence of  certain    well  known    symptoms  of 


41) 


THE  CHARLOTTE  MEDICAL  JOURNAL 


local  infection,  and  the  prompt  result  of 
anti-malarial  treatment  so  overshadowed  the 
presence  of  a  few  streptococci  that  one 
who  weighs  all  sides  of  a  case  carefully 
must  necessarily  discard  the  streptococci  as 
a  cause  and  adopt  the  purely  malarial  hy- 
pothesis. 

Thus  while  remembering  the  great  im- 
portance of  modern  aids  to  diagnosis  let  us 
guard  against  becoming  one-sided,  and  re- 
member that  our  predecessors  often  obtain- 
ed excellent  results  before  the  present  age 
of  microscopes,  cultures,  etc. 

To  summarize  :  Let  me  enforce  upon  my 
readers  that  all  puerperul  fever  is  not  sep- 
tic ;  that  the  next  most  frequent  cause  of 
fever  in  the  perineum  is  probably  malarial ; 
that  it  is  our  duty  when  confronted  by  a 
suspicious  case,  to  make  an  accurate  diag- 
nosis by  means  of  bacteriological  cultures 
together  with  clinical  symptoms,  and 
blood  examinations,  at  the  earliest  pos- 
sible moment,  while  we  treat  our  patient  in 
the  interval,  before  reaching  a  positive  opin- 
ion, from  both  standpoints  ;  and  that  finally, 
when  the  true  nature  of  the  complication  is 
revealed,  we  should  use  the  most  active  and 
up-to-date  measures  for  the  treatment  of  the 
same. 


Streptococcus  Infections. 

Ry  Frederick  C.  Taylor,  M.D.,  Cleveland,  Ohio, 
Lecturer  on  Histology,  Cleveland  College  of 
Physicians  and  Surgeons;  Visiting  Sur- 
geon St.  John's  Hospital. 

While  it  is  claimed  that  the  introduction, 
aseptically,  of  various  chemical  compounds, 
such  as  croton  oil,  turpentine,  etc.,  into  the 
living  animal  tissues,  may  produce  suppur- 
ation, it  is  questionable  whether  this  is  ever 
true.  .Suppuration  under  such  circumstances 
may  certainly  ensue,  but  in  all  probability 
there  is  a  bacterial  infection  as  a  primary 
cause.  Not  that  the  bacteria  must  neces- 
sarily be  introduced  with  the  foreign  ma- 
terial— the  vitality  of  the  part  may  be  im- 
paired by  the  irritation,  its  resisting  power 
weakened  and  micro-organisms,  heretofore 
latent  or  held  in  subjection  in  the  blood  or 
tissues,  gather  at  the  spot,  multiply,  inau- 
gurate a  destructive  campaign  and  a  sup- 
purative inflammation  ensues. 

The  weight  of  evidence  is  overwhelming- 
ly in  favor  of  the  view  that  suppuration 
without  bacterial  infection  never  occurs. 

The  power  of  causing  suppuration  is  not 
confined  to  one  specific  bacterium,  but  is 
common  to  many  species,  the  most  impor- 
tant of  which  are  the  staphylococcus  pyo- 
genes aureus,  albus  and  citreus,  bacillus 
pyogenes  f«ctidus,   bacillus  pyocyamus,  mi- 


crococcus gonorrhoea,  and  streptococcus 
pyogenes. 

The  staphylococci  occur  most  frequently, 
but  from  a  clinical  standpoint,  the  strepto- 
cocci are  of  more  interest  and  of  only  a  little 
less  frequency. 

Under  the  microscope  the  streptococci 
appear,  as  the  name  signifies,  in  chains — 
generally  from  five  to  ten  immobile  cells 
presenting  the  appearance  of  beads  on  a 
string ;  in  cultivations  on  gelatine  small 
whitish,  slow  growing  colonies  are  seen 
separated  one  from  another,  having  no  ten- 
dency to  coalesce  or  to  liquefy  the  culture 
media. 

Clinically  streptococcus  infections  are 
characterized  by  their  extreme  malignancy 
— extension  along  the  lymphatics,  the  gen- 
eral systemic  involvement  and  the  forma- 
tion of*  metastatic  abscesses. 

Streptococci  are  present  either  as  the  sin- 
gle causative  agent  or  together  with  other 
specific  poisons,  not  only  in  localized  lesions 
as  laryngitis,  pharyngitis,  abscesses  and 
pustules,  but  also  in  general  pathological 
conditions  classified  under  various  heads. 

In  erysipelas,  puerperal  fever,  ulcerative 
endocarditis,  and  osteo-myelitis,  the  strep- 
tococcus is  always  present,  and  is  usually 
present  in  scarlatina,  variola,  yellow  fever, 
cerebro-spinal  meningitis  and  kindred  affec- 
tions. Indeed  the  streptococcus  erysipelatis 
of  Fehleisen  and  the  streptococcus  puerpe- 
ralis  of  Frankel  do  not  differ  in  the  slightest 
degree  either  microscopically  or  under  cul- 
tivation, from  the  classical  streptococcus 
pyogenes.  So  much  for  etiology.  Clini- 
cally in  streptococcus  infections  we  have  a 
condition  always  serious,  always  of  extreme 
gravity — not  that  our  patients  under  these 
circumstances  always  die  or  are  invariably 
in  a  critical  condition — but  the  possibilities 
of  serious  complications  are  so  great — the 
development  of  remote  lesions  so  insidious, 
that  it  behooves  us  to  be  always  on  guard, 
never  relaxing  our  vigilance  until  every 
vestige  of  disease  is  eliminated. 

The  local  symptoms  presented  in  this 
form  of  infection  are  the  same  as  those  of 
all  suppurative  bacterial  invasions  though 
usually  of  a  somewhat  more  severe  charac- 
ter, except  the  swelling  which  may  be  in- 
considerable. In  addition  we  have  a  mark- 
ed tendency  to  lymphatic  involvement  and 
extensions  through  the  lymphatic  system 
with  the  formation  of  metastatic  abscesses. 

Large  areas  of  induration  usually  surround 
the  local  foci  often  rendering  the  detection 
of  pus  difficult.  When  the  superficial  layers 
of  the  skin  alone  are  involved  the  rapid 
breaking  down  of  the  cells  "melting  away" 
of  the  tissues  leaving  an  angry,  exceedingly 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


41 


sensitive    surface    behind,  is    very    charac- 
teristic. 

In  addition  to  the  usual  manifestations, 
the  constitutional  disturbance  is  most  mark- 
ed ;  the  temperature  not  always  high,  but 
persistent  and  in  advanced  conditions  often 
suddenly  becoming  subnormal.  Pulse  rapid, 
full,  and  later  becoming  weak,  irregular, 
and  not  responding  readily  to  the  ordinary 
cardiac  stimulants.  The  patient  presents  a 
picture  of  septic  intoxication  out  of  all  pro- 
portion to  the  local  lesions.  It  is  this  tox- 
aemia that  renders  the  disease  so  serious,  and 
it  is  this  condition  that  must  be  persistently 
fought,  if  we  would  restore  our  patient  to 
health.  The  indications  for  treatment  are 
simple — thorough  and  complete  evacuation 
of  the  pus  and  removal  by  curettage  or 
otherwise  of  all  necrosed  tissue.  Energetic 
antisepsis  must  be  the  rule  and  rigidly  ad- 
hered to.  It  is  not  sufficient  in  these  cases 
with  localized  foci  of  infection  to  simply 
open  and  drain — every  portion  of  the  in- 
fected area  should  be  exposed  that  antisep- 
tics and  germicides  may  have  easy  access. 
Cut  wide  and  deep — scrape  or  dissect 
away  all  broken  down  tissues  and  use 
powerful  germicides  freely. 

While  watching  the  local  lesions  do  not 
lose  sight  of  the  general  conditions — tonics, 
stimulants,  agents  that  inhibit  the  develop- 
ment of  bacteria  should  be  used  persistently. 
In  addition  to  iron,  quinine,  strychnia,  and 
alcoholics,  any  or  all  as  the  conditions  seem 
to  demand,  aromatic  sulphuric  acid  seems 
to  exert  an  almost  specific  influence  in  these 
cases.  Ten  drops  well  diluted,  three  times 
daily,  has  in  my  hands  proven  most  satis- 
factory. 

I  wish  to  report  two  cases  of  streptococ- 
cus infection  coming  under  my  care — one 
interesting  from  the  remote  secondary  man- 
ifestations, the  other  from  its  close  resem- 
blance clinically  to  an  anthrax  infection. 

Case  i. — Mrs.  T.,  aet.  62,  well  nourish- 
ed and  in  good  general  condition,  consulted 
me  for  a  severe  pharyngitis,  (I  was  at  the 
time  treating  sore  throats  in  three  other 
members  of  the  same  family.) 

The  pharynx  was  red,  angry  looking, 
little  exudation,  but  exceedingly  sensitive. 
Temperature  101.5  deg.  F.,  pulse  no,  full 
and  bounding,  severe  headache,  and  chills. 
The  pharyngitis  proved  stubborn,  resisting 
for  several  days  all  treatment.  It  finally 
yielded,  but  the  general  condition  did  not 
improve.  After  a  few  days  my  attention 
was  called  to  the  middle  finger  of  the  left 
hand,  where  I  found  a  small  subcutaneous 
drop  of  pus  over  the  terminal  phalanx  ;  this 
was  cleared  away  and  a  moist  bichloride 
dressing  applied.  At  this  time  the  patient 
was  taking  pyrophosphate  of  iron,  quinine 


and  strychnia  every  four  hours.  The  next 
day  the  conditions  were  not  improved,  the 
entire  finger  was  swollen,  a  red  line  up  the 
arm  and  tenderness  of  the  axillary  glands 
denoted  lymphatic  involvement.  The  gen- 
eral condition  was  exceedingly  grave — a 
perfect  picture  of  septic  intoxication. 

Under  local  anesthesia  the  finger  was 
freely  incised,  bichloride  fomentations  ap- 
plied, and  aromatic  sulphuric  acid  inter- 
nally ordered. 

The  improvement  was  steady — though  a 
considerable  amount  of  tissue  sloughed  out ; 
and  my  patient  was  soon  up  and  around, 
and  made  an   uninterrupted  convalescence. 

Here  we  had  a  mixed  infection — strepto- 
coccus complicating  a  staphylococcus  infec- 
tion, and  rendering  a  comparative  mild 
condition  one  of  great  gravity. 

Case  2. — Mrs.  H.,  aet.  68,  was  admitted 
to  my  service  at  St.  John's  Hospital,  Octo- 
ber 28th,  1898.  At  the  time  of  admission 
she  was  in  a  semi-comatose  condition  ;  tem- 
perature 100.5  deg-  F.,  pulse  128,  weak, 
intermittent,  unquestionably  profoundly 
septic.  She  was  taken  immediately  to  the 
operating  room,  and  then,  under  general 
anesthesia,  I  opened  five  large  pus  cavities 
on  the  back — the  largest  contained  sixteen 
ounces  of  thick,  reddish,  foul  smelling  pus, 
and  the  other  four  together  about  thirty 
ounces.  Each  abscess  was  opened  with  a 
cross  incision,  the  contents  evacuated,  all 
necrosed  tissue  removed  with  a  spoon  cu- 
rette, the  cavity  washed  with  a  saturated 
solution  of  permanganate  of  potash,  and 
loosely  packed  with  iodoform  gauze. 

The  general  treatment  as  sketched  above 
was  conscientiously  followed  out.  Her 
condition  improved  at  first,  but  on  the  third 
day  a  septic  diarrhea  developed,  the  tem- 
perature became  sub-normal,  pulse  weaker, 
intermittent  and  more  irregular,  finally 
coma  and  death,  November  4th. 

Her  daughter  entered  the  hospital  at  the 
same  time  having  on  both  arms  from  wrist 
to  elbow,  pustules  and  areas  of  induration. 
She  had  been  caring  for  her  mother,  and 
undoubtedly  so  infected  herself.  The  pus- 
tules were  opened,  curetted,  bichloride 
fomentations  applied,  and  tonics  and  stim- 
ulants internally  administered.  She  made 
an  uninterrupted  recovery. 

On  November  8th,  I  was  asked  to  see 
Sister  D.,  of  the  hospital  staff,  and  found 
on  her  arms  several  pustules.  She  had 
waited  on  Mrs.  H.  from  the  time  of  her  ad- 
mittance, had  cared  for  the  body  after  the 
death,  washed  the  clothing  and"  bedding. 
The  pustules  proved  very  obstinate,  new 
ones  developing  as  others  yielded  to  treat- 
ment, altogether  fifteen  to  eighteen  were 
present.     In  this  case  the  general  condition 


42 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


was  kept  under  control  with  quinine  and 
sulph.  acid,  and  the  local  lesions,  after  cu- 
rettage, treated  first  with  bichloride,  later 
with  formaline,  resulting  in  complete  re- 
covery. 

In  these  cases  we  have  a  perfect  clinical 
picture  of  anthrax  infection.  In  Mrs.  H. 
carbuncles,  in  the  others  malignant  pustule. 
At  the  time  of  the  admission  of  Mrs.  H. 
the  facilities  for  bacteriological  examina- 
tions were  not  at  hand,  and  her  condition 
did  not  admit  of  delay,  but  in  the  other 
cases  cultivations  proved  a  pure  streptococ- 
cus infection. 

These  cases  well  illustrate  the  gravity  of 
this  form  of  infection,  the  severity  of  the 
local  manifestations,  and  the  remote  secon- 
dary lesions,  together  with  the  ease  with 
which  other  individuals  may  become  in- 
fected. 

In  conclusion  I  wish  to  emphasize  the 
importance  from  a  prognostic  as  well  as  a 
therapeutic  standpoint  of  bacteriological 
examinations  in  all  suppurative  conditions, 
of  energetic  local  treatment,  and  in  strepto- 
coccus infections  especially,  of  close  atten- 
tion to  the  general  condition. 

128  Franklin  Avenue. 


Some  Little  Things  on  Drugs  and    Diet. 

By  Albert  Bernheirn,   A.  M.,   M.  D.,   Paducah, 
Kentucky. 

"I  took  Drake's  Plantation  Bitters  and 
Ayer's  Pills  first,  and  then  I  discovered  I 
had  disease  of  the  liver  and  kidneys.  I  saw 
the  advertisement  of  S.-T.-1860-X,  and  I 
bought  a  dozen  right  off.  Ayers'  almanac 
taught  me  something  about  the  human 
frame  and  I  took  Ayers'  pills.  I  spent 
$200  on  Helmbold's  buchu,  and  I  took  that 
with  Schenck's  pills  and  pulmonic  syrup, 
for  something  was  the  matter  with  my 
ungs.  I  changed  off  from  Schenck's  to 
Jayne's  expectorant,  and  finally  IgotPiso's 
Consumption  Cure  ;  I  think  it  did  me  good. 
I  wanted  to  cure  my  digestion,  so  I  got 
Vinegar  Bitters  and  Rocky  Mountain  Bit- 
ters and  Snyder's  Aromatic  Bitters  and  I 
took  turn  about,  one  dose  of  one  and  then 
of  another.  I  cannot  remember  all  I  took. 
I  kept  a  list  once  but  I  lost  it.  Yes  sir,  I 
went  for  everything. 

I  took  Dr.  Pierce's  Pleasant  Purgative 
Pellets,  Radway's  Ready  Relief,  Dr. 
Wright's  Indian  Vegetable  Pills,  Jayne's 
Pills,  Schencks  Seaweed  Tonic,  Hamlin's 
Wizard  Oil  (that  was  for  my  rheumatism) 
for  which  I  also  used  Gargling  Oil,  Cen- 
taur Liniment,  Kunkel's  Bitter  Wine  of 
Iron,  Cram's  Fluid  Lightning  (that's  when 


I  had  neuralgia),  Hop  Bitters — oh!  I  can't 
tell  how  many  more — Pond's  Extract,  Ster- 
ling's Camphorated  Ginger,  the  King  of 
Pain,  Vegetine,  Fitler's  Rheumatic  Rem- 
edy and  Kidney  Cordial.  I  can't  think  of 
them  all,  and  now  I've  got  skin  disease;  I 
am  using  Cuticura  remedies  and  Chinka- 
lyptus. 

I  am  not  taking  anything  else  now  except 
a  dose  of  podophyllin  every  Tuesday  and 
Thursday  mornings  and  Saturday  night, 
and  a  bottle  of  citrate  of  magnesia  next 
morning.  Sometimes  I  take  blue  mass  on 
Monday,  but  that  is  only  during  rainy 
weather.  I  forgot  to  say  I  have  worn  a 
liver  pad  for  five  years ;  and  I  think  I  am 
ruptured,  and  I  also  wear  a  truss  when  I  am 
moving  around  much." 

What  is  that?  Is  that  an  advertisement 
for  the  columns  of  a  medical  paper?  Is  it 
a  history  of  a  patient?  It  is  not  intended 
as  an  advertisement.  The  above  is  a  history 
of  a  patient,  written  by  the  patient  him- 
self, written  in  a  letter  to  a  Philadelphia 
daily  paper,  about  twenty  years  ago,  by 
Mr.  John  F,  Rigdon.  I  hope  that  Mr. 
Rigdon  is  still  living  in  this  vale  of  tears 
and  slough  of  despond.  Still,  should  he 
have  left  this  worst  of  all  worlds,  I  shall 
gladly  hope  that  he  is  enjo/ing  the  best  of 
health  on  the  green  and  pink  plains  of  the 
Elysium  ;  and  that  he  had  or  will  have  oc- 
casion to  drink  Lethe  on  the  shore  of  the 
Acheron,  where  Chairon  is  waiting  to 
carry  him  over  for  a  penny  (obolos)  to  the 
offices  of  Drs.  Esculapius  and  Hippocrates, 
and  to  the  drugstores  of  Medea. 

This  was  only  one  account  of  medicines, 
taken  by  patients  really  sick  and  imagin- 
ably sick.  Mr.  John  F.  Rigdon  has  many 
fellow-brothers  and  fellow-sisters.  I  shall 
not  consider  it  as  my  duty  to  state  the  value 
or  non-value  of  all  these  medicines.  I 
shall  not  dispute  that  one  or  the  other  of 
this  enormous  number  of  patent  medicines 
we  have  in  America  might  have  value, 
might  do  some  good — to  the  patient  per- 
haps not  too  much ;  to  the  manufacturer 
perhaps  not  too  little. 

To  be  short,  much  too  much  medicine  is 
taken-  by  the  people  of  this  country. 
Laveran,  the  French  physician,  discoverer 
of  the  malarial  agent  states  in  regard  to 
malarial  fever  :  "In  a  general  way  it  may 
be  said  that  in  malarial  districts  far  too 
much  sulphate  of  quinine  is  given  to  pa- 
tients who  have  no  need  of  it,  while  a 
sufficient  quantity  is  not  given  to  patients 
suffering  from  paludism.* 

It  is  sure  that  this  doctrine  is  well  justi- 
fied as  to  America.      And  what  is  said  here 

*W.  S.  Thayer,    Lectures  on  Malarial  Fevers. 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


4:: 


of  quinine  may  be  said  of  many  other 
drugs  too.  Next  to  quinine,  or  perhaps 
more  than  this,  we  must  name  calomel. 
The  infant  is  nursed  on  calomel  and  quinine, 
the  child  is  impregnated  with  these  drugs, 
and  the  old  man  or  woman  must  learn  to 
eat  or  swallow  them  if  he  or  she  had  not 
got  them  in  younger  years.  And  what  is 
the  result.  On  the  one  side,  may  be,  an 
impaired  hearing  or  sight,  on  the  other  side 
a  chronic  disorder  in  the  gastro-intestinal 
tract,  beginning  with  the  teeth  and  ending 
with  the  rectum,  including  liver.  But  I 
shall  hear,  quinine  is  the  best  remedy  against 
malaria.  Sure  it  is  and  must  be  taken  in 
malarial  fevers.  But  it  is  taken  by  the  pa- 
tients without  prescription  for  everything 
and  anything  from  a  "Katzenjammer"  and 
slight  cold  to  typhoid  fever  and  all  other 
fevers.  And  calomel  is  taken  for  anything 
and  everything,  from  a  fetor  ex  ore  caused 
by  neglected  teeth,  to  the  acute  gastritis 
and  carcinoma  of  the  rectum.  I  think  that 
every  doctor,  in  prescribing  calomel,  has  a 
special  view  in  doing  so,  at  least  I  assume 
so.  But  it  is  the  doctor  who  causes  people 
to  swallow  quinine  and  calomel  by  ounces, 
at  least  the  "doctors  trained  people  for 
doing  so." 

But,  to  be  sure,  calomel  is  a  good  remedy 
too,  for  cleaning  disturbed  intestine.  None 
will  deny  that.  But  what  is  the  cause,  in 
a  large  number  of  instances,  of  these  dis- 
orders? One  of  the  causes  I  shall  name — 
only  one,  but  this  one  I  regard  as  not  the 
most  unfrequent.  We  eat  far  too  much  in 
America,  more  than  necessary  for  the  econ- 
omy of  our  body,  more  than  our  stomach 
and  bowels  are  able  to  dispose  of,  more  than 
our  gastro-intestinal  tract  can  stand.  Just 
let  us  take  the  bills  of  fare  of  one  day 
(Tuesday)  at  our  hotels. 

Breakfast: — Oranges,  stewed  prunes, 
rolled  oats,  radishes,  olives,  green  onions, 
broiled  Potomac  shad,  fried  roe,  broiled 
sirloin  steak,  fried  onions,  baked  apples 
with  breakfast  bacon,  codfish  in  cream, 
fried  mush,  eggs  and  omelettes  to  order, 
potatoes,  plain  rolls,  soda  biscuit,  griddle 
rolls,  dried  and  buttered  toast,  maple  syrup, 
New  Orleans  molasses,  coffee,  tea,  cocoa, 
milk. 

Dinner: — Cream  of  Barley,  lettuce, 
radishes,  green  onions,  baked  white  fish, 
butter  sauce  and  potatoes,  short  ribs  of  beef, 
horse  radish,  sirloin  of  beef,  drip  gravy, 
young  mutton  with  jelly,  baked  chicken 
pie,  banana  fritters,  custard  sauce,  potatoes, 
stewed  tomatoes,  sweet  potatoes,  corn,  egg 
bread,  buttermilk,  steamed  pound  pudding 
with  brandy  sauce,  blackberry  pie,  cocoa- 
nut  pie,  apricot  sherbet,  ice  cream,  cakes, 
cheese,  water  crackers,  coffee. 


Supper: — Bouillon,  radishes,  lettuce, 
young  onions,  salt  mackerel,  fried  codfish 
balls,  broiled  sirloin  steak,  mushrooms, 
sugar  cured  hams,  chipped  beef  in  cream, 
eggs  and  omelettes,  potatoes,  cold  roast 
beef,  baked  beans  with  bacon,  split  rolls, 
biscuits,  rice  cakes,  toast,  pears,  coffee,  tea, 
milk. 

You,  of  course,  will  say  it  is  not  neces- 
sary to  eat  all  this!  You  are  right  in  say- 
ing so,  but  we  see  that,  indeed,  many  peo- 
ple eat  the  whole  bill  of  fare  the  "full  line," 
and  that  not  only  men  but  women  too, 
young  girls  and  children.  In  fact,  you 
must  at  times,  wonder  where  these  young 
ladies  (not  to  speak  of  men)  will  find  the 
space  to  store  all  these  eatables,  and  how 
they  will  have  power  enough  to  digest  them 
in  good  health.  For  a  while  we  will  be 
able  to  dispose  of  them,  and  we  are  getting 
stronger,  but  some  time  after,  stomach  and 
intestine  will  not  do  any  longer,  because 
they  cannot,  it  was  too  much  work  for 
them,  and  the  result  of  it  is  an  atonic  stom- 
ach and  atonic  bowels,  constipation,  stasis 
in  the  circulation  of  the  blood,  gastric  ca- 
tarrh, sluggish  liver  and — calomel.  It 
might  do  good,  and  the  circulus  vitiosus 
begins  anew,  until  even  calomel  cannot 
remove  the  disturbances  of  the  body. 

If  we  would  test  such  a  daily  food  upon 
its  amount  of  albumen,  fat,  starch  and 
sugar,  we  would  find  a  quantity  much  too 
large  for  the  amount  stipulated  by  the  cham- 
pion of  physiologists  as  to  the  animal  econ- 
omy— the  Munich  professor,  Dr.  Karl  von 
Voit.  Even  the  most  recent  researches 
state  that  the  quantity  named  by  Voit  might 
still  be  reduced.  Voit  makes  out  three 
different  stages,  one  for  the  man  being  at 
rest,  the  second  for  the  moderate- working 
man,  the  third  for  the  hard-working  laborer. 
But  it  is  the  irony  of  fate  that  the  man 
who  might  be  able  to  stand  such  a  circum- 
stantial and  compact  food,  namely  the 
working  laborer,  is  not  able  to  have  il, 
while  the  man  who  can  afford  to  have  it,  is 
not  likely,  capable,  of  overcoming  such 
a  quantity  of  food. 

But  somebody  will  inform  me  that  this  is 
a  hotel  bill  of  fare,  and  that  in  the  general 
household  the  menu  is  not  so  extravagant. 
I  shall  admit  that  it  is  not  so  extravagant, 
but  it  is,  anyway,  prodigious  enough  and 
certainly  more  than  necessary,  far  more, 
indeed. 

1  7e7/7  make  concession  to  a  hearty  dinner 
and,  be  it  so,  a  hearty  supper  too,  but  the 
American  breakfast  is  too  vast.  If  it  is 
true  that  a  yankee  gunner  has  said  to  com- 
modore Dewey,  "to  hell  with  breakfast; 
let's  finish  'em  now!"  we  have  proof  and 
evidence    enough    that    we    can    destroy    a 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


whole  Spanish  fleet  without  even  a  break- 
fast. Certainly  it  is  not  my  intention  to 
banish  the  breakfast  at  all,  but  the  enor- 
mous breakfast  should  be  avoided  because 
it  is  not  necessary. 

An  old  German  saying  runs:  "Ein  gutes 
Ruchlein  ist  besser  als  ein  Bruehlein,"  (a 
little  repose  is  better  than  a  broth).  And 
when  could  we  apply  this  saying  better 
than  for  the  morning?  We  had  rest  and 
sleep  for  several  hours,  we  have  been 
strengthened,  and  we  need  not  the  hearty 
breakfast,  A  cup  of  coffee,  or  tea,  or  cocoa, 
some  bread  perhaps,  with  butter,  maybe  an 
egg  or  two,  I  should  think  it  is  enough,  and 
I  know  it  is.  If  somebody  prefers  oatmeal 
or  some  other  gruel,  he  may  eat  it.  The 
majority  of  people,  as  a  rule,  are  not  hun- 
gry in  the  morning  just  after  they  get  up — 
but  they  eat  the  hearty  breakfast  neverthe- 
less, many,  probably,  with  the  intention  to 
prevent  the  hunger  to  come.  Quite  a  dif- 
ferent state  of  affairs  it  is  if  you  get  up  in 
the  very  early  morning  and  you  have  done 
some  work  ;  after  that  a  hearty  breakfast 
might  be  in  the  right  place. 

But  most  of  the  physicians  will  agree 
with  me  if  I  say  it  is  very  hard  to  combat 
stomach  troubles  and  disorders  of  the  bow- 
els by  means  of  diet.  Not  that  I  mean  to 
say  that  diet  is  not  one  of  the  best  remedies, 
it  is  often  the  remedy — but  because  the  pa- 
tient has  been  trained  and  educated  for 
drugs.  Very  often  they  will  leave  you  and 
go  to  see  another  doctor  who  is  quick  and 
very  ready  to  prescribe  some  medicine.  Yes, 
this  medicine  relieves  the  patient  and  the 
trouble  that  re-appears  very  soon  is  relieved 
by  the  refilling  of  the  prescription,  may  it 
be  now  blue  mass,  or  calomel,  or  sulphate 
of  magnesia.  The  patient  regards  this 
medicine  as  just  as  daily  a  food  as  he  does 
bread  :  but  sooner  or  later  it  will  not  help 
any  longer,  and  the  harm  that  is  done,  is 
due  not  to  the  patient  alone,  but  more  so  to 
the  quick  and  ready  drug  doctor. 

I  shall  indeed  not  deny  the  value  of  drugs, 
but  it  is  my  opinion  that  this  always  and 
ever  writing  doctor  does  more  harm  than  a 
Mauser  rifle.  I  shall  not  indorse  the  nihil- 
ism in  medicine  of  half  a  century  ago,  but 
we  had  better  train  the  patient  and  educate 
him  to  the  understanding  I  hat  not  all  of 
salvation  depends  on  drugs,  but  some  of  it 
— ami  not  t lie  least — on  hygiene,  hygiene  in 
the  widest  sense  of  the  word.  Sometimes 
you  cannot  help  in  meeting  with  one  pre- 
scription or  another  that  chills  you  not  a 
little.  Such  a  prescription,  at  times,  looks 
as  if  the  doctor  would  have  read  the  index 
of  a  book  on  materia  medica  and  taken 
from    it  a  number  of  drugs,    put  the  quan- 


tity on  their  side,  and  given  that  as  a  pre- 
scription. Chemistry,  you  cannot  see  in  it, 
because  very  often  it  is  nothing  but  a  dirty 
mixture ;  physiology  you  will  hardly  be 
capable  of  discovering  in  it ;  very  often  the 
one  drug  neutralizes  the  other,  and  this 
then  is  the  most  fortunate  thiug,  because 
the  mixture  is  hereby  prevented  from  doing 
evil.  If  you  see  a  doctor's  prescription,  of 
a  so-called  light  of  a  physician — a  mixture 
of  antikamnia,  antifebrin,  calomel  and  tan- 
nic acid  (many  a  man  does  not  know  that 
antikamnia  contains  antifebrin)  and  that 
the  patient  gets  well,  I  should  think  that 
he  got  well  in  spite  of  the  medicine,  and 
this  shows  evidence  that  the  human  body 
not  only  can  stand  large  quantities  of  food, 
but  that  it  can  overcome  even  some  medi- 
cines. 

Another  time  troubles  of  the  stomach 
and  the  alimentary  system  might  be  cured 
or  rather  prevented,  not  so  much  by  drugs, 
as  by  precautionary  measures.  Some  years 
ago  an  English  medical  paper  brought  out 
an  article  on  the  temperature  in  the  mouth 
after  cold  and  hot  drinks.  I  made  some 
experiments  on  myself  and  found  high  ele- 
vation of  the  temperature  after  drinking 
hot  liquids  or  after  gargling  with  them, 
and  then  again  a  fall  of  the  temperature 
after  ice  water  and  ice  cream  ;  the  differ- 
ence between  the  highest  and  lowest  tem- 
perature was  as  much  as  nine  degrees,  from 
96  to  105  degrees  F.  What  you  may  find 
the  case  in  the  mouth,  is  liable  to  be  found 
in  the  stomach  too,  perhaps  not  to  an  equal 
extent.  Should  we  wonder  when  the  quick 
change  from  hot  coffee  to  ice  water  would 
produce  disturbances  in  the  stomach  and 
oesophagus,  and  last  not  least  in  the  struct- 
ure of  the  teeth.  Like  the  enamel  of  a  pot 
will  crack  if  you  expose  it  alternately  to 
hot  water  and  cold  water  for  any  length  of 
time,  so  the  enamel  of  the  teeth  will  van- 
ish by  maltreatment  too,  and  not  the  least, 
by  exposure  to  hot  drinks  (120  degrees  and 
higher)  and  cold  drinks  (40  degrees  and 
lower  to  ice  temperature).  One  of  the 
coldest  and  at  the  same  time  most  harmful 
of  this  kind  is,  in  my  opinion,  ice  cream 
with  soda.  Another  point  I  often  hear  is 
the  "ice  cold  beer."  Ice  cold  is  not  the 
way  to  drink  beer.  Very  often  I  have  heard 
men  say,  or  women,  "I  cannot  ('rink  beer, 
it  makes  me  bilious."  I  say  it  it  is  not  the 
beer  that  makes  bilious,  it  is  the  ice  cold 
temperature  that  has  this  effect.  Beer  is, 
without  doubt  the  least  harmful  of  all  the 
alcoholic  drinks,  quite  especially  because 
the  percentage  of  its  alcohol  is  low,  and 
because  beer  alone  contains  some  other 
nourishing  substances,  like  malt,  sugar  and 
salts.      But  never  drink  beer    with    a    tern- 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


15 


perature  below  55  degrees.  F. — cool  beer 
but  not  tee-cold  beer. 

Another  fact  that  should  be  accounted 
for  in  disorder  of  stomach  and  intestines  is 
the  too  large  use  of  fat.  Butter  and  lard, 
anywhere  and  everywhere,  and  I  mean  par- 
ticularly the  simultaneous  use  of  butter  and 
meat.  Some  one  has  said,  there  are  three 
different  zones  noticeable  in  the  use  of  fat. 
The  zone  of  fish  oil,  the  zone  of  lard  and 
butter  and  the  zone  of  vegetable  oils  ;  these 
zones  are  arranged  here  from  north  to  south. 
He  who  turns  his  attention  to  this  will  find 
that  this  is  quite  correct,  and  if  here  in  the 
.South  we  must  use  fat,  let  it  be  olive  oil,  and 
not  lard  or  butter. 

A  friend  of  mine,  who  lived  for  many 
years  in  the  far  east,  in  Java  and  on  the 
Philippine  Islands,  told  me  that  in  those 
countries  he  began  to  understand  the  pro- 
hibition of  Moses  in  regard  to  pork  and 
the  mixing  of  flesh  and  milk.  He  said 
nobody  will  eat  meat  and  butter,  or  drink 
milk,  at  the  same  time,  and  when  he  does 
eat,  he  has  to  atone  for  it  by  troubles  of 
various  kinds.  Let  us  give  a  short  sum- 
mary of  the  above  : 

1.  The  physician  shall  prescribe  less  pre- 
scriptions and  look  rather  for  the  hygienic 
conditions  of  life  in  the  patient. 

2.  Correct  and  proper  diet  can  do  more 
good  to  a  patient,  because  it  prevents  dis- 
ease, and  "a  grain  of  prevention  is  more 
valuable  than  a  pound  of  cure." 

3.  The  patient  will  follow  the  advice  of 
the  doctor,  if  the  patient  shall  have  been 
educated  and  trained  for  this  method  of 
treatment. 

4.  The  doctor  must  have  studied  physi- 
ology and  physiological  chemist  rv,  and 
must  not  copy  the  drugs  in  his  prescrip- 
tions just  as  they  run  to  his  eyes,  and  must 
not  give  prescriptions  because  the  patient 
asks  for  one.  Very  often  the  patient  does 
not  think  it  a  medical  service  if  he  will  not 
be  able  to  bring  a  paper  to  the  drugstore. 

5.  Hot  drinks  and  cold  drinks  don't 
agree  simultaneouslv. 

6.  Avoid  the  mixing  of  meat  and  too 
large  quantities  of  butter,  and  keep  from 
animal  fat,  quite  especially  in  summer  time, 
and  more  particularly  in  warmer  regions, 
such  as  here  in  the   South. 


Otitis  Media  Chronica. 

By  J.  II.  McCassy,    M.  A.,  M.  I).,  of   Dayton,   ( ). 

.Suppuration  in  the  middle  ear  has  a  death 
rate  of  2^  %,  and  is  nearly  as  fatal  a  disease 
as  typhoid  fever.  In  this  disease  a  slight 
cold  may    precipitate    a    fatal    mastoiditis, 


meningitis,  or  septicaemia.  The  victim  of 
this  disease  who  fails  to  put  forth  every 
laudable  effort  to  have  himself  cured,  vol- 
untarily sleeps  over  a  deadly  volcano.  The 
frequent  earaches  in  children  during  damp 
or  cold  weather,  are  often  the  fore- 
runners of  suppuration  in  the  middle  ear. 
Among  the  most  frequent  causes  of  this 
disease  are  naso-pharyngeal  catarrh,  denti- 
tion, scarlet  fever,  measles,  diphtheria, 
whooping  cough,  phthisis,  and  the  diving 
or  ducking  of  the  head.  Even  hunting 
dogs  that  dive,  have  otitis  media  and 
become  deaf.  In  the  battle  of  Santiago  de 
Cuba,  eight  out  of  the  ten  casualties  upon 
the  American  ships  were  rupture  of  the  ear 
drums  due  to  the  terrific  cannonading,  be- 
cause the  men  were  on  deck  for  inspection, 
when  Cervera's  ill-fated  squadron  made  a 
dash  for  the  open  sea,  and  the  men  rushed 
to  their  guns  and  began  blazing  away,  with- 
out taking  the  customary  naval  precaution 
of  plugging  their  ears  with  cotton. 

In  the  human  anatomy  there  are  four  cen- 
tres for  maintaining  equilibrium.  One  is  lo- 
cated in  the  skin  of  the  feet,  another  in  the 
stomach,  a  third  one  in  the  eye,  and  the 
fourth  in  the  ear.  Disturbance  of  any  one 
of  these  will  produce  dizziness.  Otorrhosa, 
if  unchecked,  will  in  time  invade  and  dis- 
turb this  function  of  the  ear,  impair  hearing 
and  health  and  unnecessarily  often  result 
fatally.  Too  frequently,  through  neglect, 
otorrhcea  passes  beyond  the  middle 
ear,  and  by  invading  the  labyrinth  causes  a 
condition  known  as  Meniere's  disease.  In 
this  disease  a  plastic  exudation  into  the  mu- 
cous membrane  and  labyrinth  interferes 
with  the  function  of  the  cilia  or  auditory 
hairs  in  the  conduction  of  sound  waves, 
thus  producing  deafness.  The  exudation 
also  interferes  with  the  function  of  the  au- 
ditory nerve  through  its  connection  with  the 
cerebellum  in  controlling  equilibrium.  Gid- 
diness and  vomiting  in  this  disease  is  ac- 
counted for  by  the  close  relationship  that 
the  auditory  hairs  bear  to  the  stomach.  In 
irrigating  the  ears  of  many  patients  the 
water  pressure  affects  the  labyrinth  and 
produces  temporary  dizziness,  and,  occa- 
sionally vomiting. 

It  is  not  the  nature  of  otorrhoea  to  remain 
stationary  or  harmless.  It  rarely  gets  well 
without  treatment,  but  invariably  tends 
toward  destruction  of  the  ear,  if  not  of  life 
itself.  The  reason  of  this  is,  the  glandular 
element  is  scant  in  the  otitic  mucosa,  and 
the  membrane  here  serves  the  double  func- 
tion of  periosteum  and  mucous  membrane. 
This  accounts  for  the  frequency  of  necrosis 
following  otitic  inflammations.  Among 
the  ossicles  the  incus  is  the  most  often  nec- 
rosed, because  the  blood  supply  to  it  is  from 


4»; 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


one  small  artery,  which  is  easily  occluded, 
any  slight  pressure  from  swelling  being 
sufficient. 

Treatment:— After  free  drainage  has 
been  established  next  comes  cleanliness. 
[rrigaton  with  sterilized  water,  with  or 
without  the  addition  of  such  antiseptics  as 
bicarbonate  of  soda,  boric  acid,  carbolic 
acid,  corrosive  sublimate,  etc.,  has  a  well 
established  place  in  the  treatment  of  sup- 
puration of  the  middle  ear.  In  ordinary 
cases  it  is  not  necessary  to  add  antiseptics  to 
water  that  has  been  boiled.  But  in  irriga- 
ting the  attic,  a  solution  of  salicylic  acid  in 
alcohol  and  ether  will  penetrate  well  into 
small  crevices  because  it  has  a  lower  surface 
tension  than  water.  In  attic  snppuration 
the  intra-tympanic  canula  is  indispensable. 
The  use  of  this  instrument  is  somewhat 
painful  and  at  times  intolerant  to  the  patient 
but  can  be  overcome  by  gentle  persistence. 

Removal  of  the  bad  odor  is  a  very  good 
index  as  to  the  success  of  treatment  in  at- 
orrhoea.  Any  treatment  that  fails  to  remove 
the  bad  odor  in  due  time  is  not  succeeding, 
and  a  change  must  be  made.  Caries  and 
necrosis  in  the  tympanum  should  be  dealt 
with  in  the  same  manner  as  in  other  parts 
of  the  body.  Granulations,  cholesteatoma, 
carious  ossicles,  necrosed  bone,  and  other 
obstructions  to  free  drainage  should  be  de- 
tected and  removed.  The  Eustachian  tube 
should  be  kept  open  and  ossicular  stiffening 
should  be  prevented  by  massage.  Dressing 
the  ear  with  liquid  antiseptics  is  of  little 
value,  because  of  the  necessarily  weak  solu- 
tion used  and  speedy  evaporation  leaving 
only  a  small  residue  of  the  drug. 

In  otorrhoca  we  may  presuppose  that  there 
is  perforation  of  the  drum  and  for  this 
reason  some  of  the  good  antiseptics  are 
contraindicated.  For  example,  corrosive 
sublimate  should  be  used,  if  at  all,  with 
great  caution,  else  poisoning  may  result  by 
its  passing  down  the  Eustachian  tube.  Per- 
oxide of  hydrogen  decomposes  on  heating, 
this  necessitates  its  employment  at  the  tem- 
perature of  the  surrounding  atmosphere, 
besides  it  is  an  unstable  drug,  and  is  often 
a  positive  irritant.  When  it  comes  in  con- 
tact with  pus  gas  is  evolved.  The  pressure 
thus  exerted  tends  to  seriously  damage  the 
middle  ear.  Placing  it  in  contact  with  pus 
in  small  cavities  is  like  putting  the  two 
parts  of  Seidlitz  powder  into  the  stomach, 
one  after  the  other.  It  is  quite  apparent 
that  peroxide  of  hydrogen  has  no  place  in 
the  treatment  of  otorrlura. 

Boric  acid  in  powdered  form  has  been 
long  and  extensively  used  in  the  treatment 
of  otorrhcea.  It  has  proved  itself  a  safe 
and  a  useful  drug.  Notwithstanding  the 
fact  that  used  in  the  powdered  form  on  ab- 


raded surfaces  it  produces  local  irritation, 
and  forms  flakes  and  crusts  with  inflamma- 
tory products.  Iodine  is  the  antiseptic  of 
all  ant'.septics,  among  the  non-metallic  ele- 
ments, being  obtained  from  kelp,  the  ash 
of  certain  sea-weeds.  Iodoform  is  obtained 
by  the  action  of  iodine,  in  the  presence  of 
fixed  alkalies,  upon  alcohol  or  ether,  and 
contains  over  96  %,  by  weight,  of  iodine. 
Iodoform  acts  as  an  antiseptic  by  evolving 
its  iodine.  It  is  a  great  antiseptic  and  it  is 
a  pity  that  its  offensive  odor  almost  pre- 
cludes the  possibility  of  its  use  in  human 
practice,  especially  in  ordinary  chronic  dis- 
eases of  the  eye,  ear,  nose  and  throat,  and 
other  diseases  where  the  patient  mingles 
with  the  general  public.  When  a  patient 
gets  a  whiff  of  it  once,  he  knows  what  you 
are  using.  Iodoform  may  be  universally 
employed  by  the  veterinary  surgeon,  but 
not  by  the  aurist.  I  am  glad  to  know  that 
the  ingenuity  of  the  chemist  has  produced 
a  preparation  equal  to  iodoform  in  antisep- 
tic and  healing  properties,  that  is  odorless. 
I  refer  to  nosophen,  which  is  obtained  by 
the  action  of  iodine  on  solutions  of  phenol- 
phtalein  and  contains  over  61  %  of  iodine. 
Nosophen,  like  iodoform  exerts  its  antisep- 
tic properties  by  slowly  evolving  its  iodine. 
I  have  used  it  in  a  large  number  of  cases 
where  I  formerly  used  boric  acid  and  I  am 
convinced  of  its  signal  power  in  checking 
bacterial  activity,  and  in  absorbing  inflam- 
matory products,  and  otherwise  promoting 
rapid  healing  in  suppurating  surfaces  and 
cavities.  The  following  detail  is  very  es- 
sential for  the  successful  treatment  of  otor- 
rhcea :  Irrigate  the  ear  daily  if  possible, 
mop  dry  with  cotton  each  time.  Put,  say 
five  to  ten  drops  of  a  2  to  4  %  solution  of 
nitrate  of  silver  into  the  ear  ;  wait  for  one 
or  more  minutes,  again  irrigate  and  dry 
with  cotton  ;  then  dust  in  some  nosophen 
powder,  aristol  or  boric  acid,  and  close  the 
ear  with  nosophen,  or  borated  gauze.  Nei- 
ther the  powder  nor  the  gauze  should  be 
put  in  so  tight  as  to  cause  pressure  in  the 
middle  ear.  Nosophen  has  the  advantage 
over  boric  acid  of  being  a  better  antiseptic, 
less  soluble  and  non-irritant.  Nosophen 
gauze  contains  3%  of  nosophen  ;  it  is  equal 
to  iodoform  gauze  in  antiseptic  properties, 
and  being  odorless  renders  it  preferable. 
Besides,  the  iodoform  gauze  on  the  market 
contains  10%  of  iodoform,  which  is  far  too 
strong.  Some  years  ago  I  used  this  gauze 
as  dressings  after  cataract  and  other  opera- 
tions, but  was  forced  to  discard  because  it 
produced  unpleasant  irritation  and  blister- 
ing of  the  skin.  The  fact  that  nosophen  is 
odorless  and  can  be  sterilized  up  to  220  de- 
grees C,  without  decomposing,  gives  it  a 
decided  advantage. 


THE  CHARLOTTE  MEDICAL  JOURNAL 


17 


I  lay  great  stress  on  the  use  of  dry  dress- 
ing and  gauze  protection  in  draining  and 
healing  chronic  suppuration  of  the  middle 
ear.  If  repeated  instillation  of  alcohol 
fails  to  remove  masses  of  granulation  tissue 
from  the  ear  it  may  be  necessary  to  resort 
to  stronger  escharotics  or  even  the  curette. 
In  places  where  the  actual  cautery  can  be 
applied  it  is  better  than  drugs  such  as  tinct. 
iodine,  nitrate  of  silver,  chromic  or  trichlo- 
racetic acid,  because  such  drugs  spread  and 
attack  some  of  the  surrounding  healthy  tis- 
sues. The  two  latter  should  be  sparingly 
applied  in  saturated  solution  with  a  small 
amount  of  cotton  on  a  fine  cotton  carrier  to 
very  limited  areas  for  fear  the  facial  nerve 
or  other  important  structures  be  injured. 
Many  cases  of  facial  paralysis  have  been 
caused  by  disease  in  the  ear.  Occasionally 
a  like  result  follows  accidental  injury  to  the 
facial  nerve  by  escharotics  and  operations 
on  the  ear. 

I  will  conclude  with  a  few  words  on  clo- 
sing drums  :  An  ear-drum  suddenly  per- 
forated or  removed  has  little  or  no  effect  on 
hearing  for  the  time  being,  but  its  absence 
permits  exposure  of  the  delicate  structures, 
and,  in  time  great  damage  to  the  hearing 
will  follow.  For  this  reason  diligent  en- 
deavors should  be  made  to  close  the  perfo- 
ration or  reproduce  the  drum.  Healing 
must  take  place  from  the  bottom  up.  So 
long  as  there  is  a  discharge  of  pus  from  the 
middle  ear  it  will  be  useless  to  attempt  to 
close  the  perforation.  Being  well  assured 
then  that  this  important  preliminary  step 
has  been  accomplished,  and  if  the  perfo- 
ration shows  no  signs  of  disappearing  touch 
the  margin  of  the  site  of  the  drum  care- 
fully with  a  saturated  solution  of  trichlora- 
cetic acid  ;  irrigate  before  and  after  using 
the  acid  ;  repeat  the  use  of  the  acid  weekly, 
if  necessary.  Supplement  this  by  touching 
the  same  margins  twice  to  four  times  a 
week  with  a  solution  (2%  to  4%)  of  ni- 
trate of  silver  which  promotes  granulatiion 
and  closure  of  the  perforation  by  inducing 
swelling  of  the  parts.  When  the  drum 
closes  the  hearing  may  be  diminished  owing 
to  thickening  of  the  drum,  but  in  a  few 
weeks  to  a  few  months  this  thickening  will 
disappear  and  the  hearing  will  return  ;  irri- 
gate before  and  after  using  the  silver.  Dust 
in  some  nosophen  powder  and  close  the  ear 
with  gauze.  Gauze  possesses  much  greater 
power  of  absorption  than  absorbent  cotton 
and  affords  much  greater  protection.  No 
cases  require  more  nicely  selected  antisep- 
tics, delicacy  of  application  and  punctuality 
in  treatment  than  these.  In  one  case  lately 
the  drum  was  nearly  closed  on  two  different 
occasions,  but  each  time  the  patient  ab- 
sented   herself  for  one  whole  week.     This 


neglect  resulted  in  a  set  back  each  time. 
The  patient  was  assured  that  unless  she 
could  come  for  treatment  daily  it  would  be 
a  failure.  After  this  she  came  for  treatment 
daily  and  the  perforation  was  closed  in  two 
weeks.  The  treatment  of  these  cases  is 
like  hatching  eggs.  Delicate  instrumen- 
tality must  be  punctually  and  assiduously 
applied. 

Bright's  Disease — flalaria. 

By  J.  A.  Reagan,  M.  D.,  Weaverville.  N.  C. 

After  having  practiced  medicine  for 
many  years  in  this  mountain  section,  in- 
cluding some  six  counties,  and  never  having 
seen  a  case  of  Bright's  disease.  Some 
twenty-five  years  ago  I  became  anxious  to 
know  why  there  was  no  cases  in  this  sec- 
tion of  the  country,  and  my  mind  was 
directed  to  malaria  as  the  leading  cause  of 
the  disease.  There  is  no  malaria  or  malagua 
in  this  mountain  region  between  the  Blue 
Ridge  and  the  Alleghany  range,  which 
divides  North  Carolina  from  Tennessee. 

I  saw  most  of  the  old  physicians  of  this 
section,  and  told  them  my  impressions. 
All  said  they  had  never  thought  of  it.  but 
there  might  be  some  truth  in  it.  Dr.  Cain, 
who  after  graduating  in  this  country,  went 
to  Europe  and  completed  his  medical  course, 
practiced  in  Charleston,  South  Carolina, 
some  twenty  years, 'but  after  the  war  settled 
in  Asheville,  said  he  had  only  had  one  case 
of  Bright's  disease  since  he  came  to  this 
State,  and  that  gentleman  was  in  the  habit 
of  driving  stock  to  South  Carolina  every 
fall,  and  was  in  this  way  liable  to  malarial 
attacks;  that  he  would  willingly  give  me 
all  the  help  I  desired  in  pursuing  the  in- 
vestigation. He  died  some  years  back,  but  in 
my  last  talk  with  him  on  the  subject  he  said 
he  was  convinced  that  malaria  had  a  great 
deal  to  do  in  causing  the  disease,  if  it  was 
not  the  cause  of  it. 

I  wrote  an  article  that  was  published  in  a 
Philadelphia  Medical  Journal,  some  twenty 
years  ago,  calling  the  attention  of  physi- 
cians practicing  in  non-malarial  sections  to 
this  subject,  and  asking  their  opinion  in  re- 
gard to  it,  but  I  have  never  heard  of  any 
one  noticing  it.  Perhaps  they  were  willing 
to  tread  in  the  old  track  until  some  German 
professor  should  make  the  discovery,  and 
then  they  would  herald  it  to  the  world  and 
at  once  embrace  it.  Well  that  time  has 
about  come.  An  editorial  in  the  Journal 
of  the  American  Medical  Association  : 

"In  this  connection  recent  studies  which 
have  been  made  concerning  the  influence  of 
malarial  infection  upon  the  kidneys  are  of 
great  interest,  and  1     seems    to  be  the    uni- 


£8 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


versal  experience  of  those  who  have  made 
a  careful  study  of  malarial  infection  that 
albuminuria  indicating  renal  difficulty  due 
to  malaria  is  exceedingly  common.  Thus 
Osier  states  that  it  occurred  in  46.4  per 
cent,  of  the  cases  in  his  ward."  He  also 
quotes  Thayer,  Kerley,  and  Fruitnight  as 
endorsing  the  theory  that  malaria  has  a 
wonderful  effect  in  causing  kidney  diseases, 
even  in  children  in  malarial  sections. 

Since  I  began  this  investigation,  twenty- 
five  years  ago,  I  have  had  two  cases.  One 
was  a  boy,  some  ten  or  twelve  years  ago, 
whose  mother  moved  here  from  Georgia. 
He  was  in  the  last  stage  when  I  saw  him. 
I  tested  his  urine  and  found  one-third  albu- 
min. I  saw  him  but  once,  as  he  died  in  a 
few  days  after  I  saw  him.  I  told  his  mother 
J  could"  do  nothing  for  him  when  I  exara- 
inedlhim.  The  other  was  a  gentleman  who 
had  been  frequently  exposed  to  malaria, 
and  years  back  had  had  several  malarial 
attacks.  So  after  an  investigation  of  some 
twenty-five  years,  my  mind  is  firmly  settled 
that  malaria  has  more  to  do  in  producing 
that  distressing  disease  than  anything  else. 
If  this  be  the  case,  may  we  not  change  the 
treatment  so  as  to  be  more  successful  in 
relieving  this  distressing  disease? 


Syphilitic   Sore  Throat. 

By  John  S.  Moreman,  M!D.,  Obstetrician  to  St. 
Ann's  Maternity  Hospital,  Louisville,  Ky. 

It  has  been  estimated  that  one-third  of 
the  civilized  world  have  either  inherited  or 
acquired  syphilis,  but  this  estimation  if  cor- 
rect  is  astonishing  and  hardly  believable, 
for  one  would  not  like  the  idea  that  out  of 
thirty  of  his  friends  ten  have  this  dreaded 
disease.  This  proportion  is  too  large,  but 
notwithstanding  there  is  more  syphilis  than 
most  people,  physicians  or  laymen,  imagine, 
and  the  physician  often  sees  it  in  patients 
where  there  is  no  suspicion  that  it  is  preva- 
lent. The  eye  specialist  recognizes  it  in  the 
changes  of  the  retina,  the  gynecologist  in 
the  women  with  frequent  abortions,  the 
neurologist  in  nerve  changes,  the  throat 
doctor  in  pharynx,  and  in  fact  all  the  pro- 
fession recognizes  it  in  their  special  branch. 
The  attention  is  especially  called  to  the 
manifestations  of  it  in  the  pharynx,  includ- 
ing the  gums,  tonsils  and  soft  palate. 

Syphilis  in  the  region  of  the  throat  is 
often  seen  from  the  primary  lesion  too  late 
in  the  third  stage,  even  twenty  years  or 
more  after  the  primary  lesion.  Next  to  the 
genito-urinary  organs  the  tonsil  is  the  loca- 
tion   of  the    chancre     frequently,  acquired 


by  the  permiscuous  use  of  drinking  vessels, 
tobacco,  pipes,  etc.,  and  when  appearing 
on  the  tonsil  there  is  very  little  difficulty  in 
recognizing  the  lesion.  It  has  all  the  ap- 
pearance of  the  chancre  of  the  penis,  but  in 
this  location  there  is  a  great  deal  more  pain 
and  discomfort,  and  the  glands  behind  the 
ear  and  in  the  neck  are  sooner  involved. 
The  treatment  is  similar  to  that  for  a  chancre 
on  the  penis,  and  that  method  being  fami- 
liar will  not  be  given. 

What  is  still  more  important  to  recognize 
is  the  appearance  of  symptoms  of  the  dis- 
ease in  the  throat  during  the  secondary  and 
tertiary  stages.  In  the  secondary  stage, 
even  before  the  characteristic  spots  have 
made  their  appearance,  the  patient  will 
complain  of  a  sore  throat  which  gives  him 
a  great  deal  of  pain  on  swallowing,  and 
even  water  is  unbearable.  The  pain  may 
come  on  very  suddenly,  develop  in  one  day 
or  gradually  the  pain  gets  worse  and  worse 
from  day  to  day  until  they  have  to  appeal 
to  the  physician  for  relief,  and  unless  recog- 
nized the  treatment  given  will  be  useless. 
Examination  of  the  parts  may  not  show  any 
ulcers,  and  often  it  takes  careful  search  to 
find  them,  for  a  little  one  behind  the  tonsil 
or  above  the  soft  palate  will  escape  obser- 
vation. A  very  small  one  will  cause  the 
whole  "pharynx  and  adjacent  parts  to  be 
very  painful.  Often  the  parts  are  not  red- 
dened, except  in  the  immediate  neighbor- 
hood, but  in  a  few  cases  everything  will 
have  a  deep  angry  reddened  appearance. 
If  the  ulcer  or  patch  is  discovered  it  has  a 
punched  out  appearance,  reddened  edges, 
indurated  and  will  have  an  excivated  ap- 
pearance ;  the  growth  can  be  observed  from 
day  to  day.  The  surface  of  the  lesion  some- 
times has  a  yellow  pus  on  it,  but  if  it  is  in 
a  position  where  the  swallowed  saliva  passes 
freely  over  it,  it  may  be  washed  very  clean 
and  will  not  show  an  accumulation  of  dead 
tissue.  This  is  caused  by  a  constitutional 
disease,  and  the  ulcer  patch  is  the  local 
manifestations  of  it,  and  the  treatment 
should  be  mainly  constitutional  and  not 
local.  The  local  treatment  is  to  keep  the 
parts  as  clean  as  possible,  which  will  facil- 
itate healing,  but  not  cause  repair.  Cleans- 
ing agents  commonly  used  are  a  strong  so- 
lution of  the  nitrate  of  silver,  bichloride  of 
mercury,  carbolic  acid,  permanganate  of 
potassium,  and  similar  antiseptics  applied 
thoroughly  with  a  cotton  applicator,  and 
should  be  used  two  or  three  times  a  day. 
The  old  idea  that  the  lesion  should  be  curet- 
ted or  burnt-out  with  the  electric  cautery 
or  the  actual  cautery  is  not  practised  to-day 
as  much  as  formerly,  for  we  know  more 
about  the  etiology  and  our  attack  on  the 
disease  is  in  the    right    direction.^ The  use 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


49 


of  the  stick  of  nitrate  of   silver  is  neverthe" 
less  good. 

Our  great  specifics  for  syphilis  is  the 
iodide  of  potassium  and  mercury,  but  in 
this  condition  the  mercury  acts  too  slow, 
and  being  able  to  get  the  patient  under  the 
iodide  of  potassium  treatment  quicker  we 
are  able  to  control  the  effects  easier.  As 
we  get  the  patient  under  the  iodide  the 
lesion  heals  and  often  will  get  well  in  a 
reasonable  time,  but  we  should  not  stop  the 
administration  as  soon  as  the  throat  symp- 
toms disappear,  but  continue  it  for  a  long 
time. 

In  this  class  of  patients,  the  syphilitic*, 
we  find  a  great  many  whose  systems  are 
thoroughly  effected  with  the  germ  and  their 
general  health  is  very  poor,  and  we  want  a 
good  tonic  and  also  an  elimination  of  poison- 
ous material,  and  iodia,  in  teaspoonful 
doses,  three  or  four  times  a  day,  has  this 
delightful  effect,  for  it  has  combined  in  each 
drachm  five  graiins  of  the  iodide  of  potas- 
sium and  three  grains  of  the  phosphate  of 
iron  with  stillingia,  helonias,  saxifraga, 
menisperum  with  aromatics  to  make  it  as 
palatable  as  possible,  and  increasing  or 
diminishing  the  dose  we  can  get  any  amount 
of  t he  ingredients  required.  It  is  claimed 
that  in  syphilis  the  mercurial  treatment 
should  be  kept  up  for  at  least  two  years  or, 
better  still,  three  years,  after  all  signs  of 
the  disease  have  disappeared,  but  in  the  us  ■ 
of  iodia  this  long  period  of  trertment  is  not 
necessary,  and  one  or  one  year  and  a  half 
of  the  iodia  treatment  is  sufficient.  Hot  I 
baths,  in  connection  with  the  treatment, 
will  facilitate  matters. 

Sometimes  these  ulcers  are  allowed  to 
continue  so  long  without  treatment  that  the 
result  is  a  loss  of  tissue  and  adhesions  be- 
tween the  different  parts  take  place  and  the 
soft  palate  becomes  adherent  to  the  poste- 
rior wall  of  the  pharynx  for  which  there  is 
no  radical  cure.  We  have  cicatricial  tissue 
to  operate  on,  and  if  cut  there,  it  is  sure  to 
be  followed  by  a  loss  of  tissue,  and  in  a  few 
instances  a  fatal  gangrene  has  resulted. 
The  best  operative  means  to  give  relief  is 
the  use  of  a  dilator  which  should  be  used 
every  day  for  an  hour  or  two,  but  even  then 
the  opening  between  the  pharynx  and  the 
posterior  nares  slowly  closes  until  often  it 
is  only  the  size  of  a  pencil. 

In  the  tertiary  stage  of  the  disease  we 
may  have  the  mucous  patches  with  all  the 
discomforts  accompanying  it,  and  when  this 
occurs  we  use  the  same  line  of  treatment. 
In  this  stage  we  see  a  form  of  sore  throat 
where  there  is  no  active  lesion,  no  patch  or 
ulcer  is  found,  but  the  patient  complains  of 
a  continual  tightness  about  the  throat,  pain 
on    swallowing,   and   an    examination   only 


reveals  a  reddened  condition  with  hyperes- 
thesia, and  even  the  effort  to  open  the  mouth 
is  painful.  This  condition  is  very  similar 
to  rheumatic  sore  throat,  but  this  latter  dis- 
ease is  effected  by  changes  in  the  weather, 
whereas  syphilis  is  not  materially  effected 
by  it.  A  careful  examination  of  the  patient 
with  the  history  will  show  that  there  is 
syphilis  in  the  system,  and  the  treatment 
must  be  with  the  iodia  and  in  good  size 
doses,  for  if  allowed  to  run  on  without  pro- 
per remedies  we  eventually,  after  several 
weeks,  have  an  ulceration  in  the  pharynx 
which  takes  the  course  of  the  lesion  seen  in 
the  secondary  stage.  In  examining  a  pa- 
tient who  complains  of  the  throat,  a  post- 
nasal examination  should  be  made  with  the 
mirror  for  the  lesions  have  been  found  on 
the  upper  side  of  the  soft  palate  and  unre- 
cognized there,  after  some  weeks  of  local 
treatment  with  sprays  there  is  sure  to  be  a 
perforation  of  the  palate,  and  when  it  is 
seen  on  the  lower  side  then  the  anti-syphi- 
litic treatment  is  instituted,  but  too  late  to 
cure  without  leaving  deformities. 


Hyperemia  of  Conjunctiva. 

By  Edw.  W.  Wright,  M.  D.,   Brooklyn,    X.  Y. 

Congestion  of  the  conjunctiva  is  not  a 
serious  condition,  though  it  may  be  so 
troublesome,  so  annoying,  so  persistent,  as 
to  prevent  the  comfortable  and  proper  use 
of  the  eyes. 

Hyperemia  is  really  more  a  symptom 
than  an  affection.  Its  duration  may  be 
transient,  and  its  effects  soon  forgotten  ,or 
it  may  be  constantly  present  and  its  results 
always  troublesome. 

Hyperemia  of  the  conjunctiva  differs 
from  conjunctivitis.  In  hyperemia  there 
is  an  increase  of  tears;  in  conjunctivitis 
there  is  pus  or  mucus  in  varying  propor- 
tions. 

In  hyperemia  we  find  the  blood-vessels 
dilated,  especially  those  on  the  palyebral 
portion  of  the  lower  lid.  The  inner  and 
outer  corners  of  the  eye  are  involved  more 
than  the  central  part.  When  well  marked, 
the  congestion  may  extend  to  the  caruncle 
and  on  the  sclerotic.  Furthermore,  we 
often  have  a  general  suffusion  of  the  con- 
junctiva which  is  in  marked  contrast  to  the 
normal  conjunctiva.  The  normal  yellowish 
pink  of  the  conjunctiva  is  changed  to  a 
general  redness,  while  the  blood-vessels  in 
meshes,  or  parallel  columns,  are  plainly 
visible. 

At  times  the  congestion  gives  rise  to  little 
complaint,  while  again  it  is  so  annoying, 
so  irritating,  that  reading  and  writing  is 
carried  on  with  distress.      While  congestion 


50 


THE    CHARLOTTE  MEDICAL  JOURNAL. 


of  the  conjunctiva  is  a  very  mild  condition 
in  comparison  with  some  other  affections  of 
the  system,  it  yet  has  a  retarding  influence 
on  the  amount  and  success  of  work  and 
pleasures  obtained  by  the  use  of  the  eyes. 
The  insistence  and  persistence  of  this  hyper- 
jemic  condition  mars  the  pleasure  of  writing, 
reading  and  other  duties. 

The  constant  hot  burning  sensations,  the 
itching  of  the  lid-margins  and  the  watering 
of  the  eyes  are  the  leading  indications  of  its 
presence. 

Sometimes  complaint  is  made  that  "sand" 
is  in  the  eyes.  Others  speak  of  heaviness 
of  the  lids,  especially  in  the  mornings. 
Smarting,  pricking,  itching  are  the  expres- 
sions frequently  used  to  express  the  con- 
dition. 

By  looking  at  the  conjunctiva  lining  the 
under  surfaces  of  the  lids,  we  observe  the 
increased  number  and  size  of  the  blood- 
vessels and  a  deeper  redness  in  the  coloring 
of  the  conjunctiva. 

All  these  conditions  are  intensified  by 
artificial  light,  consequently  there  is  more 
complaint  at  night. 

The  light  of  the  theatre  and  the  glare  of 
the  sunlight  on  water  give  additional  an- 
noyance. If  the  blood  circulation  be  in- 
creased by  exertion,  food  or  stimulants  we 
find  the  hyperemia  more  marked. 

Lids  that  are  snugly  and  firmly  applied 
to  the  eyeball  suffer  most. 

The  greatest  sufferers  are  those  who  have 
eye-strain.  In  addition  to  their  asthenopic 
troubles  the  hyperemia  is  quite  a  factor. 
Sometimes  patients  complain  more  of  the 
hyperemia  than  of  the  eye-strain.  When 
the  hyperemia  is  due  solely  to  eye-strain, 
it  is  frequently  noted  that  the  vessels  are 
clearly  defined.  They  run  in  parallel  lines 
from  the  margins  of  the  lids  backwards. 
This  is  most  marked  in  the  morning.  At 
night,  the  use  of  the  eyes  through  the  day 
may  add  a  general  suffusion  of  redness. 

In  protracted  cases,  the  congestion  has 
lasted  so  long  that  the  papilla;  are  swollen 
and  visible,  and  the  mucous  membrane  is 
somewhat  thickened,  presenting  the  ap- 
pearance of  granulations. 

Causes. — Impure  air,  strong  or  cold 
winds,  dust,  smoke,  hot  and  dry  atmos- 
pheres, foreign  bodies,  as  chalazion,  dis- 
placed cilia  or  affection  of  the  lachrymal 
passages. 

Those  who  smoke,  or  use  alcohol  in  ex- 
cess, have  hyperemia.  Nasal  catarrh  is 
frequently  accompanied  by  congestion  of 
the  conjunctiva. 

Eye-strain  is  the  cause  of  the  majority  of 
the  protracted  cases.  When  the  eyes  are 
subjected  to  constant  use,  especially  at  near 
and  small   objects,  the  strain  is  manifested 


in  congestion  of  the  lids.  In  those  who 
have  hypermetropia,  or  myopia,  or  astig- 
matism, or  insufficiency  of  some  of  the  ex- 
traocular muscles,  we  find  evidences  of  eye- 
strain. The  hyperemia  may  be  the  first 
sign  of  eye-strain  and  precede  the  headache, 
the  aching  eye,  or  the  pain  behind  the  eye. 
Sometimes  the  glasses  worn  are  not  ad- 
justed properly,  and  this  will  be  another 
cause  of  conjunctival  congestion. 

Treatment. — Of  course,  the  first  step 
in  the  treatment  is  the  removal  of  the  cause. 
If  very  bright  light,  or  cold  winds,  or  dusty 
occupation,  then  wear  colored  or  clear  pro- 
tective glasses.  If  the  air  of  the  room  is 
too  hot  and  too  dry,  then  lower  the  tem- 
perature and  increase  the  humidity,  the 
latter  by  placing  open  vessels  containing 
water  about  the  rooms.  The  nasal  catarrh 
should  have  direct  and  proper  treatment. 

For  the  hyperemia  cold  compresses  for 
ten  minutes,  two  or  three  times  a  day,  are 
often  very  grateful  and  very  beneficial. 
Cold  water  douche  from  fine  needled  jet, 
or  a  spray  of  water  and  alcohol,  over  the 
closed  lids  is  of  marked  assistance.  In  eye- 
cup,  with  lids  open,  in  lotion  for  thirty 
seconds,  using  a  solution  of  common  salt, 
(gr-  "— 3j)  or 

Sod.  bibor    gr.  ii,    or  ac.  boric    gr.  x. 

Sod.  chlor.  gr.    i,  aqua  camp.  3iij. 

Aqua  ad.      gi.  aqua    ad.       Ji. 

or  instillations  of  two  to  four  drops  every 
two  to  four  hours  of  a  lotion  of  ac.  boric 
gr.  viii.,  or  sod.  chlor.  gr.  ii.,  aqua  rosse  Ji. 
R-  Ac.  boric,  gr.  x,  or  sod.  bibor  gr.  i. 
Spts.  camp.  nj7v.,  aqua  camp.  3ii. 
aqua  ad.  gi.,  aqua  ad.         3i. 

In  chronic  conditions  where  the  mucous 
membrane  is  somewhat  thickened  and  the 
vessels  are  visible  in  net-work  form,  zinc 
sulph.  (gr.  i — gi.)  in  one  drop  instillation, 
three  times  a  day  is  good. 

In  protracted  cases,  with  the  papillae  in 
evidence,  and  a  resemblance  to  granulations 
present,  the  use  of  ac.  tannin  gr.  x,  glyce- 
rinise  3i.  three  times  a  week  with  cotton 
applicator  will  level  the  surface  and  restore 
the  lid  surface  to  a  normal  condition. 

When  the  lids  are  heavy  and  are  with 
difficulty  kept  open,  we  can  spray  over 
them,  while  closed,  a  solution  consisting  of 
equal  parts  of  spts.  vin.  rectf.,  spts.  am- 
moni  avom,  spts.  rosemar. 

A  person  who  has  lost  sleep  and  whose 
eyes  present  a  reddened  appearance  in  the 
morning  can  quickly  find  relief  by  the  in- 
stillation of  one  drop  of  i%  solution  of 
cocaine ;  three  drops  of  a  lotion  of  boric 
acid  and  aqua  camp.,  and  evaporation  of 
the  spirit  mixture  on  the  closed  lids. 

Those  cases  that  arise  from  eye-strain 
must  find   the  remedy  in  the   relief   of  the 


THE  CHARLOTTE  MEDICAL    JOURNAL. 


51 


Directions  for   the    Use  of 


ChrOlliC  Nasal  Catarrh. — "Of  the  internal  remedies  we  may  mention 
Blennostasine — this  remedy  having  a  direct  effect  on  the  mucous  membrane  of  the  nose, 
and  if  given  regularly,  congestion  in  the  mucous  membrane  disappears,  or  is  constantly 
mitigated.  The  remedy  is  given  in  doses  of  three  to  five  grains  every  three  hours,  and 
should  be  continued  as  long  as  the  catarrhal  condition  persists.  It  exerts  no  unpleasant 
effect,  and  can  be  continued  for  an  indefinite  period." 

ACUte  COTyZa- — "I"  mJ  experience  I  have  found  one  grain,  given  half-hourly, 
to  {produce  the  best  results  in  Acute  Coryza.  Blennostasine  is  particularly  applicable 
to  colds  of  singers  and  speakers,  as  the  blenostatic  effect  is  preferable  to  that  of  bella- 
donna, and  it  certainly  produces  a  tonic  effect  on  the  vocal  mechanism." 

Hay  Fever. — "All  hay  fever  patients  who  have  taken  Blennostasine  have  been 
promptly  relieved,  and  though  a  recurrence  of  the  symptoms  next  year  may  not  be  pre- 
vented, the  usual  attack  may  be  aborted  if  the  treatment  is  begun  sufficiently  early." 

Influenza.  LaCrippe.  &C. — "Blennostasine  is  the  most  effective  remedy 
n  treating  'grippe'  that  I  have  ever  tried,  and  is  much  to  be  preferred  to  the  synthetical 
drugs." 

Blennostasine  is  best  given  in  pilular  form  ;  one,  three  and  five  grain  gelatine-coated 
pills  arc  supplied.      .Samples  and  literature  free  on  request. 


McKESSON  &  ROBBINS, 


New  York, 


The  New  Antiseptic 


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NORWICH.  NEW  YORK. 


52 


THE  CHARLOTTE     MEDICALJOURNAL. 


strain.  No  lotion,  or  application,  or  course 
of  treatment  will  cure  the  condition  while 
the  eye-strain  continues. 

If  there  is  an  excess  of  accommodative 
effort,  this  must  be  lessened  if  needs  be  by 
the  wearing  of  a  proper  glass. 

The  astigmat  must  have  his  astigmatism 
corrected ;  the  myope  must  wear  the  pro- 
perly selected  lens,  and  the  bypermetrope 
must  wear  a  glass  sufficient  to  take  all  strain 
from  the  eyes. 

When  the  eye-strain  has  become  a  thing 
of  the  past  in  the  patient's  histoiy,  also  will 
the  hyperemia. 

.115  Montague  Street. 


The  Problem  of   Life. 

By  Wm.  S.  Stoakley,  M.  D.,   Millboro  Springs, 
Virginia. 

The  acute  thought  expressed  with  basic 
force,  and  logically  directed  and  concluded 
in  this  connection  by  Dr.  Joseph  Clements 
of  Kansas  City,  Mo.,  in  the  November 
(189S)  No.  of  The  Charlotte  Medical  Jour- 
nal, under  the  caption,  "What  is  Life?" 
suggests  the  following  remarks  which  are 
given  simply  for  what  they  are  worth,  and 
with  no  intention  of  presuming  to  explain 
the  unexplainable,  neither  presuming  to 
cast  the  semblance  of  a  ray  of  new  light  on 
the  subject,  the  discussion  of  which  in  some 
of  its  phases,  is  as  old  as  are  the  Zend  and 
Sanscrit  languages. 

Only  then,  to  say  :  When  we  carry  our 
investigations  of  matter  to  its  ultimate,  it 
seems  but  fair  to  acknowledge  the  goal 
whereof  it  leads ;  and  if  we  loose  ourselves 
on  the  point  of  teneous  materiality  in  vain 
search  of  the  origin  of  life,  and  at  the  same 
time  seeing  ab  orbc  condito — through  the 
"windows  of  the  soul"  an  immateriality — 
auto-genesic,  and  manifested  in  matter 
through  its  power  of  existence  in  multitu- 
dinous forms  under  natural  law,  designed, 
each  atom,  and  aggregation  of  atoms  ac- 
cording to  its  kind,  to  be  dominated  and 
directed  under  the  same  natural  law  by 
mind  as  seen  in  man — a  designer  under  this 
law;  let  us  admit  that  Mr.  Huxley  was  on 
the  point  of  solving  the  problem  of  life 
when  he  touched  the  border-land  of  imma- 
teriality, where  he  only  required  "a  little 
stronger  lens  to  see  the  skillful  finger  tracing 
the  delicate  spinal  cord  into  all  its  ramifi- 
cations." 

The  delicate  artistic  arrangement  of  which 
Mr.  Huxley  speaks  cannot  be  other  than 
dependent  on  far  distant  and  equally  artistic 
touches,  and  what  concern  can  these  far 
distant  elaborations  have  in  this  particular 
spinal  matter  apart  from  design  and  designer 


planning  the  tout  ensemble  of  material  cre- 
ation? 

If  design  is  not  seen  in  the  unerring 
fashioning  of  the  heterogeneous  into  the 
homogeneous  and  conversely ;  with  per- 
petual temporal  correspondent  succession  as 
to  coexistences  external,  the  chaotic  result 
of  the  lack  of  it  can  be  well  imagined. 

We  have  studied  the  cell  with  its  nucleus 
and  nucleolus  and  protecting  wall  for  the 
origin  of  life,  and  fail  to  find  it. 

We  seek  the  protoplasmic  mass  and  dis- 
cover force  and  motion. 

If  this  ultimate  force  and  motion  is  with- 
out super-material  direction  how  does  it 
happen  that  these  powers  when  generated 
by  man's  ingenuity  under  natural  law  re- 
quire mental  direction  in  accomplishing 
certain  purposes? 

Matter  is  no  less  material  because  of  its 
radiantcy. 

Force  and  motion  no  less  in  need  of  direc- 
tion by  reason  of  ultimate  subtilty. 

We  analize  this  protoplasma  and  discover 
the  elementaries  C.  H.  O.  N.,  which,  with 
their  combinations  and  recombinations  com- 
pose the  world,  and  it  swings  amidst  in- 
calculable chemic  activities,  which  Messrs. 
Huxley,  Tyndall  and  Spencer  agree,  fail  to 
account  for  bioplasmic  activities,  while 
Ferrier  and  Tyndall  say  that  molecular  ac- 
tivities cannot  pass  into  mental  activities. — 
Dr.  C.—ibid. 

It  is  admitted  that  "the  ultimate  principle 
of  life,  in  the  animal  and  vegetable  worlds, 
in  all  their  variety  and  multiplicity,  is  ab- 
solutely alike." — ibid. 

If  then,  the  material  origin  of  life  is  not 
established  after  material  tracings  of  such 
tenuity  as  Mr.  Crooke  and  others  have  at- 
tained, we  may  reasonably  conclude  that : 
Notwithstanding  all  the  elaborated  concat- 
enations of  abstruse  observation  along  this 
line,  though  indicative  of  profound  erudi- 
tion, we  are  without  a  material  reason  with 
which  to  rebut  Byron's  dramatic  exposi- 
tion! (to  say  nothing  of  the  views  of  John, 
the  "Jew  of  Palestine,")  where  he  makes 
his  characters  say  : 
Alio.      "Who  shall  shake  these 

Solid  mountains,  this  firm  earth, 
And   bid    those  clouds    and   waters 

take  shapes 
Distinct  from  that  which  we  and  all 

our  sires 
Have  seen  them  wear  on   their  eter- 
nal way? 

Who  shall  do  this? 
Japh.     He,  whose  one  word  produced  them. 
Aho.       Who  heard  that  word? 
Japh.     The  Universe  which  leaped  to  life 
before  it." 


flleaven  and  Earth  a  Mystery. 


THECHARLOTTE  MEDICAL  JOURNAL. 


53 


THE 


Charlotte  Medical  Journal. 

Editorial  Department. 


E.  C.   REGISTER,   M.  D.  J.  C.   MONTGOMERY.   M.  D. 

Editors  and  Publishers. 

No.  36  South  Tryon  Street,    -    -    -    - 
Charlotte,  N.  C. 


SUBSCRIPTION.  $2-50  PER  YEAR, 


THE  SUCCESSFUL  CONSULTANT. 

The  easiest  way  to  succeed  in  building 
up  a  practice  as  a  consultant  is  to  agree 
heartily  with  the  physician  in  charge  of  the 
case.  Tell  the  family  that  all  has  been 
done  that  can  be.  Listen  interestedly  to 
the  history  by  the  doctor,  nurse  and  rela- 
tives, take  notice  of  the  symptoms  empha- 
sized, retire  into  another  room  to  talk  it 
over,  and  then  satisfy  the  friends. 

A  good  appearance,  neatness  of  dress, 
an  a  certain  sedateness  of  speech  are  also 
helpful.  By  this  is  meant  the  ability  to 
say  "an  undisputed  thing,  in  such  a  solemn 
way."  These  directions,  systematically 
followed,  are  almost  sure  to  succeed.  A 
doctor  is  more  apt  to  call  a  consultant  who 
leaves  him  feeling  satisfied. 

But  one  is  quite  certain  to  fail  in  carry- 
ing out  these  rules,  until  he  has  ceased  to 
be  a  therapeutist.  Any  remnants  of  the 
old  idea  of  curing  people  must  have  been 
outgrown.  Laisser-faire  is  the  materia 
medica  absolutely  necessary  to  the  success 
of  the  consultant  on  the  lines  laid  down. 

Nor  is  this  therapeutic  nihilism  difficult 
to  obtain.  German  literature,  especially 
of  two  or  three  decades  ago,  is  verv  helpful. 
Experience  in  the  fads  of  medicine  that  one 
has  seen  arise  and  fade,  the  follies  of  all  the 
irregulars,  the  necessity  of  contending  with 
the  exaggerated  claims  of  new  remedies  all 
assist  in  acquiring  the  esoteric  culture  that 
one  medicament  is  as  good  as  another  and 
that  all  are  alike  useless.  Casual  remarks 
volunteered  by  successful,  old  men  are  also 
of  assistance.  One  tells  us  that  if  he  finds 
empty  any  vial  in  his  pocket-case  which  he 
intends  to  use,  he  gives  the  bottle  next  to 
it.  Another  that  he  has  made  a  good  many 
dollars  out  of  five  cents  worth  of  sugar  of 
milk.  There  is  no  more  expressive  way  of 
representing  the  status  of  a  practitioner, 
than  to  say  that  he  has  great  faith  in  med- 
icines. 


Time  and  experience,  a  thorough  course 
in  pathology,  and  a  careful  attendance  upon 
medical  societies  where  no  plan  of  treat- 
ment is  held  to  be  worthy  of  discussion  un- 
til supported  by  a  table  of  statistics,  all  these 
are  beneficial  in  forming  a  frame  of  medical 
mind  that  is  almost  impregnable.  A  man 
of  such  culture  can  give  valid  reasons  against 
any  enthusiastic  procedure.  Almost  by  his 
presence  any  mention  of  trivial  details  of 
the  sick  room  or  year-book  recommenda- 
tions dies  on  the  lips  unuttered. 

One  or  two  objections  only  arise  while 
presenting  this  general  plan  of  attaining 
prosperity  as  a  consulting  physician.  These, 
however,  are  so  outside  the  question  of  in- 
dividual success  that  they  are  only  men- 
tioned incidentally. 

One  is  that  a  conviction  once  generally 
held  by  the  profession  is  in  great  danger  of 
filtering  out  to  the  laity.  Some  of  them 
are  obstinate  in  wanting  to  be  cured  instead 
of  being  satisfied  with  a  perfectly  good  rea- 
son why  they  cannot  be.  Then,  too,  there 
is  some  danger  in  this  practical  age  that  if 
the  impression  should  become  general  that 
consultations  were  primarily  to  conserve 
the  reputations  of  the  consultants  they  would 
become  less  general.  In  this  way,  indeed, 
a  financial  injury  to  the  individual  might 
indirectly  occur. 

The  other  criticism  is  almost  sentimental. 
It  is  that  after  this  culture  has  been  attained 
one  of  his  own  children  might  be  taken 
dangerously  ill.  Almost  surely  a  sense  of 
dissatisfaction  would  arise  temporarily. 
Demonstrated,  scientific  medicine  is  indis- 
putable and  impregnable  so  far  as  it  ex- 
tends, but  how  painfully  limited  it  is ! 
Would  he  not  desire  to  call  in  some  of  the 
possibilities  that  are  not  lying  outside  his 
cultivated  field  ?  Are  there  not  beyond  cer- 
tainties, possibilities  and  probabilities? 

If  his  child  should  recover  after  some 
nights  vigil  he  may  later  ascribe  it  to  vis 
wedicatrix  naturce,  but  at  the  same  time 
some  strange  ideas  will  float  through  his 
brain  ;  he  will  wonder  whether  the  physi- 
cian who  is  born,  not  made,  may  not  steer 
his  ship  clear  of  shallows  which  are  not  yet 
chartered,  may  not  gain  for  her  a  favoring 
breeze  of  which  his  instruments  did  not  tell 
him,  might  not  pull  her  from  the  jaws  of 
death  by  some  rare  expedient  not  yet  des- 
cribed. 


CREASOTE  VS.  CARBOLIC  ACID. 

The  difference  between  these  two  com- 
mon drugs  may  be  patent  to  many  of  the 
readers  of  this  Journal.  But  we  so  often 
see  results  looked  for  that  are  never  re- 
ceived, that  it  becomes  us  not  to  neglect  to 
study  minutely  the  materia  medica  and  ther- 


54 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


apeutic  action  of  those  drugs  we  use  almost 
daily  as  we  deal  out  medicine  to  suffering 
humanity,  that  place  their  health  in  our 
care. 

Creasote,  properly  speaking,  is  obtained 
from  wood,  usually  beech  wood,  but  in 
writing  a  prescription  for  creasote  we  often 
have  (German  creasote)  dispensed  to  our 
patients,  and  when  we  look  up  our  materia 
medica  we  find  that  we  are  giving  carbolic 
acid,  for  (German  creasote)  is  nothing 
more  than  carbolic  acid. 

Creasote  is  a  valuable  stimulant  and  con- 
structive. It  can  be  given  in  drachm  doses 
where  the  stomach  is  not  irritable,  and  most 
any  stomach  will  stand  ten  to  fifteen  minims 
three  times  a  day. 

In  its  use  we  find  the  most  happy  results 
may  be  obtained  in  slow  wasting  diseases, 
especially  tuberculosis,  that  sends  such  a 
multitude  to  the  grave  yearly. 

By  beginning  with  ten  minims  of  creasote 
and  increase  gradually  to  all  the  patient  will 
bear,  we  improve  the  appetite,  lessen  the 
cough  and  expectoration,  and  sometimes  as 
it  were,  cure  a  tuberculous  subject  that  was 
marching  steadily  downward. 

The  uses  of  carbolic  acid  are  many,  so 
far  as  external  uses  are  concerned,  and  too 
much  cannot  be  said  in  its  praise  as  a  local 
antiseptic  ;  pure  and  in  its  various  combin- 
ations may  be  found  a  valuable  assistant  to 
nature's  effort  at  reparation. 

But  when  we  look  to  its  uses  as  an  inter- 
nal medicament  they  are  indeed  limited, 
and  the  dose  must  necessarily  be  small,  for 
one  such  as  we  give  of  creasote  would  bring 
our  patient  near  unto  death,  and  in  many 
cases  cause  final  dissolution  before  we  could 
be  summoned  to  tell  the  weary  mortal 
"good-bye." 

The  physician  should  be  careful  to  specify 
wood  creasote  for  internal  use,  and  the  drug- 
gist should  be  familiar  with  the  two  drugs 
so  as  not  to  dispense  German  creasote  when 
the  wood  creasote  is  written,  for  he  might 
send  some  poor  sufferer  to  his  long  home 
untimely. 

IS  THERE  SOMETHING    BEYOND  SCIENCE? 

It  may  be  ignorance  which  continues  to 
fight  disease  which  is  hopeless;  it  may  be 
worse — a  desire  for  the  fee  ;  it  might  be 
that  courage  which  never  gives  up  the  ship, 
even  if  the  captain  has  lost  hope,  what 
boots  it  to  plunge  all  into  the  abyss  of  de- 
spair? Who  knows  in  what  very  irregular 
tashion  others  might  not  get  ashore?  Wilt 
thou  love  thy  neighbor,  tell  him  not,  'there 
is  no  help  for  thee,'  but  only  say,  'I  cannot 
do  it,  I  do  not  understand  it,'  says  Para- 
celsus. 


If  there  are  powers  and  possibilities 
which  remain  for  the  science  of  future  gen- 
erations to  explore  how  are  we  to  get  any 
benefit  from  them  for  sick  mortals  now? 
Are  we  to  discard  our  boasted  science  and 
again  practice  the  occult?  How  shall  we 
gain  this  clearness  of  vision  that  does  not 
depend  upon  induction?  How  can  one  ob- 
tain intuition  if  not  so  gifted  by  nature? 

In  his  own  involved,  confused,  Brown- 
ingesque  style  the  author  attempts  to  ex- 
plain it  in  this  manner  :  "A  man,  who,  by 
abstraction  from  all  sensuous  influences,  and 
by  childlike  submission  to  the  will  of  God, 
has  made  himself  partaker  of  the  heavenly 
intelligence,  becomes  possessed  of  the  phi- 
losopher's stone;  he  is  never  at  a  loss ;  all 
creatures  on  earth  and  powers  in  heaven 
are  submissive  to  him  ;  he  can  cure  all  dis- 
eases." This  is  the  neo-Platonic  method 
of  becoming  a  seer. 

It  is  very  difficult  to  adapt  our  modern 
thought  and  modern  language  to  this  that 
Paracelsus  felt  to  be  the  highest  truth  that 
he  could  impart.  The  majority  of  us  do 
not  try.  They  remark  that  many  diseased 
conditions  are  self-limiting.  That  because 
mercury  was  given  in  a  case,  or  that  some- 
body said  the  Lord's  prayer,  proves  nothing 
— that  the  case  got  well  of  itself.  All  of 
which  is  sagely  true  and  should  be  borne 
in  mind.  Cases  of  diphtheria  get  well  of 
themselves,  which  did  not  preclude  the 
strange  idea  whether  there  be  not  virtue  in 
introducing  horses'  blood  into  the  patient's 
circulation.  Tyndall  pleads  with  his  scien- 
tific hearers  to  cherish  their  imagination 
amid  their  cold  logical  studies  and  demon- 
strations. How  else  shall  future  progress 
be  made  if  not  by  hypotheses  and  theories 
reaching  beyond  known  facts? 

To  the  physician  whose  business  it  is  to 
grapple  with  diseases  it  is  even  allowable  to 
act  on  the  guesses  of  the  scientific  imagi- 
nation in  emergencies  where  demonstration 
is  unavailable.  If  Braddock  had  survived 
his  defeat  by  the  Indians,  he  might  have 
proven  that  his  conduct  of  the  army  was 
according  to  all  precedent,  but  a  victory 
which  should  have  made  a  precedent  would 
have  been  more  useful  to  the  world. 


HEREDITY  OR  ASSOCIATION==WHICH? 

There  has  been  some  contention  among 
able  men  whether  heredity  or  association 
exerts  the  greater  influence  on  human  char- 
acter. From  the  standpoint  of  our  obser- 
vation, we  have  long  since  arrived  at  the 
conclusion  that  association  is  calculated  to 
produce  greater  effects  in  a  moral  or  im- 
moral point  of  view,  than  that  of  heredity. 
For  instance  you  take  a  certain   number  of 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


55 


boys  whose  parents  have  taken  great  pains 
in  their  raising  and  moral  teaching,  and 
allow  them  to  associate  with  a  lot  of  street 
hoodlums,  and  they  will  soon  be  found 
about  as  bad  as  their  companions.  Then, 
again,  if  we  take  a  number  of  young  men 
who  have  been  raised  to  observe  moral  and 
religious  teaching  by  their  country  parents, 
and  allowed  to  go  to  a  city  to  act  in  the 
capacity  of  clerks  or  otherwise,  and  happen 
to  form  associates  of  a  lot  of  wild,  immoral 
young  men,  nine  cases  out  of  ten,  they  will 
be  tempted  to  participate  in  the  evil  prac- 
tices of  their  immoral  companions. 

These  considerations  illustrate  the  posi- 
tion, how  essential  it  is  that  all  parents 
should  be  careful  to  inculcate  moral  princi- 
ples in  the  raising  of  their  children  so  as  to 
diminish  the  number  of  bad  boys  as  much 
as  possible.  But  this  is  an  uphill  business 
in  cities  where  there  are  so  many  immoral 
parents. 

Perhaps  Col.  Hogeland's  theory  is  correct 
that  the  ringing  of  the  curfew  bell  would 
promote  moral  development,  by  keeping 
the  youngsters  off  the  street  at  night. 


ANiriAL  EXTRACTS. 

Fifteen  grains  of  Liebig's  extract  of  beef, 
the  commercial  product,  was  administered 
hypodermically  to  a  rabbit  weighing  four 
pounds.  The  pulse  became  more  frequent, 
with  rapid  respiration.  In  two  hours  symp- 
toms of  paralysis  of  the  extremities  devel- 
oped, and  the  animal  was  unable  to  stand. 
The  paralysis  increased  and  death  finally 
occurred  in  twelve  hours  with  paralysis  of 
respiration. 

A  second  rabbit  who  received  sixty  grains 
died  in  thirty  minutes.  The  commercially 
prepared  dry  powder,  of  the  thyroid  gland, 
caused  symptoms  of  Graves'  disease  :  in- 
creased pulse,  exophthalmos,  and  some  tem- 
perature. In  large  doses,  death  occurred. 
The  same  experience  was  had  with  the  dry 
powdered  suprarenal  capsule. 

The  above  facts  should  make  us  more 
careful  in  prescribing  prepared  foods  for 
the  sick,  because  they  contain  toxines  which 
are  capable  of  causing  death.  The  writer 
administered  hypodermically  five  minims 
of  a  solution  of  commercial  meat  extract  to 
a  healthy  man  weighing  16S  pounds.  After 
one  hour  the  temperature  rose  to  104  deg., 
with  pain  in  the  back,  muscular  weakness, 
and  some  cloudiness  of  the  intellect.  Four 
ounces  of  afresh  extract  was  given  in  the 
same  way  to  a  woman  weighing  115  pounds. 
No  disagreeable  symptoms  followed,  except 
that  due  to  the  swelling  produced  by  the 
fluid  beneath  the  skin  at  the  place  where 
the   hypodermic    injection    was   made.      In 


half  an  hour  no  soreness  was  felt.  While 
15  grains  of  the  commercial  extract  of  beef 
will  kill  a  rabbit,  60  grains  of  a  fresh  ex- 
tract has  caused  no  symptoms. 

When  we  come  to  prescribe  animal  ex- 
tracts as  medicines,  we  must  use  greater 
caution  than  in  their  use  for  food.  In  dis- 
eases of  the  thyroid,  or  in  the  absence  of  the 
thyroid,  the  gland  has  been  prescribed.  It 
has  been  proved  that  thyroidless  dogs  are 
benefited  by  taking  sheep's  thyroids,  al- 
though death  always  occurs  in  three  weeks 
or  less.  Impure  thyroids,  commercially 
prepared,  produce  the  symptoms  of  exoph- 
thalmic goitre  in  dogs,  rabbits  and  monkeys. 
Cunningham  (Journal  Exp.  Med.,  March, 
1S9S)  has  written  a  valuable  paper  on  Ex- 
perimental Thyroidism,  in  which  he  proved 
that  fresh  thyroids  are  not  injurious  and 
produce  no  symptoms.  The  extract  of  the 
suprarenal  capsule  has  decided  physiologi- 
cal properties.  It  elevates  the  blood  pres- 
sure enormously.  Oliver  and  Schafer  (Jour- 
nal Phys.,  1895)  showed  experimentally 
that  it  was  the  most  valuable  heart  tonic 
known. 


THE  INSPECTION  OF   THE   CORNEA  IN 
OPHTHALMIA  NEONATORUM. 

It  is  unfortunate  that  well  informed  phy- 
sicians in  caring  for  cases  of  ophthalmia 
neonatorum  do  sometimes  neglect  the  rule 
which  requires  a  daily  thorough  examina- 
tion of  the  cornea.  Such  examination  is 
important  not  only  in  the  interest  of  the 
sight  of  the  eye,  but  in  the  interest  of  the 
physician  himself.  By  it  he  discovers  the 
first  encroachments  of  a  necrotic  process 
which  early  and  vigorous  measures  may  ar- 
rest. At  least  he  is  able  to  give  timely 
warning  of  disaster  and  thus  protect  his 
reputation.  A  thorough  examination  is 
most  important  of  all  at  the  first  visit,  if  the 
case  has  progressed  for  several  days  before 
coming  under  observation,  for  already  the 
eye  may  be  irreparably  damaged.  If  this 
fact  is  not  at  once  announced,  the  doctor  is 
very  naturally  blamed  for  final  results. 

The  most  frequent  causes  of  his  neglect 
of  this  duty  are  a  fear  that  the  means  he 
employs  will  be  held  responsible  for  any 
damage  to  sight  which  the  disease  may 
cause  or  may  have  caused,  the  absence  of  a 
suitable  retractor,  and  the  fact  that  as  he 
attempts  to  draw  the  lids  apart  he  is  baffled 
by  eversion  of  the  lids  and  spasm  of  the 
orbicularis.  But  in  this  disease,  if  ever  in 
any,  timidity  must  give  place  to  boldness. 
Moreover,  the  difficulties  are  only  apparent 
and  are  encountered  only  by  the  inexpe- 
rienced. 

For  exposing  the  cornea  in  these  cases 
and    without    instruments    the    following 


56 


THE  CHARLOTTE  .MEDICAL  JOURNAL. 


method  has  been  described  before,  but  is  so 
simple,  excellent  and  safe,  that  we  feel  jus- 
tified in  again  calling  attention  to  it.  With 
the  head  of  the  child  held  firmly  in  the 
usual  position  between  his  knees  the  sur- 
geon places  the  tip  of  the  fore  finger  of  one 
hand  on  the  upper  eye  lid  in  such  a  way 
that  the  end  of  the  nail  rests  on  the  skin  of 
the  very  edge  of  the  lid.  Then  by  so  press- 
ing the  lid  backward  and  upward  that  its 
edge  keeps  continuously  in  contact  with  the 
eye  ball  he  will  be  surprised  how  easily  it 
is  pushed  out  of  the  way.  Now  by  pulling 
down  the  lower  lid  with  a  finger  of  the 
other  hand  he  has  the  cornea  completely 
uncovered.  Thus  is  avoided  the  spasm  and 
the  eversion  of  the  upper  lid  with  the  least 
show  of  harshness.  Even  the  greatest 
amount  of  swelling  does  not  interfere  with 
a  thorough  and  deliberate  inspection. 


ABDOMINAL     PAINS. 

It  is  not  our  intention  to  enter  into  an 
exhaustive  article  on  this  important  subject, 
still  it  is  one  which  should  be  recognized 
as  worthy  of  careful  attention,  for  often  it 
is  nature's  voice  telling  plainly  that  some- 
thing is  wrong. 

The  physician  is  called  in  these  cases  for 
two  purposes,  to  relieve,  and  to  cure  the 
afflicted  one ;  his  duty  is  not  simply  to 
choke  this  voice  of  suffering  nature  with  an 
opiate,  but  to  translate  it,  so  as  to  ascertain 
just  what  it  is  trying  to  tell ;  it  may  be  only 
complaining  of  an  attempt  to  overwork  the 
stomach,  by  filling  it  full  of  undigestible 
food ;  it  may  mean  that  the  patient  has  an 
unstable  nervous  system,  and  is  suffering 
from  hysterica]  gastralgia ;  it  may  in  fact 
mean  so  many  things  that  it  is  necessary  to 
make  an  elaborate  examination  in  order  to 
discover  just  what  it  does  mean  ;  many  a 
physician  has  in  cases  of  gastralgia  in 
women  in  the  latter  part  of  pregnancy 
given  opiate  to  relieve  the  pain  which  he 
attributes  to  some  error  of  diet,  or  lack  of 
proper  care  and  gone  home  contented  a  half 
hour  later,  leaving  the  patient  resting  com- 
fortably, only  to  be  called  again  in  a  few 
hours  to  find  the  woman  in  convulsions. 
What  does  this  mean  ?  Simply  that  he  has 
carelessly  neglected  to  heed  one  of  the  most 
common  warnings  that  is  given,  that 
puerperal  convulsions  are  close  at  hand. 

I  low  often  in  children  and  young  adults 
have  abdominal  pains  more  or  less  severe 
been  simply  attributed  to  some  disorder  of 
the  stomach  or  intestines  and  been  treated 
for  months,  with  various  pepsin  mixtures, 
restricted  diet  and  laxatives,  with  no  better 
result  than  that,  sometimes  the  patients  are 
better,  and  then  they  are  worse.      After  a 


longer  or  shorter  time  they  probably,  to 
satisfy  parents  or  friends,  and  because  the 
doctor  does  not  know  what  else  to  do,  re- 
ceive treatment  for  worms  with  no  better 
result.  Something  may  at  this  time  attract 
attention  to  the  patient's  back,  where  the 
physician  may  to  his  astonishment  and 
chagrin  find  serious^inflammatory  disease  of 
the  vertebrae.  After  such  an  experience 
we  should  learn  that  it  is  well  to  examine 
the  back  of  a  patient  who  has  a  history  of 
recurring  abdominal  pains  and  we  will  be 
suprised  to  find  what  a  large  per  cent,  of 
them  have  disease  of  the  vertebrae. 


THE  TREATHENT  OF  STRABISMUS. 

A  study  of  recent  literature  discloses  a 
renewal  of  interest  in  the  theory  and  cure 
of  strabismus.  When  we  read  the  discus- 
sions of  such  eminent  observers  as  Hansen, 
Grut,  Wahlfors  and  Schweiger,  as  to 
whether  the  real  essence  of  squint  rests  on 
innervation  or  an  anatomical  basis  we  are 
reminded  that  there  is  much  to  learn  yet 
regarding  the  anatomy,  physiology  and 
pathology  of  the  ocular  muscles,  and  the 
relationship  of  accommodation  to  conver- 
gence. 

This  discussion  has  been  extended  also  to 
the  relative  merits  of  operations.  Landolt 
and  DeWecker  especially  emphasize  the 
importance  of  advancement  of  the  weaker 
instead  of  tenotomy  of  the  stronger  muscle, 
in  all  cases.  They  are  not  alone  in  this 
position.  Many  workers  in  this  line  have 
invented  special  methods  of  advancement, 
most  of  which  are  good.  But  it  remains 
true  that  as  far  as  our  knowledge  goes  at 
present,  tenotomy  will  be  done  in  a  large 
class  of  cases. 

Neither  have  the  dioptic  and  orthopedic 
measures  failed  to  receive  their  due  share  of 
attention.  Most  notable  is  the  recent  mon- 
ograph of  Priestly  Smith,  who  points  out 
the  means  of  educating  squinting  children 
into  the  habit  of  ocular  equilibrium. 

All  these  things  have  helped  to  place  the 
subject  of  strabismus  in  an  advanced  posi- 
tion over  what  it  was  twenty  years  ago.  It 
need  not  much  surprise  us  should  the  laity 
still  think  that  the  treatment  of  squint  in- 
volves a  little  cutting  only  to  get  the  eyes 
straight.  But  no  physician  is  longer  ex- 
cusable for  the  same  notion.  The  correc- 
tion of  deformity,  gratifying  as  it  is,  is  but 
an  incident.  The  higher  aim  is  the  restor- 
ation of  comfortable  binocular  fixation. 
This  demands  the  highest  faculties  of  the 
surgeon,  sometimes  a  tenotomy,  sometimes 
an  advancement,  occasionally  both ;  but 
always  a  profound  study  of  all  the  ocular 
conditions  and  a  rational  application  of  such 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


57 


optical  facts  and  principles  as  will  insure 
the  desired  results.  An  operation  should 
never  be  viewed  otherwise  than  us  part  of 
the  treatment,  which  will,  as  a  rule,  extend 
over  a  period  of  several  months  or  years. 
It  is  needless  to  add,  these  remarks  apply 
only  to  cases  of  concomitant  squint  with 
vision  possible  to  each  eye. 


THE  ABUSE  OF  J1ED1CAL  CHARITY. 

Fifty  years  ago  the  city  of  London  found 
that  one-third  of  its  population  received 
free  medical  treatment  at  its  numerous  hos- 
pitals and  dispensaries.  Were  they  pau- 
pers? If  not  paupers  would  the  liberality 
of  the  medical  profession  tend  to  pauperize 
the  dispensary  patients?  These  and  other 
questions  produced  such  a  stir  in  the  com- 
munity that  a  royal  committee  was  appoint- 
ed by  the  government  to  investigate.  The 
committee  found  a  bad  condition  of  affairs, 
sent  in  its  report  with  suggestions  of  relief 
and  that  was  the  end  of  it.  The  abuse  still 
continues.  And  now  the  city  of  New  York 
is  having  a  similar  experience  with  its  com- 
mittees. The  various  societies  have  dis- 
cussed the  abuse  of  medical  charity  and  ap- 
pointed committees  to  confer  with  other 
societies  to  find  a  remedy  for  the  evil.  Two 
years  ago  the  remedy  suggested  resulted 
only  in  an  acrimonious  discussion  between 
hospital  phpsicians  and  those  not  holding 
an  appointment.  What  can  be  done?  The 
evil  in  London  and  New  York  exists  in 
Berlin,  where  a  physician's  fee  is  as  low  as 
twenty  pfennig  (five  cents).  And  all  over 
the  United  States  the  public  are  ready  to 
receive  free  medical  treatment.  Should  we 
allow  it?  Should  we  while  restoring  the 
body  to  health  allow  the  mind  of  our  patient 
to  be  weakened  by  the  influence  of  free 
medical  treatment?  If  it  is  injurious  to 
give  money  where  it  is  not  needed,  it  is 
worse  to  give  free  medical  treatment  to  the 
general  public  who  are  not  beggars  at  first. 

I  well  remember  the  scorn  with  which  a 
medical  missionary  from  Asia  spoke  of  the 
medical  charity  in  New  York.  "Why 
should  your  people  be  treated  for  nothing? 
Are  they  without  money  ?  No.  They  live 
in  warm  houses,  wear  good  clothes — no 
rags  among  them.  All  have  meat  daily. 
I  see  none  suffering  from  exposure,  or  the 
,vant  of  food.  Look  at  their  fat  faces. 
We  do  not  see  people  so  well  off  at  the  hos- 
pitals in  the  East.  They  come  in  rags, 
wearing  no  jewels.  Their  faces  are  pinched 
with  hunger.  They  are  poor,  but  not  pau- 
pers. They  are  wretched,  but  not  debased. 
Honor,  truth  and  a  nobility  of  mind  are 
written  on  their  faces,  and  we  respect  them. 
Medical  charity  would  be  their  ruin.     They 


all  pay  something,  by  their  work  or  in 
money.  The  rulers  of  those  people  will  not 
allow  them  to  be  pauperized." 


THE  PASSING  OF  THE  EXPECTORANT. 

The  effect  of  the  study  of  pathology  upon 
treatment  is  no  where  more  evident  than  in 
our  treatment  of  acute  bronchitis  now  as 
compared  with  that  of  a  few  years  ago. 
The  knowledge  that  a  variety  of  agents, 
mostly  of  bacterial  origin,  are  its  causative 
factors  ;  that  the  cause  is  sometimes  to  be 
found  in  the  stomach,  or  again  in  the  kid- 
ney, and  so  on,  leads  us  to  look  askance  on 
our  former  treatment,  with  nauseating  mix- 
tures, under  the  name  of  expectorants.  A 
well  known  clinician  and  teacher  recently 
said,  '-there  are  no  expectorants,"  and  in  a 
measure  this  is  true,  if  we  think  of  the  class 
to  which  ipecac,  senega  and  squills  belong. 
Indeed  the  major  part  of  the  value  of  the 
ammonia  compounds  is  undoubtedly  due  to 
their  local  effect  on  the  stomach. 

Now  we  treat  the  cause  and  symptoms, 
formerly  we  attacked  the  cough  as  a  distinct 
disease.  At  present  an  occasional  calomel 
purge,  soothing  inhalations,  codeine  or  its 
relatives  with  tonics,  in  the  early  period, 
and  perhaps  potassium  iodid  later  on  con- 
stitute the  general  plan  of  treatment  as  pur- 
sued in  the  large  cities  to-day.  Certainly 
these  attacks  do  not  seem  to  last  quite  as 
long  as  they  did  when  we  aggravated  the 
condition  by  an  additional  gastritis  due  to 
the  fermenting  syrup  and  the  irritating 
substances  combined  with  it. 


HIGH  DEGREES  OF  MYOPIA. 

By  this  term  we  usually  mean  cases  of 
twelve  or  fifteen  dioptres  or  more  of  near 
sightedness.  A  person  with  such  a  degree 
of  myopia  is  certainly  afflicted  with  a  great 
misfortune.  Without  glasses  he  is  practi- 
cally blind.  With  glasses  he  often  obtains 
at  best  but  poor  and  restricted  vision. 

It  is  no  wonder  then  that  the  high  myope 
has  been  in  recent  years,  introduced  to  the 
surgeon's  knife.  The  surgical  procedure 
adopted  for  his  relief  is  the  removal  of  the 
crystaline  lens.  If  the  aphasic  eye  requires 
a  convex  glass  of  14. D.  to  15. D.  for  distinct 
vision,  an  eye  not  aphasic,  requiring  aeon- 
cave  glass  of  14. D.  to  15. D.,  ought  to  have 
normal  vision  without  glasses  after  removal 
of  its  crystaline  lens.  In  practice  it  is  often 
found  that  a  myope  who  before  operation 
required  a — 20. D.  or — 25. D.  glass  to  see 
with,  will,  after  the  operation  see  without 
any  glass.  Percival  (Arch.  Ophth.,  Vol. 
xxvi,  No.  1)  points  out  the  reasons  for  this. 
We  cannot  discuss  them  here.     It  certainly 


THE  CHARLOTTE  MEDICAL   JOURNAL. 


is  true  that  the  vision  without  glasses  or 
with  weak  glasses  is  frequently  much  better 
after  this  operation  than  with  strong  glasses 
before.  It  is  also  claimed  that  accommo- 
dation being  no  longer  exercised,  the  pro- 
gressiveness  of  the  myopia  is  checked. 

There  are  some  dangers  attached  to  the 
operation.  Myopia  predisposes  to  retinal 
detachment,  which  the  operation  alone 
sometimes  causes.  Myopic  eyes  are  usually 
more  or  less  diseased,  hence  the  risks  of 
operation  would  materially  seem  greater. 
Though  many  successful  cases,  with  bril- 
liant results,  have  been  reported  by  eminent 
operators  in  this  country,  as  well  as  abroad, 
it  would  be  well  for  any  one  who  contem- 
plates performing  this  operation  to  remem- 
ber the  remarks  of  Dr.  H.  Knapp  :  "I  con- 
fess not  to  be  very  partial  to  removing  a 
non-cataractous  lens.  The  proper  value  of 
this  treatment  of  myopia  will  be  recognized 
when  the  period  of  its  boom  is  passed." 


NASAL  TREATflENT  AS  A  CAUSE  OF  EAR 
DISEASE. 

Do  not  spray  the  nose.  Do  not  use  the 
douche.  Be  careful  how  you  operate  en 
the  nose.  Why?  Because  such  procedures 
cause  inflammations  of  the  ear  with  tinnitus 
and  deafness.  Inquiry  among  deaf  people 
proves  this  to  be  true.  Ninety  per  cent, 
snuff  water  up  the  nose  to  relieve  nasal  oc- 
clusion, or  use  the  spray  or  douche.  Treat- 
ment of  the  nose  is  the  most  common  cause 
of  deafness.  A  severe  cauterization  of  the 
inferior  turbinated  was  followed  by  a  mas- 
toid abscess  in  twelve  hours,  which  required 
operation.  Packing  the  nose  with  styptic 
cotton  has  caused  acute,  severe  otitis. 

The  danger,  however,  lies  with  the  more 
insidious  cases,  those  in  which  deafness  is 
chronic  from  the  beginning.  Pain  is  ab- 
sent. The  patient  feels  no  ill  effect  at  first. 
Weeks  and  months  may  pass  by  before  the 
patient  begins  to  notice  that  his  hearing  is 
bad  when  he  has  a  "cold."  When  he  re- 
covers from  the  cold  his  hearing  may  im- 
prove. But  after  each  succeeding  attack 
the  deafness  does  not  follow.  »Such  patients 
go  to  their  family  physician  who  sprays  the 
nose  for  the  "cold;"  the  patient  recovers 
from  the  cold  and  believes  the  nasal  treat- 
ment was  a  benefit  to  the  hearing.  The 
family  physician  is  deceived  and  believes 
nasal  treatment  is  beneficial.  Not  every 
specialist  on  the  ear  knows  that  nasal  sprays 
or  douches  are  injurious. 

It  is  almost  impossible  to  convince  pa- 
tients that  the  nasal  douche,  which  makes 
the  nose  feel  so  good  can  possibly  harm  the 
ear.      And  I  know    patients    who    use    the 


douche,  although  convinced  it  makes  them 
deaf. 

How  does  nasal  treatment  injure  the  ear? 
Through  the  nervous  system.  A  nasal 
douche  is  stimulating.  This  is  followed  by 
a  depression  which  causes  a  congestion  of 
the  ear.  Watch  the  drum  membrane  before 
and  after  a  nasal  spray  or  douche,  and  note 
the  congestion  of  the  malleus  handle  and 
folds  produced  by  the  nasal  treatment. 
This  congestion  may  be  so  great  that  rup- 
ture of  some  of  the  smaller  vessels  occur 
and  minute  hemorrhages  can  be  seen. 

Do  not  be  deceived  by  the  douche.  It  is 
tricky.  Its  ill  effects  are  not  always  evident 
at  the  time  while  its  immediate  benefit  is 
unquestioned.  Let  every  physician  who 
has  the  best  interests  of  his  patients  at  heart 
avoid  the  spray  or  the  douche  and  treat  the 
nose  with  care,  watching  the  ear  all  the 
time  that  no  harm  may  result. 


MODERN  SURGERY  AND  THE  PERITONEUM. 

Probably  nothing  in  very  recent  years  has 
done  so  much  to  lessen  the  dangers  of  lap- 
arotomy and  to  increase  the  number  of  its 
good  results  as  the  suggestion  of  Wiggin, 
made  some  six  years  since,  that  the  perito- 
neal cavity  be  filled  with  normal  salt  solu- 
tion, and  that  this  fluid  be  allowed  to  re- 
main after  closure  of  the  section.  In  the 
days  preceding  the  introduction  of  this 
method,  the  so-called  toilet  of  the  perito- 
neum was  religiously  performed.  Every 
drop  of  fluid  was  carefully  mopped  out. 
In  doing  this  many  unavoidable  abrasions 
of  the  serous  membrane  were  produced. 
This  not  only  afforded  an  opportunity  for 
infection  but  also  fruitful  areas  for  inflam- 
matory exudate,  and  consequent  adhesions. 
Inasmuch  as  the  abdominal  pain,  of  which 
so  many  patients  complain  so  bitterly  before 
abdominal  section,  is  caused  for  the  most 
part  by  peritoneal  adhesions  rather  than 
the  disease  itself — scarcely  any  relief  can  be 
expected  from  the  removal  of  the  diseased 
structures  if  new  adhesions  be  allowed  to 
form.  Often,  in  such  cases,  the  last  con- 
dition is  infinitely  worse  than  the  first. 

Intestinal  obstruction,  due  to  adhesions, 
was  certainly  much  more  frequent  in  for- 
mer days  than  now.  The  rationale  of  its 
employment  (as  pointed  out  by  Wiggin) 
is  very  clear.  The  salt  solution 
keeps  the  abraded  surfaces  apart  long 
enough  to  prevent  the  formation  of  adhe- 
sions. Furthermore  it  dilutes  any  poisonous 
material  that  may  escape  our  notice,  and, 
of  all  the  means  of  preventing  shock  it  is 
one  of  the  best.  After  a  varying  period  of 
from  one  to  six  hours,  it  is  taken  up  by  the 
peritoneal  lymphatics,    stimulating  thereby 


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59 


the  absorption  of  any  blood  or  foreign  ma- 
terial that  may  accidentally  be  left.  The 
salt  solution  so  absorbed  acts  as  a  food  and 
a  stimulant  to  the  system  in  general,  allevi- 
ating to  a  marked  degree  the  thirst  and 
vomiting  due  to  anaesthesia,  preventing  the 
suppression  of  urine,  increasing  diaphore- 
sis, and,  in  general  promoting  the  comfort 
of  the  patient.  This  is  only  another  evi- 
dence of  the  fact  that  American  surgeons 
are  the  leaders  of  surgical  progress. 


FLUCTUATIONS  IN  THE  DISEASE    CURVE. 

In  the  clinical  observation  of  disease  a 
striking  fact,  often  brought  to  our  notice, 
is  that  we  are  frequently  called  upon  to 
treat  a  series  of  affections  of  a  similar  na- 
ture, yet  not  generally  classed  as  belonging 
to  the  epidemic  diseases.  At  other  times 
such  affections  may  be  extremely  rare.  In  this 
connection  may  be  mentioned  the  fact  that 
in  one  of  the  largest  venereal  hospitals  in 
this  country  it  is  a  common  condition  to 
find  that  for  a  period  of  several  months  all 
venereal  sores  will  be  of  a  syphilitic  nature, 
again  the  pendulum  will  swing  to  the  oppo- 
site side  and  only  chancroids  are  to  be  found. 
A  similar  condition  of  affairs  occurred  in 
Paris  shortly  after  Diday  had  first  made 
clear  the  differential  diagnosis  between 
chancre  and  chancroid.  When  he  sought 
case6  to  prove  his  assertion  that  they  were 
separate  diseases  a  chancroid  could  not  be 
found,  and  this  fact  nearly  served  to  dis- 
prove his  conclusions. 

Correlative  to  the  foregoing  is  the  fact 
that  in  some  seasons  all  of  our  cases  of  se- 
rious disease,  such  as  typhoid  fever,  diph- 
theria, or  pneumonia,  get  well,  no  matter 
how  treated ;  and  at  other  times  most  of 
them  die  despite  all  treatment.  These  two 
facts  have  a  mutual  relationship,  in  that  the 
causative  factor  in  each  condition  is  a  micro- 
organism. Experience  has  taught  us  that 
climatic  conditions,  existing  in  the  prece- 
ding season  have  something  to  do  with  these 
phenomena.  Especially  is  this  so  in  re- 
gard to  the  growth  of  the  typhoid  bacillus, 
and  the  Plasmodium  malarice.  We  know 
that  the  virulence  of  most  micro-organisms 
can  be  greatly  attenuated  in  the  laboratory, 
by  the  use  of  heat.  Undoubtedly  the  same 
thing  occurs  in  nature.  Fluctuations  in 
atmospheric  pressure,  the  increased  amount 
of  oxygen  in  the  air  during  prevailing  north 
winds,  the  frequency  of  thunder  storms  and 
certain  other  climatic  conditions,  not  yet 
well  understood,  seem  to  be  potent  factors  in 
determining  the  virulence  of  many  of  these 
micro-organisms. 

Furthermore,  recent  experiments  show 
that  the  X  rays  have  a  decided    restraining 


influence  upon  bacterial  and  cellular  life. 
Without  doubt  vibrations  corresponding  to 
the  X  rays  are  to  be  found  in  nature,  and 
results  similar  to  those  occurring  in  the  lab- 
oratory maybe  confidently  expected  to  take 
place.  That  there  are  other  wave  phenom- 
ena analogous  to  the  X  rays,  with  a  differ- 
ent vibrating  coefficient  is  very  probable, 
and  these  likewise  may  be  shown  to  have 
some  effect  on  the  growth  of  organisms,  and 
perhaps  on  the  resistance  of  the  cells  them- 
selves. Who  can  say  that  the  hygienists 
of  the  20th  Century  may  not  discard  anti- 
septics entirely? 


THE    SYHPATHETIC    NERVOUS    SYSTEH 

While  the  cerebro-spinal  nervous  system, 
has  been  the  object  of  most  careful  study 
and  experience,  the  sympathetic  has  been 
almost  neglected.  Those  who  have  been 
specially  interested  in  the  study  of  the 
nervous  system  have  long  felt  the  want  of  a 
more  exact  knowledge  of  this  important 
part ;  and  it  is  with  pleasure  that  they  note 
the  work  of  Onuf  and  Collins  of  New  York, 
who  started  their  experiments  for  the  pur- 
pose of  discovering  the  sympathetic  centres 
in  the  brain  and  cord.  Their  experiments 
have  not  only  shed  much  new  light  upon 
this  subject  but  have  also  developed  some 
very  interesting  physiological  facts;  such 
as,  the  removal  of  the  cervical  ganglion 
causing  digestive  disturbances,  consisting 
of  diarrhoea  and  putrefaction  of  the  fasces, 
as  also  did  the  removal  of  the  thoracic  and 
semilunar  ganglia.  The  removal  of  the 
thoracic  sympathetics  caused  the  appearance 
of  a  large  amount  of  sugar  in  the  urine, 
which  was  still  present  four  months  after 
operation.  We  simply  call  attention  to 
these  interesting  facts  in  order  to  show  how 
important  this  work  will  be  to  the  profes- 
sion ;  it  will  be  hoped  that  these  gentlemen 
have  simply  opened  the  door  through  which 
others  will  enter  and  carry  on  this  work, 
until  we  are  perfectly  familiar  with  all  the 
functions  of  the  whole  nervous  system, 
then  we  will  probably  do  less  groping  in 
the  dark,  and  many  things  that  are  at  pre- 
sent unexplainable  will  be  perfectly  clear 
to  us. 


IS  SEXUAL  PERVERSION  INCREASING? 

The  undue  prominence  given  to  the 
deeds  of  sexual  perverts  by  the  daily  press 
in  some  of  our  large  cities  would,  at  first 
sight  appear  to  strengthen  the  statements 
of  certain  pessimistic  philosophers  that 
such  vices  are  on  the  increase  among  our 
American  people.  The  very  opposite  is 
more  probably  true.  In  Europe,  where  Lhese 
vices  are  common  they  attract  little    atten- 


60 


THE  CHARLOTTE   MEDICAL  JOURNAL. 


tion  but  in  this  country  the  universal  dis- 
gust excited  by  such  deeds,  together  with 
their  relative  rarity  combine  to  make  the 
matter  more  noticeable.  Without  doubt 
there  is  considerable  taint  of  this  kind 
abroad  in  the  land,  but  it  is  largely  confined 
to  foreigners,  chiefly  among  the  Italians. 
Whether  in  this  case  it  is  due  to  an  inher- 
ited vice  of  constitution  or  to  their  crowded 
manner  of  living  is  a  question.  It  is  none 
the  less  true  that  a  considerable  number  ot 
the  rectal  cases  coming  to  a  large  dispen- 
sary are  from  among  this  race,  due  to  one 
form  of  sexual  perversion,  /'.  e.  pederasty. 
Of  course  in  coming  to  any  general  con- 
clusion as  to  the  prevalence  of  these  vices, 
we  must  exclude  the  insane,  the  vagaries 
of  whom  often  take  on  the  form  of  sexual 
perversion.  We  may  also  assume  that 
slight  departures  from  the  normal  sexual 
act  are  sufficiently  common  in  otherwise 
untainted  individuals  to  be  considered 
physiological.  Such  conditions  are  com- 
mon the  world  over  and  have  no  signifi- 
cance. However,  of  the  graver  forms  of 
perversion  such  as  are  commonly  met  with 
in  Europe,  we  seldom  see  an  example. 


BOOK  REVIEWS. 

Human  Anatomy.  A  complete  Systematic 
Treatise  by  various  authors,  including  a  Spe- 
cial Section  on  Surgery  and  Topographical 
Ad  atomy.  Edited  by  Henry  Morris,  M.  A., 
and  M.  B.,  London.  Senior  Surgeon  to  the 
Middlesex  Hospital;  Examiner  in  Surgery  in 
the  University  of  London;  Member  of  the 
Council,  and  Chairman  of  the  Court  of  Exami- 
ners of  the  Royal  College  of  Surgeons  of  Eng- 
land: Honorary  Member  of  the  Medical  Socie- 
ty of  the  County  of  New  York.  Illustrated 
hy  seven  hundred  and  ninety  wood-cuts,  the 
greater  part  of  which  are  original  and  made 
expressly  for  this  work  by  special  artists;  over 
two  hundred  printed  in  colors.  Second  edi- 
tion, revised  and  enlarged.  Published  by  P. 
I'.lakiston's  Son  &  Co.  Philadelphia.  $6.00, 
cloth. 

This  is  the  best  and  most  complete  anat- 
omy that  has  been  published  in  many  years. 
It  gives  a  complete  and  systematic  descrip- 
tion of  every  part  and  organ  of  the  human 
body  so  far  as  studied  in  the  dissecting 
room.  The  author  has  not  deemed  it  wise 
to  consider  Histology  and  development, 
except  the  mode  and  dates  of  development 
of  the  bones,  and  a  few  other  instances, 
thinking  these  more  properly  belonged  to 
books  on  Physiology.  The  different  sub- 
jects have  been  written  by  different  authors 
who  are  known  to  have  devoted  special  at- 


tention to  the  subjects  allotted  to  them. 
The  illustrations  are  of  the  highest  order, 
and  for  the  most  part  entirely  original. 
The  value  of  the  colored  plates  as  compared 
to  the  old  black  ones  will  be  apparent  to 
every  student  of  anatomy.  In  the  illustra- 
tions of  the  bones,  the  origin  of  the  muscles 
are  indicated  by  red  lines,  the  insertions  by 
blue  lines,  and  the  attachment  of  ligaments 
by  dotted  black  lines.  A  special  feature  of 
the  book  is  the  method  of  describing  the 
illustrations.  It  consists  in  printing  the 
descriptions  in  different  type  at  the  end  of 
the  pointers.  Thus  it  will  be  found  that 
muscles,  fasciae,  and  ligaments  are  in  one 
kind  of  type ;  arteries,  veins,  and  lympha- 
tics in  another;  bones  in  a  third,  and  nerve 
structure  in  a  fourth.  The  arrangement  of 
the  work  is  such  that  a  student  can  readily 
turn  to  what  he  wants  without  having  to 
look  through  a  whole  section  as  is  the  case 
with  many  anatomies. 

The  publishers  have  done  their  part  well. 
The  work  is  printed  in  large  clear  type  on 
fine  paper,  and  the  binding  constructed  so 
as  to  allow  the  book  to  lie  open  without  the 
use  of  weights.  Taking  everything  into 
consideration  it  is  undoubtedly  the  best 
anatomy  published  in  the  English  language. 

A  Text-Book   of  Obstetrics.     By   Barton   Cook 
Hirst,  M.  D.,   Professor  of  Obstetrics  in  the 
University  of  Pennsylvania,  with  653  Illustra- 
tions.     Philadelphia :    W.  B.   Saunders,   925 
Walnut  Street.     1898.     Price,  Cloth  $5.00  net, 
Sheep  or  Half  Morocco  $6.00  net. 
This  great  work  is  considered  under  seven 
main    divisions :     I.    Pregnancy ;     II.    The 
Physiology  and  Management  of  Labor  and 
the  Puerperium  ;     III.  The   Mechanism  of 
Labor  ;  IV.  The  Pathology  of  Labor  ;  V.  The 
Pathology  of  the  Puerperium  ;   VI.   Obstet- 
ric  Operations;     VII.  The   New  Born  In- 
fant. 

We  have  many  excellent  text-books  on 
Obstetrics,  but  this  one  possesses  such  a 
high  grade  of  excellence  that  it  will  at  once 
merit  and  secure  the  attention  of  the  pro- 
fession, and  being  a  pre-eminently  practical 
one,  will  not  only  be  valuable  whether  in 
the  hands  of  a  tyro  in  obstetrics,  or  in  those 
of  a  veteran  practitioner,  who  wishes  to 
ascertain  the  latest  and  best  in  this  line  of 
work.  The  author  states  in  the  preface 
that  this  work  is  the  outcome  of  twelve 
years'  work  devoted  entirely  to  obstetrics 
and  gynecology.  In  this  work  are  found 
many  beautiful  and  excellent  illustrations, 
which  are  indispensable  in  a  work  on  ob- 
stetrics, and  the  majority  of  which  are  from 
original  photographs  and  drawings. 

We  note  with  pleasure  the  masterly  man- 
ner in   which    puerperal    sepsis  is  treated. 


THE  CHARLOTTE  MEDICAL  JOURNAL 


The  subject  of  pathology,  physiology  and 
diseases  of  the  new  born  occupy  thirty 
pages  of  the  volume.  Schultze's  method, 
with  month-to-month  insufflation,  is  con- 
sidered the  best  method  of  treating  asphyxia  ; 
neonatorum.  The  work  ably  serves  the 
purpose  for  which  it  was  written,  "to  serve 
as  a  guide  to  undergraduate  students  and  to 
physicians  in  active  practice."  The  work 
is  a  splendid  one.  It  is  clear,  lucid  and 
concise,  well  printed  and  bound,  and  has  a 
good  index. 

A  Primer  of  Psychology  and  Mental  Disease, 
for  Use  in  Training  Schools  for  Attendants 
and  Nurses,  and  in  Medical  Classes.  By  C.  B. 
Burr,  M.  D.  Medical  Director  of  Oak  Grove 
Hospital  for  Nervous  and  Mental  Diseases, 
Flint,  Mich.;  Formerly  Medical  Superintend- 
ent of  the  Eastern  Michigan  Asylum,  Mem- 
ber of  the  American  Medico-Psychological 
Association,  etc.  Second  Edition,  Thoroughly 
Revised.  5}  x7J  inches.  Pages  ix-llG.  Ex- 
tra Cloth  $1.00,  net.  The  F.  A.  Davis  Co., 
Publishers,  1914-16  Cherry  street,  Philadel- 
phia: 117  West  Forty- second  St..  New  York 
City,  9  Lakeside  Building,  2i8-220  S.  Clark 
St.,  Chicago,  111. 

The  first  twenty-eight  pages  of  this  vol- 
ume is  devoted  to  Psychologyy  and  is  of 
value  to  the  student  or  to  any  one  especially 
interested  in  those  subjects  pertaining  to  the 
mind.  The  latter  portion  of  the  work  is 
devoted  to  Management,  and  cases  of  in- 
sanity and  is  very  practical.  The  last 
chapter  is  on  what  to  do  and  what  to  avoid 
in  caring  for  the  insane.  The  little  work  is 
very  practical  indeed. 

The  Sexual  Instinct,  Its  Use  and  Dangers  as 
Affecting  Heredity  and  Morals.  Essen- 
tials to  the  Welfare  of  the  Individual  and  the 
Future  of  the  Race.  By  James  Foster  Scott, 
B.  A.,  (Yale  University),  M.  D.,  C.  M.  (Edin- 
burgh University).  Late  Obstetrician  to 
Columbia  Hospital  for  Women,  and  Lying-in- 
Asylum,  Washington,  D.  C;  Late  Vice-Pres- 
ident of  the  Medical  Association  of  the  Dis- 
trict of  Columbia,  Etc.,  Etc.  E.  B.  Treat  & 
Co. ,  New  York. 

The  design  of  this  work  is  to  furnish  the 
non-professional  man  with  a  sufficiently 
thorough  knowledge  of  matters  pertaining 
to  the  sexual  sphere — knowledge  which  he 
cannot  afford  to  be  without.  If  this  book 
was  read  by  every  citizen  in  the  country  the 
outcome  for  good  would  be  marvelous. 
Literature  bearing  on  such  subjects  has  been 
scant  and  of  an  inferior  kind.  In  this  work 
the  author  discusses  the  importance  of  the 
subject,  the  physiology  of  sexual  life,  the 
consequences  of    impurity,    etc.       Sections 


on  gonorrhoea,  onanism,  syphilis,  are  very 
good.  The  work  contains  436  pages,  and 
the  price  is  $2.00. 

Medical  News  Pocket  Formulary  for  1899.  By 
E.  Quin  Thornton,  M.  D.,  Demonstrator  of 
Therapeutics,  Pharmacy,  and  Materia  Medica 
in  the  Jefferson  Medical  College,  Philadel- 
phia. Lea  Brothers  &  Co.,  Philadelphia  and 
New  Y'ork,  1899. 

The  author  states  that  in  preparing  this 
little  volume  there  has  been  no  intention 
that  it  should  replace  individual  thought  on 
the  part  of  the  practitioner,  whose  diagnosis 
of  each  case  must  govern  the  character, 
quantity  and  combination  of  the  remedies 
selected.  That  there  is  a  broad  and  legiti- 
mate field  of  usefulness  for  works  of  this 
character  is  self-evident,  for  even  the  best 
informed  practitioner  may  at  times  over- 
look an  appropriate  drug,  and  the  young 
physician  will  perform  his  duty  better,  both 
to  his  patient  and  himself,  if  he  has  at  hand 
the  collective  experience  of  the  profession. 
The  arrangement  of  the  text  has  been  plan- 
ned to  condense  to  the  greatest  convenience. 
Diseases  are  arranged  alphabetically,  and 
under  each  are  given  efficacious  prescrip- 
tions for  simple  cases  as  well  as  for  the 
various  stages  and  complications. 

The  volume  contains  a  table  of  doses, 
poisons  and  their  antidotes,  important  in- 
compatibles,  etc.  By  close  application  the 
volume  will  be  of  great  help. 

The  Phoneudoscope  and  Its  Practical  Applica- 
tion,   with   Thirty-seven   Illustrations,    with 
Translations  of    Special    Articles    by   Felix 
Regnault,    M.    D.,    M.    Anaslasiades,    M.   D. 
Translated   by  A.  Geo.   Baker,   A.  M.,    M.  D. 
Philadelphia  :   Geo.  P.  Pilling  &  Son.     1898. 
This  book  is  a  highly  interesting  work  on 
Phonendoscopy,  and  should  be  in  the  library 
of  every  progessive    physician.     The  most 
important    and    useful    application    of    the 
Phoneudoscope  consists  in  making  the  arti- 
ficially   produced    sounds    audible    for    the 
purpose  of  ascertaining  the  formation  and 
outline  of   the   different  parts  of  the  body. 
This  work    is   beautifully   illustrated    from 
plates    brought    from    abroad   and    is    well 
bound  in  cloth. 

A  Compend  on  Obstetrics.  By  Henry  G.  Lan- 
dis,  A.  M.,  M.  D.  Revised  and  Edited  by 
William  H  Wills,  M.  D.  Sixth  Edition. 
Philadelphia:  P.  Blakiston's  Sons  &  Co., 
1012  Walnut  St.      1898. 

This  is  the  sixth  edition  of  this  compend 
on  obstetrics  thus  showing  the  esteem  in 
which  it  has  been  held  by  the  student  and 
practitioner  of  medicine.  As  far  as  possi- 
ble the  original  concise  style  of  instruction 


THE  CHARLOTTE  MEDICAL  JOURNAL 


adopted  by  the  author  remains  the  same. 
There  have  been  some  omissions  and  some 
additions  necessary.  The  following  sub- 
jects   have    been   enlarged  in  this    edition. 

Diseases  of  the  Skin.  An  Outline  of  the  Princi- 
ples and  Practice  of  Dermatology.  By  Mal- 
colm Morris,  M.  D.  New  and  Revised  Edi- 
tion.    Philadelphia  :   Lea  Brothers  &  Co. 

This  is  avery  useful  and  valuable  book 
on  the  diseases  of  the  skin.  It  contains  588 
pages  and  is  divided  into  twenty-five  chap- 
ters, with  a  good  index.  All  diseases  pe- 
culiar to  the  skin  are  thoroughly  and  elabor- 
ately considered  in  these  pages.  The  au- 
thor, as  a  writer  and  teacher  upon  subjects 
pertaining  to  the  skin,  is  well  known 
throughout  our  country  and  abroad,  and 
any  thing  from  his  pen  carries  with  it  au- 
thority. The  work  contains  many  very 
fine  illustrations,  many  of  which  are  new, 
which  will  increase  the  usefulness  of  the 
work.  The  book  is  convenient  in  size  and 
is  altogether  a  book  greatly  to  be  desired. 
It  is  printed  neatly  and  prettily  bound. 

Diseases  and  Their  Cure.  Fifty  Years  Expe- 
rience. By  A.  H.  Crondace,  M.  D.  Publish- 
ed by  the  Author,  Quincy.  111. 

The  first  two  hundred  and  twelve  pages 
of  this  work  is  devoted  to  Diseases  and 
Their  Cure.  Under  this  head  is  given  a 
simple  general  outline  of  the  common  dis- 
eases with  their  appropriate  treatment. 
The  diseases  treated  are  those  that  occur 
daily  in  the  household.  Each  disease  is 
described  very  clearly  and  the  treatment 
prescribed  is  most  satisfactory. 

Twelve  pages  of  the  work  is  devoted  to 
the  Twelve  Tissue  Remedies.  The  remain- 
ing portion  is  devoted  to  the  application 
of  Biochemic  Remedies.  The  book*  is  well 
printed  and  neatly  bound. 

Saunders  Medical  Formulary  with  an  Appen- 
dix. By  William  M.  Powell,  M.  D.  Fifth 
edition.  Philadelphia:  W.  B.  Saunders,  925 
Walnut  St.     1899. 

This  volume  contains  the  favorite  pre- 
scriptions of  the  most  eminent  physicians. 
It  is  handy  and  convenient,  and  very  val- 
uable to  beginners.  It  is  covered  in  leather 
and  can  be  carried  in  the  pocket. 

Coca  and  its  Therapeutic  Application.  By  An- 
gelo  Mariani,  with  illustrations.  Third  Edi- 
tion. Now  York.  .1.  N.  .lavas,  52,  West  Fif- 
teenth Street. 

^  This  pamphlet  gives  a  description  of  the 
Coca  plant,  its  physiological  and  thera- 
peutic uses. 


A  Pilgrimage  :  or  the  Sunshine  and  Shadow  of 
the  Physician.     By  Wm.  Lane  Lowder,  B.  S., 
M.D. 
This  is  a  most  interesting  little  book.      It 

gives  the    ups  and  downs  of   a  physician's 

life.      It  is  neatlv  bound. 


LITERARY   NOTES. 

The  American  Monthly  Review  of  Re- 
views begins  its  new  volume  with  a  strong 
issue  and  a  largely  increased  circulation. 
The  two  important  and  timely  subjects  of 
American  diplomacy  and  territorial  expan- 
sion figure  prominently  in  the  January 
number.  The  editor  reviews  the  historic 
year  1898  from  the  international  view-point 
and  discusses  pending  national  problems  ; 
Mr.  Henry  Macfarland,  the  Washington 
correspondent,  contributes  a  study,  based 
on  intimate  knowledge,  of  the  diplomacy 
of  the  war,  and  Prof.  Harry  Pratt  Judson, 
of  the  University  of  Chicago,  writes  an  ex- 
haustive paper  on  "Our  Federal  Constitu- 
tion and  the  Government  of  Tropical  Terri- 
tories." Mr.  W.  T.  Stead  gives  an  interest- 
ing estimate  of  the  young  Russian  Czar ; 
Miss  Laura  Carroll  Dennis  describes  the 
career  and  work  of  the  rising  American 
sculptor,  George  Grey  Barnard,  and  a 
sketch  of  the  late  General  Garcia,  the  Cuban 
patriot,  is  contributed  by  Mr.  George  Reno. 
Margherita  Arlina  Hamra  gives  a  succinct 
account  of  the  Red  Cross  movement  and 
the  work  of  that  organization  in  the  late 
war. 


To  have  the  men  who  have  demonstrated 
their  organizing  ability  by  great  business 
successes  tell  their  secrets  of  organization, 
is  the  object  of  the  editor  of  The  Cosmopo- 
litan. That  he  is  succeeding,  is  proved  in 
the  January  issue  by  the  article  from  Chas. 
R.  Flint,  who  is  regarded  in  New  York  as 
one  of  the  three  or  four  ablest  organizers  in 
America.  He  is  president  of  the  Rubber 
Trust  and  the  head  of  the  great  mercantile 
house  of  Flint,  Eddy  &  Co.,  which  has  its 
ramifications  in  almost  every  port  of  the 
world.  Mr.  Flint  tells  very  openly  what 
makes  for  success  in  the  organization  of 
business.  His  article  may  be  read  with  in- 
terest by  the  Rockefellers,  the  Armours, 
and  the  Wanamakers,  as  well  as  by  the 
humblest  clerk  seeking  to  fatham  the  secret 
of  business  success. 

In  the  same  line  is  an  article,  also  in  the 
January  Cosmopolitan,  telling  how  Mr. 
Piatt  organized  and  conducted  the  campaign 
for  the  election  of  Roosevelt.  It  is  by  a 
gentleman  who  was  actively  engaged  at  the 
Republican    headquarters    during  the  cam- 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


63 


paign,  and  who  gives  a  vivid  picture  of  the 
perfection  to  which  political  organization 
has  been  carried  in  New  York  State  by  the 
most  astute  of  managers.  The  wary  old 
Senator  who  has  been  a  lifetime  in  politics 
and  the  youngest  political  aspirant  will 
alike  find  food  for  reflection  in  Mr.  Blythe's 
article. 


Lippincott's  Magazine  for  January, 
1899. — The  complete  novel  in  the  January 
issue  of  Lippincott's  is  "The  Mystery  of 
Mr.  Cain,"  by  Miss  Lafayette  McLaws, 
daughter  of  the  Confederate  general  of 
that  name.  The  scene  is  in  Georgia,  and 
the  plot  is  so  uncommon  that  to  reveal  it 
would  be  unfair  to  the  reader. 

"The  Other  Mr.  .Smith"  is  a  society 
story — but  of  the  unconventional  kind — by 
Ellen  Douglas  Deland. 

"John  Rutland's  Christmas,"  by  Henry 
A.  Parker,  is  a  tale  of  practical  philanthropy, 
personally  administered. 

In  "Black  Feather's  Throw"  Joseph  A. 
Altsheler  deals  again  with  the  times  when 
Indians  tortured  their  white  prisoners  and 
burned  them  at  the  stake. 

The  history  of  an  ill-fated  empress — 
"Poor  Carlotta,"  wife  of  Maximilian  of 
Mexico — is  told  by  Lucy  C.  Lillie. 

Charles  Cotesworth  Pinckney  revives 
"The  Great  Debate  of  1833,"  in  which 
Calhoun  bore  a  prominent  part  and  was 
opposed  by  Webster. 

Dr.  Felix  L.  Oswald  offers  "An  Inter- 
national Study  on  Liberty,"  bringing  out 
the  widely  differing  significations  which  the 
word  is  made  to  bear,  or  aspects  of  the 
thing  that  are  insisted  on,  by  different  races 
or  sets  of  men. 

"Fin  de  Siecle  Individualism"  is  brought 
to  book  by  Gertrude  Evans  King. 

"A  Reporter's  Recollections" — of  work 
and  incidents  in  the  West  some  fifteen  y&ars 
ago — are  supplied  by  J.  L.   Sprogle. 

Lender  the  caption,  "Why  I  did  not  be- 
come a  Smuggler,"  L.  C.  Bradford  tells  of 
an  adventurous  trip  in  Texas  in  1878-9. 

The  poetry  of  the  number  is  by  May 
Riley  Smith,  Dora  Read  Goodale,  Arthur 
D.  F.  Randolph,  Charles  G.  D.  Roberts, 
and  Harrison  S.  Morris. 


are  attracting  wide  notice  in  the  Cornhill 
by  their  cleverness ;  and  the  beginning  of  1 
short  serial.  The  number  for  January  1  4, 
gives  the  full  text  of  Lord  Roseberry's  re- 
cent address  on  Literary  Statesmen,  which 
has  been  the  subject  of  general  comment ; 
an  article  from  Blackwood's  on  The  Ethics 
of  Conquest,  which  relates  to  the  Philip- 
pines ;  and  a  bright  paper  on  The  Madness 
of  Mr.  Kipling. 


Several  features  of  striking  interest  will 
be  found  in  the  opening  numbers  of  The 
Living  Age  for  the  new  year.  The  num- 
ber for  January  7  contains,  among  other 
things,  a  pungent  and  wholesome  lecture 
on  Art  and  Morality,  by  M.  Ferdinand 
Brunetiere,  which  is  translated  for  the  mag- 
azine and  copyrighted  by  it ;  the  first  instal- 
ment of  The    Etchingham    Letters,    which 


The  Forum  begins  the  new  year  with 
an  excellent  number.  Sir  Charles  Dilke 
writes  forcefully  on  "The  Future  Relations 
of  Great  Britain  and  the  United  States ;" 
Adjutant-General  Corbin  contributes  a 
paper  on  "The  Army  of  the  LJnited  States," 
showing  the  wonderful  improvement  of  late 
years  in  its  personnel ;  and  Mr.  G.  Everett 
Hill,  who  was  private  secretary  to  the  late 
Col.  G.  E.  Waring,  gives  the  substance  of 
the  Colonel's  report  to  the  United  States 
Government  "On  the  Sanitation  of 
Havana."  All  of  the  remaining  articles 
are  eminently  readable. 

Announcement  of  Importance  to 
Every  Physician. — Messrs.  Lea  Broth- 
ers &  Company  announce  for  publication 
in  March,  1899,  the  first  volume  of 
"Progressive  Medicine,"  a  new  annual 
which  will  be  issued  in  four  handsome,  oc- 
tavo, cloth  bound  and  richly  illustrated 
volumes  of  about  400  pages  each.  The 
several  volumes  will  appear  at  intervals  of 
three  months.  In  this  age  of  unusual  pro- 
gress, so  rapid  is  the  advance  in  all  depart- 
ments of  medical  and  surgical  science  that 
the  need  for  condensed  summaries  which 
shall  keep  the  practitioner  up  to  date  at  the 
least  possible  expenditure  of  valuable  time 
has  become  imperative.  Many  attempts  in 
the  way  of  Year-Books,  Retrospects  and 
Abstracts  have  been  made  to  meet  this 
growing  need,  but  in  nearly  all  of  these  the 
process  of  condensing  has  not  been  pre- 
ceded by  a  sifting  of  the  good  from  the  use- 
less, and  consequently  the  reader  is  pre- 
sented with  a  mass  of  information  from 
which  he  must  select,  with  care  and  study, 
the  items  which  are  useful  and  reliable. 

What  the  busy  physician  needs  to-day  is 
a  well-told  tale  of  medical  progress  in  all 
its  lines  of  thought,  told  in  each  line  by  one 
well  qualified  to  cull  only  that  matter  wor- 
thy of  his  attention  and  necessary  to  his 
success.  He  needs  material  which  shall 
teach  him  all  that  the  master  of  his  spe- 
cialty knows  of  the  year's  work. 

It  is  with  the  object  of  presenting  only 
such  readable  and  useful  material  that  these 
volumes  are  published,   and   every   contrib- 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


utor  to  the  pages  of  "Progressive  Medicine" 
will  say  what  he  has  to  say  in  an  original 
narrative  form,  so  that  every  statement  will 
bear  a  personal  imprint  expressing  not  only 
the  views  of  the  author  cited,  but  the  opin- 
ion of  the  contributor  as  well. 

To  insure  completeness  of  material  and 
harmony  of  statement,  each  narrative  will 
receive  the  careful  supervision  of  the  Gen- 
earl  Editor,  Dr.  Hobart  Emory  Hare,  whose 
reputation  will  everywhere  be  acknowl- 
edged as  ensuring  practical  utility  in  a  high 
degree.  Those  associated  with  Dr.  Hare  in 
the  production  of  "Progressive  Medicine," 
include  a  brilliant  gathering  of  the  younger 
element  of  the  profession,  well  represent- 
ing the  class  which  is  so  energetically  con- 
tributing   to  make  modern  medical  history. 

With  the  appreciation  of  the  self-evident 
utility  of  such  a  work  to  all  practitioners, 
the  publishers  are  enabled  to  ask  the  very 
moderate  subscription  price  of  ten  dollars 
for  the  four  volumes. 

The  publishers  offer  to  send  full  descrip- 
tive circulars  and  sample  pages  to  those  ap- 
plying for  them. 


MISCELLANEOUS. 


Acute  Hemorrhagic  Ascites. 

At  a  meeting  of  the  Royal  Academy  of 
Medicine  in  Ireland  Dr.  Finny  recorded  the 
clinical  notes  of  a  case  of  ascites  which 
occurred  in  a  gentleman,  aged  42,  and 
which  ran  its  fatal  course  in  three  months 
from"  its  onset.  (British  Medical  Journal, 
Dec.  10,  189S.) 

Paracentesis  was  required  five  times  in 
the  last  three  weeks,  and  removed  six  and  a 
half  gallons  by  simple  drainage.  The  fluid 
from  first  to  last  was  like  blood  in  colour, 
and  on  standing,  deposited  a  soft,  deep- 
stained  sediment,  one-eighth  or  one-tenth 
of  the  volume.  The  patient  was  apparently, 
up  to  the  last  fortnight  of  his  life,  a  healthy, 
well-nourished  man,  of  a  good  fresh  colour, 
a  bright  disposition,  and  of  very  active 
habits,  and  even  up  to  a  month  before  his 
death  was  able  to  go  out  a  partridge  shoot- 
ing and  walked  eight  miles,  and  all  through 
his  illness  he  had  a  good  appetite  and  par- 
took of  solid  food.  He  never  experienced 
any  gastric  or  intestinal  distress,  and  were 
it  not  for  the  great  size  and  inconvenience 
of  the  abdomen  he  made  no  complaint. 
However  he  was  very  sensitive  to  any  jolt- 
ing in  a  carriage  and  to  any  slight  impact 
against  the  epigastrium.  The  primary  di- 
agnosis, based  on  the  ascites  and  the  appa- 
rent diminution  of  liver  dullness,  yielded 
after    the  second  tapping  to  that  of  malig- 


nant disease  of  the  omentum,  although  no 
tumour  could  be  detected  before  or  after 
tapping.  This  was  confirmed  by  the  post 
mortem  examination  which  revealed  a  re- 
markable condition  of  the  parts.  The  liver 
smooth  and  healthy,  but  pushed  out  of  sight 
of  the  intestines,  which  were  pressed  to  the 
right  side  by  an  enormous  thickening  of  the 
transverse  mesocolon  and  omentum  by  a 
soft  growth,  which  filled  up  the  whole  of 
the  left  side  of  the  abdomen,  and  was  in 
part  two  inches  thick,  and  which  readily 
broke  down  on  handling  and  oozed  blood 
from  every  part.  Dr.  Purser  pronounced 
the  neoplasm  to  be  sarcomatous.  Dr.  Finny 
pointed  out  the  extreme  rarity  of  hemor- 
rhagic ascites  ;  of  its  being  in  such  quantity 
as  to  make  tapping  imperative  ;  of  its  so 
rapidly  re-forming;  and  of  the  absence  of 
all  inflammatory  symptoms  or  rise  of  tem- 
perature. 

Diphtheria  as  it  Occurred  in  Two  Families 
in  West  Texas. 

In  the  early  part  of  November,  1898,  the 
local  doctor  was  called  to  see  a  girl  of  two 
years  in  Mr.  W.'s  family  of  eight  children, 
ranging  in  ages  from  one  to  fifteen  years. 
Located — eight  miles  from  railroad,  in  a 
most  isolated  place,  on  a  high  gravel  knoll 
with  good  drainage.  No  one  had  been 
there,  and  they  had  not  been  any  where. 
Upon  examination  the  girl's  soft  palate, 
both  anteriorly  and  posteriorly,  both  tonsils, 
posterior  pharynx,  posterior  and  anterior 
nares  were  covered  and  filled  with  the  char- 
acteristic membrane  of  diphtheria,  and  the 
glands  of  the  neck  were  so  swollen  that  it 
made  a  straight  line  of  the  surface  from  the 
clavicle  to  the  inferior  maxillary  on  either 
side.  It  was  the  sixth  day  of  her  illness, 
that  the  doctor  first  saw  her. 

Bacteriological  examination  proved  the 
diagnosis.  She  was  put  on  antiseptic  and 
tonic  line  of  treatment,  which  did  no  good, 
for  the  toxaemia  continued  and  she  suc- 
cumbed to  the  ravages  of  the  disease  the 
twelfth  day. 

During  her  illness  the  doctor  was  told 
that  the  girl  two  years  younger  had  had  a 
similar  sore  throat  for  ten  days  prior  to  the 
former's  illness,  and  on  examination  of  her 
throat  found  pharyngeal  paralysis. 

The  house  and  contents  were  thoroughly 
disinfected,  but  in  four  days  later  a  boy  six 
years  of  age  showed  membrane  on  both 
tonsils,  and  temperature  103.  He  was  at 
once  isolated,  and  antiseptic  and  tonic 
treatment  pursued  with  a  steady  progress 
of  the  disease  until  the  seventh  day  when 
anti-diphtheritic  serum,  P.,  D.  &  Co.'s  was 
obtained  and  1500  units  injected,  and  re- 
peated the  next    day  with    1000    units ;  the 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


>\r, 


membrane  disappeared  on  the  third  day 
after  first  dose  of  serum,  and  the  patient 
got  along  nicely  w'th  the  exception  of  a 
slight  irritability  of  the  stomach. 

Seven  days  after  the  membrane  had  dis- 
appeared the  boy  died  very  suddenly  of 
what  was  taken    for  a   stroke  of    paralysis. 

A  neighbor  lady  of  Mr.  W.'s  had  what 
appeared  to  be  a  well  developed  case  of 
diphtheria,  after  nursing  the  sick  girl,  but 
recovered  in  a  few  days  with  a  tonic  and 
antiseptic  treatment. 

Her  little  girl  of  six  years  developed  a 
marked  case  on  the  20th  of  November, 
membrane  on  both  tonsils  and  temperature 
of  a  103.  .She  received  anti-diphtheritic 
serum,  1000  units,  on  third  day  of  her  ill- 
ness, and  1500  on  fourth  day,  the  membrane 
all  disappeared  on  the  third  days  from  first 
injection,  and  she  recovered  without  any 
sequel  to  date. 

J.     R.     GILBERT,     M.    D. 

Ranger,  Texas. 


Rheumatism    in  Children. 

It  is  a  recognised  fact  that  many  diseases 
present  peculiar  clinical  characters  in  young 
children  which  arc  not  seen  in  adults,  says 
an  editorial  in  the"  Archives  of  Pediatrics." 
In  some  diseases  the  clinical  course  is  so 
dissimilar  in  infants  and  adults  as  to  make 
them  seem  like  totally  different  conditions. 
This  is  particularly  true  of  rheumatism, and 
led  to  the  belief  in  former  years  that  the 
disease  did  not  occur  in  early  childhood. 
It  is  now  known  that  that  belief  was  an 
error. 

Among  those  who  have  studied  rheuma- 
tism in  children  most  careful  and  have  done 
most  to  correct  older  errors  of  belief  regard- 
ing it,  is  Dr.  W.  B.  Cheadle.  In  a  recent 
article  in  "Treatment,"'  he  describes  the 
various  peculiarities  of  the  disease  in  the 
young,  and  writes  most  judiciously  regard- 
ing the  treatment.  He  refers  particularly 
to  the  fact  that  the  risk  of  cardiac  complica- 
tions in  acute  rheumatism  is  in  inverse  pro- 
portion to  the  age  of  the  patient.  Hence 
the  great  importance  of  an  early  and  correct 
diagnosis  of  rheumatism  in  children.  But 
such  a  diagnosis  is.  unfortunately,  often 
very  difficult  to  make,  and  not  commonly 
acute  rheumatism  is  only  thought  of  as  a 
cause  of  some  childish  ailment  when  irre- 
mediable damage  has  been  done  to  the  heart 
by  an  endocarditis  or  percarditis  which  has 
run  an  insidious  course.  And  yet,  if  sought 
for  carefully,  there  are  in  nearly  every  in- 
stance certain  symptoms  which  ought  to 
suggest  the  true  nature  of  the  ailment. 

The  mistake  made  in  the  diagnosis  of 
acute  rheumatism   in  children   arise  chiefly 


from  the  fact  that  in  this  class  of  patients 
the  symptoms  of  arthritis,  acid  sweats  and 
pyrexia,  to  which  we  trust  chiefly  in 
diagnosing  the  disease  in  older  people,  are 
less  prominent.  The  disease  runs  what  in 
the  adult  would  be  called  a  sub-acute  course. 
In  acute  rheumatism  of  early  life  arthritis 
is  at  its  minimum  ;  endocarditis, pericarditis, 
and  chorea  at  their  maximum ;  pleurisy, 
tonsillitis,  and  the  vaso-motor  and  hemor- 
rhagic phenomena,  the  erythemata  and  pur- 
pura, are  more  common,  tending  to  decline 
as  puberty  is  passed.  There  is  also  a  special 
tendency  in  children  for  the  various  phases 
of  the  affection  to  arise  independently  and 
apart  from  one  another.  This  is  an  import- 
ant point,  which  Dr  Cheadle  was  one  of  the 
first  to  point  out.  Endocarditis  or  pericard- 
itis may  arise  in  a  rheumatic  child  not  only 
without  any  accompanying  joint  affections, 
but,  in  rare  instances,  without  any  recognis- 
ed rheumatic  phenomena  to  give  warning 
of  the  nature  of  the  true  complaint.  As  a 
rule,  however,  a  slight  stiffness  of  the  joints, 
chorea,  crop  of  nodules,  or  erythema  give 
some  slight  indication  of  a  rheumatic  con- 
dition. When  a  case  of  endocarditis  or 
pericarditis  arises  in  a  child  there  is  always 
a  strong  prima  facie  presumption  that  it  is 
rheumatic.  If,  with  the  cardiac  affections, 
we  have  chorea,  fibrous  nodules,  tonsillitis, 
erythema  or  pleurisy,  whether  these  have 
occurred  recently  or  have  cropped  up  at  in- 
tervals through  months  or  even  years,  the 
cardiac  inflammation  is  almost  certainly, 
rheumatic. 

The  existence  of  a  family  predisposition  is 
of  great  significance.  The  occurrence  of  the 
conditions  mentioned  above  and  even  the 
presence  of  the  subcutaneous  nodules  alone, 
which  are  pathognomonic  of  rheumatism, 
are  sufficient  for  diagnosis.  As  the  heart 
affection  is  so  serious  in  children  this  organ 
should  be  carefully  examined  whenever  any 
of  these  rheumatic  symptoms  are  met  with, 
and  in  every  feverish  attack,  simple  though 
it  may  appear,  the  condition  of  the  heart 
should  be  regularly  ascertained. 


Rontgen   on    the  Rontgen   Rays. 

Such  a  host  of  investigators  have  devoted 
themselves  to  the  development  of  Professor 
Rontgen's  great  discovery, that  it  would  be 
no  matter  for  surprise  if  there  was  nothing 
left  for  the  discoverer  to  find  out  about  his 
own  discovery.  Some  novel  properties  of 
the  X-rays,  however,  have  been  described 
by  Professor  Rontgen  in  a  third  communica- 
tion on  this  subject  to  the  Berlin  Academy. 
Among  these  the  following  appear  to  be 
specially  interesting  : 

If  a  fluorescent   screen  is  covered  with  a 


66 


THE    CHARLOTTE  MEDICAL  JOURNAL. 


plate  completely  opaque  to  the  X-rays,  a 
slight  fluorescence  can  nevertheless  be  seen 
when  the  tube  is  in  action.  Rontgen  has 
shown  that  this  is  due  to  rays  proceeding 
from  the  air  of  the  room,  which  emits  X-ra)  s 
wherever  it  is  itself  exposed  to  their  action. 
This  fact  points  to  the  necessity  of  placing 
photographic  plates  in  a  sheath  of  lead 
when  used  for  long  exposures,  to  prevent 
them  being  fogged  by  diffused  rays  from  the 
back  or  sides.  Of  the  rays  which  are  given 
off  by  the  platnum  plate  of  a  focus  tube, 
those  are  most  effective  for  producing 
pictures  which  leave  the  platinum  at  as 
great  an  angle  as  possible,  within  a  limit 
of  80  degs. 

The  specific  transparency  of  bodies  is 
greater  the  thicker  the  body.  The  ratio  of 
the  thicknesses  of  two  equal  transparent 
plates  of  different  material  is  dependent  on 
the  thickness  and  the  material  of  the  medium 
through  which  the  rays  have  to  pass  before 
they  reach  the  plates. 

For  instance,  the  ratio  of  the  thickness  of 
platinum  and  aluminum  plates  of  equal 
transparency  will  be  reduced  to  one-half  if 
the  rays  are  passed  through  a  thick  glass  plate 
before  they  strike  the  metal  plates.  Rontgen, 
like  Swinton  and  others,  has  shown  that 
the  contrast  between  bodies  of  different 
transparencies  depends  on  the  E.  M.  F.  used 
to  excite  the  tubes. 

A  spark  gap  in  the  secondary  circuit  acts 
in  the  same  way  as  an  intercalated  Tesla 
transformer  ;  both  produce  more  intense  and 
less  easily  absorbed  rays.  By  the  use  of  a 
Tesla  transformer  and  wire  electrodes  in  a 
narrow  tube,  X-rays  can  be  produced  with  a 
vacuum  of  3. 1  mm. ,  the  usual  vacuum  being, 
of  course,  about  0.0002  mm.  Hard  tubes, 
as  Rontgen  calls  those  tubes  which  require  a 
very  high  E.  M.  F,,  can  be  softened,  as  is 
well  known,  by  heating,  or  by  re-admission 
of  air,  or,  as  is  not  so  well  known,  by 
heating  limetree  charcoal  placed  in  a  side 
tube,  or  by  sending  through  the  tube  a  very 
powerful  discharge.  The  composition  of  the 
rays  given  off  by  the  platinum  anti-cathode 
depends  essentially  on  the  time  change  of 
the  discharge  current.  The  quantity  of  the 
rays  is  not  affected  by  the  change  of  the 
primary  current,  but  their  intensity  is 
proportional  to  the  strength  of  the  primary 


Heredity  and  Disease. 

Dr.  Harry  Campbell,  in  an  essay  on  the 
"Marriage  of  the  Unfit."  which  was  pub- 
lished in  a  recent  issue  of  the  Lancet,  says  : 
"I  maintain  that  all  diseases  are  hereditary  ; 
you  cannot  eliminate  the  influence  of  hered- 
ity from  any   disease,   and  I  will  prove  it. 


What  is  disease?  It  is  an  abnormal  life. 
And  what  is  life?  It  consists  of  an  inter- 
action between  the  individual  and  his  envi- 
ronment. Therefore  disease  is  abnormal 
interaction  between  the  two.  It  follows 
that  you  cannot  possibly  eliminate  the  part 
played  by  the  individual  from  the  causation 
of  any  disease,  since  it  is  his  structure  which 
determines  whether  he  shall  or  shall  not  re- 
act abnormally  to  a  given  environment. 
Now  his  structure  is  essentially  determined 
by  heredity.  I  have  therefore  proved  my 
point.  This  is  no  mere  logical  quibbling, 
but  a  practical  fact.  I  will  test  my  position 
by  taking  a  disease  with  which  most  people 
will  probably  say  heredity  has  nothing  at 
all  to  do — the  wheal  caused  by  flea-bite. 
This  affection  depends  upon  the  morbid  in- 
teraction of  the  host]  and  the  specific  envi- 
ronment constituted  by  the  poison  with 
which  the  parasite  inoculates  him.  As 
every  one  knows,  the  liability  to  be  flea- 
bitten  and  the  tendency  to  suffer  from 
wheals  when  thus  bitten  differ  greatly  in 
different  individuals.  Some  suffer  little  or 
not  at  all  in  this  way ;  others  grievously. 
Upon  what  does  this  difference  depend? 
It  depends  upon  differences  in  the  organi- 
zation or  structure  of  the  host,  and  these 
differences  are  essentially  determined  by 
heredity.  Hence  all  parasitic  diseases, 
from  a  flea-bite  to  pulmonary  consumption, 
from  typhoid  to  malignant  tumor,  are  hered- 
itary. Such  diseases  depend  upon  defect 
in  the  organism  as  regards  some  specific 
environment ;  but  others,  such  as  chronic 
Bright's  disease,  diabetes,  ovarian  cyst, 
strangulated  hernia,  may  occur  indepen- 
dently of  any  specific  environment,  and  it 
is  obvious  that  these  are,  a  fortiori, 
hereditary. 

Hypnotism  in  the  Treatment  of  Alcoholics. 

Dr.  Rybakow,  draws  the  following  con- 
clusions from  cases  under  his  own  observa- 
tion as  well  as  from  the  literature  on  the 
subject.  : — (1)  Alcoholics  are  very  suscept- 
ible to  hypnotism,  and  subject  themselves 
to  hypnotic  influence  much  more  readily 
than  many  other  patients.  (2)  Hypnotism 
is  a  very  good  remedy  in  the  treatment  of 
alcoholism.  (3)  The  favourable  effect  of 
the  treatment  shows  itself  in  the  improve- 
ment of  the  subjective  symptoms,  the  disap- 
pearance of  the  depression,  of  the  apathy, 
and  finally,  in  the  complete  loss  of  the  thirst 
for  alcohol.  Sometimes  one  sitting  suffices 
not  only  to  overcome  the  desire  for  the 
habitual  portion,  but  also  to  break  off  acute 
attack.  (4)  By  repeating  the  sittings  one 
may  at  times  delay  the  patient's  cravings; 
the  intervals,  however,  vary,  depending 
entirely  upon  the  individual  characteristics. 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


(5)  Complete  cure  by  hypnotism,  according 
to  the  experience  of  the  author,  is  seldom 
obtained  ;  relapses  also  are  proportionally 
frequent.  However,  other  authors  report 
instances  of  complete  cure  by  hypnotism. 
The  duration  of  the  treatment  depends 
especially  upon  the  degree  of  degeneration  ; 
the  milder  the  degeneration  the  more  posi- 
tive and  lasting  the  cure.  (6)  Relapses  are 
most  frequently  noticed  in  patients  under 
this  treatment  when  the  sittings  are  discon- 
tinued too  early.  (7)  In  the  treatment  of 
the  craving  for  alcohol  by  hypnotism,  the 
utmost  care  should  be  taken  in  reference  to 
the  promptness  of  the  sittings.  (8)  The 
hypnotic  treatment  may  be  instituted  at  any 
time;  it  is,  however,  better  that  the  sitting 
take  place  during  the  state  of  sobriety.  At 
all  events,  it  should  be  delayed  until  the 
agitation  and  hallucinations  have  subsided. 


Family     Prevalence     in    Relation     to 
Inheritance. 

Family  prevalence,  as  distinguished  from 
inheritance,  is  certainly  a  remarkable  pheno- 
menon. (Archives  of  Surgery,  Oct.  1898.) 
It  would  imply  that  conditions  so  produced 
are  due  to  some  peculiarity  resulting  from 
that  particular  couple,  and  not  from  either 
parent  singly.  The  close  similarity  often 
observed  in  twins,  both  as  regards  features 
and  morbid  tendencies,  is  an  example  of  the 
same  kind  of  influence.  In  animals  which 
brings  forth  many  at  a  brood  we  find  no 
difficulty  in  conceiving  that  one  litter  may 
differ  from  others  bred  of  the  same  parents. 
An  instance  in  which  of  a  litter  of  rabbits 
nearly  all  had  congenital  cataract  once 
occurred  under  my  own  observation.  Pro- 
bably it  will  be  found  on  careful  investiga- 
tion that  this  difference  between  inherited 
and  family  prevalence,  upon  which  Adams 
insisted  so  strongly,  is  not,  after  all,  of  un- 
iversal prevalence.  Some degreeof inherited 
tendency  may  probably  be  found  in  most 
instances  of  family  prevalance.  In  the  case 
of  retinitis  pigmentosa  and  deaf-mutism 
this  is  not  infrequent.  Still,  however,  the 
main  fact  remains  unquestioned  that  it  is 
quite  possible  for  several  brothers  and  sisters 
to  show  some  very  peculiar  form  of  pro- 
clivity which  cannot  be  traced  in  any 
progenitor. 

Soil  as  a  Factor  in  the  Spread  of  Disease. 
Dr.  John  Robertson  (Treatment,  Sept. 
8,  1898.)  before  the  British  Medical  Asso- 
ciation, referred  to  the  great  importance  of 
the  subject,  which  he  said  had  not  received 
the  attention  it  deserved  until  the  past  ten 
or  fifteen  years.  Numerous  investigations 
were  now  going  on,  and  it  was  much  to  be 


desired  that  the  subject  should  be  put  upon 
a  scientific  basis.  In  some  experiments 
which  Dr.  Maitland  Gibson  and  himself 
,  had  undertaken  they  found  that  in  typhoid 
planted  at  a  depth  in  the  surface  there  was 
noted  a  tendency  to  grow  upwards  rather 
than  downwards.  That  tendency  had  a 
most  important  bearing  on  the  spread  of 
.  disease  by  the  soils.  During  the  winter 
I  months,  organisms  disappeared  from  the 
surface  soil,  and  apparently  took  refuge  in 
the  deeper  layers  of  the  ground.  But  even 
there  the  typhoid  organism  will  not  survive 
unless  the  soil  has  been  contaminated  with 
organic  pollution. 

The  important  question  was  how  the  dis- 
organism  was  transferred  from  the  soil  to 
the  man,  and  he  felt  certain  that  dust  was, 
under  certain  conditions,  the  chief  agency 
in  the  transference  of  the  poison  from  the 
soil  to  the  subject.  That  might  be  direct  or 
indirect.  The  practical  conclusion  was  that 
infectious  particles  in  the  air  were  heavy, 
and  quickly  subsided  if  the  air  was  allowed 
to  remain  still.  He  was  inclined  to  believe 
that  the  "raft"  theory  was  the  correct  one, 
and  if  that  were  the  case,  it  went  far  to  ex- 
plain why  only  the  persons  living  in  or  en- 
tering an  infected  area  became  infected. 
Such  heavy  particles  would  not  travel  a 
great  distance,  but  would  rather  tend  to 
contaminate  the  food.and  water  in  the  area. 


The    Infectivity  of  the   Urine   in   Typhoid 
Fever. 

The  fact  that  the  urine  of  patients  suffer- 
ing from  typhoid  fever  may  contain  the 
typhoid  bacillus  in  large  quantities,  though 
it  has  been  established  by  the  observation 
of  several  observers,  has  not,  perhaps,  at- 
tracted the  attention  which  it  deserved. 
The  British  Medical  Journal  states  that 
Wright  and  Semple  have  published  that  in 
six  out  of  seven  cases  examined,  the  bacillus 
was  easily  detected  in  the  urine,  and  they 
pointed  out  the  important  bearing  of  the 
observation  on  practical  hygiene.  Last 
year  Dr.  P.  Horton  Smith  read  a  paper  at 
the  meeting  of  the  Royal  Medical  and 
Chirurgical  Society  in  which  he  showed 
the  bacilli  might  be  present  in  the  urine  at 
some  period  of  the  disease  in  enormous 
quantities — from  5,000  to  172  millions  per 
c.cm.  of  urine.  In  one  case  the  organisms 
were  preceded  by  blood  in  the  urine  ;  in  the 
rest  there  were  no  concomitant  symptoms 
save  a  trace  of  albumen  and  turbidity  of  the 
urine.  The  bacilli  generally  appeared 
suddenly,  and,  what  is  of  the  greatest  im- 
portance, he  never  found  them  in  the  first 
or  second  week.  Dr.  J.  Petruschky,  director 
of  the  Bacteriological  Institute  at  Dantzig. 


THE  CHARLOTTE  MEDICAL  JOURNAL 


has  recently  examined  the  urine  in  fifty 
cases  of  typhoid  fever,  and  in  three  he 
found  the  bacillus  in  enormous  numbers, 
in  all  cases  late  in  the  disease.  The  bacilli 
persisted  in  the  urine  after  defervescene  for 
a  period  more  or  less  prolonged — in  one 
case  for  two  months,  in  another  for  four 
weeks,  and  in  another  for  eight  days.  The 
fact  that  the  urine  may  be  infectious  to 
man  was  established  by  an  unfortunate 
accident,  which  Dr.  Petruschky  relates. 
The  sister  of  the  ward  accidentally  drank  a 
small  quantity  of  urine  which  had  been 
passed  by  a  typhoid  patient  into  a  wine- 
glass, and  after  an  incubation  period  of 
twelve  days  she  developed  typhoid  fever. 
The  subject  is  one  which  appears  to  require 
further  investigation,  more  especially  as  to 
the  period  of  the  illness  at  which  the  bacilli 
may  be  expected  most  probably  to  appear 
in  the  urine,  since  if  it  should  turn  out  that 
they  are  present  as  frequently  as  Wright 
and  Semple  suppose  during  an  early  stage, 
the  bacteriological  examination  of  the  urine 
might  be  a  valuable  aid  to  diagnosis  in 
doubtful  cases.  The  facts  already  known, 
however,  are  quite  sufficient  to  emphasize 
the  importance  of  disinfecting  the  urine  and 
of  instructing  nurses  and  others  about  the 
patient  to  exercise  the  most  scrupulous  care 
in  disinfecting  their  hands,  or  any  vessels 
which  may  have  become  contaminated 
with  urine. 


Protective    Action    of    the    Liver  against 
Microbes. 

Roger,  according  to  the  British  Medical 
Journal,  has  found  that  certain  cultures  of 
anthrax  bacillus  introduced  into  a  branch  of 
the  portal  vein  did  not  kill  rabbits,  whereas 
cultures  of  the  same  virulence  injected  into 
other  blood  vessels  did  cause  death.  He 
then  found  that  the  lungs  possessed  a  pro- 
tective action  against  the  streptococcus, 
whilst  the  liver  possessed  none.  The 
staphylococcus  aureus  grows  rapidly  in  the 
brain,  but,  like  the  anthrax  bacillus,  is  de- 
stroyed by  the  liver.  The  liver  seems  to  be 
powerless  against  bacillus  coli,  and  even  to 
favor  the  growth  of  this  microbe.  Both 
liver  and  kidney  arrest  the  growth  of  oi'dium 
albicans.  Recently  Roger  has  made  further 
experiments  on  rabbits  to  determine  what 
conditions  modify  the  protective  action  of 
the  liver.  This  protective  action  is  less 
marked  when  the  animal  is  kept  without 
food,  but  remains  observable  even  after 
three  days  of  fasting.  If  £  c.cm,  of  a 
sterilised  culture  of  bacillus  prodigiosus  is 
injected  into  an  intestinal  vein,  the  liver 
loses  all  its  protective  power  against 
staphylococcus  aureus.  Large  doses  of 
glucose — given  by  the  mouth— weaken  the 


protective  power  of  the  liver,  whereas 
small  doses  increase  it.  The  effect  of  ether 
is  most  striking ;  5  drops  of  ether  injected 
into  the  portal  vain,  or  2  c.cm.  given  by 
the  mouth,  abolish  the  protective  action  of 
the  liver,  whereas  small  doses  by  the  mouth 
— 2  or  3  c.cm.  of  a  solution  of  ether  in 
alcohol  and  water — increase  it.  When  the 
ether  is  injected  subcutaneously  its  effect  is 
much  less  marked.  Perhaps  the  beneficial 
action  of  portions  containing  ether,  in  the 
case  of  patients  with  infectious  diseases, 
may  be  explained  on  the  supposition  that 
dilute  doses  of  ether  given  in  this  way  in- 
crease the  protective  action  of  the  hepatic 
cells  against  certain  microbes. 


The  Liabilit}'  to  Cramp  after  Sleep. 

It  is,  says  Jonathan  Hutchinson,  well 
known  that  the  state  of  sleep  predisposes 
to  cramp  in  muscles.  The  exciting  cause 
is  probably  always  muscles  action.  Of  all 
the  muscles  in  the  body  the  gastrocnemius 
is  probably  the  one  most  prone  to  it.  The 
usual  time  for  its  occurrence  is  just  after 
waking  in  the  morning.  It  may,  however, 
in  restless  sleepers  who  move  their  limbs  in 
bed,  come  on  during  sleep  and  put  an  end 
to  it  by  the  pain  caused.  Those  liable  to 
cramp  in  the  calf  must  be  very  careful  as  to 
movements  of  their  legs  just  after  waking. 
When  once  the  sleep  state  has  passed  off 
and  the  muscles  are,  so  to  speak,  thoroughly 
awake,  there  is  comparatively  little  risk  of 
its  coming  on. 

I  was  explaining  the  above  to  a  patient 
who  had  suffered  much  from  cramp,  when 
he  replied  :  "Yes,  I  have  found  that  out 
for  myself,  and  I  am  so  determined  to  avoid 
bending  my  legs  soon  after  waking,  that  I 
always  take  care  that  the  bed  clothes  are 
not  tucked  in,  so  that  I  can  slide  out  of  bed 
feet  first  to  keep  them  straight." 


Cold  Feet. 

Digestion,  says  Jonathan  Hutchinson, 
always  increases  the  liability,  and  attacks 
may  come  on  during  a  meal  or  soo.i  after- 
wards. If  a  meal  causes  cold  feet,  headache 
will  usually  follow.  In  many  patients  any 
little  mental  worry  or  excitement  brings  on 
an  attack.  Patients  liable  to  frequently 
recurring  coldness  of  the  feet  and  hands 
sometimes  say  that  nausea  or  even  vomiting 
may  be  caused  if  the  feet  become  very  cold. 
I  think  that  the  feet  have  more  influence  in 
this  respect  over  the  stomach  than  have  the 
hands.  The  mere  fact  of  the  feet  being 
cold  (say  from  tight  boots)  will  often  cause 
headache.  On  the  other  hand,  severe  head- 
aches, however  caused,  are  usually  attended 
by  cold  feet. 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


Programme  of  the  First  Annual  Session 

OF  THE 

Tri- State  Medical  Society  of  the  Carolinas 
and  Virginia,  to  be  held  at  Charlotte, 
North  Carolina,  January  18th  to  20th, 
1899. 

TEMPORARY    OFFICERS. 

President  (temporary),  Dr.  W.  H.  H. 
Cobb,  Goldsboro,  N.(C.  ;  Treasurer,  Ur.H. 
H.  Dodson,  Milton,  N.  C.  ;  Secretary,  Dr. 
Paulus  A.  Irving,  Richmond,  Va.  ;  Dr.  E. 
C.  Register,  Charlotte,  N.  C,  Chairman 
Committee  of  Arrangements, 

ii  A.  M. — Opening  of  the  First  Annual 
Session. 

i.  Divine  Invocation.  Rev.H.F.Chreitz- 
berg,  D.  D.,  Charlotte,  N.  C. 

2.  Address  of  Welcome  on  Behalf  of  the 
Profession  and  the  Citizens  of  Charlotte. 
Col.  H.  C.  Jones,  Charlotte,  X.  C. 

3.  Response  to  the  Address  of  Welcome. 
Dr.  Hugh    T.  Nelson,   Charlottesville,  Va. 

4.  Address  by  the  President.  Dr.W.  H. 
H.  Cobb,  Goldsboro,  N.  C. 

5.  Executive  Session.  Reports  of  Offi- 
cers.    Reports  of  Committees. 

6.  Registration  of  Members. 

PAPERS. 

1 .  Purposes  of  Tri-State  Medical  Organi- 
zations. Dr.  Paul  B.  Barringer,  University 
of  Virginia. 

2.  Psuedo  Membranous  Enteritis.  Dr.  J. 
M.  Fladger,  Summer  ton,  S.  C. 

3.  Cold  as  a  Remedial  Agent.  Dr.  E.  B. 
Glenn,  Asheville,  N.  C. 

4.  Lithemia.  Dr.  J.  N.  Upshur,  Rich- 
mond, Va. 

5.  Blood- Washing  and  Blood-Letting. 
Dr.  A.  B.  Knowlton,   Columbia,  S.  C. 

6.  The  Early  Recognition  of  Pulmonary 
Tuberculosis  and  of  the  Pre-Tubercular 
State.  Dr.  Charles  L.  Minor,  Asheville, 
N.  C. 

7.  A  plea  for  the  Earlier  Recognition  of 
Consumption.  Dr.  Louis  F.  High,  Dan- 
ville, Va. 

8.  Food  and  its  Auxiliaries.  Dr.  F.  W. 
P.  Butler,  Edgefield,  S.  C. 

9.  The  Treatment  of  Urethral  Discharges. 
Dr.  James  M.  Parrott,  Kinston,  N.  C. 

10.  Remarks  on  the  Relation  of  Diet  to 
Hay  Fever  and  Asthma.  Dr.  John  Dunn, 
Richmond,  Ya. 

1 1 .  Typhoid  Fever  :  Diagnosis  and  Treat- 
ment.  Dr.  Rolfe  E.  Hughes,  Laurens,  S.C. 

12.  Reports  of  Cases,  etc.  (Followed  by 
general  discussion.) 

13.  Appendicitis  Complicated  with  In- 
ternal Perforation.  Dr.  George  W.  Long, 
Graham,  N,  C. 

14.  Diagnosis  and  Treatment  of  Tubercu- 


losis Peritonitis.   Dr.W.  L.  Robinson,  Dan- 
ville.Va. 

15.  Report  of  Cases  of  Rupture  of  Uterus 
during  Pregnancy.  Dr.  Frank  D.  Kendall, 
Columbia,  S.  C. 

16.  Dystocia.  Dr.  David  A.  Stanton, 
High  Point,  N.  C. 

17.  Vomiting  in  Pregnancy.  Dr.  R.  S. 
Martin,  Stuart,  Va. 

18.  The  Treatment  of  Placenta  Previa. 
Dr.  J.  C.  Harris,  Anderson,  S.  C. 

19.  Application  of  Electricity  to  Diseases 
of  Women.  Dr.W.T. Woodley,  Charlotte, 
N.  C. 

20.  Material  Aids  in  the  Management  of 
the  First  and  Second  Stages  of  Labor.  Dr. 
James  Albert  Anderson,  Danville,  Virginia. 

21.  Tubal  Pregnancy.  Dr.  Virginius 
Harrison,  Richmond,  Va. 

22.  Abdominal  Palpation  Versus  Vaginal 
Examination  in  Obstetrical  Practice.  Dr. 
John  F.  Winn,  Richmond,  Va. 

23.  Ovaritis.  Acute  and  Chronic.  Dr. 
L.  G.  Frazier,  Youngsville,  N.  C. 

24.  Diagnosis  and  Treatment  of  Cancer 
of  the  Breast.  Dr.  Hunter  McGuire,  Rich- 
mond, Va. 

25.  The  Importance  of  Early  Operation 
in  Appendicitis.  Dr.  John  Whitehead, 
Salisbury,  N.  C. 

26.  Surgical  Treatment  of  Duodenal  Ul- 
cer.     Dr.  Hugh  M.  Taylor,  Richmond,  Va. 

27.  Drainage  in  Abdominal  Surgery.  Dr. 
J.  W.  Long,  Salisbury,  N.  C. 

28.  Sciatica  and  Its  Treatment.  Dr. 
Samuel  A.  Lile,  Lynchburg,  Va. 

29.  Report  of  Two  Cases  of  Nephrec- 
tomy. Dr.  George  Ben.  Johnston,  Rich- 
mond, Va. 

30.  The  Report  of  a  Case  of  Complete 
and  of  Partial  Ophthalmoplegia  of  the  Right 
Eye.  Dr.  Charles  W.  Kollock,  Charles- 
ton,  S.  C. 

31.  The  Eye  as  a  Causative  Factor  in 
Functional  Nervous  Diseases.  Dr.  W.  H. 
Wakefield,  Charlotte,  N.  C. 

32.  The  Present  Status  of  Laryngology 
and  Rhinology.  Dr.  W.  Peyer  Porcher, 
Charleston,  S.  C. 

33.  Headache — Ocular  and  Nasal.  Dr. 
J.  A.  White,  Richmond,  Va. 

34.  Brief  Report  of  Cases.  Dr.  J.  Steven 
Brown,  Salisbury,  N.  C. 

35.  Treatment  of  Fractures.  Dr.  Hugh 
T.  Nelson,  Charlottesville,  Va. 

36.  Subject  not  yet  received.  Dr.  S.  C. 
Baker,  Sumter,  S.  C. 

37.  Some  Practical  Points  in  the  Treat- 
ment of  Diphtheria.  Dr.  Ramon  D.  Gar- 
cin,  Richmond,  Va. 

38.  What  Medicine  Owes  to  Bacteriolo- 
gy.    Dr.  E.  C.  Levy,  Richmond,  Va. 

39.  The    Medical   Examining  Boards  of 


70 


THE  CHARLOTTE    MEDICALJOUKNAL. 


North  Carolina  and  Virginia  :  Their  Rela- 
tion to  Each  Other  and  the  Profession.  Dr. 
A.  S.  Priddy,  Keysville,  Va. 

40.  State  Institutions  for  Epileptics.  Dr. 
William  Francis  Drewry,   Petersburg,  Va. 

41.  Examination  of  Feces  as  Aids  to 
Diagnosis.  Dr.  H.  Stuart  MacLean,  Rich- 
mond, Va. 

42.  The  Influence  of  Chronic  Nasal  Oc- 
clusion on  Cerebration.  Dr.  Dirk  Adrian 
Kuyk,  Richmond,  Va. 

43.  Diagnosis  of  Renal  Calculus.  Dr. 
Moses  D.  Hoge,  Jr.,  Richmond,  Va, 

44.  The  Practical  Treatment  of  Carbolic 
Acid  Poisoning.  Dr.  Stephen  Harnsber- 
ger,  Catlett.  Va. 

45.  Modern  Views  on  the  Nature  and 
Treatment  of  Pulmonary  Consumption.  Dr. 
H.  B.  Weaver,  Asheville,  N.  C. 

Unfinished  Business  :  Papers  previously 
announced  and  still  unread.  Volunteer 
papers.      Adjournment. 

RAILROAD   FARES. 

The  railroads  have  granted,  through  the 
instrumentality  of  the  Southeastern  Passen- 
ger Association,  a  reduced  rate,  only  charg- 
ing one  and  one-third  fare  to  and  from 
Charlotte  from  any  point  in  the  three  States. 

Conditions  :  Each  person  desiring  to  avail 
himself  of  the  reduced  rate  must  purchase 
a  first-class  ticket  to  the  place  of  meeting 
(Charlotte).  Tickets  for  the  return  jour- 
ney will  be  sold  at  one-third  the  first-class 
tariff  fare  only  to  persons  helding  certifi- 
cates of  the  standard  form  duly  signed  by 
Dr.  W.  H.  H.  Cobb,  president,  and  vised 
by  T.  J.  Witherspoon  (C.  T.  A.  S.  Rail- 
way) as  special  agent.  These  certificates 
will  be  svpplied  by  the  secretary. 

HOTEL    RATES. 

The  Central  Hotel,  which  has  ample  ac- 
commodations and  which  is  very  near  the 
hall  where  the  meeting  will  be  held,  will 
be  the  headquarters  of  the  Association,  and 
have  granted  a  rate  of  two  dollars  ($2.00) 
a  day  to  members  of  the  Association. 


Appendicitis  and  Renal  Colic. 

Dieulafoy,  in  a  clinical  lecture,  says  the 
British  Medical  Journal,  points  out  that  in 
some  cases  the  diagnosis  between  appendi- 
citis and  renal  colic  is  one  of  considerable 
difficulty.  A  patient  under  his  care  had 
two  years  previously  suffered  from  pain  in 
the  right  side  of  the  abdomen,  somewhat 
diffuse  in  character,  and  accompanied  by 
vomiting  and  constipation.  There  were 
three  attacks  in  all  at  different  times,  and 
on  one  occasion  the  diagnosis  was  thought 
to  lie  between  hepatic  and  renal  colic.      On 


the  last  occasion  it  was  noted  that  there 
was  no  tenderness  over  the  cascum,  and 
from  the  fact  that  there  was  severe  testicu- 
lar pain  the  medical  man  in  charge  of  the 
case  concluded  that  it  was  one  of  renal  colic. 
Dieulafoy,  who  saw  the  case,  however,  was 
inclined  to  doubt  the  diagnosis  of  renal 
colic,  as  there  was  no  tenderness  over  the 
kidney  :  and,  secondly,  from  the  fact  that 
the  testicular  pain  gradually  increased  in 
intensity  to  subside  in  the  same  manner  in- 
stead of  coming  on  suddenly  and  rapidly 
disappearing,  as  in  renal  colic.  The  case 
was  operated  on  by  Marion,  who  found  a 
curved  appendix  lying  behind  the  caecum. 
It  was  in  an  ulcerated  condition,  and  ad- 
herent to  the  psoas-iliacus.  In  this  situa- 
tion it  exerted  some  pressure  on  the  genito- 
crural  nerve.  In  point  of  fact,  this  nerve 
is  partly  distributed  to  the  cremasteric  and 
testicle,  and  it  is  to  its  irritation  that  the 
testicular  pain  of  renal  colic  is  due ;  conse- 
quently, the  result  in  an  appendicitis  of  this 
nature,  or  renal  calculus,  etc.,  will  be  the 
same  although  the  cause  is  different.  Dieu- 
lafoy states  that  in  very  many  cases  he  has 
noticed  a  certain  degree  of  similarity  in  the 
symptoms  of  appendicitis  and  stone  in  the 
kidney. 

Growing  Pains. 

Dr.  Bennie  says  that  "growing  pains" 
have  been  diagnosticated  by  him  less  fre- 
quently as  the  years  rolled  by,  and  that  cases 
which  have  been  classified  together  under 
this  name  are  the  following  : — Myalgia  from 
fatigue  :  this  is  the  commonest  variety, 
usually  about  the  knees  and  ankles  after 
unusual  exertion.  They  are  probabl/  due 
to  auto-infection  brought  about  by  excessive 
production  of  effete  materials  in  the  blood 
and  their  inefficient  elimination.  Elevating 
the  limbs  and  rubbing  with  the  palm  of  the 
hand  in  a  direction  towards  the  heart,  re- 
lieving venous  stasis  and  facilitating  a  sup- 
ply of  healthy  blood  to  the  exhausted 
muscles, promptly  quiets  the  pain.  Rheuma- 
tism :  This  is  second,  if  not  first,  in  fre- 
quency. There  are  slight  pain  in  the  joints, 
little  or  no  swelling,  and  very  mild  fever, 
and  hence  the  true  cause  is  recognised ;  but 
rheumatic  endocarditis  frequently  develops 
in  these  cases.  Diseases  of  joints  and  bones 
of  the  lower  extremities  :  Cases  of  hip-joint 
disease  and  suppurative  epiphysitis  of  the 
upper  end  of  the  fibula,  diagnosed  by  the 
laity  and  allowed  to  go  on  untreated,  are 
related  under  this  heading.  Fevers,  accom- 
panied by  pains  in  the  limbs,  in  one  in- 
stance proving  to  be  the  inception  of  typ- 
hoid fever, constitute  this  class.  The  malady 
"growing  pains,"  with  its  frequent  con- 
comitant, growing  fever,  like  its  congener, 


THECHARLOTTE  MEDICAL  JOURNAL. 


71 


disorders  of  dentition,  as  a  separate  morbid 
entity  exists  principally  as  an  article  of 
faith.  The  complaint  still  maintains,  how- 
ever, a  strong  hold  on  the  lay  mind,  and 
forms  an  extremely  common  lay  diagnosis, 
which  is  often  the  cause  of  much  suffering 
and  even  death. 


Certain  Points  of  Interest   in  Phthisis. 

II.  P.  Loomis  (Medical  Record)  con- 
cludes that  the  prognosis  of  phthisical  pa- 
tients with  poor  digestive  powers  is  very 
bad.  It  matters  little  what  their  lung-con- 
dition is,  they  seldom  recover.  Climate 
avails  little,  and  medication  is  worse  than 
useless.  When  assimilation  is  good,  the 
prognosis  is  always  favorable,  often  even 
with  desperate  lung-conditions.  Rapid 
heart-action  renders  the  prognosis  bad  when 
observed  in  a  beginning  tuberculosis.  Age 
modifies  the  type.  Phthisis  of  advanced 
age  is  often  latent  in  its  beginning,  slow  of 
advance,  tending  destruction  of  limited  por- 
tions of  the  lung.  Patient  often  linger  for 
years  when  provided  with  comforts  of  life, 
have  proper  food  and  a  fair  allowance  of 
stimulants.  Hemoptysis  early  in  the  disease 
does  not  affect  the  prognosis  one  way  or  the 
other,  especially  if  it  is  not  followed  by 
fever,  which  lasts  for  a  number  of  days. 
Heredity,  not  considered  as  the  causal  agent, 
has  very  little  to  do  with  the  patient's  chances 
of  recovery.  Alcoholic  subjects  do  badly. 
They  develop  rapid  hearts  and  dyspnea.  At 
any  place  of  altitude  the  dyspnea  and  hem- 
optysis increase.  Unless  a  patient  gains  in 
weight  he  is  not  doing  well,  no  matter 
which  way  his  other  symptoms  point.  Be- 
fore a  patient  can  gain  in  weight,  the  fever 
must  diminish  or  disappear,  the  assimila- 
tion must  be  good,  sleep  must  be  fair,  and 
sweats  stop.  A  person  with  a  strong  de- 
termination and  a  happy  disposition,  who 
has  made  up  his  mind  to  get  well,  has,  the 
author  believes,  a  far  better  chance  than 
one  with  a  nervous  disposition,  who  has  no 
inherent  reserve  power  and  who  is  easily 
influenced  by  his  surroundings.  The  location 
of  the  lesion  is  important.  A  man  in  the 
third  stage  with  a  cavity  at  the  apex  has 
more  chance  than  one  with  slight  tuberculous 
changes  scattered  throughout  the  lungs. 
The  prognosis  is  good  in  those  cases  which 
develop  secondnry  to  pleurisy. 

There  is  a  way  of  examining  the  lung, 
which  will  reveal  a  very  small  lesion.  The 
patient's  hand  is  placed  on  the  opposite 
shoulder,  the  ear  is  placed  over  that  portion 
of  the  lung  uncovered  by  the  scapula,  viz., 
just  above  and  external  to  where  the  bron- 
chial tubes  are  given  off  ;  there  will  be  heard 
prolonged  tubular  breathing  and   fine  rales 


on  coughing.  This  is  the  very  first  physi- 
cal sign  of  tuberculosis — an  evidence  which 
will  make  a  diagnosis  possible  weeks  be- 
fore the  signs  are  evident  in  front  and  be- 
neath the  clavicle.  These  signs  generally 
antedate  any  expectoration.  One  help  in 
the  diagnosis  of  doubtful  cases  is  often 
omitted,  although  very  important,  i.  e..  the 
tuberculin  test  By  its  aid  tuberculosis  in 
the  human  subject  can  be  detected  just  as 
accurately  as  in  cattle.  It  is  useful  both  in 
making  the  diagnosis  of  a  beginning  case 
and  in  deciding  if  a  case  is  cured.  It  is  to 
be  applied  in  the  following  manner  :  Take 
the  patient's  temperature  every  six  hours 
for  a  few  days  to  see  he  has  no  diurnal  tem- 
perature above  normal ;  then  inject  one-half 
milligram  of  tuberculin  and  have  his  tem- 
perature taken  every  four  hours  during  the 
next  twenty-four  hours.  At  the  end  of 
two  days,  if  there  has  been  no  temperature 
above  one  degree,  a  second  injection  of  two 
milligrams  should  follow ;  if  there  is  still 
no  reaction  after  two  days  more,  a  third 
and  final  injection  of  five  milligrams  is 
given.  If  there  is  still  no  reaction,  the  pa- 
tient is  free  from  tuberculosis.  A  newer 
aid  in  diagnosis  is  the  X-ray.  This  gives 
corroborative  evidence  and  enables  us  to 
recognize  the  extent  of  consolidated  areas 
and  cavities. 


The  Action  of  Mineral  Waters  and  Drugs 
on   the  Bile. 

W.  Bain  (Journal  of  Balneology,  July, 
1S98,)  records  investigations  he  has  carried 
out  in  the  case  of  a  man,  aged  forty-nine, 
with  a  permanent  cutaneous  biliary  fistula. 
He  comes  to  the  following  conclusions : 
The  amount  of  bile  secreted  in  the  twenty- 
four  hours  in  a  man  somewhat  below  me- 
dium height  and  weight  averages  77^  cc.m., 
and  the  bile  solids  15.8  grammes."  More 
bile  is  secreted  during  the  day  than  at  night. 
The  sulphocyanate  of  potaeh  in  the  saliva 
is  not  derived  from  the  biliary  salts.  The 
old  sulphur  spring  of  Harrogate,  Carlsbad 
mineral  water,  euonymin,  benzoateof  soda, 
salicylate  of  soda,  and  the  Kissingen  Spa 
Spring  of  Harrogate,  increase  both  the 
quantity  of  bile  and  bile  solids.  Podo- 
phyllo-resin  and  iridin  augment  the  bile- 
solids  without  appreciably  affecting  the 
quantity  of  bile.  The  strong  Montpellier 
Spring  of  Harrogate  and  podophyllo-toxin 
appear  to  diminish  slightly  both  the  quan- 
tity and  the  solids.  Hot  water  and  soda 
water  in  pint  doses  do  not  seem  to  increase 
the  biliary  secretion.  Salicylate  of  soda  in- 
creases the  excretion  of  uric  acid  in  the 
urine.  Dr.  Bain  also  gives  an  excellent  ac- 
count of  the   literature  of  the  subject. 


7:2 


THE  CHARLOTTE   MEDICAL  JOURNAL. 


Vaginal  Bacteria  in  Pregnancy. 

Since  Boderlein  published  his  monograph 
entitled  Das  vaginal  Secret  in  1892,  this 
subject  has  appeared  to  be  one  of  great  fas- 
cination to  large  numbers  of  gynaecologists, 
both  on  the  Continent  and  in  the  United 
States.  Unfortunately,  says  the  British 
Medical  Journal,  Nov.  12,1898,  the  bacteri- 
ological equipment  of  many  was  deficient, 
and  the  startling  results  at  which  the  earlier 
observers  arrived  have  fortunately  been 
proved  by  the  recent  careful  work  of  Krong 
in  Leipzig  and  Whitridge  Williams  in  Bal- 
timore to  be  due  largely  to  faulty  technique. 
Several  important  facts  seem  at  length  to 
have  been  established.  Doderlein  was  the 
first  to  isolate  from  the  vaginal  secretion  of 
pregnant  women  a  special  organism  which 
he  named  the  vagina  bacillus  ;  this  organism 
has  now  taken  a  definite  place  in  the  list  of 
the  bacterial  flora  of  the  human  body,  all 
observers  being  agreed  upon  its  occurrence 
and  its  morphological  characters.  Doder- 
lein further  endeavors  to  establish  its  claim 
to  be  regarded  as  one  of  the  chief  defences 
of  the  genital  tract  against  bacterial  inva- 
sion from  without.  He  attributed  to  it  the 
normal  acid  reaction  of  the  vaginal  secretion 
and  distinguished  two  kinds  of  secretion  in 
pregnant  women,  the  "normal"  and  the 
"abnormal."  The  former  was  acid  in  re- 
action, and  contained  vagina  bacilli  only; 
the  latter  was  neutral  or  alkaline,  and  from 
it  the  vagina  bacilli  had  disappeared,  their 
place  being  taken  by  various  organisms, 
some  of  which  were  pathogenic.  He  be- 
lieved, further,  that  he  had  proved,  by  ex- 
periment, that  udon  certain  pathogenic  or- 
ganisms, notably  steptococci,  the  vagina 
bacillus  exerted  a  powerful  germicidal  ac- 
tion ;  certainly  he  showed  that  the  healthy 
vagina  of  a  pregnant  woman  cannot  be  suc- 
cessfully inoculated  with  the  common  organ- 
isms of  suppuration,  but  his  efforts  to  show 
the  antagonism  of  cultures  were  less  suc- 
cessful. The  well-known  liability  to  infec- 
tion after  labour  he  attributed  to  the  ab- 
sence of  the  bacillus  which  is  washed  away 
by  the  liquor  amnii,  and  which  cannot  long 
exist  in  an  alkaline  medium  like  the  lochia. 
In  cases  in  which  the  vaginal  secretion  was 
"abnormal,"  Doderlein  urged  the  employ- 
ment of  antiseptic  douches  as  a  prophylac- 
tic measure,  and  was  a  strong  advocate  of 
the  possibility  of  autoinfection  in  pregnant 
women.  Fortunately  for  the  peace  of  mind 
of  the  accoucheur,  Kronig  and  Whitridge 
Williams  have  now  independently  proved 
that,  with  the  exception  of  the  gonococcus, 
pathogenic  organisms  do  not  occur  in  the 
vaginal  secretion  of  pregnant  women,  no 
matter  what  may  be  its  physical  characters. 
Doderlein' s  results  were  due  to  faulty  tech- 


nique, that  is,  to  insufficient  care  having 
been  taken  to  avoid  contamination  from  the 
vulva.  Upon  the  bactericidal  action  of  the 
vaginal  secretion  the  latter  observers  sup- 
port Doderlein.  Kronig  has  shown  that 
cultures  of  the  streptococci  introduced  into 
the  vagina  of  a  pregnant  woman  are  de- 
stroyed within  six  hours.  These  facts  have 
an  important  practical  bearing.  If  the  va- 
gina does  not  contain  pathogenic  organisms 
during  pregnancy,  autoinfection  from  the 
vagina  must  be  impossible  ;  and  the  occur- 
rence of  septic  infection  must  imply  that 
organisms  have  been  introduced  from  with- 
out. The  potent  bactericidal  action  of  the 
secretion  renders  douching  during  pregnan- 
cy not  only  superfluous  but  possibly  harm- 
ful. Lastly,  since  the  presence  of  strepto- 
cocci in  the  lochia  implies  the  occurrence  of 
streptococci  infection,  the  discovery  of  this 
organism  should  be  regarded  as  an  import- 
ant diagnostic  point  in  relation  to  morbid 
conditions  of  the  puerperium. 


Electricity    as  an  Aid   to  Diadermic  Medi- 
cation. 

Gilles  discusses  the  aid  of  electricity  in 
introducing  medicine  into  the  system 
through  the  skin,  and  states  that  it  is  not 
yet  certain  whether  process  is  merely  me- 
chanical— that  is,  one  of  cataphoresis — or 
truly  chemical — in  other  words,  electrolysis. 
(British  Medical  Journal).  The  assimila- 
tion has  been  proved  at  both  poles,  electro- 
positive bodies,  such  as  lithium,  being  best 
absorbed  at  the  anode,  and  electronegative, 
as  iodine,  at  the  cathode.  The  author  has, 
however,  succeeded  in  proving  that  the  ab- 
sorption of  iodine  takes  place  to  some  ex- 
tent at  the  anode.  The  drug  should  be 
given  in  dilute  solution,  the  surface  of  con- 
tact large,  the  density  of  the  current  ac- 
cordingly small,  and  its  intensity  as  high  as 
possible.  The  indifferent  pole  is  formed  by 
a  bath  of  salt  solution  into  which  the  hand 
or  foot  is  dipped,  the  active  by  a  local  bath 
applied  to  the  affected  part.  When  this  is 
impossible,  a  pad  of  wool  is  soaked  in  a 
solution  of  the  electrolyte  and  the  current 
distributed  through  it  by  means  of  a  pewter 
electrode.  Other  methods  are  detailed  by 
the  author  for  use  in  special  cases.  Chlo- 
ride of  lithium  given  diadermically  pro- 
duced excellent  results  in  4  cases  in  which 
the  administration  was  commenced  just  as 
the  attack  was  declining ;  in  2  others  there 
was  no  apparent  result.  Chronic  gout  was 
usually  unaffected,  though  in  2  cases  small 
tophi  disappeared  during  the  treatment. 
Acute  rheumatism  was  only  benefited  dur- 
ing convalescence,  but  the  administration 
of  lithium  in  this   way  restored  mobility  to 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


73 


several  joints  which  had  ankylosed  through 
the  disease  ;  in  a  case  of  rheumatoid  arth- 
ritis no  good  resulted.  In  chronic  rheuma- 
tism the  muscles  were  favorably  influenced, 
and  the  joints,  except  in  i  case,  improved, 
though  incompletely.  In  all  cases  pain  was 
alleviated,  at  any  rate  temporarily.  No 
therapeutic  effects  have  hitherto  been  ob- 
tained by  the  diadermic  use  of  bromide  of 
potassium.  The  author  next  proceeded  to 
investigate  the  possibility  of  using  iron  in 
the  same  way ;  he  employed  a  solution  of 
the  sulphate  to  which  a  small  quantity  of 
tartaric  acid  had  been  added.  The  current 
was  not  as  a  rule  more  than  20  milliam- 
peres  ;  the  foot  alone  could  be  employed,  as 
the  absorption  of  the  drug  produced  a  yel- 
lowish-brown tint  of  the  skin,  most  notice- 
able after  a  day,  and  persisting  for  several 
months.  In  chlorosis  and  simple  anaemia 
the  results  were  very  good,  the  gastric 
troubles  and  general  condition  rapidly  im- 
proving ;  in  neurasthenia  and  hysteria  they 
were  similar  to  those  from  other  electrical 
methods,  but  less  certain.  The  administra- 
tion of  iron  in  this  way  appears  to  have  a 
good  effect  in  cases  of  haemorrhage ;  1  of 
recurrent  epistaxis  was  particularly  bene- 
fited by  it.  The  method  is  evidently  worthy 
of  an  extendid  trial. 


under  the  care  of  a  skilled  physician.  We 
can  excuse  these  things  upon  the  part  of 
weak,  emotional  women.  But  how  sup- 
posedly strong  men,  men  of  brains,  force  of 
character,  and  judgment  necessary  to  attain 
eminence  at  the  bar,  can  be  a  party  to  such 
madness  is  beyond  comprehension  upon  any 
other  grounds  save  that  of  mental  aberration. 
In  this  case  and  in  others  the  father  should 
have  been  indicted  for  man-slaughter,  and 
should  have  been  punished. 


Christian-Science  Fanatics. 

Dr.  I.  N.  Love,  the  brilliant  editor  of  the 
St.  Louis  Medical  Mirror,  gives  the  Chris- 
tian .Science  people  his  opinion  as  follows  : 

Surely  one  who  has  lived  in  this  world 
for  any  length  of  time  ought  not  to  be  sur- 
prised at  anything.  And  yet  one  cannot 
suppress  a  feeling  of  astonishment,  mingled 
with  contempt,  to  see  sensible  people  car- 
ried away  by  the  fanaticism  of  Christian 
Science,  so-called.  Hardly  a  day  passes 
that  we  do  not  see  the  record  of  some  fla- 
grant case  of  neglect  and  death  traceable  to 
the  vagaries  of  Christian  Science.  It  is  but 
a  short  time  since  one  of  our  most  promi- 
nent attorneys  in  St.  Louis,  bearing  the 
title  of  Judge,  permitted  his  only  daughter 
to  suffer  for  several  weeks  with  typhoid 
fever,  and  cruelly  deprived  her  of  a  physi- 
cian, though  she  clamored  piteously  for 
one,  her  mother  responding  to  her  appeals 
only  with  the  assurance  that  if  she  only 
willed  it  she  was  not  sick,  forcing  her  to 
get  up  daily  and  dress  herself  and  go  about 
the  house  in  the  performance  of  light 
domestic  duties. 

The  result  of  course  was  death.  In  the 
face  of  this  experience  the  mother  sub- 
sequently died  from  cancer  of  the  womb, 
from  which  she  might  have  been  saved,  had 
the   case   been   placed   at   the   proper    time 


Tubercular  Peritonitis  in  Children. 

Dr.  Marfan  distinguishes  three  vatieties 
of  tubercular  peritonitis  in  children.  (Med- 
ico-Surgical Bulletin,  Dec.  25th,  1898). 

Ascites  tuberculosus  chronicus.  This  is 
the  most  frequent  form,  either  ending  in 
recovery  or  developing  into  peritonitis 
fibro-caseosa.  In  this  event  the  ascites 
diminishes  and  becomes  encapsulated  with 
the  gradual  production  of  tubercular  masses. 
Recovery  in  this  form  is  extremely  rare. 
An  abscess  usually  develops,  which  may 
rupture  into  the  intestines  or  externally  in 
the  umbilical  region.  .Sometimes  the  de- 
generated lymph-glands  form  fibrous  adhe- 
sions with  the  neighboring  tissues  and  lead 
to  the  third  variety. 

Peritonitis  tuberculosa  fibro-adhesiva.  In 
this  variety  occlusion  of  the  intestines  may 
result  from  the  overproduction  of  fibrous 
tissue.  Compression  of  the  liver  and  spleen 
may  also  take  place. 

In  the  medical  treatment  of  tubercular 
peritonitis  cod-liver  oil  and  creosote  or  its 
derivatives  are  of  value,  and  must  be  tried 
in  mild  cases,  as  tubercular  peritonitis  has 
in  many  cases  a  tendency  to  heal  sponta- 
neously. Laparotomy  is,  in  the  author's 
opinion,  indicated  in  :  Cases  of  peritonitis 
fibro-caseosa  with  ascites.  Localized  peri- 
tonitis with  encapsulated  fluid.  In  cases  of 
resulting  intestinal  obstructions. 


How  to  Avoid  Tuberculosis. 

H.  Tucker  Wise  (Med.  Record)  recom- 
mends the  following  to  maintain  health  and 
ward  off  a  recurrence  of  the  malady  : 

A  generous  dietary  of  nitrogenous  food. 
Free  ventilation  of  dwellings  and  sleeping- 
rooms  by  open  windows  with  wire-gauze 
blind.  Adequate  house-heating  in  winter. 
Boiling  of  all  milk  and  cream  previous  to 
use.  Eight  hours  of  sleep  should  be  ob- 
tained every  night,  if  not  sound  sleep,  con- 
tract the  hours  to  seven  and  rest  in  the  day. 
If  debilitated  with  weak  digestion,  rest  in 
the  recumbent  position  a  quarter  of  an  hour 
before  and  after  meals.  The  loosest  cloth- 
ing   possible    should    be    worn,    especially 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


round  the  waist  and  lower  ribs,  to  afford 
absolute  freedom  in  respiration.  System- 
atic exercise  daily  in  the  open  air  on  foot. 
If  means  and  station  in  life  admit  of  a  long 
holiday  from  time  to  time,  live  during  the 
weather  in  a  tent  in  the  open  air  or  in  a 
summer  house  for  most  of  the  day  ;  and,  if 
unemployed,  pursue  a  hobby  to  occupy  the 
mind. 


The  Old  Fashioned  Saddle  Bags. 

We  copy  the  following  encomium  on  the 
morality  of  "the  old-fashioned  saddle  bags" 
from  a  paper  read  before  the  Missouri  Val- 
ley Medical  Society,  at  Council  Bluffs,  la., 
Sept.  15,  1898,  by  S.  D.  Tobey,  M.  D.,  of 
Oakland,  Iowa. 

"To  conclude,  the  saddle  bags  were 
looked  upon  as  containing  an  element  of 
morality  which  communicated  itself  to  its 
surroundings.  Next  to  the  old  minister, 
the  family  physician  was  looked  to  for  ad- 
vice, and  was  trusted  to  warn  the  youth 
of  the  country  of  the  rocks  and  dangerous 
pitfalls  of  life.  He  would  be  called  to 
counsel  in  many  cases  too  delicate  for  even 
the  venerable  divine. 

"There  are  articles  which  are  now  con- 
sidered as  indispensable,  as  the  hypodermic 
syringe,  which  the  saddle  bags  did  not  con- 
tain. There  was  the  uterine  speculum  and 
the  uterine  sound.  I  do  not  mean  any  re- 
flection on  the  legitimate  use  of  these  use- 
ful instruments.  I  refer  to  a  use  of  them 
which  too  often  reflects  disgracefully  upon 
a  profession  that  of  all  others  ought  to  rep- 
resent the  highest  degree  of  honor,  hon- 
esty, integrity  and  morality. 

"By  no  means  do  I  intend  to  insinuate 
that  modern  surgeons,  as  a  class  are  guilty 
of  malpractice,  but  I  do  mean  to  assert  that 
in  every  town  of  any  size  there  is  always 
to  be  found  at  least  one  among  the  frater- 
nity who  could  be  depended  upon  to  assist 
the  unnatural  wife  in  her  efforts  to  avoid 
the  responsibilities  of  maternity,  or  to  assist 
the  unfortunate  victim  of  misplaced  confi- 
dence, or  perhaps  of  unholy  lust,  in  con 
cealing  the  evidence  of  her  disgrace.  The 
doctor  with  the  old  saddle  bags  would  have 
spurned  with  righteous  indignation  a  propo- 
sition of  such  an  unholy  nature. 

"In  proof  of  this  we  have  only  to  com- 
pare the  number  of  children  born  into  the 
average  family  fifty  years  ago,  with  the 
families  of  to-day. 

"Fifty  years  ago  the  average  young  lady 
possessed  organs  of  which  she  was  sup- 
posed to  be  entirely  ignorant  until  she  be- 
came a  married  woman.  If  she  had  a  head- 
ache, or  pain  in  the  side,  or  dragging  sen- 
sation in  the  pelvis,  her  mother  had  a  pri- 
vate    consultation    with    the    man    of    the 


saddle  bags,  and  as  a  result  the  girl  was 
given  some  tansy  tea,  and  a  few  days  rest, 
and  her  complaints  were  soon  forgotten. 
She  did  not  flounce  down  town  three  times 
a  week  to  her  favorite  doctor's  office  and 
plant  herself  in  the  operating  chair  with  as 
much  self  assurance  and  confidence  as 
though  it  were  merely  that  of  the  dentist. 
The  digital  examination,  the  introduction 
of  the  speculum  and  the  sound,  and  all  the 
modus  operandi  of  the  specialist,  which  it  is 
not  necessary  to  mention,  are  taken  as  a 
matter  of  only  ordinary  significance,  and 
bring  not  a  blush  nor  even  a  feeling  of  nat- 
ural revulsion  on  the  part  of  the  patient. 

"Thank  God!  The  vast  majority  of  our 
girls  have  been  blessed  with  mothers  of  too 
much  sense  for  this  state  of  affairs  to  become 
universal,  but  there  is  not  a  medical  man 
of  any  experience  who  does  not  feel  in  his 
heart  that  such  things  are  getting  altogether 
too  common  in  our  land  for  the  interests 
of  morality." 

Creosote  in  Chronic  Constipation. 

Vladimiro  de  Holstsin  ("Cronica  Med- 
ica")  finds  in  creosote  an  excellent  means 
of  combating  chronic  constipation  without 
exercising  any  purgative  action  properly  so 
called.  The  creosote  should  not  be  pre- 
scribed in  pills,  capsules,  or  alcoholic  solu- 
tions, but  pure  and  in  drops.  The  effective 
dose  is  about  seven  or  eight  drops  taken 
twice  daily,  immediately  after  breakfast, 
and  after  dinner,  in  a  glass  of  milk,  beer, 
wine  and  water,  or  pure  water.  To  begin 
with,  one  drop  of  creosote  is  administered, 
and  that  amount  increased  by  one  drop 
daily  until  the  desired  effect  is  obtained. 
In  this  way  the  necessary  dose  is  determined 
for  each  case  individually.  This  treatment 
has  to  be  coutinued  for  some  time,  some 
months  in  fact,  and  not  only  overcomes  the 
chronic  constipation,  but  at  the  same  time 
restores  the  appetite  and  braces  up  the  sys- 
tem. Under  its  influence  the  stools  become 
regular,  bland,  and  copious,  and  free  from 
pain  or  any  sign  of  intestinal  irritation. 

To  write  an  article  for  maids  and  mothers, 
and  then  to  make  it  so  interesting  that  it 
will  rivet  the  attention  of  the  fathers  of 
maids  and  husbands  of  wives,  is  a  guarantee 
of  very  wide  reading.  Professor  Thurston 
Peck,  of  Columbia  University,  has  succeed- 
ed in  doing  this  in  the  paper  which  he  de- 
votes to  women  in  the  January  Cosmopo- 
litan. Professor  Peck  has  a  keenly  analyt- 
ical mind,  and  he  weighs  the  pros  and  cons 
very  carefully.  His  conclusions  are  tender 
and  compassionate,  but  nevertheless  very 
emphatic.  It  is  a  valuable  contribution  to 
"New  Woman"   literature. 


THE  CHARLOTTE  MEDICAL  JOURNAL 


7:^ 


The  Gonorrheal  Ophthalmia  of    Infants. 

Dr.  N.  L.  North  presented  a  paper  on 
this  subject  at  the  New  York  State  Medical 
Association  (Boston  Medical  and  Surgical 
Journal,  Jan.  5,  1899). 

He  said  that  the  cause  of  the  disease  was 
the  introduction  of  the  gonorrheal  germ 
into  the  conjunctival  sac  and  the  growth  of 
the  same.  The  infection  might  be  received 
from  the  maternal  genitals  at  birth,  or  from 
the  mother  or  other  attendant  any  time  after 
birth.  In  case  the  mother  was  suffering 
from  gonorrhea,  the  longer  the  labor  was 
the  greater  was  the  danger  to  the  in- 
fant's eyes.  On  this  account  males  were 
more  frequently  affected  than  females  be- 
cause, by  reason  of  the  larger  size  and  the 
greater  hardness  of  their  heads,  more  delay 
was  occasioned  in  their  delivery.  The  mi- 
croscope enabled  us  to  make  a  positive  di- 
agnosis of  gonorrheal  ophthalmia.  As  to 
prophylaxis,  this  was  of  the  utmost  import- 
ance, and  the  antiseptic  precautions  now  so 
generally  used  in  regard  to  both  the  mother 
and  the  child  had  rendered  it  a  much  rarer 
disease  than  formerly.  The  prognosis  was 
grave,  and  the  blindness  of  75  per  cent,  of 
the  inmates  of  the  institutions  for  the  blind 
in  the  world  was  said  to  be  due  to  this  cause. 

When,  however,  prompt  and  efficient 
treatment  was  resorted  to  there  were  few 
affections  in  which  more  satisfactory  results 
could  usually  be  obtained.  By  the  applica- 
tion of  a  2  per  cent,  solution  of  nitrate  of 
silver  to  the  eyes  of  every  infant  born  in  it 
Crede  reduced  the  mortality  in  his  own  hos- 
pital at  Leipsic  from  75  per  cent,  to  almost 
nothing.  For  this  prophylactic  treatment 
Dr.  North  believed  that  a  saturated  solution 
of  boric  acid  was  quite  as  efficient  as  nitrate 
of  silver,  and  it  had  the  advantage  that  its 
use  was  followed  by  no  reaction.  Having 
given  a  resume  of  the  symptoms,  he  de- 
scribed the  treatment  which  he  usually  em- 
ployed. 

The  lids  having  been  carefully  opened 
and  all  discharge  cleaned  away,  a  solution 
of  nitrate  of  silver  of  the  strength  of  from 
ten  to  forty  grains  to  the  ounce,  according 
to  the  circumstances  of  the  case,  was  ap- 
plied by  means  of  the  toothpick  applicator. 
The  eyelashes  were  then  anointed  with  a 
little  vaseline,  squeezed  from  a  collapsing 
tube,  to  prevent  gluing  of  the  lids  and  re- 
tention of  discharges.  Cold  applications 
were  kept  up  continuously,  and  the  nitrate 
of  silver  once  in  twenty-four  hours.  Of 
late  he  had  employed  a  solution  of  formalin 
(or  formaldehyde)  of  the  strength  of  1  to 
1,000,  and  had  been  much  pleased  with  its 
effects.  He  had  found  that  when  using  this 
a  much  weaker  solution  of  nitrate  of  silver 


was  required,  and  a  weak  solution  could  be 
applied  by  the  nurse  as  often  as  desired. 
Formaldehyde  had  no  harmful  effect  upon 
the  structure  of  the  cornea,  and  he  consid- 
ered it  a  most  valuable  addition  to  our  means 
of  treatment.  These  cases  requiring  the 
continuous  application  of  cold  compresses 
and  the  free  use  of  antiseptics,  naturally 
demanded  the  constant  and  most  careful 
attention  of  both  the  physician  and  the  at- 
tendants. 


Syphilis  in  the  Third  Generation. 

The  alleged  transmission  of  syphilis  to 
the  third  generation — that  is  to  say  its  trans- 
mission from  an  individual  to  his  or  her 
grandchildren,  is  a  question  not  only  of 
great  theoretical  interest,  but  also  of  no 
little  practical  importance.  The  report, 
says  the  British  Medical  Journal,  Dec.  24, 
1898,  of  the  Committee  of  the  Royal  Col- 
lege of  Physicians  of  London  on  Syphilis 
in  the  Army,  presented  last  year,  ap- 
peared to  assert  or  assume  that  such  trans- 
mission did  occur.  The  evidence  for  such 
an  occurrence  has  been  re-examined  by  Dr. 
George  Ogilvie,  and  a  study  of  the  series 
of  alleged  instances,  which  he  has  collected 
from  literature  with  much  industry  and 
marshalled  with  great  skill,  hardly  seems 
to  warrant  the  conclusion  to  which  he  comes 
(not  it  would  seem  without  reluctance)  that 
evidence  affords  not  indeed  absolute  proof, 
but  a  "reasonable  probability"  that  syphilis 
may  descend  to  the  third  generation.  C. 
Hochsinger  also  has  recently  studied  the  list 
of  published  cases,  and  has  laid  down  the 
conditions  which  must  be  fulfilled  by  any 
case  which  can  be  accepted  as  proving  the 
occurrence  :  ( 1 )  It  must  be  proved  that  the 
grandparent  or  grandparents  had  syphilis 
before  the  conception  of  the  parent.  (2) 
It  must  be  proved  that  a  parent  (second 
generation)  had  congenital  syphilis,  and 
this  can  only  be  done  if  the  individual  is 
seen  and  treated  in  infancy,  or  if  a  series 
of  quite  characteristic  lesions  are  mani- 
fested at  a  later  age.  (3)  It  must  be  proved 
that  neither  of  the  parents  has  suffered  from 
acquired  syphilis,  and  finally  (4)  It  must  be 
proved  that  the  child  (third  generation)  is 
really  suffering  from  hereditary  and  not 
from  acquired  syphilis.  It  is  on  the  third 
head  that  most  of  the  alleged  instances 
break  down,  and  Hochsinger's  conclusion  is 
that  there  is  not  a  single  case  on  record  in 
which  the  evidence  is  conclusive.  It  will 
be  generally  admitted  that  a  very  different 
fate  may  attend  the  products  of  conception 
of  parents  one  or  both  of  whom  have  suf- 
fered from  syphilis.  In  a  large  but  undeter- 
mined number  of  instances  the  foetus  dies  in 
utero  if  the  disease  is  in  an  active  stage  in 


76 


THE  CHARLOTTE  MEDICAL   JOURNAL. 


the  parents.  The  child,  if  born  alive,  may 
succumb  in  early  infancy  to  the  severity  of 
the  disease,  or  it  may  present  the  well 
known  lesion  of  hereditary  infantile  syph- 
ilis, and  under  suitable  treatment  reach  the 
adult  age,  either  without  further  manifes- 
tations or  after  suffering  from  the  well 
known  lesions  of  late  hereditary  syphilis. 
When  it  has  reached  the  adult  age  the  indi- 
vidual may  present  obvious  traces  of  the 
disease,  not  only  in  lesions  of  mucous  mem- 
brane, skin,  teeth,  and  bones,  but  also  in 
general  stunting  of  growth  and  feebleness 
of  health.  On  the  other  hand  a  child  which 
has  suffered  from  inherited  syphilis  in  in- 
fancy may  be  thoroughly  robust,  and  show 
no  traces  of  the  disease  when  it  reaches  the 
adult  age.  The  proof  that  such  individu- 
als have  recovered  completely  from  the  dis- 
ease is  afforded  by  the  fact  that  they  are 
liable  to  acquire  syphilis.  How  often  this 
occurs  cannot  be  stated,  but  that  it  does 
occur  there  can  be  no  doubt.  These  indi- 
viduals, at  least,  could  not  have  transmit- 
ted the  disease  of  the  fathers  to  the  third 
generation.  Not  a  little  of  the  importance 
of  syphilis  from  the  point  of  view  of  pub- 
lic policy  is  due  to  the  circumstance  that  in 
addition  to  the  sickness  and  premature 
deaths  which  it  causes  among  those  who 
acquire  it,  it  has  a  serious  effect  in  dimin- 
ishing fecundity  and  in  increasing  the 
death  rate  of  the  children  which  are  born 
alive.  If  a  woman  have  borne  one  syphi- 
litic child  it  will  usually  be  found  that  the 
mortality  is  very  high  among  her  offspring 
born  later,  even  if  they  do  not  present  ob- 
vious signs  of  hereditary  syphilis. 


A  Speedy  Method  of  Dilating  the  Rigid  Os. 

Dr.  J.  Farrar  (British  Medical  Journal) 
in  a  paper  read  before  the  section  of  Ob- 
stetrics, British  Medical  Association,  men- 
tions a  rapid  method  of  overcoming  this 
troublesome  condition,  which  is  best  de- 
scribed by  the  following  illustrative  cases 
and  comments  : 

Case  1. — I  had  been  in  attendance  on  a 
primapara  on  and  off  for  some  48  hours. 
The  os  was  thin,  rigid,  and  obstinately  un- 
yielding; frequent  attempts  at  stretching 
it,  first  with  the  finger,  then  with  a  me- 
chanical dilator,  both  with  chloroform  and 
without  it,  and  afterwards  with  india  rub- 
ber bags,  had  all  proved  futile  ;  as  had  also 
the  internal  exhibition  of  approved  medi- 
caments, chloral  hydrate,  bromide  of  po- 
tassium, morphine,  etc.  In  spite  of  these 
attempts,  however,  the  os  still  remained 
firm,  its  margin  feeling  almost  like  a  circle 
of  sheet  tin,  and  its  orifice  not  larger  than 
a  shilling.     The  pains    were    very    strong, 


frequent,  and  almost  persistent,  and  the  pa- 
tient— who  was,  I  should  add,  a  deaf  mute 
— was  losing  self-control.  The  case  was 
therefore  becoming  serious,  and  as  it  was 
necessary  that  relief  should  be  given  with- 
out further  waiting,  I  determined  to  incise 
the  margin  of  the  os.  The  woman  being, 
as  I  have  said,  a  deaf-mute,  and  exceed- 
ingly frightened  and  despondent  at  the  con- 
dition of  matters,  I  could  not  on  the  one 
hand,  as  in  ordinary  cases,  talk  and  reason 
with  her,  and  tell  her  what  I  proposed  to 
do ;  and,  on  the  other  hand,  I  scarcely 
thought  it  prudent  to  alarm  her  by  the  pain 
she  would  feel  on  the  incision  being  made, 
as  this  would  probably  make  her  quite  un- 
manageable ;  and  as,  further,  the  adminis- 
tration of  chloroform  was  contraindicated 
owing  to  symptoms  of  approaching  exhaus- 
tion, I  had  only  local  anesthesia  left  to  me. 
The  anesthetic  I  chose  was  cocaine.  With 
a  10  per  cent,  solution  of  the  hydrochlorate 
on  a  piece  of  rag  I  smeared  the  os  round 
and  round,  first  on  the  outside  and  then 
within,  finally  leaving  the  rag  within  the 
margin  and  the  head  of  the  child.  At  the 
end  of  four  minutes,  by  which  time  I  con- 
sidered anesthesia  would  be  sufficiently  ad- 
vanced for  my  purpose,  judge  of  my  aston- 
ishment— and  I  may  say,  my  gratification — 
when  on  introducing  the  scissors  to  make 
my  limited  incisions,  I  found  the  os  had  not 
only  lost  its  rigidity,  but  that  it  was  widely 
open,  and  as  flexible  and  distensible  as  a 
rubber  bag.  How  had  this  sudden  change 
in  the  physical  condition  of  the  os  been 
brought  about?  Was  it  one  of  those  strik- 
ing cases  of  coincidence  which  the  medical 
man  meets  with  occasionally,  or  was  it  ow- 
ing to  the  application  of  the  cocaine?  It 
struck  me  very  forcibly  that  mere  coinci- 
dence could  not  satisfactorily  explain  the 
phenomenon.  The  change  was  too  strik- 
ing and  too  suddenly  brought  about ;  and  I 
felt  strongly  that  coincidence  had  nothing 
to  do  with  it,  but  that  it  was  the  cocaine, 
and  nothing  but  the  cocaine,  that  I  must 
credit  with  the  alteration.  However,  before 
venturing  to  publish  the  case,  I  decided  to 
wait  for  an  opportunity  of  further  testing 
this  supposed  power  of  the  drug,  and  luck- 
ily, I  had  not  long  to  wait ;  for  in  a  couple 
of  month's  time  I  had  a  case  which  I  felt 
would  prove  to  be  a  severe  test  for  the 
experiment. 

Case  2. — This  patient  also  was  a  prima- 
para, but  one  over  40  years  of  age.  The  os 
was  obstinately  rigid,  the  pains  very  strong 
and  frequent ;  there  was  a  suspicion  of  ap- 
proaching exhaustion,  and  also  much  de- 
spondency on  the  part  of  the  woman  at  the 
slow  progress  she  was  making — for  she  had 
been  in  labor  nearly  3  days.      After  waiting 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


nearly  this  length  of  time  to  give  nature 
every  chance,  I  applied  the  solution  of  co- 
caine, but  not,  I  must  confess,  without  some 
degree  of  "fear  and  trembling,"  as  to 
whether  the  result  would  confirm  my  ardent 
wishes,  or  leave  me  disappointed.  But  lo, 
and  behold !  in  four  minutes'  time  the  os 
yielded,  and,  as  in  the  former  case,  was  now 
so  distensible  that  I  was  easily* enabled  to 
slip  it  over  the  head  of  the  child,  and  com- 
plete the  delivery  in  due  course.  After  this 
I  felt  there  could  be  no  question  as  to  what 
had  brought  about  this  sudden  and  striking 
change  in  the  physical  condition  of  the  os. 
Surely  it  could  not  simply  be  an  accident  of 
time — a  coincidence  merely,  but  rather  the 
direct  result  of  an  applied  and  active  cause, 
this  being  the  application  of  the  cocaine, 
and  nothing  but  the  cocaine.  The  author 
reports  three  additional  cases  in  all  of  which 
the  method  was  equally  successful. 


Utero-Intestinal  Fistula. 

Neugebauer  has  issued  valuable  tables  of 
28  cases  of  utero-intestinal  fistula  (Epitome 
British  Medical    Journal,  Dec.  10,  1S98). 

In  12  the  fistula  was  not  detected  till  after 
death;  in  21  the  patients  were  pregnant  or 
recently  delivered.  In  11  of  these  cases  the 
fistula  was  due  to  retained  foetus,  "missed 
labor."  In  1  very  unusual  case  the  patient 
had  yellow  fever  in  the  fourth  month  of 
pregnancy.  The  vomiting  set  up  abortion, 
followed  by  fatal  peritonitis.  A  commu- 
nication 4  inches  wide  was  found  between 
the  intestine  and  the  uterq-vaginal  canal 
(Rheinische  Monatschrift  fur  fraktisch 
Acrztc,  1850,  p.  574)-  I"  9  the  fistula  oc- 
curred from  injuries  at  delivery,  or  puerpe- 
ral complications.  Thus  in  2  cases  the  in- 
jury was  due  to  the  forceps,  in  1  to  version, 
in  1  to  manual  detachment  of  the  placenta; 
3  other  cases  are  indefinite  in  this  respect, 
but  apparently  some  injury  during  labor  ex- 
plains them.  There  remain  7  cases  where 
the  patients  were  not  pregnant  but  recently 
delivered.  Two  were  purely  teratological 
in  newborn  children.  In  two  the  fistula 
was  caused  by  rupture  of  a  hamiatometra 
into  the  rectum,  in  2  by  evacuation  of  pus 
from  a  suppurating  myoma,  in  1  from 
precisely  the  same  condition  there  being 
also  tuberculosis  of  the  intestine.  As  to 
the  part  of  the  intestinal  canal  involved, 
the  communication  of  the  uterine  cavity 
was  with  the  stomach  in  2  cases,  the  rectum 
in  9,  the  sigmoid  llexure  in  3,  the  transverse 
colon  in  1,  some  part  of  the  large  intestine 
not  specified  in  2,  and  the  small  intestine  in 
12.  This  series  includes  some  repetitions, 
as  in  1  case  there  was  a  fistula  involving 
the  small  intestine  and  the  sigmoid  flexure, 


in  1  there  were  three  small  intestinal  fistula?, 
and  in  1  as  many  as  three  rectal  fistula ; 
there  was  also  a  double  case  of  this  type 
not  clearly    defined. 

More  distinctly  the  individual  28  cases 
are  thus  classified  :  Utero-gastric  fistula,  2  ; 
utero-intestinal  (small),  11;  utero-colic,  or 
utero-rectal,  14;  unspecified  case  1.  No 
fewer  than  14  of  the  28  died.  Of  the  14 
recoveries,  spontaneous  closure  occurred  in 
11.  This  seems  the  rule  when  the  fcetal 
relics  are  evacuated  in  "missed  labors."  In 
one  forceps-injury  case  the  fistula  did  not 
close  for  years.  In  1  case  the  os  externum 
was  closed  by  sutures  after  paring  of  its 
edges,  so  that  the  catamenia  drained  into 
the  intestine.  Resection  of  the  fistulous 
portion  of  intestine  was  successfully  per- 
formed in  2  cases  through  an  abdominal  in- 
cision ;  in  1  case  abdominal  section  was  un- 
dertaken in  order  to  remove  a  foetus,  re- 
tained in  the  uterus  which  was  incompletely 
ruptured.  Fasces  and  ascarides  had  issued 
from  the  uterus,  which  communicated  at 
the  fundus  with  the  small  intestine.  The 
Datient  died.  In  another  fatal  laparotomy 
the  uterus  and  intestine  were  separated  and 
the  fistulas  closed  by  suture.  Resection  of 
the  intestine  would,  it  was  admitted'  have 
been  safer.  Nine  died,  unoperated  upon, 
by  exhaustion  and  pyaemia ;  2  from  tuber- 
culosis ;  1  from  yellow  fever.  The  2  tera- 
tological cases  were  naturally  fatal.  Treat- 
ment answers  better  than  operation,  con- 
sidering the  circumstances  under  which 
utero-intestinal  fistula  is  usually  seen.  Re- 
moval of  the  source  of  irritation — generally 
retained  foetal  bones — ensures  cure.  The 
2  cases  of  operation  for  closure  of  the  bowel 
from  the  original  aspect  proved  failures. 

Quinin    in   Malarial    Fever. 

Dr.  Robert  Koch  having  had  the  temerity 
to  declare  that  the  "black- water  fever"  of 
South  Africa  is  really  "quinin  poisoning," 
has  most  effectually  injjjred  the  reputation 
of  quinin,  at  least  in  the  minds  of  the  laity 
in  South  African  territory,  and  has  thereby 
occasioned  a  heated  discussion  in  British 
medical  journals  and  societies.  Dr.  Koch's 
opinion  is  not  excepted  by  the  English 
physicians  who  are  resident  in  South  Africa, 
and  they  vehemently  protest  that  it  is 
superficial  and  fallacious,  arguing  with 
liberal  references  to  long  experiences,  which 
show  that  black-water  fever  patients  re- 
cover quickly  if  treated  promptly  with 
heroic  doses  of  quinin — that,  in  the  words 
of  Dr.  R.  U.  Moffat  of  Uganda  (British 
Medical  Journal,  Sept.  24,  1898),  "there  is 
only  one  treatment  for  malaria  :  quinin. 
more  quinin,  and  yet  more  quinin." — Am. 
Therapist,  November. 


78 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


The  Operative  Treatment  of  Cancer  of  the 
Breast. 

In  a  recently  delivered  clinical  lecture  on 
Halsted' s  operation  for  the  removal  of  can- 
cer of  the  breast,  Butlin  (The  Hospital, 
Dec.  10,  189S)  speaks  very  highly  of  that 
proceeding,  which,  since  the  year  1895,  he 
has  made  his  routine  proceeding.  It  should 
be  noted  that  the  researches  of  Heidenhain 
and  Stiles  have  shown  that  cancer  of  the 
breast  spreads  rapidly  backwards  towards, 
and  then  into,  the  pectoral  fascia,  even 
when  there  appears  to  the  naked  eye  to  be 
a  considerable  interval  between  the  poste- 
rior border  of  the  tumor  and  the  fascia. 
Moreover  there  is  considerable  difficulty  in 
satisfactorily  separating  the  fascia  from  the 
muscle,  and  both  the  investigators  agree  in 
believing  that  the  cancer  cells  are  so  soon 
and  so  widely  conveyed  by  the  lymphatics 
of  the  breast,  and  especially  towards  the 
pectoral  fascia,  that  the  disease  is  not  en- 
tirely removed  by  the  operations  usually 
performed.  Although  they  differ  in  cer- 
tain details  as  to  the  direction  of  distribu- 
tion by  the  lymphatics  they  both  agree  that 
the  whole  breast  should  be  removed.  It 
appeared,  then,  to  Mr.  Butlin,  that  an  op- 
eration designed  to  remove  thoroughly  all 
the  structures  in  which  the  cancer  of  the 
breast  may  be  disseminated  would  be  the 
means  of  saving  the  lives  of,  at  least  some 
women  affected  by  the  disease,  and  that 
of  the  various  operations  which  had  been 
proposed,  the  one  designed  and  practised 
by  Halsted  best  fulfilled  the  requirements. 

In  this  operation  everything  which  is  re- 
moved comes  away  in  one  continuous  mass, 
and  this  mass  contains  the  whole  of  the 
mammary  gland,  the  whole  of  the  pectoral 
muscle,  with,  perhaps,  the  exception  of  the 
clavicular  portion,  the  fascia  beneath  the 
pectoral  muscle  and  that  in  front  of  and 
behind  the  lesser  pectoral,  the  loose  connec- 
tive tissue  on  the  side  and  back  walls  of  the 
axilla,  the  fat  and  all  which  it  contains  right 
up  to  the  clavicle.  This  operation  is,  of 
course,  a  serious  one,  but  if  care  is  taken  to 
lessen  the  hemorrhage  by  operating  delib- 
erately and  taking  up  every  vessel  as  soon 
as,  or  even  before  it  bleeds,  it  is  not  more 
dangerous  than  any  other  large  operation 
for  the  same  disease.  Between  the  begin- 
ning of  1895  and  the  end  of  1897  Mr.  But- 
lin has  performed  it  33  times  with  but  one 
death. 

Now  as  to  results.  Taking  those  that 
have  been  done  three  years  and  over,  there 
are  thirteen  cases  only  to  consider,  and,  of 
these,  nine  were  alive  and  well  when  last 
seen  or  heard  of  (from  their  medical  men) 
at  periods  of  from  three  to  four  years  after 
the  operation.      In  more    than  one  of    the 


successful  cases  the  glands  in  the  axilla 
were  cancerous. 

In  none  of  the  cases  did  he  remove  the 
supraclavicular  glands  for  he  is  inclined  to 
agree  with  Cheyne  in  thinking  that  cases  in 
which  these  are  affected  are  hopeless.  But 
on  that  point  he  reserves  his  opinion.  Mr. 
Butlin  says  that  he  is  not  so  sanguine  as  to 
believe  that  surgeons  are  going  to  cure  every 
case  of  cancer  of  the  breast  at  some  not  far 
distant  time,  but  he  does  believe  that  far 
better  results  will  be  secured  in  the  future 
than  we  have  been  accustomed  to  in  the 
past ;  and  if  the  results  given  by  Mr.  Wat- 
son Cheyne  and  by  Prof.  Halsted  are  added 
to  those  which  he  now  describes,  it  will  be 
found  that  out  of  forty-two  patients  treated 
by  the  three  operators,  more  than  three 
years  ago  twenty-three  are  still  alive  and 
well,  or  have  died  of  some  other  cause 
than  cancer  after  passing  the  three  year's 
limit.  "And  these  results  have  been  se- 
cured under  the  most  disheartening  circum- 
stances. There  is  hardly  a  single  case  in 
which  the  disease  was  not  known  to  have 
existed  for  several  months,  and  in  many  of 
them  it  had  been  noted  for  one,  two,  or 
more  years.  There  were  several  of  them  in 
which  the  primary  tumour  was  ulcerated, 
and  several  in  which  the  axillary  glands 
were  filled  with  cancer." 

We  think  that  these  results  should  be 
taken  note  of,  for  if  once  the  general  prac- 
titioner gets  rid  of  the  pessimism  with 
which  the  whole  subject  was  overlain  a  few 
years  ago,  and,  indeed,  still  is  in  the  minds 
of  many  men,  cases  will  be  sent  up  for  op- 
eration at  a  far  earlier  date  than  has  hith- 
erto been  the  case,  and  the  results  may  thus 
become  proportionally  better. 


Appendicitis  during  Pregnancy. 

Bouillier,  in  the  British  Medical  Journal 
Dec.  10,  1898,  discusses  this  subject  on  a 
basis  of  22  observations,  considering  (1) 
the  influence  of  pregnancy  on  appendicitis. 
(2)  the  influence  of  appendicitis  on  preg- 
nancy. As  to  the  first  point  he  concludes 
that  pregnancy  plays  no  part  as  an  etiologi- 
cal factor  in  the  causation  of  appendicitis. 
The  pregnant  woman  is  not  more  subject  to 
this  form  of  inflammation  than  the  non- 
pregnant. The  influence  of  appendicitis  on 
pregnancy  is,  on  the  other  hand,  well  marked. 
In  7  out  of  the  22  cases  abortion  at  about 
the  fourth  month  resulted,  either  before  or 
after  surgical  treatment.  Spontaneous 
abortion  may  be  due  either  to  the  febrile 
condition  and  the  affection  of  the  general 
health,  or  to  infection  of  the  pelvic  organs 
from  the  appendix  ;  possibly  to  both  factors. 
The  mortality  in  the  22  cases  was  :  Maternal, 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


30.4  per  cent.  ;  foetal,  47.8  per  cent.  ;  con- 
sequently pregnancy  renders  the  prognosis 
of  appendicitis  more  serious.  The  treat- 
ment is  that  of  appendicitis,  the  pregnancy 
not  constituting  a  contraindication.  Early 
intervention  is  desirable,  since  if  the  case 
be  left  there  is  a  grave  danger  of  puerperal 
complications  due  to  general  infection  or  to 
direct  infection  of  the  pelvic  organs. 


Tuberculosis  and   the   Milk   Supply. 

Delephine,  (The  Lancet  of  Sept.,  17, 
1898,)  states  that  healthy  cowsheds,  well 
lighted  and  ventilated,  easily  cleaned,  ar- 
ranged so  as  to  separate  the  animals  as 
completely  as  possible  from  each  other  and 
to  prevent  the  food  and  litter  of  one  from 
being  contaminated  by  others,  Good  water- 
supply.  After  discovery  of  a  tuberculous 
animal,  thorough  disinfection  of  its  stall, 
and  if  possible  of  the  whole  shed.  Isolation 
sheds  of  the  same  kind  for  cattle  found  to 
be  affected  with  a  moderate  or  slight  degree 
of  tuberculosis.  Stalls  well  isolated  from 
the  others  might  be  provided  in  this  shed 
for  animals  which  have  not  been  tested  and 
have  to  be  kept  in  quarantine  until  tested, 
or  better  still,  a  special  testing  shed  fre- 
quently disinfected  might  be  provided. 
Immediate  slaughter  of  all  cows  in  advanced 
state  of  tuberculosis.  Fattening  of  cows 
with  moderate  tuberculosis,  these  cows  not 
to  be  allowed  to  come  again  at  any  time  in 
contact  with  the  healthy  ones.  Any  dairy 
produce  from  these  tuberculous  cows  to  be 
sterilized.  If  butter  be  made  the  cream 
should  be  treated  for  some  time  at  85  deg. 
which  does  not  interfere  with  the  making 
of  good  butter  (Bang).  Tuberculous  cows 
should,  however,  be  fattened  as  soon  as 
possible  and  their  milk  used  for  as  short  a 
time  as  possible.  Tuberculous  cows  with 
tuberculous  udders  arc  usually  in  a  state  of 
advanced  tuberculous,  but  in  many  cases  a 
cow  with  tuberculous  udder  should  be 
slaughtered  at  once.  All  calves  to  be  fed 
from  the  first  on  sterilized  milk.  The 
thoroughly  sterilized  milk  of  tuberculous 
cows  might  be  used  for  this  purpose.  To 
avoid  the  other  sources  of  deterioration 
which  the  author  has  mentioned :  The 
udder  and  milkers'  hands  should  be  kept 
absolutely  clean  The  milk  cans  or  pails 
should  be  washed  with  boiling  water  or 
sterilized  by  steam.  This  milk  should  be 
cooled  immediately  after  being  milked  and 
its  temperature  kept  below  40  deg.  F.  until 
it  is  treated  in  the  dairy  (by  lilt  rat  ion  separa- 
tion, sterilization,  etc.)  Milk  which  has 
not  been  sterilized  and  which  has  to  be  sent 
by  rail  from  the  dairy  to  a  distance  should 
be  kept  by  packing  in  ice  or  otherwise  at  a 


temperature  below  40  deg.  F.,  if  possible, 
until  it  reaches  the  consumer.  The  same 
precautions  with  regard  to  cooling  apply  to 
all  milk  which  cannot  be  consumed  within 
a  few  hours — say  eight  or  ten  hours  at  the 
most — from  the  time  of  milking.  The 
authorities  should  be  asked  to  regulate  the 
importation  of  foreign  milk  and  dairy  pro- 
duce with  a  view  to  insure  that  the  precau- 
tions above  mentioned  have  been  duly  taken 
to  insure  the  wholesomeness  of  these  pro- 
ducts. The  authorities  should  be  asked  to 
find  the  means  to  prosecute  and  punish 
adequately  all  kinds  of  neglect  rendering 
milk  dangerous  to  health,  so  as  to  place  the 
farms  and  dairies  where  proper  precautions 
are  taken  on  a  fair  footing  in  the  general 
competition. 

A  Good  Rule  for  the  Country  Doctor. 

It  is  often  the  source  of  much  worry  and 
bother  after  we  have  been  ten  miles  in  the 
country  to  see  a  patient,  and  leave  direc- 
tions for  their  welfare,  and  instructions  for 
a  report  on  the  following  day  as  to  how  he 
is  progressing  and  the  results  obtained  from 
the  medicine  given. 

The  next  day  comes  and  John  is  told  to 
saddle  old  Kate  (a  mule  that  John  has  rid- 
den since  his  first  experience  on  horse-back) 
and  go  down  to  town  and  tell  Dr.  Solomon 
how  your  pa  is  to-day.  John  has  not  been 
in  the  room  an  hour  altogether  since  the 
doctor  was  there,  and  is  supposed  to  know 
exactly  how  his  father  is,  and  does  not 
realize  that  he  knows  less  than  nothing 
about  his  father's  condition  until  the  doctor 
begins  asking  him  questions  concerning  his 
father.  Then  to  the  embarrassment  of  John 
and  worry  of  the  doctor,  they  both  find  that 
the  old  mule  made  the  trip  for  no  purpose, 
for  the  doctor  has  to  go  back  to  see  how  to 
make  his  prognosis.  Whose  fault  is  it  that 
such  things  occur?  It  is  not  the  boy's,  for 
a  boy  never  thinks ;  it  is  not  the  nurse's 
that  have  just  been  installed,  for  they  don't 
know  what  you  ought  to  know.  So  we 
will  have  to  lay  a  good  part  of  the  blame 
to  ourselves. 

A  good  rule  to  follow  when  you  expect  a 
report  the  next  day,  is  to  outline  such  symp- 
toms as  you  most  desire  watched  and  re- 
ported on,  and  you  will  be  much  pleased 
with  the  results. 

By  instructing  the  family  about  such 
actions  as  you  expect  from  the  medicine, 
you  will  often  save  them  alarm  and  your- 
self a  midnight  ride. 

No  one  can  appreciate  an  intelligent  re- 
port of  their  patient's  condition  until  he  is 
worn  from  long  rides  and  loss  of  sleep,  then 
he  will  readily  talk  to  the  family,  and  have 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


his  list  of  questions  to  be  answered  before 
the  messenger  leaves  home. 

J.  R.  Gilbert,  M.  D. 
Ranger,  Texas. 


The    Value  of   Casts   in    the    Prognosis  of 
Albuminuria. 

According  to  L.  Bard  the  persistence  of 
albumen  in  the  urine,  after  an  attack  of 
parenchymatous  nephritis,  is  compatible 
with  a  complete  substance  of  the  inflamma- 
tory process  in  the  kidney.  (Medicine, 
January,    1S99). 

In  parenchymatous  nephritis  the  most 
pronounced  degenerative  changes  are  in  the 
epithelial  cells  of  the  tubules.  If  the  inflam- 
mation subsides,  the  cells  may  be  restored 
to  their  normal  condition.  However,  if 
the  newely  formed  cells  are  imperfectly  re- 
generated, the  lining  of  the  tubules  may 
resemble  somewhat  scar  tissue,  and  perfect 
physiological  activity  of  the  kidney  is  not 
to  be  expected.  An  analogous  pathological 
condition  results  from  superficial  burns  of 
the  skin ;  the  thin  epidermis  that  is  regene- 
rated is  never  capable  of  the  normal 
function  of  the  skin.  Kidneys  the  seat  of 
the  cicatricial  changes  described  may  secrete 
albumen  in  the  urine,  and  the  author 
designates  the  affection  as  • 'albuminuric 
cicatricielle."  The  prognosis  is  usually 
good,  since  the  albuminuria  is  not  depend- 
ent directly  on  an  inflammatory  process. 

A  careful  study  of  casts  found  in  the 
urine  aids  one  materially  in  differentiating 
cicatricial  albuminuria  from  parenchyma- 
tous nephritis,  and  in  judging  the  severity 
and  prognosis  of  the  last  named  affection. 
Granular  casts  arise,  from  the  debris  of 
degenerated  epithelial  cells  of  the  urinary 
tubules  and  vary  with  the  intensity  of  the 
process.  In  severe  inflammation,  owing  to 
the  increased  proliferation  and  destruction 
of  the  epithelial  cells,  the  casts  are  consistent 
and  opaque.  As  the  inflammation  subsides 
the  debris  is  correspondingly  diminished, 
and  the  casts  becomes  clearer  and  more  or 
less  transparent.  In  many  cases,  especially 
when  the  inflammatory  process  is  not 
severe,  epithelial  cells  that  are  not  wholly 
degenerated  and  still  show  their  contour 
are  found  adherent  to  the  casts.  The  dia- 
meter of  the  casts  corresponds  to  that  of  the 
tubule  from  which  it  arises,  and  increases 
with  the  severity  and  age  of  the  process, 

After  the  inflammation  subsides,  and  if 
the  epithelium  of  the  affected  urinary 
tubules  is  regenerated  in  the  imperfect 
manner  described,  resulting  in  the  forma- 
tion of  scar-like  tissue,  the  urine  may  con- 
tain albumen.     Casts  may  also  be  present, 


but  they  will  be  of  the  hyaline  and  not  of 
the  epithelial' variety. 

Amorphous,  waxy,  or  colloid  casts  are 
seldom  found  in  pure  parenchymatous 
nephritis,  but  are  more  likely  to  appear 
when  the  process  is  combined  with  sclerosis 
or  secondary  atrophy  of  the  kidney.  Real 
epithelial  casts — i.  e.,  those  made  up  of 
mosaic-like,  well  preserved  epithelial  cells 
— are  very  seldom  found  in  parenchymatous 
nephritis.  They  occur  most  frequently  in 
toxic  nephritis  and  signify  desquamation 
without  real  inflammatory  changes  in  the 
epithelium.  The  author's  recorded  observa- 
tions deal  with  parenchymatous  nephritis 
only. 

The  author  concludes,  then,  that  if  albu- 
minuria persists  after  the  subsidence  of  a 
real  parenchymatous  nephritis,  and  repeated 
examination  fails  to  reveal  the  presence  of 
granular  or  colloid  casts,  one  is  justified  in 
assuming  that  the  inflammatory  process  has 
disappeared  and  that  the  albuminuria  has 
its  source  in  the  cicatricial  condition  of  the 
epithelial  cells  of  the  tubules.  The  number, 
size,  consistence,  and  character  of  the  casts 
reveal  very  closely  the  intensity  of  the  exist- 
ing process,  although  the  conclusions  drawn 
from  such  evidence  may  not  appear  to  cor- 
respond, at  that  time,  to  the  clinical  symp- 
toms. 


The  Diagnosis  of  Nephritis  without   Albu- 
minuria. 

Dr.  Arthur  R.  Edwards  (Amer.  Journal 
Med.  Science,  Oct.  1898,)  concludes  a  pa- 
per on  this  subject  as  follows  : 

Carefully  repeated  routine  chemical  and 
microscopical  examination  of  the  urine 
every  twenty-four  hours  usually,  but  not 
invariably,  detects  acute  and  chronic  neph- 
ritis. The  diagnosis  of  the  albuminuric 
and  non-albuminuric  types  of  nephritis  is 
aided  by  searching  examination  of  other 
viscera  and  parts,  e.  g.,  by  a  disturbance  of 
cardio-vascular  changes,  retinal  involve- 
ment, etc.  These  visceral  or  somatic  changes 
usually  present  in  nephritis  may  be  lacking 
in  concrete  instances,  or  be  capable  of  other 
or  divers  interpretation,  as  atheroma,  etc. 
The  urinary  findings  most  essential  to  the 
diagnosis  of  nephritis  may  be  lacking,  as 
well  as  many  other  signs  and  symptoms  of 
minor  dignity.  Nephritis  may  be  unattend- 
ed by  albuminuria.  Such  nephritis  is  usually 
interstitial  in  type.  While  certain  instances 
of  non-albuminuric  nephritis  correspond  to 
the  type  described  by  D.D.Stewart,  yet  non- 
albuminuric  nephritis  may  not  exactly  corre- 
spond to  the  said  type, since  acute  nephritis, 
chronic  parenchymatous  nephritis,  and 
chronic  intestinal  nephritis  may  occasion- 
ally   occur    without    albuminuria.      Casts 


THECHARLOTTE   MEDICAL  JOURNAL. 


si 


should  always  be  searched  for ;  they  are 
more  constantly  found  than  is  albumin,  yet 
seem,  in  certain  instances,  to  betoken  renal 
degeneration  rather  than  inflammation. 
They  are  not  invariable  in  nephritis,  nor 
are  they  invariably  nephritic.  Future  clini- 
cal caution  and  pathological  examinations 
will  probably  increase  the  number  of  cases 
of  non-albuminuric  renal  inflammations  of 
acute,  subacute,  and  chronic  types.  Non- 
albuminuric  nephritis  is  of  special  import- 
ance in  life  insurance  and  kindred  exami- 
nations, and  in  practice,  since  prophylactic 
measures  may  be  instituted,  and  the  prog- 
nosis obviously  influenced. 


Remarks  on  Exophthalmic  Goitre. 

At  the  New  York  County  Medical  Socie- 
ty, Dec.  19,  1S98,  Dr.  J.  Herbert  Claiborne 
read  a  paper  with  this  title.  (Med.  Record, 
January  9,  1899). 

He  said  that  three  most  prominent  and 
constant  symptoms  were  acceleration  of  the 
heart's  action,  exophthalmos,  and  goitre, 
and  yet  it  was  claimed  that  both  the  exoph- 
thalmos and  the  goitre  might  be  lacking. 
The  disease  had  been  described  as  an  atonic 
condition  of  the  vasomotor  centres  of  the 
vagus  and  spinal  accessory  nerves.  The 
theory  that  exophthalmic  goitre  was  due  to 
a  derangement  in  the  cervical  sympathetic 
was  probably  the  most  generally  accepted 
one.  It  had  been  maintained  that  the  lesion 
in  the  cervical  sympathetic  produced  a  dila- 
tation of  the  vessels  of  the  thyroid,  and  those 
designed  for  the  postbulbar  tissues,  by  a 
paralysis  of  the  vasomotor  nerves  of  these 
regions,  and  that  at  the  same  time  the  con- 
stant irritation  of  the  vagus  and  spinal  ac- 
cessory interferred  with  the  proper  inhibi- 
tion of  the  heart.  In  other  words,  one  set 
of  symptoms  was  explained  on  the  ground  of 
an  actual  lesion, and  the  other  set  by  an  irrita 
tion,  which  was  obviously  unsatisfactory 
A  lesion  of  the  vagus  would  result  in  an 
opposite  effect  on  the  heart,  i.e.,  a  slowing 
of  its  action.  Moreover,  the  cilio-spinal 
centre  would  be  affected,  and  there  would 
be  certain  pupillary  symptoms.  As  such 
symptoms  were  not  present,  this  fact  seemed 
to  exclude  the  sympathetic  system.  Autop- 
sies on  certain  cases  of  exophthalmic  goitre 
showed  changes  in  a  few  instances,  but  in 
only  a  few.  Reference  was  then  made  to 
certain  other  theories  that  had  been  pro- 
pounded to  explain  the  causation  of  this 
disease.  In  this  disease  there  was  a  lack  of 
association  between  the  upper  eyelid  and 
the  movement  of  the  cornea  in  looking 
downward.  This  was  known  as  'the 
Graefe  symptom,"  and  had  been  considered 
absolutely  pathognomonic  of  exophthalmic 


goitre.  When  "Stellwag's  symptom1'  was 
present,  the  patient  had  the  appearance  of 
a  frightened  stag.  This  was  probably  due 
to  the  retraction  of  the  lids.  It  was  more 
properly  called  "Dalrymple's  symptom," 
as  the  former  was  really  applied  to  an  in- 
frequency  of  nictitation.  The  "Fiske-Bry- 
son  symptom"  was  a  diminished  power  in 
expansion  of  the  chest.  Observers  were 
quite  generally  agreed  on  the  constancy  of 
this  symptom.  If  the  Graefe  symptom  was 
associated  with  tachycardia  and  dilatation 
of  the  thyroid,  the  diagnosis  was  no  longer 
in  doubt.  The  cause  of  the  exophthalmos 
had  not  yet  been  determined  ;  it  was  still 
attributed  to  the  muscle  of  Muller,  which 
was  said  to  be  under  the  control  of  the  sym- 
pathetic. He  had  noticed  that  there  was 
generally  a  set  expression  of  the  muscles  of 
the  face,  and  he  believed  that  exophthalmos 
and  retraction  of  the  lids  were  partly  the 
result  of  a  lack  of  proper  action  of  the  orbi- 
cularis. The  headache  quite  frequently 
present  in  this  disease  could  often  be  re- 
moved by  the  correction  of  the  slight  de- 
gree of  hypermetropia  present.  He  did  not 
believe  that  the  muscle  of  Muller  was  a  fac- 
tor. The  course  of  the  disease  was  generally 
slow,  and  he  did  not  believe  that  any  pa- 
tients recovered  completely.  The  duration 
of  a  recoverable  case  had  been  stated  to  be 
two  or  three  years,  but  many  patients  died 
of  some  intercurrent  disease,  while  in  others 
the  disease  remained  stationary.  Post-mor- 
tem examinations  on  cases  of  exophthalmic 
goitre  had  been  singularly  barren  of  results. 
The  death-blow  to  the  thyroid  theory  of 
exophthalmic  goitre  was  to  be  found  in  the 
fact  that  all  of  the  symptoms  may  exist 
without  enlargement  of  the  thyroid.  The 
treatment  of  exophthalmic  goitre  was  neces- 
sarily the  treatment  of  its  symptoms. 


Auto-intoxication    in  Epilepsy. 

Solaro  in  a  synthetic  review  of  recent 
opinions  on  this  question,  says  the  British 
Medical  Journal,  finds  probable  evidence 
of  auto-intoxication  in  the  phenomena  of 
the  aura,  in  the  supervention  of  dementia, 
in  the  dyspeptic  disorders  which  often  pre- 
cede an  attack  of  epilepsy,  for  example, 
vomiting,  foetor  of  breath,  constipation, 
diarrhoea,  slight  icterus,  etc.  So  also  the 
sphygmographic  changes  observed  in  blood 
tension  before  and  during  an  attack  may  be 
referred  to  toxic  influences.  The  toxicity 
of  the  urine  was  found  by  Voisin  and  Petit 
to  be  less  during  the  attack  and  greater  after. 
Krainsky  found  that  for  one  or  two  days 
before  an  attack  the  elimination  of  uric  acid 
in  the  urine  was  lessened,  whilst  imme- 
diately after    an    attack   it   was    increased. 


82 


THE  CHARLOTTE  MEDICAL   JOURNAL. 


This  was  so  constant  a  phenomenon  that 
attacks  could  be  predicted  or  diagnosed 
afterwards  from  the  examination  of  the 
urine  with  regard  to  the  uric  acid.  The 
actual  substance  causing  the  attack,  accord- 
ing to  Krainsky,  is  carbaminate  of  ammo- 
nia. Indican  and  acetone  have  also  been 
suggested  as  epileptogenic  poisons.  The 
serum  of  the  blood  of  epileptics  has  a  strong 
toxic  action  during  the  attacks.  Treatment 
addressed  to  the  eliminating  organs,  to  the 
digestive  tract,  receives  fresh  sanction  on 
the  view  that  auto-intoxication  plays  no  in- 
considerable part  in  the  production  of  the 
epileptic  attack.  The  role  of  the  bromides 
in  calming  the  cerebral  irritability  is  in  no 
way  lessened  by  laying  stress  upon  the  im- 
portance of  getting  rid  of  toxic  substances 
in  the  organism. 


Diet  in  Hyperacidity. 

Many  efforts  have  been  made  recently  to 
throw  light  upon  various  stomach  diseases 
by  an  investigation  into  gastric  chemistry. 
The  main  object  of  these  researches,  says 
the  British  Medical  Journal,  August  13th, 
1898,  has  been  to  evolve  through  a  better 
understanding  of  the  diseases  themselves  a 
more  satisfactory  and  rational  treatment, 
both  dietetic  and  other.  It  is  only  too 
patent  that  the  labelling  of  a  case  as  dys- 
pepsia only  brings  one  to  the  threshold  of 
the  inquiry,  as  this  term  should  signify 
nothing  more  than  a  symptom  complex 
caused  by  gastric  disease.  It  is  equally 
clear  that  the  treatment,  dietetic  or  other, 
must  be  haphazard  if  the  efficiency  with 
which  the  stomach  discharges  its  functions 
in  the  case  in  question  is  unknown.  Not- 
withstanding this,  the  methods  of  investi- 
gating gastric  chemistry  have  found  little 
favour  in  this  country,  and  therefore  it  is 
more  than  probable  that  cases  of  hypera- 
cidity are  passed  by  unnoticed.  Almost 
pari  passu  with  the  above-named  researches 
and  in  some  sense  dependent  upon  them, 
much  investigation  has  been  made  into  the 
general  metabolism  of  the  body.  By  ascer- 
taining the  input,  and  carefully  coniDaring 
it  with  the  output,  it  becomes  possible  to 
find  out  to  what  extent  the  various  constit- 
uents of  the  food  are  utilised  by  the  bodv. 
To  such  an  extent  has  this  subject  been  ad- 
vanced, that  in  not  a  few  clinics  abroad 
the  investigation  of  metabolism  is  looked 
upon  as  almost  a  routine  necessity  in  certain 
cases. 

At  any  rate  it  is  obvious  that  if  the  func- 
tions of  the  stomach  both  secretory  and  mo- 
tor be  known,  and  the  methods  of  treat- 
ment dietetic  and  other  be  carefully  con- 
trolled by  an  investigation  into  the  metabol- 


ism of  the  body,  some  valuable  information 
should  be  forthcoming.  H.  Strauss  and  L, 
Aldor  have  made  such  a  research  in  regard 
to  diet  in  hyperacidity  due  to  the  excess  of 
free  hydrochloric  acid.  Some  have  thought 
that  a  diet  chiefly  nitrogenous  was  indica- 
ted, but  on  the  other  hand  this  diet  irritates 
the  stomach  and  should  thus  aggravate  the 
disease.  Other  well-known  physicians  have 
even  advocated  the  presence  of  a  considera- 
ble amount  of  carbohydrates  in  the  dietary. 
Against  this  view  must  be  placed  the  fact 
that  a  relatively  rich  deposit  of  starchy  ma- 
terial is  found  in  the  contents  of  the  stom- 
ach obtained  after  the  test  meal  given  to 
those  suffering  from  hyperacidity.  Strauss 
and  Aldor  believe  that  the  problem  is  to  be 
solved  by  reducing  the  carbohydrates,  while 
at  the  same  time  providing  sufficiency  of 
substances  free  from  nitrogen.  The  replace- 
ment of  ordinary  starchy  food  stuffs  by 
those  in  solution  will  not  satisfy  the  require- 
ments. The  damage  done  to  the  total  met- 
ebolism  in  hyperacidity  is  well  recognized 
and  is  evidenced  by  the  deficient  nutrition 
of  such  patients. 

The  author  maintain  that  the  desired  end 
may  be  attained  by  introducing  an  abund- 
ant amount  of  fat  into  the  diet.  Dr.  Strauss 
undertook  a  series  of  investigations  upon 
patients  suffering  from  various  stomach 
affections,  by  which  he  was  able  to  show 
that  in  the  majority  of  cases  the  addition 
of  a  certain  amount  of  oil  to  the  dietary 
was  followed  by  a  diminution  both  in  the 
total  acidity  as  well  as  in  the  acidity  due  to 
free  hydrochloric  acid.  It  has  been  stated 
that  fat  impairs  the  motor  functions  and 
absorptive  powers  of  the  stomach,  but  even 
if  this  were  to  some  extent  correct,  the 
patient  is  nevertheless  thus  provided  with  a 
qurntity  of  combustible  material  which  is 
only  otherwise  supplied  with  much  diffi- 
culty. Having  thus  satisfied  themselves  on 
these  points,  the  authors  proceeded  to  test 
how  far  it  would  be  possible  to  substitute 
fat  for  carbohydrates,  and  at  the  same  time 
to  maintain  a  rational  mixture  of  nitro- 
genous and  non-nitrogenous  food  stuffs. 
They  made  five  investigation  into  4  cases 
of  hyperchlorhydria.  The  observations  ex- 
tended over  five  to  eight  days,  during  which 
period  abundant  fatty  matters  (125.5  S-  'n 
two  and  nearly  160  g.  in  three  investiga- 
tions) were  added  to  the  dietary,  and  the 
metabolism  was  most  minutely  investigated. 

The  subjective  condition  of  the  patients, 
as  well  as  the  functions  of  the  stomach, 
were  also  carefully  noted.  The  tables  ap- 
pended in  Strauss  and  Aldor's  article  show 
that  the  utilisation  of  both  fatty  and  nitro- 
genous matters  was  extremely  good.  The 
patient's  weight  remained  constant,  or  in- 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


creased.  The  use  of  abundant  fatty  matters 
produced  no  unpleasant  effects,  for  only  in 
one  case  were  there  any  dyspeptic  symptoms, 
and  these  were  very  fleeting.  The  authors 
claim  to  have  established  the  fact  that  in 
gastric  hyperacidity  there  is  a  considerable 
toleration  of  fatty  matters,  and  that  if  it  is 
desired  to  improve  the  patient's  nutrition 
fats  must  occupy  a  considerable  place  in  the 
diet  sheet.  The  fat  used  was  obtained  from 
milk,  butter,  cream,  and  oil;  cream  is 
especially  to  be  recommended.  A  portion 
of  the  carbohydrates  required  should  be 
supplied  in  a  state  of  solution,  but  on  the 
other  hand  attention  is  drawn  to  the  fact 
proved  by  Strauss  himself  that  oatmeal  soup 
very  quickly  leaves  the  stomach  of  those 
suffering  from  considerable  motor  insuffi- 
ciency both  when  the  secretion  of  hydro- 
chloric acid  is  normal  and  when  it  is  in- 
creased. 

The  subject  is  obviously  one  which  de- 
serves considerable  attention,  and  if  the  in- 
vestigations of  Drs.  Strauss  and  Aldor,  most 
carefully  devised  and  carried  out,  are  con- 
firmed by  more  extended  clinical  trials,  these 
authors  will  have  advanced  our  knowledge 
of  the  dietetic  treatment  of  disease, and  will 
further  have  shown  the  value  of  scientific 
research  applied  to  the  treatment  of  disease. 


Fear  Neurosis. 

Dr.  Morton  Prince  (Boston  Medical  and 
Surgical  Journal  for  December  22d)  claims 
that  this  is  a  distinct  neurosis,  and  that  it 
has  never  as  yet  been  described.  The  rea- 
son why  this  neurosis  has  been  overlooked 
is  because  it  has  been  regarded  merely  as  a 
manifestation  of  timidity.  But,  while  it  is 
quite  true  that  it  arises  from  timidity,  or 
self-consciousness,  yet  it  persists  long  after 
all  timidity  has  passed  away  as  an  automatic 
affection.  While  the  symptoms  are  the 
natural  physical  manifestations  of  fear,  they 
are  not  accompanied  by  this  emotion.  The 
condition  exists  apart  from  any  psychical 
state  as  a  group  of  pure  physical  symptoms. 

At  first  there  is  a  natural  or  excessive 
timidity.  In  this  timid  condition  certain 
environments  excite  fear  and  its  accompani- 
ments, such  as  tremor,  palpitation,  faint- 
ness,  etc.  By  constant  repitition  of  this 
excitement,  these  symptoms  become  welded 
together  into  an  automatic  process,  which 
persists  as  habit  neurosis.  This  must  be 
regarded  as  a  sort  of  degeneration  of  ner- 
vous process  by  which  associated  actions 
become  grouped  together.  This  is  a  pro- 
cess by  which  certain  arts  are  learned,  as 
violin  playing,  etc.,  and  certain  morbid 
states  arc  developed,  as  some  of  the  neu- 
roses and  psychoses. 


After  the  condition  of  this  neurosis  has 
been  well  developed  the  exciting  cause  of 
any  individual  attack  is  some  primary  sug- 
gestion in  the  form  of  apprehension,  or  ex- 
pectation that  these  symptoms  will  repeat 
themselves.  To  this  there  is  usually  added 
the  direct  excitant  of  making  some  public 
appearance. 

There  is  a  feeling  of  being  watched, 
faintness,  perspiration,  flushing  of  the  face, 
confusion  of  thought,  depression,  a  sense 
of  indigestion,  a  feeling  of  goneness,  an 
ataxic  feeling  in  hands  and  feet,  dryness  in 
the  throat,  coldness  in  the  hands. 

These  feelings  and  symptoms  become  so 
organized  that  the  fear  of  their  recurrence 
renders  it  impossible  for  some  singers, 
musicians  and  public  performers  to  appear 
before  an  audience.  The  thought  that  they 
are  going  to  perform  will  bring  on  the 
whole  train  of  symptoms,  and  render  them 
unable  to  go  on  with  their  practice. 

These  symptoms  may  complicate  a  true 
condition  of  neurasthenia,  but  may  exist  by 
themselves  as  an  independent  neurosis. 
The  symptoms  are  often  of  such  intensity 
as  to  be  a  matter  of  considerable  suffering. 
They  come  on  with  such  suddenness  as  not 
to  allow  for  thought.  At  a  time  when  the 
person  is  lecturing,  playing,  practising,  or 
so  on,  these  feelings  come  on  with  a  rush. 
To  continue  with  the  performance  under 
these  conditions  calls  for  the  utmost  exercise 
of  will  power,  and  this  in  turn  is  very  ex- 
hausting. 

The  knowledge  of  the  possible  return  of 
these  symptoms  at  some  critical  moment 
depresses  the  person.  This  intensified  the 
neurosis.  Actual  suffering  results  from 
this  in  the  form  that  the  persons  thinks 
they  are  regarded  as  timid  when  they  are 
really  not  so. 

Auto-intoxication  and   Albuminuria. 

Praetorius  (Bermingham  Medical  Re- 
view) thinks  it  impossible  to  deny  that 
there  are  cases  of  functional  albuminuria, 
cases  in  which  there  is  no  organic  disease 
of  the  kidneys.  This  is  especially  the  case 
in  so-called  cyclical  albuminuria,  where  the 
albuminuria  is  present  in  the  morning,  and 
disappears  as  the  day  goes  on.  He  quotes 
a  case  associated  with  enlarged  liver  which 
proved  to  be  due  to  hydatids,  and  disap- 
peared after  this  had  been  cured  by  incision 
and  drainage.  But  he  contends  that  the 
main  cause  of  functional  albuminuria  is 
auto-intoxication,  either  gastric,  or  in- 
testinal, or  hepatic, or, as  in  the  albuminuria 
of  myxocdema,  from  the  thyroid  glands;  or 
from  some  deranged  tissue  metamorphosis, 
such  as  occurs  in  gout,  diabetes,  and  obesity. 


84 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


Laryngeal  Hemorrhage. 

Geyer,  (Journal  of  Laryngology)  refers 
to  the  different  causes  of  laryngeal  haemor- 
rhages, injuries,  ulcers,  anomalies  of  the 
blood,  vicarious  menstruation,  overstrain- 
ing of  the  voice  in  singers,  catarrh,  laryn- 
gitis sicca .  The  hemorrhage  may  be  external 
and  vary  from  a  few  drops  to  a  fatal 
quantity,  or  it  may  be  submucous.  He 
describes  two  cases  with  hemorrhagic 
tumors. 

i.  A  woman  forty  years  old,  with  good 
family  history,  had  enjoyed  good  health. 
Two  years  ago  she  had  haemorrhage  from 
the  uterus,  which  was  cured  after  curetting 
and  removal  of  a  placenta  polypus.  For 
seven  weeks  the  patient  had  hawked  clear 
fluid  blood,  varying  up  to  a  cupful  in  twenty- 
four  hours.  Slight  cough.  Great  weakness. 
Hoarseness  for  two  days.  Menstruation 
normal. 

Examination  showed,  slightly  under  the 
petiolus,  a  sessile  tumour  the  size  of  a  cur- 
rant, surface  smooth  and  covered  with 
fresh  blood,  colour  bluish  red.  The  tumour 
was  firmly  situated,  and  could  be  slightly 
moved  with  the  probe.  Diagnosis  :  bleed- 
ing poly  pus  on  the  lower  side  of  the  epiglottis. 
It  was  attempted  to  produce  shrinking  of 
the  tumour  by  applying  trichloracetic  acid. 
This  caused  severe  dyspnoea  for  two  hours, 
which  nearly  necessitated  tracheotomy. 
After  twenty-four  hours  the  dyspnoea  pass- 
ed off. 

As  it  was  considered  advisable  to  repeat 
the  treatment,  and  as  removal  through  the 
mouth  might  lead  to  severe  haemorrhage,  it 
was  decided  to  operate  with  an  external 
incision.  After  a  previous  tracheotomy  on 
April  29th,  Dr.  Ebenau  performed  subhyoid 
pharyngotomy  and  removed  the  tumor  with 
a  sharp  spoon.  The  base  was  cauterized 
with  trichloracetic  acid.  The  haemorrhage 
ceased  after  removal  of  the  tumour,  but 
returned  after  a  few  days.  The  laryngo- 
scope showed  a  new  tumour  the  size  of  a 
pea.  Then  it  was  no  longer  doubtful  that 
it  consisted,  not  of  a  tumour,  but  of  a  blood 
coagulum,  which  was  confirmed  by  the 
microscope.  Large  haemorrhage,  with 
necrosis  of  the  superficial  layer  and  infiltra 
tion  of  leucocytes.  After  removal  of  the 
blood  coagulum  now  under  the  petiolus,  a 
bleeding  vein  was  seen,  which  was  closed 
by  repeated  cauterization.  Nine  months 
after  the  operation  there  has  been  no  more 
haemorrhage. 

2.  Woman,  forty-eight  years  old,  suffered 
from  intermittent  severe  hoarseness, tickling 
in  the  throat,  and  shortness  of  breath  on 
exertion.  The  laryngoscope  showed  the 
presence     of    a    tumour    anteriorly    in    the 


glottis,  the  size  of  a  hazel  nut  :  colour,  pale 
red ;  surface  uneven ;  of  pretty  hard  con- 
sistence. The  tumour  had  a  broad  basis, 
and  was  situated  on  the  anterior  end  of  the 
left  vocal  cord.  It  had  the  appearance  of  a 
fibroma.  It  was  removed  with  the  snare. 
Th.e  microscope  showed  it  to  be  not  much 
altered  laryngeal  tissue,  with  an  old  haemor- 
rhage under  the  mucous  membrane.  It  was 
mostly  organized  with  enlarged  thin-walled 
vessels,  containing  partly  hyaline  amorph- 
ous and  partly  thready  exudation.  There 
was  abundant  pigment  in  the  endothelial 
cells.  Six  months  after  the  operation  there 
were  very  small  stippling-like  red  points, 
which  looked  like  granulations,  at  the  situa- 
tion of  the  tumor.  Vocal  cords  were  white  ; 
voice  clear.  Blood  has  not  been  coughed 
up  since  the  operation. 

The  author  refers  to  a  similar  case 
published  by  Semon  in  Vol.  IV.,  p.  418,  of 
Fraenkel's  "Archives,"  which  was  at  first 
supposed  to  be  malignant.  He  points  out 
the  importance  of  the  differential  diagnosis 
between  these  and  cancer,  and  emphasizes 
the  importance  of  free  movement  of  the 
cord  in  the  former. 


Diet    for  Surgical  Cases. 

At  the  New  York  County  Medical  Asso- 
ciation, Dec.  19,  1898,  Dr.  Wyeth  said  that 
there  was  a  careful  system  of  dieting  em- 
ployed, which  he  considered  extremely  im- 
portant in  all  surgical  cases.  (Medical  Re- 
cord, January  7,  1899).  It  was  just  as  im- 
portant, in  his  opinion,  to  eliminate  septic 
poisonous  gases  and  ptomaines  from  the 
bowel  as  it  was  to  supply  suitable  nourish- 
ment to  the  system.  At  intervals  of  about 
one  week  the  patient  was  given  the  small 
calomel-and-soda  triturate  tablets  up  to  one 
or  two  grains.  One  or  two  teaspoonfuls  of 
Carlsbad  salt  in  hot  water  were  given  in 
the  morning  of  the  day  of  operation,  to  se- 
cure a  thorough  emptying  of  the  intestine. 
The  nourishment  should  be  administered  in 
moderate  quantity  three  times  daily.  He 
did  not  advocate  a  limited  and  soft  dies  ; 
surgical  patients  could  often  digest  a  small 
quantity  of  beef,  chicken,  or  quail  better 
than  broths.  In  the  way  of  meats,  he  would 
give  sirloin  or  tenderloin  steak,  roast  beef, 
roast  mutton,  mutton  chop,  or  stewed 
chicken.  Goose,  bacon,  or  fat  of  any  kind 
should  be  forbidden.  Eggs  should  be  given 
sparingly.  The  yolk  contributed  to  the 
formation  of  gases  in  the  alimentary  canal, 
and  consequently,  if  the  yolk  was  given  at 
all,  the  yolk  of  one  egg  should  be  added  to 
the  whites  of  two  or  three  eggs,  and  the 
eggs  shirred.  Shredded  wheat,  the  crust  of 
a  roll,  and  fresh  butter  in  moderate  quanti- 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


ty  might  also  be  allowed.  All  uncooked 
vegetables  were  strictly  forbidden.  Beans, 
peas,  and  carrots,  cooked  slowly,  asparagus, 
and  sweet  potatoes  in  moderate  quantity 
were  chiefly  relied  upon.  The  white  or 
Irish  potato  was  not  so  satisfactory.  When 
given,  it  should  be  boiled,  thoroughly  mash- 
ed, mixed  with  cream,  and  then  baked. 
Fruits  were  very  rarely  permissible. 


Christian    Scientists. 

The  christian  scientists,  says  the  Medical 
Record,  do  not  have  it  all  their  own  way 
in  Ohio,  an  attempted  manslaughter  by 
victims  of  that  particular  psychosis  has  re- 
cently received  a  slight  check  in  Cincinnati. 
A  certain  Harriet  Evans,  who  non-treated 
a  man  with  typhoid  fever  so  successfully 
that  he  died,  was  convicted  on  December 
8th  of  practising  medicine  illegally,  and 
was  fined  $100.  Another  "scientist," 
named  Allie  Putnam,  met  the  same  fate  on 
December  21st.  The  person  had  non-treated 
a  man  witli  alleged  gastric  disorder,  and 
had  demanded  and  received  a  fee  for  her 
inaction.  This  second  conviction  has  ex- 
cited the  other  illegal  malpractioners,  and 
a  fund  has  been  raised  to  carry  Putnam's 
case  to  a  higher  court.  A  wealthy  victim 
of  the  delusion  is  said  to  have  given  $10,- 
000  to  meet  the  expenses  of  the  appeal,  and 
the  trustees  of  the  Christian  Science  church 
say  that  the  building  fund  of  $24,000  is 
available  for  the  same  purpose.  They  say 
they  will  make  this  a  test  case  and  will 
fight  it  through  all  the  courts  if  necessary, 
even  up  to  the  supreme  court  of  the  United 
States. 


Spinal    Meningitis   Complicating    Measles. 

Starck  describes  the  case  of  a  girl,  8 
years  of  age,  who  had  a  typical  attack  of 
measles,  and  on  the  second  day  of  the  erup- 
tion she  complained  of  great  pain  on  move- 
ment. (British  Med.  Journal.)  The  nurse 
found  it  impossible  to  turn  the  patient  on 
her  side,  because  of  the  extreme  tenderness. 
All  movements  of  the  legs  and  arms  were 
followed  by  muscular  spasms.  The  skin 
over  the  legs  and  arms  was  hypersesthetic. 
the  neck  was  stiff,  and  the  head  slightly 
retracted.  The  temperature  was  101  deg.  F. 
On  the  same  evening  there  was  retention  of 
urine,  which  lasted  several  days.  On  the 
fifth  day  of  the  nervous  symptoms  the  pa- 
tient was  able  to  pass  urine,  but  consider- 
able pain  was  experienced  in  doing  so.  On 
the  seventh  day  the  arms  were  free  from 
pain,  the  legs  were  still  attacked  with 
painful  spasms  when  touched.  In  a  fort- 
night the  child  was  able  to  walk  a  short 
distance  alone;  the  legs  were  still  stiff   but 


not  painful.  The  knee-jerk  was  exaggerated. 
Micturition  was  painful,  and  the  bowels 
only  acted  after  purgatives.  Ultimately 
the  patient  made  a  good  recovery.  Measles 
seemed  to  be  the  only  possible  cause  of  this 
condition  ;  all  other  diseases  were  carefully 
excluded,  and  the  child's  previous  health 
had  been  excellent.  The  cranial  nerves 
and  brain  were  unaffected.  The  author 
says  that  scarlet  fever  and  typhoid  are  more 
often  followed  by  lesions  of  the  spinal  cord  ; 
he  has  not  been  able  to  discover  a  case 
similar  to  the  present  one  after  an  exhaus- 
tive examination  of  the  complications  and 
sequela?  of  measles. 


Automatic  Pressure  Regulator. 

Compressed  air  having  become  an  impor- 
tant factor  in  up  to  date  treatment  in  re- 
spiratory and  aural  affections,  all  practical 
improvements  in  air  compressing  apparatus 
are  readily  appreciated  by  every  progressive 
physician.  The  Globe  Manufacturing  Co., 
of  Battle  Creek,  Mich.,  have  devoted  much 
time  to  this  work,  and  have  recently  brought 
out  a  number  of  valuable  improvements  in 
air  compressors,  receivers,  etc. 

Their  new  Automatic  Pressure  Regulator 
is  being  received  with  much  favor.  It  can 
be  attached  to  any  air  receiver,  which  may 
then  be  stored  at  high  pressure  which  is 
automatically  reduced  to  any  desired  extent 
to  suit  the  work  in  hand,  thus  securing  uni- 
form results,  with  an  economical  expendi- 
ture of  air.  This  ingenious  device  is  so 
arranged  that  at  any  time  both  the  high  and 
reduced  pressure  can  be  read  from  a  single 
gauge. 

The  Globe  Automatic  Cut  Off,  made  by 
the  same  company,  has  many  new  and  at- 
tractive features.  If  further  information  is 
desired,  write  the  manufacturers  for  des- 
criptive circulars. 


Drainage  in  Suppurative  Appendicitis. 

A.  McLean  (Medical  Age,)  concludes 
that  :  Where  pus  is  present,  tubing  should 
be  used,  for  gauze  will  not  free  a  cavity  of 
pus.  Where  inflammatory  transudate  or 
exudate  is  present  gauze  proves  the  most 
satisfactory.  Where  gauze  drainage  is  used 
in  the  peritoneal  cavity  the  external  end 
should  be  lower  than  the  internal,  allowing 
much  freer  action.  Mixed  drainage  is  to 
be  recommended  where  septic  peritonitis 
accompanies  suppurative  appendicitis. 
Drainage  should  be  dispensed  with  as  soon 
as  possible,  and  the  external  wound  allowed 
to  unite,  for  the  sooner  the  union  the  bette-, 
and  the  chances  of  a  ventral  hernia  follow- 
ing are  less. 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


Longevity  In  Spain. 

According  to  Dr.  F.  Oloriz,  Prefessor  of 
Descriptive  Anatomy  in  the  Medical  Facul- 
ty of  Madrid,  it  may  be  estimated  that  the 
proportion  of  centenarians  at  the  present 
day  for  the  Peninsula  and  the  adjacent 
islands  is  25  per  million  (British  Medical 
Journal,  Dec.  24,  '98).  The  ratio  in  1857 
was  12.  in  i860  13.97,  and  in  1877  29.87. 
In  the  census  of  1887  the  proportion  had 
fallen  to  23.39.  On  the  whole,  however, 
the  proportion  of  centenarians  to  popula- 
tion in  Spain  has  notably  increased  during 
the  last  century ;  while  the  total  population 
has  not  quite  doubled,  the  proportion  of 
centenarians  has  trebled.  The  distribution 
of  centenarians  in  the  different  provinces  of 
Spain  is  very  unequal.  Malaga,  Almeria, 
Murcia,  Cadiz,  Seville,  Granada,  and  in 
general  the  Andalusian  provinces  stand  at 
the  head  of  the  list ;  in  Malaga, for  instance, 
the  proportion  rises  to  something  over  100 
per  million.  The  second  place  is  occupied 
by  the  Galician  provinces,  the  others  fol- 
lowing with  slight  differences  till  the  bot- 
tom is  reached  in  the  provinces  of  Alava, 
Soria,  and  Teruel,  in  which  not  a  single 
case  of  centenarianism  is  registered.  Pro- 
fessor Oloriz  concludes  that,  generally 
speaking,  in  the  southern  zone  of  Spain, 
from  Sierra  Morena  to  the  coast,  including 
the  Spanish  African  Colonies  and  the  Ca- 
nary Islands,  the  proportion  of  centenarians 
is  approximately  from  50  to  60  per  million 
of  population  ;  in  the  north-eastern  region 
proportion  averages  from  35  to  40,  becom- 
ing much  less  in  the  Cantabrian  zone,  from 
west  to  east;  it  hardly  reaches  15  in  the 
valleys  of  the  Tagus  and  the  Guadiana  ;  it 
falls  to  7  in  those  of  the  Ebro,  with  the 
Eastern  Mediterranean  slopes,  in  spite  of  the 
relative  abundance  of  centenarians  in  the 
city  of  Barcelona ;  and  to  less  than  5  per 
million  in  the  valley  of  the  Douro.  To  sum 
up,  extreme  longevity  is  exceptional  in  the 
central  regions  of  the  Peninsula  ;  it  increases 
towards  the  maritime  regions,  especially  in 
the  south,  and  it  reaches  its  maximum  on 
the  two  sides  of  the  Straits  of  Gibraltar. 
The  proportion  of  sexagenarians  in  the  same 
regions  varies,  but  in  a  manner  altogether 
different.  For  instance,  while  the  propor- 
tion of  persons  of  60  years  of  age  is  7  per 
cent,  in  the  North-east,  the  Cantabrian  re- 
gions, Catalonia,  and  the  Balearic  Isles,  it 
is  6\  in  the  valley  of  the  Ebro,  about  6  on 
the  East  Coast,  and  in  the  two  Castilles, 
and  falls  to  5^-  in  Andalusia,  especially  on 
the  sea  coast.  Comparing  this  geographi- 
cal distribution  with  that  of  the  centenari- 
ans, Professor  Oloriz  concludes  that  in  the 
north  extreme  and  ordinary  longevity  coin- 
cide;  in  the  centre  the   latter  is   moderate, 


and  the  former  exceptional,  but  in  the  south 
the  proportions  are  inverted,  as  if  the  hot 
climate  of  Andalusia  used  up  the  energy  of 
the  human  frame  more  rapidly  in  average 
members  of  the  race,  while  being  more  fa- 
vorable in  prolonging  life  to  an  extreme 
degree  in  the  exceptional  individuals  who 
live  beyond  the  seventh  decade.  Professor 
Oloriz  is  careful  to  guard  against  drawing 
positive  conclusions  as  to  the  effect  of  cli- 
mate in  the  production  of  extreme  longev- 
ity, but  he  thinks  it  probable  that  the  sea 
coast,  with  slight  variations  of  temperature, 
is  more  favourable  thereto  than  inland  and 
variable  climates.  From  his  investigations 
he  thinks  himself  warranted  in  stating  that 
centenarianism  is  in  Spain  relatively  more 
common  in  women  than  in  men,  in  celi- 
bates than  in  the  married,  and  in  the  illit- 
erate than  in  persons  of  education. 


Moles. 

Dr.  T.  C.  Gilchrist,  in  a  paper  read 
before  the  American  Dermatological  As- 
sociation, said  that  according  to  the  leading 
pathologists, molesare  incomplete  sarcomata 
— growths  from  the  wall  of  either  the  lym- 
phatics or  the  blood-vessels.  Unna  stands 
alone  in  saying  that  the  structure  of  a  mole  is 
derived  from  the  epidermis,  and,  there- 
fore, is  of  epithelial  origin.  Gilchrist  said 
that  he  had  excised  a  pigment  mole  from 
the  abdomen  of  a  child,  and  several  from 
adults.  The  mole  from  the  child  showed 
nests  of  cells  in  the  epidermis.  His  own 
observations,  therefore,  confirmed  the  view 
held  by  Unna.  From  this  it  follows  that, 
since  the  cells  of  the  tissue  forming  the 
mole  are  of  epidermal  origin,  the  malignant 
growth  of  such  a  tissue  must  be  carcinoma. 
In  this  view  Dr.  Welch  concurs.  It  must 
be  borne  in  mind,  then,  that  the  malignant 
growth  of  a  mole  is  not  a  melanotic  sarcoma, 
but  a  carcinoma.  Dr.  Abel,  the  author 
said,  had  recently  shown  that  the  pigment 
in  the  negro  is  a  very  complex  body,  and 
that  a  granule  remains  after  isolating  the 
pigment.      This  granule  contains  iron. 

The  pigment,  when  separated,  is  found 
to  be  free  from  iron.  The  conclusion  is, 
that  the  pigment  in  melanotic  growths  and 
in  the  negroe's  skin  is  not  derived  from  the 
blood,  but  alterations  in  the  protoplasm  it- 
self. Certain  Italian  observers  claim  that 
the  bodies  found  in  cancer  are  blastomyces 
and  are  allied  to  the  yeast  fungus,  but  these 
bodies  are  not  constantly  present,  and  they 
are  found  in  benign  growth  and  in  many 
other  lesions  of  the  skin.  Moreover,  no 
pure  culture  has  been  obtained  from  cancer, 
and  attempts  to  reproduce  undoubted  cancer 
from    the    supposed    parasite   have   so   far 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


proved  unsuccessful.  Dr.  Gilchrist,  in  clos- 
ing the  discussion,  touched  on  the  question 
of  prognosis.  He  stated  that  early  and 
complete  excision  before  the  occurrence  of 
metastasis  should  effect  a  cure.  He  could 
not  understand  how  there  could  be  a  mixed 
tumour,  as  all  the  cells  in  a  mole  are  of 
epidermal  origin. 


Toxi- Alimentary  Dyspnoea. 

Bohn,  according  to  the  British  Medical 
Journal,  has  made  a  series  of  observations 
on  the  occurrence  of  dyspnoea  under  certain 
conditions  of  toxic  absorption  from  the  ali- 
mentary canal.  This  form  of  dyspnoea  is 
intermittent,  but  of  continual  tendency.  It 
is  sometimes  exclusively  nocturnal,  but 
sometimes  occurs  during  the  day  as  well, 
and  when  of  nocturnal  occurrence  it  is  gen- 
erally in  the  early  part  of  the  night.  The 
dyspnoea  begins  as  simply  defect  of  respira- 
tion with  a  feeling  of  weight,  but  no  pain 
or  agony.  The  first  symptom  is  liable  to 
appear  as  the  patient  is  falling  asleep,  or, 
should  the  attack  be  diurnal,  it  is  provoked 
by  some  effort  which  may  be  apparently 
slight,  as  going  upstairs,  an  animated  con- 
versation, or  carrying  something  slightly 
too  heavy.  An  attack  presents  the  follow- 
ing features  :  The  patient  first  complains 
of  a  "bar-of-iron"  feeling  across  the  chest, 
with  sense  of  weakness  and  utter  prostra- 
tion. This  is  followed  by  a  sensation  of 
rigidity  of  the  chest,  so  that  respiratory 
movements  seem  impossible.  At  the  same 
time  there  may  be  gastric  convulsion,  giving 
rise  to  noisy  eructations  followed  very  often 
by  vomiting.  The  heart  beats  in  an  agita- 
ted manner,  and  respiration  then  takes  on 
the  characteristics  of  an  asthmatic  seizure ; 
the  face  becomes  pale,  and  cold  sweats 
break  out.  The  attack  lasts  for  half  an  hour 
or  more,  to  be  followed  by  sanguineous  ex- 
pectoration. These  symptoms  may  not  be 
all  present  in  the  same  case,  for  gastric  eruc- 
tation may  be  absent.  Physical  examina- 
tion shows  the  presence  of  tachycardia  and 
bruit  de  galop,  but  examination  of  the  lungs 
reveals  few  if  any  physical  signs.  There 
may  be  intervals  of  long  duration  between 
the  attacks.  This  form  of  dyspnoea  is  often 
accompanied  by  certain  symptoms  of  an  in- 
teresting character,  such  as  pallor  of  the 
face  and  integuments,  and  digiti  mortui 
and  vertigo,  and  inefficient  kidney  actions. 
The  condition,  according  to  the  writer,  is 
one  of  arterial  spasm  with  accompanying 
increased  arterial  tension,  and  thus  it  is 
likely  to  cause  sclerosis  of  the  vessels.  As 
to  the  cause  of  this  affection,  and  the  vari- 
ous complications  which  accompany  it, 
evidently  would  go  to  show  that  some  ali- 


mentary defect  is  present,  this  occurring  in 
subjects  whose  arterial  system  is  in  any 
way  affected,  or  whose  eliminating  organs 
are  defective  in  their  action.  Some  tempo- 
rary indiscretion  of  diet  is  liable  to  be  fol- 
lowed by  the  absorption  of  some  toxic  ma- 
terial, causing  an  attack  of  dyspnoea.  The 
writer  pointsoutthatthisform  of  seizuremust 
not  be  confounded  with  urasmic  dyspnoea, 
the  latter  being  due  to  an  endogenous  form 
of  poisoning  from  the  retention  of  toxic 
materials  produced  in  the  organ  itself.  Ali- 
mentary toxaemia,  on  the  other  hand,  is 
exogenous,  and  depends  on  poisonous  ma- 
terials coming  from  outside.  It  follows, 
therefore,  that  on  the  choice  of  diet  will 
depend  altogether  our  success  in  treatment. 
Patients  with  arterial  sclerosis  must  there- 
fore exercise  particular  care  in  diet,  and 
should  there  be  any  tendency  to  dyspnoeic 
seizures,  the  diet  should  be  largely  composed 
of  milk,  one  suggestion  being  to  give  the 
patient  milk  diet  for  a  week  at  a  time,  to 
be  followed  by  a  somewhat  more  liberal 
menu  the  following  week. 


The  Mortality  of  Cancer. 

Mr.  Roger  Williams  (The  Hospital,  Dec, 
17,  1898,)  has  compiled  two  tables  which 
illustrate  respectively  the  increase  in  the 
prevalence  of  cancer  and  the  relative  in- 
crease among  males  and  females.  The  in- 
crease is  not  in  particular  parts  of  the  body, 
but  in  all  parts,  and  has  not  considerably 
altered  the  proportionate  localisation  ratios. 
In  1S40  the  proportion  of  deaths  from  can- 
cer to  population  was  1  to  5,646;  in  1896  it 
was  1  to  1,306;  and  the  proportions  to  total 
deaths  were  respectively  1  to  129  and  1  to 
22.  The  increase  in  cancer  is  far  greater 
in  proportion  than  the  increase  of  popula- 
tion, and  has  been  so  steady  and  regular 
that  it  cannot  be  attributed  to  improved 
diagnosis  or  other  casual  error.  The  in- 
crease in  mortality  in  males  is  nearly  twice 
that  of  females.  The  writer  believes  that 
the  great  increase  in  the  consumption  of 
food,  especially  of  meat,  is  one  etiological 
factor  of  this  increased  cancer  mortality. 
Another  factor,  he  believes,  is  the  greater 
urbanisation  of  the  population,  especially  of 
males.  Roswell  Park  finds  evidence  of  a 
similar  increase  of  cancer  mortality  in  the 
returns  of  the  New  York  State  Board  of 
Health.  These  returns  show  that  in  1895 
the  total  number  of  deaths  from  cancer  was 
double  that  in  1SS5. 


Dr.  Wm.  D.  Bowen,  of  Bath,  N.  C,  will 
be  married.,  on  the  19th  of  January,  to  Miss 
Orpah  Hackney,  of  Wilson,  N.  C.  We 
wish  them  uninterrupted  happiness. 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


The  Relative  Importance  of  Flies  and  the 
Water  Supply  in  Spreading  Disease. 

Dr.  Veeder,  of  the  Sanitary  Club  of  Buf- 
falo, Dec.  14,  1898,  read  a  paper  with  this 
title.  He  said  (Medical  News,  Dec.  31st, 
1898)  : 

From  the  practical  sanitary  standpoint, 
camp  diseases  can  be  divided  into  intestinal 
and  malarial,  the  former  including  typhoid 
and  yellow  fever,  dysentery  and  cholera. 
In  camps,  malaria  is  spread  almost  entirely 
by  water,  intestinal  diseases  almost  entirely 
by  flies.  The  failure  of  measures  directed 
to  the  water-supply  in  the  Cuban  campaign, 
he  ascribed  to  this  fact.  Even  now,  ty- 
phoid is  rife  in  Manilla  and  Honolulu.  In 
the  recent  campaign  in  Fashoda,  although 
the  climate  was  especially  dry,  and  general 
conditions  as  to  water-supply  favorable,  ty- 
phoid was  the  greatest  scourge  of  the  army. 
An  epidemic  of  dysentery  was  cited,  taken 
in  hand  when  forty  cases  had  developed 
with  ten  deaths,  the  disease  having  spread 
from  house  to  house  by  short  wleaps.  After 
adopting  measures  to  prevent  access  of  flies, 
not  a  single  new  case  developed.  The  pro- 
gress of  a  camp  disease  by  short  leaps, 
should  suggest  that  it  was  borne  by  flies 
while  a  general  dissemination  should  call 
attention  to  the  water-supply.  Fly-borne 
epidemics  also  follow  the  direction  of  the 
wind.  In  large  cities,  with  general  water- 
supplies,  free  drainage  and  absence  of  privy 
vaults,  water  is  the  great  carrier  of  disease, 
whereas,  camps,  like  small'  villages,  have 
most  to  fear  from  flies.  For  this  reason, 
typhoid  is  more  or  less  prevalent  at  all  sea- 
sons in  the  cities,  usually  only  in  the  dry 
and  sultry  weather  of  early  autumn  in  small 
villages. 

He  strongly  condemned  the  practice  of 
burying  typhoid  excrement,  citing  a  series 
of  little  epidemics  that  could  be  traced  to 
a  nurse  who  had  followed  this  method. 
After  the  nurse  had  herself  succumbed  to 
the  disease  the  epidemic  ceased.  Typhoid 
bacilli  will  penetrate  to  the  surface  of  the 
soil,  if  buried.  Disinfection  is  necessary 
and,  both  on  account  of  its  color,  its  per- 
manence after  evaporation,  and  efficiency, 
copper  sulphate  is  to  be  preferred.  In  camp, 
on  account  of  the  practical  impossibility  of 
diagnosing  incipient  typhoid,  all  excreta 
should  be  disinfected.  The  coloration  of 
the  ground  would  show  just  how  far  the 
disinfection  had  been  successful.  Volatile 
disinfectants  are  not  so  serviceable  as  non- 
volatile. The  Government  plan  of  furnish- 
ing large,  portable,  water-tight  tanks  for 
use  as  sinks,  is  good  in  theory  but  scarcely 
practical.  The  Indians  avoid  sickness  by 
frequently  moving  their  camps.     Burial  of 


feces  could  be  relied  upon  to  afford  protec- 
tion against  infection  by  flies  for  a  few 
hours.  Boiling  vould  render  water  safe  to 
drink  and,  even  against  malaria,  this  pre- 
caution would  afford  almost  complete  im- 
munity, as  the  conveyance  of  this  disease  by 
mosquitoes  has  been  greatly  exaggerated. 
Not  only  knowledge  but  discipline  is  nec- 
essary to  protect  the  soldier,  and  sanitation 
under  the  guns  of  the  enemy  is  a  difficult 
matter. 

Palatable  Throat  Pastilles. 

We  can  scarcely  look  back,  says  Dr.  Hitt 
in  the  Medical  Council,  over  our  childhood 
days,  and  think  of  the  nauseating  doses  of 
medicine  which  were  given  to  us,  without 
noticing  a  chilly,  creeping  sensation  run- 
ning up  and  down  our  spinal  column.  The 
remedy  was  almost  as  bad  as  the  disease. 
This  was  especially  true  in  treating  the  va- 
rious throat  troubles  of  children.  Their 
crying  on  account  of  the  nauseating  doses 
given  them  only  added  more  fuel  to  the  fire, 
and  their  throats  often  grew  worse  instead 
of  better.  Many  of  the  tablets  in  which 
sugar  of  milk  or  licorice  was  used  as  a  base 
were  more  nauseating  than  medicine  used  in 
liquid  form,  on  account  of  having  to  hold 
them  in  the  mouth  so  long.  I  have  lately 
become  acquainted  with  a  very  palatable 
and  readily  soluble  throat  pastille,  in  which 
a  special  Pate  de  Jujube  is  used  as  a  base. 
They  are  manufactured  in  England  and  are 
known  as  "Allenbury's"  Throat  Pastilles. 
There  are  upwards  of  fifty  varieties  of  these 
pastilles  made  from  the  formulas  of  the  most 
noted  throat  specialists  of  Great  Britain. 

No.  2,  for  instance,  contains  ^  grain  of 
ipecacuanha  aud  is  readily  taken  by  chil- 
dren. No.  10,  Benzoated  Voice,  is  espe- 
cially useful  to  public  speakers  and  singers 
as  a  slight  stimulant  to  the  vocal  organs  and 
to  remove  huskiness.  The  No.  11,  Chlo- 
rate of  Potash,  is  a  very  agreeable  way  of 
giving  this  widely  used  remedy.  The  No. 
22,  Red  Gum,  as  an  astringent  in  relaxed 
throat,  and  No.  23,  Eucalyptus  (Gum  1  gr., 
Oil  -|  min.)  as  an  antiseptic,  stimulant  and 
astringent  are  very  nice.  No.  28,  Com- 
pound Guiacum  (containing  Guiacum, 
Chlorate  of  Potash  and  Red  Gum),  No.  43, 
Menthol,  i-iogr.,  and  No.  29  Compound 
Phatany  and  Cocaine  (Extract  Phatany,  gr. 
2  ;  Cocaine  Hydrochlorate,  gr.  i-ioth)  are 
very  efficacious  in  diseases  of  the  throat  in 
which  these  remedies  are  indicated.  In  ton- 
silitis  the  No.  44,  Menthol  and  Cocaine 
(menthol,  1-20  gr.  ;  cocaine  1-20  gr.)  is  an 
excellent  pastille.  It  acts  as  a  stimulant, 
antiseptic  and  sedaive,  enabling  the  patient 
to  swallow  with  little  or  no  pain.  These 
pastilles   have  given  satisfaction  in  a  large 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


majority  of  the  cases  in  which  they  have 
been  used,  and  I  believe  they  will  meet  with 
a  warm  reception  from  the  physicians  of 
America. 


The  Effects  Produced  by  Anaesthetics  upon 
the  Kidneys  and  Circulation. 

Thompson  and  Kemp  (New  York  Med-, 
ical  Record,  Sept.  3,  1898),  have  arrived 
at  the  following  conclusions  :  ( 1 )  Ether  ap- 
pears to  cause  contraction  of  the  renal  arte- 
rioles producing  deleterious  effects  upon  the 
secreting  cells  similar  to  what  obtains  upon 
ligature  of  the  renal  artery.  The  quantity 
of  urine  becomes  lessened  and  finally  there 
is  suppression.  Albuminuria  always  devel- 
ops. These  results  are  due  to  a  specific 
effect,  not  to  any  general  change  in  the  cir- 
culation. (2)  Chloroform,  while  depress- 
ing the  heart  and  lowering  blood  pressure, 
induces  no  changes  in  the  kidneys  besides 
slight  diminution  in  the  quantity  of  urine 
excreted,  and  a  small  amount  of  albumen 
after  prolonged  anaesthesia,  the  result,  it  is 
believed,  of  the  concomitant  failure  of  ar- 
terial circulation  and  dangerous  lowering 
of  blood  pressure.  (3)  "A.  C.  E."  mixt- 
ure :  When  given  with  95  per  cent,  of  air 
the  blood  pressure  falls,  but  the  kidneys  ap- 
pear only  affected  in  the  same  slight  man- 
ner as  with  chloroform.  If,  however, 
given  by  the  "closed"  or  "semi-closed" 
method,  a  very  marked  depression  of  the 
heart  with  fall  of  blood  pressure  take  place, 
and  the  kidneys  show  an  ether  effect,  that  is 
diminution  (without  suppression,  however) 
of  albuminuria  and  damage  to  the  secreting 
cells.  (4)  Schleich's  mixture  (various  so- 
lutions of  chloroform,  sulphuric  acid,  petro- 
leum ethers,  benzin)  produce  effects  upon 
the  circulation  corresponding  with  those  of 
chloroform,  that  is,  depression  of  the  heart 
and  fall  of  blood  pressure,  and  upon  the 
kidneys  similar  to  those  arising  from  ether, 
although  not  so  severe,  namely,  diminution 
approaching,  but  without  total  suppression 
of  urine,  albuminuria,  and  damage  to  the 
secreting  cells.  The  renal  changes  were 
more  marked  than  with  the  A.  C.  E.  mixt- 
ure. (5)  With  nitrous  oxide  the  effects 
were  transient  and  comparable  to  those  of 
asphyxia,  and  were  not  specific,  but  rather 
the  results  of  deprivation  of  oxygen.  Even 
with  nitrous  oxide  slight  albuminuria  ap- 
peared. The  experiments  were  made  on 
dogs.  The  research,  it  is  contended,  shows 
that  the  A.  C.  E.,  and  Schleich's  mixtures 
possess  no  advantage  over,  and  are  even 
more  dangerous  than  chloroform  or  ether, 
that  chloroform  is  more  harmful  to  the  cir- 
culation than  ether,  that  ether  is  distinctly 
more    deleterious    to    the    kidneys    than    is 


chloroform,  it  should  not,  therefore,  be  em- 
ployed when  initial  renal  disease  exists. 


Fads  and  Fallacies  of  Rectal  Surgery. 

L.  Straus  (Louisville  Jour.  Surg,  and 
Med.,  July,  1898)  makes  the  following  ob- 
jections to  the  Manly  operation  for  internal 
hemorrhoids  : 

1.  Cocainization  of  the  sphincter  suffi- 
cient to  make  the  operation  painless,  would 
endanger  life.  2.  Complete  anal  dilatation 
is  necessary  ;  if  this  were  done  efficiently 
serious  shock  would  result  unless  a  general 
anesthetic  were  given ;  this  is  especially 
the  case  in  women.  3.  Complete  crushing 
of  the  tunics  of  the  tumor  is  tedious,  pain- 
ful, and  dangerous.  Any  procedure  which 
requires  the  bringing  about  of  a  condition 
over  which  we  have  no  control  is  unsurgi- 
cal  and  unscientific.  Outerbridge's  opera- 
tion for  hemorrhoids  receives  the  following 
criticisms  :  1.  Eor  this  operation,  complete 
paralysis  of  the  sphincters  is  required  ;  com- 
plete divulsion  should  not  be  practiced  in 
all  cases,  certainly  not  in  tubercular  cases. 
2.  It  is  a  long  and  bloody  operation.  3.  If 
union  does  not  come  by  first  intentio,n  pus 
may  form,  and  the  result  may  be  anything 
but  satisfactory,  if  not  absolutely  danger- 
ous, because  of  the  increased  chances  of 
sepsis.  Should  the  suture  give  way  the 
wound  must  heal  by  granulation  over  a 
large  surface. 


X-Rays  and  Lupus. 

It  is  reported  from  Vienna  that  Dr-  Schiff 
has  successfully  treated  cases  of  lupus  vul- 
garis by  means  of  the  X-rays.  His  process, 
says  the  British  Medical  Journal,  is  to  set 
up  an  independent  inflammation  in  the  lu- 
poid area  by  exposing  the  part  to  a  very 
intense  radiation.  So  far  investigation  into 
the  germicidal  effects  of  the  X-rays  have 
gone  to  show  that  their  activity  in  this  re- 
spect is  not  greater  than  that  of  the  ordin- 
ary light.  But  Dr.  Schiff's  result  is  not  a 
germicidal  one,  and  we  know  that  inflam- 
mation, and  even  necrosis,  may  result  from 
exposure  in  certain  cases,  although  we  do 
not  know  the  determining  factor  which 
leads  to  injury  in  some  cases,  but  not  in 
others  under  apparently  similar  conditions. 
It  is  not,  however,  altogether  improbable 
that  Dr.  Schiff's  results  may  be  due  to  a 
direct  germicidal  action  of  the  X-rays  on 
the  tubercle  bacillus.  Light,  we  know,  is 
deleterious  to  this  organism,  and  Dr.  Fin- 
sen,  of  Copenhagan,  has  reported  cases  of 
cure  in  lupus,  by  protracted  exposure  to 
concentrated  light,  so  arranged  that  the 
ultra  violet  rays  predominated. 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


Dust  and  Disease. 

Dr.  John  Robinson  in  dealing  with  tnis 
important  question  says  : 

I  feel  certain  that  dust,  uuder  certain  con- 
ditions, is  the  chief  agency  in  the  transfer- 
ence of  the  poison  from  the  soil  to  the 
subject ;  and  this,  of  course  may  be  direct 
or  indirect.  A  good  deal  of  attention  has 
been  directed  to  this  subject  by  Continen- 
tal observers  within  recent  years,  and  I 
think  from  the  experiments  which  have 
been  made  by  others,  together  with  my  own 
observations,  I  am  now  entitled  to  say  that 
dust  is  a  very  frequent  means  of  spreading 
soil  diseases. 

Those  of  us  who  did  bacteriological  work 
ten  to  fifteen  years  ago  will  remember  how 
seldom  our  plate  cultivations  became  con- 
taminated with  air  organisms  in  our  moist 
chambers.  A  moist  chamber  was  ready  for 
use  in  less  than  an  hour's  time,  that  is  to 
say,  the  organisms  present  in  the  air  had 
subsided  in  this  time,  so  as  to  leave  the  air 
sterile.  It  was  usually  found  that  if  any 
contamination  did  occur  it  was  due  to 
moulds,  the  spores  of  which 'are  known  to 
be  very  small  and  light.  Quite  recently  I 
have  had  an  oppportunity  of  making  ex- 
tended observations  in  a  large  lead-lined 
chamber,  six  feet  high,  the  walls  of  which 
were  wetted,  and  it  was  found  that  plates 
of  gelatine  exposed  for  fifteen  minutes  at 
the  bottom  of  this  chamber  became  contam- 
inated first  with  micrococci,  bacilli,  and 
moulds ;  afterwards  with  moulds ;  and  at 
the  end  of  two  hours  and  a  quarter  (as  a 
mean  of  five  observations)  they  ceased  to 
become  contaminated.  Observations  were 
made  as  to  the  number  of  particles  in  this 
air  at  the  beginning  and  at  various  inter- 
vals during  these  observations  by  means  of 
one  of  Aitken's  dust  counters  and  also  by 
means  of  passing  a  beam  of  light  through 
the  air,  and  it  was  found  that  at  a 
time  when  the  air  became  sterile  as  far  as 
the  gelatine  plates  were  concerned  it  yet 
remained  crowded  with  particles  of  dust  to 
such  an  extent  as  to  exceed  the  capabilities 
of  the  small  dust  counter  I  had  at  my  dis- 
posal. It  was  also  seen  that  the  particles 
were  being  carried  about  actively  by  con- 
vection currents.  The  practical  conclusion 
to  be  drawn  from  these  experiments  is  that 
the  infectious  particles  in  the  air  are  heavy 
and  quickly  subside  if  the  air  is  allowed  to 
remain  still. 

I  am  inclined  to  believe  that  the  raft  the- 
ory is  the  correct  one  (with  a  few  excep- 
tions, as  in  the  case  of  the  spores  of  certain 
moulds).  If  this  is  the  case,  it  goes  far  to 
explain  the  reason  why  persons  living  in  or 
entering  an  infected  area  only  become  in- 
fected,      for    it    presupposes      that      such 


heavy  particles  will  not  travel  great  distan- 
ces, but  will  rather  tend  to  contaminate  food 
and  water  in  the  area.  For  instance,  dur- 
ing a  long  warm  summer,  one  area  may  in- 
fect numerous  other  areas,  and  so  extensive 
and  widespread  outbreaks  occur  in  contrast 
to  the  much  more  localised  outbreaks  which 
occur  during  a  short  summer.  While  this 
is  the  case,  there  appears  to  be  abundant 
evidence  that  there  are  certain  limi- 
tations to  the  spread  of  typhoid  infection 
by  dust.  It  is  not  possible  for  me  here  to 
review  the  recent  work  of  Flugge,  Germa- 
no,  Neisser,  and  others  as  to  the  conditions 
under  which  dust  may  carry  the  typhoid 
infection,  but  it  seems  to  me  that  their  work 
fits  in  well  with  the  dust  theory  founded  on 
practical  experience  of  the  methods  of 
spread  of  typhoid  fever. 


The  Cure  of    Diabetes. 

Pietro  Lupo,  writing  in  the  "Canadian 
Practitioner,"  states  as  follows  : — 

For  two  years  I  have  been  persuaded  that 
uric  acid  diathesis,  diabetes,  oxaluria,  etc., 
are  different  phases  of  one  single  morbific 
entity,  and  since  I  knew  of  no  single  case 
truly  cured  on  the  meat  diet,  and  since  I 
experienced  in  myself  the  beneficial  effects 
of  a  diet  exclusively  vegetable,  banishing 
wine  absolutely  and  rendering  the  blood 
very  alkaline — in  myself,  who  used  to  suffer 
in  a  dreadful  manner,  so  as  to  almost  make 
me  attempt  suicide — I  made  bold,  by  way 
of  experiment,  to  prescribe  the  same  diet, 
exclusively  vegetable,  for  the  first  case,  and 
saw  in  this  patient,  too,  the  beneficial  re- 
sults of  such  a  dietary.  With  greater  hope 
of  success  I  ordered  the  second  case  to  take 
the  same  diet,  and  in  him  the  effects  have 
been  truly  marvellous.  In  the  vegetable 
dietary  I  excluded  nothing — all  edible  soups, 
peas,  beans,  saccharine  fruits,  including  the 
grape.  I  allowed  everything,  and  the  re- 
sults have  been  as  above. 

In  my  second  case  it  was  noticed  that 
after  two  months  of  the  vegetable  diet  the 
analysis  of  the  urine  showed  not  only  a 
complete  absence  of  sugar,  but  the  pres- 
ence of  many  crystals  of  oxalate  of  lime, 
from  sixty  to  seventy  for  each  field  under 
the  microscope.  It  might  seem  that  this 
was  owing  to  the  vegetable  diet,  especially 
as  they  had  not  been  noticed  when  the  urine 
was  diabetic.  And  so  one  might  fear  that 
the  patient  had  only  changed  his  diabetic 
condition  for  an  oxaluricone,  and  we  would 
then  not  know  how  to  feed  him,  as  the  ex- 
clusively meat  diet  and  the  mixed  diet  had 
done  no  good.  But  I,  firmly  convinced, 
instructed  the  patieut  to  continue  the  vege- 
table diet,    and  the  result  has  been  that  the 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


91 


oxalate  of  lime,  too,  has  disappeared    from 
the  urine. 

One  certainly  cannot  draw  decisive  infer- 
ences from  these  two  cases,  especially  as  the 
etiology  of  diabetes  is  multiple ;  but  we 
can,  I  think,  conclude  that  very  many  dia- 
betics can  be  cured  on  the  vegetable  diet. 
I  have  under  my  care  at  present  a  case  in 
which  the  analysis  of  urine  shows  more 
than  ioo  crystals  of  oxalate  of  lime  for 
each  field  of  the  microscope.  This  patient 
is  improving  on  the  vegetable  diet. 


The  Contagiousness  of  Tuberculosis. 

Moussu,  of  Alfort,  who  has  made  a  spe- 
cial study  of  the  conditions  under  which 
tuberculosis  is  transmitted  by  contagion, 
reported  his  results  to  the  Congress  of  Tu- 
berculosis recently  held  in  Paris.  He  made, 
says  the  British  Medical  Journal,  an  experi- 
ment which  consisted  in  exposing  to  direct 
tuberculous  contagion  several  animals  of 
different  species  by  placing  them  in  the 
same  byre  with  tuberculous  cattle.  Care 
was  taken  to  ascertain  that  the  animals — 
among  which  were  7  bovines,  17  goats,  2 
sheep  and  1  pig — were  all  healthy  before 
exposure.  The  7  bovines  reacted  to  tuber- 
culin before  they  showed  any  clinical  sign 
of  tuberculosis.  All  save  one  were  killed, 
and  in  all  there  were  found  tuberculous  le- 
sions generally  limited  to  the  mediastinal 
or  mesenteric  glands.  Of  the  17  goats, some 
reacted  distinctly  on  being  subjected  to  the 
tuberculin  test ;  the  others  were  shown  by 
post  mortem  examination  to  be  tuberculous. 
The  2  sheep  reacted  to  the  tuberculin.  In 
one  which  was  killed  in  no  long  time  after- 
wards there  was  no  tuberculous  lesion  visi- 
ble to  the  naked  eye.  In  the  other,  which 
was  killed  after  a  longer  interval,  distinct 
tuberculous  lesions  were  found.  The  pig 
had  been  bitten  on  the  thigh,  and  had  been 
infected  with  tuberculosis  at  the  site  of  the 
wound  by  bacilli  contained  in  the  litter  of 
the  byre.  'The  length  of  stay  of  all  the  ani- 
mals in  the  infected  byre  varied  from  five 
months  to  one  or  two  years.  The  author 
adds  that  dogs  and  fowls  exposed  to  conta- 
gion in  the  same  manner  always  remained 
free  from  tuberculosis. 


Typhoid  Fever  and  Insanity. 

Paris  records,  says  the  British  Medical 
Journal,  the  case  of  a  woman,  aged  44  years, 
who  for  several  years  had  been  insane  with 
ideas  of  persecution  and  of  grandeur.  An 
attack  of  typhoid  fever  occurred,  and  ran 
an  uncomplicated  course,  and  as  it  subsided 
the  insane  ideas  became  less  prominent  and 
less  fixed.  A  relapse  of  typhoid  followed, 
with    very   severe    symptoms,    and    on    re- 


covery the  patient  seemed  perfectly  sane. 
The  case  had  always  been  regarded  as  in- 
curable, and  the  disappearance  of  mental 
symptoms  was  thought  at  first  to  be  only 
temporary ;  the  patient  was  accordingly 
kept  in  the  asylum  some  months  longer ; 
but  now,  after  three  years,  there  has  been 
no  return  of  insanity.  Hyvert  records  three 
cases  of  insanity  in  which  typhoid  fever  oc- 
curred. In  two  of  these  an  improvement 
in  the  mental  condition  followed.  One,  a 
woman,  aged  20,  with  acute  mania  of  two 
months'  duration,  completely  recovered 
from  her  mental  symptoms  as  the  typhoid 
subsided  ;  the  other,  also  a  woman  aged  20, 
weak-minded,  with  hallucinations  and  in- 
sane ideas,  had  a  severe  attack  of  enteric 
with  rigors  and  broncho-pneumonia  ;  when 
these  passed  off  the  mental  condition  was 
found  to  be  much  improved,  and  the  patient 
left  the  asylum  practically  cured. 


Nervous  Dyspepsia. 

Attention  has  been  called  by  Dr.  Mur- 
doch to  the  sudden  and  marked  changes  in 
the  amount  of  hydrochloric  acid  occurring 
in  this  disease  ;  this,  together  with  the  usual 
mental  depression,  the  pain  in  the  eyeballs, 
and  the  drowsiness  and  loss  of  memory, 
being  the  most  prominent  symytoms  of  the 
disorder.  The  object  of  treatment  must  be 
to  restore  the  lost  balance  of  the  secretory 
nerves,  and  for  this  purpose  strychnine  and 
electricity  are  perhaps  our  most  efficient 
agents.  In  the  cases  he  reports,  this  treat- 
ment proved  very  successful.  It  included 
especially  intragastric  faradisation.  Bath- 
ing and  exercise,  of  course,  must  not  be 
neglected,  and  a  properly  regulated  diet  is 
of  the  greatest  importance.  It  should  be 
regulated  according  to  the  state  of  the  gas- 
tric secretions.  Some  patients  take  too 
little  food.  In  closing,  he  quotes  Allbutt  : 
"In  certain  cases  of  neurasthenia  or  pseudo- 
neurasthenia  the  stomach  is  the  primary 
source  of  departure  from  health  ;  in  others, 
if,  indeed,  the  irritation  of  the  morbid  se- 
ries lay  with  the  nervous  system,  the  secon- 
dary impairment  of  the  stomach  may  be- 
come the  central  feature,  and  the  alleged 
neurasthenia  may  be  due  to  bad  products 
of  digestion,  which  returning  again  to  the 
stomach,  depress  it  and  its  work  still  fur- 
ther ;  if  so  a  cure  is  to  be  obtained  by  gas- 
tric medication  only;  the  stomach  is  the 
link  in  the  vicious  circle  which  has  to  be 
forged  anew." 

Dr.  J.  S.  Lafferty,  of  Glass,  N.  C,  has 
moved  to  High  Point,  N.  C,  and  will  here- 
after practice  medicine  there.  The  doctor 
is  a  skillful  physician,  and  will  do  well  in 
his  new  field. 


THE  CHARLOTTE  MEDICAL  JOURNAL 


Gastric  Hyperesthesia. 

A.  Pick  understands  under  this  term  an 
increased  sensitiveness  of  the  gastric  mu- 
cous membrane  to  chemical,  mechanical, 
and  thermal  stimuli,  or  to  any  one  of  them. 
(British  Medical    Journal). 

Thus  a  patient  with  good  appetite  has 
pain  when  certain  articles  of  food  or  drink 
are  taken,  and  this  is  not  relieved  until  such 
food  or  drink  has  disappeared  from  the 
stomach.  The  more  empty  the  stomach  the 
more  certainly  is  pain  produced  by  these 
articles.  The  stomach  is  most  often  hyper- 
sensitive to  sugar,  fat,  and  carbohydrates. 
There  is  in  these  cases  no  pain  when  the 
stomach  is  empty.  Of  thermal  stimuli  the 
stomach  is  more  often  sensitive  to  cold. 
The  abnormal  sensations  may  vary,  amount- 
ing sometimes  to  severe  pain,  and  even  vom- 
iting may  occur.  It  is  characteristic 
that  fluids  are  as  badly  borne  as  solids  or 
even  worse.  As  to  chemical  stimuli,  some- 
times acids  cannot  be  taken,  as  they  pro- 
duce so-called  heartburn  or  even  cramp-like 
pain  in  the  stomach  region.  Heartburn, 
occurring  a  couple  of  hours  after  food,  is 
usually  due  to  hyperchlorhydria.  Pick  is 
convinced  of  the  reality  of  this  acid  hyper- 
esthesia. Sometimes  along  with  it  there 
are  typical  signs  of  hypersecretion.  Past 
gastric  affections,  over-eating,  psychical 
influences,  mental  overwork,  hysteria,  neu- 
rasthenia, influenza  are  among  the  causes 
of  gastric  hyperesthesia.  Pain,  eructation, 
heartburn,  and  vomiting  are  the  chief  symp- 
toms. The  pain  is  usually  diffuse  and  dis- 
appears when  vomiting  supervenes;  it  may 
be  lessened  by  faradism.  The  vomiting  is 
characteristic  in  so  much  that  fluids  are  more 
often  vomited  than  solids.  Sometimes  ver- 
tigo and  faintness  are  complained  of.  The 
diagnosis  is  based  upon  the  healthy  state  of 
the  gastric  juice  and  the  occurrence  of  pe- 
riods free  from  symptoms.  The  diagnosis 
from  gastric  ulcer  may  be  difficult.  The 
treatment  must  be  directed  to  the  neurosis 
on  which  the  disease  depends.  The  feeding 
is  important.  The  faradic  current  is  useful. 
The  treatment  is  largely  suggestive.  Me- 
dicinal agents  occupy  a  secondary  place; 
cocaine  and  menthol  are  the  most  efficient. 
The  use  of  alkalies  is  only  symptomatic 
treatment,  and  of  these  magnesia  usta  is 
the  best   for  allaying  the  heartburn. 


Control  of  Diphtheria. 
\V.  K.  Jaques  (Journal  of  the  American 
Medical  Association,  Nov.  26,  1898,)  says 
antitoxin  should  be  subjected  as  little  as 
possible  to  the  vicissitudes  of  commerce.  It 
deteriorates  with  age,  and  the  irregular 
demand  often  leaves    it    on    the    druggist's 


shelf  for  months.  When  it  is  needed  it  is 
usually  in  an  emergency,  when  the  life  of  a 
patient  is  dependent  upon  the  quality  of 
the  first  dose  of  serum.  Irresponsible  firms 
have  been  tempted  to  place  an  unreliable 
grade  of  serum  on  the  market.  Foreign 
governments  have  restricted  the  manufacture 
of  the  article.  If  State  officers  are  not 
able  to  do  this,  they  are  at  least  in  a  posi- 
tion to  investigate  and  satisfy  themselves 
of  the  best  grades.  No  greater  service  can 
health  officers  perform  than  to  arrange  for 
a  fresh  supply  of  a  reliable  grade  of  anti- 
toxin, throwing  careful  restrictions  about 
the  distribution  of  that  intended  for  pur- 
poses of  charity.  Delayed  treatment  always 
means  increased  infection. 

As  to  the  reduction  of  mortality  from 
careful  bacteriological  work  and  the  use  of 
a  reliable  antitoxin,  Dr.  Jaques  says  that 
the  predisposition  to  this  disease  is  as  great 
in  Chicago  as  in  any  city  of  its  size  in  the 
world.  Its  geographical  situation  makes 
it  the  commercial  center  of  the  United 
States ;  while  the  immense  system  of  rail- 
ways radiating  from  and  through  it  makes 
it  a  rendezvous  for  all  classes.  Added  to 
this  are  its  crowded  districts  and  its  raw 
lake  winds,  which  have  together  made  the 
city  a  shining  mark  for  diphtheria.  By 
furnishing  convenient  culture  media,  micro- 
scopic examinations,  the  best  obtainable 
grade  of  antitoxin,  and  the  services  of  ex- 
pert physicians  as  inspectors  and  operators, 
Chicago  has  reduced  its  death-rate  from  this 
disease  37.5  to  6.7  per  cent. 


Galvanism  of  the  Neck  in  Obstinate  Vom- 
iting. 

As  early  as  1884  Apostoli,  says  "Medi- 
cine," 1899,  read  an  article  before  the 
French  Society  of  Electrotherapy  upon  gal- 
vanism of  the  pneumogastric  nerve  for 
vomiting.  In  his  earlier  communication 
Apostoli  gave  exact  rules  for  the  applica- 
tion, the  duration  of  each  siting, and  strength 
of  current  to  be  employed.  Two  methods 
were  advised — in  one  the  positive  pole  was 
placed  on  the  side  of  the  neck  and  the  neg- 
ative over  the  epigastrium.  In  this  way  he 
believed  that  the  descending  galvanic  cur- 
rent was  passed  along  the  pneumogastric 
nerve.  He  also  described  a  method  known 
as  the  bipolar,  in  which  a  current  was 
passed  transversely  through  the  neck  just 
below  the  mastoid  region.  Galvanism  ap- 
plied in  this  way  is  very  efficient  in  the  con- 
trol of  vomiting  from  reflex  causes,  and  es- 
pecially those  of  a  hysterical  character. 
Experience  shows  that  the  passage  of  the 
current  from  one  side  of  the  neck  to  the 
other  is  somewhat  more  efficient  than  when 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


93 


the  current  is  passed  from  the  neck  to  the 
epigastrium.  We  have  used  the  term  gal- 
vanism of  the  neck  in  designating  Apostoli's 
method  as  it  conveys  no  doubtful  theory  of 
the  structures  acted  upon  by  the  current. 
The  act  of  vomiting  is  a  very  complex  one, 
and  in  addition  the  uncertainty  of  passing 
a  descending  galvanic  current  along  the 
pneumogastric  nerve  is  so  great  that  we  pre- 
fer to  employ  the  term  galvanism  of  the 
neck  as  indicating  a  procedure  of  consider- 
able value  in  the  treatment  of  obstinate 
cases  of  vomiting. 


Hot  Water  in  the  Treatment  of  Gonor- 
rhea. 

C.  S.  Murrell  (Massachusetts  Medical 
journal,  1898,  Vol,  Will)  recommends 
not  water  irrigations  in  the  treatment  of 
gonorrhea.  The  apparatus  consists  of  a 
soft  catheter,  which  is  passed  to  within  one 
inch  of  the  prostatic  urethra.  It  is  then 
connected  with  a  "gravity  apparatus,"  in 
which  the  water  is  gradually  heated  up  to 
the  point  of  tolerance.  The  steam  Mows  in 
through  the  catheter,  and  returns  between 
the  catheter  and  the  mucous  membrane. 
Several  quarts  of  warm  water  may  be  used 
at  each  treatment.  Some  patients  can 
tolerate  a  temperature  as  high  as  180  deg. 
or  190  deg.  F.  The  following  advantages 
are  claimed  for  this  method  of  treatment  : 

1.  The  course  of  the  disease  is  shortened 
by  at  least  two  thirds,  making  the  average 
limit  of  the  case — viz.,  stoppage  of  the  dis- 
charge— nearer  one  week  than  three. 

2.  The  discharge  immediately  changes 
from  a  purulent  to  that  of  the  nature  of 
gleet,  and  is  reduced  to  a  very  small  quantity. 

3.  There  is  absence  of  chordee  and  pain 
in  passing  urine. 

4.  Stricture,  as  a  sequel,  which  is  well 
understood  to  be  the  frequent  result  of  using 
strong  astringents,   is  improbable, 


of  true  diphtheria  the  diphtheria  bacilli 
disappeared  within  three  days  after  the 
complete  separation  of  the  false  membrane  ; 
in  160  cases  they  persisted  for  a  longer 
time  anmely,  in  103  cases  for  seven  days, 
in  34  cases  for  12  days,  in  16  cases  for  15 
days,  in  4  for  three  weeks,  and  in  3  for 
five  weeks,  after  the  time  when  the  exuda- 
tion had  completely  disappeared  from  the 
upper  passages."  The  author  further  cited 
the  statement  of  Hewlett  and  Knight  that 
they  were  sometimes  able  to  convert  the 
non-virulent  pseudo-diphtheria  bacillus  into 
a  virulent  Klebs-Loffler  bacillus ;  and  that 
by  careful  treating  it  has  apparantly  been 
possible  to  convert  a  typical  Klebs-Ldfrler 
into  a  typical  non-virulent  pseudo-bacillus. 
To  get  rid  of  the  bacilli  A.  C.  Abbott, 
director  of  the  Bacteriological  Laboratory, 
Philadelphia, recommends  thorough  applica- 
tion once  daily,  to  the  parts  that  have  been 
affected,  of  a  solution  of  60  grains  of  silver 
nitrate  to  the  ounce  of  water.  Two  applica- 
tions are  usually  sufficient,  but  occasionally 
a  third  is  necessary.  Weaker  solutions 
were  found  to  be  more  painful.  It  should 
not  be  used  until  the  membrane  has  disap- 
peared, as  otherwise  the  coagulum  formed 
might  protect  organisms  below  it. 


Vitality   of  the   Diphtheria    Bacillus. 

Macgregor  (The  Hospital  Dec.  17,  1S9S) 
reports  a  case  of  a  boy,  aged  eight  years,  in 
which  the  Klebs-Loffler  bacilli  were  present 
in  a  virulent  condition  nearly  six  months 
after  the  attack  of  diphtheria.  He  cites 
other  instances  of  a  similar  kind.  Thus 
Schafer  records  a  case  where  bacilli  found 
in  the  throat,  examined  seven  and  a  half 
months  after  t he  attack,  proved  virulent  by 
inoculation  of  animals.  Tobeisen  found 
diphthera  bacilli  in  the  throat  of  24  out  of 
46  patients  at  the  time  of  their  discharge 
from  the  hospital  and  in  19  out  of  the  24 
cases  the  bacilli  proved  virulent.  Bigg 
stated  that  "in  245  cases  out   of  405    cases 


Subcutaneous  Injection  of  Iron. 

Birgelen,  (British  Medical  Journal)  says 
that  there  are  cases  in  which  a  course  of 
iron  is  strongly  indicated  and  yet  it  cannot 
be  given  by  the  mouth.  The  author  has 
recently  treated  four  patients  with  the  sub- 
cutaneous injections  of  iron  in  whom  the 
effects  of  rest  and  diet  were  as  far  as  possi- 
ble eliminated.  He  used  a  10  per  cent, 
watery  solution  of  ferrum  citricum  oxyda- 
tum,  but  more  recently  a  similar  solution  of 
ferrum  citricum  ammoniatum.  The  injec- 
tions were  made  into  the  arm  under  all  the 
ordinarv  precautions.  The  solution  should 
not  be  more  than  ten  days  old  and  should 
be  sterilized.  Even  with  these  precautions 
there  were  signs  of  local  irritation,  espe- 
cially in  the  case  of  the  first  named  salt. 
The  author  then  gives  details  of  his  four 
cases.  In  the  first  case  there  was  the  clear- 
est evidence  of  the  good  effects  of  this  mode 
of  treatment.  In  the  second  case  the  im- 
provement could  not  be  so  distinctly  as- 
signed to  the  treatment,  whereas  in  the 
third  case  the  treatment  was  unsuccessful, 
and  in  the  fourth  it  had  to  be  interrupted 
owing  to  an  abscess  which  appeared  in  the 
arm.  The  author  thinks  that,  although  the 
results  are  not  brilliant,  yet  the  value  of  the 
treatment  cannot  be  denied.  The  subcu- 
taneous method  is  only  to  be  adopted  when 
treatment  by  the  mouth  fails. 


94 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


BUFFALO  LITHIA  WATER 

Disintegrates  and    Eliminates  Renal    and  Vessical   Calculi,  Uric  Acid    Phosphatic  and 

Oxalic  Concretions. 

Modus  Operandi  of  the    Water  in   such   cases  as  suggested  by  Dr.  J.   W.  MALLET, 
Prof,  of  Chemistry,  University  of  Virginia. 


University  of  Virginia,  Charlottesville, \  a.,  Oct. 11, 1898, 
Col.  Thos.  F.  Goode,  Buffalo  Lithir.  Springs,  ,  a- 

Dear  Sir:-I  have  examined  at  your  request  thiee  col- 
lections of  calculi,  handed  me  on  your  oehalf  by  Di  .A.  U-. 
Kimberlev,  of  which  those  marked  No.  1  and  Nc.  -,  l  was 
informed  had  been  reported  on  by  Dr.  F.  S.  Whaley,  resi- 
dent Physician  at  the  Buffalo  Lithia  Springs,  as  passed 
by  patients  under  the  action  of  the  water  of  Spring  No. 
2:  the  collection  No.  1  representing  renal  and  No.  ^vesi- 
cal calculi— the  collection  marked  No.  3  being  vesical  cal- 
culi reported  on  by  Dr.  G.  L. 
Wimberlv,  of  Rocky  Mount, 
North  Carolina.  I  have  also 
axamined  at  your  request  a 
fourth  specimen  of  disintegra- 
ted calculous  material  which 
was  sent  me  nearly  two  years 
ago  by  Dr.  E.  C.  Laird,  at  that 
time  Resident  Physician  at  the 
springs,  reported  on  by  Dr. 
Laird  as  passed  in  large  quan- 
tity—several ounces  in  all— by 
a  patient  using  the  water  of 
one  of  these  springs;  this  last 
specimen    I  have    designated 

PECIMEN    NO.    1.  No.  4. 

No.  1  consisted  of  three  granules,  of  iight  cinnamon 
brown  colour,  both  outside  and  on  a  surface  of  fracture; 
two    of   them   were  of  regular    shape,  somewhat  honey- 

combed,  looking  as  if  acted  upon  by  a  solve nt    of  medium  phosphate  (ferric) 

:  aggregate  weight  of  the   collection  oxalate    -        - 


SPECIMEN  NO. 
this  collection  magnified 
whole  collection  gave: 

Uric    Acid 

Sodium    urate  - 

Calcium   urate        .... 
Ammonium  magnesium  phosphate 
Calcium   phosphate 


No  3  consisted  of 
seven  granules,  or 
separate  small  cal- 
culi of  browner  and 
darker  colour  than 
Nos.  1  and  2,  both 
externally  and  on  a 
surface  of  fracture. 
With  generally 
rounded  forms,  the 
external  surfaces 
were  finely  rough 
and  pitted,  as  in  No. 
1,  and  the  interior 
porous,  presenting 
the  appearance  of 
having  been  acted 
upon  by  a  solvent 
liquid ;  aggregate 
weight  of  collection 
.598  gramme.  Pho- 
tograph No.  3  shows 
8  diameters.     Analysis  of  the 


degree  of  hardness:  aggregate 

181  gramme.     Photograph  No.  1  represents  this  eollectio 
magnified  IK  diameters.     An  analysis  of  the 
collection  gave  the  following  results: 

Urieacid  

Ammonium     urate 

Sodium  urate 

Calcium  urate 

Ammonium  magnesium  phosphate 

Calcium  phosphate 

Organic  colouring  matter _ 

Proteid  organic  matter,  and  hygroscopic  moisture 


•hole  of  this 


rare 


1.61 


ICO. (Ill 


Collection  No. 
2  consisted  of  10 
granules, for  the 
most  part  of 
light  yellowish 
brown  color  like 
No.  1,  but  rather 
lighter  and  whi- 
tish on  the  out- 
side, smoother 
and  more  round- 
ed than  those  of 
No.  1 :  but  one 
(the  largest) 
granule  exhibit- 
ing a  hoiif.v- 
comed  surface 
(this  one  also  a 
little  blood- 
stained mucous 
on  the  outside, 
which  was  scra- 
ped off  prior  to 
analysis)  mode- 
rately hard  and 


ium  oxalate    -  trace 

Organic  colouring  matter  -        -        -        -        Notable  trace 
Proteid  organic  matter,  and  hygroscopic  moisture        .95 

100.00 
No.  4  was  a  fine  sandy 
powder  of  a  light  buff 

.     .72    colour,    nearly  white. 

.   1.19     Under    the    microscope 

trace    the     greater    part     was 

trace  seen  to  consist  of  small 
crystals  and  crystal 
fragments.  There  were 
a  few  minnte  fibres  of 
wood  (tne  presenoe  of 
which  was  pointed  out 
by  Dr.  Laird,  and  ex- 
plained by  the  mode  of 
collecting  the  speci- 
men); these  were  pick- 
ed out  prior  to  analysis. 
Weight  of  specimen  as 
received  1.544  gramme, 
Photograph  No.  4  exhib- 
its the  appearance  of  SPECIMEN  NO,  4. 
this  material,  magniged  .65  diameters.  The  results  of 
analysis  were: 

Ammonium  magnesium  phosphate 64.93 

Calcium   phosphate 21.65 

Iron  phosphate  (ferric) 13 

Calcium  carbonate 3.99 

Uric  acid 3.73 

Ammonium  urate • 3.81 

Sodium  urate 58 

Calcium    urate 32 

Proteid  organic  matter,  and  hygroscopic  moisture  .       .86 

100.00 
and  3,  the  concentric  structure 


In  the  case  of  Nos. 

showing  distinct   concentric  layers;    aggregate  weight  of  of  the  granules   was  too   fine,  and  the  whole  quantity  of 

the    collection    .829   gramme.      Photograph    No.  2    shows  material  too  small   to   admit  of  separate  examination  of 

this   collection,   magnified    l.K   diameters    Analysis  of  the  such  thin  layers  as  were  present  of  various   composition, 

whole   collection  gave:  due  to  varying  character  of  the    urine   during    the  time 

Uric   acid 71.32  within  which  each  calculus  had  formed. 

Ammonium    urate 4.73 

Kodiuii    urate 18  It  seems  on  the  whole  probable  that   the  action   of  the 

Calcium  urate jo  water  is  primarily  and  mainly    exerted   upon   uric   acid 

Calcium  oxalate 2o!26  an"  tlle   urates,   but  that  when  these  constituents  occur 

Ammonium  magnesium  phosphate ..............  ....       1.15  along  with,  and  as  cementing  matter  to,   phosphatic  or 

Calcium  phosphate .94  oxalic  calculous  materials,  the  latter  may  be  so  detached 

Iron  phospbatcOVrrie) ....!.........  trace  a,ul   broken   down   as   to   disintegrate   the   calculus  as  a 

organic  ((doming  matter ..[...trace  "hole  in    these   cases    also,   thus   admitting  of  urethral 

Proteid  organic  matter  and  hygroscopic  moisture.'.'       1.32  discharge. 

100.00 


(Signed)        J.  W.  MALLET. 


Buffalo  Lithia  Water 


in  cases  of  One  Dozen  Half 
Gallon  Bottles,  $5.00.  F. 
O.  B.  Here. 

Sold  by  all  First-class  Druggists. 
THOS.  r*.  GOODB,  Proprietor  Buffalo  Lithia  Springs,  Va. 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


95 


Superior  to 

IODOFORM. 


Odorless. 

Tasteless. 


No  more  expensive  to  use  than  Iodoform, 
being  at  least  four  times  as  voluminous. 


DSOPHEN 


Iodoform  is  universally  regarded  as  such  an  excellent  healing  agent,  that  claims  of  superiority 
over  it  for  Nosophen  may  appear  as  an  exaggeration,  but  there  is  indisputable  clinical  evidence 
that  it  causes  a  wound  to  heal  more  rapidly,  and  with  less  or  no  suppuration;  moreover,  it  never 
produces  a  dermatitis  around  the  edges  of  a  wound  as  Iodoform  always  does,  Nosophen  being 
absolutely  non-toxic  and  non-irritating.  Besides  as  a  surgical  dressing  in  major  and  minor 
surgery,  it  is  adapted  to  other  most  varied  employment,  as  an  antiseptic  in  the  treatment  of 
chancroid  and  all  abscesses  and  ulcers,  herpes,  eczema  and  other  skin  diseases,  either  as  a  powder 
or, combined  with  vasaline  and  lanoline,  as  an  ointment;  Nosophen  is  a  strong  desiccant  and  excel- 
lent results  are  obtained  with  insufflations  in  purulent  discharges  from  the  middle  ear,  in  nasal 
catarrh,  etc. 

Eudoxine  (The  Bismuth  Salt  of  Nosophen). 

This  chemical  salt  of  Nosophen  is  intended  for  employment  as  an  intestinal  antiseptic  and 
as  such  it  gives  most  excellent  results.  To  judge  from  clinical  reports,  it  is  decidedly  an  efficient 
intestinal  antiseptic,  and  has  the  great  advantage  of  being  absolutely  harmless  and  non-irrita- 
ting, odorless  and  tasteless.  Indicated  in  typhoid  fever,  chronic  intestinal  catarrh,  diarrhoea  of 
phthisis,  infantile  diarrhoea,  chronic  enteritis,  etc. 

Literature  on  request.     Sole  Agents  for  the  U.  S.  and  Canada: 

STALLMAN  &  FULTON,     10  Gold  St.,  New  York. 


The   Safest,  Most  Agreeable  and 
Reliable  Anti-rheumatic. 


$alephen 


An  Important  Advance  in  Gonor- 
rhoea Therapeutics. 


Prof^r&fl 


Sem&tese 


A  Scientific  Food,  Tonic  and 
Restorative. 


The  Chalybeate  Tonic 
and  Nutrient. 


Lycctfcl 


Ferr«-S«inar©se 


The  Uric  Acid  Solvent    and 
Anti-arthritic. 


Send  for  samples  and  literature  to 

FARBENFABRIKEN   OF  ELBERFELD  CO.,  40  Stone  St.,  New  York. 

Selling  agents  for  the  Bayer  Pharmaceutical  Products  : 

istol,  Creosote  Carbonate  (Creosotal),  Europhen,  Ferro-Somatose,  Cuaiacol  Carbonate  (Ductal).  Hemicranin,  Heroin, 

lodothyrine,  Lacto-Somatose,  Losophan.  Lycetol,  Phenacetin,  Piperazine-Bayer,  Protargfol,  Quinalgen.  j 

Salicylic  Acid.  Salophen,  Somatose,  Sulfonal,  Tannigen,  Tannopine,  Trional.  W 


96 


THE  CHARLOTTE  MEDICAL  JOURNAL 


Buffalo  Lithia  Water 

in  Uric  Acid  Diathesis 

DR.  THOMAS  H.  BTJCKI,ER,  of  Paris  {formerly  of  Baltimore),  Sttggester  of 
I,ithiaas  a  Solvent  for  Uric  Acid,  says:  "  Nothing  I  could  say  would  add  to  the  well- 
known  reputation  of  the  Buffalo  I/ithia  Water.  I  have  frequently  used  it  with  good  results 
in  Uric  Acid  Diathesis,  Rheumatism  and  Gout,  and  with  this  object  I  have  ordered  it  to 
Europe,  from  Coleman  &  Rogers,  of  Baltimore.  lithia  is  in  no  form  so  valuable  as 
where  it  exists  in  the  Carbonate,  the  form  in  which  it  is  found  in  Buffalo  Lithia 
Water,  Nature's  mode  of  solution  and  division  in  water  which  has  passed  through  Lepido- 
lite  and  Spodumene  Mineral  formations." 

HUNTER  McGUIRE),  M.D.,  I/TyD.,  President  and  Professor  of  Clinical  Sur- 
gery, University  College  of  Medicine,  Richmond,  Va.,  says:  "Buffalo  iLithia  Water, 
as  an  alkaline  diuretic,  'is  invaluable.  In  Uric  Acid,  Gravel,  and  indeed,  in  diseases  gener- 
ally dependent  upon  a  Uric  Acid  Diathesis,  it  is  a  remedy  of  extraordinary  potency.  I 
have  prescribed  it  in  cases  of  Rheumatic  Gout,  which  had  resisted  the  ordinary  remedies, 
with  wonderfully  good  results.  I  have  used  it  also  in  my  own  case,  being  a  great  suf- 
ferer from  this  malady,  and  derived  more  benefit  from  it  than  from  any  other 
remedy." 

DR.  WILLIAM  B.  TOWLES,  Professor  of  Anatomy  and  Materia  Medica  in  the 
Medical  Department  of  the  University  of  Virginia :  "Buffalo  Lithia  Spring  belongs  to 
the  Alkaline,  or  perhaps  the  Alkaline-Saline  Class,  for  it  has  proved  far  more  efficacious  in 
many  diseased  conditions  than  any  of  the  simple  Alkaline  waters.  I  feel  no  hesitancy  what- 
ever in  saying  that  in  Gout,  Rheumatic  Gout,  Rheumatism,  Stone  in  the  Bladder, 
and  in  all  diseases  of  Uric  Acid  Diathesis,  I  know  of  no  remedy  at  all  comparable  to  it." 

Water  in  Cases  of  One  Dozen  Half  ^Gallon  Bottles,  $5.00.    F.  O.  B.  Here 

Sold  by  all  first-class  Druggists 

THOS.  P.  GOODB,  Proprietor  -  Buffalo  I4thia  Springs,  Va, 


Physicians  at  Hot  Springs 

Use  Buffalo  Lithia  Water 


PERSONALLY  AND  PRESCRIBE  IT  FOR   OTHERS,  IN 


GOUT,  RHEUMATIC 


Dr.  ALGERNON  S.  GARNETT,  Sur- 

feon  (retired)  U.  S.  Navy,  Resi- 
entPhysician, Hot  Springs,  Ark.: 

"  My  experience  in  the  use  of 

Buffalo  Litbk  W*ter 

is  limited  to  the  treatment  of  Gout, 
Rheumatism,  and  that  hybrid  dis- 
ease 'Rheumatic  Gout'  < so-called), 
■which  is  in  contradistinction  to  the 
Rheumatoid  Arthritis  of  Garrod. 

"I  have  had  excellent  results 
from  this  Water  in  these  affections, 
both  in  my  own  person  and  in  the 
trealme?it  of  patients  for  whom  I 
have  prescribed  it.  Of  course,  the 
remedial  agent  is  its  contained  Al- 
kalies and  their  solvent  properties. 

"Hence  it  is  a  prophylactic  as 
ivell  as  a  remedy  in  Nephritic  Colic 
and  forming  Calculi,  when  due  to  a 
redundancy  oj  Lithic  Acid." 


GOUT,  RHEUMATISM, 
CALCULI,  Etc.,  Etc. 


NEPHRITIC  COLIC, 


The  late  Dr.  WM.  F.  CARRINGTON, 

Resident  Physician,  Hot  Springs, 
Ark.,  Surgeon  (retired),  u.  S. 
Navy,  Surgeon  Confed.  States 
Navy,  Medical  Director  Army  of 
Northwestern  Virginia : 

"  Buffalo  Litbiai  W^ter 

has  signally  demonstrated  its  re- 
medial power  in  Gout,  Rheumatic 
Gout,  Rheumatism.Uric  Acid  Grav- 
el, and  other  maladies  dependent 
upon  the  Uric  Acid  Diathesis. 

"//  not  only  eliminates  from  the 
blood  the  deleterious  agent  before  it 
crystallizes,  but  dissolves  it  in  the 
form  of  Calculi,  at  least  to  a  size 
that  renders  its  passage  alongthe 
ureters  and  urethra  comparatively 
easy." 


SPRING  PAMPHLET 
FREE  ON  APPLICATION 


Dr.    T.   B.  BUCHANAN,    Resident 
Physician,  Hot  Springs,  Ark.: 
"  Send  me  five  cases 

Buffalo  Litbifc  Wfcter 

Spring  No.  2.  I  have  made  use  of 
this  Water  for  Gout  in  my  own  per- 
son, and  prescribed  it  for  patients 
similarly  suffering,  with  the  most 
decided  beneficial  results.  I  take 
pleasure  in  advising  Goutypatients 
to  use  these  springs." 

Dr.  G.  W.  LAWRENCE,  Resident 
Physician,  Hot  Springs,  Ark.: 
"I  prescribe 

Buffalo  Litbii  Wfcter 

with  great  confidence  in  Uric  Acid 
Diathesis,  Gout,  Rheumatic  Gout, 
and  Rheumatism. 

"When  traveling  it  is  my  habit 
to  use  this  water  as  a  guarantee 
for  getting  a  pure  water." 


Water  in  Cases  of  One  Dozen  Half=Gallon  Bottles,  $5.00,  f.o.b.  here. 

THOS.  F.  GOODB,  Proprietor  -  Buffalo  IVithia  Springs,  Va 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


THE  BEST  PREPARED  FOOD. 


-For  THE  BABY* THE  IrWAUD,*THE  CONVALESCENT/THE  AGED  A 

Uir.UFCT   AWADItC  ^  ^^*^  IT  r  It  NT  A  I IU  C  ITOI 


rsS^r^aSEB 


NEARLY  ALWAYS  SUCCESSFUL 
WHEN  AIL  OTHER  KINDS 
OF  NOURISHMENT,^ 
HAVE  FAILED.  j£*i 


i3* 

SAMPLES  for  CLINICAL  TEST 

SUPPLIED  to  PHYSICIANS 

and  TRAINED  NURSES 

ON  REQUEST. 


fOF  TODAY 

AND   WILL  CONTINUE 

TO  YIELD  SATISFACTORY  RESULTS  in  NUTRITION 

FAR  INTO  THE  FUTURE,  BECAUSE  ITS  MERITS  HAVE  BEEN 

PROVED  BY  CLINICAL  SUCCESS  in  the  PAST. 

'     Shippinq  Depot,  JOHN  CARLE  &  SONS ,  153  Water  Street,  NewYork. 

Cv-  "  SOLD  BY  DRUGGISTS  EVERYWHERE. 


The  Vomiting  of  Pregnancy. 

Dr.  Bacon  (Amer.  Jour,  of  Med.  Science) 
states  : 

The  abnormal  irritability  of  the  nervous 
system,  including  the  vomiting  center,  is  to 
be  allayed  by  keeping  the  patient  in  the 
horizontal  position,  by  attention  to  the  skin, 
bowels,  and  kidneys,  using  rectal,  and,  if 
necessary,  hypodermic  injections  of  salt 
solution. 

The  hysterical  condition  which  is  so 
commonly  present  should  be  controlled  by 
strengthening  the  will  and  influencing  the 
dominant  idea  of  the  patient.  All  sources 
of  peripheral  irritation  should  be  discovered 
and  treated. 

In  extreme  cases  subcutaneous  saline  in- 
jections serve  the  three-fold  purpose  of  (a) 
diluting  the  blood  and  increasing  vascular 
tension;  (b)  eliminating  toxins  through 
renal  and  intestinal  emunctories  ;  (c)  fur- 
nishing two  most  important  kinds  of   food. 

Induction  of  abortion  is  never  indicated. 
At  a  stage  when  it  is  safe  and  efficient  it  is 
not  necessary,  and  in  extreme  cases  it  adds 
greatly  to  the  danger,  rarely  stops  the  vom- 
iting, and  can  be  replaced  by  the  artificial 
serum. 


READING  NOTICES. 


Airlie,  N.  C,  April  15,   1898. 
The  Ammonol  Chemical  Co.,  New  York 

Gentlemen  : — The  first  use  I  made  of 
Ammonol  was  in  my  own  case.  Some  two 
months  since  I  was  taken  in  the  morning 
with  very  premonitory  symptoms  of  grippe 
which  continued  to  develop  in  intensity  un- 
til at  night  I  found  myself  with  high  fever 
and  partially  delirious.  I  called  in  a  friend 
whose  diagnosis  was  grippe  and  prescribed 
Ammonol,  grs.  v.,  Morphine  Seed,  gr.  £, 
to  be  repeated  in  one  hour.  Fever  abated ; 
a  gentle  perspiration  was  induced ;  slept 
pleasantly  the  remainder  of  the  night  and 
the  grippe  was  aborted.  Ammonol  forms 
a  preparation  that  supplies  to  the  profession 
a  much  needed  remedy. 

Dr.  E.  A.  Thorne. 

Female  Neurosis. 

ivI  have  prescribed  Dioviburnia  and 
Neurosine  in  Female  Neurosis  with  results 
entirely  satisfactory.  I  shall  continue  to 
use  these  two  products  in  combination  in 
all  cases  indicated." 

J.  J.  Kelly,  M.  D., 

Oct.  26,  1898.   *  Argentine,   Kans. 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


A    Valuable  Opportune  Remedy. 

This  is  the  time  of  the  year  when  Grippe, 
Neuralgia,  Dengue  and  "bad  colds"abound 
— in  fact,  are  all  but  universal,  and  the 
physician  is  kept  busy  prescribing  for  them. 
Among  the  favorite  remedies  in  such  cases 
is  Laxiquinin, which  while  of  comparatively 
recent  introduction,  has  already  acquired 
an  enviable  reputation  as  a  remedy  in 
Grippe.  Neuralgia  and  Dengue,  and  allied 
ailments,  Laxiquinin  if  given  in  the  begin- 
ning of  a  cold,  will  abort  it,  while  it  is  in- 
valuable in  the  treatment  of  Grippe,  Dengue 
and  other  catarrahai  and  Malarial  diseases, 
from  which  it  takes  away  the  chief  terror — 
the  "back-bone"  characteristics.  Laxi- 
quinin, Toniquinin  and  Iquinin  are  manu- 
factured by  the  Iquinin  Chemical  Co.,  of 
St.  Louis.  For  samples  and  literature  ad- 
dress the  manufacturers  as  above. 


Vague  and  Indefinite  Pains  due  to  Latent 
Rheumatic  Conditions. 

The  physician  is  frequently  called  upon 
to  treat  patients,  who  though  not  ill  enough 
to  be  in  bed  are  not  at  all  well.  Their 
appetite  is  capricious,  they  sleep  indiffer- 
ently or  even  if  they  sleep  soundly,  they  are 
not  refreshed  and  in  the  morning  they  are 
more  fatigued  and  ill  at  ease  than  was  the 
case  on  retiring.  Upon  awaking  there  is 
frequently  an  aching  sensation  in  the  loins, 
sometimes  in  the  lower  limbs,  which  is 
noticed  upon  getting  out  of  bed  or  in  dress- 
ing, and  particularly  in  putting  on  their 
hose  or  lacing  their  shoes.  As  the  day 
progresses  this  soreness  may  partially  wear 
off,  but  there  is  at  all  times  a  vague,  un- 
defined, uneasy  painful  feeling. 

A  competent  examination  of  the  urine  in 
these  cases  will  in  almost  every  instance  be 
found  to  disclose  a  notable  absence  of  the 
soluble  urates.  On  the  contrary  it  may  be 
loaded  with  the  phosphates  and  very  fre- 
quently bile  will  be  present  as  also  uric 
acid.  If  the  condition  remains  neglected, 
tne  probable  results  will  be  sooner  or  later 
a  pronounced  attack  of  rheumatism  in  one 
or  another  of  its  forms.  All  that  is  needed 
to  induce  such  a  condition  is  a  sudden 
change  in  the  weather  or  the  exposure  on 
the  part  of  the  patient  to  cold  or  wet  or  a 
combination  of  the  two.  This  is  due  to  a 
latent  rheumatic  diathesis,  to  which  every 
adult  is  liable. 

In  such  cases  the  physician  will  find 
Tongaline  in  any  one  of  its  forms  as  indi- 
cated, given  at  short  intervals  with  copious 
draughts  of  hot  water,  a  remedy  which  goes 
directly  to  the  source  of  the  trouble.  Tonga- 
line    seeks    out    the    retained  excretions  or 


perverted  secretions,  which  it  either  neutra- 
lizes or  renders  amenable  to  the  physiologi- 
cal action  of  the  emunctories,  and  then  it 
brings  to  bear  its  strong  eliminative  powers, 
correcting  the  complaint  promptly  and 
thoroughly. 


Allen  &    Hanburys    Ltd.,    London. 

It  will  be  interesting  to  our  readers  to 
learn  that  the  oldest  and  foremost  phar- 
maceutical house  in  England  has  lately 
established  a  branch  at  No.  82  Warren 
Street,  New  York,  hence  some  of  the  more 
important  of  its  preparations,  notably 
throat  Pastilles,  and  Infants  Foods,  may  be 
obtained. 

Allen  &  Hanburys  Ltd.,  was  established 
A.  D.  1715  and  has  never  ceased  growing, 
not  only  in  point  of  size  but  in  the  estima- 
tion of  the  medical  profession.  Its  reputa- 
tion for  accuracy  and  purity  of  products  is 
such  when  physicians  wish  to  be  absolutely 
sure  of  what  their  patients  are  getting  they 
invariably  prescribe  "Allen  &  Hanburys." 
This  is  no  mean  tribute  after  nearly  two 
hundred  years  of  commercial  life. 

The  specialties  they  are  now  introducing 
to  the  physicians  of  the  United  States  are  : 
Throat  Pastilles;  "Perfected"  Cod  Liver 
Oil,  manufactured  by  their  own  workmen 
in  their  three  factories  in  Norway;  "Taste- 
less" Castor  Oil,  which  is  not  only  tasteless 
but  pure  castor  oil;  "Bynol"  an  intimate 
combination  of  "Allenburys"  Malt  Ex- 
tract with  their  own  Cod  Liver  Oil  :  and 
last  but  not  least  the  "Allenburys"  Series 
of  Infants  Foods  manufactured  in  accord- 
ance with  Allen  &  Hanburys  original 
System  of  Progressive  Infant  Feeding, 
which  provides  for  foods  adapted  to  the 
several  stages  of  Infant  Feeding.  This 
scientific  system  is  meeting  with  unbounded 
success  in  England,  as  it  ought  everywhere. 

Literature  and  samples  of  these  special- 
ties will  be  furnished  free  on  application  to 
No.  82  Warren  Street,  New  York. 


The  usefulness  of  good  Hypophosphites 
in  Pulmonary  and  Strumous  affections  is 
generally  agreed  upon  by  the  Profession. 

We  commend  to  the  notice  of  our  readers 
the  advertisement  on  page  20  of  this  num- 
ber. "Robinson's  Hypophosphites"  also 
"Robinson's  Hypophosphites  with  Wild 
Cherry  Bark"  (this  is  a  new  combination 
and  will  be  found  very  valuable)  are  elegant 
and  uniformly  active  preparations ;  the  pre- 
sence in  them  of  Quinine,  Strychnine, 
Iron,  etc..  adding  highly  to  their  tonic 
value. 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


LISTERINE 


The  Standard  Antiseptic, 


LISTERINE  is  a  non-toxic,  non-irritating  and  non-escharotic  antiseptic,  composed  of  ozonifer 
ous  essences,  vegetable  antiseptics  and  benzo-boracic  acid. 

LISTERINE  is  sufficiently  powerful  to  make  and  maintain  surgical  cleanliness  in  the  antisepti 
and  prophylactic  treatment  and  care  of  all  parts  of  the  human  body. 

LISTERINE  has  ever  proven  a  trustworthy  antiseptic  dressing  for  operative  or  accidental 
wounds. 

LISTERINE  is  invaluable  in  obstetrics  and  gynecology  as  a  general  cleansing,  prophylactic, 
or  antiseptic  agent,  and  is  an  effective  remedy  in  the  treatment  of  catarrhal  conditions  of 
every  locality. 

LISTERINE  is  useful  in  the  treatment  of  the  infectious  maladies  which  are  attended  by  inflam- 
mation of  accessible  surfaces — as  diphtheria,  scarlet  fever  and  pertussis. 

LISTERINE  is  especially  applicable  to  the  treatment  of  scarlet  fever,  used  freely  as  a  mouth 
wash,  or  by  means  of  the  spray  apparatus. 

LISTERINE  is  extensively  prescribed  in  typhoid  fever,  both  for  its  antiseptic  effect  and  to  im- 
prove the  condition  of  the  stomach  for  the  reception  of  nourishment. 

LISTERINE  agreeably  diluted,  is  prescribed  with  very  good  results,  in  the  treatment  of  diph- 
theria, both  as  a  prophylactic  and  curative — internal  antiseptic — agent. 

LISTERINE  is  used  extensively  with  good  results  in  the  treatment  of  whooping  cough. 

LISTERINE  diluted  with  water  or  glycerine  speedily  relieves  certain  fermentative  forms  of 
indigestion. 

LISTERINE  is  indispensable  for  the  preservation  of  the  teeth,  and  for  maintaining  the  mucous 
membrane  of  the  mouth  in  a  healthy  condition. 

LISTERINE  employed  in  a  sickroom  by  means  of  a  spray,  or  saturated  cloths  hung  about,  is 
actively  ozonifying  and  imparts  an  agreeable  refreshing  odor  to  the  atmosphere. 

LISTERTNE  is  of  accurately  determined  and  uniform  antiseptic  power  and  of  positive  ori 
ginality. 

LISTERINE  is  kept  in  stock  by  the  leading  dealers  in  drugs,  everywhere 


Lambert's  Lithiated  Hydrangea, 


Close  clinical  observation  //as 
caused  Lambert's  Lithiated 
Hydrangea  to  be  regarded  by 
Physicians  generally  as  a  very 
valuable  Renal  Alterative 
and  Antilitiiic  Agent. 


Albuminuria,  Lithaemia, 

Bright's  Disease,      Nephritis 
Cystitis, 
Diabetes, 
Gout, 
Haematuria, 


Rheumatism, 

Urinary  Calculus, 
and  all  forms  of 
Vesical  Irritation 


For  Descriptive  Literature,  Address 


Lambert  Pharmacal  Co., 


ST.     LOUIS. 


100 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


Grateful    Testimony. 

The  Imperial  Granum  Co., 

New  Heaven,  Conn. 

Dear  Sir — I  feel  assured  you  have  the 
best  food  preparation  on  the  market.  I 
had  a  son — a  soldier — come  home  low  with 
typhoid  fever.  I  used  Imperial  Granum 
and  it  acted  like  a  charm.     He  is  now  well. 

It  allays  inflammation,  reduces  fever, 
quiets  the  patient  and  is  a  great  blessing. 
I  wish  you  a  happy  Christmas 


M.  D. 


Newport,  Dec.  16,  \\ 


Phillips'  Emulsion. 

There  is  no  necessity  for  the  discon- 
tinuance of  the  use  of  Cod-Liver  Oil  (be- 
cause of  failure  to  obtain  results  from  Plain 
Oil  or  some  Emulison)  for  the  undoubted 
therapeutic  value  of  Cod-Liver  Oil  but 
emphasizes  the  necessity  of  its  scientific  ex- 
hibition to  insure  satisfactory  results  from 
its  employment.  The  cause  of  failure  in  its 
administration  is  not  obscure  :  few  patients 
can  take  plain  oil  owing  to  its  repugnant 
taste  and  the  difficulty  of  assimilating  it. 
The  province  of  an  emulsion  being  to  dis- 
guise the  taste,  and  to  exhibit  a  definite 
volume  of  chemically  unchanged  oil  in 
condition  for  easy  absorption,  it  follows 
that  this  will  be  defeated  unless  the  oil  is 
thoroughly  emulsified  and  in  combination 
with  agents  that  will  not  saponify  it,  as 
sponification  renders  it  valueless  and  even 
harmful. 

In  emulsions  with  the  Alkaline  Hypo- 
phoshites  of  lime  and  soda  the  association 
of  the  oil  with  such  agents  entirely  changes 
the  character  of  the  oil  and  produces  a 
liquid  soap.  While  less  repugnant  to  the 
taste  than  plain  oil,  the  medicinal  value  of 
such  a  preparation  is  greatly  diminished, 
and  it  is  because  of  this  that  many  a  dis- 
gusted practitioner  has  abandoned  using 
Cod-Liver  Oil  in  any  form. 

Admitting  a  preparation  of  Cod-Liver 
Oil  with  Hypophoshites  of  lime  and  soda 
to  be  unscientific  because  productive  of 
chemical  alteration  in  the  oil  it  follows  that 
a  combination  of  oil  with  the  phosphate 
salts,  giving  positive  acid  reaction  and  thus 
precluding  saponification,  would  seem  to  be 
based  on  sound  therapeutic  reasoning, 
furthermore,  if  such  an  emulsion  exhibits  a 
large  percentage  of  chemically  unchanged 
oil  in  minute,  microscopic  sub-division 
closely  analogous  to  milk  (Nature's  Emul- 
sion) it  must  be  preferred  to  plain  oil  as 
well  as  to  Alkaline  Emulsions,  because  of 
the  difficulty  and  failure  already  referred 
to  attending  their  administration. 


Phillips'  Emulsion  positively  exhibits  the 
important  advantage  noted,  the  oil  is 
emulsified  with  pancreatine,  and  because 
of  its  scientific  preparation  it  has  for  many 
years  enjoyed  an  extensive  professional 
support.  A  more  concise  statement  of  its 
claims  for  professional  recognition  will  be 
found  in  our  advertising  columns,  and  we 
say  with  all  candor  that  it  is  an  ethical  pre- 
paration, ethically  introduced  and  main- 
tained. 


"Allenburys"  Throat  Pastilles. 

The  leading  throat  specialists  and  phy- 
sicians generally  in  England  and  the  Con- 
tinent have  for  many  years  been  employ- 
ing the  "Allenburys"  Pastilles  with  the 
best  results.  These  elegant  Pastilles(jujube) 
have  no  rough,  angular  corners,  are  soft 
and  demulcent,  and  are  prepared  with  that 
accuracy  for  which  the  oldest  and  largest 
drug  house  in  England  is  so  justly  famous. 

The  London  Lancet  says:  -'Nothing 
can  be  more  gratifying  to  the  sight  and 
more  attractive  to  the  taste  than  Messers. 
Allen  &  Hanburys'  collection  of  Jujubes, 
prepared  by  a  special  process.  The  tints 
are  very  clear  and  brilliant,  the  paste  is 
not  adhesive,  and  it  seems  that  the  only 
difficulty  is  to  make  a  choice  amongst  the 
great  variety.  The  Glycerine  Pastilles  form 
a  very  elegant  and  tempting  preparation." 

For  list  of  formulae  see  page  112  and  when 
ordering  please  do  so  by  number.  Address 
Allen  &  Hanburys  Ltd.,  82  Warren  Street, 
New  York. 


Ecthol. 

Sample  of  Ecthol  was  received  and  at 
time  of    receiving  had  good    case  to  use  it. 

Miss had  the  misfortune  to  run  hedge 

thorn  one  inch  long  in  leg  above  ankle.  It 
remained  in  one  week  when  she  was  brought 
to  my  office  to  have  it  extracted.  Was  suc- 
cessful in  removing  thorn,  but  it  being  a 
dead  one  pieces  of  bark  remained  in  wound. 
Disinfected  wound  with  bi-chloride,  bound 
it  up  and  sent  patient  home.  Was  sum- 
moned in  two  days  and  found  limb  inflamed 
to  groin,  swollen  and  very  painful.  Re- 
moved bandage  which  was  followed  by  a 
small  quantity  of  pus.  Re-applied  dress- 
ing. That  night  bottle  of  Ecthol  was  re- 
ceived, visited  patient  next  day,  and  put 
her  on  Ecthol,  teaspoonful  six  times  a  day, 
and  injected  medicine  in  the  wound  and 
applied  cloth  saturated  with  same.  In  four 
days  pain,  swelling  and  inflammation  gone, 
wound  healing  and  patient  able  to  do  her 
work.  A.  L.  Stiers,  M.  D. 

Dawson,  Neb.,  Nov.  25th,  1898. 


THE»CHARLOTTE  MEDICAL  JOURNAL.  101 


HYDROZONE 

(3o  volumes  preserved  aqueous  solution  of  H:02) 

IS  THE  MOST    POWERFUL   ANTISEPTIC   AND    PUS   DESTROYER. 
HARMLESS  STIMULANT  TO  HEALTHY  GRANULATIONS. 

GLYCOZONE 

(C.  P.  Glycerine  combined  with  Ozone) 

IS  THE  MOST  POWERFUL  HEALING 

AGENT  KNOWN. 

These  Remedies  cure  all  Diseases  caused  by  Germs. 

Successfully  used    in  the    treatment  of  Gastric  and  Intestinal 

Disorders  (Chronic  or  Acute): 

DYSPEPSIA,  GASTRITIS,  GASTRIC  ULCTCR, 

HEART-BURN,  CONSTIPATION, 

DIARRHOEA,  Etc. 

•'Half  an  hour  before  meals,  administer  from  4  to  8  ozs.  of  a  mixture  ^fl- 
taining  2  per  cent,  of  Hydrozone  in  water.  Follow  after  eating  with 
Glycozone  in  one  or  two  teaspoonful  doses  well  diluted  in  a  wineglass- 
ful  of  water." 

Send  for  free  24o-page  book  "Treatment  of  Diseases  caused  by  Germs,** 

containing  reprints  of  120  scientific  articles  by  leading 

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Physicians  remitting  50  cents  will  receive  one  complimentary  sample 

of  each  "Hydrozone"  and  "Glycozone"  by  express,  charges  prepaid. 


Prepabkd  ohly  by 


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THE  CHARLOTTE    MEDICAL  JOURNAL. 


"Influenza." 

During  the  epidemic  of  the  past  winter  I 
have  used  Kryofine  in  a  large  number  of 
cases.  Headache  and  muscular  pains  dis- 
appeared after  first  dose.  There  was  con- 
tinued amelioration  of  all  the  subjective 
symptoms.     For  the  relief  of  pain  Kryofine 


acts  very  rapidly  and  surely,  the  relief  often 
occurring  within  fifteen  minutes. 

John  H.  Curtis,  M.  D. 
Professor  of  Therapeutics  and  Clinical  In- 
structor in  Medicine,  College  of  Physi- 
cians and  Surgeons ;  Attending  Physi- 
cian Lake  Geneva  Sanitarium,  etc.,  etc., 
Chicago. 


The  Doctor  as  a  Speculator 

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THE  CHARLOTTE  MEDICAL  JOURNAL. 


TABLE    OF    CONTENTS    FOR   JANUARY,    1899, 


i03 


Original   Communications- 

The  Symptoms  and  Diagno- 
sis of  Simple  Glaucoma, 
by  Gaillard  S.  Tennent, 
M.D.,  Asheville,  N.  C. . .     23 

Hemori'hage  in  the  New- 
Bora,  by  John  N.  Upshur, 
M.D.,  Richmond,  Va 28 

A  case  of  Incontinence  of 
Urine  cured  by  Anterior 
and  Posterior  Colporaphy, 
by  A.Lapthorn  Smith,  B. 
A.,M.D.,  M.R.C.S.,  Eng- 
land      29 

Head  Injuries, by  J.Herbert 
Austin,  M.D.,M.  R.  C.  S., 
England  29 

Anaesthesia  and  Anaesthe- 
tics, by  C.C.  Hersman,M. 
I).,  Pittsburgh 31 

Abortion  of  Fevers,  by  T. 
Edwards  Converse,  M.  D.. 
Louisville,  Ky 34 

Pernicious  Malarial  Fever 
Complicating  the  Puer- 
peral State — with  Report 
of  a  case,  by  F.  D.  Gray, 
M.D.,  Jersey  City,  N.J. .     37 

Streptococcus  Infections, 
by  Frederick  C.  Taylor, 
M.D.,  Cleveland,  Ohio...     40 

Some  little  things  on  Drugs 
and  Diet,  by  Albert  Bern- 
heim.  A.M.,  M.D.,  Padu- 
cah,   Ky 42 

Otitis  Media  Chronica,  by 
J.  II.  McCassy,  M.A.,M. 
I)..  Dayton.  Ohio 45 

Bright's  Disease-Malaria, 
by  J.  A.  Reagan,  M.  !>., 
Weaverville,  N.  C 47 

Syphilitic  Sore  Throat,  by 
John  S.  Moreman,  M.  D., 
Louisville,  Ky 48 

Hyperemia  of  Conjunctiva. 
by  Edw.W.  Wright,  M.D., 
Brooklyn.  N.  Y 49 

The  Problem  of  Life,  by 
Win.  s.  Stoakley,  M.  D., 
Millboro  Springs,  Va 52 

Editorial. 

The  Successful  Consultant.  53 

Creasote  vs.  Carbolic  Acid.  53 
Is  there  Something  beyond 

Science? 54 

Heredity   or   Association — 

Which ? 54 

Animal  Extracts 55 

Inspection  of  the  Cornea  in 

Ophthalmia  Neonatorum  55 

Abdominal  Pains 56 

Treatment  of  Strabismus. .  56 

Abuse  of  Medical  Charity.  57 

Passing  of  the  Expectorant  57 

High  Degrees  of  Myopia..  57 
Nasal  Treatment  as  a  cause 

of  Ear  Disease 58 

Modern    Surgery   and    the 

Peritoneum 58 

Fluctuations  in  the  Disease 

Curve 59 


Sympathetic  Nervous  Sys- 
tem       59 

Is  Sexual  Perversion  In- 
creasing?      59 

BouK   Reviews, 

Human  Anatomy.  A  com- 
plete Systematic  Treatise 
by  various  authors,  inclu- 
ding a  Special  Section  on 
Surgery  and  Topographi- 
cal Anatomy.  Edited  by 
Henry  Morris,  M.A.,  and 
M.  B.,  London 60 

A  Text  Book  of  Obstetrics. 
By  Barton  Cook  Hirst, M. 
D.,  Philadelphia 60 

A  Primer  of  Psychology 
and  Mental  Disease,  for 
Use  in  Training  Schools 
for  attendants  and  Nurses 
and  in  Medical  classes. 
By  OB. Burr. M.D., Flint, 
Mich 61 

The  Sexual  Instinct,  its  use 
and  Dangers  as  Affecting 
Heredity  and  Morals.  By 
James  Foster  Scott,B.A., 
M.D..C.M 61 

Medical  News  Pocket  For- 
mulary for  1899.  By  E. 
Quin  Thornton,  M.  D., 
Philadelphia 61 

The  Phonendoscope  and  its 
Practical  Application, 
with  thirty-seven  illus- 
trations, by  Felix  Reg- 
nault,  M.D 61 

A  Compend  on  Obstetrics. 
By  Henry  G.  Landis,  A. 
M.,M.D.,  Philadelphia..     61 

Diseases  of  the  Skin.  By 
Malcolm  Morris,  M.  D., 
Philadelphia 62 

Diseases  and  Their  Cure. 
By  A.H.  Crondace,  M.D., 
Quincy,  111 62 

Saunders  Medical  Formu- 
lary with  an  Appendix. 
By  William  M.  Powell, 
M.  D 93 

Coca  and  its  Therapeutic 
Application.  By  Angelo 
Mariani,   New  York 62 

A  Pilgrimage;  or  the  Sun- 
shine and  Shadow  of  the 
Physician.  By  Wm.Lane 
Lowder,  B.S..M.D 62 


Literary  Notes. 

The  American  Monthly  Re- 
view of  Reviews 62 

The  Cosmopolitan 62 

LippincotCs   Magazine  for 

January,  1899 63 

The   Living   Age    for    the 

New  Year 63 

The  Forum 63 

Announcement  of  Import- 
ance to  every  Physician .     63 


Miscellaneous. 

Acute  Hemorrhagic  As- 
cites     

Appendicitis  and  Renal 
Colic 

Action  of  Mineral  Waters 
and  Drugs  on  the  Bile  . . 

A  Speedy  Method  of  Dila- 
ting the  Rigid  Os 

Appendicitis  During  Preg- 
nancy   

A  Good  Rule  for  the  Coun- 
ty Doctor- 

Cold  Feet 

Certain  Points  of  Interest 
in  Phthisis 

Christian-Science  Fanatics 

Creosote  in  Chronic  Consti- 
pation   

Diphtheria  as  it  Occurred 
in  two  Families  in  West 
Texas 

Electricity  as  an  Aid  to 
Diadermie  Medication. . . 

Family  Prevalence  in  Re- 
lation to  Inheritance 

Growing  Pains 

Gonorrheal  Ophthalmia  of 
Infante 

Heredity   and  Disease 

Hypnotism  in  the  Treat- 
ment of  Alcoholics    

How  to  Avoid  Tuberculosis 

Infectivity  of  the  Urine  in 
Typhoid  Fever 

Protective  action  of  the 
Liver  against  Microbes. . 

Programme  of  the  first  An- 
nual Session  of  the  Tri- 
State  Medical  Society  of 
the  Carolinas  and  Virgin- 
ia, to  be  held  at  Char- 
lotte, N.  C 

Quinin  in  Malarial  Fever. 

Rheumatism  in  Children. . 

Rontgen   on    the   Rontgen 

Rays 

Soil    as   a    Factor    in    the 

Spread  of  Disease 

Syphilis  in  the  Third  Gene- 


ration 


The  Liability  to  Cramp  af- 
ter Sleep 

Tubercular  Peritonitis  in 
Children 

The  Old-Fashioned  Saddle 
Bags 

The  Operative  Treatment 
of  Cancer  of  the  Breast. . 

Tuberculosis  and  the  Milk 
Supply 

The  Diagnosis  of  Nephritis 
without  Albuminuria 


69 

77 
65 
65 

67 

75 

68 
73 
74 
78 
79 
80 


104 


THE  CHARLOTTE  MEDICAL  JOURNAL 


Auto-intoxication  in  Epi- 
lepsy      81 

Automatic  Pressure  Re- 
gulator       85 

All enburys  Throat  Pastilles  100 

Auto-intoxication  and  Al- 
buminuria      83 

A  Valuable  Opportune  Re- 
medy      98 

Allen  &  Hanburys  Ltd., 
London 98 


Christian  Scientists... 
Control  of  Diphtheria. 


Diet  for  Surgical  cases 84 

Drainage    in    Suppurative 

Appendicitis 85 

Diet  in  Hyperacidity 82 

Dust  and  Disease 90 

Ecthol, 100 

Fads     and     Fallacies 

Rectal  Surgery 

Female  Neurosis 

Fear  Neurosis 


of 


Gastric  Hyperesthesia. 


Galvanism  of  the  Neck  in 

Obstinate  Vomiting 92 

Grateful  Testimony 100 

Hot  Water  in  the   Treat- 


ment of  Gonorrhea. 
Influenza. 


Laryngeal  Hemorrhage. 
Longevity  in  Spain 

Moles 

Nervous  Dyspepsia 


Palatable  Throat  Pastilles  88 

Phillips'  Emulsion 100 

Remarks  on  Exophthalmic 

Goitre 81 

Spinal  Meningitis  Com- 
plicating Measles 85 

Subcutaneous    Injection  of 

Iron 93 

Toxi-Alimentary  Dyspnoea  87 

The  Mortality  of  Cancer. .  87 


The  Value  of  Casts  in  the 
Prognosis  of  Albuminu- 
ria   

The  Relative  Importance 
of  Flies  and  the  Water 
Supply  in  Spreading  Dis- 
ease  

The  Effects  Produced  by 
Anaesthetics  upon  the 
Kidneys  and  Circulation . 

The  Cure  of  Diabetes 

The  Contagiousness  of  Tu- 
berculosis   

Typhoid  Fever  and  Insanity 

Utero-Intestinal  Fistula... 

Vaginal  Bacteria  in  Preg- 
nancy   

Vitality  of  the  Diphtheria 
Bacillus  

Vomiting  of  Pregnancy... 

Vague  and  Indefinite  Pains 
due  to  Latent  Rheumatic 
Conditions 

X-Rays  and  Lupus 


90 


72 


Annual  Banquet  at  Piney  Woods  Inn. 

Piney  Woods  Inn  at  Southern  Pines,  N. 
C,  has  opened  for  the  winter  season  and 
announces  the  annual  banquet  in  honor  of 
the  Commercial  Travelers,  to  be  held  at  the 
hotel,  Monday  evening,  January  9th. 

During  the  past  two  years  these  banquets 
have  been  a  pronounced  success,  and  it  is 
the  aim  of  the  commercial  travelers  to  so 
arrange  his  route  that  he  may  be  present  on 
that  occasion.  Manager  St.  John  always 
gives  the  traveler  the  glad  hand  of  welcome, 
and  the  spread  which  he  prepares  for  the 
boys  is  a  most  bounteous  one,  and  we 
doubt  not  but  that  the  annual  reunion  this 
year,  like  those  of  former  occasions,  will  be 
one  of  pleasure  long  to  be  remembered. 
— Exchange. 


Dr.  Fred.  D.  W.  Evelyn,  of  St.  Luke's 
Hospital,  San  Francisco,  claims,  as  the  re- 
sult of  fifteen  years'  experiments,  to  have 
found  a  certain  cure,  by  the  inoculation  of 
horses  blood,  for  drunkenness,  as  well  as 
for  the  transmission  of  the  hereditary  taint 
of  alcoholism. 


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TRAIPfEjD    NURSR, 

GLASS,  N.  C. 

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THE  CHARLOTTE  MEDICAL  JOURNAL. 


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A    NEW    BOOK!    JUST    PUBLISHED!! 

A  Pilgrimage;  or  the  Sunshine  and  Shadows  of  the  Physician. 

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"We  know  nothing  of  the  writer  of  'Sunshine  and  Shadows  of  the  Physician,'  but  he  has 
written  a  rare  little  book,  worthy  of  wide  diffusion  in  the  Profession.  It  contains  chapters  on  the 
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Dr.  George  F.  Butler,  Professor  of  Materia  Medica  and  Clinical  Medi- 
cine, College  of  Physicians  and  Surgeons,  Chicago;  attending  "["physician 
Cook  County  Hospital,  etc.,  in  the  course  of  an  article  in  the  Chicago  Clinic, 
says  : 

"With  the  exception  of  morphine,  no  drug  possesses  so  positive,  prompt  and 
efficient  an  analgesic  property  as  kryofine  ;  indeed,  there  are  painful  disorders,  such 
as  migraine  and  particularly  the  pains  of  locomotor  ataxia  and  certain  spinal  dis- 
eases, where  kryofine  seems  nearly  as  efficient  as  morphine  and  attended  with  less 
unpleasant  sequelae. " 

In  the  services  of  Drs.  Rudisch,  A.  Meyer  and  A.  G.  Gerster,  Mt.  .Sinai 
Hospital,  N.  Y.,  it  was  found  that : 

"As  a  hypnotic  in  insomnia,  unaccompanied  by  severe  pain,  it  has  proved  of 
undoubted  value.  In  a  case  of  acute  suppurative  arthritis,  general  sepsis  and  peri- 
carditis, the  drug  did  not  affect  the  pulse.  When  the  child  was  restless  at  night,  2A 
grs.  of  kryofine  produced  a  quiet  sleep  lasting  several  hours." — Drs.  Haas  and  Mor- 
rison, N.  Y.  Medical  Journal. 


Literature  and  C.     BISCHKOFF     &     CO.,  .      Dose:5-74 

samples  sent  grains ;  tablets  or 

on  request.  ^Te-w  York.  crystalline  powder. 


108 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


SCRIBNER'S 
MAGAZINE 
FOR     1899 


GOVERNOR  ROOSEVELT'S    "THE 
ROUGH  RIDERS"  (illustrated  se- 
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ROBERT  LOUIS  STEVENSON'S 
LETTERS  (never  before  published), 
edited  by  Sidney  Colvin. 


RICHARD  HARDING  DAVIS: 

Stories  and  special  articles. 


RUDYARD  KIPLING— HENRY  VAN 
DYKE— WILLIAM  ALLEN  WHITE 
and  many  others;  Short  Stories. 


GEORGE  W.  CABLE'S  NEW  SERIAL 
story  of  New  Orleans.  "The  Ento- 
mologist"—Illustrated  by  Herter. 


SENATOR  HOAR'S    Reminiscences- 
Illustrated. 


MRS.  JOHN  DREW'S  Stage  Reminis- 
cences— illustrated. 


JOEL  CHANDLER  HARRIS'S  new 
collection  of  Stories.  "The  Chroniles 
of  Aunt  Minervy  Ann." 


Q'S    SHORT    SERIAL,      "A  Ship  of 
Stars." 


ROBERT  GRANT'S  Search-Light  Let- 
ters— Common-Sense  Essays. 


SIDNEY  LANIER'S  Musical   Impres- 
sions. 


C.  D.  GIBSON'S  The  Seven  Ages  of 
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THE  MAGAZINE  IS  $3.00  A  YEAR; 
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THE  CHARLOTTE  MEDICAL  JOURNAL 


109 


THE  DENNIS  FLUOROMETER 


MANUFACTURED   BY 


The  Rochester  Fluorometer  Co.  SsVil 


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Velvet  Case.     Patented  April  27,  1897. 

THE  DENNIS  FLUOROMETER  is  a  necessary  adjunct  of  perfect  x-ray  work. 
It  supplies  accurate  cross-section  of  the  body  or  limb,  rectifies  distortions  of  p'osition  and 
distortions  caused  by  the  divergence  of  the  rays,  and  locates  with  geometrical  exactness 
anything  which  is  observable  in  the  Roentgen  shadow.  It  forms  a  perfect  shadow  of 
any  portion  of  the  anatomy,  making  it  indispensable  in  cases  of  dislocations  and 
fractures.  Accurate  methods,  precise  instruments,  precise  results.  THE  DENNIS 
FLUOROMETER  supplies  all  this.  It  gives  protection  to  the  Surgeon  in  court;  also 
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lformation  and  particulars  write  for  illustrated  catalogue. 


110 


THE    CHAELOTTE  MEDICAL  JOURNAL. 


Uniformly   Effective,   Agreeable  and  Lasting. 

The   Standard   Preparation  of  Erythroxylon 
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During  past  30 
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THE  CHARLOTTE  MEDICAL  JOURNAL.  m 


Trophonine 


a  palatable  and  nutritious  liquid  food,  contains  the  nutritive  elements  of  beef,  egg- 
albumen,  and  wheat  gluten,  so  prepared  as  to  be  readily  absorbed  and  aid  almost 
immediately  in  the  process  of  reconstruction.  It  furnishes  the  sick  with  the  largest 
possible  supply  of   nourishment  and  with  the  minimum  tax  on  the  digestive  organs. 


Protonuclein 


by  increasing  the  number  of  Leucocytes,  destroys  toxic  germs,  increases  the  inherent 

resistance  to   disease,   quickens  glandular   activity,   arouses  the   nutritive  forces, 

gives  tone  to  the  system,   and  stimulates  cell-life  through  the  organism. 


Peptenzyme 


is  the  only   perfect   digestive.         It   digests   every    variety  of  food.         In   physiological 

activity  it  presents  the  active  and  mother  ferments  of    the  entire  group  of  digestive 

organs.     It  aids  digestion  by  furnishing  an  additional  supply  of  protoplasmic 

material  out  of   which  active  ferments  are    elaborated,  and  perfects  the 

process  by    increasing    cellular    activity. 


Samples  and   Literature  on   request. 

Reed  &  Carnriek      -        New  York 


112 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


The  "Allenburys"  Throat  Pastilles 


THESE  PASTILLES  have  now  for  many   years   been  I 
widely  employed,  and  with  the  best  results,  by  the  leading 
Throa't  specialists  and  physicians  generally.    Long  expe- 
rience has  shown  the  following  kinds  to  be  the  more  gen- 
erally useful  and  frequently  prescribed : 

No.    2.     Ipecacuanha.    Readily  taken  by  children.   These 
Pastilles  are  of  the  same  strength  as  the  Lozen- 
ges of  the  Britisn  pharmacopoeia. 
No.    3.    Morphia  and  Ipecacuanha.  (l-40th  grain  Morphia 
and  \i  grain  Ipecacuanha). 

Menthol,  Cocaine  and  Red  Gum.     (Menthol  and 
Cocaine,  aa.  gr.  l-20th  ;  Red  Gum,  gr.  ii). 
Benzoated  Voice.    Useful  to  public  speakers, etc. 
Chlorate   of  Potash.    A    more  agreeable  form 
than  the  Lozenge  of  the  Pharmacopoeia. 
Rhatant.     Astringent. 

Tannin.     Astringent,  and  of  the  same  strength  as 
the  Tannic  Acid   Lozenges  of  the  British   Phar- 
macopoeia. 
No.  17.    Chlorate    op  Potash  and  Borax.      Containing 
these  two  useful  remedies  in  combination. 
Red  Gum.    Astringent. 

Eucalyptus  (Gum  and   Oil).    Antiseptic,  stimu- 
lant, and  astringent. 
No.  24.    Cocaine.     (l-20th  grain).    Sedative  to  the  mucous 

membrane. 
No.  24a.  Cocaine.     (1 -10th  grain). 
Mo.  26.    Codeine.     (l-8th  grain  Codeine).    Sedative. 
No.  27.    Compound  Eucalyptus.     (Red  Gum,  Chlorate  of 
Potash,  and  Cubebs) 


No.    9. 

No.  10. 

No.  11. 

No.  13. 

No.  14. 


No.  22. 
No.  23. 


Compound  Guaiacum.      (Guaiacum,  Chlorate  of 
Potash,  and  Red  Gum). 

The  "Allenburys"  Throat  Pastilles  are  sold  in  decorated  ti 
Sent  on  receipt  of  price  to  any  address,  post  paid. 


No.  2'.).  Compound  Rhatant  and  Cocaine.  (Ext.  Rhatany, 
gr.  ii;  Cocaine  Hydrochlor.,  gr.  l-10th).  A  very 
efficacious  astringent  and  anodyne. 

No.  32.    Red  Gum  and  Chlorate  of  Potash.    Astringent. 

No.  38.  Chlorate  of  Potash,  Borax,  and  Cocaine.  (2 
grains  Chlorate  of  Potash.  1  grain  Borax,  l-20th 
grain  Cocaine). 

No.  41.    Eucalyptus  Oil.    Antiseptic  and  stimulant. 

No.  43.     Menthol.    (1-20  grain).  Stimulant  and  antiseptic. 

No.  43a.  Menthol.     (l-10tli  grain). 

No.  44.  Menthol  and  Cocaine.  (l-20th  grain  Menthol  and 
l-20th  grain  Cocaine  in  each).  Stimulant,  anti- 
septic, and  sedative. 

No.  45.  Menthol  and  Rhatany.  (Menthol,  l-20th  grain; 
Extract  of  Rhatany,  2  grains).  Antiseptic,  stimu- 
lant and  astringent. 

No.  48.  Tannin,  Catenne,  and  Black  Currant.  Astrin- 
gent, stimulant,  and  soothing. 

No.  52.  Tannin  and  Black  Currant.  Astringent  and 
soothing. 

No.  54.    Menthol  and  Eucalyptus  Oil. 

boxes,  at  30  cents  retail. 


ALLEN  &  HANBURYS,  LTD., 

U.  S.  Branch:  82  Warren  Street,  New  York. 


(LONDON,  ENG.) 


Agent  for  Canada  W.   Lloyd  Wood,  Toronto- 


Books  for  Medical  Students. 


A  Text-Book  for  Training  Schools  for  Nurses. 

By  P.  M.  Wise,  M.  D.,  President  of  the  New- 
York  State  Lunacy  Commission;  Medical  Super- 
intendent St.  Lawrence  State  Hospital;  Profes- 
sor of  Psalmistry,  University  of  Vermont,  etc. 
With  an  introduction  by  Dr.  Edward  Cowles, 
Physician-in-Chief  and  Superintendent  McLean 
Hospital. 

Second  edition.  Two  volumes,  illustrated, 
16mo,  sold  separately,  each,         -         -  $1.25 

"This  text-book  has  been  adopted  by  the  ten 
State  Hospitals  of  New  York,  representing  ap- 
proximately four  hundred  pupils." 

Dr.  G.  Alder  Blumer  (the  medical  superinten- 
dent of  the  Utica  State  Hospital)  says;  "It  is  an 
admirable  piece  of  work.  It  is  written  very 
clearly,  and  in  language  which  can  be  very 
readily  understood  by  the  nurse.  It  cover's  tbe 
whole  ground,  and  contains  a  great  deal  of  mat- 
ter not  to  be  found  in  other  books,  and  with  the 
adoption  of  this  book  other  text-books  will  not 
be  required  for  the  training  school." 


A  Text-Book  of  Materia  Medica  for  Nurses. 

Compiled  by  Lavina  L.  Dock,  graduate  of  Belle- 
vue  Training  School  for  Nurses,  late  superin- 
tendent of  nurses,  Illinois  Training  School  for 
Nurses,  etc. 

Third  edition,  revised  and  enlarged.  Thir- 
teen thousand.     12mo.  -  -        -  $1.50 

"The  work  is  interesting,  valuable,  and  wor- 
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Record. 

"It  is  written  very  concisely,  and  little  can  be 
found  in  it  to  criticise  unfavorably,  except  the 
inevitable  danger  that  the  student  will  imagine 
after  .reading  that  the  whole  subject  has  been 
mastered.  The  subject  of  therapeutics  has  been 
omitted  as  not  a  part  of  a  nurse's  study,  and  this 
omission  is  highly  to  be  commended.  It  will 
prove  a  valuable  book  for  the  purpose  for  which 
it  is  intended.—  N.  Y.  Medical  Journal. 

An  Aid  to  Materia  Mediea. 

By  Robert  H.  M.  Dawbarn,  M.D  ,  Professor  of 
Operative  Surgery  and  Surgical  Anatomy,  New 
York  Polyclinic. 

Third  edition,  revised  and  enlarged  by  Wool- 
sey  Hopkins,  M.D.     12mo.        -        -        -      $1.00 


G.  P.  Putnam's   Sons,         27  and  29  West  23d  St.,  New  York  City. 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


113 


"The  abortive  properties  which  it  possesses  evidently  lie  in 
the  complete  inocculation  of  the  blood  with  an  antiseptic  that 
will  render  the  blood  an  infertile  field  for  the  propagation  of 
germs  or  the  growth  of  disease  ferments." 

The  above  quotation  is  from  a  paper  entitled  "AN  ANTISEPTIC  METHOD 
OF  ABORTING  AND  CONTROLLING  FEVERS,"  read  before  the  Illinois 
State  Medical  Society,  and  refers  to 

VISKOLEIN 

IN  THE  TREATMENT  OF 

TYPHOID  FEVER  MD  PNEUfiONIA 

VISKOLEIN  acts  as  an  antipyretic,  and  antiseptic,  and  a  stimulant.  It  reduces 
the  temperature  rapidly,  safely  and  permanently,  and,  at  the  same  time,  by  its  antiseptic 
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For  formula,  literature,  clinical  reports  and  other  information,  address 

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The  Dow  Portable  Electric  Assistant  is  the 
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Gentlemen:  Chicago,  March  22,  1897. 

The  portable  battery,  "Dow's  Physician's 
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Yours  truly, 
HUGH  BLAKE  WILLIAMS,  M.  D. 

(ientlemen:  Braintree,  March  1,  lg98. 

I  believe  it  to  be  the  most  complete,  compact 
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in  the  office  of  physicians  and  surgeons  alive  to 
the  advancement  of  Scientific  medicane  and 
modern  surgery.  Respectfully  yours, 

HENRY   L.    DEARING,  M.    D., 


Send  for  circiular  and  price  list. 

The  Dow  Portable  Electric  Assistant  Co. 


218  Tremont  St.,  Boston,  Mass.,  U.  5.  A. 


114 


THE  CHARLOTTE.  MEDICAL  JOURNAL 


KINA    TONIC 

MTTT  .  .  T  ,  lor  Atonic  Dyspepsia,  Amenorrhea,  loss  of  ap-  On  receipt  of  10c.  silver, 
t  UKMUbA.  iron  petjt6)  Anaemia,  Chlorosis,  Tardy  recovery  after  or  stamps,  we  will  send  a  full 
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appetite,  vomiting  of  drunkards,  etc. 


Louisville,  Ky. 


Threa  Medals  Awarded  at  the  World's  Columbian  Exhibition,  Chicago,  1893. 


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MANUFACTURERS  OF 

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The  unquestioned  superiority  of  our  Specialties,  and  the  unparalled  and  phenomenal  success 
they  have  achieved  with  the  leading  physicians  and  surgeons  of  the  United  States,  and  the  large 
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THE  CHARLOTTE  MEDICAL  JOURNAL.  115 

There  is  no  longer  any  Doubt 
DIOVIBURNIA 

has  proven  to  be  THE  MOST  POWERFUL  UTERINE  TONIC 
ATTAINABLE.  The  STANDARD  REMEDY  in  Dysmenorrhea, 
Amenorrhea,  Leucorrhea,  Menorrhagia,  Vomiting  in  Pregnancy, 
Gestation,  Parturition,  Threatened  Abortion,  Miscarriage,  Subin- 
volution, etc.     As  an 

Anti-spasmodic  and   Anodyne  Unexcelled. 

In  female  neurosis  combine  DIOVIBURNIA   3ii.  with  NEUROSINE   3iv. 
Dessertspoonful  in  hot  water  every  three  hours. 

BEWARE   OF  SUBSTITUTION, 

Literature  and  formula  mailed  on   application. 

DIOS  CHEMICAL  COMPANY. 

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A  PRIVATE  HOSPITAL  for  MEDICAL   AND  SURGICAL  CASES, 

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W.  P.  Nicolson,  M.  D.,  Surgery. 
K.  R.  Kime,  M.  D.,  Gynecology. 
W.  L.  Champion,  M.  D.,   Genito- Urinary  and 
Rectal  Diseases. 


CONSULTANTS. 


.).  S.  Todd,  M.  D.,  General  Medicine. 
S.  G.  C.  PiNCKNEY,  M.  P.,  Nervous  Diseases. 
A.  W.  Calhoun,    M.  Dm   Eye,   Ear,   Nose  and 
Throat. 
Bernard  Wolff,   M.  D.,   Skin  Diseases  and    F    g<   BouRNS>  M.  D<)  Pathology   and  Bacte- 


C.  C  Stockakd,  M.  D.,  Drug  Habits. 


riology. 


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^K£^f|  O*    Indicated     in     Stomach     Derangements. 

O     It   increases   the  flow  of   the    Digestive 

juices,    thereby    causing   the    stomach  to    do   its    own 

work,     without     the     aid     of     artificial     digestants. 

Dose — One  or  more  teaspoonfuls  three  times  a  day. 


CACTI  N  A  PILLETS.    The  HEART  REGULATOR. 

Dose— One  Pillet  every  hour,  or  less  often,  as  required. 
SULTAN  DRUG  CO.,  St.  Louis  and  London. 


116 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


Accuracy. 

Yale  and  Kew 

Observatory 

Standards  used 

in  testing. 


A  New  Idea. 

If  your  dealer  has  none  in  stock,  we  will  mail 
on  receipt  of  price 


Thermometor 

for  the 

Lower 
Vest  Pocket. 


Desirability. 

Magnifying  lens, 
Quick  registration 
Indestructible  index 
Self  registering,  Case 
is  aluminum  and 
will  not  tarnish, 
Fits  in  lower  Vest 
pocket. 


No.  404    Selected  magnifying  lens,  certified,  aluminum  case,  $1.00 
No.  808    One  minute        "  "  "  "  "        1.25 

Every  thermometer  bearing  the  name  or  trade  mark  (B.  D.  &  Co.)  of  Beckton,  Dickinson  & 
Co.  has  been  standardized  and  will  not  change  with  age.     For  Sale  by 

BECTON,  DICKINSON  &  CO.,  45  Vesey  St.,  New  York,  U.  S.  A. 


Arnold  Sterilizers. 

All  shapes  and  sizes  for  all  purposes.  They 
are  used  and  recommended  throughout  the 
world. 

By  Physicians,  to  sterilize  instruments, 
surgical  dressings,  etc. 

By  Hospitals,  for  general  sterilizing  pur- 
poses. 

By  Laboratories,  for  bacteriological  in- 
vestigations. 

By  Families,  to  sterilize  and  pasteurize 
milk  for  babies  and  invalids. 

Catalogue  mailed  on  application. 

WILMOT  CASTLE  &  CO.,  24  Elm  St.,  Rochester,  N.  Y. 


NORTH  CAROLINA 

Medical  College 


THREE  YEARS  ORADED  COURSE. 


Expenses  Moderate! 

Instructions  Thorough ! 


FOR    CATALOGUE    ADDRESS 


J.  P.  MONROE,  M.  D., 

Davidson,  N.  C. 


W.  H.  WAKEFIELD,  M.  D. 


Practice  limited  to 


Eye,  Ear  Nose  and  Throat. 

No.  40  South  Tryon  Street, 
CHARI.OTTE},     JV.     C. 


MARSHALL'S  CONVERTIBLE  BUGGY  CASE. 

Changes  into  Saddle 
Bag  (is  both  in  one). 
Finest,  best  durable 
leather  finish  outside 
and  in  (lined).  Con- 
tents :  14  1-oz.  rubber, 
18  6-dr.  cork  S.— Total 
32  bottles,  with  space- 
between  rows  forpows 
der  papers,  2  sundry 
spaces, one  under  each 
lid,  754x2^x254. 

Delivered,  privilege 
of  examination,  C  O. 
D.,  bal.  $8.50;  or,  ex- 
press paid,  $9,  if  you  remit  $1  earnest  fee.  We  sell  Saddle 
Bags  low  as  $4.75.  24-bottle,  with  2  S-spaces,  $5.50.  Best 
"Leader"  Buggy  Case,  26  3-dr.,26  6-dr.,  4  3-oz.  bottles  in 
springs,  1  sundry  space,  $3,75.  We  mall  full  line  prices, 
and  illustrations  (on  mentioning  this  Journal)  if  asked 
for. 

SOUTH  BRANCH  M'F'G  CO., 

562s  .lackgon  A v,>,,  Chicago  III. 


OUR  CUT  5. 


TflE  CHARLOTTE  MEDICAL  JOURNAL 


HI 


PHENALGIN  etna) 


"Among  the  many  hypnotics  offered  the  medical 
profession  during  the  past  few  years,  Phenalgin  cer- 
tainly takes  the  lead.  Its  greatest  superiority  is 
found  in  the  well-established  fact  that  it  does  not 
cause  any  heart  depression,  nor  is  there  any  reaction 
following  its  continued  administration.  In  doses  of 
five  or  ten  grains  it  overcomes  pain,  and  produces  the 
most  refreshing  sleep,  from  which  the  patient  awakes 
exhilarated  and  invigorated." — The  N.  Y.  Polyclinic. 

Phenalgin  is  sold  by  every  wholesale  druggist.  Your 
retailer  can  obtain  it  for  you  without  delay  or  trouble. 
Generous  samples  of  powder  or  tablets  sent  free  by  mail 
to  physician.*. 

ETNA  CHEMICAL  CO.,  313  West  St.,  New  York,  U.S.A. 


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Situated  in  the  heart  of  the  renowned  long  leaf  pine  belt  and  at  its  highest  elevation,  sK 
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superior  location  in  the  midst  of  the  noble  pines,  whose  health-giving  and  delicious  odor  is  conr 
stantly  inhaled,  and  the  remarkable  purity  of  the  water  here  obtained,  together  with  extremely 
mild  climate,  renders  this  the  most  desirable  resort  for  persons  suffering  from  lung,  throat  and 
malarial  troubles. 

The  new  magnificent  Piney  Woods  Inn  and  six  smaller  hotels  offer  unusually  excellent 
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Double  Daily  Service  in   Pullman  Vestibule  Limited  Trains  via  the  Seaboard 

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118  THE  CHARLOTTE   MEDICAL  JOURNAL. 


The  Latest  Medical  Publications 

LEA  BROTHERS  &  CO.,  Publishers, 

complete  catalogue  Philadelphia  and  New  York. 

upon  application.  r 


Hare'S  Text-BOOk  Of  Practical  TherapeatiCS. — A  Text-Book  of  Practical  Therapeu- 
tics; With  Especial  Reference  to  the  Application  of  Remedial  Measures  to  Disease  and  their  Employ- 
ment upon  a  Rational  Basis.  By  Hobart  Amory  Hare,  M.  D.,  Professor  of  Therapeutics  and  Materia 
Medica  in  the  Jefferson  Medical  College  of  Philadelphia.  Wih  special  chapters  by  Drs.  G.  E.  De 
Schweinitz,  Edward  Martin  and  Barton  C.  Hirst.  New  (7th)  edition.  In  one  octavo  volume 
of  about  775  pages.  Cloth.  $3  50,  net;   leather,  $4.50,  net.    Just  ready. 


Hardaway  OU  Skin  Diseases. — Manual  of  Skin  Diseases.— With  Special  Reference  to 
Diagnosis  and  Treatment.  For  the  use  of  Students  and  General  Practitioners.  By  W.  A.  Harda- 
way, M.  D.,  Professor  of  Diseases  of  the  Skin  in  the  Missouri  Medical  College,  St.  Louis.  New  (2d) 
edition,  entirely  rewritten  and  much  enlarged.  In  one  handsome  i2mo.  volume  of  560  pages,  with 
»bout  40  engravings  and  2  colored  plates.     Cloth,  $2.25,  net. 


Williams  On  Children. — Medical  Diseases  of  Infancy  and  Childhood.— By  Dawson  Wil- 
liams, M.  D  ,  Physician  to  the  East  London  Ilospi'al  for  Children.  In  one  l2mo.  volume  of  629 
pages,  wi.h  illustrations.     Cloth,  $2.75,  net.    Just  ready. 


DaV6np0rt'S  Gynecology — A  Manual  of  Gynecology.  Designed  especially  for  the  use 
of  Students  and  General  Practitioners.  By  Francis  H.  Davenport,  M.  D.,  Assistant  Professor  of 
Gynecology  in  the  Medical  Department  of  Harvard  University,  Boston.  New  (3d)  revised  and  en- 
larged edition.     In  one  handsome  l2mo.  volume  of  387  pages,  with  150  illustrations.      Cloth,  #1.75,  net. 


Greens  Pathology  and  Morbid  Anatomy.— Pathology  and  Morbid  Anatomy.    By 

T.  Henry  Green,  M.  I)  ,  Lecturer  on  Pathology  and  Morbid  Anatomy  at  Charing  Cross  Hospital  Med- 
ical School,  London.  New  (Sth)  American  from  ihe  eigh  h  and  revised  English  edition.  In  one  very 
handsome  roval  octavo  volume  of  about  6oo  pages,  with  215  engravings,  many  being  new.  Cloth, 
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9  Eleln'S  HlStOlogy. — Elements  of  Histology.  By  E.  Klein,  M.  D.,  F.  R.  S.,  Lecturer  on 
General  Anatomy  and  Physiology  in  the  Medical  Sch  ol  of  St.  Bartholomew's  Hospital,  London,  and 
J.  S.  Eijkins,  M.  A.,  M.  B.,  Joint  Lecturer  on  and  Demonstrator  of  Physiology  in  the  Medical  School 
of  St.  Bartholomew's  ILspital,  London.  New  (5th)  edition.  Enlarged  and  thoroughly  revised.  In 
one  !2mo.  volume  of  506  pages,  with  296  illustrations.     Cloth,  $2.00.  n,t.     Just  ready. 


Playfair'S  Midwifery.— A  Treatise  en  the  Science  and  Practice  of  Midwifery.  By  W.  S. 
Pi.ayi  air,  M.  I)  ,  l.L.  !>.,  F.  R.  C.  P.,  Emeritus  Frofessor  cf  Obstetric  Medicine  in  King's  College, 
London.  Examiner  in  Midwifery  to  the  Universities  of  Cambridge  and  London.  New  seventh  Amer- 
ican from  the  ninth  Englih  edition.  In  one  very  handsome  octavo  volume  of  700  pages,  with  207 
engravings  and  7  full  page  p'ates.     Cloth,  £3  75,  net;   leather,  $475,  net. 

Dudley's  Gynecology. — A  Treatise  on  the  Principles  and  Practice  of  Gynecology.  For 
Students  and  Practitioners.  By  E.  C.  Dudley,  M.  D  ,  Professor  of  Gynecology  in  the  Chicago  Med- 
ici College.  In  one  very  handsome  octavo  volume  of  652  pages,  with  422  engravings,  of  which  47 
are  colored,  and  2  full  page  plates  in  colors  anj  monochrome.  Cloth,  #5.00,  net ;  leather,  #6.00,  net. 
Just  ready. 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


119 


Electro  ~  Medical 
Electro-Surgical  Instruments 

MANUFACTURED  BY 

The  Waite  &  Bartlette  Manufacturing  Co., 

108  East  Tweny- Third  Street,  New  York. 


The  Ranney  Wimshurst  Holtz  Static  Machine 


Is  the  most  poxverftd  made,  therefore, 
for  X-Ray  Examinations  and  for  a 
wide  range  of  therapeutic  effect ,  it  stands 
tin equaled. 

OUR  EXPERIENCE 

Of  Over  Ffiteen  Years  in 

Static  Machine  Construction 

Is  Your  Gain, 

USED    IN    THE 

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Society  of  the  New  York  Hospital, 
Post-Grad.  Med.  School   and  Hospital, 
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Send  for   Illustrated  Catalogue. 


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WALION 

A  Laxative  Salt  of  Lithia. 


Prepared  only  for  the  Medical  Profession. 

INDICATIONS.— Gout  and  all  of  those  diseases  arising  from  a  gouty  condition  of  the  sys- 
tem, rheumatism  and  all  of  those  diseases  arising  from  a  general  rheumatic  condition,  chrome 
constipation,  hepatic  torpor  and  obesity.  In  all  cases  where  there  is  a  pronounced  leaning  to 
corpulency,  it  reduces  to  a,  minimum  the  always  present  tendency  to  apoplexy.  In  malaria 
because  of  its  wonderful  action  on  the  liver,  increasing  twofold  the  power  of  quinine. 

Inasmuch  as  some  difficulty  is  experienced  by  physicians  in  procuring  Thialion,  we  will,  on 
receipt  of  one  dollar,  send  one  bottle  containing  four  ounces,  sufficient  for  three  weeks  treat- 
ment, prepaid  to  any  address. 


Literature  on 


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•:>>>>>>>>>>>»>»i>i>>>>  iiiiiHiinmiiiiimiHinmi 


120  THECHARLOTTE     MEDICAL  JOURNAL. 

Modern  Clinical  Diagnosis 

DEMANDS  THE  ^CONSTANT  USE  OF  THE 

Microscope. 

Queen  Cont.  II.  stand  with  complete  outfit  for 
Physician's  work  in  examination  of  urine,  blood 
and  sputum,  •  ---.._  $95.00 

Centrifuge, 

For  urine  and  milk,  etc.,  as  per  cut,  -  -         10.00 

For  urine,  blood  sputum,  including  Haematokrit, 
double  speed,  ------  20.00 

Haemaoytometer. 

Thoma-Zeiss  for  counting  red   corpuscles  only, 

in  case,  -------  12.50 

"A^lf  1^  Same  for  both  red  and  white  corpuscles,  -  18.00 

Hsemaglobinometer, 

The  von  Fleischl  is  the  best,  -         -         -  26.00 

The  Gower  is  considerably  used,      -  -  -  2.50 

Write  for  Catalogue  B.M.  of  Microscopes  and  Apparatus  for  Clinical  Laboratory  Work. 

QUEEN  &  CO., 

Optical  and  Scientific  Inst.  Works,    PHILADELPHIA,  PA. 
N.  Y.  Office,  59  Fifth  Ave, 

St.  Peter's  Hospital, 

CHARLOTTE,   N.   C. 

The  Largest  and  most  Thoroughly  Equipped  Hospital  in  the  State. 

Under  strictly  regular  management,  attended  by  a  corps  of  six  prominent  physi- 
cians, with  large  experience.  Trained  nurses  for  all  cases.  Great  care  has  been  taken 
in  the  arrangement  of  the  Surgical  Department,  which  gives  the  Hospital  every  facility 
for  treating  surgical  cases. 

fflF^For  information  regarding  rates  for  board,  nursing,  and  medical  attention, 
address 

Mrs.  JOHN  WILKES,  Sec'y, 

508  West   Trade  Street, 

CHARLOTTE,  N    C. 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


121 


Spencer 
Microscopes. 

We  make  a  full  line  of  these  beautiful  in- 
struments. Professional,  Laboratory,  College 
and  School  Stands  with  all  accessories.  All 
are  equipped  with  our  famous 

Spencer  Objectives 

made  under   the  personal   supervision  of  Mr. 
Herbert  R.  Spencer. 
Unsurpassed  in  excellence. 
A  fine  Microscope  is  to-day  a  necessary  part 
of  every  physician's  outfit. 
Do  you  own  one? 

Catalogues  and  prices  furnished  on  applica- 
tion. 

Spencer  Lens^Company, 

367-73  Seventh  St.,  Buffalo,  N.  Y. 

When  writing  please  refer  to  this  Jonrnal. 


The  Bahy's  Life 

Depends  on  the  food  it  gets. 

Insufficient  nourishment  is  the  cause  of 

much  of  the  fatality  among  Infants. 

If  the  food  is  right  the  digestion  will  be  good 


is  the  BEST  FOOD  IN  THE  WORLD^FOR 

INFANTS.  There's  nothing  "just  as  good," 
or  "nearly  as  good."  The  best  is  none  too 
good  for  little  babies.  It  is  a  complete  diet  in 
itself.  It  does  not  depend  on  milk  to  make  it 
nutritious.  It  has  to  be  prepared,  but  th«  re- 
sults are  always  good.  It  has  no  effect  on  the 
bowels — neither  laxative  nor  astringent. 

A  sample  can,  sufficient  for  atrial,  will  be  sent 
free  to  any  physician  requesting  it. 


WOOLRICH  &  CO., 

Palmer,  Mass. 


122 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


Is  the  most  useful  and 
practical  apparatus 
ever  offered  to  Phy- 
sicians for  the 

SPECIAL  TREATMENT 

of  Chronic  Bron- 
c  h  i  t  i  s,  Incipient 
Consumption  and 
all  Catarrhal  Af- 
fections of  the  Head, 
Throat,  Lungs,  and 
Deafness. 


Far  better  than  the  Pulit- 
zer Air  Bag  and  Cathe- 
ter in  Treatment  of 
Deafness- 


Sizes,  15x9x19  Inches  High. 

This  is  our  recently  improved  six-bottle  Nebulizer  with 
vibrating  cock,  which,  with  our  Needle  Point  Air  Valve, 
enables  the  operator  to  perfectly  control  the  vibrations 
under  any  pressure  desired. 

FORCED  inhalations  promplty  arrest  the  progress  of 
diseases  of  the  air  passages,  allay  irritation  in  Bronchitis 
and  control  the  coughs  soothe,  the  inflamed  membranes, 
ieal  ulcerations,  stimulate  secretions,  and  restore  the  phys- 
iologic functions — promoting  a  more  perfect  oxidation 
in  the  process  of  nutrition  and  assimilation.  Operator  has 
perfect  control  of  the  pressure,  as  air  guage  indicates 
amount  used,  which  is  very  essential,  and  enables  physi- 
cians to  treat  children,  timid  persons  or  invalids. 


Sizes,  9*x30  Inches. 

Our  Combined  Air  Tank  and  Pump  is  a  grear 
improvement  over  old  style.  Heavy  Coppef 
Nickel-Plated.  None  better.  Twice  the  size  o 
those  usually  sold  for  $25.00. 

Portable  Eureka  Nebulizer. 

This  shows  our  Portable  Eureka  Nebulizer 
Combination.  It  is  convenient  to  carry  in  buggy, 
and  can  be  left  with  patient  if  necessary;  once 
using  physician  would  not  do  without.  No  treat- 
ment relieves  so  quickly  the  acute  condition  of 
Asthma,  Pneumonia,  Bronchitis,  Hay  Fever  and 
Catarrh.  It  is  easy  to  work  andwill  not  get  out 
of  order. 

WRITE  FOR  PRICE  AND    LITERATURE 

O.  Q.  HOLMAN, 

Gen.  Agt.,  LaGrange,  111. 


Size  on  base,  10xl6x20i  in.  high. 
Weight  in  Case,  24  lbs. 


THE  CHARLOTTE  MEDICAL  JOURNAL.  123 

SYR.  HYPOPis.  CTJELLOWST 

Contains  the  Essenial  Elements  of  the  Animal  Organization  -Potash  and  Lime  ; 

The  Oxidising  Agents — Iron  and  Manganese  ; 

The  Tonics— Quinine  and  Strychnine  ; 

And  the  Vitalizing  Constituent — Phosphorus  ;  the  whole  combined  in  the  form 
of  a  syrup  with  a  Slightly  Alkaline  Reaction. 

It  Differs  in  its  Effects  from  all  Analogous  Preparations ;  and  it  pos- 
sesses the  important  properties  of  being  pleasant  to  the  taste,  easily  borne  by  the 
stomach,  and  harmless  under  prolonged  use. 

It  has  Gained  a  Wide  Reputation,  particularly  in  the  treatment  of  Pulmonary 
Tuberculosis,  Chronic  Bronchitis,  and  other  affections  of  the  respiratory  organs. 
It  has  also  been  employed  with  much  success  in  various  nervous  and  debilitating 
diseases. 

Its  Curative  Power  is  largely  attributable  to  its  stimulant,  tonic,  and  nutritive  pro- 
perties   by  means  of  which  the  energy  of  the  system  is  recruited. 

Its  Action  is  Prompt  ;  it  stimulates  the  appetite  and  the  digestion,  it  promotes  as- 
similation, and  it  enters  directly  into  the  circulation  with  the  food  products. 

The  prescribed  dose  produces  a  feeling  of  buoyancy,  and  removes  depression  and  melan- 
choly ;  hence  the  preparation  is  of  great  value  i/i  the  treatment  of  mental  and  nervous 
affections.  From  the  fact,  also,  that  it  exerts  a  double  tonic  influence,  and  induces 
a  healthy  flow  of  the  secretions,  its  use  is  indicated  in  a  wide  range  of  diseases. 


JVOTICE-CAUTIOIV. 

The  success  of  Fellows'  Syrup  of  Hypophosphites  has  tempted  certain  persons  o 
offer  imitations  of  it  for  sale.  Mr.  Fellows,  who  has  examined  samples  of  several  of 
these,  finds  that  no  two  of  them  are  identical,  and  that  all  of  them  differ  from 
the  original  in  composition,  in  freedom  from  acid  reaction,  in  susceptibility  to  the  effects 

of  oxygen  when  exposed  to  light  or  heat,  in  the  property  of  retaining  the 

Strychnine  in  solution,  and  in  the  medicinal  effects. 

As  these  cheap  and  inefficient  substitutes  are  frequently  dispensed  instead  of  the 
genuine   preparation,  physicians   are  earnestly  requested,  when   prescribing  the  Syrup, 

to  write  "Syr.  Hypophos.  Fellows." 

As  a  further  precaution,  it  is  advisable  that  the  Syrup  should  be  ordered  in  the  ori- 
ginal bottles;  the  distinguishing  marks  which  the  bottles  (and  the  wrappers  surround 
ing  them)  bear,  can  then  be  examined,  and  the  genuineness — or  otherwise — of  the  con- 
tents thereby  proved. 


Medical  Letters  may  be  addressed  to 

Mr.  FELLOWS'  48  Vesey  Street,  NEW  YORK, 


124  THE  CHARLOTTE  MEDICAL  JOURNAL. 


Hard  Coughs  and  Colds 


"It  is  quite  common  for  individuals  with  incipient  pneumonia 
to    visit   the  physician's  office  'on  account  of  a  severe  cold.'" 

"  If  the  physician  be  called  early,  if  he  recognize  the  malady 
promptly,  and  if  he  act  vigorously  and  wisely,  he  may  arrest  the 
disease  at  this  point.  " 


Both  of  these  quotations  are  from  the  writings  of 
Prof.  I.  N.  Danforth,  of  the  Northwestern  University 
Medical  College  of  Chicago.  They  are  found  in  the  last 
edition  of  the  American  Text-book  of  Applied  Thera- 
peutics. 


To  Abort  Pneumonia  We  Suggest  a  Trial  of 

Ayer9s 
Cherry  Pectoral 

This  is  an  anodyne-expectorant,  the  formula  of  which  will  be  fur- 
nished any  physician  upon  request. 

For  Hard  Coughs  and  Colds,  especially  when  the  cough  is  trouble- 
some and  the  pain  harrassing,  a  prompt  arrest  of  all  threatening  symp- 
toms may  be  expected  to  follow  the  use  of  this  anodyne-expectorant. 

As  a  local  application  for  a  congested  or  painful  lung,  requiring  an 
anodyne  and  counter-irritant  effect,  we  have 

Ayer's  Cherry  Pectoral  Plaster 

We  will  gladly  send  one  bottle  of  Ayer's  Cherry  Pectoral  and 
one  Pectoral  Plaster  to  any  physician,  express  charges  prepaid,  upon 
request. 

J.  C.  AYER  CO.,  Lowell,  Mass. 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


125 


y§T|p 


Piem 


■jf 


CftLORliE  OffStlSlff  DRY  CELL  BATTERIES 

jftliCKSg  mVORiTE  IN  "EVERY  COUNTRY  AND  IN  EVERY  CLi 

ECAUSEI 

EY  ARE  ALWAYS 
READY  FOR 


JHIMEDIATE  USE 
MIHE-.  CURRENT 
BfS  ABSOLUTELY  / 
■■CONSTANT,  i 
jpEYARESO  1 
ffliHTACHIED  Ml 
sPl^JHEM,  r* 
ifiEEgAiPf^ 

ILLUSTRATED,' 
WMiMIENf8, 
fc;  ■  MAfDED  ON 

Application 


BICftUll 

THER_E^ 

mo:waSss 

GASES 

NO  CQ£ 

ACJi 

N£CR 

CtlRR@if 

NOXLUT4 

/  GLASSJ^Al 

ASKYfJ 
/I05HOW 

/HewJa 
BatteM 

THEVEW. 
THI61S  ON  fHE-ini 


gTHE  Chloride  of|Sjjimiii1^^ 


BALTIMORE,  MD.  U.  S, AL 


Elixir  Iodo=Bromide 
of  Calcium  Comp.  (T.ldens) 

Unequalled  as  a  blood  Tonic,  Alterative  and  Reconstructed.     In  cases  of  Syphilis 

Scrofula,  Tuberculosis,  Abscesses  and  all  Blood  Humors. 
-j^V-w'-w-r^w-w-w'-w-^v  f  T^r  Prescribed  bv  prominent  physicians 

Jt*    l^L  W  JtVA-i^-    (TILDEN'S)   throughout  the  country  in  all  forms 

of  Bronchitis,  Catarrh,  Phthisis,  Throat  and  Lung  Troubles.      In    Chronic  Cystitis 

it  relieves  the  annoying  symptoms  almost  like  magic,  being  regarded  as  a  friend  of 

humanity, 

]^IvSiI:*U^A.2^iIM^J  IV  (TILDEN'S)  diate  relief  and 
cure  of  Spasmodic  Asthma  (acute  or  chronic),  Hayfever  and  Croup.  Physicians 
prescribe  it  with  unvarying  results. 

ELIXIR  MALTOPEPSINE  (TILDEN'S)  dial  agent  for  Indi- 
gestion, Dyspepsia,  Loss  of  Appetite,  Constipation,  Vomitiing  in  Pregnancy, 
Diarrhoea  and  Nervousness. 

LIQUID  ANTIPYRETIC  (t.lden-s)   £%£•£"!£&: 

indicated    in    all    forms    of    Neuralgia,  LaGrippe,  Typhoid    and    Malarial   Fevers, 
Rheumatism  and  Sciatica. 

LITERATURE  FURNISHED  ON  APPLICATION. 
MANUFACTURED  ONLY  BY 

THE   TILDEN    COMPANY, 

MANUFACTURING  PHARMACISTS, 
NEW  LEBANON,  N.  Y.  ST.  LOUIS,  MO. 


126 


THE    CHARLOTTE  MEDICAL  JOURNAL. 


For  Physicians'  use  only. 
For  the  treatment  and  cure  of  Phthisis  Pulmonalis,  Cancer,  Septicaemia,  Ma- 
laria and  La  Grippe.     In  the  three  latter  diseases  Aseptolin  is  a  specific,  and 
in  the  others  gives  great  relief  and,  in  a  majority  of  cases,  permanently  cures. 

As  there  are  several  imperfectly  compounded  preparations  in  the  market, 
alleged  to  be  prepared  in  accordance  with  Dr.  Edson's  formula,  great  care 
should  be  taken  to  get  only  the  genuine,  made  under  the  personal  supervision 
of  Dr.  Cyrus  Edson  by  the 

ASEPTA  CHEMICAL  COMPANY, 

24  Whitehall  Street,  New  York. 

For  sale  by  the  G.  F.  Harvey  Co.,  Saratoga  Springs,  N.  Y. 

Dr.  E.  T.  Smith,  Buffalo,  N.  Y.:  "The  Aseptolin  has  done  more  good  than 
any  treatment  I  ever  used  in  tuberculosis." 

Dr.  M.  ROCKMAN,  Missoula,  Mont.:  "That  it  is  the  best  remedy  for  tuber- 
culosis yet  discovered  there  can  be  do  question." 

Dr.  F.  W.  Bradbury,  Pinehurst,  N.  C:  "All  cases  in  which  I  have  used 
Aseptolin  have  been  benefited  in  some  way." 

Dr.  W.  F.  MlLROY,  Omaha,  Neb. :  ''I  am  forced  to  conclude  that  Asepto- 
n  has  exerted  a  direct  beneficial  influence  upon  the  pathological  condition 
on  this  tuberculous  patient's  chest." 


5.  A.  L.  R.  R.  Schedule  in  Effect  August  16,  1898. 


SOUTHBOUND. 

No.  403.        No.  41. 
Lv.  Charlotte,  S.  A.  L.  *7  50am    *10  25pm 


Ar.  Clinton.                       "        *9  45am  *J2  14am 

Ar.  Abbeville,                   "        1103am  135am 

Ar.  Athens,                        "          113pm  3  43am 

Ar.  Atlanta,     (Central  time)    2  50pm  5  20am 


NORTHBOUND. 

No.  492. 
Lv.  Charlotte,             S.  A.  L.  10  25am 

No.  38. 
*7  50am 

Lv.  Monroe, 
Lv.  Hamlet, 

*9  40pm 
"      *11 15pm 

*6  05am 
8  00am 

Ar.  Wilmington, 

"         

*12  05pm 

Lv.  Raleigh, 
Ar.  Henderson, 

' '        *2  16am 
"          3  28am 

*11  25am 
*12  57pm 

Ar.  Weldon, 

Ar.  Richmond,  A. 

Ar.  Washington.  Penn 

Ar.  Baltimore, 

Ar.  Philadelphia, 

Ar.  New  York, 


C.  L. 
R.R. 


■4  55am 
8  20am 

12  31pm 
1  46pm 
3  50pm 

*6  23pm 


45pm 
7  34pm 
1  30pm 

10  08am 
3  50am 

*6  53am 


Ar.  Portsmouth, 
Ar.  Norfolk, 


S.  A.  L. 


7  25am 
H  35am 


5  20pm 
*5  35pm 


WESTWARD. 

No.  41. 


Lv.  Charlotte 

Ar.  Mt.  Holly 

Ar.  Lincolnton 

Ar.  Shelby 

Ar.  Ellenboro 

Ar.  Rutherfordton 


,  10  25pm 


No.  403. 
7  50am 
9  45am 

10  35am 

11  37am 

12  15pm 
12  50pm 


f8  40am     Lv Hamlet. 

10  00am     Ar Cheraw 


6  20pm 
|5  00pm 


EASTWARD. 

No.  38.  No.  402. 

Lv.  Charlotte *5  10am  8  28pm 

Ar.  Monroe 5  55am  9  10pm 

Lv.  Monroe 6  05am  9  40pm 

Lv.  Marshville 6  25am         

Lv.  Wadesboro 7  01am  10  31pm 

Lv.  Rockingham 7  4 lam  11  05pm 

Ar.  Hamlet 7  55am  1 1  23pm 

Lv.  Hamlet 8  20am        

Lv.  Laurinburg 8  46am        

Lv,  Maxton. . .    9  05am        

Lv.  Lumberton 9  53am        

Ar.  Wilmington 12  05pm        


Daily. 


Daily  Ex.  Sunday. 


EDISON  COMBINATION  ELECTRO-MEDICAL 
GENERATOR 

Will  generate  current  for 

GALVANIC      ] 
FARADIC         j  w 
SINUSOIDAL  (  VVUK* 
CAUTERY       I 
Will  operate  MOTOR  or  DIAGNOSTIC  LAMP 
Run    by  battery  only,  entirely  independent  of  any  electric  lighting 
system. 

E^I>I»01V     MPG.     CO. 

St.  James  Building.  Broadway,  26th  St., 

NEW  YORK  CITY. 
Write  for  Complete  Catalogue. 


'HE   CHARLOTTE  MEDICAL  JOURNAL.  127 


&&& 


"It  Props  the 
Heart  Nicely." 

A  physician    speaks    in    this  unique  way  of  one 
of  the  therapeutic  properties    of  Kola-Cardinette. 

"  The  stimulant  effect  of  this  preparation  upon  the 
cardiac  muscle  is  well  marked.  Unlike  many  heart 
stimulants,  however,  Kola=Cardinette  does  not  in- 
duce  a  subsequent  reactionary  depression.  While  it 
is  a  prompt  and  reliable  stimulant  it  is  also  a  per- 
manent  systemic  and  nerve  tonic.  The  Cereal  Phos- 
phates with  which  the  Kola  is  combined,  serve  to 
fortify  the  muscular  and  nervous  system  and  in  thk 
way  retain  the  heart-strength  which  the  Kola  '  io 
duces." 

THE    PALISADE    M'F'O  GO« 
VONKERS-    **      '/ 

Send  for 
■  HOW  IT  CAME  ABOUT" 


128 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


THE  WARNER  LIRRARY  COMPLETED  THIS  MONTH. 

The  Special  Introductory  Price  to  be  Immediately  Advanced. 


AFTER  more  than  two  years  of  constant  la- 
bor, the  Library  of  the  "World's  Best  Litera- 
ture, under  the  editorial  direction  of  Charles 
Dudley  Warner,  is  nearly  finished.  Its  com- 
pletion will  be  a  distinct  literary  event.  The 
special  introductory  price  under  the  arrange- 
ment made  by  Harper's  Weekly  Club  will  posi- 
tively be  withdrawn  when  the  last  volumes 
(which  are  now  on  the  press)  are  issued.  Read- 
ers will  do  well  to  make  note  of  this  fact,  since 
by  joining  the  Club  now  they  will  obtain  the 
work  at  nearly  one-half  the  price  at  which  it 
will  hereafter  be  sold.  We  have  no  hesitation 
in  advising  our  readers  to  take  advantage  of 
this  opportunity.  We  believe  the  Warner  Li- 
brary is  a  work  of  such  extraordinary  charac- 
ter that  it  will  sooner  or  later  find  its  way  into 
every    home  of  culture   and   refinement.     The 


fact  that  such  a  marvelous  survey  of  the  liter 
ature  of  the  world,  with  the  exposition  and 
criticism  of  the  foremost  living  men  of  letters, 
can  be  had  for  a  sum  less  than  the  cost  of  the 
simplest  collection  of  single  volumes,  makes 
this  a  work  which  from  the  mere  standpoint  of 
economy  no  lover  of  books  can  afford  to  be 
without.  The  Library  is  not  only  an  immense 
saving  of  time  and  study,  but  of  money  as  well. 
A  postal  card  sent  to  the  Harper's  Weekly 
Club,  91  Fifth  Avenue,  New  York,  will  secure 
full  particulars  regarding  the  favorable  terms 
upon  which  it  is  now  being  offered  to  Club 
members.  We  believe  there  are  few  of  our  read- 
ers who  will  not  feel  we  have  done  them  a  spe- 
cial service  in  calling  their  attention  to  this 
monumental  work,  and  giving  timely  notice  o 
the  withdrawal  of  the  low  club  price. 


THE  CHARLOTTE   MEDICAL  JOURNAL.  129 


^^TffTffTffi^fi^fffi'fyi^tiyrtfTtfiifnfHyi^iifnyr^^^^^T^p^'i^i'^f^r 


[Schieffelins) 


\  bensolyptus 

r    Bensolyptus  is  an  agreeable  alkaline  solution  of  various  highly 
^  approved  antiseptics,  all  of  which  are  of  recognized  value  in 

Catarrhal  Affections 

because  of  their  cleansing,  soothing  and  healing  properties. 
Bensolyptus  is  highly  recommended  in  all  inflammations  of 
mucous  membranes,  especially  in  diseases  of  the 

Nose  and  Throat  and  as  a  Mouth=Wash  and  Dentifrice. 

It  is  also  of  value  for  internal  use  in  affections  of  the  alimen-   1 

?-   tary  tract   attended  with   fermentation  of   food,  eructations,   i 

and  heart  burn.  1 

*     sendforpvr&teto       Scbieffelin  &  Co.,  New  York  \ 

I    .T?^  Iff  Iff  Hf  Iff  Iff  Iff  Iff  t  ff  I  f  f  Hf  >  tf  I  If  Tff  Hf  >f»  Mf  Hf  1 1f  I  ff  f  ff  Iff  >'ff  llf  I  ff  >ty »    ^ 

■i 
*  t  J  rv  •  2  „  ~  Because  it  is  FREE  from  all    4 

NeeClS    nO    UlSgUlSe,  Disagreeable  Taste  or  Odor.    ^ 

I   Peter  Moller's 

Hydroxyl-Free 

Cod  Liver  Oil. 

Always  of  the  highest  standard  of  quality,  is  now  prepared  by  a  new  process,  the 
result  of  years  of  scientific  investigation,  whereby  the  oil  is  kept  from  atmospheric 
contact  from  the  beginning  of  the  process  of  manufacture  until  it  is  safely  corked  up 
in  bottles,  thus  preventing  contamination  of  any  kind  and  excluding  all  impurities. 

^ .         A,  .      Ask  for  PETER  MOLLER'S  OIL,  and  see  that  the  bottle— a  flat 

Give  thlS    oval  one— bears  our  name  as  agents.    Notice  the  date  in  perforated 

INJ<=»w  Oil      letters  at  bottom  of  the  label.     We  shall  be  glad  to  forward  speci- 

rr?  .     ■        mens  of  Moller's  Oil  to  members  of  the  medical  profession,  either 

a  Trial,      for  chemical  investigation  or  practical  "exhibition,"  and  we  shall 

also  be  glad  to  supply  full  information  regarding  Moller's  New  Process. 

Schieffelin  &  Co.,  New  York,  j 

jfcjy^U^  i.  f|t, ,  t,.  t...  1...  t„,  1...  i...  i...  A..,.A|,| *M  t.  .1.  ■*...*. .  t„  t, ,  i, .  tui,.li.,.i..lii.' 


130  THE  CHARLOTTE  MEDICAL  JOURNAL 

m  [) (JOT A  L      (Quaiaco1  Carbonate) 

1       *»  CREOSOTALJ 

^  (Creosote  Carbonate)  < 

\fift  are  the  most  eligible  and  effective  of  germicides,  and  the  most  vigorous  neutral*  1 
Fffl  izers  of  microbic  poisons  in  the  intestinal  tract.  The  remarkable  results  obtain*  ; 
uRBt  ed  in  tuberculosis,  typhoid  fever,  rheumatoid  arthritis,  etc.,  are  explainable  by  j 
£&&5  the  great  powers  of  elimination  of  toxalbumins  that  these  remedies  have  been  i 
ffiuS  proven  to  possess.  They  are  themselves  neutral,  non=toxic,  and  absolutely  free  j 
JaW  from  all  caustic  and  irritant  qualities.  , 

£?5j  At  the  Clinic  of  Professor  E.  VON  LEYDEN,  at  Berlin,  Creosotal  has  been  used  in  j 
jRjA  a  large  number  of  cases  of  phthisis  pulmonum  with  very  good  results.  It  agreed  well 
jffift  with  all  the  patients.  It  had  a  very  favorable  effect  upon  the  night  sweats  and  the  ! 
llWf  fevers ;  and  the  cough  and  expectoration  either  disappeared  entirely,  or  were  markedly 
5r3«  improved.     The  body  weight  increased  in  most  cases.  \ 

llMf  ^r*  PAUL  JACOB,  Physician-in-Chief  of  Professor  Von  Leyden's  Clinic,  whose  ! 
&f$!t  report  is  published  in  full  in  the  Charite  Annalen,  Berlin,  1897,  claims  that  Creosotal  1 
»kw  has  a  specific  action  in  phthisis,  and  that  every  case  that  is  not  too  far  advanced 
)5s$A  can  be  greatly  benefited  by  its  use.  , 

m  f\  O  D  H  f\  I        (Betanaphtol= Bismuth- 
iUKrllUL  VonHeyden) 

UrCT  The  employment  of  Orphol,  which  is  a  neutral,  odorless,  tasteless  and  non-toxic 
xJsrt  powder,  is  indicated  in  all  fermentative  gastro-intestinal  processes,  in  ptomaine  poison- ' 
HfKf  ings-  gastro-enteric  catarrhs,  typhoid  fever,  etc.  Practical  Intestinal  Antisepsis  can 
5r§^  be  effected  and  maintained  by  its  use.  Unlike  opium,  tannin,  etc.,  Orphol  in  no  way 
\flC4  interferes  with  the  digestion,  so  that  patients  suffering  from  dyspepsia  bear  it  well. 
£&|5  Betanaphtol-Bismuth  is  antiseptic  as  well  as  astringent,  and  is  therefore  far  superior 
kK/Q  to  the  new  tannin  compounds  recently  introduced;  for  tannin  is  well  known  not  to  pos- 
wttX  sess  any  bactericide  action  at  all.  Four  or  five  15-grain  doses  of  Orphol  will  usually 
Jj?f?  cure  the  very  worst  cases  of  diarrhoea;  and  in  cholera  infantum  2  to  5  grains  adminis- 
IBiJI  tered  every  three  or  four  hours  act  admirably. 

VTfft  Orphol  is  soothing  to  the  irritated  and  inflamed  intestinal  mucous  membrane,  besides 
VjGjif  acting  as  a  continuous  disinfectant.  It  does  away  with  the  dangers  of  caustic  or  poison- 
$$&  ous  antiseptic  substances,  such  as  carbolic  acid,  naphtol,  resorcin,  the  bichloride  of 
\jflC4  mercury,  etc.,  and  the  use  of  complicated  and  uncertain  diarrhoea  and  cholera  mixtures. 

iXEROFORM  (TriB=ro,= 

|/VUI\V/1     V>rrV<^*         VonHeyden) 

tSjfc  Xeroform  is  the  ideal  substitute  for  iodoform,  being  an  antiseptic,  desiccating  and 
\W«  deodorizing  agent  which  is  odorless,  non-poisonous  and  non-irritating,  with  very  pow- 
><Nrt  erful  antibacterial  properties.  Professors  Hueppe  and  Fasano,  Dr.  Reynders,  and 
\Bff  others,  have  found  it  to  be  a  very  effectual  intestinal  antiseptic  in  cholera,  intestinal 
§5^$  tuberculosis,  etc.  ;  but  its  chief  application  is  as  an  external  antiseptic  in  the  place  of 
\flC4  iodoform.  Xeroform  has  been  employed  by  Drs.  Heuss,  Cumston,  Griinfeld,  Beyer, 
£&&*  Metall,  Paschkis,  and  many  other  observers,  in  the  most  varied  surgical  affections;  for  , 
\¥1C4  °Perat^ve  procedures,  amputations,  enucleations,  and  cancer  operations;  for  suppura- 
Jjy|A  tive  bursitis,  lymphadenitis,  and  alveolar  periostitis;  for  paronychias,  deep  abscesses, 
*?»2  and  suppurating  buboes.  In  venereal  diseases  it  has  been  extensively  employed  in  the 
JWlJ  treatment  of  chancroid;  and  in  dermatology  for  impetigo,  furunculosis,  sycosis,  eczema 
5rJvi  and  pruritus.  It  has  also  been  successfully  used  in  ophthalmic  and  gynaecological 
MKf  practice,  and  for  insufflation  into  the  nose  and  ear.  Its  fine  pulverization  enables  the 
$7^3  physician  to  cover  a  large  surface  with  a  very  small  quantity  of  the  drug. 

IWlf  SCHERING  &  GLATZ,  58  Maiden  Lane,  New  York, 

5rje3  Literature  furnished  on  application.  Sole  Agents  for  the  United  States. 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


131 


Clinical  Observation 


has  demonstrated  the  nutritive  and 
therapeutic  value  of 


tyetrolem 


As  a  reconstructive  food  and  alterative  it  meets  every 
requirement  of  progressive  alimentation.  It  not  only  furnishes  assimil- 
able nutritive  material,  but  unlike  other  oils  or  emulsions,  it  does  not 
excite  repugnance  and  is  well  borne  by  the  jaded  stomach.  Angier's 
Petroleum  Emulsion  with  Hypophosphites  is  not  only  in  itself  nourish- 
ment that  can  be  easily  conveyed  to  the  starving  tissues,  but  it  also, 
on  account  of  the  presence  of  petroleum,  increases  absorption  and  facili- 
tates oxidation.  In  "Wasting  Diseases  it  is  of  paramount  value,  as  it 
enables  the  patient  to  appropriate  the  maximum  amount  of  nutriment 
from  food  taken.  It  increases  the  number  of  red  blood  corpuscles  so 
that  the  effete  products  of  combustion  are  properly  eliminated  and  nature 
is  aided  in  carrying  on  its  work  of  reconstruction  and  repair. 

In  all  Stubborn  COUghs  and  bronchitis  the  efficacy  of  Angier's  Petro- 
leum Emulsion  has  been  most  markedly  demonstrated,  the  permeating 
effect  of  the  petroleum  giving  to  it  a  distinct  and  unique  value.  In  no 
class  of  cases  has  the  Emulsion  been  found  more  generally  useful  than  in 
bronchitis,  acute,  sub-acute  and  chronic  By  the  process  of  osmosis  and 
endosmosis  its  high  penetrative  power  and  emollient  action  is  rapidly 
manifested.  There  is  an  immediate  reduction  of  congestion  in  the  bronchi, 
followed  by  a  rapid  disappearance  of  the  inflammation,  muco-purulent 
discharge  and  all  reflex  symptoms. 

Absolute  experiment  is  the  only  test  of  conjecture,  and  we  cheer- 
fully supply  samples  and  literature  of  Angier's  Petroleum  Emulsion 
to  all  physicians  who  desire  to  study  its  therapeutic  action  or  investi- 
gate the  claims  we  make  in  its  behalf. 


Two  sizes,  6  and  12  oz. 

OF    DRUGGISTS 

DOSE— Two  teaspoonfuls  four  times  a 
day,  in  water,  milk,  wine  or  other 
vehicle. 


ANGIER  CHEMICAL  CO., 

Allston  District, 

BOSTON,  MASS. 


132 


THE  CHARLOTTE   MEDICAL  JOURNAL. 


This,  That  and  the  Othet* 


A  Winter  Remedy 

That  Codeine  had  an  especial  effect  in  cases  of 
nervous  coughs,  and  that  it  was  capable  of  con- 
trolling excessive  coughing  in  various  lung  affec- 
tions, was  noted  before  its  true  physiological 
action  was  understood.  Later  it  was  clear  that 
its  power  as  a  nervous  calmative  was  due,  as 
Bartholow  says,  to  its  special  action  on  the  pneu- 
mogastric  nerve. 

Codeine  stands  apart  from  the  rest  of  its 
group,  in  that  it  does  not  arrest  secretion  in  the 
respiratory  and  intestinal  tracts.  In  marked 
contrast  is  it  in  this  respect  to  morphine.  Mor- 
phine dries  the  mucous  membrane  of  the 
respiratory  tract  to  such  a  degree  that  the  condi- 
tion  is  often  made  worse  by  its  use;  while  its 
effect  on  the  intestinal  tract  is  to  produce  con- 
stipation. There  are  none  of  these  disagreeable 
effects  attending  the  use  of  Codeine. 

Antikamnia  has  stood  the  test  of  thorough 
experimental  work,  both  in  the  laboratory  and  in 
actual  practice;  and  is  now  generally  accepted 
as  the  safest  and  surest  of  the  coal-tar  products. 

"Antikamnia  and  Codeine  Tablets,"  each 
containing  4?£  grains  Antikamnia  and  M  grain 
Sulph.  Codeine  afford  a  very  desirable  mode  of 
exhibiting  these  two  valuable  drugs.  The  pro- 
portions are  those  most  frequently  indicated  in 
the  various  neuroses  of  the  throat,  as  well  as  the 
coughs  incident  to  lung  affections. 

Acute  Inflammation    of   the  Prostate 
Gland 

The  Journal  of  the  American  Medical  Association 
contains  a  report  on  inflammation  of  the  prostate 
gland,  which  was  presented  to  The  Section  on 
Surgery  and  Anatomy  at  the  Forty-ninth  annual 
meeting  of  the  American  Medical  Association, 
held  at  Denver,  Colo,  June,  1898,  by  Listen  Homer 


Montgomery,  M.  D,  of  Chicago,  Ills.  His  plan  of 
treatment  in  acute  inflammation  of  the  prostate 
gland  is  to  wash  out  the  abscess  cavity  wilh 
hydrogen  peroxid,  give  copious  hot  water  enema 
and  hot  hip  baths  frequently,  avoid  morphine 
internally  and  advise  care  lest  the  patient  strain 
at  stool  or  during  micturition.  On  the  theory 
that  toxins  are  retained  in  the  circulation  and 
within  the  gland  and  to  prevent  degeneration  in 
the  gland  substance,  ho  administers  triticum 
repens  or  fluid  extract  tritipalm  freely,  com- 
bined with  gum  arabic  or  flaxseed  infusion. 
Along  with  these  remedies  the  mineral  waters, 
particularly  vichy  with  citrate  of  potash,  go  well 
together.  Hydrate  of  chloral  or  this  salt  com- 
bined with  antikamnia  are  the  very  best  anodyne 
remedies  to  control  pain  and  spasms  of  the  neck 
of  the  bladder.  These  pharmacologic  or  medi- 
cinal remedies  are  the  most  logical  to  use  in  his 
judgment,  while  externally,  applications  of  an 
inunction  of  10  or  20  per  cent  iodoform,  lanoline, 
as  well  as  of  mercury,  are  also  of  value. 


Migraine— (Catarrhal . ) 

R    A  ntlkamnia  and  Codeine  Tablets No.  xil 

Sig.— Crush  and  take  one  every  three  hours. 


Grows  in  Favor 

As  the  years  go  by  there  is  one  drug  that  con- 
stantly grows  in  favor.  To  the  physician  of  the 
Transmississippi  region  it  is  probably  doubtful 
if  it  is  necessary  to  say  that  this  remedy  is 
antikamnia;  as  all  have  used  it.  But  increasing 
experience  demonstrates  its  adaptability  to  con- 
ditions other  than  at  first  advised.  It  Is  notably 
of  value  in  ovarian  and  other  pelvic  pain.  If 
you  have  not  tr'ed  it  in  this  class  of  cases,  do  so. 
—American  Journal  Surgery  and  Gynecol. 


**•••••**•••••**•***•••*•••*•••••••** 

!  Laxative  Logic  I 

T<„     :„J „_xi :_    ...:i.i i.    •.!._     _i_-     _i? i_i_     i  __      . 


To  induce  catharsis  without  the  objectionable  sequalae  common  to  _ 
majority  of  laxatives,  no  remedv  responds  to  the  need  of  the  physician 
with  more  satisfaction  and  celerity  than  SYRUP  OF  FIGS.  As  made  by 
the  California  Fig  Syrup  Co.  from  the  highest  grade  Alexandria  Senna, 
SYRUP  OF  FIGS  has  achieved  a  potency  and  recognition  as  an  agent  of 
established  therapeutic  worth.  There  is  no  preparation  that  simulates 
Nature  so  well  in  its  effect.  No  other  is  better  suited  to  the  permanent 
relief  of  intestinal  inactivity,  a  functional  derangement  directly  respon- 
sible for  the  condition  described  as  constipation.  Its  gentle  effect  upon  the 
intestinal  mucous  membrane  and  the  natural  peristalsis  which  follows  the 
administration  of  SYRUP  OF  FIGS  gives  to  it  a  unique  value  as  a  laxative, 
and  suggests  its  adaptability  to  women  and  children  because  of  its  agreeable 
taste  and  persuasive  action.  It  is  invaluable  to  persons  who  through  in- 
firmity or  occupation  are  committed  to  a  sedentary  life.  It  is  simple,  safe 
and  reliable,  and  possesses  the  particular  merit  that  its  use  does  not  induce 
the  cathartic-taking  habit,  and  in  all  cases  where  a  laxative  is  indicated  it  is 
a  help  and  not  a  hindrance. 

SPECIAL  INVESTIGATION  IS  SINCERELY  INVITED. 

"  Syrup  of  Figs  "  is  never  sold  in  bulk.  It  retails  at  fifty  cents  a  bottle, 
and  the  name  of  "  Syrup  of  Figs,"  as  well  as  the  name  of  the  "  California 
Fig  Syrup  Co  ,"  is  printed  on  the  wrappers  and  labels  of  every  bottle. 

CALIFORNIA   FIG  SYRUP  CO.,  San  Francisco;    Louisville;    New  York. 


************************************* 


THE   CHARLOTTE   MEDICAL  JOQRNAL. 


133 


mcnlng^c& 


Is  pressed  from  choicest  Concord  Grapes— it  is  Concord  Grapes  in  liquid  form,  and  where 
fruit  nutrition  is  desired  it  is  without  an  equal.  Especially  is  this  so  in  all  cases  of  Fever. 
Welch's  Grape  Juice  is  being  largely  used  in  the  Fever  districts  of  the  South  with  marked  suc- 
cess, it  stems  the  tide  of  the  fever,  imparting  an  immediate  vigor  from  which  there  is  no  reaction. 
In  convalescence  it  builds  up  the  wasted  tissues,  putting  new  life  in  the  blood.  It  forms  an 
agreeable  and  nutritive  substitute  for  milk,  taxing  the  stomach  to  a  less  degree.  A  small  glass- 
ful at  meal  time  will  give  health  to  the  tired  mother  and  the  sickly  child. 

Booklet  free.  A  3  oz.  Bottle  6  cts.  A  Pint  Bottle  free  to  any  physician  if  receiver  will  pay 
express. 


THE  WELCH  GRAPE  JUICE  CO., 


WESTFIELD,  N.  Y. 


m  Universal  Multi-Nebular 


Vaporizer 


In  the  Treatment  of 
all    diseases  of  the 

Respiratory    Organs 
and  Middle  Ear 

By   Ton    Different 
Methods,  including 

Vapo-Pulmonary    Mas- 
sage    and     Vapo-Aural 

Massage. 

Is  Indispensable  in 
Office  Practice. 

Write  for  circular  describing  the 

instrv/nu  ni  ami  methods 

of  use. 

Globe  Mfg.  Co. 
Battle  Creek,  Midi. 


.    I  OR  OFFICE  USE  .  . 


When  writing,  advertisers  pleaze 
tiou  this  journal. 


134 


THE  CHARLOTTE  MEDICAL JOUKNAL. 


f  tm  Z  g^+*%  I  r*  for  Bowel  and  Liver  Tor por. 
WniOnid  Under  its  use  the  Hepatic 
Secretions  resume  their  normal  function,  hence, 
it  is  the  remedy  for  constipation,  as  it  does  not 
dispose  the  bowels  to  subsequent  costiveness. 
Dose — One  fluid  drachm  three  times  a  day. 


Peaeoek's  Bromides  gggg 

Definite  Strength.     Absolute  Purity. 

Dose — One  or  two  fluid  drachms,  in  water, 
three  or  more  times  a  day,  as  indicated. 


PEACOCK  CHEMICAL  CO., 

II2  N.  Second  St.,  St.  Louis.  36  Basinghall  St.,  London. 


Mistura  Quinqui  lodidorum 


(Mist.   Quinqui   Iodid.) 

EACH  FLUID  DRACHM  CONTAINS 

Arsenici  Iodidum, 1-24  grains. 

Ferri  Iodidum 1-5    grainsj 

Hydrargri  Iodidum, 1-24  grains. 

Potassii  Iodidum, 2-J    grains. 

Manganesii  Iodidum, 1-5    grains. 

In  Secondary  and  Tertiary  Syphilis  this  preparation 
is  considered  by  all  the  leading  authorities  on  the 
subject  to  be  the  best.  It  should  be  given  in  teaspoon- 
ful  doses,  three  or  four  times  a  day,  and  continued  for 
several  months. 

Per  Dozen  Bottles  $8,00. 

R.  H.  JORDAN  &  CO. 

CHARLOTTE,   N.  C. 


THE»CHARLOTTE«MEDICAL  JOURNAL.  135 


'  The  greatest  therapeutic  discovery  of  the  age,  and  of  the  ages,  is  thai 
where  we  cannot  produce  good  blood  we  can  introduce  it." 


What  is  Haematherapy? 

A  New  Thing— and  a  New  Name  which,  though  literally  translated 
(Blood  Treatment),  may  not  convey  to  every  one  a  definite  idea.  It  is  a 
treatment  which  consists  in  opposing  to  a  condition  of  disease  the  very 
power— good  and  sufficient  Blood— that  would  naturally  prevent  it,  that 
would  still  cure  it  spontaneously,  and  that  actually  does  cure  it  spon- 
taneously, wherever  the  blood-making  work  of  the  system  is  perfectly 
efficient;  and  therefore  also  will  cure  it;  if  a  deficiency  of  the  vital  ele- 
ment be  supplied  from  without,  under  proper  medical  treatment. 

That  Blood  is  such  a  power  as  here  described,  is  an  undisputed  physio- 
.  A  ?ILJK  0F,  BoviNI,NE  v  logical  fact.      Its    transmission   from    one 

Showmg  the  Blood-corpuscles  Intact.     animated   organism   to  another,  for  the  PUr- 

pose  of  supplying  a  defect  in  the  latter,  is 
the  substance  of  the  Blood  Treatment ;  and 
How  to  Do  this,  in  different  cases,  is  the 
form  or  description  of  the  same.  Blood 
may  be  taken  from  a  healthy  bullock 
(arterial  blood— elaborated  with  due  scien- 
tific skill) ;  or  it  may  be  obtained  in  the  well- 
attested  living  conserve  known  as  bovinine, 
from  any  druggist ;  and  may  be  introduced 
into  the  veins  of  the  patient  in  either  of  four 
ways,  that  may  be  most  suitable  to  the  case : 
viz.:  by  the  mouth  and  stomach;  by  injec- 
tion, with  one-third  salt  water,  high  up  in 
the  rectum;  by  hypodermical  injection;  or  by 
by  Prof.  it.  r.  Andrew*  m.d.  topical  application  to  any  accessible  lesion. 
THE  CURE  OF  PULMONARY  CONSUMPTION  - 
is  one  of  the  latest  and  most  wonderful  developments  of  Blood  Power — 
introduced  mainly  by  the  mouth,  and  sometimes  also  by  spraying  bovin- 
ine into  the  trachea  by  an  atomizer.  Every  week  of  judicious  internal 
blood  treatment,  with  proper  medical  and  hygienic  care,  has  resulted  in 
steady  improvement  as  to  all  symptoms,  with  scarcely  an  instance  of 
check,  much  less  of  relapse,  until  complete  apparent  cure,  and  that  in 
the  more  advanced  stages  of  the  disease.  As  further  examples,  may  be 
mentioned:  Anaemia,  Cholera  Infantum,  Typhoid  Fever,  Hemorrhagic 
Collapse,  and  many  other  of  the  most  dangerous  and  aggravated  diseases. 

IN  SURGERY:  A  CHRONIC  ULCER, 
of  no  matter  how  long  standing  or  obstinate  and  aggravated  character, 
can  be  cured  with  certainty — at  least,  the  first  instance  of  failure  has  yet 
to  be  heard  of — by  constant  application  of  bovinine  to  the  wound  with 
proper  surgical  treatment  and  sterilization.  Such  cases  are  usually  cured 
in  from  four  to  six  weeks.  So  of  traumatic  injuries  of  all  kinds;  carbun- 
cles, fistulas,  abscesses,  and  even  gangrene. 

NUMEROUS  CLINICAL  REPORTS 
of  well  known  Physicians  and  Hospitals,  where  the  Power  of  Supplied 
Blood  is  constantly  relied  on  as  a  cardinal  factor  in  the  cure  of  disease 
and  support  of  surgery,  are  at  the  service  of  every  practitioner  who 
desires  to  keep  up  with  the  progress  of  his  profession,  and  may  readily 
be  obtained  (including,  of  course,  the  technique  and  subsidiary  treat- 
ments pursued)  by  applying  to 
THE  BOVININE  COMPANY,  75  West  Houston  Street,  New  York 


136 


THE  CHAKLOTTE  MEDICAL  JOURNAL. 


mmonol 

behaves  as  a  stimulant 


as  well  as  an 


flnttfntretfc 
**«<*  Analgesic 


thus  differing  from 
other  Coal-tar  pro- 
ducts. It  has  been 
used  in  the  relief  of  rheumatism  and  neuralgic  pains,  and  in 
the  treatment  of  the  sequelae  of  alcoholic  excess.  AMMONOL  is  also  prepared  in  the 
form  of  salicylate,  bromide,  and  lithiate.  The  presence  of  Ammonia,  in  a  more  or  less 
free  state,  gives  it  additional  properties  as  an  expectorant,  diuretic,  and  corrective  of 
hyperacidity. — London  Lancet 

?3he.  stimulant 

AMMONOL  is  one  of  the  derivatives  of  Coal-tar,  and  differs  from  the  numerous  similar  products 
In  that  it  contains  Ammonia  in  active  form.  As  a  result  of  this,  AMMONOL  possesses  marked  stimula- 
ting- and  expectorant  properties.  The  well-known  cardiac  depression  induced  by  other  Antipyretics 
has  frequently  prohibited  their  use  in  otherwise  suitable  cases.  The  introduction  of  a  similar  drug, 
possessed  of  stimulating  properties,  is  an  event  of  much  importance.  AMMONOL  possesses  marked 
anti-neuralgic  properties,  and  it  is  claimed  to  be  especially  useful  in  cases  of  dysmenorrhcea. — The 
Medical  Magazine,  London. 

•-TftaWSa*-   THE  AMMONOL  CHEMICAL  CO,    -MKSSSE-" 

Manufacturing  Chemists. 
NEW  YORK,  U.  S.  A. 

J.    S.    PHILLIPS, 

MERCHANT    T  A  I  LO  R,  3iS.Tryon  Street, 

CHARLOTTE,  -  -  N .  C. 

A  COMPLETE  ASSORTMENT  OF  SUITINGS  AND  TROUSERINGS  ON  HAND 

TO  SELECT  FROM.      ^ORDERS  SOLICITED 

Wheeler's  Tissue  Phosphate. 

Wheeler's  Compound  Elixir  of  Phosphates  and  Calisaya.  A  nerve  food  and  nutritive  tonic  forth e 
treatment  of  Consumption,  Bronchitis,  Scrofula  and  all  forms  of  Nervous  Debility.  This  elegant  prep- 
aration combines  in  an  agreeable  Aromatic  Cordial,  acceptable  to  the  most  irritable  conditions  of  the 
stomach:  Say  Bone  Lime  Phosphate,  Soda  Phosphate,  Iron  Phosphate,  Phosphoric  Acid,  and  the  active 
principles  of  Calisaya  and  Wild  Cherry. 

The  special  indication  of  this  combination  of  Phosphates  in  Spinal  Affections,  Caries,  Necrosis, 
Ununited  Fractures,  Marasmus,  Poorly  Developed  Children,  Retarded  Detention,  Alcohol,  Opium, 
Tobacco  Habits,  Gestation  and  Lactation,  to  promote  Development,  etc.,  and  as  a  physiological  resto- 
rative in  Sexual  Debility,  and  all  used-up  conditions  of  the  Nervous  System,  should  receive  the  careful 
attention  of  good  therapeutists. 

NOTABLE  PROPERTIES:  As  reliable  in  Dyspepsia  as  Quinine  in  Ague.  Secures  the  larger  per- 
centage of  benefit  in  Consumption  and  all  Wasting  Diseases,  by  determining  the  perfect  digestion  and 
assimilation  of  food.  When  using  it,  Cod  Liver  Oil  may  be  taken  without  repugnance.  It  renders 
success  possible  in  treating  chronic  diseases  of  women  and  children,  who  take  it  with  pleasure  for 
prolonged  periods,  a  factor  essential  to  maintain  the  good  will  of  the  patient.  Being  a  Tissue  Con- 
structive, it  is  the  best  general  utility  compound  for  tonic  restorative  purposes  we  have,  no  mischiev- 
ous effects  resulting  from  exhibiting  it  in  any  possible  morbid  condition  of  the  system. 

Dose:— For  an  adult,  one  tablespoonful  three  times  a  day,  after  eating;  from  seven  to  twelve  years 
of  age,  one  dessertspoonful ;  from  two  to  seven,  one  teaspoonful ;  for  infants,  from  five  to  twenty  drops, 
according  to  age.    Prepared  at  the  Chemical  Laboratory  of 

T.  B.  WHEELER,  M.  D.,  Montreal'  P.  Q. 

^~To  prevent  substitution,  put  up  in  pound  bottles  only,  and  sold  by  all  druggists  at  One  Dollar 
READ   THE      PAMPHLET    SENT    YOU 


THE  CHARLOTTE  MEDICAL   JOURNAL. 


137 


PRIVATE  SANATORIUM 


WM.  SIMPSON  ELKIN,  M.  D. 

AND 

HUNTER  P.  COOPER,  M 

FOR 

GENERAL  and 

ORTHOPEDIC 

SURGERY. 

Modern  four*story  granite  and  brick 
building,  fifty-two  rooms.  Heated  by 
Hot  Water.  Lighted  by  Electricity 
and  gas.  Perfect  plumbing  and  ven- 
tilation. All  rooms  have  sunny  expo- 
sure. Resident  house  Surgeon,  and 
best  trained  graduate  nurses.  Modern 
Operating  Room  and  complete  Steri- 
lizing Apparatus. 


Address 


DRS.  ELKIN  &  COOPER,  Atlanta.  Ga. 


DOCTORS    DO  NOT  DIFFER 


IX  THEIR  OPINIONS  OF 

The  McClelland  &  hitt 

COMBINATION 

FEMALE  .SYRINGE 

AND  WHY? 

B  cause  it  is  exceedingly 
simple  in  construction  and 
completely  accomplishes  the 
purpose  for  which  it  was  de- 
signed. It  consists  of  a  long- 
point  or  barrel,  on  which  a 
hard  rubber  bulb  and  three 
blades  or  arms  for  dilating  the 
vagina.  It  can  be  takenapart, 
and  is  very  easytoelean  The 
advantages  claimed  for  tin- 
syringe  are : 

First.  It  is  the  only  combi- 
nation syringe  that  will  hilite 
the     parts   well,    30   that  ne- 

medicine  comes  in  direct  coad  pat-d  aphii.  22. 

tact  with  all  the  diseased  surface,  thus  insuring  beneficial  results. 

SECOND.  It  is  the  only  syringe  throwing  six  jets  of  water,  all  in  different  directions.  In 
this  way  no  part  escapes  thorough  washing  and  medication. 

Third.     It  is  so  simple  in  application  that  any  woman  can  operate  it. 

Fourth.     There  is  no  danger  of  injecting  the  fallopian  tubes  with  this  syringe. 

Through  this  instrument  vigorous  antiseptic  agents  can  be  efficiently  and  actively  used.  _  It 
is  as  far  superior  to  the  old  style  syringe  as  the  electric  light  is  to  the  tallow  dip,  and  will  in  time 
supplant  it. 

The  syringe  is  put  up  in  boxes  for  family  use,  and  can  be  adjusted  to  any  syringe.  It  meets 
and  supplies  a  long-felt  want,  and  can  be  safely  and  efficiently  employed. 

PRICE  TO  PHYSICIANS,  $2.00.     Sent  prepaid  to  any  address  upon  receipt  of  price. 

The    St.  Louis    Surgical    Instrument    Company,  St.  Louis,  Mo. 


138 


THE  CHAELOTTE  MEDICAL  JOURNAL. 


8 
hi 

I'X    Jyt*  INFALLIBLE  REMEDY  fOB 

p^UMATISM,  NERVOUS  W 

If  MCRlPP£G08t  SCIATICA  ANO  LUMBWO.J 

jgWUINT^WftE  W  USE  OF  SALICVUU  6«jj 


H/Qmc 


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Nf%t™ntains  Ton&T  CirnTcrflaa  ""Tr05,3^" 


mi 


IS1*  tA  GRIPPE.  GOUT.  Sc/ATlftanJ  UW"| 

fe^-intwally.  and  removed.  ufitaeFth-""*! 

POTiate   the  symptoms.    <V       "    •    , 

NO  MORPHINE  NOR  OW^    *& 

£""s  "ou"pl«asant  nor  injurious  eftl*>i      GL 

g  <Wr«,,  Uasfioonfuls,  diluted  {n^W^ 

""*!  ani  fyfc,-e  retiring.  f) 

|  |*«  J'  00  per  bottle,   for  sale  by  a"  W" 
ufUj«  DRUG  COMPANY,  Sole  Proprietor 
1^ 


% 


WHY  HOT  PRESCRIBE 
TPMALJME? 
It  is  no  longer  an 
experiment.*®® 
Its  value  has  been 
demonstrated  bij 
over  15  years  of 
practical  use.®  • 


THE  CHARLOTTE  MEDICAL  JOURNAL 


RHEUMATISM 


p^nl  H  E  concurrent  testimony  of  thousands  of 
^        physicians  who  have  used  Tongaline  in 
H|    all  forms  of  rheumatism,  whether  sim- 
ple  or   complicated,   declares    it  to  be 
"almost  a  specific." 

In  all  of  these  diseases  Tongaline  is  an 
Invaluable  remedial  agent,  thoroughly  eliminat- 
ing the  toxaemia,  which  under  other  treatment 
seems  ever  present,  hindering  convalescence 
and  producing  relapses.  Here  Tongaline  acts 
as  an  efficient  alterative  and  eliminative,  remov- 
ing causes  and  restoring  normal  conditions. 

The  internal  administration  of  Tongaline  in  any  of  its  forms,  as  indicated, 
may  be  supplemented  by  the  local  application  of  Tongaline  Liquid. 


NEURALGIA 


SSI 


HE    most  frequent  causes   of  neuralgia 
are  a  rheumatic  or  gouty  diathesis,  blood 
disorders,  malarial  conditions,  colds  and 
exposure. 
Tongaline   is  the  rational  remedy  in  neural- 
gia,   not   only   on    account    of    its    pronounced 
anodyne  and   anti-neuralgic  effects,    but   more 
particularly  from  its  strong   eliminative   action 
on  the  toxines  of  rheumatism  or  gout,  as  well 
as  from  its  being  a  decided  cholagogue. 

The  internal  administration  of  Tongaline  in  any  of  its  forms,  as  indicated, 
may  be  supplemented  by  the  local  application  of  Tongaline  Liquid. 


Sxmocutave  < 


ANTI-RHEUMATIC 
ANTI-MEURALGIC, 


140 


THE  CHARLOTTE,  MEDICAL  JOURNAL. 


GRIPPE 


=T]ONGALINE  exercises  a  special  alterative 
ST  and  eliminative  action  with  positive  af- 
11  finity  for  the  excretory  system  of  glands, 
necessarily  producing  a  thorough  elim- 
ination of  the  toxic  and  morbific  secretions  of 
the  system  through  the  various  emunctories. 

Tongaline  is,  therefore,  an  ideal  remedial 
agent,  not  only  for  the  prompt  relief  of  the  acute 
stage  of  grippe,  but  for  the  prevention  of  sequelae 
invariably  attended  with  such  serious  conse- 
quences. 

The  internal  administration  of  Tongaline  in  any  of  its  forms,  as  indicated, 
may  be  supplemented  by  the  local  application  of  Tongaline  Liquid. 


NERVOUS  HEADACHE 


VM 


H 


T  the  approach  of  an  attack  of  nervous  head- 
ache a  dose  of  Tongaline  will  be  found  to 
cut  it  short,  but  it  is  always  advisable  to  first 
open  the  bowels  by  the  use  of  calomel  or 
podophyline. 

In  the  paroxysm  of  nervous  headache  Tonga- 
line  will  prove  most  efficient,  relieving  nausea, 
subduing  nervousness  and  superinducing  sleep. 

The  internal  administration  of  Tongaline  in  any  of  its  forms,  as  indicated, 
may  be  supplemented  by  the  local  application  of  Tongaline  Liquid. 


^Anuu\\\xv£  < 


AMU-RHEUMATIC 
ANTI-NEURALGIC, 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


14! 


G  O  U 


O  IMG  ALINE  stands  without  a  rival  for  the 
relief  of  gout  and  gouty  rheumatism. 
The  first  dose  of  Tongaline  greatly  alle- 
viates the  pain,  generally  a  brisk  purga- 
tive should  be  given  at  the  outset,  the  second  or 
third  doses  subdue  the  pain,  and  marked  general 
amelioration  is  observed.  With  a  continuance 
of  the  remedy  the  inflammation  and  tumefaction 
begin  to  decrease,  and,  in  a  large  proportion  of 
cases,  rapidly  disappear. 

The  interna/  administration  of  Tongaline  in  any  of  its  forms,  as  indicated, 
may  be  supplemented  by  the  local  application  of  Tongaline  Liquid. 


5CIATICA»4UMBAG0- 


HESE    diseases,   although    different    in 
origin  and  nature,  the  one  a  neuralgic 
and  the  other  a  rheumatic  affection,  are 
generally    associated.      Hence,    in   the 
older  ordinary   treatment  of  sciatica  and  lum- 
bago the  element  of  pain  was  combated  locally 
without  regard  to  constitutional  medication. 

Tongaline  besides  being  anti-neuralgic  and 
anti-rheumatic,  exerts  a  specific  action  on  the 
excretory  system,  thus  not  only /■■■'*■"«"£ 
pain  but  thoroughly  eliminating  from  the  body 
the  direct  cause  of  the  disease. 

The  internal  administration  of  Tongaline  in  any  of  its  forms   as  indicated, 
may  be  supplemented  by  the  local  application  of  Tonga/me  Uqu,4. 


S>vuvc\N\xv£  < 


\hm$ 


ANTIRHEUMATIC 
AMTI-NEURALGIG. 


a 

LiLLJJ 


142 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


BROMIDIA 

HYPNOTIC 

ECTHOL 

A.NTIPURUEENT 

IODIA 

A.ETERA.TIVE 

PAPINE 

ANODYNE 

LITERATURE    FURNISHED    ON    APPLICATION. 

BATTLE  &  CO., 

Chemists'  Corporation,       ST.  LOUIS,  MO.,  II.  S.  A. 


CHAPOTEAUT'S 

PHOSPHO-GLYCERATE  OF  LIME 

(Syn.  Glycero-phosphate  of  Lime.) 
A  NERVE  FOOD  AND  STIMULANT. 


Neurasthenia 

IDIOPATHIC 

OR 

SYMPTOMATIC 


Pure  Phospho-glycerate  of 
lime  is  exceedingly  sensi- 
tive to  light,  air  and  heat, 
but  keeps  well  in  capsules 
or  in  the  form  of  a  syrup 
or  wine.  For  these  reasons 
we  request  the  profession 
to  specify  the 
"CHAPOTEAUT" 

PREPARATIONS. 


Indicated  in  convalescence,  chlorosis,  anemia,  albuminuria,  phosphaturia, 
tuberculosis,  and  especially  in  sexual  neurasthenia  and  wasting  diseases  resulting 
in  nervous  exhaustion. 

4  to  12  grains  daily  for  adults  ;  half  doses  for  children. 

capsules,  4  gra.ns  each.  .     RIGAUD  &  CHAPOTEAUT,  Paris. 

WINE,  A.  GRAINS  TO  THE  TABLESPOON FUL.  *^" 

syrup,  a,  grains  to  the  tablespoonful.  U.  S.  Agents,  E.  FOUGERA  &  CO.,  N.  Y. 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


143 


Fairchild's  PEPTOGENIC  MILK  POWDER  effects, 
by  means  of  the  animal  proteolytic  enzyme,  the  conver- 
sion  of  caseine  into  minutely  coagulable  and  soluble  albu= 
minoids,  corresponding  in  constitution  and  digestibility  to 
the  peptone=like  albuminoids  of  breast  milk. 

This  influence  of  the  PEPTOGENIC  POWDER 
imparts  a  new  and  peculiar  property  to  the  milk  ;  the  milk 
becomes  in  its  physical  characteristics,  density,  color  and 
taste,  and  in  its  behavior  with  acids  and  with  the  gastric 
juice,  remarkably  like  mothers'  milk.  FAIRCHILD  BR05. 
&  FOSTER,  New  York. 


M'INTOSH 

BATTERIES 

ARE   ALWAYS 

STANDARD. 

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144 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


THE  IMPROVED  "YALE"  SURGICAL  CHAIR. 

^-HIGHEST  AWARD  WORLD'S  FAIR,  OCT.  4th,  1893. 

1st.  Raised  by  foot  and  lowered  by  automatic  device.— Fig'.  I. 

2d.  Raising- and  lowering1  without  revolving-  the  upper  part 
of  the  chair.— Fig-  VII. 

3d.    Obtaining-  heiprht  of  39J<  inches.— Fig-.  VII. 

4th.  As  stronpr  in  the  highest,  as  when  in  the  lowest  position. 

-Fig.  VII. 
i  5th.  Raised,  lowered,  tilted  or  rotated  without  disturbing  pa- 
tient. 

6th.  Heavy  steel  springs  to  balance  the  chair. 

7th.  Arm  Rests  not  dependent  on  the  back  for  support.— Fig, 
VII — always  ready  for  use;  pushed  back  when  using  stir- 
rups—Fig. XVII — may  be  placed  at  and  away  from  side 
of  chair,  forming  a  side  table  for  Sim's  position— Fig. 

8th.  Quickest  and  easiest  operated  and  most  substantially  se- 
rFig.  V.— Semi- Reclining.  ^    cured  in  positions.  y~- 

f«th.  The  leg  and  foot  rests  folded  out  of  the  operator's  way 
at  any  time— Figs.  XI,  XV  and  XVII. 

10th.  Head  Rest  universal  in  adjustment,  with  a  range  of 
from  14  inches  above  seat  to  13  inches  above  back  or 
Chair,  furnishing  a  perfect  support  in  Dorsal  or  Sim« 
position.— Fitrs.  XIII  and  XV.  .W 

11th.    Affording  unlimited  modifications  of  positions.  \ 

12th.    Stability  and  firmness  while  being  raised  and  rotated. 

13th.    Only  successful  Dorsal  position  without  mining  patient. 

14th.  Broad  turntable  upon  which  to  rotate  the  chair,  which 
cannot  be  bent  or  twisted. 

15th,  Stands  upon  its  own  merits  and  not  npon  the  reputa- 
tion of  others. 

Pronounced  the  ne  plus  ultra  by  the  Surgeon,  Gynaecologist,  Oculist  and  AurlsL 

MANUFACTURED    EXCLUSIVELY   BY 

Canton   Surgical   and    Dental   Chair   Co., 

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Fig.  XVII— Dorsal Position, 


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THE  CHARLOTTE  MEDICAL  JOURNAL.  145 


IN 

WOUNDS 


"The  cleanest,  sweetest  and  most  stimulating-  antiseptic."'  "Relieves  congested  parts,  short- 

— Dr.  Lucas,  Cleveland,  O.  ens  and  ameliorates  the  disease." — 

"An  ideal  dressing*  for  wounds." — Dr.  Smith, Poultney.Vt.  Dr.  Calvin,  Dayton,  Ohio. 

"In  fresh  cut  wounds  I  have  found  no  superior  in  Vitogen."  "Transformed   a   horrid  mass  of 

— Dr.  Horrell,  Colchester,  111.  putresence   into   a   rapidly  healing 

"Keeps  wounds  drier  and  healthier  than  do  other  Anti-  sore.'' — Dr.  Mitchell, Verona,  Md. 
septics." — Dr.  Sellers,  Adamsville,  Ala. 

HOST    PEREECT                lllTIOmTin  Non-odorous, 


ANTISEPTIC 


LOWEST    PRICED  fill    I    IV  LI       I    IU  Non-toxic. 

Used  regularly  by  over  15,000  American  Physicians  and  Surgeons: 
ONE  BOTTLE        Dispensed  by  Pharmacists  in  Perforated  screw  cap  bottles,   2  oz.  50c,  4< 
FREE,  for  trial.     $1.00,  or  mailed  prepaid  on  receipt  of  price. 

VIN  5UR0Z0NE         SARATOGA  OINTHENT 

Creates  better  appetite,  more  complete  diges- 
tion, more  energetic  circulation,  more  perfect 
secretion.  Indicated  in  Gout.  Diabetes,  Rheu- 
matism. Albuminuria.  Full  Pint  Bottle  Free. 
Booklet  on  request. 


Antiseptic,  Soothing,  Non-Secret,  Endorsed 
everywhere  by  discriminating  Physicians. 

Dispensed  by  Pharmacists.  1  oz.  cans,  75c. 
per  dozen. 

ThE  Q.  F.  HARVEY  CO..S     ng  Saratoga  Springs,  New  York, U.S.A. 

Canadian  Branch:  Mille  Roches.  Ontario.     Messrs.  KEZAR  &  BENNETT,  Agents.    1 

CENTRAL  HOTEL, 


CHARLOTTE,  JV.  O. 

Under  new  management. 

Centrally  Located, 

Liberally   Conducted. 

Manager 

5PERRY   &  LUCAS,  Proprietors, 


146 


THE  CHARLOTTE  MEDICAL  JOURNAL 


Elegant  Pharmaceutical  Specialties, 

Attention  is  called  to  the  Excellence,  and  valuable  Therapeutic  Properties, 
of  these  Preparations. 


NUTRITIVE,   TONIC,   ALTERATIVE. 

A  Standard  Remedy  in  the  Treatment  of  Pulmonary  Phthisis,  Bronchitis.  Scrofulous  Taint, 
General  Debility,  etc.     Stimulates  Digestion  and  promotes  Assimilation. 

FORMULA.— EACH  FLUIDOUNCE  CONTAINS 

Hypophosphite  Soda,     2    gr.        Hypophosphite  Iron,      1 


gr.  Hypophosphite  Manganese,    1VJ   gr 

Quinine,     %  gr.  "  Strychnine,     1-16  gr  . 

"  Oz.  Bottles,   50  Cts.  PINTS,  $100- 


This  preparation 


not  precipitate — retains  all  the  salts  in  perfect  solution. 


Robinson's   X^i***^  Jtiioe   and  IPe;psin« 


(Pure  Concentrated  Pepsin,  combi 


ith  Pure  Lime  Juice.) 


An  Exceedingly  Valuable  Combination  in  cases  of  Dyspepsia,    Indigestion,  Biliousness,  Heart- 
burn and  Mai-Assimilation. 

APERIENT  AND  CHOLAGOGUE. 

IMPAIRED  digestion  is  a  consequence  of  a  sedentary  life,  coupled  with  mental  and  nervous 
strain.  RELIABLE  PEPSIN  is  one  of  the  best  digestive  agents  known.  PURE  LIME  JUICE  with  its 
aperient  and  cholagogue  characteristics,  with  the  Pepsin,  furnishes  a  compatible  and  most  effi- 
cient combination  as  a  remedy  for  the  disorders  named. 

ROBINSON'S  LIME  JUICE  AND  PEPSIN  is  palatable  and  grateful  to  the  taste. 

DOSE— Adult  dessertspoonful  to  tablespoonful,  after  eating.  Children,  one-half  to  one  teaspoonful,  according 
o  age.    Price,  6  oz.  Bottles,  sO  cts.    16  oz.  Bottles,  $1.00. 

Please  Specify  ROBINSON'S 
For  Sale  by  Druggists. 

Manufacturing  Pharmacists,   LOUJSVILLE,  KY. 

Manufacture  also  Robinson's  Hypophosphites  and  Wild  Cherry,   Robinson's  Phosphoric  Elixir 

Robinson's  Elixir  Paraldehyd,  Flexner's  Albuminate  Iron. 
Founded  1842 — Incorporated  1890.     Interesting  Pamphlets  to  Practitioners  mailed  on  application. 


Robinson=Pettet  Co., 


ELECTRO-NEUROTONE 

United  States  Patents,   500==539. 


The  new 

ELECTRO=MASSAGE 

APPARATUS 

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in  treatment  of  Neuralgia,  Scia- 
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effects  of  Paralysis. 

Endorsed  by  highest  authorities 
in  the  United  States,  England 
and  Canada. 

Manufactured  only  by 


The  American  Electro-Neurotone  Co-, 

NIAGARA  FALLS,  N.  Y. 


Send  for  Treatise. 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


A.11  Physicians  Know 

the  disgust  that  follows  each  dose  of  plain  Cod  Liver  Oil  or  Emulsion.  Patients  re- 
quiring such  a  remedy  can  least  afford  to  risk  any  disturbance  of  the  digestive  apparatus. 

HAGBE'S 
CORDIAL   OF   COD   LIVER   OIL 

WITH  HYPOPHOSPHITES  OF    LIME   AND  SODA 

contains  all  the  essential  constituents  of  Cod  Liver  Oil.  without  the  grease,  the  same  as 
pure  Cod  Liver  Oil  does  with  the  grease.  The  Emulsions  contain  less  than  half  the 
active  principles  of  either. 

CORD.  OL.  MORRHUAE  COMP.      (Hagee) 

is  dispensed  in   16-oz.   bottles  by  all  druggists. 

KATHARMON  CHEMICAL  CO., 

ST.  LOUIS.  MO. 


The    only  Rational  Remedy 
FOR   TUBERCULOSIS 

COCK'S  ANTI=BACILLI    COMPOUND, 
A  Vitalizing,  Reconstructive  and  Nontoxic  Bacillicide, 

A  RATIONAL  REMEDY  and  the  most  powerful  curative  agent  ever  discovered  for 
the  treatment  of  Tuberculosis.  Catarrh,  Bronchitis,  diseases  of  the  Respiratory  Organs 
and  Mucous  Membranes. 

is  a  combination,  both  chemical  and  mechanical,  of  the  gases  of  Formaldehyde,  Ozone, 
Hydrogen,  Allotropic  Oxygen,  and  the  products  of  the  combustion  of  Sulphur  and 
Carbon  under  high  atmospheric  pressure. 

Send  for  Pamphlets  containing  reprints  from  Medical  Journals,  reports  of  cases 
cured  by  ANTI-PHYMIN  under  the  microscopical  observation  of  well-known  phy- 
sicians. 

References  to  a  few  of  the  Physicians  who  have  used  and  observed  the  effects  of 
the  remedy  :  Prof.  L  E.  Harper,  M.  D.,  College  of  Physicians  and  Surgeons,  Chicago, 
111.  ;  Rukus  Bartlett,  M.  Dm  125  LaSalle  St.,  Chicago,  111.  ;  Chas.  Pague,  M.  D., 
205  Inter-Ocean  Blk.,  Chicago,  111.  ;  F.  E.  Daniel,  M.  D..  Asst.  State  Health  Officer, 
Editor  Texas  Medical  Journal, Austin,  Texas;  Roger  Atkinson,  M.  D.,  San  Marcos, 
Texas;  L.L.Shropshire,  M.  D.,  San  Antonio,  Texas;  J.W.Daniel,  M.  D. 
Houston,  Texas. 

For  reports,  pamphlets,  prices.  &c,  Address, 

i.   r^.   ivYo:v»   «ss   00., 

Sole  Distributing  Agents.  XBW      RI^^ANS,  I^A. 


148  THE  CHARLOTTE  MEDICAL   JOURNAL. 

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|*^fr  I  f^\  f*^  r"^  VAEANS  a  diminution  of  the  number 

"j  I  V    M  V.  J  ^^M  '        of  the  fundamental  red  corpuscles; 

a  reduced  percentage  of  oxygen-carry- 
^^^  ^^^  «^^i^™^.    ^      ing  haemoglobin,  and  as  a  consequence, 

tj  Z'   \   \#    Eh     t?  lr         a   diminished   resisting   power  against 

^^^      w      Lm  I  V  more  serious  disease. 

Pepto-Mangan  "  Gude  "  supplies  these  deficiencies.  It  furnishes 
Organic  Iron  and  Manganese  to  the  blood  elements,  increases  the 
haemoglobin,  and  restores  to  the  blood  its  normal  germicidal  potency. 

*pepfoVV^iv  ("(jade") 

LITERALLY     "  BUILDS     BLOOD"     IN    CASES    OF 

Anaemia,  Chlorosis,  Amenorrhea,  Rickets,  Bright's  Disease,  etc. 

Send  for  samples  and  reports  of  "blood  counts,"  etc. 

To  assure  the  proper  filling  of  your  prescriptions,  order  Pepto-Mangan  "Gude" 

in  original  bottles  (  §  xi).     It's  never  sold  in  bulk. 

M.    J.    BREITENBACH    COMPANY, 

Laboratory,  Solo  Agents  for  United  States  and  Canada, 

Leipzig.  Germany.  56-58    WARREN    ST.,    NEW   YORK. 


The  "Allenburys"  Throat  Pastilles 

THESE  PASTILLES  have  now  for  many  years  been  [ 
widely  employed,  and  with  the  best  results,  by  the  leading 
Throat  specialists  and  physicians  generally.    Long  expe- 
rience has  shown  the  following  kinds  to  be  the  more  gen- 
erally useful  and  frequently  prescribed: 

No.  2.  Ipecacuanha.  Readily  taken  by  children.  These 
Pastilles  arc  of  the  same  strength  as  the  Lozen- 
ges of  the  Britisu  Pharmacopoeia. 

No.  3.  Morphia  and  Ipecacuanha.  (l-40th  grain  Morphia 
and  '4  grain  Ipecacuanha). 

No.  9.  Menthol,  Cocaine  and  Red  Gum.  (Menthol  and 
Cocaine,  aa.  gr.  l-20th  ;  Red  Gum,  gr.  ii). 

No.  10.    Benzoated  Voice.    Useful  to  public  speakers, etc. 

No.  11.  Chlokate  op  Potash.  A  more  agreeable  form 
than  the  Lozenge  of  the  Pharmacopoeia. 

No.  13.     Rhatany.     Astringent. 

No.  14.  Tannin.  Astringent,  and  of  the  same  strength  as 
the  Tannic  Acid  Lozenges  of  the  British  Phar- 
macopoeia. 

No.  17.  Chlohate  of  Potash  and  Borax.  Containing 
these  two  useful  remedies  in  combination. 

No.  22.    Red  Gum.    Astringent. 

No.  23.  Eucalyptus  (Gum  and  Oil).  Antiseptic,  stimu- 
lant, and  astringent. 

No.  24.  Cocaine.  (1 -20th  grain).  Sedative  to  the  mucous 
membrane. 

No.  24a.  Cocaine.     (l-10th  grain). 

Mo.  20.    Codeine.     (l-8th  grain  Codeine).    Sedative. 

No.  27.  Compound  Eucalyptus.  (Red  Gum,  Chlorate  of 
Potash,  and  Cubebs). 

No.  28.  Compound  Guaiacum.  (Guaiacum,  Chlorate  of 
Potash,  and  Red  Gum). 

The  "Allen  burys"  Throat  Pastilles  are  sold  in  decorated  tin  boxes, 
Sent  on  receipt  of  price  to  any  address,  post  paid. 

ALLEN  &  HANBURYS,  LTD.,  (LONDON,  ENQ.) 

U.  S.  Branch:  82  Warren  Street,  New  York. 

Agent  for  Canada  W.  Lloyd  Wood,  Toronto- 


No.  29.  Compound  Rhatany  and  Cocaine.  (Ext.  Rhatany 
gr.  ii;  Cocaine  Hydrochlor.,  gr.  l-10th).  A  very 
efficacious  astringent  and  anodyne. 

No.  32.    Red  Gum  and  Chlorate  of  Potash.   Astringent. 

No.  38.  Chlorate  of  Potash,  Borax,  and  Cocaine.  (2 
grains  Chlorate  of  Potash.  1  grain  Borax,  l-20th 
grain  Cocaine). 

No.  41.     Eucalyptus  Oil.     Antiseptic  and  stimulant. 

No.  43.     Menthol.    (1-20  grain).  Stimulant  and  antiseptic. 

No.  43a.  Menthol.     (1-lOth  grain). 

No.  44.  Menthol  and  Cocaine.  (l-20th  grain  Menthol  and 
l-20th  grain  Cocaine  in  each).  Stimulant,  anti- 
septic, and  sedative. 

Menthol  and  Rhatany.  (Menthol,  l-20th  grain  ; 
Extract  of  Rhatany,  2  grains) .  Antiseptic,  stimu- 
lant and  astringent. 

No.  48.  Tannin,  Cayenne,  and  Black  Currant.  Astrin- 
gent, stimulant,  and  soothing. 

No.  52.  Tannin  and  Black  Currant.  Astringent  and 
soothing. 

No.  54.    Menthol  and  Eucalyptus  Oil. 

30  cents  retail. 


No.  45. 


150 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


Is  the  most  useful  and 
practical  apparatus 
ever  offered  to  Phy- 
sicians for  the 

SPECIAL  TREATMENT 

of  Chronic  Bron- 
c  h  i  t  i  s,  Incipient 
Consumption  and 
all  Catarrhal  Af- 
fections of  the  Head, 
Throat,  Lungs,  and 
Deafness. 


Far  better  than  the  Pulit- 
zer Air  Bag  and  Cathe- 
ter in  Treatment  of 
Deafness. 


Sizes,  15x9x19  Inches  High. 

This  is  our  recently  improved  six-bottle  Nebulizer  with 
vibrating  cock,  which,  with  our  Needle  Point  Air  Valve, 
enables  the  operator  to  perfectly  control  the  vibrations 
under  any  pressure  desired. 

FORCED  inhalations  promplty  arrest  the  progress  of 
diseases  of  the  air  passages,  allay  irritation  in  Bronchitis 
and  control  the  coughs  soothe,  the  inflamed  membranes, 
heal  ulcerations,  stimulate  secretions,  and  restore  the  phys- 
iologic functions — promoting  a  more  perfect  oxidation 
in  the  process  of  nutrition  and  assimilation.  Operator  has 
perfect  control  of  the  pressure,  as  air  guage  indicates 
amount  used,  which  is  very  essential,  and  enables  physi- 
cians to  treat  children,  timid  persons  or  invalids. 


Sizes,  9ix30  Inches. 

Our  Combined  Air  Tank  and  Pump  is  a  grear 
improvement  over  old  style.  Heavy  Coppef 
Nickel-Plated.  None  better.  Twice  the  size  o 
those  usually  sold  for  $25.00. 

Portable  Eureka  Nebulizer. 

This  shows  our  Portable  Eureka  Nebulizer 
Combination.  It  is  convenient  to  carry  .in  buggy, 
and  can  be  left  with  patient  if  necessary;  once 
using  physician  wouldnotdo  without.  No  treat- 
ment relieves  so  quicky  the  acute  condition  of 
Asthma,  Pneumonia,  Bronchitis,  Hay  Fever  and 
Catarrh.  It  is  easy  to  work  and  will  not  get  out 
of  order. 

WRITE  FOB  PRICE  AND    LITERATURE 

O.  Q.  HOLMAN, 

Gen.  Agt.,  LaGrange,  111. 


Size  on  base,  10x16x20$  in.  high. 
Weight  in  Case,  24  lbs. 


THE    CHARLOTTE  MEDICAL  JOURNAL. 


151 


JkjT  ALTINE  is  a  highly  concentrated  extract  T|Ar  AL  T  EXTRACTS  which  are  thinner  than 
-*-*•*-  of  barley,  wheat  and  oats.  Barley  alone  -*-»-*-  M  ALTINE  are  thinner  for  the  simple 
is  employed  in  the  manufacture  of  all  other  reason  that  they  contain  more  water — are  not 
malt  extracts,  and  not  one  of  them  is  as  highly  concentrated  as  MALTINE  is  and  therefore  are 
concentrated  as  MALTINE.  less  nutritious  and  more  costlv. 

Wine 


e) 


MALTINE    is    rendered    particularly  deli-  IkIT  ALTINE,  aside  from  its  great  nutritive 

cious  and  refreshing  if  administered  with  -*-"-■-  value,  is  so  rich  in  Diastase   that  a  dose 

any    of    the    aerated    waters,    milk,    wine    or  readily  digests  all   the  starchy  food,   such  as 

spirits.     Thus  a  pleasing  change  is  afforded  to  bread,  potatoes  -and  cake,  which   the   average 

capricious  or  fastidious  invalids.  adult  eats  at  a  single  meal. 

The"OREQON"  Medicine  Case        THE  "western- 

GLASS  STOPPER  AND  METAL  CAP 


FOR  HAND  AND  BUGGY  USE 


Price,     $*0.00. 

Dimensions.-  11  in.  long,  6iin.  high,  and  of  in. 
wide.  Contains  24  1-oz.,  24  3- dr.,  3  3-oz.,  and  4 
'2-0/..  ii.  S.  &  M.  C.  bottles  for  acids,  etc.  Also 
a  large  Supply  space,  1 0x5x1  in.  deep.  It  is 
fitted  with  the  '"Western"  Silver  plated  springs 
for  holding  bottles,  metal  covered  flanges  at 
head  of  corks,  preventing  same  from  coming  out 
and  spilling  contents;  nickel  spring  lock  and  key 
and  extra  styong  handle  with  metal  reinforce- 
ment on  inside. 

Is  made  of  heavy  black  grained  water-proof 
leather  (cowhide),  hand  stitched  around  the 
edges,  and  lined  with  thoroughly  durable  mate- 
rial. The  sides  and  bottom  of  case  are  protected 
with  leather  buttons. 


SAFETY    BOTTLE 

For  Hediclne  Cases  and  Bags. 

A  Reliable  Container  for  Carbolic  Acid,  Tr.  Iron,  Iodine. 
Ergot,  Chloroform  and  similar  fluids. 


I  It  is  made  of  the  best  heavy  flint 

glass,  with  an  emery  ground  glass 
stopper  fitted  accurately  to  an  open- 
4  ing,  and  the  same  is  absolutely  kept 
in  place  with  a  metal  cap,  which 
ii>\  firmly  screws  over  the  stopper  and 
around  the  neck  of  the  bottle,  thus 
preventing  any  possible  chance  of 
the  stopper  becoming  loose,  and  re- 
ducing the  liability  of  leakage,  if 
any,  to  virtually  nothing,  as  this  is 
not  an  ordinary  sand  ground  stopper, 
but  one  especially  ground  for  us  with 
emery,  making  the  same  fit  very 
snug  in  the  neck  of  the  bottle.  The 
|!|  merits  of  this  device  are  easily  ap- 
preciated, as  nearly  every  doctor 
||j  has  had  trouble  and  inconvenience 
">y  not  having  a  reliable  container 
for  such  and  similor  fluids  named 
above. 

This  bottle  is  as  perfect  as  money  and  modern 
skill  can  make  it. 
For  prices  and  sizes  of  the  above  see  other  side. 
Made  in  five  sizes,  H,  2,  4.  6  and  8  ounces. 


Western   Leather  Mfg  Co.,         JVo.  52  Wabash  ave.,  Chicago. 

Send  for  complete  catalogue  showing  over  a  hundred  different  styles  of  cases,  bags,  etc. 


152  THE  CHARLOTTE  MEDICAL  JOURNAL. 

the  Attention  of  WINE     Of     COCA. 

Physicians  to  our         »■■■■■»    «'     wwwn. 

As  being  the  only  preparation  of  COCA  which  is  of 
UNIFORM  JSTDRE^OTH, 

Containing  .15  of  a  grain  of  Cocaine  to  each  fluidounce, 

The  unsatisfactory  results  consequent  upon  the  administration  of  many  different 
makes  of  this  remedy,  due  principally  to  variation  in  the  alkaloidal  strength  of 
the  crude  drug  used  in  their  manufacture,  is  entirely  overcome  in  our  preparation 
which  is  made  from  specially  selected  leaves, 

ASSAYED  and  STADARDIZED, 

Enabling  the  physician  to  regulate  the  dose  to  meet  the  requirements  of  each 
particular  case.     Those  who  have  prescribed  it,  assure  us  that  it  is 

THE  ONLY  PREPARATION 

That  can  be  taken  for  an  indefinite  length  of  time,  without  unpleasant  effect,  by 
persons  with  weak  or  rebellious  stomachs.     Our 

Wine  of  C  oca,  Beef  and  Iron 

Is  also  highly  commended  as  a  valuable  tonic  for  OVERWORKED  MEN  AND 
DELICATE  WOMEN,  and  has  been  successfully  administered  in  cases  of  nausea 
consequent  upon  pregnancy,  where  other  remedies  have  failed. 

4iT  Liberal  Samples  will  be  supplied  physicians  upon  application. 

GILPIN,  LANCDON  &  CO, 

Baltimore,  Md. 


firay,s(|lycerineTon'cComP' 


(Qlyeerine,  Sherry  Wine,  Gentian,  Taraxacum,  Phosphoric  Acid,  Carminatives.) 

Formula  DR.  JOHN   P.  GRAY. 

Neutralizes  Acidity  of  the  stomach  and  checks  fer= 
mentation. 

Promotes  appetite,  increases  assimilation  and  does 
not  constipate. 

Indicated  in  Malnutrition,  Anaemia,  Melancholia, 
Nervous  Prostration,  Phthisis,  Bronchitis,  Catarrhal 
Conditions,  Convalescence,  General  Malaise. 

THE    PURDUE    FREDERICK   CO., 

No.   15  Murray  Street,  New  York. 


The  Charlotte  Medical  Journal. 


Vol.   XV. 


CHARLOTTE,  N.   C,  FEBRUARY,   ii 


No. 


Lithaemia.* 

By  John  N.  Upshur,  M.D.,  Richmond,  Va.,Prof. 

of  the  Practice  of  Medicine,  in  the  Medical 

College  of  Virginia. 

Clinical  observation,  and  personal  expe- 
rience for  several  years  have  impressed  upon 
me  the  importance  of  this  subject.  Gout, 
when  frankly  declared  in  a  joint,  is  very 
easy  of  diagnosis,  and  clear  in  its  therapy, 
but  when  the  subject  of  the  gouty  diathesis 
rarely  or  never  has  a  joint  involved,  and  the 
lithajmic  manifestations,  indicative  of  ex- 
cess of  uric  acid  in  the  system,  declared  by 
phenomena  in  skin,  mucous  membrane,  vis- 
cera, ears  or  eyes,  the  diagnosis  becomes 
more  complicated,  and  consequently  the  in- 
dications for  treatment  more  vague  and  em- 
barrassed. A  factor  in  the  manifestation 
of  t  he  phenomena  above  indicated  is 
age.  We  find  thai  when  the  subject  has 
attained  middle  life,  when  all  nutritive  pro- 
cesses have  reached  their  climax,  especially 
if  there  be  heredity  as  a  predisposing  cause, 
mental  strain, worry  and  anxiety.  I  am  con- 
fident, both  as  the  result  of  my  personal 
experience,  as  well  as  clinical  observation, 
that  some  subjects  have  combined  two  here- 
dites,  tubercular  and  gouty.  The  first 
shows  itself  in  early  life,  some  tubercular 
joint  affection,  or  incipient  tuberculosis  of 
the  lungs,  overcome  by  an  improved  envi- 
ronment, the  substitution  of  hyper-nutrition 
for  a  condition  of  malnutrition,  and  the 
gouty  diathesis  over-rides  and  stamps  out 
the  tubercular.  We  find  ia  the  subject  in- 
crease in  weight,  digestive  and  assimilative 
power,  improved  energy  and  greater  capa- 
city for  work.  We  are  surprised  to  seethe 
prognosis  of  early  demise,  changed  radically 
to  a  state  in  which  the  subject  has  a  first- 
class  chance  of  living  out  his  expectancy. 
I  would  not  be  understood  to  take  position 
as  a  sceptic  as  to  the  causative  and  infec- 
tious nature  of  the  tubercle  bacillus,  but  I 
ask  you  to  ponder  the  question  of 1 'he  auti- 
germicidal,  yes,  fatal  effect  upon  the  tuber- 
cular germs  of  excess  of  uric  acid  i>i  the 
system,  finding  as  it  does  elimination  from 


^Presented  to  the  Tri-State  Medical  Society 
of  Virginia  and  the  Carolinas  at  its  meeting 
held  at.  Charlotte,  N,  C,  January  18,  19,  20,1899. 


the  body  by  every  emunctory   channel,  and 
mucous  surface. 

Of  the  active  causes  of  lithaemic  manifes- 
tations, various  articles  of  diet  must  bear 
the  onus,  and  this  causation  varies  with  dif- 
ferent subjects,  manifesting  itself  in  various 
ways,  the  general  proposition  that  sweets 
and  acids,  wines  and  malt  liquors,  excess  of 
various  kinds  of  nitrogenous  foods,  all 
make  themselves  known  in  symptoms  ran- 
ging from  simple  discomfort  to  agonizing 
pain.  Strawberries,  or  an  orange,  a  raw 
tomato,  or  even  a  little  tomato  in  soup,  de- 
claring its  effects  by  a  violent  erythema  on 
the  hands,  or  feet,  or  face,  itching  of  the 
nose,  or  a  furious  and  tormenting  urticaria 
within  a  few  hours  after  digestion,  some- 
times only  recognized  by  a  sense  of  tension 
or  swelling  of  the  fingers,  a  burning  sensa- 
tion in  the  toes,  or  the  sense  of  the  shoe  be- 
ing too  tight.  At  other  times  we  find  the 
effete  material  seeking  elimination  from  the 
system  by  the  skin,  and  a  furious  and  in- 
tractable eczema,  moist  and  acute,  in  its 
manifestations.  I  treated  a  lady  for  an  ob- 
stinate attack  of  gout  in  left  foot  and  ankle. 
Tin-  same  time  the  next  year  she  developed 
an  obstinate  attack  of  acute  (moist)  eczema 
in  her  left  arm,  resistant  to  treatment  both 
local  and  general,  a  full  dose  of  pilocarpine 
at  night  resulted  in  the  most  profound  exa- 
cerbation of  the  eczema  next  day,  so  that 
she  was  unable  to  grasp  anything  with  that 
hand,  and  the  arm  so  swollen  that  it  was 
tense  and  hard  and  very  painful,  and  the 
itching  beyond  the  endurance.  Great  com- 
fort was  given  by  the  application  of  a  strong 
solution  of  bicarbonate  of  soda  in  cherry 
laurel  water,  swelling  subsiding  and  itching 
and  pain  relieved,  and  arm  almost  com- 
pletely well  in  forty-eight  hours.  I  believe 
this  eczema  was  litJnvmic,  and  the  pilocar- 
pine temporarily  aggravated  the  condition 
by  a  largely  increased  amount  of  uric  acid 
elimination.  Persistent  and  distressing  itch- 
ing of  the  nose  will  sometimes  be  the  only 
indication  of  lithaemia.  The  digestive  tract 
is  a  frequent  seat  of  uric  acid  elimitative 
irritation.  Some  of  the  cases  of  acid  dys- 
pepsia that  come  under  observation  are 
clearly  traceable  to  elimination  of  uric  acid, 
and  not  responsive  to  ordinary  remedies. 
The  burning  is  more  intense,  there  is  a  sense 
of  glow  in  the  stomach,  alternating  at  times 
with  nausea,  and  accompanied  by  areas  of 


154 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


itching,  flying  about  from  scalp  to  nose, 
or  face,  upper  and  lower  extremities.  The 
subject  will  sometimes  awake  in  the  morn- 
ing with  a  nasty,  pasty  taste  in  the  mouth, 
urgent  desire  to  go  to  stool,  and  will  have 
frequent  copious  and  very  acid  actions, 
amounting  to  fifteen  or  twenty  in  the  fol- 
fowing  twenty-four  hours,  scalding,  burn- 
ing, and  very  exhausting,  with  a  sense  of 
fainting  or  goneness.  At  the  same  time 
the  urine  is  scalding,  scanty,  high  colored, 
and  very  acid.  The  condition  seems  to  re- 
lieve itself,  the  bowels  becoming  quiet  so 
soon  as  eliminative  action  is  complete.  Or 
the  manifestation  may  be  in  the  form  of 
acute  pain  in  the  bowels,  most  commonly 
located  in  the  Colon,  Sigmoid  flexure,  pylo- 
rus, or  some  part  of  the  Colon  tract,  coming 
on  with  a  sense  of  depression.  Sometimes 
agonizing  cardialgia  succeeded  by  nausea, 
the  pain  then  becoming  fixed  in  one  of  the 
points,  the  caecum  is  its  most  common  lo- 
cation, some  cases  similating  very  closely 
Appendicitis.  The  pain  is  burning,  rend- 
ing in  its  character,  with  a  sense  of  unen- 
durance.  It  must  be  felt  to  be  appreciated. 
The  writer  has  had  four  attacks  of  this  na- 
ture, two  being  in  the  caecum,  one  in  sig- 
moid, and  one  in  the  pylorus.  It  felt  as 
though  a  mass  of  hot  live  coals  had  been 
put  at  the  spot,  reinforced  by  a  free  dose  of 
mustard.  After  the  agony  of  the  early  part 
of  the  attack  had  been  controlled,  the  sense 
of  soreness  extending  over  the  whole  abdo- 
men, was  so  great  as  to  make  even  the  act  of 
changing  one's  position  in  bed  intensely 
painful.  On  one  occasion, for  a  week  after 
the  attack  there  was  a  sensation  as  though 
a  knife  was  run  into  the  abdomen,  when  any 
jolt  came,  the  rolling  of  the  carriage  over 
the  street  crossing  was  almost  insupporta- 
ble. In  conjunction  with  the  last  and  most 
severe  attack  located  in  the  caecum,  a  retino- 
choroiditis  developed  in  the  left  eye, making 
itself  felt  first  by  a  sensation  as  if  a  grain  of 
sand  was  in  the  eye,  followed  by  pain  and 
soreness  in  the  ball,  and  loss  of  sight  up  to 
the  point  of  being  unable  to  recognize  any 
object  other  than  light.  The  eye  was  com- 
pletely restored  in  ten  days  after  taking  a 
mixture  of  Strychnine,  Dil.  Muriatic  Acid, 
and  Pepsin.  I  tried  the  experiment  of  a 
bottle  of  beer  on  going  to  bed  at  night, 
awoke  next  morning  with  nasty  taste  in  my 
mouth,  crawling,  itching  sensation  of  skin 
on  variousparts  of  the  body  ,and]painful  ring- 
ing in  the  ears.  This  ringing  in  the  ears  is  one 
of  the  most  common  manifestations  of  lithae- 
mia,  with  or  without  headache.  This  latter  is 
dull,  persistent,  with  more  or  less  confusion 
of  ideas,  though  Haig  says  its  duration  is 
under  twenty-four  hours.  I  fully  agree  as 
to  the  other  characteristics  of  it  which  he 


describes.  My  experience  of  blurred  or 
indistinct  vision  in  connection  with  these 
headaches  has  been  similar  to  his.  Nor  is 
this  all,  interference,  with  normal  metabol- 
ism, is  a  not  infrequent  cause  of  lithaemic 
manifestations;  anything  causing  over  ner- 
vous strain,  business  cares  or  worries,  anx- 
iety about  a  patient,  overwork,  reacting  on 
the  stomach  through  its  nervous  supply,  in- 
terfering primarily  with  digestion  and  sub- 
sequently with  metabolism,  will  be  produc- 
tive of  as  well  defined  evidence  of  lithaemia 
as  any  other  one  thing.  Very  commonly 
associated  will  be  a  toprid  liver.  This 
organ  has  failed  to  dispose  of  the  effete  ma 
terial  that  should  be  burnt  off.  Uric  ac 
accumulates  in  it,  the  blood  becomes  too 
acid  and  the  undefinable  lithaemic  symptoms 
show  themselves.  Nor  will  ordinary  alka- 
line remedies  bring  relief,  until  the  liver 
and  portal  circulation  have  been  unloaded 
by  a  sufficient  dose  of  calomel,  and  thus  with 
these  conditions  described,  is  it  strange  we 
see  gouty  kidney,  atheromatous  degenera- 
tions of  the  blood  vessels,  the  develop- 
ment of  mental  depression,  or  organic  de- 
generative change  in  the  brain. 

Time  does  not  allow  for  me  to  go  into  a 
more  detailed  discussion  of  this  subject. 
You  will  find  it  all  elaborately  treated  with 
the  hand  of  a  master  by  Haig  in  his  work 
"Uric  Acid  in  the  Causation  of  Disease." 
But  in  justice  to  myself  I  must  say,  my  own 
clinical  observation  and  personal  experience 
had  pointed  out  to  me  these  clinical  facts 
which  I  have  so  imperfectly  detailed, 

Whether  these  symptoms  are  due  to  ex- 
cess of  uric  acid  in  the  system,  or  whether, 
as  Haig  claims,  this  excess  is  relative  from 
an  interference  with  the  balance,  I  can  not 
say.  He  says  a  certain  amount  of  uric  acid 
is  taken  in  daily  with  our  food,  a  certain 
amount  generated  in  the  system ;  that,  if 
the  balance  is  interfered  with  and  not  so 
much  excreted  as  has  been  accumulated  in 
the  organism,  that  the  blood  becomes  acid, 
fails  to  be  a  solvent  and  thus  uric  acid  is  left 
in  the  tissues, joints  or  deposited  in  the  liver, 
spleen  or  kidneys.  Just  so  soon  as  the  blood 
becomes  alkalinized  by  soda  phosphate  or 
the  salicylates,  it  becomes  a  solvent  for  the 
uric  acid,  it  is  taken  up  and  excreted  from 
the  system.  I  can  testify  to  the  efficiency 
of  soda  phosphate  and  the  salicylates, though 
the  latter  are  apt  to  disagree  with  the 
stomach.  Haig  says  "and  lithia 
though  said  to  be  a  beautiful  solvent  of  uric 
acid  in  the  test  tube,  yet  when  given  to  the 
human  subject  by  the  mouth  never  reaches 
the  uric  acid  at  all,  because  it  forms  at  once 
an  insoluble  compound  with  the  phosphate 
of  soda  in  the  blood,  thus  removing  from 
that  fluid  one  of  the  natural  solvents  of  uric 


LIS 

a- 
id 


THE  CHARLOTTEoMEDICAL  JOURNAL, 


155 


acid,  and  diminishing  its  power  of  holding 
uric  acid  in  solution."  This,  if  it  be  true, 
is  a  terrible  bio  n  to  all  of  the  varied  lithia 
waters  that  have  been  so  much  vaunted  as 
remedial  in  every  variety  of  lithaamia  or 
gout,  so  far  as  the  lithia  salt  held  in  solutiou 
is  concerned.  That  water,  freely  drunk, 
does  much  good  in  the  process  of  elimina- 
nation,  there  can  be  no  doubt,  but  it  is  be- 
cause as  a  solvent  it  takes  out  of  the  system 
effete  matters.  Beale  says,  "water  freely 
drunk,  goes  into  the  cracks  and  crannies  of 
the  system  and  washes    out  the    cobwebs." 

In  conclusion,  the  treatment  of  lithaemia 
consists  chiefly  in  dietetic  regulation  and 
this  must  depend  on  each  individual  case. 
The  value  of  sodium  phosphate,  I  have  al- 
ready alluded  to.  The  saline  cathartics,  in 
full  blooded  subjects,  the  purgative  waters, 
especially  the  Rubinat  Condol,  the  bitter 
tonics,  especially  Nux  Vomica,  and  the  in- 
fusion of  cinchona.  Strychnia  is  valuable 
because  it  not  only  improves  nervous  con- 
ditions and  digestive  processes,  but  is  also 
eliminative,  by  its  quickening  the  perform- 
ance of  function  in  the  emunctories.  It 
causes  marked  rise  in  urinary  acidity,  and 
cures  headache  (Ilaig).  Exercise  is  of 
great  importance,  walking,  horseback,  or 
bicycle.  I  am  inclined  to  the  opinion  that 
the  administration  of  the  salycilates  should 
be  preceded  by  a  course  of  pure  alkali,  as 
potass,  bicarb,  until  the  urine  is  neutral. ami 
because  it  makes  the  salicylates  more  effi- 
cient and  diminishes  the  danger  of  a  subse- 
quent   endocarditis,  and    valvular   damage. 

In  articles  of  diet,  I  would  especially  men- 
tion as  useful  free  use  of  milk.  Taken  hot 
it  improves  digestion,  acts  as  a  stimulant  to 
nutritive  processes,  and  predisposes  to  alka- 
linity of  the  blood.  Tea,  I  regard  as  more 
harmful  than  coffee.  Its  tannin  constituent 
tends  to  gastric  derangement,  and  thus  se- 
condarily interferes  with  metabolism.  Cof- 
fee has  a  tendency  to  the  kidneys,  and  is, 
in  some  measure,  eliminative.  I  would 
condemn  especially,  wines,  malt  liquors, 
&c,  believing  that  whiskey  is  least  harm- 
ful, but  even  it  should  not  be  taken  unless 
there  is  some  factor  of  debility  general  or 
digestive,  which  demands  it,  and  even  then 
it  should  be  in  very  small  quantity. 

Time  does  not  admit  that  I  should  go 
more  fully  into  the  discussion  of  this  sub- 
ject, but  if  what  I  have  said  has  excited 
your  interest  and  given  you  food  for  thought 
I  am  amply  repaid. 

210  W.  Grace  St . 

DISCUSSION. 

Dr.  Geo.  W.  Long. — I  wish  to  remark 
that  I  was  very  much  interested  in  the  Doc- 
tor's   paper,  and    don't  know    that    I    can 


add  anything  of  value,  at  the  same  time,  I 
would  like  to  speak  for  myself  of  the  results 
that  have  been  more  satisfactory  than  any 
other  method  pursued,  in  those  cases  where 
I  emphasized  the  dietary  regulations,  espe- 
cially the  cutting  down  of  meat,  nitroge- 
nous foods.  I  think  that  is  a  very  important 
matter  in  these  cases.  Of  course,  we  have 
various  phenomena  following  the  excess  of 
uric  acid  in  the  blood.  We  have  the  trouble, 
for  instance,  that  is  often  seen  and  descri- 
bed under  the  head  of  eczema  or  nettle  rash 
and  of  course  so  far  as  seeking  the  immedi- 
ate cause  of  that  would  be  an  emetic  then 
and  there  of  ipecac,  and  remove  the  offend- 
ing trouble  and  then  as  to  a  proper  laxative 
there  can  be  no  doubt  in  my  mind.  Of 
course,  it  is  all  right  to  have  exercise  and 
plenty  of  it,  and  employment,  but  especial- 
ly those  people  who  lead  sedentarv  lives,  if 
they  indulge  freely  in  nitrogenous  foods, my 
experience  leads  me  to  believe  that  those 
cases  are  liable  to  have  rheumatic  (?)  colic 
and  rheumatic  gout,  etc.  Good  results  can 
be  obtained  from  cutting  down  nitrogenous 
foods  more  especially,  one-third,  two-thirds, 
or  entirely  if  possible.  I  don't  know  how 
that  reconciles  with  Dr.  Upshur's  views 
about  the  use  of  milk.  I  would  like  to 
know  how  that  is  and  to  hear  from  some- 
body else. 

Dr. Hunter  McGuire. — I  ought  to  be  in 
a  position  to  say  something  on  this  subject, 
for  until  not  long  ago  I  was  disabled,  and 
until  very  recently  I  didn't  know  anything 
about  pathology.  I  don't  believe  to-day 
we  know  any  better  how  to  explain  the  ac- 
tion of  uric  acid  salt  than  we  did  a  hundred 
years  ago.  I  am  indebted  to  the  book  the 
writer  refered  to  Haig(  ?),  for  most  valua- 
ble information  on  the  subject  that  I  never 
understood  until  I  got  hold  of  that  book.  I 
think  I  do  understand  it  now.  I  never  be- 
gan to  get  well  until  I  followed  the  sugges- 
tions made  by  this  writer.  No  one  ever 
tried  harder  to  get  rid  of  anything  than  I 
did  to  get  rid  of  this  trouble.  No  one  ever 
took  physic  more  greedily  than  I  did  trying 
to  get  well,  but  the  suggestions  that  this 
man  makes,  as  soon  as  I  adopted  them  I 
began  to  get  better,  until  to-day  so  far  as  I 
know  I  am  free  from  gout  and  can  do  as 
much  work  as  I  ever  did.  And  his  sugges- 
tion is  very  simple.  Give  up  all  meat, every 
variety  of  meat.  I  haven't  touched  meat 
for  many,  many  months.  Give  up  all  coffee, 
tea,  cocoa,  because  they  contain  uric  acid. 
Drink  milk,  eat  every  variety  of  vegetable 
and  fruit  that  you  can  get  hold  of.  Don't 
hesitate  to  eat  tomatoes,  I  eat  them  when- 
ever I  can  get  hold  of  them.  I  don't  hesi- 
tate to  eat  an  orange.  I  don't  hesitate  to 
drink  whiskey  when  I  want   it,  but    fortu- 


156 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


nately  I  don't  want  it  very  often.  Now, 
that  is  briefly  the  way  I  have  recovered  my 
health  and  gotten  rid  of  this  gout.  I  will 
suggest  another  thing,  that  the  nervous  sys- 
tem has  a  little  more  to  do  with  it  than  we 
are  disposed  to  admit.  Although  I  had  gout 
so  badly  and  it  lasted  so  long,  attacking  my 
eyes  and  making  me  blind  for  a  little  while, 
preventing  my  reading  for  weeks  and 
weeks,  although  I  have  had  it  in  both  feet 
at  the  same  time,  and  my  knees  were  all 
swollen  and  deformed,  suffering  horribly,  I 
haven't  got  on  my  fingers  or  toes  a  trace  of 
it,  I  haven't  got  a  trace  of  uric  acid.  And 
my  gout  usually  came  when  I  was  run  down, 
when  I  had  too  many  sick  people,  when  I 
had  what  every  one  of  you  have  had,  pa- 
tients who  gave  me  too  much  anxiety. 
Cases  incurable  I  never  troubled  my  mind 
much  about  after  I  concluded  that  nothing 
could  be  done,  but  in  cases  which  could  be 
helped,  and  a  number  of  them,  some- 
times eight,  ten  or  a  dozen  people  who 
would  die  if  I  made  a  mistake,  constant 
anxiety  in  those  cases  gave  me  gout.  I  never 
drank  wine  or  beer  or  anything  of  the 
sort,  never  cared  for  them  in  my  life,  have 
always  been  a  small  eater,  always  glad  to 
be  able  to  take  a  small  drink  of  whiskey, 
and  I  congratulate  myself  that  I  am  able  to 
do  it  now  and  it  does  not  hurt  me.  I  don't 
know  about  strawberries.  I  don't  believe 
I  earned  the  gout  by  high  living.  If  I  had 
I  would  have  lost  it.  for  I  have  lost  every- 
thing else  that  I  have  earned.  It  must  hove 
been  inherited.  If  it  was  it  was  the  only 
thing  that  I  inherited  that  I  held  on  to.  I 
only  speak  about  it  because  I  have  had  so 
much  personal  experience.  We  might  well 
look  and  see  how  much  the  nervous  system 
has  to  do  in  this  trouble.  It  has  something 
more  to  do  with  it,  I  think,  than  we  are 
usually  disposed  to  admit. 

Dr.  Paul  Barringer. — There  is  one 
physical  characteristic  of  gout  that  has  been 
referred  to  that  is  so  simple  and  has  proba- 
bly occurred  to  most  of  you,  that  I  hesitate 
to  refer  to  it,  and  yet  in  a  purely  accidental 
manner  my  attention  was  called  to  it.  I 
refer  to  what  the  doctor  referred  to  as  the 
finger  and  toe  deposits.  He  also  will  pro- 
bably agree  with  me  that  the  ear  is  fre- 
quently a  source  of  deposit  also.  I  wonder 
why  the  foot  and  the  fingers  and  the  ear 
should  be  the  sources  of  deposit  of  uric  acid 
salts.  A  few  years  ago  a  friend  came  to 
me  and  said  that  he  had  a  hot  water  heater 
that  wouldn't  heat,  that  it  was  too  small, 
he  could  get  it  to  212  and  it  wouldn't  heat 
any  hotter.  In  a  joking  manner  I  said  : 
"Saturate  your  water  with  salt  and  I  think 
you  can  raise  it  to  about  240."  He  did  so 
and  had    very  satisfactory  results    for  three 


or  four  days.  He  came  to  me  in  very  great 
distress  and  said:  "My  machine  won't 
run."  I  investigated  it  and  found  his  ra- 
diator solidly  packed  with  sodium  chlorate 
and  pure  water. 

When  we  consider  that  the  blood  at  a 
temperature  of  101  or  101^,  or  some  point 
about  that,  we  have  sodium  chlorate  (?)  and 
other  salts  of  uric  acid,  that  enter  the  blood, 
you  readily  understand  that  the  same  blood 
enters  the  fingers  and  finger  tips  at  about 
9S,  97  and  96,  and  so  on  down.  As  you 
stand  on  a  cold  pavement  and  your  feet  be- 
come chilled,  you  see  that  the  fall  in  tem- 
perature is  almost  90,  it  must  have  gone  in 
the  minute  arteries  of  the  fingers  and  toes, 
and  will  produce  a  deposit  at  that  point. 
Those  of  you  who,  on  a  cold  frosty  morn- 
ing, have  felt  the  clip  of  a  passing  breeze, 
know  the  hypersensitiveness  of  the  ear,  and 
know  how  it  is  brought  about  by  the  nega- 
tive circulation.  I  feel  sure  that  it  is  the 
cause  of  the  deposit  of  the  uric  acid  salt  in 
the  fingers  and  toes.  With  regard  to  the 
joints,  I  have  given  the  matter  some  thought, 
I  think  that  it  is  due  to  the  fact  that  it  is 
purely  superficial  circulation,  and  that  there 
are  in  the  joints  no  centers  of  heat  produc- 
tion as  is  to  be  found  in  the  muscles,  that 
we  have  the  surface  of  the  joints  cooler  than 
the  remaining  parts  of  the  limbs,  and  this 
deposit  of  uric  acid  salt  around  the  joints  is 
due  to  the  same  cause  as  that  the  uric  acid 
entering  the  blood  at  101  will  deposit  that 
uric  acid  at  whatever  point  the  circulating 
fluid  passes  below  that  temperature. 

Dr.  Upshur. ^1  would  like  to  say  a 
few  words  in  conclusion,  and  beg  the  in- 
dulgence of  the  Society  for  trespassing  upon 
their  time.  I  want  to  say  a  word  first  with 
regard  to  the  point  the  doctor  made  as  to 
milk,  as  it  is  a  nitrogenous  food.  I  want 
to  premise  what  I  am  going  to  say  by  say- 
ing that  one  of  the  things  I  have  always 
had  a  horror  of  all  my  life  was  chemistry. 
It  would  have  been  better  for  me  if  I  had 
not  had  this  horror  of  chemistry.  I  don't  ever 
attempt  to  look  deeply  into  any  chemical  dis- 
cussions, or  those  things  brought  about  by 
chemical  processes.  My  views  with  regard 
to  milk's  not  doing  as  other  nitrogenous 
foods  would  do  are  based  on  two  facts. 
The  first  is  the  fact  of  personal  experience, 
which  after  all  is  the  best  teacher.  For 
many  years,  the  last  ten  or  fifteen  years,  I 
have  at  times  suffered  acutely  with  these 
unusual  and  irregular  attacks  of  gout.  Nat- 
urally they  do  set  one  to  thinking.  Natur- 
ally this  question  of  diet  was  a  subject  up- 
permost in  my  mind  as  a  solution  of  this 
question,  both  because  I  believed  that  the 
legitimate  solution  of  the  problem  lay  in  the 
direction  of  the  diet,  and  secondly,  because 


THE  CHARLOTTE   MEDICAL  JOURNAL. 


157 


I  believed  most  profoundly  in  the  Scripture 
injunction  with  regard  to  medicine,  that  it 
is  more  blessed  to  give  than  to  receive,  and 
therefore,  whenever  you  hear  of  my  taking 
a  dose  of  medicine  you  may  know  that  lam 
in  a  corner  and  can't  crawl  out,  so  my  gouty 
trouble  was  treated  along  the  line  of  diet. 
Now,  my  experience  with  regard  to  milk, 
and  I  drink  a  great  deal  of  milk  that  it  is 
the  very  best  thing  I  can  do  in  the  diet  line 
for  my  gout  and  I  was  at  a  loss  to  know 
why  it  was  so  until  I  came  across  this  won- 
derful book  of  Dr.  Haig(?).  I  haven't 
read  it  all  yet.  It  is  very  much  like  fruit 
cake,  you  must  take  a  little  bit  of  it  at  a 
time  if  you  want  to  digest  it  thoroughly.  I 
say  this  because  it  is  so  comprehensive,  and 
a  man  wants  to  ponder  well  what  he  says 
and  digest  it  thoroughly,  because  he  will 
constantly  come  back  to  it  as  a  rich  store- 
house and  find  something  exceedingly  use- 
ful to  him.  1  find  that  Dr.  Ilaig  lays 
down  as  a  proposition,  certainly  not  that 
milk  promotes  the  alkalinity  of  the  blood, 
here  comes  to  the  explanation  of  milk  for 
this  condition  of  things  when  I  couldn't 
explain  it  before,  and  that  is  the  reason 
why  milk  will  do  this  as  a  nitrogenous  food 
when  other  articles  of  food,  like  a  meat 
diet,  will  not  do  it,  especially  the  dark 
meats,  promote  the  development  and  reten- 
tion of  the  uric  acid  in  the  system  when 
milk  does  not,  because  of  the  fact  that  it 
alkalinize  with  the  blood  and  at  the  same 
time  tends  to  promote  elimination  through 
the  kidneys. 

Now,  there  is  another  fact  that  is  exceed- 
ingly interesting  to  me  which  Dr.  Ilaig 
lays  down,  that  in  every  system,  in  the 
morning  a  cleansing  should  take  place,  that 
it  is  a  time  as  it  were  of  cleaning  up  the 
house.  The  urine  is  highly  colored  and 
there  is  a  great  amount  of  uric  acid  in  the 
system,  the  alkaline  tide  sets.  The  whole 
organism  should  get  ready  for  the  battle 
of  the  day.  Then  the  question  as  to 
other  articles  of  diet.  The  experience 
which  Dr.  McGuire  gives  with  reference 
to  tomatoes  and  oranges,  which  I  touch 
very  cautiously.  It  is  undoubtedly  true 
that  what  is  one  man's  food  is  another  man's 
poison.  Strawberries  are  absolute  poison 
to  me,  and  I  have  seen  over  and  over  again 
cases  where  they  produced  gout  or  brought 
it  back  after  it  had  been  seemingly  cured. 
1  assure  you  I  would  as  soon  touch  poison 
as  one  of  them.  I  have  had  little  tingling 
gouty  sensations  in  my  lingers  within  an 
hour  after  eating  an  orange  or  tomatoes, 
Now,  I  will  go  a  point  further,  and  this  is  a 
point  in  which  I  have  to  disagree  with  Dr. 
Ilaig.  Relief  doesn't  always  come  in 
the    line    of    a     vegetable     diet.  There 


are  conditions  of  the  stomach  which  we 
might  call  vegetable  dyspepsia.  You  take 
the  first  step  in  the  direction  of  digestive  dis- 
turbances and  when  you  do  that  you  at  least 
negatively  establish  the  fact  that  there  is  to 
be  a  retention  of  uric  acid  in  the  system,  and 
interfere  with  its  elimination  and  you  may 
have  well  declared  gout  as  a  result  of  that 
condition.  Now,  there  is  no  question  of 
the  fact,  but  that  the  nervous  system  is  a 
factor  in  its  existence  and  in  its  potency,  for 
producing  the  gout — not  the  gout  that  the 
Englishman  has  where  he  has  his  toes 
all  swollen  up  and  uncomfortable  as  a 
result  of  his  high  living — but  where  you 
have  it  in  these  parts,  is  a  vague  and 
ill-defined  symptom  of  lithemia.  I  like  the 
term  lithemia  better  than  that  of  gout,  and 
there  is  a  distinction.  Lithemia  is  Ameri- 
can, gout  is  English  as  a  result  of  high  liv- 
ing. Lithemia  comes  to  the  Americans  from 
the  tense  condition  of  the  nervous  chords.  It 
is  the  old  story  of  straining  the  lute  up  to 
the  point  where  there  comes  a  rift,  and 
the  music  is  all  mute.  Many  a  man  has  died 
suddenly,  as  a  result  of  apoplexy  or  of  or- 
ganic heart  trouble  and  the  trouble  has  been 
the  blood  vessels  of  the  brain  or  in  some 
organic  change,  it  may  be  the  deposit 
of  chalk  upon  the  valves  of  the  heart, 
and  primarily  the  cause  of  that  man's 
death  has  been  his  lithemic  condition. 
I  believe  there  is  nothing  we  should  guard 
so  carefully  as  this  nervous  condition.  Now, 
as  pure  fact,  personally  while  I  have  had 
rarely  or  never  any  of  the  joints  troubled, 
I  have  scarcely  got  a  joint  in  either  hand 
that  I  haven't  got  with  the  marks  of  lithe- 
mia, and  in  the  ball  of  that  thumb  I  have 
got  a  little  globular  mass  that  rolls  around  it 
like  a  marble  when  I  press  on  it,  and  yet  I 
have  never  had  an  attack  of  gout  in  a  joint 
in  my  life.  With  regard  to  eggs,  I  would 
say  it  is  true  with  these  as  with  regard  to 
other  articles  of  diet.  Eggs  have  the  repu- 
tation of  being  very  digestible,  but  in  my 
experience  I  have  found  them  very  indiges- 
tible. I  constantly  find  patients  who  can't 
take  eggs,  they  disagree  with  them  and  are 
a  source  of  trouble. 

Finally,  one  word  with  regard  to  colchi- 
cum.  No  one  here  will  deny  its  useful 
properties,  because  it  exercises  some  re- 
markable powers.  I  very  rarely  give  col- 
chicum  to  a  patient.  It  is  a  thing  that  is 
apt  to  leave  the  digestion  unimpaired. 
Usually  colchicum  is  objectionable  to  take, 
and  I  very  much  prefer  to  find  a  solution 
through  other  therapeutic  lines,  and  the 
phosphate  of  sodium  is  peculiarly  happy  in 
its  influence  for  the  relief  of  these  condi- 
tions. 


158 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


fledical    Examining     Boards — Especially 
those  of  Virginia  and  North  Carolina. 

By  A.  S.  Priddy,  M.  D.,    Ex-Member    Virginia 

State  Board  of  Medical  Examiners, 

Keysville,  Virginia. t 

It  is  with  great  pleasure  and  satisfaction 
that  we,  the  representatives  of  the  medical 
profession  of  Virginia  meet  our  brethren  of 
the  Carolinas  in  this  hospitable  and  pro- 
gressive city  of  historic  old  Mecklenburg 
county  whose  people  gave  the  first  expres- 
sion to  the  sentiment  that  the  American 
colonies  were  fit  for  their  own  independent 
self-government  and  would  have  no  other. 
North  Carolina,  adjoining  the  confines  of 
Virginia  for  nearly  300  miles,  without  any 
natural  boundary  or  barrier,  and  being  first 
settled  by  Virginians,  has,  in  times  of  war, 
always  been  found  shoulder  to  shoulder 
with  our  people,  and  in  business  pursuits  in 
time  of  peace  has  been  our  fair  competitor. 
So  strong  and  numerous  have  been  the  al- 
lied interests  of  the  two  States  that  I  am 
very  much  disposed  to  accept  as  true  a  tra- 
dition relaetd  some  years  ago  by  Gen.  Jubal 
A.  Early  at  a  Confederate  Veteran  reunion 
in  Richmond  that  in  the  early  part  of  the 
Eighteenth  century  a  commission  headed 
by  Col.  William  Byrd,  of  Westover,  met  a 
like  commission  on  the  part  of  North  Car- 
olina to  designate  the  boundary  line  of  the 
two  States  or  rather  Colonies,  so  great  was 
the  desire  of  Virginians  to  be  North  Caro- 
linians, and  vice  versa  ;  and  having  parta- 
ken freely  of  the  hospitality  and  convivial- 
ity which  always  attend  meetings  of  Vir- 
ginians and  North  Carolinians,  they  spent 
much  time  in  losing  the  even  supposed  line 
bet  wen  the  two  States,  and  to  this  day  the 
citizenship  of  many  inhabitants  of  the 
country  aforesaid  is  a  disputed  question.  I 
hail  with  much  joy  this  meeting  as  the 
means  of  bringing  into  closer  touch  the 
physicians  of  Virginia  and  the  two  Caro- 
linas, and  of  effecting  an  organization  for 
the  mutual  good  of  ourselves  and  the  peo- 
ple, of  whose  lives  and  health  we  are  in  a 
great  measure  the  custodians.  So  when 
our  committee  on  organization  honored  me 
with  a  request  to  prepare  a  paper  on  some 
medical  subject  of  interest  to  this  Society, 
I  had  no  trouble  in  deciding  that  a  talk 
about  the  Medical  Examining  Boards  of 
Virginia  and  North  Carolina  would  be  of 
more  general  interest  than  any  with  which 
I  was  familiar,  and  inasmuch  as  Virginia 
and  North  Carolina  were  the  first  States  to 


fRead  before  the  Tri-State  Medical  Society 
of  the  Carolinas  and  Virginia,  in  Charlotte,  N. 
Carolina,  January,  1899. 


enact  laws  constituting  State  boards  of 
Medical  Examiners,  I  have  written  my  pa- 
per with  special  reference  to  them,  with  no 
disparagement  of  South  Carolina,  who  has 
followed  her  two  sister  States  of  this  soci- 
ety, and  even  though  her  medical  law  is 
not  so  old.  I  am  informed  it  is  doing  a  good 
work  for  the  people  and  the  profession  of 
the  State.  It  is  a  perfectly  plain  propo- 
sition that  the' public  safety  is  dependent 
upon  the  public  health,  and  public 
wealth,  or  upon  capable  and  conscien- 
tious physicians,  for  no  nation  can  attain 
and  hold  high  rank  as  an  intellectual  and 
political  power  whose  citizens  or  subjects 
are  under  influences  which  tend  to  enervate 
and  to  make  physical  wrecks  of  them.  The 
decadence  of  some  of  the  greatest  powers 
of  the  world  has  been  due  to  these  causes. 
In  our  immediate  time  we  have  seen  the 
great  Chinese  nation  go  down  in  disgrace, 
almost  before  the  little  army  of  "Japs"  and 
nothing,  in  my  opinion,  contributed  more  to 
this  result  than  the  habitual  enslavement  of 
the  Chinese  people  to  the  use  of  opium  for 
generations.  It  passeth  all  understanding 
how  an  intelligent  and  enlightened  people 
whose  capacity  for  dealings  with  those  com- 
plex and  trying  questions  which  confront 
nations  has  won  the  respect  and  admiration 
of  the  world  could  so  long  commit  the  lives 
and  health  of  those  dear  to  them  to  the  care 
of  a  class  of  people  whose  legal  require- 
ment for  fitness  to  practice  the  healing  art 
was  the  possession  of  sufficient  money  to 
pay  the  license  tax  and  even  this  was  not  a 
prerequisite  in  all  of  the  States.  So  great 
was  the  popular  indifference  and  in  many 
cases  prejudices  against  regulating  the  prac- 
tice of  medicine  by  law,  it  being  regarded 
as  a  scheme  for  the  formation  of  a  combine 
of  Doctors  that  the  people  continued  to 
elect  and  re-elect  Legislatures  which  would 
bequeath  to  the  coming  generations  large 
"Acts"  of  their  legislative  work  filled  with 
such  laws  as  an  "Act  to  protect  fish  in  the 
waters  of  a  Chickahominy  or  a  Currituck," 
but  with  no  act  to  protect  the  people  against 
that  illiterate,  ignorant,  or  unscrupulous 
class  which,  under  the  title  of  Doctor  of 
Medicine,  in  some  cases  self-designated  and 
in  others  lawfully  acquired  by  the  sojourn 
of  a  few  weeks  at,  and  by  the  payment  of  a 
small  amount  of  money  to,  some  of  the 
numerous  Medical  Colleges  as  the  purchase 
money  fora  diploma.  That  the  physicians  of 
America  without  any  legal  compulsion  have 
for  the  most  part  been  honest,  faithful  and 
capable  men,  that  and  many  of  them  have 
attained  the  highest  positions  among  the 
great  men  of  the  world,  are  tributes  to 
American  honor  and  manhood  rather  than 
to  the  requirements  of  public  policy  bylaw. 


THE  CHARLOTTE'  MEDICAL  JOURNAL. 


159 


It  has  been  ever  thus  in  the  world's  history 
that  mankind  would  reject  the  kind  offices 
of  those  laboring  unselfishly  for  mankind's 
good.  Under  this  prolonged  chaotic  con- 
dition, men  too  lazy  to  earn  an  honest  liv- 
ing by  manual  labor,  others  too  wanting  in 
education  and  intelligence  to  win  footholds 
in  any  of  the  other  learned  professions, 
found  easy  admission  into  the  ranks  of  the 
medical  profession. 

So  great  became  the  demand  for  Medical 
Colleges  of  slack  requirements  and  of  low 
priced  tuition,  that  most  of  the  large  cities 
abounded  in  institutions,  which  vied  with 
each  other  in  graduating  the  largest  classes 
on  easiest  terms.  These  so-called  graduates 
under  the  protecting  ^Egis  of  a  diploma 
were  turned  loose  on  a  gullible  public.  It 
was  against  this  class,  more  than  against 
the  traveling  fakir  who  boldly  sold  his  nos- 
trums on  the  streets  and  court-green  that 
public  protection  was  needed,  inasmuch  as 
the  average  nostrum  is  more  efficacious  from 
the  talismanic  charm  of  secrecy  in  its  prep- 
aration than  from  the  possession  of  any 
drug  good  or  bad  in  its  composition. 

It  is  indeed  a  sad  commentary  on  the 
weakness  of  human  nature  that  people  who 
are  the  most  exacting  as  to  securing  the  best 
of  everything  in  business  details,  even  to 
the  best  blacksmiths  for  shoeing  their  horses, 
will  blindly  follow  the  advice  of  charlatans 
in  dealing  with  the  infirmities  of  their  own 
bodies.  In  view  of  this  indifferent  and 
uneducated  condition  of  the  public  mind 
on  these  important  matters,  the  few  faith- 
ful members  of  Medical  Societies  of  Vir- 
ginia and  of  North  Corolina,  who,  though 
repulsed  for  many  years,  kept  up  their  fight 
for  a  medical  law,  should  congratulate  them- 
selves and  should  merit  the  eternal  grati- 
tude of  the  people  of  the  two  States  for 
having  secured  in  1884-5  tne  passage  of  laws 
regulating  the  practice  of  medicine  and 
surgery  by  constituting  a  State  Board  of 
Medical  Examiners,  the  first  in  the  United 
States,  even  though  their  powers  were  some- 
what limited. 

The  position  of  member  of  such  a  board 
is  a  responsible  and  trying  one — the  mem- 
ber is  an  officer  for  the  faithful  execution 
of  the  law  and  at  the  same  time  he  is  called 
on  to  obey  the  unwritten  law  of  discretion 
(which  is  as  strong,  though  frequently 
somewhat  conflicting)  as  the  written  one. 
.So  well  did  the  societies  select  the  members 
that  the  successful  working  of  the  law  is 
due  to  them,  whereas  they  might  have  fixed 
the  seal  of  public  condemnation  not  only 
on  medical  laws  in  those  two  States  for  it 
was  but  an  experiment  watched  by  them 
all.  As  a  licentiate  of  one  of  the  first  ex- 
aminations   by    the    Virginia    Board,    as  a 


member  of  committee  to  get  the  law  amend- 
ed by  the  Legislature  as  a  member  of  the 
Board  for  five  years,  and  as  the  patron  of 
the  present  law  while  a  member  of  the  Vir- 
ginia Legislature  I  can  testify  to  the  im- 
provement in  the  personnel,  in  the  prelim- 
inary education  and  in  the  professional  ed- 
ucation of  those  who  come  before  the  board. 
The  people  of  Virginia  now  value  it  as  one 
of  the  most  prized  of  State  institutions  and 
I  am  informed  that  the  same  may  be  said 
of  North   Carolina. 

The  first  examinations  revealed  a  deplor- 
able state  of  affairs  :  To  quote  an  extract 
from  a  recent  paper  of  Dr.  Landon  B.  Ed- 
wards before  the  Medical  and  Surgical  So- 
ciety of  D.  C.  "The  results  of  the  earlier 
examinations  were  simply  alarming.  Over 
50  per  cent,  of  these  reputable  medical 
colleges  failed  to  pass  satisfactory  examin- 
ations although  the  markings  were  extreme- 
ly liberal  and  the  required  standard  only 
73  per  cent.  "I  know  myself  that  for  sev- 
eral years  the  papers  turned  in  have  been, 
for  the  most  part  models  of  neatness  and 
orthography,  whereas  in  1885-6-7  many 
graduates  of  reputable  colleges  turned  pa- 
pers in  in  which  the  ignorance  of  medicine 
and  surgery  was  conspicuously  equalled  by 
bad  spelling  and  by  most  flagrant  viola- 
tion of  the  common  rules  of  English  gram- 
mar. Some  good  papers,  as  far  as  the 
knowledge  of  the  questions  was  concerned, 
were    greatly    damaged  in  this  way. 

The  good  work  of  our  Boards  has,  like 
the  scriptural  grain  of  mustard  seed,  ex- 
tended the  branches  of  its  influence  into 
nearly  all  of  the  other  States  ;  a  State  which 
cannot  now  boast  of  a  medical  examining 
board  of  some  form  is  indeed  in  the  back- 
woods of  provincialism.  The  boards  are 
working  with  a  common  purpose  of  reach- 
ing a  uniform  standard  of  grade  in  exam- 
inations. The  medical  colleges  for  the  most 
part  have  taken  advantage  of  the  experi- 
ence gained  from  boards  and  have  formed 
an  organization  known  as  the  Association 
of  American  Medical  Colleges  which  re- 
quire a  rigid  examination  of  all  matricu- 
lates on  the  academic  branches  and  a  four 
year  course  of  study;  courses  in  chemical, 
bacteriological  and  physiological  laborato- 
ries are  compulsory  parts  of  the  course. 
Reference  to  the  records  of  the  Virginia 
board  shows  that  colleges  whose  percentage 
of  rejected  graduates  on  the  early  examin- 
ations was  as  high  as  50%  now  show  a  re- 
duction to  15%  or  20%.  Although  so 
much  has  been  accomplished  within  the  last 
fifteen  years  there  is  much  yet  to  be  done 
ere  the  boards  reach  the  state  of  perfection 
for  which  we  all  most  devoutly  wish. 

The  medical  societies  should  remember  at 


160 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


all  times  that  the  Boards  are  creatures  of 
the  Societies  and  they  should  work  for  their 
betterment  and  in  every  way  uphold  their 
hands.  They  should  see  that  their  best  men 
are  selected  for  members  of  the  Board,  and 
that  no  one  is  elected  who  does  not  work 
for  and  keep  well  up  with  the  medical  so- 
ciety of  his  State.  In  many  remote  locali- 
ties the  law  is  being  openly  violated  by  men 
who  disregard  and  defy  the  law,  or  who 
evade  it  under  some  subterfuge.  Now  the 
boards  have  neither  time  nor  money  neces- 
sary to  visit  the  neighborhoods  and  conduct 
a  personal  prosecution  of  the  offenders  and 
it  is  a  duty  of  every  lawful  physician  in 
the  profession,  and  of  the  people,  to  bring 
these  cases  to  the  attention  of  the  proper 
officers  of  the  law  and  to  aid  in  punishing 
them  as  well  as  in  purging  the  locality  of 
such  cattle. 

There  is  a  highly  objectionable  feature 
in  our  law  which  permits  undergraduates 
to  appear  before  the  boards,  and  the  pro- 
fession should  take  steps  to  have  the  law  so 
amended  that  each  and  every  applicant 
must  present  a  diploma  from  a  reputable 
college  before  being  allowed  to  commence 
the  examination.  Some  claim  to  be  grad- 
uates of  schools  which  they  never  have  seen, 
and  thereby  an  injustice  is  done  the  schools 
while  a  great  many  register  as  undergrad- 
uates, usually  second  course  students,  who 
wish  to  get  the  dread  of  an  examination 
from  their  minds,  and  to  whom  failure  and 
repeated  attempts  to  pass  the  board  do  not 
mean  the  same  as  to  a  graduate.  A  large 
percentage  of  failures  occur  in  this  way, 
and  an  enormous  amount  of  work  and  worry 
is  entailed  on  the  board.  I  am  certain  the 
real  intention  of  the  designer  of  the  law 
was  that  only  those  should  be  examined 
who  are  ready  and  intend  to  enter  practice 
and  the  law  should  certainly  be  made  to 
read  that  way. 

A  question  which  has  been  much  agita- 
ted in  the  different  State  boards  and  in  the 
National  Conference  of  Medical  Examining 
Boards,  has  been  the  one  of  recognition  of 
certificates  of  other  boards,  and  as  yet  noth- 
ing has  been  accomplished  along  this  line. 
Some  object  to  it  because  of  the  lack  of 
uniformity  in  standard  of  examinations  by 
different  boards,  while  others  have  opposed 
it  for  constitutional  and  legal  reasons.  I, 
myself,  think  that  at  present  it  would  not 
be  proper  for  such  a  general  arrangement, 
but  as  far  as  Virginia  and  North  Carolina 
are  concerned  there  are  especial  reasons  and 
conditions  which  suggest  such  an  arrange- 
ment :  In  the  first  place,  our  laws  are  prac- 
tically and  essentially  the  same.  A  careful 
comparison  of  the  results  of  the  examin- 
ations   for    many    years  tends  to    convince 


most  any  one  of  the  equality  in  standard 
of  the  two  boards.  While  I  am  not  a  law- 
yer, yet  I  am  thoroughly  familiar  with  the 
Virginia  law,  having  introduced  it  in  the 
legislature ;  and  I  have  also  studied  the 
medical  laws  of  North  Carolina,  and  I  fail 
to  find  one  line  in  either  which  will  cause 
even  the  strictest  constructionist  to  contend 
that  the  by-laws  cannot  be  so  arranged  that 
special  courtesies  can  be  extended  licenti- 
tiates  of  one  board  by  the  other.  Of  the 
more  than  600  medical  students  who  annu- 
ally attend  the  three  schools  of  Virginia,  a 
large  percentage  is  represented  by  North 
Carolinians  ;  and  all  three  schools  have  hon- 
ored themselves  by  calling  distinguished 
North  Carolinians  to  chairs  in  each.  Many 
North  Carolina  graduates  remain  with  us, 
and  become  adopted  sons  of  the  Old  Domin- 
ion, while  as  many  Virginians  are  induced 
to  become  citizens  of  the  Old  North  State, 
by  the  seductive  influences  of  your  hospi- 
tality and  enterprise.  Between  no  other 
two  States  of  the  Union  is  there  greater 
social,  business,  and  professional  intercourse 
than  between  these  two  States.  I  hope  that 
the  two  boards  may  be  brought  into  closer 
touch,  and  that  in  a  short  while  the  certifi- 
cates of  one  will  be  recognized  by  the  other 
and  that  they  may  continue  to  work  for  the 
perfection  of  the  great  work  in  which  they 
have  so  long  taken  the  lead. 


Tubal   Pregnancy,  f 

By  Virginius  Harrison,  A.  M.,  M.  D.,  Lecturer 
on  the  Practice  of  Surgery,  University  Col- 
lege of  Medicine,  Richmond,  Va. 

I  cannot  fail  to  believe  that  many  women 
lose  their  lives  each  year  from  undiagnosed 
tubal  pregnancy,  having  their  death  ascribed 
to  various  indefinite  causes  which  are  sup- 
posed to  produce  sudden  death.  This  will 
be  more  emphatic  if  we  recall  the  cases  of 
tubal  pregnancy  that  come  under  surgical 
care  with  a  false  diagnosis.  Knowing  of 
two  such  cases  occurring  within  the  past  six 
months,  I  am  prompted  to  write  this  paper 
in  order  to  elicit  a  discussion  of  this  subject, 
especially  in  regard  to  its  diagnosis  ;  for  we 
who  see  these  cases  first  are  often  as  much 
responsible  for  the  outcome  of  the  case  as 
he  who  applies  the  first  dressing  to  the  per- 
forated abdominal  injury. 

Case  i. — Mrs.  P.,  age  24,  white,  one 
child  two  years  old.  History:  Tubercular, 
painful  menstruation  from  the  beginning. 
On  vaginal  examination  was  found  to  have 

fRead  before  the  Tri-State  Medical  Society  of 
the  Carolinas  and  Virginia,  at  Charlotte,  N.  C, 
January,  1899. 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


tubal  disease  on  both  sides.  Operation  ad- 
vised but  declined,  with  the  hope  that  de- 
lay would  bring  relief.  After  an  unusual 
painful  menstruation  in  October,  1896,  de- 
cided to  have  the  operation  performed. 
Soon,  however,  symptoms  of  pregnancy 
developed  and  I  advised  waiting.  In  No- 
vember she  d-d  not  menstruate.  I  did  not 
examine  her,  nor  did  tubal  pregnancy  occur 
to  me  until  December  6th,  when  she  was 
taken  with  a  sudden  pain  in  the  left  side. 
She  was  removed  to  the  hospital  that  even- 
ing and  operated  on  the  next  day.  On 
opening  the  abdomen,  a  large  quantity  of 
dark  blood  escaped  and  continued  to  do  so 
until  the  tube  on  the  left  side  was  secured. 
The  pelvis  was  filled  with  clotted  blood. 
The  tube  was  ruptured,  filled  and  distended 
with  clots  of  blood.  The  ovum  was  not 
found.  The  diagnostic  points  were  suffi- 
cient to  pronounce  it  tubal  pregnancy.  The 
tube  and  ovaries  of  both  sides  were  removed 
as  they  were  diseased. 

Cask  2. — On  June  18th,  1898,  I  was  sent 
for  to  see  Mrs.  ,  age  36,  white.  Per- 
sonal history  excellent.  Had  had  three 
children,  the  youngest  three  years  old.  The 
object  of  my  visit  was  to  do  something  to 
stop  her  "sickness,"  which  had  been  on  her 
for  about  nine  weeks.  I  brought  out  in  the 
consultation  that  at  the  beginning  of  the 
attack  she  had  suffered  a  great  deal  of  pain 
in  the  region  of  the  right  ovary,  which  had 
lasted  for  several  days ;  this  was  relieved 
by  morphine.  About  a  week  later,  she  was 
seized  by  another  similar  attack,  and  suffer- 
ed from  nausea  both  during  the  attack  and 
for  a  short  time  afterward.  I  made  a  va- 
ginal examination,  which  revealed  a  large 
mass  in  the  right  side  of  the  cul-de-sac, 
which  felt  like  a  cystoma  of  the  right  ovary. 
1  told  her  what  I  had  found,  and  that  it 
might  be  tubal  pregnancy,  and  advised  im- 
mediate operation.  She  decided  in  a  day 
or  two  to  have  it  done,  and  went  to  the 
Virginia  hospital,  where,  on  June  25th, 
1898,  1  removed  this  "specimen  from  the 
right  side.  On  the  leftside,  I  found  a  large 
cyst  of  the  ovary,  which  I  also  removed. 
This  mass  is  the  prettiest  specimen  of  tubal 
pregnancy  I  have  ever  seen,  and  is  com- 
plete in  all  its  parts.  You  will  notice  the 
fetus,  a  little  disturbed  by  handling  and  the 
fluids ;  notice  the  eyes,  mouth,  chin,  pro- 
longations for  hands  and  feet.  The  umbil- 
ical cord  leading  to  the  placenta.  Imme- 
diately outside  of  the  sac  you  will  observe 
t  he  blood  clot  from  the  hemorrhage  at  the 
time  of  rupture.  This  is  surrounded  by 
lymph  thrown  out  by  nature  to  protect  the 
peritoneal  cavity,  the  outer  part  of  which 
has    become    organized.     The    patient   left 


the  hospital  entirely  recovered  in  three 
weeks  after  the  operation. 

Case  3. — White,  age  30,  married  five 
months.  History,  dysmenorrhea,  had  had 
the  cervix  dilated  with  no  apparent  benefit. 
Six  weeks  before  I  saw  her  had  had  a  severe 
attack  of  pain  in  the  right  side  of  her  abdo- 
men which  was  relieved  by  morphine  and 
rest  in  bed  for  several  days. 

She  came  to  this  city  and  was  seen  by  me 
on  October  29th  1898.  Her  condition  was 
such  as  to  make  me  suspect  typhoid  fever. 
In  the  evening  of  the  31st  of  October  I  was 
hastily  summoned  to  see  her,  and  found  her 
in  great  agony,  the  pain  being  referred  to 
the  lower  part  of  the  right  side  of  the  abdo- 
men. .Some  shock,  but  not  severe.  Pulse 
120.  Temperature  102  deg.  F.  Rigidity 
of  the  right  side  present,  but  not  marked. 
I  was  not  able  to  differentiate  the  cause  of 
her  trouble,  but  considered  it  either  tubal 
pregnancy  or  appendicitis. 

Morphine  was  administered  hypodermi- 
cally  and  salts  by  the  mouth.  I  saw  her 
early  the  next  morning,  and  her  condition 
was  going  from  bad  to  worse.  The  rigidi- 
ty had  markedly  increased,  as  had  the  tem- 
perature and  pulse.  She  was  immediately 
removed  to  the  Virginia  hospital.  As  she 
had  been  a  surgical  patient  of  Dr.  Hunter 
McGuire  he  was  called  and  we  operated  on 
her  that  morning. 

Section  revealed  the  intestines  matted 
and  covered  with  lymph,  beneath  which  we 
found  a  large  suppurating  mass  in  the  broad 
ligament  with  the  tube  adherent  immediate- 
ly above.  The  case  was  considered  one  of 
tubal  pregnancy,  which  had  ruptured  into 
the  broad  ligament  six  weeks  previously, 
and  had  now  become  infected. 

Owing  to  the  necrotic  condition  of  the 
sac  and  the  ligament  we  ruptured  the  ab- 
scess in  delivering  it.  The  general  perito- 
neal cavity  had  been  previously  walled  off 
with  sterilized  strips  of  plain  gauze.  The 
pelvis  was  drained  by  a  glass  tube  and  gauze 
strips.  The  tube  remained  in  for  36  hours, 
the  gauze  for  one  week  and  renewed  daily 
as  long  as  drainage  was  kept  up.  The  tem- 
perature and  pulse  ran  a  septic  course  for  a 
week.  Concentrated  nourishment,  strych- 
nia and  the  rectal  use  of  the  saline  enematas 
enabled  the  patient  to  overcome  this,  and 
in  eight  weeks  the  wound  healed  and  the 
patient  well. 

History. — The  study  of  this  subject  is  not 
a  new  and  untrammelled  road.  On  the  con- 
trary, Albucasis  described  his  first  case  in 
the  middle  of  the  eleventh  century.  Bayn- 
ham,  of  Virginia,  did  an  operation  in  1790, 
and  another  in  1799,  both  successful.  About 
this  time  other  pioneer  operators  did  suc- 
cessful work. 


162 


THE  CHARLOTTE  MEDICAL  JOURNAL 


Since  Lawson  Tait  performed  his  first 
successful  operation  for  ruptured  tubal  preg- 
nancy in  1883,  a  new  era  has  dawned  and 
much  has  been  written  on  the  subject  until 
now  there  is  hardly  a  journal  that  does  not 
report  some  successful  operation.  When 
we  all  have  learned  to  diagnose  tubal  preg- 
nancy, to  find  one  going  beyond  the  fourth 
month  will  be  a  surgical  curiosity,  and  the 
discussion  of  the  late  treatment  will  be  then 
unnecessary. 

Etiology. — Concerning  the  etiology  of 
tubal  pregnancy,  many  theories  have  been 
advanced,  but  none  have  been  generally  ac- 
cepted as  definite.  Nor  is  this  likely  to  oc- 
cur until  the  exact3  location  of  the  meeting 
of  the  ovum  and  spermatozoa  has  been  sat- 
isfactorily demonstrated.  Tait  and  Sutton3 
both  believe  that  this  occurs  in  the  uterus. 
Minot3  says:  "Nothing  positive  is  known 
as  to  the  site  of  impregnation  in  the  man, 
but  there  is  no  reason  to  suppose,  as  is  un- 
fortunately done,  that  the  site  is  variable, 
or  different  from  that  in  other  mammalia." 
Hertwig  and  Minot3  admit  that  impregna- 
tion takes  place  in  the  oviduct  in  placental 
mammals. 

The  most  plausable  theory,  and  one  that 
will  be  recognized  until  proof  of  a  better, 
seems  to  be  some  mechanical  obstruction  in 
the  Fallopian  tube  to  the  ovum  on  its  jour- 
ney to  the  uterus,  but  not  sufficient  to  pre- 
vent the  spermatozoa  to  pass  to  the  l&cation 
of  the  ovum.  Whether  this  obstruction  is 
due  to  the  tortuous  condition  of  the  tube,  or 
diminution  of  the  calibre  by  bands  or  tu- 
mors or  lesion  of  the  epithelium  lining  the 
tube,  are  the  points  much  discussed,  and 
still  undecided.  A  case  is  reported  by  Wil- 
liams and  Salman3  in  which  there  was  no 
apparent  condition  in  the  tube  to  account 
for  the  tubal  pregnancy.  The  statement 
generally  met  with  that  tubal  pregnancy  is 
more  often  found  in  women  who  have  been 
sterile  for  several  years  needs  some  qualifi- 
cation. 

"It  may  occur,"  according  to  Mr.  Tre- 
ves,"4 "in  the  first  pregnancy  in  woman 
who  have  been  married  from  eight  to  twenty 
years.  May  follow  a  normal  pregnancy  or 
an  abortion,  in  a  newly  married  woman  or 
a  mother  of  a  large  family.  Both  tubes  may 
be  pregnant  at  the  same  time  or  at  dif- 
ferent times."  You  may  have  at  the  same 
time  intra-  and  extra-uterine  pregnancy. 

Varieties. — It  is  not  my  purpose  to  enter 
into  a  discussion  as  to  how  many  varieties 
and  sub-varieties  we  may  meet  in  operating, 
for  the  treatment  varies  but  little.  I  will 
accept  the  opinions  as  held  by  Mr.  Tait,° 
Treves,4  Lusk,1  Price,2  et.  als,  that  all  cases 
are  tubal  at  first,  and  all  others  are  produced 
by  abortion    or  rupture  of    the    tube.      The 


possibility  of  a  pregnancy  commencing  in 
the  ovary  or  abdomen  is  admitted  by  Greig 
Smith,  ct.  als. 

Pathology. — We  owe  a  great  deal  to 
Bland  Sutton  and  Tait  for  what  we  know 
of  the  pathology  of  tubal  pregnancy.  The 
changes  which  occur  in  the  tube  as  it  en- 
larges is  due  to  an  increase  in  the  vascular- 
ity, and  not  to  an  increase  in  the  number 
and  size  of  the  muscular  fibres,  as  occur  in 
uterine  pregnancy.  The  walls  of  the  tube 
become  thinned  and  thereby  weakened. 
The  fimbriated  extremity  narrows,  so  that 
by  the  eighth  week  the  abdominal  opening 
is  closed.  Before  this  abdominal  osteum 
closes  we  may  have  either  rupture  of  the 
tube  or  tubal  abortion.  By  tubal  abortion 
we  mean  that  the  pregnant  contents  of  the 
tube  has  been  expelled  through  the  fimbri- 
ated   extremity  into  the  abdominal   cavity. 

Rupture  of  a  tube  is  said  to  be  primary 
when  it  occurs  between  the  third  and  twelfth 
week,  and  to  be  secondary  between  the 
twelfth  week  and  the  full  term.  The  rup- 
ture may  take  place  into  the  peritoneal  cav- 
ity, or1  "between  the  folds  of  the  broad 
ligament,  i.  e,,  outside   the  peritoneal  cavi- 

Joseph  Price6  referring  to  the  extra-peri- 
toneal variety,  makes  this  statement  : 
have  not,  it  is  curious  to  remark,  observec 
a  so-called  intra-ligamentous  variety  of  this 
condition,  and  accordingly  am  somewhat 
sceptical  as  to  its  frequency  and  correctness 
of  the  pathology  advocated  by  Hart  and 
Carter,  as  shown  by  frozen  sections." 

At  another  time  and  later  in  a  paper  on 
Surgery  of  Tubal  Pregnancy,  he  says  :  "I 
am  convinced  by  my  own  surgical  experi- 
ence that  ectopic  pregnancies  are  always 
tubal,  that  they  rupture  and  end  in  some 
varietv  of  intra-peritoneal  mischief." 

In  the  American  Text-Book  of  Gyneco- 
gy,  the  American  Text-Book  of  Obstetrics, 
Abdominal  Surgery  by  Greig  Smith,  Sys- 
tem of  Surgery  by  Treves,  and  other  books, 
we  will  find  the  extra-peritoneal  variety 
described.  Therefore  I  will  consider  the 
subject  under  the  two  varieties  of  rupture, 
at  the  same  time  granting  that  there  is  some 
doubt  as  to  the  existence  of  the  extra-peri- 
toneal variety. 

The  point  of  attachment  in  the  tube  of 
the  placenta  is  an  important  one  as  regards 
the  result  of  the  rupture  to  the  mother.  If 
the  placenta  is  situated  in  the  upper  surface 
of  the  tube,  and  the  rupture  occurs  in  this 
locality,  the  placenta  is  apt  to  be  detached 
in  whole  or  part,  in  addition  to  tearing  the 
increased  vascularity- of  the  tube,  making  a 
fatal  issue  from  primary  hemorrhage  more 
probable.  On  the  other  hand,  if  the  pla- 
centa has   located  itself    on  the  floor  of  th 


THE  OHARLO'TTE  MEDICAL  JOURNAL. 


Ki.l 


tube,  so  to  speak,  it  would  be  undisturbed 
by  a  rupture  in  other  parts  of  the  tube,  and 
if  the  rupture  occurred  in  the  floor,  the  re- 
sistence  of  the  dense  tissues  of  the  broad 
ligament  would  soon  exert  sufficient  pres- 
sure to  control  the  hemorrhage.  The  causes 
of  rupture  are  often  slight,  such  as  a  mis- 
step, straining,  hemorrhage  into  the  sac, 
sexual  intercourse  has  been  known  to  pro- 
duce a  rupture,  and  of  course  the  natural 
growth  of  the  ovum  with  the  stretching  and 
thinning  of  the  tube  wali.  Usually  a  pri- 
mary intra-peritoneal  rupture  is  followed 
by  death,  due  to  hemorrhage,  without  the 
immediate  intervention  of  surgical  aid. 
Should  death  not  occur,  and  much  blood 
escapes  into  the  peritoneal  cavity,  it  soon 
collects  in  the  cul-de-sac  as  a  pelvic  hema- 
tocele. The  date  of  rupture  determines  the 
amount  of  blood  lost  (in  a  degree)  and 
whether  the  ovum  is  to  escape  into  the  ab- 
dominal cavity.  After  the7  seventh  week 
the  ovum  rarely  escapes  from  the  tube,  but 
more  blood  is  lost,  as  the  sac  walls  are  pre- 
vented from  contracting  by  the  retention  of 
the  ovum.  Mr.  Tait  and  Dr.  Joseph  Price 
believes  that  every  case  of  pelvic  hemato- 
cele is  due  to  ruptured  tubal  pregnancy.  In 
the  early  weeks  when  the  ovum  escapes 
from  the  tube,  and  the  placenta  is  not  des- 
troyed, the  foetus  may  develep  to  term,  and 
the  patient  pass  through  a  spurious  labor, 
and  the  foetus  may  mummify,  saponify — a 
lithopaedian  be  formed  by  calcification  or 
suppuration  may  take  place,  and  the  sac 
open  into  the  bowel,  bladder,  vagina,  or 
even  through  the  abominal  walls.  I  recall 
a  case  where  suppuration  had  taken  place, 
operated  on  ten  or  twelve  years  ago.  The 
patient  had  carried  the  tumor  for  nine  years, 
it  finally  opened  into  the  rectum  through 
which  foetal  bones  were  passed.  Then  it 
was  that  she  came  to  Dr.  Hunter  McGuire 
who  removed  the  remaining  bones. 

There  are  other  varieties  described  by 
some  authorities  as  a  separate  class,  but 
for  practical  purposes  those  I  have 
named  will  be  sufficient.  The  extraperi- 
toneal rupture  of  the  tube,  as  has  al- 
ready been  mentioned,  is  not  primarily  as 
dangerous  to  the  patient,  though  a  second- 
ary rupture  may  occur  with  all  the  dire  con- 
sequences of  internal  hemorrhage  and  septic 
peritonitis.  According  to  Bland  Sutton, 
"this  rupture  occurs  after  the  death  of  the 
I  <  it  us,  and  is,  in  nearly  every  case,  induced 
by  suppuration  of  the  sac."  When  the 
rupture  of  the  tube  has  occurred  without 
the  escape  of  the  ovum,  nature  often  comes 
to  the  rescue  and  builds  a  wall  of  lymph 
around  the  ruptured  sac,  to  prevent  its  con- 
tents from  invading  the  peritoneal  cavity. 
This  lymph    may  become   organized  as  was 


shown  well  in  a  case  I  recently  operated 
upon.  Tubo-uterine  or  interstitial  preg- 
nancy is  not  a  true  tubal  pregnancy,  for  it 
occurs  in  that  portion  of  the  tube  which 
passes  through  the  uterine  tissue.  The 
changes  in  the  sac  are  not  like  the  true 
tubal  variety,  though  it  may  rupture  into 
the  abdominal  cavity,  and  it  may  occur  at  a 
much  later  date  than  in  the  variety  already 
described.  Tubo-uterine  gestation  may  ter- 
minate by  rupturing  into  the  uterine  cavity 
and  be  discharged  per  via  naturalis. 

Symptoms. — The  symptoms  of  tubal  preg- 
nancy vary  with  the  period.  During  the 
first  month  or  six  weeks  the  ordinary  symp- 
toms of  uterine  pregnancy  may  exist.  In 
other  cases  we  may  not  find  the  history  so 
complete,  in  fact  but  meagre  signs  jwill  be 
obtained,  and  until  the  colicky  pains  occur 
the  physician  will  not  be  consulted.  These 
pains  may  never  present  themselves  until 
the  time  of  rupture,  as  was  true  in  II.  I. 
Boldt's8  three  cases,  one  of  which  ruptured 
in  his  office  waiting  room.  If  the  physi- 
cian is  consulted  when  these  pains  occur  or 
at  the  time  of  rupture,  he  will  elicit  that 
there  has  been  some  change  in  the  menstrual 
function — there  may  be  a  diminution  in 
quantity  or  a  shorter  duration,  and  shreds 
may  be  passed.  The  breasts  are  sensitive, 
morning  sickness  present.  She  or  her 
friends  will  tell  you  she  was  as  well  as 
usual,  until  the  colicky  pains  commenced, 
or  after  a  slight  exertion  there  was  a  sudden 
sharp  pain  in  one  side  of  her  abdomen,  and 
she  became  very  faint.  If  you  see  her  soon 
after  the  rupture  you  will  find  her  more  or 
less  profoundly  shocked,  and  often  impend- 
ing death  will  only  be  averted  by  an  accu- 
rate diagnosis,  and  a  prompt  and  bold  sur- 
gical intervention.  If  the  hemorrhage  has 
not  been  large,  or  the  shock  great,  she  will 
soon  rally,  and  will  consider  these  symp- 
toms were  incident  to  a  miscarriage  which 
she  has  had,  as  now  the  uterus  commences 
to  throw  off  the  decidua  with  a  flow  of 
blood,  and  the  patient  will  feel  as  well  as 
usual  until  taken  with  a  secondary  rupture 
within  a  few  hours  to  a  few  weeks. 

On  vaginal  examination  before  rupture, 
little  can  be  done  in  making  a  positive  diag- 
nosis, yet  with  the  concomitant  symptoms 
we  can  give  a  very  probable  diagnosis. 
After  rupture  has  taken  place,  we  can  either 
feel  the  tube  enlarged,  boggy,  exquisitely 
tender,  situated  a  little  behind  and  to  one 
side  of  the  uterus,  pushing  this  organ  for- 
ward. Or  we  may  feel  the  cul-de-sac  filled 
with  blood,  according  to  Joseph  Price,  a 
diagnostic  sign  of  ruptured  tubal  pregnancy. 
The  abdomen  may  be  distended  and  tym- 
panitic due  to  the  floating  up  of  the  intes- 
tines by  the  blood  of  the  pelvis. 


164 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


If  the  foetus  lives  to  full  term,  sooner  or 
later  after  the  rupture  you  will  be  able  to 
make  out  its  form  and  position  in  the  ab- 
dominal cavity.  There  will  be  an  increase 
in  the  size  of  the  abdomen,  usually  on  one 
side  or  the  other,  in  contra-distinction  to 
the  median  enlargement  of  uterine  gesta- 
tion. This  lateral  enlargement  is  indepen- 
dent of  the  uterus,  which  can  be  felt  in  front 
of  and  to  the  opposite  side  of  tubal  enlarge- 
ment. At  term  the  woman  will  go  through 
a  spurious  labor  and  may  fool  both  patient 
and  doctor  unless  the  history  of  the  case  has 
been  inquired  into.  After  the  labor  has 
subsided,  the  tumor  will  decrease  in  size, 
and  the  changes  already  mentioned  may 
take  place. 

Diagnosis. — The  fate  of  the  patient  often 
depends  upon  a  correct  diagnosis,  and  this 
to  be  made  promptly,  for  as  Lusk  has  aptly 
said  :  "The  resources  of  surgery  are  rarely 
successful  when  practiced  upon  the  dying." 

The  diagnosis  before  rupture  is  seldom 
made  except  by  accident,  though  some  cases 
have  been  reported.  One  case  I  remember 
was  diagnosed  by  Dr.  Hugh  M.  Taylor,  of 
Richmond,  Va.,  and  at  a  subsequent  visit, 
while  advising  the  necessity  of  an  operation, 
the  tube  ruptured.  Dr.  Taylor's  was,  how- 
ever, a  unique  experience. 

The  clinical  history  of  a  change  in  the 
menstrual  function,  either  in  quantity,  char- 
acter or  time  of  occurrence,  the  breasts  be- 
coming sensitive,  morning  sickness  present, 
colicky  pains  in  one  side  of  the  abdomen, 
would  give  sufficient  data  to  give  a  proba- 
ble diagnosis  of  tubal  pregnancy  ;  particu- 
larly is  this  the  case  when  on  vaginal  ex- 
amination, you  find  the  tube  enlarged,  ten- 
der, and  boggy.  Any  or  all  these  subjec- 
tive symptoms  may  be  absent,  and  no  one, 
not  even  the  patient,  suspect  her  condition, 
until  she  is  seized  with  the  sharp  pain  in 
one  side  of  the  abdomen,  the  lips  will  pale, 
the  pulse  will  be  rapid  and  feeble,  the  skin 
bathed  in  a  cold  clammy  sweat,  in  fact  all 
the  symptoms  of  shock  and  internal  hemor- 
rhage, more  or  less  profound,  according  to 
the  amount  of  blood  escaping  into  the  peri- 
toneal cavity.  When  the  hemorrhage  has 
been  large  the  temperature  will  be  sub-nor- 
mal. With  these  symptoms  present,  and 
by  vaginal  examination  revealing  the  posi- 
tion of  the  boggy  enlarged  ruptured  tube, 
or  the  cul-de-sac  filled  with  blood,  there  is 
only  one  condition  that  it  could  be  mistaken 
for,  and  that  is  rupture  of  a  tube  containing 
pus.  The  ruptured  pus-tube  would  give  a 
more  persistent  pain,  rapid  rise  of  tempera- 
ture, and  the  symptoms  of  internal  hemor- 
rhage probably  absent,  with  certain  absence 
of  the  clinical  history  of  pregnancy. 

If  the  case  is  seen  some  time  after  rupture, 


the  diagnosis  can  (only)  be  made  by  the 
history  of  the  case,  and  vaginal  examina- 
tion, though  even  now  the  diagnosis  will 
not  always  be  clear,  as  will  be  seen  in  the 
two  cases  I  report. 

Treatment. — This  part  of  the  subject  will 
have  to  be  considered  under  several  heads, 
as  the  condition  of  the  patient  and  foetus 
varies  with  the  period  of  gestation. 

The  treatment  naturally  divides  itself  into 
the  method  (a)  before  rupture,  (b)  at  the 
time  of  rupture,  (c)  after  rupture  up  to  the 
fourth  month,  (d)  from  fourth  month  up  to 
term,  (e)  after  spurious  labor. 

The  treatment  by  electricity  has  had  some 
warm  advocates,  and  even  now  some  good 
surgeons  advise  its  use,  particularly  before 
rupture  occurs,  with  the  hope  of  destroying 
the  ovum.  Those  who  advocate  this  meas- 
ure do  not  expect  to  meet  with  uniform  suc- 
cess, while  others  claim  that  the  method  is 
both  uncertain  and  unsafe.  Inflammatory 
action  has  been  recorded  after  the  use  of 
electricity.  Even  should  the  foetus  be  elec- 
trocuted we  have  the  conditions  remaining 
for  another  ectopic  gestation,  and  a  foreign 
body  that  may  become  infected,  and  neces- 
sitate a  more  serious  operation.  On  the 
other  hand,  an  abdominal  section  before 
rupture  in  uncomplicated  cases,  is  the  work 
of  a  few  minutes,  a  simple  procedure,  and 
should  be  attended  with  almost  no  mor- 
tality. 

Mr.  Treves  in  his  System  of  Surgery  con- 
sideres  no  other  save  the  operative  treat- 
ment. Greig  Smith,  in  his  work  on  Ab- 
dominal Surgery,  says,  "the  position  that 
electricity  holds,  at  present,  as  a  plan  of 
treatment  in  extra-uterine  foetation  is,  that 
it  is  suitable  in  the  early  stages,  where  it  is 
not  very  dangerous,  and  is  followed  by  an 
encouraging  degree  of  success."  Continu- 
ing in  the  same  paragraph,  he  says,  "it  must 
be  noted  that  in  these  early  stages  the 
diagnosis  is  uncertain  ;  that  the  stimulation 
of  an  electric  discharge  may  induce  rupture, 
and  that  the  danger  is  not  over  when  the 
foetus  is  killed.  It  may  not  destroy  the 
vitality  of  the  placenta."  This  latter  state- 
ment was  illustrated  in  one  of  the  cases  al- 
ready quoted  from  Dr.  Boldt.  The  case 
was  not  diagnosed  correctly  at  the  first 
visit,  and  Dr.  Boldt  considered  the  patient 
suffering  from  a  return  of  endometritis, 
from  which  she  had  suffered  several  years 
previous.  Consequently  he  applied  a  50- 
milliamperes  current  for  ten  minutes  on 
Monday.  Friday,  when  she  returned  for 
treatment,  she  was  seized  with  the  pain 
while  waiting  to  see  the  doctor.  "This  il- 
lustrates the  unreliability  of  the  galvanic 
current  in  such  cases.     The  embryo  was  not 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


165 


killed  or  the  rupture  would  not  have  taken 
place." 

The  uncertainty  of  the  results  I  think 
should  be  sufficient  to  condemn  this  method 
of  treatment.  The  evacuation  of  the  liquor 
amnii  by  aspiration  or  incising  the  cyst 
through  the  vagina  has  fallen  into  disuse  on 
account  of  many  more  failures  being  record- 
ed than  successes.  The  same  may  be  said 
of  the  injection  of  fluids  into  the  sac,  in  ex- 
pectation of  destroying  the  foetus. 

Elytrotomy,  or  the  vaginal  operation  for 
tubal  pregnancy,  is  advocated  by  men 
whose  opinions  command  respect,  yet  it 
seems  to  be  too  uncertain  as  well  as  unscien- 
tific. We  cannot  with  certainty  predict 
the  conditions  in  the  abdomen  until  it  has 
been  opened.  The  intestines  may  be  adhe- 
rent to  the  sac,  or  the  sac  to  any  of  the  pel- 
vic organs.  To  attempt  to  relieve  these 
adhesions  by  the  vaginal  route,  would  cer- 
tainly be  working  in  the  dark.  There 
would  be  a  great  risk  of  tearing  the  viscera, 
and  of  causing  hemorrhage  that  will  be 
stopped  with  great  difficulty,  if  at  all,  and 
the  danger  of  not  removing  all  the  dis- 
eased tissue.  In  this  day  of  progress,  sur- 
gery tends  towards  radicalism,  or  in  other 
words,  complete  work.  This  I  think  will 
rarely  be  done  save  in  the  very  simple  cases 
by  the  vaginal  route.  I  have  advocated 
none  >>l  these  methods,  for  I  consider  the 
treatment  before  rupture  by  an  abdominal 
section  to  be  the  ideal  one.  Unfortunately 
we  meet  with  but  few  that  arc  diagnosed 
at  the  time. 

The  treatment  at  the  time  of  rupture  va- 
ries with  the  condition  of  the  patient.  The 
effect  produced  by  the  rupture  may  only  be 
moderate  in  degree,  and  the  patient  already 
recovering  from  the  shock  when  seen  by 
the  surgeon.  If  such  is  the  case  a  short  de- 
lav  to  prepare  for  an  aseptic  operation  is 
justifiable  and  demanded.  Do  not  put  off 
longer  than  is  necessary,  for  a  repetition  of 
the  hemorrhage  may  occur  at  any  time. 

We  may  not  find  at  the  first  visit  such  a 
happy  condition  of  our  patient,  in  fact,  her 
condition  may  be  alarming,  not  only  requi- 
ring an  accurate  diagnosis  but  the  prompt 
action  on  the  part  of  the  surgeon  if  the 
acute  anemia  is  progressing  or  even  not 
improving. 

The  use  of  the  normal  salt  solution  by  in- 
fusion either  direct  into  the  vein  or  under 
the  skin  will  here  find  a  happy  application, 
and  will  no  doubt  aid  in  saving  many  lives. 
Certainly  it  will  do  much  in  keeping  the 
patient  alive  until  the  preparation  for  the 
operation  has  been  made.  The  indication 
for  treatment  at  the  time  of  rupture  can  but 
be  to  open  the  abdomen  and  in  the  one  case 
to  remove  the  ruptured  tube  to  prevent  fu- 


ture hemorrhage  in  the  near  future,  and  in 
the  other  to  secure  the  bleeding  vessels  by 
removing  the  tube. 

If  the  rupture  is  extra-peritoneal,  the  case 
is  not  likely  to  be  so  urgent,  the  pressure 
of  the  layers  of  the  broad  ligament  will  soon 
control  the  bleeding.  If  the  foetus  is  de- 
stroyed at  the  time  of  rupture,  very  little, 
if  any  increase  in  the  size  of  the  pelvic  he- 
matoma will  occur,  consequently  there  will 
be  very  little  danger  of  secondary  rupture. 
The  operation  can  be  deferred  until  every 
thing  has  been  prepared  for  an  aseptic  sec- 
tion. Should,  however,  infection  from  the 
tube  or  rectum  occur,  the  hematoma  must 
be  removed  at  once. 

If  the  foetus  continues  to  live  and  devel- 
ope  after  rupture  in  the  broad  ligament,  the 
patient  is  in  danger  of  the  consequences  of 
a  secondary  rupture  at  an}'  time.  The  in- 
dication here  is  for  the  early  operative  in- 
tervention. Some  claim  this  to  be  the  time 
to  use  electricity.  Its  use  here  has  been 
followed  by  failures,  and  a  case  has  been 
reported  where  the  application  of  electricity 
caused  rupture  with  a  fatal  termination  be- 
fore the  preparation  for  an  abdominal  sec- 
tion could  be  made.  In  these  cases  of  intra- 
ligamentous gestation,  as  they  are  some- 
times called,  with  the  foetus  living,  and 
hourly  threatening  to  rupture,  we  will  meet 
with  a  varied  condition  of  affairs  in  opera- 
ting  which  will  tax  the  ingenuity  of  the 
surgeon  to  the  utmost.  Yet  the  results  will 
not  be  near  as  disastrous  as  allowing  secon- 
dary rupture  to  occur.  The  disposition  of 
the  placenta  is  the  bane  of  the  operation. 
After  the  fourth  month  and  up  to  the  spuri- 
ous labor  or  term, we  meet  with  another  se- 
rious condition  of  affairs,  which  requires 
acute  discernment  on  the  part  of  the  surgeon 
to  advise  the  best  treatment.  Here  we 
have  a  living  child,  growing  dav  by  day, 
and  the  placenta  enlarging,  adding  to  the 
gravity  of  the  condition  of  the  patient, 
should  operation  be  suddenly  demanded. 
Without  serious  trouble  these  cases  some- 
times go  on  to  full  term  through  spurious 
labor, — the  child  dies,  the  amniotic  fluid 
absorbs,  and  the  circulation  in  placenta 
ceases.  If  we  were  certain  all  cases  would 
so  happily  terminate,  we  would  not  hesi- 
tate to  advise  the  expectant  plan  of  treat- 
ment. We  cannot  promise  such  results,  so 
I  must  advocate  the  removal  by  abdominal 
incision  as  soon  as  diagnosed,  unless 
otherwise  contra-indicated  by  other  condi- 
tions in  the  patient.  Should  you  decide  to 
defer  operating,  the  patient  must  be  care- 
fully watched,  and  when  untoward  symp- 
toms present  themselves,  resort  to  imme- 
diate extirpation  of  the  pregnancy. 

The  chief  danger  of  operating  after  the 


166 


THE  CHARLOTTE     MEDICALJOURNAL. 


fourth  month  is  from  the  placenta.  To 
leave  it  in  situ  it  may  become  infected,  and 
be  a  source  of  great  danger.  To  remove  it 
subjects  the  patient  to  a  very  great  risk  of 
a  fatal  hemorrhage.  During  the  operation 
we  may  find  the  placenta  attached  just 
where  we  wish  to  make  the  incision  in  the 
sac,  or  we  may  dislodge  it  accidentally. 
We  are  not  justified  in  attempting  to  re- 
move the  placenta  unless  we  are  certain  we 
can  control  the  feeding  vessels.  Some  sur- 
geons advise  that  we  cut  the  cord  off  close 
to  the  placenta,  sew  up  the  sac.  with  the 
hope  of  the  absorption  of  the  placenta,  and 
if  this  does  not  occur,  to  do  the  secondary 
operation  for  its  removal.  Other  surgeons 
advise  us  to  bring  the  sac  up  and  sew  to  the 
lips  of  the  abdominal  wound,  leaving  the 
cord  protuding  through  the  opening  in  the 
sac,  so  that  the  placenta  can  be  removed 
when  detached.  The  sac  is  of  course  pack- 
ed with  iodoform  gauze. 

After  spurious  labor  when  the  child  is 
dead  and  the  circulation  in  the  placenta  has 
ceased,  the  operation  is  not  so  hazardous. 
It  is  hardly  necessary  to  say  that  this  ab- 
normal condition  should  he  removed.  The 
route  of  removing  must  be  determined  by 
the  case.  If  in  close  proximity  to  the  va- 
gina and  attached,  it  may  be  removed  per 
vaginam,  particularly  would  this  be  indica- 
ted if  supuration  has  taken  place.  As  a 
rule,  however,  the  ventral  incision  will  be 
better.  If  the  case  is  extra-peritoneal,  it 
may  push  the  peritoneum  up  to  such  an  ex- 
tent as  to  strip  it  from  the  abdominal  pari- 
etes  and  enable  the  operator  to  remove  the 
abnormality  without  opening  the  peritoneal 
cavity.  The  incision  in  this  case  should 
not  be  made  in  the  median  line,  as  the  pe- 
ritoneum is  often  attached  here,  even  when 
stripped  off  latterally. 

Having  considered  the  various  conditions 
and  the  indicatious  for  treatment,  I  think 
you  will  all  agree  with  me  in  regard  to  the 
importance  of  the  subject,  and  especially  in 
regard  to  the  diagnosis  and  early  operative 
intervention.  It  is  only  delayed  surgery 
that  gives  us  these  late  cases  to  deal  with. 
We  all  appreciate  the  dire  consequences  of 
delay  in  appendectomy.  Let  us  be  equally 
on  the  alert  for  this  condition,  and  operate 
when  any  tyro  in  surgery  should  be  suc- 
cessful. 

REFERENCES. 

1.   American  Text-Book  Gynecology. 
1    Surgery  of  Tubal  Pregnancy.  Joseph  Price. 
Journal. 

3.  American  Obstetrics,  June,  1898.  (Bland 
Sutton  quoted  by  Williams  &  Salmon.) 

4.  System  of  Surgery .     Treves. 

'>.  Abdominal  Surgery,     (ireig  Smith, 
(i.  The  Present  Status  of  Abdominal  Surgery. 
Joseph  Price. 


7.  Bland     Sutton. 

8.  American   Journal  Obstetrics,   June,  1898. 
H.  I.   Boldt. 

2706  E.  Grace  St. 


Tvphoid  Fever,  Diagnosis  and  Treatment. t 

By  Rolfe  E.  Hughes,  M.  II,  Laurens,  S.  ( '. 

If  I  could  consistently  think  that  your 
patience  in  listening  to  me  would  be  re- 
warded by  impressing  you  with  any  very 
new,  valuable  or  radical  suggestions,  then 
indeed  with  great  calmness,  1  would  exult- 
ingly  treat  at  length  the  subject  I  have  be- 
fore me  ;  that  of  Typhoid  Fever,  its  Diagno- 
sis and  Treatment ;  but  I  realize,  being  upon 
a  well  beaten  path,  one  that  has  been  ably 
traveled  by  many  eminent  Diagnosticians 
before,  and  certainly  I  would  shrink  from 
even  treading  cautiously  upon  a  way  so  hard 
and  worn,  but  for  my  enthusiasm  inspired 
by  the  organization  of  this  society,  and 
seeing  I  am  accompanied  along  the  route 
by  the  most  eminent  men  of  three  States. 
Most  of  the  Virginia  gentlemen  present  are 
personal  friends,  North  Carolina's  Sons  are 
our  entertainers  and  the  Palmetto  State, my 
adopted  home,  is  well  represented,  so  I  at 
least  expect  leniency  of  criticism,  and  should 
I  lose  my  way,  attribute  it  rather  to  a  want 
of  time  for  gathering  full  directions,  and 
place  me  on  the  right  route. 

It  is  useless  for  me  to  add  how  honored  I 
feel  at  being  allowed  to  appear  before  a 
Medical  body  of  as  high  character  as  the 
Tri-State  Society,  and  be  permitted  to  par- 
ticipate in  its  scientific  deliberations.  'Tis 
a  happy  moment  for  me  and  I  shall  ever 
remember  gratefully  and  pleasantly  these 
distinguished  privileges,  for  aside  from  the 
real  and  scientific  part,  there  is  something 
inspiring  and  touching,  to  see  a  congrega- 
tion of  medical  men  discussing  the  ills  of 
mankind  and  the  best  possible  means  of 
combatting  them. 

Man  is  heir  to  many  troubles,  our  life 
work  is  the  study  of  these.  'Tis  a  serious 
responsibility  and  oftimes  a  gloomy  under- 
taking. Our  life  is  spent  on  the  darker 
side  of  human  existence  and  misery,  in  the 
deepening  shadows  of  which,  as  some  wri- 
ter has  aptly  said,  "the  God-like  creations 
of  the  poet  seem  hideous  masks;"  still  our 
duty  is  always  the  same,  studying  nature, 
vigilantly  watching,  cheerfully  aiding.  All 
through  our  professional  lives,  stern  reali- 
ties daily  dawn  upon  us,  much  of  the  senti- 
ment, romance  and  tenderness   of   our  real 


fRead  before  the  Tri-State  Medical  Society  of 
the  Carolinas  and  Virginia,  at  Charlotte,  N.  C, 
January,  1899. 


THE  CHARLOTTE  MEDICAL  JOURNAL,. 


167 


selves  has  been  sacrificed  in  our  search  for 
truth. 

Each  day  tells  us  more  ;  the  strides  are 
rapid,  newer  fields  are  opened  up,  and  we 
are  told  of  myriads  of  bacteria  swarming  in 
the  air,  apparently  the  purest,  and  lurking 
at  so  many  places  we  least  expect ;  that  our 
cool,  clear  mountain  spring  is  a  favorite  re- 
sort, and  even  that  the  Sacrament  and  Holy 
Wine  is  not  exempt.  We  further  know 
many  of  our  worst  diseases  are  directly 
traceable  to  these  organisms,  each  having 
his  preferred  mode  of  attack  and  selected 
soil.  Probably  one  of  the  best  known  now 
is  the  bacillus  of  Eberth,  which  by  drink- 
ing water,  milk  or  what  not,  insidiously 
steals  along  the  alimentary  track  and  find- 
ing a  suitable  camping  ground  at  Peyer's 
patches,  flourishes  and  multiplies  to  such  an 
extent  that  he  moves  his  habitat  to  neigh- 
boring tissues,  and  continuing  to  trespass, 
the  integrity  of  the  tissues  is  so  upset  that 
we  have  a  patient,  usually  his  age  will  be 
between  fifteen  and  forty  years,  (this  of 
some  diagnostic  value)  with  headache,  in- 
somnia, furred  tongue,  flagging  energies, 
disturbed  circulation,  anorexia,  episcaxis. 
He  thinks  he  is  "bilious;"  we  too  often 
concur,  order  mercury  and  podophylin  ; 
patient  departs,  partakes  of  hog-sausage, 
coarse  beef,  hard  boiled  eggs,  heavy  bread, 
chicken  salad,  fruit  cake  and  such  poisons, 
when  we  are  summoned  again.  Our  diag- 
nosis should  have  been  made  before,  but 
diagnosis  of  typhoid  fever  is  not  always 
easy;  even  in  uncomplicated  cases  a  careful 
and  exhaustive  physical  examination  of  pa- 
tient and  investigation  of  surroundings  is 
always  necessary.  All  are  familiar  with 
the  array  of  its  symptoms  so  nicely  arranged 
in  text-books,  and  few  of  us  prepared  for 
the  serum  tests,  hence  it  is  an  individual 
study  of  each  case  and  the  intelligence  of 
the  practitioner  that  decides. 

For  instance,  the  characteristic  tempera- 
ture record  of  the  so-called  step  ladder  tem- 
perature, is  in  many  cases  a  curiosity.  The 
pulse  is  not  necessarily  characteristic  and 
certainly  not  pathognomic. 

Enlargement  of  the  spleen  is  of  strong 
diagnostic  value,  combined  witli  others.  It 
is  usually  palpable  by  the  eighth  day,  and 
if  there  is  not  too  much  tympanites,  this 
disappears  as  fever  lessens.  Septicaemia, 
malaria  and  miliary  tuberculosis  should  here 
be  excluded. 

Rose  spots  are  important  signs,  and  when 
present  are  typical,  but  I  have  never  seen 
them  in  more  than  thirty  per  cent,  of  the 
cases;  their  appearance  is  usually  on  the 
ninth  day.  Gurgling  in  right  iliac  fossa 
must  be  looked  for,  but  many  intestinal 
troubles    have  these  and  all    the  diarrhoeas, 


so  if  accompanied  by  tenderness,  and  we 
can  exclude  appendicitis  and  pelvic  ab- 
scesses, then  we  may  expect  typhoid. 

The  initial  chill  amounts  to  very  little  so 
far  as  a  diagnosis  is  concerned,  and  often  as 
many  as  six  chills  may,  at  varying  intervals, 
occur  in  unquestionable  cases  of  typhoid. 
This  is  misleading  and  in  my  section  of 
South  Carolina,  where  malaria  abounds, 
often  is  the  cause  of  confusion.     Thus  : 

First.  In  typhoid  we  have  the  initial 
chill. 

Second.   Chill  at  onset  of  relapse. 

Third.   Result  of  antipyretics. 

Fourth.  At  ushering  in  of  complications 
as  pneumonia,  pleurisy,  acute  otitis,  sup- 
puration in  mesenteric  veins,  pyaemia,  ab- 
scess of  kidneys,  perforation,  etc. 

Fifth.   During  convalescence  in  bad  cases. 

Sixth.  When  concurrent  malaria  exists — 
this  is  rare. 

To  recapitulate,  I  look  for  the  following, 
and  combined,  consider  them  accurate,  ma- 
laise, headache,  chilliness,  pain  in  back  and 
limbs,  tongue  pale  and  indurated  (in  beg;n- 
ning),  margins  indentated,  it  is  put  out 
slowly  and  retracted  indifferently  ;  there  is 
confusion  of  ideas  and  mental  torpor.  Tin- 
nitus aurum,  epistaxis,  ascending  pyrexia, 
photophobia  anorexia,  rose  spots,  gurgling 
and  tenderness  in  right  iliac  fossa,  consti- 
pation or  diarrhoea,  and  lastly  vertigo. 
This  I  regard  of  great  value.  Patient  on 
attempting  to  stand  erect,  trembles,  and  the 
nervous  symptoms  are  pronounced.  There 
a  diagnosis  is  to  be  made  from  cerebrospi- 
nal meningitis,  for  many  cases  of  typhoid 
begin  as  typical  meningitis.  Fortunately 
the  latter  trouble  is  rare,  and  other  symp- 
toms with  surroundings,  usually  settle  all 
doubts. 

So  much  for  the  diagnosis;  now  how 
shall  it  be  treated? 

Within  the  last  few  years  over  eleven 
hundred  remedies  have  been  tried  or  sug- 
gested for  typhoid  fever.  All  sorts  and 
kinds  of  food  have  been  advocated  ;  hydro- 
therapy and  antipyretics  for  the  tempera- 
ture;  intestinal  antisepsis,  etc.  While  spe- 
cial symptoms  arising  in  the  natural  course 
of  the  disease  have  been  experimentally 
dealt  with  by  almost  every  resource  of  the 
pharmacopcea,  but  there  are  few  measures 
or  means  at  the  command  of  the  physician 
which  fulfill  our  wishes  invariably,  or  even 
none  which  in  all  cases  so  far  promises  a 
specific  ;  therefore  he  who  adopts  any  one 
fad  to  the  exclusion  of  all  other  efforts,  be 
it  in  the  line  of  hydrotherapy,  antisepsis,  or 
what  not,  fails  in  his  duty  to  his  patient, 
his  profession,  or  himself.  It  has  been 
said  :  "The  best  treatment  is  a  good  physi- 
cian."    One  knowing  the  natural  course  of 


t«8 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


the  disease  and  able,  therefore,  to  intelli- 
gently anticipate  its  various  complications 
and  phases,  knowing  these,  how  can  he 
have  any  radical  fixed  schedule  which  can 
be  best  for  all  cases  and  their  inconstances? 
He  should  be  watchful  and  conservative, 
backed  by  the  judgment  to  adopt  such  mea- 
sures as  his  good  sense  will  in  individual 
cases  dictate.  It  may  be  Woodbridge  or 
Brand,  in  whole  or  in  part,  or  probably  a 
happier  medium  by  the  combined  antiseptic 
and  hydrotherapy  methods  ;  judgment  must 
be  exercised  in  mode  or  manner  of  each. 
Unquestionably  hydrotherapy,  variously 
modified,  is  for  its  indications  the  best  treat- 
ment known,  always  to  be  used  in  hospitals 
and  in  private  practice  when  possible.  The 
treatment  summarized  embraces  : 

I.  General  management  and  nursing. 

II.  Diet. 

III.  Treatment  of  the  temperature. 

IV.  Antiseptic  medication. 

V.  Treatment  of  special  symptoms. 

VI.  And  the  convalescence. 

Genera/  Management. — A  typhoid  pa- 
tient should  be  in  a  cool,  well  ventilated 
apartment,  confined  to  the  bed  from  the  on- 
set and  remaining  until  convalescence  is 
well  established.  The  woven  wire  bed  with 
soft  hair  mattress  is  best.  A  rubber  cloth 
should  be  under  the  sheet ;  a  good  nurse  in 
charge,  and  the  physician  should,  at  each 
visit,  write  out  specific  instructions. 

Diet. — Foods  easiest  digested  and  ob- 
viously those  leaving  behind  the  smallest 
amount  of  residue.  Milk  heads  the  list  and 
ordinarily  about  three  pints  for  an  adult  in 
34  hours.  It  is  often  advisable  to  dilute 
this  with  water,  lime  water  or  even  asriated 
waters.  It  should  be  given  at  regular  in- 
tervals and  care  exercised,  for  too  much 
leaves  masses  of  curds  and  thus  proves  irri- 
tating. The  usual  broths,  chicken  or  mut- 
ton, come  next,  and  many  of  the  beef  juices 
are  good. 

Water  should  be  given  in  abundance  and 
pleasantly  cool.  My  experience  justifies 
making  this  of  paramount  importance,  and 
I  wish  I  could  go  into  the  merits. 

Treatment  of  the  Temperature. — Bathing 
or  spong-'ng  and  not  the  use  of  coal  tar  anti- 
pyretics. Sponging  with  cool  water  is  the 
preferred  practice  wiHi  the  most  successful 
physicians  of  my  section.  Dr.  J.  P.  Simp- 
son, of  Laurens,  who  deservedly  enjoys  a 
great  reputation,  and  has  had  extensive 
experience  with  typhoid  fever,  has,  to 
my  certain  knowledge,  had  amazing  suc- 
cess, especially  in  the  last  two  years.  Dr. 
Simpson's  method  of  administering  the  bath 
is  to  place  a  wire  cot  by  the  bed,  upon  this 
lay  a  piece  of  oil  cloth  and  cut  opening  in  the 
centre  for  water  to  escape  into  vessel  below, 


weight  of  patient  causing  the  cloth  to  dip, 
thus  throwing  water  to  centre ;  patient 
stripped,  is  sponged  with  water,  tempera- 
ture 70.  In  some  instances  it  is  poured 
over,  always  using  it  in  temperatures  of 
102^  or  103,  and  repeating  as  necessary  to 
control  this  temperature;  friction  is  used 
while  administering  and  to  point  of  bring- 
ing glow  ;  when  returned  to  bed,  cold  pack 
to  head. 

Antiseptic  Medication. — The  efforts  to 
settle  upon  an  agent  destructive  to  the  ty- 
phoid bacilli,  or  the  toxic  agent  they  pro- 
duce, so  far  is  a  failure,  and  we  adopt  Yeo's 
plan  of  the  chlorine  waters  ;  it  has  not  been 
satisfactory,  but  certainly  does  no  harm, 
therefore,  is  a  pious  fraud.  The  intentions 
are  good.  For  my  own  part,  salol  is  the 
remedy  when  there  is  no  cardiac  compli 
cations. 

Treatment  of  Special  Symptoms. — For 
tympanites  and  abdominal  pain,  turpentine 
stupes;  diarrhrea  if  severe,  starch  and  laud- 
anum enemas,  or  subgallate  of  bismuth  ;  no 
opium,  even  in  form  of  Dover's  powders. 
Constipation,  if  demanding  notice,  is  best 
met  Dy  Hunyadi  water. 

As  to  haemorrhage  and  peritonitis,  the 
two  grave  complications,  all  are  familiar 
with,  and  I  suppose  treat  alike. 

For  the  nervousness,  hydrotherapy  again 
comes  and  cold  water  to  head ;  after  the 
sponging  and  application  of  cold  water  cap, 
the  result  is  usually  so  satisfactory  as  to  ad- 
mit of  no  strictly  medicinal  sedatives. 

Brandy  and  strychnia  head  the  list  for 
progressive  heart  failure  ;  digitalis  is  not 
good. 

Convalescence  requires  even  as  much  care 
and  watching  as  the  acute  and  active  stage 
of  the  disease.  Over-eating  and  too  much 
exercise  are  usually  the  causes  of  relapse. 
The  other  minor  details  fall  in  line  too  nat- 
urally to  tax  your  patience  here,  so  I  re- 
lieve you. 


A  Plea  for  the  Earlier  Diagnosis  of   Pul- 
monary Consumption. f 

By  Louis  F.  High.  M.  I)..  Danville,  Va. 

The  prevailing  impression  in  a  large  part 
of  the  professional  mind  is  that  consump- 
tion is  almost  always  incurable,  therefore 
its  existence  need  not  be  early  sought  for 
since  it  being  first  and  last  hopeless  the  evil 
truth  will  be  known  in  plenty  of  time  to 
bring  a  long  season  of  sorrow  at  best, so  the 
earlier  the  grave  nature  of    the  malady  is 


fRead  before  the  Tri-State  Medical  Society  of 
the  Carolinas  and  Virginia,  at  Charlotte,  N.  C, 
January,  1899. 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


known  the  longer  will  be  the  period  in 
which  doctor  and  patient  will  be  forced  to 
contemplate  the  fatal  result. 

To  those  who  believe  in  its  absolute  fa- 
tality the  time  from  incipiency  to  the  stage 
in  which  the  disease  is  unmistakable  seems 
as  so  much  comfort  given  the  patient  at 
life's  last  mile  post.  If  the  premises  were 
correct  the  conduct  here  delineated  might 
be  most  commendable,  but  such  it  is  not  and 
the  physician  who  believes  that  all  cases  of 
Pulmonary  consumption  must  die  of  that 
disease  does  not  keep  up  with  what  is  be- 
ing done  in  this  line  of  practice  or  lacks  con- 
fidence in  the  power  and  resources  of  pro- 
gressive medicine. 

It  is  not  an  uncommon  occurrence  for 
patients  to  get  well  of  consumption,  though 
there  are  physicians  in  great  number  who 
believe  otherwise  and  question  the  diagno- 
sis of  veraeity  of  one  who  makes  a  contrary 
statement. 

It  has  been  stated  upon  scientific  authori- 
ty that  about  fifty  per  cent,  of  mankind  is 
at  some  time  of  life  effected  by  the  con- 
sumptive germs.  The  death  rate  of  the 
whole  world  lias  been  estimated  at  fourteen 
per  cent,  of  those  who  die.  Evidently 
some  must  recover  from  the  effects  of  the 
bacillus  and  as  a  matter  of  fact  they  do  be- 
come germ  free.  The  frequency  of  the 
cases  in  which  this  very  often  unknown  and 
unconscious  change  takes  place  presents 
evidence  of  the  existing  disorder  t<>  such 
limited  extend  that  the  cause  is  never  sus- 
pected. 

As  other  diathesis  may  present  variations 
of  development  from  the  mildest  to  the  most 
decided,  so  may  be  the  natural  or  artificial 
immunity  to  tubercular  formation,  varying 
from  that  which  exists  in  the  person  who 
has  it  and  is  spontaneously  cured  to  that 
class  in  whom  it  is  rapidly  fatal. 

Between  the  extremes  there  are  cases  that 
grade  from  the  lightest  form  to  a  condition 
of  sufficient  severity  to  put  the  patient  in  a 
state  in  which  he  seeks  medical  advice  and 
under  treatment  for  some  ill-defined  and 
seemingly  insignificant  trouble  he  is  cured 
without  the  real  nature  of  his  ailment  ever 
being  suspected.  A  single  prescription  or 
a  hygienic  change  may  prove  itself  suffi- 
cient to  restore  the  slight  strength  needed 
to  perfect  the  lessened  immunity.  No  ones 
imagination  is  appealed  to  in  the  attempt  to 
establish  the  truth  of  the  foregoing  state- 
ment for  it  lias  been  abundantly  proven  by 
post  mortem  investigation. 

The  encapsulation,  calcification  and  fib- 
roid changes  observed  after  death  in  cases 
where  nature  unaided  has  successfully  oppo- 
sed the  encroachment  of  germic  onset  shows 
its  inherent  tendency  to  overcome  the  mor- 


bific presence.  Therefore  it  follows  that 
when  the  bacillus  does  gain  a  hold  sufficient 
to  produce  systemic  disorder  it  has  done  so 
against  the  effort  which  has  not  only  already 
been  made,  but  which  is  still  going  on.  In 
many  cases  the  natural  resistance  has  needed 
slight  reinforcement  which  if  ii  had  been 
given  in  proper  time  would  have  proven 
an  impassable  barrier  to  further  germ  de- 
velopment. 

Every  physician  who  takes  the  trouble 
and  pains  to  become  thoroughly  familiar 
with  the  means  and  methods  of  making  ex- 
haustive examination  of  the  lungs,  and  will 
take  the  trouble  to  fully  investigate  the  con- 
dition of  the  lungs  of  those  patients  who 
present  themselves  for  treatment  of  some 
vague  and  ill-defined  ailment  whose  chief 
symptom  is  usually  of  the  digestive  organs 
will  frequently  find  pulmonary  involvement 
of  sufficient  intensity  to  account  for  the  in- 
disposition of  the  patient.  At  the  same 
time  he  will  find  that  class  of  cases  of  con- 
sumption that  is  nearly  as  often  amenable 
to  treatment  as  diseases  of  other  kinds. 

An  analysis  of  the  records  of  twenty-five 
cases  in  which  the  point  of  early  diagnosis 
was  noted  it  is  shown  by  the  statements  of 
the-  patients  that  though  they  had  received 
treatment  from  other  physicians  for  the  ail- 
ment for  which  they  applied  to  me  their 
lungs  had  never  been  examined  nor  had 
their  temperature  been  observed. 

So  this  evidence — and  a  great  deal  more 
which  unfortunately  was  not  recorded — 
seems  to  show  that  the  great  mass  of  the 
profession  has  not  yet  come  to  the  place 
where  they  can  appreciate  the  fact  that  a 
mild  tubercular  infection  may  be  the  cause 
of  a  correspondingly  slight  disorder.  Many 
believe  that  the  tubercular  process  becomes 
engrafted  on  to  a  subnormal  vitality  and  is 
therefore  a  result  rather  than  a  cause  of  the 
primary  decline. 

It  is  certainly  a  difficult  matter  to  say 
which  is  cause  and  which  effect  in  some 
cases  but  in  the  majority  of  instances  it  has 
appeared  as  a  concomitant  of  an  unhigienic 
mode  of  life.  This  view  may  be  the  result  of 
an  investigation  in  which  a  large  number  of 
patients  belong  to  a  class  who  live  with  lit- 
tle regard  for  sanitary  laws.  Nevertheless 
failure  to  recognize  the  beginning  of  the 
disease  allows  the  germ  colonies  to  increase 
in  number  and  power  unless  the  natural  re- 
sistance of  the  patient  is  alone  able  to  hin- 
der their  propagation  and  growth. 

At  the  outset  in  mo6t  cases  there  is  a  time 
when  the  loss  of  resistance  is  so  slight  that 
the  balance  might  be  easily  restored  if  only 
the  real  condition  was  appreciated.  At  this 
point — so  directly  bearing  on  the  ultimate 
issues  of  life — those  means  that  improve  the 


170 


THE  CHARLOTTE   MEDICAL  JOURNAL. 


quality  of  the  constituents  of  the  blood  and 
tend  to  promote  constructive  changes, which 
as  a  rule  are  not  difficult  to  inaugurate,  will 
often  decide  between  recovery  and  disease. 

To  let  the  golden  first  moments  of  pul- 
monary tuberculosis  pass  without  realizing 
its  existence  is  to  deepen  the  idea  of  the  in- 
curableness  of  consumption  and  takes  noth- 
ing from  some  of  the  needless  reproach  that 
has  been  brought  on  medicine. 

The  serious  relation  that  a  person  suffer- 
ing with  pulmonary  tuberculosis  sustains  to 
the  general  public  is  one  of  the  important 
reasons  why  the  existence  of  that  disease 
should  be  known  at  the  earliest  possible 
moment.  Any  action  looking  to  the  pro- 
tection of  society,  whether  it  be  State  or 
municipal,  must  have  the  hope  of  its  success 
based  upon  the  finding  out  of  those  who 
come  within  the  pale  of  the  sanitary  regu- 
lations as  soon  as  such  person  becomes  in- 
fected. 

Nothing  could  impair  or  render  useless 
the  final  operation  of  laws  directly  dealing 
with  means  looking  to  the  prevention  of 
bacilliary  dissemination  more  than  the  pre- 
sent lack  of  interest  shown  by  some  physi- 
cians in  making  an  early  diagnosis. 


The  Practical  Treatment  of  Carbolic  Acid 
Poisoning. f 

By  Dr.  Stephen  Harnsberger,  Catlett,  Ya. 

Oliver  (London  Lancet,  Nov.  19th,  and 
The  Philadelphia  Medical  Journal,  under 
head  of  Latest  Literature,  Dec.  10th,  iSg^) 
reports  the  case  of  a  woman  having  swal- 
lowed seven  drachms  of  commercial  car- 
bolic acid.  Treatment  :  Lavage  of  the 
stomach  ;  removal  of  eight  ounces  of  blood 
and  the  intravenous  injection  of  four  pints 
of  normal  salt  solution.      Recovery. 

In  the  preceding  abstract  we  see  realized 
the  essential  end  of  all  our  effort.  No  re- 
source could  have  accomplished  more*  But 
in  view  of  the  increasing  mortality  from 
carbolic  acid  poisoning  in  recent  years,  is  it 
not  a  fact  that  the  question  of  diminishing 
this  death  rate  by  a  more  simple,  more 
quickly  obtainable  and  more  easily  admin- 
istered treatment  should  concern  scientists 
more  earnestly?  Text  books  on  the  sub- 
ject, at  least  those  to  which  I  have  access, 
either  suggest  nothing  of  decided  value,  or 
else  designate  remedies  not  at  hand,  or  too 
slow  in  their  preparation  or  action  to  meet 
the  urgency  of  emergency  cases.  Carbolic 
acid  is  used  in  one  capacity  or  another    by 


tRead  before  the  first  meeting-  of  Tri-State 
Medical  Society  (S.  C,  N.  C.  and  Va.)  Held  at 
Charlotte,  N.  O,  January,  1899. 


almost  every  family  in  the  land — cheapness 
being  its  chief  basis  of  favor.  Therefore, 
the  fact  cannot  be  concealed  that  its  anti- 
dote, if  possible,  should  be  simple  and  at 
hand  whenever  needed.  Animated  by  a 
personal  knowledge  of  the  successful  ter- 
mination of  several  cases  of  carbolic  acid 
poisoning,  I  beg  to  present  the  history  of 
the  one  that  will  indicate  most  clearly  the 
practical  good  of  a  very  handy  and  simple, 
and,  from  the  results  accomplished,  appar 
ently  rational  mode  of  treatment. 

During  the  month  of  October,  1896,  the 
residents  of  mv  village  were  very  much 
worked  up  over  the  appearance  in  one  of 
the  families  of  a  malignant  type  of  diph- 
theria. Every  householder  rushed  to  the 
local  dealers  for  some  prophylactic,  and  as 
carbolic  acid  was  cheap  and  abundant,  its 
sale  far  outran  all  other  reputed  germ-de- 
stroying agents.  In  their  great  haste  to 
outdo  the  little  Klebs-Lceffler  bacillus  safety 
was  lost  sight  of;  many  did  not  label  their 
bottles  at  all,  and  some  even  had  bottles 
filled  on  which  remained  intact  the  labels 
of  former  innocent  preparations.  This  hap- 
pened at  the  home  of  the  boy  whose  case  I 
will  now  briefly  describe — where  the  Syrup 
of  Figs  bottle  was  filled  with  carbolic  acid. 

On  December  18,  1896,  all  the  members 
of  the  family  were  at  church  when  the  boy, 
Robert  B.,  aged  stxteen  years,  who 
had  been  accustomed  to  the  use  of 
Syrup  of  Figs,  took  down  the  bottle 
from  its  usual  place  in  the  press,  poured  out 
a  large  kitchen  spoonful,  (approximating 
an  ounce  and  a  half)  and  swallowed  it 
quickly.  The  intense  burning  made  him 
realize  his  mistake.  He  at  once  drank  wa- 
ter freely  but  with  no  relief.  Without  fur- 
ther delay  he  started  off  for  my  office,  half  a 
mile  distant,  at  a  double  quick  pace.  By 
the  time  he  reached  the  railroad  track,  per- 
haps one  half  the  distance,  his  legs  became 
so  weak  that  he  could  not  raise  his  feet  over 
the  rails.  Three  young  men  who  were  on 
their  way  from  church  found  him  in  this 
condition  and  carried  him  to  my  home, 
which  he  reached  at  9  130  p.  m.,  or  about 
thirty  minutes,  perhaps,  after  the  ingestion 
of  the  poison.  My  son  12  years  of  age, 
who  was  in  the  office  at  the  time,  at  once 
detected  the  odor  of  carbolic  acid.  The 
patient  was  in  a  limp  and  comatose  state ; 
respiration  was  suspended  and  pulse  imper- 
ceptible ;  the  surface  of  his  body  was  cold 
and  of  noticeable  bluish  tinge.  There  was 
also,  at  times,  marked  objective  tremblings, 
but  no  convulsive  phenomena.  It  need 
scarcely  be  mentioned  that  death  seemed 
inevitable.  Moved  by  my  knowledge  of 
previous  cases  of  carbolic  acid  poisoning,  I 
did  not  risk  the  delay  of  lavage  but  at  once 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


introduced  into  his  stomach  a  pint  of  cream. 
At  the  same  time  I  kneaded  the  organ  in 
order  to  produce  as  perfectly  as  possible,  or 
rather  in  imitation,  physiological  motility 
and  the  more  intimate  mixing  of  the  contents, 
as  well  as  have  the  cream  form  a  protective 
film  over  the  entire  mucous  surface  and  in 
this  way  help  to  limit  the  absorption  of  the 
carbolic  acid  into  the  circulation  and  to  stop 
its  further  destructive  action  locally.  I  used 
no  strychnine  or  other  stimulant  commonly 
administered  to  brace  up  the  weakened  res- 
piratory and  cardiac  forces — only  dry  heat 
to  his  feet  and  friction  to  his  ankles  and 
arms.  The  cream  was  administered  every 
few  minutes  and  the  kneading  kept  up. 

About  or  shortly  after  midnight  his  res- 
piration became  much  less  embarrassed 
and  improved  co-existently  with  the 
strength  of  the  pulse  and  return  of  the  nor- 
mal color  of  the  skin.  The  motor  disturb- 
ance of  the  lower  limbs  did  not  give  place 
to  functional  energy  for  some  time  after 
cerebration  was  restored.  At  first,  with 
returning  consciousness,  lie  would  reply  to 
questions  in  monosyllables,  repeating  some 
one  word  perhaps  a  dozen  times  and  always 
using  a  word  taken  from  the  question  asked. 
This  condition  gradually  improved,  but  it 
was  at  least  an  hour  before  he  was  able  to 
answer  questions  intelligently.  I  kept  up 
the  administration  of  cream  or  unskimmed 
milk,  only  not  so  frequently,  for  at  least 
two  ami  a  half  hours  after  he  became  ra- 
tional. In  the  mean  time  I  had  him  re- 
moved to  his  home.  In  addition  1  ordered 
a  full  dose  of  magnesium  sulphate  in  water, 
and  to  be  followed  by  all  the  water  he 
would  drink.  Also  one  drachm  of  the 
fluid  extract  of  hydrangea.  Both  bowels 
and  kidneys  responded  promptly.  A  mouth 
wash,  composed  of  Euthymol  i  part,  water  4 
parts,  and  two  teaspoonful-doses  internally, 
at  proper  intervals,  allayed  the  tenderness 
and  caused  the  inflamed  mucous  surfaces  to 
heal  almost  at  once.  He  was  out  the  2nd 
day —  only  a  little  nervous,  and  with  some- 
what impaired  appetite.  Of  course  so  few 
cases  can  only  sii^1-'^  further  medical  en- 
quiry. 

In  closing,  allow  me  to  make  a  slight  di- 
gression. Actuated  by  my  experience  in  such 
cases.  I  was  led  to  try  a  few  experiments 
on  the  human  subject  with  carbolic  acid 
extinguished  with  glycerine  and  cream,  or 
with  alcohol,  glycerine  and  cream.  From 
the  results  obtained  I  am  of  the  opinion  that 
as  much  as  4  drachms  of  carbolic  acid  can 
be  administered  in  this  manner,  to  an  adult, 
without  risk  of  symptoms  of  its  toxic  effects 
— and  in  certain  cases  even  larger  doses. 
Under  two  drachm  doses  neither  objective 
nor    subjective    symptoms    were    observed. 


Three  drachm  doses  caused  only  a  slightly 
warm  sensation  in  the  mouth  and  throat  but 
no  gastric  uneasiness.  No  effect  was  noted 
upon  the  pupils,  pulse,  respiration,  temper- 
ature or  kidneys.  If  further  trial  estab- 
lishes the  non-toxic  effects,  local  or  systemic, 
of  large  doses  of  carbolic  acid  thus  modi- 
fied, it  seems  proper  to  predict  much  ben- 
efit from  its  internal  administration,  espe- 
cially in  fermentative  gastro-intestinal  dis- 
orders. 

As  the  Society  adjourned  the  night  of  the 
19th,  instead  of  at  noon  on  the  20th  as  was 
understood  would  be  the  case  by  most  of 
the  members,  there  was  no  discussion  of  the 
above  subject.  For  this  reason  and  the  good 
it  may  do,  it  would  not  be  out*of  place,  per- 
haps, to  report,  in  connection" with  the  fore- 
going paper,  the  following  case,  by  Dr. 
John  Sweaney,  of  Leaksville,  X.  C. 

Case,  child,  age  ..'.',  months.  Supposed  to 
have  swallowed  2  drachms  of  carbolic  acid. 
Gave  one  teaspoonful  of  magnesium  sul- 
phate in  solution,  followed  by  glycerine. 
Also  egg  and  sweet  milk.  For  the  shock, 
nitro-glycerine  and  strychnin.  Child  made 
an  uninterrupted  and  perfect  recovery.  If 
given  at  once  the  sulphate  of  magnesia 
unites  with  the  carbolic  acid  and  forms  the 
sulpho-carbolate  of  magnesia.  This  is  the 
only  known  chemical  antidote,  and  proba- 
bly not   very  well  known  to  the   profession. 


Uricacidaemia  as  the  Cause  of  Hay  Fever 
and  Asthma. f 

By  \)r.  John  Dunn,  Richmond,  Va. 

Repeated  failures  through  several  years 
to  cure  hay  fever  by  treatment  applied  di- 
rectly to  the  nose  membranes,  even  when 
these  were  the  seat  of  hypertrophies,  poly- 
pi, etc.,  led  me  finally  to  tell  patients  suff- 
ering with  this  trouble  that  while  their  dis- 
comfort could  be  lessened  by  removal  of  the 
diseased  conditions  in  the  nose,  this  local 
treatment  would  have  no  effect  in  prevent- 
ing a  recurrence  of  the  hay  fever.  The 
pollen  hypothesis  had  seemingly  so  many 
points  in  its  favor  that  I  was  unwilling  to 
admit  that  "hay  fever"  could  be  purely 
symptomatic  of  a  more  or  less  definite  con- 
dition of  the  blood. 

Bishop's  book  and  papers  first  turned 
my  attention  to  the  connection  between  hay 
fever  and  uric  acid.  Haig's  work  on  Uric 
Acid  made  a  clearer  understanding  of  this 
connection  possible. 

The  following  case  was  the  first  to  lead 

tRead  before  the  Tri-State  Medical  Society 
(N  C,  S.  C.  and  Va.),  held  at  Charlotte,  N.  C, 
January,  1898. 


172 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


me  to  examine  more  carefully  than  ever  be- 
fore into  the  possible  causative  relationship 
between  uricacidagmia  and  both  hay  fever 
and  hay  asthma. 

Mr.  A.,  aged  46,  consulted  me,  in  the 
winter  of  1897, in  regard  to  his  nose.  "Doc- 
tor, I  want  you  to  burn  my  nose.  It  is 
the  only  way  in  which  I  can  get  relief." 
This  was  the  patient's  introduction  of  him- 
self to  me.  I  asked  him  what  was  the  mat- 
ter with  his  nose.  He  told  me  it  was  "tight 
as  a  drum  and  pained  him,"  "that  he  could 
get  no  air  through  it,"  "could  not  get  his 
breath."  He  was  constantly  blowing  his 
nose  and  was  evidently  suffering  considera- 
ble discomfort.  "Why  do  you  want  it 
burnt?"  I  asked.  "Because  I  get  more 
relief  in  that  way  than  in  any  other.  In 
the  past  few  years  I  have  suffered  almost 
constantly  with  my  nose,  which  I  have  had 
burnt  twenty  or  twenty-five  times, and  I  have 
had  something  sawed  out  of  it,  but  it  has 
grown  up  again.  I  have  a  catarrh  powder, 
which  relieves  me  for  a  few  minutes  at  a 
time."  Examination  of  the  nose  revealed 
the  turbinated  membranes  as  swollen  and 
tense  as  numerous  old  scars  caused  by  the 
electro-cautery  would  permit  them  to  be. 
There  existed,  however,  some  free  air  space 
in  the  nose,  through  which  he  could  "not 
get  a  breath  of  air."  This  fact,  that  there 
existed  free  air  space  in  a  nose  which  gave 
the  sensation  of  being  entirely  closed,  is 
one  I  have  frequently  noticed,  especially 
during  asthmatic  attacks.  I  declined  to 
burn  these  membranes.  I  then  inquired 
into  the  diet  of  Mr.  A.,  who  weighed  250 
pounds,  and  found  that  it  consisted  almost 
exclusively  of  meat  and  quantities  of  beer. 
Regulation  of  the  diet,  with  administration 
of  alkalies,  afforded  entire  relief  from  the 
distressing  nasal  symptoms  without  any 
treatment  of  an}  kind  being  applied  to  the 
nasal  membranes, which  on  the  old  hypoth- 
esis that  the  source  of  the  disease  lay  in 
these  swollen  turbinates  would  have  requir- 
ed extensive  reduction,  either  through  the 
aid  of  acids  or  the  cautery.  Three  weeks 
ago  Mr.  A.,  reported  that  his  nose  still  re- 
mained comfortable.  The  results  obtained 
in  this  case  of  perennial  hay  fever  were  du- 
plicated in  the  case  of  Mrs.F.,  aged  35,  who 
for  years  had  suffered  from  hay  fever  whose 
manifestations  as  a  rule  were  severest  in  the 
late  spring  months.  Attention  to  her  diet 
relieved  the  hay  fever  within  a  few  days 
and  far  more  completely  than  any  intra- 
nasal treatment  to  which  she  had  subjected 
herself.  A  letter  from  her  husband  received 
October  last,  states  that  the  relief  obtained 
has  been  permanent.  It  must  be  understood 
that  both  Mrs.  F.  and  Mr.  A.  have  contin- 


ued to  follow  the  advice  given  them  in 
regard  to  diet,  etc. 

When  the  regular  hay  fever  season  came 
in  August,  the  influence  of  diet  in  the  cau- 
sation of  hay  fever  and  hay  asthma  was 
clearly  demonstrated  in  several  cases,  some 
of  which  I  shall  here  mention  briefly. 

The  first  case  was  that  of  Miss  L.,  aged 
16,  who  for  several  years  had  suffered  se- 
verely from  autumnal  hay  fever,  which  this 
year  had  been  accompanied  by  asthmatic 
attacks  of  such  severity  that  the  greater 
part  of  the  night  before  she  was  brought  to 
my  office  she  had  spent  gasping  for  breath. 
Examinatian  of  her  nose  revealed  a  typical 
hay  fever  condition,  of  the  membranes, 
which  were  swollen,  pale,  and  the  seat  of 
profuse,  clear  secretion.  In  places  the  tur- 
binates touched  the  septum.  Posteriorily, 
the  middle  turbinate  on  the  left  side  at  its 
end  formed  a  huge,  whitish,  oedematous 
swelling,  polypoid  in  appearance,  which 
was  jammed  so  tightly  against  the  septum 
that  a  snare  wire  could  not  be  forced  be- 
tween them.  There  was  a  general  oedema- 
tous and  puffed  condition  of  all  the  portions 
of  the  turbinates  visible  by  posterior  rhino- 
scopy. The  young  lady's  eyes  were  red 
and  watery.  In  short,  there  were  present 
all  the  conditions,  which  those  who  believe 
in  the  mechanical  origin  of  hay  fever  would 
rejoice  to  find,  hoping  by  their  removal  to 
cure  the  disease.  I  next  asked  Miss  L. 
what  she  had  eaten  for  breakfast  that  morn- 
ing. "Ham  and  bread,"  was  her  reply. 
"And  for  supper  last  evening?"  "Ham  and 
breat."  "Were  yoif  helped  to  ham  more 
than  once?"  "I  suppose  I  was,  as  I  am  very 
fond  of  it."  "What  did  you  eat  for  dinner?" 
"Ham  and  bread  again.  I  cannot  touch 
any  vegetables  but  corn  and  sweet  potatoes, 
and  I  do  not  care  for  any  meats  except  ham 
and  veal."  She  drank  tea  and  coffee  spar- 
ingly. Such  a  diet  as  the  above  for  a  girl 
of  sixteen, who  spent  the  greater  part  of  her 
summer  days  idling  about  the  house  and 
reading,  could  but  produce  systemic  de- 
rangement, and  here  it  had  caused  hay  fever 
and  asthma,  as  the  sequal  proved.  A  small 
portion  of  the  swollen,  posterior  end  of  the 
middle  trubinate  was  removed  with  the  cold 
snare.  No  other  nasal  treatment  was  given. 
The  patient  was  forbidden  to  taste  meat  of 
any  kind  and  to  omit  the  use  of  tea  and 
coffee.  Twenty  drops  of  the  saturated  so- 
lution of  the  Iodide  of  potash,  after  meals, 
three  times  a  day  were  prescribed.  At  the 
end  of  a  few  days  the  nasal  condition  was 
markedly  improved  and  a  week  later  the 
nasal  membranes  had  returned  to  their  nor- 
mal condition.  The  puffiness  and  oedema 
had  disappeared,  as  had  the  asthma  and  na- 
sal discomfort.      Even  the  huge  swelling  of 


THECHARLOTTE  MEDICAL  JOURNAL. 


173 


the   posterior  end  of  the  middle   turbinate 
was  no  longer  present. 

The  next  case  is  one  of  hay  fever  with 
asthma.  Mr.  F.,aged  28,  a  tobacconist,  in 
his  attention  to  business  not  infrequently 
would  remain  in  his  shipping  office  at  work 
the  whole  night  through.  His  custom  was 
to  eat  his  meals  hurriedly  and  hasten  imme- 
diately to  his  work.  This  mode  of  living 
had  produced  an  anaemia, which  from  year 
to  year  was  accompanied  by  hay  fever  and 
asthma.  Mr.  F.  has  been  under  my  care 
from  time  to  time  for  several  years,  during 
which  I  have  had  occasion  to  remove  a  few 
small  polypi  from  the  region  of  the  middle 
turbinates.  My  treatment,  except  that  ap- 
plied to  the  nose,  had  been  general  and  with 
no  recognition  of  a  possible  dietetic  origin 
of  the  trouble.  About  the  middle  of  Aug., 
1S98,  he  called  at  my  office  one  morning 
suffering  greatly  from  asthma  and  a  profuse, 
watery  discharge  from  the  nose.  lie  gave 
the  following  .history  :  "Last  Sunday  I  ate 
heartily  and  afterwards  took  a  long  bicycle 
ride.  On  my  return  I  felt  badly.  My 
mother  brought  me  a  glass  of  some  very 
sour  wine  and  told  me  to  drink  it,  saving  it 
might  make  me  feel  better.  I  did  so  and 
early  next  morning  my  trouble  began,  and 
I  have  been  growing  worse  ever  since." 
Examination  of  the  nasal  cavities  revealed 
no  abnormalizes  save  the  characteristic 
(rdema  ami  watery,  anaemic  appearance  of 
the  puffed  membranes.  There  were  no 
polypi  present.  The  septum  was  straight 
Acting  on  the  supposition  that  uricacidae 
mia  was  the  cause  of  the  trouble, Mr.  F.was 
treated  accordingly  and  in  a  few  days  ent ire- 
relief  was  obtained.  No  local  treatment  for 
the  nasal  mucous  membranes  was  given. 
It  is  of  interest  to  note  here  that  Mr.  F.'s 
father  accompanied  his  son  to  my  office. 
He  was  lame  and  walking  with  a  stick, and 
on  looking  at  his  feet,  I  saw  that  from  the 
right  shoe  the  greater  part  of  the  upper 
had  been  cut  away.  "Gout?"  I  asked. 
"Yes,  this  attack  has  lasted  now  for  some 
time.  When  I  was  a  young  man  I  suffered 
from  asthma  just  as  my  son  does  now. 
Since  the  gout  first  attacked  my  toe,  now  a 
good  many  years  ago,  1  have  never  had  an 
attack  of  asthma.  I  have  notes  on  another 
case  in  which  the  appearance  of  gout  was 
followed  by  complete  cessation  of  an  asth- 
ma of  many  years  standing. 

With  the  above  cases  before  us  it  will  be 
well  for  us  to  consider  the  most  widely 
spread  beliefs  in  regard  to  the  cause  of  hay- 
fever.  The  pollen  hypothesis  has  had  and 
still  has  many  advocates,  and  yet  frequently 
patients  ask,    "if   my  disease    be  caused  by 

pollen  why  is  it  that  ?"   the  remainder 

of  the  question  varying  and  being  seeming- 


ly unanswerable  on  this  hypothesis.  For 
example,  Mrs.  C,  aged  50,  a  large  full 
blooded,  active  woman,  has  suffered  from 
autumnal  hay  fever  for  many  years.  In 
1897,  when  the  season  came  round  for  her 
to  have  an  exacerbation,  i.  e.,  the  latter 
part  of  August,  to  her  delight  her  nose  re- 
mained comfortable,  yet  hardly  had  she 
congratulated  herself  when  she  was  taken 
with  "something  resembling  a  congestive 
chill  and  was  desperately  ill  for  a  few  days." 
In  talking  to  Mrs.  C.  about  her  case  she  told 
me  of  a  friend  of  hers,  and  a  great  sufferer 
from  hay  fever,  who  had  "had  at  the  time 
the  hay  fever  should  have  come  on"  a  sim- 
ilar congestive  attack,  and  that  year  she 
"had  escaped  hay  fever." 

Considering  hay  fever  as  a  manifestation 
of  uricacidamiia,  these  "congestive  attacks" 
are  susceptible  of  explanation  ;  considering 
hay  fever  as  a  result  of  the  action  of  pollen 
in  diseased  nasal  membranes,  we  are  at  a 
loss  to  know  why  the  latter  case  should  have 
escaped  hay  fever  during  the  season  for  it, 
when  others  in  the  same  region  were  affect- 
ed as  usual. 

/.oca/  Morbid  Conditions  oft  he  Nasal  Mu- 
cous Membraue. -This  to  the  rhinologist  who 
would  confine  the  origin  of  all  intra-nasal 
troubles  to  the  nasal  cavities  and  their  con- 
contents  is  the  one  which  appeals  most 
strongly.  It  is  certainly  true  that  in  all 
eases  at  the  time  of  the  exacerbation  of  hay 
fever  or  asthma  we  find  either  abnormal  or 
pathological  conditions  present  in  the  nasal 
membrane  ;  but  that  these  conditions  are  the 
cause  of  the  hay  fever  has  never  been  proven. 
Again,  conditions  similar  to  those  found  in 
the  noses  of  hay  fever  sufferers,  so  far  as 
the  eye  may  judge,  exists  in  the  noses  of 
peopie  who  have  no  hay  fever.  Or  take 
the  visible  condition  of  the  nasal  membranes 
during  the  attacks  of  hay  fever  and  during 
the  long  months  when  the  hay  fever  is  ab- 
sent ;  no  advocate  of  the  pollen  hypothesis 
claims  that  the  nasal  mucous  membrane  re- 
turns to  normal  after  the  pollen  season  is 
over.  .Some  claim  that  curing  the  diseased, 
and  I  suppose  that  they  mean  the  visibly 
diseased,  intra-nasal  tissues  cures  the  hay 
fever. 

Let  us  examine  the  visible  conditions  of 
the  nasal  membranes  in  a  few  cases  of  hay 
fever.  Mrs.  C,  aged  50,  above  mentioned, 
has  had  hay  fever  in  August  and  September 
for  many  years,  and  it  always  makes  its  ap- 
pearance with  an  intense  itching  in  a  small 
mole  situated  on  the  face  about  three-quar- 
ters of  an  inch  from  the  left  alaof  the  nose. 
Later  her  eyes  begin  to  water,  burn  and  itch, 
and  then  the  nasal  trouble  begins.  I  have 
had  occasion  to  examine  Mrs.  C.'s  nose, 
both  during   and    between    attacks ;   at  the 


THE  CHARLOTTE  MEDICAL  JOURNAL 


latter  times  I  could  find  no  condition  exist- 
ing for  which  I  could  in  another  person, 
not  suffering  from  hay  fever,  advise  treat- 
ment of  any  kind.  The  septum  is  not  per- 
fectly straight  and  regular,  but  nowhere 
touches  the  turbinated  tissues,  which  save 
for  a  moderate  amount  of  puffiness  (no 
hypertrophies)  are  to  all  appearances  nor- 
mal. During  the  attacks  which  are  of  great 
severity  the  swelling  is  never  sufficient  to 
entirely  block  the  air  passages.  2d.  The 
case  of  Mr.  A.,  aged  35,  in  whose  nose  the 
only  visible  abnormalities  were  some  ten- 
dency to  puffiness  of  the  turbinates.  3d. 
Miss  L.,  aged  16,  seen  at  the  height  of  at- 
tack, turbinates  much  swollen,  the  posterior 
end  of  the  left  middle  turbinate  so  much  so 
that  forced  as  it  was  against  the  septum 
might  if  unrelieved  have  been  the  starting 
point  for  one  or  more  polypi.  The  mem- 
branes returned  to  normal  without  direct 
treatment  save  removal  of  a  small  piece  of 
swollen  turbinate.  4th.  Mr.  F.,  aged  28, 
had  several  small  polypi  springing  from  the 
superior  turbinate,  and  some  general  hyper- 
trophy of  the  turbinates  posteriorly.  Re- 
moval of  the  polypi  and  treatment  of  the 
hypertrophies  did  not  prevent  the  recur- 
rence of  the  hay  fever  and  asthma. 

That  nasal  polypi  alone  are  not  necessa- 
sarily  the  cause  of  hay  fever  is  shown  by 
the  fact  that  many  cases  are  seen  where 
nasal  polypi,  even  in  large  numbers,  exist 
without  it.  That  the  reverse  is  true,  I  think 
there  can  be  no  doubt,  viz.  :  that  whatever 
causes  the  hay  fever  acts  so  profoundly  on 
the  nasal  mucous  membrane  that  changes 
are  brought  about  which  result  from  time 
to  time  in  the  formation  of  polypi.  This 
can  scarcely  be  denied  by  any  one  who  has 
examined  many  cases  of  hay  fever,  for  all 
stages  of  the  development  of  nasal  polypus 
can  be  observed. 

The  cases  above  mentioned,  especially 
those  of  Mr.  A.  and  Miss  L.,  seem  to  show 
clearly  that  excessive  meat  eating  may  pro- 
duce nasal  troubles  which  in  no  demonstra- 
ble particular  differ  from  the  ordinary  peren- 
nial and  autumnal  hay  fever  ;  that  the  visi- 
bly abnormal  conditions  and  the  discomfort 
accompanying  them  disappeared  after  reg- 
ulation of  the  diet  shows  that  what  is  put 
into  the  stomach  has  far  more  to  do  with 
the  causation  of  some  forms  of  hay  fever 
and  hay  asthma  than  has  any  local  morbid 
intra-nasal  condition  ;  that  during  the  past 
hay  fever  season  every  case  I  have  seen, 
which  would  follow  out  my  directions  in  re- 
gard to  diet,  etc.,  has  been  either  relieved 
or  much  benefitted,  and  this  while  continu- 
ing to  live  without  change  of  surroundings, 
making  no  effort  to  escape  from  -'the  pollen 
laden"  atmosphere,  seems  to  show  that  hay 


fever  and  hay  asthma  are  often  food,  not 
pollen,  products. 

In  regard  to  the  treatment  of  autumnal 
hay  fever  and  hay  asthma,  little  need  here 
be  said.  Where  the  nasal  tissues  are  the 
seat  of  the  polypi,  the  latter  should  be  re- 
moved. True  hypertrophies,  and  obstruc- 
ting septal  deviations  and  ridges,  or  spurs 
and  synechias  demand  surgical  interference. 
The  patient,  however,  should  be  told  that 
this  work  is  done,  not  to  cure  the  hay  fever, 
but  because  it  will  render  the  nose  more 
comfortable  and  would  be  required  in  any 
case.  Physiologically  swollen  turbinated 
tissue  no  more  requires  the  assistance  of 
surgery  or  the  cautery  in  any  of  its  forms, 
than  does  the  patch  of  acute  eczema,  or  the 
oedematous  ankle  of  Bright's  disease.  The 
application  of  the  cautery  to  the  turbinated 
membranes,  swollen  in  an  exacerbation  of 
hay  fever,  and  as  the  result  of  uric  acid  irri- 
tation, may  give  the  patient  some  tempo- 
rary comfort,  but  does  not  cure  the  hay 
fever,  and  does  actual  harm.  During  the 
exacerbation  a  camphor-menthol-albolene 
spray  will  give  considerable  relief.  One's 
success  in  the  prevention  of  the  attacks  of 
autumnal  hay  fever,  and  in  lessening  their 
duration  and  severity  when  present  will  de- 
pend, however,  first  of  all  upon  one's  recog- 
nition of  the  facts  that  it  is  the  result  of  im- 
proper eating  and  living,  that  it  is  neither 
necessarily  the  result  of  visible  morbid  intra- 
nasal conditions,  although  these  may  exist, 
nor  of  the  action  of  pollen,  although  dust 
and  pollen  may  have  their  influence  in  in- 
creasing the  severity  of  the  intra-nasal  irri- 
tation, and  lastly,  that  hay  fever  although 
it  may  develop,  does  not  depend  upon  a 
"neurotic  condition"  oran  "idiosyncrasy." 

Considering  hay  fever  as  the  result  of 
uricacidagmia  the  treatment  should  be 
accordingly.  It  is  of  the  first  importance 
that  our  patient  should  give  up  altogether 
eating  meat  for  some  time  before  and  dur- 
ing the  hay  fever  season.  Such  articles  of 
food  as  raise  the  acidity  of  the  blood,  and 
thus  prevent  the  excretion  of  the  uric  acid 
present  in  the  blood,  should  also  be  for- 
bidden. 

Haig  has  shown  that  meat,  inasmuch  as 
it  contains  uric  acid,  is  the  article  of  food 
which,  if  used  in  excess,  and  especially  if 
taken  with  substances  such  as  wines,  beer, 
tea,  coffee,  etc.,  which  raise  the  acidity  of 
the  blood,  will  sooner  or  later  produce  uric- 
acidagmia. Repeated  attacks  of  uricacid- 
semia  bring  about  irritations  and  inflam- 
matory conditions  in  various  parts  of  the 
body,  and  also  in  time  produce  changes 
whereby  the  power  of  excreting  not  only 
the  uric  acid  introduced  into  the  blood  with 
the  food,  but  that  produced  in  normal  tissue 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


175 


metabolism,  is  weakened.  This  latter  should 
be  borne  in  mind,  as  it  helps  to  explain 
why  the  attacks  of  hay  fever  are,  as  a  rule, 
more  easily  controlled  by  regulating  the 
diet,  and  by  the  administration  of  alkalies 
and  tonics  in  the  case  of  the  young  than  of 
older  people.  I  am  convinced,  however, 
that  the  deleterious  effect  of  a  meat  diet  in 
the  causation  of  uricacidaemia  is  not  solely 
due  to  the  uric  acid  it  contains,  for  this  is 
relatively  small  in  amount.  Meat  contains 
elements  that  stimulate  tissue  metabolism. 
This  metabolism  results  in  the  production, 
among  other  things,  of  uric  acid.  If  now, 
this  uric  acid  be  for  any  reason  not  excre- 
ted, but  retained  in  the  blood,  uricacidaemia 
results.  For  calling  my  attention  to  this 
point  1  am  indebted  to  Dr.  J,  S.  Wellford, 
of  Richmond    Va. 

Coffee,  tea,  cocoa,  acid  wines  and  beer 
are,  besides  meat,  the  chief  articles  of  food 
forbidden  by  Haig.  Coffee,  tea  and  cocoa 
have  for  their  active  principles  substances 
identical  with  uric  acid,  and  thus  used  as 
food,  not  only  raise  the  acidity  of  the  food, 
but  add  uric  acid  to  the  amount  already  pre- 
sent in  the  blood.  Acid  wines  and  beer, 
which  is  also  acid,  not  only  raise  the  acidity 
of  the  blood,  but  result  in  increased  tissue 
metabolism,  which  as  above  stated  means 
increase  in  uric  acid.  Eggs  increase  tissue 
metabolism.  I  do  not  mean  to  convey  the 
idea  that  these  substances  should  be  forbid- 
den to  all  the  world  as  articles  of  food:  bill 
1  do  wish  to  say  that  in  the  treatment  of 
uricacidaemia  we  should  bear  these  facts  in 
mind  and  make  use  of  them  accordingly  : 
for  we  shall  meet  with  patients  where  the 
strictest  avoidance  of  all  the  above  men- 
tioned articles  will  conduce  greatly  to  their 
well  being. 

If  our  patient  is  seen  a  few  weeks  before 
the  hay  fever  season  begins  and  will  follow 
our  suggestions  in  regard  to  diet,  exercise, 
bathing,  etc.,  then,  in  young  people  a  mild 
tonic  is  all  the  additional  treatment  neces- 
sary ;  if  the  young  patient  come  under  our 
care  first  during  the  hay  fever  season,  an 
alkali  in  the  beginning  in  considerable  doses 
will  be  required.  In  older  people  the  suc- 
cess of  such  treatment  while  striking  is  not 
always  successful.  Why?  Probably  be- 
cause after  repeated  attacks  of  uricacidaemia 
when  the  general  tissue  changes  are  great 
and  when  the  power  of  excreting  uric  acid 
formed  in  the  normal  tissue  metabolism  is  les- 
sened there  result  changes  whereby  enough 
uric  acid  is  retained  in  the  blood  to  bring 
about  uricacidaemia.  It  is  important  to  bear 
this  in  mind,  or  we  may  attribute  our  failures 
to  the  wrong  cause.  As  a  rule,  the  older  the 
patient,  the  more  he  has  lived  up  to  the  notch 
of  a  meat  and    acid  diet,  the    more  difficult 


do  we  find  the  hay   fever    exacerbations  to 
control. 

In  cases  of  perennial  hay  fever  and  asthma 
our  problem  is  vastly  more  complicated,  for 
we  are  dealing  with  the  conditions  of  the 
blood,  in  which  precipitation  of  uric  acid 
takes  place  with  great  ease,  and  in  many  of 
these  cases  tissue  metabolism  is  so  imper- 
fectly accomplished  that  the  result  is  condi- 
tions which  perpetuate  a  chronic  uricacid- 
aemia. The  question  is  then  no  longer  of 
a  meat  or  vegetable  diet,  with  the  adminis- 
tration of  tonics  or  alkalies.  We  have  to 
regulate  the  organs  which  excrete  uric  acid 
and  thus  prevent  its  undue  accumulation  in 
the  blood.  We  have  to  restore  the  normal 
tone  to  general  tissue  metabolism  which 
regulates  the  condition  of  the  blood,  and  at 
the  same  time  the  relative  ease,  or  difficulty, 
with  which  uric  acid  is  precipitated  into  the 
tissues.  Anxiety,  fright,  over-exertion, 
want  of  proper  bodily  exercise,  interference 
with  the  functions  of  the  excretory  system, 
whether  through  causes  organic  or  func- 
tional, food,  the  relative  constituents  of 
which  are  unsuitable  to  the  mode  of  life, 
and  many  other  things  to  begin  to  mention 
which  would  take  us  too  far  afield,  all  have 
their  influence  in  bringing  about  uric  acid 
precipitation. 

Thus  we  see  the  problem  of  affording  re- 
lief may  be  vastly  complicated.  It  is  not, 
however,  always  so,  and  if  we  bear  in  mind 
that  hay  fever  and  asthma  are  but  manifesta- 
tions of  uricacidaemia  and  treat  our  patient 
accordingly,  while  we  may  have  failures, 
we  shall  also  have  successes. 

DISCUSSION. 

Dr.  J.  N.  Upshur. — I  don't  know  any- 
one who  could  read  upon  such  a  subject  as 
this  who  should  command  more  profound 
respect  and  attention  from  me,  than  my 
friend,  Dr.  Dunn.  I  know  how  careful 
he  is  in  his  reasonings,  how  careful  he  is  in 
stating  a  conclusion  unless  he  has  just  cause 
for  that  conclusion,  and  it  is  not  with  the 
intention  of  criticising  him,  but  simply  be- 
cause there  are  some  few  things  in  connec- 
tion with  hay  fever  that  are  not,  even  with 
his  clear  reasoning,  perfectly  clear  to  me, 
no  doubt  due  to  my  inability  to  grasp  the 
subject  as  I  should.  One  of  these  facts  is  a 
very  new  and  interesting  fact, that  hay  fever 
may  be  due  to  excess  of  uric  acid  in  the 
blood.  It  is  very  easy  to  understand  how 
it  can  be  due  to  uric  acid  when  we  remem- 
ber that  one  of  the  manifestations  or  condi- 
tions of  that  trouble,  is  seen  in  itching 
which  we  have  about  the  nose,  evidently 
when  there  is  too  much  uric  acid  in  the 
blood.  But  the  point  which  interests  me 
particularly  in  connection  with  this  and 
which  I  do  not  understand,  is  that  patients 


THE  CHARLOTTE   MEDICAL  JOURNAL. 


who  are  subjects  of  hay  asthma,  if  hay  asth- 
ma is  due  to  an  attempt  of  elimination  of 
uric  acid  through  the  mucous  membrane, 
why  these  patients  shall  have  the  same  con- 
ditions existing  in  the  same  system,  and  yet 
have  hay  asthma  only  at  certain  seasons  of 
the  year.  Now,  I  have  a  lady  who  has 
been  a  subject  of  hay  asthma  for  a  great 
number  of  years,  who  no  doubt  is  more  or 
less  lithemic,  who  has  had  manifestations 
of  lithemia  or  gout  at  other  seasons  of  the 
year.  But  where  there  is  nothing  special 
in  the  food  to  develop  this  hay  asthma,  yet 
regularly  at  the  given  day  will  develop  the 
symptoms  of  hay  asthma.  I  have  known 
this  lady  under  conditions  where  the  diet 
has  been  exceedingly  abstemious,  where  she 
has  been  traveling  or  at  sea  for  hours  and 
taken  no  food  at  all.  A  week  subsequent, 
on  the  22d  day  of  August,  without  any 
premonition,  entering  the  sleeping  car  to 
leave  the  city,  sneezed  and  her  fever  came 
on  and  lasted  for  six  weeks.  Now,  I  think 
if  it  can  be  explained  on  this  line,  and  if 
the  treatment  which  is  to  effect  a  cure  can 
be  effected  from  a  dietic  standpoint,  we  are 
very  much  indebted  to  these  gentlemen  who 
have  carefully  and  honestly  and  with  mark- 
ed ability  pointed  out  this  new  road  to- 
ward health.  If  you  gentlemen  have  seen 
thir  sort  of  thing,  you  know  there  are  few 
things  that  have  caused  greater  suffering. 
That  is  the  difficult  point  for  me  to  under- 
stand with  regard  to  hay  asthma,  and  I 
would  like  very  much  for  the  doctor  to  ex- 
claim why  they  don't  have  these  phenomena 
at  other  seasons  of  the  year  but  are  develop- 
ed simply  at  the  hay  asthma  season  from  the 
presence  of  uric  acid,  when  it  seems  to  me 
that  if  this  be  the  cause  they  should  have 
this  trouble  in  any  other  month  of  the  year — 
January,  February,  or  any  other  month. 

Dr.  Dunn. — The  patient  to  whom  you 
refer,  Doctor,  has  she  never  hay  asthma  ex- 
cept in  August? 

Dr.  Upshur. — This  lady  is  a  patient  of 
the  Doctor's,  let  me  say,  and  has  as  much 
confidence  in  him  and  admiration  for  him 
as  I  have.  She  has  had  slight  manifesta- 
tions of  hay  asthma  in  June,  but  not  with 
the  same  regularity  she  has  had  in  August 
always.  Since  sitting  here,  one  thing  has 
suggested  itself  to  me  probably  as  a  cause  of 
this  manifestation  in  June,  and  that  is  that 
she  is  exceedingly  fond  of  strawberries,  and 
probably  my  theory  of  strawberries  may 
there  have  come  out,  but  at  other  times  of 
the  year,  the  same  conditions  existing,  this 
lady,  who  is  also  a  patient  of  mine,  has  no 
manifestations  or  indications  or  hay  asthma, 
and  yet  for  twenty-five  years  she  has  had  this 
manifestation  of  hay  asthma.  She  has  had 
hay  asthma  and  been  at  sea  for  a  week  and 


lost  it  entirely.  Of  course,  the  ditetic  ele- 
ment would  come  in  there,  because  she  was 
taking  no  food  while  at  sea,  but  the  moment 
she  landed  the  symptoms  of  hay  fever  have 
returned, and  that  is  a  thing  I  am  interested 
in.  It  is  for  information  and  arriving  at 
some  happy  issue  in  this  matter  that  I  want 
to  arrive  at  some  conclusion  that  I  can 
grasp. 

Dr.  Dunn. — The  point  made  by  Dr. 
Upsher  occurred  to  me  in  preparing  these 
remarks ;  fearing,  however,  to  make  my 
paper  too  long,  I  omitted  any  attempt  at  an 
explanation.  It  will  probably  be  found 
along  the  following  lines.  Hay  fever  oc- 
curs in  persons  who  are  subject  to  lithemia  ; 
in  other  words,  in  persons  whose  general 
condition  is  such  that  all  of  the  uric  acid 
which  makes  its  way  into  the  blood  is  with 
difficulty  excreted  and  there  exists  thus  a 
tendency  for  it  to  precipitate  somewhere  in 
the  system.  In  these  persons,  during  the 
early  summer,  when  the  day  and  night  are 
both  warm,  the  excretory  system,  aided 
greatly  on  its  cutaneous  side,  is  able  to  get 
rid  of  the  uric  acid  as  it  is  formed.  The 
great  sweat  system  of  the  skin  is,  however, 
working  under  high  pressure.  About  the 
middle  of  August  the  nights  begin  to  get 
cool,  and  thus  the  activity  of  the  sweat 
glands  is  lessened,  and  as  a  result  some  of 
the  uric  acid  is  not  excreted.  It  is  precipi- 
tated in  the  nasal  mucous  membranes,  and 
the  result  is  hay  fever.  Witness  how  com- 
mon head  colds  are  at  this  season  of  the 
year;  nor  is  it  unlikely  that  the  conditions 
which  induce  head-colds  in  non-lithemic 
persons  have  much  influence  in  causing  the 
nasal  mucous  membranes  to  be  the  seat  of 
the  uric  acid  precipitation  in  persons  who 
suffer  from  lithemia. 

Dr.  Jos.  A.  White. — It  is  a  little  out  of 
order  to  make  remarks  upon  a  paper  when 
the  author  has  practically  closed  the  discus- 
sion, but  I  understand  Dr.  Dunn  was  sim- 
ply answering  a  question.  The  theory  Dr. 
Dunn  has  just  enunciated,  is  of  practically 
recent  origin,  and  since  the  investigations 
as  to  the  effect  of  lithemia  and  its  various 
manifestations,  is  simply  the  new  explana- 
tion of  what  is  the  causation  of  the  devel- 
opment of  hay  fever,  but  I  have  no  doubt  in 
the  world  that  experience  has  demonstrated 
that  it  has  a  very  good  foundation  in  fact, 
but  by  itself  displays  all  the  various  phases 
and  manifestations  of  these  reflexes  that  we 
meet  with  in  connection  with  nasal  troubles. 
For  instance,  as  I  understand  Dr.  Dunn  to 
state  that  he  has  practically  drawn  the  con- 
clusion that  hay  fever  is  to  be  ascribed  to  a 
neurosis,  and  I  think  in  that  respect  his  pa- 
per  is  what   I  would   have   expected   from 


THE  CHARLOTTEnMEDICAL  JOURNAL, 


177 


him,  but  I  don't  think  he  has  drawn  exactly 
a  correct  conclusion. 

Mr.  Dunn. — I  may  have  said  that,  but  I 
am  willing  to  admit  that  the  conclusion 
may  not  be  correct, 

Dr.  White. — I  have  had  considerable  ex- 
perience in  these  cases  and  I  am  very  fami- 
liar with  the  theories  trying  to  explain  these 
peculiar  mysteries  that  we  meet  with  all  the 
time  in  the  practice  of  medicine,  of  which 
we  have  no  satisfactory  explanation,  and 
to-day  they  haven't  any  satisfactory  expla- 
nation. We  are  always  trying  to  form  the- 
ories that  we  work  out,  and  we  always 
come  sooner  or  later  to  stumbling  blocks 
that  won't  accord  with  our  theories,  and 
we  pass  over  these  to  look  for  something 
else.  This  is  not  only  true  as  regards  hay 
fever  arising  from  the  spores  of  plants. 
or  some  blood  alteration  like  uric  acid,  but 
it  applies  to  other  things  besides  hay  fever 
and  asthma.  Now,  I  am  satisfied  that  it  is 
the  cause  of  a  great  many  attacks  in  case  of 
hay  fever  and  ordinary  asthma,  that  it  is 
not  periodic, which  we  do  not  call  hay  asth- 
ma, but  I  am  satisfied  also  that  the  explana- 
tion of  it  is,  from  whatever  cause,  I  don't 
care  whether  it  is  irritation  that  started  out 
with  symptoms,  I  don't  care  what  causes 
this,  it  is  after  all  the  neurosis  theory  that 
is  the  best.  It  is  always  going  to  have  a 
foundation.  1  don't  care  what  else  you  add 
to  it,  it  always  comes  back  to  one  single 
thing,  and  that  is  the  weakness  of  the  nerve 
centers,  the  weakness  of  the  reflex  sub-cen- 
ters that  allows  these  peculiar  manifesta- 
tions as  to  the  result  of  any  irritation,  and 
the  result  of  hay  fever  is  too  well  known  a 
fact  for  anybody  to  dispute.  I  have  got  an 
attack  of  asthma,  a  violent  attack  of  asthma 
an  attack  that  would  scare  me  more  than 
the  patient  because  the  patient  has  had 
them  often,  I  think  the  patient  is  going  to 
strangle  in  my  office.  All  of  us  have  had 
that  experience.  Why  should  touching 
some  point  of  irritation  in  the  nose  cause  a 
violent  attack  of  spasm  of  the  bronchial 
tubes?  Yet  I  have  seen  it  repeatedly.  That 
isn't  because  there  is  uric  acid  in  that  man's 
blood.  He  has  uric  acid  there  all  the  time 
if  he  lias  it.  There  is  no  more  reason  why 
touching  his  nose  should  give  him  that  at- 
tack than  touching  his  toe  because  of  uric 
acid.  It  is  because  the  respiratory  tract 
when  irritable  in  this  way  is  controlled  by 
sensitive  nerves  immediately  conducting 
that  impression  to  a  sub-center  in  this  pecu- 
liar manifestation  or  characteristic.  I  don't 
doubt  that  uric  acid  may  be  the  cause  that 
has  weakened  these  centers  so  they  are  easi- 
ly affected  by  an  irritation,  because  if  they 
hadn't  lost  ordinary  resistance  there  would 
be  no  reilex  manifestation  of  neurosis.  The 


same  thing  applies  to  periodical  attacks. 
Why  is  it  that  we  have  every  now  and  then 
an  influenza  that  propagates  itself  all  over 
the  country  in  every  direction?  Why  don't 
we  have  that  sort  of  thing  all  the  time 
whenever  a  man  has  a  cold  in  his  head? 
Because  of  peculiar  atmospheric  conditions. 
It  doesn't  attack  everybody.  It  may  attack 
me  and  my  neighbor  escapes.  Because  I 
am  not  immune  from  whatever  it  is  that 
propagates  the  trouble.  So  it  is  that  these 
people  who  have  weak  centers  are  affected 
certain  seasons  of  the  year  by  certain  atmos- 
pheric influences. 

Dr.  Robinson. — I  hate  to  get  up  so  often, 
but  this  is  a  subject  in  which  I  am  very 
much  interested.  I  was  for  twenty-five 
years  a  subject  of  hay  fever  myself,  and  I 
have  suffered  a  good  deal  at  the  hands  of 
Dr.  White,  both  of  torture  and  of  relief. 
The  paper  of  Dr.  Dunn  impressed  me  very 
much.  For  twenty-five  years  I  sought  the 
sea  coast  and  the  sea  air  for  relief,  and  it 
usually  gave  me  immunity  while  I  was  there. 
The  inference  would  be  that  there  was  at- 
mospheric causes  bringing  that  on  from  the 
20th  to  the  30th  of  May  that  provoked  these 
attacks.  That  doesn't  necessarily  imply 
that  uric  acid  conditions  underlying  my 
nose  in  a  local  space  have  gotten  my  nose 
in  a  condition  to  make  it  more  irritable  by 
whatever  atmospheric  causes.  Not  only 
that,  but  a  statement  from  Dr.  Upshur  bears 
out  the  fact  that  although  when  1  did  go  to 
the  seashore  and  come  back,  if  I  would  eat 
fruit  I  would  immediately  have  an  attack, 
even  before  I  got  through.  For  twenty-five 
years  I  was  subject  to  urinary  troubles  and 
uricacidncmia.  For  three  years  I  have  taken 
alkalies  when  I  was  dieting  myself  pretty 
fairly.  In  that  time  I  have  not  had  any  re- 
course to  sea  air,  and  I  haven't  had  any  hay 
fever. 

Dr.  Dunn. — I  wish  merely  to  say  that 
Dr.  White  and  myself  are  in  accord  in  re- 
gard to  the  neurosis  element  of  hay  fever. 
I  do  not  believe  that  hay  fever  is  either  a 
neurosis  or  that  a  neurosis  must  exist  before 
hay  fever  is  a  possibility ;  but  I  do  believe 
that  the  excessive  irritation  of  the  nasal 
mucous  membranes  caused  by  the  precipi- 
tation therein  of  uric  acid  may  make  such 
an  impression  upon  the  central  nervous 
system  as  to  induce  a  neurosis  and  all  that 
is  meant  by  the  use  of  the  term. 


Statistics  of  life  insurance  companies  show 
that  in  the  last  25  years  the  average  of  wo- 
man's life  has  increased  from  about  42  to 
56  yeers,  or  more  than  8  per  cent.  In  the 
same  period  man's  life  on  the  average  has 
increased  in  length  5  per  cent. 


178 


THE  CHARLOTTE     MEDICALJOURNAL. 


Simultaneous   Blood-washing    and  Blood- 
letting in  Uraemia. f 

By  A.  B.  Knowlton,  M.  D.,  Columbia,  S.  C, 

Through  an  oversight  on  my  part,  the 
complete  title  of  this  article  does  not  ap- 
pear upon  the  programme  ;  with  your  per- 
mission, therefore,  I  invite  your  attention  to 
"Simultaneous  Blood-washing  and  Blood- 
letting in  Unemia." 

Blood-letting  as  a  treatment  of  uraemia 
has  been  recommended  and  practiced  for 
many  years  with  varying  degrees  of  success 
claimed  for  the  procedure,  while  blood-wash- 
ing, or  the  intravenous  injection  of  the  nor- 
mal salt  solution  has,  for  this  condition,  had 
many  advocates  during  the  past  eighteen 
months.  It  is,  however,  the  combined  of 
simultaneous  practice  of  blood- washing  and 
blood-letting  to  which  I  will  especially  al- 
lude. 

No  claim  is  made  for  the  therapeutic  ef- 
fect of  this  combined  procedure  in  uraemia 
of  a  chronic  nature,  but  when  we  have  the 
blood  surcharged  with  toxic  elements,  and 
the  nervous  centers  irritated  by  excrementi- 
tious  material  as  in  a  severe  attack  of  acute 
urasmia,  it  becomes  evident  that  to  remove 
a  portion  of  the  poison  by  bleeding,  and  to 
immediately  re-establish  the  cardiac  and 
vascular  tone  by  an  intra-venous  injection 
of  normal  salt  solution,  is  a  most  rational 
treatment. 

The  only  published  treatment  along  this 
immediate  line  which  has  come  to  my  atten- 
tion was  a  case  of  puerperal  eclampsia  re- 
ported in  the  Therapeutic  Gazette  for  Feb- 
ruary, 1898,  and  in  which  case  the  bleeding 
was  from  the  uterine  sinuses  in  the  form  of 
a  post-partum  hemorrhage  which  was  pur- 
posely permitted  to  continue  until  sufficient 
blood  was  thought  to  be  lost,  while  the  sa- 
line injection  was  given  hypodermically — 
the  objects,  however,  were  the  same,  first, 
to  lessen  the  sum-total  of  poison  in  the  sys- 
tem by  bleeding,  and  second,  to  dilute  the 
remaining  blood  passing  to  the  nervous  cen- 
ters, and  to  maintain  vascular  tone  by  sup- 
plying the  system  with  water.  The  only 
other  case  which  I  have  seen  reported,  in 
which  the  bleeding  and  intravenous  were 
done  conjointly,  is  that  of  Dr.  Young  in  the 
Maryland  Medical  Journal  for  Nov.  19th, 
1898,  in  which  case  the  patient  was  suffer- 
ing from  septicaemia  after  an  operation  for 
purulent  appendicitis,  and  in  which  he 
bled  from  one  arm  while  he  injected  the  so- 
lution into  a  vein  of  the  other — both  these 
cases  made  good  recoveries. 


fRead  before  the  Tri-State  Medical  Society  of 
the  Carol  inas  and  Virginia,  at  Charlotte,  N.C., 
January, 1899. 


I  submit  three  cases  of  my  own,  the  first 
two  of  which  were  reported  in  the  Phila- 
delphia Medical  Journal  for  July  23,  1898, 
and  I  beg  your  permission  here  to  present 
them.  The  first  of  these  cases  occurred  on 
Nov.  16,  1897,  which,  so  far  as  I  am  aware 
is  the  first  published  attempt  at  this  com- 
bined procedure  of  blood-washing  and  blood- 
letting for  this  condition. 

Case  I. — On  Nov.  16,  1897,  I  was  called 
to  Mrs.  P.  who  had  passed  through  a  nor- 
mal labor  the  day  before,  having  given  birth 
to  a  healthy  full-term  child,  and  who  had 
been  in  convulsions  for  two  hours.  In  ad- 
dition to  the  usual  treatment,  normal  salt 
solution  (3  pints)  were  injected  into  the 
right  median  basilic  vein,  and  at  the  same 
time  about  twenty-two  ounces  of  blood 
were  drawn  from  the  left  temporal  artery. 
The  patient  rallied  somewhat,  but  did  not 
regain  complete  consciousness,  dying  in 
three  hours  after  my  arrival. 

Case  II. — On  April  15th,  1898,  I  was 
called  to  Maggie  P.,  colored,  who  was  in 
the  eighth  month  of  pregnancy,  and  had 
had  four  convulsions  of  increasing  intensity 
during  the  two  preceding  hours.  There 
were  no  signs  or  symptoms  of  labor,  and 
although  the  patient  was  unconscious,  I  de- 
cided to  make  a  thorough  test  of  this  treat- 
ment, and,  accordingly  did  not  dilate  or 
empty  the  uterus.  I  injected  three  pints  of 
normal  salt  solution  into  the  right  arm 
(median  basilic  vein)  and  simultaneously 
bled  about  20  ounces  from  the  left.  No 
other  treatment  was  given.  In  half  an 
hour  after  the  injection  and  bleeding,  the 
patient  had  one  convulsion,  which  was  said 
by  the  woman  present  to  be  much  lighter 
than  any  of  the  others.  In  six  hours  more 
she  had  another  convulsion,  which  was  even 
still  lighter  and  amounted  to  only  a  faint 
tremor.  In  the  meantime  the  patient  be- 
came conscious  and  called  for  nourishment. 
In  eight  hours  more  (14  hours  since  the 
bleeding  and  injection)  I  dilated  the  cervix 
under  chloroform  and  delivered  the  child. 
The  woman  had  no  more  convulsions,  and 
made  a  good  recovery.  In  view  of  the 
rapidly  increasing  intensity  of  the  convul- 
sions before  the  treatment,  and  their  lessen- 
ing intensity  and  subsidence  after  the  treat- 
ment and  before  I  emptied  the  uterus,  I  am 
convinced  that  the  patient's  life  was  saved 
by  the  procedure. 

Cask  III. — August  10th,  1898,  Mr.  A. 
had  been  in  ura?mic  coma  for  17  hours  when 
I  arrived.  I  immediately  bled  about  25 
ounces  from  the  left  arm  and  injected  about 
4  pints  of  salt  solution  into  the  right.  I 
repeated  the  injection  (about  a  quart)  in  an 
hour.  Patient  gradually  responded  to  reflex 
tests,  and    in  about    three    hours  was    con- 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


179 


scious.  Two  more  quarts  of  saline  injec- 
tion given  on  next  day.  Patient  made  a 
good  recovery,  though  urine  still  shows 
some  albumen  and  feet  occasionally  cede- 
matous. 

I  believe  that  the  day  is  not  far  distant 
when  this  means  of  depletion  and  dilution 
of  the  blood  will  be  universally  considered 
most  rational  treatment  in  all  forms  of  acute 
toxaemia,  such  as  uraomic  coma,  puerperal 
eclampsia,  pernicious  malaria  (except  where 
there  exists  too  great  a  dyscrasia) ,  and  in 
all  conditions  of  over-loading  of  the  blood 
with  excrementitious  products. 

The  amount  of  blood  which  we  could 
safely  abstract  from  the  human  being  is  a 
somewhat  unsettled  question.  According 
to  Dr.  Bovie  we  may  take  1-19  of  the  entire 
body-weight  from  the  dog,  provided  we 
immediately  supply  the  vessels  with  normal 
salt  solution.  If  this  be  true,  and  if  Paine 
is  correct  in  his  estimate  that  one-tenth  of 
a  man's  body-weight  represents  proximately 
the  amount  of  his  blood,  and  if  also  a  man 
can  stand  about  the  same  proportional  de- 
pletion as  the  dog,  it  follows  that  from  a 
man  weighing  150  pounds  *j\  pints  of  blood, 
or  about  one-half  the  entire  amount  of  his 
poison-laden  blood  could  be  safely  abstract- 
ed, provided  we  immediately  or  simultan- 
eously supply  his  system  with  a  sufficient 
quantity  of  a  normal  salt  solution. 

As  to  the  quantity  of  solution  which 
could  safely  be  injected — 1  have  never  in- 
jected more  than  5  pints  at  one  time,  while 
Dr.  Young  has  injected  nearer  3  quarts. 
The  Liepzig  School  of  Experimentation  has 
demonstrated  that  the  salt  solution,  amount- 
ing to  as  much  as  three-fourths  the  original 
quantity  of  blood,  could  be  injected  into  the 
dog  without  any  unfavorable  symptoms 
whatever — if  human  beings  can  as  safely 
stand  a  proportional  quantity,  about  six 
quarts  can  be  injected  into  a  man  weighing 
150  pounds  without  even  an  unfavorable 
symptom.  It  was  also  demonstrated  that 
it  required  salt  solution  \\  times  the  total 
quantity  of  the  dogs  blood  to  produce  death 
— if  t he  analogy  still  holds  good  it  would 
require  about  11  quarts  of  the  salt  solution 
to  kill  a  man  of  150  pounds  weight.  This 
is  truly  astonishing,  and  while  we  would 
hardly  be  justified  in  going  to  such  extremes 
either  in  abstracting  blood  or  injecting  the 
solution,  we  are  forced  to  the  conclusion 
that  the  circulatory  system  is  capable  of  a 
very  wide  range  of  adaptability,  and  that 
the  abstraction  and  watering  of  the  blood 
have  heretofore  been  far  too  limited  to  give 
the  best   results. 

It  has  been  claimed  that  the  pulse  is  the 
best  guide  in  administering  the  solution. 
This  is  true  to  a  limited  extent  only,  for  it 


has  been  demonstrated  that  after  the  pri- 
mary effect  of  stimulation  is  over  the  vessels 
accommodate  themselves  to  the  quantity  of 
fluid  injected  in  such  a  way  as  to  keep  the 
blood  pressure  at  a  uniform  standard,  and  it 
is  a  fact  that  although  the  injection  may 
still  be  continued  death  will  ensue  without 
an  additional  rise  in  blood-pressure.  When 
the  injection  is  continued  beyond  primary 
stimulation  we  should  not  look  for  a  con- 
tinued increase  of  pulse-tension  but  rather 
for  a  quicked  pulse  and  increased  respira- 
tion, for,  when  the  blood  is  surcharged  with 
fluid  there  must  of  necessity  be  an  increased 
number  of  heart-beats  and  respirations  in 
order  to  give  a  normal  amount  of  oxygena- 
tion. This  is  borne  out  by  a  recent  case 
j-upon  which  I  operated  for  gun-shot  wound 
of  the  abomen,  in  which,  however,  there 
had  been  no  hemorrhage,  but  where  there 
was  a  marked  increase  of  pulse  and  respir- 
ation after  the  first  two  quarts  had  been  in- 
jected and  which  only  subsided  when  the 
injection  was  discontinued. 

I  recently  heard  an  eminent  physician 
say  that  he  had  never  seen  any  good  results 
from  the  intra-venous.  I  too  have  seen  it 
fail,  but  so  far  as  the  procedure  is  concerned 
I  believe  that  the  failures  were  due  more  to 
the  small  quantity  of  fluid  used  than  to  any 
other  one  feature.  While,  therefore,  I 
would  not  suggest  such  extremes  as  would 
seem  to  be  even  justified,  I  would  in  all 
cases  where  the  blood  needed  an  immediate 
unloading  of  its  poisonous  material,  strong- 
ly urge  much  larger  quantities,  both  in  the 
matter  of  depletion  and  dilution,  than  have 
heretofore  been  done. 

If  then  the  experiments  upon  the  dog 
have  given  even  a  proximate  estimate  of 
what  the  human  being  can  stand,  we  may 
justly  expect  to  lower  our  mortality-rate 
not  only  in  uraemia,  but  in  all  conditions  of 
toxaemia  and  septicaemia,  at  a  very  early 
day. 

DISCUSSION. 

Dr.  W.  L.  Robinson. — This  is  a  ques- 
tion of  great  interest  and  one  in  which  I 
have  been  interested  myself.  It  seems  most 
rational  that  if  you  can  eliminate  from  the 
system  the  poison  by  bleeding  a  patient  and 
then  supplying  a  normal  salt  solution,  that 
it  ought  to  be  the  most  radical  and  satisfac- 
tory relief  in  that  case.  The  question  might 
naturally  be  asked  by  those  who  heard  the 
paper  on  the  extraction  of  blood  and  con- 
trol of  convulsions,  whether  or  not  the  con- 
vulsions might  have  been  controlled  by  sim- 
ple expedients.  It  is  rational  to  have  given 
credit  to  saline  injection.  I  would  make 
one  suggestion  in  addition  that  the  doctor 
didn't  bring  out,  and  that  is  in  those  cases 
where  there  is  a  very  weakened  circulation, 


180 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


that  it  would  be  well  for  intravenous  use  to 
place  your  saline  solution  within  the  vein 
before  you  stop  the  abstraction  of  blood 
from  the  other  arm,  or  else  you  will  find 
some  difficulty. 

Dr.  Knowlton. — I  would  like  to  men- 
tion one  point  as  regards  the  technique  of 
the  operation.  It  is  a  very  simple  operation, 
but  I  have  seen  several  very  good  sur- 
geons fail  to  perform  it,  and  just  at  the 
juncture  when  the  operation  was  extremely 
necessary.  It  is  this  :  I  think  it  is  un- 
wise to  tie  the  vein  above  until  after  the 
vein  is  thoroughly  exposed.  If  you  cut 
down  upon  the  vein  after  it  has  been  tied, 
the  vein  is  tense,  and  much  more  liable  to 
be  wounded,  and  if  you  wait  until  after  it  is 
tied  it  is  fully  distended  and  the  puncture  is 
much  easier.  In  other  words  make  the  in- 
cision -first,  then  do  the  tying,  then  the 
puncture. 

Dr.  Barringer. — While  not  bearing 
directly  on  this  subject,  I  have  endeavored 
to  systematize  the  influences  of  all  toxaemia 
and  to  bring  about  a  systematic  way  in 
which  to  present  this  to  students,  which  I 
think  I  can  present  in  less  than  five  minutes. 
Whether  it  be  septicaemia,  or  toxaemia,  or 
uraemia,  I  think  our  forces  are  limited  to 
three  things.  We  can  flush  the  center,  we 
can  dilute  the  poison,  or  we  can  diminish 
the  rapidity  with  which  the  poison  is  ap- 
plied to  the  centers.  You  have  all  seen 
morphine,  chloral,  and  that  class  of  drugs 
relieve  convulsions  by  flushing  the  centers. 
By  bleeding  you  can  remove  a  certain 
amount  of  poison,  but  unless  a  man  is  ex- 
tremely plethoric  we  hesitate  to  bleed  where 
we  know  that  we  can  by  slowing  the  circu- 
lation with  veratrum  veridi  and  its  class, 
bring  down  the  portion  of  blood  passing 
through  a  center  in  a  given  time  to  a  mini- 
mum. If  the  toxaemia  is  so  great  that  even 
when  the  center  is  flushed  as  by  chloral, 
where  the  blood  is  brought  down  as  bleed- 
ing, convulsions  still  occur,  I  think  under 
those  circumstances,  and  in  those  cases  only 
is  it  wise  to  still  carry  further  the  amount 
of  bleeding  and  then  substitute  saline  solu- 
tion, which  is  not  in  any  sense  a  vital  fluid. 
Saline  solution  in  those  cases  simply  renders 
more  easy  the  action  of  the  heart  in  supple- 
menting the  amount  of  blood  removed. 


The    Medical    Treatment  of   Appendicitis, 
or  Appendicitis    Without  Operation. f 

By   Charles  B.    McAnally,    Madison,    N.C. 

My  excuse  for  presenting  this    paper    to 


TRead  before  the  Tri-State  Medical  Society  of 
the  Carohnas  and  Virginia,  at  Charlotte.  N.'C, 
January,  1899. 


you  is  that  my  own  experience  does  not  al- 
ways teach  me  that  every  case  of  appendi- 
citis demands  the  treatment  that  now  seems 
so  universally  popular,  not  only  with  sur- 
geons, strictly  speaking,  but  also  with  the 
profession  generally,  and  I  mean  by  that 
surgical  interference. 

During  my  few  years  of  professional 
work  it  has  been  my  good  fortune  to  be 
confined  largely  to  the  practice  of  general 
medicine.  Having  this  work,  both  in  town 
and  country,  you  will  readily  understand 
the  advantage  such  a  situation  is  to  the  ob- 
servation of  any  special  disease  or  diseased 
conditions.  We  all,  every  day  of  our  pro- 
fessional life,  see  the  vast  difference  of  dis- 
ease, even  of  its  characteristics,  as  found  in 
'our  patients  in  the  various  professions  and 
environments  of  individual  cases. 

My  experience  with  appendicitis  began 
almost  in  the  very  commencement  of  my 
practice  ten  or  twelve  years  ago.  But  with 
one  or  two  exceptions  I  have  never  been 
fully  convinced  of  the  necessity  of  an  oper- 
ation for  its  relief,  and  these  exceptions 
were  in  cases  receiving  no  medical  treatment 
until  there  was  extensive  local  peritonitis 
complicating  the  primary  trouble.  The 
history  of  five  cases  occurring  in  my  prac- 
tice, and  three  in  that  of  Dr.  W.  J.  McAn- 
ally during  the  past  eighteen  months  will 
be  sufficient  to  demonstrate  what  has  caused 
me  to  be,  perhaps,  over  conservative  as  re- 
gards surgical  treatment  of  these  cases.  I 
would  not  for  a  moment  have  you  under- 
stand that  I  do  not  believe  in  operating  for 
the  cure  of  a  great  many  of  these  cases,  for 
I  do  know  there  are  cases  that  only  this 
will  offer  any  hope.  Even  some  of  the 
cases  that  are  relieved  by  medical  treatment 
will,  I  doubt  not,  ultimately  demand  the  en- 
tire removal  of  the  appendix  and  its  sur- 
rounding irritating,  inflammatory  products. 
Sept.  30th,  1897,  I  was  called  to  see  (S.  G.) 
a  young  man  17  years  of  age,  farmer,  good 
history,  etc.  I  found  him  in  bed,  lying  on 
his  right  side,  with  his  knees  brought  for- 
ward towards  abdomen,  face  rather  pale 
and  somewhat  drawn  with  small  red  spot 
on  cheeks,  eyes  bright  and  watchful,  tongue 
large,  white-coated  and  pointed — brownish 
on  back  part,  breath  very  offensive  ;  com- 
plained of  severe  pain  in  right  iliac  region, 
sometimes  radiating  up  beyond  umbilicus. 
No  appetite,  not  able  to  rest  for  three  or 
four  days  prior  to  my  visit,  and  gave  fol- 
lowing history  : 

Five  days  before  this  was  in  field  pulling 
fodder  when  he  noticed  a  slight  heaviness  in 
his  lower  right  abdomen  and  felt  disposed  to 
take  shorter  step^with  his  right  foot  than 
with  his  left,  and  that  it  relieved  him  to 
lean  forward  and  keep  his  body,  as  regard- 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


ed  his  right  leg,  as  nearly  immovable  as 
possible,  and  in  a  slightly  forward  position. 
He  finally  came  home  and  laid  down  for  a 
few  hours,  then  got  up  and  walked  about  a 
little  but  all  the  time  had  that  uneasy  feeling 
in  'lower  right  side.'  He  passed  two  days 
this  way  with  only  a  little  more  pain,  etc., 
until  the  third  day  when  he  was  compelled 
to  take  to  his  bed  and  had  remained  there, 
suffering  more  and  more  each  day.  Bowels 
had  moved  during  first  two  days  one  time 
each  day,  and  one  time  during  the  last  three 
days,  and  had  eaten  nothing  since  he  first 
complained.  I  found  his  temperature  102 
degrees,  pulse  98  ;  extremely  tender  over 
the  right  iliac  region,  no  distension  of  bow- 
els except  skin  just  a  little  tense  and  full 
over  the  tender  area  ;  lying  on  his  back  he 
could  lie  flat,  but  would  almost  immediately 
flex  his  right  leg  on  his  body  saving  it  gave 
him  pain  in  his  bowels  or  right  side  to 
straighten  out. 

I  made  diagnosis  of  appendicitis  and  pre- 
scribed and  gave  calomel  and  bi-carbonate 
soda,  gr.  xv.  each.  M.  Sig.  Div.  1^  pow- 
ders. One  every  half  hour  until  all  given. 
This  was  at  4  p.  m.,  and  was  to  be  followed 
early  next  morning  with  tablespoonful  of 
Epsom  salts.  J  also  prescribed  thirty  drops 
Spirits  Turpentine  internally  and  stupes  to 
bowels  under  warm  applications  of  bran, 
meal  or    wood    ashes.       In  case  this  did    not 

relieve  pain  I  left  .1  doz.  j  gr.  doses  sulph. 
morph.  to  be  given  every  hour  until  four 
Were  taken  or  relief  given.  I  saw  him  next 
day  at  2  p.  m.,  found  his  general  condition 
about  the  same,  temperature  101,  pulse 
115.  Tenderness  si  ill  severe  but  had  got- 
ten a  little  sleep  after  taking  two  closes  of 
morphia;  bowels  open  freely,  urine  free,  no 
appetite;  a  little  increase  of  the  tension 
over  tender  region.  Former  R.  repeated 
except  acetanilid  and  caffein  were  given 
instead  of   morphia. 

Not  being  fully  satisfied  with  his  condi- 
tion I  asked  for  a  consultation  and  next 
day  at  4  p.  m.  I  saw  him  with  Dr.  C.  Pa- 
tient was  much  better  in  almost  every  res- 
pect. Had  had  copious  stools,  rested  well 
four  hours  and  had  asked  for  a  little  milk. 
Tympanitic  quality  of  bowels  about  the 
Bame,  temperature  101  degrees,  pulse  no. 
Pain  very  much  relieved.  Tongue  still 
heavily  coated  ami  breath  foul.  The  doc- 
tor agreed  with  my  diagnosis  and  recom- 
mended the  treatment  continued,  which 
was  done  except  only  enough  of  the  pur- 
gative was  given  to  keep  bowels  freely  open. 
Patient  made  an  uninterrupted  recovery, 
and  within  two  weeks  was  able  to  be  out 
at  his  usual  work.  He  has  bad  no  unpleas- 
ant  symptoms  from   il   since. 

Case  No.  2    was  T.  \V.,  a  school-boy,  12 


years  old.  Gave  following  history  :  Was 
playing  at  school  when  he  noticed  that  he 
was  inclined  to  bend  forward  toward  his 
right  side  when  he  was  running.  As  he 
went  home  in  the  evening  he  found  him- 
self able  to  walk  all  right,  but  was  a  little 
sore  in  the  lower  right  side  of  bowels.  This 
was  Friday.  Saturday  and  Sunday  he  felt 
irritable,  without  appetite  and  general  feel- 
ing of  drowsiness  with  slight  pain  in  the 
lower  right  side  of  bowels  and  up  above  his 
navel,  and  spent  his  time  lying  about.  All 
these  symptoms  increased  until  I  saw  him 
on  the  Thursday  following.  He  had  not 
been  back  to  school.  I  found  him  lying  on 
his  back,  with  right  leg  flexed,  unabletolie 
any  other  way  with  comfort  ;  very  tender 
over  right  iliac  region,  very  considerable 
tympanitis,  but  no  tenderness  at  any 
other  point.  Pulse  102,  temperature  io2,V. 
Bowels  constipated,  very  thirsty,  no  appe- 
tite, not  able  to  sleep.  Same  treatment  as 
in  former  case  except  acetanilid  and  caffein 
given  with  the  morphia  and  turpentine 
every   four  hours. 

.Saw  him  next  day;  found  temperature 
103  pulse  no,  stools  five  since  I 
saw  him  the  same  time  the  day  before. 
Treatment  was  continued  twenty-four  hours 
when  1  found  him  much  better,  but  with 
considerable  tenderness  over  the  region  of 
the  appendix.  The  mercury  and  soda  were 
continued  in  half  quantity  which  was 
deemed  sufficient  to  keep  bowels  free  three 
or  four  times  a  day  ;  only  liquid  food  allow- 
ed in  any  case  and  at  end  of  ten  days  pa- 
tient was  up  but  carried  himself  a  little  stiff 
with  the  muscles  of  right  side  for  a  week 
or  two  more.  In  this  case  I  am  confident 
there  were  adhesions  of  some  extent  as  up- 
on close  examination  there  was  tenderness 
and  some  fullness  over  the  region  of  first 
tenderness.  But  no  further  trouble  has 
come  to  him  and  if  there  was  an  unopened 
abscess  there  it  has  not  so  far  given  trouble. 

Third  case — Young  man  26  years  of  age, 
family  history  good,  personal  history  good. 
Was  "taken  on  iSth  December,  1898,  with 
severe  pain  in  bowels.  He  thought  he  had 
••cramp  colic."  Took  a  big  dose  of  whis- 
key, got  some  relief  for  a  few  hours,  but 
still  had  cramping  pains  in  lower  right  side 
of  bowels  low  down  even  below  the  region 
of  appendix.  I  suspected  strangulated 
hernia  from  his  immediate  condition,  but 
on  close  examination  I  found  tenderness  of 
the  iliac  region,  no  appearance  of  any  scro- 
tal hernia  and  no  tenderness  up  the  cord. 
The  muscles  were  held  so  tense  I  could  not 
satisfactorily  distinguish  any  tumor.  This 
patient  had  been  very  sick  at  stomach,  but 
was  somewhat  relieved  of  that  before  I  saw 
him.        Found      temperature      100       pulse 


182 


THE  CHARLOTTE  MEDICAL  JOURNAL 


10S,  deeply  coated  tongue,  breath  very  of- 
fensive, bowels  constipated.  I  at  once  gave 
calomel  and  soda  as  in  previous  cases,  and 
had  an  enema  of  hot  water,  castor  oil  and 
turpentine  given  at  once,  with  directions  to 
repeat  every  two  hours  until  free  evacua- 
tion of  bowels  was  secured.  Also  gave 
morphia  and  acetanilid  four^  grain  doses  of 
morphia  to  be  given,  one  each  hour  until 
relieved  of  pain.  Acetanilid  given  in  five 
grain  doses  every  two  hours  for  three  doses, 
then  to  be  given  every  four  hours.  Saw 
him  next  day,  found  him  well  purged,  wa- 
ter free,  temperature  99  deg's.  pulse  90. 
Diet  was  regulated  and  treatment  contin- 
ued but  modified  as  symptoms  were  relieved 
Seven  days  after  patient  was  up  and  has 
suffered  no  relapse. 

The  other  two  cases  in  my  own  practice 
were  similar  except  the  pain  in  the  begin- 
ning was  high  up  and  was  only  localized  at 
appendix  after  first  twenty-four  hours.  The 
treatment  was  same,  and  all  recovered. 

The  following  three  cases  were  reported 
to  me  by  Dr.  W.  J.  McAnally,  as  above 
mentioned  : 

Case  1.  Mrs.  C,  age  29,  was  taken 
with  severe  pain  in  right  iliac  region,  Jan. 
24.  1898.  Fever,  headache,  anorexia  and 
constipation  followedthe  occurrence  of  pain 
in  the  abdomen  and  on  the  25th  I  was  called 
to  see  her.  Found  the  patient  lying  on  her 
back  with  right  leg  drawn  up  and  the  ab- 
dominal muscles,  especially  of  the  right 
side,  were  very  rigid.  There  was  marked 
tenderness  over  McBurney's  point,  and  the 
pulse  104,  temperature  102.5  deg's.,  tongue 
coated,  no  desire  for  food.  I  prescribed 
gss  Epsom  salts  at  onee,  turpentine  stupes 
over  the  tender  point,  and  one  grain  doses 
of  a  powder  70  parts  acetanilid,  20  bicar- 
bonate Soda,  10  citrate  of  caffein  every  3  to 
4  hours  with  gr.  -£  of  morphia  as  often  as 
necessary  to  keep  patient  easy,  grains  v  of 
quin.  sul.  tid.,  and  allowed  no  solid  food; 
gave  milk  in  small  quantities  every  2  to  4 
hours ;  albumen  water  and  egg-nogs  were 
taken  several  times  a  day.  With  this  treat- 
ment the  patient  was  kept  right  easy  and 
fever  was  never  above  103  degrees.  The 
Epsom  salts  was  given  every  evening,  and 
from  one  to  two  moves  from  the  bowels  se- 
cured each  day.  The  patient  vomited  sev- 
eral times  during  the  attack  but  I  thought 
perhaps  the  morphia  caused  it.  At  no  time 
during  the  sickness  could  I  detect  a  tumor. 
But  on  the  7th  day  about  one  ounce  of  pus 
was  passed  with  the  morning  evacuation. 
There  was  no  more  fever  and  all  symptoms 
gradually  subsided  except  the  tenderness 
over  McBurney's  point.  The  patient  was 
up  doing  her  work  in  another  week  from 
the     time      that      the      pus     was     passed, 


but  she  was  weak  and  pale.  The  tender- 
ness never  did  entirely  leave,  and  about  six 
weeks  after  the  first  attack  she  had  a  second 
one  much  less  severe  than  the  former.  The 
same  treatment  brought  her  out  again  in  3 
or  4  days.  Tenderness  all  subsided  after 
this  and  she  had  no  more  trouble.  Good's 
peptomangan  was  given  to  build  her  up. 

Case  2.  Mrs.  M.,  age  42,  on  the  9th  of 
June  was  taken  with  severe  pains  in  the 
right  iliac  region.  The  same  day  I  was 
called  to  see  her.  Found  temperature  101, 
and  pulse  99,  much  soreness  in  region  of 
appendix  ;  abdominal  muscles  on  right  side 
were  tense  ;  tongue  coated.  Diagnosis  ap- 
pendicitis. Gave  about  same  treatment  as 
for  case  1.  Fever  did  not  get  over  102,  and 
in  six  days  she  was  up  and  going  about  the 
house.  She  had  some  soreness  about  the 
appendix  for  several  weeks  and  was  anemic. 
Gave  Tinct.  Ferri  chlor.  nj/.  v  to  xv,  doses 
tid.,  and  she  soon  improved,  and  has  since 
had  no  trouble. 

Case  3.  Mrs.  D.  I.  C.  during  the  second 
week  in  August,  1898,  complained  of  pain 
and  soreness  in  the  right  iliac  region  but  as 
she  had  given  birth  to  a  two-pound  boy  the 
20th  of  July  she  thought  this  soreness  was 
the  result  of  the  labor.  On  the  10th  of  Au- 
gust I  was  called  to  see  her ;  temperature 
was  103,  pulse  108,  tongue  was  coated  and 
it  was  easy  to  feel  a  tumor  in  region  of  the 
appendix.  Patient  was  of  course  in  bed, 
and  had  been  there  two  days  when  I  first 
saw  her.  The  abdominal  walls  were  tense 
on  the  right  side  and  the  right  knee  was 
drawn  up.  Diagnosed  appendicitis  and 
followed  the  same  plan  of  treatment  as 
used  in  cases  1  and  2.  The  morphia  kept 
the  patient  tolerably  comfortable  and  the 
Epsom  salts  moved  the  bowels  nicely  each 
day.  The  feeding  was  the  same  as  for  the 
other  cases,  and  with  this  simple  treatment 
she  got  along  nicely.  On  the  16th  she 
passed  several  ounces  of  pus,  and  for  three 
days  after  this  a  little  pus  was  seen  with 
each  passage.  All  the  symptoms  except 
the  soreness  disappeared  almost  immedi- 
ately. As  late  as  Nov.  10th  she  would  feel 
sore  in  her  right  side  after  a  walk  of  a  half 
mile. 

The  advocate  of  operative  inter- 
vention in  all  cases  of  appendicitis  ad- 
vise early  operation.  Some  even  go  so  far 
as  to  say  that  it  must  be  done  within  the 
first  twenty-four  hours. 

I  have  no  hesitancy  in  saying  that  to  fol- 
low this  rule  absolutely  there  would  be  no 
operations  as  in  95%  of  the  cases  we  see  we 
are  not  called  until  the  third  or  fourth  day. 
We  may  sometimes  be  called  earlier  when 
the  attack  is  preceded  or  ushered  in  by  these 
sympathetic    pains  above  the   umbilicus,  or 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


183 


over  the  region  of  the  sympathetic  ganglion. 
These  are  the  cases  of  colic  we  often  meet. 
Prof.  Nothagel,  of  Vienna,  one  of  the 
leading  clinical  observers  of  the  world  de 
clares  that  more  than  80%  of  all  cases  of 
appendicitis  will  recover  under  medical 
treatment.  lie,  however,  like  the  late  Prof. 
A.  L.  Loomis,  advised  the  opium  treatment 
and  not  the  combination  treatment  I  have 
mentioned  and  used.  My  experience  has 
been  so  satisfactory  with  my  own  treatment 
that  I  shall  hesitate  to  depart  from  it  until, 
at  least,  I  meet  with  such  reverses  as  shall 
justify  the  change.  I  wish  to  say  just  here 
that  I  think  perhaps  after  the  initial  treat- 
ment with  the  mercurial,  almost  any  of 
the  various  evacuants  would  answer  in  its 
stead.  I  have  seen  thialion  (a  laxative  salt 
of  lithia)  highly  recommended  in  similar 
conditions  but  have  never  used  it  myself. 


Pseudo-Membraneous   Enteritis.* 

By  -I.  M.  Fladger,  .\1.  I)..  Summerton,  S.  C. 

In  presenting  a  paper  on  the  subject 
selected,  1  do  not  claim  to  give  anything 
new  to  the  profession  in  regard  to  the  path- 
ology, diagnosis,  or  treatment  of  this  dis- 
ease. 

But  as  it  is  a  rare  trouble,  perhaps  not 
having  been  treated  by  many  present,  and 
also  as  the  history  of  the  case  to  be  present- 
ed for  your  consideration  differs,  in  so  many 
respects,  from  the  usual  course  of  the  dis- 
ease, that  it  is  indeed  unique. 

The  definition  given  in  the  books,  is  as 
follows:  "A  non-febrile  affection,  consist- 
ing in  a  peculiar,  and  usually  persistent, 
morbid  condition  of  the  mucous  membrane, 
marked  by  the  periodical  formation  of  vis- 
cous, shreddy,  ami  tubular  exudates,  on  the 
discharge  of  which  amelioration  of  all  symp- 
toms occurs." 

We  have  no  accounts  of  this  trouble  in 
the  writings  of  the  ancients,  and  indeed 
nothing  describing  it  as  a  distinct  trouble 
until  about  t he  eighteenth  century,  when 
some  writers  speak  of  the  tubular  exudate. 
associated  witli  diarrhea  and  dysentery.  It 
was  not  until  the  year  1N1S,  that  Powell 
recognized  it  as  a  distinct  tremble,  and  since 
then  it  has  had  a  place  in  nosology.  It  is 
rarely  seen  in  childhood — mostly  between 
the  ages  of  4,0  and  50.  Females  are  much 
more  liable  to  it  than  males,  and  the  blonde 
type — light  hair  and  fair  complexions — but 
without    consuming  your    time  in   giving  a 


*Read  before  the  Tri-State  Medical  Society  of 
tin-  ( larolinas  and  Virginia,  at  ( lharlotte,  N.  C, 
January,  1899. 


general  history,  I  will  proceed  to  give  that 
of  my  patient. 

On  March  29th,  1895,  was  called  to  see 
Nannie,  daughter  of  Rev.  C,  a  robust  and 
healthy  child  of  five  years,  dark  complexion, 
black  hair  and  brown  eyes.  Found  her  suf- 
fering with  an  acute  gastritis;  temperature 
102,  pulse  115,  and  respirations  about  30. 
The  tongue  was  coated  with  a  heavy  white 
fur,  and  the  nausea  and  vomiting  were 
most  distressing. 

I  prescribed  calomel  1-10  gr.  with  sacch. 
pepsin  every  hour  ;  warm  applications  over 
the  epigastrium.  &c,  with  only  partial  re- 
lief of  symptoms.  On  my  second  visit  that 
day,  found  her  extremely  prostrated.  As 
the  integrity  of  the  stomach  was  not  im- 
proved, I  commenced  to  use  nutritive  ene- 
mata,  alternating  liquid  peptonoids,  with 
bovinine  and  milk,  and  later  brandy  was 
added,  according  to  indications. 

The  case  went  on  for  a  few  days  with 
little  or  no  improvement  in  the  gastric  symp- 
toms, but  the  coated  tongue  was  succeeded 
by  an  intensely  red  and  sleek  one,  attended 
with  a  very  high  temperature  and  great  rest- 
lessness. Locally  I  used  mustard,  turpen- 
tine, poultices,  &c,  with  a  final  resort  to  a 
blister  of  Spanish  flies.  I  should  add  that 
the  materia  medica  was  exhausted  in  the 
use  of  remedies  internally,  and  with  the  as- 
sistance at  times  of  two  medical  men,  the 
relief  was  only  temporary.  The  thirst  was 
most  intense  and  distressing  throughout  the 
course  of  the  disease. 

Her  appeals  for  water,  that  would  be 
rejected  as  soon  as  swallowed,  were  indeed 
pathetic.  When  convinced  that  she  could 
not  retain  it,  she  insisted  that  her  brother 
and  sister  should  drink  it,  and  even  guests 
at  the  house  were  importuned  to  do  like- 
wise. This  was  about  the  third  week  of 
her  illness.  There  was  never  any  marked 
tenderness  over  the  abdomen,  nor  was  there 
any  tympanitis,  but  rather  a  depressed  and 
sunken  appearance  of  the  whole  area. 

As  I  lived  near,  I  visited  her  three  or  four 
times  a  day,  and  watched  the  case  very  care- 
fully. The  gastric  symptoms  were  so  ur- 
gent that  my  mind  was  not  at  all  prepared 
for  the  peculiar  sequelae  about  to  be  des- 
cribed. 

About  3  o'clock  in  the  afternoon  I  was 
hastily  summoned  to  her  bedside  to  be  told 
that  she  was  sinking  rapidly.  Every  ap- 
pearance of  the  patient  confirmed  that  opin- 
ion. A  cadaverous  color  of  skin,  bathed 
in  a  cold  sweat,  no  pulse  at  the  wrist,  res- 
pirations 40  to  50  to  the  minute,  and  every 
symptom  pointed  to  a  rapid  dissolution. 

I  remained  with  her  for  several  hours,  and 
to  my  surprise,  about  7  o'clock  she  began 
to  rally,  and    under  the  influence  of   stimu- 


184 


THE  CHARLOTTE  MEDICAL  JOURNAL 


lants  she  soon  regained  consciousness.  I 
regret  that  I  did  not  keep  a  daily  record  of 
symptoms,  but  soon  after  this  my  attention 
was  called  to  the  peculiar  character  of  the 
discharges.  Floating  in  a  thin  liquid  I 
noticed  shreds  of  membrane,  mucus,  &c, 
which  at  first  made  me  think  of  dysentery, 
but  that  was  too  contradictory  to  all  the 
symptoms. 

Here  was  a  bowel  retaining  and  absorb- 
ing all  the  nourishment  she  had  taken  for 
three  weeks,  with  little  or  no  tormina  or 
tenesmus  at  stool,  so  I  was  compelled  to 
await  developments  before  giving  &  positive 
diagnosis.  The  gastric  symptoms  improved 
rapidly  from  this  time,  but  the  emaciation 
was  extreme,  such  as  is  seen  in  typhoid 
about  the  fourth  week.  The  father  was  a 
very  intelligent  gentleman,  and  I  requested 
him  to  examine  carefully  all  the  dejecta. 
From  time  to  time,  but  not  constantly,  did 
these  exudates  appear  ;  but  one  morning  he 
showed  me  a  piece  of  the  tubular  variety, 
six  inches  or  more  in  length.  My  diagnosis 
of  pseudo-membranous  enteritis  was  then 
made  out.  The  treatment  was  supporting 
internally,  astringents  locally ;  first  the 
vegetable,  but  later,  nitrate  of  silver,  10 
grains  to  the  ounce,  introduced  through  a 
rectal  tube  12  inches  long. 

The  digestion  was  then  so  much  improved 
that  she  took  readily  liquid  nourishment  in 
the  normal  way.  These  applications  of 
silver  were  made  once  a  day  until  symp- 
toms of  absorption  were  noticed  in  the  skin, 
when  they  were  discontinued.  Under  full 
doses  of  iodide  of  potash  the  skin  cleared 
rapidly,  and  I  then  considered  her  conva- 
lescent. As  soon  as  practicable,  and  on 
account  of  the  near  approach  of  hot  weather, 
a  change  to  the  up-country  was  suggested. 
She  continued  to  pass  shreds  of  membrane 
for  about  three  months,  and  had  a  slight 
attack  of  indigestion  while  away,  but  with 
this  exception  her  convalescence,  though 
slow,  was  uninterrupted.  When  she  was 
advanced  far  enough  to  begin  walking,  she 
lost  all  power  of  co-ordination  and  had  to 
be  taught  as  an  infant.  I  have  given  a  very 
imperfect  history  of  the  case,  and  will  re- 
capitulate in  so  far  as  to  show  the  varia- 
tions from  the  normal  course  of  the  disease. 

1st.  The  patient  was  a  child  of  five  years, 
whereas  all  reported  cases  are  adults. 

2d.  The  attack  was  ushered  in  with  the 
most  alarming  symptoms,  attended  by  high 
febrile  excitement. 

3d.  The  course  of  the  disease  was  much 
shorter  than  usual — most  cases  assuming  a 
chronic  character  and  running  on  for  years. 

4th.  Complete  loss  of  motion,  and  later 
of  co-ordination. 

I  have  not  seen   the  case  for   three  years, 


but  from  last  accounts  she  had  made  a  com- 
plete recovery,  developing  rapidly,  both 
mentally  and  physically. 

DISCUSSION. 

Dr.  S.  C.  Baker. — I  would  like  to  ask 
Dr.  Fladger  a  question  in  reference  to  this 
case.  I  would  not  like  to  enter  into  a  dis- 
cussion of  the  paper  from  his  standpoint. 
I  would  like  to  ask  if  there  was  any  deposit 
from  the  throat  in  any  way. 

Dr.  Fladger. — None  at  all. 

Dr.  Baker. — It  simply  occurred  to  me 
when  you  spoke  of  loss  of  muscular  power 
later  on  in  the  disease  that  perhaps  it  was  a 
diphtheritic  affection.  It  seemed  tome  pos- 
sible that  diphtheria  might  attack  the  stom- 
ach and  intestines  without  being  observed 
in  the  fauces.  I  simply  wanted  to  ask  the 
question. 

Dr.  W.  L.  Robinson. — I  would  like  to 
ask  in  the  same  line  whether  or  not  there 
was  much  pain  connected  with  the  first  stage 
of  this  affection. 

Dr.  Fladger. — No,  sir,  no  great  pain, 
not  so  much  as  I  expected  to  see. 

Dr.  Robinson. — My  motive  for  asking 
was  that  I  have  had  two  cases  of  intes- 
tinal diphtheria,  one  about  five  years  a] 
in  which  we  were  slow  in  diagnosing  be- 
cause the  symptoms  of  diphtheria  were  not 
developed  elsewhere  for  some  little  while. 
In  that  case  there  was  intense  pain,  the  pa- 
tient for  days  had  to  be  kept  under  the  in- 
fluence of  anodynes  given  in  large  quantities. 
However,  large  portions  of  the  mucous 
membrane  were  thrown  off,  and  it  was  dem- 
onstrated later  that  it  was  a  case  of  diph 
theria.  In  the  last  eighteen  months  I  had  a 
similar  case  of  intestinal  diphtheria  who 
was  more  easily  diagnosed  on  account  of  the 
experience  with  the  first.  The  anti-diph- 
theritic serum  promptly  relieved  in  a  few 
days ;  the  cast  of  the  bowels  being  thrown 
off  and  subsequent  manifestations  on  throat 
proved  diagnosis — both  recovered. 

The  case  of  the  essayist  was  a  most  unu- 
sual one,  difficult  of  diagnosis.  Sepsis, 
doubt  not.  entered  largely  into  the  course 
of  the  disease,  and  helped  to  baffle  the  doc- 
tor's efforts.  In  such  cases,  when  the  stom- 
ach will  not  retain  and  the  bowel  is  irrita- 
ble, I  have  used  the  saline  solution  (with 
Valentine's  meat  juice  added)  injected  un- 
der the  mammary  glands  with  decided  ben- 
efit. In  post-operative  cases  it  is  especially 
useful. 

Dr.  Crowei.l. — I  would  like  to  ask  the 
Doctor  if  he  said  the  patient  had  no  rise  of 
temperature.  I  thought  he  stated  there  was 
no  temperature. 

Dr.  Fladger. — You  are  mistaken,  the 
temperature  was  high  all  the  time. 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


Dr.  Hugh  T.  Nklson. — Almost  all  of  us 
under  certain  circumstances  have  observed 
cases  of  pseudo-membranous  enteritis. 
In  a  large  female  school  not  very  far  from 
the  town  I  live  in,  some  eighteeen  years 
ago,  there  were  several  cases  of  what  was 
thought  to  be  and  I  suppose  undoubtedly 
was  diphtheria,  which  we  hadn't  the  means 
of  determining  then  as  we  have  now.  Two 
of  those  young  ladies  were  very  ill,  and  one 
of  them  died.  Another  one  during  the  ill- 
ness of  these  two  cases  gave  no  evidence  to 
any  of  the  physicians  in  attendance  of  any 
diphtheritic  deposits  and  symptoms  of  en- 
teritis, and  it  went  on,  prostration  became 
very  great,  and  she  went  on  and  died.  Of 
course  we  made  no  analysis,  but  the  opinion 
of  the  physician  in  attendance  was,  a  case 
of  diphtheritic  enteritis.  The  case  was 
carefully  watched,  but  there  never  was  any 
indication  of  any  trouble  of  this  kind  until 
these  evidences  came,  from  the  bowels.  I 
am  certain  this  was  a  case  of  genuine  en- 
teric (or  enteritic)  diphtheria.  I  don't 
think  she  was  sick  over  seven  or  eight  days 
from  the  time  she  was  taken  ill. 


Report  of  a  Case  of  Appendicitis,  Compli 

eated  with   Intestinal  Perforation  — 

Recovery.! 

By  George  W.  Long,  M.  I).,   Graham.  N.  '  '. 

My  reason  for  not  attempting  a  discussion 
of  the  diagnosis,  pathology  and  treatment 
of  appendicitis  is  simply  because  1  know  I 
am  not  competent  to  pass  upon  it.  Infor- 
mation gained,  however,  from  examining 
work  already  done  by  others  that  are  com- 
petent authority,  and  my  own  limited  expe- 
rience, leads  me  to  believe  that  it  is  possible 
for  a  general  country  surgeon,  who  is  sim- 
ple and  clean  in  his  surgical  work,  and 
methods,  who  uses  his  own  common  sense, 
and  does  not  try  to  follow  any  body's  spe- 
cial method,  to  add  greatly  to  the  conserva- 
tion of  human  life.  To  emphasize  this 
thought,  1  will  briefly  give  you  some  of  the 
salient  points  of  a  case  which  recently  came 
under  my  own  observation. 

The  patient  was  too  poor  to  secure  the 
services  of  an  expert  surgeon,  or  to  go  to  a 
hospital  for  treatment.  Mrs.  T.  S.,  aged 
19,  colored,  mother  of  two  children,  con- 
sulted Dr.  George  W.  Kernodle,  September 
12th,  189S,  complaining  of  slight  fever  and 
soreness  over  the  abdomen,  which  the  doctor 
suspected  might  be  the  beginning  of  an  at- 
tack of  typhoid  fever.      Appropriate    treat- 


fRead  before  the  Tri-State  Medical  Society  of 
the  Carolina*  and  Virginia,  at  Charlotte,  N.  C, 
January,  1899. 


ment  caused  patent  to  become  much  more 
comfortable,  but  never  so  much  so  as  to  per- 
mit her  physician  to  feel  that  all  was  well. 
September  19th,  1898,  the  doctor  was  called 
to  find  her  aborting.  October  1st,  she  was 
moved  in  a  wagon,  on  a  bed,  half  a  mile. 
October  7th,  Dr.  Kernodle  called  me  in  con- 
sultation. 

She  presented  a  picture,  coupled  with  the 
previous  history,  which  pointed  unmistak- 
ably to  pus  in  the  right  side  of  the  belly. 
We  informed  her  and  her  friends  that  we 
thought  she  had  appendicitis,  and  although 
the  outlook  was  not  promising,  the  thing 
to  do  was  to  open,  at  once,  the  belly  and 
liberate  the  pus.  Accordingly,  with  the 
best  aseptic  precautions  possible,  under  the 
circumstances,  with  our  crude  environments, 
under  Squibb's  ether,  a  large  quantity  of 
foul  pus  was  liberated  by  an  incision  several 
inches  long,  in  the  usual  locality.  At  the 
time,  Dr.  Kernodle  suggested  that  the  pus 
had  a  fecal  odor.  I  have  to  regret  that  I 
failed  to  appreciate  his  valuable  suggestion, 
as  will  appear  later. 

Having  made  several  ineffectual  attempts 
to  find  the  appendix,  we  decided  to  make 
a  counter  opening  in  the  lumbar  region, 
improvise  a  drainage  tube  out  of  soft  cath- 
eter, irrigate  with  warm  saline  solution, 
and  pack  with  gauze.  The  patient  reacted 
nicely,  ordered  light,  nutritious  diet,  abso- 
lute rest,  dorsal  decubitus.  Dr.  Kernodle 
resided  near  by,  and  gave  her  all  necessary 
attention  for  about  a  month,  watching  her 
general  improvement ;  the  posterior  wound 
healing  up  all  right,  but  the  one  in  the  ab- 
domen only  partially  so. 

One  month  from  the  first  operation  I  was 
re-called,  and  in  this  consultation  we  had 
also  the  valuable  services  of  Dr.  J.  L.  Ker- 
nodle. The  discharges  from  the  abdominal 
wound  were  decidedly  fecal,  and  Dr.  Ker- 
nodle informed  me  that  gas  and  ingested 
material  had  been  escaping  ever  since  my 
last  visit.  We  decided  to  enlarge  the  open- 
ing and  proceeded  under  ether,  as  before, 
commencing  just  below  the  border  of  the 
ribs,  an  incision  was  carried  down  to  and 
below  the  McBurney  point,  opening  up 
probably,  a  larger  field  than  an  expert  would 
have  required.  We  found  a  large  opening 
in  the  lower  portion  of  the  ascending  colon 
with  very  necrotic,  ragged  edges.  The  per- 
foration in  the  bowel  was  so  large  that  Dr. 
Kernodle  easily  carried  a  large  sized  sponge 
in  his  hand  well  up  into  the  colon.  The 
appendix  was  finally  found,  though  with 
considerable  difficulty,  ligated  about  one- 
eighth  of  an  inch  from  the  cajcum,  with 
silk  and  cut  off.  Apparently  it  was  per- 
fectly normal  and  healthy.  A  longitu- 
dinal section  of  it,  made  at  once,  revealed 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


two  very  small  substances,  possibly  the  size 
of  hemp  seed,  which  we  supposed  were 
enteroliths.  The  ragged  edges  of  the  rent 
in  the  bowel  were  trimmed  with  scissors, 
sutured  with  a  common  cambric  needle, 
armed  with  silk  after  Lembert's  method 
— the  peritoneal  surfaces  of  the  bowel 
being  brought  togefher.  A  warm  saline 
irrigation,  a  gauze  packing,  over  this 
absorbent  cotton,  an  abdominal  bandage,  to 
be  changed  as  indicated,  bowels  to  be  bound, 
absolute  rest,  opiates  if  necessary,  light  nu- 
tritious diet,  dorsal  decubitus,  constituted 
the  treatment.  The  bowels  acted  by  enema 
one  week  from  the  operation,  and  have 
been  moving  satisfactorily  ever  since.  The 
abdominal  wound  had  about  healed  the  lat- 
ter part  of  December,  which  was  the  last 
time  I  saw  the  case.  The  cure  seems  to  be 
all  that  could  be  desired.  Patient  able  to 
walk  about  the  house,  though  advised  to 
resume  customary  work  gradually.  I  was 
not  surprised  at  rinding  the  perforation  in 
the  bowel,  especially  when  I  recalled  Dr. 
Kernodle's  suggestion  in  the  first  operation, 
but  I  was  at  a  loss  to  know  how  such  a  fine, 
healthy  looking  appendix  could  be  consis- 
tent with  an  appendicitis,  complicating  in- 
testinal perforation.  Whether  the  removal 
of  the  appendix  was  right  or  not  is  still  to 
me  a  questio  vexata. 

DISCUSSION. 

Dr.  J.  W.  Long. — The  paper  to  which 
we  have  just  listened  is  an  interesting  one 
and  represents  one  of  the  complications  that 
we  are  liable  to  find  in  appendicitis.  While 
the  doctor  was  reading  his  paper  my  mind 
ran  back  over  some  of  the  cases  of  ap- 
pendicitis I  have  seen,  and  I  recall  two, 
possibly  three  cases  where  the  appendicitis 
was  complicated  by  a  perforation  of  the 
secum.  One  case  I  remember  distinctly 
was  where  the  perforation  was  just  at  the 
base  of  the  appendix  and  took  in  perhaps 
two  or  three  lines  of  the  secum  proper.  In 
other  words,  there  was  a  perforation  which 
embraced  the  size  of  the  base  of  the  appen- 
dix, or  the  secum.  I  do  not  recall  that  in 
these  cases  I  made  any  effort  more  than  1 
do  in  an  ordinary  case  of  sloughing,  perfor- 
ated septic  appendix.  The  appendix  in 
each  case  was  perforated  and  the  dressing 
employed;  that  is  the  drainage  because 
the  amount  of  sepsis  from  it  would  have 
been  more  than  improper  to  have  closed  an 
opening  of  this  kind  without  drainage,  as 
the  chief  object  is  drainage. 


A  woman  at  No-Name  Pond,  Me,  says 
the  Boston  Herald,  has  recently  given  birth 
to  her  twenty-fifth  son. 


Headache- Ocular  and  Nasal.f 

By  Joseph  A.  White,  A.  M.,  M.  D.,  Professor  of 

Eye  Diseases  and  Associate  Professor  of  Ear, 
Nose  and  Throat  Diseases  in  the  University 
College  of  Medicine,  Richmond.  Va.;  Surgeon 
to  the  Richmond  Eye,  Ear,  Nose  and  Throat 
Infirmary;  Member  of  the  American  Ophthal- 
mological  Society;  The  American  Laryngo- 
logical,  Rhinological  and  Octological  Society, 
etc.,  etc. 

Headache  or  neuralgia,  intermittent  or 
constant,  periodical  or  continuous,  is  one  of 
the  annoying  pathological  conditions,  that 
confront  the  practitioner  at  every  turn  in 
his  professional  work.  Its  etiology  is  fre- 
quently a  problem  as  hard  to  solve  as  any 
abstruse  question  in  astronomy.  Remedy 
after  remedy  fails  to  give  relief,  and  both 
physician  and  patient  are  in  despair  of  ever 
getting  rid  of  what,  for  want  of  a  better 
name,  is  denominated  "nervous  headache 
or  neuralgia."  And  yet  this  term,  chosen 
at  random,  designates  exactly  what  it  is,  a 
reflex  irritability  of  the  tri-geminal  branches 
from  easily  explained  causes,  which  have 
only  been  thoroughly  investigated  by  spe- 
cialists in  the  last  twenty  years,  although 
occasionally  referred  to  by  some  writers 
during  the  last  two  centuries.  I  do  not 
propose,  therefore,  to  discuss  any  new  pro- 
position, but  simply  to  submit  well  known 
facts  to  refresh  the  memory  of  those  who 
know  as  much  of  this  subject  as  I  do,  and 
to  arouse  the  attention  of  others  who  may 
have  overlooked  them.  If  you  will  recall 
your  professional  reading  to  mind,  very 
few  of  you  can  remember  many  references 
to  the  influence  of  eye  and  nasal  troubles  in 
the  production  of  headache.  Even  in  the 
text-books  on  Eye  and  Nasal  Diseases,  ex- 
cept in  a  limited  number  issued  in  the  last 
few  years,  little  or  no  importance  is  attach- 
ed to  this  subject.  It  is  true  that  in  speak- 
ing of  "asthenopia,"  headache  is  sometimes 
given  as  a  symptom,  but  no  special  stress  is 
laid  upon  it.  As  short  a  time  back  as  1888 
(only  ten  years)  Coming's  book  on  head- 
ache and  neuralgia,  although  dedicated  to  a 
prominent  occulist,  practically  excludes  the 
eye  and  nose  in  the  etiological  consideration 
of  the  subject.  It  seemed  to  me,  therefore, 
an  eminently  practical  matter  to  bring  be- 
fore this  body  of  busy  and  intelligent  medi- 
cal men,  who  meet  together  to  receive  and 
impart  information  that  might  prove  of 
mutual  interest  and  benefit  to  them  or  their 
patients. 

We  constantly  meet  with  cases  of   head- 


|Read  before  theTri-State  Medical  Society  of 
the  Carolinas  and  Virginia,  at  Charlotte,  N.  C, 
January,  1899. 


THECHARLOTTE   MEDICAL  JOURNAL. 


187 


ache  in  persons  of  all  ages,  which,  with  a 
little  careful  questioning,  can  be  traced  di- 
rectly to  its  startpoint  in  the  use  or  abuse 
of  the  eyes,  because  it  occurs  only  when 
the  eyes  have  been  used  continuously  at  j 
close  work,  and  as  a  further  confirmation  ' 
of  this  diagnosis,  there  is  no  discomfort 
when  eye  work  is  discontinued.  Moreover, 
the  eyes  themselves  give  other  symptoms 
calling  attention  to  them,  such  as  smarting, 
congestion,  and  soreness.  All  of  us  are  fa- 
miliar with  such  cases.  It  is  the  ordinary 
picture  of  asthenopia  or  weak  eyes,  whether 
due  to  refractive  or  muscular  defects.  It  is 
these  cases,  to  which  the  older  text-books 
referred,  when  headache  was  mentioned  at 
all  as  one  of  the  consequences  of  laborious 
eye  work  ;  yet  in  some  of  them  medical  ob- 
servers were  led  astray  by  the  severity  of 
the  head  symptoms  into  attributing  them  to 
cerebral  causes. 

When  the  headache  is  frontal  or  tempo- 
ral, and  is  accompanied  by  unmistakable 
symptoms  of  eye  trouble,  and  can  be  shown 
to  follow  upon  use  of  the  eyes,  few  physi- 
cians will  make  an  error  in  diagnosis;  al- 
though, even  when  we  have  such  a  clearly 
defined  clinical  picture,  1  have  known  cause 
and  eil'ect  confounded,  in  as  much  as  the 
patients  have  been  told  that  the  trouble  was 
malarial,  rheumatic  or  stomachic  neuralgia, 
and  that  the  weak  eyes  were  caused  by  the 
pain(  ?). 

But  many  of  these  cases  are  far  from 
clearly  defined.  When  we  meet  with  sub 
jects  of  chronic  cephalagia,  especially  with 
pain  in  the  parietal  and  occipital  regions, 
or  with  frontal  and  temporal  neuralgia  ac- 
companied by  stomachic  disturbances,  we 
are  not  apt  to  look  to  the  eyes  as  the  start- 
ing point  of  the  trouble,  especially  if  vision 
is  apparently  perfect,  ami  there  are  no  local 
ocular  symptoms  to  guide  us.  I  have  seen 
hundreds  of  cases  of  headache  from  latent 
defects  who  never  thought  of  their  eyes  in 
connection  with  this  trouble,  because  of 
their  vision,  and  only  had  their  attention 
directed  to  this  possible  cause,  after  all 
treatment  failed  them,  bv  some  one  who 
had  gone  through  the  same  experience. 
Frequently  these  subjects  are  dyspeptics  and 
suffer  from  habitual  constipation,  or  are  of 
rheumatic  habit  with  excess  of  uric  acid, 
deficient  excretion  of  urea,  and  defective 
liver  action,  and  in  consequence  the  physi- 
cian is  led  further  from  the  true  source  of 
the  trouble,  in  ascribing  it  to  these  appa- 
rent causes.  Again  we  meet  with  subjects 
where  both  physician  and  patient  are  at 
first  satisfied  that  eye  trouble,  probably 
some  marked  refractive  error,  is  the  cause, 
and  being  disappointed  because  its  seeming- 
ly perfect  correction  does  not  give  the  ex- 


pected relief,  at  once  eliminate  the  eyes 
from  any  further  etiological  consideration 
and  branch  out  in  other  lines  in  the  search 
for  its  causation.  Eye  strain,  causing  local 
or  reflex  discomfort,  comes  at  times  from 
so  many  differing  ocular  conditions  that  the 
expected  results  are  not  always  achieved  by 
even  the  perfect  correction  of  the  more  pro- 
nounced defect.  Temporary  relief  is  often 
obtained,  to  be  followed  later  on  by  a  re- 
lapse from  the  irritation  set  up  by  the  slight- 
er uncorrected  error,  whether  of  refractive 
or  of  muscular  equilibrium.  Moreover, 
these  defects  are  frequently  grafted  upon  a 
neurotic  constitution  that  readily  responds 
by  reflex  nervous  disturbances  to  the  slight- 
est local  irritation,  and  unless  all  the  trouble 
is  thoroughly  corrected  no  permanent  result 
is  achieved. 

The  ocular  causes  of  headache,  neuralgia, 
etc.,  etc.,  are  either  defects  in  the  shape  of 
the  eyeball,  refractive  errors,  so-called, such 
as  near  sight,  far  sight  or  irregular  refrac- 
tion (astigmatism)  ;  or  lack  of  proper  bal- 
ance in  the  muscles  that  move  the  eye  (mus- 
cular error)  ;  or  both  combined.  As  the 
latter  for  the  most  part  depend  upon  the 
former  they  are  usually  associated, although 
we  often  find  refractive  errors  without  in- 
terference with  the  muscular  equilibrum, 
and  occasionally  defective  muscular  balance 
without  refractive  errors.  Hence  it  is  that 
the  aa [jit  st nic nt  of  glasses  does  not  always 
cure  the  reflex  effect,  even  when  apparently 
the  restoration  of  vision  is  perfect.  Swanzy 
in  the  last  edition  of  his  book,  says,  "As- 
tigmatics  (i.  e.  people  who  have  an  irregu- 
lar refractive  condition  of  the  eyes)  fre- 
quently suffer  from  headache  due  to  constant 
effort  to  see  distinctly,  and  we  cure  the 
headache  when  we  correct  the  astigma- 
tism." Whilst  in  the  main  this  statement 
is  true,  it  is  not  invariably  so, because  these 
subjects  are  sometimes  sufferers  from  imper- 
fect muscle  balance,  which  does  not  adjust 
itself,  even  after  the  correction  of  the  opti- 
cal error,  which  might  have  been  its  pri- 
marv  cause.  In  the  perfect  adjustment  of 
the  muscular  defect,  as  well  as  the  correc- 
tion of  the  optical  error,  lies  the  secret. 
And  yet  many  ophthalmologists  overlook 
this  point,  due  to  the  fact  that  lack  of  mus- 
cle balance  may  be  latent,  being  concealed 
by  tension  of  the  recti  muscle,  just  as  re- 
fractive errors,  especially  far  sight  and  far 
sighted  astigmatism,  may  be  latent,  con- 
cealed by  tension  of  the  ciliary  muscle.  It 
sometimes  requires  the  most  persistent  and 
repeated  efforts  with  prisms  to  reveal  it, 
especially  if  the  defect  is  a  lack  of  accurate 
leveling  of  the  two  eyes,  or  so-called  hyper- 
phoria. I  have  seen  cases  of  one  or  two 
degrees  of  hyperphoria  that  manifested  not 


188 


THE  CHARLOTTE   MEDICAL  JOURNAL. 


the  slightest  trace  in  the  ordinary  examina- 
tion with  the  phorometer  (an  instrument 
of  precision  arranged  with  rotary  prisms  to 
measure  defects  of  the  ocular  muscles),  just 
as  we  have  all  seen  cases  of  far  sight  and 
low  grade  far  sighted  astigatism  that  could 
not  be  improved  in  vision  by  any  glass,  as 
it  was  already  perfect.  The  use  of  a  myd- 
riatic, however,  promptly  reveals  the  latter 
defects  by  depriving  the  accommodative 
muscle  of  its  excessive  tension  and  power 
of  correcting  the  defect ;  but  the  artificial 
double  vision,  given  by  the  horizontally 
placed  prisms  in  the  phorometer  for  the  de- 
tection of  hyperphoria,  does  not  always  re- 
lax the  undue  tension  of  the  superior  and 
inferior  recti,  which  conceals  the  muscular 
error.  Strange  to  say  this  very  rarely  ap- 
plies to  the  vertically  placed  prisms,  as  the 
deviation  of  the  eyes  in  or  out,  known  as 
esophoria  and  exophoria,  are  almost  invari- 
ably detected  by  this  means.  In  fact,  as 
exophoria,  or  outward  deviation  of  the 
eyes,  is  often  an  expression  or  result  of  the 
defective  vertical  balance,  caused  by  the 
latent  hyperphoria,  its  presence  is  some- 
times the  only  clue  we  have  to  the  existence 
of  the  latter;  and  especially  is  this  true,  if, 
when  measuring  the  strength  of  the  internal 
and  external  recti  by  prismatic  exercises, 
we  find  they  both  approximate  the  normal 
standard,  notwithstanding  the  apparent 
outward  tendency.  I  have  a  case  in  my 
mind  that  came  to  me  several  years  ago 
from  a  distance,  a  young  woman  of  neuro- 
tic tendency  who  had  long  suffered  from 
persistent  headache,  for  which  all  kinds  of 
treatment  had  been  instituted,  not  neglect- 
ing the  uterus  in  the  general  search  for  the 
cause,  but  without  avail.  A  suggestion 
that  her  eyes  might  be  a  factor  in  her  trou- 
ble brought  her  for  examination.  I  found 
low  grade  astigmatism  with  oblique  meri- 
dians, and  felt  satisfied  its  correction  would 
relieve  her.  It  did,  but  the  effect  was  not 
lasting,  and  inside  of  two  months  she  was 
back  again.  The  phorometer  gave  me  no 
encouragement  to  hope  that  I  would  solve 
the  problem,  as  there  was  apparently  no 
lack  of  muscle  balance,  but  when  tested  the 
strength  of  the  superior  recti  with  vertically 
placed  prisms,  I  found  such  contradictory 
results  in  different  sittings  that  I  was  confi- 
dent there  was  some  hyperphoria.  1  made 
her  wear  a  prism  with  base  up  before  one 
eye  for  several  days,  when  the  defect  be- 
came slightly  manifested;  but  in  a  few 
hours  after  taking  off  the  prism,  there  was 
a  re-establishment  of  the  muscle  balance. 
After  two  weeks  of  this  experience,  I  de- 
cided to  cut  the  superior  rectus  of  the  ap- 
parently higher  eye.  I  did  a  partial  central 
tenotomy,  and  on  using  the  phorometer  to 


see  the  result,  found  a  still  greater  degree 
of  hyperphoria  manifested,  because  of  the 
traumatic  disturbance  of  the  abnormal  ten- 
sion of  the  vertical  muscles.  I  increased 
the  effect  at  once  until  the  eyes  were  leveled. 
All  discomfort  disappeared  and  up  to  this 
time,  several  years  after,  she  has  had  no 
further  trouble.  This  case  shows  how  dif- 
ficult it  is  at  times  for  even  an  expert  to 
make  a  positive  diagnosis. 

Refractive  cases  are  equally  puzzling  at 
times.  Even  when  the  correction  of  the 
defect  is  apparently  all  that  could  be  desired 
after  a  thorough  examination  under  a  my- 
driatic, with  resulting  perfect  vision,  head- 
ache will  persist.  This  is  due  sometimes  to 
neglecting  to  incorporate  a  low  grade  cylin- 
der for  a  correction  of  a  slight  astigmatism 
with  the  spherical  lens,  whether  in  far  sight 
or  in  near  sight,  but  especially  in  the  former 
defect,  and  this  is  particularly  the  case  when 
the  astigmatic  meridian  slants  or  is  oblique. 
The  greatest  care  is  required  in  the  adjust- 
ment of  such  a  cylinder,  because  if  it  is  not 
exactly  in  the  correct  axis  there  will  be  no 
relief.  It  is  astonishing  at  times  what  a 
slight  variation  in  the  position  of  the  cylin- 
der will  make  or  mar  the  result  as  far  as 
comfort  is  concerned,  although  the  varia- 
tion in  vision  may  be  almost  imperceptible. 
Repeated  subjective  examinations,  the  astig- 
mometer,  and  retinoscope  all  must  be 
brought  into  play  to  give  the  most  harmo- 
nious results. 

It  is  these  cases  of  slight  refractive  errors, 
especially  if  combined  with  latent  defective 
muscle  balance,  that  present  the  greatest 
difficulties.  I  hive  seen  many  patients 
whose  lives  were  made  miserable  by  con- 
stant pain  in  the  back  and  top  of  the  head 
whose  vision  was  perfect  and  with  eye  mus- 
cle balance  apparently  normal,  and  yet  the 
pain  was  due  to  eye  strain,  from  the  unin- 
termitting  effort  to  keep  vision  perfect  and 
the  muscle  balance  normal  by  overcoming 
a  low  grade  astigmatism  and  a  slight  mus- 
cular error,  as  in  the  case  above  referred  to. 
In  some,  glasses  alone  give  relief  ;  in  others, 
prism  exercises  are  required  ;  and  in  a  min- 
ority of  them  adjustment  of  the  muscle  bal- 
ance by  operation  is  necessary. 

It  is  curious  that  the  most  marked  refrac- 
tive errors  and  the  most  decided  muscular 
defects,  amounting  even  to  strabismic  de- 
viation, are  not  the  ones  that  give  the  most 
trouble  in  regard  to  headache,  neuralgia, 
etc.  It  is  true  that  headache  frequently  re- 
sults from  the  effort  to  overcome  high  de- 
gree of  far  sight  and  astigmatism,  and  abo 
from  the  excessive  demand  upon  the  con- 
verging muscles  in  marked  near  sight.  But 
these  cases  are  usually  those  that  give  most 
satisfactor/  results  from    proper  adaptation 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


of  glasses,  either  spherical,  cylindrical  or 
prismatic.  Occasionally,  however,  we  find 
the  muscular  defect  out  of  all  proportion  to 
the  refractive  error,  amounting  sometimes 
to  latent  double  vision  (which  becomes  man- 
ifest by  placing  a  red  glass  over  one  eye), 
or  even  to  the  abolition  of  binocular  vision, 
and  this  too  without  any  apparent  devia- 
tion of  the  eyes  from  parallelism.  You  can 
easily  understand  how  great  the  strain  on 
such  eyes  must  be,  and  the  natural  irritation 
that  must  arise  from  the  continual  effort  to 
coalesce  or  ignore  the  double  images  in  the 
field  of  vision. 

If  time  permitted,  I  could  give  many  in- 
teresting examples  from  my  case  book  of 
these  conditions.  I  will  refer  to  one,  how- 
ever, because  of  its  interesting  features  and 
its  satisfactory  result. 

It  was  a  married  woman,  the  daughter  of 
a  physician,  who  had  been  a  great  sufferer 
for  years,  which  she  attributed  to  an  annoy- 
ing form  of  indigestion,  called  by  her  phy- 
sician "nervous  dyspepsia,"  and  which 
compelled  her  to  confine  herself  to  the  most 
rigorous  diet.  She  had  a  decided  refractive 
error,  accompanied  by  defective  conver- 
gence, amounting  at  times  to  double  vision 
without  apparent  outward  deviation.  The 
correction  of  the  optical  error  l>v  glasses  im- 
proved her  vision  and  allowed  her  more 
latitude  in  the  use  of  her  eyes,  but  with 
slight  modification  of  her  attacks  of  head- 
ache. I  advised  her  to  allow  tenotomies  to 
be  done  to  correct  the  muscular  defect,  and 
she  consented  to  the  opera! ionf.  The  re- 
sult was  the  correct  ion  of  the  muscular  error. 
the  cessation  of  the  headache,  and  the  res- 
toration of  a  good  digestion,  all  the  symp- 
toms of  so-called  nervous  dyspepsia  having 
disappeared.  These  had  evidently  been 
manifestations  of  a  reflex  nervous  distur- 
bance emanating  from  the  local  irritation 
caused  by  the  eye  strain. 

Sometimes  I  have  cases  referred  to  me 
suffering  from  recurring  frontal  headache, 
pain  in  the  top  of  the  head,  or  neuralgia  of 
the  first  or  second  branches  of  the  trigemi- 
nus, supposedly  caused  by  some  ocular  de- 
fect, especially  when  the  pain,  as  it  often 
does,  involves  the  eyeball  itself,  as  well  as 
the  surroundings  of  the  orbit.  The  most 
critical  examination  of  the  eye  fails  to  re- 
veal the  slightest  optical  error  or  defective 
muscle  balance,  practically  excluding  the 
eye  from  being  the  causation,  and  necessi- 
tating investigation  in  another  direction. 
What  is  more  natural  than  to  look  to  the 
upper  air  passages,  so  richly  supplied  by 
branches  of  the  trigeminus,  as  a  possible 
location  for  the  origin  of  the  disturbance  in 
the  domain  of  this  nerve,  whether  conges- 
t  i  \  <■  headache,  migraine  or  neuralgia?      If  a 


person  has  neuralgia  in  the  lower  jaw,  you 
do  not  go  to  the  lower  end  of  the  spinal 
column  to  look  for  its  causation.  Even  if 
there  is  no  local  pain  in  any  special  tooth, 
you  would  naturally  expect  some  trouble  of 
the  teeth,  and  look  there  first  for  the  pos- 
sible origin  of  the  irritation  in  the  domain 
of  the  inferior  maxillary.  Is  it  not  logical, 
therefore,  to  search,  first,  at  home  for  the 
trouble  in  the  domain  of  the  other  two 
branches  of  the  trigeminus,  namely,  in  the 
ocular  and  nasal  regions?  If  the  eye  fails 
to  show  any  cause  of  the  irritation,  it  is  not 
unwise  to  explore  the  nose  and  post-nasal 
space.  .So  many  head  pains  originate  from 
these  two  centres  of  irritation  that  their 
causation  being  demonstrated  and  corrected, 
we  will  have  only  a  minority  of  cases  of 
uncertain  origin  left  to  lay  at  the  doors  of 
imperfect  digestion,  malaria,  rheumatism, 
uric  acid.  etc.  .So  many  facts  in  support  of 
this  statement  are  recorded  in  latter  day 
medical  literature,  that  it  is  useless  to  argue 
it.  As  I  said  before,  I  wish  merely  to  re- 
call these  facts  to  your  recollection. 

A  careful  examination  of  the  nasal  spaces 
will  in  many  of  your  cases  of  headache  and 
neuralgia  only  confirm  these  facts,  and  often 
too  when  the  patients  repudiate  any  sugges- 
tion of  nasal  trouble.  Every  one  who  has 
ever  had  cold  in  the  head  knows  he  can 
have  linih  headache  and  neuralgia  as  an  \c- 
companiment  or  result  of  the  nasal  obstruc- 
tion. These  pains  in  the  forehead  and  face 
are  the  reflex  effects  of  the  direct  pressure 
and  irritation  of  terminal  branches  of  the 
trigeminus  through  its  ganglionic  connec- 
tions. For  example,  it  is  a  common  expe- 
rience for  a  patient  to  complain  of  frontal 
headache  and  pain  in  the  upper  teeth  as  the 
almost  immediate  effect  of  an  application  of 
chromic  acid  to  the  middle  turbinate,  even 
under  cocaine  anaesthesia,  and  sometimes  as 
a  result  of  merely  touching  the  turbinate 
with  a  probe.  In  the  same  way  a  very 
small  point  of  irritation  in  the  nose  or  naso- 
pharynx, from  hypertrophies,  spurs,  adhe- 
sions, etc.,  could  bring  about  reflex  pain  in 
the  head  and  face  either  intermittent  or  con- 
stant;  and  these  pathological  formations 
can  exist  in  the  nose  without  any  obstruc- 
tion and  without  any  other  local  symptoms 
to  call  the  patient's  attention  to  them. 
Hence  often  the  disclaimer  of  any  nasal 
trouble.  But  many  are  fully  conscious  of 
nasal  trouble  manifested  by  imperfect 
breathing,  the  occasional  or  continual  ob- 
struction of  one  or  the  other  nostril,  or  a 
discharge  from  the  nose,  or  a  constant  de- 
sire to  clear  the  throat.  Examination  may 
reveal  the  presence  of  adenoid  tissue  at  the 
roof  of  the  naso-pharynx,  or  thickenings  of 
the  nasal    tissues,  causing   contact  or    pres- 


190 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


sure  in  the  nostrils.  Adenoids  and  nasal 
obstruction  of  any  kind  have  been  shown 
to  be  a  fruitful  source  of  headache  and  neu- 
ralgias. I  do  not  mean  to  say  that  all  peo- 
ple who  have  such  nasal  changes  have  head- 
ache or  neuralgia.  This  would  be  as  far 
from  correct  as  to  state  that  all  people  with 
refractive  or  muscular  eye  troubles  have 
headache.  In  neither  case  would  it  be  true. 
But  I  say  of  people  who  suffer  from  head- 
ache and  facial  neuralgia  a  very  large  num- 
ber will  find  the  source  of  irritation  in  the 
eye,  or  in  the  nose  and  naso-pharynx.  Why 
some  people  suffer  from  reflex  manifesta- 
tions and  others  do  not  from  the  same  cau- 
sation is  not  easy  to  explain.  Theoretically, 
we  may  conclude  that  it  is  due  to  the  differ- 
ence in  the  condition  of  the  reflex  centres 
which  in  the  one  case  are  for  some  reason 
below  par  and  incapable  of  resisting  the  in- 
fluence of  peripheral  irritation  ;  and  in  the 
other  being  absolutely  normal  and  not  sus- 
ceptible to  the  same  influence.  Constitu- 
tional causes  which  lower  the  resistance  of 
nerve  centres,  such  as  malarial  and  rheu- 
matic changes,  imperfect  digestive  appara- 
tus, excess  of  uric  acid,  etc.,  may  undoubt- 
edly help  to  keep  up  the  malign  influence, 
but  after  the  train  of  symptoms  has  once 
started,  the  source  of  local  or  peripheral 
irritation  must  be  done  away  with  before 
constitutional  treatment  avails. 

As  already  stated,  when  there  is  trouble 
with  the  eyes,  the  error  must  be  corrected 
by  the  proper  adaptation  of  glasses,  by  pris- 
matic exercises  or  by  surgical  operations  to 
adjust  the  muscle  balance. 

When  the  causation  is  presumably  in  the 
nose  or  naso-pharynx,  we  must  look  for  the 
pathological  alteration  that  is  the  starting 
point  of  the  irritation.  If  adenoids  are  pre- 
sent, they  should  be  curetted;  if  simple 
hypertrophy  of  the  turbinates,  it  can  be  re- 
duced by  applications  of  acid  (chromic  or 
glacial  acetic)  although  sometimes  it  is 
necessary  to  remove  it  with  the  snare.  The 
most  troublesome  cases  are  those  with  dense 
hypertrophy  of  the  middle  turbinate,  re- 
sulting in  pressure  on  the  septum  and  fre- 
quently adhesions,  usually  of  an  osseous 
character,  between  them.  These  adhesions 
must  be  done  away  with  either  by  means  of 
the  saw,  drill,  cutting  forceps  or  otherwise 
and  the  enlarged  turbinate  removed.  Blen- 
orrhaui  of  the  ethmoid  spaces  is  often  an 
attendant  complication  and  adds  to  the  dif- 
ficulties. The  treatment  is  consequently 
tedious,  but  is  often  satisfactory,  even  in 
these  worse  cases,  and  eminently  so  in  the 
simpler  ones. 

In  addition  to  the  local  treatment,  both 
topical  and  surgical,  we  must  attend  to  any 
existing    dyscrasia  or  constitutional  distur- 


bances, whether  of  the  digestive  or  circu- 
latory apparatus,  and  especially  correct  any 
tendency  to  lithaemia,  by  regulation  of  the 
diet  and  appropriate  remedies. 

This  regulation  of  the  diet  and  habits,  as 
well  as  the  choice  of  remedies,  whilst  differ- 
ing according  to  individual  traits  in  each 
case,  should  be  directed  to  strengthening 
the  reflex  centres,  and  thus  not  only  confirm 
the  immediate  result  achieved  by  the  local 
treatment,  but  to  keep  up  this  good  effect 
and  prevent  relapses  by  the  improvement 
of  their  powers  of  resistance. 

200  E.  Franklin  St. 

DISCUSSION. 

Dr.  C.  W.  Kollock. — The  time  is  draw- 
ing near  for  us  to  close,  but  I  don't  like  to 
let  a  good  paper  like  that  pass  without 
saying  something.  Dr.  White,  of  course, 
has  treated  it  very  thoroughly,  and  is  right 
in  saying  it  is  this  irritation  in  refraction 
which  causes  the  greatest  trouble.  Any 
one  who  does  any  eye  work  will  bear  him 
out  in  this.  The  reason  is  that  these  peo- 
ple who  have  the  slight  error  in  refraction 
go  on  attending  to  their  usual  business  and 
never  let  the  eye  rest.  In  those  cases  in 
which  the  error  of  refraction  is  greater, 
where  cessation  from  work  is  impossible, 
then  they  should  choose  some  other  occupa- 
tion. Headache  that  comes  from  all  these 
cases  of  refraction,  want  of  balance,  etc., 
are  really  to  my  mind  the  causes  of  the 
troubles  in  breaking  up  of  the  health.  If  a 
man  has  a  headache  he  is  absolutely  unfit 
to  do  any  kind  of  work,  he  can't  think,  he 
is  disabled  for  the  time  being,  no  matter 
what  may  be  the  cause.  I  had  a  young 
man  come  to  me  whose  family  thought  he 
was  losing  his  mind  on  account  of  this  com- 
plaint of  headache.  The  examination  of  the 
eyes  revealed  the  neurosis  of  the  eyes. 
Glasses  were  prescribed,  and  the  young  man 
had  no  more  trouble.  A  lady  was  sent  to 
me  once  who  had  almost  every  disease  in 
the  catalogue  of  diseases.  Her  physician 
had  evidently  treated  her  for  every  thing  he 
could  think  of,  and  yet  she  got  no  better. 
He  finally  thought  she  had  some  trouble 
with  her  eyes,  and  the  examination  proved 
she  had  a  simple  hypertrophy.  I  treated 
her  for  that,  and  her  headaches  improved, 
her  appetite  improved,  and  she  was  finally 
cured.  She  had  been  married  at  about  35 
years  of  age,  and  was  at  that  time  37.  She 
had  never  been  pregnant ;  but  a  few  months 
after  this  treatment  she  became  pregnant. 
I  don't  mean  to  say  the  glasses  caused  this, 
but  at  the  same  time  it  was  a  very  satisfac- 
tory case.  A  lady  once  came  to  me  who 
was  suffering  tortures;  she  couldn't  lie 
down  because  of    the  pain  on    that    side  of 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


191 


the  face ;  the  pain  in  the  ear  was  terrible. 
She  couldn't  eat  because  she  couldn't  chew. 
It  was  true  she  wore  false  teeth,  but  these 
she  couldn't  wear.  I  examined  the  ear  and 
the  gums,  but  could  find  no  cause  for  the 
trouble.  I  must  admit  that  I  slipped  up 
here  in  my  examination  and  didn't  examine 
the  nasal  cavity.  Why  I  did  not  do  it  I 
don't  know,  except  that  I  was  somewhat 
dumb-founded  at  finding  nothing  the  mat- 
ter with  the  eye  and  ear.  During  the  ex- 
aminations she  sniffled  once  or  twice.  I 
said,  "You  have  got  a  cold."  She  said, 
"Oh,  I  have  a  little  cough."  I  then  found 
the  trouble,  and  she  made  a  prompt  recov- 
ery. 

Dr.  D.  A.  Kuyk.— Dr.  White  has  fully 
covered  the  ground,  but  I  want  to  report 
another  case  of  a  lady  patient  whom  I 
treated.  This  lady  had  been  confined  to  a 
dark  room  for  about  three  weeks  and  was 
afraid  to  go  out  at  night.  She  came  to  my 
place  with  a  heavy  shade  over  her  eyes  and 
her  face  incased  in  a  double  veil.  Upon 
testing  her  eyes  I  found  just  the  condition 
which  Dr.  White  so  aptly  described  of  as- 
tigmatism in  the  ciliary  muscle.  The  treat- 
ment of  this  entirely  relieved  her,  not  at 
once  of  the  terrible  sensitiveness  to  light, 
but  of  the  accompanying  headache.  All  of 
you,  no  doubt,  have  had  similar  experien- 
ces, but  here  was  that  poor  creature  who 
had  been  confined  to  her  room  with  head- 
ache for  weeks. 

Dr.  John7  Dunn. — There  are  two  points 
in  Dr.  White's  paper  to  which  1  want  to 
refer.  In  the  first  place,  Dr.  White  said 
the  impossibility  of  giving  relief  by  cor- 
rection of  the  refractive  error  in  the  hyper- 
phoria, the  correction  of  the  refractive 
error  may  fail  to  give  relief,  but  at  the 
same  time  it  gives  such  a  clearing  to  vision 
that  the  demand  for  accurate  single  vision 
is  imperative,  ami  thus  it  often  happens 
that  the  correction  of  a  refractive  error 
makes  the  patient  suffer  more,  provided 
the  muscular  errors  be  left  unrelieved,  will 
make  the  patient  suffer  more  than  he  did 
when  he  wore  no  glasses  at  all.  This  is  a 
very  important  point,  and  it  is  one  that 
often  causes  the  general  practitioner  a  good 
deal  of  criticism  on  the  part  of  the  oculist 
who  gives  the  correct  glasses  for  the  refrac- 
tive error  but  fails  to  correct  because  of  the 
patient's  unwillingness  to  be  treated  for 
muscular  error.  Another  point  is  that  not 
all  refractive  errors  need  glasses.  The  gen- 
eral condition  of  the  patient  has  a  good 
deal  to  do  with  tin-  necessity  for  wearing 
glasses.  This  is  often  seen  for  instance 
after  an  attack  of  fever  when  to  accommo- 
date the  eyes  is  made  with  a  great  deal  of 
effort,  and  where  the  use  of  the  eyes  is  very 


painful  for  a  considerable  number  of  weeks. 
Not  only  so,  but  in  cases  of  uterine  trouble. 
The  use  of  appropriate  glasses  will  not  give 
relief  in  a  great  many  cases  as  long  as  the 
uterine  trouble  is  left  untreated. 

Dr.  White. — I  have  nothing  further  to 
say  except  that  I  am  very  much  obliged  to 
these  gentlemen  for  confirming  the  state- 
ments in  my  paper.  I  have  only  to  add 
that  if  we  could  get  such  results  as  Dr. 
Kollock  obtained  in  one  of  the  cases  he 
mentioned,  the  opthalmologist  would  be  in 
greater  demand  than  the  gynaecologist,  as 
the  latter  sees  a  large  number  of  such 
patients,  and  if  the  adaptation  of  glasses 
would  accomplish  what  even  the  local  treat- 
ment fails  to  do,  the  gynaecologist  would  be 
out  of  a  job. 

Dr.  W.  S.  Davidson. — I  would  like  to 
mention  a  case  that  I  had  sometime  ago,  of 
a  young  lady  about  sixteen  years  old  who 
had  eye  trouble  and  throat  trouble,  and  I 
sent  her  to  one  of  the  best  doctors,  I  thought. 
He  fitted  glasses  on  her  and  everything  was 
wrong,  they  didn't  suit.  But  after  awhile 
she  had  ear  trouble,  too.  After  putting  on 
some  bichloride  it  was  all  right,  and  I  re- 
mark from  what  one  of  the  gentlemen  said, 
I  think  it  proved  something  else  was  wrong 
In-forehand. 


What  Medicine  Owes  to  Bacteriology. t 

By  E.  C.  Levy,M.  D., Richmond,  Va.,  Professor 
of  Histology,  Pathology,  and  Bacteriology, 
Medical  College  of  Virginia;  President  of  the 
Richmond  Academy  of  Medicine  and  Surgery. 

Only  the  true  devotees  of  science — and 
these  have  been  conspicuous  by  their  scar- 
citv  in  all  times — are  so  inthralled  by  the 
love  of  knowledge  for  its  own  sake  as  to 
ask  of  their  mistress  naught  but  that  she 
shall  lead  them,  even  over  rough  and  thorny 
ways,  into  new  paths  of  knowledge  and 
over  higher  realms  of  wisdom.  Most  men, 
especially  in  this  utilitarian  age,  view  each 
new  discovery  of  science  from  the  stand- 
point of  its  usefulness  and  see  naught 
desirable  in  the  most  glorious  achievements 
of  the  human  intellect  when  these  do  not  at 
once  result  in  some  practical  application, 
some  immediate  benefit  to  themselves  or  to 
mankind  at  large.  If  it  must  be  admitted 
that  the  rank  and  file  of  our  own  profession 
belong  to  this  latter  class,  it  must  also  be 
granted  that  there  is  nothing  derogatory  in 
the  admission.  The  function  of  the  physi- 
cian is  to  heal  the  sick,  and  to  this  end  must 


fRead  before  the  Tri-State  Med.'cal  Society  of 
the  Carolinas  and  Virginia,  at  Charlotte,  N.  C, 
January,  1899. 


192 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


be  turned  all  his  energies, all  that  is  strongest 
and  highest  and  noblest  in  his  mentality. 
Having  throughout  life  to  deal  with  the 
concrete  problems  of  human  suffering, 
small  wonder  that  he  finds  no  time  to 
wander  into  the  alluring  byways  of  abstract 
science  or  that  he  greets  with  a  chilling 
ltcui  bono1''  each  announcement  of  the 
enthusiastic  worker  in  some  sister  science. 

Now  that  the  hopelessness  of  refuting 
the  facts  of  bacteriologic  science  has  been 
demonstrated,  it  is  still  common  to  hear 
many  who  formerly  contested  all  the  claims 
of  bacteriology  falling  back  on  the  statement 
that,  admitting  the  teachings  of  this  science, 
yet  these  are  after  all  of  no  practical  interest 
to  the  medical  profession,  and  that  however 
much  light  may  have  been  thrown  upon  the 
etiology  and  pathology  of  many  diseases 
yet  the  vastly  more  important  point  of 
curing  these  conditions  has  not  been 
materially  advanced.  I  have,  therefore, 
selected  the  subject  of  this  paper  with  the 
idea  of  indicating,  in  such  manner  as  can 
be  done  within  the  limits  assigned,  the 
practical  services  which  bacteriology  has 
rendered  to  the  science  of  medicine. 

Unquestionably  foremost  among  these 
services  stands  the  fact  that  to  bacteriologic 
teachings  were  due  the  development  of 
antiseptic  surgery,  whose  introduction 
revolutionized  the  chirurgic  art,  opening 
up  at  once  new  possibilities  and  enabling 
the  surgeon  without  fear  to  enter  regions 
whose  invasion  was  previously  not  to  be 
thought  of;  removing  all  mystery  associated 
with  suppuration,  surgical  fever,  erysipelas, 
and  hospital  gangrene  ;  and  making  every 
surgical  operation  far  more  than  a  mere 
mechanical  problem  whose  solution  meant 
a  few  minutes  (the  fewer,  the  better)  of 
cutting  and  coaptation.  But  the  history  of 
antiseptic  surgery  is  too  familiar  to  every 
physician  to  justify  the  enlarging  upon  this 
topic  in  spite  of  the  wealth  of  material  it 
offers  in  maintaining  the  point  under  dis- 
cussion. Let  those,  however,  who  are  in- 
clined to  oppose  the  idea  that  bacteriology 
has  contributed  much  of  practical  value  to 
our  art  reflect  on  the  triumphs  of  antiseptic 
surgery  ere  they  attempt  to  belittle  the 
science  to  which  it  owes  its  origin. 

Right  here  such  opponents  may  reply 
that  the  doctrines  of  Lister  were  formulated 
at  a  time  when  but  few  facts  in  bacteriology 
were  known  and  when  it  laid  no  claim  to 
being  a  science.  Admitting,  they  will  say, 
that  the  most  brilliant  triumph  of  bacter- 
iology was  the  outcome  of  such  imperfect 
knowledge,  then  the  further  growth  of  the 
science  should  have  led  to  even  more  strik- 
ing developments  of  usefulness  if  the  sub- 
ject is  indeed  as  important  as  is  claimed. 


At  first  glance  this  argument  might  seem 
not  without  justice,  but  such  remarks,  more 
closely  investigated,  show  an  ignoring  of 
the  course  of  development  of  almost  every 
discovery  which  has  ever  been  made  in  any 
line-  It  is  the  rule,  rather  than  the  excep- 
tion, that  the  announcement  of  some  entirely 
new  principle  leads  almost  at  once  to 
practical  results  of  a  more  radical  nature 
than  those  arising  from  subsequent  patient 
and  laborious  investigations  of  the  subject. 
The  invention  of  movable  types  was  a 
greater  advance  from  the  previous  time- 
consuming  and  unsatisfactory  methods  of 
preserving  the  thoughts  of  living  genius 
than  have  been  all  subsequent  achievements 
of  typographic  art.  Great  as  has  been  the 
advance  from  the  original  hand-press  to  the 
massive  and  wonderful  mechanical  devices 
of  the  present  day,  which  print,  fold,  and 
paste  thousands  of  copies  an  hour,  yet  we 
justly  recognize  the  revolutionary  effect  of 
the  art  of  printing  upon  human  progress  as 
dating  from  the  fifteenth  century  when  the 
principle  was  discovered,  and  we  regard  all 
subsequent  developments  in  this  art  as  dif- 
fering in  degree  only  from  those  of  that 
day. 

From  a  scientific  point  of  view  nothing 
could  be  more  radical  than  the  recent  dis- 
covery of  X-rays,  for  it  brought  to  light  a 
form  of  energy  previously  unheard  of,  yet 
within  a  few  months  after  the  announce- 
ment of  this  discovery  about  all  that  was 
essential  in  its  application  had  been  worked 
out,  and  it  is  not  unsafe  to  say  that,  how- 
ever much  certain  minor  details  may  be 
subsequently  elaborated,  yet  none  of  these 
results  will  equal  in  brilliancy  those  which 
were  almost  at  once  attained. 

Hence,  when  we  admit  that  no  applica- 
tion of  bacteriology  has  exceeded  in  practi- 
cal results  the  introduction  of  antiseptic 
surgery,  we  are  but  illustrating  the  common 
course  of  new  discoveries.  In  this  very 
instance,  too,  the  parallel  may  be  carried 
further.  Just  as  in  the  cases  above  cited, 
while  nothing  as  radical  as  the  first  principles 
of  antiseptic  surgery  has  since  been  in- 
troduced, yet  the  perfecting  of  technic  has 
gone  on,  and  many  cumbersome,  useless, 
and  even  injurious  details  of  the  original 
method  have  been  supplanted  by  the  more 
modern  practices  of  its  successor,  aseptic 
surgery.  The  conception  that  the  air,  and 
possibly  the  tissues  of  the  patient  himself, 
teemed  with  germs  of  suppuration  seemed 
to  require  the  use  of  antiseptic  sprays  in  the 
operating-room  and  the  application  of 
powerfully  germicidal  irritations  over  the 
field  of  operation  in  every  case.  Now  it  is 
known  that  the  air  is  a  source  of  danger 
which  may  commonly  be  ignored  and  that 


THE  CHARLOTTE   MEDICAL  JOURNAL. 


193 


normal  internal  organs  are  free  from  bac- 
teria, while  the  actual  sources  of  possible 
infection  are  recognized  in  the  integument 
of  the  patient,  in  the  hands  of  the  surgeon 
or  his  assistants,  and  in  instruments  and 
dressings.  These  are  subjected  to  such 
disinfecting  processes  as  are  suitable  for 
each,  and  the  increased  ease  of  operating 
and  the  greater  readiness  with  which  the 
healing  process  occurs  in  tissues  which  have 
not  been  subjected  to  the  prolonged  mace- 
rating and  irritating  action  of  powerful 
antiseptics,  are  secondary  triumphs  which, 
while  not  so  radical  an  advance  over  former 
methods  as  was  the  original  introduction  of 
Listerism,  are  yet  to  be  regarded  as  essential 
improvements  over  that  method.  It  may 
be  pointed  out  that  the  technic  of  modern 
asepticism  is  the  outcome  of  painstaking 
bacteriologic  investigations. 

After  this  cursory  view  of  the  debt  which 
our  profession  owes  bacteriology  on  the 
surgical  account,  let  us  take  up  the  con- 
tributions of  this  science  to  internal  medi- 
cine. Here,  there  is  no  one  thing  which  is 
seemingly  as  brilliant  as  the  records  of  anti- 
septic and  aseptic  surgery,  for  the  benefits, 
though  in  the  aggregate  at  least  equal  to 
those  conferred  upon  surgery,  are  scattered 
and  must  be  considered  individually. 

To  account  for  this  difference  is  not  diffi- 
cult. Accepting  the  common  division  of 
medical  treatment  into  preventive  and  cura- 
tive, and  contrasting  these  with  the  prin- 
cipal of  aseptic  surgery,  we  see  how  infi- 
nitely more  difficult  are  the  conditions  met 
with  in  the  medical  than  in  the  surgical 
class.  To  perform  an  aseptic  operation  re- 
quires only  that  we  shall  for  a  brief  space 
of  time  exclude  the  entrance  of  bacteria  to  a 
limited  exposed  area — conditions  not  so 
trying  when  once  their  nature  is  under- 
stood. On  the  other  hand,  preventive 
medicine,  so  far  as  bacterial  diseases  are 
concerned,  demands  continuous  effective 
opposition  to  the  entrance  of  widely-dis- 
tributed pathogenic  organisms  to  any  part 
of  the  system,  and  curative  treatment,  as 
applied  to  the  same  class  of  cases,  involves 
the  destruction  of  these  germs,  or  the 
neutralization  of  their  toxic  products,  after 
the  citadel  has  been  invaded.  Let  us  now 
see  what  has  been  done  towards  meeting 
these  exacting  requirements. 

In  the  line  of  preventive  medicine  not 
only  have  there  been  introduced  methods  of 
widespread  usefulness  in  checking  the  inva- 
sion of  certain  diseases  whose  origin  and 
mode  of  transmission  have  become  known 
through  bacteriologic  investigation,  but 
these  methods  have  also  been  applied  with 
much  success   to   that   large   class   of  cases 


which,  while  clearly  of  an  infectious  nature, 
are  still  of  doubtful  etiology. 

In  combating  the  spread  of  that  great 
modern  scourge,  tuberculosis,  the  sanitarian 
has  encountered  at  every  step  the  most 
violent  opposition  on  the  part  of  the  very 
ones  whom  he  has  sought  to  benefit,  and 
his  failure  to  accomplish  even  more  striking 
results  when  those  which  have  actually  been 
attained  must  be  attributed  not  to  lack  of 
knowledge  but  to  failure  to  secure  the  sup- 
port of  popular  sentiment.  The  lines  along 
which  he  has  for  the  most  part  been  forced 
to  confine  his  attention  are  in  the  direction 
of  the  prevention  of  the  transmission  of  the 
disease  from  animal  to  man,  and  he  has  been 
allowed  to  do  but  little  in  checking  the 
direct  transmission  from  man  to  man. 
Dairy,  meat  and  herd  inspection  are  now 
recognized  functions  of  boards  of  health  in 
many  states  and  cities,  and  to  bacteriology 
is  due  not  only  the  introduction  of  these 
protective  measures  but  also  the  methods  by 
which  they  are  carried  out.  While  the 
above-mentioned  measures  are  directed 
against  a  mode  of  transmission  far  less  im- 
portant than  that  which  in  most  com 
munities  is  but  little  considered,  still  they 
are  far  better  that  the  entire  ignoring  of 
every  means  of  prevention  of  the  spread  of 
the  disease.  In  some  cities  rigid  regulations 
have  been  enacted  as  to  spitting  in  public 
conveyances  and  places  of  assembly,  but 
all  attempts  to  introduce  any  sort  of  legal 
control  over  the  mode  of  living  of  the 
victims  of  tuberculosis  have  thus  far  en- 
countered too  violent  opposition  to  admit 
of  their  being  carried  into  effect.  It  is  to 
the  education  of  the  public  itself  that  we 
must  look  for  the  adoption  of  the  proper 
measures  of  protection.  When  the  infectious 
nature  of  tuberculosis  shall  have  become 
more  generally  understood,  popular  senti- 
ment will  itself  enforce  what  at  the  present 
time  scientific  appeal  is  powerless  to  effect. 

In  diphtheria  bacteriology  not  only  en- 
ables the  physician  to  decide  promptly  and 
positively  the  nature  of  suspected  cases,  but 
it  also  furnishes  him  with  an  absolutely 
trustworthy  guide  as  to  the  length  of  time 
that  it  is  necessary  to  isolate  any  given  case 
after  apparent  recovery,  thus  at  both  ends 
of  the  disease  lessening  the  danger  of  a 
single  case  transmitting  the  disease  to  others 
of  the  household  or  even  throughout  an 
entire  community. 

In  typhoid  fever  the  recognition  of  the 
fact  that  the  feces  contain  the  materies 
morbi  of  the  disease  has  led  to  preventive 
measures  in  the  disinfection  of  the  stools  of 
typhoid  patients,  and  to  guarding  against 
contamination  of  the  water  supply.  Where 
there    is   reason   to    suspect   that  such    con- 


194 


THE  CHARLOTTE  MEDICAL   JOURNAL. 


tamination  has  actually  occurred,  it  is  a 
lessen  learned  from  bacteriology  that  such 
water  should  be  boiled  before  drinking. 
In  many  communities  the  introduction  of 
city  filters  has  been  uniformly  followed  by 
a  diminution  in  the  annual  number  of  cases 
of  typhoid  fever. 

The  effective  disinfection  of  appartments 
after  occupancy  by  contagious  cases  is 
another  hygienic  measure  whose  technic  has 
been  perfected  through  bacteriologic  teach- 
ings. 

This  by  no  means  ends  the  account  of 
what  preventive  medicine  owes  to  bacter- 
iology, but  an  outline  of  the  debt  in  other 
directions  now  demands  consideration, 
which  must  here  be  of  an  equal  cursory 
character. 

Coming  to  the  question  of  the  curative 
measures  which  internal  medicine  owes  to 
bacteriology,  we  find  the  use  of  antitoxins 
as  the  most  important  contribution.  Up  to 
the  present  time  the  only  common  disease 
of  this  country  in  the  cure  of  which  an 
antitoxin  has  proved  of  very  great  value  is 
diphtheria.  Antitoxic  serum  is  now  gen- 
erally recognized  as  the  most  valuable  agent 
in  the  treatment  of  this  disease.  Statistics 
of  the  most  extended  nature  conclusively 
prove  this,  but  even  more  convincing  is  the 
personal  testimony  of  the  thousands  of  phy- 
sicians who  have  employed  the  remedy.  It 
is  very  common  to  hear  the  statement  made 
by  practitioners  of  ability  that  they  now 
approach  the  treatment  of  this  dread  malady 
of  childhood  with  a  confidence  unknown  in 
former  years  or,  at  any  rate,  without  that 
overpowering  sense  of  helplessness  which 
they  formely  felt. 

The  opposition  to  diphtheria  antitoxin 
comes,  for  the  most  part,  from  those  who 
have  never  employed  the  remedy,  or  who, 
using  it,  have  utterly  ignored  all  the  re- 
cognized rules  and  expected  it  to  accomplish 
the  impossible.  It  has  never  been  claimed 
that  antitoxin  could  restore  the  integrity  of 
organs  whose  cells  have  become  profoundly 
affected  before  the  remedy  is  given,  yet  it  is 
still  no  uncommon  thing  to  witness  its  ex- 
hibition late  in  the  course  of  the  disease  by 
men  who  have  never  learned  that  the  remedy 
is  to  be  given  as  soon  as  the  diagnosis  is 
made  and  not  as  a  last  resort.  It  is  needless 
to  point  out  that  not  only  is  antitoxin  the 
result  of  bacteriologic  study,  but  that  its 
production  is  entirely  dependent  upon  that 
science. 

In  the  treatment  of  tetanus,  antitoxin  has 
not  yet  been  as  successful  as  in  diphtheria, 
although  laboratory  experiments  prove  it  to 
have  even  greater  power  of  neutralizing  the 
toxin  of  that  disease  than  diphtheria  anti- 
toxin   has    over    its    corresponding    toxin. 


The  reason  for  this  discrepancy  lies  in  the 
fact  that  when  tetanus  is  first  diagnosticated 
the  disease  has  already  progressed  to  a  point 
corresponding  to  a  late  stage  of  diphtheria 
— a  stage  in  which,  as  has  been  repeatedly 
pointed  out,  antitoxin  is  well-nigh  power- 
less. Recently  much  light  has  been  thrown 
on  this  point,  and  a  mode  of  employing 
tetanus  antitoxin  has  been  suggested  which 
will  perhaps  render  its  use  of  service  in 
otherwise  hopeless  cases.  It  has  been 
demonstrated  that  the  cells  of  the  central 
nervous  system  possesses  a  spec'al  affinity 
for  the  toxin  of  tetanus,  and  that  the  poison 
of  the  disease  is  thus  gradually  removed 
from  the  general  circulation  and  fixed  in 
the  cells  of  the  brain  and  spinal  cord,  where 
its  effects  are  exerted.  This  offers  a  rational 
explanation  not  only  of  the  special  symp- 
toms present  in  tetanus  infection  but  also 
of  ineffectiveness  of  subcutaneous  injections 
of  antitoxin  after  such  a  combination  has 
occurred — the  antitoxin  not  coming  into 
sufficiently  direct  contact  with  the  toxin 
which  is  fixed  in  the  cells  of  the  central 
nervous  system. 

Following  out  this  idea,  Roux  andBorrel, 
within  the  past  year,  have  suggested  the 
advisability  of  injecting  tetanus  antitoxin 
directly  into  the  brain  of  the  patient,  where 
it  is  at  once  brought  into  intimate  relation 
with  the  combined  toxin.  Theirexperiments 
upon  guinea-pigs  have  shown  that  by  this 
method  the  lives  of  infected  animals  can  be 
saved  at  a  stage  where  mere  subcutaneous 
injections  of  the  antitoxin  are  without  effect. 
Already  this  method  has  been  applied  to 
the  human  subject  in  twelve  cases,  nine  in 
Europe  and  three  in  this  country.*  Of 
these  cases  five  recovered  and  seven  died. 
Most  of  the  fatal  cases  were  either  of  a 
character  so  profound  that  not  even  under 
the  anesthetic  used  during  the  operation  did 
the  muscular  spasm  disappear,  or  else  the 
patient  died  from  complications  not  directlv 
due  to  the  tecanus  infection.  When  it  is 
remembered  that  in  all  of  these  cases  the 
treatment  was  undertaken  as  a  last  resort, 
after  it  appeared  that  death  would  other- 
wise certainly  occur,  a  recovery  rate  of  42 
per  cent,  is  to  be  regarded  as  exceedingly 
encouraging. 

Regarding  the  use  of  anti-streptococcic 
serum, reports  have  been  most  contradictory. 
It  seems  as  if  the  remedy  will  prove  of 
value  under  certain  conditions.  The  pro- 
duct is  as  yet  not  satisfactory,  it  being 
especially  prone  to  lose  its  power  with  age, 
and  the  virulence  of  the  streptococci  from 
which  it  is  manufactured  is  so  variable  that 


*George  G.  Rambaud,  N.  Y.  Med.  Jour., lxviii, 
25,  p.  884. 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


experiments  made  with  any  given  specimen 
cannot  usually  be  reproduced  with  the  next. 

In  the  treatment  of  bubonic  plauge  much 
more  satisfactory  results  have  been  attained 
by  serotherapy  than  we  would  have  been 
led  to  expect  from  the  usual  rapid  course  of 
the   disease. 

While,  then,  practical  results  with  anti- 
toxic serums,  so  far  as  the  common  diseases 
of  this  country  are  concerned,  are  as  yet 
limited  mostly  to  their  employment  in  diph- 
theria, still  the  discovery  of  the  underlying 
principles  involved  may  be  regarded  as  a 
most  brilliant  triumph,  and  there  is  no 
doubt  in  the  minds  of  those  who  are  in 
touch  with  bacteriologic  progress  that  little 
by  little  these  principles  will  be  elaborated 
until  the  system  is  perfected. 

The  use  of  protective  vaccines  against 
several  diseases  has  already  been  attended 
with  satisfactory  results  and  promises  much 
for  the  future.  It  is  beyond  the  scope  of 
this  paper  to  go  into  details  on  this  subject. 

The  treatment  of  inoperable  cases  of  sar- 
coma, especially  of  the  spindle-cell  variety, 
with  Coley's  streptococcus  and  prodigiosus 
toxins,  while  not  by  any  means  uniformly 
successful  and  also  attended  by  many  draw- 
backs, has  yet  been  shown  to  offer  at  least 
some  chance  of  recovery  to  a  class  of  cases 
otherwise  certainly  doomed  to  speedy  death. 

In  that  rather  rare  but  justly  dreaded 
disease,  hydrophobia,  the  treatment  by 
Pasteur  is  now  recognized  as  the  most  valu- 
able procedure  at  the  disposal  of  the  physi- 
cian.  While  this  does  not  strictly  fall 
under  the  head  of  bacteriology,  since  the 
germ  of  the  disease  is  as  yet  unknown,  still 
we  have  every  reason  for  believing,  from 
analogy,  that  bacteria,  or  allied  micro-or- 
ganisms, are  the  etiologic  factor,  and  the 
methods  employed  in  the  manufacture  of 
the  virus  are  similar  to  those  of  bacteriologic 
technic. 

The  important  role  of  antiseptics  inter- 
nally employed  is  the  direct  outcome  of  the 
teachings  of  bacteriology.  No  substance 
has  yet  been  discovered  which  will  effect- 
ually destroy  germs  which  have  once  gained 
entrance  to  the  human  organism  without  at 
the  same  time  being  directly  poisonous  to 
the  host,  but  the  restraining,  or  antiseptic, 
influence  of  many  substances  is  constantly 
taken  advantage  of  by  the  physician, 
especially  in  conditions  of  fermentation 
occurring  in  the  digestive  tract.  With  the 
systematic  investigation  on  the  part  of 
bacteriologists  of  each  new  compound 
elaborated  by  the  chemist,  it  is  entirely 
possible  that  die  combined  effects  of  these 
two  classes  of  scientists  may  yet  result  in 
the  discovery  of  an  ideal  internal  antiseptic 
and  germicidal  agent. 


Up  to  this  point  this  paper  has  dealt  with 
only  such  practical  points  in  bacteriology  as 
have  directly  contributed  to  the  saving  of 
human  life  either  through  surgery,  preven- 
tive medicine  or  therapeutices.  Brief  notice 
must  now  be  taken  of  two  indirect  methods 
by  which  our  power  as  physicians  has  been 
extended  through  bacteriologic  teachings  ; 
for  without  recognition  of  these  our  sense 
of  obligation  to  this  science  would  be  bv  no 
means  complete. 

In  the  diagnosis  of  many  diseases  bac- 
teriology offers  the  only,  opportunity  for 
prompt  recognition  at  a  sufficiently  early 
period  for  our  therapeutic  means  to  be  cap- 
able of  exerting  their  full  effect.  In  other 
conditions  many  obscure  points  can  be 
cleared  up  by  this  mode  of  investigation — a 
service  whose  importance  is  only  now  be- 
coming generally  recognized  and  whose 
possibilities    are    far   from  fully  developed. 

Finally  must  be  mentioned  the  insight 
into  the  pathology  of  disease  in  general 
which  has  been  gained  through  bacteriology, 
a  point  little  appreciated  by  the  general 
practitioner.  Valuable  as  were  the  lessons 
of  the  post-mortem  table  before  the  days  of 
bacteriologic  science,  yet,  after  all,  necrop- 
sies do  but  show  the  lesions  of  disease  after 
they  have  gone  on  to  the  point  of  fatal  issue, 
except  in  so  far  as  their  earlier  stages  may 
at  times  be  studied  in  intercurrent  affections. 
In  the  latter  case,  however,  it  is  a  composite 
and  not  a  simple  picture  which  is  offered 
for  inspection.  Furthermore,  light  is  but 
seldom  thrown  by  human  autopsis  upon  the 
course  of  disease  ending  in  recovery.  By 
means  of  animal  experiments,  conducted 
with  either  living  bacteria  or  their  toxins, 
the  entire  course  of  many  diseases  can  be 
studied  in  detail  from  the  time  of  their  in- 
cipience to  the  point  of  death  or  recovery. 
Such  important  facts  have  been  learned  as 
that  a  pure  tuberculous  infection  of  the 
lungs  does  not  give  rise  to  cavity  formation, 
but  that  this  occurs  through  superadded 
infection  by  the  streptococcus  pyogenes  or 
other  micro-organisms ;  that  the  normal 
secretion  of  the  peritoneum  and  other 
mucous  and  serous  membranes  possesses 
decided  germicidal  powers;  that  the  same 
bacteria  may  give  rise  to  a  variety  of  affec- 
tions under  conditions  as  yetnot  understood  ; 
that  fatigue,  cold,  insufficient  food,  vitiated 
atmosphere  predispose  to  many  infections — 
and  so  the  list  might  be  prolonged  for  many 
pages. 

In  bringing  this  paper  to  a  close,  I  realize 
how  i m perfectly  the  subject  has  been  hand- 
led. I  have  merely  sought  to  outline  the 
service  of  bacteriology  to  medicine  rather 
than  to  deal  with  any  one  of  these  exhaustive- 
ly,for  no  one  division  of  the  subject  could  be 


196 


THE  CHARLOTTE  MEDICAL   JOURNAL. 


satisfactorily  dealt  with  in  a  paper  of  this 
length.  That  physician  must  be  ungrate- 
ful indeed  who  fails  to  accord  due  credit  to 
a  science  which  has  given  him  antiseptic 
and  aseptic  surgery,  has  made  preventive 
medicine  almost  an  exact  science,  has  fur- 
nished him  with  the  means  of  combating  a 
most  fatal  disease  and  of  alleviating  many  of 
the  symptoms  of  others,  has  made  easy  the 
diagnosis  of  many  important  diseases  and 
has  contributed  to  our  understanding  of  a 
class  of  cases  whose  study  had  previously 
been  highly  unsatisfactory. 

Dystocia,  t 

By  David  A.  Stanton,  M.  D.,  High  Point,  N.  C. 

The  only  excuse  which  I  can  offer  for 
presenting  this  old  subject  is  its  importance, 
and  that  it  needs  no  far-fetched  ideas  or  fine 
spun  theories  to  cause  us  to  appreciate  the 
significance  of  difficult  labor. 

Once  in  the  lying-in  room  where  we  know 
it  is  impossible  for  dame  nature  to  take  pro- 
per care  of  a  faithful  wife  and  the  life  of  an 
unborn  babe,  we  can  ever  afterwards  ap- 
preciate the  subject  of  dystocia. 

To  help  both  safely  and  comfortably  as  we 
can  to  a  successful  termination  of  the  crisis 
makes  a  home  unmeasureably  happy  and 
raises  our  profession  in  the  eyes  of  all.  To  do 
this  we  should  be  thoroughly  familiar  with  all 
forms  of  difficult  labor. from  the  simplest  ute- 
rine inertia  requiring  only  a  dose  of  quinine 
or  a  hypodermic  injection  of  strychnine  ni- 
trate to  the  severest  case  of  contracted'pelvis 
necessitating  a  Cesarean  section  or  sym- 
physiotomy. 

Uterine  inertia  due  to  other  causes  than 
malformations,  the  most  frequent  source  of 
dystocia  met  with  and  is  alike  trying  to  physi- 
cian and  patient.  If  a  person  who  is  objection- 
able to  the  patient  remains  in  the  room  pains 
will  often  be  inhibited,  such  a  person  should 
be  put  out,  and  we  should  make  ourselves 
agreeable  to  the  patient  and  her  friends. 
We  have  all  heard  it  said,  the  doctor  has 
frightened  the  pains  away.  The  severity 
of  the  pains  caused  by  the  uterine  contrac- 
tions will,  in  some  particular  cases  cause  an 
inhibitory  action  to  be  set  up  and  thus  ren- 
der the  pains  ineffectual,  in  such  instances 
15  gr.  doses  of  bromide  of  potassii,  or  hy- 
drate of  chloral  repeated  in  fifteen  or  twenty 
minutes,  or  a  hypodermic  injection  of  mor- 
phine and  atropine  will  be  of  much  benefit. 

This  sedative  treatment  will  do  good  in 
primiparas  where  the  pains  become  ineffec- 
tual from  the  tiring  of  the  muscles  in  their 
first  effort  to  dilate  the  cervix.  After  a 
short  period  of  rest  the  pains  will  return 
with    renewed  vigor.      .Should   they  fail  to 


do  so  in  a  reasonable  length  of  time  the 
sedative  treatment  should  be  followed  with 
alcohol,  quinine  or  strychnine. 

If  the  os  is  rigid  and  unyielding  hot  water 
injections  against  the  cervix  will  do  good. 
But  if  the  labor  is  delayed  by  a  deformed 
pelvis  the  deformity  ought  to  be  recognized, 
and  a  history  of  malposition  and  difficult 
labors  in  a  woman  should  arouse  our  suspi- 
cion of  a  deformed  pelvis.  It  is  with  shame, 
though,  we  admit  that  ignorance  or  thought- 
lessness along  this  line  has  cost  the  life  of 
many  a  woman  and  even  more  children. 
And  these  deformities  are  not  so  infrequent 
but  what  every  active  practitioner  will  meet 
with  some  cases  during  his  professional 
career.  The  number  of  deformed  pelves 
is  variously  estimated  at  from  two  to  eight 
per  cent.  The  flat  pelvis  is,  perhaps,  found 
more  often  than  any  other  deformity,  though 
there  are  a  variety  of  deformities  mentioned 
in  works  on  obstetrics.  It  follows,  there- 
fore, that  an  ability  to  recognize  deformities 
in  the  female  pelvis  is  a  necessary  equip- 
ment for  every  practitioner  of  medicine, 
who  may  be  called  upon  to  attend  women 
in  confinement,  and  a  knowledge  of  pelvi- 
metry is  as  essential  to  the  intelligent  and 
successful  practice  of  obstetrics  as  are  per- 
cussion and  auscultation  to  the  practice  of 
medicine. 

The  following  case  was  given  me  by  a 
brother  physician,  which  goes  to  prove  th 
force  of  the  above  remark  : 

Dr.  A.  was  called  by  Dr.  B.  to  assist  in 
a  shoulder  presentation.  The  condition  of 
the  patient  was  good  and  the  foetal  sound 
could  be  distinctly  heard  and  was  regular. 
The  membranes  had  ruptured  sixteen  hours 
before  the  consultant  arrived.  However, 
in  their  desire  to  relieve  their  patient  they 
forgot  that  the  woman  had  a  pelvis  and  at 
once  did  a  podalic  version,  consuming  one 
and  a  half  hours  in  getting  the  after  coming 
head  through  the  pelvis.  During  this  ex- 
perience they  had  plenty  of  time  to  remem- 
ber that  deformed  pelvis  exist  outside  of 
text-books.  The  child  was,  of  course,  dead, 
and  it  was  useless  to  consider  Cesarian  sec- 
tion. They  kept  on  with  forceps  to  the 
head  and  blunt  hook  in  the  mouth,  and 
finally  delivered  a  dead  baby,  another  vic- 
tim to  the  flat  pelvis,  and  I  might  add, 
thoughtlessness  also,  for  I  am  sure  a  Sym- 
physiotomy or  a  Cesarian  section  done  in 
time  would  have  saved  both  mother  and 
child;  as  it  was,  both  were  lost. 

A  pelvimeter  should  be  in  our  obstetrical 
bag.  But  where  one  is  not  at  hand  we 
should,  in  doubtful  cases,  measure  the  con- 
jugate with  the  index  and  middle  finger 
of  the  right  hand  held  stiffly.  Pass 
them  up  to  the    promitory   of    the    sacrum. 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


197 


let  the  thumb  slide  upon  the  mons-veneris 
and  make  pressure  until  we  plainly  feel 
the  impress  of  the  arcuate  ligament  under 
the  lower  edge  of  the  symphysis.  With 
the  finger  nail  of  the  other  hand  a 
mark  is  made  at  this  point,  withdraw 
the  hand  and  the  distance  from  this 
point  to  tip  of  middle  finger  will  be  the 
diagonal  conjugate — subtract  2f  centimeters 
and  the  remainder  is  the  true  conjugate. 
When  the  true  conjugate  is  not  more  than 
9^  centimeters  (3^  inches)  there  is  almost 
sure  to  be  trouble  with  a  normal  sized  head 
and  forceps  or  premature  labor  will  have  to 
be  resorted  to.  When  the  conjugate  is  as 
low  as  8  c.  (3  inches)  premature  labor  is 
indicated.  A  conjugate  of  from  7^  to  7  to 
6  c,  requires  premature  labor  with  Cesa- 
rian  section  four  weeks  before  term. 

If  the  patient  is  not  seen  until  labor  has 
begun,  one  of  the  following  modes  of  de- 
livery must  be  chosen,  after  waiting  to  see 
if  the  head  will  engage  :  Application  of 
forceps,  version,  symphysiotomy,  or  Cesa- 
rian  section.  So  long  as  the  child  is  living 
craniotomy  should  not  be  considered.  Hav- 
ing measured  the  pelvis  we  can  more  easily 
decide  what  to  do  in  the  premises.  With  a 
conjugate  below  fr|  c,  the  woman  should 
go  to  term  and  be  delivered  by  Cesarian 
section. 

Labor  is  obstructed  in  about  2  per  cent, 
of  all  cases  by  some  abnormality  of  the 
parturiant    canal. 

The  cervix  may  obstruct  labor  by  reason 
of  atresia,  cicatricial  contraction,  or  rigi- 
dity, or  there  may  be  transverse  or 
longitudinal  septa  in  the  canal.  Atresia 
of  the  cervix  in  a  pregnant  woman  must, 
of  course  be  acquired  after  impregnation. 
It  is,  however,  rarely  complete.  Cicatri- 
cial contraction  of  the  cervix  may  generally 
be  overcome  by  hydrostatic  dilators.  Con- 
genital narrowness  of  the  vagina  or  vulva 
is,  as  a  rule,  overcome  by  the  advance  of 
the  presenting  part,  though  often  at  the  ex- 
pense of  vaginal  or  perineal  laceration. 
Hydrostatic  dilators  will  help  wonderfully 
in  such  cases,  but  in  some  instances  it  may 
be  necessary  to  resort  to  incision. 

Carcinoma  of  the  cervix  will  in  nearly 
50  per  cent,  of  the  cases  interrupt  gestation 
at  various  stages.  When  they  do  go  to 
term  some  may  be  delivered  spontaneously, 
though  this  is  not  the  rule.  Cesarian  sec- 
tion is  commonly  the  proper  treatment  for 
these  cases  and  should  be  selected  if  there 
is  good  reason  to  doubt  the  possibility  of 
spontaneous  or  artificially  aided  labor. 

Fibroids  of  the  uterus  and  cervix  low 
enough  in  situation  to  become  incarcerated 
in  the  pelvis  are  likely  to  cause  insuperable 
obstruction,  besides  favoring  abnormal  posi- 


tions of  the  childs  head.  If  attempts  under 
anesthesia  to  dislodge  the  tumor  and  push 
it  above  the  pelvic  brim  fails,  a  Porro-Cesa- 
rian  operation  should  be  performed,  even 
though  the  tumor  is  not  of  such  size  as  ab- 
solutely to  prevent  the  delivery  of  the  child, 
because  on  account  of  its  low  vitality  the 
pressure  to  which  it  would  be  subjected  by 
drawing  the  child  past  it  would  cause  it  to 
slough  and  probably  cause  a  fatal  infection. 
Obstruction  in  labor,  on  the  part  of  the 
foetus  occurs  in  about  6  per  cent,  of  women, 
when  due  to  over-growth.  Pregnancy  may 
be  expected  to  be  prolonged  beyond  the  three 
hundredth  day,  and  every  day  the  foetus 
remains  in  the  womb  beyond  the  usual  time 
some  little  increase  may  be  expected.  It  is  a 
safe  rule  to  allow  no  women  to  exceed  the 
normal  duration  of  pregnancy  more  than 
three  weeks. 

The  various  double  monstrocities,  hydro- 
cephalics, prematurely  ossified  heads,  and 
tumors  of  the  foetus,  cannot  be  treated 
by  a  single  rule,  but  each  case  requires 
management  peculiar  to  itself. 

Shoulder  presentations,  occurring  once 
in  260  confinements,  has  an  estimated  ma- 
ternal mortality  of  11  per  cent. — one-half 
of  the  children  perish.  I  mention  the  treat- 
ment only  to  insist  upon  an  endeavor  being 
made  early  before  the  membranes  are  rup- 
tured to  bring  the  head  or  breech  through 
the  os,  and  it  ought  to  generally  succeed  by 
combined  external  and  internal  methods. 
The  introduction  of  the  entire  hand  ought 
to  be  reserved  for  cases  where  the  waters 
have  been  long  drained  away  when  first 
seen. 

With  prolapsed  cord  many  children  per- 
ish, but  I  have  not  found  it  so  difficult  to 
replace.  In  August,  1897,  was  called  to 
see  a  negro  woman  in  labor  and  found  the 
funis  prolapsed  into  the  vagina,  waters  had 
escaped  about  fiften  minutes  before  I  ar- 
rived, the  pains  were  vigorous"^  and  head 
engaging.  Gave  chloroform  and  pushed 
the  cord  well  up  beyond  the  head,  stopped 
the  anesthetic  and  with  my  hands  made 
strong  pressure  over  uterus  and  held  the 
head  firmly  against  the  brim  of  the  pelvis 
until  the  pains  caused  the  head  to  engage. 
Labor  then  proceeded  without  further 
trouble. 

Face  presentation  may  give  rise  to  much 
trouble  when  the  child  fails  to  rotate 
to  the  front  though  it  seldom  fails  to  thus 
rotate  and  requires  little  more  attention  than 
a  vertix  presentation  but  should  it  fail  to  ro- 
tate direction  may  be  given  with  the  blade  of 
a  forcep  or  the  hand  inserted  so  as  to  make 
pressure  on  the  posterior  cheek.  If  this  fails 
both  blades  of  the  forceps  may  be  applied 
to   the    head  and  a   considerable  amount  of 


198 


THE  CHARLOTTE   MEDICAL  JOURNAL. 


force  used  in  trying  to  rotate  the  head. though 
this  is  dangerous  to  the  child.  If  the  child 
be  small  and  the  pelvis  large,  it  may  be  de- 
livered in  the  mento-posterior  position. 
Finally,  if  all  these  measures  fail  there  is 
no  resource  left  except  craneotomy. 

I  have  not  seen  anywhere  a  neck  presen- 
tation recorded ;  however,  I  have  seen  one 
case  in  consultation.  In  September,  1S96, 
I  was  sent  for  by  Dr.  Tomlinson  to  assist 
him  in  delivering  Mrs.  J.,  at  Archdale. 
On  enquiry  I  learned  she  was  seven  months 
advanced,  and  had  been  in  labor  twelve 
hours.  For  six  hours  there  had  been  no 
descent  of  the  child.  Examination  reveal- 
ed the  presenting  part  tightly  wedged  into 
the  pelvis.  Under  complete  anesthesia  it 
was  impossible  to  force  the  child  back  or 
to  pass  the  hand  beyond  the  presenting  part 
to  change  its  position.  Palpation  showed 
the  child  to  be  lying  with  its  abdomen  to 
the  mother's,  head  flexed  back  between  its 
shoulders.  After  considerable  effort  a  cord 
was  passed  around  the  neck  and  by  strong 
traction  enough  space  was  secured  to  de- 
capitate the  head  with  a  blunt  pointed  his- 
tory. The  body  was  easily  delivered,  as 
was  also  the  after  coming  head. 

In  most  cases  the  management  of  twins 
does  not  differ  from  that  of  ordinary  labor. 
But  the  degree  to  which  the  uterus  is  dis- 
tended may  cause  some  inertia  in  the  first 
stage  of  labor,  and  after  the  first  child  is 
born,  it  will  facilitate  matters  to  rupture 
the  membranes  and  let  the  waters  drain 
away.  If  labor  pains  do  not  return  in  fif- 
teen minutes  after  the  first  child  is  born,  try 
to  induce  them  by  friction  over  the  uterus, 
and  a  dose  of  ergot  may  be  given.  Occa- 
sionally serious  difficulty  arises  from  parts 
of  both  foetus  presenting  simultaneously, 
thus  impeeding  the  entrance  of  either  child 
into  the  pelvis,  or  they  may  get  locked  to- 
gether so  as  to  render  delivery  impossible 
without  artificial  aid.  It  may  be  far  from 
easy  to  discover  the  cause  of  the  obstruction, 
as  a  case  in  my  practice  verified  some  years 
ago,  when  the  heads  both  presented.  When 
first  seen  there  was  no  mistake  as  regarding 
what  was  felt  on  examination.  It  was  the 
head  in  the  R.  O.  A.  position.  I  waited 
six  hours  expecting  the  labor  to  terminate 
any  hour,  as  there  was  good  dilatation  and 
pains  vigorous.  During  these  hours  of 
anxious  waiting  there  was  no  descent  of  the 
head  Dilatation  being  sufficient  I  applied 
the  forceps,  but  was  astonished  at  the  force 
necessary  to  dislodge  the  head  and  bring  it 
to  the  perineum,  though  finally  succeeded 
and  delivered  twins,  both  head  presentation. 
In  this  in&tance  it  was  impossible  to  tell 
where  or  what  the  obstruction  was,  except 
a    conjecture,    that    there    were     twins     in 


utero.  I  now  believe  the  second  child's 
head  was  engaged  against  the  chest  of  the 
first. 

When  both  heads  present  at  the  brim  it 
will  generally  be  possible  to  get  one  out  of 
the  way  by  appropriate  manipulation,  in- 
ternal and  external,  and  application  of  for- 
ceps to  the  other ;  but  if  both  heads  are 
allowed  to  enter  the  pelvis  the  difficulty  will 
be  grave. 

DISCUSSION. 


W.  Long. — I    don't    think   there 
a    more    practical    or    interesting 


Dr.  J- 
has  been 

paper  brought  before  this  Society  than  Dr. 
Stanton's.  It  is  one  of  absorbing  interest 
from  the  fact  that  it  concerns  us  all,  for  we 
all  see  cases  of  dystocia,  unless,  perhaps  it 
be  some  of  our  distinguished  friends  who 
limit  their  work  to  fitting  glasses,  and  those 
who  confine  themselves  to  looking  through 
the  microscope  and  hunting  bugs  ;  but  for 
those  of  us  who  see  obstetric  cases  it  is  a 
very  interesting  subject.  W'hile  Dr.  Stan- 
ton was  reading  his  paper,  and  when  he 
mentioned  a  case  of  dystocia  due  to  the 
presence  of  solid  tumor  in  the  pelvis,  I  re- 
called a  case  which  I  had  the  pleasure  of 
seeing  with  Dr.  Stanton  a  number  of  years 
ago — I  think  in  1893 — of  a  woman  who  was 
about  three  months  pregnant,  and  whose 
pelvis  was  completely  choked  by  fibroid 
tumors.  The  condition  was  such  that  it 
was  clearly  impossible  for  the  woman  to  be 
delivered,  so  it  was  thought  best  to  do  a 
hysterectomy,  in  other  words,  to  do  a  Porro 
operation.  Dr.  Stanton  and  his  associate, 
Dr.  Cox,  and  myself,  proceeded  to  operate 
at  once,  lemoving  the  entire  mass  of  tumors 
and  uterus  with  its  contained  gestation. 
The  primary  object  was  to  relieve  this  wo- 
man from  the  dangers  to  which  she  would  be 
subjected  in  childbirth.  The  abdomen  was 
closed  without  draining,  the  pedicle  being 
dropped,  and  so  far  as  I  have  been  able  to 
discover  it  was  the  first  operation  ever  done 
by  that  method  in  America,  and  probably 
the  second  in  the  world  for  that  particular 
condition  and  by  that  particular  method. 

I  recall  a  case  of  dystosia  that  came  un- 
der my  observation  about  a  year  ago.  A 
lady  living  in  the  western  part  of  the  State 
came  to  me  with  a  tumor  of  considerable 
size.  She  gave  a  history  of  having  had 
great  difficulty  in  her  last  three  confine- 
ments. She  was  the  mother  of  five  chil- 
dren, possibly  six.  On  examination  I  found 
that  she  was  three  and  a  half  months  preg- 
nant ;  that  the  uterus  was  pushed  far  up- 
wards and  a  little  to  the  left,  lying  under 
the  ribs  in  the  position  of  the  spleen.  The 
pelvis  and  the  lower  half  of  the  abdomen 
was    filled    with  a  fluctuating   tumor.      We 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


199 


advised  her  to  have  this  tumor  removed,  as 
it  was  clearly  impossible  for  her  to  be  de- 
livered in  the  natural  way  with  this  tumor 
present.  With  the  assistance  of  my  asso- 
ciate, Dr.  Whitehead,  and  Drs.  McKenzie, 
Dorset,  and  H.  F.  Long  of  Statesville,  I 
opened  the  abdomen  about  a  month  after 
that, time  and  attempted  to  remove  the  tumor. 
I  found  it  was  an  intra-ligamentous  der- 
moid. The  walls  of  the  cyst  were  so  ex- 
ceedingly fragile  that  it  was  impossible 
under  the  circumstances  to  peel  out  the  en- 
tire tumor,  so  I  did  what  I  conceived  to  be 
the  best  thing  under  the  circumstances, 
which  was  to  make  an  incision  in  the  pos- 
terior fornix  of  the  vagina  and  drain  the 
tumor  in  that  way.  Later  she  returned  to 
our  town  and  was  delivered  in  my  absence 
by  my  associate,  Dr.  Whitehead.  Now, 
this  was  a  case  in  which  the  woman's  life 
and  the  child's  life  would  have  been  sacri- 
ficed if  she  had  come  to  term  unless  she  had 
had  a  Cesarian  section.  I  have  now  in  our 
hospital  at  .Salisbury  a  Lady  whom  I  deliv- 
ered last  August  and  whom  I  saw  for  the 
first  time  during  her  confinement.  I  made 
a  vaginal  examination  and  found  she  had  a 
tumor,  probably  not  larger  than  an  orange, 
though  I  was  unable  to  clearly  define  the 
limitations  of  the  mass.  She  was  in  the 
first  stage  and  the  presentation  high.  The 
tumor  was  caught  between  the  head  and  the 
basin  of  the  pelvis.  By  pushing  the  tumor 
back,  and  by  dint  of  a  great  deal  of  effort 
on  her  part  and  encouragement  on  my  part, 
we  managed  by  an  all  night  "seance"  to 
get  the  baby  through.  By  my  advice  she 
has  come  to  the  hospital  to  have  this  tumor 
removed,  feeling  sure  that  if  it  should  in- 
crease in  size  it  would  be  almost  impossible 
to  deliver  her  in  case  of  a  subsequent  preg- 
nancy. [Later:  On  Jan.  23d  I  removed 
from  this  woman  an  ovarian  dermoid  twice 
the  size  of  a  large  orange  and  containing 
hair,  bone,  teeth,  and  sebacious  matter.] 
The  lesson  which  1  would  glean  from 
these  cases  I  have  reported  as  bearing 
upon  the  subject  which  Dr.  Stanton  has  so 
ably  presented  to  us,  is  that  in  some  cases 
of  dystocia  we  must  take  time  by  the  fore- 
lock and  remove  the  difficulty  before  the 
woman  comes  to  labor. 

Dr.  J.  C.  Walton. — 1  have  enjoyed 
very  much  Dr.  Stanton's  most  valuable  pa- 
per, and  in  this  connection  I  want  briefly 
to  report  a  case  that  I  recently  saw  of  pro- 
lapsus of  the  uterus.  The  uterus  was  out- 
side— about  one-third  or  one-half  of  the 
uterus.  The  woman  had  been  having  hard 
pains  all  day,  ineffectual  pains,  and  by 
dilating  with  the  hand  and  the  use  of  the 
forceps  we  succeeded,  after  a  great  deal  of 
difficulty,  in    removing  the  child.     In  this 


case  the  uterus  was  pushed  out,  and  we  had 
a  great  deal  of  trouble  on  that  account,  but 
got  her  through  all  right.  This  was  the 
first  case  of  prolapsus  of  the  uterus  I  ever 
had  in  my  experience,  and  is  a  rare  compli- 
cation. 

Dr.  Geo.  Ben.  Johnston. — I  have  lis- 
tened with  a  great  deal  of  interest  to  Dr. 
Stanton's  paper,  and  whereas  I  am  not  an 
obstetrician,  I  am  in  an  allied  branch,  and 
would  like  to  make  mention  of  a  case  which 
was  very  similar  to  the  first  case  Dr.  Long 
reported.  The  case  was  referred  to  me  by 
Dr.  Dayton  of  this  State.  The  woman  was 
forty  years  of  age,  mother  of  seven  children, 
and  had  gone  six  years  without  any  preg- 
nancy. Having  become  pregnant  again  and 
suffering  great  pelvic  pain,  she  was  exr 
amined  by  her  doctor  and  a  tumor  of  the 
uterus  was  discovered.  Indeed  the  pelvis 
was  so  choked  he  deemed  a  natural  delivery 
impossible.  He  referred  the  case  to  me  for 
treatment,  and  upon  examination  and  the 
history  of  the  case  gave  the  probable  diag- 
nosis of  uterine  fibroid  complicated  by  preg- 
nancy, having  advanced  to  the  four  and  a 
half  month.  Examination  showed  a  tumor 
nearly  filling  the  pelvis,  so  completely  in- 
cluding the  vagina  as  to  make  it  impossible 
to  reach  the  cervix  by  the  examining  finger. 
This  tumor  was  attached  to  the  anterior 
portion  of  the  uterus,  about  the  junction  of 
the  cervix  with  the  body.  It  made  an  ex- 
tremely disagreeable  and  painful  impression 
upon  the  bladder.  Th*  patient's  condition 
was  not  favorable,  she  was  wasted  and 
weak,  but  it  was  deemed  advisable  to  per- 
form an  immediate  operation  upon  the 
hypothesis  that  she  could  not  be  deliv- 
ered by  the  natural  medium  ;  that  in  all 
likelihood  she  could  not  go  to  term  to  be 
subjected  to  a  Cesarian  section  for  the  res- 
cue of  the  child;  that  abortion  would  take 
place  which  would  be  so  complicated  by 
the  tumor,  that  death  would  likely  ensue. 
The  operation  was  performed  without  a 
great  deal  of  difficulty  except  the  danger 
incident  to  wound  of  the  bladder  owing  to 
the  location  of  the  tumor.  When  the  tumor 
was  removed  we  discovered  that  it  was  the 
size  of  a  small  cocoanut,  that  the  uterus  was 
conical  in  shape,  and  when  the  uterus  was 
opened  it  was  discovered  that  its  walls  were 
of  uneven  thickness.  The  wall  at  its  right 
horn  was  so  thin  that  it  would  give  the  Im- 
pression that  the  pregnancy  might  have 
been  an  interstitial  one.  So  that  after  open- 
ing this  specimen  I  was  more  than  ever  con- 
vinced that  the  operation  was  a  proper  one 
because  I  believe  that  if  an  attempt  at  abor- 
tion had  been  made,  that  the  uterine  con- 
traction might  have  ruptured  and  probablv 
would  have  ruptured  the  uterus  at  this  point. 


200 


THE  CHARLOTTE  MEDICAL  JOURNAL 


which  would  have  complicated  an  already 
complicated  case.  The  woman  made  an  ex- 
cellent recovery-withoutany  untoward  symp- 
toms whatever.  My  mind  was  easier  made 
up  as  to  what  should  be  done  in  this  case, 
having  had  the  advantage  of  previous  con- 
versation with  Dr.  Long  during  the  time 
that  he  operated  upon  and  reported  the  case 
to  which  he  alluded. which  at  that  time  was 
a  unique  case  and  which  represented  one  of 
the  very  few  cases  reported  in  medical  lite- 
rature. 

Dr.  J.  K.  Parrott. — Dr.  Stanton's  pa- 
per was  of  especial  interest  to  me,  and  I 
listened  to  the  discussion  by  Dr.  Johnson 
and  Dr.  Long  with  much  pleasure.  It  was 
of  especial  interest  to  me,  because  about 
eighteen  months  ago  I  was  called  in  consul- 
tation to  see  a  case  of  labor  in  which  we 
found  the  pelvis  was  so  much  choked  up  by 
a  mass  that  I  recommended  a  Cesarian  sec- 
tion which  was  done  at  once,  before  the 
woman  was  exhausted.  We  removed  the 
child,  removed  the  placenta,  and  closed  the 
wound  in  the  uterus,  which  by  the  way  we 
made  transversely  instead  of  longitudinally, 
by  three  layers  of  sutures.  We  closed  the 
abdominal  wound.  The  woman-  recovered 
and  the  child  and  mother  are  still  living. 
I  made  at  the  time  an  ovarian  section  so  as 
to  prevent  the  future  pregnancy  of  the  wo- 
man. I  took  that  to  be  the  proper  thing  to 
do  under  the  circumstances.  I  found  at 
the  time  of  the  operation  it  was  more 
convenient  to  do  by  lifting  out  of  the  abdo- 
minal cavity  the  pregnant  uterus  and  to 
compress  the  uterus  just  at  the  cervical  junc- 
tion instead  of  using  the  ligature  as  is  often 
the  case.  I  found  I  could  steady  it  better,  as 
I  made  the  incision  and  afterwards  as  I 
closed  it. 

Dr.  Hugh  T.  Nelson. — In  this  connec- 
tion I  would  like  to  report  two  or  three 
cases  that  I  have  never  seen  any  notice  of 
in  any  of  the  journals  and  I  have  never  seen 
any  obstetricians  who  have  had  the  misfor- 
tune to  have  such  cases.  In  two  of  these 
cases  there  was  complete  rupture  of  the  va- 
gina following  shoulder  and  arm  presenta- 
tion. In  the  first  of  these  cases  there  had 
evidenty  been  an  attempt  at  version  and  the 
physician  who  saw  the  case  had  thought 
there  existed  a  twin  pregnancy,  and  I  was 
sent  for  to  help.  I  entirely  failed  in  my 
effort  at  version.  The  physician  who  came 
in,  said  he  was  pretty  confident  that  he 
could  do  a  version.  He  did  so  and  was 
very  much  surprised  to  find  that  the  child 
disappeared  entirely  from  the  field  of  ope- 
ration, but  the  delivery  was  easily  accom- 
plished. The  patient  was  found  to  be  in 
profound  shock,  and  died  that  night.  I 
went  up  the  next  day  and  made  a  post  mor- 


tem examination  and  found  that  there  had 
been  an  extensive  tear  of  the  vagina  just  at 
the  vaginal  junction.  The  next  case  I  saw 
the  patient  was  moribund  at  the  time.  The 
arm  was  protruding  and  without  any  effort 
on  my  part  at  all,  simply  the  slightest  pain, 
the  child  disappeared  well  up  in  the  abdom- 
inal cavity.  The  mother  was  moribund  at 
the  time,  but  I  didn't  wish  her  to  die,  so  I 
extracted  the  child  and  made  an  autopsy  as 
soon  as  she  died,  and  found  exactly  the 
same  state  of  affairs,  the  difference  between 
the  two  cases  being  that  the  effort  of  the 
physician  did  the  rupturing  in  one  and  the 
other  was  done  by  natural  effort,  because 
in  both  cases  the  child  was  born  before  the 
rupture  had  taken  place. 

Dr.  Hunter  McGuire. — I  would  like 
to  urge  a  little  conservatism  about  these 
things.  Of  course,  every  case  has  to  be 
considered  by  itself,  but  briefly  I  would  like 
to  mention  two  cases  that  are  in  my  hospi- 
tal, no,  three  cases,  one  in  another  hospital. 
One  a  woman,  four  and  a  half  months  preg- 
nant, fibroids  were  discovered  as  soon 
as  conception  took  place  and  something 
was  necessary  to  be  done.  This  woman  is 
from  Prince  Edward  county.  I  opened  the 
abdomen  and  took  out  the  tumor  and  left 
the  uterus.  In  that  case  there  had  two 
weeks  passed  and  the  woman  had  lost  her 
child.  The  second  case  I  did  a  similar  ope- 
ration, and  that  woman  is  still  carrying  her 
child  and  is  ready  to  go  home.  I  don't 
mean  to  say  that  we  should  never  operate. 
I  mean  to  say  that  we  ought  to  have  some 
concern  for  the  baby.  We  have  no  right 
to  destroy  it  if  there  are  other  means  availa- 
ble. In  both  these  cases  the  tumors  are 
gone  but  the  uteri  are  there  and  in  one  case 
the  child  is  still  living.  I  have  a  woman  in 
the  Virginia  Hospital  upon  whom  I  will 
operate  as  soon  as  I  get  home,  who  came 
last  year  to  the  same  hospital  with  large  fib- 
roid tumor.  I  found  out  that  one  of  the 
young  gentlemen  had  produced  an  abortion 
on  that  woman,  destroyed  the  baby  and  sent 
her  home.  She  has  come  back  this  year  in 
the  same  condition.  I  don't  think  we  have 
got  a  right  to  let  that  man  continue  this 
operation,  killing  baby  after  baby,  there- 
fore when  I  get  home  I  am  going  to  open 
the  abdomen  and  see  if  I  don't  remove  that 
tumor  and  leave  that  baby,  and  in  all  prob- 
ability stand  a  very  good  chance  of  saving 
that  baby's  life. 

Dr.  Stanion. — I  just  wish  to  thank  the 
gentlemen  for  the  discussion.  Dr.  Nel- 
son's remarks  upon  the  rupture  of  the  vagi- 
na recalled  to  my  mind  another  accident  like 
those  he  mentioned.  The  case  was  in  Dr. 
Cox's  practice.  I  don't  recollect  the  posi- 
tion of  the  head,  but  anyway  he  had  to  de- 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


201 


liver  with  forceps,  and  as  soon  as  he  deliv- 
ered the  child  he  found  that  the  vagina  was 
ruptured.  It  was  only  a  few  miles  from 
town  and  he  sent  for  me  to  assist  in  repair- 
ing the  laceration.  The  tear  was  in  the  left 
posterior  and  extended  to  near  the  cervix. 


Ovaritis— Acute   and    Chronic,  t 
By  Dr.  L.  G.  Frazier,    Youngsville,  N.C. 

Before  going  into  the  diagnosis,  pathol- 
ogy and  treatment  of  Ovaritis,  Acute  and 
Chronic,  perhaps  it  is  necessary  first,  to 
give  some  account  of  the  anatomy  and 
physiology  of  the  gland,  For  instance, 
there  is  perhaps  no  gland  in  the  body  which 
surpasses  the  ovary ;  for  though  it  may  not 
be  of  very  great  importance  to  the  life  of 
the  individual,  yet  it,  and  its  functions,  may 
well  be  said  to  be  the  pivot  on  which  our 
race  depends.  Even  in  the  individual, 
though  life  may  be  endangered  only  in  a 
certain  class,  or  a  few  of  the  ovarian  dis- 
eases, yet  the  frequency  of,  and  the  discom- 
fort attending  all  the  others,  are  enough  to 
exalt  the  gland  into  a  structure  of  extreme 
importance.  The  ovary  and  its  diseases 
are  generally  and  too  frequently  passed  un- 
noticed by  the  general  practitioner. 

The  human  ovary  makes  its  appearance 
as  a  blastema  on  the  Wolfian  body  about 
the  seventh  week  of  extra-uterine  life.  It 
has  been  confirmed  by  many  eminent  wri- 
ters that  this  early  part  of  its  existence  being 
absolutely  identical  with  that  of  the  male 
testicle,  though  throughout  its  after  history 
it  lias  many  differences  from  the  male  gland, 
yet  it  resembles  it  so  much  in  anatomical 
structure,  physiological  purpose  and  patho- 
logical change,  I  think  we  are  perfectly 
justifiable  in  going  back  to  the  ancient  no- 
tion that  it  is  the  "testis  muliebris."  One 
distinguished  writer  has  drawn  a  difference 
between  the  two  glands  in  that  the  devel- 
oping cells  of  the  ovary  are  plastic  or  en- 
dermic,  while  the  spermatic  cells  of  the 
testes  are  epidermic.  There  are  reasons  for 
not  confirming  this  idea,  yet  we  do  know 
that  the  two  are  closely  analogous  even  in 
their  diseases.  In  its  development  the  ovary 
becomes  enclosed  in  a  fold  of  the  perito- 
neum known  as  the  broad  ligament  of  the 
uterus.  Some  writers  hold  to  the  view  that 
on  the  posterior  surface  of  the  ovary,  the 
peritoneum  does  not  exist,  if  so,  it  has  be- 
come blended  with  the  underlying  coat,  the 
tunica  albuginia  of  after  life.  The  ovaries 
are  situated  on  a  level  with  the  inlet  of  the 


tRead  before  the  Tri-State  Medical  Society  of 
the  Carolinas  and  Virginia,  at  Charlotte,  N.  C, 
January,  1899. 


true  pelvis,  behind  the  fallopian  tubes  and 
round  ligaments,  the  left  in  front  of  the 
rectum,  and  the  right  in  relation  to  some 
coil  of  the  small  intestine,  occupying  Doug- 
las1 Pouch.  The  ovaries  may  vary  some- 
what in  location,  they  are  attached  to  the 
uterus  by  a  ligament  of  contractible  tissue 
derived  from  the  uterus,  called  the  ovarian 
!  ligament.  They  are  supplied  with  blood 
J  vessels  corresponding  in  origin  to  those  of 
J  the  testis  ;  the  spermatic  and  the  nerves  are 
derived  chiefly  from  the  renal  plexus  of  the 
sympathetic.  The  size  of  the  ovaries  varies 
at  different  stages  of  life,  the  age  of  the  in- 
dividual having  a  great  deal  to  do  with  it. 
At  the  time  of  the  first  menstrual  period, 
the  ovaries  are  considered  to  be  full  grown. 
Ovulation  begins  at  various  ages,  and  usu- 
ally begins  earlier  in  warm  climates  than  in 
cold.  The  function  of  the  ovaries  is  pri- 
mary in  the  process  of  reproduction.  Their 
physiological  action  precedes  that  of  the 
uterus,  and  continues,  as  a  rule,  until  the 
menopause,  and  sometimes  after.  By  care- 
ful observations  it  has  been  noted  that  ovu- 
lation and  menstruation  occur  independ- 
ently of  each  other,  but  this  is  an  excep- 
tion and  not  the  rule.  What  I  mean  by 
ovulation  iscell  growth  of  the  ovary.  Un- 
derneath the  peritoneal  covering  of  the 
ovary  is  a  fibrous  covering  known  as  the 
"Tunica  albuginia,"  composed  of  ordinary 
fibrous  connective  tissue,  and  sending  tra- 
becule in  all  directions  into  the  interior  of 
the  gland.  These  cells  undergo  a  peculiar 
growth,  enlarging,  coming  to  the  surface, 
and  rupturing  simultaneously  with  the 
menstrual  excitement.  Their  contents  are 
generally  discharged  into  the  uterus  by  the 
ducts  of  these  glands.  Sometimes  this  hap- 
pens independently  of  the  influence  of  the 
womb,  when,  it  is  said,  the  contents  are 
lost  in  the  peritoneal  cavity. 

This  peculiar  cell  growth  of  the  ovaries 
results  in  what  are  known  as  Graafian  ves- 
icles, or  the  ovisacs  of  Martin  Barry.  The 
Graafian  vesicle  is  nothing  more  or  less  than 
a  cell,  the  product  of  a  gland,  of  basement 
membrane,  blood  vessels  and  epithelium. 
The  cell  bursts,  discharges  its  nucleus  as 
other  cells  are  seen  to  do,  but  that  nucleus 
has  specific  powers,  goes  through  processes 
under  certain  circumstances  differing  in  this 
from  all  other  cells.  The  gland,  therefore, 
and  its  cells,  have  more  highly  developed 
and  complex  functions  to  perform  than  any 
other  gland,  is  more  apt  to  suffer  from  dis- 
turbance, and  these  special  functions  being 
in  action  during  a  certain  period  only  of  the 
individual's  life,  hence  we  find  ovarian  dis- 
eases, especially  adapted  to  this  period, 
namely,  between  the  years  of  13  and  45.  I 
may   say  just  here,  however,  that    this   cell 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


growth  does  not  cease  entirely  at  the  cli- 
macteric period.  It  goes  on  to  some  extent 
as  long  as  there  is  life,  and  I  may  also  say 
there  are  certain  diseases  which  diminish 
the  activity  of  this  cell  growth,  between 
puberty  and  the  climacteric  period,  such  as 
the  wasting  diseases — phthisis,  cancer,  etc. 
Pregnancy  reduces  it,  also  the  period  of  lac- 
tation. 

The  ovary,  then,  is  a  simple  gland  devel- 
oped as  other  glands,  and  formed  of  sim- 
ilar elements.  It  is  peculiar  in  that  its  cell  nu- 
clei have  special  powers  during  a  certain  pe- 
riod of  life, and  this  simplification  of  its  phys- 
iology, I  think,  does  much  towards  simpli- 
fying its  pathology.  But  perhaps  I  ought 
to  confine  myself  more  closely  to  the  sub- 
ject. There  is  a  hyperemic  condition  of 
the  ovaries,  so  closely  allied  to  the  forms  of 
inflammation  I  am  to  speak  of,  and  most 
especially  the  chronic  forms,  I  do  not  think 
I  would  be  doing  either  myself  or  hearers 
justice  to  pass  it  by  unnoticed. 

Ovarian  hyperemia  is  the  result  of  an 
oversufhcient  activity  of  the  ovaries  and  is 
therefore  the  converse  of  ovarian  amenor- 
rhea and  dysmenorrhea  ;  it  is  by  no  means 
a  rare  affection,  it  is  well  marked  in  its  his- 
tory, the  chief  signs  of  which  is  menorrha- 
gia. 

The  following  is  a  history  of  a  case  I 
have  had  under  my  care.  The  young  lady 
is  the  child  of  parents  of  markedly  nervous 
temperament,  and  I  might  almost  say  pre- 
maturely developed,  and  when  at  the  early 
age  of  13  years  and  three  months  began  to 
menstruate.  From  the  very  beginning  she 
passed  a  great  deal  of  blood  at  her  monthly 
periods,  and  at  first  suffered  no  pain  during 
the  time.  She  enjoyed  excellent  health  for 
some  time  after  she  began  to  menstruate, 
during  which  time  the  flow  was  very  pro- 
fuse, lasting  from  five  to  eight  days.  By  the 
time  she  was  fourteen,  her  health  being  im- 
paired, she  was  listless,  sleepy,  dull  and 
sluggish,  and  occasionally  would  have  faint- 
ing spells,  and  became  very  dull  of  mem- 
ory, reduced  in  flesh  and  decidedly  anaemic. 
Steady  pressure  over  the  ovaries  gave  great 
pain,  which  she  said  turned  her  quite  sick. 
This  pressure  however,  was  made  just  two 
days  before  her  period,  and  during  men- 
struation this  pain  was  induced  by  less 
pressure,  but  in  the  entero-menstrual  period 
it  could  not  be  produced  at  all.  Her  health 
seemed  better  during  the  flow,  and  that  was 
the  reason  why  her  parents  did  not  seek 
medical  aid  sooner.  In  such  a  case  there  is 
no  doubt  in  my  mind  that  there  is  hyper- 
emia, not  of  the  ovaries  only  but  of  ;he 
whole  sexual  apparatus,  due  to,  it  may  be, 
the    increased  ovarian  activity.      My  expe- 


rience up  to  the  present,  has  not  as  yet  been 
so  extensive  as  to  trace  such  a  case  through- 
out its  course  but  I  have  met  with,  many 
cases  which  I  have  had  sufficient  reasons  to 
believe  as  identically  of  the  same  nature  in 
later  stages,  and  I  think  their  menstrual 
periods  are  mnch  the  same  as  other  women 
after  they  have  had  a  child.  The  marriage 
life  seems  to  have  a  great  deal  to  do  with 
rectifying  this  abnormal  excitement  of  the 
ovaries.  If  a  patient  suffering  with  abnor- 
mal excitement  of  the  ovaries,  viz  :  hyper- 
emia, remain  unmarried,  they  go  on  suffer- 
ing from  menorrhagia,  become  extremely 
anemic,  the  menopause  comes  on  at  the 
usual  time,  but  marked  with  abnormal  pro- 
fuseness.  I  have  often  noticed  that  mar- 
riage, even  without  result  of  child-bearing 
modifies  this  trouble  to  a  marked  degree. 

Now  just  a  word,  in  brief,  as  to  the  treat- 
ment of  the  case  I  have  just  noted.  My 
first  advice  was  that  the  patient  be  taken 
from  school,  and  that  for  at  least  one  year, 
and  all  instructions,  especially  in  music, 
should  cease,  and  a  change  from  books  and 
society  and  indoor  amusements,  to  outdoor 
exercise  and  amusements.  I  then  put  my 
patient  on  tonics  to  restore  the  general 
health. 

Just  a  word  as  to  marrying  :  One  case  I 
had  under  my  charge  .vas  permanently 
cured  by  marriage,  and  I  believe  many  a 
case  of  hyperemia  of  ovaries  and  menor- 
rhagia have  been  cured  by  marriage.  I 
strongly  advocate  marriage  in  some  cases. 
Just  here  I  lay  special  stress  on  music  as 
being  detrimental  to  young  women  just 
emerging  into  womanhood  and  beginniugto 
menstruate.  To  keep  a  young  woman  just 
at  this  critical  period  seated  upright  on  a 
music  stool  with  her  back  unsupported, 
practicing  vigorously  for  some  hours  can 
only  be  detrimental  to  her  physical  welfare. 
Musical  exercises  are  hurtful  for  other  rea- 
sons, for  those  who  are  gifted  and  are  espe- 
cially fond  of  music,  their  emotions  seem  to 
be  much  excited  by  it.  But  I  must  hasten 
on. 

Absolute  rest  is  one  of  the  most  essential 
parts  in  the  early  treatment  of  ovarian  hy- 
peremia. The  patient  should  be  confined 
to  a  somewhat  prone  position  a  few  days 
before,  during,  and  after,  the  catamenial 
flow.  An  application  of  a  counter  irritant 
over  the  ovarian  region  just  beforthe  flow  is 
beneficial,  but  the  most  useful  part  of  the 
treatment,  I  think,  is  the  administration  of 
full  doses  of  ergot  just  before,  and  duringt, 
hee  flow.  The  bromides  I  have  found  to 
be  of  great  benefit  in  ten  grain  doses  twice 
a  day.  When  hyperemia  is  caused  by  a 
desire  for  the  opposite  sex,  as  is  often    the 


THE  CHARLOTTE  -MEDICAL  JOURNAL. 


2o:s 


case,  I  find  the  following  anaphrodisiac  pill 
given  three  times  a  day  of  great  value  : 

ft  Camphor  gr.    n. 

Ext.  Henbane  gr.  i. 

Sig.  :     Give  one  or  two  pills  a  day. 

To  relieve  the  pain  I  find  this  pill  to  be 
of  great  benefit  : 

ft         Ext.  Henbane  gr.  iss 

Opium  Pulvis  gr.  ss 

Sig.      One  pill  three  times  a  day. 

Just  here,  let  me  say,  it  is  very  necessary 
that  ovarian  hyperemia  be  treated  in  the 
early  stages.  This  trouble  is  so  often 
passed  unnoticed  by  the  general  practi- 
tioner and  left  to  nature,  that  consequently 
the  patient  grows  worse  and  worse  until 
she  has  what  we  term  chronic  ovaritis. 

ACUTE      OVAUITIS. 

This  affection  of  the  ovaries  is  quite  dis- 
tinct from  other  ovarian  troubles,  because,  I 
think,  we  are  almost  perfectly  justifiable  in 
saying  it  is  always  the  result  of  some  spe- 
cial cause,  usually  a  specific  poison,  such  as 
gonorrh(ral  infection,  septic  poison  in  the 
parturient  condition,  or  some  constitutional 
condition,  like  the  eruptive  fevers,  and  in 
acute  rheumatism.  It  may  also  be  trau- 
matic, though  this  is  rare. 

There  is,  I  suppose,  much  confusion  of 
thought,  as  regards  the  pathology  of  ova- 
ritis. There  is  no  doubt  that  ovarian  hyper- 
emia, and  acute  and  chronic  ovaritis,  are 
often  confounded.  Still  the  causes  of  each 
are  typical,  and  the  distinction  should  be 
readily  made.  The  acute  affection,  as  is 
well  known,  runs  its  course  rapidly,  and 
terminates  either  in  death,  or  subsidence  of 
the  inflammatory  symptoms  and  a  damaged 
state  of  the  ovaries.  In  chronic  ovaritis 
there  are,  on  the  contrary,  changes  which 
take  place  more  slowly  and  are  not  marked 
by  the  same  symptoms  of  inflammation. 
In  hypenemia  of  the  ovaries,  of  course,  we 
have  no  tissue  change.  It  seems  to  me  that 
the  differential  diagnosis  between  acute  and 
chronic  ovaritis  is  as  well  defined,  both  in 
clinical  history  and  anatomical  changes,  as 
acute  and  chronic  nephritis.  Now  just  a 
Few  words  as  regards  the  pathology  : 

When  ovaritis  is  the  result  of  septic  poi- 
soning in  the  parturient  condition,  only  one 
ovary  is  affected,  as  a  rule.  All  the  tissues 
of  the  ovary  are  affected  and  take  part  in 
the  trouble.  This  is  the  first  morbid  change 
produced.  Then  there  is  swelling  of  the 
gland  from  the  transudation  of  serum.  All 
the  tissues  are  inflamed  or  involved,  fre- 
quently the  fimbriated  extremity  of  the  fal- 
lopian Uibe  is  involved,  and  the  peritoneum 
around  the  ovary.  The  vesicles  are  occa- 
sionally  destroyed  by  effusion    or    purulent 


infiltration.  Sometimes  one  large  abscess  is 
formed,  in  other  cases  a  number  of  small 
ones  are  found.  In  addition  to  these  path- 
ological changes  there  are  others  which  may, 
or  may  not,  occur.  Occasionally  there  are 
prolapsus  of  the  ovary,  and  sometimes  ad- 
hesions to  the  neighboring  organs.  When 
there  is  a  formation  of  an  abscess,  and  a 
collection  of  pus,  it  may  open  into  the  rec- 
tum or  the  peritoneal  cavity.  Sometimes 
the  abscess  does  not  open  at  all  but  remains 
encysted. 

SYMPTOMS. 

There  are  both  local  and  constitutional 
symptoms  in  acute  ovaritis,  occasionally 
there  is  a  chill  or  rigor,  followed  by  a  deci- 
ded rise  of  temperature ;  there  is  nausea 
and  vomiting,  and  acute  pain  in  the  region 
of  the  ovaries.  There  is  a  marked  exag- 
geration of  the  nervous  system,  but  no  de- 
lirium. Frequently  there  is  hysteria,  and 
in  some  cases  mania  is  developed.  There  is 
not  a  vast  difference  between  ovaritis  and 
other  acute  pelvic  inflammations.  In  the 
former  the  nervous  symptoms,  I  think,  are 
more  marked,  and,  in  mild  cases  the  con- 
stitutional disturbances  are  less  severe. 
There  is  a  rise  in  temperature,  increased 
pulse  rate,  and  deranged  primary  nutrition. 
The  appetite  is  very  poor  and  some  symp- 
toms of  dyspepsia,  flatulence  and  constipa- 
tion. Later  on  there  is  a  pus  formation, 
followed  by  a  chill  or  irregular  rigors.  The 
local  symptom  is  acute  pain,  especially  over 
the  ovary  that  is  affected,  the  patient  being 
able  often  to  point  out  the  exact  spot  where 
the  pain  starts.  There  is  marked  tender- 
nesss  on  pressure  over  the  affected  ovary. 
There  is  generally  some  tenesmus,  a  fre- 
quent desire  to  urinate  and  there  is  often 
severe  pain  on  defecation,  especially  if  the 
left  ovary  is  affected.  The  physical  signs 
which  I  deem  as  of  extreme  importance  in 
differential  diagnosis  : 

We  find  extreme  tenderness  on  pressure. 
In  fact  I  have  had  patients  who  would  not 
allow  me  to  make  any  pressure  at  all.  This 
pain  is  more  acute,  and  more  definitely  lo- 
cated than  in  pelvic  inflammation.  When 
the  ovary  is  very  much  swollen,  as  it  often 
is,  it  can  be  felt  through  the  abdominal 
walls.  By  the  vaginal  examination,  we 
find  the  parts  very  tender  and  hot.  The 
finger,  if  possible,  should  be  carried  high 
up  behind  the  uterus,  when  the  ovary  may 
be  felt  or  caught  between  the  finger  and 
sacrum.  The  ovary  will  be  found  to  be 
slightly  movable,  enlarged  and  very  tender. 
Rectal  examination  will  perhaps  enable  us 
to  better  locate  it. 

PROGNOSIS. 

We    should    always    expect    a   fatal    ter- 


204 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


ruination  when  there  is  suppuration  and 
the  abscess  opens  into  the  peritoneal  cav- 
ity. Death  may  also  occur  from  septicae- 
mia. There  are  better  hopes  of  the  patient 
when  the  contents  of  the  abscess  finds  its 
way  through  the  rectum  or  vagina,  or  when 
the  abscess  becomes  encysted.  The  ovary, 
of  course,  is  impaired,  and  is  no  longer  ca- 
pable of  performing  its  normal  functions, 
still,  if  one  ovary  is  left  in  a  normal  state, 
we  can  assure  our  patient  that  there  is  a 
chance  of  her  regaining  her  health  and 
bearing  children. 

TREATMENT. 

The  first  and  most  important  is  com- 
plete rest.  We  must,  if  possible,  em- 
ploy such  treatment  in  the  beginning  as 
will  control  or  abort  the  inflammation,  and 
to  do  this,  I  find  absolute  rest,  with  small 
doses  of  opium  in  combination  with  extract 
of  henbane,  given  as  often  as  needed  to 
relieve  pain,  the  best.  If  the  stomach  is  so 
irritable  as  to  refuse  the  opium,  then  it 
must  be  given  hypodermically.  vSome  ad- 
vocate the  use  of  quinine  in  large  doses  ;  in 
my  own  experience  I  have  not  found  it  to 
be  of  any  great  value,  still  I  think  it  may 
be  given  without  harm  and  perhaps  do  good 
in  some  cases.  If  my  patient  is  nervous, 
as  the  most  of  them  are,  I  give  bromide 
and  a  little  chloral  at  night,  or  Kola  com- 
pound. The  bowels  should  be  well  looked 
after,  and  not  be  kept  too  long  confined,  in 
fact,  the  bowels  should  be  moved  once  a  day 
by  a  mild  enema.  Local  applications,  I 
think,  relieve  the  patient  to  some  extent. 
I  find  warm  poultices,  mild  mustard  plasters, 
or  flannels  wrung  out  of  hot  water  and 
covered  with  oiled  silk,  give  the  patient 
much  comfort.  The  application  of  leeches 
is  somewhat  beneficial.  The  patient  should 
be  well  nourished.  If  there  is  suppuration 
and  no  discharge  of  pus,  and  septicaemia  is 
expected,  asperation  should  be  done  with- 
out delay. 

Prof.  Virgil  O.  Hardon,  of  Atlanta,  Ga., 
highly  recommends  asperation.  In  my  own 
experience  I  have  not  yet  found  it  necessary 
to  asperate.  In  the  beginning  of  a  case  of 
acute  ovaritis,  I  have  gotten  good  results  by 
the  administration  of  hydrastis  Canadensis, 
in  20  minim  doses  every  four  and  one  half 
hours.  The  followig  formula  I  have  found 
of  special  benefit,  to  allay  pain. 

R  Henbane  Ext. 

Camphor  aa  gr.  x 

Dover's  Powder  grs.  xx 

Mx.   ft.  Pills  no.  10. 

Sig.  One  pill  every  two  or  three  hours. 

CHRONIC  OVARITIS. 

Concerning  chronic  inflammation  of  the 
ovary,  we  do  not  find  a  great    deal    in    the 


writings  of  our  authorities  in  gynaecology, 
still  by  careful  examinations  and  grouping 
of  symptoms,  I  have  been  able  to  satisfy 
myself  that  the  condition  may  be  accu- 
rately defined  and  readily  diagnosed,  and  in 
my  opinion,  successfully  treated  in  a  great 
many  cases.  Chronic  ovaritis  may  be  a 
later  stage  of  hyperasmia,  it  may  be  the 
result  of  the  acute  form  ;  but  a  great  many 
cases,  I  might  say  the  majority  of  cases,  so 
far  as  my  experience  has  been,  occur  from 
sexual  excess  and  masturbation.  Some 
cases  occur  as  a  sequela  of  exanthemata 
and  rheumatic  fever  and  probably  syphilis. 
Chronic  inflammation  of  the  ovary  is  not 
an  uncommon  disease,  for  out  of  eighty-one 
dissections  Henning  found  the  ovaries  dis- 
eased in  fifty-three  cases.  Time  will  not 
permit  me  just  here  to  go  into  the  pathology 
of  chronic  ovaritis.  I  shall  only  give  symp- 
toms and  treatment.  The  symptoms  which 
have  enabled  me  to  class  a  number  of  cases 
together  as  chronic  ovaritis  are  :  First,  in 
the  history  of  the  case,  that  the  monthly 
periods  have  been  irregular,  generally  too 
frequent,  and  that  they  have  been  too  pro- 
fuse. If  the  affection  have  a  subsequent 
origin,  then  there  can  be  obtained  some 
story  of  a  sufficient  reason  for  the  disease, 
either  in  gonorrhoeal  infection  or  a  puer- 
peral accident  leading  to  an  acute  inflam- 
matory attack  or  an  over  indulgence  in  the 
sexual  congress.  There  is  nearly  always  a 
sense  of  weight  and  fullness  in  the  ilio- 
hypogastric region  in  chronic  ovaritis,  and 
sometimes  there  is  tympanitic  swelling. 
The  discomfort  is  so  great  the  patient  can 
not  bear  her  corset  very  tight.  Sickness 
and  nausea  are  often  present,  and  generally 
just  a  few  days  before  the  menstrual  period. 
There  is  a  marked  depression  of  the  nutri- 
ent and  nervous  system ;  at  times  I  have 
found  my  patient  with  a  capricious  appe- 
tite. The  bowels  are  generally  constipated. 
These  symptoms  are  progressive,  the  pa- 
tient's general  health  becoming  more  im- 
paired month  after  month  as  the  disease  ad- 
vances. There  is  generally  menorrhagia. 
Still  in  some  old  standing  cases  amenorrhea 
is  the  result.  All  of  thee  symptoms  are 
aggravated  by  walking,  standing,  or  riding 
or  any  overexertion.  Sexual  excitement 
and  coitus  usually  cause  a  great  deal  of  pain. 
By  physical  examination  we  find  the  ovaries 
tender  to  the  touch,  sometimes  the  ovary  is 
movable  and  occasionally  a  separation  from 
the  uterus  can  be  distinguished.  The  phys- 
ical signs  and  symptoms  of  chronic  ovaritis 
greatly  resemble  those  of  ovarian  hypere- 
mia. The  prognosis  of  chronic  ovaritis 
depends  a  great  deal  upon  the  early  treat- 
ment. Chronic  ovaritis  should  be  care- 
fully treated  as  early  as  possible. 


THE  CHARLOTTE'oMEDlCAL  JOURNAL, 


205 


TREATMENT. 

The  first  steps  in  the  treatment  of  chronic 
ovaritis  is  to  lessen  the  blood  supply  and 
relieve  pain,  by  Correcting  the  deranged  en- 
ervation.  This  requires  rest  in  the  early 
stages,  in  the  recumbent  position ;  milch 
good  may  be  derived  from  massage,  or  some 
kind  of  exercise  in  the  reclining  position. 
The  bowels  should  be  kept  well  open  with 
saline  laxatives.  Tonics  are  indicated  in 
almost  all  cases.  To  relieve  the  pain  and 
lessen  the  hyperaemia,  I  usually  give  brom- 
ide of  sodium  in  combination  with  fluid 
extract  of   hydrastis. 

ft  Bromide   Sodium  gr.  xx 

Fluid  Ext.  Hydrastis     gtts.  xx 

Three  times  a  day  I  find  produces  the  de- 
sired effect.  Good  results  may  be  obtained 
by  the  administration  of  salicylate  of  sodium 
gr.  x  in  combination  with  grs,  v  of  antipy- 
rine,  best  given  before  or  between  meals.  1 
also  find  sulfonal  a  desirable  remedy.  When 
iron  is  indicated  I  give  small  doses  of  mer- 
cury with  chloride  of  iron.  1  also  give 
syrup  iodide  of  iron  in  large  doses,  if  the 
chloride  and  mercury  is  not  preferable.  As 
to  surgical  interference  in  these  cases,  I 
only  have  to  say,  the  advancement  of  ab- 
dominal and  pelvic  surgerv  at  t  he  present 
time  has  resulted  in  the  removal  of  ovaries 
as  the  most  prompt  and  efficient  treatment 
of  chronic  ovaritis.  If  the  ovary  is  causing 
great  suffering,  and  the  indications  are  that 
it  will  be  a  long  and  tedious  trouble  to  the 
patient,  and  most  especially  if  general  and 
persistent  treatment  on  the  part  of  the  phv- 
sician  has  failed,  also  taking  into  consider- 
ation that  the  ovaries  are  not  necessarv  to 
existence,  and  can  be  removed  perhaps  with 
safety,  then  I  think  the  ovary  should  be 
removed.  It  is  in  accordance  with  the  rules 
of  modern  surgery  to  remove  any  organ  or 
portion  of  the  body  that  one  can  live  with- 
out, in  case  a  disease  of  the  part  tends  to 
take  life  or  cause  untold  suffering  for  an 
unlimited  time.  Yet  I  am  only  in  favor  of 
removing  the  ovary  when  it  is  utterly  im- 
possible to  save  it.  The  ovary,  if  it  is  pos- 
sible to  save  it  without  jeopardizing  the 
patient's  life,  and  making  her  a  lifetime 
sufferer,  it  should  be  done,  for  as  Dr.  Good- 
ell  has  so  wisely  said  in  a  paper  before  the 
Pennsylvania  State  Society,  "in  the  popu- 
lar mind  a  woman  without  ovaries  is  no 
woman." 


Modern  Views  of    the  Nature    and  Treat- 
ment of   Pulmonary  Tuberculosis. t 

By  H.  B.  Weaver,  M.  I).,  Asheville,  X.  C. 

If    an  apology  is  necessary  for   the  intro- 
duction at  this  meeting  of  a  subject  of  which 


so  much  has  already  been  written  it  is  found 
in  the  vast  importance  which  attaches  to, 
and  the  wide  diversity  of  opinion  regarding 
the  nature  and  treatment  of  pulmonary  tu- 
berculosis. Perhaps  this  phase  of  the  sub- 
ject, "including  prevention,  represents  the 
nlost  active  fields  of  medical  thought  and 
research  during  the  last  two  decades." — 
(Pritchard.) 

Notwithstanding  the  practical  results  that 
have  been  attained  by  the  hygienic  preven- 
tion formulated  upon  the  better  knowledge 
of  the  cause  and  nature  of  the  disease,  which 
reveals  the  fact  that  in  the  United  States 
alone,  the  death  rate  from  consumption  has 
been  reduced  thirty-eight  per  cent,  in  the 
last  ten  years,  jet  the  fact  remains  that  the 
mortality  from  this  fearful  scourge  amounts 
to  more  than  all  other  contagious  diseases 
put  together,  and  yet  further,  at  the  end  of 
this  decade,  the  medical  world  stands  view- 
ing with  great  concern  and  anticipation  the 
results  of  the  incessant  toils,  both  in  labor- 
atory research  and  clinical  experimentation 
of  such  men  asTrudeaux,  Von  Ruck,  Klebs, 
Denison,  Waugh,  Waxham,  Whittaker,  Pa- 
quin,  Mosler,  Brunton,  Hager,  Gerhardt, 
and  many  others,  the  sum  of  whose  labors 
is  simply  appalling  in  dimensions,  to  find, 
if  happily,  among  all  these  newer  methods 
and  measures  of  treatment,  any  remedy  that 
might  be  classed  in  the  nature  of  a  specific 
for  consumption.  Although  the  concensus 
of  opinion  at  the  present  is  not  assuring, 
yet  the  dawning  of  the  20th  century  is  ra- 
diant with  hope,  for  we  shall  yet  surely 
find  a  remedy  indeed. 

It  is  universally  conceded  by  eminent 
pathologists  that  two-thirds  of  the  human 
race  are  afflicted  with  tuberculosis.  Of  100 
complete  autopsies  made  by  Schlenger,  66 
bodies  were  found  tuberculous.  Osier  found 
in  1,000  necropsies,  excluding  216  which 
died  of  phthisis,  59,  or  7  per  cent.,  had 
tuberculous  lesions,  which  had  been  repair- 
ed. Buchord  found  in  his  post-mortems 
over  75  per  cent,  tuberculous. 

In  tiie  language  of  Whittaker,  we  will 
say,  therefore,  to  be  within  the  limits  of 
perfect  safety,  "that  two-thirds  of  man- 
kind are  effected  with  tuberculosis,  and  one- 
third  dies  of  the  disease."  "Therefore,  in 
one-half  of  all  the  cases  recovery  is  com- 
plete, or  the  disease  is  reduced  to  such 
quiescence  as  to  become  practically  non- 
existent." If  one-half  of  all  the  cases  are 
cured  spontaneously,  nature  then  must  pro- 
vide a  remedy  within  her  own  resources  by 
which  this  cure  is  accomplished.  What  is 
the  process  of  cure?     All   intelligent  thera- 


fRead  before  the  Tri-State  Medical  Society  of 
theCarolinas  and  Virginia,  at  Charlotte,  N.  C, 
January,  1899. 


206 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


peusis  is  necessarily  based  on  a  correct  un- 
derstanding of  the  pathogenesis  of  the  given 
disease  we  wish  to  treat.  Without  a  reason- 
able and  just  conception  of  the  cause  and 
nature  of  consumption,  we  cannot  imitate 
nature  in  her  process  of  cure.  Pulmonary 
tuberculosis  is  primarily,  in  the  great  ma- 
jority of  cases,  a  local  disease,  involving 
but  a  small  portion  of  one  lobe  of  the  lung. 
This  process  follows  well  defined  routes. 
Catarrhal  affections  of  the  bronchial  mem- 
branes, regularly  accompanied  with  super- 
ficial denudation  of  the  epithelium,  serve  as 
portals  for  the  entrance  and  implantation 
of  the  spores  of  the  bacillus.  From  this 
focus  they  advance  through  the  lymph 
spaces  and  lymph  channels  into  and  through 
the  blood,  and  rarely,  if  ever,  along  the 
mucous  surface  from  the  mouth  to  the  air 
cells. 

Pathology  teaches  that  one  peculiarity  of 
the  tubercle  bacillus  is  to  incorporate  itself 
with  a  white  blood  corpuscle,  and  by  its 
toxic  stimulation,  converts  it  into  a  large 
lymphoid  cell  and  to  a  multiplication  of  the 
connective  tissue  cells  of  the  parts.  After 
a  while  this  lymphoid  cell  will  grow  to  the 
proportions  of  a  multinuclear-giant  cell, 
containing  a  number  of  bacilli.  They  in- 
duce vascular  changes  and  increased  de- 
posits of  leucocytes  which  have  emigrated 
through  the  thinned  walls  of  the  terminal 
vessels  ready  to  join  themselves  to  the  spores 
of  the  bacilli  which  have  disappeared  in  the 
granular  mass  which  is  the  result  of  coagu- 
lation af  the  nucli  of  the  lymphoid  and 
great  cells.  With  the  formation  of  this 
agglutinated  mass  of  decayed  cell  elements 
the  process  of  caseation  is  established.  The 
presence  of  this  mass  of  necrosed  tissue  acts 
as  an  irritant  upon  the  capillaries  of  the 
vicinity  and  a  wall  of  new  formed  granu- 
lation tissues  is  thrown  up  around  the  focus. 
If  this  barrier  of  new  formed  tissue  is  suffi- 
ciently strong  to  withstand  the  further  in- 
vasion by  the  bacilli,  there  will  be  encap- 
sulation of  the  focus  and  arrestment  of  the 
disease  :  otherwise  there  will  be  extensive 
caseaous  infiltration.  An  increased  exuda- 
tion of  blood  serum  will  finally  bring  about 
emulsification  of  the  cheesy  focus  and  the 
beginning  of  an  abscess  cavity. — (Gerster.) 

Thus  we  have  presented  a  classical  pic- 
ture of  the  evolution  of  a  veritable  tubercle  ; 
and  pulmonary  tuberculosis  is  but  the  ag- 
gregation of  a  number  of  tubercles  in  one 
or  more  portions  of  the  lungs. 

Therefore,  if  these  modern  theories  of  the 
nature  of  tuberculosis,  the  truth  of  which 
since  the  discovery  of  Koch  announced  in 
1SS2,  no  longer  remains  to  be  demonstra- 
ted, three  facts  are  brought  out  very  clearly  : 

1.     That  from  thirty  to  fifty  per  cent,  of 


the  cases  make  spantaneous  cures  according 
to  nature's  process. 

2.  That  tuberculosis  is  different  from 
other  microbic  affections  in  that  it  is  not 
self-limited  or  self  protected, 

3.  That  it  is  distinguished  from  a  major- 
ity of    other    affections    in  that  we    do    no 
find  leucocytosis  attending  it.  f 

"Can  we  correllate  these  facts  and  infer 
that  the  failure  of  self-immunization  is  due 
to  the  fact  that  nature  has  here  failed  to 
combat  the  disease  for  a  lack  of  her  defen- 
ders, the  leucocytes?  Nothing  in  art  ap- 
proaches the  efficacy  of  nature  in  controll- 
ing and  curing  tuberculosis.  The  natural 
processes  of  cure  would  seem  to  be  first, 
that  means  by  which  toxins,  or  anti-toxins 
are  manufactured  in  the  body  which  will 
directly  destroy  the  tubercle  bacilli ;  or,  in 
the  second  place,  by  sterilizing,  immunizing 
or  invigorating  the  soil.  All  more  or  less 
of  the  latter  methods  of  treatment  have 
been  in  imitation  of  nature's  process  of  cure. 

If  it  be  admitted  that  there  are  on  every 
hand  around  us  instances  of  acquired  im- 
munity to  tuberculosis,  and  if  the  disease  is 
due  to  a  special  toxin  working  in  the  sys- 
tem, it  must  be  only  through  the  develop- 
ment in  that  system  of  an  appropriate  anti- 
toxin, or  by  the  injection  or  otherwise,  of 
an  anti-toxin  manufactured  outside  of  the 
body,  that  there  will  be  produced  a  resist- 
ance sufficient  to  stay  the  progress  of  the 
disease.  In  serum  therapy  each  of  these  theo- 
ries is  contending,  to-day  for    the   mastery. 

The  first  that  there  can  be  created  in  the 
body  an  anti-toxic  condition  of  the  blood 
and  tissues,  which  will  be  antagonistic  to 
the  further  tubercular  infection,  finds  its 
correllate  in  the  -primary  or  direct  method 
of  treatment. 

The  second,  "that  instead  of  exciting  in 
the  human  body  a  resisting  anti-toxin,  it  is 
created  in  an  animal  and  given  to  the  in- 
valid gratis,"  finds  its  counter-part  in  the 
secondary  or  indirect  method  of    treatment. 

The  first,  or  primary,  method  is  that  in- 
augurated by  Koch,  and  consists  of  the  use 
of  tuberculin, or  some  of  its  various  modifica- 
tions, some  of  which  are  tuberculocidin, 
antiphthisin,  oxytuberculin,  tuberculin  R, 
and  Von  Ruck's  Watery  Extract  of  Tuber- 
cle Bacilli.  The  second  consists  in  the  use 
of  the  different  serums  produced  from  the 
animals,  such  as  the  goat  and  horse,  some 
of  which  are  Muralingous,  Paquin's  and 
Fich's  serum.  About  these  two  methods 
there  is  as  yet  great  speculation.  Time  is 
yet  too  short  to  pronounce  dogmatically, 
without  sufficient  clinical  tests,  in  favor  of 
either.  Reasoning  from  analogy,  as  in  the 
case  of  anti-toxin  as  a  specific  for  diphthe- 
ria, it  would  seem  that  some   positive  cura- 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


207 


tive  results  might  have  been  expected  from 
serum  therapy.  As  a  matter  of  fact  such 
results  have  been  claimed,  but  these  claims 
have  been  disputed  by  equally  as  competent 
observers  and  the  evidence  in  support  of 
such  claims  are,  to  say  the  least,  inconclu- 
sive. The  burden  of  proof  lies,  therefore, 
with  the  advocates  of  the  secondary  method 
upon  the  following  propositions  : 

i.  To  what  extent  can  natural  immunity 
to  the  disease  be  conferred  through  the 
serum  of  a  horse  to  the  human  being. 

2.  The  length  of  time  the  animal  should 
be  treated  before  it  is  immune,  and  the 
length  of  lime  that  should  elapse  after 
immiKiization  before  the  serum  is  with- 
drawn. 

These  are  pertinent  questions.  Prof. 
Waxham,  of  Denver,  replies  in  effect  to 
these  propositions,  "  If  anti-toxin  is 
nature's  remedy  for  overcoming  disease,  it 
would  seem  that  in  a  disease  that  is  essen- 
tially chronic,  with  no  tendency  to  self- 
limitation,  if  immunity  is  conferred,  it 
would  be  necessary  to  supply  the  system 
continuously  and  indefinitely  in  order  to 
preserve  the  immunity  and  prevent  a  re- 
lapse." 

A  patient  with  tuberculosis  in  its  earlier 
stages  may  be  cured  by  the  administration 
of  anti-toxin.  Will  he  remain  cured  and 
how  long  are  important  considerations.  "In 
diphtheria  it  lias  been  proven  that  the  im- 
munity produced  by  anti-toxin  in  full  pro- 
tective doses  last  at  most  only  three  weeks. 
Is  it  reasonable  to  suppose  that  an  anti- 
toxin for  tuberculosis  would  produce  im- 
munity for  a  longer  period.  If  the  pa- 
tient's environment  is  not  changed,  if  the 
same  conditions  and  environments  exist 
after  as  before  the  treatment,  or  if  the 
patient  inhales  again  the  fatal  bacillus, 
will  there  not  be  a  return  of  the  disease? 

On  the  other  hand  the  direct  method  has 
more  to  recommend  it  to  general  favor  in 
that  it  has  possibly  but  one  element  of 
doubt  :  the  toxity  of  the  bacterial  pro- 
duct. 

There  are  two  bacterial  products  that 
differ  from  all  other  tuberculin  prepara- 
tions. They  are  Koch's  Tuberculin  R  and 
the  "Watery  Extract  of  Tubercle  Bacilli" 
produced  by  Dr.  Von  Ruck.  Both  of 
these  authors  claim  that  their  preparations 
are  pure  solutions  of  the  proteids  of  the 
bodies  of  the  tubercle  bacilli  themselves 
and  are  unmixed  with  the  culture  fluid 
upon  which  they  grow,  wherein  they  are 
distance  from  all  other  tuberculin  products. 
It  is  claimed,  and  not  without  show  of  rea- 
son, that  Tuberculin  R  was  not  a  pure  so- 
lution of  the  proteids,  hut  an  emulsion  of 
the-  fragments  of  the  bodies  containing  fats. 


The  withdrawal  of  this  product  from  use  bv 
the  manufacturers  is  sufficient  proof  of  this 
claim.  The  superiority  of  Von  Ruck's 
method  over  all  others  consists  in  the  fact 
that  he  succeeded  in  extracting  the  fats  with 
sulphuric  ether.  Of  this  product  he  says  : 
"The  Watery  Extract  as  produced  by  me, 
and  into  which  absolutely  no  culture  fluid 
enters,  is  free  from  all  admixtures  and  im- 
purities. It  is  a  perfectly  pure  solution  of 
the  germs  only,  and  being  filtered  through 
porcelain,  is  absolutely  free  from  any  germs 
or  fragments  thereof.  For  its  preservation 
a  fraction  of  a  percent  of  Phenol  is  added, 
which  in  nowise  alters  its  clinical  value." 

I  have  been  rather  particular  in  describing 
this  product  as  I  believe  it  the  most  reliable 
and  potent  one  of  the  tuberculin  products 
and  one  from  which  the  profession  should 
get  better  results  in  the  treatment  of  con- 
sumption than  all  others. 

During  1S98  Dr.  Von  Ruck  treated  with 
this  Watery  Extract,  78  cases  of  pulmonary 
tuberculosis  at  his  Winyah  Sanitarium,  in 
Asheville,  N.  C,  with  the  following  re- 
sults : 

No.  Cases.     Recovering.     Improved.  Stage' 

A  20     3      JO      IOO     OO     OO     OO     OO    O  1st 

B  37  4  ^7  73  7  !9  3  8  °3d 
C        21    4      3       14      9    43      733.323d 


Total  783.75  50    64.1   16  20.5  10  12.8  2  2.6 

Among  the  78  were  14  with  tuberculosis 
of  the  larynx.  In  9  instances,  of  more  or 
less  tubercular  infiltration  of  the  larynx  the 
infiltration  disappeared  under  treatment  in 
4,  was  greatly  improved  in  2,  and  improved 
in  3. 

Dr.  Williams,  of  Asheville,  also  reports 
12  cases  treated  by  him  with  the  Watery 
Extract  during  the  past  year.  Seven  of 
these  were  first  stage  cases,  all  discharged 
as  cured.  Three,  more  advanced  stages,  1 
of  which  was  discharged  cured,  the  other  2 
greatly  improved  ;  2  cases  in  the  third  stage, 
1  of  which  was  discharged  cured,  and  1  case 
(treated  only  3  weeks)  grew  worse. 

Drs.  Denson  and  Longstreet  Taylor  both 
have  obtained  goodresults  from  this  remedy. 

The  anti-tubercle  serum  of  Paul  Paquin 
has  been  used  in  a  great  number  of  cases  by 
different  physicians  with  apparent  benefit. 
Bishop,  of  Chicago,  in  his  new  edition,  re- 
ports 361  cases  that  are  of  value  in  recom- 
mending this  remedy  to  the  favorable  con- 
sideration of  the  profession. 

Paquin  has  reported  293  with  the  follow- 
ing results  :  Recoveries  that  seem  perma- 
nent, 57;  considerably  improved,  36  ;  im- 
proved, I2i  ;  disappeared  from  observation, 
41  ;  deaths,  36.  Add  to  this  76  later  cases 
of  Bishop  and  we  have  the  following  total 
results:     Recoveries,  71;    improved,    205; 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


unimproved,  14;  disappeared,  41  ;  deaths, 
38.  Dr.  Charles  Denison  has  reported  good 
results  from  the  use  of  Karl  Fich's  serum, 
the  details  of  which  we  have  been  unable 
to  obtain.  Dr.  Ambler  also  reports  that  he 
has  had  very  great  success  so  far  with  this 
remedy  in  120  cases,  the  report  of  which  is 
not  yet  completed  by  him.  He  continues 
to  use  it  with  increased  faith  in  its  efficacy. 

As  to  the  drug  treatment  of  consumption, 
creosote  and  some  of  its  derivatives  are  the 
only  drugs  that  have  held  their  places  in  the 
treatment  of  this  disease.  That  creosote 
acts  as  a  specific  no  one  of  any  repute  pre- 
tends to  claim.  Sammerbrodt  maintains 
that  creosote  alters  the  chemical  properties 
of  the  juices  of  the  body  so  that  they  no 
longer  furnish  a  suitable  soil  for  the  tubercle 
bacilli,  the  colonies  of  which  will  not  grow 
in  it.  Ludwig  claims  that  creosote  destroys 
the  toxin  of  the  tubercle  bacillus,  and  Peter 
ascribed  its  virtue  to  the  substitution  of  a 
curable  hypermia  for  a  tuberculous  hyper- 
mia.  Trudeaux  found  that  rabbits  inocula- 
ted with  tuberculosis  and  then  treated  with 
creosote  subcutaneously,  present  the  same 
lesions  as  control  animals  not  so  treated. 

Dr.  Burroughs,  of  Asheville,  is  the  pro- 
mulgator of  a  treatment  which  he  denomi- 
nates "Intra-Pulmonary  Medication"  for 
the  cure  of  tuberculosis.  It  consists  simply 
of  the  introduction  into  the  lungs  of  a  medi- 
cated spray  under  high  pressure  of  three  or 
four  atmospheres  from  an  air  receiver  with 
a  De  Villeis  instrument.  The  medicament 
consists  essentially  of  some  of  the  antiseptic 
oils,  such  as  20  drops  menthol,  20  drops 
eucalyptus,  20  oil  Pine  needles  and  20  drops 
of  creosote  to  half  oz.  Glymol.  He  claims 
great  success  from  this  treatment,  of  which 
I  have  been  eye  witness  of  many  cases.  I 
am  sorry  that  I  am  unable  to  give  a  detailed 
report  of  his  many  hundreds  of  cases. 

It  is  certain  that  creosote  in  doses  that  can 
be  safely  administered,  either  by  the  stom- 
ach, hypodermically,  or  by  inhalation  of 
vapors  or  sprays  medicated  with  it,  has  no 
direct  influence  on  the  tubercle  bacillus  or 
on  the  streptococcus.  The  same  argument 
holds  good  in  regard  to  any  and  all  antisep- 
tic or  germicidal  medicine,  such  as  the  es- 
sential oils,  menthol,  thymol  camphor  and 
the  terebenthenate,  which  dissolved  in  puri- 
fied petrolium  oil,  are  under  high  pressure 
forced  into  the  air  passages.  They  surely 
do  good  in  the  way  of  stimulating  the  cough 
and  expectoration,  relieving  the  always  ex- 
isting bronchitis  and  inflammatory  condi- 
tions of  other  mucous  membranes,  but  to 
say  that  they  attack  the  bacillus  in  its  habi- 
tat and  then  and  there  so  sterilize  and  neu- 
tralize its  effects  on  the  tissue  in  the  tuber- 
cular process,  is  to  say  the    least,  not  in  ac- 


cordance with  the  views  of  eminent  patho- 
logists. But,  nevertheless,  the  virtue  of 
creosote  is  undeniable  in  the  treatment  of 
consumption,  although  not  so  popular  as  in 
former  years.  To  my  mind  creosote  acts 
by  destroying  the  organism  which  sets  up 
fermentation  in  the  stomach  and  intestinal 
canal,  thereby  improving  digestion  and  nu- 
trition. The  remedy  acts  best  in  moderate- 
ly large  doses,  say  from  15  to  30  drops  after 
meals,  given  best  in  milk. 

Climate. — The  universal  testimony  is  that 
climate  actually  cures  consumption.  "It  is 
accepted  in  fact,"  says  Dr.  Whittaker, 
"that  climate,  meaning  for  the  most  part, 
climate  of  altitude,  is  a  remedy  so  power- 
ful, as,  if  practicable  in  every  case,  to  ren- 
der superfluous  every  other  treatment." 
"Altitude  acts  in  various  ways.  First,  by 
dryness.  High  air  is  dry  air  and  dryness 
is  inimicable  to  the  growth  of  the  bacillus." 
Second,  by  cold.  Cold  favors  dryness.  It 
also  stimulates  the  nervous  system  and  in- 
duces sleep.  Third,  a  high  altitude  has 
sunshine.  The  tubercle  bacillus  is  killed 
only  by  sunshine.  Tubercle  bacilli  are 
killed  by  direct  exposure  to  sunlight  from  a 
few  minutes  to  a  few  hours.  Fourthly,  al- 
titude gives  "gymnastics"  to  the  lungs  and 
developes  the  collapsed  air  cells,  causing 
them  to  take  more  oxygen  and  hence  more 
ozone,  which  is  carried  by  the  red  corpus- 
cles to  the  tissues,  which  are  invigorated 
thereby.  An  ideal  climate,  if  it  could  be 
found,  for  consumption  is  one  of  moderate 
elevation,  2,500  or  3,000  feet;  moderately 
moist  and  moderately  warm,  with  sufficient 
sunshine ;  where  the  changes  in  tempera- 
ture are  not  too  sudden  or  too  great. 

We  believe  we  are  safe  in  saying,  with- 
out exaggeration,  that  more  of  these  ele- 
ments of  desirability  are  found  in  the  cli- 
mate of  the  Asheville  plateau  than  any 
other  locality  in  the  United  States.  This 
region  is  indeed  the  happy  medium  for  the 
all-the-year-round  residence  for  the  con- 
sumptive. 

While  the  lower  regions  of  the  southwest, 
such  as  Aiken,  Thomasville  and  San  Anto- 
nio, perhaps  possess  the  proper  requisites 
of  dryness,  yet  they  are  deficient  in  the  great 
essential,  which  is  so  potent  in  its  nature 
for  the  cure  of  consumption,  and  that  essen- 
tial is  altitude.  The  New  Mexico  and 
Denver  regions  have  in  their  favor  altitude, 
yet  they  do  not  possess  a  sufficient  amount 
of  moisture  and  warmth  for  the  most  favor- 
able influence  upon  the  disease.  The  aver- 
age precipitation  of  the  Asheville  climate 
is  about  60  in  the  summer  and  50  in  the 
winter,  while  the  average  temperature  is 
about  45  in    the  winter   and  70  in  the  sum- 


THECHARLOTTE   MEDICAL    JOURNAL. 


209 


mer,  and  the  sun  shines  300  days  in  the 
year. 

I  have  purposely  refrained  from  the  con- 
sideration of  the  hygienic  and  dietetic  meth- 
ods of  treatment,  from  the  fact  that  there  is 
nothing  new  to  be  said  in  reference  thereto. 

In  closing  this  paper,  for  the  length  of 
which  I  ask  pardon,  I  beg  of  you  to  join 
me  in  the  indulgence  of  the  hope  that  these 
modern  methods  of  investigation  and  treat- 
ment will  bring,  in  the  near  future,  the 
boon  to  mankind — the  sure  cure  for  con- 
sumption. 

DISCUSSION. 

Dr.  Monroe. — If  Dr.  Levy  is  present  I 
am  satisfied  he  can  tell  us  something  along 
this  line. 

Dr.  Levy. — I  thank  Dr.  Monroe  exceed- 
ingly for  calling  upon  me,  and  I  will  state 
that  before  Dr.  Weaver  left  his  seat  he  re- 
quested me  to  discuss  his  paper,  and  I  agreed 
to  do  so,  but  after  hearing  the  paper.  Dr. 
Weaver  having  taken  the  subject  up  so  fully 
and  methodically,  and  it  is  so  excellent  in 
every  respect,  I  hope  he  will  excuse  me 
from  my  promise,  for  there  is  really  nothing 
to  say  after  his  able  exposition  of  the  sub- 
ject. 

The  Society  insisted  on  hearing  from  Dr. 
Levy,  and  he  continued  : 

I  would  just  say  that  I  agree  most  hearti- 
ly with  Dr.  Weaver  in  regard  to  his  expres- 
sions as  to  toxins  and  antitoxins  in  this  dis- 
ease. I  had  the  opportunity  last  May  here 
to  express  my  views  on  this  subject  in  the 
course  of  a  discussion  by  Dr.  Minor  of  Ashe- 
ville,  on  the  attitude  of  the  general  practi- 
tioner towards  serum  therapy,  and  1  then 
expressed  the  same  opinion  which  Dr. 
Weaver  has  expressed  to-day,  that  tubercu- 
losis not  being  a  self-limited  disease  there  is 
very  little  hope  at  any  time  from  using  the 
real  antitoxin,  because  antitoxins  are  not 
agents  which  have  any  bactericidal  action 
whatever.  What  we  need  in  tuberculosis 
is  certainly  not  antitoxins,  but  a  germicidal 
agent.  Antitoxin  will  never  be  of  any  use 
in  limiting  the  extent  of  the  tuberculous 
process,  or  certainly  in  putting  an  end  to  it. 

Dr.  J.  A.  Burroughs. — Mr.  President 
and  gentlemen,  I  enjoyed  Dr.  Weaver's  pa- 
per very  much,  was  in  a  better  frame  of 
mind  to  discuss  it  this  morning  than  I  am 
now,  just  coming  out  of  this  committee 
meeting. 

Would  say  this,  that  I  think  we  have  no 
specific  for  tuberculosis,  but  that  we  should 
bring  forward  every  known  remedy  and 
everything  that  we  know  in  regard  to  the 
management  and  treatment  of  the  subject 
that  would  result  in  a  cure  of  the  trouble; 
believe,  first  of  all,  that  climate  ranks  above 


everything  in  regard  to  the  treatment  of 
tuberculosis ;  placing  the  patient  in  a  pro- 
per climate.  Secondly,  believe  that  proper 
food,  nitrogenous  food,  so  as  to  get  the  di- 
gestive tract  in  condition,  that  it  will  assim- 
ilate food,  is  a  great  help,  for  instance,  milk, 
good  beef  steak,  eggs,  &c. 

Then  pulmonary  gymnastics,  which  is  of 
value  ;  teach  the  patient  to  take  deep,  full, 
long  inspirations  many  times  daily  in  a 
clean,  non-  dust,  non-germ-laden  atmosphere 
where  he  h  as  to  make  a  number  of  respira- 
tions a  minute  to  get  enough  oxygen  in  his 
lungs,  in  doing  this  collapsed  air  cells  are 
brought  into  action  and  a  better  pulmonary 
circulation  induced.  Believe  in  sending 
this  class  of  patients  up  to  the  mountains 
where  they  can  receive  the  benefit  of  the 
altitude  and  get  more  oxygen  in  the  system, 
increase  the  red  corpuscles  of  the  blood,  and 
also  enjoy  an  atmosphere  which  is  not  germ 
laden,  thus  placing  them  in  a  better  position 
for  an  arrest  or  recovery. 

Again,  I  believe  in  intra-pulmonary  med- 
ication. Dr.  Weaver  touched  upon  that  sub- 
ject this  morning.  Of  all  treatments  that 
have  been  suggested,  I  think  intra-pulmon- 
ary medication,  with  proper  food  and  hy- 
giene, and  in  skilled  hands,  is  best.  My 
observation  with  intra-pulmonary  medica- 
tion has  been  such  that  I  would  almost  be 
afraid  to  lay  the  record  of  my  books  before 
you  to-day  showing  the  cases  I  have  had, 
have  never  done  so,  but  someday  I  propose 
to  give  them  to  this  society,  and  it  is  a  mat- 
ter of  no  consequence  to  me  whether  they 
believe  them  or  not.  Dr.  Weaver  asked  me 
to  state  to  the  Society  the  manner  in  which 
I  give  this  intra-pulmonary  medication.  It 
is  not  in  a  large  room  that  is  filled  with 
fumes  of  germ-destroying  oils,  but  is  a  sim- 
ple thing.  Have  a  large  hydraulic  pump 
in  the  basement,  that  gives  about  ninety 
pound  pressure,  and  several  tanks  and  re- 
ceivers, have  my  rubber  hose  connected 
with  the  cut-off  and  Devilbiss  spraying  ap- 
paratus, which  can  be  turned  any  way. 
The  fluid  used  for  a  base  is  glymol,  a  pre- 
paration from  petroleum,  a  very  powerful 
germicide  and  antiseptic  itself,  it  has  the 
property  of  dissolving  the  sputum  like  gly- 
cerine. In  this  glymol  I  place,  say  in  the 
cup,  about  half  an  ounce  or  more,  say  five 
to  ten  drops,  of  creosote,  fifteen  to  twenty 
drops  of  oil  of  eucalyptus,  fifteen  to  twenty 
drops  of  oil  of  pine  needles,  and  fifteen  to 
twenty  drops  of  menthol  saturated  in  gly- 
mol, which  would  be,  at  least,  ten  grains  of 
menthol. 

It  is  a  great  aid  in  teaching  patients  how 
to  breath,  have  the  women  to  undo  their 
corsets  and  have  their  clothes  loosened,  and 
teaeh  them  to    take  a  deep   inhalation  so  as 


210 


THE  CHARLOTTE  MEDICAL   JOURNAL. 


to  get  it  down  into  the  air  cells ;  teach  the 
men  in  the  same  way  to  breath  it  down  thor- 
oughly, but  both  men  and  women  will  have 
to  be  careful  to  have  no  clothing  too  tight 
or  they  will  fail  to  expand  chest  and  derive 
full  benefit  from  the  local  application. 

Would  say  this  much,  when  no  other 
remedy  is  given  except  this  intra-pulmonary 
medication,  as  above  described,  in  the  Ashe- 
ville  climate,  it  is  remarkable  to  see  the  way 
the  temperature  will  come  down  under  this 
treatment ;  you  take  a  patient  there  and  the  j 
temperature  runs  from  102  to  103  every  '■ 
afternoon,  and  you  give  him  the  treatment, 
if  you  can  get  him  to  take  it  thoroughly  you 
will  find  that  the  temperature  will  begin  to 
drop  a  fraction  of  a  degree,  and  the  first 
thing  you  know  you  have  a  temperature  of 
99,  or  normal ;  you  will  have  it  that  way  in 
ten  days  after  you  start  the  intra-pulmonary 
medication.  If  you  give  this  treatment  for 
a  month  and  the  temperature  does  not  drop 
under  it  you  had  just  as  well  send  the  patient 
home. 

In  regard  to  medicine  internally,  have 
found  nothing  in  the  way  of  value  in  the 
stomach  except  creosote.  I  wrote  a  paper 
for  the  Southern  Medical  and  Surgical  Jour- 
nal of  Savannah,  on  the  use  of  Creosote  in 
Tuberculosis,  and  I  want  to  lay  special 
stress  on  creosote,  because  the  majority  of 
the  drug  on  the  market  is  nothing  more  nor 
less  than  carbolic  acid.  If  you  will  give 
Morson's  Creosote,  made  from  beechwood 
tar,  as  I  have  given  it,  you  will  find  it  of 
value,  but  if  you  give  commercial  creosote, 
in  the  doses  that  I  give  it,  you  will  have 
carbolic  acid  poison.  Creosote  made  from 
beechwood  tar  is  not  irritating,  disinfects 
the  alimentary  tract,  and,  in  my  mind,  does 
have  a  special  action  on  tuberculosis.  This 
creosote  is  given  in  from  twenty  to  ninety 
drop  doses  three  times  daily  ;  in  that  way 
it  assists  digestion,  &c.  Cod  liver  oil  is  a 
splendid  food  when  the  patient  is  able  to 
take  it,  but  in  this  treatment  of  intra-pul- 
monary medication  with  creosote  and  good 
food  in  the  right  climate,  it  is.  remarkable 
to  see  the  way  the  patient  gains  flesh  and 
the  color  come  to  his  cheeks ;  the  gratitude 
of  the  patient  is  something  to  make  the 
physician  feel  happy. 

Dr.  Louis  F.  High. — I  can't  improve  on 
the  most  excellent  expositition  of  the  treat- 
ment of  tuberculosis  as  set  forth  by  Dr. 
Burroughs,  but  I  can  add  an  humble  amount 
to  what  he  has  said,  hoping  in  that  way  to 
increase  the  sum  total  of  knowledge  in 
regard  to  the  subject.  In  the  matter  of 
climate  I  am  abundantly  able  to  say  from  an 
analysis  of  forty  cases  that  the  effect  of  it  is 
sometimes  remarkable.  I  don't  mean  to 
say  that  in  Danville,  where  I  live,  we  have 


a  climate  that  is  of  the  most  desirable  kind 
in  which  to  treat  tuberculosis,  but  in  an 
observation  of  forty  cases  of  consumption 
developed  among  persons  whose  occupa- 
tions have  kept  them  indoors,  I  have  been 
able  to  see  the  good  effect  of  pure  air  and 
sunshine,  the  effect  of  change  of  occupa- 
tion and  putting  those  people  out  of  doors 
to  live,  and  in  a  record  of  forty  cases  in 
which  the  disease  developed  among  people 
whose  occupations  kept  them  indoors  for 
twelve  hours  during  the  twenty-four,  I  have 
noticed  the  impovement  in  every  case  in 
which  those  persons  have  ceased  to  labor 
indoors,  have  ceased  to  labor  entirely,  or 
taken  an  outdoor  occupation,  and  therefore 
it  shows  very  plainly  to  me  the  advantage 
of  sunlight  and  the  advantage  of  change 
of  scene,  and  those  things  which  tend  to 
produce  constructive  change,  is  something 
very  remarkable.  And  therefore  I  would 
urge  as  a  matter  of  treatment  that  a  case 
developing  consumption  whose  occupation 
keeps  him  in  doors,  that  the  very  first  thing 
that  should  be  done  is  to  leave  off  the  occu- 
pation and  engage  in  labor  that  keeps  him 
out  of  doors  a  great  deal. 

Dr.  Chas.  B.  McAxally. — I  want  to 
say  just  a  word  in  regard  to  this  matter, 
and  I  want  to  disagree  with  Dr.  Burroughs 
just  a  little,  too.  I  know  what  I  do  when 
I  take  such  steps  as  that,  but  it  is  in  regard 
to  the  cod  liver  oil.  Now,  as  Dr.  Bur- 
roughs said,  that  does  a  great  deal  of  good 
where  they  will  take  it,  but  every  patient 
that  you  find,  one  of  the  first  manifestations 
that  he  brings  to  you  when  he  comes  to 
your  office  is  the  dyspeptic  symptoms,  and 
after  they  reach  that  stage,  cod-liver  oil 
will  not  be  takan  in  the  majority  of  cases. 
There  is  another  point  about  this  treatment 
that  I  fully  agree  with,  and  that  is  the  in- 
halation of  that  medicated  air.  I  have 
myself  during  this  last  year  gained  consid- 
erable benefit  in  two  or  three  cases  from 
that,  but  others  I  didn't  get  any,  whatever, 
though  the  general  effect  that  it  had  on  my 
mind  in  regard  to  the  treatment  was  that  it 
offered  as  much  benefit  as  almost  anything 
else. 

Dr.  J.  N.  Upshur. — I  would  like  to  say 
just  one  word  in  that  connection.  1  listened 
to  this  discussion  with  a  great  deal  of  inter- 
est. One  of  the  things  struck  me  individ- 
ually. There  have  been  a  number  of  cases 
that  these  gentlemen  have  seen.  I  am  thank- 
ful to  say  that  in  my  own  experience  in 
Richmond  Isee  a  minimum  number  of  cases 
of  tubercular  consumption.  Of  course, 
in  an  experience  extending  now  over  a  good 
many  years,  I  have  seen  a  good  many  cases 
of  consumption,  but  the  thing  which  pointed 
most  to  the  conditions  attending  upon  con- 


THE  CHARLOTTE  MEDICAL  JOORNAL. 


211 


sumption,  in  my  observation,  is  that  it  be- 
gins away  back,  often  before  the  patient 
gets  to  the  doctor;  there  is  underlying  the 
whole  thing,  and  as  the  starting  point  in 
consumption,  that  condition  which  we  call 
malnutrition.  The  patient  is  a  little  off  in 
strength,  begins  to  lose  appetite,  has  quick- 
ened pulse,  some  difficulty  in  breathing, 
upon  exertion,  and  you  examine  that  pa- 
tient, gentlemen,  and  you  don't  find  any 
signs  there  to  point  to  the  fact  that  there  is 
any  trouble,  except  you  may  find  some  little 
weakened  respiration.  There,  as  a  starting 
point  in  cases  of  consumption,  is  malnutri- 
tion down  at  the  beginning.  I  don't  pro- 
pose to  discuss  this  question  of  the  germs  in 
consumption,  because  we  all  know  what  is 
found  there,  but  they  don't  find  it,  so  far  as 
I  am  aware,  back  in  the  beginning  of  this 
condition  of  malnutrition.  Now  the  whole 
question  of  the  treatment  of  consumption 
turns  upon  one  significant  fact,  and  that  is 
the  fact  of  an  improved  nutrition ;  and 
everything  that  these  gentlemen  have  said 
with  regard  to  climate,  diet,  etc.,  is  simply 
a  point  in  that  direction,  for  improve  the 
nutrition  in  the  patient  and  that  lesion  in 
the  lungs  gets  better,  not  because  they  use 
medicated  air,  with  oils  of  various  kinds 
in  the  lungs  of  that  patient,  but  simply 
because  they  are  doing  what  is  improving 
the  nutrition  of  that  patient,  and  just  in 
proportion  as  you  improve  the  nutrition  of 
a  patient  and  get  it  up  as  far  as  possible  to 
the  normal  standard,  just  in  that  proportion 
the  patient  gets  well  as  a  consequence, 
not  because  by  putting  into  the  system  these 
various  things  they  will  help  that  patient 
cure  that  case  by  killing  the  bacilli,  but  be- 
cause the  thing  which  is  most  fatal  to  them 
is  an  improved  nutrition.  That  is  to  my 
mind  the  salient  fact. 

Dr.  J.  A.  Burroughs. — The  doctor 
has  struck  the  key  note  ;  there  is  no  doubt 
in  the  world  that  every  case  of  tuberculosis 
has  its  origin  in  malnutrition,  and  every 
physician  who  is  up  on  the  subject,  recog- 
nizes this  fact.  Want  to  say  in  intra-pul- 
monary  medication,  no  man  can  take  hold 
of  this  subject  and  learn  it  all  at  once,  I 
learn  something  about  it  day  by  day  ;  treat 
my  patients  better  now  than  I  did  last  year, 
and  treated  them  better  last  year  than  I  did 
the  year  before,  my  records  show  this,  but 
I  want  to  say  this,  that  you  liquefy  the 
sputum  this  way  easier,  killing  out  the 
germs  in  their  very  home,  preventing  a  re- 
absorption  of  the  poison  in  the  system  and 
infection  of  new  area  of  tissue,  as  there 
would  be  if  you  did  not  give  intra-pulmo- 
nary  treatment. 

Dr.  Upshur. — I  just  want  to  correct  the 
doctor  in  one  point  that  I  am  afraid  he  did 


not  mean.  I  am  not  saying  anything  against 
interpulmonary  treatment.  The  point  I 
want  to  make  is  simply  a  help,  and  that 
what  cures  the  patient  is  getting  the  patient's 
nutrition  up  to  or  above  the  normal  stand- 
ard. 

Dr.  Weaver. — Mr.  Chairman,  inclos- 
ing this  discussion,  I  plead  guilty  to  the  soft 
impeachment  of  Dr.  Upshur.  I  do  believe 
in  the  idea  that  malnutrition  is  the  great 
prime  factor  in  the  causation  of  tuberculosis. 
But  the  length  of  my  paper  prevented  a 
further  elaboration  of  that  phase  of  the 
subject.  I  even  go  further  than  the  speaker 
and  maintain  that  there  is  a  condition  ante- 
rior to  the  bacillary  infection  and  that  con- 
dition is  more  than  a  predisposition  or  dys- 
crasy,  — it  is  a  disease  itself  which  we  have 
to  treat ;  that  disease  is  an  hypertrophy,  as 
Cohnsays;  it  is  malnutrition.  That  con- 
dition of  the  body  is  the  first  primary  factor 
and  Koch 's  tubercle  bacillus  is  the  secondary 
factor  in  the  causation  of  tuberculosis. 
Hence  I  believe  that  it  is  of  the  first  impor- 
tance to  improve  by  any  and  all  means  the 
nutrition  of  the  body.  This  is  where  hered- 
ity comes  in  with  its  work.  It  is  the  inher- 
itance of  the  seed,  the  subjects  fail  in  con- 
formation of  the  chest,  he  has  small  expan- 
sion on  inspiration,  weak  heart,  pale  and 
anemic  skin,  no  vitality,  a  true  (?)  predis- 
position to  consumption,  a  failure  in  the 
vital  energies.  This  condition  can  also  be 
acquired.  Anything  that  debilitates,  the 
enervation  of  the  nervous  system,  an  inflam- 
matory condition  of  the  air  passages  (bron- 
chitis for  instance),  the  debility  resulting 
from  some  infectious  disease  (such  as  mea- 
sles or  influenza)  any  or  all  of  these  acquired 
conditions,  are  prime  factors  in  the  etiology 
of  this  disease.  Hence  our  first  treatment  is 
to  improve  these  conditions  by  hygienic 
and  dietetic  methods,  regulation  of  exercise 
and  food  and  sleep,  and  all  the  auxiliaries 
to  health.  Then  come  our  later  methods 
of  treatment  of  which  we  have  spoken. 
Now  in  regard  to  Dr.  Burroughs'  "Intra- 
Pulmonary  Medication." 

We  do  not  believe  that  the  medicated 
sprays  have  a  specific  action  on  the  tubercle 
bacillus  in  its  habitat,  but  that  they  stimu- 
late expectoration,  soothe  and  mollify  the 
inflammatory  conditions  of  the  air  passages, 
especially  the  bronchitis  which  is,  more  or 
less,  always  present,  and  has  a  germicidal 
effect  on  the  streptococci,  which  are  always 
present  in  large  numbers  in  advanced  sta- 
ges of  tuberculosis  and  which  are  the  cause 
of  the  mixed  infection  and  the  resultant 
fever.  This,  I  think,  is  mainly  and  espe- 
cially the  benefit  to  be  derived  from  the 
medicated  air  treatment.  I  employ  this 
method  a  great  deal,   whenever  and    wher- 


m 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


ever  the  case  demands  it.  I  use  a  common 
air  receiver,  with  from  30  to  60  pounds 
pressure,  with  ■&  Davidson  or  DeVilbiss 
tube,  which  will  throw  the  medicated  air 
far  down  into  the  bronchial  tubes  and  prob- 
ably into  the  air  cells  themselves. 

The  medicines  that  I  use  are  various  ones, 
including  the  essential  oils,  terebinthenates, 
carbolic  acid  and  creosote.  I  vary  the  mix- 
ture and  strength  according  to  the  patient. 
This  is  a  favorite  prescription  :  A  3  to  10 
per  cent,  of  camphor-menthol  in  glymol, 
followed  by  the  inhalation  of  20  drops  each 
of  eucalyptus,  oil  of  pine  needles,  carbolic 
acid  and  creosote  dissolved  in  glymol.  If 
these  sprays  are  used  intelligently  and  per- 
sistently I  can  testify  from  my  own  experi- 
ence in  a  great  number  of  cases  they  will 
be  of  great  and  permanent  benefit  to  the 
patient. 

Just  one  other  thought,  Mr.  President, 
and  1  have  done.  Dr.  Burroughs  referred 
to  the  fever  accompanying  tuberculosis.  In 
regard  to  its  cause,  especially  in  its  later 
stages,  I  want  to  say  this  :  It  has  been  de- 
monstrated over  and  over,  by  competent 
observers,  that  simple  uncomplicated  tuber- 
culosis is  easily  curable,  yet  it  may  seem 
strange  to  the  casual  observer  how  few 
cures  are  actually  made.  And  what  is  the 
reason?  It  is  because  so  few  cases  in  the 
incipiency  of  the  disease,  uncomplicated 
with  other  infectious  micro-organisms,  are 
met  with  in  actual  practice.  We  all  know 
that  unless  tuberculosis  is  accompanied  by 
some  other  pathologic  lesion,  the  progress 
is  very  slow,  that  the  tubercle  bacillus  very 
seldom  causes  rapid  tissue  changes,  and 
scarcely  or  never  produces  pus.  But  it  is 
when  other  micro-organisms,  especially 
streptococci  and  staphylococci  make  their 
appearance  that  rapid  necrosis  and  break- 
ing down  of  the  tissues  take  place.  Then 
we  have  the  mixed  infection.  It  is  then 
we  have  the  hectic  fever  resulting  from  the 
absorption  of  the  streptococcus  germ  into 
the  system.  In  every  instance  in  my  expe- 
rience where  I  have  had  rapid  destruction 
of  tissue  in  pulmonary  consumption  with 
profuse  expectoration ;  on  microscopical 
examination  of  the  sputum,  there  have  been 
found  in  large  numbers  the  streptococci. 
It  was  in  these  cases  I  found  the  fever,  and 
it  was  in  these  cases  I  used  the  spray,  of 
which  Dr.  Burroughs  and  .  myself  have 
spoken,  with  such  marked  effect.  After  a 
thorough  application  of  some  of  these  ger- 
micidal medicines  to  the  bronchi  and  air 
cells,  the  fever  generally  fell  one  to  three 
degrees  and  the  patient  was  always  rendered 
more  comfortable.  Herein  is  where  the 
medicated  sprays,  under  proper  pressure  do 
their  effectual  work.     They  kill  the  strepto- 


cocci in  some  degree  and  stimulate  the  lungs 
to  throw  off  the  pus  in  which  millions  of 
these  germs  are  imbeded,  at  the  same  time 
they  soothe  and  heal  the  inflamed  mucous 
membranes.  This,  to  my  mind,  is  the  sali- 
ent point ;  this  medication  stops  the  strep- 
tococcal invasion. 


Report  of  Two  Successful  Nephrectomies. t 

By  George  Ben  Johnston,  M.D.,  Richmond.  Va.. 

Professor  of  Gynecology  and  Abdominal 

Surgery.  Medical  College  of  Virginia. 

The  two  specimens  which  I  present  for 
your  inspection  are  from  a  considerable  col- 
lection obtained  during  the  course  of  a 
large  number  of  operations  on  the  kidneys. 
I  do  not  offer  them  because  they  are  unusu- 
ally rare  but  because  they  are  fine  specimens 
of  their  types  and  chiefly  because  the  trou- 
bles for  which  these  kidneys  were  removed 
grew  out  of  mobility  of  the  organs  and  il- 
lustrate dangers  to  which  I  directed  the  at- 
tention of  the  profession  in  a  paper  on 
movable  kidney,  presented  to  the  Southern 
Surgical  and  Gynecological  Association 
several  years  ago. 

Case  I. — Nephrectomy  for  cyst  of  right 
(movable)  kidney.  Recovery. — Case  refer- 
red by  Dr.  Moses  D.  Hoge,'  Mrs.  J. P. A., 
aged  60  years.  About  fifteen  years  ago 
patient  herself  noticed  a  movable  tumor  on 
the  right  side  of  the  abdomen,  and,  on  call- 
ing the  attention  of  her  family  physician  to 
this,  the  latter  diagnosticated  movable  kid- 
ney. Since  that  time  patient  has  suffered 
with  intermittent  attacks  of  gastric  and  ner- 
vous nature.  These  have  gradually  become 
more  frequent  and  severe,  and  had  been  es- 
pecially annoying  during  the  twelve  months 
preceding  the  time  at  which  I  was  called  in 
consultation.  Rapid  increase  in  size  of  tu- 
mor for  past  eight  months,  and  this  increase 
especially  pronounced  during  past  two 
weeks.  Patient  not  confined  to  bed.  Com- 
plains of  numbness  of  lower  extremities, 
especially  on  right  side.  Appetite  good. 
Bowels  and  urination  regular. 

When  I  first  saw  this  case,  in  consulta- 
tion with  Dr.  H.  H.  Levy,  the  diagnosis 
was  made  of  movable  kidney  with  probable 
hydronephrosis,  and  it  was  thought  that 
only  a  nephrectomy  would  afford  a  cure. 
Before  undertaking  this  an  examination  of 
the  urine  was  made  to  determine  the  ade- 
quacy of  the  other  kidney  to  carry  on  the 
function  of  both  organs*  This  examination 
showed  such  a  marked  diminution  in   the 


fRead  before  the  Tri-State  Medical  Society  of 
the  Carolinas  and  Virginia,  at  Charlotte,  N.  C.< 
January,  1899. ■ 


THE  CHARLOTTE  MEDICAL  JOURNAL, 


213 


amount  of  urea  eliminated  that  I  advised 
against  immsdiate  operation,  deeming  it 
best  to  obtain  further  information  on  this 
point.  The  patent  then  passed  into  the 
hands  of  Dr.  Hoge,  with  whom  I  again 
saw  the  case  in  consultation.  By  this  time 
the  excretion  of  urea  had  more  nearly  ap- 
proached the  normal  and  operation  was 
advised. 

The  patient  was  admitted  to  the  Old  Do- 
minion Hospital  on  Nov.  14,  1898.  Exam- 
ination through  relaxed  abdominal  wall  re- 
vealed the  presence  of  a  large, smooth,  globu- 
lar, freely-movable,  fluctuating  tumor  in  the 
region  of  the  right  kidney ,  which  was  thought' 
to  be  either  a  hydronephrotic  kidney  or  a 
cyst  of  that  organ. 

Operation. — November  15,  1898.  Chlo- 
roform anesthesia.  Langenbuch's  incision. 
As  soon  as  the  peritoneal  cavity  was  open- 


gauze  sheets.  The  posterior  layer  of  peri- 
toneum was  incised  and  the  cystic  kidney 
liberated.  The  vessels  and  ureter  were  lig- 
ated  separately  with  heavy  chromicized  cat- 
gut. There  was  practically  no  bleeding. 
The  slit  in  the  peritoneum  was  closed  with 
a  running  suture  of  fine  catgut.  The  ab- 
dominal wound  was  closed  with  through- 
and-through  sutures  of  silkworm  gut.  An 
impervious  dressing,  consisting  of  gauze 
covered  by  a  layer  of  muslin  saturated  in 
flexible  collodion,  was  applied.  No  drain- 
age. The  patient  was  on  the  operating 
table  only  twenty-eight  minutes.  During 
this  time  16  ounces  of  normal  salt  solution 
were  infused  into  the  subclacular  region. 

Reaction  was  prompt  and  recovery  was 
without  event.  This  patient  left  the  hospi- 
tal in  two  weeks  from  the  day  of  opera- 
tion. 


1    the    left    kidnev  was    searched    for  and]      The    kidney    after    removal    presented  a 


found  to  be  present.  It  was  much  hyper- 
trophic!. The  intestines  were  then  dis- 
placed to  the'  left    and    padded    away  with 


large  cyst,  with  very  thin  walls,  containing 
500  cc.  of  clear  fluid.  A  very  small  amount 
of  apparently  healthy  kidney  tissue  remain- 


214 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


ed.  Microscopic  examination  of  the  unaf- 
fected portion  was  made  by  Dr.  Moses  D. 
Hogtr,  by  whom  the  case  had  been  referred 
to  me,  and  he  submitted  to  me  the  fol- 
lowing report  : 

The  kidney  and  sac  with  its  fluid  contents 
were  placed  entire  in  a  formalin  solution. 
A  small  piece  of  the  kidney  substance  near 
junction  of  the  sac  with  the  healthy  portion 
of  the  organ  was  removed  for  microscopic 
examination.  The  tissue  was  hardened 
in  alcohol,  embedded  in  paraffin,  sectioned 
on  the  microtome,  stained  with  indigo- 
carmine  and  mounted  in  balsam  in  the  usu- 
al way.  The  fibrous  capsule  was  consid- 
erably thickened  and  firmly  attached  to  the 
kidney ;  the  walls  of  the  veins  were  unusu- 
ally thin,  while  those  of  the  arteries  were 
considerably  thickened,  especially  the  inti- 
ma.  The  venous  system  was  empty  ;  the 
arterial,  filled  with  blood.  The  glomeruli 
were  somewhat  compressed  and  did  not  fill 
Bowman's  capsule.  The  lining  epithelium 
of  the  excreting  tubules  was  intact, showing 
no  change  from  the  normal.  A  few  patches, 
small  in  extent,  of  connective  tissue  were 
noted. 

Comments. — Several  forms  of  cysts  of 
the  kidney  are  recognized,  of  which  the 
conglomerate  cysts  (or  cystic  metamorpho- 
sis), simple  cysts,  and  hydatid  cysts  are  the 
most  important.  The  first  of  these  is  fre- 
quently congenital  and  is  usually  a  bilateral 
affection,  the  latter  fact  rendering  opera- 
tion unavailable.  Furthermore,  nephrecto- 
my, which  would  be  the  only  operation  to 
be  considered,  is  not  commonly  indicated 
for  the  reason  that  there  usually  remains  a 
considerable  amount  of  fairly  normal  kidney 
tissue,  which  is  capable  of  serving  a  useful 
purpose. 

Simple  cysts,  of  which  the  case  here  cited 
is  an  instance,  are  more  amenable  to  surgi- 
cal treatment.  When  of  small  size,  and 
when  situated  in  an  otherwise  healthy  kid- 
ney, surgical  intervention  is  not  indicated. 
At  other  times  repeated  aspirations  may 
finally  cause  disappearance  of  the  cyst,  but 
this  procedure  should  seldom  be  resorted  to. 
Again,  incision  and  drainage  may  be  indi- 
cated. In  the  case  here  reported  none  of 
the  above-mentioned  procedures  were  deem- 
ed advisable  on  account  of  the  fact  that  the 
kidney  was  a  movable  one  and  the  amount 
of  healthy  secreting  surface  remaining  was 
not  sufficient  in  amount  to  make  its  preser- 
vation desirable. 

Hydatid  cysts  of  the  kidney  are  of  rather 
infrequent  occurrence,  especially  in  this 
country. 

Case  II. — Nephrectomy  of  left  kidney 
immovable)  for  suppurative  diseases, with  cal- 
culus. Recovery. — Mrs.M.E.L.,  white, aged 


38  years.  Married  nine  years,  has  had  three 
children.  No  miscarriage.  Consulted  me 
December  5,  1898,  and  gave  following  his- 
tory :  Was  reasonably  healthy  as  a  girl. 
Was  tardy  in  commencing  to  menstruate, 
beginning  at  eighteen.  Periods  always  re- 
gular and  painless.  When  twenty  began 
to  experience  vague  pains  in  region  of  the 
left  kidney.  These  pains  were  never  con- 
tinuous nor  lancinating  but  sometimes  se- 
vere, at  no  time,  however,  requiring  mor- 
phine for  their  relief.  Frequent  attacks  of 
"wind  colic,"  sometimes  nausea  and  vomi- 
ting and  great  nervousness.  All  symptoms 
aggravated  during  menstruation.  Never 
had  kidney  colic  nor  passed  bloody  urine. 

In  July,  1897,  while  rubbing  her  side 
with  a  liniment  she  detected  a  lump.  The 
lump  was  hard  to  the  touch  but  not  tender. 
Did  not  consult  physician.  Never  had  rig- 
gors,  fever  or  sweats.  Noticed  no  pus  or 
blood  in  urine.  Physical  examination  show- 
ed quite  a  large  tumor  below  the  short  ribs, 
occupying  the  left  side  of  the  abdomen.  It 
was  freely  movable  in  every  direction.  The 
question  was  to  determine  whether  this  tu- 
mor was  one  of  the  spleen  or  of  the  kidney. 
To  throw  further  light  on  this  question  my 
colleague,  Dr.  E.  C  Levy,  made  examina- 
tions of  the  blood  and  urine  and  submitted 
to  me  the  following  report  :  The  blood  ex- 
amination showed  4,360,000  red  cells  and 
12,000  leucocytes  to  the  cubic  millimeter. 
Hemoglobin  55  per  cent,  of  normal.  No 
hematozoa  malarire.  The  increased  number 
of  leucocytes  were  of  the  polymorphonuclear 
neutrophile  variety.  This  examination, 
while  not  excluding  all  questions  of  the  ab- 
dominal tumor  being  an  enlarged  spleen,  at 
least  showed  that  it  was  not  a  leukemic 
spleen  and  to  some  extent  excluded  a  mala- 
rial spleen.  After  examining  the  urine  and 
finding  in  it  pus  from  the  kidney,  the  leu- 
cocytosis  was  explained  by  the  suppuration. 

The  urine  was  cloudy,  markedly  acid, 
with  a  specific  gravity  of  1.015  and  contain- 
ed a  small  amount  of  albumin.  Microsco- 
pic examination  of  the  sediment  obtained 
by  means  of  the  centrifuge  showed  the  pre- 
sence of  a  morphoud  urates,  a  moderate  num- 
ber of  leucocytes,  and  a  few  red  blood  cells. 
The  presence  of  pus  in  a  frankly  acid 
urine  was  considered  indicative  of  its  renal 
origin.  Hence  the  findings  in  the  exami- 
nations of  the  blood  and  urine  in  this  case 
led  to  the  opinion  that  the  abdominal  tumor 
was  an  enlarged  and  suppurating  kidney 
(most  probably  from  a  calculus)  rather  than 
an  enlarged  spleen. 

On  December  10,  1898,  I  operated  on  this 
case  at  the  Old  Dominion  Hospital,  in  the 
presence  of  the  class  of  the  Medical  College 
of  Virginia.     The  tumor  seemed  too  large 


THE  CHARLOTTE   MEDICAL  JOURNAL. 


215 


to  extract  through  a  lumbar  incision.  I 
therefore  executed  a  transperitoneal  opera- 
tion through  Langenbuchs's  incision  of  the 
left  side.  Right  kidney  examined  and 
found  normal.  Intestine  displaced  to  the 
right  and  protected  by  gauze  sheets.  Pos- 
terior layer  of  peritoneum  incised.  The 
freeing  of  the  kidney  was  rendered  tedious 
and  difficult  by  many  adhesions.  The  ped- 
icle was  ligated  in  sections,  vessels  and 
ureter  separately. 

Considerable  oozing  occurred  and  for  this 
reason  drainage  was  established  by  means 
of  a  rubber  tube  passed  through  an  incision 
made  in  the  loin.  The  rent  in  the  perito- 
neum was  closed  with  a  continuous  catgut 
suture  and  the  abdominal  wound  with   silk 


and  somewhat  nodular  appearance.  Upon 
palpation  it  was  felt  to  contain  a  large 
amount  of  fluid  and  also  a  calculus  which 
branched  as  it  extended  up  from  the  pelvis 
of  the  organ  towards  the  perephery.  Upon 
opening  the  kidney,  25  cubic  centimeters  of 
thick, yellow  pus  escaped.  The  large, branch- 
ing stone(4-5  centimeters  in  its  longest  diam- 
eter) was  exceedingly  friable  and  was  found 
on  analysis  to  consist  of  calcium  phosphate. 
There  were  eight  distinct  abscess-cavities, 
communicating  more  or  less  with  each  other. 
Only  a  very  small  area  (about  2  centime- 
ters in  length)  of  apparently  normal  kidney 
tissue  remained  at  the  upper  extremity  of 
the  organ, 

The  progress  of  recovery  was  reasonably 


worm  gut  and  dressed  as  in  Case  I.  (satisfactory.  The  drain  was  removed  forty- 

The   kidney  after  removal  was   found   to    eight  hours  after  the  operation.        Six  days 

weigh  435  grams,  was   of    irregular    shape  ,  later  temperature  developed.      I   reopened 


216 


THE  CHARLOTTE  MEDICAL  JOURNAL 


the  drainage  wound  and  evacuated  a  con- 
siderable collection  of  pus,  after  which 
everything  went  on  smoothly.  The  patient 
was  discharged  thirty-eight  days  after  op- 
eration. 

Comments. — Stone  in  the  kidney  is  the 
commonest  surgical  affection  of  this  organ 
and  the  most  treacherous.  It  simulates  so 
many  other  conditions  that  its  presence 
often  escapes  early  detection.  When  it 
does  not  produce  rapid  disorganization  of 
the  kidney  it  frequently  brings  about  such 
a  degree  of  irritation  as  to  reduce  the  vic- 
tim to  complete  invalidism. 

Early  surgical  intervention  is  most  im- 
portant. Nephrolithotomy,  or  the  removal 
of  a  stone  from  an  otherwise  healthy  kid- 
ney, affords  infinite  relief  and  is  freer  from 
danger  than  any  other  major  operation.  If 
a  stone  should  not  be  found  in  every  case, 
the  condition  producing  the  symptoms  for 
which  the  operation  was  undertaken  will 
usually  be  amenable  to  operation  and  result 
in  cure,  hence  the  failure  to  find  stone  is 
immaterial.  Every  suspected  case  should 
be  explored. 

Nephrectomy  will  only  be  required  in 
those  cases  in  which  destruction  of  the  kid- 
ney has  taken  place.  When  it  is  decided 
on,  the  supposed  healthy  kidney  should  in- 
variable be  first  examined  by  inspection, 
palpitation,  and  incision  if  neceesary.  This 
is  easily  accomplished  in  the  transperito- 
neal operation.  By  the  lumbar  route  a  se- 
parate cut  is  required.  Failure  to  observe 
this  precaution  has  more  than  once  led  sur- 
geons into  improper  radical  steps. 

DISCUSSION. 

Dr.  W.  L.  Robinson. — This  is  a  very 
interesting  subject  and  one  in  which  I  feel 
greatly  interested.  I  will  relate  one  case 
that  is  very  instructive.  A  woman  who 
had  been  suffering  at  intervals  of  six  or 
eight  weeks,  for  a  year  or  more  before  I 
saw  her,  had  great  pain  and  vomiting, 
lasting  two  or  three  weeks,  unable  to  sleep 
except  under  an  anodyne.  The  trouble  was 
accompanied  by  constipation,  and  relief 
usually  came  in  the  attempt  from  removing 
obstructions  to  bowels  by  large  enemata. 
When  referred  to  me  she  had  been  suffering 
with  constant  nausea  and  pain  for  ten  days, 
and  the  trouble  I  thought  came  from  a  dis- 
placed kidney.  I  made  an  incision  from 
the  tenth  rib  down  toward  the  McBurny's 
point  and  when  I  first  opened  I  thought 
there  was  a  cyst  which  turned  out  to  be  a 
dilitation  of  the  ureter  with  the  damning  up 
of  the  urine  from  lesion  ;  also  the  appendix 
was  attached  to  the  kidney.  I  simply  moved 
the  appendix,  split  the  capsule  of  the  kid- 
ney and  sewed  it  back  in  place.     That  was 


four  years  ago  with  a  perfect  recovery  and 
no  attack  since,  in  fact  has  not  lost  a  day 
from  work  since. 

Dr.  J.  M.  Flippen. — I  would  like  to 
ask  Dr.  Johnson  if  he  doesn't  think  it  advi- 
sable to  catheterise  the  ureter  in  case  of 
stone  in  the  kidney,  using  a  catheter  tapped 
with  wax.  If  there  is  a  stone  there,  upon 
withdrawing  the  catheter  and  examining 
the  ends  of  it  with  a  lense,  you  will  readi- 
ly detect  the  scratch  of  the  stone  upon  the 
wax.  I  would  just  like  to  ask  him  if  he 
doesn't  think  that  advisable  in  the  case  of 
such  an  operation. 

Dr.  Johnson. — It  is  an  extremely  diffi- 
cult thing  to  catheterize  the  ureters — diffi- 
cult in  the  female  and  still  more  so  in  the 
male — and  with  the  point  that  of  the  cathe- 
ter coated  with  wax  the  procedure  would 
be  further  complicated.  Besides,  the  vol- 
ume of  wax  would  necessarily  be  so  small 
that  any  impression  made  upon  it  by  con- 
tact with  a  stone  would  leave  the  operator 
still  in  doubt  whether  this  impression  had 
been  made  by  a  stone  or  by  its  coming  in 
contact  with  some  elevation  of  the  mucous 
membrane.  Now,  I  regard  an  exploratory 
operation  on  the  kidney  as  a  very  trivial 
affair.  I  think  it  as  free  from  danger  as 
any  surgical  operation  can  be,  and  if  there 
is  a  condition  which  is  so  pointed  as  to  in- 
duce the  belief  that  there  is  a  stone  in  the 
kidney,  then,  in  the  event  that  no  stone  is 
found, the  exploration  will  reveal  some  other 
condition  demanding  intervention,  and 
will  put  us  in  position  to  relieve  that  con- 
dition. Therefore  I  think  it  far  preferable 
to  make  an  exploratory  operation  rather 
than  attempt  any  makeshift  of  detecting 
stone  in  the  kidney  by  so  unsatisfactory  a 
device  as  catheterizing  the  ureter. 

Dr.  J.  M.  Parrot. — I  would  like  to  ask 
Dr.  Johnston  if  he  didn't  think  it  advisable 
to  ligate  the  ureter  and  the  pedicle  separ- 
ately? 

I  know  in  that  operation  where  there  is 
much  inflammation,  such  as  the  doctor  cited 
in  the  last  case,  it  is  almost  impossible  to 
ligate  the  pedicle  separately  by  the  lumbar 
incision,  and  therefore  I  asked  the  question. 
Now,  we  had  a  case  at  home  sometime  since 
very  similar  to  this  last  one,  and  by  the 
lumbar  incision  we  found  it  impossible  to 
separate,  in  fact,  we  didn't  attempt  it.  I 
think  time  would  have  been  wasted  by  such 
a  proceeding. 

Dr.  Johnston. — If  possible,  I  have  in- 
variably done  that.  In  both  cases  here  re- 
ported the  ureter  and  pedicle  were  ligated 
separately.  Sometimes  this  is  difficult,  but 
it  can  always  be  done,  and  easily  done, 
through  an  anterior  incision.  By  the  lum- 
bar incision,  especially  in  fat  subjects,  where 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


217 


you  work  through  varying  thicknesses  of 
abdominal  wall,  it  is  an  extremely  difficult 
thing  to  do,  and,  therefore,  in  such  in- 
stances I  ligate  the  pedicle  as  a  whole  rather 
than  attempt  ligation  in  parts. 


The  Treatment  of    Urethral   Discharges.! 

By  James  M.  Parrot,  M.  D:,  Kinston,  N.  C. 

In  discussing  the  treatment  of  urethral  dis- 
charges I  shall  confine  myself  to  the  direct 
pathological  conditions  causing  them  and 
shall  exclude  all  the  passing  complications 
so  often  met  with  in  this  class  of  diseases. 
This  restriction  is  made  in  order  that  more 
time  may  be  devoted  to  the  discussion  of 
the  treatment  of  the  diseases  themselves, 
and  not  because  the  complications  are  con- 
sidered to  be  too  infrequent  to  demand  at- 
tention and  so  innocent  as  to  be  passed  un- 
noticed. The  treatment  of  urethral  dis- 
charges has  been  more  or  less  discussed  since 
the  days  of  Moses.  Hundreds  and  thous- 
ands of  ideas  have  been  advanced  along  this 
line  and  it  is  neither  desirable  nor  practical 
to  discuss  them  all.  Each  method  has  its 
advantages  and  disadvantages.  In  the  ma- 
jority the  latter  overbalance  the  former 
while  a  few  only  present  qualifications  of 
sutficient  importance  as  to  demand  really 
careful  attention. 

Until  a  few  years  ago  gonorrhua  was 
treated  empirically.  Xo  distinction  was 
made  either  clinically,  or  therapeutically. 
The  discovery  of  the  gonococci,  however, 
laid  the  foundation  for  a  rational  treatment, 
and  since  that  time  many  improvements 
have  been  made.  Some  years  ago  Janet 
suggested  the  irrigation  method  recently 
practiced  with  such  success  by  Valemine 
and  Goldberg.  As  perfected  by  Valentine 
this  treatment  is  the  best  yet  devised.  Sta- 
tistics carefully  selected  by  Goldberg  show 
that  90%  of  all  cases  were  cured  within  14 
days.  In  my  hands  it  has  cured  50%  within 
10  days,  26%  within  15  days.  11%  within 
21  days,  8%  within  28  days;  the  remain- 
ing 5%  being  much  benefitted  by  it  and 
doubtless  would  have  been  cured  quicker 
had  my  directions  been  carefully  followed. 
1  have  never  had  any  complications  since 
this  treatment  has  been  in  use  save  in  one 
case.  This  patient  did  very  nicely  for  6 
days,  and  then  failed  to  report  at  my  office 
regularly  for  the  treatment  until  the  tenth 
day.  At  that  time  he  was  much  better, 
however,  and  asked  for  an  injection  because 
of  the  inconvenience  of  the    official    treat- 


fKead  before  the  Tri-State  Medical  Society  of 
the  Carolinas  and  Virginia,  at  Charlotte,  N.  C, 
January, 1899. 


ment.  On  the  22d  and  23d  day  he  drank 
excessively,  the  urethritis  rapidly  grew 
worse.  Later  it  improved  a  great  deal,  but 
about  the  40th  day  a  well  marked  gonor- 
rhceal  rheumatism  developed. 

The  apparatus  made  by  Reichardt  &  Co. 
is  probably  the  best  and  usually  I  prefer  a 
solution  of  permanganate  of  potash.  On 
the  morning  of  the  1st  day  I  irrigate  with 
1-3000  solution,  at  the  afternoon  seance  a 
1-4000  solution  is  used.  These  anterior  ir- 
rigations are  coutinued  in  this  manner  daily 
until  the  4th  afternoon.  At  that  sitting, 
after  using  half-pint  of  a  1-5000  solution 
anteriorly  I  elevate  my  apparatus  and  give 
a  posterior  irrigation,  called  by  many,  and 
properly  an  intro-vesical  irrigation.  By 
this  time  the  disease  is  usually  under  con- 
trol, however,  if  it  has  not  improved  very 
much  it  is  well  to  postpone  intro-vesical 
treatment  until  the  5th  or  6th  day.  At  the 
morning  seance  immediately  following  the 
first  posterior  irrigation,  I  treat  only  the 
penile  urethra,  after  that  all  irrigations  are 
intro-vesical ;  on  the  7th  or  8th  day  of  treat- 
ment the  discharge  is  generally  scanty,  and 
all  symptoms  much  improved.  Then  only 
one  treatment  a  day  is  given.  This  is  con- 
tinued using  a  solution  varying  in  strength, 
according  to  the  case  and  symptoms,  from 
1-6000  to  1-3000  permanganate  of  potash. 
By  the  9th  or  10th  day  all  discharge  has 
stopped,  except  rarely  a  slight  mucoid  mat- 
ter from  the  anterior  urethra.  With  such  a 
case  it  is  best  to  irrigate  every  other  day  for 
two  or  three  time. 

With  this  treatment  I  always  at  the  verv 
beginning  prescribe  salol  in  5  grain  doses  3 
or  4  times  a  day.  If  much  ardor  urines  he 
present  it  is  well  to  give  also  an  alkaline 
diuretic,  a  combination  of  benzoate  of  soda 
and  citrate  of  potash  being  probably  the 
best.  The  patient  is  of  course  placed  on 
the  usual  diet  and  given  the  customary  di- 
rections concerning  personal  cleanliness. 
He  is  specially  cautioned  against  the  use  of 
alcoholic  beverages  and  sexual  indulgence. 
The  following  cases,  chosen  at  random  from 
my  record  book  illustrate  ver)'  nicely  the 
average  patient  treated  by  this  method. 

Case  1. — Mr.  C.,  age  22,  general  health 
good.  When  seen  presented  a  well  marked 
case  of  acute  anterior  gonorrhoea  of  8 
hours  duration.  Microscopic  examination 
made  and  gonococci  were  discovered. 
Irrigation  treatment  was  begun  at  once,  as 
above  described,  and  15  grains  each  of  ben- 
zoate of  soda  and  citrate  potash  were  ad- 
ministered every  4  hours  for  3  days.  Five 
grains  salol  were  given  4  times  a  day  for  6 
days.  On  the  tenth  day  he  was  discharged 
cured. 

Case   2. — Mr.    E.    A.,   age  32,     general 


218 


THE  CHARLOTTE     MEDICALJOUKNAL. 


health  poor.  For  several  years  has  suffered 
from  indigestion  and  has  the  strumous  di- 
athesis. On  examination  I  found  a  true 
gonorrhoea  of  14  hours  duration,  gonococci 
being  found  in  the  discharge.  The  irriga- 
tion treatment  was  begun  at  once  and  an 
iron  tonic  ordered.  Salol  was  given  3  times 
a  day.  He  was  discharged  cured  on  the 
14th  day. 

Case  3. — Mr.  G.  R.,  age  18.  When 
seen  had  a  pronounced  acute  posterior  gon- 
orrhoeal.  Posterior  irrigations  were  begun 
at  once  and  medium  doses  of  salol  and  cit- 
rate potash,  with  tincture  of  hyoscyamus 
were  prescribed.  He  began  to  improve 
after  the  second  seance  and  was  cured  on 
the  1 6th  day  of  treatment. 

Case  4. — Mr.  P.,  age 38,  married.  Wife 
much  troubled  with  leucorrhcea.  Gave  a 
clean  personal  history  prior  to  this  affair. 
On  examination  I  found  a  rather  scanty, 
milky  discharge.  Meatus  but  little  inflamed 
with  mild  ardor  urince.  Patient's  father 
and  grandfather  died  of  tuberculosis,  and 
he  himself  rather- frail  and  delicate.  No 
gonococci  were  found  in  the  discharge. 
Anterior  irrigations  of  a  1-2000  solution  of 
nitrate  of  silver  were  used  in  the  same  man- 
ner as  was  the  permanganate  of  potash  in 
the  above  cases.  Usual  advice  for  such 
patients  given  and  tonics  ordered.  On  the 
12th  day  lie  was  discharged  cured.  In  this 
case  the  silver  salt  was  substituted  for  the 
permanganate  of  potash,  because  I  believe 
it  has,  with  such  patients,  a  better  and  a 
peculiar  controlling  influence.  This  man 
evidently  had  an  acute  urethritis  contracted 
from  his  wife  who  suffered  much  with 
chronic  endo-cervicitis. 

We  are  sometimes  consulted  by  traveling 
men  and  others  who  can  not,  or  will  not, 
come  to  our  office  daily  for  treatment  by  this 
method.  Then  some  other  must  be  substi- 
tuted. I  begin  at  once  with  an  injection 
aimed  at  the  specific  organism.  If  the  germ 
is  there  why  temporize  and  wait  until  the 
acute  stage  has  passed,  and  after  the  gono- 
cocci have  buried  themselves  into  the  deeper 
penile  structures,  and  often  out  of  our 
reach,  or  have  travelled  backward  and  pro- 
duced a  posterior  gonorrhoea  or  some  other 
complication  of  a  serious  nature?  The  only 
scientific  treatment  is  to  attack  the  enemy  in 
his  own  stronghold  and  before  irreparable 
damage  has  been  done.  I  order  at  once  an 
injection  of  a  ■£%  to  3%  solution  of  protar- 
gol,  the  strength  varying  with  the  case. 
The  patient  is  given  also,  per  orum,  salol 
and,  if  necessary,  benzoate  of  soda  or  cit- 
rate of  potash.  Protargol  is  by  far  the  best 
remedy  for  urethral  injection,  and  does  not 
form  an  albumenoid  with  the  tissues  and 
secretions  so  quickly  as  do  the  other   silver 


salts  ;  argoninis  also  very  good,  being  better 
than  the  nitrates.  Careful  direction  should 
be  given  as  to  the  use  of  the  inject;on,  and 
a  conical,  pointed  urethral  syringe  should 
always  be  ordered.  My  own  experience 
with  protargol  in  17  cases  has  proven  that  it 
lessens  the  liability  to,  and  the  frequency 
of,  complications,  and  cuts  short  the  attack 
from  one  to  three  weeks  as  compared  with 
other  injections.  If  used  early  and  properly 
posterior  gonorrhoea  will  be  very  infrequent 
and  mild.  In  all  cases  with  much  sexual 
excitemeut  monobromate  of  camphor  should 
be  given  in  full  doses.  A  very  careful  ex- 
amination should  be  made  of  every  case 
before  the  patient  is  discharged,  and  if  not 
entirely  well  should  be  kept  under  treat- 
ment until  all  symptoms  disappear,  partic- 
ular attention  being  paid  to  the  presence  or 
absence  of  clap  shreds  in  the  urine.  This  I 
consider  is  very  important. 

Subacute  urethritis,  either  anterior  or  pos- 
terior, had  best  be  treated  by  the  irrigation 
method,  when  possible,  though  in  thes2 
cases  it  does  not  cure  so  quickly  as  in  acute 
cases.  If  the  Janet- Valentine  treatment  is 
not  practical  then  protargol  orargonin  should 
be  prescribed  with  salol  and  alkaline  diuret- 
ics. Here  again  it  is  necessary  to  give  very 
positive  advice  as  to  diet  and  the  use  of  alco- 
holic beverages  and  the  indulgence  in  sex- 
ual intercourse.  A  careful  watch  should  be 
kept  upon  the  case  and  all  complications 
promptly  met  and  treated. 

The  successful  treatment  of  chronic  ure- 
thritis is  often  more  puzzling  than  the  acute 
or  subacute  varieties.  Each  and  every  case 
must  be  studied  very  closely,  the  cause 
sought  out  and  the  proper  remedy  applied. 
No  physician  can  be  entirely  successful  in 
this  field  of  work  unless  this  is  done. 
When  a  stricture  is  found  (and  these  are 
much  less  frequent  than  is  generally 
thought)  it  must  be  gradually  dilated,  either 
by  weekly  vesical  irrigations  as  described 
below,  or  by  the  passage  of  proper  bougies, 
or  preferably  by  both.  Most  strictures 
(67%)  occur  in  the  penile  urethra,  within 
two  inches  of  the  bulbo-membranous  junc- 
tion. They  are  easily  overlooked  and  will 
be  unless  careful  search  is  made.  Of  course 
a  conical  pointed  bougie  should  be  used  in 
dilating  it.  An  ordinary  sound  if  relied 
upon  entirely  will  often  fail  to  make  known 
the  presence  of  a  stricture.  This  should  be 
remembered.  A  stricture  of  large  caliber, 
if  of  a  valve-like  construction  will  cause 
much  trouble  by  producing  a  prolonged 
urethritis.  It  catches  the  urine  behind  its 
folds,  and  retains  a  few  drops  which  decom- 
pose to  a  certain  extent,  and  act  as  an  irri- 
tant.    It    causes    also    a    ballooning  of  the 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


219 


urethra  at  this  point  and  thus  produces  a 
catarrhal  inflammatory  process  there. 

When  no  stricture  is  found  the  urethra 
should  be  carefully  inspected  with  an  endo- 
scope and  all  local  foci,  if  any  be  found, 
touched  with  a  40  gr.  to  ounce  solution  of 
nitrate  of  silver.  If  the  urethra  present  a 
catarrhal  inflammation,  injections  of  a  1  to 
3%  solution  of  protargol  is  beneficial.  This 
should  be  combined  with  the  proper  inter- 
nal treatment  for  the  strongly  acid  urine 
which  frequently  complicates  such  a  case. 
Insufflations  of  powdered  protargol  through 
the  endoscope  has  proven  in  my  hands  very 
effective  with  two  cases  presenting  local 
foci  not  cured  by  the  nitrate  solution.  Both 
these  silver  salts  in  such  strength  are  painful 
and  should  not  be  used  very  often.  In  those 
cases  of  chronic  anterior  urethritis  due  to 
general  infection  by  the  gonococci  and  in 
those  cases  presenting  strictures  or  local 
foci  and  in  all  cases  of  uncomplicated  pos- 
terior urethritis,  by  far  the  best  treatment  is 
the  weekly  intra-vesical  irrrigation  with  1- 
4000  to  1-2000  solution  of  nitrate  of  silver, 
combined  if  need  be  with  capsules  contain- 
ing either  yellow  oil  of  sandal  wood,  or 
cubebs  and  copaiba,  using  always  small 
doses  of  salol.  Care  should  be  exercised  in 
the  use  of  the  last  mentioned  drugs  not  to 
injure  the  kidneys,  a  watch  being  also  kept 
upon  the  stomach  and  general  health. 

The  intra-vesical  irrigations  are  best  given 
with  Valentine  apparatus,  used  in  the  treat- 
ment of  acute  gonorrhoea.  The  instrument, 
especially  the  nozzle  and  hand-piece,  to- 
gether with  the  lower  end  of  the  tube  and 
shield,  should  always  be  thoroughly  and 
carefully  sterilised  before  and  after  using. 
This  precaution  should  be  exercised  in  treat- 
ing any  variety  of  gonorrhoea.  About  a  quart 
of  the  silver  solution,  of  the  strength  before 
mentioned  is  put  in  the  irrigator  and  raised 
about  10  feet  above  the  patient,  care  being 
taken  not  to  elevate  it  so  high  as  to  produce 
enough  force  in  the  stream  to  injure  the 
urethra.  The  patient  is  instructed  to  uri- 
nate and  either  lie  down,  or  sit  on  the  edge 
of  a  chair,  the  latter  being  preferable.  The 
penis  is  then  introduced  through  the  hole 
of  a  small  rubber  apron  made  for  the  pur- 
pose and  grasped  with  the  left  hand,  thumb 
on  the  dorsum  and  fingers  on  the  corpus 
spongiosum.  The  meatus,  together  with 
the  anterior  urethra  is  now  washed,  one- 
third  of  the  solution  being  used  for  this 
purpose.  The  nozzle  is  then  pressed  firmly 
but  gently  into  the  meatus  and  a  full  stream 
turned  on.  If  the  urethra  balloons,  the  pa- 
tient is  instructed  to  take  two  or  three  deep 
inspirations  in  rapid  succession  and  to  at- 
tempt immediately  to  urinate.  The  fluid 
will  then  flow  freely  into  the  bladder — one 


soon  learns  by  the  touch  when  this  is  taking 
place.  When  the  bladder  is  comfortably 
full  the  injection  is  stopped  and  the  patient 
is  instructed  to  urinate.  This  seance  is  re- 
peated once  every  5  to  7  days,  according  to 
the  special  indications.  The  following  case 
illustrates  this  mode  of  treatment  : 

On  May  3d,  1898,  a  Mr.  E.,  age  27,  a 
clerk  by  occupation,  presented  himself  at 
my  office  with  a  typical  chronic  urethritis, 
of  gonorrheal  origin.  Gonococci  were 
found  in  the  discharge.  Intra-vesical  irri- 
gations of  1-2000  solution  of  nitrate  silver, 
used  every  4  days  for  3  sittings,  then  every 
6  days  until  June  3d,  on  which  day  the  last 
seance  was  done.  I  saw  him  seven  days 
after,  and  as  there  were  no  evidences  of 
gonorrhoea  present  the  treatment  was  not 
repeated  and  the  patient  was  discharged 
cured.  This  is  one  of  several  cases.  I  do 
not  believe  he  could  have  been  cured  "so 
quickly  and  promptly  by  any  other  method. 
The  intra-vesical  irrigation  is  also  of  much 
benefit  in  the  treatment  of  those  cases  of  pros- 
atic  origin.  Very  often,  however  the  passage 
of  large  sounds,  or  the  use  of  Winternitz's 
psychrophore  (the  last  preferred)  before  the 
intra-vesical  irrigation,  will  produce  a  more 
rapid  and  efficient  cure  than  is  possible 
without  their  use. 

The  surgeon  is  very  often  consulted  by 
men  who  complain  of  various  sexual  dis- 
orders, with  a  scanty  urethral  discharge  of 
a  milky  or  mucilaginous  appearance  of  more 
or  less  persistence,  together  with  local  pains 
and  oftentimes  nocturnal  emissions,  or  im- 
potence. These  cases  may,  or  may  not  give 
a  gonorrhceal,  or  excessive  venery  history, 
though  very,  very  often  they  do.  Melan- 
cholia and  neurasthenia  are  frequently  pres- 
ent. A  careful  urethral  examination  re- 
veals nothing  except  possibly  a  slight 
paleness  of  the  walls.  Urinary  analysis  is 
generally  negative  except  a  slight  cloudi- 
ness and  sometimes  a  few  cells  from  the 
seminal  vesicles.  A  careful  rectal  examin- 
ation, however,  demonstrates  the  presence 
of  an  enlargement  in  the  region  of  the 
seminal  vesicles,  generally  small  and  cord 
like,  somewhat  doughy  and  more  or  less 
tender.  We  at  once  make  the  diagnosis 
chronic  seminal  vesiculitis.  The  vesicles 
are  stripped  by  gently  kneading  them  with 
the  forefinger,  per  rectum,  the  stroke  being 
toward  the  urethra.  This  should  be  done 
about  once  every  6  days,  though  we  must 
be  governed  by  each  case  as  to  frequency. 
The  patient  will  pass,  after  this  manipula- 
tion a  small  amount  of  cloudy  urine.  This 
form  of  treatment  is  the  plan  outlined  by 
Fuller  in  his  most  excellent  work,  "Disor 
ders  of  the  Male  Sexual  Organs."  The 
following  case,  selected    from  those  which 


220 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


have  occurred  in  my  practice  very  clearly 
represents  that  variety  of  this  disease  which 
comes  within  the  scope  of  this  paper,  viz  : 
those  having  urethral  discharges. 

Gase  1. — Mr.  A,  E.,  age  26,  complained 
of  severe  pain  with  each  ejaculation.  Noc- 
turnal emissions  often.  Anaemic  and  ner- 
vous— non  alcoholic.  Persistent  mastur- 
bator  for  five  years  following  his  17th  birth 
day.  Impotence  now  complete.  On  exam- 
ination I  found  a  urethral  discharge  of  two 
years  standing.  Rectal  examination  de- 
monstrated the  presence  of  a  tender,  pear- 
shaped  enlargement  above  the  prostate  and 
reached  with  difficulty,  though  after  a  little 
experience  this  was  overcome.  Seminal 
stripping  was  practiced.  The  treatment 
was  given  weekly  for  4  months,  at  which 
time  he  was  discharged  cured.  Tonics 
were  prescribed,  and  sound,  wholesome 
advice  given. 

Case.  2. — Mr.  B.  F.,  age  38,  gave  history 
of  several  gonorrrhoeas.  The  present  trouble 
continued  after  the  last  attack,  26  months 
before  consulting  me.  Discharge  usually 
scanty  though  at  times  rather  profuse. 
Ardor  urincc  frequently  present,  lasting 
only  a  few  days  at  a  time,  however.  Gen- 
eral health  good.  Sexual  functions  and 
organs  normal.  Endoscopic  examination 
of  urethra  showed  it  to  be  healthy.  Semi- 
nal vesicles  enlarged  and  slightly  painful. 
Occasional  nocturnal  emissions  and  slight 
ejaculatory  pains.  Was  treated  unsuccess- 
fully by  several  methods  by  as  many  phy- 
sicians, and  when  seen  was  doubtful  and 
rather  despondent.  I  at  once  began  Fuller's 
method  of  vesical  stripping,  and  very 
shortly  he  began  to  improve.  He  was  dis- 
charged   cured    at  the  end  of  3^     months. 

These  two  cases  very  greatly  impressed 
me  with  the  importance  of  both  acute  and 
chronic  vesiculitis,  especially  the  latter,  and 
in  my  opinion  too  much  stress  cannot  be 
laid  upon  the  seminal  vesicles  as  the  fre- 
quent seat  of  disease.  In  all  cases  of  ure- 
thral discharge,  of  an  obscure  origin  a  very 
careful  examination  of  them  should  be 
made,  and  even  if  complicated  with  other 
apparent  causes  they  should  receive  prompt 
and  careful  treatment. 


Epilepsy:  State  Institutions  for  Epileptics.* 

By  William  Francis  Drewry,  M.  D.,  of  Peters- 
burg, Va.,  Superintendent  of  the  Central  State 
Hospital;  Member  of  the  Commission  on  State 
Care  of  Epileptics,  &c. 

Were  I  to  read  before  the  Medical  Society 


fRead  before  the  Tri-State  Medical  Society  of 
the  Carolinas  and  Virginia,  at  Charlotte,  N.  C, 
January,  1899. 


of  Virginia  a  paper  on  "State  Care  of  Epi- 
leptics," it  would  be  as  a  "twice  told  tale," 
but  as  the  matter  has  probably  not  been 
presented  to  the  profession  of  the  Carolinas, 
I  offer  that  as  my  apology  to  the  Virginia 
contingent  of  this  audience,  for  again  wri- 
ting on  the  subject. 

Before  passing  to  the  main  object  of  this 
paper,  viz  :  to  review  the  progress  that  has 
been  made  in  the  matter  of  public  care  of 
epileptics,  permit  me  to  present,  in  a  rather 
cursory  manner,  some  observations  on  the 
history,  Drevalence,  cause,  pathology,  prog- 
nosis and  treatment  of  epilepsy. 

It  is  a  disease  of  great  antiquity.  It  has 
probably  affected  mankind  almost  from  the 
time  our  first  parents  were  driven  from  the 
Garden  of  Eden.  Certainly  as  far  back  into 
ancient  times  as  authentic  medical  records 
go,  we  know  it  has  afflicted  the  human  race. 

Euripides  gives  such  a  clear  description 
of  its  symptoms,  that  one  is  convinced  of 
his  familiarity  with  the  disease.  We  find 
mention  of  it  in  the  works  of  Galen,  Hip- 
pocrates, Celeus,  Plato,  Aretaeus  and  other 
renowned  writers  among  the  ancients. 

The  Father  of  medicine,  though  practis- 
ing in  the  5th  Century  B.  C,  when  the 
whole  subject  of  disease  was  wrapped  up  in 
the  greatest  superstition,  was  a  man  of  sci- 
entific attainments.  He  speaks  much  on 
the  order  of  a  modern  physician.  Hear 
him  on  the  "Sacred  Disease,"  as  epilepsy 
was  known  in  that  day. 

"The  sacred  disease  appears  to  me  no 
wise  more  Divine  nor  more  sacred  than  oth- 
er diseases;  but  has  a  natural  cause  from 
which  it  originates  like  other  affections. 
Men  regard  its  nature  and  cause  as  Divine 
from  ignorance,  and   wonder   because   it    is 

not  at  all  like  other  diseases 

They  who  first  referred  this  disease  to  the 
gods  appear  to  me  to  have  been  just  such 
persons  as  the  conjurors, purificators, mount- 
ebanks and  charlatans  are  now.  Such  per- 
sons, then,  using  the  divinity  as  a  pretext 
and  screen  for  their  own  inability  to  afford 
any  assistance,  have  given  out  that  this  dis- 
ease is  sacred,  adding  suitable  reasons  for 
the  opinion,  and  they  have  instituted  a 
mode  of  treatment  which  is  safe  for  them- 
selves, namely,  by  applying  purifications 
and  incantations,  and  enforcing  abstinence 
from  baths  and  many  articles  of  food  which 
are  unwholesome  to  men  in  disease.  This 
disease  is  formed  from  these  things  which 
enter  into  and  go  out  of  the  body  and  it  is 
not  more  difficult  to  understand  and  cure 
than    the    others,  neither  is  it    more  Divine 

than  other  diseases 

Men  ought  to  know  that  from  nothing  else 
but    the  brain   come  joy,  despondency  and 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


221 


lamentation,  and  by  the. same  organ  we  be- 
come mad  and  delirious." 

In  the  New  Testament  we  read  descrip- 
tions of  epilepsy  as  well  as  insanity.  A 
troubled  father  pleading  for  mercy  for  his 
afflicted  son,  says,  "For  ofttimes  he  falleth 
into  the  fire  and  oft  into  the  water."  Some 
authorities  believe  that  the  "thorn  in  the 
flesh,"  which  was  a  source  of  so  much 
anxiety  to  St.  Paul,  was  epilepsy.  Among 
the  ancient  Romans  it  was  a  disease  of 
much  ill-omen.  In  fact,  all  along  down 
the  centuries,  this  dreaded  malady  was 
generally  regarded  as  a  mysterious  manifes- 
tation of  the  Evil  Spirit.  The  most  absurd 
theories  regarding  its  cause  and  treatment, 
were  advocated  by  the  highest  authorities 
of  their  time.  To  "stay  the  mysterious 
spell"  all  manner  of  ridiculous  remedies 
were  prescribed.  For  instance,  a  decoction 
made  from  the  skull  of  a  dead  man  who  had 
met  a  violent  death,  was  regarded  as  a 
"specific."  Snake  heads  steeped  in  rum, 
was  a  favorite  prescription.  The  Romans 
thought  the  drinking  of  human  blood  from 
a  recent  wound,  an  unfailing  remedy. 

It  was  not  until  Marshall  Hall  advocated 
the  theory  of  reflex  irritation  that  any  pro- 
gress was  made  in  the  knowledge  of  the 
disease.  Later  on  came  Hughlings  Jackson, 
with  the  belief  that  the  convulsive  seizures 
were  due  to  an  explosion  of  nerve  force  in 
the  higher  cortical  and  sub-cortical  brain 
centers,  caused  by  nutritional  disturbances. 

Ilaig,  in  his  recently  published  researches, 
demonstrated  the  close  connection  of  attacks 
of  epilepsy  with  variations  in  the  excretion 
of  uric  acid.  "Here  and  there  in  litera- 
ture," says  a  distinguished  writer  in  the 
Alienist  and  Neurologist  of  October,  1898, 
"opinions  have  been  expressed  that  the  pro- 
bable cause  of  many  nervous  symptoms  is 
to  be  sought  in  an  intoxication  or  auto-in- 
toxication of  the  organism." 

Notwithstanding  some  of  the  most  emi- 
nent neuro-pathologists  have  given  special 
study  to  this  disease,  we  are  yet  without 
accurate  knowledge  of  a  definite  lesion  upon 
which  may  be  based  rational  treatment.  As 
long  as  the  etiology  and  pathology  are  so 
obscure,  treatment  must  of  necessity  be 
more  or  less  experimental. 

Van  Gieson,  chief  pathologist  at  the  New 
'York  vState  Pathological  Institute,  writes 
in  a  recent  number  of  the  "Archives 
of  Neurology  and  Psychopathology,"  that, 
"All  the  facts  which  the  pathological 
anatomist  and  physiological  chemist  have 
gained  in  the  study  of  this  dire  malady, 
give  no  explanation  of  the  process  that  gives 
rise  to  the  epileptic  phenomena."  He  dep- 
recates the  use  of  bromides  in  the  treatment 
of  epilepsy,  believing  that  in  many  pases  its 


administration  on  this  entirely  empirical 
basis,  although  relieving  the  symptoms, 
may  damage  the  nervous  system  severely. 

x\s  to  the  curability  of  true  epilepsy,  I 
am  decidedly  skeptical.  It  is  practicably 
incurable.  I  have,  of  course,  seen  cases  in 
which  the  convulsions  stopped  for  some  con- 
siderable length  of  time,  as  long  in  some  in- 
stances as  2  years.  I  have  also  seen  many 
cases  improve  under  this  or  that  line  of 
treatment.  There  are  doubtless  some  cases, 
particularly  in  children,  in  which  by  the 
removal  of  the  reflex  cause,  if  that  can  be 
discovered,  the  disease  is  arrested  or  cured. 
While  brain-surgery  has  probably  accom- 
plished a  few  permanent  cures,  it  is  a  pro- 
cedure that  can  be  adopted  in  only  a  limited 
number  of  cases. 

Taking  all  cases — reflex,  traumatic,  and 
the  so-called  idiopathic — probably  not  more 
than  three  or  four  percent,  are  permanently 
restored,  it  matters  not  what  line  of  treat- 
ment may  be  adopted. 

During  the  past  ten  or  twelve  years  1 
have  tried,  in  quite  a  number  of  cases,  about 
every  drug  that  has  been  recommended  as 
useful  in  the  treatment  of  epilepsy,  and  I 
am  still  experimenting,  but  I  have  little 
faith  in  the  efficacy  of  any  known  medicinal 
remedy  in  curing  this  fearful  disease. 

As  to  what  constitutes  a  cure  in  epilepsy, 
it  is  an  undetermined  matter.  In  a  paper 
on  "Remissions  in  Epilepsy,  &c,"  read  by 
Dr.  Wharton  Sinkler  before  the  American 
Neurological  Association,  in  May,  1S98, 
that  distinguished  neurologist  reviews  the 
literature  on  this  subject,  citing  the  opin- 
ions of  different  writers.  Various  observers 
report  cases  in  which  there  were  long  inter- 
missions of  attacks.  Almost  invariably 
there  was,  sooner  or  later,  a  recurrence  of 
the  fits.  Gray  is  undetermined  as  to  what 
may  be  considered  a  cure.  Dana  claims 
that  5  to  10  per  cent,  gets  well.  Ross  says 
a  few  cases  are  cured.  Nothnagel  considers 
epilepsy  a  curable  disease,  4  or  5  per  cent, 
getting  well  without  treatment.  Hamilton 
regards  the  disease  as  curable.  Nieineyer 
says  recovery  is  rare.  Yet  none  of  these 
authorities  define  what  is  rearly  meant  by 
a  cure.  Sinkler  reports  24  cases  of  idio- 
pathic epilepsy,  in  which  there  have  been 
remissions  varying  from  two  years  to  twenty- 
nine  years.  He  closes  his  interesting  arti- 
cle in  these  words  : 

"After  consideration  of  the  cases  above 
referred  to,  in  which  after  prolonged  inter- 
vals, even  as  long  as  twenty-nine  years, 
there  has  been  a  recurrence  of  the  disease, 
we  are  forced  to  the  conclusion  that  it  is  not 
justifiable  to  consider  any  case  of  epilepsy 
cured,  no  matter  how  great  has  been  the 
interval  of   freedom  from    attacks  and   ap- 


222 


THE  CHARLOTTE  MEDICAL   JOURNAL. 


pearance  of  normal  health.  Notwithstand- 
ing this  unfavorable  conclusion,  the  study 
of  these  cases  brings  out  a  fact  which  is 
satisfactory,  for  it  shows  that  remissions  of 
many  years'  duration  may  occur,  in  which 
the  patient  is  in  normal  health,  and  is  able 
to  pursue  his  life,  as  if  he  had  never  suffered 
from  epilepsy." 

What  effect  epilepsy  has  on  the  mind  is 
an  important  question.  Certainly  it  has  a 
marked  influence  on  the  mental  develop- 
ment of  children,  frequently  leading  to 
idiocy.  The  frequent  violent  explosions  of 
nerve  force  must  arrest  or  retard  mental 
evolution. 

There  can  be  no  doubt  that  epilepsy  leads, 
in  many  instances,  to  mental  and  moral  de- 
generacy. Dementia  is  frequently  preceded 
by  epilepsy  of  long  standing. 

It  is,  however,  a  difficult  matter  to  give 
with  any  degree  of  accuracy  the  proportion 
of  epileptics  that  become  insane.  Eight  or 
ten  per  cent,  of  all  insane  persons  have  a 
history  of  epilepsy. 

Dr.  Frederick  Peterson  believes  that  less 
than  ten  per  cent,  of  epileptics  become  in- 
sane. Dr.  J.  H.  McBryde,  however,  is  of 
the  opinion,  "That,  with  rare  exceptions, 
habitual  epileptics  suffer  sooner  or  latter 
from  some  degree  of  mental  impairment." 

The  Journal  of  the  American  Medical 
Association,  in  concluding  an  editorial  in 
its  issue  of  Dec.  3d,  1898,  regarding  the 
difference  of  opinion  of  these  two  equally 
eminent  authorities,  says  :  *Tt  may  be  said 
that  it  requires  a  rather  broader  conception 
of  insanity  than  is  commonly  admitted  to 
apply  it  to  epileptics  generally,  or  even  to 
all  the  chronic  cases  in  their  later  develop 
ment.  They  are  unfortunates,  to  some  ex- 
tent mentally  impaired  in  a  large  propor- 
tion of  cases,  but  it  is  as  easy  to  over-esti- 
mate the  frequency  of  such  defect  as  to  un- 
der-estimate  it." 

At  any  rate,  the  mental  capacity  of  an 
epileptic  may  vary  from  that  of  the  highest 
order  of  genius  to  that  of  a  complete  imbe- 
cile. Napoleon,  Julius  Cassar,  Petrarch, 
Peter  the  Great,  Handel,  Swift,  Richlieu, 
Marleborough,  Weltington,  Mahommet, 
are  among  the  geniuses  of  the  first  order 
who  were  subjects  of  convulsive  seizures  or 
epilepsy. 

That  the  disease  is  to  a  marked  degree 
hereditary,  is  generally  admitted.  The  off- 
spring of  an  epileptic  may  be  idiotic,  in- 
sane, morally  deficient,  or  otherwise  de- 
generate. 

In  New  York  and  Connecticut  the  trans- 
mission of  the  disease  is  considered  of  seri- 
ous enough  import  to  influence  the  taking 
of  steps  looking  to  the  enactment  of  a  law 
forbidding  the  marriage  of  epileptics. 


Now  let  us  study  the  epileptic  as  an  in- 
dividual, as  an  element  of  the  community. 

Owing  to  the  distressing  nature  of  his 
malady,  he  is  almost  an  outcast  from 
society.  On  account  of  it  he  is  debarred 
from  enjoying  equal  advantages  with  his 
more  fortunate  fellow-beings.  Deprived  of 
opportunities  of  acquiring  an  education  or 
a  trade,  he  grows  up  in  more  or  less  ignor- 
ance. Denied  social  enjoyments,  church 
privileges,  &c,  he  lives  in  discontent  and 
selfishness.  His  lot  is  indeed  a  hard  one. 
Rich  or  poor,  old  or  young,  his  life  is  beset 
with  trials  of  a  most  aggravating  nature. 
No  one  likes  to  employ  him  in  his  store, 
office,  factory  or  elsewhere,  for  fear  he  may 
have  an  epileptic  attack  while  engaged  at 
his  work.  The  fact  that  he  has  fits  causes 
him  to  be  shunned  and  neglected.  Can  there 
possibly  be  anything  more  mortifying  than 
to  be  seized  with  a  fit  and  thus  made  the 
object  of  a  group  of  curious  spectators? 
In  a  public  assemblage  can  there  be  any- 
thing more  appalling  than  a  person  in  the 
convulsive  stage  of  epilepsy?  An  object  of 
never-ceasing  anxiety,  an  unconcealed  skel- 
eton in  the  household,  he  is  a  menace  to  the 
happiness  and  comfort  of  the  family.  For 
obvious  reasons  it  is  impossible  to  give  him 
proper  attention  at  home. 

Many  families,  in  which  there  are  epilep- 
tics, are  poor  and  absorbed  in  struggles 
for  a  livelihood  ;  consequently,  the  care  of 
a  dependent  who  contributes  almost  nothing 
to  his  support,  becomes  a  grievous  burden. 
Indeed,  the  presence  of  an  epileptic  in  a 
family  often  means  the  withdrawal  from  the 
ranks  of  wage-earners,  of  two  persons — one 
the  epileptic  himself,  and  the  other  the  per- 
son who  is  responsible  for  the  care  of  his 
unfortunate  charge. 

From  a  medico-legal  point  of  view  the 
epileptic  is  an  uncertain  and  dangerous  ele- 
ment in  our  midst.  Frequently  he  is  tem- 
porarily deranged  after  a  seizure,  and  at 
times  may  commit  homicide  or  other  crime. 
The  mental  aberration  may  vary  from  the 
slightest  deflection  to  the  most  profound 
dementia  or  furious  mania.  The  epileptic 
dyscrasia  manifests  itself  in  various  ways. 
No  one  can  tell  when  or  how  a  sud- 
den impulse  may  seize  the  erratic  victim 
of  epilepsy.  There  can  be  no  denial  of  the 
fact  that,  owing  to  the  protean  manifesta- 
tions of  his  malady,  the  epileptic  has  com- 
mitted some  of    the  most  revolting   crimes. 

It  is  clear, therefore, that  certain  safeguards 
should  be  thrown  around  these  unfortunate 
creatures,  both  for  their  own  sakes,  and  in 
the  interest  of  the  public  peace  and  welfare. 

Reduced  to  poverty  and  want,  and  having 
nowhere  else  to  go,  many  epileptics,  in- 
cluding children,  drift  into  the  almshouses, 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


223 


where  they  are  forced,  in  many  instances, 
to  associate  with  degraded  humanity  of 
every  kind.  These  local  institutions  are 
without  means  for  the  suitable  care,  treat- 
ment and  employment  of  this  class  of 
patients.  It  is  objectionable  to  many 
epileptics  to  associate  with  the  average 
inmate  of  a  poor  house ;  and,  on  the 
other  hand,  no  other  class  of  people  so 
demoralize  the  entire  administration  of  the 
poor  house  as  do  epileptics,  who  are,  as  a 
general  rule,  irritable  and  hard  to  please. 

Long  and  almost  criminal  neglect  has  sent 
many  an  epileptic  to  the  hospital  for  the 
insane.  Frequently  they  are  pronounced 
insane  when  they  are  not,  and  forced 
to  go  to  the  asylum — an  unsuitable  place 
for  them.  Certainly  the  defective  commit- 
ment law  of  Virginia  has  caused  many  a 
sane  epileptic  to  be  confined  in  a  jail  or  a 
hospital  for  the  insane.  To  convalescent  in- 
sane patients  particularly  is  the  presence  of 
epileptics  harmful, involving  a  great  danger 
of  relapse  in  their  mental  disease. 

The  aspect  of  a  patient  in  an  epileptic 
paroxysm  is  shocking  to  witness,  and  the 
sight  has  been  known  to  induce  a  similar 
attack  in  an  onlooker.  On  the  other  hand, 
association  with  the  insane,  tends  to  aggra- 
vate the  disease  of  the  epileptic  and  to  make 
him  more  irritable  and  unmanageable. 

During  the  past  few  years  I  have  en- 
deavored to  ascertain  as  accurately  as  pos- 
sible, from  available  data,  the  number  of 
epileptics  in  my  own  State.  I  do  not  think 
it  an  over-estimate  to  put  the  number  at 
3,000.  The  usually  accepted  ratio  in  this 
country  is  2  per  thousand  of  the  general 
population.  In  North  Carolina,  then,  there 
are  about  2,500,  and  in  .South  Carolina,  say 
2,000  epileptics.  These  figures  are.  of 
course,  approximate. 

They  are  to  be  found  scattered  through- 
out our  land,  in  private  homes,  jails,  poor 
houses,  asylums,  etc.  But  wherever  they 
are  they  are  discontented,  unhappy  and  full 
of  evil  forebodings,  and  lead  more  or  less 
miserable  lives. 

View  the  matter  in  any  way  you  will, 
there  can  be  but  one  conclusion  :  The  aver- 
age indigent  epileptic  is  sadly  in  need  of  a 
home,  hospital  or  colony,  where  he  can  be 
cared  for  in  a  humane  manner,  and  have 
his  disease  studied  and  treated  in  accordance 
with  the  most  scientific  methods.  But  this 
is  not  all  the  epileptic  needs.  He  needs 
employment  both  of  mind  and  body.  This 
can  be  provided  nowhere  as  well  as  at  an 
institution  equipped  especially  for  him. 

That  the  public  conscience  has,  to  a  great 
extent,  been  aroused  to  the  needs  of  epilep- 
tics is  evidenced   in  the  number  of   institu- 


tions which  have  already  been  opened  to 
them. 

Credit  for  the  first  effort  made  in  the 
care  of  epileptics  in  a  special  institution  is 
due  a  Frenchman  by  the  name  of  Pasteur 
Bost,  who,  in  1848,  opened  an  indus- 
trial home  in  Southern  France  for  a  few 
patients.  In  1869  the  now  celebrated  Biele- 
feld Colony  for  Epileptics  began  on  a  very 
small  scale.  To-day  this  colony,  one  of  the 
greatest  charities  in  all  the  world,  has  near- 
ly 1,500  epileptics  comfortably  living  in 
homes  on  1,400  acres  of  land,  where  they 
work  and  enjoy  the  ordinary  pleasures  and 
privileges  of  life  like  other  people,  and,  at 
the  same  time,  receive  the  best  possible 
medical  treatment. 

But  let  us  review  what  has  been  done  in 
our  own  country  along  the  lines  of  humane 
care  of  epileptics. 

It  would  be  too  long  a  story  to  tell  of  the 
persistent  efforts  on  the  part  of  public  spirit- 
ed citizens  and  philanthropists  to  induce  the 
Legislatures  of  various  States  to  recognize 
the  needs  of  these  unfortunates.  Nor  would 
it  be  a  short  story  to  tell  of  the  successes  at- 
tained here  and  there  in  the  way  of  small 
institutions  established  and  maintained  by 
local  charity  organizations  and  philanthro- 
pic individuals.  I  propose,  however,  to  give 
results  and  not  the  laborious  efforts  by  which 
the  results  were  accomplished.  The  first 
private  charity  institution  for  epileptics  in 
this  country  was  established  at  Baldwins- 
ville,  Mass.,  in  1882.  It  still  exists  and  is 
doing  a  grand  work  for  epileptic  children. 
There  are  several  other  private  institutions 
for  such  patients,  but  we  will  pass  on  to 
accounts  of  the  public  institutions. 

The  first  State  institution  built  exclusive- 
ly for  epileptics  was  in  Ohio.  In  1879  the 
Legislature  of  that  State  seriously  consid- 
ered the  matter,  but  not  till  1890  was  a  law 
enacted  providing  for  the  establishment  of 
a  hospital  for  epileptics — sane  and  insane — 
to  be  located  at  Galipolis.  On  November 
30,  1893,  the  institution  was  opened  for  the 
reception  of  patients.  It  had  capacity  at 
that  time  for  only  250  male  patients.  Sep- 
tember 1st,  1894,  cottages  for  200  females 
were  completed  and  at  once  occupied.  The 
buildings  now  consist  of  twelve  or  more 
cottages,  with  from  fifty  to  seventy-five 
beds  each ;  one  cottage  for  the  insane 
with  capacity  for  200  patients;  one 
large  industrial  building,  equipped  for 
mechanical  pursuits  of  various  kinds,  one 
kitchen,  two  congregate  dining-rooms, 
one  bakery,  one  laundry,  one  building  for 
cold  storage  and  manufacturing  of  ice,  and 
such  other  buildings  as  are  necessary  at  a 
large  establishment  of  the  kind.  Other 
buildings,  such  as  a  chapel,  an  amusement- 


'224 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


hall,  a  hospital  for  the  sick,  &c,  will  soon 
be  constructed.  $455,000.00  have  already 
been  expended  in  construction.  The  farm 
attached  to  this  institution  consists  of  sev- 
eral hundred  acres  of  land.  At  this  time 
there  are  nearly  nine  hundred  patients  be- 
ing treated  there.  On  a  visit  to  this  insti- 
tution in  the  spring  of  1897,  I  was  deeply 
impressed  with  the  humane  and  scientific 
work  that  was  being  done  there.  Nearly  all 
the  labor  about  the  cottages,  laundry,  kitch- 
en, &c,  was  being  done  by  the  patients. 
Many  of  them  were  engaged  in  grading, 
excavating,  quarrying,  building,  planting 
trees  and  flowers,  attending  to  stock,  gar- 
dening and  farming.  Others  were  making 
brooms,  baskets,  mattresses,  repairing  shoes, 
etc.  In  short,  there  was  a  systematic  effort 
to  provide  some  healthy  occupation  for  all 
who  were  able  to  work.  A  school  for  the 
children  was  flourishing,  and  already  proof 
had  been  given  of  its  usefulness  as  a  means 
of  improving  the  physical,  intellectual  and 
moral  condition  of  the  little  patients.  Out- 
door sports,  in-door  games  and  amusements, 
religious  services,  Sunday  school, letc. ,  added 
to  the  comfort  and  welfare  of  the  inmates. 
A  spirit  of  contentment  and  good  feeling 
seemed  to  pervade  the  hospital.  The  pa- 
tients appeared  to  appreciate  the  beneficent 
results  of  the  humane  and,  in  a  measure, 
curative  treatment  they  were  receiving  for 
their  hitherto  irremediable  malady. 

I  was  told  by  Dr.  H.  C.  Rutter,  the  able 
Superintendent,  that  marked  improvement 
in  the  physical  and  mental  condition  of  the 
patients  had  been  noticeable  with  each  re- 
curring year.  Under  the  skillful  treatment 
patients  were  receiving  there  the  number 
of  epileptic  seizures  had  decreased  more 
than  300  per  cent.,  and  had  become  of  a 
very  much  milder  character.  About  6  per 
cent,  of  those  treated  have  been  discharged 
recovered.  No  case  is  pronounced  cured 
until  two  years  have  elapsed  since  occur- 
rence of  the  last  paroxysm. 

New  York  was  the  second  State  to  recog- 
nize in  a  substantial  way  the  requirements 
of  epileptics.  After  years  of  patient  and 
persistent  efforts  on  the  part  of  the  advo- 
cates of  State  care  of  dependent  epileptics, 
the  Craig  Colony,  for  sane  epileptics,  mod- 
eled in  great  measure  after  the  noted  Biele. 
field  Colony,  was  a  reality. 
-  In  1894,  by  legislative  enactment,  $140,- 
000.00  was  appropriated  to  purchase  pro- 
perty and  provide  accommodations  neces- 
sary to  begin  the  colony.  An  estate  com- 
prising nearly  2,000  acres  of  land  in  Liv- 
ingston county  was  selected.  Located  in 
the  great  Genesee  valley  the  farm  is  fertile 
and  well  watered ;  contains  700  acres  of 
original    growth    walnut,   maple,   hickory, 


oak,  pine,  and  other  hard  woods  useful  for 
manufacturing  purposes.  Having  on  it  a 
number  of  old  buildings  formerly  used  by 
the  Shakers  (for  they  were  the  owners  who 
sold  the  property  to  the  State),  it  was  not 
a  difficult  matter  to  repair  and  remodel 
enough  of  them  to  provide  for  a  goodly 
number  of  patients.  In  February,  1896, 
the  colony  was  formally  opened  and  soon 
200  epileptics  were  comfortably  domiciled 
there  in  home-like  cottages,  with  beautiful 
gardens  and  grounds  attached,  given  suit- 
able employment,  and  placed  under  humane 
and  scientific  medical  treatment.  The  Leg- 
islature, seeing  what  a  humane  act  it  had 
been  to  establish  the  colony,  appropriated, 
in  1896,  $75,000.00  more  for  the  construc- 
tion of  new  buildings,  including  a  hospital 
for  acute   medical   and   surgical    cases,  etc. 

In  1897  an  additional  appropriation 
of  $126,000.00  was  secured  for  the  purpose 
of  constructing  administration  buildings, 
houses  for  employees,  and  enlarging  the 
facilities  for  carrying  on  the  various  indus- 
tries which  had  been  established  there  for 
the  benefit  of  the  patients. 

From  a  recent  article  written  by  Dr.  W. 
P.  Spratling,  the  energetic  Superintendent 
of  the  colony,  I  glean  some  facts  which  are 
interesting,  and  shows  that  the  colony  is 
rapidly  developing  into  an  ideal  institution 
for  the  treatment  of  epilepsy  and  the  care 
of  epileptics.  During  May,  of  last  year, 
there  were  270  patients — 148  men  and  12: 
women — distributed  in  a  number  of  houses 
dotted  here  and  there  over  the  beautiful 
grounds  which  had  been  carefully  laid  out 
in  accordance  with  a  general  scheme  of  de- 
velopment for  landscape  gardening,  etc. 

The  last  legislature  appropriated  a  con- 
siderable sum  to  be  used  in  constructing 
additional  buildings,  including  cottages  for 
patients.  Each  cottage  will  be  a  home 
itself  for  twelve  to  twenty-four  patients,  and 
one  or  two  servants,  and  will  have  its  own 
kitchen,  dining  room,  etc.  Separate  build- 
ings for  children  will  be  constructed,  each 
containing  a  school-room,  a  kindergarten, 
a  sitting  room,  a  play  room  and  a  work 
room. 

One  visiting  this  great  institution,  which 
it  was  my  pleasure  to  do  in  1897,  is  at  once 
forcibly  impressed  that  it  is  the  purpose  of 
those  in  authority  to  make  it  not  only 
equal  but  superior  to  the  German  colony. 
One  sees  all  around  him  evidences  of  its  in- 
dustrial and  educational  features.  Forty  or 
more  men  are  employed  daily  in  the  indus- 
trial buildings,  consisting  of  a  carpenter, 
blacksmith,  upholstery  and  general  repair 
shops,  a  printing  office,  &c.  The  farm  and 
garden,  cultivated  almost  exclusively  by  the 
patients,  are  sources  of  considerable  reve- 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


22^ 


nue,  besides  being  of  marked  benefit  to  the 
patients  employed  thereon.  It  is  the  pur- 
pose of  the  managers  to  produce  chiefly 
through  the  labor  of  the  epileptics,  every- 
thing that  is  consumed  at  the  colony.  For 
instance,  all  the  beef,  mutton,  cereals,  chick- 
ens, eggs,  milk  and  other  foodstuffs  are 
products  of  the  farm-  All  the  vegetables 
used  there  are  raised  in  the  Colony  gardens. 
The  ratio  of  earnings  of  the  patients  to  the 
cost  of  their  maintenance  is  already  over  50 
percent.  During  April,  1898,  75  percent, 
of  all  male  patients,  and  Si  per  cent,  of  all 
female  patients,  were  employed  at  some 
useful  labor,  at  the  rate  of  6  to  8  hours  a 
day  regularly.  The  men  were  employed  in 
the  various  out-door  occupations,  in  the 
shops,  &c,  and  the  women  in  the  laundry, 
sewing-rooms,  in  the  kitchens,  as  waitresses, 
assistant  muses.  &c. 

Dr.  Spratling  says  :  "It  has  become  to  be 
a  well  recognized  principle  in  the  treatment 
of  epilepsy  that  systematic  employment 
possesses  genuine  and  distinctive  merit,  and 
the  necessity  for  making  ample  provision 
for  the  employment  of  all  patients  at  the 
Colony  was  early  recogni/.ed.  and  as  far  as 
possible  carried  into  effect." 

At  both  the  Ohio  Hospital  and  the  New 
York  Colony  the  aim  is  to  treat  t he  indi- 
vidual. The  medical,  dietetic  and  moral 
treatment  in  each  case  given  special  atten- 
tion. Investigations  into  various  methods 
of  treatment  are  being  constantly  made,  and 
the  use  of  any  remedies  that  hold  out  the 
least  promise  of  benefit  are  given  patient 
trial  and  results  noted. 

The  reported  recovery  rate  at  the  Craig 
Colony  is  about  what  it  is  at  the  Ohio 
Hospital,  viz.,  6  per  cent,  of  all  treated. 

A  training  school  for  nurses  especially  for 
epileptics  has  been  started  at  the  Craig  Col- 
ony, which  will  prove  a  valuable  adjunct  to 
the  medical  department.  The  nurses  are 
taught  cooking  in  all  its  branches,  for  among 
the  means  of  treating  epilepsy,  a  proper 
dietary  is  one  of  the  most  important.  Lec- 
tures on  the  science  and  art  of  housekeep- 
ing arc  included  in   the  curriculum. 

The  Ohio  institution  has  a  pathological 
laboratory,  in  which  original  research  in 
epilepsy  is  prosecuted  under  direction  of  a 
skilled  and  scientific  expert  in  that  line. 
At  tiie  Craig  Colony  a  laboratory  is  in 
edurse  of  construction,  which,  when  com- 
pleted, will  be  a  model  in  every  respect. 

Doubtless  valuable  information  regarding 
the  pathology,  etiology  and  treatment  of 
epilepsy  will  emanate  from  these  great  cen- 
ters of  observation  and  study. 

In  1895  the  Legislature  of  Massachusetts 
passed  an  act  providing  for  the  establish- 
ment of  a  State  Hospital  for  Epileptics,  on 


the  site  of  the  old  State  Primary  .School  at 
Monson.  The  hospital  has  been  opened  for 
some  months,  and  is  authorized  to  receive, 

(1)  epileptics  from    the    Insane    Hospitals, 

(2)  those  who    may  be   legally   committed, 

(3)  voluntary  sane  epileptics,  who  may  be 
detained  for  a  limited  period ;  but  only 
adults  who  are  not  criminals,  idiots,  ine- 
briates or  violently  insane  can  be  received. 

The  California  Legislature,  during  its 
session  of  1S97,  authorized  the  establish- 
ment of  an  epileptic  colony,  for  the  accom- 
modation of  about  500  patients,  to  be  trans- 
ferred from  the  various  hospitals  of  the  State. 
Already  over  500  epileptic  children  are  be- 
ing cared  for  at  the  Hospital  for  children 
at  Eldridge. 

Michigan  has  a  public  institution  for 
epileptics,  conducted  on  the  industrial  plan. 

The  generosity  of  liberal  individuals, 
notably  Henry  C.  Lea,  of  Philadelphia,  to- 
gether with  the  aid  of  the  State,  made  the 
Oakbourne  Colony  for  Epileptics  in  Penn- 
sylvania a  possibility.  "It  is,"  says  theMed- 
ical  News,  "an  undertaking  which,  from 
its  humane  basis  and  its  eminently  practical 
results,  must  meet  with  the  sympathy  of 
every  one  interested  in  the  welfare  of  this 
unfortunate  class  in  the  community  and  that 
such  results  outweigh  the  cost  of  the  mone- 
tary outlay  is  conceded  by  all  students  of 
sociology." 

The  advocates  of  the  public  care  of 
epileptics  in  the  State  of  New  Jersey, 
being  of  the  ever-active,  progressive  kind, 
did  not  let  a  failure  three  years  ago 
(when  the  Legislature  passed  an  act  pro- 
viding for  the  establishment  of  a  colony, 
which  for  economic  reasons  was  vetoed  by 
the  Governor),  discourage  them  in  making 
another  attempt.  A  few  weeks  ago  the 
Legislature  of  that  State  passed  a  bill,  which 
has  been  approved  by  the  Governor,  having 
in  view  the  establishment  of  an  "epileptic 
village."  $15,000.00  was  appropriated  for 
the  purpose.  Already  a  farm,  not  far  from 
Trenton,  consisting  of  200  acres  of  land, 
with  several  buildings  thereon,  has  been 
purchased.  The  institution  will  be  opened 
within  a  few  months  for  the  reception  of 
patients. 

In  various  other  States  efforts  are  being 
made  to  have  colonies  or  institutions  of 
some  kind  established  for  the  exclusive  ac- 
commodation of  epileptics. 

Last  year  the  lower  branch  of  the  Legis- 
lature of  Kentucky  voted  favorably  on  a 
proposition  to  establish  an  Epileptic  Colony 
in  that  Stale,  but  the  bill  came  up  in  the 
Senate  too  late  in  the  session  to  be  voted 
upon.  The  friends  of  the  bill  fully  expect 
to  see  it  passed  by  the  next  Legislature. 

In  Virginia   the   question  of  establishing 


226 


THE  CHARLOTTE   MEDICAL  JOURNAL. 


a  colony  has  been  agitated,  off  and  on,  dur- 
ing the  past  five  years.  Public  sentiment 
favorable  to  such  an  institution  is  undoubt- 
edly growing. 

In  1895  the  Virginia  State  Medical 
Society,  urged  upon  the  Legislature  the 
importance  of  this  humane  project.  Dur- 
ing the  session  of  the  General  Assem- 
bly of  1895-96  a  Commission  was  appointed 
to  look  into  the  matter  of  State  care  of  epi- 
leptics, &c.  The  Commission  set  about  its 
task  with  enthusiastic  interest,  and  after 
making  a  thorough  investigation  into  all 
phases  of  the  subject,  visiting  the  institu- 
tions in  New  York  and  Ohio,  in  search  of 
information,  submitted  a  report,  which  con- 
cludes substantially  as  follows  : 

1.  Every  principle  of  justice  and  hu- 
manity is  in  opposition  to  the  indiscrimin- 
ate commingling  of  epileptics,  the  insane 
and  paupers  of  every  class  in  the  same  in- 
stitution. Neither  the  Hospital  for  the 
Insane  nor  the  poor  house  is  a  suitable 
place  for  a  sane  epileptic. 

2.  As  a  rule,  epileptics  in  private  fam- 
ilies are  deprived  of  the  ordinary  advantages 
of  making  a  support  for  themselves,  of  ac- 
quiring an  education,  or  of  enjoying  the 
usual  privileges  and  pleasures  of  life,  but 
on  the  contrary,  are  a  heavy  tax  upon  other 
individuals. 

3.  It  would  ultimately  be  in  the  in- 
terest of  public  peace  and  economy  if  the 
State  would  assume  charge  of  all  indigent 
epileptics,  and  provide  suitable  means  and 
ways  by  which  at  least  many  of  them  could 
contribute  to  their  own  support. 

4.  One  of  the  State  Hospitals  should  be 
utilized,  in  part  at  least,  for  the  care  of  all 
the  insane  white  epileptics  of  the  State, 
thus  leaving  the  two  other  hospitals  for  the 
accommadation  of  all  white  insane  persons 
who  are  not  epileptic.  At  the  hospital 
selected  for  the  insane  epileptics  suitable 
buildings  should  be  set  apart  exclusively  for 
this  class  of  patients,  so  that  their  diet,  em- 
ployment, medical  treatment,  etc.,  could  be 
regulated  in  the  proper  manner,  which  is 
impossible  to  do  when  they  are  com- 
mingled, as  at  present,  with  other  patients. 
This  policy  has  already  been  adopted  at  the 
Central  Hospital  at  Petersburg,  where  all  the 
female  epileptics  occupy  a  separate  building. 
This  segregation  has  proven  to  be  a  benefit 
to  both  the  epileptics  and  the  non-epileptic 
insane  of  this  institution. 

5.  A  colony,  modeled,  in  the  main,  after 
the  Craig  Colony  in  New  York,  should  be 
established  in  this  State  for  sane  epilep- 
tics. Separate  accommopations  should  of 
course  be  made  for  the  negro  epileptics. 
There  should  be  procured,  either  by  pur- 
chase   or    by    long  time   lease,  a    tract    of 


fertile,  producsive  land,  say  of  1,000  acres, 
in  a  healthful  region,  with  an  abundant 
supply  of  pure  water,  good  natural  drain- 
age, and  means  for  the  ready  disposal  of 
sewage.  The  location  should  be  near  some 
large  town,  and  easy  of  access  from  all  sec- 
tions of  the  State.  Having  selected  such  a 
site,  the  colony  should  begin  on  a  small 
scale  and  be  gradually  developed  in  a  way 
that  would  seem  best  adapted  to  the  needs 
and  requirements  of  the  class  of  patients 
for  whose  benefit  it  is  established. 

6.  In  the  beginning  there  should  be  only  a 
few  plain,  inexpensive  cottages  for  the  ac- 
commodation of,  say,  100  epileptics  and  the 
required  officers  and  employees,  and  neces- 
sary out-buildings.  Workshops  and  other 
buildings  for  various  trades  and  industries, 
hospital  for  the  sick  and  infirm,  hall  for  re- 
creation, chapel,  school  house,  etc.,  should 
be  built  later  on  as  the  colony  develops. 
Farming,  gardening,  stock  raising,  fruit 
culture,  etc..  should  be  prominent  features 
in  the  beginning.  Mechanics  among  the 
patients  would  aid  materially  in  developing 
the  institution  on  the  industrial  line. 

7.  Incalculable  benefit  would  be  derived 
from  the  school  for  educating  the  children, 
as  other  children  and  young  people,  and 
from  the  shops  in  teaching  many  of  the 
beneficiaries  trades  and  industrial  occupa- 
tions. Indeed,  many  would  be  enabled, 
under  proper  supervision,  to  support  them- 
selves entirely  while  under  treatment  in 
such  a  colony.  The  labor  the  patients 
would  do,  such  as  working  on  the  farm,  in 
the  shops,  stock  raising,  etc.,  would  event- 
ually make  the  colony  self-sustaining  to  a 
great  extent. 

8.  The  collection  of  a  large  number 
of  epileptics  in  such  an  institution,  un- 
der the  treatment  of  a  well  equipped  and 
organized  hospital  corps,  together  with  a 
pathologist, would  afford  opportunities  for  a 
scientific  study  of  this  widely  prevalent  dis- 
ease, which  would  eventuallylead  to  a  greater 
knowledge  of  its  nature  and  cause,  hence, 
more  satisfactory  results  from  treatment. 
Underskilled  medical  and  surgical  treatment 
combined  with  suitable  diet,  labor  and  hy- 
gienic regulations,  a  goodly  number  would 
be  restored  or  at  least  improved  sufficiently 
to  go  out  into  the  world  and  earn  a  living 
for  themselves. 

9.  The  colony  should  be  managed  by 
a  board  of  directors,  composed  of  five 
members,  to  be  appointed  by  the  Gov- 
ernor, by  and  with  the  advice  and  consent 
of  the  Senate,  and  the  term  of  office  for 
each  member  should  be  five  years. 

10.  The  board  should  appoint  as  superinten- 
dent a  skilled  physician,  whose  term  of  of- 
fice should  not  be  less  than  six  years.     They 


THE  CHARLOTTE  MEDICAL  JOURNAL, 


should  also  appoint  the  other  necessary  offi- 
cers, fix  their  terms  of  office,  salaries,  etc. 
ii.  The  directors  should  be  permitted  by 
law  to  receive  any  gift  or  bequest  of  money, 
or  any  donation  to  be  applied,  principal  or 
interest,  to  the  erection  of  buildings,  to  the 
support  or  education  of  the  patients,  or  to 
the  general  use  of  the  coiony. 

12.  The  expense  of  establishing  and  equip- 
ping the  colony  should  be  borne  exclusively 
by  the  State,  but  its  maintenance  should  be 
paid  for  in  part  by  the  various  counties  and 
cities  sending  patients  there,  say  $40  per 
annum  for  each  indigent  patient. 

13.  Pay  patients  should  be  admitted  on 
terms  to  be  regulated  by  the  board  of  direc- 
tors. 

14. The  commitment  of  pay  patients  should 
be  voluntary  on  their  part.  Indigent  pa- 
tients should  be  commited  by  county  or  city 
authorities  upon  certificate  of  a  reputable 
physician.  The  number  of  patients  receiv- 
ing benefit  from  the  colony  should  be  pro- 
portioned among  the  several  cities  and  coun- 
ties. At  first,  as  many  as  practicable  should 
be  taken  from  the  poor  houses,  hospitals  for 
the  insane,  etc. 

1 5. From  a  list  sent  by  the  local  authorities, 
the  board  of  directors  and  superintendent 
should  select  such  cases  as,  in  their  judg- 
ment, would  be  most  suitable  for  residence 
in  the  colony.  The  object  of  this  would  be 
to  prevent  the  crowding  in  of  helpless  pa- 
tients who  could  be  of  no  service  in  develop- 
ing the  colony. 

Finally  :  While  we  believe  there  is  urgent 
necessity  for  such  an  institution  as  we  have 
outlined,  we  think  it  would  be  the  part  of 
wisdom  in  establishing  a  radically  new 
Rarity,  to  carefully  consider  every  step; 
therefore,  we  would  recommend  that  the 
General  Assembly  appoint,  or  authorize  the 
Governor  to  appoint,  commissioners  whose 
duty  it  shall  be  to  pursue  these  investigations 
further,  get  options  on  various  sites,  submit 
plans,  estimates  of  cost,  and  furnish  such 
other  information  as  may  be  desirable,  or 
necessary  to  give  the  Governor  and  the 
Legislature  full  information  preparatory  to 
establishing  an  epileptic  colony  for  the  hu- 
mane, scientific  and  economical  treatment 
and  care  of  epileptics. 

The  Commission  is  composed  of  Dr. Geo. 
W.  LeCato  (State  Senator)  of  Accomac 
county,  chairman  ;  lion.  William  P.  McRae 
(ex-member  House  of  Delegates)  of  Peters- 
burg, Charles  V.  Vawter  (Superintendent 
Miller  Manual  School)  of  Albemarle  coun- 
ty, ami  Dr.  William  F.  Drewrey  (Superin- 
tendent Central  Slate  Hospital)  of  Peters- 
burg, Col.  J.  Hell  Bigger,  of  Richmond, 
Becrrtary. 

The  report  of  the  Commission  was  most 


favorably  received  by  the  Legislature,  and 
I  have  not  a  doubt  that  in  a  few  years  an 
Epileptic  Colony  will  be  established  in 
Virginia. 


The  Advisability  of   Bone   Suturing  in 
Treatment  of  Fractures.f 

By  Hugh  T.  Nelson,  M.  D.,  Charlottesville,  Va. 

The  above  subject  having  been  treated  at 
great  length  by  numerous  writers  may  to 
the  hearer  appear  hackneyed,  yet,  as  one 
meets  in  all  walks  of  life  persons  who  are 
awkward  cripples  as  the  result  of  fractured 
bones  (some  dating  long  years  since)  there 
would  appear  something  left  unsaid  or  un- 
learned. 

Scrutinizing  attentively  one  is  apt  to 
conclude,  without  reflection,  that  the  fault 
lies  with  the  physician  or  surgeon  treating 
the  case  ;  yet  there  are  few  of  the  above, 
even  of  much  repute,  who  have  not  fre- 
quently failed  in  their  earnest  efforts  to  pre- 
vent deformity,  greater  or  less,  as  resulting 
from  fracture. 

This  is  equally  true  of  fractures  of  the 
shafts  of  long  bones  as  of  fractures  of  the 
joints.  To  attribute  the  deformity  follow- 
ing fracture  to  bad  surgery  or  incompetent 
surgeons,  is  by  no  means  just  or  fair,  for  in 
a  preponderance  of  cases  this  lies  with  the 
patient  or  methods  persued  by  his  surgeon  ; 
the  which  having  been  inculcated  through 
supposedly  wiser  minds,  in  the  acquiring 
his  profession,  he  honestly  pursues.  It  is 
of  small  moment  to  blame  men  for  follow- 
ing great  teachers,  saying  they  should  for 
themselves  devise  better  means  for  accom- 
plishing desired  and  desirable  ends,  provi- 
ded those  already  in  vogue  are  not  in  their 
hands  capable  of  producing  satisfactory  re- 
sults. Nor  should  it  be  said  that  the  fail- 
ures of  physicians  and  surgeons  to  prevent 
excessive  deformity  and  loss  of  function  is 
due  either  to  lack  of  comprehension  of  the 
forces  involved  introducing  such  deformity, 
or  ignorance  of  the  proper  manner  of  using 
those  mechanical  appliances  already  devised 
in  such  numbers  as  to  maintain  proper  ap- 
position of  severed  fragments.  In  a  large 
number  of  cases  of  fracture  excellent,  even 
perfect,  results  are  arrived  at  by  using  any 
of  the  special  appliances  depicted  in  the 
text-books  on  the  subjects,  or  those  adver- 
tised in  the  "Surgical  Appliance"  Cata- 
logues of  the  country.  Yet  these  same  ap- 
pliances not  infrequently  fail  of  accomplish- 


fRead  before  theTri-State  Medical  Society  of 
the  Carolinas  and  Virginia,  at  Charlotte,  N.  C, 
January,  1899. 


228 


THE  CHARLOTTE   MEDICAL  JOURNAL. 


ment  in  the  skilled  hands  of  those  who  de- 
vised them. 

Fractures  are  often  treated  without  a  pro- 
per knowledge  of  those  natural  laws  in- 
volved in  producing  that  deformity  almost 
always  seen  in  a  recent  untreated  case.  To 
undertake  the  appliance  of  any  kind  of 
mechanical  contrivance  while  yet  ignorant 
of  natural  laws  or  the  ways  of  overcoming 
the  forces  producing  displacement  of  frag- 
ments is  a  sign  of  inefficiency  and  lack  of 
intelligence.  As  above  stated,  there  are 
yet  some  cases  of  fracture  where  deformity 
not  infrequently  results  however  well  the 
surgeon  weigh  the  conditions  maintaining 
and  applies  his  apparatus,  using  natural 
science  as  a  guide. 

Simple  fracture  of  the  leg  or  forearm  will 
with  the  most  primitive  treatment,  yield 
good  results,  provided  the  joints  are  not  in- 
volved ;  but  badly  comminuted  fractures, 
even  in  good  localities,  so  to  speak,  fre- 
quently give  untold  trouble  and  the  physi- 
cian has  often  been  mortified  by  his  results 
although  the  work  has  been  carefully  and 
scientifically  done.  It  is  not  to  be  intima- 
ted that  there  is  any  method  by  which  all 
fractures,  even  those  which  at  first  attempt 
at  reduction  appear  of  slight  moment,  can 
be  cured  without  deformity.  For  the  most 
unlearned  must  see  that  a  certain  class  of 
fractures  if  cured  at  all  can  only  be  so  done 
at  the  expense  of  changed  shape  and  im- 
paired usefulness. 

In  this  paper  an  exhaustive  treatise  is  not 
attempted  :  the  only  effort  made  being  to 
indicate  what  has  seemed  to  the  writer 
feasible  methods  of  treating  those  frac- 
tures which  are  so  often  cured  with  de- 
formity and  impaired  usefulness.  The 
broad  statement  is  here  made  that  fractures 
take  place  in  many  portions  of  the  skeleton 
and  under  many  conditions,  intrinsic  or  ex- 
trinsic, in  which  satisfactory  results,  with- 
out or  with  minimised  deformity,  are  only 
attainable  by  suturing-  together  the  several 
fragments.  Also,  that  in  many  cases  such 
procedure  instituted  immediately  after  the 
accident  should  be  done  as  a  routine  method 
both  in  order  to  save  the  patient  valuable 
time  as  well  as  lessen  the  fatigue  and  suffer- 
ing incident  to  other  methods  of  treatment. 

The  citation  of  a  few  cases  will  best  serve 
to  illustrate  that  class  of  fracture  where  this 
method  of  treatment  is  imperatively  de- 
manded. 

Case  I. — Olaff  Carrlsohn,  employed  with 
a  force  of  hands  working  on  an  Iron  bridge 
slipped  and  fell  into  the  bed  of  a  stream 
about  eighty  feet  below.  I  lis  fall  was  bro- 
ken  by  both  thighs  striking  on  an  iron 
girder  situated  some  twenty  feet  beneath 
the    position  occupied  by    him.     The  long 


axis  of  the  body  must  have  been  at  the  time 
of  impact  nearly  if  not  quite  at  right  angles 
to  the  iron  girder.  Brought  to  the  Pied- 
mont Hospital,  of  Charlottesville,  and  strip- 
ped of  his  wet  clothing,  he  was  found  to  be 
of  powerful  development,  in  the  full  vigor 
of  early  manhood — but  with  comminuted 
fractures  of  both  femora,  in  the  right  limb 
just  above  the  knee  joint,  in  the  left  imme- 
diately belowthe  junction  of  the  lower  and 
middle  thirds.  He  was  carefully  measured 
and  two  anterior  splints,  as  devised  by  our 
distinguished  surgeon,  the  late  Nathan  R. 
Smith  were,  under  anaesthesia,  applied.  So 
soon  as  recovered  from  the  effects  of  this 
last  the  patient  became  comfortable  and 
seemingly  did  well.  These  splints  were 
kept  on  for  four  weeks  ;  upon  their  removal 
the  left  femur  was  found  the  seat  of  vicious 
union,  while  in  the  right  there  was  no  union 
whatever,  the  bone  fragments  being  flexed 
strongly  on  the  leg  with  the  upper  extremi- 
ty almost  piercing  the  skin.  The  shorten- 
ing of  both  limbs  was  decidedly  marked, 
but  owing  to  the  double  deformity  progres- 
sing synchronously  it  had  escaped  notice. 
Dr.  A*.  M.  Phelps,  of  New  York,  saw  the 
patient  at  this  juncture  and  expressed  the 
opinion  that  the  lower  fragments  of  both 
femora  were  so  short  that  no  form  of  me- 
chanical appliance  could  counteract  the 
combined  action  of  the  Solei  and  Gastroct- 
nemei  muscles  and  prevent  them  from  drag- 
ging these  fragments  backwards.  He,  how- 
ever, suggested  a  refracturing  of  the  left 
femur  and  advised  the  putting  up  of  both 
in  plaster  splints,  maintaining  a  greater  de- 
gree of  flexion  than  formerly  used.  The  pa- 
tient was  accordingly  anaesthetized,  the  limb 
fractured  and  the  bandages  applied  by  Dr. 
Phelps.  For  three  weeks  the  patient  appa- 
rently did  well,  and  was  very  comfortable. 
Now  he  complained  of  a  burning  sensation 
in  the  right  thigh  behind  the  seat  of  fracture. 
A  trap  was  cut  in  the  plaster  and  the  upper 
end  of  the  lower  fragment  was  discovered 
protruding  through  the  skin.  Removal  of 
the  pressure  relieved  this  pain  and  at  the 
end  of  another  week  both  casts  were  re- 
moved. The  left  thigh  was  found  much 
shortened,  with  some  deformity  backwards, 
with  of  course  no  union  in  the  right.  As 
the  only  means  of  saving  this  limb  bone  su- 
ture was  then  determined  on  and  the  writer 
under  aseptic  conditions  made,  two  long 
incisions,  one  external,  from  just  above  the 
upper  border  of  the  external  tuberosity, and 
the  other  parallel  and  opposite,  in  the  right 
thigh.  The  limb  had  previously  been  ren- 
dered bloodless.  The  incisions  were  deep- 
ened, and  a  wedge  shaped  piece  of  bone, 
one  and  one-half  inches  long  posteriorly, 
and  one-half  inches  long  anteriorly,  and  in- 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


229 


volving  the  entire  shaft  of  the  femur  was 
found  entirely  separated  from  the  two 
other  fragments  and  removed.  The  re- 
maing  fragments  were  sawn  perpendicu- 
larly across,  their  surfaces  approximated  and 
a  hole  bored  in  each  fragment  from  without 
inwards.  Through  the  orifice  in  the  lower 
fragment  a  piece  of  iron  stovepipe  wire, 
which  had  been  previously  burned  in  an 
alcohol  flame,  was  passed  from  without  in- 
ward, bent  at  right  angles,  inserted  through 
the  hole  in  upper  fragment  from  within 
outwards  and  shouldered  after  being  drawn 
taut.  The  two  ends  of  wire  were  now 
twisted  together,  turned  over  and  the  cork 
screw  shaped  iron  hammered  down  into 
the  shaft  of  the  bone.  This  had  been 
done  after  the  periosteum  had  been  dissected 
from  the  edge  of  each  fragment  in  order  to 
give  a  good  field  for  work.  The  parts 
were  now  thoroughly  irrigated  with  mercu- 
ric chloride  solution,  the  surface  of  the 
wounds  approximated  and  held  together  by 
long  pins — such  as  ladies  use  in  fastening  on 
their  hats — and  a  figure  of  eight  silk  thread 
thrown  around  them.  Drainage  tubes  were 
inserted  in  the  wound  and  an  ample  soft 
dressing  applied.  A  plaster  cast  was  then 
adjusted  over  this,  the  limb  being  in  exten- 
sion. The  operator  felt  satisfied  that  the 
combined  action  of  all  the  muscles  of  leg 
and  thigh  would  fail  in  disturbing  the  rela- 
tions of  those  fragments.  A  photograph 
taken  a  year  afterwards  disclosed  the  fol- 
lowing result  :  The  man  is  shorter  than 
before  the  accident,  by  two  inches-and-a- 
half,  hut  as  strong  and  as  perfect  in  physi- 
cal health  as  ever.  The  deformity  in  the 
left  limb  is  considerable,  but  the  shortening 
in  each  is  the  same.  The  shortness  of  the 
lower  fragment  could  not  in  this  case  have 
been  combatted,and  Bucks  extension  would 
only  have  dragged  the  lower  fragment  away 
from  the  middle  one  and  the  flexion  at  the 
knee  joint  would  still  have  maintained. 
In  fact,  this  method  was  tried  after  remov- 
ing the  first  plaster  splint  referred  to  above. 
In  this  case  the  suggestion  to  suture  was 
made  by  Dr. "helps.  The  operation  owing 
to  the  close  relation  of  the  fragments  to  the 
great  vessels  and  nerves  at  the  upper  portion 
of  the  Popliteal  space,  of  extreme  difficulty, 
so  difficult  in  fact  that  but  for  the  kind  sus- 
taining and  assistance  of  the  late  Dr.  Win. 
B.  Towles,  the  operation  would  have  been 
abandoned  and  the  limb  sacrificed. 

Cask  II. — George  Washington,  26  years 
of  age,  resident  of  Greene  county,  Vir- 
ginia, was  seen  by  the  writer  after  hav- 
ing been  shot  through  the  right  thigh  at  the 
junction  of  the  middle  and  upper  thirds. 
The  load  of  small  shot,  fired  at  short  range, 
passed  into  the  anterior  aspect  of  the  thigh, 


just  external  to  the  femoral  vessels,  commi- 
nuting the  shaft  of  the  femur  and  lodging 
under  the  skin,  immediately  posterior  to 
the  wound  of  entrance.  More  than  one 
inch  of  the  bone  was  driven  back  and  finely 
comminuted.  The  big  burly  negro  when 
first  seen,  had  been  wounded  about  thirty- 
six  hours  and  the  wound  was  undoubtedly 
already  infected.  A  counter  opening  was 
made,  a  number  of  shot,  several  bits  of 
cloth  and  fragments  of  bone  removed,  the 
wound  aseptically  dressed,  a  long  splint  ap- 
plied and  the  man  brought  for  further  treat- 
ment to  Charlottesville,  a  distance  of  more 
than  twenty  miles.  Suppuration  set  in  very 
profusely,  so  only  such  attempts  at  immobi- 
lization of  the  limb  as  consistent  with  clean- 
liness were  attempted.  Efforts  were  futile, 
so  attempts  at  immobilization,  except  for 
sand  bags  wrapped  in  rubber  cloth,  were 
stopped  and  the  wound  simply  kept  clean. 
Suppuration  was  reduced  to  its  minimum 
in  about  two  weeks,  and  then  notwithstand- 
ing there  existed  a  sinus  leading  down  to 
the  bone  an  attempt  was  made  to  get  union. 
Hamilton's  long  splint  was  employed,  no 
union  resulted ;  immobilization  by  plaster 
with  a  trap  immediately  over  the  fistula 
was  for  six  weeks  attempted,  still  nothing 
but  a  movable  condition  prevailed.  Finally 
operation  number  one  was  resorted  to.  The 
man,  one  year  afterwards,  was  doing  full 
work,  in  excellent  health,  but  with  an  una- 
voidable shortening  of  between  two  and 
three  inches  of  his  injured  limb.  Necrosis 
of  the  injured  ends  of  the  fragments  pre- 
vented any  union,  and  although  it  was  sup- 
posed the  saw  had  removed  all  necrosed 
bone,  suppuration  set  in  after  the  wiring. 
Hydrogen  di  oxide,  full  strength,  soon  con- 
trolled this  and  recovery  was  complete. 
Except  for  this  method  of  treatment  he 
would  to-day  be  stumping  about  on  one  leg 
or  else  carrying  with  him  a  dangling,  use- 
less limb,  necrotic — if  not  tubercular. 

Case  III. — Richard  Turner,  aged  18,  en- 
gaged in  digging  a  well,  slipped  and  fell  42 
feet,  sustaining  compound  comminuted  frac- 
ture at  junction  of  the  middle  and  upper 
thirds  of  right  femur.  He  was  brought 
to  the  Dispensary  of  the  University 
of  Virginia  about  six  hours  after  the 
accident.  Fracture  was  tempoarily  put 
up  in  boards,  and  the  day  following 
a  plaster  bandage,  extending  from  foot 
to  groin,  was  applied,  and  completed  with 
a  spica  of  same  carried  around  the  body. 
The  patient  became  comfortable  and  seemed 
doing  well.  This  dressing  was  kept  on  25 
days.  On  its  removal  the  fragments  were 
found  not  in  apposition,  one  was  lying  al- 
most transverse  the  axis  of  the  limb  and  on 
its  external  aspect  protruding  nearly  through 


230 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


the  skin.  An  X-rays  picture  was  taken  and 
here  shown.  The  weak  battery  renders 
very  imperfect,  but  serves  to  show  the 
state  of  the  fragments.  Two  days  after  the 
above,  the  patient  having  been  carefully 
prepared  for  operation,  the  loose  piece  of 
bone  was  removed  through  an  excision 
made  on  the  external  aspect  of  the  thigh. 
The  piece  removed  involved  about  half  the 
cylindrical  aspect  of  the  femur,  was  two 
and  three  quarter  inches  long  and  larger  at 
its  upper  extremity.  It  was  lying  almost 
at  right  angles  to  the  axis  of  the  femur  and 
was  surrounded  by  muscular  fibre  and  for- 
mative tissue.  In  addition  to  this  the  up- 
per fragment  was  pulled  forwards  and  up- 
wards, while  the  ends  of  both  were  in  a 
condition  of  incipient  necrosis.  Squaring 
these  ends  necessitated  a  shortening  of  the 
limb  to  the  extent  of  no  less  than  three  in- 
ches ;  it  was,  therefore,  determined  to  su- 
ture the  fragments  as  they  were,  placing  a 
steel  dowelling  pin  in  the  marrow  cavity, 
thus  maintaining  immobility.  The  two 
fragments  were  now  sutured  together  with 
a  stout  silver  wire  prepared  for  the  purpose, 
while  a  steel  rod  six  inches  in  length  and 
three-sixteenths'of  an  inch  in  diameter  was 
placed  in  the  marrow  cavity,  allowing  a 
projection  of  an  inch  and  a  half  into  each 
cavity,  and  leaving  nearly  three  inches  ex- 
posed to  the  periosteum,  which  had  been 
dissected  off  the  fragment  that  had  been  re- 
moved. Thorough  antiseptic  dressing  and 
a  drainage  tube  were  employed,  and  the 
limb  put  up  in  a  Hamilton's  splint.  This 
dressing  remained  six  days  and  the  limb 
was  again  dressed  and  put  up  in  plaster. 
Conditions  seemed  satisfactory  but  for  the 
continual  suppuration  from  the  fistula, 
which  necessitated  the  making  of  a  tray  for 
purposes  of  cleanliness.  This  cast  was  al- 
lowed to  remain  twenty-seven  days  before 
removal,  when  good  union  in  good  position 
was  observed — a  large  amount  of  callus 
maintaining  on  the  inner  aspect  of  the  bone. 
The  fistula  being  probed  it  was  found  to 
lead  to  the  marrow  cavity,  and  the  dowel- 
ling  pin  could  be  distinctly  felt  by  the 
probe.  A  stout  cast  was  then  applied  from 
tuberosities  to  trochanter-major,  and  tube- 
rosity of  ischium,  and  patient  put  on 
crutches.  Eighteen  days  later  this  cast  was 
removed,  good  union  was  found,  but  large 
amount  of  callous  and  necrosis.  The  X-ray 
photograph  demonstrates  the  condition. 
Hereafter  the  necrotic  bone  will  be  removed 
and  if  necessity  demand,  the  dowelling  pin 
also. 

Case  IV. — Willy  Payne,  a  white  lad  of 
ten  years  of  age,  fell  from  a  tree  and  sus- 
tained a  compound  comminuted  fracture  of 
right  humerus  at  the  junction  of   the  lower 


diaphysis  with  its  epiphysis,  the  lower  frag- 
ment of  the  bone  being  finely  comminuted 
as  regards  the  internal  condyle,  while  the 
external  condyle  was  intact,  although  sev- 
ered from  the  shaft.  The  patient  had  also 
suffered  a  fracture  of  right  radius  at  the 
junction  of  lower  and  middle  thirds,  a  Col- 
lis  fracture,  and  dislocation  of  the  radio- 
carpal joint.  A  four  inch  incision  wa9 
made  over  the  lower  end  of  the  upper  frag- 
ment, embracing  the  existing  wound,  the 
state  of  affairs  fully  investigated  and  found 
as  previously  stated.  The  comminuted 
fragment  of  the  inner  condyle  was  held  by 
the  periosteum  and  perichondrium  as  though 
in  a  pouch,  the  joint  surface  being  intact. 
A  hole  was  drilled  through  the  external 
condyle,  the  fragment  then  properly  ad- 
justed, the  boring  tool  carried  up  into  the 
shaft  of  the  humerus,  and  an  ordinary  box 
nail  of  two  inches  (having  been  rendered 
aseptic  in  an  alcohol  flame)  driven  in  and 
the  entire  wound  closed  by  catgut  sutures. 
A  drainage  tube  was  inserted  and  an  an- 
gular metalic  splint  adjusted  over  ample 
dressings.  Five  days  later  the  wound  was 
dressed,  drainage  tube  removed  and  splint 
re-applied.  Recovery  was  uninterrupted, 
with  no  deformity  and  perfect  union.  Two 
months  later  an  incision  was  made  down  on 
the  head  of  the  already  protruding  nail, 
and  its  removal  easily  accomplished.  An 
X-ray  picture  of  the  fractured  bone,  with 
its  confining  nail  in  position,  taken  just 
previous  to  its  removal,  gives  an  excellent 
idea  of  the  work  and  its  result. 

Case  V. — David  S.  Bradley,  45  years  of 
age,  of  Luray,  Virginia,  about  three  months 
since,  sustained  a  fall  from  a  tree,  fractur- 
ing, in  the  fall,  the  left  humerus  at  the 
junction  of  the  middle  and  upper  thirds. 
The  injury  was  first  treated  by  Drs.  Keller 
and  Hudson,  of  Luray,  who,  however,  fail- 
ed to  secure  union.  The  personal  history 
shows  that  up  to  about  four  years  since  the 
patient  was  an  habitual  drinker,  but  since 
that  time  has  abandoned  its  use.  No  indi- 
cation of  any  specific  trouble.  Was  in  the 
Staunton  Asylum  for  the  Insane  four  years 
since.  Remained  under  its  jurisdiction  for 
about  seven  months.  The  mental  condition 
now  fairly  good.  The  patient  was  brought 
to  the  Dispensary  of  the  University  of  Vir- 
ginia, and  it  was  there  decided  to  operate, 
since  the  limb  in  its  condition  was  worse 
than  useless.  The  night  previous  to  opera- 
tion the  patient  was  well  purged  and  the 
left  arm  was  thoroughly  scrubbed  with  soap 
and  warm  water,  next  with  1  to  2,000  bich- 
loride of  mercury  and  a  hot  bichloride  com- 
press applied,  which  remained  for  24  hours. 

The  patient  on  the  morning  of  operation 
being  anaesthetised  there  was  a  free  incision 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


231 


Photograph  of  Case  iv 


232 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


made  down  to  the  bone  on  the  outer  aspect 
of  the  arm.  The  seat  of  fracture  was  found 
enveloped  in  a  mass  of  formative  tissue  con- 
stituting the  so-called  "false  joint."  The 
ends  of  the  fragments  were  soft  and  bled 
easily — being  practically  useless.  These 
were  sawn  off  with  as  small  loss  of  length 
as  was  consistent  with  the  securing  of  firm 
bone,  through  which  to  pass  the  wire  and 
secure  the  suturing,  which  the  accompany- 
ing photographs  show.  They  also  serve  to 
show  the  different  steps  of  the  operation 
fairly  well.  The  wound  healed  entirely  in 
two  weeks  and  without  suppuration  and 
the  patient  was  returned  home.  An  appre- 
ciative letter  from  Dr.  Keller  and  a  grateful 
one  from  the  patient  assured  us  of  the  com- 
plete success  of  operation.  In  this  case  as 
in  all  here  reported,  except  the  first  two, 
two  wires  were  used,  the  one  applied  later- 
ally through  both  fragments,  the  other  an- 
tero-posteriorly,  so,  as  far  as  possible  to  re- 
strict motion.  vSuturing  wires  should  be  so 
arranged  as  that  the  twisted  ends  avoid 
large  vessels  and  nerves,  thus  removing  the 
possibility  of  fatal  hemorrhage  or  paraly- 
zing neuritis.  A  case  of  fatal  hemorrhage 
produced  by  pressure  necrosis — incident  to 
the  use  of  a  decalcified  bone  ferule — has  been 
reported.  The  splicing  material  ulcerating 
into  the  femoral  artery  and  causing  death 
before  aid  could  be  rendered. 

The  writer  claims  no  originality  for  the 
methods  here  cited,  many  surgeons  today 
using  this  practice  in  treatment  of  fractures. 
The  idea  is  an  old  one  ;  thanks  to  aseptic 
surgery,  we  of  today  have  no  hesitancy  in 
converting  a  simple  or  even  comminuted 
fracture     into  a  compound  one. 

The  conditions  necessitating  treatment 
of  fracture  by  bone  suture  may  be  briefly 
summarized  thus  : 

i.  All  fractures  where  vicious  union  pro- 
duces serious  deformity  or  impairment  of 
function,  no  matter  how  long  the  duration 
— provided  the  grounds  upon  which  we  act 
be  reasonable.  That  is  to  say  those  in  which 
the  conditions  of  the  fragments  themselves 
admit  of  securing  mobility  of  a  stiffened 
joint,  straightening  of  angulation,  or  ap- 
proximation to  original  length.  This  con- 
dition can  frequently  be  determined  only  by 
incision  and  dissection.  Even  then  if  it  be 
found  that  no  benefit  can  accrue  from  break- 
ing up  the  existing  relations  between  the 
fragments,  no  harm  need  result. 

2.  All  fractures  where  ligamentous  union 
exists,  demand  this  treatment  to  secure, 
either  in  whole  or  in  part,  perfect  perform- 
ance of  function.  The  causes  of  such  union 
— if  union  it  may  be  called — are  for  the  most 
part  intrinsic,  alcoholism,  syphilis,  rheu- 
matism.     Such  a  condition   frequently  pre- 


vails, however,  from  the  entanglement  of 
soft  tissue  between  the  extremities  of  the 
involved  fragments. 

All  recent  forms  of  fracture  where  mus- 
cular action  renders  difficult  the  mainten- 
ance of  severed  fragments  in  apposition 
no  matter  whether  said  fractures  be  simple 
or  compound.  All  fractures  involving 
joints,  particularly  if  there  be  comminution 
of  the  fragment  entering  into  the  com- 
position of  the  joint.  Of  course  under  all 
circumstances,  the  age,  physical  condition, 
etc.,  of  the  patient  must  be  duly  considered. 

The  cases  here  detailed  and  other  similar 
work  has  been  done  before  the  medical  class 
of  the  University  of  Virginia  from  which 
corps  skillful,  trained  help  is  always  to  be 
made  available  and  to  the  assistance  of 
which  the  uniformly  successful  surgical 
work  of  that  institution  is  largely  due. 


Perforating    Ulcer   of   Duodenum — Opera- 
tion—Recovery.* 

By  Hugh  M.  Taylor,  M.  D.,  Richmond,  \'a.. 
Professor  of  Practice  of  Surgery,  University 
College  of  Medicine:  Surgeon  to  Virginia 
Hospital,  etc. 

Fortunately,  this  is  a  rare  disease.  We 
say  fortunately,  because  its  diagnosis  is  con- 
ceded to  be  very  difficult,  and  in  many  in- 
stances impossible;  and  because,  as  is  the 
case  in  many  acute  gastro-enteric  lesions, 
life  can  only  be  saved  by  early  surgical 
intervention. 

It  was  my  privilege  recently  to  meet  with 
a  case  in  which  not  only  were  the  difficulties 
in  making  a  diagnosis  impressed,  but 
equally  so  was  the  imperative  need  of 
prompt  operation  illustrated.  The  intra- 
abdominal lesion  was  not,  at  first,  diagnos- 
ed as  one  of  duodenal  perforation.  Per 
contra,  it  was  supposed  to  be  a  case  of 
ruptured  appendicial  pus  collection,  with 
suppurative  peritonitis.  Prompt  operation 
saved  the  life  of  an  interesting  young  wo- 
man, otherwise  doomed,  and,  as  far  as  our 
researches  enabled  us  to  ascertain,  permits  ■ 
us  to  put  upon  record  the  second  case  of 
perforating  duodenal  ulcer  to  recover  after 
operative   intervention. 

We  would  not  convey  the  impression  that 
our  interest  in  this  case  is  centered  in 
the  fact,  if  it  be  a  fact,  that  this  is  the 
second  recovery  recorded.  Our  interest 
should  be  focussed  in  the  lesson  it  teaches, 
that  such  cases  can  be  saved  by  prompt 
surgery.      As    to    the    number   of    recorded 


*Read  before  the  first  meeting  of  Tri-State 
Medical  Societj  (S.  C,  N.  C.  and  Va.)  Held  at 
Charlotte,  N.  C,  January,  1899. 


THECHARLOTTE   MEDICAL  JOURNAL. 


recoveries,  it  is  due  ourselves  to  state  that 
we  have  not  looked  into  the  subject  very 
exhaustively. 

In  the  Twentieth  Century  Practice*  the  | 
statement  is.  made  that  sixteen  cases  of  per-  j 
forating  duodenal  ulcer  have  been  operated  j 
upon  within  the  last  six  years,  but  no  re- 
port is  made  as  to  the  number  which  re- 
covered. 

Greig  Smith, \  in  his  work  on  abdominal 
surgery,  says  that  at  least  one  success  is 
recorded. 

In  the  American  System  of  Practical 
Medicine, \  by  Loomis  and  Thompson,  the 
statement  is  made  that  four  cases  have  been 
operated  upon — one  with  success. 

The  medical  and  surgical  literature  of 
perforating  duodenal  ulcer  is  strikingly 
meagre.  As  far  as  we  have  ascertained,  its 
surgical  interest  seems  only  to  have  attracted 
the  attention  of  Greig  Smith.  In  such  works 
as  the  American  Pest- Honk  of  Surgery; 
Surgery  by  American  Authors,  Parks; 
System  of  Surgery,  by  Treves;  Practice  of 
Surgery,  by  Wharton  and  Curtis,  Wyeth's, 
Moullins,  and  others,  duodenal  ulcer  is 
only  mentioned  as  a  frequent  complication 
of  extensive  burns. 

Even  a  brief  resume  of  all  that  has  been 
recorded  in  the  works  on  Practice  of  Medi- 
cine as  to  the  etiology,  special  and  differ- 
ential diagnosis,  and  medical  treatment  of 
duodenal  ulcer,  would  he  beyond  the  limits 
6f  this  paper,  and  while,  in  all  of  its  phases, 
it  is  interesting,  we  must  limit  ourselves  to 
its  diagnosis  and  surgical   treatment. 

It  is  a  matter  of  common  observation  that 
while  gastric  and  duodenal  ulcer  have  much 
in  common,  there  are  notable  and  inexpli- 
cable clinical  difference.  Duodenal  ulcer, 
in  the  proportion  of  16  to  2,  occurs  in  adult 
men  and  not  infrequently  in  robust  men. 
It  may  occur  at  any  age,  from  infancy  to 
senility.  Gastric  ulcer,  on  the  other  hand, 
is  prone  to  occur  in  anaunic  young  women. 
Let  me  remark,  in  passing,  that  I  have 
never  been  able  to  reconcile  the  occurrence  of 
gastric  ulcer  in  young  women  with  the 
generally  accepted  theory  that  it  is  due  to 
thrombosis  or  to  some  type  of  obliterating 
arteritis  of  a  terminal  artery.  Degenera- 
tion of  the  blood  vessels  is  not  the  rule  in 
the  young.  No  exciting  cause  for  thrombo- 
sis commonly  co-exists,  and  in  vegetative 
endocarditis  duodenal  ulcer  does  not  occur. 
On  the  other  hand,  in  support  of  the  theory 
of  obliterating  arteritis,  it  is  claimed  that 
thrombosis  and  ulceration  have  been  artifi- 
cially   produced.       Whether    this    circum- 


Wolume  VIII.  page  473,  1898. 
tVolume  II,  page  785,  1898. 
X Volume  III,  page  19.1.  L898. 


scribed  molecular  death  is  due  to  thrombus, 
to  an  arteritis  obliterans,  to  a  neuritis  with 
trophic  degeneration, or  is  microbic  in  origin, 
must,  for  the  present,  remain  an  open  ques- 
tion, and  it  is  equally  impossible  to  explain 
why,  in  some  instances,  duodenal  ulcer  is 
attended  with  marked  local  symptoms,  and 
in  others  with  no  symptoms  at  all.  Prior 
to  rupture,  the  symptoms,  if  any  are  mani- 
fested, are  easily  and  frequently  confused 
with  those  incident  to  gastric  ulcer — morbid 
changes  about  the  pylorus,  inflammatory 
conditions  about  the  bile  tract,  and  with  so- 
called  gastralgia,  neuralgia,  etc. 

Notably  by  Loomis  and  Thompson,  in 
American  System  of  Practical  Medicine, 
the  differentiation  between  gastric  and 
duodenal  ulcer  is  fully  elucidated.  It  is 
claimed  that  duodenal  ulcer  is  more  fre- 
quent in  men,  and  is  less  frequently  attended 
by  hemorrhage  or  dyspeptic  symptoms  ;  that 
icterus  is  more  common  ;  that  pain  does  not 
come  on  for  three  or  four  hours  after  the 
ingestion  of  food,  and  what  is  of  special 
interest  to  the  surgeon,  perforation  and  per- 
itonitis is  more  frequently  met  with  as  a 
sequence  of  the  duodenal  ulcer.  These 
writers  fail,  however,  to  differentiate  be- 
tween the  symptoms  of  duodenal  ulcer  and 
those  incident  to  bile  tract  troubles,  cancer 
of  pylorus,  pancreas,  etc.,  and  we  think 
they  are  much  more  emphatic  in  their  con- 
clusions than  would  be  expressed  by  surgical 
clinicians  experienced  in  diagnosing  ob- 
scurely defined  intra-abdominal  lesions. 

Greig  Smith  emphasizes  this  point,  and 
claims  that  the  disease  4iis  usually,  as  regards 
symptoms,  latent,  or  produces  evidences  of 
its  existence  so  vague  and  uncertain  that 
diagnosis  of  duodenal  ulcer  is  rarely  made." 

As  in  other  intra-abdominal  lesions,  ex- 
ceptionally classical  symptoms  may  clearly 
define  a  typical  case.  The  leading  symp- 
toms— i.  e.,  vomiting  and  pain  some  hours 
after  meals,  occasional  hemorrhages  and 
local  pains  and  tenderness  are  equally  com- 
mon symptoms  of  so  many  other  morbid 
conditions.  Even  in  perforation,  the  cases 
are,  as  a  rule,  atypical,  with  "confusing  and 
misleading  symptoms. 

The  case  we  recently  treated  illustrates 
this  last  conclusion.  The  patient,  a  young 
school  girl,  a;t.  about  17  years,  while  not 
robust,  had  always  enjoyed  fairly  good 
health.  About  one  week  before  the  per- 
foration occurred  she  began  to  experience 
some  intra-abdominal  pain,  but  does  not 
recall  that  it  was  focussed  in  any  one  special 
spot,  or  that  it  was  made  worse  by  eating, 
exercise,  or  anything  she  did.  It  was,  how- 
ever, sufficiently  severe  to  prompt  her  to  see 
her  physician  several  times,  and  she  was 
told   by   him    that    he    feared    it    might    be 


234 


THE  CHARLOTTE  MEDICAL  JOURNAL 


incipient  inflammation  of  the  appendix. 
There  was  no  vomiting  of  either  food  or 
blood,  no  bloody  stools.  She  had  rarely  in 
her  life  suffered  from  indigestion,  and  this 
obscure  pain  had  existed  only  a  week.  I 
was  requested  to  see  the  case  in  consultation 
at  two  o'clock  at  night.  At  that  time  she 
was  profoundly  collapsed  from  a  supposed 
ruptured  appendicial  pus  collection.  The 
evening  before  she  had  been  on  the  street, 
and,  after  eating  a  hearty  supper,  walked 
with  some  friends  six  or  eight  blocks  to  a 
depot.  On  her  way  back,  she  walked  very 
rapidly,  and  just  as  she  reached  home  she 
was  taken  with  violent  pain,  etc.  I  have 
dwelt  upon  the  history  of  this  case  because 
it  sustains  the  conclusion  that  duodenal 
ulcer  may  exist  with  minor  local  somptoms 
prior  to  rupture  and  very  confusing  symp- 
toms after  rupture.  Perforation  of  the 
duodenal  evidently  occurred  several  days 
before  the  night  of  the  acute  symptoms, and 
a  circumscribed  pus  collection  was  walled 
in  by  adhesion  of  the  transverse  colon  to  the 
duodenum  at  the  point  of  perforation.  This 
was  subsequently  revealed  by  a  large  patch 
of  lymph  on  the  duodenum  with  a  cor- 
responding patch  on  the  transverse  colon. 
Perforation  and  local  infection,  and  the  for- 
mation of  the  circumscribed  abscess, 
evidently  occurred  while  the  patient  was 
up  and  about,  and  this  abscess  and  local 
peritonitis  was  not  attended  with  sufficiently 
severe  symptoms  to  cause  either  very  much 
suffering  or  anxiety,  and  certainly  they 
were  not  such  as  would  foreshadow  the 
impending  danger.  When  this  abscess 
burst  into  the  peritoneal  cavity,  the  symp- 
toms rapdly  became  extremely  "acute.  The 
rapid  pulse,  subnormal  temperature,  pinch- 
ed features,  vomiting  and  rigid  abdominal 
muscles,  presented  a  clear  clinical  picture 
of  intra-abdominal  infection.  But  there 
were  no  guiding  symptoms  indicative  of 
the  source  of  the  infection.  The  same  acute 
symptoms  are  common  to  infection  from 
the  appendix,  ileus,  peptic  typhoid,  tuber- 
cular perforations,  etc.  Granting  that  the 
pain  was  above  the  umbilicus,  time  and 
again  we  have  seen  the  pain  of  acute  ileus 
or  appendicitis  focussed  above  the  umbilicus, 
and  very  recently  we  saw  a  case,  in  which 
there  was  no  abdominal'  pain,  no  muscular 
rigidity , the  abdominal  walls  could  be  pressed 
without  pain  back  to  the  spinal  column. 
There  was,  however,  short  pleuritic-like 
pain  under  the  right  breast.  There  was  a 
history  of  appendicitis,  and  a  section  re- 
vealed a  gangrenous  appendix. 

If  we  recall  the  distribution  of  the  great 
sympathetic  ganglion  to  the  abdominal 
viscera,  we  will  be  reminded  of  the  fact 
that  pain  from   almost  any  part  of  the  in- 


testinal tract  will  commonly  be  referred  to  a 
point  about  or  even  above  the  umbilicus  in 
the  region  of  the  superior  mesenteric  plexus. 

The  great  desideratum  in  this,  as  in  many 
intra-abdominal  troubles,  does  not  seem  to 
be  an  improved  operative  technique,  but 
rather  greater  proficiency  in  diagnosis. 

The  surgeons  interest  in  the  treatment  of 
duodenal  ulcer  begins  possibly  when,  by 
medication  and  dietetics,  the  case  is  found 
to  be  incurable,  possibly  when  profuse  or 
prolonged  hemorrhage  endangers  life 
through  acute  or  chronic  anemia,  and  cer- 
tainly when  perforation  and  local  or  general 
infection  occurs.  This  infection  should  be 
classed  with  that  incident  to  appendicitis, to 
bullet  wounds  of  the  bowels,  to  typhoid 
perforation,  etc.  In  each  instance  we  have 
infection  from  intestines  in  which  path- 
ological conditions  give  active  pyogenic 
properties  to  its  ptomaine  factors.  In  gen- 
eral peritoneal  infection  from  appendicitis, 
from  perforation  in  connection  with  cholan- 
gitis or  cholecystitis,  or  gastric  or  typhoid 
ulcer,  and  in  bullet  wounds  of  the  hollow 
viscera,  preventive  surgery  is  ideal.  The 
key  to  success  is  an  early  operation  to  pre- 
vent rather  than  the  almost  forlorn  task  of 
trying  to  cure  diffuse  suppurative  or  septic 
peritonitis.  Perforating  duodenal  ulcer  is 
as  logically  within  the  province  of  justifiable 
surgery  as  any  of  the  morbid  conditions 
above  mentioned,  and  certainly,  if  correctly 
interpreted,  the  symptoms  present  a  clinical 
picture,  clearly  noting,  from  some  source,  a 
general  peritoneal  infection.  It  is  uniformly 
fatal  to  wait  for  the  typical  manifestations 
of  general  infection.  Appreciating  this 
truism,  Dr.  Nuckolls,  as  soon  as  he  saw  the 
patient,  asked  for  consultation  and  advised 
her  removal  to  the  Virgina  Hospital.  There 
was  a  delay  of  four  or  five  hours  incident 
to  removing  the  patient  to  the  Hospital  and 
in  trying  to  react  her  by  means  of  saline 
infusion,  strychnia,  morphine,  and  the  usual 
remedies  called  for  in  profound  shock. 

It  was  10  o'clock — twelve  hours  from  the 
beginning  of  the  acute  symptoms— when  the 
operation  was  begun.  In  that  time  general 
suppurative  peritonitis  was  fully  developed. 
Asssistedby  Drs.  Edward  McGuire,  Virgin- 
ius  Harrison,  and  Marvin  Nuckolls,  the 
usual  section  for  appendicitis  was  made. 
In  incising  the  peritoneum,  gas  and  pus 
poured  out  of  the  general  peritoneal  sac. 
No  diminution  in  the  area  of  hepatic  dull- 
ness had  been  appreciated.  The  appendix 
was  quickly  delivered,  and,  much  to  our 
surprise,  was  found  not  involved  in  the 
least.  Thinking  the  focus  was  in  the  uter- 
ine adnexia,  the  incision  was  enlarged  down- 
ward, and  an  examination  of  the  pelvis 
was    also  negative  in  its  results,    except    to 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


235 


disclose  much  puddling  of  sero-purulent 
fluid.  Having  eliminated  the  two  most 
common  sites  of  infection,  and  as  there 
were  no  evidences  of  strangulation  of  ileus 
we  turned  our  attention  to  the  bile  tract. 
To  expose  this  site,  our  incision  had  to  be 
extended  well  up  to  the  ninth  costal  carti- 
lage. This  long  incision  and  extensive  ex- 
posure of  the  abdominal  contents  enabled 
us  to  note  that  the  intestine — notably  the 
transverse  colon — was  covered  in  many 
places  with  the  commonly  observed  diph- 
theritic-like lymph  deposit.  There  was  also 
more  injection  of  all  the  structures,  and  the 
presence  of  a  considerable  quantity  of 
greenish-looking  fluid  was  also  noted.  The 
bile  tract,  when  fully  exposed,  was  also 
found  intact  and  not  the  focus  of  trouble. 
Very  quickly,  however,  we  found  the  duo- 
denal perforation.  It  was  situated  on  the 
anterior  surface  of  the  third  portion  of  the 
duodenum,  about  midway  between  its  free 
border  and  mesenteric  attachment,  and  from 
it  the  duodenal  contents  were  freely  escap- 
ing. The  perforation  had  the  character- 
istic punched-out  appearance,  and  was  nol 
larger  than  the  lumen  of  a  goose-quill.  For 
an  inch  or  more  around  the  perforation  the 
duodenal  wall  was  thick,  indurated  and  in- 
elastic, and  covered  with  a  layer  of  yellow, 
grayish  lymph. 

There  was  nothing  unique  in  the  opera- 
tion. The  infected  lymph  was  carefully 
peeled  off  from  around  the  perforation,  and 
an  effort  was  made  to  invert  the  ulcer  by 
means  of  interrupted  silk  sutures.  This 
was  found  impracticable  ;  the  thick  duode- 
nal wall  and  friable  tissue  were  the  diffi- 
culty. A  purse  string  buried  deep  in  the 
thickened  wall  was  made  to  encircle  the 
perforation,  and  when  tied  this  effectually 
closed  the  opening.  With  silk  sutures  the 
ugly  looking  adjacent  peritoneal  tissue  was 
brought  over  the  purse  string  and  perfora- 
tion. 

The  further  technique  consisted  in  care- 
fully wiping  away  with  gauze  sponges  the 
lymph  deposit  wherever  found.  Next  the 
visceral  and  abdominal  cavity  were  sub- 
jected to  prolonged  irrigation  with  hot  saline 
solution,  and  finally  the  abdomen  was  rid- 
dled with  gauze  drainage. 

Convalescence  was  slow  —  a  conse- 
quence of  imperfect  drainage  and  infec- 
tion of  the  abdominal  incision.  For  the 
first  three  or  four  days  a  great  deal  of  blood 
serum  was  drained  off ;  this  gradually  les- 
sened in  quantity,  and  in  five  or  six  days 
the  patient  was  anaesthetized  and  all  the 
drains  except  that  one  which  was  in  contact 
with  the  sutured  perforation  were  removed. 
Puddling  of  pus  was  found  to  have  occur- 
red  along    or    behind  several  of  the  strips, 


and  a  discharge  of  pus  from  these  infected 
tracts  lasted  for  several  weeks.  The  ulti- 
mate outcome  was  a  satisfactory  convales- 
cence, and  the  patient,  when  discharged, 
presented  a  better  condition  than  is  the  lot 
of  many  who  recover  from  a  celiotomy  of 
less  serious  proportions. 


The  Eye  as  a  Causative  Factor  in   Func- 
tional Nervous  Disorders.* 

By  W.  H.  Wakefield,  Charlotte,  N.  < '. 

Even  the  careless  observer  cannot  fail  to 
notice  that  functional  nervous  disorders  are 
increasing  in  frequency  und  intensity 
among  our  American  people.  The  causes 
of  neurosis  are  almost  infinite  in  number 
and  variety,  but  they  are  divisible  into  two 
classes,  viz  :  the  remote,  or  predisposing 
and  the  immediate  or  exciting.  The  remote 
or  predisposing  causes,  while  frequently  of 
insufficient  activity  to  originate  neurosis, 
may,  when  the  nervous  disturbance  has 
once  been  established  by  some  exciting 
cause,  be  sufficient  to  perpetuate  it  for  an 
indefinite  time.  Exciting  or  immediate 
causes  may,  or  may  not  be  long-continued, 
and  their  effects  will  depend  on  their  inten- 
sity of  action,  duration,  and  the  suscepti- 
bility of  those  subjected  to  their  influence. 
This  susceptibility  is  probably  present  only 
in  those  persons  in  whom  predisposing  cau- 
ses operate  and  is  in  proportion  to  the  activ- 
ity and  intensity  of  these  remote,  causative 
factors.  It  is  not  my  purpose  in  this  paper, 
to  attempt  a  discussion  of  the  varied  con- 
ditions that  act  as  causes,  remote  and  imme- 
diate, and  my  remarks  will  be  confined, 

i st.  To  anatomical  abnormalities,  often 
overlooked,  of  a  single  organ,  and  the  man- 
ner in  which  they  act  as  predisposing  causes. 

2d.  To  the  influence  of  conditions  in- 
duced by  civilization  as  exciting  causes. 
In  leaving  out  of  consideration  all  other 
disturbances  of  nervous  equilibrium,  I  do  so 
with  a  full  appreciation  of  the  fact  that 
many  of  them  are  of  equal  importance  to 
the  conditions  which  I  will  discuss.  It  is  not 
claimed  for  the  causes  discussed  that  they  are 
the  only  agencies  of  note  that  operate  to  pro- 
duce the  disorders  named,  but  simply  that 
they  are  important  and  do  not  receive  the 
recognition  they  merit. 

The  organ  whose  abnormal  anatomy  acts 
as  a  predisposing  cause  of  functional  nerv- 
ous disorders  is  the  eye.  The  visual  act 
requires,  for  its  proper  performance,  the 
most  precise  action  and  co-ordination  on  the 


*Read  before  the  Tri-State  Medical  Society  of 
the  Carolinas  and  Virginia,  at  Charlotte,  N.  C, 
January,  1899. 


236 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


part  of  the  recti  and  ciliary  muscles,  and  if 
the  observed  objects  are  close  to  the  eye  and 
small  the  consumption  of  nerve  force  is 
greater  than  that  attending  the  exercise  of 
any  other  bodily  organ.  In  order  to  arrive 
at  a  fair  understanding  of  this  subject,  let 
us  briefly  review  the  theories  involved  in 
the  adjustment  of  the  eyes  in  the  act  of 
vision. 

When  parallel  rays  of  light  (for  our  pur- 
pose rays  coming  from  a  distance  of  20  feet 
are  considered  as  parallel)  enter  healthy, 
normal  eyes,  they  are  refracted  as  they  pass 
through  the  media,  forming  on  the  retina  a 
clear,  distinct  image  the  muscular  mechan- 
icism  of  the  eye  meanwhile  remaining  pas- 
sive. Rays  of  light  from  near  objects  are 
not  parallel,  but  divergent,  and  must  be 
more  strongly  refracted  in  order  to  meet  on 
the  retina.  This  is  effected  by  the  contrac- 
tion of  the  ciliary  muscle  producing  varia- 
tion in  the  convexity  of  the  lens,  thus  in- 
creasing its  refractive  ability.  The  nearer 
rhe  object  the  more  divergent  the  rays,  hence 
the  greater  the  demands  on  the  focussing 
muscle.  If  the  eye  is  normal,  this  function 
is  performed  with  ease,  the  ciliary  muscle 
having  abundant  strength  to  produce  the 
changes  to  any  reasonable  extent  without 
fatigue.  The  eye  may  be  said  to  be  normal 
when  images  of  an  observed  distant  object 
(20  feet  distant  or  further)  are  clearly  fo- 
cussed  on  each  yellow  spot,  the  ciliary  and 
recti  muscles  being  at  rest.  These  are  the 
conditions  that  permit  minimum  inervation. 
In  deviating  from  the  normal  the  eye  may 
be  too  short  (hyperopic  or  far  sighted),  too 
long  (myopic  or  near  sighted),  or  astig- 
matic (oval),  or  one  or  more  of  the  recti 
muscles  may  be  too  weak  (muscular  insuffi- 
ciency). These  conditions  are  the  anatom- 
ical abnormalities  mentioned  as  acting  as 
predisposing  causes  of  functional  nervous 
disorders,  and  any  one  of  them  when  pres- 
ent is  capable  of  producing  considerable 
perplexity.  In  hyperopia  the  eye  is  too 
short  for  parallel  rays  to  focus  on  the  retina 
without  inervation  and  contraction  of  the 
focusing  muscle,  and  this  action  on  the  part 
of  the  muscle  of  accommodation  is  in  direct 
proportion  to  the  extent  of  the  hyperopia. 
So  long  as  this  eye  continues  to  see  clearly, 
at  any  distance,  this  effort  must  be  contin- 
ued, and  the  nearer  the  object  the  greater 
the  exertion  ;  hence  such  an  eye  is  never  at 
rest  except  when  closed,  and  as  a  portion 
of  its  accommodative  power  is  consumed  in 
its  performing  distant  vision  (which  should 
be  passive),  it  has  less  reserve  to  draw  from 
when  looking  at  near  objects.  If  this  eye 
be  used  for  considerable  periods  of  time  at 
close  work,  as  in  reading,  sewing,  engrav- 
ing, etc.,  the  ciliary  muscle  is    overtasked, 


and  the  constant  strain  of  nervous  energy 
passing  to  the  laboring  muscle  exhausts  the 
nerve  force  of  the  body  (consumes  its  re- 
serve.) In  astigmatism  the  refracting  sur- 
faces of  the  eye  are  oval,  and  light  rays 
passing  into  it  in  any  meridian  are  brought 
to  a  focus  at  a  different  point  from  the  rays 
that  go  in  at  any  other  meridian  ;  hence 
clear-cut  images  are  impossible,  but  by 
"sectional  contraction"  of  the  ciliary  mus- 
cle vision  is  aided.  The  strain  on  the  mus- 
cle is  intense,  and  the  consumption  of  ner- 
vous energy  is  in  proportion  to  the  exertion 
of  the  muscle.  I  am  aware  that  the  theory 
of  sectional  contraction  is  not  accepted  by 
many,  but  it  accounts  for  the  peculiar  strain 
of  astigmatism  better  than  any  other.  "The 
foregoing  explains  the  act  of  vision  as  per 
formed  by  each  eye  separately. 

The  performance  of  the  visual  act  with 
both  eyes  fixing  an  object  necessitates  the 
co-ordinate  action  of  the  ciliary  and  the 
recti  muscles.  We  have  not  space  to  fully 
explain  the  relation  existing  between  "con- 
vergence" and  "accommodation,"  and  can 
merely  state  that  when  the  normal  eyes  are 
fixed  on  a  distant  object  the  visual  lines 
(lines  running  from  the  yellow  spot  of  each 
eye  to  the  object)  are  parallel,  and  the  ex- 
ternal (recti)  and  internal  (ciliary)  muscles 
are  in  a  state  of  minimum  innervation  ;  also 
that  as  the  point  of  fixation  approaches  the 
face,  these  muscles  are  correspondingly  in- 
nervated. For  a  definite  degree  of  accom- 
modation a  corresponding  degree  of  con- 
vergence must  be  used,  and  vice  versa. 
When  hyper-metropia  is  present  this  har- 
monious action  (co-ordination)  is  disturbed, 
the  muscles  are  fretted,  and  heavy  demands 
made  on  the  nervous  system. 

Not  infrequently  one  or  more  of  the  recti 
or  oblique  muscles  are  weaker,  proportion- 
ally, than  their  opponents.  This  condition, 
called  insufficiency,  is  a  greater  obstacle  to 
easy  co-ordination  than  hypermetropia,  and 
when  present,  a  constant  (though  uncon- 
scious) effort  is  necessary  to  preserve  binoc- 
ular vision,  the  degree  of  the  effort  being 
in  proportion  to  the  amount  of  insufficiency 
and  the  use  made  of  the  eyes. 

Persons  having  hyperopia,  astigmatism, 
or  an  insufficiency  of  any  of  the  external 
ocular  muscles  do  not,  of  necessity,  suffer 
serious  inconvenience,  but  the  visual  act  is 
rendered  much  more  difficult  than  when 
such  conditions  are  absent.  Competent 
observers,  such  as  Donders,  VonGraefe  and 
scores  of  able  men  now  living,  taught,  and 
teach  that  perplexities  of  the  visual  art, 
such  as  I  have  named  and  endeavored  to 
explain,  briefly,  are  fruitful  sources  of  the 
ailments  enumerated. 

We  will  now  consider  the  merits  of    civ- 


THE  CHARLOTTE   MEDICAL  JOURNAL. 


237 


ilization  as  an  exciting  cause.  The  stage 
of  civilization  to  which  we  have  attained 
sustains  a  causation  relative  to  functional 
nervous  diseases  largely  through  the  nature 
of  the  tasks  which  it  imposes  on  its  subjects. 
The  time  in  which  we  live  is  a  competitive 
age  in  the  full  sense  of  the  term  :  men, 
women,  boys  and  girls  vie  with  each  other 
in  the  race  for  riches,  fame,  position,  knowl- 
edge, honors,  pleasure,  bread,  etc.  Year 
after  year,  with  increasing  fierceness,  this 
struggle  goes  on  forcing  and  stimulating 
many  to  do  beyond  their  strength,  imposing 
on  many  intelligent  and  educated  persons 
conditions  unfavorable  to  their  well-being, 
and  it  is  this  class,  those  who  cunnot  harmo- 
nize with  their  surroundings,  that  furnishes 
many  of  the  sufferers  from  functional  ner- 
vous disturbances.  The  "good  old  days"  of 
our  grandparents  did  not  produce  such  a 
crop  of  "neurasthenics"'  as  the  last  decades 
of  the  nineteenth  century,  simply  because 
life  was  taken  easier  then  than  now.  The 
"break-neck  speed7'  at  which  we  live  and 
labor,  anil  the  immense  increase  during  the 
last  fifty  years  in  the  amount  of  "close"  or 
near  work  done,  arc  active  causes  (not  the 
only  causes)  of  the  distressing  ailments 
under  consideration.  Is  civilization  respon- 
sible for  these?  It  is  directly  responsible 
for  the  latter  and  it  lias  given  the  former  a 
tremendous  impetus  by  furnishing  it 
"means  ami  ends."  That  the  life  Forces 
are  more  rapidly  consumed  and  conditions 
favorable  to  the  development  of  functional 
nervous  troubles,  more  frequently  induced 
by  fast  living  than  by  temperate  lives,  goes 
without  saying.  (By  fast  living  is  meant 
excesses  of  all  kinds,  in  work  or  pleasure.) 
The  tremendous  development  during  the 
last  fifty  years  in  the  mechanical  arts  and 
machinery,  the  general  introduction  of  rail- 
roads and  telegraphs,  the  flooding  of  the 
world  with  cheap  books,  magazines  and 
great  newspapers,  the  establishment  of  free 
schools  for  the  masses  and  the  multiplica- 
tion of  high  schools — these  and  many  other 
similar  developments,  the  products  of  civ- 
ilizatation,  and  in  their  turn  acting  as  civ- 
ilizing agents,  have,  it  is  scarcely  necessary 
to  say,  immensely  increased  the  amount  of 
near  work  done.  Habits  of  life  have 
changed,  the  children  of  muscle-workers, 
even  muscle-workers  themselves,  have  be- 
come brain-workers,  and  in  the  performance 
of  their  duties  exacting  and  excessive  de- 
mands are  made  on  the  organ  of  vision. 
YYc  have  shown  that  when  this  organ  is 
normal  it  possesses  the  ability  to  respond 
with  ease  to  any  reasonable  demands  that 
may  be  made  on  it,  that  if  it  be  abnormal, 
it  labors  at  a  disadvantage,  and  the  increased 
demands  made  on  it  by  the  near    work    of 


civilization,  may  be  sufficient  to  severely 
task  its  muscles  and  exhaust  the  "reserve" 
nervous  energy  of  the  body.  A  train  of 
symptoms  peculiar  to  this  condition  have 
been  recognized  for  years  by  observers,  and 
to  them  has  been  given  the  name  "asthen- 
opic symptoms."  They  generally  come  on 
while  (or  after)  the  eyes  are  being  used  at 
near  work,  and  consist  of  headaches,  mild 
or  severe,  pains  in  the  eye,  burning  of  the 
lids,  the  sensation  of  a  foreign  body  under 
the  lids  ;  in  reading  the  letters  run  together, 
or  become  indistinct.  These  symptoms 
present  themselves  more  generally  under 
artificial  light  than  in  clear  daylight. 

In  addition  to  these  somewhat  mild  "as- 
thenopic  symptoms,"  it  is  not  unusual  to 
observe  in  some  subjects  frequent  attacks 
of  migrain,  neuralgia,  headaches,  with  nau- 
sea after  attending  church  or  the  opera,  and 
in  some  "neurotic  subjects"  general  neu- 
rasthenia. It  is  not  claimed  that  all  suffer- 
ers from  chronic  headache,  neuralgia,  etc., 
have  refractive  errors  or  muscular  insuffi- 
ciencies, but  facts  gathered  by  observation 
and  experience  warrant  the  opinion  that  in 
very  many  of  these  cases  the  predisposing 
cause  lies  in  some  abnormality  of  the  organ 
of  vision,  and  that  practically  all  persons 
presenting  the  simple  asthenopic  symptoms 
have  demonstrable  ocular  errors,  and  that 
the  correction  of  these  errors,  in  the  great 
majority  of  cases,  affords  relief  from  their 
distress,  and  this,  too,  in  cases  in  whom 
drugs  have  failed  to  afford  more  than  a  pass- 
ing relief. 

In  view  of  the  facts  enumerated  I  have  no 
hesitancy  in  advancing  the  opinion  that  all 
patients  presenting  the  symptoms  described, 
if  not  relieved  in  a  reasonable  time  by  med- 
ical and  hygienic  treatment  should  have  the 
condition  of  their  eyes  looked  into  by  some 
one  competent  to  perform  that  duty.  I 
append  a  brief  history  of  a  few  cases,  hop- 
ing thereby  to  shed  some  light  on  the  char- 
acter of  the  ailments  under  discussion  and 
the  form  of  treatment  which,  in  many  case6, 
is  the  only  curative  measure  that  affords  per- 
manent relief. 

Case  J. — Mrs.  T.  ;  saw  me  in  July  1892  ; 
aged  34;  housekeeper.  From  childhood 
has  presented  the  "simple  asthenopic  symp- 
toms" on  reading  or  sewing.  About  three 
or  four  years  ago  purchased  from  a  jeweler 
a  pair  of  convex  glasses,  the  use  of  which 
afforded  some  relief  for  a  time,  but  for  the 
past  two  years  she  has  suffered  frequently 
from  sick  headache.  She  is  extremely  ner- 
vous, and  for  six  months  has  been  quite 
feeble,  appetite  capricious,  bowels  consti- 
pated, sick  headaches  proving  more  fre- 
quent and  worse ;  passes  sleepless  nights 
and  suffers  from  what  her  physician    calls 


238 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


nervous  dyspepsia.  She  cannot  read  or  sew 
ten  minutes  without  inducing  severe  pains 
in  the  eyes  and  head;  is  so  prostrated  that 
she  cannot  visit  a  neighbor  or  attend  church  ; 
consults  me  on  the  advice  of  her  physician, 
who  had  been  in  almost  constant  attendance 
upon  her  for  four  or  five  months.  The  ex- 
amination of  her  eyes  without  a  mydriatic 
demonstrates  the  fact  that,  with  and  with- 
out her  glasses,  her  distant  vision  is  20-20 : 
also  that  she  has  a  low  degree  of  manifest, 
simple  hyperopia  and  weak  internal  recti 
muscles.  Her  eyes  were  now  brought  un- 
der the  influence  of  atropia  by  instilling  into 
each  eye  one  drop  of  a  four-grain  solution 
three  times  daily.  During  the  succeeding 
seventy-two  hours  her  refraction  was 
worked  out,  showing  a  high  degree  of  com- 
pound hyperopic  astigmatism.  Proper 
glasses  were  prescribed  and  worn,  and  the 
patient  without  any  medication,  progressed 
rapidly  to  a  condition  of  health  and  com- 
fort, gaining  25  pounds  in  weight  in  three 
months. 

One  other  feature  in  this  case  is  worth 
mentioning.  The  solution  of  atropine  was 
first  dropped  in  eyes  about  3  p.m.,  and 
again  at  8  p.  m.,  at  which  time  the  patient 
retired  for  the  night  and  secured  eight  hours 
of  refreshing  sleep — the  first  good  night's 
sleep  in  about  six  months.  She  continued 
to  sleep  well,  and  was  free  from  headaches, 
so  long  as  the  eyes  were  under  the  influence 
of  atropine,  but  in  four  or  five  days  after 
its  discontinuance,  sleeplessness  and  head- 
aches returned  and  the  atropine  was  re- 
sumed, using  weaker  solutions  each  week 
for  four  weeks.  The  eyes  by  this  time  had 
grown  accustomed  to  the  lenses  and  on  re- 
covering from  the  effects  of  the  atropine 
the  nervous  symptoms  did  not  return.  The 
prompt  alleviation  of  the  distressing  symp- 
toms by  the  atropine  solution  can  be  ex- 
plained by  its  stopping  the  drain  on  the 
nervous  system  through  the  ciliary  muscle 
which  it  paralyzed. 

Case  2. — Miss  W.,  student,  aged  16; 
consulted  me  July  30,  1892 ;  asthenopic 
symptoms  for  years;  steadily  growing 
worse ;  similar  to  Mrs.  A.  ;  had  studied 
very  hard  for  several  months  during  the 
winters  of  1S91-92,  but  in  April  of  the 
present  year  (1892)  was  obliged  to  desist 
from  study.  She  suffered  much  from  head- 
ache, pains  in  the  eyes  and  back  of  the  head. 
Her  physicians  used  atropine  solution  in 
her  eyes  and  "rung  the  changes"  in  admin- 
istering tonics.  At  his  advice  she  consulted 
me.  Her  eyes  were  then  very  much  inflamed, 
photophobia  annoyed  her  greatly,  and  her 
headaches  were  distressing  if  she  used  her 
eyes  at  near  work  for  even  a  few  minutes. 
She    was  reduced  in  flesh,    pale    and    very 


nervous  ;  vision  20-20  and  all  glasses  ren- 
dered it  worse.  One  drop  of  a  4-grain 
atropine  solution  was  put  into  each  eye 
three  times  daily,  and  in  twenty-four  hours 
vision  in  right  eye  was  reduced  to  9-200 
and  the  left  to  11-200,  which  represented 
her  degee  of  distant  vision  with  the  focus- 
ing muscle  paralyzed.  Suitable  glasses, 
correcting  her  comp.  hyperopic  astigma- 
tism, were  prescribed  and  worn.  These 
anda6-oz.  bottle  of  elixir  lactopeptin,  with 
phos.  f.  q.  and  s.,  constituted  the  treatment, 
which  resulted  in  her  complete  restoration 
to  health. 

In  September  1892,  she  entered  college, 
and  has  had  no  trouble,  although  she  stud- 
ied very  hard,  leading  her  classes, 

Case  S. — Mr.  H.,  student,  aged  18,  con- 
sulted me  December,  1891  ;  has  suffered  a 
good  deal  from  headache  since  he  was  nor 
12  years  of  age.  Before  going  to  college, 
two  years  ago,  he  had  his  eyes  examined 
and  wore  glasses  to  correct  his  hyperopic 
astigmatism.  These  afforded  him  relief  for 
about  two  years.  When  in  college,  in  1891, 
he  had  a  "bilious"  attack,  which  confined 
him  to  his  bed  a  week  or  so.  On  resuming 
his  studies  his  head  ached  a  good  deal,  and 
in  about  two  weeks  he  experienced  peculiar 
symptoms.  His  head  appeared  as  large  as 
a  barrel,  his  left  hand,  arm,  leg  and  foot  ap- 
peared enormously  enlarged.  After  a  few 
days  of  rest  and  medication  these  sensations 
disappeared  to  return  again  on  resuming 
his  studies. 

He  visited  an  oculist  in  Detroit,  who  in- 
creased the  strength  of  his  lenses  a  trifle,  but 
the  symptoms  returned  as  soon  as  near  work 
was  resumed.  He  left  school,  but  months 
afterward  was  unable  to  read  more  than  15 
minutes  without  severe  headache.  I  found 
that  his  lenses  corrected  his  refractive  error, 
but  I  also  found  the  internal  recti  muscles 
and  the  right  inferior  rectus  were  weak. 
The  internal  recti  muscles  were  exercised 
twice  daily  by  prisms  for  a  month,  thereby 
vastly  increasing  their  strength  and  reliev- 
ing his  distress  on  doing  near  work  a  trifle. 
A  prism,  correcting  about  three-fourths  of 
his  vertical  insufficiency  (inferior  rectus) 
was  incorporated  in  his  right  lens,  which 
rendered  him  entirely  comfortable.  He 
reads  "all  day  and  half  the  night"  with  no 
distress. 

Case  Jf. — Miss  G.,  aged  12,  a  healthy- 
looking,  jolly  girl;  suffers  very  much  after 
reading  or  sewing  ;  is  very  fond  of  reading, 
but  her  headache  forces  her  to  stop  in  20  to 
30  minutes.  Although  perfectly  healthy 
in  every  other  particular,  she  was  subjected 
to  a  thorough  course  of  medical  treatment 
(extending  over  three  months)  but  as  her 
headaches  were  not  relieved  in  the  least,  her 


THE  CHARLOTTE  MEDICAL    JOURNAL. 


Directions  for  the   Use  of 

ChroniC  Nasal  Catarrh.— "Of  the  internal  remedies  we  may  mention 
Blennostasine — this  remedy  having  a  direct  effect  on  the  mucous  membrane  of  the  nose, 
and  if  given  regularly,  congestion  in  the  mucous  membrane  disappears,  or  is  constantly 
mitigated.  The  remedy  is  given  in  doses  of  three  to  five  grains  every  three  hours,  and 
should  be  continued  as  long  as  the  catarrhal  condition  persists.  It  exerts  no  unpleasant 
effect,  and  can  be  continued  for  an  indefinite  period." 

ACUte  Coryza.— "In  my  experience  I  have  found  one  grain,  given  half-hourly, 
to  produce  the  best  results  in  Acute  Coryza.  Blennostasine  is  particularly  applicable 
to  colds  of  singers  and  speakers,  as  the  blenostatic  effect  is  preferable  to  that  of  bella- 
donna, and  it  certainly  produces  a  tonic  effect  on  the  vocal  mechanism." 

Hay  Fever.— "All  hay  fever  patients  who  have  taken  Blennostasine  have  been 
promptly  relieved,  and  though  a  recurrence  of  the  symptoms  next  year  may  not  be  pre- 
vented, the  usual  attack  may  be  aborted  if  the  treatment  is  begun  sufficiently  early." 

Influenza,  LaGrippe,  &C— "Blennostasine  is  the  most  effective  remedy 
n  treating  'grippe'  that  I  have  ever  tried,  and  is  much  to  be  preferred  to  the  synthetical 
drugs." 

Blennostasine  is  best  given  in  pilular  form  ;  one,  three  and  five  grain  gelatine-coated 
ills  are  supplied.      Samples  and  literature  free  on  request. 


McKESSON  &  ROBBINS, 


New  York. 


The  New  Antiseptic 


CONTAINER 


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THE  NORWICH  PHARMACAL  CO., 

NORWICH,  NEW  YORK. 


240 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


parents  brought  her  to  me  for  examination 
in  February,  1893.  Careful  examination 
of  her  eyes,  without  a  mydriatic,  revealed 
simple  hyperopia  in  the  right  and  comp. 
hyperopic  astigmatism  in  the  left  eye.  The 
use  of  homatropin  disclosed  a  comp.  hyper- 
opic astigmatism  in  both  eyes  low  in  degree. 
Glasses  correcting  all  the  astigmatism  and 
a  small  portion  of  the  hyperopia  were  pre- 
sented, and  their  use  relieved  the  patient  in 
a  week's  time.  She  can  read  with  entire 
comfort. 

This  list  of  cases  could  be  continued  in- 
definitely from  my  own  practice  and  all  oc- 
ulists could  add  to  it  presenting  cases  simi- 
lar in  character  and  full  ot  interest  to  the 
earnest  medical  man.  But  my  paper  is  al- 
ready too  lengthy  and  I  must  hurry  to  its 
close. 

Resume. — The  position  taken  is  that  the 
number  of  persons  consulting  physicians 
for  relief  from  some  functional  disorder 
from  which  they  suffer,  has  materially  in- 
creased during  the  last  25  to  30  years,  and 
in  accounting  for  this  increase,  the  exact- 
ing near  work  of  civilization  is  shown  to 
be  causative  through  the  heavy  burdens 
which  it  places  on  the  ocular  apparatus. 
It  has  also  been  shown  that  when  this  ap- 
paratus is  normal  these  burdens  cause  no 
serious  inconvenience,  but  when  certain 
abnormalities  are  present,  it  labors  at  a  dis- 
advantage and  the  burdens  become  onerous, 
resulting  in  muscular  and  nervous  exhaus- 
tion more  or  less  profound. 

The  plan  of  treatment  advocated  and  set 
forth  in  the  report  of  cases  is  in  line  with 
one  of  the  first  principles  involved  in  the 
practice  of  the  healing  art,  viz  :  "Remove 
the  cause;"  failing  in  this,  "Counteract 
its  effects." 


Report  of  Cases  of  Rupture  of  Uterus 
During  Pregnancy.! 

By  Francis  D   Kendall,  M.  D.,   Columbia.   S.  C. 

I  have  two  very  short  cases  I  wish  to  re- 
port, so  will  take  but  a  very  few  moments 
of  your  valuable  time. 

Case  i. — I  was  sent  for  by  a  mid- wife 
at  2  A.  M.,  in  haste,  July  13th,  1894.  She 
had  a  woman  in  labor  (colored)  and  needed 
the  assistance  of  a  physician.  I  hurriedly 
went  to  her,  and  found  the  woman  had  just 
died.  vShe  was  still  quite  warm.  On  ex- 
amining the  abdomen,  found  it  very  large. 
Digital  examination,  could  feel  the  child's 
head,  but  could  not  ascertain    the  position, 


tRead  before  the  Tri-State  Medical  Society  of 
the  Carolinas  and  Virginia,  at  Charlotte,  N.  C, 
January,  1899. 


as  the  head  moved  upward  when  touched. 
I  then  tried  to  apply  forceps,  but  the  head 
slipped  entirely  out  of  my  reach.  I  could 
distinctly  feel  the  child  moving — so  I  deter- 
mined to  open  the  body.  As  soon  as  I 
opened  the  abdomen,  the  child's  head  pop- 
ped up  through  the  opening  I  had  made  ; 
it  was  entirely  out  of  the  uterus.  On  ex- 
amining the  contents  of  the  abdomen,  I 
found  that  the  uterus  had  ruptured  the  en- 
tire length  on  the  left  side,  from  the  fundus 
to  the  os,  and  on  the  right  side  there  was 
an  intra-mural  fibroid  tumor,  which  with 
the  womb  weighed  14^  pounds;  the  child 
was  a  well  formed  boy,  weighing  9  pounds. 
The  woman  had  borne  six  children  before 
without  trouble,  except  the  one  before  this, 
which  was  removed  with  instruments,  alive. 
The  woman  was  a  negress,  34  years  old. 
and  has  always  been  healthy.  The  child 
died  just  after  it  was  delivered. 

Case  2. — This  case  is  somewhat  similar 
to  the  above.  I  was  again  called  by  a  mid- 
wife, this  time  eight  miles  in  the  country, 
at  4  o'clock  in  the  morning,  on  January 
20th,  1897;*  when  I  got  there  it  was  6 
o'clock.  I  found  a  handsome  young  wo- 
man dying;  could  seethe  child  moving  dis- 
tinctly ;  I  waited  until  the  end  came,  which 
was  at  6  :3s  A.  M.      Just  as  soon  as  she  died 

1  opened  her,  and  found  that  the  uterus  had 
ruptured,  seemed  to  have  just  split,  from 
the  fundus  toward  the  os  ;  the  placenta  was 
still  intact  and  the  cord  pulsating,  but  very 
feebly;  rent  in  the  uterus  on  left  side,  and 
the  child  partly  out  of  the  organ,  and  alive 
and  kicking.  I  tied  the  cord  and  removed 
a  fine  boy  weighing  \o\  pounds.  He  is 
still  alive  and  well.  This  was  a  young  wo- 
man, 18  years  old,  first  time  pregnant,  well 
formed,  weighing  about  130   pounds,  5  feet 

2  inches  high,  white,  and  in  good  circum- 
stances for  a  farmer's  wife. 

1309  Plain  Street. 


The  Dios  Chemical  Co.,  St.  Louis.  Mo.. 
are  determined  to  stop  the  nefarious  busi- 
ness of  substituting  their  two  products, 
Dioviburnia  and  Neurosine.  Physicians 
recognize  the  therapeutic  value  of  these 
products  in  the  class  of  cases  in  which  they 
are  indicated,  and  whereas  this  Company 
caters  exclusively  to  the  Profession,  we  be- 
lieve it  is  due  them  that  the  Physicians  co- 
operate in  stopping  substitution  and  if  they 
will  report  to  the  Dios  Company  such  Drug- 
gists as  attempt  substituting  their  products 
it  will  be  considered  strictly  confidential 
and  their  name  will  in  nowise  be  mentioned. 

We  trust  the  patrons  of  our  Journal  will 
co-operate,  not  only  in  protecting  the  man- 
ufacturer, but  themselves  as  well. 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


241 


THE 


Charlotte  Medical  Journal 

Editorial  Department. 


E.  C.   REGISTER,   M.  0.  J.  C.   MONTGOMERY.   M    D. 

Editors  and  Publishers. 

No.  36  South  Tkyon  Street,    -    -    -    - 
Charlotte,  N.  C. 


SUBSCRIPTION.  $2-50  PER  YEAR, 


THE  TRI-STATE  HEDICAL  SOCIETY  OF  THE 
CAROLINAS  AND  VIRGINIA. 

At  i  i  o'clock  Oil  Wednesday  morning, 
January  18th,  1899,  the  Tri-State  Medical 
Society  met  in  the  Court  House  at  Char- 
lotte, N.  C,  for  permanent  organization, 
and  was  called  to  order  by  Dr.  E.  C.  Reg- 
ister, of  Charlotte. 

Dr.  II.  F.  Chreitzberg,  Pastor  of  the 
Tryon  Street  Methodist  Church  of  Char- 
lotte, invoked  the  Divine  blessing. 

ADDRESS    OF     WELCOME. 

Dr.  Register  introduced  Col.  II.  C.  Jones, 
one  of  Charlotte's  most  prominent  lawyers, 
who  welcomed  the  Convention   by  saying  : 

Gentlemen  of  the  Medical  Society: — I  am 
satisfied  that  the  most  agreeable  part  of  the 
program  which  has  been  set  forth  for  this 
meeting  lias  devolved  upon  me,  the  duty  of 
welcoming  you  in  the  name  of  the  Medical 
.Society  of  Charlotte  and  in  the  name  of  the 
citizens  of  this  place.  It  has  fallen  to  my 
lot  many  times  in  my  long  residence  in 
Charlotte  to  welcome  many  Societies  and 
Guilds  and  Associations  of  men,  and  it  has 
always  been  a  matter  of  peculiar  pleasure 
to  me  to  welcome  any  branch  of  this  So- 
ciety of  the  great  medical  profession.  It 
goes  without  saying  that  it  is  a  pleasure  to 
any  Southern  town,  or  in  fact  to  any  town, 
to  welcome  a  representative  body  of  culti- 
vated gentlemen.  But  coupled  with  the 
pleasure  that  we  naturally  feel,  or  any  town 
might  feel,  in  having  it  selected  as  a  place 
for  your  meeting,  any  thoughtful  commu- 
nity or  any  thoughtful  body  of  citizens  must 
feel  as  they  see  the  gathering  of  the  repre- 
sentatives of  the  medical  profession ,  that  they 
are  in  touch  with  oneof  the  grand  divisions 
of  the  army  of  those  who  work  in  the  line 
of  searching  out  truth,  and  the  fascination 
of  your  investigation  is  that  the  truth  which 
you  seek,  and    all  other    professions   recog- 


nize the  fact  that  the  truth  you  seek  is  ab- 
solute truth,  not  truth  clipped  and  shaped 
and  fashioned  to  meet  the  requirements  of 
some  dogma  of  an  ecclesiastical  creed,  or 
some  plank  or  platform  of  a  party,  not  a 
truth  decked  to  catch  the  ear  or  the  fancy 
of  the  multitude  at  large,  but  truth  absolute 
and  truth  beneficent ;  the  truth  that  guides 
you  in  your  efforts  to  lighten  the  burdens  of 
human  suffering  and  will  guide  you  in 
those  conflicts  which  you  are  ever  waging 
at  our  bedsides  with  the  phantom  of  death. 
There  is  a  peculiar  fascination  for  those  who 
watch  your  body,  because  of  the  fact  that  it 
is  the  most  conservative  of  all  the  bodies,  be- 
cause of  the  care  with  which  you  investi- 
gate, because  with  you  a  subject  passes  from 
the  domain  of  the  speculative  into  the  do- 
main of  the  absolute  truth.  We  welcome 
you  not  only  because  of  the  great  interest 
we  have  in  your  researches,  these  constant, 
these  tireless  researches  of  yours,  but  we 
have  other  acknowledgements  to  make,  and 
in  making  them  in  the  name  of  this  com- 
munity 1  violate  no  cannon  of  good  taste 
when  I  speak  of  the  immense  obligations 
which  society  owes  for  its  culture  and  re- 
finement to  you  ;  and  even  in  politics,  that 
seem  so  far  removed  from  the  domain  of 
your  investigations,  the  membership  of  this 
great  body  has  always  stood  for  the  genuine 
and  for  the  true.  We  acknowledge  not 
only  the  benefits  that  we  derive  from  your 
services  in  the  art  of  medicine,  but  we  know 
that  men  never  had  the  decency  to  cleanse 
their  streets  until  you  taught  them  filth  was 
one  of  the  worst  foes  that  imperilled  their 
lives.  All  these  things  I  am  here  to  ac- 
knowledge, and  in  the  name  of  the  city  of 
Charlotte  and  her  medical  fraternity,  to 
welcome  you  here. 

Now,  as  I  said  before,  there  is  an  abso- 
lute pleasure  in  welcoming  you  foroursakes 
and  for  yours,  and  to  acknowledge  our  in- 
debtedness. And  then,  as  a  matter  of  course, 
we  expect  to  attend  your  deliberations  here 
and  as  a  matter  of  course  we  expect  to  be 
immensely  edified  by  your  discussions,  for 
in  looking  over  your  program  we  see  many 
subjects  that  are  entirely  familiar  to  us,  for 
instance,  pseudo-membraneous  enteritis,  and 
many  other  subjects  of  that  sort  that  are 
matters  of  daily  discussion  among  the  lay- 
men, for  you  know  every  laymen  thinks  he 
knows  more  law  than  the  lawyers  and  more 
medicine  than  the  doctors. 

But  there  is  one  subject  that  I  miss  from 
your  program  that  I  expected  and  hoped 
would  be  there,  and  there  would  be  some 
deliberation  upon.  You  can  not  be  aware 
that  we  have  an  epidemic  of  grip  in  our 
midst,  for  you  have  ignored  it  in  your  list 
of  theses,  and  I  thought,  perhaps,  you  were 


242 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


ignorant  of  the  fact,  and  I  would  mention 
it  in  a  semi-professional  way,  not  onlyas  a 
warning,  but  to  apprise  you  of  the  fact  that 
there  seems  to  be  some  diversity  in  the 
practice  of  our  local  physicians  here  in  re- 
gard to  the  treatment  of  it,  and  I  thought 
we  should  have  some  deliverance  from 
you  on  that  subject.  Now,  for  instance,  a  j 
week  or  so  ago  I  was  in  company  with  one 
of  my  doctor  friends  here  and  he  said  he 
had  the  grip.  Me  at  once  entered  into  a 
dissertation  on  the  proper  treatment,  and  he 
said  corn  whiskey  and  glycerine  was  the 
best  thing  for  the  grip,  and  he  was  still 
arguing  upon  it  when  a  fellow  came  in 
wheezing  and  coughing,  and  he  diagnozed 
the  case  and  said  he  had  the  grip.  I  sat  by 
and  listened,  of  course,  for  him  to  prescribe 
corn  whiskey  and  glycerine.  But  I  glanced 
over  his  shoulder,  and  what  do  you  think 
he  wrote?  "Assafoctida  pills,  five  grains 
each,  number  ten,  to  be  taken  four  at  a 
time  and  repeated  every  four  hours. ' '  That 
is  what  he  wrote  and  the  fellow  went  off 
with  it.  I  was  a  little  amazed,  and  after 
he  was  gone  I  asked  him  how  about 
it.  "Well,"  he  said,  "I  know  that  fellow, 
in  the  first  place,  and  can  trust  him  to  take 
the  whiskey  anyhow  without  any  prescrip- 
tion. In  the  next  place,  it  will  never  do  to 
have  this  a  matter  of  common  knowledge, 
for  all  the  revenue  of  the  medical  profession 
would  be  turned  into  the  bar  rooms,  and  it 
wouldn't  do."  I  was  greatly  amazed. 
I  was  in  the  position  of  the  doctor  who 
found  a  remedy  that  was  a  very  good  thing 
for  the  Dutchman  but  was  hell  for  the  Irish- 
man. My  friend  took  a  dose  of  corn  whis- 
key and  I  noticed  he  left  out  the  glycerine. 
I  suggested  to  him  that  he  had  left  out  the 
glycerine,  and  he  said  it  wasn't  absolutely 
necessary  to  take  the  glycerine  along  with 
the  whiskey,  that  he  had  some  glycerine  at 
home  and  he  would  take  it  when  he  got 
home.  The  thing  got  still  more  obscure 
until  after  a  while  he  took  another  dose  of 
corn  whiskey.  I  suggested  that  he  had 
better  make  a  memorandum  to  take  the 
glycerine,  but  he  said  the  regular  dose  was 
three  parts  of  whiskey  to  one  of  glycerine, 
and  he  would  take  that  one  part  of  glyce- 
rine when  he  got  home  with  the  last 
drink.  Well,  I  asked  him  what  he 
would  advise  me  to  do  if  I  gotit.  He 
said  that  would  depend  entirely  on  how 
late  I  was  up  the  night  before.  1  had 
some  curiosity,  and  met  the  fellow  after- 
wards on  the  street  to  whom  he  had  given 
the  assafoetida.  I  asked  him  how  it  worked. 
He  said  it  had  a  curious  sort  of  smell  about 
it  when  it  came  loose  in  his  pocket,  that  he 
took  the  darn  thing  and  it  knocked  the  grip 
out  of  him,  but  his  wife    had  hidden  away 


all  his  clothes.  So  you  see  how  important 
it  is  that  we  shall  have  some  deliverance 
on  the  subject  of  treating  the  grip. 

There  are  many  other  things  I  might 
mention.  This  appendicitis  business,  for 
instance.  These  newspaper  men  are  eter- 
nally alarming  this  community,  and  the 
doctors  look  wise  and  shake  their  heads. 
I  saw  a  fellow  here  the  other  day  who  had 
eaten  a  dinner  of  fried  oysters,  and  he  was 
ready  to  swear  he  had  appendicitis.  It  is 
important  that  you  should  let  us  know  some- 
what of  the  symptoms  of  appendicitis. 

As  for  microbes,  I  beg  you  not  to  dis- 
turb that  question.  This  community  is 
resting  after  a  long  period  of  vexatious 
opinions  on  the  subject  of  microbes,  and 
there. have  been  many  prayers  and  beseech- 
ings  to  the  newspapers  to  let  i*.  alone,  and 
we  hope  that  you  will  not  disturb  that 
subject. 

But  in  a  general  way,  gentlemen  of  the 
medical  profession,  this  community  has 
nothing  else  to  ask  of  you  except  that  you 
will  let  them  know  how  they  can  contribute 
to  your  enjoyment,  and  let  me  assure  you 
that  it  will  be  a  matter  of  pleasure  and  pride 
to  them  to  know  that  they  have  been  able 
to  do  so.  We  hope  that  we  shall  so  demean 
ourselves  in  that  respect  that  we  will  make 
it  agreeable  for  you  to  come  again. 

RESPONSE    TO    THE    ADDRESS  OF  WELCOME. 

Dr.  Hugh  T.  Nelson,  of  Charlottesville, 
Va.,  responded  to  the  address  of  welcome, 
as  follows  : 

Chairman,  Ladies  and  Gentlemen : — It 
is  indeed  with  unfeigned  embarrassment 
that  I  undertake  to  speak  before  this  assem- 
bly, which,  though  not  a  very  large  one,  is 
one  that  I  imagine  and  feel  sure  is  critical. 
And  yet  while  I  feel  this  embarrassment,  I 
also  feel  that  it  is  a  true  pleasure  to  me  to 
have  to  respond  to  this  address  of  welcome 
which  we  have  just  heard  so  pleasantly  de- 
livered. I  say  it  is  a  pleasure  to  me  because 
I  feel  that  in  making  this  response,  I  echo 
the  opinions  of  a  representative  body  of  a 
noble  profession  from  three  representative 
States  of  this  great  Republic.  I  say  repre- 
sentative men,  because  I  have  scanned  the 
list  composing  those  who  now  propose  to 
organize  the  Tri-State  Medical  Society,  and 
I  see  among  them  many  names  that  I  know 
to  be  of  those  who  are  earnest  workers  in 
the  field  of  science,  of  that  science  which 
has  for  its  object  the  alleviation  of  human 
suffering  and  the  prolongation  of  life.  I 
say  they  are  from  representative  States,  be- 
cause when  I  mention  North  Carolina, South 
Carolina  and  Virginia,  that  triplet  of  sisters 
which  do  now  and  which  have  always 
stood  as  representatives  of  every  State  in 


THE  CHARLOTTE   MEDICAL  JOURNAL. 


243 


the  Republic.  What  is  more  fitting  than 
that  this  organization  of  a  Tri-State  Medi- 
cal Society  should  be  made  here  in  this  old 
city  of  Charlotte?  Its  people  are  from  that 
grand  old  Scotch-Irish  stock  which  had 
peopled  this  entire  Piedmont  Valley  section 
of  our  country.  We  come  to  them,  and  we 
believe  in  coming  to  them  we  come  to  the 
truest  people  upon  whom  God's  sun  shines 
to-day.  I  come  to  you  more  gladly  simply 
because  I  too  acknowledge  in  my  ancestry 
the  same  stock  which  has  populated  your 
country.  Then  I  say  it  is  a  fitting  place  in 
which  this  organization  should  be  begun, 
because  here  from  the  earliest  times  of  this 
country,  from  its  earliest  population  by  your 
parents,  it  has  been  foremost  in  all  aggres- 
sive movements  which  have  had  for  their 
ultimate  object  the  good  of  the  people. 
Long  before  our  brethren  of  Massachusetts 
had  broken  the  British  tea  caddies  and 
thrown  their  contents  into  Boston  Harbor, 
the  people  here  in  this  town,  and  probably 
on  this  very  spot,  had  organized  rebellion  and 
told  old  George  the  Third  that  he  couldn't 
control  them.  Later  on,  early  in  the  Revo- 
lution, before  the  guns  of  Lexington  had 
ceased  to  boom,  here  the  spirit  of  freedom 
had  begun  an  organized  effort  for  the  pro- 
tection of  human  life  and  for  humanity  and 
the  guns  from  Kings  Mountain  were  echoing 
over  your  valleys.  In  every  movement  you 
have  been  foremost.  In  1S61,  this  Old 
North  State  came  to  the  front  grandly  and 
nobly,  and  as  a  Virginian  I  feel  proud  to 
say  here  in  the  middle  of  your  State  that 
to-day  in  the  soil  of  my  native  State  the 
bones  of  more  North  Carolinians  are  bleach- 
ing and  rotting  than  from  any  other  State 
within  this  glorious  Southland.  1  say  it  is 
a  matter  we  should  be  proud  of  that  we 
meet  here  in  this  State  under  such  auspices. 
You  have  been  foremost  not  only  in  the 
times  which  have  departed,  but  when  it  be- 
came necessary  in  the  very  recent  past,  with- 
in the  last  year,  that  some  movement  should 
be  put  on  foot  which  should  maintain  for- 
ever and  eternally  the  integrity  of  the  An- 
glo-Saxon race  and  maintain  its  supremacy 
over  every  other  race,  the  movement  in 
North  Carolina  was  inaugurated  you  stand 
before  the  eyes  of  the  other  States  as  pre- 
eminent for  defending  yourselves  and  have 
shown  to  the  world  that  wherever  God's 
sun  shines  on  the  Anglo-Saxon  race,  it  is 
that  race  which  shall  dominate.  We  are 
glad  to  come.  We  are  glad  under  such 
auspices  as  these  to  come  and  organize  the 
Tri-State  Medical  Society,  and  God  grant 
that  in  its  progress,  its  usefulness  and  its 
work,  it  may  take  pattern  after  this  glorious 
old  State  in  which  we  are  to-day  assembled. 
The  Society  being  now  ready  for  business, 


Dr.  W.  II.  II.  Cobb,  of  Goldsboro,  the  Tem- 
porary President,  took  the  chair,  and  de- 
livered his  address,  as  follows  : 

PRESIDENT    COBB'S     ADDRESS. 

Gentlemen    of  the   Medical    Association  of 

the  Caro/iuas  and  Virginia: 

It  is  eminently  appropriate  that  the  per- 
manent organization,  and  first  regular  meet- 
ing of  this  Association  should  be  held  in 
this  city,  honored  as  the  birthplace  of 
American  liberty  ;  and  in  this  State,  whose 
brave  compatriots  of  the  signers  of  the 
Mecklenburg  Declaration  of  Independence, 
on  the  ioth  day  of  November  1898,  in  the 
City  of  Wilmington,  in  a  second  Declara- 
tion of  Caucasian  Independence,  proclaimed 
to  the  world  that,  henceforth  and  forever, 
the  Anglo-Saxon  shall   rule. 

As  you  have  received  such  cordial  and 
eloquent  welcome  to  the  Queen  City  of  the 
South,  Ibid  you  doubly  welcome  in  the 
name  of  the  Grand  Old  North  State,  and 
beg  you  accept  her  open-handed  and  large 
hearted  hospitalities  and  greeting. 

I  would  be  less  than  human  did  I  not 
greatly  appreciate  the  distinguished  honor 
of  being  the  first  presiding  officer  of  this 
learned  and  scientific  Association.  Chosen, 
I  feai,  through  your  kindness  and  generos- 
ity, and  not  for  my  fitness  or  ability  to  dis- 
charge the  responsibilities  of  this  high  office. 

The  founders  of  this  Association,  embra- 
cing some  of  the  ablest  and  most  scientific 
physicians,  surgeons  and  specialists  of  the 
States  embraced,  earnestly  strive  to  cement 
closer  the  bonds  of  union  of  the  medical 
profession  ;  to  elevate  the  science  of  med- 
icine in  all  its  branches,  by  building  up  an 
organization  that  will  keep  pace  with  sim- 
ilar institutions,  wherever  located,  in  high- 
toned  character,  talent,  efficiency  and  sci- 
entific attainments. 

This  Association  is  not  the  creature  of,  or 
feeder  for  any  school,  clique,  ring  or  set  of 
specialists  or  professors,  as  has  been  unchar- 
itably suggested  by  some  good,  but  mis- 
guided brethren ;  but  was  organized  for 
mutual  help,  encouragement  and  progress, 
and  fostering  a  pure,  cultivated,  enlightened 
medical  science,  and  by  orgnaization  give 
weight  and  dignity  to  the  utterances  and 
essays  of  its  members. 

It  is  not  intended  as  a  disorganizer,  or 
absorber  of  State  medical  Societies,  for  our 
membership  is  limited ;  and  our  loyalty  to 
State  societies  is  shown  by  the  prerequisite 
for  membership,  which  consists  in  being  a 
member  in  good  standing  in  his  respective 
vState  medical  society, 

I  yield  to  no  one  in  loyalty  and  fidelity  to 
my  State  society  ;  and  could  I  believe  that 
this  Association  would  prove    injurious    to 


244 


THE  CHARLOTTE  MEDICAL  JOURNAL 


my  grand  old  State  medical  society,  which 
has  but  few  peers  and  no  superiors,  and 
which  has  exalted  me  far  beyond  my  deserts, 
bestowing  upon  me  its  highest  honors  ;  I 
would  at  this  moment  decline  the  very  great 
honor  you  have  conferred  upon  me.  and 
withdraw  from  your  fellowship. 

This  organization  offers  to  young,  prom- 
ising, meritoriousand  ambitious  young  men, 
who  desire  to  rise  above  State  lines,  and 
gratify  a  laudable  ambition,  a  wider  field 
for  the  display  of  their  talents,  than  that 
possessed  by  State  societies. 

Our  Annual  meetings  should  be  charac- 
terized by  the  pleasures  of  reunion,  the  in- 
terchange of  thought  and  opinion,  to  the 
building  up  of  medical  science,  and  the 
accumulating  of  annual  experiences  for  the 
furtherance  of  medical  history. 

Permit  me  to  congratulate  you  upon  the 
grand  results  of  our  present  organization. 
We  have  successfully  launched  our  medical 
craft,  and  started  upon  our  first  voyage,  not 
with  a  cargo  of  embalmed  beef  for  the  sick 
and  wounded,  but  freighted  with  the  rich 
gems  of  forty-five  able  and  scientific  papers, 
the  authors  of  some  of  them  being  num- 
bered among  the  most  learned,  scientific 
and  eminent  members  of  the  profession  in 
this  great  country  of  ours. 

The  large  number  of  valuable  papers  pre- 
sented at  this  meeting,  will  far  more  inter- 
est you  than  any  address  that  I  could  pre- 
sent, so  that  I  will  close  by  declaring  this 
Association  duly  opened  for  the  transaction 
of  business,  and  beg  your  indulgence,  for- 
bearance and  charity  in  the  discharge  of  the 
responsibilities  imposed  upon  me. 

TRANSACTIONS    OF     THE    ASSOCIATION. 

After  the  President's  address  the  first 
business  was  the  appointment  of  a  com- 
mittee on  Constitution  and  By-Laws,  in 
order  to  have  a  permanent  organization 
President  Cobb  appointed  on  that  com- 
mittee : 

Dr.  J.  G.  Tompkins,  of  South  Carolina. 

Dr.  Paul  Barringer,  of  Virginia. 

Dr.  Geo.  W.  Long,  of  North  Carolina. 

Dr.  Barringer  asked  that  with  the  per- 
mission of  the  President,  the  committee  be 
allowed  to  retire  and  prepare  their  report. 

Dr.  Paul  A.  Irving. — It  is  a  very  impor- 
tant work  that  this  committee  has  to  do, and 
I  think  they  ought  to  take  as  long  a  time  as 
necessary.  I  have  to  suggest  that  they  bring 
in  their  report  at  the  evening  meeting  of 
the  Society  unless  they  can  do  so  earlier. 

Dr.  Paul  Barringer. — 1  know  nothing 
more  than  that  a  very  simple  draft  has  been 
gotten  up,  and  how  much  change  vvill  be 
required  it  will  be  impossible  for  me  to  say 
at  this  time,  as  I  have  had  no    consultation 


with  the   other  members  of  the  committee, 
and  I  appreciate  Dr.  Irving's  suggestion. 

There  being  no  objection,  it  was  ordered 
that  the  committee  report  at  the  afternoon 
session. 

The  President  stated  that  the  next  busi- 
ness in  order  was  the  Registration  of  Mem- 
bers. 

Dr.W.  L.  Robinson. — I  suggest  that  as 
we  are  all  assembled  here,  we  had  better 
proceed  to  work  the  best  we  can.  I  see  no 
reason  myself  why  at  least  some  of  the  busi- 
ness should  not  be  transacted, 

The  first  paper  on  the  program  was  read 
by  Dr.  Paul  Barringer,  of  the  University  of 
Virginia,  on  the  "Purposes  of  Tri-State 
Medical  Organization." 

Pres't  Cobb. — Is  it  the  pleasure  of  the  As- 
sociation that  we  proceed  with  other  papers? 
Dr.  George  Ben.  Johnson,  of  Richmond, 
Va. — Mr.  President,  I  move  that  we  pro- 
ceed with  the  program  for  the  afternoon 
session  until  the  report  is  ready. 

Dr.  Johnston's  motion  was  put  to  the 
Society  and  was  carried. 

Dr.  J.  M.  Fladger,  Summerton,  S.  C, 
read  a  paper  on  "Pseudo-Membranous  Ente- 
ritis." 

Dr.  Hugh  T.  Nelson. — Before  the  next 
paper  is  called,  I  would  like  to  ask, not  that 
I  myself  want  to  discuss  this  paper  which 
has  just  been  read  and  which  I  listened  to 
with  a  great  deal  of  interest  and  certainly 
have  no  comments  to  make  on  it,  but  I  just 
ask  as  a  matter  of  information  if  the  papers 
that  are  read  can  be  discussed,  and  I  think 
it  would  be  advisable  and  certainly  it  would 
be  instructive  if  the  different  papers  can  be 
discussed  as  they  are  read. 

Pres't  Cobb. — It  would  be  best  to  discuss 
them  as  they  are  read,  unless  there  are 
several  papers  under  the  same  head. 

Dr.  Geo.  W.  Long. — I  would  like  to  in- 
quire, if  in  order,  whether  or  not  it  will  be 
well  enough  to  ask  where  these  papers  shall 
go.  We  have  no  committee  on  publication. 
Pres't  Cobb. — When  we  have  a  Commit- 
tee on  Publication  the  papers  will  be  refer- 
red to  them.  They  are  being  read  now  to 
prevent  loss  of  time,  and  they  will  be  so  re- 
ferred when  we  have  a  Committee  on  Pub- 
lication, unless  objection  is  raised. 

The  next  paper,  "Gold  as  a  Remedial 
Agent,"  by  Dr.  F.  B.  Glenn,  of  Asheville, 
N.  C,  was  read  by  title,  as  the  author  was 
absent. 

Dr.  J.  N.  Upshur,  of  Richmond, Va., read 
a  paper  on  "Lithemia." 

Secretary  Irving  requested  that  the  mem- 
bers come  up  and  register. 

On  motion  of  Dr.  E.  C.  Register,  the 
Society  adjourned  to  meet  again  at  three 
o'clock. 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


WEDNESDAY    AFTERNOON. 

President  Cobb  called  the  Society  to 
order  at  3  :20. 

The  first  order  of  business  was  the  report 
of  the  committee  on  Constitution  and  By- 
Laws,  which  was  read  by  Dr.  J.  C, 
Tompkins,  of  Edgefield,  S.  C,  first  as  a 
whole  and  then  read  by  articles, 

Dr.  Geo.  Ben.  Johnson. — It  seems  to  me 
that  this  committee  has  discharged  its  duties 
in  a  most  admirable  way  and  provided  a 
Constitution  and  By-Laws  that  will  meet 
with  the  approval  of  every  member  of  this 
Society,  and  I  therefore  move  that  it  be 
adopted  as  a  whole.  It  will  take  a  great 
deal  of  time  to  read  and  adopt  each  article 
separately. 

Dr.  Paul  B.  Barringer. — Before  this  is 
done,  I  would  like  as  a  member  of  the  com- 
mittee to  say  that  we  would  like  some  ad- 
vice, and  we  were  not  satisfied  ourselves  as 
to  the  state  of  affairs.  The  duties  of  the 
Secretary  and  Treasurer  respectively,  we 
would  like  to  ask  the  advice  of  the  Society 
on.  In  this  instance  the  Secretary  collects 
and  the  Treasurer  holds.  I  am  not  abso- 
lutely sure  and  would  like  some  expression 
of  opinion  from  the  Society  as  to  it.  Can 
any  of  you  give,  me  the  experience  of  the 
North  Carolina  Society?  I  know  pretty 
well  what  we  have  in  Virginia. 

The  President  called  for  remarks  on  the 
subject,  and  Dr.  Johnston  moved  that  the 
Society  adopt  the  report  of  the  committee 
as  it  stood. 

Dr.  Barringer. — 1  am  perfectly  willing 
to  accept  that.  The  initiation  fee  is  left 
absolutely  blank. 

Dr.  \V.  L.  Robinson. — I  don't  see  how 
we  can  adopt  that  as  a  whole  until  these 
provisions  are  made,  and  I  move  the  adop- 
tion as  a  whole,  except  those  things  which 
the  committee  desires  advice  upon. 

Dr.  Geo.  \Y.  Long. — The  committee  de- 
sires advice  and  time  for  discussion. 

Dr.  Jos.  A.  White. — I  move  to  amend 
the  Constitution  as  submitted,  that  discus- 
sions of  papers  be  limited  to  five  minutes 
to  each  speaker  instead  of  ten  minutes,  and 
no  one  be  allowed  to  speak  more  than  twice 
on  the  same  subject. 

Dr.  J.  N.  Upshur.— I  think  Dr.  White 
is  making  a  mistake  in  making  as  short  a 
limit  as  five  minutes.  Very  few  men  speak 
more  than  five  minutes,  but  sometimes  on 
an  important  question  it  is  impossible  to  lay 
down  the  principle  facts  of  the  subject  in 
five  minutes,  which  is  a  very  short  time.  It 
is  a  very  good  thing  to  cut  oft'  a  discussion 
that  isn't  pertinent  to  the  question  in  point, 
but  when  an  interesting  question  is  up  that 
rule  might  prevent  some  very  useful  things 
being  said.      A  man   might  be   just  getting 


to  the  point  where  he  was  making  his  point 
in  the  discussion. 

Dr.  White. — The  reason  I  made  that  mo- 
tion is  because  in  the  light  of  experience, 
all  of  our  Societies  have  adopted  that  limit. 
The  American  Medical  Association  is  limit- 
ed to  five  minutes,  and  our  own  State  So- 
ciety is  limited  to  five  minutes,  because  we 
have  found  that  a  man  can  make  his  point 
in  a  five  minutes  talk  just  as  well  as  in  ten, 
and  uses  fewer  words  and  saves  time. 
Time,  when  you  have  forty  papers  to  read 
and  discuss  as  you  have  here,  is  a  very  im- 
portant item. 

Dr.  J.  C.  Tompkins. — There  is  an  im- 
portant exception  for  the  reason  that  the 
first  day  of  the  Society  is  set  aside  for  one 
I  subject  alone  according  to  the  Constitution. 

Dr.  Hugh  M.  Taylor. — May  I  ask  about 
setting  aside  the  first  day  of  the  meeting 
for  the  discussion  of  some  special  subject  ? 

Dr.  Tompkins. — The  entire  day  is  for  the 
discussion  of  some  special  subject  to  be  de- 
signated by  the  President  about  a  month 
previous  to  the  meeting. 

Dr.  Barringer. — If  Dr.  Taylor  will  allow 
me,  it  is  moved  that  the  meeting  of  the 
Society  shall  occupy  in  the  main  three  days 
each  session.  During  the  first  day  there 
will  be  taken  up  for  consideration  some 
subject  announced  at  the  previous  meeting, 
and  as  much  of  the  entire  day  will  be 
occupied  with  the  discussion  of  those  papers 
as  there  are  papers  present  to  discuss.  Of 
course,  if  it  only  takes  two  or  three  hours, 
it  is  a  special. order  so  long  as  there  is  any 
material  on  that  subject.  After  that  the 
general  order  of  discussion  begings. 

Dr.  Taylor. — I  would  like  to  ask,  Mr. 
Chairman,  if  you  had  not  better  state  as 
much  of  the  first  day  as  is  necessary  shall 
be  utilized  for  that  subject,  as  I  would 
understand  from  that  that  the  first  day  is  to 
be    devoted    exclusively  to  it. 

Dr.  Barringer. — I  am  not  the  Chairman 
of  that  Committee,  but  the  phraseology 
there  is  that  that  subject  shall  be  made  a 
special  object  for  discussion  the  first  day. 

Dr.  T-  W.  Long. — May  I  rise  to  second 
the  motion  to  amend  made  b)  Dr.  White? 
I  feel  sure  he  is  right  in  saying  that  ten 
minutes  is  too  long  for  any  one  man  to 
discuss  a  paper,  and  that  is  the  rule  that 
obtains  certainly  in  a  large  majority  of  the 
Medical  Societies  over  the  country.  A  man 
who  has  anything  to  say  and  has  clearly 
defined  ideas  as  to  what  he  wants  to  say, 
can  easily  express  himself  in  that  time,  and 
to  go  beyond  the  limit  of  five  minutes  takes 
up  so  much  time  for  the  discussion  of  each 
individual  paper  that  the  Society  is  crowded 
and  interesting  papers  must  suffer  because 
of  the  lack  of  time  to  read  and  discuss  them 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


properly,  so  I  approve  most  heartily  Dr. 
White's  motion.      I  second  his  motion. 

Dr.  W.  L.  Robinson. — I  move  that  the 
time  of  reading  a  paper  be  changed  from 
thirty  minutes  to  twenty.  That  has  also 
been  changed  in  most  Societies,  and  it  is 
ample  time  for  the  important  points  to  be 
made. 

Dr.  White. — I  understood  twenty  minutes 
and  not  thirty.  I  want  Dr.  Robinson's 
amendment  carried  also  in  addition  to  my 
own. 

President  Cobb  put  the  motion  to  the 
house  of  limiting  the  debate  to  five  minutes 
and  the  papers  to  twenty  minutes.  Motion 
prevailed. 

Dr.  C.  W.  Kollock. — I  would  like  to  ask 
for  that  part  of  the  Constitution  to  be  read 
that  refers  to  the  initiation  fee,  whether  it 
is  meant  that  there  shall  be  an  initiation  fee 
and  the  annual  dues  in  addition. 

Pres't  Cobb. — An  annual  fee  in  addition. 
The  first  year  one  fee  pays  for  the  initiation 
and  the  dues. 

Dr. Kollock. — It  seems  to  me  that  the  year- 
ly fee  would  be  sufficient  for  that  one  initia- 
tion and  for  the  yearly  fee  also,  for  if  we 
make  it  too  large  we  will  keep  out  a  certain 
number  of  men.  We  must  remember  there 
area  great  many  medical  societies,  and  these 
things  amount  to  a  great  deal  with  many 
men,  and  if  we  make  it  too  high  it  will  keep 
away  many  good  men  who  would  otherwise 
join.  I  would  suggest  a  change  there  and 
say  five  dollars  a  year, 

Dr.  Barringer. — In  speaking  for  the  com- 
mittee, I  will  say  that  we  left  that  open,  but 
I  don't  think  the  committe  will  agree  exact- 
ly with  Dr.  Kollock.  I  would  say  an  initia- 
tion fee  of  say  blank  dollars  and  one-fifth  or 
one-sixth  or  one-tenth  of  that  annally  would 
be  more  satisfactory.  While  the  committee 
didn't  express  their  views  on  that  subject, 
I  think  that  was  their  desire. 

Dr.  Geo.  W.  Long. — The  committee  sub- 
mits then  a  five  dollar  initiation  fee  and  two 
dollars  annual  dues  after  the  first  year. 

Dr.  Hugh  H.  Taylor. — I  hope  the  com- 
mittee will  not  make  the  fees  that  way.  In 
the  first  place,  I  do  not  see  that  we  will  need 
a  great  deal  of  money  in  this  organization 
unless  we  do  differently  from  most  of  the 
similar  organizations  and  try  to  publish 
transactions,  which  is  very  much  out  of 
vogue  at  the  present  time.  The  journals  are 
ready  and  willing  to  publish  the  papers  as 
read  before  the  Society  and  the  dues  are 
low,  and  only  those  societies  in  which  there 
are  volumes  of  transactions  published  re- 
quire a  large  fee.  Take  the  American 
Medical  Association  for  example.  What 
do  you  get  from  this  Association?  One  of 
the  best  weekly  journals  in  the  country, and 


membership  in  the  American  Medical  Asso- 
ciation. I  myself  think  three  dollars  annual 
dues  will  be  large  enough  for  the  present 
needs  of  the  Society,  and  that  amount  can 
be  increased  from  time  to  time  if  three  dol- 
lars is  not  enough. 

Dr.  J.  G.  Tompkins. — I  would  say  for  the 
enlightenment  of  the  doctor  that  the  com- 
mittee has  decided  to  put  the  annual  dues 
at  two  dollars  after  the  first  year,  five  dollars 
covering  everything  for  the  first  year,  and 
two  dollars  per  year  after  that. 

Dr.  White. — That  is  three  dollars  initia- 
tion and  two  dollars  annual  dues. 

Dr.  George  W.  Long. — The  first  five  dol- 
lars cover  everything  for  the  first  year. 

Dr.  White. — That  is  three  dollars  initia- 
tion fee  and  two  dollars  annual  dues.  An 
initiation  fee  is  never  annual  dues. 

Dr.  Kollock. — I  have  no  objection  to  and 
do  not  oppose  the  last  report  of  the  com- 
mittee. I  didn't  know  that  it  was  not  their 
object  to  publish  transactions.  I  didn't 
know  transactions  were  out  of  vogue,  and  I 
think  almost  all  Societies  publish  transac- 
tions yet,  but  if  that  is  not  the  object  of  the 
.Society  the  two  dollar  fee  is  sufficient,  so  I 
shall  not  oppose  that. 

Dr.  Tompkins. — The  phraseology  is  that 
each  member  on  initiation  shall  pay  an  ini- 
tiation fee  of  blank  dollars  which  shall  in- 
clude his  dues  for  the  first  year.  Each 
member  shall  pay  in  advance  annually  the 
sum  of  blank  dollars,  etc. 

Pres't  Cobb. — As  I  understand  it,  the 
motion  is  made  to  insert  the  initiation  fee 
and  annual  dues  shall  be  five  dollars  for  the 
first  year,  and  thereafter  the  annnal  dues 
shall  be  two  dollars. 

The  President  put  this  motion  before  the 
Society,  and  it  was  voted  down. 

Dr.  Barringer. — To  simplify  matters  and 
endeavor  to  meet  the  wishes  of  ail  parties, 
I  would  make  for  the  Committee  a  recom- 
mendation that  the  membership  fee  and  an- 
nual dues  be  for  the  first  year  three  dollars 
and  thereafter  one  dollar  per  year. 

Dr.  White. — As  I  understand  it,  there 
can  be  no  objection  to  two  dollars  per  an- 
num. We  can  not  have  any  objection  to 
that.  If  you  have  an  initiation  fee,  it  must 
have  a  fixed  specific  value.  Then  the  an- 
nual dues  are  separate  and  distinct.  If  you 
put  the  initiation  fee  at  three  dollars  and 
the  annual  dues  at  two  dollars,  it  will  be 
five  dollars  the  first  year  and  two  dollars 
every  year  afterwards. 

Dr.  J.  W.  Long. — As  that  report  has 
been  rejected,  I  think  we  had  better  say 
nothing  about  the  initiation  fee,  but  I  move 
that  the  annual  dues  be  two  dollars,  payable 
in  advance. 


THE  CHARLOTTE  MEDICAL  JOURNAL, 


247 


Pres't  Cobb  put  this  motion  before  the 
Society,  and  it  was  carried. 

Dr.  J.  \V.  Long. — The  motion  was  that 
the  annual  dues  be  two  dollars  payable  in 
advance,  so  when  a  man  joins  the  .Society 
he  must  pay  his  two  dollars  and  no  initia- 
tion fee. 

Dr.  Barringer. — That  is  the  way  the  com- 
mittee understands  it. 

Dr.  White. — I  move  that  we  have  an  ini- 
tiation fee  of  one  dollar  in  addition. 

Dr.  Geo.  W.  Long. — Dr.  Long's  motion 
has  been  adopted  and  I  can  submit  that  this 
matter  is  settled,  and  he  explicitly  and  ex- 
pressly stated  that  there  was  no  initiation 
fee,  but  that  each  member  should  pay  two 
dollars  in  advance. 

Dr.  Paulus  A.  Irving. — We  have  done 
this  thing  rather  hurriedly.  I  don't  think 
the  gentlemen  have  considered  the  matter. 
You  haven't  got  enough  money  now  to  run 
this  Society.  If  you  undertake  to  print 
transactions,  though  it  has  not  been  [deter- 
mined yet  whether  you  will  do  that, then  the 
two  dollars  initiation  fee  won't  print  the 
transactions,  won't  pay  the  postage  or  buy 
stamps,  or  anything  of  that  sort.  I  think 
we  had  better  reconsider,  and  as  a  silent 
voter,  I  move  a  reconsideration.  I  have 
just  been  talking  with  Dr.  Register  here, 
and  he  says  it  will  take  at  least  three  hun- 
dred dollars  to  print  the  transactions.  Now. 
there  is  quite  an  element  here  who  favor 
printing  transactions.  If  you  don't  want 
transactions  printed,  you  need  not  recon- 
sider the  motion. 

Dr.  Geo.  \Y.  Long. — 1  understood  we 
werer  not  going  to  have  transactions.  I 
will  admit  it  will  cost  a  great  deal  of 
money. 

President  Cobb. — We  can  determine  that 
on  the  vote  of  reconsideration. 

Dr.  Geo.  W.  Long. — Provided  these  re- 
considerations are  made  by  men  who  have 
voted  in  the  affirmative. 

Dr.  Geo.  Ben.  Johnson. — The  question 
of  publishing  transactions  is  one,  it  seems  to 
ine,  that  we  will  come  to  a  little  later  on. 
The  Council  after  canvassing  this  matter 
will  make  a  recommendation  to  the  Associa- 
tion. If  the  Council  deem  it  desirable  that 
the  Association  should  publish  transactions 
and  make  that  recommendation,  it  is  a  per- 
fectly simple  thing  for  the  Association  to 
rescind  the  action  based  upon  Dr.  Longs 
motion  and  to  increase  the  initiation  fee. 
I  think  it  desirable,  therefore,  in  order  that 
our  business  may  be  expedited,  that  we  pass 
this  matter  for  the  present  with  the  under- 
standing that  if  it  becomes  desirable  to  take 
it  up  latter  we  can  do  so. 

Dr.  Irving  accepted  Dr.  Johnson's  sug- 
gestion and  withdrew  his  motion. 


Dr.  Upshur. — I  suggest  that  as  a  result 
of  a  good  many  years  observation  of  the 
cost  of  Medical  Societies  and  other  societies, 
there  is  absolutely  no  more  unpopular  thing 
than  the  raising  of  dues  after  they  have 
been  fixed.  It  is  very  popular  to  lower 
dues,  but  very  unpopular  to  raise  dues. 
The  whole  thing  turns  upon  what  amount 
Of  money  the  Society  will  require  and  to 
fix  the  annual  dues  at  such  an  amount  as 
will  answer  the  demands. 

Dr.  Barringer  read  "Each  member  shall 
pay  an  annual  fee  of  two  dollars  in  advance," 
as  being  the  vote  of  the  Society  as  the  Com- 
mittee understood  it,  and  stated  that  if  any 
change  was  desired,  of  course  the  committee 
was  at  the  order  of  the  Society. 

Dr.  White. — The  only  thing  is  to  decide 
if  we  shall  have  an  initiation  fee.  I  move 
simply  one  dollar  as  an  initiation  fee.  Per- 
sonally, it  makes  nodifference  to  me  whether 
it  is  one,  two,  three  or  five  dollars.  We 
should  fix  it  at  such  a  sum  as  is  necessary 
to  get  the  amount  needed.  I  am  willing  to 
accept  any  amendment  to  my  motion  that 
any  member  wishes  to  make,  so  we  have 
some  initiation  fee. 

Dr.  Johnston. — We  have  the  dues  set 
forth  already,  and  it  seems  to  me  we  have 
put  the  cart  before  the  horse.  We  don't 
know  what  our  needs  will  be  until  we  de- 
termine what  our  work  is  going  to  be,  and 
I  think,  therefore,  all  this  talk  is  superflu- 
ous. We  might  as  well  go  on  and  adopt 
our  Constitution  and  By-Laws,  and  when 
we  ascertain  what  our  needs  will  be  we  can 
provide  for  them. 

Dr.  Upshur. — I  move  the  action. of  two 
dollars  be  rescinded  until  we  adopt  the  By- 
Laws  and  find  out  what  the  needs  of  the 
Society  will  be.     Then  we  can  fix  the  dues. 

Pres't  Cobb. — It  is  moved  and  seconded 
that  the  action  fixing  the  fee  at  two  dollars 
in  advance  be  rescinded. 

The  question  was  so  put  before  the  So- 
ciety, and  the  vote  appearing  to  be  about 
the  same  for  and  against  it,  a  division  was 
called  for. 

Dr.  Upshur. — I  would  like  to  say  by  way 
of  explanation,  I  do  not  wish  to  delay  the 
proceedings  at  all,  but  simply  to  get  at  this 
thing  in  a  business  way.  We  are  obliged 
to  have  a  certain  amount  of  money  to  con- 
duct the  business  of  this  society,  and  if  we 
go  to  work  and  fix  the  dues  and  initiation 
fees  at  a  certain  sum,  and  then  have  a  cer- 
tain amount  of  work  to  be  done,  and  then 
your  dues  don't  amount  to  that,  you  start 
out  with  a  debt  on  the  Society.  It  seems 
to  me  it  is  simply  a  business  principle  to 
have  an  income  which  is  commensurate 
with  what  we  need  that  income  for.  When 
we  know  what  we   want  to   do,  we  will  be 


248 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


in  a  position  to  know  what  those  dues  shall 
be.  They  should  be  as  low  as  they  can  be 
for  defraying  the  expenses  of  the  .Society 
and  keeping  it  out  of  debt. 

Pres't  Cobb. — We  have  wasted  a  great 
deal  of  time  on  this.  Dr.  Upshur's  motion 
is  very  much  to  the  point.  All  favoring 
the  motion  to  pass  over  that  portion  of  the 
By-Laws  referring  to  initiation  fee,  as  a 
division  was  called  for,  will  please  say 
"aye." 

The  motion  was  carried. 

Pres't  Cobb. — What  is  the  next  section 
on  which  the  Committee  wishes  instruction? 

Dr.  Barringer. — I  believe  there  is  no  other 
section  in  doubt.  When  we  bring  in  the 
report,  we  will  endeavor  to  bring  in  two 
forms,  one  with  transactions  and  fee  that 
shall  embrace  transactions,  and  one  a  fee 
that  shall  embrace  the  lowest  possible  amount 
on  which  the  Society  can  run  without  trans- 
actions. 

Paper  was  read  by  Dr.  A.  B.  Knowlton, 
of  Columbia,  S.  C.,  on  "Simultaneous 
Blood-washing  and  Blood-letting  in  Urae- 
mia." 

"A  Plea  for  the  Earlier  Recognition  of 
Pulmonary  Consumption,"  was  the  title  of 
the  next  paper,  read  by  Dr.  Louis  F.  High, 
of  Danville,  Va. 

Dr.  James  M.  Parrot,  Kinston,  N.  C, 
read  a  paper  on  "The  Treatment  of  Urethral 
Discharges." 

A  paper,  "Remarks  on  the  Relation  of 
Diet  to  Hay  Fever  and  Asthma,"  was  read 
by  Dr.  John  Dunn,  of  Richmond,  Va. 

Dr.  Geo.  W.  Long,  of  Graham,  N.  C, 
read  a  paper  on  "Appendicitis  Complica- 
ted with  Intestinal  Perforation." 

Dr.  W.  L.  Robinson,  of  Danville,  Va., 
read  a  paper  on  "Diagnosis  and  Treatment 
of  Tubercular  Peritonitis." 

The  Society  adjourned  to  meet  at  10 
o'clock  on  Thursday  morning. 

THURSDAY    MORNING. 

At  10  130  o'clock  Pres't  Cobb  said  :  The 
Tri-fitate  Association  will  please  come  to 
order.  The  first  business  in  order  is  the 
report  of  the  committee  on  Constitution  and 
By-Laws. 

Dr.  J.  G.  Tompkins. — That  report  has  all 
been  adopted  with  the  exception  of  the 
amount  of  the  fee,  and  we  can't  decide  on 
that  until  we  ascertain  from  the  Association 
about  what  the  expenses  will  be.  If  it  is 
decided  that  the  Proceedings  of  the  Asso- 
ciation are  to  be  published  in  pamphlet 
form,  it  will  take  more.  I  am  the  only  re- 
presentative of  the  committee  here,  and  we 
can't  do  anything  with  regard  to  that  fee 
until  we  get  the  sense  of  the  Association  as 
to  whether  or  not  the  Proceedings  shall  be 


printed  in  pamphlet  form.  In  addition  to 
printing  the  Proceedings,  or  Transactions, 
etc.,  the  By-Laws  and  Constitution  will 
have  to  be  printed,  and  we  will  have  to 
make  a  calculation  on  that  before  we  can 
judge  about  what  the  fee  will  be. 

Dr.  J.  N.  Upshur. — Mr.  President,  to  put 
this  thing  in  shape  before  the  Society  I 
would  move,  Sir,  that  the  Transactions  of 
the  Society  shall  be  printed. 

This  motion  was  seconded,  and  Dr.  Up- 
shur continued  : 

I  have  thought  very  maturely  on  that  sub- 
ject, and  I  am  satisfied  that  it  is  a  thing 
necessary  absolutely  to  the  well-being  of  the 
Society  that  its  Proceedings  shall  be  printed. 
In  the  first  place,  a  great  many  of  the  Socie- 
ties, the  State  .Societies  at  least  and  I  believe 
the  Tri-State,  many  of  them,  do  print  their 
transactions.  To  print  the  transactions  and 
put  the  Proceedings  of  the  Society  in  com- 
pact form  is  of  very  great  value  to  the  mem- 
bers of  the  Society  at  any  time  that  they 
may  want  to  refer  to  any  paper  which  may 
be  read  before  the  Society  for  any  purpose, 
either  for  practical  use  as  in  connection 
with  the  work  in  cases  to  which  it  might 
bring  them  help.  If  those  papers  are  sim- 
ply published  in  the  journals,  they  are  scat- 
tered, and  it  is  impossible  for  him  to  keep 
track  of  the  papers  where  they  are  published. 
No  man  can  do  that.  It  is  a  valuable  col- 
lection to  any  man's  library  to  have  these 
papers  for  reference,  so  it  is  important  to 
us  as  members  of  the  Society  to  have  these 
papers  in  compact  form  for  personal  use. 
But  there  is  a  reason  which  to  my  mind  is 
more  urgent  than  that,  and  it  is  that  for  a 
Society  to  print  its  transactions  gives  it  dig- 
nity and  place  and  position  with  the  other 
sister  Societies  throughout  the  country,  and 
I  don't  see  how  we  can  take  the  rank  we 
ought  to  take  unless  these  transactions  are 
put  in  such  shape  as  to  bring  the  work  of 
this  Society  materially  and  clearly  before 
our  Associations  throughout  the  country 
who  are  going  to  inspect  and  pass  upon  and 
review  the  proceedings  of  the  Society.  So 
I  believe  it  is  an  absolute  necessity  for  the 
vital  well-being  of  this  Society  that  their 
transactions  shall  be  printed. 

Dr.  Hugh  T.  Nelson. — Mr.  President,  I 
think  what  Dr.  Upshur  says  is  true  in  a 
great  many  respects,  but  I  saw  yesterday 
that  there  was  a  very  serious  objection  to 
the  publication  of  transactions.  We  are 
just  now  beginning  to  organize,  and  the 
probabilities  are  that  in  pushing  a  measure 
of  this  kind,  it  is  going  to  make  our  initia- 
tion fee  or  our  annual  dues  rather  a  burden- 
some matter,  that  we  are  going  to  do  harm 
to  our  organization  in  its  very  attempt  at 
organization,  and  for  that  reason  I  do  not 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


249 


think  this  question  ought  to  be  put  at  the 
present  time.  It  is  true  that  the  transac- 
tions would  be  valuable  on  the  shelves  of 
our  libraries  as  a  matter  of  reference,  and  it 
would  be  a  matter  or  pleasure  to  me  to  have 
a  volume  in  compact  form,  printing  every 
paper  that  is  read.  But  it  would  entail  an 
expense  that  we  can't  consider.  It  is  not 
going  to  be  done  witli  a  less  fee  than  five 
dollars  a  year.  This  would  drive  men  away 
from  the  Society,  because  the  gentlemen 
who  oppose  this  Society  are  members  of 
three  or  four  Societies,  State,  county,  and 
others,  and  for  that  reason,  while  I  would 
like  to  have  these  transactions  in  a  compact 
form  on  the  shelves  of  my  library  for  refer- 
ence, I  am  opposed  for  the  reasons  I  have 
stated  to  having  proceedings  published. 

Dr.  J.  A.  Burroughs. — I  am  a  modest 
gentleman  and  seldom  have  anything  to  say. 
But  it  is  my  idea  that  it  will  be  a  mistake 
for  the  Medical  Society  not  to  have  its 
transactions  published  in  pamphlet  form. 
I  want  to  say  in  the  beginning  that  I  have 
no  paper  to  read  at  this  Society,  and  I  hope 
it  will  be  many  a  day  before  I  will  have 
one  ;  but  if  we  don't  publish  the  transactions 
of  the  Society,  the  papers  will  be  scattered 
and  will  be  lost,  and  we  will  not  get  a  large 
membership,  and  it  will  be  difficult  for  us 
to  get  papers.  If  we  want  to  make  this 
Society  a  useful  organization,  not  only  to 
members  but  to  others  who  may  chance  to 
have  the  transactions,  we  must  have  the 
proceedings  of  this  meeting  published  in 
pamphlet  form,  just  as  our  Tri-State  and 
our  State  organizations  have  published,  and 
we  will  prize  the  copies  highly  and  keep 
them  in  our  libraries,  and  especially  the 
charter  members  of  this  Association  will 
prize  those  copies.  I  for  one,  sir,  am  in 
favor  of  making  the  initiation  fee  as  it  is  in 
several  organizations  that  I  belong  to,  five 
dollars  including  the  first  annual  dues,  the 
first  year's  dues.  I  doubt  if  that  will  cover 
all  the  expense.  The  men  who  have  joined 
this  Society,  I  unhesitatingly  say,  are 
public  sprited  men  of  the  profession  of  three 
different  States.  They  are  men  who  will 
not  stand  on  the  difference  of  three  dollars 
in  regard  to  having  the  transactions  pub- 
lished, but  are  men  who  are  willing  to  pay 
it  and  glad  to  pay  it  in  furthering  the  in- 
terests of  the  medical  profession.  And  I 
want  to  put  a  motion  to  the  Society  if  it  is 
in  order,  and  I  want  to  put  myself  on  record 
as  supporting  the  five  dollar  admittance  fee 
including  the  first  year's  annual  dues. 

Dr.  Hunter  McGuire. — I  think  we  will 
make  a  mistake  in  not  printing  our  transac- 
tions. It  would  show  a  lack  of  dignity 
and  strength  that  would  be  fatal.  In  the 
first    place,    a    great    many  men     wouldn't 


write  a  paper  and  come  here  and  read  it  to 
an  afternoon  assembly  of  a  very  few  mem- 
bers. It  would  hardly  pay  that  man  to  go 
to  the  trouble  to  write  a  good  paper  to  have 
it  wasted  in  that  way.  I  think  we  would 
start  out  with  the  greatest  mistake  we 
could  possibly  commit  not  to  direct  that  our 
transactions  be  published. 

Dr.  I.  W.  Faison. — I  haven't  signed  the 
register  yet,  but  I  think  I  will,  and  I  want 
to  rise  to  second  Dr.  Upshur's  motion.  1 
think  it  is  right  and  proper  that  every 
Society  should  publish  its  transactions.  We 
can  publish  our  transactions  in  pamphlet 
form  to  start  with  and  they  can  be  bound 
afterwards.  We  can  publish  them  at  quite 
a  normal  fee.  There  is  no  need  of  the 
transactions  of  this  Society  costing  over  a 
hundred  or  a  hundred  and  twenty-five  dollars. 
There  are  a  great  many  societies  starting 
anew  as  this  one  has  that  failed  to  publish 
transactions,  and  would  give  five  times 
what  they  cost  to  have  them  now.  There- 
fore I  think  this  .Society  should  learn  in  en- 
lightened day  that  it  is  almost  necessary  to 
publish  their  transactions,  and  the  Society 
will  always  be  grateful  to  itself  if  it  should 
publish  its  transactions. 

Dr.  Chas.  W.  Kollock. — I  don't  think 
we  can  consider  for  a  moment  not  publish- 
ing transactions  of  some  kind.  It  will 
never  do  for  the  papers  to  be  scattered 
throughout  the  journals  and  we  will  never 
get  them  together  and  they  will  never  do 
this  Association  any  good.  Members  wish- 
ing to  come  in  want  to  see  the  transactions. 
We  would  have  to  say,  "We  have  no 
transactions."  Then  again  it  seems  to  me 
there  are  only  two  plans  which  we  can  con- 
sider, either  publishing  them  in  the  form  of 
Transactions,  or  in  one  of  the  three  journals, 
then  the  members  who  want  them  would 
have  to  subscribe  to  tbat  journal  which 
would  amount  in  the  end  to  what  they 
would  have  to  pay  for  the  transactions,  and 
then  that  would  "hardly  be  a  feasible  plan 
unless  the  journal  was  known  as  the  Journal 
of  the  Tri-State  Medical  Association.  I 
can  only  say  that  as  far  as  the  expense  is 
concerned,  we  have  only  two  or  three  hun- 
dred members  of  our  State  Society.  Our 
annual  dues  are  three  dollars  a  year,  and  we 
have  now  about  a  thousand  dollars  in  the 
bank  above  al!  expenses,  and  our  transac- 
tions were  printed  without  any  advertise- 
ments on  the  back  of  the  cover. 

Dr.  Upshur.— I  would  like  to  ask  Dr. 
Earnest  Levy  if  he  can  make  a  statement 
of  what  would  be  the  cost  of  two  hundred 
and  fifty  copies  of  the  transactions.  He  is 
the  editor  of  a  medical  journal  and  in  touch 
with  printing  and  can  give  us  some  practical 
information  on  the  subject  that  would  give 


250 


THE  CHARLOTTE   MEDICAL  JOURNAL. 


us  something  to  work  on.  We  have  on  our 
roll  about  one  hundred  and  fifty  members. 
The  five  dollars  annual  dues  would  give  us 
an  income  of  certainly  six  hundred  dollars 
allowing  for  those  who  fail  to  pay, and  I  am 
inclined  to  think  that  the  publication 
of  that  number  of  transactions  could  be 
done  inside  of  that  figune  without  any  diffi- 
culty to  the  Society  and  leave  a  balance  in 
the  treasury  which  would  defray  the  other 
current  expenses  of  postage,  etc. 

Dr.  Levy. — Replying  to  Dr.  Upshur's 
injuiry,  I  would  say  it  all  depends  on  the 
number  and  size  of  these  transactions.  I 
would  say  it  would  cost  about  $1.50  or  $1.25 
a  page  of  the  common  long  primer  type.  I 
don't  see  that  it  could  be  less.  One  thing 
about  our  present  meeting  is  that  the  volume 
of  our  transactions,  owing  to  the  large 
number  of  papers,  is  certainly  going  to  be 
utterly  unproportionate  to  our  present 
membership.  Other  Societies  with  two, 
three,  four,  or  even  six  times  the  member- 
ship that  this  Society  has  have  not  large 
volumes  of  transactions.  I  should  think 
the  volume  of  our  transactions  this  year 
would  certainly  come  up  to  250  or  300  pages, 
and  would  cost  certainly  not  less  than  two 
hundred  and  fifty  dollars  this  year.  This 
would  be  my  estimate  on  it  and  it  would 
probably  be  nearer  three  hundred  dollars. 

Dr.  Hugh  M.  Taylor.— I  think  the  Society 
is  convinced  that  it  is  in  debt  already  in 
sending  out  letters,  stamps,  etc.  Dr. 
Irving  told  me  yesterday  that  we  owe  about 
eighty  dollars  now.  I  think  the  program 
of  this  society  is  probably  as  long  as  that  of 
our  State  Society.  The  transactions  of  our 
State  Society  cost  between  $600.00  and 
$700.00. 

Dr. Levy. — The  cost  of  publishing  a  larger 
number  would  not  be  proportionately  large, 
as  the  great  cost  is  that  of  sitting  up  the 
type.  The  additional  number  of  volumes  is 
simply  the  additional  cost  of  paper,  press 
work  and  binding. 

Dr.  Taylor. — I  do  not  think,  Mr.  Presi- 
dent, we  will  diffuse  an  interest  in  this  So- 
ciety by  publishing  transactions.  What  I 
mean,  we  will  publish  a  limited  number  of 
transactions  that  will  be  a  benefit  to  our  So- 
ciety. The  American  Medical  Association 
and  a  number  of  other  Societies  do  not  pub- 
lish transactions.  1  am  perfectly  willing  to 
publish  them,  but  I  think  we  will  be  simply 
in  debt  if  we  start  out  on  a  less  sum  than 
$500.00. 

Dr.  James  M.  Parrott. — I  think  as  a  mat- 
ter of  historic  record  we  ought  to  publish 
the  records  of  this  Society.  A  few  years 
from  now  we  would  like  to  have  a  record 
of  these.  In  reference  to  the  cost,  accord- 
ing to  Dr.  Levy's   estimate,  I  should  think 


we  could  publish  the  transactions  for  $400, 
and  that  with  a  membership  of  a  hundred 
and  fifty  at  five  dollars  each  would  give  us 
a  revenue  of  $750.  I  think  it  is  our  duty 
to  publish  transactions. 

Dr.  W.  L.  Robinson. — If  we  don't  start 
right  in  this  business  we  are  going  out,  and 
it  looks  like  a  picayunish  piece  of  business 
to  start  without  any  transactions.  It  seems 
to  me  that  with  150  members  at  $5  apiece, 
we  ought  to  publish  250  or  150  copies  of 
our  proceedings.  Now,  another  thing  we 
have  talked  about  here  is  the  number  of  pa- 
pers we  have  got.  The  majority  are  very 
short  papers,  not  many  of  them  are  long 
papers.  A  great  many  of  them  have  not 
come  in.  Some  of  them  have  never  been 
written,  and  you  will  find,  I  am  satisfied, 
that  when  you  come  to  publish  these  things 
you  will  not  have  such  a  large  volume. 
And  I  do  hope  this  Society  will  uphold  its 
dignity  and  have  its  transactions    printed. 

Dr.  Robinson's  remarks  were  heartily 
applauded. 

Pres't  Cobb  then  put  Dr. Upshur's  motion 
before  the  Society  that  the  Society  should 
publish  its  proceedings  annually,  and  the 
motion  was  carried. 

Dr.  LTpshur. — I  move  to  carry  out  this 
idea  that  the  assessment,  the  dues,  of  this 
Society  shall  be  five  dollars  per  year  and  no 
initiation  fee  charged. 

Dr.  Levy, — I  think  this  is  an  equally  seri- 
ous question  with  the  other.  We  have  quite 
a  problem  before  us.  If  we  have  a  high 
initiation  fee  we  must  count  on  a  small 
membership  for  the  Society.  On  the  con- 
trary, with  a  low  annual  due  we  can  safely 
count  on  a  large  membership,  and  will  pro- 
bably get  in  the  same  amount  of  money  with 
a  small  fee  that  we  would  otherwise  with  a 
large  fee,  and  would  in  addition  have  a 
membership  that  would  be  a  credit  to  an 
organization  of  this  character.  I  think  it 
ought  seriously  to  be  considered  whether  it 
is  not  to  our  advantage  to  have  a  low  fee 
with  a  large  membership  rather  than  a  small 
membership  with  a  high  fee. 

Dr.  Upshur. — I  want  to  say  one  word. 
It  is  not  human  nature, we  don't  appreciate 
anything  we  don't  pay  for,  and  the  man 
who  wants  to  belong  to  this  Society  is  wil- 
ling to  pay  five  dollars  to  do  it,  and  a  great 
many  good  men  will  join  this  Society  and 
pay  the  dues  of  five  dollars  cheerfully.  The 
fees  of  our  local  Society  in  Rhichmond  are 
six  dollars  a  year  and  there  are  twenty-four 
meetings  a  year.  We  don't  have  any  trans- 
actions published  at  the  end  of  the  year, 
either,  and  this  thing  of  charging  a  dollar, 
or  two  dollars,  is  a  thing  perfectly  absurd. 
The  members  of  this  Society  will  take  an 
interest  in  it  and  we  will  have  a  good  mem- 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


251 


bership  at  a  fee  of  five  dollars.  I  think  less 
than  that  would  be  inconsistent  with  the 
dignity  of  the  Society,  and  this  will  give  us 
a  revenue  that  will  enable  us  to  do  what  is 
necessary  and  compatible  with  the  dignity 
of  the  Association. 

Dr.  White. — I  move  to  amend  the  motion 
and  make  the  annual  fee  three  dollars  and 
the  initiation  fee  two  dollars,  which  I  am 
satisfied  will  give  us  more  money  in  the  end 
than  the  five  dollars  dues.  A  great  many 
men  whom  we  would  like  to  have  in  this 
Society  will  stay  out  simply  on  account  of 
the  five  dollar  fee, men  to  whom  two  dollars 
is  a  matter  of  some  moment,  and  I  therefore 
move  to  amend  that  proposition  and  make 
the  annual  dues  three  dollars  and  the  initia- 
tion fee  two  dollars. 

Dr.  Upshnr. — I  will  accept  that  amend- 
ment. 

Pres't  Cobb  submitted  Dr.  Upshur's  mo- 
tion, as  amended  by  Dr.  White,  that  the 
annual  dues  should  be  three  dollars  and  the 
initiation  fee  two  dollars.  The  motion  pre- 
vailed. 

Dr.  J.  W.  Long. — I  want  to  ask  the  priv- 
ilege of  introducing  to  this  Society  one  of 
North  Carolina's  most  distinguished  sons, 
an  ex-President  of  the  Nortli  Carolina  Med- 
ical Society,  a  surgeon  who  is  well  known 
not  only  in  the  State  but  outside  of  our 
State — Dr.  H.  T.  Babnson,  of  Salem. 

Dr.  Bahnson. — I  am  certainly  obliged  to 
Dr.  Long  for  what  lie  meant,  and  I  accept 
the  courtesy  witli  a  great  deal  of  pleasure. 
though  1  came  rather  to  hear  than  to  be 
heard. 

Pres't  Cobb. — I  extend  to  you  the  cour- 
tesy of  the  floor,  and  will  be  glad  to  hear 
from  you  at  any  time.  Can  the  Committee 
make  its  report  now? 

Dr.  J.  G.  Tompkins. — I  am  the  only 
member  present  and  would  like  to  ask  time 
to  report  at  the  afternoon  session. 

There  being  no  objection,  it  was  ordered 
that  the  report  be  deferred  until  the  after- 
noon session,  and  the  Society  proceeded  to 
the  regular  order  of  business. 

Dr.  David  A.  Stanton,  of  High  Point, 
N.  C,  read  paper,  subject  :   '-Dystocia." 

Dr.  J.  G.  Tompkins-  submitted  the  only 
clause  of  the  Constitution  that  had  not  been 
adopted,  relative  to  the  time  of  paying  an- 
nual dues,  to  the  effect  that  any  member 
who  shall  fail  to  pay  his  annual  dues  within 
one  year  shall  lose  his  membership. 

The  Constitution  was  then  adopted  as  a 
whole. 

Dr.  Upshur. — I  move  that  we  go  into  the 
election  of  an  Executive  Council.  The  pro- 
bability is  that  the  Society  will  get  through 
with  its  work  this  afternoon,  and  if  we  de- 
lay the    election  of    the    Executive  Council 


until  this  afternoon,  we  will  be  very  much 
hampered,  because  this  Council  will  have 
to  report  the  nominations  for  officers,  and 
if  this  Executive.  Council  is  elected  this 
forenoon  they  will  be  ready  to  report  this 
afternoon,  and  the  business  of  the  Society 
will  be  facilitated.  I  therefore  move  that 
we  go  into  an  election  of  the  Executive 
Council. 

Dr.  Upshur's  motion  was  carried,  and 
the  committee  was  requested  to  read  that 
portion  of  the  Constitution  referring  to  this 
election. 

Dr.  Barringer  read  for  the  committee, 
"The  Executive  Council  shall  consist  of 
nine  members,  three  from  each  State,  and 
from  those  elected  at  the  primary  meeting 
three  shall  serve  three  years,  three  shall 
serve  two  years,  and  three  shall  serve  one 
year."  The  length  of  terms  is  to  be  deter- 
mined by  the  number  of  votes  received,  but 
always  the  members  of  the  Council  shall 
consist  of  three  from  each  State.  As  a 
member  of  the  committee,  I  would  call  the 
attention  of  the  Society  to  this. 

Dr.  Kollock  nominated  from  .South  Caro- 
lina, Dr.  J.  G.  Tompkins,  Dr.  S.  C.  Baker 
and  Dr.  A.  B.  Knowlton. 

Dr.  LTpshur  nominated  from  Virginia, 
Dr.  Paul  Barringer,  Dr.  Hugh  M.  Taylor 
and  Dr.  George  Ben.  Johnston. 

Dr.  Barringer. — One  member  shall  be 
elected  from  each  State  to  serve  three  years. 
There  must  be  in  the  primary  election  a 
differentiation,  as  there  must  be  one  man 
from  each  State  for  three  years.  As  I  un- 
derstand it — I  speak  without  conferring 
witli  other  members  of  the  committee — the 
man  getting  the  highest  number  of  votes 
shall  serve  three  years,  the  man  the  next 
highest  number  shall  serve  two  years,  and 
the  man  who  gets  the  next  highest  number 
shall  serve  one  year.  The  result  is  that 
there  will  be  a  vacancy  from  each  State  of 
one  member  of  that  Council  each  year. 

Dr.  Crowell. — It  seems  that  there  is  no 
one  to  say  anything  from  North  Carolina. 
I  think  I  shall  put  in  nomination  Dr.  E.  C. 
Register,  Dr.  D.  A.  Stanton,  and  Dr.  John 
Whitehead,  of  Salisbury. 

Other  nominations  were  made  as  follows  : 

From  South  Carolina — Dr.  C.  W.  Kol- 
lock. 

From  North  Carolina — Dr.  J.  C.  Wal- 
ton, Dr.  W.  H.  H.  Cobb,  Dr.  J.  W.  Long. 

From  Virginia — Dr.  A.  S.  Priddy,  Dr. 
Hugh  T.  Nelson,  and  Dr.  W.  L.  Robinson. 

Dr.  George  Ben.  Johnston. — When  this 
organization  was  first  spoken  of  there  was 
some  opposition  to  it  in  Virginia,  and  I  dare 
say  the  same  kind  of  opposition  was  felt  in 
North  and  South  Carolina.  The  President 
alluded  to  this  in  his  address  of  yesterday. 


252 


THE  CHARLOTTE  MEDICAL  JOURNAL 


It  was  charged  by  those  who  opposed  the 
organization  that  this  Society  was  gotten 
up  for  the  benefit  of  medical  schools  and 
specialists.  I  was  somewhat  unwilling  to 
go  into  this  organization  in  the  outset,  be- 
cause I  really  did  not  see  that  there  was 
any  necessity  for  the  formation  of  a  Society 
of  this  kind.  However,  later  on  I  became 
convinced  that  this  Society  could  exercise  a 
good  influence ;  that  it  could  be  made  a 
valuable  Society,  and,  therefore,  I  consent- 
ed to  join,  and  I  am  more  than  delighted  at 
the  prospects  I  have  witnessed  since  attend- 
ing this  initial  meeting.  Now,  in  order 
that  this  charge  may  be  disproved,  I  think 
it  proper  that  these  gentlemen  who  made  it 
should  see  that  such  was  not  intended.  The 
three  first  nominated  are  all  professors  in  the 
medical  colleges  of  Virginia,  and  I,  there- 
fore, want  to  request  Dr.  Upshur  to  with- 
draw my  nomination  as  a  member  of  this 
Council. 

Dr.  Barringer. — Before  the  Doctor  an- 
swers that  request,  I  want  to  say  that  I 
agree  perfectly  with  Dr.  Johnston,  and  Dr. 
Johnston's  views  have  expressed  so  fully 
my  own  feelings  with  regard  to  the  matter 
that  1  will  say  nothing  more  than  to  request 
Dr.  Upshur  also  that  lie  will  withdraw  my 
name. 

Dr.  Hugh  M.  Taylor. — I  attach  no  im- 
portance to  the  petty  little  insinuations  that 
have  been  mentioned  in  this  connection. 
At  the  same  time,  the  matter  of  who  is 
elected  is  certainly  a  matter  of  no  small  mo- 
ment to  the  Society,  and  I  wish  to  add  my 
request  to  what  Dr.  Barringer  has  said  and 
request  Dr.  Upshur  to  withdraw  my  name. 

Dr.  Upshur. — It  gives  me  great  pleasure, 
Sir,  to  comply  with  the  requests  of  these 
gentlemen.  In  doing  so,  I  would  say  in 
justice  to  myself  and  in  justice  to  my  col- 
league, Dr.  Johnston,  as  well  as  Dr.  Bar- 
ringer and  Dr.  Taylor,  I  wish  to  emphati- 
cally disavow  here  that  the  idea  that  a  medi- 
cal school  existed  anywhere  in  the  State  of 
Virginia  was  in  my^mind  when  I  made 
these  nominations,  that  I  did  it  from  the 
simple  fact  that  I  thought  I  had  selected 
men  who  had  hustle  and  go  in  them  and 
ability  to  work  in  this  Executive  Council. 
I  knew  what  was  in  Dr.  Johnston  in  the 
matter  of  organization  and  ability  for  the 
purposes  of  this  Executive  Council  and  be- 
lieve he  would  be  a  valuable  man,  and  I  be- 
lieved Dr.  Barringer  and  Dr.  Taylor  would 
also  be  valuable  men,  but  I  am  the  last  man 
anywhere  with  a  suggestion  even  that  medi- 
cal colleges,  or  anything  that  has  got  to  do 
with  medical  colleges  should  come  into  tl 
Society.  They  are  fully  able  to  take  care 
of  themselves,  I  believe.  The  Medical  Col 
lege  of  Virginia  is  able  to  take  care  of  itself 


and  the  medical  profession  are  paramount 
to  petty  quarrels  or  insinuations  or  anything 
connected  with  medical  schools  or  indi- 
vidual medical  men,  and  it  is  for  the  ad- 
vancement and  the  good  and  the  welfare 
of  the  profession  and  as  a  help  in  the  dis- 
charge of  their  duty  to  humanity  that  these 
medical  organizations  are  organized,  and  by 
God's  help  will  be  pushed  to  a  successful 
issue. 

Dr.  Weaver. — I  think  it  very  proper  that 
the  Western  section  of  North  Carolina  be 
represented  on  this  Council,  therefore  I  put 
in  nomination  Dr.  Burroughs,  of  Asheville. 

Dr.  J.  C.  Walton. — I  believe  we  ought  to 
exercise  some  wisdom,  as  our  Virginia  breth- 
ren have  acted  so  nobly  in  the  matter  of  the 
selection  of  this  committee,  and  I  think  it 
best  to  nominate  one  from  each  section  of 
the  State.  We  have  Dr.  Burroughs,  a  good 
man  from  Asheville,  Dr.  Register  here  in 
Charlotte,  then  the  east  would  be  entitled 
to  some  man,  and  I  would  nominate  Dr. 
Oscar  McMullan. 

Dr.  Faison. — Dr.  McMullan  is   not  here. 

Dr.  Munroe. — I  would  like  to  make  one 
suggestion  on  the  matter  of  the  North  Caro- 
lina representation  and  the  geographical 
distribution  of  it,  and  as  we  want  a  man 
from  the  east  I  hope  that  the  Society  will 
vote  for  our  president. 

Dr.  Walton  withdrew  his  nomination  of 
Dr.  McMullan. 

Dr.  Burroughs. — I  wish  my  name  to  be 
withdrawn  and    Dr.  Weaver's  substituted. 

Dr.    Weaver We    will    not    submit    to 

that. 

Dr.  J.W.  Long. — I  think  my  friend,  Dr. 
Parrott,  nominated  me,  and  as  my  associate, 
Dr.  Whitehead,  has  been  nominated,  I  re- 
quest that  my  name  be  withdrawn. 

Dr.  Parrott. — I  will  state  for  Dr.  Long's 
benefit  that  the  reason  I  nominated  him  was 
because  Dr. Whitehead  was  not  present.  If 
Dr.  Long  will  consent,  I  will  refuse  to 
withdraw  his  name  on  that  ground.  If  he 
insists,  of  course  I  will  do  so,  Mr.  President. 

Dr.  Kollock  requested  that  his  name  be 
withdrawn. 

Dr.  Upshur. — If  you  want  who  is  present, 
I  would  nominate  Dr.  John  H.  Claiborne, 
of  Petersburg. 

Dr.  Levy. — There  being  only  three  nomi- 
nations from  Virginia,  it  has  just  occurred 
to  a  gentleman  here  who  has  asked  me  to 
put  it  before  the  meeting,  it  is  necessary  to 
ballot  on  these  three  men  on  account  of  the 
fact  that  the  one  getting  the  largest  number 
of  votes  will  serve  for  three  years,  etc. 

Dr.  Barringer. — I  see  the  difficulty  grow- 
ing out  of  the  nominations  from  Virginia, 
and    would  therefore  nominate  with  great 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


253 


pleasure  and  unction,  Dr.  Robinson, of  Dan- 
ville, and  Dr.  Upshur,  of  Richmond. 

Dr.  Upshur. — Did  I  understand  Dr.  Bar- 
ringer  to  nominate  me?  I  am  one  of  those 
unfortunate  people  in  a  medical  school  and 
I  couldn't  possibly  serve  after  having  made 
a  few  remarks  here  this  morning  on  the 
subject. 

Dr.  J.  M.  Fladger  was  put  in  nomination 
from  South  Carolina. 

Dr.  George  Ben.  Johnston. — I  want  to 
make  a  motion  in  reference  to  Virginia.  It 
is  not  likely  that  any  gentleman  who  is  in 
nomination  from  Virginia  will  receive  a 
larger  vote  than  the  others.  The  proba- 
bility is  that  the  three  candidates  will  come 
out  with  an  even  vote,  and  I  therefore  move 
that  the  Secretary  be  instructed  to  cast  the 
ballot  for  these,  and  that  they  draw  straws 
for  their  term,  the  gentleman  getting  t  la- 
longest  straw  to  serve  three  years,  the  next 
longest  two  years,  and  the  one  getting  the 
shortest  straw  to  serve  one  year. 

Dr. Upshur. — I  would  like  to  suggest  that 
in  drawing  those  straws  that  the  straws  be 
of  different  lengths  and  eacli  one  be  told 
which  is  his  straw. 

Dr.  White  moved  that  nominal  ion-  be 
clused. 

Secretary  Irving. — It  gives  me  great 
pleasure  to  cast  the  bollot  of  Virginia  for, 
Dr.W.  L.  Robinson,  Dr.  Hugh  T.  Nelson, 
and  Dr.  A.  S.   Priddy. 

Dr.  Priddy  said  that  as  he  was  the  young- 
est member,  he  would  take  the  short  term. 

Dr.  Robinson. — As  I  am  the  next  young- 
est member  I  will  take  the  two  year  term. 

Dr.  Johnston. — The  objection  these  gen- 
tlemen manifest  to  drawing  straws  is  more 
than  likely  due  to  the  fact  that  there  isn't  a 
julip  at  the  other  end  of  it. 

The  ballots  were  cast  for  members  of  the 
Executive  Council  from  North  and  South 
Carolina,  and  Dr.  Levy  moved  that  as  there 
were  some  papers  to  be  read  yet,  that  the 
tellers  be  allowed  to  retire  and  make  their 
report  later. 

Dr.  W.  T.  Woodley,  of  Charlotte,  had 
not  prepared  his  paper,  but  addressed  the 
Society  on  "Application  of  Electricity  to 
Diseases  of  Women." 

Dr.  J.  C.  Walton  and  Dr.  A.  B.Knowl- 
ton  discussed  Dr.  Woodley's  address. 

The  tellers  made  the  following  report  of 
election  of  Executive  Council : 

North  Carolina — Three  Vears  :  Dr.  J. 
W.  Long;  Two  Vears:  Dr.  J.  A.  Bur- 
roughs ;   One  'Sear  :   Dr.  E.  C.  Register. 

South  Carolina — Three  Vears  :  Dr.  S. 
C.  Baker ;  Two  Years  :  Dr.  J.  G.  Tomp- 
kins ;   One  Vear  :   Dr.  J.  M.  Fladger. 

Virginia — Three  Vears  :    Dr.  Hugh    T. 


Nelson  ;  Two  Years  :  Dr.  W.L.  Robinson  ; 
One  Year  :  Dr.  A.  S.  Priddy. 

On  motion  of  Dr.  J.  W.  Long,  it  was 
decided  that  this  committee  should  meet  in 
the  court  house  thirty  minutes  before  the 
afternoon  session. 

Dr.  L.  G.  Frazier,  of  Youngsville,  N.C., 
read  a  paper  on  "Ovaritis;  Acute  and 
Chronic." 

The  next  paper  on  the  program  was  that 
by  Dr.  Hunter  McGuire,  but  as  he  had  not 
expected  his  paper  to  be  called  so  early,  he 
had  left  it  at  the  hotel,  and  asked  permis- 
sion to  read  it  by  title,  or  to  read  it  at  the 
afternoon  session,  saying  that  he  preferred 
to  read  it  by  title  as  it  was  quite  long,  or 
he  would  now  give  a  synopsis  of  it. 

The  Society  voted  to  have  Dr.  McGuire 
read  his  paper  at  the  afternoon  session. 

Dr.  II.  B.  Weaver,  of  Asheville,  N.  C, 
read  a  paper  on  "Modern  Views  on  the 
Nature  and  Treatment  of  Pulmonary  Con- 
sumption." 

On  motion  of  Dr.  Barringer,  it  was  or- 
dered that  remarks  on  Dr.  Weaver's  paper 
be  deferred  and  made  a  special  order  for 
the  afternoon  session. 

Dr.  D.  O'Donoghue.— The  Charlotte 
Medical  Association  will  tender  a  banquet 
to  the  members  of  the  Tri-State  Association 
at  10  o'clock  at  the  Buford  Hotel.  Any 
member  who  wants  to  be  present  can  get 
tickets  at  Dr.  Register's  office. 

Secretary  Irving  read  the  following  com- 
munication : 

To  the  President  of  the  Tri-State  Medi- 
cal Association,  assembled  in  Charlotte,  N. 
C.  : — Dear  Sir :  Elizabeth  College  hereby 
extends  a  hearty  invitation  for  the  members 
of  the  Tri-State  Association  assembled  to 
visit  the  College  sometime  during  the  pre- 
sent sessioa  of  this  Association.  We  would 
consider  it  both  a  pleasure  and  an  honor  to 
receive  your  distinguished  body  at  the  Col- 
lege.    Most  respectfully, 

C.  B.  King,  President 
of  Elizabeth  College  for  Women. 

On  motion  of  Dr.  Kollock,  the  Society 
instructed  the  .Secretary  to  thank  the  Presi- 
dent of  the  College  for  his  kind  invitation. 

On  motion  of  Dr.  Barringer,  the  Society 
adjourned  to  meet  at  2   o'clock. 

THURSDAY    AFTERNOON. 

The  Society  was  called  to  order  at  3  130 
o'clock. 

The  first  business  was  the  discussion  of 
Dr.  Weaver's  paper,  which  had  been  de- 
ferred from  the  morning  session.  Drs. 
Levy,  Burroughs,  High,  McAnally  and  Up- 
shur discussed  this  subject,  the  discussion 
being  closed  by  Dr.  Weaver. 

Dr.  Munroe  moved  that  Dr.  McGuire  be 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


requested  to  read  the  paper  that  he  did  not 
have  with  him  before  dinner. 

Dr.  Hugh  T.  Nelson  asked  permission 
first  to  read  the  report  of  the  Executive 
Council :  There  was  full  attendance,  all 
nine  members,  three  from  each  State,  were 
present,  and  they  elected  Dr.  Hugh  T. 
Nelson,  Chairman,  and  Dr.  J.  W.  Long, 
.Secretary. 

The  Committee  made  the  following  nom- 
inations : 

President— Dr.  W.  II.  II.  Cobb;  Vice- 
President,  from  Virginia — Dr.  W.  L.  Rob- 
insou  ;  Virce-President,  from  South  Caro- 
lina—Dr.  C.  W.  Kollock  ;  Vice-President, 
from  North  Carolina — Dr.  H.  B.  Weaver; 
.Secretary — Dr.  Paulus  A.  Irving;  Treas- 
urer— Dr.  Paulus  A.  Irving. 

The  Council  recommends  that  the  Secre- 
tary and  Treasurer  be  allowed  the  actual 
expenses  connected  with  the  discharge  of 
his  official  duties ;  also,  that  the  temporary 
officers  be  reimbursed  for  the  expenses  they 
have  incurred  in  the  organization  of  the 
.Society. 

The  Council  further  recommends  that  the 
Society  hold  its  next  regular  meeting  in 
Charleston,  S.  C,  at  some  date  to  be  deter- 
mined upon  in  the  future  by  the  Executive 
Council. 

The  Committee  recommends  the  follow- 
ing as  the  subject  for  discussion  as  prescribed 
in  the  By-Laws,  for  the  next  annual  session  : 
The  Southern  Negro — 

(i)  His  Hereditary  Tendencies,  as  learn- 
ed from  his  race  history  in  America  and 
Africa. 

(2)  His  Racial  Fecundity;  the  influence 
of  climate,  city  and  country  life. 

(3)  His  Race  Mortality;  in  childhood, 
in  adult  life,  in  city  and  country. 

(4)  His  recent  erratic  tendencies;  the 
cause,  suggestions  as  to  prevention. 

Dr.  Nelson. — It  is  just  suggested  to  me 
by  a  member  of  the  committee  as  to  the  ex- 
pense of  having  the  two  offices  of  Secretary 
and  Treasurer,  would  incur  a  great  deal  of 
correspondence  between  the  two  officers  and 
an  extra  expense  that,  for  the  present  at 
least,  we  would  recommend  a  practical  con- 
solidation of  the  two  offices,  and,  therefore, 
we  thought  it  best  not  to  elect  two  officers, 
but  only  one.  In  our  judgment  it  seemed 
best  to  take  that  course. 

President  Cobb. — Gentlemen  of  the  Tri- 
State  Medical  Society,  you  have  heard  the 
report  of  the  committee.  All  the  report  is 
before  you  except  the  first  section. 

Dr.  Hugh  M.  Taylor  moved  that  the  re- 
port of  the  committee  as  a  whole  be  ac- 
cepted. 

Dr.  Nelson. — It  is  moved  and  seconded 
that  the    report  of    the  committee,   particu- 


larly the  first  part  of  it,  be  hereby  ratified 
by  this  convention. 

Dr.  Taylor's  motion,  as  seconded  by  Dr. 
Nelson,  was  unanimously  carried. 

President  Cobb. — I  am  not  a  speaking 
man.  It  is  an  honor  unexpected  and  an 
honor  undeserved.  I  heartily  thank  you 
for  this  expression  of  your  confidence,  and 
i  hope  you  will  bear  with  my  infirmities. 

Dr.  A.  S.  Priddy. — In  as  much  as  two  of 
the  three  temporary  officers  have  been  hon- 
ored by  re-election,  and  the  temporary  treas- 
urer was  not  re-elected  for  economic  reasons, 
I  move  that  the  thanks  of  this  Society  be 
tendered  Dr.  H.  H.  Dodson  for  his  efforts 
as  treasurer  of  the  temporary  organization 
for  effecting  permanent  organization. 

Dr.  Priddy's  motion  was  unanimously 
adopted. 

Dr.  H.  H.  Dodson. — 1  have  to  thank  the 
Society  for  the  action  in  this  matter,  and  I 
heartily  agree  with  the  committee  that  it 
was  the  best  thing  under  the  circumstances 
to  do,  and  as  for  the  labors  laid  upon  my- 
self they  were  certainly  very  light  as  you 
know.  I  have  not  much  cash  remaining  in 
my  hands. 

Dr.  Hunter  McGuire  read  his  paper  on 
Treatment  of  Cancer  of  the  Breast." 

Dr.  J.  W.  Long. — My  paper  is  next  on 
the  program,  and  while  it  would  take  only 
a  few  minutes  to  read  it,  I  recognize  the 
lateness  of  the  hour  and  that  there  are  quite 
a  number  of  distinguished  gentlemen  here 
from  a  distance,  so  with  your  permission,  I 
will  just  read  my  paper  by  title  and  give 
place  to  our  visitors. 

Dr.  George  Ben.  Johnston. — Dr.  White 
is  anxious  to  get  off  on  the  evening  train, 
and  if  you  will  allow  it  I  will  exchange 
places  on  the  program  with  Dr.  White. 

There  was  no  objection,  and  Dr.  J.  A. 
White,  of  Richmond,  read  paper.  Subject  : 
•'Headache — Ocular  and  Nasal." 

Discussed  by  Drs.  Kollock,  Kuyk,  Dunn 
and  Davidson. 

Dr.  George  Ben  Johnson  of  Richmond, 
read  Paper,  subject:  "Report  of  Two 
Cases  of  Nephrectomy. 

Discussed  by  Drs.  Robinson,  Flippen  ami 
Parrott. 

Dr.  Kollock,  read  a  paper,  being  "The 
Report  of  a  Case  of  Complete  and  Partial 
Ophtalmoplegia  of  the  Right  Eye." 

Dr.  Kollock  exhibited  two  photographs, 
one  taken  before  the  trouble  and  the  other 
showing  the  eye  after  the  trouble  had 
developed. 

Secretary  read  the  following  papers  by 
title  : 

Brief  Report  of  Cases :  by  Dr.  J.  S. 
Brown,  Salisbury,  N.  C. 

Some  Practical  Points  in  the  Treatment 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


265 


of  Diphtheria;  by  Dr.  R.  D.  Garcin,  Rich- 
mond,Va. 

The  Medical  Examining  Boards  of  North 
Carolina  and  Virginia,  Their  Relation  to 
Each  Other  and  the  Profession  ;  by  Dr.  A. 
S.  Priddy,  Keysville,  Va. 

State  Institutions  for  Epileptics;  Dr.  W. 
F.  Drewry,  Petersburg,  Va. 

Examination  of  Feces  as  Aids  to  Diagno- 
sis; Dr.  H.  S.  McLean,  Richmond,  Va. 

The  Medical  Treatment  of  Appendicitis  ; 
Dr.  Chas.  B.  McAnally. 

Secretary  Irving. — I  notice  that  the 
Executive  Council  have  brought  in  a  subject 
for  discussion  at  the  next  annual  meeting  of 
this  Society,  but  they  have  made  no  provi- 
sion as  to  who  shall  lead  in  that  discussion 
or  prepare  the  papers. 

President  Cobb. — It  is  (he  duty  of  thai 
Executive  Council  to  select  a  member  of 
the  Society  upon  each  heading.  A  special 
discussion  I  think  is  incubent  upon  them  to 
suggest  to  this  Association  the  member  of 
the  Society  who  shall  write  a  paper  under 
each  separate  head. 

Dr.  J.  G.  Tompkins. — Speaking  for  the 
Association,  1  think  it  was  understood  that 
this  was  to  be  a  general  discussion  and  the 
entire  first  day's  meeting  devoted  to  it  if  so 
much  at  that  time  was  necessary,  but  we 
didn't  understand  that  \vc  were  to  designate 
who  were  to  prepare  the  papers;  that  it  was 
the  sense  of  that  committee,  as  we  under- 
stood it,  for  everyone  to  take  it  upon  him- 
self and  make  a  study  of  it  and  to  say  on  it 
whatever  he  could. 

Dr.  Hugh  T.  Nelson. — I  believe  it  is 
customary  after  a  subject  has  been  selected 
in  medical  societies  to  appoint  somebody  to 
open  the  discussion,  or  to  elect  him,  as  the 
case  may  be,  and  with  that  idea  in  view  and 
that  the  whole  subject  may  be  studied  and 
discussed  by  different  members  of  the 
Society,  I  would  nominate  as  the  leader  in 
that  discussion  Dr.  Paul  B.    Barringer. 

Dr.  Paulus  A.  Irving  seconded  this 
nomination  and  amended  Dr.  Nelson's 
motion  that  it  was  really  the  sense  of  the 
Council  that  Dr.  Barringer  be  selected  as 
the  leader  and  to  select  his  assistants. 

The  amendment  was  accepted  and  the 
motion  was  carried. 

The  .Society  then  adjourned  to  meet  again 
at  7  130  o'clock. 

NIGHT     SESSION. 

The  night  session  was  held  in  the  parlor 
of  the  Central  Hotel,  the  following  being 
the  order  of  business  : 

Dr,W.  II.  Wakefield,  of  Charlotte,  N.C., 
read  a  paper  on  "The  Eye  as  a  Causa- 
tive   Factor    in    Functional    Nervous    Dis- 


eases," which  was  discussed  by  Drs.  Ko\- 
lock  and  Kuyk. 

"Treatment  of  Fractures,"  was  the  sub- 
ject of  paper  read  by  Dr.  Hugh  T.  Nelson, 
of  Charlottesville,  Va.  Discussed  by  Drs. 
Bahnson  and  Johnston. 

Dr.  E.  C.  Levy,  of  Richmond,  Va.,  read 
paper  on  "What  Medicine  Owes  to  Bacte- 
riology." Discussed  by  Drs.  Weaver,  Bur- 
roughs and  Kollock. 

Dr.  Dirk  Adrian  Kuyk,  Richmond,  Va., 
read  paper  on  "The  Influence  of  Chronic 
Nasal  Occlusion  on  Cerebration."  Discus- 
sed by  Dr.W.  S.  Davidson. 

The  following  Committee  on  Publication 
was  appointed  : 

Dr.  Hugh  M.  Taylor,  Richmond,  Va. 

Dr.  J.  N.  Upshur,  Richmond,  Va. 

Dr.  Paulus  C.  Irving,  Richmond,  Va. 


Lead  as  an  Abortifacieut. 

V  fatal  case  of  lead-poisoning  from  the 
use  of  diachylon  pills  taken  for  the  purpose 
of  bringing  on  a  miscarriage  is  reported  by 
Dr.  George  F.  Crooke  in  a  receent  issue  of 
The  Hospital.  The  case,  when  seen,  pre- 
sented symptoms  so  much  more  formidable 
than  those  which  are  commonly  observed  in 
ordinary  chronic  lead  poisoning  that  we 
think  it  desirable  to  draw  attention  to  the 
aspect  which  lead  poisoning  may  take  on 
when  it  assumes  the  form  of  what  is  spoken 
of  as  lead  encephalopathy,  as  it  does  under 
some  circumstances.  The  patient  was  a 
young  married  woman  23  years  of  age. 
She  was  lying  on  the  floor  raving  in  mani- 
acal delirium,  struggling  violently  with 
those  who  were  endeavoring  to  restrain  her, 
and  apparently  writhing  in  great  agony 
Her  seizures  were  paroxysmal  and  her  in- 
telligence was  quite  gone.  Her  breath  was 
foetid,  and  exceedingly  offensive  ;  the  tongue 
was  dry,  and  coated  with  a  greyish,  black 
fur ;  blackened  sordes  had  collected  about 
the  teeth  and  gums,  along  the  free  border 
of  which  there  was  a  distinct,  slaty-blue 
line.  The  patient  soon  lapsed  into  a  con- 
dition of  coma,  on  which  convulsions  of  a 
violent  nature  supervened.  She  seemed 
blind,  and,  on  examination,  both  optic 
discs  were  found  to  be  quite  choked.  The 
urine  when  drawn  off  was  found  to  be  acid, 
contained  albumin,  leucocytes,  and  a  few 
red  blood-cells  and  cellular  and  hyaline 
casts.  She  died  two  days  later,  never 
having  thoroughly  regained  consciousness. 
From  the  time  that  the  coma  and  convul- 
sions set  in  there  was  considerable  rise  of 
temperature.  She  had  miscarried  about  a 
week  before  this  condition  of  affairs  came 
on,  but  on  the  post  mortem  examination 
there  was  no  evidence  of  inflammatory 
mischief  about  the  uterus. 


256 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


Dr.  Crooke  says  that  the  practice  of  tak- 
ing diachylon  in  the  form  of  pills,  for  the 
purpose  of  bringing  on  miscarriage,  is  far 
more  prevalent  among  the  working  classes 
than  is  generally  supposed,  and  that,  in 
view  of  the  known  effects  of  lead  upon  the 
nervous  system,  the  nature  of  some  of  the 
obscure  nervous  disorders,  with  attendant 
anaemia  which  occur  in  women  who  have 
admitted  miscarriage,  may  be  cleared  up  by 
bearing  in  mind  the  possibility  of  lead 
poisoning  from  the  criminal  use  of  dia- 
chylon. The  less  acute  forms  of  lead  poi- 
soning are  so  much  the  most  frequent  that 
we  are  all  apt  to  associate  plumbism  with 
colic  or  wrist-drop,  or  with  early  decrepi- 
tude and  albuminuria,  as  it  occurs,  for  ex- 
ample, among  painters.  The  more  serious 
forms,  lead  encephalopathy,  in  which  con- 
vulsions and  coma  occur,  leading  rapidly  to 
death,  are  rarely  seen  by  the  mass  of  prac- 
titioners ;  but  such  cases  are  known  well 
enough  to  those  who  practise  among  oper- 
atives who  are  exposed  to  the  more  deadly- 
forms  of  lead  poisoning.  Not  only,  then, 
should  the  possibility  of  acute  plumbism 
always  be  borne  in  mind,  but  it  should  be 
remembered  that  the  onset  of  this  form  in 
young  women  is  often  masked  by  symp- 
toms so  slight  and  apparently  functional,  as 
to  be  very  apt  to  throw  practitioners  off 
their  guard.  Hysteria,  in  a  woman  ex- 
posed to  lead-poisoning,  is  a  matter  to  treat 
with  much  caution. 


The  Treatment  of  Gout  by   Alkalies. 

As  the  result  of  a  careful  series  of  experi- 
ments in  regard  to  the  action  of  alkalies  in 
gout,  Dr.  Arthur  P.  Luff  comes  to  the  con- 
clusion (The  Hospital,  June  iS,  '9S)that  the 
ordinary  alkalies,  the  lithium  salts,  piper- 
azine,  and  lysidine  do  not  exercise  any  spe- 
cial solvent  effect  on  sodium  biurate,  and 
their  administration  with  the  object  of  re- 
moving uratic  deposits  in  the  joints  and 
tissues  appears  to  be  useless,  and,  moreover, 
it  is  apparently  contra-indicated  in  gout  on 
ccount  of  its  leading  to  an  increased  for- 
mation of  uric  acid  in  the  kidneys.  It  must, 
however,  be  noted  that  Dr.  Luff's  investi- 
gations were  made  by  means  of  laboratory 
experiments,  and  although  these  appear,  for 
the  time  being,  to  knock  on  the  head  the 
theory  which  has  in  many  cases  been  the 
excuse  for  the  administration  of  these  rem- 
edies, they  by  no  means  touch  the  fact  that 
many  patients,  suffering  from  various  man- 
ifestations of  gout,  are  better  both  in  health 
and  temper  while  taking  alkalies.  How 
these  act  is  another  matter.  Dr.  Luff  has 
shown  that  they  do  not  act  in  the  way  that 
they  have  been  commonly  supposed  to  do, 
but    there    is   nothing  in  his  paper  to  show 


that  they  have  no  benefical  influence.     This 
must  be  decided  by  clinical  observation. 


THE  TREATMENT  OF 

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simplified  by  the  use  of  EULEXINE. 
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no  stomachic  disturbance. 

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for  filling-  physicians'  prescriptions. 

Formula:  Eulexine  10  percent..  Rliamnus 
Purshiana,  20  per  cent..  Aromatics  and  Glyce- 
rin, q.  s. 

•  Rigid    Diet    not   Essential    when  this 
Preparation   is    Used. 

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5.  E.  cor.  59th  and  Wallace  St.,  Chicago,  III. 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


257 


Superior  to 

ioi>oi^or:m:. 


Odorless. 

Tasteless, 


No  more  expensive  to  use  than  Iodoform, 
being  at  least  four  times  as  voluminous. 


DSOPHEN 


Iodoform  is  universally  regarded  as  such  an  excellent  healing  agent,  that  claims  of  superiority 
over  it  for  Nosophen  may  appear  as  an  exaggeration,  but  there  is  indisputable  clinical  evidence 
that  it  causes  a  wound  to  heal  more  rapidly,  and  with  less  or  no  suppuration;  moreover,  it  never 
produces  a  dermatitis  around  the  edges  of  a  wound  as  Iodoform  always  does,  Nosophen  being 
absolutely  non-toxic  and  non-irritating.  Besides  as  a  surgical  dressing  in  major  and  minor 
surgery,  it  is  adapted  to  other  most  varied  employment,  as  an  antiseptic  in  the  treatment  of 
chancroid  and  all  abscesses  and  ulcers,  herpes,  eczema  and  other  skin  diseases,  either  as  a  powder 
or, combined  with  vasaline  and  lanoline,  as  an  ointment;  Nosophen  is  a  strong  desiccant  and  excel- 
lent results  are  obtained  with  Insufflations  in  purulent  discharges  from  the  middle  ear,  in  nasal 
catarrh,  etc. 

Eudoxine  (The  Bismuth  Salt  of  Nosophen). 

This  chemical  salt  of  Nosophen  is  intended  for  employment  as  an  intestinal  antiseptic  and 
us  sue))  it  gives  most  excellent  results.  To  judge  from  clinical  reports,  it  is  decidedly  an  efficient 
intestinal  antiseptic,  and  has  the  great  advantage  of  being  absolutely  harmless  and  non-irrita- 
ting, odorless  and  tasteless.  Indicated  in  typhoid  fever,  chronic  intestinal  catarrh,  diarrhoea  of 
phthisis,  infantile  diarrhoea,  chronic  enteritis,  etc. 

Literature  on  request.    Sole  Agents  tor  the  rj.  s.  and  Canada: 

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The   Safest,  Most  Agreeable  and 
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Anti-arthritic. 


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Selling  agents  for  the  Bayer  Pharmaceutical  Products : 

I.  Creosote  Carbonate  (Creosotal).  Europhen.  Ferro-Somatose.  Cuaiacol  Carbonate  (D^oUl)._Hem_icjanin.  Heroin, 
lodothyrinc,  Lacto-Somatose^  Losophan,  Lycetol,  Phenacet: 


Piperazine-Bayer.  Protargol,  Quinalgen, 
' SM^^'j^Ts^^e^^OTMSoak',  SaMonal,  Tannigen,  Tannopine,  Trional 


,<%<%**W%+>'%**W*'* 


258 


THE  CHARLOTTE  MEDICAL    JOURNAL. 


Quinine   Hemoglobinuria. 

Murri  reports  a  case  of  this  affection 
(British  Medical  Journal)  : 

A  girl,  aged  17,  contracted  tertian  ague 
in  July,  1898.  In  spite  of  treatment  she 
was  not  cured  in  January,  1894,  and  was 
still  taking  quinine.  At  that  time  she  had 
an  attack  of  ictero-hemoglobinuric  fever 
directly  after  taking  quinine,  and  subse- 
quently whenever  quinine  was  taken  such 
an  attack  was  observed,  consisting  in  rigors, 
vomiting,  followed  by  smoky  urine,  and 
lastly  jaundice.  The  spleen  became  larger 
and  firmer,  and  sometimes  the  liver  enlarged 
also,  with  hypochondriac  pain.  At  the 
beginning  of  an  attack  there  was  simple 
polyuria,  then  from  being  acid  the  reaction 
became  alkaline,  and  lastly  peptone,  serum 
albumin,  globulin,  hemoglobulin,  and  uro- 
bilin, hyaline  casts,  epithelial  renal  cells, 
and  leucocytes,  but  no  red  corpuscles  or  bile 
pigments  appeared.  After  an  attack  the 
above  all  disappeared,  the  serum  albumin 
and  peptone  last.  An  examination  of  the 
blood  showed  there  was  a  diminution  of  the 
number  of  red  corpuscles,  but  the  malarial 
parasite  could  never  be  found.  In  spite  of 
this  effect  of  quinine  it  had  its  usual  influ- 
ence in  prolonging  the  interval  between  the 
attacks  of  true  malaria.  The  author  gives 
reasons  for  believing  that  quinine  hemo- 
globinuria  occurs  only  in  those  whose  or- 
gans have  been  altered  by  malaria,  quinine 
alone  being  insufficient  to  produce  it.  (1) 
For  20  years  he  has  been  trying  to  produce 
quinine  hemoglobinuria  in  animals  without 
success.  (2)  In  a  healthy  man  75  or  even 
400  grains  of  quinine  produce  no  hemo- 
globinuria, while  in  this  girl,  after  malaria, 
1.54  gr.  did  with  absolute  certainty.  (3) 
No  case  of  quinine  hemoglobinuria  has 
been  reported  which  was  not  complicated 
by  malaria.  (4)  The  proof  that  one  has  not 
to  do  with  an  idiosyncrasy  in  a  person  with 
whom  malaria  is  a  coincidence  is  furnished 
by  the  fact  that  quinine  intoxication  appears 
in  most  cases  sometimes  after  a  good  many 
doses  have  had  to  be  taken — that  is,  after 
the  malarial  poison  has  had  time  to  act  on 
the  organism,  but  not  before.  (5)  It  is  not 
produced  by  an  intolerance  gradually  set  up 
by  repeated  doses  of  quinine,  for  large  and 
repeated  doses  are  often  given  in  non-mala- 
rial diseases,  and  yet  not  a  single  case  of 
quinine  hemoglobinuria  has  been  reported 
in  these.  (6)  This  hemoglobinuria  is  al- 
most unknown  in  Europe,  except  in  Sicily 
and  Greece,  and  becomes  relatively  fre- 
quent in  extra-European  countries  where 
malaria  is  more  virulent.  (7)  The  author's 
patient  had  three  ictero-hemoglobinuric 
attacks  after  the  malaria  was  cured,  and 
without    any    quinine   having  been   given. 


This  shows  that  the  hemoglobinuric  mech- 
anism had  become  so  easily  set  in  motion 
that  its  usually  specific  stimulus  (quinine) 
could  be  replaced  by  others,  though  exactly 
what  these  were  could  not  be  discovered. 
It  seemed  as  though  the  biological  change 
left  in  the  patient  by  malaria  would  not  be 
permanent,  for  some  months  after  the  pa- 
tient had  been  cured  of  her  malaria,  and 
had  had  no  quinine  attacks,  a  little  over  1^ 
gr.  of  quinine  given  experimentally  had 
very  little  effect,  and  even  7f  gr.,  though* 
causing  intoxication  (fever,  albuminuria, 
peptonuria,  and  urobilinuria),  produced  no 
hemoglobinuria. 


Seaboard   Medical    Association. 

The  Seaboard  Medical  Association  of 
Virginia  and  North  Carolina  met  in  Wilson, 
N.  C. ,  Jan.  12-13.  The  attendance  was 
large.  Very  excellent  papers  were  read 
which  elicited  an  abundance  of  able  dis- 
cussion, especially  the  papers  on  Malarial 
Hemoglobinuria.  Officers  elected  for  the 
ensuing  year : 

President,  Dr.  Lucien  Lofton,  Emporia, 
Va.  ;  First  Vice-President,  Dr.  George  G. 
Thomas,  Wilmington,  N.  C.  ;  Second  Vice 
President,  Dr.  John  E.  Philips.  Suffolk ; 
Secretary,  Dr.  John  C.  Roelmau,  Wash- 
ington, N.  C.  ;  Treasurer,  Dr.  Charlas  T. 
H.  Laughinghouse,  Greenville,  N.  C. 

The  next  meeting  to  take  piace  sometime 
in  midwinter.  Place  left  to  discretion  of 
executive  committee. 


READING  NOTICES. 


Sanmetto  in  General  Naso-Pharyngeal  and 
Bronchial  Catarrh    Complicated    with 
Gastro-Intestinal  Catarrh— Also  in 
Hypertrophy  of  Prostate,  Dysu- 
ria  and  Painful  Micturition. 
I  have  used  Sanmetto  in  my  own  case, 
e.   general   naso-pharyngeal    and   bronchial 
catarrh  with  the  invariable  complication  in 
all  such  cases,  gastro-intestinal  catarrh, with 
the  very  best  results,  and  I  frequently  pre- 
scribe it  in  such  cases  with  the  most  satis- 
factory results.      I  use  it  in  all  cases  of  hyp- 
ertrophy of    the    prostate,  dysuria,  difficult 
and  painful  micturition,  and  such  as  need 
to  have  the  genital  tract  braced  up, with  the 
very  best  results.       J.  B.  Duncan,  M.D. 
Bedford,  Ind. 


I  have  used  Peacock's  Chionia  and  find 
it  very  effective.  I  shall  continue  to  pre- 
scribe it  in  my  practice. 

A.  P.  Dalrymplk,  M.  D. 

New  York,  N.  Y. 


THE  CHARLOTTE   MEDICAL  JOURNAL. 


Jl:  Ung't  Resinol 


3i — iii. 

THOROUGHLY  EFFICIENT  AS  AN 


Antipruritic,  Antiseptic, 
Local  Antiphlogistic  and  Skin  Nutriment 

And  is  now  successfully  used     jq  000     PHYSICIANS   in  the  United  States 


and  prescribed  by  over 


and  Canada. 


For  Eczema.  Erysipelas,  Pruritus  and  all  Itching  and 
Inflammatory  Skin  Diseases- 


Bi 


Elix.  Cascanata  siv-x. 


Laxative,  Alterative,  Antacid  and  Tonic. 

Stimulates  the  elimination  of  effete  matter  and  restores  the 
normal  alkalinity  of  the  blood. 

A  specific  for  habitual  constipation  and  the  digestive  derangements  resulting  therefrom 

RESINOL  CHEMICAL  CO.         -        Baltimore,    Md. 


Internally 


Safe- 
Prompt  and 
Effective 


BB  ^BJH  Bl  ^B|l  P   m§  ■       — I  VBH  Irih  H 


Colchicine  (mcthpl)  Salicylate. 


Externally 


INDICATIONS.— In  Goat,  Neuralgia,  Rheumatoid  Arthritis,  Sciatica 
and  all  Rheumatoid  or  Gouty  Affections. 


Aii  original  bottle  of  50  Capsules  of  Colcht-Sai  and  an  original  bottle  of  2  ounces  of  Betul-ol 
sent  by  mad  on  remittance  of  80  cents  eacli  to  the  wholesale  agents, 

E.  FOUGERA  &  CO.,  New  York. 

LITERATURE    AND    SAMPLES    ON    APPLICATION. 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


What  to  Inject  in  Gonorrhoea. 

In  an  instructive  paper,  entitled  "What 
to  Inject  and  How  in  Gonorrhoea"  (Wis- 
consin Medical  Recorder,  December,  1898), 
Dr.  Ludwig  Weiss,  Attending  Physician  to 
the  Skin  and  Genito-Urinary  Department 
of  the  German  Policlinic,  New  York,  states 
that  he  cannot  concede  to  the  Janet  method 
of  irrigation  the  sure  abortive  and  curative 
properties  claimed  for  it.  On  the  other 
hand,  he  thinks  that  it  must  be  conceded 
that  we  possess  in  protargol  a  remedy  which 
fulfills  every  indication  required  of  an  ideal 
antigonorrhoicum.  This  is  attributable  to 
its  superior  penetrating  power  due  to  the 
fact  that  it  does  not  enter  into  insoluble 
combinations  with  the  normal  tissue  fluids ; 
to  its  freedom  from  irritation  in  solutions 
ordinarily  used ;  to  the  fact  that  it  destroys 
the  gonococcus  with  absolute  certainly,  and 
that  we  can  enhance  its  curative  influence 
by  prolonged  application.  The  author's 
general  conclusions  are  as  follows  ; 

1.  Commence  treatment  as  soon  as  pos- 
sible. 

2.  Use  prolonged  injections  of  protargol. 

3.  Examine  every  other  day  at  least,  with 
microscope,  whether  gonococci  have  di- 
minished. 

4.  Keep  injections  up  until  gonococci 
have  vanished. 

5.  Astringents  for  the  post-gonorrhoic 
flow  are  rarely  necessary,  as  protargol  acts 
as  such  also. 

6.  Irtigate  when  the  posterior  urethra  is 
affected  with  one-fourth  per  cent,  solution 
of  protargol  either  by  Janet's  method  or, 
better  yet,  with  a  large  barreled,  olive  point- 
ed syringe. 

7.  Protargol  thus  used  cures  gonorrhoea 
quicker  than  any  other  known  remedy  or 
method. 


The  Rational  Treatment  of  Grippe. 

The  necessity  of  a  powerful  eliminant  in 
every  prescription  for  grippe  is  self-evident. 
While  antipyretics  and  antiperiodics  may 
somewhat  stimulate  the  excretions  and  re- 
lieve congestion,  thereby  controlling  certain 
features  of  the  disease,  a  complete  cure  can- 
not be  expected  until  the  grippe  poison  is 
thoroughly  eliminated  and  the  diseased  or- 
gans   enabled  to  resume   normal  functions. 

The  successful  treatment  of  grippe  de- 
pends upon  the  thoroughness  of  the  remedy 
employed,  hence  we  ask  why  temporize 
with  antipyretics  and  antiperiodics  when 
Tongaline  always  secures  prompt  and  effi- 
cient as  well  as  permanent  results. 

The  internal  use  of  Tongaline  Liquid 
taken  at  short  intervals  in  hot  water,  wash- 
ed down  with  copious  draughts  of  hot  water 


may  be  supplemented  by  its  local  applica- 
tion to  the  inner  parts  of  the  thighs  and  to 
the  abdominal  surfaces.  Or  as  grippe  in- 
variably renders  the  stomach  irritable  and 
the  nerves  sensitive,  the  disturbing  effects 
of  internal  medication  can  be  entirely  avoid- 
ed by  the  external  use  of  Tongaline  Liquid 
alone. 

In  fact  when  the  system  is  thoroughly 
under  the  influence  of  Tongaline,  the  pro- 
gress of  the  grippe  is  arrested  and  as  a  re- 
sult there  is  immediate  recuperation,  fol- 
lowed shortly  by  a  perfect  cure. 


Intra-Nasal  Diseases. 

Speaking  of  Unguentine,  we  have  found 
it  an  excellent  application  to  the  nose  after 
the  removal  of  spurs  of  the  septum  or  ante- 
rior hypertrophies  by  either  the  saw,  snare 
or  cautery.  Frequently  the  crusty  scab 
which  forms  is  the  source  of  considerable 
annoyance  to  the  patient  and  actually  de- 
lays the  healing  process. 

The  frequent  washing  with  alakaline  so- 
lutions renders  the  tissues  boggy  and  even 
then  is  not  always  effectual.  A  small  pled- 
get of  cotton  with  the  ointment  applied  to 
one  side  and  placed  in  situ  will  promote  a 
more  rapid  healing  of  the  nasal  tissues  than 
any  other  method  with  which  we  are  famil- 
iar. After  a  few  hours  a  bit  of  the  oint- 
ment may  be  applied  frequently  and  the 
abraded  surface  kept  comfortable  as  well  as 
clean  during  the  healing  process. — Atlanta 
Medical  Weekly. 


Dr.  Horace  Tracy  Hanks,  New  York, 
writes  in  the  American  Gynecological  and 
Obstetrical  Journal  for  December  that  from 
an  experience  with  Nosophen  of  fully  four 
years  in  his  gynecological  practice,  he  be- 
lieves that  this  antiseptic  powder  has  vir- 
tues equal  to  those  of  Iodoform,  while  it  is 
odorless  and  should,  therefore,  supersede 
this  vile  smelling  drug,  and  he  believes  it 
will  do  this  eventually,  as  Nosophen  is  no 
more  expensive  to  use,  because  of  being  so 
much  more  voluminous  than  Iodoform. 
Nosophen,  he  states,  is  a  pale  and  yellow- 
ish powder,  containing  about  60  per  cent, 
iodine  in  chemical  combination  with  phe- 
nolphtalein.  He  fiuds  it  to  act  perfectly 
well  in  preventing  excessive  and  rapid  sup- 
puration in  all  abrasions  and  erosions  of  the 
cervix,  and  on  all  raw  surfaces  after  curette- 
ment.  He  uses  Nosophen-gauze  for  pack- 
ing the  uterine  cavity  after  removing  the 
debris  of  an  abortion  and  after  curerting 
for  other  causes,  the  gauze  packing  remain- 
ing sweet  for  three  days  in  such  cases.  Also 
on  abdominal  wounds  the  Nosophen-Gauze 
meets   every  indication  of  iodoform-gauze. 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


261 


THE  BEST  PREPARED  FOOD. 


-For  THE  BABY*  THE  INVALID.*THE  CONVALESCEN.T.*THE  AGED.  | 


&^grS\ffB& 


NEARLY  ALWAYS  SUCCESSFUL 
WHEN  AIL  OTHER  KINDS 
OF  NOURISHMENT^^ 
HAYE  FAILED.  JM- 


SAMPLES  FOR  CLINICAL  TEST 

SUPPLIED  TO  PHYSICIANS 

and  TRAINED  NURSES 

ON  REQUEST. 


fOF  TODAY 
'and  will  continue 

TO  YIELD  SATISFACTORY  RESULTS  fN  NUTRITION 

FAR  INTO  THE  FUTURE,  BECAUSE  ITS  MERITS  HAVE  BEEN 

PROVED  BY  CLINICAL  SUCCESS  in  the  PAST. 

\fjC    Shippinq  Depot,  JOHN  CARLE  &  SONS,  153  Water  Street,  NewYork. 

\&L-  SOLD  BY  DRUGGISTS  EVERYWHERE. 


Well  Known -Well  Liked. 

The  other  day  the  superintendent  of  one 
of  the  largest  city  hospitals  in  this  country, 
said  to  a  representative  of  The  Imperial 
Granum  Company,  the  manufacturers  of 
that  reliable  dietetic  preparation,  Imperial 
Granum  :  "It  is  not  necessary  for  your 
firm  to  send  any  one  here  to  tell  me  about 
their  product  for  I  have  used  it  both  in  pri- 
vate and  hospital  practice  for  over  twenty- 
five  years,  and  can  hardly  believe  that  even 
the  youngest  members  of  the  medical  pro- 
fession do  not  know  of  the  merits  of  this 
well  known  and  well  liked  food  for  invalids 
and  convalescents." 


Iquinin  Remedies. 

In  the  treatment  of  La  Grippe  many  phy- 
sicians have  found  the  Iquinin  remedies  of 
great  value.  Generally  the  attack  finds  a 
constipated  condition  of  system,  and  the 
Laxiquinin  administered  in  doses  of  one  to 
three  tablets  every  two  to  fours,  according 
to  the  age  of  the  patient  or  urgency  for  pur- 
gation,will  bring  prompt  results.  The  ach- 
ing distressing  break-bone  pains  will  be  re- 
lieved  at   the   same   time   that  purgation  is 


being  accomplished.  After  free  evacuation 
of  the  bowels,  the  Iquinin  may  be  given  in 
doses  of  one  to  two  tablets  every  two  to 
four  hours  according  to  the  age  of  the  pa- 
tient. This  should  be  continued  in  dimin- 
ishing doses  for  several  days.  After  the 
subsidence  of  the  acute  symptoms,  a  severe 
case  of  La  Grippe  leaves  a  fearful  depres- 
sion of  the  nervous  system,  and  potent  tonics 
are  indicated,  and  no  better  has  been  found 
than  the  Toniquinin  tablets,  one  tablet  three 
times  a  day.  This  may  be  given  for  from 
one  to  five  weeks,  as  the  case  may  require. 
Simple  cases  are  often  relieved,  and  often 
cured  by  several  doses  of  Laxiquinin  alone. 


I  take  great  pleasure  in  offering  my  testi- 
mony to  the  great  value  of  Cactina  Pillets, 
in  cases  of  weak  and  irregular  action  of  the 
heart.  I  have  used  them  for  four  years 
and  have  never  been  disappointed  in  them. 
They  not  only  stimulate  the  heart,  but  im- 
prove that  organ  permanently.  I  find  them 
very  useful  in  all  cases  of  typhoid  fever  and 


pneumonia. 
Kent,  Ind. 


C.  B.  Mathews,  M.D. 


262 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


The  Treatment  of  "LaGrippe"  or  Epidemic 
Influenza. 

"La  Grippe"  is  an  infectious  disease 
whose  specific  germ  is  a  bacillus  possessing 
the  power  of  segmentation  or  subdivision, 
thus  multiplying  with  great  rapidity  when 
a  favorable  medium  is  attacked.  It'is  taken 
into  the  body  from  the  atmosphere  through 
the  nose  and  mouth.  Its  action  causes  a 
congestion  of  the  air  passages  (nose,  throat 
and  lungs),  similar  to  catarrhal  conditions. 

But  further,  it  causes  severe  constitutional 
disturbances  which  manifest  themselves  by 
neuralgias,  muscular  pains  (myalgias)  fever 
and  chills  ;  and  causes  congestion  of  various 
internal  organs,  leaving  the  patient  debili- 
tated with  weak  heart,  neurasthenia  and 
frequently  with  weakened  lungs  and  kid- 
neys. These  latterjconditions  are  often 
aggravated  by  remedies  injudiciously  taken 
during  the  course  of  the  disease,  and  fatal 
terminations  are  sometimes  traceable  to  the 
use  of  drugs  which  are  calculated  to  further 
depress  the  already  weakened  system. 

Bearing  in  mind  the  leading  symptoms 
and  tendency  of  this  disease,  it  is  wise  to 
avoid  any  drug  which  will  weaken  the 
heart's  action  or  depress  the  patient's  vital- 
ity in  any  way.  Most  drugs  used  to  relieve 
pain  are  depressing  in  their  after  effects. 
Most  drugs  used  to  reduce  fevers  are  weak- 
ening to  the  heart's  action.  Many  people 
take  upon  themselves  the  risk  of  dosing 
with  phenacetine,  antipyrin,  antifibrin,  etc. 
These  drugs  should  only  be  used  under  com- 
petent medical  advice,  for  cases  of  danger- 
ous syncope  have  followed  upon  the  careless 
partaking  of  these  remedies. 

Among  the  drugs  practically  harmless 
and  at  the  same  time  efficacious  can  be  men- 
tioned quinine.  This  drug  in  small  doses 
strengthens  the  heart's  action  and  reduces 
fever  besides  acting  as  an  internal  antisep- 
tic. As  quinine  in  small  doses  alone  will 
not  relieve  the  pains  or  headache,  nor  en- 
tirely reduce  the  fever  I  have  been  in  the 
habit  of  combining  with  it  phenalgin  as 
follows  : 

Quinine  three  (3)  grains  in  capsules, 
Phenalgin  five  or  ten  (5  or  10)  grains  in 
powders  at  one  dose,  to  be  taken  every 
three  hours.  This  formula  has  proven  very 
successful  in  aborting  what  might  have  been 
a  severe  attack  of  "LaGrippe,"  and  rapidly 
curing  milder  cases. 

In  common  with  many  of  the  profession, 
it  had  been  my  habit  prior  to  my  acquaint- 
ance with  the  stimulant  non-depressant 
character  of  Phenalgin,  to  prescribe  alco- 
holic stimulants  when  giving  the  other  coal 
tar  product,  to  overcome  their  depressing 
effect.  But  the  free  use  of  ilcohol  is  always 
followed  by  great  depression  and    reaction. 


The  contrary  is  true  of  the  coal-tar  product 
Phenalgin.  The  action  of  this  drug  is 
soothing  and  its  anodyne  effect  is  usually 
followed  by  refreshing  sleep. 

Convalescence  from  "LaGrippe"  is  has- 
tened by  careful  attention  to  nutriment  and 
aided  by  judicious  tonics  of  the  chalybeate 
variety. 

An  efficacious  method  of  local  treatment 
for  "LaGrippe"  and  at  the  same  time  often 
a  most  valuable  preventative  is  to  spray  the 
nose  and  throat  several  times  daily  with  one 
of  the  many  antiseptic  solutions  in  the 
market,  of  which  the  principal  ingredients 
are  boric  acid,  eucalyptol  and  other  essen- 
tial oils. 

It  should  be  remembered  that  this  disease 
attacks  with  greatest  severity  those  whose 
vital  forces  are  made  weaker  by  indiscre- 
tions and  excessive  nerve  strain.  Therefore 
the  rules  of  health  should  be  carefully  ob- 
served, especially  those  referable  to  sleep 
and  proper  diet. 

In  giving  these  hints  for  treatment,  it  is 
not  desired  to  assume  that  "LaGrippe"  is  a 
disease  easily  overcome  without  close  per- 
sonal attention  by  the  physician,  but  there 
are  very  many  cases  which  otherwise  would 
become  severe  and  serious,  that  could  be 
checked  by  promptly  following  the  course 
herein  outlined. 

J.  A.  Hofhbimer,  M.D.,  323 W.  126th  St..  N. 
Y.  

To  the  Members  of    the    Medical  Society 
of   North   Carolina. 

As  the  Secretary  has  had  a  number  of 
letters  from  members  of  the  Society  in  re- 
gard to  the  Transactions  for  1898,  some 
public  statement  concerning  them  is  doubt- 
less admissible  on  his  behalf.  Dr.  R.  D. 
Jewett  has  had  the  minutes  and  papers  of 
the  1898  meeting  since  last  summer;  he  as- 
sumed all  responsibility  for  their  publication 
and  distribution  as  he  was  secretary  for  the 
last  meeting  and  one  of  the  committee  on 
publication,  all  of  which  was  eminently  fit 
and  proper,  and  the  purpose  of  this  notice 
is  simply  to  mention  the  facts  in  the  case. 
All  cred't  in  regard  to  the  Transactions  for 
1898  is  due  Dr.  Jewett  and  to  him  all  com- 
plimentary communications  concerning 
them  should  be  sent. 

Geo.  W.  Pressly,   Sec'y. 

Notwithstanding  the  large  number  of 
Hypophosphites  on  the  market,  it  is  quite 
difficult  to  obtain  a  uniform  and  reliable 
syrup.  "Robinson's"  is  a  highly  elegant 
preparation,  and  possesses  an  advantage 
over  some  others  in  that  it  holds  the  various 
salts,  including  Iron,  Quinine,  and  Strych- 
nine, etc.,  in  perfect  solution,  and  is  not 
liable  to  the  formation  of  fungous  growths. 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


263 


LISTERINE 


The  Standard  Antiseptic. 


LISTERINE  is  a  non-toxic,  non-irritating  and  non-escharotic  antiseptic,  composed  of  ozonifer 
ous  essences,  vegetable  antiseptics  and  benzo-boracic  acid. 

LISTERINE  is  sufficiently  powerful  to  make  and  maintain  surgical  cleanliness  in  the  antisepti 
and  prophylactic  treatment  and  care  of  all  parts  of  the  human  body. 

LISTERINE  has  ever  proven  a  trustworthy  antiseptic  dressing  for  operative  or  accidental 
wounds. 

LISTERINE  is  invaluable  in  obstetrics  and  gynecology  as  a  general  cleansing,  prophylactic- 
or  antiseptic  agent,  and  is  an  effective  remedy  in  the  treatment  of  catarrhal  conditions  of 
every  locality. 

LISTERINE  is  useful  in  the  treatment  of  the  infectious  maladies  which  are  attended  by  inflam 
mation  of  accessible  surfaces— as  diphtheria,  scarlet  fever  and  pertussis. 

LISTERINE  is  especially  applicable  to  the  ti-eatment  of  scarlet  fever,  used  freely  as  a  mouth 
wash,  or  by  means  of  the  spray  apparatus. 

LISTERINE  is  extensively  prescribed  in  typhoid  fever,  both  for  its  antiseptic  effect  and  to  im- 
prove the  condition  of  the  stomach  for  the  reception  of  nourishment. 

LISTERINE  agreeably  diluted,  is  prescribed  with  very  good  results,  in  the  treatment  of  diph- 
theria, both  as  a  prophylactic  and  curative — internal  antiseptic — agent. 

LISTERINE  is  used  extensively  with  good  results  in  the  treatment  of  whooping  cough. 

LISTERINE  diluted  with  water  or  glycerine  speedily  relieves  certain  fermentative  forms  of 
indi 


LISTERINE  is  indispensable  for  the  preservation  of  the  t3eth,  and  for  maintaining  the  mucous 

membrane  of  the  mouth  in  a  healthy  condition. 
LISTERINE  employed  in  a  sick  room  by  means  of  a  spray,  or  saturated   cloths  hung   about,  is 

actively  ozonifying  and  imparts  an  agreeable  refreshing  odor  to  the  atmosphere. 
jISTERTNE  is  of   accurately   determined   and   uniform   antiseptic   power   and  of   positive  ori 

ginality. 
jISTERINE  is  kept  in  stock  by  the  leading  dealers  in  drugs,  everywhere. 


Lambert's  Lithiated  Hydrangea, 


Close  clinical  observation  has 
caused  Lambert's  Lithiatkd 
Hydrangea  to  be  regarded  by 
Physicians  generally  as  a  very 
valuable  Renal  Alterative 
and  Antilithic  Agent. 


Albuminuria,  Lithaemia, 

Bright's  Disease,      Nephritis, 
Cystitis,  Rheumatism, 

Diabetes,  Urinary  Calculus, 

Gout,  and  all  forms  of 

I  hematuria.  Vesical  Irritation 


For  Descriptive  Literature,  Address 


Lambert  Pharmacal  Co., 


ST.     LOUIS. 


THE  CHARLOTTE  MEDICAL  JOURNAL 


The  Treatment  of  Pulmonary  Phthisis. 

The  opinion  has  been  held  that  the  develop 
ment  of  Phthisis  is  preceded  and  accompa 
nied  by  appreciable  disorder  of  the  digestive 
system.  Particularly  is  this  true  of  Pulmo- 
nary Phthisis.  It  is  now  known  that  pyo- 
genic germs  work  conjointly  with  the  tuber- 
cle bacillus  in  disintegrating  lung  tissue. 

In  fact,  the  pus  forming  germs  constitute 
the  more  formidable  factor  as  to  the  force  of 
invasion,  as  evinced  by  the  remarkable  ex- 
perimental researches  of  Koch  and  Berlin. 
His  tuberculin  cure  was  indeed  a  sad  disap- 
pointment for  the  reason  that  it  simply  at- 
tacked the  tubercle  bacillus'  and  this  to  a 
minimum  extent  without  in  the  least  affect- 
ing the  general  phthisical  dyscrasiae. 

With  the  lights  of  the  day  before  us  it 
seems  consistent  with  good  judgment  to 
employ  those  methods  at  command  which 
at  least  promise  antisepsis  constitutionally — 
notwithstanding  the  various  methods  in 
vogue  during  the  past  years  for  ameliora- 
tion or  cure  in  bacterial  disease. 

Cod  Liver  Oil  is  considered  in  this  article 
as  is  customary,  in  connection  with  the 
medicinal  treatment.  It  has,  however,  lit- 
tle or  no  claim  to  be  classed  as  a  medicine. 

It  has  some  adherents  in  the  treatment  of 
Phthisis  yet  the  authorities  of  the  day  dis- 
courage it  rather  than  use  it.  It  often  occa- 
sions nausea  and  diminishes  the  appetite  or 
gives  rise  to  eructations  and  in  such  event 
is  absolutely  contra-indicated.  After  all, 
it  could  under  the  best  circumstances  be  con- 
sidered only  as  an  article  of  diet.  When 
destructive  changes  in  the  lung  ensue  as  in 
the  stage  softening,  Cod  Liver  Oil  is  posi- 
tively harmful  for  the  reason  that  it  pro- 
duces fat  intoxication. 

Its  combination  with  the  hypophosphites 
has  been  pretty  largely  employed  in  differ- 
ent countries,  but  without  effects  sustaining 
any  just  claim  of  having  specific  action. 

Pulmonary  Phthisis,  unless  greatly  ad- 
vanced (i.  e.  both  lungs  involved  extensive- 
ly), is  usually  readily  checked.  The  care- 
ful practitioner  will  recognize  in  this  par- 
ticular, the  merits  of  Angier's  Petroleum 
Emulsion,  and  antiseptic  constituents  are 
so  eminently  suited  to  diseased  lung  tissue 
and  to  the  general  system. 

It  does  not  tax  the  digestion — is  always 
the  most  soothing  and  grateful  to  the  pa- 
tient and  is  perfectly  assimilable.  The  Pe- 
troleum Emulsion  is  typically  nutrient 
which  is  soon  manifested  by  the  increase 
of  weight  and  generally  improved  condition 
of  the  patient.  The  gastro-intestinal  tract 
is  quickly  responsive  in  activity  and  is  not 
depressed  nor  irritated  by  its  use. 


Bronchial  hemorrhage  is  not,  as  a  rule, an 
unfavorable  event  in  the  case  of  Phthisis. 
It  does  not  follow  from  this  fact  that  the 
hemorrhage  should  not  be  arrested.  This 
tendency  to  hemorrhage  can  best  be  controll- 
ed by  the  administration  of  Arsenic  be- 
tween the  attacks.  The  Arsenical  prepara- 
tion selected  by  many  competent  observ- 
ers is  Arsenauro,  the  Liq.  Bromide  of  Gold 
and  Arsenic,  in  ten  drop  doses  three  times 
daily  after  meals.  Here  where  it  is  desira- 
ble to  continue  the  remedy  for  a  considera- 
ble period  the  dose  should  not  be  increased. 
For  obstinate  diarrhoea  the  subgallate  of 
Bismuth  is  useful. 

Cough  is  of  course  necessary  for  the  re- 
moval of  the  morbid  products  within  the 
bronchial  tubes  and  cavities.  If  the  act  of 
coughing  be  accompaneid  by  expectoration, 
palliation  is  not  required.  But  often  there 
is  what  may  be  called  a  superfluous  cough. 
Frequently  this  prevents  sleep.  Palliative 
remedies  are  then  indicated,  and  great  care 
should  be  observed  in  this  selection. 

The  following  formula  is  most  useful  in 
allaying  irritable  cough  and  preventing 
night  sweats. 

Liq.  Morphine  (Magendie),     Gtt.  xxx     ' 
Liq.  Atropine  B.  P.,  Gtt.  vi 

Ac.   Hydrocyanic  dill.  Gtt.  xxx 

Ether  Chlor.  gi 

Syrup  Prumi.  Virg.  or  Symp  Tolu. 
M.  S.      3i.  Pro  re  nafa. 


Sanmetto  in  Enuresis  Diurna  et  Nocturna. 

Some  years  ago  my  attention  was  called 
to  Sanmetto  as  a  remedy  for  troubles  of  the 
genito-urinary  organs,  particularly  in  men 
past  middle  life,  and  I  have  had  some  very 
gratifying  successes  with  its  use.  Recently 
I  was  called  upon  to  prescribe  for  two  boys, 
eight  and  ten  years  of  age  respectively. 
Everything  had  been  tried,  including  whip- 
ping, to  break  up  the  "habit"  of  wetting 
the  bed  at  night,  and  one  of  them  also  his 
clothing  in  the  day  time.  It  occurred  to  me 
that  Sanmetto  would  be  worth  tr/ing,  and 
to  the  delight  of  every  one  concerned  it  has 
been  perfectly  successful ;  and  now  for  the 
past  six  months  and  twelve  months  respec- 
tively, these  boys  have  been  entirely  cured 
of  this  unfortunate  "habit."  Undoubtedly 
the  trouble  was  due  to  irritability  of  the 
prostate  and  mucous  membrane  of  the  blad- 
der ;  hence  the  prompt  and  permanent  re- 
lief afforded  by  Sanmetto.  I  have  written 
these  few  lines  hastily,  calling  the  attention 
of  the  profession  to  these  cases,  with  the 
hope  that  others  will  try  the  same  remedy 
for  the  same  "habit." 

James  A.  Stewart,  M.  D. 

Baltimore,  Md. 


THE  CHARLOTTE  MEDICAL  JOURNAL.  265 


HYDROZONE 

(3o  volumes  preserved  aqueous  solution  of  H.Oj 

IS  THE  MOST    POWERFUL    ANTISEPTIC   AND    PUS   DESTROYER. 
HARMLESS  STIMULANT  TO  HEALTHY  GRANULATIONS. 

GLYCOZONE 

(C.  P.  Glycerine  combined  with  Ozone) 

IS  THE  MOST  POWERFUL  HEALING 
AGENT  KNOWN, 

These  Remedies  cure  all  Diseases  caused  by  Germs. 

Successfully  used    in  the    treatment  of  Gastric  and  Intestinal 

Disorders  (Chronic  or  Acute): 

DYSPEPSIA,  GASTRITIS,  GASTRIC  ULC^R, 

HEART-BURN,  CONSTIPATION, 

DIARRHCEA,  Etc. 

*  Half  an  hour  before  meals,  administer  from  4  to  8  ozs.  of  a  mixture  <_^n« 
taining  2  per  cent,  of  Hydrozone  in  water.     Follow  after  eating  with 
Glycozone  ir.  one  or  two  teaspoonful  doses  well  diluted  in  a  wineglass- 
ful  of  water." 
Send  for  free  24o-page  book  "Treatment  of  Diseases  caused  by  Germs," 
containing  reprints  of  120  scientific  articles  by  leading 
contributors  to  medical  literature. 
Physicians  remitting  50  cents  will  receive  one  complimentary  sample 
of  each  "Hydrozone"  and  "Glycozone"  by  express,  charges  prepaid. 

Hydrozone  is  put  up  only  in  extra  small, 
small,  medium,  and  large  size  bottles,  bearing  a  Prepared  okly  by 

red  label,    white  letters,   gold  and  blue  border 
with  my  signature. 

Glycozone  is  put  up  oniy  in  4-oz.,  8-oz. 
and  16-oz.  bottles,  bearing  a  yellow  label,  white 
and  black  letters,  red  and  blue  border  with  my 

^iCchand.,  Eye  Balsam  c?,.s  .,,  i,      ZTSSSSSSZTZPSS!* 

flammatory  and  contagious  diseases  ot  the  e     ~-  J 

Charles  Marchand,  28  Prince  St.,  New  York. 

fold  by  leading  Druggists.  A?oid.  Imitation*.        VW  Mention  tr  s  Publieatto* 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


GONORRHOEA 


COMPOUND 


PHENAZONE     BOUGIES 


Are  a  Specific  for  Gonorrhea  and  Gleet. 


w_ 


Long  Size.      6^2  inches  long. 

YOUR  PATIENT  has  trouble  enough  of  his  own  already,  when  he  is  sufiering 
with  Gonorrhea  or  Gleet.  DON'T  MORTIFY  HIM  with  "tell  tale"  bottles  and 
syringes,  but  use  instead  a  system  of  treatment  which  is  practical,  attracts  no  atten- 
tion, and  will  cure  promptly.  The  remedies  used  in  the  Phenazone  Bougies  are  of 
an  astringent,  antiseptic,  alterative  and  anodyne  character,  and,  as  the  Bougies  are 
freely  soluble  in  the  secretions  of  the  urethra,  they  are  thus  brought  into  direct, 
thorough  and  prolonged  action  upon  the  diseased  parts.  No  other  system  of  treatment 
will  do  this  as  promptly  or  as  well. 

FORMULA.— Zinc   Sulphate,  Creosote,   Hydrasis,   Antipyrin,  etc. 
LONG  SIZE,  for  Gleet  (6!/2  inches  long).    SHORT  SIZE,  for  Gonorrhoea  (3  inches  long). 

Price,  per  box  of  12  Bougies.     Retail  $1.25.     Physicians  $1.00 

FREE  SAMPLES.— We  will  mail,  just  once,  to  any  Physician  enclosing  -his  pro- 
fessional card,  a  liberal  Free  Sample  of  the  Phenazone  Bougies  (either  long  or 
short)  with  full  literature.     Mention  this  Journal. 

THE  STANDARD  CHEMICAL  CO.,  Ltd.,  1016  Cherry  Street,  Philadelphia. 

Southern  Agencies. — W.  P.  Poythress,  Richmond, V.     I.L.Lyon  &  Co.,  New  Orleans. 


CHRONIC  URETHRITIS 


Nervous  Headache. 

There  is  a  constantly  recurring  form  of 
nervous  headache  to  which  females  are  par- 
ticularly liable.  It  suddenly  seizes  upon  its 
victim  without  premonitory  symptoms,  is 
apparently  due  to  no  appreciable  cause  and 
continues  for  hours,  finally  leaving  the  suf- 
ferer exhausted  physically  and  mentally. 

Imperfect  excretions,  some  degree  of  auto- 
intoxication, disturbed  secretion  and  per- 
verted metabolic  functions  are  responsible 
for  this  condition. 

On  account  of  its  anodyne  properties  and 
its  strong  eliminative  action  Tongaline  is 
particularly  indicated  in  nervous  headache. 
Tongaline  will  not  only  give  prompt  relief, 
but  it  eventually  overcomes  all  tendency  to 
the  trouble. 


The  presence  of  mercury  in  an  absolutely 
soluble  form  characterizes  Sapodermin,  in 
this  vraying  from  the  usual  sublimate  soap 
in  which  the  soluble  salt  is  precipitated  by 
the  alkali  and  rendered  partly  inert.     The 


albuminate  of  mercury  however  besides 
being  a  powerful  antiseptic  and  parasiticide 
permits  the  production  of  a  neutral  soap, 
not  irritating,  but  soothing  to  inflamed  sur- 
faces. It  is  non-poisonous  and  in  stronger 
solution  an  efficient  remedy  in  specific  cases. 
Sapodermin  will  therefore  prove  invaluable 
alike  to  the  operator,  the  dermatologist,  the 
general  practitioner. 


Gentlemen  : — I  am  pleased  to  state  that 
I  think  I  have  prescribed,  in  all,  about  =;oo 
ounces  of  Resinol  since  my  first  trial  of  it 
in  practice.  To  be  candid  I  must  say  that 
it  has  proved  the  most  satisfactory  in  the 
cases  I  have  selected  of  any  ointment  I  ever 
used.  It,  with  one  or  two  others  is  about 
the  only  "ready  made"  ointment  that  I  am 
in  the  habit  of  prescribing.  Resinal  pos- 
sesses merits  that  cannot  fail  to  attract  the 
notice  of  an  observing  physician. 

Frank  Price,  M.  D., 

Braddock,  Pa. 


THE  CHARLOTTE  MEDICAL  JOURNAL, 


TABLE  OF   CONTENTS  FOR    FEBRUARY,    1899. 


267 


Original  Communications 

Lithremia,  by  John  N.  Up- 
shur, M.  D.,  Richmond, 
Va., 153 

Medical  Examining-  Board 
— Especially  those  of  Vir- 
ginia and  North  Carolina, 
by  A.  S.  Priddy,  M.  D.. 
Keysville,  Virginia 158 

Tubal  Pregnancy,  by  Vir- 
ginius  Harrison,  A.  M.. 
M.  D.,  Richmond.  Va 160 

Typhoid  Fever,  Diagnosis 
and  Treatment,  by  Rolfe 
E.  Hughes.  M.  D., 
Laurens,    S.    C 166 

A  Plea  for  the  Earlier 
Diagnosis  of  Pulmonary 
Consumption,  by  Louis  F. 
High.M.  D., Danville,  Va.  168 

The  Practical  Treatment 
of  Carbolic  Acid  Poison- 
ing, by  Dr.  Stephen 
Harnsberger,  Catlett,  Va.   17<> 

Uricacidsemia  as  the  Cause 
of  Hay  Fever  and  Asthma 
by  Dr.  John  Dunn,  Rich- 
mond,  Va 171 

Simultaneous  Blood-wash- 
ing and  Blood-letting  in 
Uraemia,  by  A.  B.  Knowl- 
tOD,  M.  D., Columbia.  S.< '.   178 

The  Medical  Treatment  of 
Appendicitis.  <ov  Appen- 
dicitis Without  Opera- 
tion, bv  Charles  15.  Mc- 
Anally,  Madison,  X.  C...    IKo 

Pseudo-Membraneous  En- 
teritis, by  .1.  M.  Fladger, 
M.  1)..  Summerton,  s.  C.   [83 

Dystocia,  by  David  A. 
Stanton.  M.  I).,  High 
Point,   N.  C 196 


Report  of  a  Case  of  Appen- 
dicitis, Complicated  with 
Intestinal  Perforation — 
Recovery,  by  George  W. 
Long,  M.  D.  Graham, 
N.  C 185 

Headache  —  Ocular  and 
Nasal,  by  Joseph  A. 
White,  A.  M.,  M.  D., 
Richmond,  Va 186 

What  Medicine  Owes  to 
Bacteriology,  by  E.  C. 
Levy,  M.  5.,  Richmond, 
Va 191 

Ovaritis  -Acute  and  Chron- 
ic, by  Dr.  L.  G.  Frazier, 
Youngsyille,  N.  C 201 

Modern  Views  of  the  Nature 
and  Treatment  of  Pulmo- 
nary Tuberculosis,  by  H. 
B.  Weaver,  M.  D.,  Ashe- 
ville,  N.  C 205 

Report  of  Two  Successful 
Nephrectomies,  by  Geo. 
Ben  Johnston,  M.D., Rich- 
mond, Va 212 

Treatment  of  Urethral  Dis- 
charges, by  -las.  M.  Par- 
rot, M.  D..*Kinston.  N.  C.  217 

Epilepsy;  State  Institutions 
for  Epileptics,  by  William 
Francis  Drewry,  M.  D.. 
Petersburg,  Va 220 

Advisab'lity  of  Bone  Sutu- 
ring in  Treatment  of  Frac- 
tures, by  HughT.  Nelson, 
M.D..(  harlottesville,Ya.  227 

1  'erforating  Fleer  of  Duode- 
num -Operation — Recov- 
ery, by  Hugh  M.  Taylor. 
M.  D.,  Richmond,  Va 232 

The  Eye  as  a  Causative 
Factor  in  Functional  Ner- 
vous Disorders,  by  W.  11. 


Wakefield,  M.  D.,  Char- 
lotte, N.  C 235 

Report  of  Cases  of  Rupture 
of  Uterus  During  Preg- 
nancy, by  Francis  D.  Ken- 
dall. M.D.,  Columbia, S.C.  240 

Editorial. 

Tri- State  Medical  Associa- 
tion of  the  Carolinas  and 

Virginia 241 

Address  of  Welcome 241 

Response  to  the  Address  of 

Welcome 242 

President  Cobb's  Address, .  243 
Transactions  of  the   Asso- 
ciation    244 

Miscellaneous- 

Intra-Nasal  Diseases 260 

Lead  as  an  Abortifacient, .  255 

Nervous  Headache, 366 

Quinine  Hsemoglobinuria, .  258 

Seaboard  Medical  Associa- 
tion    258 

Sanmetto  in-General  Naso- 
pharyngeal and  Bronchial 
Catarrh,  etc.,  etc 258 

Treatment  of  Gout  by  Al- 
kalies     256 

The  Rational  Treatment  of 
Grippe 260 

Treatment  of  LaGrippe  or 
Epidemic  Influenza, 262 

To  the  Members  of  the  Med- 
ical Society  of  North 
Carolina, 262 

Treatment  of  Pulmonary 
Phthisis, 264 

What  to  Inject  in  Gonorrhea  260 


GENTLEMEN: — As  you  have  kindly  fur- 
nished me  samples  of  the  remedy  that  cured 
a  most  intractable  malady,  1  will  respond 
to  your  request  for  my  experience  with 
Resinol.  I  suffered  intensely  with  Scrotal 
and  Anal  Pruritus  and  Hemorrhoids.  At 
night  on  disrobing  I  invariably  had  a 
"scratching  time,"  when  everything  de- 
tachable (skin,  and  scabs  from  previous 
denudation)  had  to  come.  1  also  suffered 
from  an  eczematous  eruption  upon  my  neck 
exactly  where  my  undershirt  buttoned, 
forming  a  complete  ring  around  my  neck. 
This,  with  the  first  mentioned  difficulty,  had 
resisted  all  known,  and  some  unknown, 
remedies  for  the  past  eight  years.  Resinol, 
a  sample  box,  cured  me  in  two  weeks. 
Have  used  it  on  others  in  similar  conditions 
and  it  has  never  failed  me,  and  now  I  do 
not  think  of  any  other  remedy  in  Eczema, 
Pruritus,     Itching     Piles     (so-called),     and 


have  found  it  equally  efficacious  in  some 
forms  of  Herpes,  Acne  Rosacea  and  all 
itching  eruptions  in  particular,  which,  I 
believe,  is  the  key-note  for  its  best  action. 
Vulval  Pruritus  yields  immediately  to  its 
soothing  embrace. 

J.  O.   Bates,  M.  D. 
Spring  Lake,  Mich. 

Gentlemen  : — Having  used  Unguentine 
Resinol  for  two  or  three  years,  over  fifty- 
boxes,  for  Hemorrhoids,  Pruritus  Ani  and 
Vulva,  Eczema  and  Bunions,  I  deem  it  a 
necessity,  and  would  be  at  a  loss  to  practice 
without  this  remedy,  as  it  works  where  all 
others  fail.  I  consider  it  a  grand  prepara- 
tion and  take  pleasure  in  recommending  it 
to  physicians.  1  am  sure  when  once  used 
that  no  physician  would  be  without  it. 
Ira  D.   Hopkins,  M.  D. 

Utica,  N.  Y. 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


TERRALINE 


i 


A  Preparation  of   Petroleum  for  Internal  Use. 


DOCTOR: 

When  patients  in  a  semi-convalescent  state,  do  not  respond  to  ordinary  treatment,  where  a 
defective  or  impaired  condition  is  to  be  built  up 

TERRALINE  IS  HELPFUL 

because  it  secures  a  normal  metabolism,  provides  a  compensatory  nutrition,  perserving  the 
equilibrium  between  waste  and  repair  and  the  uniformity  of  a  good  blood  supply. 

AS  A  RECONSTRUCTIVE  AGENT 

TERRALINE  can  be  safely  recommended  and  prescribed  on  account  of  its  entire  palatabiliyt 
as  a  germicidal  antagonist  to  depletion  and  its  easy  retention  by  the  stomach. 

AFTER  LA  GRIPPE 

TERRALINE  checks  decline,  increase  the  appetite,  produces  a  rapid  gain  in  weight  and  strength 
by  restoring  vital  energy  and  force  to  the  body  and  renewed  tone  to  the  nerve  centres. 

AN  ANTISEPTIC  SEDATIVE. 

Being  a  pure,  refined  cream  of  Petroleum,  TERRALINE  possesses  marked  soothing,  healing 
and  germicidal  power. 

AS  AN  EXPECTORANT 

It  relieves  the  harsh,  persistent  irritating  cough  of  Bronchitis,  Sub-acute  and  Chronic,  arrests 
inflammation  and  reduces  congestion  by  promoting  healthy  secretion  and  excretion. 

IN    PHTHISIS 

TERRALINE  rebuilds,  while  it  stimulates  the  system  to  expel  effete  and  poisonous  products  of 
the  disease.  It  fortifies  resisting  power  and  by  its  germicidal  activity  guards  the  entire  economy 
against  further  attack  or  invasion  of  micro-organisms. 

AS  A  COMMENSURATE  TISSUE  BUILDER 

TERRALINE  can  be  given  continuously.  Is  well  liked.  Is  well  borne  and  rapidly  assimilated. 
It  renovates  and  nourishes  in  General  Debility  and  Wasting  Diseases. 

IN   PULMONARY  COMPLAINTS, 

Coughs,  Colds,  Pneumonia  and  their  sequelae,  TERRALINE  counteracts  the  difficulty  of  breath- 
ing, disinfects  offensive  discharges,  promotes  free  expectoration,  soothes  irritation,  quiets  coughs 
and  heals  ulcerative  surface  of  lungs. 

PERFORMANCE  EQUALS  PROMISE 

The  timely  administration  of  TERRALINE  will  establish  its  claim  to  the  critical  consideration 
of  painstaking  Therapists.    To  make  its  merits  manifest  let  us  send  you  Samples  and  Literature. 


PREPAtfED  by 


HILLSIDE   CHEMICAL  CO.,  NEWBURGH,   N.  Y. 


THE  CHARLOTTE  MEDICAL  JOURNAL.  269 

Buffalo  DthiaWmIr" 

INJALBUMINURIA  OF 

Blight's  Disease,  Pregnancy  and  Scarlet  Fever,  Gouty  Diathesis,  etc. 


Dr.  ALFRED  L.  Loomis,  Professor  of  Pathology  and  Practical  Medicine  in  the  Medical  De- 
partment of  the  University  of  New  York,  wrote:  "For  the  past  four  years  I  have  used  Buffalo 
Lithia  WATER  in  the  treatment  of  Chronic  Bright's  Disease  of  the  Kidneys,  occurring  in  Gouty 
and  Rheumatic  subjects,  with  marked  benefit." 

DR.  Wm.  H.  Drummond,  Professor  of  Medical  Jurisprudence,  Bishop's  University  of  Mon- 
treal, Canada:  "In  the  Acute  and  Chronic  Nephritis  (Bright's  Disease  of  the  Kidneys)  of  Gouty 
and  Rheumatic  Origin,  as  well  as  in  the  graver  Albuminuria  of  Pregnancy,  I  have  found  Buf 
falo  Lithia  Water  to  act  as  a  veritable  antidote,  and  I  know  of  no  other  natural  agent  possess- 
ing this  important  quality. 

E.  C.  Laird,  M.D.,  Resident  Physician  Hot  Springs,  N.  C:  "In  the  Nausea  and  Vomiting.- 
Ursemic  Poisoning  and  Albimunuria  of  Pregnancy,  I  know  of  nothing  to  compare  with  Buffalo 
Lithia  Water.  So  uniformly  gratifying  has  been  my  experience  with  this  agent,  that  it  has 
long  been  my  habit  to  prescribe  it  as  a  prophylactic,  as  well  as  a  most  potent  remedy  through  all 
the  stages  of  Gestation,  and  to  this  I  attribute  the  fact  that  in  a  practice  of  well  nigh  twenty 
years  I  have  had  but  one  death  from  Puerperal  Eclampsia.  The  women  of  the  adjacent  country 
who  make  use  of  the  Waters  are  notably  free  from  the  disturbances  and  dangers  incident  to  this 
period." 

Dr.  M.  L.  James,  Richmond,  Va, ,  Emeritus  Professor  of  Practice  of  Medicine,  Medical  Col- 
lege of  Virginia,  reported  to  the  Richmond  Academy  of  Medicine  "a  case  of  Congestion  of  the 
Kidneys  in  a  lady  eight  months  advanced  in  pregnancy,  attended  by  marked  ffidema,and  Ursemic 
Poisoning  to  such  an  extent  as  very  seriouely  impaired  her  vision,  relieved  by  the  free  use  of 
this  water  for  three  weeks.  Other  remedies  were  used  in  these  cases,  but  the  favorable  results 
seemed  clearly  attributable  to  the  action  of  the  Water." 

Dr.  J.  T.  DAVIDSON,  New  Orleans,  La.,  ex-President  New  Orleans  Surgical  and  Medical 
Association,  says:  --I  have  several  years  prescribed'  Buffalo  Lithia  Water  in  all  cases  of 
Scarlet  Fever,  directing  it  to  be  drunk  ad  libitum,  with  the  effect  of  relieving  all  traces  of  albu- 
min in  the  urine,  and  have  found  it  equally  efficacious  in  renal  diseases  requiring  the  use  of 
alkaline  water." 

Dr.  C.  C.  McDowell,  of  Baltimore,  Md.,  Member  of  Medico-Chirurgical  Faculty  of  Mary- 
land, says:  "I  have  been  using  Buffalo  Lithia  Water,  Spring  No.  2,  in  the  treatment  of 
Scarlitinal  Nephritis  for  years,  with  most  gratifying  results." 

Dr.  John  H.  Tucker,  of  Henderson,  N.  C,  says  (referring  to  Spring  No.  1):  "In  Albumi- 
nuria of  pregnant  women  Buffalo  Lithia  Water  has  proved  a  great  blessing." 

Dr.  James  D.  McCaw,  of  Richmond,  Va.,  Honorary  Fellow  Medical  Society  of  Virginia, 
Emeritus  Professor  Medical  College  of  Virginia,  etc.,  speaks  (Virginia  Medical  Monthly)  of  "the 
great  value  of  these  waters  in  Albuminuria  of  Pregnancy." 

Water  in  cases  of  One  Dozen  Half  Gallon  Bottles,  $5.00,  F.O.B.  Here. 

Sold  by  all  First-class  Druggists. 

THOS.  F.  GOODE,  Proprietor  Buffalo  Lithia  Springs,  Va. 


270 


THE  CHARLOTTE   MEDICAL  JOURNAL. 


ANTIBRULE 


THE  VADE  MECUM  OF  MODERN  SURGERY, 
ANALGESIC.  ) 


ANTISEPTIC. 
KERATOPLASTY 


No  Similar  Combination  Known. 


ANTIBRULE  hastens  granulation  with  incredible  rapidity,  and  therefore  practically  pre- 
vents the  formation  of  scar  tissue.  While  scientists  recognize  that  there  is  no  such  thing  as 
absolute  "union  by  first  intention,"  ANTIBRULE  has  come  nearer  demonstrating  its  possibility 
than  any  agent  yet  offered  to  the  medical  profession. 

Brilliant  results  have  been  attained  through  the  use  of  ANTIBRULE  not  only  in  surgery, 
but  also  in  hopeless  cases  of  Hay  Fever,  Nasal  Catarrh,  Chronic  and  Syphilitic  Ulcers,  Gonor- 
rhoea, Eczema,  Erysipelas,  and  many  other  skin  affections. 

A  Positive  Specific  for  Leucorrhcea,  Eczema  of  the  Thighs  and  Scrotum,  Poison  Oak  Affections, 
— "^^  Pustular  Cutaneous   Diseases,  all  Inflammations  of  the   Mucous  Membranes, 

whether  of  traumatic,  idiopathic  or  specific  origin,  and  all  conditions  requiring  absolute  asepsis. 
The  only  rational,  scientific  treatment  for  BURNS  AND  SCALDS  and  the  only  specific  for  the  same. 
Stops  Pain  Instantly.  Few  practitioners  now  treat  Burns  with  preparations  containing  animal, 
~  vegetable  or  mineral  oils.  ANTIBRULE  produces  immediate  analgesia, 
and  nothing  else,  promptly  repairs  the  damaged  tissues  without  scarring. 

In  Gynaecology,  injections  before  and  after  operations  have  established  the  fact  that  ANTI- 
BRULE is  the  surgeon's  best  and  most  reliable  aseptic  and  antiseptic. 

PROPERTIES:  Analgesic,  Antiseptic,  Astringent.  Keratoplastic,  non-irritating,  Aseptic 
and  Atoxic. 

INDICATIONS:  Croup,  Sore  Throat,  Ulcers,  Wounds,  Sprains,  Contusions,  Carbuncles, 
Furuncles,  Pruritis,  Vulvitis,  Leucorrhcea,  Eczema,  Psoriasis,  Erysipelas,  Ophthalmia,  Otalgia, 
Balanitis,  Uterine,  Vaginal  and  Rectal  Ulcerations  and  Injuries,  Gonorrhoea  and  all  conditions 
where  there  is  ulceration  and  difficulty  in  healing. 

FORMULA,  literature  and  16-oz.  bottle  prepaid  by  express  to  practitioners,  on  receipt  of 
$1.00.     If  satisfaction  does  not  result  from  the  use  of  Antibrule,  price  will  be  refunded. 

ANTIBRULE  CHEMICAL  CO.,  7D8  Pine  Street,  ST.  LOUIS,  MO. 

A    NEW    BOOK!    JUST    PUBLISHED!! 

A  Plgrimage;  or  the  Sunshine  and  Shadows  of  the  Physician. 

By  WM.  LANE  LOWDER,  B.  S.,  M.  D. 

"We  know  nothing  of  the  writer  of  'Sunshine  and  Shadows  of  the  Physician,'  but  he  has 
written  a  rare  little  book,  worthy  of  wide  diffusion  in  the  Profession.  It  contains  chapters  on  the 
"Qualifications, "  "Duties"  and ''Influence  of  the  Physician."  on  "Professional  Friendship,' 
"Medical  Ethics,"  "Medical  Societies,"  and  a  concluding  one  on  the  "Pilgrimage  of  the  Physi- 
cian"— in  "Youth,"  "Manhood,"  and  "Old  Age."  Throughout  them  is  the  undertone  of  Gray's 
Elegy  (which  the  author,  in  one  place  or  another,  quotes  almost  in  full),  but  amid  much  that  is 
trite  and  occasionally  sentimental  there  is  nothing  sordid,  and  he  everywhere  reflects  the  medi- 
cal spirit  in  its  nobler  Bide. " — Philadelphia  Medical  Journal. 

This  book  is  also  highly  endorsed  by  Drs.  Theophilus  Parvin,  William  Osier,  Hunter  Mc- 
Guire,  J.  W.  Holland,  Paul  F.  Eve,  J.  M.  Bodine,  Jos.  McDowell  Mathews,  Samuel  E.  Woody, 
Clinton  W.  Kelly  and  others. 

Contains  196  pages,  handsomely  bound  in  cloth,  with  title  stamped  in  gilt  on  side.  Size 
4x6   inches    Price  One  Dollar.     Copies  may  be  had  by  addressing  the  author. 

Dr.  W.  L.  LOWDER,  McKinney,  Lincoln  Co.,  Ky. 

1 

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THE  CHARLOTTE  MEDICAL  JOURNAL. 


Passif lora  Incarnata. 

(DANIEL'S  CONCENTRATED  TINCTURE.) 

A  Product  of  the  Haypop  or  Passion  Flower. 
Properties : 

ANODYNE,  ANTISPASMODIC,  .SOPORIFIC,  SEDATIVE,  NERVE  STIM- 
ULANT AND  SLIGHTLY  LAXATIVE. 

"Where  Indicated: 

CHLORAL  AND  TOBACCO  HABITS,  NEURALGIA,  NERVE  EXHAUS- 
TION, ALCOHOLISM,  HYSTERIA,  CONVULSIONS,  EPILEPSY,  PAINFUL 
AND  UNNATURAL  MENSTRUATION,   AMD 

JNO,   B.   DANIEL, 

Atlemta,  Georgia. 

WRITE  FOR  LITERATURE    AND  TESTIMONIALS. 

For  sale  by  leading  Wholesale   Drug  Finns  of  the   U.   S. 


As    an    ANODYNE    IZ' 1}  V  O  1h  T  XT  Th     is    powerful    and 

and  HYPNOTIC  IV IV  A  V^A^  All  H    without  ill  effects. 

I  Methoxacet-p-phenetidin ) 


Dr.  (Jeorge  F.  Butler,  Professor  of  Materia  Medica  and  Clinical  Medi- 
cine, College  of  Physicians  and  Surgeons,  Chicago;  attending  physician 
Cook  County  Hospital,  etc.,  in  the  course  of  an  article  in  the  Chicago  Clinic 
says  : 

"With  the  exception  of  morphine,  no  drug  possesses  so  positive,  prompt  and 
efficient  an  analgesic  property  as  kryofine  ;  indeed,  there  are  painful  disorders,  such 
as  migraine  and  particularly  the  pains  of  locomotor  ataxia  and  certain  spinal  dis- 
eases, where  kryofine  seems  nearly  as  efficient  as  morphine  and  attended  with  less 
unpleasant  sequel*. " 

In  the  services  of  Drs.  Rudisch,  A.  Meyer  and  A.  G.  Gerster,  Mt.  Sinai 
Hospital,  N.  Y.,  it  was  found  that  : 

"As  a  hypnotic  in  insomnia,  unaccompanied  hy  severe  pain,  it  has  proved  of 
undoubted  value.  In  a  case  of  acute  suppurative  arthritis,  general  sepsis  and  peri- 
carditis, the  drug  did  not  affect  the  pulse.  When  the  child  was  restless  at  night,  2i 
grs.  of  kryofine  produced  a  quiet  sleep  lasting  several  hours."— Drs.  Haas  and  Mor- 
rison, N.  Y.  Medical  Journal. 


Literature  and  Qm     BISCHKOFF     &    CO.,  Dose :  5-7* 

samples  sent  W<     ««^IIIWI  **     wvr"  grains ;  tablets  or 

on  request.  ^few  York.  crystalline  powder. 


272 


THE  CHARLOTTE  MEDICAL   JOURNAL. 


Wallace's  Instantaneous 


(Patented  December  31,  1895.) 

This  is  OUR  $5.00  STERILIZER. 


Notwithstanding  the'Jlow  price,   this  apparatus  has  all  the 
aluable  features  of  the  highest  priced  sterilizers   we  make.    It  is 
eatest  bargain  offered  to  the  profession. 

PORTABLE,   PRACTICAL,    PERFECT. 

Especially  adapted  for  members  who  operate  at  patient's 
residences,  as  well  as  for  general  office  use. 

We  claim  for  it  superiority  over  its  competitors,  in  the  follow- 
ing   respect: 

1.  It  is  instantaneous,  generating  steam  the  moment  the  lamp  is 
lighted. 

2.  It  requires  less  fuel  than  any  other  sterilizer  in  the  market. 

3.  It  has  no  double  bottom  or  other  intricate  parts  to  get  out  of  order  or  clog  up. 

4.  It  can  be  carried  with  perfect  ease,  packing  into  the  size  and  appearance  of  a  neat  portmanteau. 

5.  THE  PATENTED  FEATURE  is  a  separate  reservior  regulating  the  supply  of  water  in  the  sterilizing  chamber. 
The  $500  Sterilizer  differs  from  the  celebrated  'Portable"  only  in  having  square  corners,  instead  of  round,  and 

is  made  of  heavy  tin,  copper  bottom  instead  of  all  copper.  Write  for  Catalogue  aud  Price  List. 

JOHN  W.    A?STA.ryI^A.OE>    COMPANY, 

For  Sale  by  all  Surgical  Instrument  Dealers.  132  Cumberland  St.,  BROOKLYN,  N.  Y. 


ROBERTSON'S  LATEST. 

Especially  adapted  to  treatment  of  the 
Middle  Ear  and  all  of  the  Respira- 
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This  cut  shows  our  new  Six-Globe  Mul- 
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prevent  back  pressure  of  vaporized  medi- 
cine into  the  globes,  and  to  prevent  evapor- 
ation through  the  tubes  when  not  in  use, 
and  new  Needle  Valve  arrangement  for 
blowing  the  vapor  out  of  the  mixing  globe, 
and  for  controlling  air  pressure  through  the 
Vibrating  Valve.  This  is  the  most  conve- 
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offered  for  a  physician's  office. 

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formula*  and  methods  of  treatment. 

Beware  of  Imitations. 

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1 20  Longworth  Street, 
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THE  CHARLOTTE  MEDICAL  JOURNAL. 


Trophonine 


a  palatable  and  nutritious  liquid  food,  contains  the  nutritive  elements  of  beef,  egg- 
albumen,  and  wheat  gluten,  so  prepared  as  to  be  readily  absorbed  and  aid  almost 
immediately  in  the  process  of  reconstruction.  It  furnishes  the  sick  with  the  largest 
possible  supply  of   nourishment   and  with  the  minimum   tax  on  the  digestive  organs. 


Protonuclein 


by  increasing  the   number  of   Leucocytes,  destroys  toxic   germs,  increases  the   inherent 

resistance   to   disease,   quickens   glandular   activity,   arouses  the  nutritive  forces, 

gives  tone   to   the   system,   and   stimulates  cell-life   through   the  organism. 


Peptenzyme 


is  the  only  perfect  digestive.        It  digests  every  variety  of  food.        In   physiological 

activity  it  presents  the  active  and  mother  ferments  of    the  entire  group  of  digestive 

organs.      It  aids  digestion  by  furnishing  an  additional  supply  of  protoplasmic 

material  out  of   which  active  ferments  are    elaborated,  and  perfects  the 

process  by    increasing    cellular    activity. 


Samples  and   Literature  on  request. 

Reed  &  Carnrick       -        New  York 


274 


THE  CHARLOTTE  MEDICAL  JOURNAL 


THE  DENNIS  FLUOROMETER 


MANUFACTURED   BY 


The  Rochester  Fluorometer  Co.  5SSJS.ui. 


Velvet  Case.     Patented  April  27,  1897. 

THE  DENNIS  FLUOROMETER  is  a  necessary  adjunct  of  perfect  x-ray  work. 
It  supplies  accurate  cross-section  of  the  body  or  limb,  rectifies  distortions  of  position  and 
distortions  caused  by  the  divergence  of  the  rays,  and  locates  with  geometrical  exactness 
anything  which  is  observable  in  the  Roentgen  shadow.  It  forms  a  perfect  shadow  of 
any  portion  of  the  anatomy,  making  it  indispensable  in  cases  of  dislocations  and 
fractures.  Accurate  methods,  precise  instruments,  precise  results.  THE  DENNIS 
FLUOROMETER  supplies  all  this.  It  gives  protection  to  the  Surgeon  in  court ;  also 
•equips  him  for  expert  testimony. 


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THE  ROCHESTER  FLUOROMETER  CO. 

225  Cutler  Building,  ROCHESTER,  N.  Y. 

For  full  information  and  particulars  write  for  illustrated  catalogue. 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


275 


"The  abortive  properties  which  it  possesses  evidently  lie  in 
the  complete  inocculation  of  the  blood  with  an  antiseptic  that 
will  render  the  blood  an  infertile  field  for  the  propagation  of 
germs  or  the  growth  of  disease  ferments." 

The  above  quotation  is  from  a  paper  entitled  "AN  ANTISEPTIC  METHOD 
OF  ABORTING  AND  CONTROLLING  FE  VERS,"  read  before  the  Illinois 
State  Medical  Society,  and  refers  to 

VISKOLEIN 

IN  THE  TREATMENT  OF 

TYPHOID  FEVER  m  PNEUflONIA 

VISKOLEIN  acts  as  an  antipyretic,  and  antiseptic,  and  a  stimulant.  It  reduces 
the  temperature  rapidly,  safely  and  permanently,  and,  at  the  same  time,  by  its  antiseptic 
action,  destroys  the  germs  of  the  disease.     The  result  must  be  rapid  recovery. 

For  formula,  literature,  clinical  reports  and  other  information,  address 

The  Viskolein  Chemical  Co., 

5  Beaver  Street,  New  York. 
P^?!I8^^^Ld^Kt23fa^  Fevers  (all  forms),  Pneumonia,  La  Grippe, 
Pyemia  and  Septicemia,  and  all  other  Zymotic  Diseases. 

The  Dow  Portable  Electric  ssistant. 


Physirians',  Surgeons'  and  Dentists'  Oatfit  Complete. 

The  Dow  Portable'  Electric  Assistant  is  the 
lust  portable  electric  outfit  ever  put  on  the  mar- 
ket and  has  been  adopted  by  the  United  States 
Army  and  Navy.  It  illuminates,  as  no  other 
apparatus  can,  the  mouth,  throat,  ear  and  nasal 
passages;  and  for  gynecological  observations  it 
s  unrivaled. 


Gentlemen: 


Chicago,  March  22,  1897. 


The  portable  battery,  "Dow's  Physician's 
Electric  Assistant,"  which  I  got  from  you  has 
been  in  constant  use  for  over  three  months.  I 
have  found  it  fully  up  to  your  representations, 
and  fully  satisfactory.  I  have  recommended  it 
to  several  professional  friends,  and  will  take 
pleasure  in  continuing  to  do  so. 
Yours  truly, 
HUGH  BLAKE  WILLIAMS,  M.  D. 

Gentlemen:  Braintree,  March  1,  1898. 

I  believe  it  to  be  the  most  complete,  compact 
and  unique  invention  yet  devised  for  application 
in  awide  range  of  cases,  destined  to  find  a  place 
in  the  office  of  physicians  and  surgeons  alive  to 
the  advancement  of  Scientific  medicane  and 
modern   surgery.  Respectfully  yours, 

HENRY   L.    DEARING,   M.    D., 


Send  for  circiular  and  price  list. 

The  Dow  Portable  Electric  Assistant  Co, 

218  Tremont  St.,  Boston,  Mass.,  U.  S.  A. 


276 


THE  CHARLOTTE    MEDICAL  JOURNAL. 


Wagner  Patent  Mica  Plate 

Static  Machine, 

The  latest  and  best  for  both  Therapeutical  and 
X-Ray  work.  Works  in  damp  weather  and  can  be 
run  at  a  very  high  rate  of  speed. 

:o: 

We  have  many  new  and  valuable  improvements 
our  line  of   Physicians'  Electrical  Supplies,    which 
will  interest  you,  comprising: 

Portable  Cautery  Batteries 

Storage  Cautery  Batteries 

Galvanic  Batteries  Faradic  Batteries 

X  Rays  Apparatus 

Electric    Engines    Millianipere    Meters 

Rheostats,   Shunt    Coils, 

Electrodes    and    Electro-Therapeutical 

Specialties. 

Our  New  Illustrated  Catalogue  will  be  sent  free  upon 

Application. 


Static  flachine. 
52-54  State  St.,  CHICAGO.  ILL. 


R.  V.  WAGNER  &  CO., 

Successors  to  the  Electro-Medical  Supply  Co. 


Hydro-Electric  Rectal  Tubes 

Especially  abapted  to  first 
Flushing  and  then  Electri- 
fyiny  the    Colon 

The  Common  Sense  Treatment 

for  obstruction  of  the  bowels  and  constipa- 
tion. Our  rectal  tubes  can  be  introduced 
through  the  sigmoid  flexture.  Our  Catheter 
soon  relieves  atony  of  the  bladder,  and  can 
be  introduced  when  others  fail. 

The  electrode  can  in  no  way  come  in 
contact  with  the  mucous  membrane.  This 
being  the  case  no  burn  or  escar  can  be  pro- 
duced. 

Send  for  reprint  of  article  by  Dr.  R.  F. 
Johnson,  in  the  Alkaloidal  Clinic  for 
January,  1899. 

Write  for  particulars. 

Information     and     prices    furnished     on 
Electro-Medical  Goods  of  all  kinds  on    ap- 
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Price   of  Set   in  Handsome  Leather 

Case,  $7.50 

Price  of  Single  Rectal  Tube  $2.50 

Price  of  Single  Catheter,  $2.25 

THE  HYDRO-ELECTRIC  INSTRUflENT  CO. 

Room  83,  125  La  Salle  St.,    CHICAGO,  ILL. 


THE  CHARLOTTE  MEDICAL  JOURNAL.  277 

Information  Wanted. 

Satisfactory     Results 

obtained  by  the  Profession  from  the  use  of 

Neurosine  and  Dioviburnia 

is  daily  increasing  the  demand,  consequently,  it  is  the 
"harvest  time"  for  Substitutors  and  whereas  we  manufac- 
ture products  exclusively  for  the  Physicians  to  prescribe,  it 
is  to  his  interest  as  well  as  ours  not  to  allow  his  prescriptions  to 
be  substituted,  reporting  to  us  the  names  of  Druggists  attempting 
this  nefarous  business.  Such  information  STRICTLY  CONFIDEN= 
TIAL.  When  prescribing  DIOVIBURNIA  or  NEUROSINE  please 
signify  (DiosJ 

DI05  CHEMICAL  COMPANY. 

St.   Louis,   flo.,   U.   S.   A. 


IMie    Atlanta    Retreat, 
A  PRIVATE  HOSPITAL  for  MEDICAL   AND  SURGICAL  CASES, 

WITH  SPECIAL  PROVISIONS  FOR 


STAFF. 

W.  P.  NlCOLSON,  M.  D.,  Surgery. 

R.  R.  KlME,  M.  D.,  Gynecology. 

W.  L.  Champion,  M.  D.,    Genito-Urinary  and 

Rectal  Diseases. 
Bernard  Wolff,    M.  D.,   Skin   Diseases  and 

Cancer. 
C.  C.  Stockard,  M.  D.,  Drug  Habits. 


CONSULTANTS. 

J.  S.  TODD,  M.  D.,  General  Medicine. 

S.  G.  C.  Pinckney,  M.  D.,  Nervous  Diseases. 

A.  W.  Calhoun,  M.  D.,  Eye,  Ear,  Nose  and 
Throat. 

F.  S.  Bourns,  M.  D.,  Pathology  and  Bacte- 
riology. 


C.  C  STOCKARD.   M.  D.,  Sup't.,   103  Walton  St.,  Atlanta,  Ga. 

C/^r-i  ry  Indicated  in  Stomach  Derangements. 
^^^S  It  increases  the  flow  of  the  Digestive 
juices,  thereby  causing  the  stomach  to  do  its  own 
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Dose — One  or  x-nore  teaspoonfuls  three  times  a  day. 

♦ 

CACTI  N  A  PILLETS.   The  HEART  REGULATOR. 

Dose— One  Pillet  every  hour,  or  less  often,  as  required. 
SULTAN  DRUG  CO.,  St.  Louis  and  London. 


278 


THE    CHARLOTTE  MEDICAL  JOURNAL. 


Uniformly   Effective,   Agreeable  and  Lasting. 

The   Standard   Preparation  of  Erythroxylon 
COCA. 


During'past  30 
years  most 
popularly  used 
Tonic-Stimulanl 
in  Hospitals,  Public 
and  Religious 
Institutions 
everywhere. 


Ell 


MARIANI 


(MARIANI    WINE) 

THE  IDEAL  FRENCH  TONIC. 


We  have  received 
over  7,000 
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from  Prominent 
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r}  |       ,      The    Concentrated  Extract — the    aromatic 

rOrmUla  .    principle  0f  the  fresh  Coca  Leaf,   blendid 
with  a  special  quality  of  grape  Juice  of  Southern  France. 

pv  #      Wine-glassful   three    times   a   day,    or  more  or 

^      'C  •     fags,  at  physician 's  discretion. 


NOURISHES, 


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STRENGTHENS  THE  SYSTE1 


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MONTREAL  :  2S  Hospital  Street. 


MARIANI  &  CO.,  52  W.  Fifteenth  St.,  NEW  YORK. 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


279 


PHENALGIN  etna) 


"Among  the  many  hypnotics  offered  the  medical 
profession  during  the  past  few  years,  Phenalgin  cer- 
tainly takes  the  lead.  Its  greatest  superiority  is 
found  in  the  well-established  fact  that  it  does  not 
cause  any  heart  depression,  nor  is  there  any  reaction 
following  its  continued  administration.  In  doses  of 
five  or  ten  grains  it  overcomes  pain,  and  produces  the 
most  refreshing  sleep,  from  which  the  patient  awakes 
exhilarated  and  invigorated." — The  N.  Y.  Polyclinic. 

Phenalgin  is  sold  by  every  wholesale  druggist.  Your 
retailer  can  obtain  it  for  you  without  delay  or  trouble. 
Generous  samples  of  powder  or  tablets  sent  free  by  mail 
to  physicians. 

ETNA  CHEMICAL  CO.,  313  West  St.,  NewYork.l.S.A. 


„  'SSSSW'A  _ 

Highest  Standard-"  Excellence 

OukGVm/egological  chair 

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At  Southern  Pines,  N.  C. 

Situated  in  the  heart  of  the  renowned  long-  leaf  pine  belt  and  at  its  highest  elevation,  si 
hundred  feet  above  sea  level,  Southern  Pines  possesses  all  of  the  advantages  of  resorts  far  the 
south,  while  being  free  from  the  many  well-known  disadvantages  often  encountered  there.  It 
superior  location  in  the  midst  of  the  noble  pines,  whose  health-giving  and  delicious  odor  is  conr 
stantly  inhaled,  and  the  remarkable  purity  of  the  water  here  obtained,  together  with  extremely 
mild  climate,  renders  this  the  most  desirable  resort  for  persons  suffering  from  lung,  throat  and 
malarial  troubles. 

The  new  magnificent  Piney  Woods  Inn  and  six  smaller  hotels  offer  unusually  excellent 
accommodations,  at  reasonable  rates. 

Double  Daily  Service  in   Pullman  Vestibule  Limited  Traias  via  the  Seaboard 

Air  Line. 

For  full  information  in  regard  to  Rates,  Schedules,  etc.,  call  on  nearest  S.  A.  L.  Ticket 
Agent,  or  address  T.  J.  ANDERSON,  General  Passenger  Agent,  Portsmouth,  Va. 


THE  CHARLOTTE  MEDICAL  JOURNAL 


KINA    TONIC 


FORMULA- Iron  'or  Atonic  Dyspepsia,  Amenorrhea,  loss  of  ap-  On  receipt  |of  10c.  silver, 
ouinine  strvch-  Petite>  Ancemia,  Chlorosis,  Tardy  recovery  after  or  stamps,  we  will  send  a  full 
nine  OX  BLOOD*  acute  diseases,  and  from  malarial  troubles,  nerv-  szie  50c.  box  of  50  tablets  for 
„  '.•  „_j  >rir  ous  break  down,  mild  forms  of  paralysis,  mor-  trial  if  you  mention  this 
lumbo  L0"  phine  and  liquor  habits,  poor  circulation,  poor  Journal.     OX  CHEM.  CO. 

appetite,  vomiting-  of  drunkards,  etc.  Louisville,  Ky. 


The  Hammock  Invalid  Folding  Bed 

The  hammock  feature  is  one  of  the  most  valuable  of  the  many  good  points  of  this  bed,  facili- 
tating the  change  and  airing  of  bedding,  giving  the  patient  the  relief  of  being  lifted  from  a  heated 
mattress  to  a  cool  and  comfortable  hammock,  securing  perfect  ventilation  of  the  body  and  prevent- 
ing bed-sores.  The  circular  opening  in  the  hammock  enables  the  use  of  a  chamber  without  incon- 
venience. In  fact  this  bed  is  a  revelution  to  the  weary  invalid,  being  invaluable  in  the  treatment 
of  all  acute  and  Chronic  Diseases,  Paralysis,  Rheumatism,  Consumption,  Continued  Fevers,  Heart 
Disease,  Fractures  and  other  severe  injuries  and  surgical  operations. 

ROLLING  CHAIRS,  ETC.  PHYSICIANS'  OFFICE  FURNITURE. 

Address.  HAMMOCK  INVALID  BED  CO.,  Indianapolis,  Indiana. 


0  mmm0 


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IN  THE  TREATMENT  OF 


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B  JANETS  INTRAVESICAL 
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TE  CHARLOTTE  MEDICAL  JOURNAL. 


Electro  -  Medical 


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Electro-Surgical  Instruments 

MANUFACTURED  BY 

The  Waite  &  Bartlette  Manufacturing  Co., 

108  East  Tweny-Third  Street,  New  York. 

The  Ranney  Wimshurst  Holtz  Static  Machine 


Ts  the  most  powerful  made,  therefore 
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OUR  EXPERIENCE 

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More    Physicians,    Hospitals    and    Sani- 
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Send  for    Illustrated  Catalogue. 


£>>>>>>>)>>>>>>>>>»>> >»>>»>>>>»>  I  )>»>>>>»>»»»>>  J 

g  Hepatic  Torpor,  Constipation, 
3  Corpulency,  Apoplexy. 


JMa§ 


These  four  conditions  are  nearly  always  associated  with  each  other  as  a  result  of  an  excess  IJ 

of  uric  acid  in  the  system.    The  last  of  the  four  is  the  closing  scene  in  the  picture.    Llthia  is  H 

the  only  remedy  which  has  even  partially  combated  this  combination.    The  trouble  has  been  H 

twofold.    First, — only  a  small  part  of  the  lithia  that  was  administered  has  been  assimilated.  H 

Second— not  enough'lithia  could  be  taken  into  the  stomach  to  dissolve  the  urio  acid  In  the  Jj 

system  without  doing  mischief.    If  enough  were  administered,  It  would  upset  the  stomach  H 
and  produce  other  internal  disarrangements. 

~  s 
s 

n 

8 

I 

g 

I 


By  making  a  practically  new  salt,  by  chemically  combining  lithia  with  an  alkaline  laxative 

ThiSlioiv 

we  produce  a  chemical  devoid  of  all  these  drawbacks  and  procure  a  remedy  which  will 
relievo  and  cure  the  quartette  mentioned  above. 

Prepared  only  for  the  Medical  Profession. 

INDICATIONS.-!  tout  and  all  of  those  diseas<  a  arising  from  a  gouty  condition  of  the  sys- 
tem, rheumatism  and  all  of  those  diseases  arising  from  a  general  rheumatic  condition,  chn  >iin- 


constipation,  hepatic  torpor  and  obesity.  In  all  cases  where  there  is  a  pronounced  leaning  to 
corpulency,  it  reduces  to  a  minimum  the  always  present  tendency  to  apoplexy.  In  malaria 
because  <>f  its  wonderful  action  on  the  liver,  increasing-  twofold  the  power  of  quinine. 

Packages  containing  four  ounces  (sufficient  for  three  weeks'  treatment)  $1.00,  obtainable 
fr«m  your  druggist,  or  direct  from  this  office,  carriage  prepaid,  on  receipt  of  price. 
Literature  on  Application. 


THE  VASS  CHEMICAL  CO., 
DANBURY,  CONN. 


*  1 1 »  >>>»»>»>»  >»»>»»  M J JXl>JXIJXOXl J JXJJXJ 


xnrjLoaxnfi 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


A  New  Idea. 

If  your  dealer  has  none  in  stock,  we  will  mail 
on  receipt  of  price 


Accuracy. 

Yale  and  Kew 

Observatory 

Standards  used 

in  testing. 


Thermometor 
for  the 
Lower 

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Desirability. 

Magnifying  lens, 
Quick  registration 
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ssi  Self  registering,  Case 
is   aluminum  and 
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pocket. 
No.  404    Selected  magnifying  lens,  certified,  aluminum  case,  $1.00 
No.  808    One  minute        "  "  "  "  "        1.25 

Every  thermometer  bearing  the  name  or  trade  mark  (B.  D.  &Co.)  of  Beckton,  Dickinson  & 
Co.  has  been  standardized  and  will  not  change  with  age.     For  Sale  by 

BECTON,  DICKINSON  &  CO.,  45  Vesey  St.,  New  York,  U.  S.  A. 

Arnold  Sterilizers. 

All  shapes  and  sizes  for  all  purposes.  They 
are  used  and  recommended  throughout  the 
world. 

By"  Physicians,  to  sterilize  instruments, 
surgical  dressings,  etc. 

By  Hospitals,  for  general  sterilizing  pur- 
poses. 

By  Laboratories,  for  bacteriological  in- 
vestigations. 

By  Families,  to  sterilize  and  pasteurize 
milk  for  babies  and  invalids. 

Catalogue  mailed  on  application. 

WILMOT  CASTLE  &  CO.,  24  Elm  St.,  Rochester,  N.  Y. 


NORTH  CAROLINA 

Medical  College 


THREE  YE  RS  GRADED  COURSE. 


Expenses  Moderate! 

Instructions  Thorough ! 


FOR    CATALOGUE    ADDRESS 


J.  P.  MONROE,  M.  D., 

Davidson,  N.  C. 


Miss  Mary  W.  Winecoff, 

Tjt*AJ[:IVjEJjE>    NURSE, 

GLASS,   N.  C. 

Several  years  experience.      Telephone  call 
Post  Office  and  Telegraph  Office, 

GLASS,    N.   C. 


MARSHALL'S  CONVERTIBLE  BUGGY  CASE. 

Changes  into  Saddle 
Bag  (is  both  in  one). 
Finest,  best  durable 
leather  finish  outside 
and  in  (lined).  Con- 
tents: 14  1-oz.  rubber, 
18  6-dr.  cork  S.— Total 
32  bottles,  with  space- 
between  rows  or  pows 
der  papers,  2fsundry 
spaces, one  under  each 
lid,  7Hx2H*2H- 

Delivered,    privilege 
of  examination,  C   O. 
- '  D.,   bal.    $8.50;  or,  ex- 

press paid,  $9,  if  you  remit  $1  earnest  fee.  We  sell  Saddle 
Bags  low  as  $4.75.  24-bottle,  with  2  S-spaces,  $5.50.  Best 
"Leader"  Buggy  Case,  26  3-dr.,26  6-dr.,  4  3-oz.  bottles  in 
springs,  1  sundry  space,  $3,75.  We  mail  full  line  prices 
and  illustrations  (on  mentioning  this  Journal)  if  asked 
for. 

SOUTH  BRANCH  M'F'O  CO., 

562s  Jackson  Ave.,  Chicago  1. 


OUR  CUT  5. 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


283 


Spencer 
Microscopes. 

We  make  a  full  line  of  these  beautiful  in- 
struments. Professional,  Laboratory,  College 
and  School  Stands  with  all  accessories.  All 
are  equipped  with  our  famous 

Spencer  Objectives 

made  under  the  personal   supervision  of  Mr. 
Herbert  R.  Spencer. 
Unsurpassed  in  excellence. 
A  fine  Microscope  is  to-day  a  necessary  part 
of  every  physician's  outfit. 
Do  you  own  one? 

Catalogues  and  prices  furnished  on  applica- 
tion. 

Spencer  Lens  Company, 

367-73  Seventh  St.,  Buffalo,  N.  Y. 

When  writing  please  refer  to  this  Journal. 


The  Baby's  Life 

Depends  on  the  food  it  gets. 

Insufficient  nourishment  is  the  cause  of 

much  of  the  fatality  among  Infants. 

If  the  food  is  right  the  digestion  will  be  good 


is  the  BEST  FOOD  IN  THE  WORLD^FOR 

INFANTS.  There's  nothing  "just  as  good," 
or  '-nearly  as  good."  The  best  is  none  too 
good  for  little  babies.  It  is  a  complete  diet  in 
itself.  It  does  not  depend  on  milk  to  make  it 
nutritious.  It  has  to  be  prepared,  but  the  re- 
sults are  always  good.  It  has  no  effect  on  the 
bowels — neither  laxative  nor  astringent. 

A  sample  can,  sufficient  for  atrial,  will  be  sent 
free  to  aDy  physician  requesting  it. 


WOOLRICH  &  CO. 

Palmer,  Mass. 


284 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


THE 


New  Queenl-12th  in.  Objective 

(Homogenous  Immersion  1.35  M.  A.) 

Gives  the  flattestfield  and  sharpest  defini- 
tion of  any  lens  now  offered.  It  is  guaran- 
teed against  detrioration  due  to  climatic 
actton  on  the  glass — a  fault  common  to  the 
best  European-made  objectives.  It  will  fit 
your  Microscope. 

Complete  Physicians'  Mieroseope  Outfit. 

Queen  Cont.  Stand.  II.  two  oculars, 
objectives  2-3ds  and  i-6th  in.  and  i-i2th  in. 
homo  imm.,  triple  revolving  nosepiece, 
Abbe  condenser  and  iris  diaphragm,  all  in 
polished  case,  $95.00. 

mM  Write  for  circulars  and  Cat.  B.  M. 
of  Microscopes  and  Clinical  Apparatus. 

QUEEN  &  CO., 

Incorporated, 
Optical  and  Scientific  Institute  Works, 

1010  Chestnut  Street, 

PHILADELPHIA,  PA. 
N.  Y.  Branch,  59  Fifth  Avenue. 


St.  Peter's  Hospital, 

CHARLOTTE,   N.   C. 


The  Largest  and  most  Thoroughly  Equipped  Hospital  in  the  State. 

Under  strictly  regular  management,  attended  by  a  corps  of  six  prominent  physi- 
cians, with  large  experience.  Trained  nurses  for  all  cases.  Great  care  has  been  taken 
in  the  arrangement  of  the  Surgical  Department,  which  gives  the  Hospital  every  facility 
for  treating  surgical  cases. 

For  information  regarding  rates  for  board,    nursing,   and   medical   attention, 


Mrs.  JOHN  WILKES,  Sec'y, 

508  West   Trade  Street, 

CHARLOTTE,  N    C. 


address 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


285 


oaww^Mofc 


^rm^LKMM9  ^^^ks^d.  %£i^<S^ 


THE  CAREFUL  PRACTICIAN,  ABOUT  TO  INVEST  IN 

1  ELECTRO  MEDICAL  APPARATUS! 

.  MAY  FIND  THE  FOLLOWING  STATISTICS  OF  YALUE:- 


"  OUR  MANUFACTURE.  SATISFIED.  NOT  SATISFIED. 

746  741  5 

l  ALL  OTHER  MANUFACTURE.        SATISFIED.  NOT  SATISFIED. 

134  31  103 

\ THE  ABOVE  IS  A  FAITHFUL  REPRODUCTION,  TAKEN  FROM  OUR_ 
P  LETTER-FILESDURING  THE  PAST  FEW  MONTHS.  C 

§•  Handsomely  Illustrated  CATALOGUE  H?8  mailed  on  Application. 

TheChlorideofSilverDry  Cell  Battery  Company, 

BALTIMORE,  MD.  U.S.A. 


Elixir  Iodo=Bromide 


of  Calcium  Comp.  (TILDENs) 

Unequalled  as  a  blood  Tonic,  Alterative  and  Reconstructed.     In  cases  of  Syphilis 

Scrofula,  Tuberculosis,  Abscesses  and  all  Blood  Humors. 
"W^'V'W"*^ •"^.'M.T'tj^  yi^r  Prescribed  bv  prominent  physicians 

M*    JLJMC  ^W    XJ^AJ^l-    (TILDEN'5)   throughout  the  country  in  all  forms 

of  Bronchitis,  Catarrh,  Phthisis,  Throat  and  Lung  Troubles.     In    Chronic  Cystitis 

it  relieves  the  annoying  symptoms  almost  like  magic,  being  regarded  as  a  friend  of 

humanity, 

RI^JS  JPIRiV^O]V13>  (TILDEN'S)  diaL^eViTnd 
cure  of  Spasmodic  Asthma  (acute  or  chronic),  Hayfever  and  Croup.  Physicians 
prescribe  it  with  unvarying  results. 

ELIXIR  MALTOPEPSINE  <t.lden-s>  ^^"dt 

gestion,    Dyspepsia,    Loss    of    Appetite,    Constipation,  Vomitnng    in    Pregnancy, 
Diarrhoea  and  Nervousness. 

LIQUID  ANTIPYRETIC  (T1Lden-s)   S^^te: 

indicated    in    all    forms    of    Neuralgia,  LaGrippe,  Typhoid    and    Malarial   Fevers, 
Rheumatism  and  Sciatica. 

LITERATURE  FURNISHED  ON  APPLICATION. 
MANUFACTURED  ONLY  BY 

THE   TILDEN    COMPANY, 

MANUFACTURING  PHARMACISTS, 
NEW  LEBANON,  N.  Y. 


ST.  LOUIS,  MO. 


THE  CHARLOTTE    MEDICALJOURNAL. 


Professional  Opinions  of 

Ayer's 

Cherry  Pectoral 

"My  daughter  was  taken  with  the  whooping-cough,  and  to  all  appearances  the  case 
was  as  bad  as  it  could  possibly  be.  I  tried  all  known  remedies,  and,  as  usual,  found 
each  one  wanting. 

"  I  then  tried  Ayer's  Cherry  Pectoral,  and  although  it  did  not  cure  the  disease  at 
once,  yet  it  lengthened  the  periods  between  the  coughing  spells  and  shortened  the 
spasmodic  attacks  of  coughing  very  much. 

"  From  this  experience  I  cannot  speak  too  highly  of  Ayer's  Cherry  Pectoral.  I  con- 
sider it  a  specific  for  nearly  every  case  of  whooping-cough.  So  I  can  say  that  after 
having  given  this  remedy  a  thorough  trial  it  is  all  I  could  ask." 

May  23,  1898.  H.  E.  WILKINS,  M.D.,  Sorento,  111. 

"  I  have  just  tried  your  Cherry  Pectoral  in  a  case  of  la  grippe,  and  with  the  most 
excellent  results.  It  is  a  fine  preparation  and  I  am  much  pleased  with  it.  This  is  the 
first  time  I  have  ever  given  permission  for  my  name  to  be  published." 

May  27,   1898.  J.  F.  RIKARD,  M.D.,  Teckville,  Miss. 


"  I  used  Ayer's  Cherry  Pectoral  in  a  case  of  chronic  bronchitis  and  found  that  it 
helped  the  patient  very  much  indeed.  As  some  cough  still  remained  I  recommended 
that  the  patient  procure  another  bottle,  as  I  knew  of  nothing  better.  I  think  the  product 
is  a  fine  one  in  every  way."  J.  GRADY,  M.D.,  Albertson,  N.  C. 

June  8,  1898.  

"Ayer's  Cherry  Pectoral  is  a  standard  article  on  my  shelf.  Its  composition,  ele- 
gance of  manufacture,  and  clinical  effects  are  all  one  could  possibly  ask.  It  is  the 
Foundation  of  my  cough  preparations.  For  general  coughs  and  colds  it  is  the  finest 
preparation  I  have  ever  met  with."        C.  D.  HATCHER,  M.D.,  Admire,  Kansas. 

March  17,  1898.  

"  I  have  used  your  Cherry  Pectoral  in  a  case  of  obstinate  cough,  and  it  seemed 
to  work  wonders.     I  have  no  hesitancy  in  testifying  to  its  good  qualities." 

July  20,  1898.  P.  WOOLERY,  M.D.,  Heltonville,  Ind. 

"  I  find  your  Cherry  Pectoral  to  be  of  the  greatest  convenience  possible,  and  I 
heartily  recommend  it  as  reliable  and  true." 

August  21,  1898.  R.  S.  EVARTS,  M.D.,  Abinene,  Texas. 

"  During  my  seventeen  years  of  active  practise  I  have  often  prescribed  Ayer's 
Cherry  Pectoral,  with  the  most  satisfactory  results,  especially  in  cases  of  pneumonia 
and  la  grippe."  WILLIAM  F.   PARK,  M.D.,  Atlanta,  Ga. 

July  13,  1898.  

"  Your  Cherry  Pectoral  and  Pectoral  Plaster,  I  am  glad  to  say,  have  given  me  per- 
fect satisfaction  in  every  way."             H.  C.  BEAN,  M.D.,  North  Dexter,  Maine. 
July  23,  1898.  

Formula  furnished  to  any  physician.  Large  bottle  of  the 
Cherry  Pectoral  and  one  Cherry  Pectoral  Plaster  sent  to  any  physi- 
cian, upon  request. 

J.  C  AYER  CO.,  Lowell,  Mass. 


THE  CHARLOTTE   MEDICAL  JOURNAL. 


287 


Its 
Bacteriology 


The  crucial  test  of  the  efficacy  of  an  antiseptic 
fluid  is  the  bacteriological  one.  When  we  state  that 
Borolyptol  is  equal  ;n  germicidal  potency  to  a  i-iooo 
solution  of  Corrosive  Sublimate  without  the  irritant  or 
toxic  properties  of  the  latter  drug,  we  base  our  claim 
upon  the  results  of  careful  laboratory  experimentation 
with  the  different  varieties  of  germ  life.  We  have 
full,  complete  and  conclusive  reports  from  the  bac- 
teriologists of  the  N.  Y.  Post-Graduate  Medical 
School,  City  Hospital  at  Boston,  and  the  Garfield 
Memorial    Hospital  at  Washington. 

These  will  be  sent  upon  request. 


BOROLYPTOL  is  palatable,  fragrant,  and 
s  hghtly  astringent.  It  does  not  stain  linen  or 
J  ™L  should  be  employed  in  Gynecology 
and  Obstetrics.  Rhino-Laryngology,  Surgery  and 
Dentistry.  Also  internally  in  the  treatment  of 
Typhoid  Fever,  and  in  the  gastro-intestinal  dis. 
orders  of  children. 

Send  for  "  Expert  Evidence." 


THE  PALISADE  M'F'O  CO. 
YONKERS,  N.  Y. 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


SYR.  HYPOPHOS.  GO.,  FELLOWS. 

Contains  the  Essen  ial  Elements  of  the  Animal  Organizatior  -Potash  and  Lime  ; 

The  Oxidising  Agents— Iron  and  Manganese  ; 

The  Tonics — Quinine  and  Strychnine  ; 

And  the  Vitalizing  Constituent — Phosphorus;   the  whole  combined  in  ihe  form 

of  a  syrup  with  a  Slightly  Alkaline  Reaction. 
It  Differs  in  its  Effects  from  all  Analogous  Preparations  :  and  it  pos- 
sesses the  important  properties  of   being  pleasant  to   the   taste,  easily  borne  by  the 
stomach,  and  harmless  under  prolonged  use. 

It  has  Gained  a  Wide  Reputation,  particularly  in  the  treatment  of  Pulmonary 
Tuberculosis,  Chronic  Bronchitis,  and  other  affections  of  the  respiratory  organs. 
It  has  also  been  employed  with  much  success  in  various  nervous  and  debilitating 
diseases. 

Its  Curative  Power  is  largely  attributable  to  its  stimulant,  tonic,  and  nutritive  pro- 
perties   by  means  of  which  the  energy  of  the  system  is  recruited. 

Its  Action  is  Prompt  ;  it  stimulates  the  appetite  and  the  digestion,  it  promotes  as- 
similation, and  it  enters  directly  into  the  circulation  with  the  food  products. 

The  prescribed  dose  produces  a  feeling  of  buoyancy,  and  removes  depression  and  melan- 
choly ;  hence  the  preparation  is  of  great  value  in  the  treatment  of  mental  and  nervous 
affections.  From  the  fact,  also,  that  it  exerts  a  double  tonic  influence,  and  induces 
a  healthy  flow  of  the  secretions,  its  use  is  indicated  in  a  wide  range  of  diseases 


NOTICB«  OATTTIO;^ 


The  success  of  Fellows'  Syrup  of  Hypophosphites  has  tempted  certain  persons  o 
offer  imitations  of  it  for  sale.  Mr.  Fellows,  who  has  examined  samples  of  several  of 
these,  finds  that  no  two  of  them  are  identical,  and  that  all  of  them  differ  from 
the  original  in  composition,  in  freedom  from  acid  reaction,  in  susceptibility  to  the  effects 

of  oxygen  when  exposed  to  light  or  heat,  in  the  property  of  retaining  the 

strychnine  in  solution,  and  in  the  medicinal  effects. 

As  these  cheap  and  inefficient  substitutes  are  frequently  dispensed  instead  of  the 
genuine  preparation,  physicians  are  earnestly  requested,  when  prescribing  the  Syrup, 
to  write  "Syr.  Hypophos.  Fellows." 

As  a  further  precaution,  it  is  advisable  that  the  Syrup  should  be  ordered  in  the  ori- 
ginal bottles  ;  the  distinguishing  marks  which  the  bottles  (and  the  wrappers  surround 
ing  them)  bear,  can  then  be  examined,  and  the  genuineness — or  otherwise — of  the  con- 
tents thereby  proved. 


Medical  Letters  may  be  addressed  to 

Mr.  FELLOWS'  48  Vesey  Street,  NEW  YORK, 


The  Charlotte  Medical  Journal. 


Vol.   XV. 


CHARLOTTE,  N.  C,  MARCH,   1899. 


No.  3. 


Malignant  Tumors  of  the  Breast. t 

liy  Hunter  McGuire,  M.  D.,  LL.  D.,   Richmond, 
Virginia,     Professor  of    Clinical   Surgery, 
I Tniversity  College  of  Medicine,  Rich- 
mond, etc. 

Malignant  tumors  of  the  female  breast 
are  so  frequent,  so  dreaded  by  humanity, 
so  little  understood  by  pathologists,  so  fatal 
in  their  results,  their  treatment  often  so 
futile,  and  their  early  diagnosis  so  impor- 
tant, that  every  practitioner  of  medicine,  as 
well  as  of  surgery  should  be  familiar  with 
their  symptoms,  diagnosis,  and,  as  far  as 
we  know,  their  treatment. 

With  the  exception  of  the  uterus,  neo- 
plasms more  often  form  in  the  female  breast 
than  in  any  other  portion  of  the  human 
body;  thus  in  13,824  cases  of  primary  neo- 
plasm in  both  sexes,  consecutively  observed 
in  several  hospitals,  17.05  percent,  were  in 
the  breast — (males  25,  females  2,397).  In 
the  same  series  of  cases  the  neoplastic  pro- 
cess had  its  seat  in  the  uterus  in  19.02  per 
cent,  of  the  cases.  (Diseases  of  the  Breast, 
by  Roger  Williams).  Indeed,  it  was  found 
that  70  percent,  of  all  the  neoplasms  affect- 
ing women  are  in  the  uterus,  breast  and 
ovaries.  This  last  result  was  obtained  from 
observations  in  9,227  cases.  From  this  same 
careful  observer  (Williams),  we  gather  the 
fact  that  in  2,432  cases  of  primary  mam- 
mary neoplasm  81.07  per  cent,  were  malig- 
nant and  only  18.03  per  cent,  non-malig- 
nant. 

Another  striking  fact  is  found  in  these 
statistics — namely,  that  neoplasms  in  gen- 
eral form  54.05  percent,  of  cancer  and  24.- 
07  per  cent,  of  non-malignant  growths ; 
but  in  the  neoplasms  that  occur  in  the  fe- 
male breast  77.07  per  cent,  are  cancer,  and 
15.07  are  non-malignant,  showing  that  tbe 
female  mammae  are  relatively  much  more 
prone  to  malignant  neoplasm  than  other 
parts  of  the  body. 

Causes. — The  influence  of  sex  is  very 
marked ;  99  per  cent,  being  found  in  the 
female  and  1  per  cent,  in  the  male,  show- 
ing that  rudimentary  and  functionless  or- 
gans are  not  likely  to  take  on  the  neoplastic 


tllead  before  the  Tri-State  Medical  Society  of 
the  Carolinas  and  Virginia,  at  Charlotte,  N.  C. 
January,  1899. 


process.  No  doubt  the  hyperemia  attend- 
ing lactation,  menstruation  and  parturition 
constitutes  an  important  fastor  in  deter- 
mining the  disease  in  women.  Statistics 
show  that  women  are  more  liable  to  carci- 
noma in  general  than  men.  It  is  said  that 
where  100  males  die  from  cancer  223  wo- 
men are  destroyed  by  the  same  cause.  Sex, 
however,  does  not  influence  liability  to  sar- 
coma. Williams  found  brunettes  more  fre- 
quently affected  with  cancer  than  blondes. 
To  show  the  frequency  of  cancer  of  the 
mammary  gland,  Andrews  collected  7,881 
cases  of  cancer,  and  found  of  them  1,232 
were  cancer  of  the  breast.  The  number 
of  deaths  in  the  United  States  in  1880  from 
cancer  of  the  breast  was  1,387.  The  left 
breast  is  said  to  be  the  one  most  frequently 
affected,  but  the  difference  between  the  lia- 
bility of  the  two  breasts  to  the  formation 
of  this  neoplasm  is  very  slight.  In  1  or  2 
per  cent,  of  the  cases  both  breasts  were  in- 
volved. 

Billings  has  demonstrated  an  interesting 
fact  from  the  statistics  he  has  gathered — 
that  the  older  and  higher  the  civilization 
of  a  community  the  greater  the  number  of 
cases  of  breast  cancers;  but  he  also  adds, 
"a  large  proportion  of  cancer  indicates 
that  the  locality  is  healthy,  and  a  long  set- 
tled one."  He  found  in  the  New  England 
States,  and  on  the  Southern  Pacific  coast, 
cancer  quite  prevalent.  The  same  condi- 
tion is  observed  in  the  central  part  of  Mich- 
igan and  in  Southern  Wisconsin.  Roswell 
Park  says  that  from  various  sources  he 
finds  that  Buffalo,  New  York,  is  the  centre 
of  a  country  with  a  radius  of  two  hundred 
miles,  where  the  death  rate  from  cancer 
is  greater  than  in  any  other  part  of  the 
United  States.  With  grim  humor  he  calls 
this  area  the  "Tropic  of  Cancer."  While 
no  part  of  the  world  is  exempt  from  the 
disease,  it  is  evidently  more  common  in 
some  localities  than  in  others.  It  is  more 
frequent  in  Europe  than  in  America,  and 
relatively  more  common  in  the  wealthy  and 
easy  going  portion  of  the  population  in 
both  countries  than  in  the  laboring  and 
hard  working  people.  Rayer  states  that 
cancer  is  less  liable  in  herbivorous  animals 
than  in  the  carnivorous — the  reverse  being 
the  case  in  tuberculosis.  Beneke  says  that 
cancer  is  uncommon  in  prisons,  where 
animal    food    is    not  abundantly    supplied, 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


but  it  is  noted  also  that  vegetarians  are 
by    no    means    exempt     from    the  disease. 

Race. — It  is  stated  by  some  writers  that 
cancer  of  the  breast  in  the  negro  is  rare. 
In  my  experience  it  has  been  almost  as  com- 
mon in  the  negro  as  in  the  white.  This  is 
confirmed  by  Dr.  Matas,  of  New  Orleans, 
who,  in  examining  the  records  of  the  Char- 
ity Hospital  found  sarcomata  (except  mela- 
notic sarcomata)  more  frequent  in  the  ne- 
gro, and  carcinomas  fully  as  common  in  the 
negro  as  in  the  white  race.  But  the  United 
States  Census  bureau  reports  show  that 
cancer  appears  twice  as  often  among  the 
whites  when  compared  with  the  blacks.  In 
this  country  the  disease  is  more  common  in 
Germans,  then  the  Irish,  and  either  of  these 
races  is  more  liable  to  it  than  natives  of 
America.  The  Indians  of  America  are 
singularly  exempt  from  cancer. 

Age. — The  disease  makes  its  appearance 
most  commonly  between  40  and  50  years 
of  age.  Gross  gives  the  average  at  4S.66 
years  or  about  the  menopause.  Probably 
the  neoplasm  more  often  precedes  than  fol- 
lows cessation  of  menstruation.  The  next 
most  frequent  period  is  between  50  and  60 
years,  after  that,  from  30  to  40,  and  last  in 
frequency  from  60  to  70  years  of  age.  Oc- 
casionally cases  are  met  between  20  and  30, 
but  they  are  rare.  I  found  one  case  in  a 
young  married  woman  of  19,  verified  after- 
wards by  the  microscope,  and  by  the  recur- 
rence of  the  disease  after  an  operation.  It 
has  been  found  that  80  per  cent,  of  the 
cases  occur  in  married  women  ;  and  Bryan 
found  that  the  more  prolific  the  woman  was 
the  more  prone  she  was  to  cancer. 

Heredity. — Opinions  as  to  the  influence 
of  heredity  on  the  production  of  cancer  are 
very  conflicting,  and  as  no  accepted  theory 
can*  be  adduced  by  which  this  can  be  settled 
we  are  reduced  to  an  examination  of  the 
results  of  statistics  in  carcinoma.  Fre- 
quently statistics  can  be  made  to  accord  to 
the  views  of  the  individual  employing  them, 
but  there  are  some  statistics  in  regard  to 
cancer  which  cannot  be  changed  and  are 
interesting  and  instructive.  I  will  ^state 
the  results  of  this  investigation  as  briefly  as 
possible.  Williams  says  that  24  per  cent, 
were  due  to  heredity,  Bryan  12  percent. 
Gross  9  per  cent.,  and  Paget  33  per  cent. 

From  statistics  we  gather :  First,  that 
either  parent  having  cancer  may  transmit  a 
liability  to  it  to  his  or  her  descendants  ;  that, 
as  a  rule,  the  mother  is  more  apt  to  do  this, 
as,  in  general,  the  mother  is  more  apt  to 
transmit  her  virtues  and  vices  to  the  off- 
spring than  the  father;  that,  as  all  nature 
has  a  tendency  to  return  to  normal  rather 
than  abnormal  conditions,  this  tendency  of 
cancer — as  well  as  other  diseases — grow  less 


and  less  with  succeeding  generations.  As 
instances  of  family  cancer  in  successive 
generations,  the  following  may  be  quoted  : 

Williams  cites  the  case  of  a  woman  with 
uterine  cancer,  whose  maternal  grandmoth- 
er, mother,  mother's  sister,  and  two  sisters 
had  all  died  of  the  same  disease  of  the 
womb.  Sibley,  of  a  mother  and  five  daugh- 
ters, all  of  whom  died  of  cancer  of  the  left 
breast.  The  first  Napoleon  lost  his  father, 
brother  and  two  sisters  with  the  disease  that 
killed  him — cancer  of  the  stomach.  The 
celebrated  case  of  Madame  Z.,  recorded  by 
Broca,  is  familiar  to  all.  Madame  Z.  died 
of  cancer  of  the  breast.  She  left  four  daugh- 
ters, all  of  whom  died  with  cancer,  and  of 
twenty-six  descendants  who  reached,  or 
passed  the  age  of  30,  fifteen  died  of  cancer. 

I  operated  for  cancer  on  the  left  breast 
of  a  very  intelligent  gentleman  of  Virginia, 
whose  grandfather  and  father  had  died  of 
cancer  of  the  face.  Two  of  this  gentle- 
man's brothers  had  died  in  the  same  way; 
and  one  sister,  upon  whom  I  had  operated 
for  cancer  of  the  breast  twenty  years  before, 
is  still  living  and  well.  This  gentleman 
recovered  from  the  operation,  and  twelve 
years  after  died  with  cancer  of  the  face. 
It  is  remarkable  that  in  the  case  of  the  sis- 
ter no  recurrence  should  have  taken  place  ; 
and  another  interesting  fact  is  that  in  the 
present  very  numerous  descendants,  many 
of  them  over  50  years  of  age,  there  should 
be  no  case  of  the  disease. 

Another  interesting  deduction  from  a 
study  of  these  cases  is,  that  the  predispo- 
sition to  cancer  may  be  latent  for  many 
years,  and  at  a  certain  time  of  life  develop. 
Thus  the  four  daughters  in  the  celebrated 
case  of  Madame  Z.  were  born  fifteen, 
twenty-five,  twenty-six  and  thirty  years 
before  the  mother  developed  cancer,  and 
yet  all  four  died  with  this  disease.  It  is 
also  noted  that  cancer  usually  makes  its  ap- 
pearance in  the  offspring  when  it  reaches 
the  same  age  that  the  disease  developed  in 
the  parent.  Sometimes  one  generation 
from  cancerous  parents  entirely  escapes,  and 
the  next  generation,  or  grandchildren  de- 
velop the  predisposition  to  the  disease. 
The  rule  is  by  no  means  invariable,  but 
quite  common,  that  transmitted  cancer  at- 
tacks the  same  organ  in  the  offspring  that 
was  affected  in  the  parent.  Sibley's  case, 
just  related,  is  a  striking  example — the  left 
breast  in  all  the  cases.  Female  relations 
are  more  apt  to  inherit  cancer  than  the 
male.  Tubercle,  rheumatism  and  gout  are 
often  associated  with  cancer,  and  these 
diseases  seem  to  be  intimately  connected. 
Another  fact  of  great  interest  and  import- 
ance is  that  cases  of  cancer  in  proportion 
to  population  are  much  more  numerous  than 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


291 


formerly.  The  disease  is  rapidly  increas- 
ing, while  cases  of  tubercular  disease,  small 
pox,  typhus  and  many  other  maladies  have 
markedly  diminished  in  number. 

7 ' raumatism. — Thirteen  percent,  of  the 
cases  of  cancer  of  the  breast  arise  from  this 
cause.  I  do  not  think  there  can  be  any 
question  that  traumatism  has  often  some- 
thing to  do  with  the  formation  of  cancer  in 
persons  predisposed  to  the  disease.  I  too 
often  see  cases  where  the  disease  makes  its 
appearance  after  a  contusion  has  been  re- 
ceived to  doubt  it.  The  injury  may  be 
slight — as  striking  against  a  bedpost  in  the 
dark — but  the  blow  may  be  sufficient  to  set 
up  the  cell  changes  that  develop  the  disease. 
In  this  way  the  broken  stays  in  a  corset 
may  provoke  some  inflammation  in  the  con- 
nective tissue,  and  the  same  cause  may  re- 
produce the  cancer  in  the  scar  tissue  after 
an  operation  has  been  done  for  carcinoma. 

Mastitis. — Mastitis,  especially  if  the 
inflammation  leads  to  suppuration  and  the 
formation  of  scar  tissue,  may  also  predis- 
pose to  the  cell  changes  which  end  in  car- 
cinoma. It  is  estimated  that  30  per  cent, 
of  all  the  cases  originate  in  this  way. 

Mental  Depression. — It  is  said  that 
prolonged  mental  depression  predisposes  to 
cancer,  and  that  individuals  who  for  years 
dread  the  disease  are  more  prone  to  have  it. 
Great  and  continued  mental  depression,  by 
producing  impaired  nutrition  and  lessening 
physiological  resistance,  may,  it  is  easy  to 
believe,  conduce  to  the  formation  of  the 
disease. 

Location. — If  two  lines,  one  vertical 
and  one  horizontal,  are  drawn  through  the 
nipple,  they  will  divide  the  breast  into  four 
segments.  It  will  be  found  that  cancer 
forms  more  frequently  in  the  upper  and 
outer  segment  than  in  the  lower  part,  and 
least  of  all  in  frequency  in  the  segment  next 
to  the  sternum.  As  the  outer  edge  of  the 
gland  is  richer  in  acini  than  the  central 
portion,  carcinoma  more  often  appears  in 
the  periphery  of  the  organ.  In  132  cases 
reported  by  Williams,  90  were  peripheral 
and  42  central. 

Types  ok  Breast  Cancer. — There  are 
two  forms  of  carcinoma  of  the  breast — one 
known  as  ascinous  and  one  as  tubular.  The 
former  is  by  far  the  most  common,  consti- 
tuting, according  to  Williams,  94  per  cent, 
of  all  the  cases  seen. 

The  ascinous  form  of  tumor,  as  its  name 
implies,  begins  in  connection  with  the  acini, 
and  the  tubular,  or  "duct  cancer,"  com- 
mences in  connection  with  the  ducts.  The 
ascinous  variety  of  cancer  of  the  breast, 
which  is  so  common,  is  subject  to  many 
histological  changes,  and  this  has  caused 
some  confusion  in  the  classification  of  can- 


cer of  the  breast  in  different  works.  It  has 
been  called,  when  the  alveoli  are  large,  al- 
veoli cancer,  but  the  name  only  tends  to 
mislead,  as  all  carcinomatous  tumors  have 
alveoli.  When  the  tumor  is  hard  and  nod- 
ular, the  stroma  predominating — dense,  in- 
durated, scar-like  in  character,  the  cells 
inclosed  in  spindle-shaped  or  elongated 
alveoli — the  variety  is  known  as  scirrhus. 
As  a  rule,  the  denser  and  harder  the  tumor, 
the  less  the  malignancy. 

When  the  cells  greatly  predominate,  and 
the  stroma — made  up  of  fibres  of  connect- 
ive tissue  infiltrated  irregularly  with  cells — 
is  sparse,  the  tumor  soft,  growing  rapidly, 
very  malignant,  it  is  called  "soft,  enceph- 
aloid,  or  medullary  cancer."  A  rare  form 
of  ascinous  cancer  of  the  breast,  sometimes 
attending  pregnancy  and  lactation — but  oc- 
casionally making  its  appearance  independ- 
ent of  these  conditions — is  sometimes  seen, 
which  runs  its  course  rapidly  and  ends  in  a 
few  months  in  death.  It  is  an  acute  type 
of  the  disease.  There  is  no  specially  defined 
tumor  but  the  whole  of  one  or  both  breasts  is 
involved.  Beginning  suddenly,  the  breast 
enlarges,  becomes  hard  and  taut,  the  skin 
red,  painful,  adherent,  with  enlargement 
of  subcutaneous  veins.  Lymphatic  involve- 
ment rapidly  supervenes.  Nothing  more 
than  palliative  treatment  can  be  done. 

The  common  form  of  acinous  cancer,  to 
distinguish  it  from  the  last,  may  be  called 
chronic  carcinoma  of  the  breast.  This  form 
requires  years  for  its  full  development  and 
termination.  Between  these  two  extremes 
of  acute  and  chronic  there  are  cases  so  rapid 
or  so  slow  in  their  formation  that  it  is  diffi- 
cult to  say  to  which  class  they  properly  be- 
long. Paget  says  the  earlier  the  disease 
begins  the  more  rapid  its  course.  With  an 
average  of  43  years,  they  live  18  months. 
At  an  average  of  51  years,  life  lasts  from 
iS  months  to  5  years.  The  disease  begin- 
ning at  the  age  of  56  to  57  years,  they  live 
from  3  to  8  years.  I  think  it  may  be  stated 
that  a  large  proportion  of  cases,  not  oper- 
ated on,  die  between  6  months  and  3  years. 

Another  form  of  acinous  cancer,  charac- 
terized by  its  extreme  chronicity,  is  called 
atrophic,  which,  according  to  Gross,  con- 
stitutes 7.9  per  cent,  of  all  the  cases  met 
with.  In  this  variety  the  neoplasm  and 
whole  breast  undergo  constant  shrinkage. 
The  epithelial  cells  undergo  fatty  degener- 
ation and  are  absorbed,  leaving  a  small, 
densely  hard  mass  (stone  cancer),  knotty 
and  irregular.  From  the  mass  are  sent  out 
hard,  white,  fibrous-like  "roots,"  into  the 
parts  around ;  retraction  of  the  nipple  is 
common,  and,  later,  fixation  of  the  mass 
and  ulceration.  Occasionally,  the  disease  is 
soon  attended    by    lymphatic    involvement 


292 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


and  cachexia,  and  ends  life  in  a  year  or  two, 
but  as  a  rule  it  is  very  chronic  and  lasts  for 
10,  15,  or  20  years.  It  is  eventually  fatal, 
and  never  followed  by  spontaneous  cure. 
In  some  cases,  the  shrinkage  is  so  great,  of 
breast  and  tumor,  that  the  part  looks  as  if  it 
had  once  been  amputated,  and  there  was 
nothing  left  but  scar  tissue. 

Still  another  rare  form  is  seen,  called 
colloid  carcinoma  of  the  breast.  This  is 
when  the  cells,  and  probably  the  stroma  as 
well,  are  filled  with  a  gelatinous,  nearly 
transparent  matter  and  have  undergone 
colloid  degeneration.  This  form  begins  as 
a  hard,  small,  solitary  tumor,  growing  very 
slowly,  tardily  involving  the  skin  and  lym- 
phatics, taking  10  or  12  years  to  run  its 
course.  In  no  other  form  of  mammary 
cancer  is  general  dissemination  so  slow. 
After  a  longer  or  shorter  time,  however, 
involvement  of  lymphatics,  skin,  and  pos- 
sibly the  other  breast,  with  general  dissem- 
ination and  cachexia,  follow.  The  slow- 
ness is  due  to  destruction  of  the  cancer 
cells  by  the  colloid  metamorphosis.  Recur- 
rence is  slow  after  operation  in  colloid  can- 
cer. 

Another  form  of  cancer  of  the  breast, 
so  rare  that  Williams,  in  2,397  cases  of  pri- 
mary neoplasm  of  the  breast  did  not  find 
a  single  instance,  is  known  as  melanotic 
cancer  of  the  breast.  The  black  or  mela- 
notic appearance  is  due  to  granules  of  mel- 
anin or  haematoidin  infiltrated  into  the  cells 
and  connective  tissue  of  the  diseased  part. 
In  a  case  of  melanotic  cancer  of  a  woman 
aged  60  years,  at  my  clinic  a  few  weeks 
ago,  numerous  melanotic  growths  were 
found  on  the  back,  both  arms,  and  abdo- 
men of  the  patient.  The  tumors  varied  in 
size  from  a  garden  pea  to  a  large  walnut. 
There  was  already  axillary  glandular  in- 
volvement and  general  cachexia.  No  oper- 
ation was  advised,  and  the  patient  in  a  few 
months  died  from  exhaustion. 

Development  and  General  Course. — 
Cancer  of  the  breast  usually  begins  as  a 
hard,  solitary  lump  in  the  mammary  gland 
— so  hard  to  the  feel  that  it  is  often  called 
scirrhous;  never  very  large  at  first,  possi- 
bly about  the  size  of  a  pullet's  egg  or  smaller, 
and  rarely  ever  larger  than  a  turkey's  egg. 
An  examination  with  the  finger  shows  usu- 
ally masses  of  hard  fibrous-like  tissue  radi- 
ating from  the  central  mass  in  different  di- 
rections. When  a  section  of  the  mass  is 
made  it  cries  under  the  knife  like  a  raw 
potato  and  has  about  the  consistency  of  that 
vegetable.  When  cut  across  the  mass  con- 
tracts, leaving  the  surface  slightly  concave. 
If  the  cut  surface  is  gently  scraped  with  a 
knife,  a  milk-like  fluid  is  obtained.  The 
cut  surfaces  have    a    dense,    white,    fibrous 


appearance,  with  here  and  there  little  fatty 
points.  These  fatty  points  are  degenerated 
epithelial  cells  in  the  alveoli,  and  are  char- 
acteristic of  carcinoma.  They  are  absent 
in  sarcoma  and  in  simple  non-malignant 
growths.  The  periphery  of  the  growth  is 
not  so  dense  or  white  as  the  central  portion, 
but  softer  and  elastic,  grey  in  appearance, 
and  covered  with  the  natural  fat  of  the 
gland.  The  tumor  has  no  capsule,  and  its 
margins  are  difficult  to  define.  It  may  be 
said  here  and  there  to  be  dovetailed  into  the 
adjoining  healthy  tissue,  and  isolated  col- 
lections of  cells  may  be  found  some  distance 
from  the  tumor  proper.  When  examined 
microscopically,  columns  of  epithelial  cells 
are  found  buried  in  dense,  hard,  fibrous  tis- 
sue. 

In  about  6  per  cent,  of  the  cases  of  the 
acinous  form  of  cancer  of  the  breast,  the 
tumor  is  soft,  very  vascular,  and  lobulated, 
growing  rapidly,  very  malignant,  and  is 
known  as  "encephaloid,"  medullary,"  or 
"soft"  cancer.  In  these  cases,  the  tumor  is 
larger,  and  lymphatic  involvement  rapidly 
supervenes,  early  ulceration  takes  place, 
and  recurrence  after  operation  is  almost 
certain.  According  to  Gross,  death  takes 
place,  on  an  average  in  8  months.  At  first 
the  tumor  may  be  firm  and  elastic  to  the 
touch,  but  later  is  soft,  and  at  some  points 
fluctuating  from  the  presence  of  cyst  for- 
mation. When  cut  into,  it  is  soft  and  pulpy 
in  consistency  and  succulent  in  appearance  ; 
but  when  microscopically  examined,  char- 
acteristic carcinoma  is  found.  Its  color  is 
reddish  grey,  with  whitish  trabecular  of 
fibrous  tissue  running  across  it  in  different 
directions.  There  is  no  envelope,  but  the 
tissues  around  are  irregularly  infiltrated  by 
the  cancer  growth.  So-called  cancer  juice 
in  abundance  is  seen  when  the  part  is  lightly 
scraped  with  the  knife. 

Duct  Cancer. — Soon  after  the  meno- 
pause, when  the  glandular  tissue  of  the 
breast  begins  to  undergo  atrophy  and  the 
ducts  remain,  the  latter  become  dilated,  and 
have  formed  in  them  occasionally  involution 
cysts.  These  cysts  are  small,  and  contain 
a  mucus-like  material.  From  the  inside  of 
these  cysts,  or  from  the  undilated  duct  itself, 
cancer  may  spring.  The  terminal  ducts 
are  the  ones  most  often  involved.  The  tu- 
mor is  generally  single,  and  about  the  size 
of  a  walnut.  When  cut  into,  a  distinct 
capsule,  consisting  of  the  dilated  duct,  is 
found,  and  within  the  cyst,  and  sprouting 
from  the  cyst  wall,  and  more  or  less  com- 
pletely filling  the  cavity,  is  a  reddish  mass, 
showing  a  tendency  to  infiltrate  the  sur- 
rounding structures. 

In  this  form  of  cancer,  which  is  not  com- 
mon, the  first  symptom  noticed  is  a    blood- 


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293 


stained  discharge  from  the  nipple  ;  the  nip- 
ple is  more  commonly  retracted  than  in  the 
acinous  variety.  The  tumor  is  in  the  cen- 
ter of  the  breast  just  below  the  nipple,  and 
never  of  very  large  size.  It  increases  slowly. 
Lymphatic  involvement  is  rare,  or  tardy  in 
making  its  appearance ;  local  recurrence 
after  operation  is  not  common.  It  occurs  in 
elderly  women. 

Paget's  Disease  of  the  Nipple. — In 
this  connection  may  be  mentioned  a  disease 
which  should  not  properly  be  classed  as 
carcinoma  of  the  skin,  but  its  presence  is  so 
often  accompanied  with  or  followed  by  can- 
cer of  the  breast  that  it  is  appropriate  to 
speak  of  it  here.  It  was  originally  described 
by  Sir  Jas.  Paget,  and  is  known  as  "Paget's 
Eczema  of  the  Nipple."  It  rarely  occurs 
in  women  under  forty  years  old,  and  may 
follow  confinement  or  lactation.  The  nip- 
ple and  areola,  the  first  seat  of  the  disease, 
become  intensely  red  and  raw,  exuding  in 
abundance  a  clear  mucus-like  discharge. 
Sometimes  a  dry  crust  forms,  difficult  to 
detach.  After  being  once  formed  it  con- 
tinues to  spread  superficially,  and  in  depth, 
until  the  skin  becomes  swollen,  raw  and 
bleeding.  After  a  time  ulceration  sets  in, 
and  a  deep  ragged  ulcer  is  seen.  At  first 
the  nipple  is  retracted,  and  eventually  may 
be  inverted.  The  disease  may  also  enter 
one  of  the  lacteal  ducts,  and  a  tumor  be 
felt  deep  under  the  nipple.  Some  suppose 
the  disease  begins  as  duct  cancer,  and  the 
eczematous  appearance  of  the  skin  is  due  to 
the  discharge  from  the  nipple  frequently 
attending  this  form  of  cancer  of  the  breast. 
Others  believe  that  the  cancer  extends  from 
the  surface  through  some  of  the  lacteal 
ducts,  and  in  this  way  cancer  of  the  breast 
is  formed.  Glandular  involvement  is  absent, 
or  very  late  making  its  appearance.  Prog- 
nosis is  good  if  the  breast  is  removed  early. 

.Symptoms  of  Cancer  of  the  Breast. 
Pain. — As  a  rule,  in  the  early  stages  of 
cancer  of  the  breast  there  is  no  pain  what- 
ever. Occasionally  there  is  pain,  and  at- 
tention is  called  to  the  breast  by  this  symp- 
tom, and  the  tumor  discovered,  but  gener- 
ally the  growth  is  found  by  accident,  and 
there  is  no  pain  until  the  disease  has  pro- 
gressed for  some  months.  It  is  a  common 
belief  that  one  cannot  have  cancer  without 
pain,  and  many  a  woman  has  allowed  can- 
cer of  the  breast,  or  of  the  womb,  to  con- 
tinue until  her  cure  was  hopeless,  because 
what  she,  and  possibly  her  physician  also, 
considered  the  characteristic  symptom  of 
cancer — pain — was  absent.  In  a  few  cases 
there  is  pain  in  the  early  stages,  and  why  a 
few  should  have  this  symptom,  and,  under 
apparently  the  same  circumstances,  others 
should    be    free,    is    impossible  to  explain. 


While  pain  in  mammary  cancer  is  generally 
absent  until  the  approach  of  ulceration,  in- 
flammatory swelling  and  non-malignant 
tumors  in  that  locality  are  generally  attend- 
ed with  pain  and  tenderness.  After  the 
disease  has  progressed  some  months,  and 
especially  when  ulceration  has  begun,  the 
pain  is  very  severe.  The  patient  has  a  con- 
stant, heavy,  aching  pain  in  the  breast,  but 
along  with  this,  at  short  intervals,  one  that 
is  sharp,  burning,  stabbing,  or  lancinating 
in  character.  This  pain  is  characteristic 
of  cancer ;  the  patient  will  tell  you  that 
she  feels  as  if  a  hot  needle  or  knife  had 
been  thrust  through  the  part,  and  that  while 
the  suffering  is  constant,  it  is  liable  to  par- 
oxysms of  increased  agony. 

Retraction  of  Nipple. — Great  stress  was 
at  one  time  laid  on  this  symptom,  but  the 
practitioner  should  not  forget  that  this  con- 
dition of  the  nipple  may  be  congenital,  or 
come  from  some  disease  or  injury  in  child- 
hood, or  results  from  chronic  mastitis,  or 
cold  abscess,  or  accompany  the  growth  of  a 
benign  tumor.  It  is  only  important  as  a 
sign  of  cancer  when  associated  with  other 
symptoms  of  the  disease.  Retraction  is 
more  common  when  the  tumor  is  situated 
near  the  centre  of  the  breast.  When  the 
lump  is  near  the  periphery  of  the  gland,  it 
is  often  absent  altogether,  or  at  least  for 
many  months.  It  is  more  common,  also,  in 
duct  cancer  than  in  the  acinous  variety. 
Gross  found  retraction  of  the  nipple  in 
cancer  of  the  breast  in  52  per  cent,  of  fhe 
cases.  He  found  this  condition  also  in  5.02 
per  cent,  of  cases  of  benign  mammary 
tumors. 

Dimpling  of  the  Skin. — In  the  early 
stages  of  cancer,  the  skin  is  freely  movable 
over  the  breast  and  tumor;  but,  as  the  dis- 
ease progresses,  the  fibrous  tissue  that  con- 
nects the  skin  with  the  breast  (the  supensory 
ligaments  of  Sir  Astley  Cooper)  are  drawn 
upon  and  the  skin  is  puckered.  When  the 
tumor  is  moved,  it  is  seen  that  it  is  more  or 
less  fastened  to  the  skin,  and  after  a  time, 
as  the  contraction  of  the  skin  goes  on,  a 
permanent  dimple  is  seen.  This  symptom 
is  important,  as  a  similar  condition  is  only 
found  in  chronic  inflammatory  affections  of 
the  mammary  glands,  attended  then  by  in- 
volvement of  the  skin  and  other  signs  of  in- 
flammatory disease. 

Diminished  Size  of  Breast. — One  of  the 
most  striking  symptoms  of  cancer  of  the 
breast,  is  that  when  the  two  breasts  are  in- 
spected it  will  be  found  that  the  diseased 
side  is  smaller  than  the  sound  organ — this, 
too,  notwithstanding  that  the  breast  on  the 
diseased  side  is  occupied  to  a  greater  or  less 
extent  by  the  tumor.  Contraction  of  the 
cancer  mass  not  only  goes  on,  but  shrinkage 


294 


THE  CHARLOTTE  MEDICAL   JOURNAL. 


also  on  the  whole  breast,  so  that  the  organ 
is  not  only  smaller  in  size  than  the  sound 
one,  but  it  is  more  tightly  fixed  to  the  chest 
and  less  pendulous  than  natural.  In  atrophic 
cancer,  this  condition  goes  on  until  the 
breast  looks  as  if  it  had  been  removed  and 
there  was  nothing  left  but  a  mass  of  cica- 
tricial tissue. 

Discharge  from  the  Nipple. — Gross  esti- 
mates this  symptom  in  7  per  cent,  of  all 
cases  of  cancer  of  the  breast.  It  is  more 
common  in  duct  cancer  than  in  the  acinous 
variety.  The  discharge,  when  it  does  occur, 
is  slight,  in  quantity  only  two  or  three 
drops,  sticky  in  character,  and  slightly 
milky  in  appearance.  Occasionally,  it  is 
bloody.  Other  neoplasms  also  sometimes 
produce  this  discharge,  as  sarcoma,  cystic 
disease,  etc.,  and  occasionally  it  attends  an 
unhealthy  condition  of  the  breast  due  to  dis- 
eases of  the  uterus  and  ovaries. 

Nodulation  and  Ulceration. — If  the  case 
is  not  operated  on, and  the  malignant  growth 
removed,  the  dimpled  and  puckered  skin 
may  become  in  time  red  or  purple  and 
swollen,  thickened  and  elevated,  instead  of 
being  depressed  as  it  has  been  ;  or,  in  other 
words,  a  ca?icerous  nodule  be  formed.  In  a 
short  time  ulceration  will  set  in,  the  thin 
red  skin  over  the  nodule  be  destroyed, and  a 
cancerous  ulcer  appear.  The  ulcer  is  irre- 
gular in  shape,  deep,  hard  and  excavated, 
and  the  skin  around  it  intimately  adherent 
to  the  parts  beneath.  The  edges  of  the  ulcer 
are  hard  and  everted  ;the  surface  is  depressed 
and  sloughing ;  the  discharge  from  it  thin, 
bloody  and  excessively  offensive  in  odor, 
inflaming  and  excoriating  the  skin  around. 

Lymphatic  Implication. — In  some  cases, 
in  the  ordinary  acinous  cancer  of  the  mam- 
mary gland,  the  skin  over  the  breast,  and 
possibly  for  some  distance  around — more 
especially  in  the  direction  of  the  axilla — be- 
comes red,  swoolen,  thickened  and  painful. 
This  is  due  to  dissemination  of  the  cancer 
in  the  plexus  of  the  lymphatics  just  below 
the  skin,  chiefly  in  the  suspensory  ligament. 
The  cancer  cells  became  rapidly  diffused 
and  all  the  cutaneous  lymphatic  branches 
are  implicated.  Sometimes  small  tubercles 
are  formed  (acute  miliary  carcinosis), or  the 
infiltrations  are  diffused  and  constitute 
carcinoma  en  cuirassc.  Very  often,  when 
the  deep  plexus  of  lymphatics  are  implicated 
and  numerous  cancer  nodules  are  formed, 
the  skin  on  the  nodules,  and  between  them, 
becomes  thickened,  tough  and  leatherlike  in 
appearance.  This  condition  is  apt  to  follow 
cancer  situated  near  the  nipple,  atrophic  in 
character,  is  very  malignant,  and  ends  life 
in  a  few  months  (in  from  six  to  twelve 
months).  At  one  time  this  was  considered 
a  distinct  variety  of  carcinoma,    but    patho- 


logists now  regard  this  cutaneous  change  as 
a  secondary  transaction  and  one  always  pre- 
ceded by  primary  cancer  of  the  breast.  The 
disease  continues,  involving  more  and  more 
of  the  adjacent  skin,  which  becomes  very 
hard,  dusky  red,  and  tightly  adherent  to  the 
parts  below  it.  So  constrictive  does  this 
cuirassc  cancer  often  become,  that  it  some- 
times mechanically  interferes  w:th  respira- 
tion. 

Glandular  Involvement . — No  other  gland 
in  the  body  is  so  richly  supplied  with  lym- 
phatics as  the  breast.  These  lymphatics, 
deep  and  superficial,  freely  anastomose  with 
one  another,  and  usually  in  six  months  after 
the  primary  cancer  had  made  its  appearance, 
enlarged  lymphatic  glands  can  be  felt  in  the 
region  of  the  axilla.  This  enlargement  shows 
that  a  cell,  or  group  of  cells,  from  the 
cancer  may  have  found  its  way  through  the 
channels  of  lymphatics  and  found  lodg- 
ment and  growth  in  a  neighboring  gland. 
The  arrest  of  the  cancer  graft  by  the  gland 
has  for  the  time  prevented  further  cancer 
dissemination.  The  glands  to  become  in- 
volved are  those  on  the  inside  of  the  axilla 
and  lying  under  the  edge  of  pectoralis  ma- 
jor. The  glands  that  lie  on  the  inner  side 
of  the  great  blood  vessels  and  receive  the 
largest  vessels  from  the  arm,  and  the  glands 
in  the  back  part  of  the  axilla  communicat- 
ing with  the  lymphatics  in  the  subcapular 
region,  are  not  at  first  diseased,  but  as  all 
the  lymphatics  in  this  region  freely  inter- 
communicate, the  last  also  in  turn  become 
affected.  So,  also,  owing  to  the  anatomi- 
cal arrangement,  after  a  time  the  glands 
above  and  below  the  clavicle  becomes  dis- 
eased. Other  branches  of  lymphatics  pass 
through  some  of  the  intercostal  spaces,  and 
the  retro-sternal  glands  may  in  the  end  be- 
come implicated,  and  as  the  system  of  lymph 
vessels  of  both  breasts  freely  communicate, 
cancer  of  one  side — especially  if  on  the 
sternal  side  of  the  gland — may  produce  en- 
larged and  diseased  axillary  glands  on  both 
sides,  although  only  one  breast  is  involved 
in  the  primary  neoplasm. 

While  glandular  dissemination  is  rarely 
observable  before  six  months,  or  for  a 
longer  period  than  that,  according  to  some 
writers,  it  is  probable  that  the  disease 
would  be  found  at  a  much  earlier  period  if 
a  careful  histological  examination  could  be 
made.  When  first  seen  the  glands  are  small, 
hard  and  painless,  and  they  gradually  and 
slowly  increase  in  size  and  the  number  in- 
volved. Occasionally,  one  or  two  very 
large  glands  seem  to  spring  up  suddenly 
and  enlarge  quickly  to  a  greater  mass  than 
the  original  tumor.  The  enlarged  glands 
are  not  present  in  every  case  of  cancer  of 
the  breast,  and  this  absence  does  not  show 


THE  CHARLOTTE 'MEDICAL  JOURNAL, 


295 


that  the  disease  is  not  cancer.  Indeed,  can- 
cer of  the  breast  may  run  its  full  course  and 
end  in  death,  and  there  may  be  no  apparent 
glandular  affection  whatever ;  but  this  is 
rare.  The  chances  of  cure,  after  glandular 
enlargement  appears,  are  materially  lessen- 
ed and  the  danger  and  rapidity  of  recur- 
rence increased. 

Adhesions. — Soon  after,  or  concurrent 
with  the  appearance  of  enlarged  and  dis- 
eased glands  in  the  axilla,  the  cancer  tumor 
becomes  attached  to  the  pectoral  fascia,  and 
a  little  later  to  the  pectoral  muscle.  This 
may  be  determined  by  forcibly  extending 
the  arm  and  putting  this  fascia  and  muscle 
on  the  stretch.  While  in  this  position  it 
will  be  found,  if  adhesion  has  occurred,  that 
the  cancer  mass  can  be  readily  moved  later- 
ally, but  not  up  and  down  in  the  direction 
of  the  fibres  of  the  muscle.  In  view  of  an 
operation,  this  information  is  important. 
In  the  fascia  and  muscle  may  be  found  small 
cancerous  foci,  left  there  by  the  lymphatics 
or  by  the  blood  vessels.  These  spots  are 
often  so  small  as  not  to  be  detected  with 
the  naked  eye,  but  may  eventually  form  the 
nidus  for  new  growths.  Histologically, 
these  deposits  are  identical  with  the  pri- 
mary neoplasm. 

Systemic  Infections. — Some  months  after 
the  glands  show  disease,  systemic  affection 
may  be  noticed.  The  time  for  this  is  vari- 
ously stated  by  different  observers  from  fif- 
teen to  thirty-eight  months.  Gross  says  the 
time  of  metastasis  and  systemic  dissemina- 
tion varies  in  different  cases  from  one  to 
three  years.  It  is  doubtless  produced  by 
cancer  cells,  or  small  masses  of  cancer  de- 
tached from  the  primary  growth  or  its  de- 
rivatives, carried  into  the  circulation,  and 
finding  lodgment  in  some  vascular  tissue  or 
organ.  No  doubt  cancer,  as  well  as  sar- 
coma, is  sometimes  disseminated  in  this 
manner ;  or,  the  cancer  material  may  be 
taken  up  by  the  lymphatics,  escape  arrest 
by  the  lymphatic  glands,  find  its  way  into 
the  thoracic  duct  or  some  large  vein — as  the 
left  subclavian — and  thus  gain  access  to  the 
general  circulation. 

Secondary  Cancer. — In  this  way  it  may 
find  a  lodgment  in  any  organ  or  tissue  ex- 
cept the  non-vascular,  as  the  cornua  or  car- 
tilage, for  metastatic  deposits  are  never 
found  in  such  structures.  Many  of  these 
cancer  emboli  are  probably  destroyed  and 
disappear,  but  some  of  them  are  deposited, 
live  and  grow — grow  occasionally  to  a  size 
immensely  greater  than  the  primary  mam- 
mary neoplasm  from  which  they  had  their 
|  origin.  More  frequently  than  any  other 
organ,  the  liver  is  the  seat  of  secondary  de- 
.  posit ;  next  the  lungs,  pleura,  bones,  brain, 
[ovary,  in  the  order  of  frequency  mentioned. 


Indeed,  any  vascular  tissue  or  organ  in  the 
body  may  be  secondarily  affected.  The 
metastasis  may  involve  one  structure  or 
many.  In  this  way  the  other  breast  may 
be  involved,  and  it  does  not  absolutely  fol- 
low because  both  mammary  glands  are  can- 
cerous that  very  great  systemic  dissemina- 
tion has  taken  place,  and  that  the  case  is 
thus  necessarily  hopeless. 

Bone  Involvement. — While  any  bone  of 
the  body  may  be  the  seat  of  secondary  can- 
cer from  primary  breast  cancer,  the  cranial 
bones  are  the  ones  most  often  diseased ; 
next,  the  bodies  of  the  vertebrae,  the  femur, 
and  the  humerus.  The  disease  is  usually 
in  the  medullary  portion  of  the  bone,  and 
often  the  first  information  the  patient  has 
of  its  existence  is  spontaneous  fracture  of 
the  bone — or  fracture  after  slight  muscular 
effort — there  being  little  or  no  pain  preced- 
ing it.  When  spontaneous  fracture  with 
evidences  of  cachexia  are  seen,  cancer  some- 
where should  be  suspected  and  looked  for. 
Cachexia. — In  the  early  stages  the  gen- 
eral health  is  not  affected,  and  a  patient 
with  cancer  of  the  breast  may  seem  to  be, 
to  all  appearances,  in  perfect  health,  but 
after  a  period  that  varies  in  different  cases, 
signs  of  general  toxaemia  and  impairment  of 
health  begin  and  continue  to  increase,  if 
the  patient  is  left  to  nature,  until  the  end, 
death  taking  place  usually  from  asthenia. 
The  appetite  is  poor,  emaciation  comes  on, 
weakness  of  body  and  mind  are  noticed,  and 
the  whole  skin  becomes  pallid,  sallow, 
waxy  and  tallowy  in  appearance.  This 
muddy,  straw-colored  tint  affects  the  skin 
only,  and  not  the  mucous  membrane,  or 
urine,  as  slight  jaundice  will;  dyspepsia, 
constipation,  possibly  nausea,  may  be  pres- 
ent. There  is  systemic  infection,  from  the 
admission  into  the  blood  of  cancer  cells — 
altered  or  not,  but  too  abundant  to  be  elim- 
inated— from  the  cancer  breast,  and  the 
blood  itself  is  changed  chemically  and  mor- 
phologically. This  cancerous  cachexia  is  not 
necessarily  fatal ;  removal  of  the  primary 
cancer  sometimes  arrests  it,  and  the  patient, 
at  least  for  a  time,  regains  her  original 
healthy  appearance. 

I  rarying  Progress  of  Cancer. — Cancer 
of  the  breast  varies  very  much  in  its  pro- 
gress in  different  individuals,  As  a  rule, 
the  younger  the  subject  the  more  rapid  and 
malignant  the  disease.  When  it  happens 
in  a  woman  under  thirty-five  years  of  age 
it  is,  in  my  opinion,  doubtful  whether  any 
operation,  however  radical,  will  lengthen 
life  or  lessen  suffering.  The  growth  and 
malignancy  is  especially  marked  in  young 
women  who  become  pregnant ;  the  increase 
in  the  supply  of  blood  to  the  mammary 
gland  during  this   period  or  during   lacta- 


296 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


tion  will  explain  this.  In  these  cases  the 
tumor  is  usually  soft  and  large  and  not  at- 
tended with  any  contraction  of  the  cancer 
tissue  or  the  mammary  gland.  In  old  peo- 
ple the  acinous  cancer  often  becomes  atro- 
phic in  character ;  and  while  it  never  gets 
well,  the  patient  will  often  live  for  ten,  fif- 
teen or  even  twenty  years,  and  may  die 
from  some  intercurrent  disease.  In  this 
type  of  cancer  the  enlarged  glands  in  the 
axilla  and  systemic  affection  are  slow  and 
tardy  in  making  their  appearance  ;  but  it  is 
well  to  remember  that  this  form  of  cancer 
may  suddenly  become — especially  if  it  is  in- 
jured— acute  and  rapid  in  its  course. 

Modifying  Changes. — Many  of  the  symp- 
toms of  cancer  may  be  modified  by  changes 
which  sometimes  occur  during  its  develop- 
ment. Although  devoid  of  nerves  or  func- 
tion, it  is  liable  to  alterations  by  injuries  or 
other  causes  that  produce  inflammation.  Con- 
gestion, suppuration, ulceration  or  gangrene 
may  ensue.  Suppuration  is  rare,  but  after 
a  certain  stage  of  its  growth  spontaneous 
ulceration  is  almost  certain  to  take  place. 
This  may  begin  in  the  deeper  parts  and  ex- 
tend to  the  skin,  or  it  may  involve  the  skin 
at  the  outset  and  spread  to  the  deeper  parts, 
or  sudden  interference  with  venous  return, 
or  some  injury  may  result  in  gangrene.  This 
may  be  moist  or  dry,  partial  or  almost  com- 
plete, and  is  attended  by  great  suffering  and 
imminent  danger.  Cystic  degeneration  may 
also  occur  and  be  the  result  of  a  hemorrhage 
into  the  mass,  or  some  obstruction  and  dila- 
tation of  the  ducts  of  the  gland.  Rare  in- 
stances are  also  seen  of  calcification  or  ossi- 
fication of  the  cancerous  neoplasm.  Occa- 
sionally in  chronic  acinous  cancer,  the  dis- 
ease, instead  of  steadily  increasing  as  it 
usually  does,  shows  symptoms  of  attempts 
at  a  spontaneous  cure.  The  mass  shrinks 
in  size,  becomes  less  painful,  weak  granu- 
lations form  in  the  bottom  of  the  ulcer,  and 
some  feeble  attempts  at  cicatrization  may 
be  observed.  This  apparent  arrest  of  the 
disease  is  temporary,  and  should  not  mislead 
the  attendant  into  the  belief  that  a  sponta- 
neous cure  will  result. 

Recurrence  of  Cancer  of  the 
Breast. — Two  cases  of  cancer  of  the  breast 
are  rarely,  if  ever,  exactly  alike.  The  dis- 
ease in  two  women  of  the  same  age,  degree 
of  health,  date  of  advent  of  cancer,  with — 
as  far  as  we  can  determine — the  same 
morphological  and  pathological  condition, 
will  not  pursue  the  same  course.  The 
relative  malignancy  differs.  So  also  with 
recurrence  of  cancer  after  an  operation  has 
been  performed.  We  cannot  tell  whether 
recurrence  will  take  place  or  not.  It  has 
been  said  that  the  histological  character  of 
the  cancer  will  tell.     The  more  typical  the 


stricture, the  better  thechance  of  exemption  ; 
the  more  atpyical,  the  worse  the  prognosis. 
So  far  this  has  not  been  proven. 

We  know  that  in  a  number  of  cases — no 
matter  how  complete  the  operation — the 
disease  will  return,  and  we  know  f.hat  when 
the  subject  is  comparatively  young,  the 
cancer  soft,  or  of  old  date,  or  the  operation 
not  thorough,  the  disease  is  almost  certain  to 
come  back.  Gross  says  that  the  average 
period  of  its  return  is  9.4  months.  Williams 
has  compiled  a  table  of  599  cases,  and  shows 
that  in  238  of  these  cases  recurrence  took 
place  in  three  months, 1 17  within  sixmonths  ; 
that  is,  about  60  per  cent,  recurred  within 
six  months.  Gross  says  that  22  per  cent, 
were  within  one  month  and  8.9  inside  of 
fifteen  days.  Winniwater's  reports  are 
even  more  discouraging,  while  Agnew  (it 
is  said)  operated  for  the  moral  effect  only, 
and  believed  the  operation  rather  tended  to 
shortened  life  than  to  lengthen  it. 

Since  Volkman,  however,  directed  atten- 
tion to  the  absolute  importance  of  a  more 
radical  operation  in  cancer  of  the  breast, 
far  better  success  has  attended  the  surgeon's 
efforts.  Recurrence  has,  in  many  instances, 
been  postponed  for  many  years,  and  abso- 
lute cures  have  increased  in  number.  Now, 
no  good  surgeon  is  content  to  simply  re- 
move the  breast  in  the  old  stereotyped  way, 
but,  in  addition  to  taking  away  the  whole 
breast  with  a  large  portion  of  the  integu- 
ment over  the  tumor,  the  axilla  is  freely 
opened,  all  the  lymphatic  glands  are  re- 
moved, and  loose  fat  and  cellular  tissue  care- 
fully cut  away.  After  this  the  fascia  cov- 
ering the  pectoral  muscle  is  carefully  dis- 
sected off,  not  only  on  the  surface  of  the 
muscles,  but  the  prolongations  of  fascia  that 
pass  down  between  the  bundles  of  muscular 
tissue  ;  if  diseased,  the  muscle  itself  is  bodily 
removed.  Since  this  radical  procedure  has 
been  done,  our  success  has  been  much 
greater. 

No  surgeon  in  this  country  has  contrib- 
uted more  to  our  knowledge  of  the  impor- 
tance of  a  complete  operation  in  cancer  of 
the  breast  than  Halstead,  of  Baltimore.  He 
gives  the  details  of  fifty  cases  operated  on 
in  Johns-Hopkins  Hospital,  with  a  local 
recurrence  in  only  three  cases  (6  per  cent). 
By  "local  recurrence"  he  means  return  of 
the  disease  in  the  region  attacked  by  the 
knife.  "Regionary  recurrences"  are  de- 
scribed by  him  as  outbreaks  of  the  disease 
in  the  skin  at  a  distance  from  the  scar,  and 
are  due  to  metastasis  in  the  skin  from  the 
original  growth.  In  peases  (63  per  cent.) 
there  had  been  no  local  or  regionary  recur- 
rence. In  43  cases  (93  per  cent.)  there  had 
been  no  true  local  recurrence,  and  Dr.  Hal- 
stead  says  that  we  have  "reason  to  hope  for 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


297 


a  brighter,  if  not  a  very  bright  future,  for 
operations  for  cancer  of  the  breast."  All 
of  these  cases  were  operated  upon  in  the 
same  thorough  way — one  or  both  pectoral 
muscles,  the  axillary  glands  and  those  above 
and  below  the  clavicle  being  removed.  The 
report  shows  that  cancer  as  a  local  disease 
may  in  many  cases  be  permanently  eradi- 
cated. Halstead  removes  in  everv  case  of 
cancer  of  the  breast  the  large  pectoral  mus- 
cle, and,  to  prevent  infection  of  the  wound 
by  pieces  and  shreds  of  cancer,  he  takes  out 
cancer,  fascia,  muscles,  glands,  etc.,  as  one 
piece. 

As  it  has  been  demonstrated  that  for  a 
long  time  the  fascia  covering  the  pectoral 
muscle  protects,  so  to  speak,  the  muscle 
from  the  spread  of  the  disease ;  that  the 
lymphatics  are  chiefly  found  upon  the  sur- 
face of  the  fascia;  that  the  lymphatic  cur- 
rent is  from  the  muscle  to  the  fascia  and  not 
the  reverse  ;  that  the  lymphatic  vessels  do 
not  follow  the  blood  vessels  between  the 
bundles  of  muscular  fibres,  it  seems  to  me 
scarcely  necessary  or  justifiable  to  remove 
the  pectoral  muscle  in  every  instance,  but 
only  in  those  cases  where  the  disease  has 
spread  that  far.  While  I  have  removed 
with  the  breast  both  pectoral  muscles,  along 
with  lymphatic  glands  of  the  axilla  and  su- 
pra-clavicular reg'on,  and  prolonged  the 
life  of  the  patient,  such  cases  should  proba- 
bly be  regarded  as  inoperable,  as  remote  in- 
fection by  metastasis  has  likely  already 
taken  p'ace.  When  macroscopic  inspection 
shows  that  the  axillary  glands  are  involved, 
and  that  it  is  difficult  or  impossible  to  fol- 
low up  all  the  cancer  foci  even  in  that  re- 
gion, it  adds  very  much  to  the  hopelessness 
of  the  case  to  find  also  muscles  involved  and 
infection  likely  spread  to  the  pleura  and 
sternal  glands.  But  when  recurrence  does 
take  place  another  operation,  as  a  rule, 
should  be  done  and  the  morbid  part  as 
freely  and  thoroughly  as  possible  be  re- 
moved. Even  when  recurrence  for  the 
third  or  fourth  time  is  seen,  the  operation, 
unless  there  is  marked  systemic  dissemina- 
tion, again  as  the  only  hope  for  life  should 
be  advised.  I  have  one  case  on  which  I 
have  operated  eight  times,  and  only  the  last 
one  successful.  The  disease  has  not  made 
its  re-appearance  after  six  years.  But,  to 
to  my  mind,  recurrence  after  an  operation 
in  the  early  stage  goes  far  to  show  want  of 
thoroughness  in  the  first  operation. 

The  sooner  the  cancer  is  removed  after 
its  presence  is  known,  the  less  the  chance  of 
a  recurrence  and  the  better  the  chance  of  a 
radical  cure.  If  the  operation  can  be  per- 
formed before  six  months  have  expired — 
before  the  disease  has  had  a  chance  to 
spread  by  contiguity,    by  lymphatics  or  by 


the  blood — the  better  and  more  certain  the 
results.  It  is  true  the  lymphatics  are  in 
some  cases  involved  before  six  months  have 
passed,  but,  as  a  rule,  such  is  not  the  case. 
Delay  is  often  recommended  by  the  practi- 
tioner, as  for  a  time  he  is  unable  to  clearly 
determine  the  nature  of  the  neoplasm.  All 
the  cardinal  symptoms  of  cancer  are  not 
present,  and  in  so  grave  a  case  he  prefers 
to  wait,  and,  as  a  rule,  in  my  experience, 
he  waits  until  other  parts  besides  the  breast 
are  involved.  Any  tumor  in  the  breast  of 
a  woman  occurring  before  the  menopause 
should  be  removed.  If  it  grows  rapidly  it 
is  Dialignant.  If  there  is  doubt  about  its 
nature  the  surgeon  should  cut  down,  re- 
move a  piece  and  find  out  what  it  is,  and  at 
the  same  time  be  prepared  to  operate  on  the 
case — to  operate  then,  not  the  next  day. 
Don't  wait  till  the  operation  is  hopeless,  or 
nearly  so.  The  frequency  and  time  of  re- 
currence will  greatly  depend  on  the  time 
the  operation  is  performed. 

Much  depends  also,  as  has  been  stated, 
on  the  character  of  the  operation.  It  is 
better  not  to  operate  at  all  than  to  do  it  im- 
perfectly. More  than  half  of  the  recur- 
rences are  situated  in  the  breast,  near  or  in 
the  old  scar,  because  the  operator  left  in  the 
skin,  or  fascia,  or  fat,  or  gland  some  of  the 
cancer  tissue,  and  when  the  disease  has 
again  made  its  appearance,  it  is  not  fairly 
a  recurrence,  but  the  growing  of  unremoved 
fragments  of  cancer  at  the  original  opera- 
lion,  and  when  the  re-appearance  is  in  the 
axillary  glands  it  is  fair  to  infer  that  they 
were  invaded  before  the  operation  was  per- 
formed, and  have  grown  and  developed 
since.  These  axillary  glands  should  have 
all  been  removed  at  the  first  operation.  To 
take  out  a  malignant  tumor  of  the  breast 
and  leave  the  rest  of  the  mammary  tissue, 
in  the  present  state  of  our  knowledge,  is 
both  cruel  and  silly.  To  leave  the  axillary 
glands  is  almost  as  bad.  Cancer  of  the 
breast  is  a  single  tumor. 

When  recurrence  takes  place  in  the  neigh- 
borhood of  the  operation  the  recurrences 
are  multiple,  showing  that  more  than  one 
small  piece  or  fragment  of  cancer  was  left. 
It  has  been  recently  recommended  that  the 
surgeon  should  avoid,  if  possible,  cutting 
into  cancerous  neoplasm  or  tissue,  but  to 
keep  the  knife  outside  of  the  diseased  part, 
to  avoid  detaching  some  small  pieces  which 
may  grow  like  grafts,  if  overlooked  and  not 
removed. 

But  while  the  foregoing  may  explain  the 
large  majority  of  the  cases  of  the  re-appear- 
ance of  cancer,  there  are  still  cases  that  ap- 
pear so  late  after  the  primary  operation — 
ten,  fifteen,  or  even  twenty  years — that  can- 
not'be  accounted  for  in  this  way.     It  is  true 


THE  CHARLOTTE  MEDICAL  JOURNAL 


that  some  cancers  of  the  breast  are  station- 
ary for  months  and  years,  and  occasionally 
undergo  atrophy,  wither,  and  almost  dry 
up.  So  a  recurrent  growth,  which  patho- 
logically and  morphologically  is  identical 
with  the  primary  neoplasm,  may  pursue  the 
same  course,  and  a  very  late  re-appearance 
may  be  the  very  tardy  growth  of  an  unex- 
tirpated  fragment. 

But  there  are  doubtless  recurrences  inde- 
pendent of  unextirpated  cancer  cells  left  as 
foci  for  the  regrowth  of  the  disease ;  recur- 
rences which  can  only  be  explained  as  inde- 
pendent re-appearances  of  cancer.  Prob- 
ably the  same  causes  that  produced  the  orig- 
inal disease  are  still  in  operation  and  have 
reproduced  it.  Fortunately  these  cases  are 
rare.  This  form  of  recurrence  may  take 
place  in  a  piece  of  the  mammary  gland  that 
has  extended  into  the  axilla,  and  was  com- 
pletely isolated  from  the  normal  gland. 
Williams  found  in  132  consecutive  cases  of 
cancer  of  the  breast,  that  thirteen  had  origi- 
nated in  supernumerary  mammary  structure, 
entirely  disconnected  with  the  normal  gland. 

Recurrence  is  more  likely  to  take  place  in 
young  women  than  in  the  old,  and  in  very 
rapidly  developing  growth,  rather  than  in 
one  stationary  or  slow  to  increase,  and  in 
the  soft  variety  of  cancer  than  the  hard. 

Origin  of  Cancer. — For  a  long  time 
two  theories  have  been  advanced  as  to  the 
essential  nature  of  cancer ;  both  of  them  are 
advocated  to-day.  The  first  is  the  embry- 
onic, or  evolutional  theory,  and  the  second 
is,  that  the  disease  is  due  to  a  micro-organ 
ism.  The  first,  while  based  on  some  sound 
and  interesting  observations,  is  not  suffi- 
cient to  explain  many  of  the  varied  mani- 
festations of  the  cancer.  The  embryonic 
theory  of  the  origin  of  cancer,  has,  how- 
ever, many  able  supporters. 

For  many  years  a  number  of  pathologists 
have  regarded  these  lesions  as  microbic  in 
character,  and  as  early  as  1872,  Nepveau 
found  micro-organisms  in  malignant 
growths,  which  he  regarded  as  specific. 
Since  then  a  number  of  investigators  at  dif- 
ferent periods  have  claimed  to  have  discov- 
ered the  real  parasite  of  cancer ;  but  their 
conclusions  have  been  challenged  by  other 
observers  and  the  theories  advanced  were 
rejected.  At  one  time  a  micro-organism, 
called  "cancer  bodies,"  or  psoro-sperms, 
which  belong  to  one  of  the  many  forms  of 
protozoa,  were  asserted  to  be  the  cause  of 
cancer.  The  special  form  supposed  to  be 
so  intimately  connected  with  the  etiology 
of  this  disease  was  known  as  "coccidium," 
and  were  discovered  chiefly  in  the  new 
formed  epithelial  cells  in  the  periphery  of 
the  cancer  mass.  But  the  parasite  must  be 
shown,  isolated,  and   made  to    produce   by 


inoculation  the  same  disease  it  was  alleged 
to  have  caused  before  it  can  be  acknowl- 
edged parasitic  in  nature.  All  attempts  at 
this  were  said  to  be  failures. 

Early  in  1895,  two  Italian  pathologists 
published,  nearly  at  the  same  time,  very  re- 
markable experimental  results  of  their  in- 
vestigations, which  have  attracted  much 
interest.  They  found  the  active  agent  in 
the  formation  of  cancer  to  be  the  blastomy- 
cetce,  which  belong  to  a  class  of  fungi  to 
which  the  common  yeast  plants  belong.  Dr. 
Roswell  Park  has  given  a  good  epitome  of 
this  work  of  the  Italians,  and  concludes  by 
saying:  "Thus,  without  quoting  in  detail 
the  experimental  labors  of  Sanfelice  Ron- 
cali,  and  their  pupils,  it  may  be  stated  as 
positively  proven  that  the  blastomycetas 
above  alluded  to,  a.  e.,  at  least,  some  of 
them,  are  capable  :  first,  of  being  isolated 
by  culture-methods  from  certain  carcino- 
mata  and  sarcomata  ;  second,  of  indentifica- 
tion  as  belonging  among  the  yeasts ;  third, 
of  producing  tumors  in  animals  by  injec- 
tion, under  suitable  precautions,  the  result- 
ing tumors  being  strikingly  analogous  to, 
or  identical  with,  those  from  which  the  cul- 
tures were  made ;  and,  fourth,  of  furnish- 
ing from  these  tumors  further  cultures,  from 
which  yet  other  experimental  inoculations 
can  be  made. 

Without  going  so  far  as  to  say  that  this 
can  be  done  in  every  instance,  or  that  all 
cancers  are  necessarily  of  parasitic  origin, 
one  is  justified  by  these  results  in  at  least 
maintaining  that  some  cancers  are  posi- 
tively of  such  origin.  If,  upon  this  experi- 
mental ground,  one  should  infer  that  all 
cancers  are  parasitic  manifestations,  he 
would  do,  as  will  be  seen,  little  violence  to 
the  laws  of  logic."  Indeed,  the  opinion 
of  a  majority  of  those  who  have  most  closely 
studied  the  subject,  is  that  the  cancer  is  due 
to  a  micro-parasite,  the  nature  of  which  is 
so  far  unknown,  but  that  it  differs  from  any 
species  of  bacteria,  or  micrococci  so  far  dis- 
covered. We  can  readily  believe  from  the 
number  and  character  of  the  men  now  in- 
vestigating this  subject,  in  both  clinics  and 
laboratories,  that  the  question  will  not  long 
be  an  unsettled  one. 

Diagnosis. — Diagnosis,  in  the  later 
stages  of  cancer  of  the  breast,  is  always 
plain,  but  in  the  early  stages  it  is  often 
very  difficult,  and  will  tax  to  the  utmost 
the  skill  of  the  surgeon.  Early  cancer  may 
be  mistaken  for  inflammatory  conditions, and 
vice  versa.  The  following  symptoms  may 
enable  one  to  make  the  distinction  : 

In  inflammation,  there  is  pain  and  ten- 
derness on  pressure;  in  early  cancer,  there 
is  no  pain  or  tenderness.  When  in  later 
stages   there  is   pain  in  cancer,  it  is  sharp 


THE  CHARLOTTE  "MEDICAL  JOURNAL. 


and  lancinating;  the  pain  of  inflammation 
is  throbbing  and  pulastile.  Dimpling  of 
the  skin,  while  not  absolutely  pathognomo- 
nic, is  much  more  liable  to  occur  in  cancer. 
If  it  happens  to  be  present  in  inflammatory 
swelling,  it  usually  marks  the  site  of  an  old 
scar.  In  inflammatory  trouble,  the  breast 
is  enlarged ;  in  cancer,  it  is  smaller  than 
natural ;  in  both,  a  certain  amount  of  fixa- 
tion exists,  but  this  is  more  maked  in  in- 
flammation than  the  early  stages  of  cancer. 
In  inflammation,  the  swelling  is  diffuse  and 
spread  over  a  large  space;  in  cancer,  the 
swelling  is  nodular  and  better  defined.  En- 
larged veins  denote  cancer;  slight  oedema 
of  the  skin  indicates  suppuration.  During 
lactation,  true  tumors  are  rare,  but  inflam- 
mation common.  Enlargement  of  axillary 
glands  occurs  in  both  conditions.  They  are 
found  in  three  or  four  weeks  in  inflamma- 
tion, and  in  four  or  five  months  after  the 
commencement  of  cancer.  In  inflammation 
the  diseased  glands  are  larger,  more  numer- 
ous, and  quite  tender  on  manipulation. 

It  is  sometimes  difficult  to  distinguish  can- 
cer of  the  breast  from  tuberculosis  of  that 
organ  in  its  early  stage.  Both  may  appear 
as  a  single  nodule  about  the  size  of  a  hen's 
egg.  In  both  diseases,  the  upper  and  outer 
segment  of  the  breast  is  the  most  common 
site.  In  both,  the  disease  at  first  is  pain- 
less ;  in  neither  is  the  contour  of  the  breast 
changed.  The  skin  is  normal  in  both  ;  the 
outline  of  the  tumors  is  ill-defined,  as  a  rule, 
in  both,  and  feel  as  if  they  were  merged 
into  the  surrounding  gland  tissue.  Both 
are  characterized  by  chronicity,  and  develop 
insiduously.  In  both,  retraction  of  the  nip- 
ple is  sometimes  found. 

After  a  short  lime,  however,  in  the  tu- 
bercular disease,  and  often  before  the  sur- 
geon sees  the  case,  the  mass  has  broken 
down  by  caseous  degeneration,  or  suppur- 
ation, and  ulcerates  through  the  skin,  leav- 
ing a  fistula-discharging  tubercular  pus. 
When  this  is  the  case,  the  distinction  is 
easily  made.  In  tuberculosis,  the  axillary 
glands  are  soon  affected;  indeed,  the  pri- 
mary disease  is  often  in  the  axillary  glands, 
and  the  breast  tuberculosis  is  secondary. 
The  glands  in  the  axilla  soon  suppurate  and 
discharge.  In  tuberculosis  of  the  breast, 
the  whole  organ  appears  larger  than  the  op- 
posite gland  ;  in  cancer,  the  diseased  breast 
is  smaller  than  its  fellow.  Breast  tubercu- 
losis is  rarely,  if  indeed  is  ever,  primary. 
A  careful  examination  will  reveal  tubercle 
somewhere  else  in  the  body.  Tuberculosis 
occurs  in  young  adult  women  ;  cancer  in 
women  over  forty  years  of  age. 

In  cancer,  the  axilliary  glands  do  not  sup- 
purate, nor  do  fistulae  form.  In  all  cases, 
where  possible,    the  aid  of  the  microscope 


should    be  employed    to  determine  the  na- 
ture of  the  formation. 

Syphilis  of  the  breast  may  be  mistaken 
for  cancer,  but  other  evidences  besides  gum- 
mata  of  the  breast  would  be  present  and  de- 
cide the  nature  of  the  disease. 

A  small  hard  neoplasm,  not  well  defined, 
with  puckered  or  dimpled  skin,  retraction 
of  nipple,  or  bloody  discharge  from  nipple, 
with  the  whole  breast  and  tumor  looking 
smaller  than  the  other  and  sound  organ, 
mean  cancer. 

Cancer  may  be  confounded  with  cyst  or 
cold  abscess.  A  cyst  and  cold  abscess  usu- 
ally are  well  defined  and  fluctuate.  Neither 
have  enlarged  glands  or  puckered  skin. 
Any  one  familiar  with  the  cardinal  symp- 
toms of  breast  carcinoma  will  be  able  to 
distinguish  it  from  sarcoma,  adenoma,  or 
villous  papilloma.  If,  however,  the  case  is 
doubtful,  an  exploratory  incision  may  be 
made,  and  the  true  nature  of  the  swelling 
determined.  The  nature  of  the  doubt  should 
be  explained  to  the  patient,  and  her  consent 
obtained  to  perform  a  complete  operation 
if  the  growth  be  found  malignant.  An 
anaesthetic  should  be  given,  and  every  pre- 
paration made  to  do  a  radical  operation  if 
found  necessary.  The  exploratory  incision 
should  be  large,  as  it  is  impossible  to  get 
much  satisfaction  out  of  a  small  incision  or 
an  exploratory  punch. 

Treatment. — The  opinion  of  those  best 
qualified  to  judge,  that  cancer,  in  the  be- 
ginning, is  a  local  and  not  a  constitutional 
disease,  makes  early  operative  treatment  of 
the  first  importance.  A  radical  operation, 
well  performed,  before  regional  infection 
has  taken  place,  gives  a  most  favorable  re- 
sult. Operations  undertaken  after  regional 
infection  exists,  or  operations  not  well  or 
thoroughly  done,  are  almost  always  fol- 
lowed by  rapid  recurrence.  It  was  the  late 
or  imperfectly  performed  operations,  or 
both  of  these  causes,  that  made  the  older 
surgeon's  statistics  so  bad  ;  that  caused  them 
to  despair  of  a  possible  cure  ;  and  that  in- 
duced one  of  the  most  distinguished  among 
them  to  declare  he  operated  only  for  the 
moral  effect.  It  is  acknowledged  that  com- 
plete hysterectomy  for  cancer  of  the  cervix, 
before  lymphatic  involvement,  very  often 
permanently  cures  the  patient.  This  is 
more  because  the  operation  is  radical  than 
because  of  the  locality  of  the  cancer;  but 
hysterectomy  is  regarded  as  a  somewhat 
difficult  operation,  and  only  the  more  skill- 
ful surgeons  attempt  it,  while  nearly  every 
surgeon  or  medical  practitioner  in  the  city 
or  country  believes  himself  competent  to  re- 
move a  cancerous  breast.  The  truth  is,  to 
remove  the  whole  of  the  disease  in  cancer 
of    the  breast  requires    a  bolder  and  better 


300 


THE  CHARLOTTE  MEDICAL  JOURNAL 


surgeon,  a  more  profound  knowledge  of  an- 
atomy, than  to  remove  the  uterus  along 
with  the  tubes  and  ovaries. 

English  and  American  surgeons  were  the 
first  to  call  attention  to  the  inadequate  op- 
erations which,  until  recently,  were  being 
performed  for  breast  cancer,  and  to  the 
writings  of  Charles  Moore,  and  Banks,  of 
Great  Britain,  and  to  the  younger  Gross  of 
Philadelphia,  the  surgical  world  is  pro- 
foundly indebted.  In  Denmark,  Germany, 
and  Austria,  the  teachings  of  Moore  were 
accepted,  and  with  improved  results. 

Unfortunately,  a  large  number  of  the 
cases  of  cancer  that  the  surgeon  sees  come 
to  him  when  the  disease  has  made  progress  ; 
when  local  and  regional  infection,  or  gen- 
eral dissemination,  make  the  removal  of  the 
whole  disease  impossible.  When  such  is 
the  case,  it  will  be  better  to  resort  to  pallia- 
tive measures.  The  patient,  when  the  case 
was  incipient,  possibly  avoided,  for  the 
time,  even  an  examination,  much  less  enter- 
tained the  idea  of  an  operation,  and  her 
medical  man,out  of  sympathy  or  ignorance, 
or  both,  encouraged  her  to  let  it  alone  or 
paint  it  with  tincture  of  iodine.  Now  with 
speedy  and  certain  death  before  her,  she  is 
willing  to  accept  any  risk  for  the  chance  of 
a  cure  or  prolongation  of  life.  To  operate 
in  hopeless  cases  only  adds  to  the  list  of  un- 
successful statistics  and  brings  surgery  into 
disrepute.  In  cancer  of  the  breast, the  rule 
should  be  to  remove  all,  or  none,  of  the 
disease.  The  smallest  fragment,  micro- 
scopic in  size,  if  left  unremoved,  possesses 
the  power  of  proliferation, and  will  certainly 
reproduce  the  growth. 

Great  age,  if  accompanied  with  great 
debility,  may  also  be  a  barrier  to  operation, 
but  old  age,  without  6erious  senile  degenera- 
tion, does  not  preclude  operative  interven- 
tion. Some  of  the  best  results  that  I  ever 
had  have  been  in  old  people.  If  the  woman 
is  old,  the  cancer  growing  slowly,  the 
operation  extensive  and  hazardous,  the 
surgeon  may  properly  decide  to  let  it  alone. 
The  extent  of  regional  and  local  infection 
must  also  be  considered.  Can  the  whole 
disease  be  removed  and  the  large  wound 
healed?  The  decision  is  often  difficult. 
Cachexia  alone  should  not  be  a  barrier  to 
the  operation.  I  have  repeatedly  seen 
cachexia  disappear,  when  its  causes — the 
cancerous  tumor — was  taken  away.  If 
there  is  a  metastatic  tumor,  an  operation  is 
useless ;  or,  if  the  patient  is  at  the  same 
time  suffering  with  fatal  tuberculosis  bia- 
betes,  nephritis,  or  cerebral  disease,  con- 
servative treatment  is  alone  justifiable. 

Cancer  en  cuirassc  is  usually  so  diffused 
as  to  make  its  removal  impossible,  and,  as  a 
rule,  such  cases    should    be    considered    in- 


operable. Atrophic  cancer  should  be  re- 
moved with  the  knife  where  it  is  practicable 
to  remove  the  whole  of  the  infected  area, 
for  while  usually  slow  in  progress,  it  is 
liable  at  any  time  to  become  rapid  and 
spreading.  When  the  case  is  inoperable, 
palliative  treatment  is  our  only  resource. 
Every  means,  as  far  as  possible,  should  be 
employed  to  preserve  the  patient's  general 
health.  Directions  should  be  given  as  to 
climate,  diet,  exercise,  clothing, etc.  Tonics 
will  likely  be  needed,  and  iron,  hypophos- 
phites,  wine,  and  malt  liquors,  may  be 
used.  When  suffering  is  great,  some  pre- 
paration of  opium  should  be  prescribed. 
No  other  drug,  in  such  cases,  is  of  value  for 
this  purpose.  The  dose  should  be  large 
enough  to  relieve  the  pain,  no  matter  how 
great  the  quantity  or  frequent  the  interval 
required. 

If  ulceration  has  occurred,  the  sore  should 
be  covered  with  gauze,  wet  with  some 
antiseptic  and  deodorizing  wash,  and 
covered  with  thick  layers  of  absorbent 
cotton,  retained  by  plaster  of  bandages. 

Early  and  thorough  removal  is  demanded 
in  recurrent  cancer, as  in  the  original  growth. 
It  is  interesting  and  important  to  know 
that  it  has  been  found  that  when  cancer  re- 
curs it  is  often  in  some  portion  of  the  skin 
that  was  left,  and  was  infected  at  the  time 
of  the  first  operation  ;  or  some  small  pieces 
of  the  breast  gland  unremoved  ;  or  in  the 
pectoral  fascia  ;or  in  the  axillary  lymphatics. 

I  only  mention  the  attempt  to  destroy 
cancer  of  the  breast  by  caustics  to  condemn 
the  practice.  These  agents,  while  valuable 
in  small  epitheliomata,  are  absolutely  in- 
adequate in  our  present  knowledge  of  the 
disease  under  consideration.  The  courage 
of  profound  ignorance  alone  would  induce 
one  to  attempt  to  clean  out  the  axilla  with 
caustics  in  breast  cancer.  They  possess  no 
advantage  over  the  knife,  while  they  have 
the  disadvantage  of  being  slow,  uncertaii 
in  the  extent  of  their  action — leaving  foul 
burns  difficult  to  heal — and,  unavoidably, 
are  attended  with  horrible  pain,  no  matter 
how  much  opium,  cocaine  or  other  similar 
drugs  are  combined  with  them. 

The  mortality  following  the  complete 
operation,  when  antiseptically  done,  is 
small — probably  no  greater  than  that  which 
has  attended  removal  of  the  breast  alone. 
Prolongation  of  life  is  certainly  often 
effected,  and  permanent  cures  not  infre- 
quently the  result.  Volkman's  statements 
of  ultimate  results  is  generally  accepted. 
He  says:  "I  unhesitatingly  make  this 
statement  for  all  cancers,  that  when  a  whole 
year  has  passed  and  the  most  careful  ex- 
amination can  detect  neither  a  local  recur- 
rence   nor  swollen  glands,    nor  any  symp- 


THE  CHARLOTTE  MEDICAL  JUQRNAL. 


301 


torn  of  internal  disease,  we  may  begin  to 
hope  that  a  permanent  cure  may  be  effect- 
ed ;  but  after  two  years  usually,  and  after 
three  years  almost  without  exception,  we 
may  feel  sure  of  the  result." 

For  the  technique  of  the  operation,  the 
reader  is  referred  to  the  more  recent  works 
in  operative  surgery.  Halstead's  method 
is  by  far  the  most  complete  and  perfect. 

Sarcoma  of  the  Breast. — Sarcoma  of 
the  breast,  in  all  its  different  varieties,  is 
not  a  common  affection  when  compared 
with  carcinoma.  Indeed,  the  breast  is  rel- 
atively less  liable  to  sarcoma  than  the  body 
generally — 9.4  per  cent,  of  the  neoplasms 
of  the  whole  body  being  sarcomatous  in  na- 
ture, while  in  the  female  breast,  3.9  per 
cent,  only  are  of  this  character.  (Williams) 
While  the  disease  may  occur  at  any  period 
of  life,  it  generally  is  found  in  women  un- 
der thirty  years  of  age,  and  may  be  "spin- 
dle cell,"  ''round  cell,"  or  "giant  cell"  in 
form.  The  first  named  is  the  most  com- 
mon, and  constitutes  about  two-thirds  of 
all  the  cases  of  sarcoma  of  the  breast.  The 
giant  cell  is  the  least  frequent.  It  is  not, 
however,  uncommon  to  find  two,  or  all 
three  varieties  in  the  same  tumor.  The 
growth  begins  in  the  connective  tissue 
around  the  acini,  and  when  we  remember 
how  much  connective  tissue  the  mammary 
gland  contains,  we  are  surprised  that  sar- 
coma of  that  organ  is  comparatively  so  rare. 
As  the  tumor  develops,  the  acini  are  de- 
stroyed and  the  ducts  distended.  The  gland 
tissue  undergoes  atrophy,  and  is  more  or 
less  destroyed.  The  tumor  is  sometimes  en- 
capsulated, but  the  capsule  is  spurious,  and 
belongs  to  and  is  a  part  of  the  malignant 
neoplasm. 

Round  cell  sarcoma  is  soft,  extremely  vas- 
cular, grows  with  great  rapidity,  and  is  the 
most  malignant  of  all  the  varieties.  The 
patient  may  live  for  a  year  or  longer,  but 
life  is  often  destroyed  in  three  or  four 
months.  The  form  is  sometimes  known  as 
medullary  sarcoma.  In  the  spindle  celled 
variety,  local  and  general  dissemination  is 
not  so  rapid.  The  tumor  is  firm  to  the  feel, 
round,  smooth  or  slightly  lobulated.  Dur- 
ing the  evolution  of  sarcoma,  rupture  of 
one  of  the  new  formed  vessels  may  take 
place  and  blood  be  extravasated  in  the  in- 
tercellular spaces;  in  this  way,  blood  cysts 
are  common. 

Rapid  growth  is  one  of  the  characteris- 
tics of  all  sarcomata,  but  occasionally  a  tu- 
mor of  this  nature  may  form  in  the  breast 
and  remain  stationary  for  years,  and  then 
suddenly  develop  its  malignancy  and  grow 
rapidly,  invading  the  neighboring  struc- 
tures; or  a  fibroma  or  adenoma,  which  has 
existed  in  the  breast  and  been  stationary  for 


years,  may   degenerate  into  a  sarcomatous 
growth. 

Symptoms  of  Sarcoma. — When  first  no- 
ticed the  tumor  may  be  the  size  of  a  walnut, 
or  pullet's  egg,  soft  and  cystic,  or  more  firm 
to  the  touch,  smooth  or  slightly  nodular. 
The  integument  over  the  growth  is  not  in- 
volved, but  free  and  movable.  When  the 
tumors  becomes  large,  the  cutaneous  veins 
are  dilated,  and  only  very  late  in  the  dis- 
ease does  the  skin  give  way  and  a  fungous 
mass  protrude  through  it.  There  is  no  ci- 
catricial contraction,  or  dimpling  of  the 
skin,  as  in  cancer.  There  is  no  pain  gen- 
erally. The  sarcomatous  tumor  is  softer, 
grows  more  rapidly,  and  is  much  larger  than 
carcinoma.  There  is  sometimes  a  blood 
discharge  from  the  nipple,  but  no  retrac- 
tion, as  is  often  the  case  in  cancer.  The 
glands  in  the  axilla  are  only  occasionally  in- 
volved, not  so  hard  or  immobile  as  in  can- 
cer. The  tendency  to  infiltrate  the  parts 
around  it,  and  the  disease  to  become  gener- 
alized and  characteristic.  Its  rapid  growth , 
for  in  a  year  it  may  become  as  large  as  a 
goose  egg,  will  distinguish  it  from  adeno- 
ma, obroma,  or  any  form  of  benign  tumor, 
In  its  last  stages,  bleeding  from  ulceration 
and  sloughing  is  common,  and  pain  may 
then  be  great  when  the  chest  wall  and  in- 
tegument become  involved.  When  this  is 
the  case  the  general  health  becomes  in- 
volved, and  symptoms  of  general  cachexia 
present  themselves.  Metastatic  tumors  ap- 
pear more  often  in  the  lungs.,  liver,  and 
brain,  but  may  form  anywhere  in  the  body. 
Sarcoma  is  disseminated  generally  by  the 
blood  vessels,  but  occasionally  also  by  the 
lymphatics,  in  the  glands  of  which  second- 
ary deposits  are  sometimes  found. 

Diagnosis  of  Sarcoma. — The  diagnosis 
of  sarcoma,  from  other  malignant  or  benign 
tumors,  may  be  made  out  from  the  above, 
but  it  is  not  uncommon  to  mistake  sarcoma 
for  an  abscess,  or  the  reverse.  A  soft, 
smooth,  cystic  sarcoma  may  readily  be  mis- 
taken for  an  abscess,  and  an  exploratory 
puncture  be  necessary  to  decide  the  question. 
Treatment  of  Sarcoma. — The  treat- 
ment is  early  and  complete  removal.  The 
operation  should  be  as  thorough  and  radical 
as  for  carcinoma.  The  axilla  should  be 
opened  ;  the  glands,  fat,  and  loose  tissue  re- 
moved. There  should  be  no  hesitation  in 
removing  skin  suspected  to  be  infected,  no 
matter  how  extensive.  Every  portion  of 
the  mammary  gland  is  of  course  to  be  re- 
moved, even  if  sound  in  its  appearance,  and 
the  connective  tissue  around  the  gland  com- 
pletely dissected  away.  This  gives  the  only 
chance  of  a  permanent  cure,  and  the  chances 
of  cure  are  better  than  in  carcinoma,  If 
recurrence    takes    place  the  disease  should 


302 


THE  CHAKLOTTE  MEDICAL  JOURNAL. 


again  be  removed,  more  completely,  if  pos- 
sible, than  at  the  first  operation.  It  is  very 
well  for  the  operator  to  feel  when  sarcoma 
or  carcinoma  return  after  early  removal 
that  the  first  operation  was  widely  and  rad- 
ically done. 

It  is  only  fair  to  say  that  W.  B.  Coley, 
of  New  York,  and  others,  have  stated  that 
they  have  seen  carcinomatous  tumors  disap- 
pear under  the  influence  of  repeated  injec- 
tions of  a  solution  of  the  toxines  of  bacillus 
prodigiosus,  and  Fehleisen's  coccus  of  ery- 
sipelas. Some  surgeons  have  reported  cures 
of  sarcoma  by  the  use  of  the  toxic  product 
of  the  latter  alone.  The  question  is  still 
unsettled,  but  there  is  no  reason  why  such 
injections  should  not  be  tried  in  cases  inop- 
erable from  delay,  or  from  the  location  of 
the  growth. 

513  East  Grace  Street. 

DISCUSSION. 

Dr.  H.  B.  Weaver. — I  do  not  rise  to  dis- 
cuss the  paper,  but  merely  to  report  a  case 
in  a  few  words  in  order  more  essentially  to 
elicit  the  opinion  of  Dr.  McGuire  in  respect 
to  the  truth  which  is  germane  to  this  ques- 
tion. It  is  a  case  of  sarcoma.  The  lady 
consulted  me  about  four  months  ago,  in 
reference  to  what  she  called  a  rising  or  blood 
boil  in  the  surface  of  the  upper  third  of 
thigh,  about  four  or  five  inches  by  three 
inches  in  diameter,  just  at  the  head  of  the 
adductor  and  sartorius.  For  a  week  or  so 
I  was  puzzkd  in  the  diagnosis,  and  thought 
in  the  beginning  it  was  probably  an  ab- 
scess. For  a  week  or  two  more  the  skin 
was  very  red  and  congested,  and  for  a  week 
or  so  it  showed  evidence  of  pitting  (?)  on 
pressure,  and  I  thought  probably  I  had  now 
an  abscess.  I  took  my  little  exploratory 
history  and  made  an  incision  into  it  about 
an  inch  and  a  half  toward  the  middle,  and 
found  no  pus.  I  then  began  to  think  very 
seriously  of  its  being  a  malignant  tumor, 
and  told  the  family  of  the  fact.  The  lady 
is  about  thirty-three  years  of  age  and  other- 
wise a  good  healthy  woman.  I  called  in  one 
of  our  surgeons,  Dr.  Meri weather,  in  con- 
sultation. He  confirmed  the  diagnosis,  but 
to  be  certain  about  it,  at  the  time  it  began 
to  slough  and  ulcerate,  we  sent  a  good  spe- 
cimen to  an  eminent  pathologist,  who  re- 
turned the  diagnosis  as  undoubtedly  being 
sarcoma.  Then  as  they  refused  even  a  hip 
joint  operation,  we  began  the  treatment 
with  Coley's  injunction  of  mixed  antitoxin 
of  streplococcus  and  erysipelas.  We  began 
with  one  drop  of  the  mixture.  The  first 
dose  was  followed  by  the  most  terrible  re- 
action I  ever  saw  for  a  patient  to  live,  the 
fever  ran  up  to  104  or  105,  vomiting  began, 
and    nausea    was  intense,   and  sweat,    and 


everything  else  of  that  character.  I  guess 
I  applied  whiskey  and  nitrate  of  strychnine 
and  everything  else,  in  a  hurry,  but  she  re- 
acted and  came  all  right,  and  on  the  third 
day  we  repeated  the  dose,  not  quite  so 
heavy,  and  the  reaction  was  less,  and  the 
chill  was  less.  In  about  four  days  the 
tumor  showed  evidence  of  retraction,  the 
whole  of  the  inflamed  part,  which  was 
about  six  to  ten  inches,  extending  clear 
down  to  the  bone,  began  to  show  evidence 
of  lessening,  the  tumor  became  smaller,  and 
up  to  last  week  the  tumor  had  sloughed  to 
about  one-third  its  size,  the  induration  and 
the  skin  clear  around  to  the  bone  had  grown 
perfectly  soft,  it  had  not  crossed  the  line  of 
Pouparts'  ligiment,  the  glands  so  far  had 
not  become  indurated,  and  it  showed  every 
evidence  of  the  tumor  yielding  to  that  treat- 
ment. Now,  that  is  the  condition  of  the 
patient  at  this  time.  The  tumor  is  proba- 
bly about  one-third  the  size  it  was  when  we 
began  the  injection.  As  that  is  the  case,  I 
would  like  to  hear  the  Doctor's  opinion. 

Dr.  Paul  B.  Barringer. — As  Dr.  Mc- 
Guire well  said,  there  is  no  subject  that  in- 
terests the  general  practitioner  more  than 
the  subject  of  mammary  cancer.  Dr.  Hal- 
stead,  whom  he  cites,  owes  his  success  to 
the  fact  that  he  was  the  first  to  recognize 
the  true  anatomical  relations  of  this  gland. 
This  is  one  of  the  places  in  the  body  in 
which  comparative  anatomy  throws  much 
light  on  the  anatomy  of  the  human  subject. 

Recognizing  that  reproduction  is  the  goal 
of  individual  existence,  we  must  recognize 
the  secondary  law  that  all  parts  of  the  re- 
productive system  are  provided,  as  far  as 
nature  can,  against  possible  disaster.  To 
this  end,  the  mammary  gland  is  supplied 
with  an  unusually  large  number  of  vessels, 
and  vessels  which  in  their  complexity  of 
origin  have  no  analogue  in  the  body — thor- 
acic, intercostals,  internal  mammaries,  and, 
by  anastomosis  below,  the  epigastrics. 
There  is  an  unbroken  column  of  blood  from 
the  internal  mammary  at  the  base  of  the 
neck   through  the   epigastrics  to  the  groin. 

To  appreciate  why  this  is,  we  must  re- 
member that  our  female  has  the  mammae  on 
the  anterior  part  of  the  torso.  On  the  cow 
the  mamma?  are  located  on  the  posterior,  or 
inferior  portions,  of  the  torso,  whereas,  as 
we  know,  the  hog  has  mammary  glands  of 
anterior,  posterior  and  median  type.  It  has 
been  my  fortune  or  misfortune  to  see  a  hu- 
man female  presenting  nearly  the  type 
shown  in  the  latter  animal,  two  normal 
mamma;,  two  immature  below,  and  two 
still  more  immature  below  these,  and  you 
can  readily  see  from  the  comparative  anat- 
omy why  they  should  thus  exist. 

I  will  call  your  attention   particularly  to 


THE  OHARLOTXE  MEDICAL  JOURNAL. 


the  anatomy  of  the  lymphatics.  While  the 
greater  part  of  these  follow  the  inferior 
border  of  the  pectoralis  major,  not  a  few 
pierce  the  chest,  and  following  the  route  of 
the  internal  mammary  artery,  join  the  tho- 
racic duct  in  the  thorax.  These  go  in  about 
the  third,  fourth,  or  fifth  intercostal  space. 
In  mammary  cancer  it  makes  no  difference 
how  elaborately  you  proceed  to  remove  the 
gland  and  the  axillary  contents  if  the  in- 
fection has  reached  the  line  of  those  tho- 
racic lymphatics,  the  operation  will  be  a 
failure.  You  may  "skin  them  alive,"  as 
has  been  charged,  by  taking  off  the  entire 
front  of  the  chest,  it  will  do  no  good  unless 
you  go  down  as  far  as  you  can  on  these  tho- 
racic lymphatics.  Dr.  Halstead  was  the 
first  to  go  down  deep  on  the  intercostals, 
and  hence  his  remarkable  results. 

I  have  reason  to  believe  that  lymphatics 
follow  this  anterior  vascular  trunk  through- 
out its  entire  length.  If  so,  obstructions 
to  axillary  and  thoracic  lymphatics  might 
force  back  the  lymph  contents,  in  spite  of 
the  valves,  and  give  rise  to  the  so-called 
metastatic  deposits  seen  on  the  lower  face 
of  the  belly.  In  short,  it  remains  for  some 
surgical  Moses  to  devise  a  plan  for  going 
down  on  these  vessels  and  removing  them 
before  we  will  have  a  deliverance  from  this 
awful  malady. 

Dr.  W.  L.  Robinson. — I  just  want  to 
thank  Dr.  McGuire  for  his  valuable  paper. 
It  was  very  instructive  to  me  and  certainly 
I  have  been  very  much  interested  in  it.  One 
thing  that  impresses  me  very  particularly, 
and  that  was  this,  I  meet  with  it  in  my  ex- 
perience and  I  am  thoroughly  satisfied  in 
the  last  few  years  the  great  majority  of  the 
cases  that  have  been  treated,  have  resulted 
in  prolongation  of  life  and  in  a  permanent 
cure  of  some  of  the  number.  Had  I  oper- 
ated as  I  did  some  years  ago  I  think  they 
would  have  been  in  their  graves  now. 

Dr.  McGuire. — I  recognize  the  kindness 
you  have  shown  me  in  letting  me  go  over 
my  time,  or  I  would  like  to  have  read  all  I 
have  to  say,  but  I  read  the  most  important 
part  of  it.  There  is  one  thing  that  inter- 
ests me,  that  the  more  the  subject  is  inves- 
tigated the  more  and  more  certainly  will  we 
come  to  the  conclusion  that  cancer  is  a  lo- 
cal trouble,  and  not  only  local  but  it  is  par- 
asitic, and  if  we  can  get  it  away  in  time 
and  do  the  work  thoroughly  the  patient 
will  get  well.  I  think  that  conclusion  is 
pretty  well  established.  I  know  that  a  large 
proportion  of  the  best  surgeons  in  the  world 
believe  that  if  this  tumor  is  properly  re- 
moved the  individual  remains  well.  I  know 
that  it  is  very  usually  believed  that  to  re- 
move a  cancerous  breast  is  a  very  simple 
operation,  but  1  think   that  those  who  have 


tried  it,  and  many  of  you  have  tried  it,  will 
agree  with  me  in  saying  that  when  the  op- 
eration is  done  completely  and  thoroughly, 
that  it  requires  a  profound  knowledge  of 
anatomy,  it  requires  a  most  skillful  surgery 
to  properly  take  out  cancer  of  the  breast. 
I  thank  you  for  your  courtesy. 


Drainage  in  Abdominal  Surgery.f 

By  J.  W.  Long-,  M.  D.,  Salisbury,  N.  C. 

The  question  of  drainage  in  abdominal 
operations  dates  back  to  the  time  when  man 
first  dared  to  invade  the  peritoneal  cavity 
possibly  before,  and  will  always  be  of  vital 
interest  to  the  surgeon  as  long  as  abdominal 
sections  are  done. 

The  trend  of  modern  surgery  is  towards 
simplicity — thorough,  complete  work  strip- 
ped of  all  superfluities.  We  have  arrived 
at  that  stage  in  abdominal  work  where  we 
can  afford  to  have  an  opinion  as  to  what  is 
best  to  be  done  and  to  practise  well  defined 
procedures  in  dealing  with  the  difficult 
problems  that  confront  us.  As  every  ope- 
rator is  in  one  sense  a  law  unto  himself,  he 
should  determine  what  methods  will  yield 
the  best  results  in  his  hands.  This  can  be 
done  only  by  extensive  reading  and  sifting 
the  literature  of  the  subject,  personal  obser- 
vations of  the  work  of  other  men,  and  one's 
own  experience.  Some  operators  drain 
every  case,  others  of  equal  note  drain  only 
a  small  per  cent.  Why  is  this?  Is  drain- 
age necessary,  or  is  it  a  habit?  If  it  is  nec- 
essary, why  does  the  surgeon  who  does  not 
drain  get  good  results?  If  it  is  unnecessary, 
why  does  the  surgeon  who  drains  every 
case  practise  a  method  which  is  useless? 

I  speak  to  men  renowned  in  abdominal 
surgery  :  I  ask  you  the  question,  "  Whv  do 
you  drain?" 

In  thinking  over  this  matter  I  can  con- 
ceive of  but  two  reasons  for  draining  :  either, 

(i)  There  is  something  in  the  abdomen 
that  needs  to  be  drained  away,  or 

(2)  During  the  operation  we  put  some- 
thing  there  that  should  be  allowed  to  escape. 

In  other  words,  we  are  dealing  with  an 
infectious  case,  or  we  infect  the  case  by  our 
manipulations. 

The  first  class  is  strongly  represented  by 
a  case  of  general  septic  suppurating  perito- 
nitis. Here  the  primal  object  is  to  drain, 
and  thereby  remove  the  infectious  material 
that  is  rapidly  killing  our  patient.  There 
fore  we  make  long  incisions,  break  up  all 
pus   pockets,  wash    freely  with    gallons    of 


fRead  before  the  Tri-State  Medical  Society  of 
the  Carolinas  and  Virginia,  at  Charlotte,  N.  C, 
January,  1899. 


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THE  CHARLOTTE  MEDICAL  JOURNAL. 


salt  solution,  and  drain  from  every  availa- 
ble point. 

The  other  class  may  be  illustrated  by  a 
case  of  simple  removal  of  the  tubes  and  ova- 
ries. Here,  there  is  no  infectious  matter, 
but  the  operator  is  not  quite  sure  of  his 
technique  and  he  inserts  a  glass  tube  or  a 
piece  of  gauze.  Had  his  aseptic  precautions 
been  perfect,  there  would  have  been  no 
need  of  drainage.  Between  these  two  ex- 
tremes there  are  many  gradations.  I  state 
candidly  that  the  question  of  drainage  in 
abdominal  cases  has  always  given  me  much 
concern. 

Think  for  a  moment !  Take  a  healthy 
stalwart  man,  open  his  abdomen  and  insert 
a  glass  tube  or  a  roll  of  gauze  down  between 
the  intestines  to  the  bottom  of  the  pelvis ! 
How  tolerant  the  peritoneum  must  be  to 
withstand  such  intrusion  ! 

True,  the  conditions  sometimes  present 
justify  resorting  to  these  harsh  measures, 
but  how  often  have  we  used  them  when  in 
the  light  of  later  experience  they  might  have 
been  omitted. 

The  peritoneum  is  really  a  great  lymphat- 
ic gland.  It  literally  drinks  up  any  fluid 
that  is  poured  into  it.  The  modern  surgeon 
does  not  hesitate  to  fill  the  cavity  with  salt 
solution  and  close  without  drainage,  know- 
ing that  in  short  while  it  will  all  be  absorb- 
ed into  the  circulation  and  really  benefit  the 
patient.  Serum  and  blood,  in  fact  any  in- 
nocuous fluid  may  be  disposed  of  the  same 
way.  Even  septic  fluids  are  absorbed  with 
greatjrapidity  which  accounts  for  the  oftimes 
early  overwhelming  of  the  general  system 
in  septic  peritonitis. 

Again,  it  is  readily  admitted  that  all  forms 
of  drainage  carry  with  them  certain  dangers 
and  inconveniences.  Drains  of  any  kind 
leave  the  abdominal  door  open, as  it  were, and 
thereby  lay  the  patient  liable  to  subsequent 
infection  after  even  the  cleanest  operation. 
Glass  drains  are  liable  to  break.  Gauze 
drains  are  hard  to  remove.  Nature  endeav- 
ors to  protect  the  peritoneum  from  the  pre- 
sence of  the  drains  by  rapidly  throwing  out 
adhesions ;  and  these  in  turn  become  a  hind- 
rance to  normal  function  and  even  a  menace 
to  life  by  their  restrictive  and  obstructive 
effects.  Later,  the  site  of  the  drain  may  be 
the  starting  point  of  hernia. 

But  to  do  away  with  drainage,  we  must 
do  clean  surgery.  Indeed,  the  ulterior  ob- 
ject of  this  paper  is  to  enter  another  plea 
for  clean  surgery.  There  must  be  no  make 
belief,  nothing  slip-shod.  There  must  be 
no  parade  of  antiseptic  methods  with  glar- 
ing inconsistences  in  the  minor  details.  To 
omit  the  drain  and  do  sloven  work,  is  to 
sometimes  lose  your  patient.  The  more 
perfect    a    surgeon's    technique  the  less   he 


drains.  Some  men  may  retain  the  drain 
from  force  of  habit,  but  a  survey  of  the  work 
of  a  considerable  number  of  surgeons  will 
convince  us  that  surgeons  are  draining  their 
abdominal  cases  very  much  less  frequently 
than  formerly.  I  feel  sure  there  are  those 
present  who  will  sustain  this  statement  from 
their  own  experience.  Kelly  says  that  for- 
merly he  drained  in  eighty-five  per  cent,  of 
his  cases, now  in  only  ten  or  fifteen  percent. 
From  the  very  beginning  of  my  abdominal 
work  I  was  always  glad  when  I  could  close 
the  abdomen  without  drainage,  and  I  find 
that  the  more  I  operate  the  less  I  drain.  So 
decided  have  my  convictions  become  upon 
this  subject  that  in  certain  cases  which  for- 
merly I  would  have  drained  now  I  do  not 
think  of  draining. 

The  limitations  of  this  occasion  would 
hardly  permit  me  to  go  into  details  suffi- 
ciently to  point  out  the  indications  for  or 
against  drainage  in  each  and  every  class  of 
cases  that  came  under  our  care,  but  it  may 
be  broadly  stated  that  septic  cases  should  be 
drained  while  clean  cases  should  not  be 
drained. 

In  fact  the  tendency  is  to  go  still  further 
and  omit  drainage  in  many  cases  accompa- 
nied by  more  or  less  infection.  I  will  cite 
a  case  to  show  what  may  sometimes  be  done 
with  a  septic  case. 

Mrs.  O.,  referred  by  Drs.  Turner  and 
Doughton,  of  Wilkesboro,  age  53,  married, 
mother  of  several  children,  has  noticed  an 
abdominal  enlargement  for  nearly  a  year,. 
During  that  time  the  periods  have  been 
irregular  and  sometimes  profuse ;  she  also 
has  a  left  inguinal  hernia.  Since  the  mid- 
dle of  June  she  has  been  confined  to  her 
bed,  and  takes  morphine  daily  for  the  pains. 
I  saw  this  patient  at  her  home  on  August 
18th.  The  abdomen  was  enormously  dis- 
tended, exquisitely  tender,  symmetrical  in 
outline.  Fluctuation  could  be  made  out, 
and  by  deep  pressure  a  mass  could  be  felt. 
The  sensation  was  that  of  a  tumor  surround- 
ed by  fluid.  I  declined  to  operate  at  the 
patient's  home,  and  advised  that  she  be 
brought  to  the  hospital,  which  was  done 
September  13th.  She  was  unable  to  sit  up 
and  was  brought  on  a  stretcher  the  distance 
of  150  miles. 

An  examination,  after  she  reached  the 
Sanatorium,  revealed  her  condition  to  be 
much  worse  than  when  seen  in  August. 
The  abdomen  was  more  distended,  large 
veins  coursed  over  it ;  the  tenderness  espe- 
cially in  the  left  side  was  extreme,  emacia- 
tion was  marked,  the  kidneys  were  secret- 
ing only  three  ounces  of  urine  in  twenty- 
four  hours,  the  pulse  weak  and  frequent, 
and  the  temperature  ranged  from  99  deg. 
to  102  deg.,    while    her  vision   was    so    im- 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


305 


paired  she  could  not  distinguish  a  white 
person  from  a  black  one.  I  kept  her  for  a 
month  before  I  dared  to  operate  on  her. 
Active  stimulation,  during  this  time,  im- 
proved her  considerably.  On  October  14th 
Drs.  John  Whitehead,  McKenzie,  Turner 
and  1  opened  the  abdomen  and  found  the 
largest  multilocular  cyst  of  the  uterus  I  have 
ever  seen.  Together  with  the  moderate 
amount  of  free  peritoneal  fluid  present  it 
weighed  not  less  than  fifty  pounds.  It  filled 
the  pelvis,  the  entire  abdomen,  displacing 
the  viscera  until  actually  it  extended  up  into 
the  thorax  quite  to  the  nipple  line.  It  was 
adherent  to  every  thing  in  sight  except, 
strange  to  say,  the  ovaries,  which  were  free 
and  normal.  The  enucleation  was  difficult 
and  tedious,  as  the  tumor  had  to  be  stripped 
by  piecemeal  from  diaphram,  abdominal 
wall  and  viscera.  The  cyst  contents  were 
varied  and  complex.  Our  head  nurse,  a 
woman  of  experience,  trained  at  the  Hop- 
kins, said  she  never  saw  such  stuff  taken 
out  of  any  person.  The  evidences  of  peri- 
tonitis and  inflammation  of  contiguous  tis- 
sues were  abundant.  Of  course,  the  uterus 
was  removed  also. 

After  copious  flushing  and  washing  (I 
use  this  word  advisedly)  with  hot  sterile 
salt  solution'the  abdomen  was  closed  with- 
out drainage.  This  woman  made  one  of 
the  nicest  recoveries  I  ever  saw,  her  func- 
tions all  became  normal,  she  gained  strength 
rapidly,  and  while  she  did  not  literally 
"pick  up  her  bed"  she  did  walk  and  went 
home  happy. 

What  could  drainage  have  added  to  this 
case?  Only  discomfort,  annoyance,  and 
another  source  of  danger.  I  could  multiply 
illustrations  till  I  wearied  you,  therefore,  I 
will  let  this  one  case  suffice,  as  it  tends  to 
establish  the  truth  of  what  I  set  out  to  prove, 
namely  :  that,  if  we  do  clean  surgery  there 
is  rarely  need  for  drainage. 


The  Diagnosis  and  Treatment  of  Tuber- 
cular Peritonitis.j 

By  W.  L.  Robinson,  M.  I).,  Danville.  Va 

The  subject  of  tubercular  peritonitis  is 
one  full  of  interest,  both  to  the  general 
practitioner  and  surgeon.  The  disease  for 
years  was  regarded  incurable,  till  surgery 
opened  up  a  field  promising  much,  which 
has  been  realized  in  certain  forms,  and  more 
recently,  while  no  special  curative  agencies 
in  the    therapeutical  line    offer   anything  of 


tRead  before  the  Tri-State  Medical  Society  of 
the  Carolinas  and  Virginia,  at  Charlotte,  N.  C, 
January,  1899. 


significance,  yet  statistics  show  from  fifteen 
to  thirty  per  cent,  of  spontaneous  cures, 
especially  in  the  young.  Reyburn  and 
Hughes  Bennett  state  that  from  examina- 
tion of  cadavers,  from  one-third  to  one-half 
of  all  individuals  who  die  after  the  age  of 
forty  have  had  spontaneous  arrest  of  tuber- 
cle in  some  stage. 

While  all  forms  of  tubercular  peritonitis 
are  full  of  interest,  I  desire  more  especially 
to  allude  to  some  points  pertaining  to  the 
more  acute  form. 

Whatever  divisions  be  made,  whether  of 
fibrous,  ascitic,  sero-membranous,  purulent 
or  ulcerative,  there  are  two  leading  features 
in  tubercular  peritonitis — one  is  plastic  ex- 
udate, the  other  effusion. 

The  first  is  always  present,  the  latter  ab- 
sent in  many  cases. 

The  varied  symptomatology  of  invasion 
and  progress  forces  diagnosis  by  careful 
exclusion. 

1st.  In  one  you  will  find  it  marked  by 
insiduous,  slow  and  even  advance  without 
or  with  only  occasional  pyrexia,  and  with 
ascitis  as  an  early  and  leading  trait. 

2d.  Again  we  may  have  a  series  of  at- 
tacks with  intervening  lulls  until  the  entire 
peritoneal  cavity  has  been  attacked  without 
effusion,  but  retraction  of  the  abdomen. 

3d.  Again  chills  with  fever  or  seemingly 
invasion  of  typhoid  fever  marks  its  progress. 

4th.  The  sudden  invasion  after  miscar- 
riage. 

5th.  Gradual  increase  of  swelling,  result- 
ing in  enlarged  abdomen  with  more  or  less 
pain  (abdominal)  and   pain  in  urinating. 

6th.  Again,  effusion  may  begin  without 
abdominal  tenderness,  without  a  febrile  con- 
dition, and  with  nutrition  unaffected.  Such 
a  condition  unexplained  in  some  other  way, 
should  arouse  suspicion  of  tuberculosis. 

When  you  can  trace  the  invasion  from 
pelvis  above  with  floating  masses  in  abdo- 
men and  deep  intestinal  percussion  sound, 
the  diagnosis  is  usually  clear. 

I  have  noticed,  in  manipulating  the  ab- 
domen with  hand  extended,  that  under  the 
finger  bulbs,  on  deep  pressure,  a  crepitant 
feel,  like  the  sensation  of  air  or  water  infil- 
tration in  cellular  tissue.  Again,  I  have 
observed  under  such  pressure  the  gurgling 
of  displaced  gas,  as  you  find  in  adhesive 
appendicitis. 

The  history  of  the  case  with  the  impres- 
sion the  individual  case  makes  on  you  (like 
deciding  when  to  operate  for  appendicitis) 
enables  you  to  sum  up  a  diagnosis ;  yet  you 
cannot  formulate  in  words  or  rules  the 
guide  thereto. 

I  can  add  something  possibly  to  these 
diagnostic    hints,  by  briefly    reviewing  the 


30J 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


history  of  several  cases.  First,  I  will  re- 
port three  cases  in  young  children. 

One  was  rosy  and  stout, of  tubercular  an- 
cestry, the  other  two  averagely  robust,  who 
came  under  my  care  in  the  last  twelve 
months. 

Case  i.  Mr.  D.'s  child,  aged  6  years,  had 
several  chills,  followed  by  fever,  and  then 
a  regular  evening  rise  of  temperature  to  103 
deg.  for  ten  days,  and  then  an  intermission 
of  a  week,  with  fever  recurring  thereafter 
irregular  in  its  history,  then  exacerbation 
often  the  highest  in  the  morning,  but  abat- 
ing several  times  in  twenty-four  hours, 
constipation  persisting  in  spite  of  several 
mercurial  purgatives.  There  were  abdom- 
inal pains, with  irritable  bladder;  the  appe- 
tite was  a  marked  feature,  never  failing 
under  fever  or  quinine,  the  latter  faithfully 
tested  for  the  first  ten  days;  sponging,  hot 
douches  over  abdomen,  painting  with  iodine 
and  collodion  over  bowels,  sun  baths,  mas- 
sage, etc.,  and  a  stay  of  two  months  in  the 
country  gradually  dissipated  every  symp- 
tom, and  now  six  months  has  elapsed  with 
perfect  health. 

Case  2.  Miss  M.,  aged  9  years,  tubercu- 
lar ancestry,  commencing  indigestion,  pains 
in  abdomen,  constipation,  slight  fever,  in- 
creasing in  the  evening,  becoming  irregu- 
lar, crepitant  feel  and  gurgling  of  gas  under 
pressure,  pulse  rapid,  hectic  flush  occurring 
several  times  daily  on  first  one  cheek  and 
then  on  the  other,  later  complicated  with 
pleuritis  ;  treatment,  saline  irrigation,  iodine 
over  abdomen,  and  massage,  fresh  air  and 
special  care  of  digestion  and  building  up 
with  apparent  restoration  of  health  ;  there 
was  fluid  felt  in  flanks  when  examined  with 
attention  to  position  ;  sick  two  and  one-half 
months.      Now  fully  recovered. 

Case  3.  Mr.  W.  W.'s  child,  aged  6  years, 
rosy  and  active,  invasion,  gradual  pain  in 
bowels,  a  few  days  of  slight  fever,  malaise, 
but  appetite  good.  This  condition  of  slight 
attack  and  lull  alternated  till  recently  an 
invasion  simulating  typhoid  fever  came  on, 
with  tenderness  persistent  over  abdomen  ; 
temperature  normal  in  the  morning  and  101 
or  102  in  the  evening.  Mercurial  purga- 
tives and  quinine  availed  nothing  and  was 
promptly  discontinued  ;  later  the  abdominal 
tenderness  became  localized  in  small  areas. 
The  crepitant  sensation  was  marked  in  this 
case.  Later  the  tenderness  disappeared, 
but  promptly  recurred  on  walking  around  ; 
the  appetite  was  excellent  and  urgent  all 
the  while.  She  is  still  under  observation. 
Some  light  will  be  thrown  on  this  case  by 
the  history  of  the  next  one,  who  was  her 
sister. 

Case  4.  Miss  M.  W.,  aged  17  years, 
tuberculous   history;   pelvic    tenderness  for 


three  years,  frequently  suffering  violently, 
especially  at  menstrual  period ;  she  was 
always  excessive  in  flow,  and  too  frequent; 
out-door  exercise  and  even  the  bicycle 
seemed  to  improve  her  every  symptom 
and  general  health.  I  advised  operation 
two  years  ago,  recognizing  the  tubercular 
involvement  of  the  appendages.  The  last 
attack  simulated  typhoid  fever,  ran  a  his- 
I  tory  of  great  violence,  nausea,  abdominal 
tenderness,  prostration,  insomnia,  irregular 
fever,  ranging  from  subnormal  to  106  deg. 
I  tided  her  over  the  first  two  weeks,  and 
she  was  on  her  feet  with  fine  appetite. 
The  recurrence  was  attended  with  constant 
fever  of  104  to  106  deg.,  and  after  five  days 
of  inability  to  nourish  and  fluid  forming,  I 
did  a  laparotomy ;  temperature  subsided 
promptly,  but  died  from  exhaustion ;  the 
appendages,  pelvic  and  surrounding  tissues, 
were  studded  with  tubercles.  I  omitted  to 
state  that  the  6  year  old  sister  menstruated 
two  months  before  last  attack. 

Case  5.  Dr.  Spencer'scase  :  Younglady, 
15  years  of  age;  had  been  suffering  with 
general  tenderness  and  apparent  appendi- 
citis, with  pain  and  fever,  for  months. 
Operation  for  appendicitis.  The  whole  of 
the  peritoneum  and  intestines  were  matted 
together,  and  nodulated  and  studded  with 
tubercles  as  thick  as  possible.  The  whole  in- 
testines were  agglutinated  in  one  mass  and 
scarlet  red.  The  adhesions  were  liberally 
broken  up,  appendix  removed,  flushed  and 
wiped  dry,  dusted  with  iodoform,  and  well 
walled  off  with  gauze.     Recovery  rapid. 

Case  6.  Mrs.  Hundly,  aged  32.  Refer- 
red to  me  by  Dr.  Smith,  of  Henry.  Tem- 
perature for  eight  weeks  had  ranged  from 
97  in  the  morning  to  104^  in  the  evening. 
Abdomen  distended  and  ascitis  ;  diagnosis 
easy.  Operation  revealed  floating  gelatin- 
ous masses  filling  the  abdomen  and  perito- 
neum, and  all  inner  surfaces  studded  with 
tubercles.  Irrigated,  dried  with  gauze, 
dusted  freely  with  iodoform  and  walled  ex 
tensively  with  gauze.  Temperature  did  not 
reach  100  after  operation,  and  gained  twenty 
pounds  in  five  weeks.  Lived  six  years, 
bore  a  healthy  child  and  died  of  pneumonia. 

Case  7.  Miss  S.  T. ,  aged  18;  always  re- 
garded as  a  healthy  girl ;  had  been  treated 
for  typhoid  fever  for  seven  weeks  ;  morning 
temperature  subnormal,  afternoon  103^  or 
more ;  fine  appetite ;  going  around.  The 
above  was  the  history  when  called  in.  She 
was  a  niece  of  the  last  named  lady , and  I  diag- 
nosed tubercular  peritonitis  ;  operated  and 
found  adhesions  too  strong  to  be  broken  up. 
Liberated  as  far  as  practicable.  Tempera- 
ture remained  normal  for  seven  days,  and 
apparent  improvement,  then  recurrence  of 
trouble,  ending  fatally  in  eight  weeks.     She 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


307 


was  a  mere  skeleton  when  I  saw  her.  I 
am  inclined  to  think  had  operation  been 
performed  when  adhesions  were  slight  a 
different  result  might  have  been  attained. 

TREATMENT. 

It  is  stated  that  from  fifteen  to  thirty  per 
cent,  of  acute  cases  spontaneously  recover. 
It  is  significant  that  the  tendency  of  the 
disease  to  self-limitation  is  sufficiently  mark- 
ed to  cause  so  careful  an  observer  as  Kaulich 
to  define  it  by  a  separate  group  in  his  clas- 
sification of  the  different  forms.  This  ten- 
dency is  not  confined  to  tubercular  perito- 
nitis, but  here,  rather  than  elsewhere,  the 
result  is  more  possible  of  attainment. 

The  lungs  appear  to  be  the  region  in 
which  the  life  history  of  the  bacillus  attains 
its  perfect  fulfillment ;  here  it  multiplies 
with  greatest  activity,  and  as  a  result  pro- 
duces the  most  disastrous  effects  upon  life 
and  tissue.  In  the  lungs  the  normal  envi- 
ronment favors  rather  than  retards  the  ex- 
tension of  the  invasion.  Yet  in  a  paper 
based  upon  the  result  of  1146  post-mortems 
at  Bellevue  Hospital,  Harry  P.  Loomis  gives 
a  very  large  percentage  of  observations 
showing  spontaneous  cicatrization  of  lung 
lesions  after  tuberculosis.  In  the  researches 
of  Loomis  we  have  the  logical  inference  be- 
fore us  that  the  ratio  he  observed  of  spon- 
taneous cicatrization  in  the  lungs  may  be 
assumed  to  be  true  of  the  peritoneum,  plus 
the  enhanced  tendency  of  the  latter  part  to 
limit  the  extension  of  disease,  but  to  accom- 
plish this,  either  in  the  lungs  or  peritoneum, 
we  must  have  unimpaired  a  certain  vital 
antagonism  to  the  disease.  Osier  says : 
"There  is  no  inherent  improbability  why 
tuberculosis  of  the  peritoneum  should  not 
undergo  involution  as  they  do  elsewhere. 
Anatomically  the  peritoneal  growth  bears 
in  its  evolution  a  close  analogy  to  the  pul- 
monary, and  this  is  further  borne  out  by  the 
retrograde  changes  through  which  it  passes, 
just  as  the  aggregations  of  miliary  nodules 
on  the  lungs  ma/  undergo  the  changes  we 
speak  of  as  healing,  becoming  hard  and 
fibroid,  so  in  the  peritoneum,  the  tubercle 
tend  in  many  cases  to  become  sclerotic,  and 
passes  into  a  condition  in  which  it  is  prac- 
tically harmless." 

Tuberculosis  being  a  disease  of  exhaus- 
tion by  pyrexia,  spontaneous  cure  must 
largely  depend  on  extent  of  invasion,  then 
the  question  resolves  itself  as  to  how  we 
can  so  sustain  the  vital  forces  that  resistant 
agent  may  keep  in  tact  the  assimulating 
powers. 

We  see  the  largest  percentage  of  re- 
coveries in  the  young  when  the  nutritive 
forces  are  at  the  summit  of  activity.  Our 
efforts  should    be  devoted  to    the    improve- 


ment of  the  general  health  by  proper  atten- 
tion to  the  digestive  organs,  the  regulation 
of  the  bowels  and  proper  dietary,  avoiding 
fermentation  producers,  using  irrigation  of 
colon,  with  saline  washes,  sponge  baths, 
massage,  pouring  hot  water  over  abdomen, 
painting  abdomen  with  iodine,  etc.  Bedford 
alum  water  or  mass,  on  account  of  the 
iodine  and  iron  it  contains,  is  indicated. 
Correction  of  constipation,  sun-light  and 
fresh  air,  are  of  paramount  importance. 

The  operative  side  is  attractive  because 
we  often  get  prompt  and  striking  results. 
Not  only  in  the  ascitic  form,  but  in  the 
class  of  cases  with  retracted  abdomen,  when 
exudative  adhesives  are  not  too  strong,  I 
see  no  reason  for  non-interference.  Careful 
severing  of  adhesions,  wiping  out  with  drv 
gauze,  free  dusting  with  iodoform,  and  ex- 
tensive walling  off  with  iodoform  gauze  is 
indicated.  The  effect  of  iodoform  in  tuber- 
cular joints  is  certainly  suggestive  of  its 
possible  good  influence  in  tubercular  perito- 
nitis. 

While  we  recognize  that  the  results  of 
laparotomy  are  strongly  encouraging,  yet 
the  explanation  of  how  it  cures  is  still  un- 
satisfactory, so  we  go  on  empirically. 
Nevertheless,  I  will  impose  on  your  time  by 
reading  an  article  by  Hildebrant  on  the 
causes  of  the  healing  influence  of  laparo- 
tomy in  tubercular  peritonitis.  It  is  at 
least  interesting  and  ingenious. 

He  says:  "Tubercular  peritonitis  is  un- 
doubtedly cured  by  laparotomy,  but  satis- 
factory explanation  is  lacking,  and  the  vari- 
ous theories  of  this  puzzling  fact  call  for 
serious  reflection." 

The  writer  first  speaks  of  the  appearances 
resulting  from  abdominal  incision  of  the 
unchanged  (healthy)  peritoneum.  He  ex- 
perimented upon  dogs  and  cats  by  dividing 
the  various  layers  of  the  abdominal  walls, 
then  closing  the  same.  After  some  time  he 
reopens  and  finds  as  a  result  of  the  laparo- 
tomy, besides  the  paralysis  of  the  intestines, 
which  is  observed  after  every  operation 
upon  the  abdomen,  and  which  leads  to 
meteorism  and  constipation,  a  distinct  hy- 
peremia, which  may  continue  for  a  week 
after  the  operation,  which  he  looks  upon  as 
venous  from  its  appearance.  This  hypere- 
mia is  in  part  due  to  the  fault}  contraction 
of  the  bowel.  The  constant  peristalsis  is  a 
powerful  means  of  ridding  the  intestines  of 
venous  blood,  and  when  this  is  absent  there 
results  a  congestive  hyperemia,  just  as  in 
paralyzed  parts  in  other  portions  of  the  sys- 
tem. The  hyperemia  is  also  due  to  inflam- 
mation, which  the  writer  holds  occur  in 
every  aseptic  laparotomy. 

As  the  nature  of  the  inflammation  is  not 
definitely  established,   the  physician   clings 


308 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


to  the  cardinal  symptoms,  and  diagnosti- 
cates (inflammation).  The  tumor,  visible 
at  the  external  portions  of  the  body,  corres- 
ponds to  increased  exudation  in  the  perito- 
neal cavity,  which  is  found  after  every 
laparotomy  upon  re-opening  the  abdomen. 
A  few  days  after  the  operation,  there  is 
seen  in  the  free  peritoneal  cavity  a  slight 
quantity  of  a  reddish  fluid  consisting  of 
cast-off  epithelium  and  a  few  pus  cells. 
These  would  be  present  in  greater  amount 
were  it  not  for  the  enormous  absorptive 
properties  of  the  peritomeum.  The  local 
production  of  warmth  and  sensitiveness  is 
the  result  of  increased  blood  supply. 

In  tubercular  peritonitis,  there  is  likewise 
an  active  hyperemia  set  up  in  consequence 
of  the  reaction  upon  the  peritoneum,  fol- 
lowing opening  of  the  abdomen,  and  seems 
to  be  even  more  intense  than  that  produced 
upon  the  normal  unaltered  peritoneum. 
This  is  probably  due  to  the  circumstance 
that  the  inflamed  tissues  hold  the  blood 
more  firmly  in  the  dilated  vessels. 

The  writer  noticed  that  when  laparotomy 
was  done  in  the  early  stages  of  the  disease, 
where  no  retrogressive  changes  have  yet 
taken  place,  no  effect  upon  the  condition 
occurred.  This  fact  is  of  importance  in 
the  explanation  in  the  curative  effect  of 
operation.  Tubercular  peritonitis  frequent- 
ly tends  to  spontaneous  cure,  especially  in 
childhood,  and  laparotomy  may  assist  the 
natural  means  which  the  body  possesses  to 
battle  against  the  disease.  The  failure  of  a 
cure  in  early  laparotomy  is  due  to  the  fact 
that  the  operation  was  undertaken  at  a  stage 
when  the  bacilli  have  not  yet  reached  their 
complete  virulence.  Operation  done  at  a 
later  stage  when  retrogressive  changes  have 
taken  place  in  the  life  of  the  germs  causing 
the  disease,  is  followed  by  cure. 

How  is  it  to  be  explained?  We  know 
that  the  congestive  hyperemia  in  the  lungs 
due  to  severe  cardiac  disease  hinders  the 
development  of  tuberculosis,  causing  retro- 
gression of  diseased  foci,  when  present,  or 
even  complete  cure. 

Bien  induced  congestive  hyperemia  as  a 
treatment  in  suitable  cases  of  tubercular 
conditions  of  the  joints  and  tendons,  with 
favorable  results.  From  this  analogy,  the 
author  believes  that  the  venous  hyperemia 
which  is  present  for  some  days  after  the 
operation,  play  an  important  role  in  the 
cure  of  the  disease. 

John  Duncan,  of  Edenburg,  says:  "I 
don't  see  how  we  can  escape  the  conclusion 
that  more  than  one  cause  is  required  to  ac- 
count for  the  advantages  of  laparotomy,  and 
that  the  most  important  are  probably  the 
relief  of  tension,  the  removal  of    irritating 


fluid,  introduction  of  air  and  the  mechani- 
cal interference." 

In  summing  up  the  treatment,  I  would 
be  inclined  in  most  cases  in  the  early  stages 
to  try  the  medical  and  hygienic  measures, 
especially  if  the  symptoms  were  not  urgent 
as  in  case  4.  But  I  feel  that  in  the  ascitic, 
sero-membranous,  the  fibrous  (in  the  early 
stages)  and  in  those  cases  caused  by  exten- 
sion from  the  pelvis,  surgery  is  the  remedy 
involving  little  risk,  and  giving  the  strongest 
hope  of  cure.  Even  in  the  flat  abdomen 
(retracted  form)  where  the  matting  of  in- 
testines and  extensive  adhesives  interfere 
with  the  circulation  and  nutrition  of  the 
parts,  I  think  surgical  intervention  is  justi- 
fiable. 


Puerperal  Insanity. 

By  J.  A.  Reagan,  M.D.,  Weaverville,  N.  C. 

It  is  very  difficult,  with  our  present  state 
of  knowledge,  and  the  different  definitions 
given  by  authors,  to  give  a  definition  of  in- 
sanity that  will  meet  the  sanction  of  the 
medical  profession,  as  is  shown  by  the  best 
authors  who  have  written  on  the  subject. 
One  author  says  :  "Insanity  is  a  prolonged 
change  in  an  individual's  usual  manner  of 
thinking,  acting,  and  feeling,  caused  by 
disease  or  mental  derangement."  Another 
says  :  "Insanity  is  a  term  applied  to  certain 
results  of  brain  disease  and  brain  defect 
which  invalidates  mental  integrity." 

Puerperal  insanity,  by  some  old  authors, 
called  puerperal  mania,  assumes  different 
forms  in  different  individuals.  One  case, 
a  woman,  educated,  and  reasonably  wealthy, 
was  very  boisterous,  and  profane.  In  her 
next  spell  her  mind  took  a  religious  turn. 
She  raved,  was  very  noisy,  sang  religious 
songs, quoted  nearly  all  of  several  chapters  of 
the  New  Testament,  refused  to  take  either 
medicine  or  food  for  two  days  and  nights. 
I  tried  every  way,  as  I  thought,  to  quiet  her. 
Put  her  in  a  bath  tub  in  warm  water  to  her 
neck,  applied  cold  to  her  head,  but  it  did 
no  good.  While  I  do  not  encourage  decep- 
tion in  any  way,  it  seemed  in  this  case  that 
it  might  be  justified,  and  as  her  whole  theme 
was  religion,  I  said  to  her  :  "Will  you  not 
take  some  Holy  Water?'1''  She  repeated  it 
two  or  three  times,  "Holy  water,  holy 
water,  yes,  I  will  take  that."  I  put  some 
hydrate  of  chloral  and  bromide  of  potash 
in  water.  She  drank  it,  and  in  a  short 
time  was  sound  asleep.  After  that  she 
took  anything  I  gave  her  to  eat,  and  took 
her  medicine  in  holy  water,  so-called,  but 
would  take  nothing  from  any  one  else.  So 
she  became  a  patient  for  me  in  a  laborious 
sense. 


THE  CHARLOTTE'  MEDICAL  JOURNAL, 


Another  woman  was  inclined  to  eat  her 
child;  was  easily  managed,  but  seemed  to 
be  unconscious  most  of  the  time,  but  would 
move  about  just  as  she  was  directed. 

A  third  case  was  a  primipara,  had  no  use 
for  her  husband  or  intimate  friends.  Stran- 
gers could  manage  her  better  than  her 
friends. 

Puerperal  insanity  most  commonly  as- 
sumes the  form  of  mania  or  melancholia, 
although  it  may  come  in  the  form  of  demen- 
tia and  moral  insanity.  It  may  occur  at 
any  time,  beginning  with  conception,  on 
through  the  puerperal  period,  or  may  occur 
in  the  period  of  lactation.  It  is  said  to  be 
excited  by  the  profound  constitutional 
changes  in  the  nervous  system,  occurring 
at  this  important  period  in  the  life  of  wo- 
men. As  to  its  cause,  there  are  a  variety 
of  opinions  among  physicians,  which  show 
that  its  cause  is  not  thoroughly  understood. 

It  is  of  the  utmost  importance  that  insan- 
ity of  any  form  should  be  early  recognized, 
as  it  is  more  easily  treated,  and  it  should  be 
carefully  watched,  as  one  that  assumes  a 
form  of  melancholia  may  at  any  time,  with- 
out any  warning,  take  her  own  life  or  the 
life  of  some  one  else  ;  but  she  is  more  likely 
to  try  to  take  the  life  of  her  child.  It  often 
assumes  the  form  of  mania  ;  she  may  kill 
her  nurse  or  her  husband.  It  becomes  very 
necessary,  therefore,  that  her  physician 
should  promptly  recognize  any  departure 
from  the  normal  manner  of  acting  or  talk- 
ing. He  should  watch  for  mental  aberra- 
tion in  all  forms  of  exhausting  diseases  in 
the  puerpera  state.  There  are  some  rare 
cases  where  the  maniac  concludes  she  is 
some  one  else. 

It  is  reported  of  a  puerperal  maniac  that 
she  dressed  in  rather  a  ludicrous  style,  and 
imagined  she  was  an  Austrian  princess  and 
entitled  to  the  throne. 

There  was  a  case  came  under  my  care 
who  believed  herself  to  be  Queen  Victoria, 
and  wished  every  body  to  recognize  her  as 
such,  and  got  angry  when  any  one  disputed 
her  right  to  the  throne  of  England.  She 
recovered  after  several  months. 

It  is  necessary  in  those  cases  to  never  re- 
gard lightly  the  slightest  sign  of  mental 
unsoundness.  The  eccentric  acts,  or  gro- 
tesque delusions  often  excite  the  merriment 
of  the  uninformed  bystanders,  but  they 
should  strike  the  physician  with  dread,  as 
a  forerunner  of  more  serious  disturbances. 
Let  us  remember,  as  Dr.  Watts  says,  "It  is 
the  mind  that  makes  the  man  ;"  therefore, 
we  should  guard  the  mind,  even  more  zeal- 
ously, than  we  would  ward  off  pestilence. 
My  opinion  is  that  there  should  be  a  dis- 
tinction made  between  pueperal  mania  and 
puerperal     insanity.      Puerperal     mania     is 


generally  a  light  disease,  and  may  be  mo- 
mentary at  any  period  of  labor,  and  the  wo- 
man seems,  when  she  comes  right  in  her 
mind,  to  know  th^t  she  has  been  saying 
foolish  things,  but  does  not  remember  what 
she  has  been  saying.  It  may  last,  in  some 
cases,  for  some  days  or  weeks,  but  is  not  of 
so  serious  a  nature  as  puerperal  insanity, 
which  comes  on  mostly  some  days,  or  even 
weeks,  after  confinement,  and  may  last  for 
months,  or  may  terminate  in  death.  Es- 
quirol  says:  "I  found  it  more  frequent,  in 
proportion,  among  the  higher  ranks,  for  out 
of  144  cases  of  mental  derangement  in  fe- 
males of  opulent  families,  the  attack  came 
on  during  childbed,  or  lactation  in  21." 
Dr.  Hoslam  states  that  of  1644  females  in 
j  Bethlehem  Hospital,  84  were  cases  of  this 
kind  ;  and  Dr.  Rush  mentions  five  cases  out 
of  seventy  at  the  Philadelphia  Lunatic  Asy- 
lum. The  premonitory  symptoms  vary  a 
good  deal.  In  some  cases  hereditary  pre- 
dispositions, or  nervous  affections  of  gesta- 
tion are  causes,  but  in  most  of  the  cases,  a 
degree  of  exhaustion,  conjoined  with  great 
or  unnatural  excitability,  headache,  and 
want  of  sleep,  are  premonitory  symptoms. 
Dr.  Hoslam  remarks  :  "The  first  symptoms 
of  the  approach  of  this  disease  after  deliv- 
ery are  want  of  sleep,  the  countenance  be- 
comes flushed,  a  constrictive  pain  is  often 
felt  in  the  head,  the  eyes  assume  a  morbid 
lustre,  and  wildly  glance  at  objects  in  rapid 
succession  ;  the  milk  is  afterward  secreted 
in  less  quantity,  and  when  the  mind  be- 
comes more  violently  disordered  is  totally 
suppressed." 

Some  writers  say  there  is  a  greater  pro- 
portion of  puerperal  insanity  in  twin  labors, 
but  I  have  never  seen  a  case  in  a  twin  birth. 

In  the  treatment  of  this  disease,  simple 
and  rational  means  should  guide  the  physi- 
cian. I  have  found  that  it  was  necessary 
to  examine  the  system  thoroughly,  and  try 
to  regulate  any  defect  in  any  of  the  organs, 
so  as  to  make  the  physical  system  as  healthy 
as  possible;  and  as  soon  as  the  patient  is 
able  to  ride  out  in  an  open  carriage,  or 
buggy,  take  her  from  home,  and  let  her 
mind  be  directed  to  strange  things  and  peo- 
ple ;  for  home  and  home  folks  are  more  or 
less  disagreeable  to  her.  It  must  be  remem- 
bered from  the  beginning  that  the  general 
health  is  below  normal.  The  nervous  sys- 
tem, worn  by  loss  of  sleep,  which  causes 
the  digestive  powers  to  be  much  weakened, 
therefore,  the  most  easily  digested  food 
should  be  given — liquids  or  semi-liquids,  or 
food  partially  digested  with  proper  medi- 
cine. Iron  and  strychnine  are  found  to  be 
advisable  in  most  cases. 

It  is  hard  some  times  to  get  the  patient 
to  take  medicine  ;  hence  they  do  not  sleep. 


310 


THE  CHARLOTTE  MEDICAL   JOURNAL. 


Different  patients  require  different  hyp- 
notics. Some  bear  hydrate  of  chloral  well 
while  it  has  no  effect  on  others.  I  believe 
more  patients  are  more  easily  affected,  and 
sleep  better  from  15  to  30  grains  of  trional, 
repeated  in  three  or  four  hours  if  need  be. 
Children  should  never  be  allowed  in  the 
room,  as  it  is  almost  sure  to  have  a  bad 
effect  on  both.  There  should  be  but  little 
if  any  force  used.  Good  judgment  will 
usually  accomplish  more  than  force.  I  re- 
member one  case  I  was  called  to  see  that 
had  been  under  two  good  physicians  and 
they  said  they  could  do  nothing  with  her. 
I  was  told  when  I  arrived  that  the  patient 
had  not  slept  any  for  two  days  and  nights. 
They  had  given  her  several  hypnotics  with 
no  effect.  I  sat  down  on  the  side  of  the 
bed,  took  one  of  her  hands  in  mine,  began 
to  talk  pleasantly  tor  her,  rubbed  her  hair 
back  from  her  forehead,  and  in  one-half 
hour  she  was  sound  asleep,  and  slept  for 
twenty-four  hours.  I  told  them  not  to 
wake  her.  When  she  awoke  next  day  she 
was  quiet,  and  her  mind  clear.  She  re- 
covered without  any  more  dementia.  It  is 
important,  in  my  judgment,  to  wean  the 
child,  if  alive,  and  use  means  to  dry  up  the 
milk  as  speedily  as  possible.  It  is  impor- 
tant to  remove  every  thing  out  of  the  room 
with  which  she  could  injure  herself  or  an- 
other, as  she  might  have  a  desire  to  kill 
herself  or  some  one  else. 

There  is  an  idea  prevalent  that  a  case  of 
puerperal  insanity  brings  a  reproach  on 
the  family,  and  in  a  few  cases  patients  have 
heard  insinuations  of  that  character  which 
have  caused  them  to  study  about  the  influ- 
ence it  will  have  on  their  children  and  after 
they  are  virtually  well,  have  relapsed,  and 
the  last  stage  has  been  worse  than  the  first. 
How  important  it  is,  therefore,  to  have  pro- 
per persons  as  visitors,  and  it  is  the  duty  of 
the  physician  to  warn  the  husband  and 
nurse  to  watch  closely  who  comes,  and 
warn  them  not  to  refer  to  her  trouble,  or 
any  thing  she  said  or  done  while  demented. 
We  cannot  be  too  careful  in  managing  this 
unfortunate  class.  A  mis-step  in  these 
cases  is  not  easily  amended. 


Pneumonia. 

By  Dr.  T.  Catlett  Gibson,  Winton,  N.  C. 

The  word  pneumonia  has  been  employed 
to  designate  inflammation  of  the  lung  tissue 
or  pulmonary  lobules,  occurring  in  different 
forms,  but  is  now  more  commonly  restricted 
to  that  form  termed  lobar  or  croupous  pneu- 
monia, and  to  which  I  shall  refer  in  this 
article. 


With  our  present  knowledge  of  the  dis- 
ease we  can  no  longer  regard  it  as  a  simple 
inflammation  of  the  lungs  accompanied  by 
pyrexia  and  its  concomitant  symptoms,  but 
as  a  specific  disease,  due  to  a  specific  cause, 
and  that  cause,  a  micro-organism — the  pneu- 
mococci.  Yet,  it  is  often  if  not  invariably 
influenced  by  exciting  causes  ;  such  as  in- 
temperance, lack  of  proper  food  and  cloth- 
ing, previous  attacks,  and  especially  expo- 
sure to  cold  and  sudden  atmospheric 
changes. 

Pneumonia  has  been  almost  universally 
divided  into  three  stages,  that  of  engorge- 
ment, yed  hepatization  and  gray  hepati- 
zation. 

During  the  first  stage  the  affected  lobe  is 
in  a  state  of  active  congestion  which  usu- 
ally lasts  from  twenty-four  to  forty-eight 
hours.  In  this  stage  we  find,  as  in  other 
inflammations,  redness, heat,  swelling,  pain, 
and  impaired  function.  The  amount  of 
blood  passing  through  the  lung  in  a  given 
time  is  greater  than  normal  at  first,  but  as 
the  inflammation  and  process  of  solidifica- 
tion increases  the  blood  supply  decreases. 
During  this  period  of  increase  blood  pres- 
sure there  is  considerable  pain,  which  is 
greatly  aggravated  by  coexisting  pleuritis. 

Pneumonia  generally  begins  abruptly 
with  a  chill,  and  at  the  same  time  there  is 
a  rapid  rise  in  temperature,  frequently  to 
104  or  105  F.  The  pulse  rate  will  vary 
from  90  to  100  per  minute,  and  the  pulse  is 
full  and  bounding.  The  respiration  is  in- 
creased to  30  or  40  or  more  per  minute, 
which  at  first  is  in  proportion  to  the  amount 
of  pain.  There  is  a  short  painful  cough, 
at  first  dry,  but  soon  accompanied  with  ex- 
pectoration of  a  rusty  tenacious  character. 
The  cheeks  are  flushed  ;  the  expression  anx- 
ious, and  the  patient  will  talk  with  some 
difficulty.  He  generally  lies  on  the  affected 
side  and  avoids  movements  of  any  kind. 

As  soon  as  there  is  an  increase  pleural 
exudation  and  solidification  of  the  lung,  he 
will  express  himself  as  "feeling  better." 
The  pulse  is  not  so  full  and  strong  as  dur- 
ing the  first  stage.  The  respirations  are 
increased,  and  out  of  proportion  to  the 
heart's  action,  which  is  due  to  solidification 
of  the  lung.  If  the  entire  lung  is  involved 
there  will  be  dyspnoea,  and  the  symptoms 
will  denote  a  gravity  of  disease  beyond  that 
usually  met  with  if  only  a  portion  of  the 
lung  is  affected. 

With  the  stage  of  resolution  there  is  a 
decided  improvement  in  all  the  symptoms. 
The  fever  diminishes,  sometimes  gradually, 
but  more  frequently  there  is  a  sudden  fall 
of  temperature  to  normal  or  a  little  below. 
The  cough  is  less  frequent  and  expectora- 
tion easier.     The  respiration  gradually  de- 


THE  CHARLOTTE"  MEDICAL  JOURNAL. 


311 


creases.  In  short,  convalescence  is  de- 
clared. 

Of  the  physical  signs  those  first  met  with 
are  an  impairment  of  movements  of  respir- 
ation. The  breathing  is  weaker  but  harsher 
than  natural.  Vocal  fremitus  is  increased. 
On  percussion,  the  resonance  will  be  slight- 
ly tympanitic,  dull,  or  flat,  according  to  the 
stage  of  engorgement  or  solidification.  Of 
the  early  physical  signs  the  most  important 
are  crepitant  niles,  which  are  almost  pathog- 
nomonic. They  are  limited  to  inspiration. 
Bronchial  breathing  and  broncophony  are 
signs  of  consolidation,  and  as  it  increases 
the  crepitant  rales  are  less  distinctly  heard, 
and  percussion  becomes  duller  with  an  in- 
creased sense  of  resistance. 

There  is  no  known  specific  treatment, 
neither  can  it  be  aborted  ;  but  by  a  judicious 
management  we  may  moderate  the  severity, 
and  thereby  lessen  the  danger  and  reduce 
the  mortality. 

The  patient  should  be  put  to  bed  and  ab- 
solute rest  in  the  recumbent  position  en- 
forced. All  movements  of  the  affected  lung 
should  be  reduced  to  a  minimum  as  soon  as 
possible.  This  is  one  of  the  first  rules  in 
the  treatment  of  inflammation.  The  chest 
wall  should  be  fixed  so  as  to  allow  the  least 
possible  expansion  by  adhesive  straps.  This 
is  best  done  by  using  adhesive  straps,  about 
an  inch  wide,  from  spools.  Place  the  pa- 
tient on  the  unaffected  side,  and  apply  the 
straps  from  the  spinal  column  to  the  median 
line  in  front,  drawing  them  tightly  over  the 
side  of  the  chest  as  they  are  applied.  Enough 
such  straps  are  to  be  used  to  cover  the  entire 
affected  lobe.  Pain  is  almost  entirely  re- 
ljeved  immediately  on  the  application  of 
the  straps,  and  the  respiration  reduced  sev- 
eral to  the  minute.  Cough  is  not  so  fre- 
quent nor  severe,  and  the  patient  can  lie  in 
almost  any  position  with  comparative  ease. 

At  the  beginning  a  saline  cathartic  should 
be  given.  The  diet  should  consist  princi- 
pally of  milk,  meat  broths,  soft-boiled, 
poached,  or  raw  eggs,  rice,  and  oatmeal. 
The  temperature  of  the  room  should  be  kept 
from  66  to  68  F.,  and  any  sudden  change 
guarded  against. 

Drugs  have  little  influence  over  the  dis- 
ease, but  the  symptoms  can  be  greatly  ame- 
liorated by  their  use.  Tincture  of  aconite 
given  during  the  first  stage  generally  has  a 
marked  beneficial  effect,  both  in  the  reduc- 
tion of  temperature  and  heart  action.  I  do 
not  believe  that  aconite  given  during  the 
stage  of  engorgement,  when  there  is  a 
strong,  full  pulse  and  high  fever,  has  a  ten- 
dency to  augment  cardiac  weakness  during 
the  second  and  third  stages  which  is  so 
much  dreaded.  Hut  a  continued  high  fever 
and  rapid    hearts  action  has   a   greater  ten- 


dency to  produce  cardiac  weakness  than 
aconite  when  judiciously  administered.  It 
should  be  given  in  small  doses,  frequently 
repeated,  until  some  impression  is  made  on 
the  pulse,  and  then  just  enough,  and  at 
longer  intervals,  to  keep  up  the  effect.  In 
alcoholic  subjects,  and  those  enfeebled  by 
age,  with  a  temperature  not  over  102.5,  ft 
is  best  not  to  give  it  at  all. 

When  the  disease  passes  into  the  second 
stage  cardiac  sedatives  should  be  discon- 
tinued, and  very  few  drugs,  if  any,  are  re- 
quired. Nauseating  expectorants  are  never 
indicated.  They  interfere  with  digestion, 
and  in  that  way  do  more  harm  than  good. 
When  associated  bronchitis  calls  for  an  ex- 
pectorant, the  aromatic  spirits  of  ammonia 
is  the  best.  Given  in  half  drachm  doses 
every  3  or  4  hours,  in  hot  milk,  it  will  pro- 
mote bronchial  secretion,  liquify  the  tena- 
cious mucus,  and  relieve  the  distressing 
cough.  Dover's  powders  and  quinine  given 
in  doses  of  5  grains  each,  three  or  four 
times  a  day,  will  relieve  the  cough,  quiet 
the  nervous  system,  and  reduce  the  temper- 
ature. 

We  should  always  anticipate  cardiac 
weakness  in  the  habitual  drinker  and  the 
aged,  and  guard  against  it  by  the  early  ad- 
ministration of  stimulants.  Alcohol  should 
be  given  freely;  the  amount  regulated  ac- 
cording to  the  former  habits  of  the  patient. 
A  quick  compressible  pulse  always  calls 
for  stimulants.  Supportive  treatment  is  in- 
dicated as  soon  as  solidification  takes  place, 
and  a  fatal  result  may  be  prevented  by  the 
timely  administration  of  supportive  reme- 
dies. If  there  is  a  tendency  to  collapse 
there  is  nothing  so  good  as  hot  milk  with 
brandy.  Aromatic  spirits  of  ammonia  may 
be  added. 

There  is  a  natural  tendency  to  a  favorable 
termination,  and  if  the  vital  powers  of  the 
patient  are  sustained  through  the  course  of 
the  disease,  the  death  rate  will  be  small. 
We  too  often  make  the  mistake  of  treating 
the  disease  instead  of  the  patient.  The 
latter  is  the  safest  until  a  specific  treatment 
has  been  discovered.  The  crisis  should  be 
carefully  watched  for,  and  additional  stim- 
ulants given  if  indicated.  Alcohol  should 
be  stopped  as  soon  as  danger  of  asthenia  is 
passed,  and  tonics,  such  as  quinine,  strych- 
nine, and  iron  given,  and  solid  food  al- 
lowed. 


The  Use  of  Resiuol. 

By   Dr.  Horace  Wardner.    M.  D.,    Supt.    Inter- 
laken  Sanatorium,  La   Porte,   Indiana. 

"Doctor,  I  burned  my  arm  with  steam. 
I  have  tried  soda  and  every  thing  I  could 
think  of,  but  it  smarts  awfully." 


312 


THE  CHARLOTTE   MEDICAL  JOURNAL. 


A  sample  box  of  resinol  was  lying  on 
my  desk.  I  gently  rubbed  the  salve  over 
the  inflamed  surface  very  thoroughly.  This 
relieved  the  pain  in  a  very  short  time.  No 
further  complaint  came  from  the  patient. 
The  arm  was  well  in  a  day  or  two. 

This  same  girl  went  out  shopping  when 
the  mercury  was  fifteen  degrees  below  zero, 
and  as  many  a  girl  with  a  trim  little  foot 
and  a  nicely  fitting  shoe  has  done  before 
and  will  continue  to  do  to  the  end  of  time, 
neglected  to  put  on  her  over-shoes.  This 
was  followed  by  chilblains  of  a  distressing 
character  for  which  she  used  various  pro- 
posed remedies,  but  was  finally  relieved  by 
the  use  of  the  ointment  from  the  same 
sample  box. 

While  sitting  at  my  desk  one  day,  I 
heard  a  voice  exclaim.  "Come  along  wid 
ye  now  or  I'll  whack  it  off  wid  a  cleaver." 
I  looked  up  to  see  a  ruddy  Irish  woman 
half  dragging  an  unwilling,  whimpering 
boy  into  the  office.  "Docthur,  what  can 
you  do  wid  a  bye  whats  got  a  ring  on  his 
tommy?"  "A  what!"  A  ring  on  his  tommy, 
Mike  show  the  Docthur." 

An  examination  revealed  a  badly  swollen 
penis  with  a  brass  ring  imbedded  firmly 
around  it.  The  boy  explained  that  he  and 
Pat  O'Houlihan  were  playing  in  the  back 
ally  with  the  ring,  aud  when  he  tried  it  on, 
it  would  not  come  off. 

A  cup  of  quick  silver  was  on  the  table. 
A  thought,  suggested  by  reading  the  report 
of  a  similar  case,  some  years  before  that 
brass  and  quick-silver  would  form  an 
amalgam,  led  to  the  immersing  of  the 
organ  in  the  mercury,  and  in  a  few  minutes, 
to  my  satisfaction  and  to  the  great  relief  of 
the  boy,  the  ring  crumbled  and  was  readily 
removed.  A  dressing  of  resinol  soon 
relieved  the  soreness  and  restored  the  organ 
to  health. 

I  have  used  resinol  in  various  cutaneous 
applications  with  great  benefit  and  relief  to 
the  patient. 

In  cases  of  pruritis  either  with  or  without 
the  eczematous  eruption,  it  is  one  of  the 
best  applications  obtainable. 

It  seem  to  penetrate  and  nourish  the  skin. 

I  have  also  found  it  very  beneficial  in 
haemorrhoids.  In  fact  it  is  useful  in  any 
affection  of  the  cutaneous  surface,  where  an 
aseptic  soothing  and  nourishing  dressing  is 
required. 

Resinol  has  been  much  improved  since 
it  was  placed  before  the  profession.  The 
gritty  character  and  tendency  to  grow  dark 
in  color  has  been  eliminated  in  the  last 
sample  I  used. 

I  have  held  a  feeling  of  antagonism  to  the 
idea  of  proprietary  pharmaceutical  prepara- 
tions, but  some  of  them  are  very  excellent 


remedies.  Listerine  has  become  a  house- 
hold word. 

Nearly  every  physician  has  found  one  or 
more  of  them  convenient  and  satisfactory. 
It  is  a  fad  of  this  "fin  de  siecle." 

It  will  run  its  course  "The  wheat  will  be 
separated  from  the  chaff,"  and  the  fittest 
will  survive,  like  Friar's  Balsom  and  the 
other  preparations  that  have  become  officinal 
after  going  through  the  stage  of  secret  or 
partially  secret  remedies. 

One  of  these  will  be  Resinol. 


The  Accidents  from  Vaccination— How  to 
Prevent    Them. 

By  Isadore  Dyer,  Ph.  B.-(  Yale),  M.  D.,  New  Or- 
leans, Prof,  on  Diseases  of  the  Skin,   New 
Orleans  Polyclinic,  Editor  New  OrleaDs 
Medical  and  Surgical  Journal,  Mem- 
ber  American    Dermatological 
Association,  &c. 

The  recent  revolution  in  the  aspect  of 
vaccination  restrictions  and  regulations  in 
Great  Britain  has  caused  a  great  deal  of 
serious  thought  regarding  the  reasons  there- 
for. 

The  lay  public  has  quietly  submitted  to 
any  dictum  of  the  medical  profession,  and 
its  selected  representatives  on  Boards  of 
Health,  for  many  years  without  remon- 
strance or  even  resistance. 

In  the  ignorance  of  that  same  medical 
profession,  crude  methods  of  practice  have 
obtained  in  many  fields  of  practice.  In 
none  has  this  been  more  patent  than  in 
vaccination. 

For  years  the  usefulness  of  this  procedure 
has  been  accepted,  because  it  has  been  re- 
peatedly demonstrated.  The  carelessness 
in  method,  the  lack  of  due  precaution  in 
the  preparation  of  material  used  and  the 
promiscuousness  of  the  application  of  vac- 
cine have  suddenly  brought  down  a  due  and 
merited  result. 

Accidents  running  the  whole  gamut  of 
complications,  from  simple  infections  to 
deep-seated  constitutional  afflictions,  have 
been  recorded  within  the  last  few  years. 

None  of  these  have  been  more  prominent 
or  more  marked  than  those  which  affect  the 
skin  itself. 

From  the  "sore  arm,"  conditions  have 
been  observed  affecting  limited  localities  on 
the  body  up  to  serious  exudative  and  septic 
affections,  directly  traced  to  the  original 
vaccination  lesion. 

In  this  catagory  we  might  enumerate 
simple  impetigo,  furunculosis,  erythema 
multiforme,  pemphigus,  psoriasis,  herpes 
zoster  and  herpetiform  dermatitis.  We 
have  even    seen    hemorrhagic    purpura  and 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


pronounced    abscesses    follow    simple    vac- 
cination. 

In  an  article  published  in  the  New  Or- 
leans Medical  and  Surgical  yournal  (Feb- 
ruary, 1896),  we  classified  the  eruptions 
of  vaccination  as  they  occurred  with  and 
subsequently  upon  the  lesion  of  inoculation. 

The  multiplication  of  these  accidents, 
simple  and  severe,  has  created  a  natural 
objection  on  the  part  of  the  laity,  arguing 
the  infrequency  of  exposure  to  small-pox, 
and  unwilling  to  risk  the  possible  dangers 
of  vaccination  which  threaten  under  pre- 
sent methods. 

The  average  practitioner  of  medicine 
blindly  accepts  the  fact  that  vaccination 
affords  certain  immunity  against  small-pox, 
and  believes  this  bit  of  philosophy  from  its 
historic  value.  He  does  not  usually  ques- 
tion either  the  source  or  the  quality  of  the 
virus  used. 

To  the  minds  of  some  practitioners  the 
objections  of  the  laity  carry  much  weight, 
and  they  have  joined  themselves  in  a  cru- 
sade against  the  procedure,  instead  of  really 
endeavoring  to  educate  themselves  upon  the 
fault  responsible. 

We  believe  utterly  in  the  complete  value 
of  vaccinnation  as  a  preventive  of  small- 
pox, and  have  convinced  ourselves  that  un- 
der proper  conditions,  with  the  right  sort 
of  vaccine  lymph,  that  there  should  be  first 
of  all  no  accidents,  and  secondly  no  reason 
for  the  popular  objection. 

On  this  account  the  article  we  are  writing 
has  been  projected. 

What  is  necessary  to  prevent  the  acci- 
dents of  vaccination? 

In  what  does  vaccination  consist? 

What  steps  should  be  taken  to  remove 
popular  prejudice? 

In  the  first  place  the  promiscuous  distri- 
bution of  vaccine  lymph  from  the  dispensa- 
tories of  commercial  institutions  should  be 
stopped. 

Vaccine  should  be  made  a  perfect  labor- 
atory product  and  should  be  dispensed  as 
antitoxins  are  from  qualified  laboratories, 
in  charge  of  intelligent  and  conscientious 
men. 

This  should  be  as  far  as  possible  under 
State  or  national  direction.  In  this  way 
the  purity  of  the  lymph  could  be  assured, 
for,  as  at  present  permitted,  epidemics  of 
infectious  cutaneous  diseases  are  not  at  all 
uncommon  as  a  result  of  impure  vaccination 
lymph. 

The  method  usually  adopted  by  Hoards 
of  Health  is  open  to  the  severest  criticism 
and  condemnation.  We  have  seen  the  rep- 
resentative of  a  Board  of  Health  publicly 
vaccinate  a  whole  district  of  children,  with 
absolutely  no  pretension  to    aseptic  precau- 


tions. The  children  were  lined  up  with 
their  sleeves  rolled  up  above  the  elbow  and 
were  taken  one  by  one  and  scratched  with 
a  vaccine  point,  each  successive  point  being 
dipped  in  a  more  or  less  dirty  glass,  full  of 
more  or  less  dirty  water.  The  children 
then  were  lined  up  until  the  site  of  vaccin- 
ation had  dried ;  the  whole  process,  from 
start  to  finish,  being  a  criminal  procedure, 
as  a  surgical  wound  had  been  created  on  a 
septic  surface,  after  which  it  was  still  more 
exposed  to  the  conditions  of  infection  which 
a  small  room,  crowded  with  the  worst  class 
of  people,  could  occasion. 

Is  it  any  wonder  that  any  sort  of  acci- 
dent, of  infectious  nature,  should  occur? 

I  have  likewise  seen  a  couple  of  hundred 
of  steerage  passengers  on  a  trans- Atlantic 
steamer  subjected  to  the  same  sort  of  treat- 
ment, one  point  or  quill  often  being  used 
for  two  subjects. 

In  what  does   vaccination   really  consist  ? 

In  the  inoculation  of  an  individual  with 
a  specific  virus,  which,  after  due  incubation, 
produces  a  lesion,  peculiar  to  the  disease 
from  which  the  original  virus  was  obtained. 

When  is  vaccination  complete? 

As  soon  as  the  first  lesion  of  vaccinia 
shows  itself. 

What  is  the  first  lesion  of  vaccinia? 

The  vesicle  usually. 

Vaccinia  does  not  differ  from  its  conge- 
ners, varicella  aud  variola.  These  diseases 
have  as  their  typical  eruption  a  successive 
papule  and  vesicle,  which  in  varicella  usu- 
ally does  not  pustulate.  If  in  either  disease 
the  pustule  did  not  form,  these  diseases 
would  be  none  the  less  varicella  and  variola. 
If  it  were  possible,  as  it  sometimes  is,  to 
prevent  the  formation  of  pustules  in  these 
diseases,  they  would  be  none  the  less  variola 
and  varicella.  Not  infrequently,  in  vac- 
cination, after  from  5  to  8  days,  there  is 
itching,  a  papule  forms,  or  a  vesicle,  inflam- 
mation subsides,  and  the  process  stops. 

Has  vaccination  been  complete? 

Is  it  necessary  for  the  subsequent  pus  in- 
fection to  occur,  bringing  in  its  train  the 
possibility  of  further  septic  infection,  in 
order  that  we  may  declare  vaccination  com- 
plete? 

Is  it  not  rather  an  indication  that  the  de- 
gree of  resistance  in  the  individual  has  pre- 
vented a  severe  intoxication  with  the  ori- 
ginal inoculation? 

It  is  our  belief,  and  it  has  been  our  prac- 
tice, both  as  a  teacher,  and  as  a  physician, 
to  declare  vaccination  complete  as  soon  as 
the  vesicle  has  formed.  This  belief  and 
practice  has  successfully  prevented,  for  a 
period  of  nearly  six  year,  any  accident  from 
vaccination  either  direct  or  indirect. 

First  of    all,  the  area  to  be    inoculated  is 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


thoroughly  washed  with  soap  and  water, 
rinsed  until  no  soap  remains,  then  sponged 
freely  with  alcohol  or  ether. 

Two  separate  inoculations  are  made  with 
two  separate  points.  Then  a  layer  of  bora- 
ted  cotton  is  placed  over  the  wound  and 
either  rubber  tissue  or  a  plaster  holds  the 
cotton  in  place.  On  the  third,  and  until 
the  seventh  or  eighth  day,  the  wound  is 
watched.  When  the  vesicle  appears,  it  is 
broken,  the  surface  washed  with  bichloride 
solution,  or  a  5  per  cent,  carbolic  acid  solu- 
tion, and  an  antiseptic  dressing  applied. 

This  procedure  has  been  adopted  among 
persons  who  have  been  exposed  at  the  time 
or  subsequently  to  small-pox.  I  have  vac- 
cinated myself  in  this  way  five  times,  and 
never  have  had  even  any  areola  of  inflam- 
matory redness  about  the  lesion  when  it  has 
formed. 

If  this  or  a  like  method  of  cleanliness 
were  employed  both  in  private  practice  and 
in  public  offices,  we  believe  that  the  acci- 
dents of  vaccination  would  attract  less  pub- 
lic notice,  because  there  would  be  none  to 
be  observed. 


"Drug  Habits."* 

By  Carl  V.  Reynolds,  M.  I). 

Selecting  for  our  consideration  this  even- 
ing a  subject, "Drug  Habits,"  studied  from 
a  medical  standpoint,  deserves  most  seri- 
ously the  immediate  attention  of  all  medi- 
cal men  to-day,  since  there  is  no  other  dis- 
ease that  wrecks  more  homes,  destroys  more 
manhood,  robs  more  of  their  truthfulness, 
makes  more  honest  men  thieves,  and  finally 
takes  from  them  their  all,  their  life. 

Why  then  should  we  have  such  a  curse 
to  the  human  constitution  existing  to-day? 

It  was  once  thought,  and  is  now  held  by 
some  that  the  first  narcotic,  in  whatever 
form  it  should  be  taken,  was  a  purely  vol- 
untary act  brought  about,  possibly,  by  the 
youth  thinking  it  manly  to  indulge,  or  by 
climatic  influences — "it's  cold,  let's  take  a 
stimulant  to  warm  us  up  and  ward  off  a 
medical  bill,"  or  by  association;  where  we 
see  the  tendency  of  our  fashion  leaders  of 
to-day  ignoring  all  lines  of  limitation,  for- 
getful of  the  fearful  results  of  fast  living 
and  dissipation,  consequently  we  have  fast 
victims  to  that  terrible  fate,  narcotic  ine- 
briates. 

But  whilst  we  are  discussing  the  volun- 
tary act,  youthfulness,  climatology  and  as- 
sociation being  excetant  of  these  evils,  one 
cannot  lose  sight  of  the  medical  men  who 
use  narcotics  continuously,  as  they  do,  not 


*Read  before  the  Buncombe  County  Medical 
Society  December  oth,  1898. 


being  so  extraordinarily  careful  in  disguis- 
ing their  remedy,  being  one  of  the  factors 
of  forming  these  dreadful  habits,  then,  not 
too  much  stress  can  be  laid  upon  the  care- 
fulness of  the  use,  dispensing  and  disguis- 
ing these  drugs. 

The  acquired  habit  is  where  we,  as  phy- 
sicians, can  do  most  good  in  eradicating 
these  contemptible  appetites;  little  harm 
will  one  dose  of  morphine  or  cocaine  do  if 
patient  is  ignorant  of  their  comforter,  but 
just  here  the  secret  lies,  on  similar  occa- 
sions the  same  relief  is  Sought,  and,  if  rem- 
edy is  found  out,  soon  we  have  our  victim, 
and  whose  fault  ?  Please  do  not  understand 
me  as  disapproving  of  the  use  of  these 
drugs,  and  partial  is  the  author  to  their  use, 
for  medicine  would  be  a  failure  without 
them,  but  if  there  is  any  time  when  a  doc- 
tor must  deceive  his  patient  it  is  when  he 
inquires  of  the  drug  used. 

The  above  mentioned  etiological  factors 
might  have  been  the  excitant  causes  gener- 
ations ago  and  are  still  doing  their  deadly 
work,  .but  since  "the  sins  of  the  father  shall 
be  visited  upon  the  third  and  fourth  gener- 
ation," the  youth  of  to-day  cannot  be  whol- 
ly responsible  for  his  misdoings,  for  inher- 
itance has  given  him  a  diseased  brain  and 
body  textures,  a  wrecked  nervous  system 
and  a  depraved  appetite  which  is  not  easily 
controlled  and  should  be  laid  at  the  door  of 
his  forefathers. 

But,  summing  it  up,  if  it  be  due  to  ma- 
liciousness, if  to  careless  administration  of 
drugs,  or  to  inheritance,  we  have  by  the  in- 
temperate consumption  of  narcotics,  a  very 
stubborn,  disagreeable  and  unsatisfactory 
class  of  patients  to  treat ;  and  as  the  field  is 
too  large  to  take  them  up  as  a  whole,  it  will 
be  the  object  of  this  paper  to  specialize  upon 
one  or  two,  that  we  may  have  a  discussion. 

Alcohol,  in  its  various  varieties,  stands 
as  a  lighthouse,  steering  many  tattered, 
weather-beaten,  and  wrecked  constitutions 
to  a  safe  and  sound  landing.  Few  names 
in  the  pharmacopeia  can  be  called  upon  to 
aid  in  more  diverse  ways,  and  always  lend 
a  helping  hand  than  the  "King"  alcohol 
when  properly  administered. 

As  an  astringent,  refringerant,  anhidro- 
tic,  rubefacient,  antipyretic,  diapharetic, 
diuretic,  stimulant,  tonic,  food,  &c,  etc.,  it 
is  one  of  our  most  accessible  drugs,  but. 
like  all  good  things,  it  is  abused,  so  it  is 
here  the  author  desires  to  direct  your  atten- 
tion this  evening. 

Then,  in  the  beginning,  we  may  make 
the  statement  safely,  that  "spirits"  may  be 
used  in  moderation  throughout  a  long  life 
without  impairing  the  general  health  to  any 
extent,  but  statistics  show  that  vast  multi- 
tudes are  dying  to-day  from  its  intemperate 


THE  CHARLOTTE  MEDICAL  JOURNAL, 


315 


use,  but  this  is  not  a  discussion  upon  the 
moral  effects  of  alcohol,  so  will  look  at  it 
from  the  various  pathological  conditions 
and  symptoms  brought  about  by  excessive 
indulgence.  Acute  alcoholism  is  the  most 
prominent  pathological  condition  where  we 
find  at  the  beginning  a  vascular  relaxation 
of  the  periphreries,  later,  the  brain  and 
higher  nerve  centres  becoming  incompletely 
paralyzed,  with  disturbances  and  exagger- 
ations of  the  emotions;  some  hilarious,  oth- 
ers melancholy,  some  bostful  others  retiring, 
some  violent,  some  drunk  in  the  head,  oth- 
ers in  the  legs,  and  finally  succumb  to  alco- 
holic coma.  In  this  condition  we  find  the 
gastric  organ,  in  an  unsettled,  uncertain — 
to  say  the  least — seasick  condition,  its  mu- 
cous membranes  and  vessels  congested  and 
having  an  angry,  red,  inflammatory  appear- 
ance, with  a  muco-purulent  discharge  from 
bleeding  points,  which  we  find  not  an  easy 
task  to  arrest  after  several  debauches. 

The  patient  may  be  in  a  state  of  quietude, 
or  with  various  hallucinations,  one  of  hom- 
icidal intent,  another  suicidal  intent,  infu- 
riated absolutely  beyond  his  control,  seek- 
ing vengence  upon  his  furniture,  his  brick 
wall,  his  wife  or  "anything  that  might  come- 
in  his  path  ;"  after  a  time  generally  awak- 
ening totally  ignorant  of  his  actions.  This 
kind  of  debauchery  may  be  indulged  in  i 
few  and  limited  number  of  occasions,  but 
soon  we  have  an  undertaker's  call  or  an  en- 
trance certificate  to  an  asylum,  which  is 
worse.  This  habit  is  so  prevalent  and  will- 
power so  weakened,  we  will  have  to  admit. 
is  one  of  t he  greatest  evils  now  existing; 
but  while  this  Iiabit  not  only  wrecks  the 
human  economy,  morally  and  physically, 
but  also,  so  upsets  the  mental  faculties  that 
an  adjuvant  is  called  upon,  and  we  have 
added  to  alcoholism,  morphinism,  cocain- 
ism  and  a  complication  to  battle  with. 

Now  picture  yourself  gazing  upon  the 
poor,  unfortunate  alcoholic  victim  gloriously 
happy  in  mind,  generally  found  where  there 
are  sounds  of  mirth  converse  and  liveliness, 
then  for  one  moment  imagine  yourself  in 
an  opiate's  den  where  we  find  in  a  secret 
chamber  the  poor  victim,  making  not  a 
sound  nor  a  movement,  but  serenely  hap- 
py in  the  calming  and  soothing  effects  of 
the  opiate,  leading  its  victim  into  quiet  and 
blissful  repose,  awakening  to  find  himself 
a  most  miserable,  forlorn  and  forsaken  be- 
ing, finding  refuge  only  in  a  repetition  of 
his  course. 

When  it  is  claimed  that  there  are  [50,  <»  >,  > 
morphine  fiends  in  the  United  States  alone, 
and  when  Mattison,  1  894  ,  makes  t  he  alarm- 
ing statement  that  70  per  cent,  of  opium 
inebriates  are  regular  practicing  physicians 
brought    about   possibly    by  experimenting 


with  the  drug,  or  by  their  irregular  life  of 
exposure  and  loss  of  sleep.  Or  in  the  case 
of  the  layman  if  brought  about  by  careless 
administration,  pain,  insomnia,  neuralgia 
or  what  not,  it  demands  of  us  the  judiciary 
and  guardians  of  health,  a  careful  and  due 
consideration  before  the  administration  of 
a  drug  which  brings  upon  our  people  a 
habit  which  overthrows  the  will-power  and 
leaves  them  a  human  wreck. 

DISCUSSION. 

Dr.  S.  W.  Battle. — I  really  have  very 
little  to  say  on  the  subject.  Of  course  it  is 
easy  for  the  physician'  to  fall  into  the  way 
of  taking  that  which  will  give  him  rest, 
which  he  must  have  in  order  to  proceed 
with  his  work  on  the  following  day,  ami  I 
believe  that  the  majority  of  physicians  who 
fall  into  morphine  habit  at  any  rate,  do  take 
it  up  in  just  that  manner.  Of  course  I  do 
not  think  that  the  doctor  is  more  susceptible 
or  that  he  is  more  liable  to  become  a  liquor 
fiend  than  other  professions,  perhaps.  In- 
deed, he  has  every  reason  to  keep  his  head 
clear.  Of  course  many  fall  into  the  liquor 
habit  and  the  morphine  habit  from  the  doc- 
tor having  prescribed  these  narcotics. 

Dh.  J.  A.  Regan. — I  think  that  the  pa- 
per which  has  been  read  is  a  very  interest- 
ing and  important  one.  I  do  not  think 
there  is  any  subject  which  we  have  more  to 
do  with  than  we  have  the  subject  before  us, 
that  is,  guarding  ourselves  and  warning 
others  of  danger.  You  know  that  the  word 
habit  is  derived  from  the  Latin,  I  have  you, 
or  I  got  you.  Now,  I  think  that  the  illus- 
tration may  be  made  in  this  way.  You  see 
a  spider  and  a  fly.  The  spider  throws  a 
thread  around  the  fly,  and  of  course  the  fly 
can  break  it.  There  is  no  trouble  about  his 
not  doing  so.  But  it  is  so  little  and  insig- 
nificant that  he  makes  no  effort  to  do  so, 
and  another  is  thrown  around,  and  another, 
until  he  gets  his  net  bound  around  the  fly 
sufficiently,  and  starts  at  him,  and  when  the 
fly  makes  an  effort  he  is  fastened  and  the 
spider  has  him.  That  is  the  way  it  is  with 
habit.  You  may  take  it  in  the  habit  of 
morphine  or  liquor  or  anything  that  has  a 
tendency  to  produce  habit  of  a  dangerous 
character.  A  person  takes  a  dose  of  mor- 
phine and  they  have  power  to  stop  it,  but 
they  go  on  taking  it  until  finally  the  mor- 
phine has  them,  and  it  is  the  same  way  with 
liquor.  I  don't  suppose  there  is  a  man  in 
the  world  who  wants  to  be  a  drunkard  or 
go  to  an  asylum,  or  come  to  a  drunkard's 
grave,  but  he  keeps  tippling  with  it,  and 
goes  on  until  the  point  is  reached  where  it 
has  him,  and  when  it  has  got  hold  upon 
him  he  has  got  the  disease,  it  is  fastened 
upon  him,  and  it  takes  a    moral  effort,  and 


316 


THE  CHARLOTTE  MEDICAL  JOURNAL 


some  times  a  good  deal  of  medicine  in  con- 
nection with  it,  to  prevent  it.  I  recollect 
a  case,  the  only  bad  case  I  ever  had.  He 
was  a  colonel,  a  man  of  prominence,  and 
was  a  complete  drunkard,  drank  day  and 
night,  until  he  lost  the  use  of  himself,  could 
not  stand  on  his  feet,  had  not  for  months 
when  I  saw  him.  He  had  to  have  a  chair 
with  rollers  to  roll  him  to  the  table  or  bed  or 
fire,  wherever  he  wanted  to  go. 

When  I  was  called  to  the  village  where 
he  lived  to  treat  him  the  physicians  laughed 
at  the  idea  of  saving  that  man.  I  took  the 
strychnia  before  him,  and  weighed  it  out, 
and  measured  the  liquor  that  I  gave  him. 
"Now,"  I  said,  ''Colonel,  if  you  will  take 
this  according  to  my  directions  I  am  respon- 
sible for  the  effect  of  it,  but  if  you  go  be- 
yond my  directions  you  are  responsible," 
and  no  other  liquor  was  he  to  have  except 
that  with  the  strychnia  in  it.  At  the  same 
time  I  used  upon  his  spinal  col- 

umn, and  within  six  weeks  I  had  that  man 
so  he  could  walk  across  the  street,  and  he 
got  entirely  well,  and  could  go  anywhere 
he  wanted  to.  The  drink  had  perfect  con- 
trol of  him.  Some  of  the  family  had  con- 
sulted with  a  prominent  man  to  know  if  it 
would  not  be  better  to  just  let  him  kill  him- 
self, but  that  man  lived  thirty  years  after 
that  treatment,  and  finally  died  of  a  differ- 
ent disease.  I  was  not  present  when  he 
died.  He  was  a  tetotaler  from  that  day  to 
the  day  of  his  death,  making  speeches  and 
everything. 

So  far  as  the  physicians  are  concerned,  I 
am  pretty  well  acquainted  with  all  the  phy- 
sicians in  North  Carolina,  the  prominent 
ones.  I  was  six  years  on  the  examining 
board,  and  examined  over  300.  In  that 
way  I  became  acquainted  with  them,  and 
have  no  hesitancy  in  saying  that  I  do  not 
know  any  number  of  men  of  any  character, 
farmer,  mechanics  or  anything  else,  where 
you  will  find  as  large  a  number  in  the  State 
of  North  Carolina,  with  as  few  with  the 
habits  of  drunkards.  There  are  a  few,  un- 
fortunately so,  but  very  few,  and  when  I 
go  to  our  annual  meetings,  and  go  to  the 
meetings  of  the  American  Medical  Associ- 
ation, I  have  never  seen  a  drunken  physi- 
cian. I  never  saw  but  one  at  the  State 
Medical  Society,  and  we  sent  him  home. 
He  came  before  the  Board  in  my  room 
drunk,  and  I  told  the  Board  I  would  have 
nothing  to  do  with  him,  and  he  was  sent 
home.  So  far  as  the  physicians  are  concern- 
ed, I  say  they  are  not  more  liable  than  other 
men,  and  I  think  less  so,  because  I  think  they 
know  the  effect  of  it,  and  as  a  general 
rule  they  are  sober  and  reliable  men.  I 
never  saw  one  intoxicated  at  the  meeting 
of  the  American  Medical  Association  where 


there  were  1,500  or  2,000  there,  so  that  I 
am  willing  to  defend  the  medical  profession 
as  far  as  I  can. 

I  think  the  paper  is  a  good  one,  and  I 
think  that  it  is  a  subject  we  are  all  inter- 
ested in,  to  try  to  save  our  fellow-men.  It 
is  our  duty  to  save  men  from  ruining  them- 
selves and  their  families,  and  anything  we 
can  do  to  ward  off  that  is  in  our  profession. 

Dr.  G.  Tennent. — I  think,  considering 
the  importance  of  the  subject,  there  are  very 
few  men  who  could  give  alcoholism  the 
study  that  it  should  have.  Dr.  Reynolds 
in  his  paper  notices  the  difference  between 
acquired  alcoholism  and  the  inherited  form, 
but  I  hardly  think  he  drew  the  lines  as 
strictly  as  they  might  have  been  drawn.  Of 
course  you  can  always  trace  the  acquired 
habit,  but  you  cannot  always  differentiate 
the  case  of  inherited  alcoholism  from  ac- 
quired, for  the  reason  that  the  man  who 
inherits  the  tendency  to  alcoholism  or  dip- 
somonia,  may  acquire  the  habit  by  the  same 
means  and  the  same  manner  as  the  man  who 
does  not  inherit  the  tendency.  I  never 
thought  about  the  subject  until  a  year  or 
two  ago  I  read  a  very  well  written  novel  by 
Walter  Besant.  The  hero  is  drawn  from 
life,  and  is  one  of  the  most  interesting  psy- 
chological studies  I  have  ever  run  across. 
This  young  man,  who  inherited  a  large  for- 
tune, was  very  bright,  had  inherited  a  good 
name,  had  no  bad  habits,  and  until  he 
studied  up  his  ancestry,  had  no  idea  that  he 
had  inherited  a  tendency  to  drinking,  but 
after  he  acquired  that  habit  he  looked  up 
this  matter  and  found  that  he  had  two  or 
three  ancestors  who  were  drunkards.  In 
his  senior  year  in  college  he  waked  up  very 
thirsty  one  night  after  studying  very  hard 
for  his  examination,  and  drank  some  water, 
and  next  drank  some  claret  he  had  in  his 
room,  and  the  claret  quenched  his  thirst, 
but  was  not  what  he  wanted,  and  he  finally 
thought  of  some  brandy  he  had  and  he 
drank  a  whole  quart  that  night  and  was  on 
a  drunk  two  nights,  but  got  over  it.  In  two 
months  from  that  time  he  waked  up  with 
exactly  the  same  feeling.  He  had  taken  the 
precaution  not  to  keep  any  liquors,  but  it 
seemed  as  if  he  must  have  some  whiskey 
and  so  he  waked  up  the  janitor  and  sent 
him  for  some.  It  went  on  that  way  for 
about  fifteen  or  twenty  years,  and  regularly 
every  two  months  he  got  on  a  spree,  until 
finally  he  committer1  suicide.  Of  course 
that  is  typical  dipsomania.  There  was  no 
cause  whatever,  except  some  peculiar  ten- 
dency which  he  had  inherited.  I  think  in 
treating  patients  it  would  pay  those  who 
have  patients  to  treat  if  they  would  remem- 
ber that  very  important  case.  An  inherited 
pyschological  condition  is  always  ten  times 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


317 


more  hard  to  cope  with  than  an  acquired 
condition. 

Dr.  M.  H.  Fletcher. — In  regard  to 
whether  you  can  inherit  a  desire  to  drink 
whiskey,  I  think  most  of  us  who  have  a  bad 
habit  are  looking  for  an  excuse.  I  think  it 
is  possible  to  be  a  dipsomaniac,  and  most  of 
us  if  we  looked  back  could  find  an  ancestor 
who  had  a  habit  of  that  kind.  I  should  say 
99  out  of  ioo  was  acquired.  If  a  man  has 
a  weakness  he  must  guard  against  that 
weakness,  and  this  gentleman  the  doctor 
referred  to  ought  to  have  studied  up  his 
history  before.  If  he  had  he  would  not 
have  touched  it. 

I  wish  I  could  agree  with  Dr.  Reagan  in 
regard  to  the  statistics  in  reference  to  the 
medical  men.  The  doctor  states  that  about 
70  per  cent,  of  the  people  who  contract  the 
opium  habit  are  physicians.  I  think  that  is 
true.  The  doctors  who  contract  the  mor- 
phine habit  do  not  attend  the  State  Medical 
Society  or  the  American  Medical  Associa- 
tion. They  have  fallen  by  the  wayside 
long  before  that,  and  are  more  apt  to  go  to 
the  Keely  institute.  We  have  a  number  of 
them.  A  thing  I  would  like  to  hear  is 
some  remedy  to  help  a  man  who  is  down 
with  the  morphine  habit. 

Dr.  YV.  P.  Whittington. — I  am  like 
Dr.  Fletcher,  1  hope  that  somebody  will  tell 
me  something  about  the  treatment  of  drug 
habits.  1  thought  that  the  paper  would 
perhaps  say  something  on  that  subject.  I 
am  very  much  interested  in  the  drug  habit, 
especially  in  the  morphine  habit.  For  a 
number  of  years  I  have  given  considerable 
attention  to  looking  up  this  question.  It 
seems  to  me  that  while  there  is  a  difference 
of  opinion  as  to  the  use  of  alcohol  in  the 
profession  that  difference  is  very  well  ex- 
plained in  Dr.  Fletcher's  remarks.  We 
have  some  bright  men  who  drink  alcohol, 
even  wood  alcohol  or  Jamaica  ginger  when 
they  cannot  get  anything  else,  and  one  cause 
of  that  is  our  arduous  labors,  our  long 
strains,  and  a  man  seeks  something  to  give 
him  strength  and  ability  to  meet  the  obli- 
gations that  fall  upon  him.  I  believe  that 
we  are  very  largely  to  blame  for  the  mor- 
phine habit,  but  also  for  the  alcohol  habit, 
because  we  do  not  give  these  things  the  at- 
tention we  ought  to.  We  spend  hours  and 
days  and  weeks  pouring  over  the  journals 
and  the  text  books  for  a  remedy  for  tuber- 
culosis or  epilepsy,  and  all  other  diseases 
that  human  tlesh  is  heir  to,  and  we  say,  that 
man  is  a  little  drunk,  or  he  has  too  much 
morphine,  anil  we  will  send  him  to  Keely, 
or  kick  him  aside.  This  ought  not  to  be. 
One  of  our  most  eminent  physicians  has 
published  his  remarks  over  his  signature 
that   we    have  a  remedy  for  alcoholism,  and 


that  is  strychnine.  It  seems  to  me  that  the 
basis  of  the  Keely  treatment  is  strychnia, 
supported  by  those  valuable  tonics,  the  dif- 
ferent preparations  of  gold,  gentian,  iron, 
bromides,  etc.  While  we  have  no  drug  that 
will  substitute  and  destroy  a  man's  desire 
for  the  effects  of  morphine,  I  believe  we 
have  a  sure  method  of  curing  every  man 
who  is  addicted  to  the  excessive  use  of  mor- 
phine. I  say  a  method.  I  don't  mean  we 
have  a  remedy,  but  I  believe  if  we  look  this 
matter  carefully  up  that  any  physician  in 
this  house  can  cure  any  man  of  the  mor- 
phine habit,  no  matter  how  long  he  has 
been  taking  it,  or  how  large  the  dose,  that 
is,  if  he  has  no  constitutional  disease  which 
requires  that  he  use  morphine  for  the  pur- 
pose of  relieving  pain.  That  should  al- 
ways be  taken  into  consideration.  In  cases 
where  we  cannot  cure  the  disease  we  have 
to  give  him  up  to  the  use  of  the  morphine. 
But  in  the  treatment  of  the  morphine  habit 
there  are  two  or  three  drugs  which  come  in 
very  nicely  in  practicing  this  method. 
Whenever  you  see  published  in  the  papers 
a  remedy  for  the  morphine  habit,  you  can 
put  it  down  as  a  fraud,  because  all  those 
treatments  are  only  methods,  and  if  you 
will  ascertain  in  the  beginning  the  amount 
of  the  drug  the  man  is  taking,  and  find  out 
what  is  the  proper  use  of  your  substitute, 
you  can  relieve  every  single  one  by  this 
method,  and  the  drugs  used  for  that  method 
are  codine,  gentian,  strychnine  and  bro- 
mides, with  the  proper  tonics  and  nourish- 
ing treatments  that  are  necessary  to  put 
your  man  in  proper  condition.  I  have 
cured  quite  a  number  of  very  severe  cases 
of  morphine.  I  cured  a  gentleman  in  this 
city  not  long  ago  who  was  almost  a  raving 
maniac.  His  wife  thought  of  sending  him 
to  the  asylum.  Now  he  is  entirely  cured. 
You  must  give  the  man  a  good  wholesome 
vegetable  purgative.  Give  him  an  elimi- 
native  treatment.  Get  rid  of  all  those  pois- 
onous compounds.  Then  after  you  have 
gotten  the  man  in  condition  to  justify  it, 
rapidly  reduce  his  morphine  and  increase 
your  other  drugs  in  proper  proportion  until 
you  get  him  off  the  morphine.  Then  rap- 
idly reduce  your  other  treatment,  support 
the  system  by  good  diet.  You  must  be  a 
judge  of  the  man's  condition,  of  his  consti- 
tution, what  he  will  bear  and  what  he  will 
not.  But  if  you  do  not  watch  he  will  cheat 
you.  A  man  will  suffer  some  while  you 
are  treating  him,  but  if  you  will  hold  him 
and  treat  his  symptoms  as  they  come  up  you 
can  relieve  any  man  of  the  morphine  habit, 
or  the  need  of  the  morphine  inside  of  three 
weeks,  and  in  three  more  weeks  you  can 
have  him  on  his  feet  and  give  him  his  free- 
dom and  put  him  back   in   business,  and  he 


318 


THE  CHARLOTTE   MEDICAL  JOURNAL. 


will  have  no  desire  whatever  for  morphine 
and  the  bromides,  and  if  you  will  use  these 
methods  properly,  increasing  one  and  reduc- 
ing the  other  up  to  a  certain  point,  you  can 
take  any  man  in  North  Carolina  who  has 
nothing  the  matter  with  him  but  the  morph- 
ine habit,  and  inside  of  six  or  twelve  weeks 
he  will  be  a  well  man.  Now,  will  he  stay 
well  ?  When  a  man  is  in  the  habit  of  taking 
morphine  he  thinks  he  is  bound  to  have  it, 
and  he  is  unless  it  is  taken  from  him  in  the 
proper  way,  and  when  a  man  has  once  been 
a  subject  of  the  morphine  habit  he  is  rob- 
bed of  his  manhood  to  that  extent.  He  is 
more  liable  to  fall  into  the  habit  again  if  he 
ever  has  neuralgia  or  toothache  than  he  was 
formerly,  and  that  is  where  the  danger 
comes.  I  cured  one  man  of  the  morphine 
habit  who  had  been  using  it  for  ten  years. 
I  cured  him,  and  in  three  months  after  he 
began  the  treatment  lie  weighed  more  than 
he  had  in  ten  years,  his  skin  was  in  better 
condition,  his  rest  and  appetite  was  better, 
and  he  was  more  like  he  was  in  his  younger 
days  than  he  had  been  for  ten  years.  He 
was  then  a  man  of  about  60.  He  went  on 
for  eight  months,  and  at  the  end  of  eight 
months  he  had  a  severe  spell  of  neurelgia, 
and  he  says:  "Now  I  think  I  can  take  a 
dose  of  morphine  and  it  won't  hurt  me." 
He  sinned  and  fell,  and  went  back  into  the 
habit  again.  Since  then  he  has  been  treated 
by  another  physician  and  I  suppose  is  prop- 
erly cured  so  far  as  I  know.  But  some  of 
them  will  not  fall,  if  you  can  keep  them 
from  the  morphine  again,  because  it  has  a 
fascinating  influence,  and  when  a  man  once 
knows  what  they  call  the  joy  is,  he  is  more 
prone  to  fall  into  it  again.  But  I  say  we 
ought  to  look  up  these  things,  and  when  we 
see  our  patients  inclined  to  go  that  way  we 
ought  to  stop  it  at  once,  by  using  such 
treatment  as  is  required. 

Dr.  Walker. — I  am  going  to  be  a  little 
personal  in  this  matter.  I  have  been  a  rail- 
road surgeon  for  thirty  years,  and  have  been 
through  the  coal  disticts  and  have  a  great 
many  accidents  to  attend.  I  come  in  at 
night  as  tired  as  can  be,  and  when  I  come 
in  I  take  a  glass  of  hot  milk.  I  am  not  one 
of  these  gooddy-good  men,  because  if  I  want 
whiskey  or  wine  I  will  take  it.  I  have  a 
good  many  German  friends  who  own  vine- 
yards and  they  frequently  give  me  wine, 
but  I  cannot  say  that  I  like  it  particularly. 
Speaking  of  the  morphine  habit,  I  was  called 
in  to  attend  a  young  lady  who  had  neural- 
gia. .She  suffered  intensely,  and  when  I 
was  called  in  she  said  she  had  morphine  in- 
jected every  day.  I  injected  a  quarter  of  a 
grain.  I  kept  that  up  every  day.  One  day 
she  said:  "You  will  never  inject  morphine 
for  me  again."     The  next  day  I  called,  and 


she  hinted  very  strongly  for  morphine,  but 
I  did  not  give  it  to  her,  and  she  has  never 
taken  morphine  since  that  time,  which 
shows  what  a  woman  will  do  when  she 
makes  up  her  mind. 

Dr.  James  Sawyer. — You  frequently 
find  that  those  who  drink  in  secret  are  the 
drunkards,  and  those  who  drink  openly  are 
the  ones  who  never  suffer  from  it.  One  of 
the  chief  injuries  of  drinking  is  not  from 
the  alcohol,  but  from  the  ingredients  put 
into  it ;  in  other  words  its  impurities.  For 
instance,  in  New  York  recently  I  was  in  a 
restaurant,  and  they  gave  a  table  d'hote  for 
75  cents,  and  for  80  cents  they  gave  a  small 
bottle  of  claret.  You  can  imagine  what 
sort  of  claret  it  was  for  5  cents.  I  just 
wanted  to  add  those  two  points,  impurities 
and  secrecy.  They  are  important  and  should 
be  looked  after. 

Dr.  L.  B.  McBrayer. — I  did  not  intend 
to  say  anything,  but  I  will  have  to  reply  to 
the  doctor  who  has  just  taken  his  seat.  In 
the  first  place  the  W.  C.  T.  U.  has  a  pretty 
strong  plea  against  this  convivial  drinking, 
and  I  have  had  these  habitues  tell  me  they 
get  along  very  well  unless  they  meet  some 
of  these  old  friends,  and  then  they  must  go 
and  take  a  drink,  and  when  they  have  taken 
the  first  drink  they  never  know  when  to 
stop.  Again,  as  to  the  impurities,  it  is 
hardly  worth  while  for  me  to  remark  on 
that  point,  as  the  author  of  the  paper  this 
evening  spoke  of  the  effect  of  alcohol  upon 
the  stomach,  and  the  pathological  effects 
from  poisons  which  is  too  well  known  to 
mention. 

Dr.  J.  A.  Burroughs. — I  just  wish  to 
say  I  don't  believe  in  the  theory  of  heredity 
in  drug  habits,  especially  in  the  whiskey 
habit.  If  that  was  true  it  seems  to  me  that 
the  whole  human  family  would  be  one  of 
drunkards.  The  first  thing  that  old  man 
Noah  did  when  he  landed  the  ark — and  all 
in  the  ark  were  related  to  him — was  to  plant 
a  vineyard  and  proceed  to  raise  him  some 
grapes  and  get  some  wine,  and  get  very, 
very  drunk.  I  am  sorry  the  old  man  be- 
came intoxicated,  but  I  am  glad  he  had  li is 
wine.  I  think  it  is  a  good  thing  to  have. 
I  would  just  say  this  in  regard  to  this  liquor 
drinking.  It  is  one  of  the  greatest  curses 
of  the  age,  and  a  thing  that  physicians  have 
but  little  to  do  with  beyond  helping  a  man 
up,  as  Dr.  Whittington  suggested,  but  re- 
garding the  morphine  or  opium  habit  I  do 
think  that  physicians  are  largely  responsi- 
ble for  the  number  of  cnses.  It  is  very  rare 
that  the  laity  purchase  opium  or  morphine 
without  prescription  of  the  physician.  It 
is  generally  given  by  a  physkvan,  very  often 
started  that  way,  and  the  physician  does 
not    keep  watch    on    them,  and    by  letting 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


319 


them  know  what  the  drug  is  when  they 
purchase  the  drug.  They  think  they  have 
a  gauge  on  themselves,  and  little  by  little 
the  habit  has  gotten  on  them.  I  must  say 
that  I  differ  with  Dr.  Reynolds'  statement. 
Wherever  he  got  his  statistics  they  are  in- 
correct about  saying  there  are  150,000  peo- 
ple in  the  United  States  with  the  morphine 
Habit.  If  lie  had  said  half  a  million  he 
would  have  been  nearer  correct.  In  regard 
to  70  per  cent,  of  those  addicted  to  the 
morphine  habit  being  physicians — that  is 
incorrect.  The  statistics  are  wrong.  Ac- 
cording to  Polk's  last  directory  there  are 
115,000  physicians  in  the  United  States  and 
Canada.  There  are  no  70  per  cent,  of  those 
addicted  to  morphine.  I  know  that  physi- 
cians do  some  times  get  into  the  habit  of 
taking  narcotics,  and  then  they  want  some- 
thing a  little  stronger  and  a  little  stronger, 
and  the  first  thing  you  know  the  devil  has 
them,  but  there  is  no  such  percent,  as  that. 
I  am  not  prepared  to  accept  it. 

On.  W.  P.  Whittington. — There  is  one 
great  trouble  about  curing  the  morphine 
habit,  and  that  is  there  are  a  great  many 
people  who  don't  want  to  be  cured.  They 
won't  even  give  a  small  sum  to  give  it  up 
until  they  are  broken  down  and  pauperized 
ami  have  no  will   power  to  build  on. 

Dr.  (i.  Tknnknt.  —  I  want  to  emphasize 
that  it  is  a  well  known  fact  that  there  is 
such  a  thing  as  typical  dipsomania,  and  that 
it  is  inherited  from  two  classes  of  ancestors. 
It  is  inherited  from  one  who  is  a  dipsoma- 
niac himself,  chock  full  of  whiskey  all  the 
time,  and  I  think  we  have  these  typical 
dipsomaniacs. 

Dr.  A.  M.  Ballard. — I  am  sorry  I  was 
not  here  in  time  to  hear  the  paper.  In  re- 
gard to  the  effect  of  morphine  I  would  like 
to  quote  what  Dr.  Ansley,  the  eminent  En- 
glish physician,  says  on  this  subject.  He 
says  that  morphine  given  hypodermically 
does  not  weaken  the  appetite  or  digestion, 
is  not  putting  the  truth  strong  enough.  He 
says  :  "I  will  say  that  the  use  of  morphine 
in  legitimate  doses  hypodermically  does  not 
weaken  the  appetite  but  strengthens  it.  and 
strengthens  the  digestion,  and  when  you 
Consider  the  frequency  with  which  it  is 
used  all  over  the  civilized  world,  and  the 
fact  that  statistics  seem  to  show  that  very 
few  of  those  who  become  addicted  to  it 
commence  to  use  it  by  using  it  for  medical 
purposes  it  cannot  be  said  to  be  a  dangerous 
drug  to  use.  Of  course,"  he  says,  "you 
should  guard  against  the  continuance  of  it 
longer  than  absolutely  necessary.  It  seems 
to  be  to  the  human  organism  what  oil  is  to 
machinery,  lubricates  the  bearings." 

1  also  think  with  Dr.  Burroughs  that  a 
very    small     proportion    of     the     morphine 


takers  are  made  so  by  commencing  to  use  it 
for  medicine,  but  most  of  those  make  them- 
selves so  by  taking  it  up  to  splice  out,  so  to 
speak,  their  strength.  They  live  a  dissipa- 
ted life,  and  I  think  statistics  show  that  a 
pretty  large  percentage  in  our  cities  have 
taken  it  up  just  for  that  purpose.  They  are 
up  all  night  possibly  dancing,  and  possibly 
the  next  night  have  to  be  up  again.  They 
feel  jaded,  and,  of  course,  they  resort  to  the 
hypodermic  syringe,  and  among  a  certain 
fast  class  in  our  cities  it  is  very  prevalent,  I 
think.  I  would  not  like  to  have  it  go  out 
from  here  that  the  morphine  maniacs  are 
started  mostly  by  the  medical  men.  I  don't 
believe  any  such  nonsense. 

Dr.  E.  B.  Glenn — I  wish  to  say  that 
every  man  who  has  to  take  a  narcotic  to 
stimulate  him  to  do  more  work  should  leave 
off  some  of  the  work  and  not  take  stimu- 
lants. 

Dr.  C.  V.  Reynolds. — I  tell  you  it 
would  do  my  heart  good  if  the  statistics 
would  not  bear  me  out.  These  gentlemen 
do  not  want  it  to  go  out  from  this  Society 
that  the  physicians  themselves  are  greatly 
responsible  for  the  morphine  fiends  to-day. 
You  mention  to  me  a  layman  down  here  in 
the  backwoods  that  doesn't  know  anything 
about  drugs — who  knows  nothing  about 
morphine — you  let  the  physician  go  into  a 
house  where  it  is  absolutely  necessary  to 
use  morphine  ;  he  will  not  give  that  patient 
morphine  five  days  until  some  member  of 
the  family  will  find  out  what  he  is  giving. 
Then  it  is  known  to  that  family  that  mor- 
phine is  used  to  relieve  pain.  The  conse- 
quence is  that  some  other  member  of  the 
family  will  take  the  morphine  or  will  give 
it  to  somebody  else,  and  in  that  way  it  is 
carried,  and  if  you  sift  the  thing  to  the 
bottom  you  will  find  that  the  physician  is 
not  only  partly,  but  wholly  responsible  for 
the  morphine  inebriates  to-day. 

In  regard  to  the  70  per  cent.,  I  do  not 
believe  it  is  quite  that  large,  but  those  are 
the  statistics.  Mattison  alleged  that  in 
1894,  and  I  thought  150,000  was  a  pretty 
large  number  to  be  in  the  United  States, 
but  Dr.  Burroughs  went  me  two  or  three 
better,  and  I  think  if  he  will  read  up  care- 
fully he  will  find  that  his  statistics  are  a 
little  wrong. 

I  thank  you,  gentlemen,  for  your  lively 
discussion.  There  are  a  great  many  other 
points  which  might  be  brought  out,  but  as 
foodstuffs  are  better  than  drugs,  I  will  retire 
in  favor  of  Dr.  Burroughs. 


"Papa,"  said  little  Johnny,  "they're  not 
in  'it.'  "  "What  are  not  in  it,  my  boy?" 
"Why,  the  other  twenty-four  letters  of  the 
alphabet." 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


General  Infection   by  the  Diplococcus  In- 
tracellulars in  an  Infant. 

P>y  John  Zahorsky,  M.D.,  Assistant  to  the  Chair 
of  Pediatrics,  Missouri  Medical  College; 
House  Physician  to  the  Bethesda 
Foundling-  Home. 

The  report  of  a  case  of  septicaemia  due  to 
the  diplococcus  intra-cellularis  by  Gwyn 
(Phil.  Med.  Jour.,  Vol.  2,  No.  24)  recalls 
a  similar  case  in  an  infant  that  occurred  in 
the  Bethesda  Foundling  Home  of  St.  Louis 
in  August,  1897. 

The  patient  was  a  boy  15  months  old. 
He  had  been  an  inmate  of  the  Home  since 
his  first  month.  Several  times  during  his 
early  months  he  suffered  from  gastro-enteric 
infection.  At  seven  months  he  showed 
very  evident  signs  of  rickets.  He  had  been 
fed  on  cendensed  milk.  This  improved 
under  treatment.  In  March,  1897,  he  passed 
through  a  severe  attack  of  pleuro-pneumo- 
nia.  After  this  he  gained  in  weight  and 
became  a  fine  looking  baby. 

On  June  nth  he  received  a  heat-stroke. 
His  temperature  at  that  time  rose  to  108 
deg.  F.  Under  cold  baths  and  stimulation 
he  recovered.  Considerable  anaemia  fol- 
lowed. Since  the  early  spring  of  1897,11c 
had  a  suppurative  otitis  media.  This  im- 
proved under  treatment,  but  had  not  entirely 
subsided  when  he  developed  acute  lepto- 
meningitis. It  seems  possible  that  the  in- 
fection extended  along  the  auditory  nerve 
to  the  brain. 

Sept.  2,  1898. — Infant  has  high  fever. 
After  a  careful  examination  no  cause  for  it 
could  be  discovered.   Prescribed  pilocarpine. 

Sept.  3. — Fever  continues  persistently  at 
105  deg.  to  107  deg.  Stools  slightly  offen- 
sive. Infant  with  this  hyperpyrexia  is  very 
bright  and  playful.  Takes  food  readily  and 
does  not  seem  very  sick.  Excessive  pulsa- 
tion of  the  anterior  fontanelle  is  noticed. 
The  blood  examination  shows  a  hyperlen- 
cocytosis. 

Sept.  4. — Patient  takes  less  food.  Vom- 
ited several  times.  The  anterior  fontanelle 
is  bulging,  and  exhibits  a  strong  pulsation. 
Ice  bag  to  the  head  and  iodides. 

Sept.  ^,  9  a.  m. — Anterior  fontanelle  very 
tense,  foul  stools  ;  used  enteroclysis.  Pulse 
rapid,  regular.  Vomited  several  times. 
Dullness  over  left  lung. 

6  p.  m. — Infant  has  been  stupid  all  the 
afternoon.  Has  twitching  of  right  side. 
Constipation.  Urine  passed  freely.  The 
existence  of  right  hemiplegia  easily  made 
out.  Extremities  are  cold.  Slightly  mot- 
tled skin.  Temperature  103  deg.  ;  pulse 
112,  and  irregular;  respiration  irregular, 
almost    Cheyne-stokes.      Right    pupil    very 


much  dilated ;  left  contracted.  Paralysis 
of  right  ocular  muscles.  Left  eye  more 
prominent,  veins  distended  (suspect  sinus 
thrombosis).  Coronal  and  saggital  sutures 
are  wide  open.  Clonic  spasms  of  right  foot. 
Hyperesthesia  of  the  skin.  Dullness  over 
right  lower  lobe  of  lung  increased. 

Sept.  6,  10  a.  m. — Coma,  absence  of  all 
reflexes — even  corneal — rigidity  of  extrem- 
ities and  trunk,  more  marked  on  right  side. 
Had  one  general  convulsion  during  the 
night.  No  petechias  or  blood  extravasa- 
tions found.  Large  peliomata  of  skin. 
Death  by  apncea  ;  respiration  ceased  several 
seconds  before  heart  stopped. 

The  post-mortem  examination,  a  few 
hours  after  death,  revealed  the  typical  pic- 
ture of  a  meningo-encephalitis.  Namely, 
enormous  congestion  of  the  pia,  and  arach- 
noid and  an  intimate  adhesion  of  the  pia  in 
places  to  the  brain  substance.  The  cerebro- 
spinal fluid  very  much  increased  and  milky 
in  appearance.  The  soft  membranes  of 
spinal  cord  to  the  second  dorsal  vertebra, 
also  very  much  inflamed.  The  whole  cere- 
bral meninges  covered  by  a  yellowish  fibrino- 
purulent  exudate.  The  encephalitis  was 
most  marked  over  the  motor  area  of  the  left 
hemisphere.  Here  existed  a  very  intimate 
adhesion  of  soft  membranes  and  brain,  and 
the  latter  was  very  much  softened.  Marked 
congestion  of  dura  over  the  region  of  the 
middle  meningeal  artery  was  noticed. 

The  exudate  was  found  at  the  base  of  the 
brain  and  under  the  tentorium,  covering  the 
pia  on  the  superior  vermiform  body  of  the 
cerebellum. 

The  right  motor  oculi  and  patheticus 
showed  marked  neuritis.  The  tegmen  tym- 
pani  was  not  perforated,  but  on  the  left  side 
a  marked  auditory  neuritis  was  present. 
The  cochlea  and  semi-circular  canals  were 
infiltrated  with  pus.  Thrombosis  of  the 
left  lateral  sinus  also  existed. 

The  pleural  cavities  contained  consider- 
able fluid.  Extensive  adhesions  were  pre- 
sent on  the  right  side  due  to  the  previous 
pleuro-pneumonia.  The  lung  exhibited 
marked  congestion  of  lower  lobes  and  con- 
siderable ojdema.  Heart  large,  no  pericar- 
ditis. Valves  of  heart  reddened  but  not 
thickened.  Thymus  gland  was  normal. 
Liver  looks  pale,  spleen  normal.  Intestine 
distended  with  gas  and  contains  foul,  faecal 
matter.  The  lymph  follicles  of  large  and 
small  intestine  were  infiltrated  and  swollen. 
The  bladder  was  distended  with  urine. 
Kidneys  congested. 

Cultures  were  made  from  the  cerebral  ex- 
udate, from  the  congested  lungs,  and  from 
the  blood  and  kidneys.  From  each  of  these 
sources  pure  cultures  of  the  diplococcus  intra- 
cellularis  meningitidis  were  obtained.      Evi- 


THE  CHARLOTTE.  MEDICAL  JOURNAL. 


321 


dently  in  this  case  a  septicaemia  due  to  this 
micro-organism  existed  some  time  before 
death.  The  pneumonic  congestion,  which 
resembled  very  much  the  first  stage  of  croup- 
ous pneumonia,  was  probably  due  to  a  local- 
ization of  the  meningococcus. 

In  conclusion,  allow  me  to  point  out  that 
a  very  high  fever,  occurring  suddenly,  and 
not  producing  in  an  infant  signs  of  prostra- 
tion and  malaise  points  to  meningitis.  This 
symptom  occurs  in  nearly  half  the  cases  of 
acute  leptomeningitis.  It  is  due,  no  doubt, 
to  a  disturbance  of  the  heat  regulation 
without  toxaemia.  I  have  found  this  sign  a 
valuable  aid  in  the  early  diagnosis  of  men- 
ingitis. 

1635  S.  Grand  Ave. 


Differential    Diagnosis  of  Diphtheria   from 
Membranous    Croup. 

By  T.  T.  Ferree,  M.  IX.  Asheboro,  N.  C. 

I  am  aware  that  the  identity  or  duality 
of  croup  and  diphtheria  is  still  a  mooted 
one.  Excellent  authorities  differ  on  this 
subject. 

Bishop  says  "Both  diseases  affect  the  mu- 
cous membrant-  with  the  result  of  producing 
a  false  membrane.  Both  diseases  attack 
Hit-  same  organ — the  larynx.  Both  obstruct 
respiration.  In  these  three  particulars 
there  is  a  close  similarity  in  the  two  dis- 
eases, but  the  author  is  not  prepared  to  ad- 
mit their  identity.''  We  live  in  an  age  of 
progressive  thought ;  the  watchword  is  "go 
forward,"  and  the  science  of  medicine  is 
making  strides  to-day  that  astonish  the  out- 
side world.  I  believe  that  the  healing  art 
is  just  in  its  infancy.  The  physician  who 
thinks  he  knows  it  all,  and  no  more  for  him 
to  "learn,  will  soon  be  relegated  to  the  things 
of  the  past.  As  I  wish  to  come  right  down 
to  facts  and  be  thoroughly  understood  in 
regard  to  the  position  I  take  relative  to  the 
differential  diagnosis  of  the  two  mentioned 
troubles  of  which  I  speak  in  this  article,  I 
ask,  What  is   diphtheria? 

Hughes  defines  it  to  be  "an  acute,  specific 
constitutional  disease,  both  epidemic  and 
contagious,  beginning  by  an  affection  of  the 
throat  characterized  by  a  local  exudation 
and  glandular  enlargements,  attended  with 
fever,  great  prostration  of  the  vital  powers 
and  albuminuria,  and  having  for  its  sequelae 
various  paralyses." 

Holt  say6,  "Diphtheria  may  be  defined 
as  an  acute,  specific,  communicable  disease, 
due  to  the  bacillus  of  Klebs  and  Lceffler. 
It  is  usually  characterized  by  the  formation 
of  a  false  membrane  upon  certain  mucous 
membranes,  especially  those  of  the  tonsils, 
pharynx,    nose,  or  larynx."     I  think  these 


two  authorities  make  the  subject  sufficiently 
plain,  and  further  effort  to  define  the 
troubles  would  be  unnecessary.  What  is 
membranous  croup — true  croup,  or  croup- 
ous laryngitis? 

Hughes  says,  "An  acute  inflammation  of 
the  mucous  membrane  of  the  larynx,  at- 
tended with  the  exudation  of  a  tough  secre- 
tion— the  false  membrane,  and  the  occur- 
rence of  spasm  of  the  glottis  ;  characterized 
by  febrile  reaction,  frequent  ringing  cough, 
dyspnoea  with  loud  inspiratory  sound,  and 
altered  or  extinct  voice,  showing  a  strong 
tendency  toward  death  by  asphyxia.', 

Bishop  says,  "Croup  is  an  inflammation 
of  the  mucous  membrane,  mostly  confined 
to  that  part  of  the  larynx  superior  to  the 
vocal  bands,  but  it  may  extend  to  the  tra- 
chea. It  is  attended  with  the  formation  of 
an  exudate,  or  inflammatory  lymph,  that  is 
deposited  in  the  form  of  a  fibrous  mem- 
brane on  the  epiglottis,  the  ventricular 
bands,  and  to  a  greater  or  less  extent  upon 
the  vocal  chords." 

I  wish  to  arrange  the  points  of  differen- 
tiation in  a  way  that  they  may  be  seen  at  a 
glance.  The  points  of  difference  which  I 
wish  to  exhibit  are  given  by  Hughes  : 

Membranous  Croup. — A  local  disease. 
Begins  in  trachea  and  extends  up.  Exuda- 
tion never  cutaneous.  No  pain  in  swallow- 
ing. No  swelling  of  sub-maxillary  and 
lymphatic  glands.  Cough  always  present, 
and  often  reduced  to  a  mere  whistle  with 
peculiar  metallic  ring.  Not  traceable  to  local 
drainage;  seldom  occurs  in  adults  ;  neither 
contagious  nor  infectious.  A  sthenic  dis- 
ease ;  membrane  does  not  extend  to  nares. 
No  symptoms  of  septicemia.  No  albumin- 
uria. Neither  attended  with,  nor  followed 
by  paralysis.  Death  seldom  caused  by  syn- 
cope. Death  due  to  suffocation.  Absence 
of  specific  germ. 

Diphtheria. — A  constitutional  disease. 
Begins  at  tonsils  and  extends  down.  Exu- 
dation often  cutaneous.  Often  severe  pain 
in  swallowing.  Swelling  of  sub-maxillary 
and  lymphatic  glands.  Seldom  much  cough 
and  then  only  hoarse.  Often  traceable  to 
local  drainage ;  often  occurs  in  adults. 
Both  contagious  and  infectious,  both  before 
and  after  death.  An  asthenic  disease,  often 
extends  to  nares  and  many  other  parts. 
Septicemia  generally  present.  Albumin- 
uria frequent.  Paralysis  not  uncommon. 
Death  from  syncope  common.  Death  fre- 
quently results  from  other  causes.  Presence 
of  the  Klebs-Lceffler  bacillus. 

If  the  points  of  differentiation  of  the  two 
diseases  referred  to  in  this  article  can  be 
relied  upon,  then  the  dual  nature  of  the  two 
troubles  can  readily  be  seen.  Since  1887  I 
have    had  more  or  less  to  do  with    diphthe- 


322 


THE  CHARLOTTE  MEDICAL  JOURNAL 


ria,  from  the  very  mildest  to  the  most  des- 
perate cases,  but  I  thank  God  I  have  never 
lost  or  had  to  die  a  single  case  under  my 
treatment  yet. 

I  have  had  four  cases  of  membranous 
croup,  and  I  am  sorry  to  say  that  three. of 
the  cases  died.  A  case  of  membranous 
or  true  croup  once  seen  will  never  be  for- 
gotten by  an  observing  mind.  I  want  to 
emphasize  the  fact  that  while  diphtheria  is 
both  highly  contagious  and  infectious,  both 
before  and  after  death,  membranous  croup 
is  neither  contagious  nor  infectious.  Three 
of  my  cases  of  croup  were  in  families 
where  there  were  several  children,  but  none 
of  them  ever  contracted  the  disease.  One 
of  the  patients  I  had  to  die  was  a  very 
bright  little  girl.  A  favorite  of  all  who 
knew  her.  At  the  funeral  she  was  kissed 
by  quite  a  number  of  children,  but  no 
trouble  ever  followed. 

It  is  remarkable  how  the  strength  of  a 
child  suffering  from  membranous  croup 
will  keep  up  ;  fhere  is  not  that  amount  of 
depression  of  the  vital  powers  that  is  seen 
so  soon  in  diphtheria.  I  have  seen  the  lit- 
tle patient  not  five  minutes  before  death 
walk  from  father  to  mother  with  uplifted 
hands  as  if  to  beg  for  breath.  They  die 
purely  suffocated. 

I  am  so  much  interested  in  the  investi- 
gation of  these  desperate  throat  troubles 
that  rush  so  many  thousands  of  our  bright 
little  folks  into  untimely  graves  that  I  am 
tempted  to  prolong  this  article  further,  but 
I  will  desist  at  present  with  the  hope  that 
abler  pens  will  take  up  the  subject  and  give 
the  medical  profession  the  benefits  of  their 
experience.  Owing  to  the  length  of  this 
article  I  will  not  suggest  any  line  of  treat- 
ment, but  may,  in  the  near  future,  offer 
something  along  that  line  should  this  paper 
steer  clear  of  the  waste  basket. 


Membranous  Croup  (so  called)  and    Diph- 
theria.* 

By  I.  A.  McSwain,  M.  D.,  Paris,  Tenn. 

The  term  membranous  croup  is  mislead- 
ing, and  by  modern  writers  is  used  only  as 
a  synonim  for  diphtheric  laryngitis. 

True  there  may  be  formations  of  false 
membrane  in  the  larynx  in  which  the  spe- 
cific infection  of  diphtheria  is  not  found, 
and  the  same  may  be  said  of  such  forma- 
tion in  the  fauces  or  on  the  tonsils. 

To  such  non-infectious  formations  of  false 
membrane    the    term     pseudo-diphtheria  is 


*  Abstract  of  a  paper  read  before  the  Tri-State 
Medical  Association  of  Arkansas,  Mississippi 
and  Tennessee. 


given.  It  may  be  said  that  such  exuda- 
tions are  of  infrequent  occurrence,  except 
in  scarlatina  and  measles,  or  possibly  in  an 
exceptional  case  of  acute  inflammation  of 
the  mucosa. 

In  all  such  cases  the  streptococcus  is  usu- 
ally the  cause  of  the  trouble. 

It  is  now  well  understood  that  the  Klebs- 
Loeffler  bacillus  is  the  cause  of  true  diph- 
theria and  that  an  exudate  in  which  this 
bacillus  is  found  is  diphtheritic,  whether  its 
locality  be  the  fauces,  tonsils,  nasal  cavities 
or  larynx,  the  difference  being  not  in  the 
nature  of  the  disease,  but  in  the  clinical 
picture,  and  this  is  due  solely  to  the  func- 
tions of  the  organ,  or  the  character  of  the 
tissues  involved,  and  the  medical  man  who 
would  undertake  to  say  that  when  an  exu- 
date forms  in  the  fhroat  which  is  visible  to 
the  eye  it  is  diphtheritic,  but  when  symp- 
toms of  laryngeal  obstruction  manifest  them- 
selves that  the  disease  is  membranous  croup 
and  not  diphtheria,  involves  himself  in  a 
hopeless  tangle  and  is  liable  to  commit 
gross  errors  in  the  management  of  the  case. 
The  more  so  from  the  fact  that  notwith- 
standing the  greatly  improved  methods  of 
diagnosis,  a  large  majority  of  practitioners 
must  depend  on  a  clinical  examination  in 
the  treatment  of  these  cases — and  the  dis- 
tinction above  mentioned  between  croup 
and  diphtheria  should  now  be  regarded  as 
an  approbrium  in  medicine — for  its  most 
natural  sequence  will  be  a  large  fatality  in 
so-called  croupous  cases,  because  of  a  fail- 
ure or  neglect  to  use  anti-diphtheritic  treat- 
ment. 

SOURCES    OK     INFECTION. 

The  old  and  oft  repeated  declaration  that 
the  patient  has  had  no  opportunity  to 
"catch"  the  disease,  and,  therefore,  cannot 
have  diphtheria,  has  often  resulted  most 
disastrously  to  the  patient  and  the  public, 
and  the  physician  must  not  let  such  state- 
ments bias  his  opinion. 

This  is  an  age  in  which  nothing  is  taken 
for  granted,  and  no  physician  should  feel 
content  in  his  diagnosis  until  he  has  ex- 
hausted all  resources  for  confirming  it. 

The  bacillus  of  diphtheria  is  known  to 
be  long  lived,  and  attaches  itself  to  all  sorts 
of  fabrics — clothing,  books,  furniture,  wall 
paper,  the  upholstered  seats  of  railway 
coaches,  and  many  other  things  may  be- 
come carriers  of  the  infection,  and  thus  it 
may  be  transmitted  over  long  distances,  and 
after  the  lapse  of  much  time,  and  no  one 
may  be  able  to  trace  the  origin  of  the  dis- 
ease. Cats,  dogs,  and  other  domestic  ani- 
mals, may  be  a  means  of  transmission,  and 
perhaps  such  animals  do  themselves  con- 
tract the  disease. 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


32:! 


In  all  suspected  cases  a  bacteriological 
diagnosis  should,  if  possible,  be  had.  Not 
every  doctor  owns  or  can  use  a  microscope, 
but  if  at  all  convenient  a  specimen  of  the 
deposit  or  sputa  from  the  throat  should  be 
collected  and  sent  at  once  to  some  one 
familiar  with  the  instrument  and  capable  of 
bacteriological  examinations. 

Proper  isolation  of  cases  and  treatment, 
however,  should  >iol  be  delayed  by  waiting 
to  learn  the  results  of  such  an  examination, 
but  should  be  instituted  at  oi/cc. 

This  is  a  disease  in  which  delays  are  ruin- 
ous ;  and  as  it  is  impossible  for  the  clini- 
cian, in  the  absence  of  the  microscope,  to 
state  positively  whether  a  given  case  is  or 
is  not  specific,  that  is,  that  the  bacillus  of 
diphtheria  is  or  is  not  present,  is  it  not  bet- 
ter to  treat  all  cases  of  well  defined  mem- 
branous format  ions  on  the  mucosa  as  though 
they  were  diphtheritic  until  proven  to  the 
contrary? 

The  same  may  be  said  of  croup  cases,  that 
do  not  yield  Lo  ordinary  remedies  in  a  short 
time. 

Just  here  is  a  source  of  error  and  a  fatal 
one  to  many  a  bright  eyed  child  and  a  blight 
to  many  a  home. 

Cases  are  every  day  being  pronounced 
croup.  Ordinary  remedies  and  a  favorable 
prognosis  is  given,  and  two  days  afterward 
they  are  dead. 

A  croup  that  does  not  yield  to  an  emetic, 
and  a  few  doses  of  coal  oil,  and  a  purgative 
dose  of  calomel,  should  be  strongly  suspect- 
ed as  a  case  of  laryngeal  diphtheria,  and  lie 
t reated  at  such. 

IK  KATMKNT. 

It  would  appear  to  many  of  us  scarcely 
necessary  to  refer  to  the  treatment  of  this 
disease;  for  by  this  time  the  efficacy  of 
antitoxin  should  be  known  every  where, 
and  be  in  common  use  by  all;  yet  all  over 
the  country,  especially  in  the  rural  districts, 
children  are  dying  by  the  score  who  might 
have  l>een  saved  by  the  timely  recognition 
of  the  disease  and  the  prompt  use  of  the 
remedy.  Aside  from  the  use  of  antitoxin 
in  the  treatment  of  diphtheria,  we  have 
little  lo  say  and  but  little  consolation  to 
offer. 

Hut  by  its  early  use  in  full  doses  a  fright- 
ful mortality  of  a  dread  disease  has  been 
reduced  from  about  56  per  cent,  to  about  12 
per  cent,  of  cases,  and  if  used  the  first  day 
of  the  disease  to   about  4  per  ce.it.  of  cases. 

These  statements,  though  bold,  are  con- 
firmed by  the  best  authorities,  and  abun- 
dantly sustained  by  those  whose  experience 
are  entitled  to  full  credit. 

The  writer  begs  pardon  for  referring  to 
his  own  observation.      For  four  years  he  has 


not  lost  a  single  case  of  diphtheria  or  mem- 
branous croup  (so-called),  and  has  used 
antitoxin  in  every  one. 

To  sum  up  the  contents  of  this  paper  : 

1st.  Diphtheria  and  membranous  croup 
should  be  regarded  as  identical. 

2d.  A  membranous  formation  is  some- 
times seen  in  which  the  bacillus  of  diph- 
theria is  absent,  and  hence  called  pseudo- 
diphtheria. 

3d.  The  only  way  to  differentiate  between 
the  two  is  by  a  bacteriological  examination. 

4th.  Delays  in  isolation  and  treatment 
should  not  be  made  pending  a  bacteriologi- 
cal diagnosis. 

5th.  Croup  that  does  not  yield  in  a  reason- 
able time  to  simple  treatment  should  be  sus- 
pected and  treated  as  diphtheritic  laryngitis. 

6th.  Antitoxin  is  the  rational,  scientific 
and  indispensable  remedy  in  the  treatment 
of  these  allied  conditions. 

yth.  It  should  be  administered  earlv  and 
in  full  doses. 

8th.  We  would  not  be  understood  as 
utterly  ignoring  all  other  treatment,  for 
many  agents  are  useful  as  adjuvants,  but 
this  paper  has  reached  its  limitations,  and 
its  purpose  has  been  to  emphasize  a  few 
points  only. 

The  Prophylaxis  of  Ophthalmia  Neona- 
torium. 

By  Harriel  E.  Garrison,  M.  D.,  Dixon.    Illinois. 

To  prevent  disease  is  now  the  study  of 
every  intelligent  physician.  But,  if  he  fails 
in  preventing  the  disease,  then  his  aim  is 
to  limit  its  ravages  to  the  least  possible 
amount  of  damage.  That  this  may  be  done 
our  scientists  are  placing  every  organ  and 
secretions  of  the  body,  in  health  as  well  as 
disease,  under  powerful  microscopical  ex- 
amination for  germs,  both  malignant  and 
beneficial.  But  we  have  long  since  learned 
that  it  is  useless  to  find  the  disease  produc- 
ing germ  unless,  as  a  means,  to  compass 
its  ultimate  destruction.  Even  the  scientist 
receives  no  reward  but  renown,  and  some- 
times a  martyr's  grave,  as  have  the  searchers 
after  the  germs  of  the  bubonic  plague  in 
Vienna. 

The  question  of  germs  being  well  on  the 
way  of  thorough  investigation,  it  now  re- 
mains to  continue  the  investigation  for 
means  to  destroy  the  power  of  the  malig- 
nant germ  without  imperiling  the  tissue  in 
which  it  is  harbored. 

For  several  years  I  have,  in  my  obstetri- 
cal practice,  been  looking  for  some  meant 
to  destroy  the  germ  which  is  fraught  with 
so  much  misery  to  both  patient  and  friends 


:vi-i 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


as  that  which  produces  ophthalmia  neona- 
torium.  Whether  the  germ  be  the  gono- 
coccus,  or  of  non-specific  origin,  the  results 
of  its  ravages  are  very  direful. 

All  the  treatments  outlined  in  the  text- 
books seem  unnecessarily  severe,  unless  we 
are  sure  of  a  malignant  source  of  contagion  ; 
and  none  can  be  more  malignant  than  the 
fresh  gonococcus  ;  and  I  am  not  sure  but  a 
very  strong  salt  solution  may  be  destruc- 
tive to  this  germ.  My  observations  have 
not  given  me  an  opportunity  to  make  a 
thorough  test. 

After  using  an  application,  while  an  in- 
terne in  the  Hospital  for  Women  and 
Children  in  Chicago,  similar  to  Crede's 
silver  nitrate,  my  mothers  made  such  stren- 
uous objections  that  I  gave  it  up  in  private 
practice  and  only  saw  to  the  eyes  being 
washed  out  with  clean  warm  water. 

After  a  trial  of  various  applications  I 
found  that,  where  there  was  any  symptoms 
of  conjunctivitis  during  the  first  week  after 
birth,  a  solution  of  salt,  chloride  of  sodium, 
as  warm  as  could  be  used  without  injury  to 
the  eye,  and  used  thoroughly,  would  relieve 
all  inflammation.  Then,  as  it  was  no  more 
trouble  to  apply  the  salt  solution  than  clear 
water,  I  began  to  use  it  as  a  prophylaxis. 
In  the  five  years  in  which  I  have  practiced 
washing  out  the  eyes  of  every  new  born 
babe  among  my  clientele  with  this  solution 
I  have  never  had  a  case  of  ophthalmia 
neonatorium,  where  I  have  taken  plenty  of 
time  and  care  in  making  the  application. 
Occasionally,  where  the  cleansing  has  been 
done  hurriedly,  there  has  appeared  a  little 
serous  effusion  on  the  edges  of  the  lids  ;  but 
under  a  thorough  repetition  of  the  salt  solu- 
tion it  would  speedily  disappear. 

My  method  of  procedure  is  to  take  boiled 
water  in  a  teacup,  add  a  teaspoonful  of 
table  salt  while  scalding  hot,  then  set  it  to 
cool,  while  I  get  the  child  ready.  The  babe 
has  had  its  first  bath,  as  the  water  in  which 
it  is  bathed  may  find  its  way  into  the  eyes 
carrying  along  diseased  germs.  If  the  room 
is  not  very  warm  it  is  dressed  before  the 
eyes  are  cleansed.  The  babe  is  placed  across 
the  knees,  a  thick  folded  napkin  under  the 
head.  If  I  am  intending  to  irrigate  the 
right  eye,  I  place  the  child  upon  the  left 
side,  pour  in  the  water  at  the  outer  canthus 
and  it  will  flood  the  eye  and  pass  out  at  the 
inner  canthus.  If  the  lids  are  much  swollen 
or  the  eyes  are  kept  persistently  closed,  I 
gently  part  the  lids,  using  as  little  force  as 
possible,  as  the  more  force  used  the  more  the 
child  will  resent  and  draw  the  lids  more 
closely  over  the  eyeballs,  and  thus  prevent 
the  solution  from  reaching  the  angles  of  the 
conjunctiva,  unless  the  lids  are  completely 
everted.      If  possible  I  try  to  pour  the  solu- 


tion from  a  teaspoon  into  the  eye  while  the 
child  is  gazing  around.  Of  course,  the  eyes 
will  be  closed  at  the  first  douche,  but  if  the 
pouring  has  been  gently  done  it  will  soon 
re-open  the  eyes. 

If  the  eyelids  are  very  oedematous  from 
pressure  on  the  head  during  delivery  the 
conjunctiva  of  the  lids  will  be  bright  red 
from  passive  congestion.  This  redness  will 
disappear  as  spoonful  after  spoonful  of  the 
salt  solution  is  poured  into  the  eye. 

Never  hurry  matters.  This  is  one  of  the 
occasions  when  time  and  patience  should 
conquer. 

After  the  solution  has  cooled  to  the  tem- 
perature where  the  eye  will  not  be  injured 
by  the  heat  quickly  and  gently  dash  it  into 
the  eye.  After  using  a  spoonful  wait  until 
the  child  again  opens  its  eyes. 

I  have  found  this  method  of  treatment 
simple  and  preventative  ;  requiring  nothing 
but  painstaking  care  on  the  part  of  the  phy- 
sician, and  not  objectionable  to  the  mother 
as,  when  properly  done,  the  child  but  feebly 
resists. 


Questions  and  Observations  on  Pernicious 

Malaria,   or    Hemorrhagic    Malaria, 

Hemorrhagic     Fever,    Yellow 

('hills,  Yellow  Disease.f 

By   E.  T.   Dickinson,   M.  D.,    Smithfield,    N.  C. 

I  am  best  acquainted  with  the  type  which 
I  think  should  be  known  as  yellow  disease, 
since  the  chill  is  slight,  and  is  no  ill  omen 
in  itself.  What  is  the  nature  of  this  con- 
dition, what  the  real  cause  and  its  source? 
The  usual  definition  is  :  "It  is  remittent  fe- 
ver of  peculiar  type,  characterized  by  sud- 
den jaundice  and  bloody  urine. ' '  Its  spread 
has  been  so  recent  and  its  occurence  so  lim- 
ited to  certain  localities  that  adequate  in- 
vestigation and  literature  have  not  accumu- 
lated. All  admit  its  close  relation  to  ordi- 
nary intermittent  and  remittent  malaria ; 
but  where  lies  the  great  difference — one 
being  so  malignant  and  the  other  so  benign  ? 
Is  the  difference  one  of  degree  or  one  of 
kind?  Why  hematogenous  jaundice  in  the 
one  and  hepatogenous  jaundice  in  the  other? 

From  the  total  number  of  eighteen  cases 
coming  under  my  observation  and  care  I 
have  been  unable  to  obtain  a  history  of  a 
single  case  that  had  suffered  previous  ill 
health  or  a  succession  of  chills.  Indeed  the 
general  history  is  that  they  were  unusually 
well.  So  it  would  seem  that  it  cannot  be 
a  gradual  accumulation  and   multiplication 

tRead  before  the  Seaboard  Medical  Society 
at  Wilson,  N.  C. 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


325 


of  the  different  types  of  malarial  poisoning 
in  the  system  which  finally  explodes  with 
one  mighty  shock,  overpowering  the  ener- 
gies battling  against  it,  and  decomposing 
the  blood  with  its  electric  force.  It  cannot 
be  distinguished  in -the  beginning  from  an 
ordinary  chill  nor  can  it  be  differentiated 
until   the   icterus   of    the   skin  takes   place. 

Many  cases  of  hematuria  occur  with  and 
after  chills,  that  are  in  no  sense  hazardous, 
and  really  make  but  little  impression  on  the 
system,  nor  does  the  hematuria  return,  even 
without  the  aid  of  quinine.  I  have  seen  no 
case  prove  fatal  or  serious,  except  those  in 
which  the  hematogenous  jaundice  occurred, 
but  no  case  in  which  this  jaundice  appeared 
has  proved  otherwise  than  fatal,  or  very  se- 
rious, and  made  a  very  slow  and  doubtful 
recovery,  requiring  several  weeks  to  regain 
even  ordinary  health.  But  unless  the  phy- 
sician is  more  honest  than  is  often  to  his 
credit  he  will  forget  conscience  and  report 
all  cases  of  any  jaundice,  with  or  following 
chill  and  hematuria  as  one  of  pernicious 
malaria,  on  which  his  apt  remedies  have 
bad  the  happy  effect   desired. 

To  one  who  has  seen  a  case  of  yellow 
disease  from  begining  to  end  can  there  be 
any  doubt  as  to  differentiation  of  this  jaun- 
dice from  that  accompanying  the  milder 
forms  of  malaria?  1  think  not.  The  former 
is  too  plain  for  comfort.  The  difference  is 
that  in  milder  malaria  there  is  ;i  gradual 
development  of  hepatogenous  jaundice,  this 
development  extending  over  several  hours, 
The  discoloration  always  being  obscure  and 
dingy,  there  being  great  contrast  between 
the  hue  of  the  conjunctiva  of  the  eve  ami 
that  of  the  general  skin.  Hut  in  the  per- 
nicious form  the  jaundice  is  hematogenous, 
due  to  destruction  of  the  red  blood  corpus- 
cles, and  it  develops  very  rapidly,  usually 
appearing  almosl  suddenly  about  two  or 
three  hours  after  the  chill,  ami  the  discolor- 
ation gives  to  the  skin  a  peculiar  metallic 
luster  very  much  resembling  that  of  gold, 
yet  not  altogether  so  vivid.  This  one  dis- 
crimination properly  made  will  enable  any 
one  with  ease  to  diagnose  this  disease,  or 
certainly  to  differentiate  it  from  the  milder 
malaria. 

But  other  important  symptoms  are  a  rapid, 
weak  and  often  flickering  pulse,  usually 
reaching  as  high  as  160  pulsations  per  min- 
ute, extreme,  incessant  and  distressing  nau- 
sea and  vomiting,  a  tendency  to  dry  skin 
and  mucous  membrane  with  not  very  fre- 
quently an  extremely  high  temperature,  the 
majority  of  cases  presenting  a  temperature 
between  102  and  [03  degrees,  which  per- 
sists without  fluctuation  except  slight  morn- 
ing and  evening  remissions  and  exacerba- 
tions.     How  shall    we    prevent    the    occur- 


rence and  spread  of  this  dreaded  disease? 
This  is  a  question  of  momentous  importance. 
This  disease  has  been  spreading  rapidly 
during  the  last  five  years,  and  as  yet  we 
know  nothing  practically  of  its  source. 
But  we  look  for  and  believe  it  to  be,  where 
least  preventable — in  the  low,  swampy  and 
marshy  bottoms,  and  that  it  is  transmitted 
to  us  through  the  atmosphere  at  night. 
This,  however,  needs   proof. 

Two  observations  I  note  as  peculiar  : — 
1st,  Smithfield  is  situated  on  the  East  bank 
of  Neuse  river,  and  contains  more  inhabit- 
ants than  the  zone  of  country  with  a  radius 
of  two  miles  around  it.  There  have  occur- 
red in  this  zone  in  the  last  three  years  more 
than  twenty  well  authenticated  cases  of  this 
disease,  and  many  more  of  simple  hema- 
turia. But  in  the  town  there  has  not  been 
one  case,  and  so  far  as  I  know  not  even  one 
case  of  hematuria.  2d.  In  this  zone  the 
white  and  the  colored  population  are  about 
equal,  yet  all  the  pernicious  misfortunes 
have  visited  the  whites,  not  one  the  colored, 
though  I  have  seen  three  cases  of  slight 
hematuria  in  this  race.  Is  the  negro  im- 
mune from  this  disease?  Then  his  serum 
may  yet  prove  useful  in  a  higher  science 
than  "Manlyan"  politics. 

How  can  we  best  treat  the  disease?  I 
believe  as  nearly  an  iron-clad  rule  can  be 
adopted  in  this  disease  as  in  any  we  know, 
though  there  are  many  points  of  individual 
difference.  Of  chief  importance  is  to  avoid 
those  remedies  that  are  sure  to  kill.  These 
four  things — morphine,  atropine,  heroic 
purging  and  heroic  cinchonizing — I  have 
learned  to  avoid  as  I  do  a  grave-yard. 
Vet  I  believe  every  text-book  I  have  exam- 
ined recommends  the  first  of  this  list. 
Morphine  or  atropine  given  for  restlessness 
and  nausea  only  increases  both  and  paralyzes 
the  secretion  of  all  glands,  the  kidneys  in- 
cluded. A  gentle,  sure,  purgative  is  effi- 
cient and  demanded.  But  too  heroic  pur- 
ging with  the  vain  hope  of  removing  the 
jaundice^,  misjudged  to  originate  from  the 
liver,  serves  only  to  further  exhaust  the  al- 
ready much  depressed  vitality,  and  thus 
knocks  its  last  leg  from  under  it.  Quinine 
in  sufficient  doses  to  kill  an  entire  family  in 
perfect  health,  I  believe,  is  capable  of  pro- 
ducing more  deaths  than  the  disease  itself, 
unassisted. 

What  are  the  conditions  that  must  be  re- 
lieved? After  arranging  to  get  surely  into 
the  circulation  15  grains  of  muriate  of  qui- 
nine every  twelve  or  six  hours  only  two  im- 
portant conditions  are  to  be  met,  and  these 
successfully  combatted  and  patient  tided 
over  twenty-four  hours  one  may  feel  com- 
fortable for  the  first  time.  These  are  nau- 
sea and  anemia. 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


Nausea  may  almost  always  be  relieved  by 
avoiding  morphine  and  giving  3i  or  3 i i  of 
Pot.  Bromid  every  3  or  4  hours  or  20  or  30 
grs.  of  Lithium  Bromid  equally  often. 
Also,  these  are  all  that  is  necessacy  for  the 
restlessness.  The  anaemia  and  decomposed 
blood  I  believe  to  be  the  real  cause  of  all 
the  deaths.  This  is  as  true  exsanguination 
as  that  from  a  spurting  artery.  Then  what 
is  to  be  done?  Two  conditions  are  to  be 
met.  A  new  circulating  medium  is  to  be 
supplied  and  the  debris  of  decomposed 
blood  removed.  The  circulation  might  be 
supplied  by  intravenous  transfusion  but  I 
have  never  done  it.  I  have  used  instead 
large  subcutaneous  injections  of  saline  solu- 
tion into  the  cellular  tissues,  and  large  sa- 
line injections  per  rectum.  I  thought  this 
to  do  much  good,  though  one  case  proved 
fatal  in  which  it  was  used,  but  I  believe  it 
greatly  prolonged  life  in  this.  In  all  cases 
the  pulse  grew  slower  and  stronger,  thirst 
was  established  and  nausea  succumbed  to 
its  demands,  and  the  kidneys  secreted  more 
freely.  How  renovate  the  blood?  Give  no 
remedy  to  check  hematuria,  as  it  is  only  de- 
composed blood  that  nature  is  relieving 
herself  of.  The  object  is  rather  to  encour- 
age this  free  flow  of  bloody  urine.  It  is 
seldom  a  case  dies  if  the  kidneys  are  doing 
their  duty  well. 

Other  symptoms  are  to  be  relieved  as  the 
indications  demand.  If  fever  is  high,  skin 
dry  and  hot.  or  liver  at  fault,  these  must 
have  attention.  As  an  all  round  remedy 
for  these  conditions,  and  also  to  keep  the 
kidneys  active  two  grains  each  of  acetanilid 
and  caffeine  citrate  and  four  grains  each  of 
salicylate  of  soda  and  ammonium  bromide, 
all  in  one  powder  or  capsule  every  two  or 
three  hours  I  give  with  satisfactory  effect. 
On  the  above  outlined  plan  of  diagnosis 
and  treatment  my  mortality  rate  has  been 
33i  Per  cenL 

Report  of  Three  Cases. 

By  B.  H.  Hale,  York  Station,  Ala. 

In  asking  for  space  in  the  columns  of 
this  Journal,  I  feel  that  I  am  facing  the 
criticism  of  those  whose  experience  and 
position  in  the  ranks  of  the  profession  place 
them  as  criterions  whom  the  lesser  practi- 
tioners may  do  well  to  emulate.  But,  not- 
withstanding this,  the  doctor  who  expects 
to  establish  himself  in  the  community  in 
which  lie  locates,  and  command  the  respect 
of  the  profession  and  laity,  must  of  neces- 
sity possess  two  qualifications.  His  firm- 
ness and  positive  declarations  must  be 
founded  upon  a  thorough  knowledge  of  that 
which  he  treats,  and  this  must  be  shown  in 


a  manner  that  will  impress  it  upon  the 
minds  of  those  with  whom  he  comes  in 
contact. 

His  assertions  must  have  as  a  basis  com- 
mon sense  in  connection  with  this  knowl- 
edge from  his  text-books.  Equipped  with 
these  as  his  armamentarium  he  goes  forth 
to  battle  against  the  thousands  of  isms 
which  always  confront  the  country  practi- 
tioner, and  found  in  battle  array  at  the  bed- 
side of  every  patient  ;  but  he  wins,  and 
crowns  his  efforts  with  victory.  This  may 
be  strange  reading  to  city  physicians,  though 
every  country  doctor  knows  these  from  ex- 
perience. 

With  this  prelude  I  will  proceed  to  give 
my  experience  in  the  treatment  of  three 
cases  as  follows  : 

A  child  seventeen  months,  of  a  scrofu- 
lous diathesis,  suffering  from  acute  catarrh, 
was  taken  with  severe  rhinitis,  together 
with  pharyngo-tonsilitis  fever  aggravated 
by  a  malarial  influence,  which  altogether 
seemed  to  be  one  of  those  cases  that  give 
the  physician  so  much  annoyance.  Treat- 
ment was  by  inunction  and  local  applica- 
tions, with  enema  on  account  of  continued 
and  excessive  nausea  and  vomiting,  which 
came  near  producing  convulsions  with  each 
attempt.  It  also  caused  great  thirst,  and 
water  was  the  one  word  uttered. 

By  local  application  of  sulph.  iron  and 
cocaine,  and  followed  at  once  with  glyco- 
thymoline  i3,  water  iii 3 ,  which  was  eagerly 
taken.  vShe  was  allowed  to  take  nothing 
else.  The  swelling  of  the  glands  was  so 
great  as  to  render  deglutition  difficult  was 
why  the  iron  and  cocaine  was  used.  After 
a  few  hours  the  vomiting  ceased,  the  in- 
flammation subsided,  and  in  36  hours  the 
child  was  well.  Had  I  used  the  last  treat- 
ment at  my  first  visit  could  have  saved  more 
than  a  day's  intense  suffering. 

A  case  of  erysipelas  from  an  ingrowing 
toe  nail  of  a  maiden  lady  about  40  years, 
which  had  extended  over  the  entire  foot  up 
to  the  ankle ;  swollen  out  of  shape,  and 
that  intense  burning  incident  to  all  cases  of 
this  character.  Her  foot  gave  such  pain  as 
to  cause  her  to  cry  out  in  anguish,  claiming 
that  amputation  was  preferable  to  such  suf- 
fering. I  applied  glyco-thymoline  to  every 
part  of  inflamed  surface,  then  wrapped  with 
an  old  linen  cloth  of  four  thicknesses  that 
had  been  saturated  in  the  solution  of  glyco- 
thymolinc,  bandaging  all  so  as  to  exclude 
the  air.  Almost  immediately  a  sensation 
of  coolness,  followed  by  a  cessation  of  pain, 
was  experienced,  which  continued,  only  a 
few  more  applications  being  necessary  to 
effect  a  radical  cure. 

The  last  and  most  marvelous  case  was 
that  of     in    unmarried    lady,  middle    aged, 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


327 


and  a  seamstress  by  occupation,  troubled 
with  hemorrhoids.  The  nodules  were  large 
and  legion  ;  were  both  external  and  inter- 
nal, and  aggravated  at  her  menstrual  period 
until  she  was  confined  to  bed  during  these 
days.  She  had  been  operated  upon  some- 
time previously,  but  with  only  temporary 
relief.  She  had  used  nostrums  without 
number,  though  none  had  given  any  ease. 
.She  was  bitter  on  her  "lot  in  life,"  as  she 
termed  the  complaint,  and  had  no  faith  in 
my  treatment  for  it.  She  only  called  me 
for  ease  while  in  bed.  I  put  her  on  tonic 
laxatives,  and  local  applications  of  glyco- 
thymoline  and  hot  water,  equal  parts.  It 
acted  like  a  charm,  the  throbbing  pain  got 
easier,  the  inflammation  subsided,  and  she 
is,  as  she  expresses  it,  entirely  a  new  per- 
son. The  treatment  was  ordered  continued 
until  satisfied  its  further  use  was  unneces- 
sary; also,  to  use  the  glyco-thymoline  with 
two  parts  of  water,  injected  into  the  bowel 
and  retained.  Her  weight  lias  increased, 
her  complexion  improved,  and  the  once 
lugging  step  is  now  elastic.  Not  only  does 
she  tell  that  she  is  well,  but  every  move- 
ment indicates  hers  a  complete  cure. 

While  the  manufacturers  do  not  claim 
more  for  it  than  an  alkaline  antiseptic,  it  is 
found  to  be  a  valuable  remedy  in  the  arma- 
mentarium of  the  physician  and  Hlls  the 
place  heretofore  reserved  for  a  number  of 
favorite  prescriptions.  Being  an  alkaline 
antiseptic  it  covers  a  broad  field  in  both 
medicine  and  surgery.  It  is  deodorizing, 
anti-phlogistic,  and  agreeable,  hence  no  ob- 
jection to  its  administration.  It  favors  re- 
solution and  fosters  cell  growth  and  thus 
materiallv  aids  in  the  repair  of  diseased 
tissue. 

I  have  used  glyco-thymoline  in  different 
strength  from  25  percent,  to  full,  owing 
altogether  to  the  condition  of  the  patient 
and  nature  of  the  case. 

We  do  not  intend  to  convey  the  idea  that 
jiyco-thymoline  is  the  only  remedy  used  in 
our  practice,  but  to  show  that  it  has  been 
effective,  and  markedly  so,  in  these,  as  well 
as  other  cases  in  which  it  has  been  Used. 


Rheumatism,    (a)   Etiology,   (b)   Pathology. 
Bj  A.  A.  Young,  M.  D.,  Newark,  N.  Y. 

(a)  The  term  rheumatism  is  a  most  con- 
venient one  for  the  physician  to  satisfy  the 
curiosity  of  him  for  whom  he  is  about  to 
prescribe,  and  isolated,  to  the  physician  at 
llu-  present  day,  the  term  means  nothing; 
it  expresses  or  conveys  no  definite  idea  of 
the  conditions  for  which  it  stands. 

To  t he  ancients  it   meant   more,    it  corre- 


sponded to  their  ideal  etiology  where  some- 
thing tangible,  presumably  some  "little 
devil"  had  entered  and  taken  possession  of 
the  body,  producing  a  twinge  here  and  a 
twinge  there  to  remind  the  sufferer  of  life's 
frailty.  To  drive  this  "devil"  out  meant 
cure  and  required  then  villainous  potations 
or  disgusting  incantations.  The  ancient 
idea  may  have  been  crude  but  it  was  pro- 
phetic of  the  future,  a  prophecv  not  vet  ful- 
filled. 

The  "little  devil"  of  yesterday  will  doubt- 
less become  the  known  specific  micro-or- 
ganism of  to-morrow  ;  the  indicator  points 
that  way,  and  when  that  day  shall  come 
our  etiological  idea  may  be  revolutionized. 
The  conclusion  has  nearly,  if  not  quite  been 
reached,  that  there  is  a  rheumatoid  bacillus,  ' 
but  the  fully  developed  rheumatoid  bacillus 
is  one  thing  and  the  developing  bacillus,  the 
manifestations  of  which  are  termed  rheuma- 
tism, is  quite  another.  A  clear  conception 
of  the  etiology  of  rheumatism  can  only  be 
obtained  from  a  correct  knowledge  of  the 
biology  of  this  specific  bacillus.  That  these 
bacillae  infest  the  entire  system  in  the  ac- 
tive stage  of  the  disease  seems  probable  and 
reasonable,  though  their  occular  manifesta- 
tions may  be  confined  to  one  single  joint, 
it  is  safe  to  assert  that  the  disease  is  a  con- 
stitutional one,  never  local;  the  local  mani- 
festation probably  marks  the  nidus  of  the 
fully  developed  bacillus,  where  it  deposits 
its  germinal  vessicle  which  enters  the  sys- 
tem and  completes  another  biological  cycle, 
ending  in  the  fully  developed  bacillus  again. 
On  no  other  assumption,  it  seems  to  me, 
can  the  occular  manifestations  be  explained 
which  are  so  often  bilateral  and  recurrent 
at  quite  definite  and  regular  periods  of  time, 
though  migratory  in  character.  Facts  war- 
rant the  assumption  that  rheumatism  is  the 
resultant  of  the  entering  and  developing  of 
a  pathogenic  organism  within  some  mens- 
trum  or  culture  medium  within  the  body; 
thus  we  are  forced  to  the  conclusion  that 
rheumatism  is  an  acute  specific  febrile  af- 
fection induced  by  the  presence  and  growth 
of  the  theoretical  rheumatoid  bacillus.  This 
theory  is  strengthened  by  facts,  a  few  of 
which  may  be  mentioned.  The  disease  pro- 
gresses most  rapidly  in  a  climate  moderate- 
ly cool,  but  subject  to  sudden,  frequent  and 
marked  changes,  together  with  a  moist  soil 
and  a  moist  atmosphere.  It,  too,  has  its 
seasons  of  activity  and  its  seasons  of  qui- 
escence, typical  of  the  known  diseases  in- 
duced by  pathogenic  micro-organisms.  The 
disease  has  an  epidemology,  has  its  periods 
of  severity  and  its  periods  of  mildness;  at- 
tacks one  organ  to-day  and  another  to-mor- 
row ;  to-day  it  is  virulent,  to-morrow  com- 
paratively innocent  ;    thus  in  a  marked  de- 


328 


THE  CHARLOTTE  MEDICAL   JOURNAL. 


gree  it  parallels  other  known  infectious  dis- 
eases which,  without  doubt,  are  the  result- 
ants of  the  development  of  their  respective 
micro-organisms  within  the  body  which 
they  have  invaded.  Heredity,  too,  has  its 
bearing.  It  is  a  well-known  fact  that  the 
children  of  rheumatic  parents  are  more 
likely  to  contract  rheumatism  than  are  those 
whose  ancestors  have  been  comparatively 
free  from  it.  If  our  hypothesis  of  the  bi- 
ology of  bacteria  be  true,  then  the  conclu- 
sion must  be  reached  that  the  germinal  ves- 
sicle  of  the  bacillus  is  directly  transmiss- 
ible from  parent,  especially  the  mother,  to 
the  unborn  child.  It  seems  reasonable  to 
assert  that  this  germinal  vessicle  resides  in 
and  is  transmissible  through  the  blood 
•  stream  of  the  mother  from  which  the  unborn 
child  draws  its  life  force  and  its  sustenance. 
If  the  micro-organism  itself  be  not  directly 
transmissible,  it  leaves  its  imprint  upon  the 
child's  inherited  constitution  ;  it  reduces 
the  child's  resisting  powers  and  makes  the 
entrance  of  the  bacillus  far  more  easy,  in 
later  years,  when  climate  changes  are  fa- 
vorable to  its  development.  Any  condition 
producing  enervation  may  be  a  predisposing 
element,  but  not  the  primal  cause  of  rheu- 
matism. The  rheumatoid  bacillus  must  first 
be  deposited  in  the  system  in  its  entirety, 
or  as  a  spore,  and  its  processes  of  reproduc- 
tion begun  before  rheumatism  as  a  disease 
can  exist  at  all.  The  etiology  of  this  affec- 
tion must  therefore  consist  of  a  proper  un- 
derstanding of  the  biology  of  the  rheuma- 
toid bacillus,  a  knowledge  yet  to  be  ac- 
quired. 

(b)  The  pathological  changes  which  fol- 
low in  the  wake  of  developing  rheumatoid 
bacillaj  are  numerous  and  confined  prima- 
rily to  the  blood,  secondarily  to  the  joints, 
tendons  and  tendinous  sheaths  which  be- 
come infiltrated  in  a  greater  or  less  degree 
with  the  products  of  inflammatory  action,  a 
peculiar  type  of  inflammation,  one  in  the 
wake  of  which  suppuration  or  pus-formation 
is  seldom  if  ever  seen.  That  the  blood 
stream  is  the  medium  which  carries  this 
morbific  agent  to  the  various  parts  of  the 
body,  where  it  sets  up  its  peculiar  inflam- 
matory action,  cannot  be  doubted.  It  is 
almost  as  equally  certain  that  this  morbific 
agent,  a  micro-organism,  has  its  developing 
life  within  some  constituent  of  the  blood, 
for  at  its  most  early  manifestations  blood 
changes  are  found,  the  first  of  which  may 
be  mentioned  is  the  increase  of  the  fibrin 
producing  agents,  fibrinogen  and  fibrino- 
plastin,  and  their  tendency  to  unite  and  co- 
agulate even  within  the  vitalized  life  blood 
itself. 

The  solubility  and  non-union  of  the  fibrin 
producing    elements    are  accomplished   by 


maintaining  an  alkaline  condition  of  the 
blood  through  the  chemical  influence  of  so- 
dium carbonate  and  disodic  phosphate.  The 
tendency  to  coagulation  increases  in  the 
same  proportion  as  the  blood  loses  its  alka- 
linity. I  am  aware  that  the  theory  of  an 
acid  condition  of  the  blood  in  rheumatism 
is  questioned,  a  condition  that  favors  the 
union  of  the  fibrin-producing  elements  from 
which  coagulation  readily  follows.  Though 
the  condition  of  the  blood  may  not  reach 
the  point  of  acidity,  it  approaches  it,  and 
in  this  same  ratio  is  increased  the  tendency 
of  the  fibrin  elements  to  unite  and  form 
clots,  which  may  be  "Nature's  protective 
policy;"  this,  however,  is  only  a  condition, 
a  sequelae  of  rheumatism,  and  not  its  cause  ; 
this  condition  indicates  that  there  are  mark- 
ed and  important  changes  in  the  blood  it- 
self due  to  some  active  and  independent 
agency,  whether  such  agency  be  bacteria 
or  products  of  their  growth.  Another  im- 
portant change  in  the  blood  is  a  decrease, 
sometimes  marked,  of  the  number  of  red 
corpuscles;  patients  soon  become  anaemic, 
a  condition  brought  about  by  the  destruc- 
tion of  the  corpuscles,  or  the  prevention  of 
their  development  within  the  organ  or  or- 
gans that  produce  them. 

The  former  theory  seems,  however,  the 
more  plausible,  since  that  other  known  mi- 
cro-organisms have  been  found  deposited 
within  these  corpuscles,  and  in  a  measure 
these  micro-organisms  are  alike  destructive 
of  the  functions  and  compositions  of  such 
invaded  blood  cells. 

Though  the  blood,  in  a  large  majority  of 
cases,  if  not  in  all,  appears  to  be  alkaline 
yet  it  is  allowed  that  the  amounts  of  urea 
and  uric  acid,  in  rheumatic  patients,  are  con- 
siderably above  the  normal ;  while  from 
some  unknown  cause  they  fail  to  unite,  as 
is  usual,  with  some  of  the  alkaline  elements 
within  the  same  menstrum  forming  possi- 
bly harmless  compounds  by  such  union.  It 
is  my  belief  that  the  tendency  to  formation 
of  fibrinous  clots  is  the  primary  result  of 
the  uric  acid  diathesis  which  seems  to  exist 
in  the  rheumatic  patient. 

This  infected  condition  of  the  blood  also 
produces  changes  in  the  vascular  system, 
especially  the  capillaries,  and  at  times  so 
weakens  them  as  to  allow  the  transudation 
of  the  red  corpuscles  through  them,  when 
ecchymotic  spots  appear  indicative  of  a 
hemorrhagic  diathesis,  a  diathesis  the  direct 
result  of  blood  infection. 

The  changes  of  the  urine  seem  more 
marked  and  positive,  the  urine  becomes 
high  colored,  scanty,  with  a  high  specific 
gravity,  it  is  markedly  acid  and  on  cooling 
deposits  the  amorphous  urates  and  uric  acid 
while  there  seems  to  have  been  but  little  if 


THE  CHARLOTTE'  MEDICAL  JOURNAL. 


329 


any  increase  in  the  amount  of  urea  formed. 
The  relation  existing  normally,  between 
these  elements,  has  been  distorted  and  this 
change  takes  place  not  within  the  bladder, 
the  recepticle  of  the  urine,  not  within  the 
kidney,  its  eliminator,  but  is  produced  by 
abnormal  tissue  change  dependent  upon  the 
development  of  the  rheumatoid  bacillus. 
The  abnormal  substances  must  therefore  in- 
vade the  blood  stream  producing  systemic 
poisoning  of  which  the  fever  is  an  index ; 
it  is  one  of  the  varieties  of  septicaemia  and 
as  such  it  must  be  treated.  Nor  must  the 
tendency  to  joint  involvment  be  overlooked, 
a  condition  which  is  likely  to  be  produced, 
secondarily,  from  the  primary  blood  infec- 
tion. All  of  the  tissues  surrounding  the 
joint  attacked,  is  involved.  The  synovial 
fluid  is  poured  forth  in  greater  abundance 
from  the  over-stimulated  membranes  bath- 
ing the  entire  joint,  inclusive  of  the  tendons 
and  tendinous  sheaths,  with  a  superabun- 
dance of  fluid,  but  a  fluid  which  has  chang- 
ed its  alkalinity  for  one  of  acidity  which 
fact  indicates  blood  change.  Neither  is  it 
probable  that  this  acidity  is  the  direct  cause 
of  inflammatory  action  which  soon  follows. 
The  synovial  fluid  poured  forth  in  such 
abundance  is  doubtless  a  remedial  agent,  not 
alone  lubricating  the  joints  but  serving  to 
cover  up  the  Fully  developed  bacillae  which 
have  invaded  and  make  such  joint  their 
home  and  from  which  their  offspring  may 
complete  another  cycle  when  liberated  by 
some  agency.  This  theory  seems  to  be 
borne  out  by  the  fact  of  the  great  tendency 
to  periodicity  of  rheumatism,  not  as  new 
attack,  but  as  recurrence  of  the  old  one. 

The  membranes  and  tissues  in  and  about 
the  invaded  joints  assume  greater  vascular- 
ity and  thickening. 

The  articular  surfaces  become  somewhat 
roughened  from  an  increase  of  the  cartila- 
genous  cells,  which  increase  frequently  pro- 
duces joint  distortion  from  the  large  amount 
of  deposit  due  to  inflammatory  action.  In- 
flammation as  is  well  known,  is  nature's 
way  of  eliminating  foreign  material;  with 
the  products  of  inflammation,  when  elimi- 
nation is  impossible,  she  covers  up  and  im- 
prisons within  their  nidus  the  fully  devel- 
oped rheumatoid  bacillae,  thus  if  not  de- 
stroying them,  prevents  in  a  measure,  fur- 
ther re-productive  processes.  The  occular 
manifestations  therefore,  which  we  term 
pathological  conditions,  are  but  the  sequelae 
of  germ  development  and  nature's  effort  in 
their  elimination.  Conditions  point  to 
causes  only  and  the  rational  treatment  must 
consist  in  the  elimination  of  the  cause. 

22  East  Miller  Street. 


Medicine. 

By  H.  Plummer,  M.  D  ,  Harrodsburg,  Ky. 

Medicine  is,  and  has  been,  a  necessity 
since  Adam  delved  and  Eve  spun.  It  is 
recognized  as  an  art  for  the  prevention, 
cure  and  alleviation  of  the  ills  to  which 
flesh  is  heir,  and  as  a  science  it  should  form 
a  part  of  the  common  law  of  the  land,  and 
respected  as  such.  But  when  Hiis  devoutly 
wished  for  recognition  shall  seize  and  fully 
possess  the  political  economists,  who  sit  in 
high  places  at  the  Capital  of  the  nation — 
whether  it  be  the  next  week,  or  the  next 
year,  or  whether  it  shall  be  postponed  till 
chaos  comes  again,  we  cannot  divine.  The 
profession  is  a  unit  in  the  belief  that  the 
Creation  of  a  Department  of  Public  Health, 
clothed  with  plenary  powers  and  preroga- 
tives, would  be  the  most  beneficent  and 
forceful  thing  which  could  happen  the 
American  people. 

Thus  would  the  cause  of  the  people  be 
fully  espoused  ;  protection  ensured  against 
preventable  diseases ;  money  would  be 
saved,  which  is  money  made,  and  the  pro- 
fession of  medicine  placed  in  that  category 
to  which  it  is  entitled,  and  accepted  as  a 
science  and  beneficence — an  evangalistic 
agency. 

It  is  as  plain  as  the  nose  of  Cyrano  de 
Bergerac  that  "public  safety  is  dependent 
on  the  public  health,  and  public  health  on 
capable  and  conscientious  physicians." 
Without  the  one  there  cannot  be  the  other. 
They  are  mutually  dependent.  The  diffi- 
culty, we  opine,  has  been,  and  is  now,  to 
make  the  average  legislator  cognizant  of  his 
duty,  and  to  recognize  the  fact  that  good 
would  come,  the  laws  faithfully  executed 
with  a  competent  medical  man  at  the  head 
of  affairs,  and  that  a  boon,  greater  than  ever 
would  be  conferred  upon  mankind  during 
the  conspicuous  progressive  century  draw- 
ing to  a  close.  But  up  to  date  the  idea 
hasn't  been  digested  by  our  Solons.  What 
a  blessing  is  digestion !  To  have  it  the  sun 
is  always  shining  and  the  shade  always 
ready  for  you  !  Would  we  had  the  dexterity 
to  perform  the  miracle,  courteously  would 
we  bestow  this  benefaction  ;  but  it  seems 
the  law-makers  cannot  divest  themselves 
from  the  "traveled  thoroughfare  by  paths 
leading  to  unfamiliar  pastures."  There  is 
too  much  Johnston !  The  profession  is 
upon  science  and  art,  but  is  not  familiar 
with  medical  politics,  nor  able  to  cozen  the 
powers  that  be.  However,  it  is  in  com- 
fortable convalescence,  with  its  lights  as 
well  as  its  shadows,  nor  shall  it  be  frigeten- 
ed  away  from  its  efforts  in  securing  a  Health 
Department    as  was  Peter   Pinder  from  his 


330 


THE  CHARLOTTE    MEDICAL  JOURNAL. 


profession  by  the  clinking  of  his  bell-metal 
pestle  and  mortar. 


"Appendicitis." 

By  J.  H.  Van   Eman,   M.  D.,   Kansas  City,  Mo., 

Professor  Diseases  of  Women,  Kansas  City 

Medieal   College  ;    Member  American 

Medical  Association,  etc.,  etc.,  etc. 

Gray  says  that,  "The  appendix  vermifor- 
mis  is  a  long  narrow  worm  shaped  tube, 
the  rudiment  of  the  lengthened  caecum  found 
in  all  the  mammalia  except  the  orang  outang 
and  the  wombat."  Whether  it  is  a  com- 
pound of  adenoid  tissue,  or  is  simply  a  tube 
covered  more  or  less  completely  by  perito- 
neum containing  a  middle  coat  of  circular 
and  longitudinal  fibres  with  a  sphincter  at 
its  proximal  end  and  lined  by  a  mucous 
membrane  well  supplied  with  mucous  glands 
does  not  concern  us  in  this  paper.  What 
we  do  most  certainly  know  is  that  it  is  the 
source  of  much  trouble  and  anxiety,  not 
only  to  its  unfortunate  possessor  when  it 
becomes  inflamed,  but  to  the  doctor  in 
charge  as  well.  In  size,  it  is  about  that  of 
an  ordinary  lead  pencil ;  in  length,  from 
two  to  seven  inches,  most  frequently  a  little 
less  than  three;  in  direction,  it  may  lie 
with  its  pointed  end  to  every  possible  point 
of  the  compass  even  extending  across  the 
brim  of  the  pelvis  into  the  right  illiac  fossa. 
Its  peritoneal  covering  varies  greatly,  some- 
times extending  but  a  short  distance  from 
itB  base  and  again  covering  in  even  its  apex. 
Its  blood  supply  is  derived  from  a  single 
rather  small  artery  within  the  folds  of  its 
mesentery.  The  canal  is  small  and  in  a 
very  large  proportion  the  point,  where  it 
empties  into  the  caecum,  is  the  most  con- 
tracted portion. 

In  health,  so  far  as  it  is  known,  it  con- 
tains an  amount  of  mucous  simply  sufficient 
to  hold  its  sides  apart  and  act  as  a  lubricant. 
For  clinical  purposes  all  that  portion  of  the 
large  intestines  below  the  illeo-caecal  valve 
should  be  taken  into  consideration.  The 
longitudinal  band  coming  down  the  colon 
and  caecum  ends  somewhat  abruptly  at  the 
base  of  the  appendix  and  is  the  guide  in 
finding  it  in  operative  work. 

Considering  the  caecum  and  appendix  as 
a  whole  we  find  it  then  only  partially  cov- 
ered by  peritoneum,  the  caecum  usually  ly- 
ing in  the  venter  of  the  illium  upon  the 
psoas  muscle,  and  is  connected  more  or  less 
firmly  to  it  by  rather  loose  connective  tissue, 
thus  giving  the  part  considerable  mobility. 
This  provision  enables  the  caecum  and  ap- 
pendix, as  it  were,  to  slide  out  of  the  way 
when    by  reason  of  a  fixed    abdominal  wall 


and  a  simultaneous  contraction  of  the  psoas 
and  illiacus  internus  muscles,  it  might  sus- 
tain damaging  pressure. 

We  have  the  testimony  of  Dr.  Byron 
Robinson,  of  Chicago,  and  many  others, 
that  circumscribed  peritonitis  is  an  unusual- 
ly frequent  disease,  also  that  the  corner,  so 
to  speak,  occupied  by  the  caecum  and  ap- 
pendix is  by  a  goodly  percentage  the  most 
frequent  site  of  this  inflammatory  condition. 
Statistics  show  that  fully  two-thirds  of  the 
cases  of  appendicular  inflammation  occur  in 
males.  This  is,  I  think,  a  result  of  the  in- 
creased development  of  the  psoas  and  illiacus 
muscles  in  the  male  and  their  more  active 
use,  and  the  greater  exposure  to  blows  and 
other  traumatisms  in  that  region.  I  shall 
not  go  further  into  the  etiology  at  this  time. 
Speaking  clinically,  as  before,  I  divide  ap- 
pendicitis in  three  classes  or  types  : 

Catarrhal — Acute  and  Chronic. 

Purulent  Encysted — Without  perforation 
and  with  perforation. 

Purulent  Perforated — Without  cyst. 

In  the  catarrhal  form  we  have  as  a  result 
of  irritation  of  some  kind,  an  increased  flow 
of  blood  to  the  appendix,  and  as  a  result  of 
this,  increased  glandular  activity,  owing  to 
the  small  caliber  of  the  appendix,  it  becomes 
over  distended,  and  as  a  result  there  is  mus- 
cular contraction  with  pain,  which  contin- 
ues until  the  appendix  is  emptied,  this  has 
aptly  been  called  appendicular  colic.  The 
irritation  continuing,  we  have  as  a  second 
result,  not  a  purulent  inflammation,  there 
being  as  yet  no  solution  of  continuity  per- 
mitting the  entrance  of  pus  producing 
germs,  but  an  exudate  within  the  muscular 
walls  and  extending  through  and  involving 
the  peritoneum.  With  the  organization  of 
this  plastic  exudate,  we  have  a  greatly 
thickened  appendix,  and  find  it  firmly  bout 
down  to  the  surrounding  tissues.  This  pro- 
cess may  go  on,  i.  e.,  exudation  and  organ- 
ization, until  the  lumin  of  the  tube  is  ob- 
literated, thus  effecting  a  cure.  This  might 
be  called  the  medical  form,  as  in  a  very 
large  majority  of  cases  this  form  of  appen- 
dicitis can  be  cured  by  rest  in  bed,  under 
opium  after  the  bowels  have  been  thorough- 
ly evacuated.  This  class  of  cases  which  re- 
quire surgical  treatment  are  those  which  by 
their  recurrence  are  very  apt  to  sooner  or 
later,  by  some  solution  of  continuity,  be- 
come purulent,  or  in  which  from  the  great 
amount  of  thickening,  or  the  firmness  and 
locality  of  the  adhesions,  produce  an  evi- 
dent tumor,  giving  pain  and  interfering 
more  or  less    with  the    patient's   avocation. 

The  symptoms  in  the  acute  catarrhal  form 
are  pain,  slight  swelling  in  region  of  ap- 
pendix, little  or  no  hardness  of  the  abdom- 
inal muscles,  constipation,  but    little  fever, 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


331 


or  hurry  of  the  pulse.  In  other  words, 
there  is  so  little  constitutional  disturbance 
that  the  condition  is  not  grave.  The  best 
time  for  operation,  when  required  in  this 
class  of  cases,  is  after  the  subsidence  of  the 
acute  attack.  In  all  other  types  there  is 
solution  of  continuity  or  at  least  a  structural 
degeneration  sufficient  to  permit  the  en- 
trance into  the  tissues  of  pyogenic  germs 
and  a  proliferation  of  pus  and  an  inflamma- 
tory condition  begins  its  course,  advancing 
in  many  cases  to  tissue  destruction,  rupture 
into  the  abdominal  cavity,  and  general  pur- 
ulent peritonitis  with  a  rapidity  both  amaz- 
ing and  deadly.  In  this  type  I  believe  an 
operation  is  always  called  for  and  the  sooner 
after  the  diagnosis  is  made  the  better. 

Whether  this  variety  of  pelvic  peritonitis 
takes  a  fairly  favorable  or  a  most  unfavor- 
ably fatal  course  depends  on  several  factors 
which  we  will  now  consider.  First,  comes 
the  peritoneal  investment  of  the  appendix, 
the  more  thoroughly  complete  its  mesentery, 
the  less  danger  of  rupture  into  the  perito- 
neal sac.  An  appendix  lying  on  the  upper 
and  outerside  of  the  caecum  is  so  far  as  po- 
sition is  concerned  most  favorable,  curled 
up  directly  in  front  comes  next,  lying  down 
along  the  inner  border  of  the  psoas  and 
pointing  into  the  pelvis  third,  and  fourthly 
pointing  upward  and  inward  the  worst. 
The  extent  and  mobility  of  the  omentum  is 
of  great  value  in  determining  the  favor- 
able course  of  an  appendicitis.  I  have 
seen  the  omentum  forming  the  inner  wall 
of  an  appendicular  abscess  too  often  to  be- 
lieve it  an  accidental  condition.  I  believe 
it  stands  like  a  faithful  sentinel  and  rushes 
to  defend  the  point  of  danger. 

A  pulse  of  115  to  120.  a  temperature  of 
101  to  102,  (some  deadly  cases  have  a  lower 
or  even  sub-normal  temperature),  an  anxious 
countenance,  a  tense  abdomen  on  the  right 
side  with  the  thigh  flexed,  continuous  pain 
and  most  marked  tenderness  at  McBurney's 
point,  with  a  well  marked  oval  swelling  in 
the  right  inguinal  region,  with  or  without 
constipated  bowels  clearly  indicates  an  en- 
cysted purulent  appendicitis,  either  with  or 
without  rupture  of  the  appendix.  This 
you  will  not  be  able  to  tell  until  after  the 
operation,  but  one  thing  you  may  be  sure  of 
and  that  is  that  the  case  is  one  for  prompt 
surgical  interference. 

In  the  last  class  of  cases,  when  by  rapid- 
ity of  ulceration  and  perforation  there  is 
an  escape  of  the  contents  of  (lie  appendix 
directly  into  the  peritoneal  cavity  in  the 
very  beginning  of  the  attack,  no  tumor  can 
be  felt,  t lie  whole  bc-lly  is  hard  and  resist- 
ing, and  all  the  deadly  constitutional  symp- 
toms mentioned  above  and  particularly  a 
feeble    and  rapid  pulse  with    cold    extremi- 


ties are  increased  an  hundred  fold.  The 
surgeon  might  well  stand  appalled  at  the 
task  before  him,  and  hesitate  if  it  were  bet- 
ter to  let  the  sufferer  die  in  peace  or  make 
the  attempt  to  save  him  with  nearly  abso- 
lute certainty  of  failure. 

In  an  amputation  we  know  almost  pre- 
cisely every  step  of  the  operation  before  us; 
in  the  operation  for  appendicitis  we  may 
have  an  operation  almost  as  simple  as  open- 
ing an  abscess  on  the  one  hand, on  the  other 
one  of  the  most  delicate  and  difficult  of  ce- 
liotomies. This  to  a  certain  extent  will  be 
illustrated  in  a  number  of  cases  which  I 
now  have  the  honor  to  report.  These  cases 
I  will  not  report  in  exactly  their  chrono- 
logical order. 

Case  i. — On  the  31st  day  of  March, 
1S95,  I  was  called  to  see  L.  C,  a  boy  of 
fifteen,  crippled  in  his  left  leg  from  child- 
hood by  infantile  paralysis.  I  found  him 
with  tense  and  tender  abdomen,  both  knees 
drawn  up,  rapid  pulse,  and  a  decided  rise 
of  temperature.  His  abdomen  was  so  sen- 
sitive I  was  unable  to  make  out  any  tumor; 
his  father  had  been  trying  to  get  his  bowels 
moved  for  four  days  and  had  failed  com- 
pletely. By  the  use  of  enemas  and  small 
doses  of  calomel  frequently  repeated,  I  suc- 
ceeded in  three  or  four  days  in  thoroughly 
evacuating  the  bowels.  His  tympanites 
gradually  disappeared,  but  the  pain,  quick 
pulse,  and  fever,  held  on  day  after  day,  the 
tenderness  was  not  at  McBurney's  point, 
but  with  the  pain  extended  across  the  lower 
part  of  the  abdomen.  About  April  20th,  a 
tumor  began  to  show  itself  in  the  left  in- 
guinal region  over  the  outerside  of  the  lower 
third  of  the  sigrnond  flexure.  On  April 
24th  I  cut  down  on  the  most  prominent 
part  of  this  swelling  and  found  that  it  laid 
behind  the  gut  which  was  bound  down  to 
it  by  strong  adhesions.  By  blunt  dissection 
I  worked  my  way  downward  and  backward 
on  the  outerside  of  the  gut  and  was  at  last 
rewarded  by  a  jet  of  stinking  pus.  I  was 
able  to  pass  a  quite  large  drainage  tube  clear 
across  the  pelvis  for  a  distance  of  seven 
inches.  The  temperature  and  pulse  went 
down  in  a  few  days  and  his  recovery  though 
slow  was  uneventful. 

Case  2. — J.  J.,  age  42.  Three  attacks 
inside  of  two  years — last  one  six  weeks  be- 
fore operation — found  a  sausage-like  tumor 
beginning  just  below  McBurney's  point  and 
extending  to  the  brim  of  the  pelvis.  Sec- 
tion made,  no  pus  found,  adhesions  broken 
up,  appendix  ligated  and  removed,  wound 
closed  without  drainage.  Patient  returned 
to  his  home  in  three  weeks  cured. 

Case  3. — March  24th,  189S,  11  -.30  p.  m., 
I  received  a  telephone  message  to  call  to 
see  a  young    man,   who    had  been  sick  for 


THE  CHARLOTTE  MEDICAL   JOURNAL. 


two  days.  This  message  was  from  the  at- 
tending physician,  who  reported  the  case 
as  an  appendicitis,  and  gave  it  as  his  opin- 
ion that  operation  should  be  made  at  once. 
On  reaching  the  patient  an  hour  later  I 
found  him  in  bed  with  his  right  knee  drawn 
up,  pulse  1 20,  temperature  103.  Bowels 
had  been  thoroughly  cleaned  out.  Pain  was 
not  great,  as  he  had  been  given  a  dose  of 
morphine  an  hour  before  to  quiet  pain. 
History. — Age  24,  single,  book-keeper. 
No  previous  attacks.  Two  and  one-half 
days  previously  had  been  awakened  in  the 
morning  about  four  o'clock  by  an  intense 
pain  in  the  illeo-cecal  region.  This  pain, 
while  moderated  by  opium  and  hot  appli- 
cations, still  continued,  but  there  was  no 
rise  of  temperature  for  more  than  24  hours. 
I  found  besides  the  dawn-up  knee  a  hard- 
ness of  the  muscles  and  tendons  in  the  right 
inguinal  region  and  also  a  small  firm  en- 
largement on  the  level  but  to  the  right  of 
McBurney's  point.  As  the  lights  were  de- 
cidedly poor  and  the  case  did  not  seem  ur- 
gent, I  decided  to  defer  the  operation  until 
daylight.  At  8  130  a.  m.,  March  25th,  the 
patient  was  anesthetized,  placed  on  an  im- 
provised table,  and  after  the  usual  cleaning 
up,  an  incision  three  and  one-half  inches 
long  was  made  over  the  most  prominent 
part  of  the  tumor  and  rather  nearer  than 
usual  to  the  illium.  After  getting  down  to 
the  muscular  layers,  they  were  separated  as 
much  as  possible  rather  than  cut.  On  get- 
ting down  to  the  caecum,  I  found  no  adhe- 
sion between  its  anterior  surface  and  the 
anterior  abdominal  walls.  After  carefully 
walling  off  the  general  peritoneal  cavity 
with  iodoform  gauze,  I  continued  my  dis- 
section, finding  the  mass  lying  to  the  right 
and  behind  the  lower  end  of  the  colon.  I 
was  compelled  to  lift  the  caecum  outside  of 
the  abdominal  wall.  I  found  the  appendix 
(unusually  short)  imbedded  in  an  exudation 
mass  containing  pus,  with  a  marked  fecal 
odor.  The  quantity  of  pus  was  not  great 
but  its  odor  was  unpleasant  to  say  the  least 
After  cleaning  out  the  wound  as  thoroughly 
as  possible,  the  appendix  was  brought  up 
ligated  with  silk,  cut  off,  cauterized  and 
dropped  back,  the  ligature  being  left  long 
and  its  end  brought  out  through  the  wound 
A  double  rubber  drainage  tube  was  intro 
duced,  the  upper  half  of  the  incision  closed 
by  deep  interrupted  sutures,  gauze  packed 
around  the  tube,  and  gauze  cotton  and  gauz 
dressings  applied  and  a  retention  bandag 
over  all.  The  temperature  remained  above 
normal  for  three  days,  going  down  gradual 
ly.  The  ligature  on  the  stump  came  away 
on  the  fourth  day  and  convalescence  was 
without  an  interruption,  and  he  returned 
to    his  home    in  Ohio    at  the  end   of    four 


weeks.  The  only  thing  in  this  case  differ- 
ent from  others  reported  is  in  the  manage- 
ment of  the  pedicle. 

Case  4. — September  30th,  1898,  9  P.  M., 
was  called  to  see  F.  D.,  a  delicate  looking 
boy  of  seven  years  and  received  the  follow- 
ing history.  Three  days  before  I  was  called 
he  ate  very  freely  of  green  walnuts,  that 
night  he  was  sick  at  the  stomach,  had  quite 
a  fever,  and  severe  collicky  pain  in  his 
bowels.  His  stools  contained  quite  an 
amount  of  undigested  walnut.  As  his  bad 
symptoms  still  continued,  they  sent  for  me. 
Found  him  lying  partly  turned  to  the  right 
side,  right  knee  drawn  up,  belly  tender  and 
tense,  tenderness  most  marked  over  McBur- 
ney's point,  some  increase  in  tension  but  no 
perceptible  tumor,  pulse  130,  teniDerature 
102,  total  loss  of  appetite,  and  much  nau- 
sea. Informed  his  friends  as  to  the  nature 
of  the  case  and  that  an  operation  would 
most  likely  be  necessary.  October  1st.,  no 
marked  change  unless  an  increase  in  the  ab- 
dominal tension.  October  2nd,  A.  M.,  un- 
der anaesthesia  could  make  out  decided  full- 
ness extending  from  the  base  of  the  caecum 
well  down  to  the  pelvic  brim,  but  would 
hardly  be  justified  in  calling  it  a  distinct 
tumor. 

On  making  section  found  no  adhesions 
between  the  caecum  and  the  abdominal  wall. 
A  coil  of  the  illeum  lay  directly  in  front  of 
the  caecum.  The  peritoneal  cavity  was  care- 
fully walled  off  with  iodoform  gauze.  Work- 
ing my  way  downward  along  the  border  of 
the  psoas  muscle,  I  found  an  abscess  con- 
taining not  more  than  two  drachms  of  pus ; 
this  was  carefully  removed,  a  double  rubber 
drainage  tube  put  to  the  bottom  of  the  cav- 
ity and  in  the  lower  angle  of  the  wound. 
Three  interrupted  through  and  through  silk 
worm  gut  sutures  were  used  to  close  the 
upper  angle  ;  gauze  was  packed  around  the 
drainage  tube  and  outer  dressings  in  the 
usual  way,  appendix  not  sought  for. 

His  fever  kept  up  for  four  or  five  days ; 
suppuration  was  very  free.  He  was  not  al- 
lowed to  sit  up  for  three  weeks  and  was  a 
little  later  dismissed  well. 

Case  5. — J.  H.,  age  15,  a  long  legged 
boy  of  very  active  habits  got  a  new  wheel 
about  the  1st  of  October.  On  this  he  rode 
many  hours  at  times  at  a  high  speed.  From 
history  he  evidently  had  suffered  with  an 
attack  of  appendicular  colic  some  six  or 
eight  months  since.  On  the  night  of  the 
5th,  he  had  severe  pain,  after  purgation  he 
felt  better.  On  the  evening  of  the  6th,  he 
was  quite  sick  with  pain  and  fever.  This 
continued  with  more  or  less  severity  until 
the  morning  of  the  8th.  During  the  previ- 
ous day  he  vomited  frequently.  When  I 
saw  him  in  consultation  with  Dr.  Hanawalt 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


333 


on  the  morning  of  the  8th  at  10  a.  m.,  he 
was  comparatively  comfortable.  Pulse  no, 
temperature  102,  bowels  thoroughly  empty, 
belly  tense  on  right  side  and  very  sensitive 
in  the  illeo-caecal  region.  At  a  point  above 
and  to  the  inner  side  of  McBurney's  point, 
an  oval  tumor  not  larger  than  a  small  hen 
egg  could  very  easily  be  made  out.  An 
operation  was  very  earnestly  advised  but 
owing  to  the  prejudices  of  the  friends 
against  the  knife,  consent  could  not  be  got- 
ten. About  1  p.  m.,  he  had  a  violent  and 
prolonged  spell  of  vomiting  during  which 
I  received  a  message  saying  I  might  oper- 
ate as  soon  as  I  wished.  Made  section  at 
5  p.  m.  No  adhesions  around  or  below  cae- 
cum ;  appendix  turned  up  over  lower  end 
of  colon  and  adherent  to  inner  border  of 
abscess  wall  formed  by  omentum.  From 
about  the  center  of  a  greatly  thickened  and 
inflammed  appendix,  a  concretion  the  size 
of  a  navy  bean  had  escaped  and  was  lying 
loose  in  the  abscess  cavity  which  con- 
tained about  one-half  an  ounce  of  pus. 
Cleaned  up  and  dressed  as  usual ;  convales- 
cence uneventful ;  cured. 

Technique. — It  goes  without  saying  that 
asepsis  should  be  as  thorough  as  in  any  other 
abdominal  work.  The  incision  through  the 
skin  and  subcutaneous  tissue  should  be 
made  with  its  center  near  McBurney's  point 
and  if  any  difference  a  little  to  the  outside 
of  the  long  axis  of  the  swelling  and  paral- 
lel to  it.  It  should  be  about  two  and  one- 
half  inches  long  in  the  beginning  and  its 
length  may  be  increased  either  at  the  lower 
or  upper  angle  as  the  exigencies  of  the  case 
may  demand.  So  far  as  may  be  possible, 
the  different  layers  of  muscles  should  be 
separated  in  the  line  of  their  muscular  fas- 
ciculi rather  than  cut.  In  young  subjects 
with  thin  abdominal  walls  this  will  be  found 
most  difficult. 

On  getting  down  to  the  peritoneum, 
darkened  and  hyperemic  from  inflammation, 
we  run  across  the  first  difficulty,  viz  :  to  say 
whether  the  tissues  directly  beneath  the 
knife  is  thickened  and  inflamed  transver- 
salis  fascia  or  whether  we  have  gone  through 
the  abdominal  peritoneum  and  the  part  we 
see  is  the  gut  itself.  If  we  pinch  up  with 
a  thumb  forcep,  a  portion  of  the  tissue  in 
the  bottom  of  the  wound  if  it  is  gut,  a  slight 
peristalsis  will  be  set  up  ;  if  it  is  not  gut  no 
movement  will  be  elicited.  If  we  are  down 
to  the  wall  of  an  abscess  there  is  something 
in  the  resciliency  of  the  mass  that  cannot 
be  expressed  in  words  that  tells  the  story 
to  the  practiced  touch.  Catch  up  a  portion 
of  the  tissue  between  two  pair  of  thumb 
forceps  careful  nick  between  and  if  you  are 
into  the  abscess  cavity  a  jet  of  pus  will  be 
thrown  out  forcibly,    usually  very  offensive 


in  odor.  The  opening  should  be  carefully 
enlarged  in  order  that  it  may  be  drained, 
any  secondary  deposits  should  be  found  and 
the  whole  cavity  drained  out  and  kept 
drained  with  gauze  or  rubber  tubes  or  both. 

No  anxious  or  persistent  effort  in  this 
kind  of  case,  viz,  with  large  abscess,  should 
be  made  to  find  and  remove  the  appendix ; 
very  little  good,  but  an  infinite  amount  of 
harm  may  be  caused  by  such  procedure. 
In  quite  a  large  proportion  of  the  cases  re- 
quiring operation  the  abscess  cavity,  owing 
to  its  size,  locality,  and  surroundings,  will 
not  be  opened  into  but  the  peritoneal  cav- 
ity instead.  When  this  occurs,  as  it  has 
with  me  in  fully  fifty  percent,  of  my  cases, 
I  carefully  wall  off  the  wound  from  the  ab- 
dominal cavity  by  pushing  in  all  around 
strips  of  iodoform  gauze  two  or  three  inches 
wide  and  sixteen  in  length.  I  then  seek 
out  the  abscess,  separate  adhesions  and  get 
up  and  bring  out  the  appendix  ligating  it 
close  up  to  the  caecum  with  cat-gut  or  silk. 
If  with  silk,  leaving  one  end  of  the  ligature 
long  and  bringing  it  out  of  the  wound.  Af- 
ter cleaning  out  the  wound,  I  close  the  up- 
per angle  one-half  or  more  of  the  wound 
with  two  or  three  deep  through  and  through 
sutures  of  silk  worm  gut. 

If  the  edges  unite  as  they  generally  do, 
much  is  gained  ;  if  they  do  not,  nothing  is 
lost.  Introducing  a  soft  rubber  drainage 
tube  in  the  lower  angle,  gauze  is  packed 
well  around  it  with  plenty  of  gauze  and 
cotton  over  dressings  and  a  retention  band- 
age over  all.  Dressings  should  be  removed 
as  soon  and  as  often  as  soiled.  Gauze  and 
tubes  for  draining  should  begin  to  be  taken 
away  by  the  third  day,  and  should  all  be 
out  by  the  end  of  the  first  week.  The  pa- 
tient should  not  be  permitted  to  get  out  of 
bed  or  stand  on  his  feet  in  ordinarily  severe 
cases  before  the  twenty-sixth  to  the  thirtieth 
day. 

After  Care. — By  "aftercare,"  I  mean 
medicinal,  dietetic  and  hygienic  treatment 
from  the  moment  the  patient  is  returned  to 
his  bed  until  full  convalescence. 

The  bed  should  be  ready  to  receive  the 
patient,  an  oil  cloth  having  been  placed  di- 
rectly under  the  sheet  for  cleanliness,  and 
hot  water  bags  or  bottles  so  arranged  as  to 
thoroughly  warm  bed  and  patient's  extrem- 
ities, but  not  burning  him  in  the  least.  Put 
patient  in  bed  keeping  head  low  so  as  not 
to  make  too  much  work  for  the  heart.  Cover 
him  well  and  keep  absolutely  quiet,  allow- 
ing none  but  attending  nurse  in  the  room. 
In  case  the  heart  action  is  weak,  rapid  and 
thready,  administer  strychnia  1-20  to  1-40 
hypodermically  according  to  age  of  pa- 
tient, to  which  may  be  added  1-100  nitro- 
glycerine and  1-150  atropia  if  required.   No 


334 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


morphine  should  be  given  owing  to  its  ef- 
fect on  the  bowels  and  if  an  opiate  is  abso- 
lutely necessary,  the  sulphate  of  codea  is 
preferable. 

The  pulse  should  be  carefully  watched 
and  strychnia  given  when  indicated.  This 
should  be  energetically  pushed  if  heart 
failure  is  evident.  It  is  time  and  labor  lost 
to  give  1-60  grain  doses  of  strychnia  every 
four  to  six  hours.  To  an  adult  give  1-20 
and  even  1-15  grain  every  half  hour  until 
the  physiological  action  is  shown  by  some 
tetanoid  movement  after  which  it  should  be 
stopped  for  four  hours — occasional  doses  of 
nitro-glycerine  (1-100)  and  atrophia(i-i5o) 
can  be  added.  Whiskey  and  digitalis  may 
be  given  hypodermically,  also  in  urgent 
need,  with  heat  to  the  extremities.  In  fact, 
heroic  measures  are  sometimes  required  and 
one  should  not  hesitate  when  there  is  every- 
thing to  gain  and  so  little  to  lose. 

In  average  cases,  however,  this  will  not 
be  necessary,  and  1-40  strychnia  every  four 
to  six  hours  will  be  all  that  is  required  and 
often  not  even  this. 

For  the  vomiting,  which  nearly  always 
follows  the  anesthetic,  there  is  nothing  re- 
quired as  a  rule  except  absolute  quiet  and  ab- 
stention from  all  fluids  and  food  for  twelve 
to  fourteen  hours.  This  sometimes  gives 
little  or  no  trouble  and  then  again  it  becomes 
a  serious  problem  in  itself,  and  may  require 
some  attention,  in  which  case  the  various 
remedies  can  be  tried — calomel  and  soda  in 
small  doses — dry  on  tongue  every  half  hour. 
Bismuth,  champagne,  etc.  Usually  this  is 
not  required. 

Upon  return  of  consciousness  the  patient's 
first  request  is  "water,"  and  this  increasing 
thirst  makes  our  first  twelve  hours  very  try- 
ing to  the  patient  and  the  nurse  as  well. 
Above  all  things  withhold  all  fluids  until 
all  nausea  and  vomiting  is  over.  In  eight 
hours,  providing  no  nausea  or  vomiting  is 
present,  water  (hot  water  at  first)  may  be 
given,  beginning  with  teaspoonful  doses 
and  repeating  in  fifteen  minutes  if  no  nau- 
sea is  provoked,  after  which  the  amount 
can  be  gradually  increased  and  cold  water 
given  instead  of  hot. 

Very  soon  after  the  operation,  an  enema 
of  one  quart  normal  salt  solution  should  be 
thrown  well  up  in  the  bowel  and  to  that 
may  be  added  a  small  quantity  of  strong 
beef  juice.  This  should  be  repeated  in  four 
to  six  hours  and  again  if  necessary.  This 
will  alleviate  the  thirst  to  some  extent  and 
also  feed  the  patient. 

Crushed  ice  is  advised  by  some,  but  I 
think  the  effect  of  the  intense  cold  on  the 
mucous  membrane  more  harmful  than  bene- 
ficial. 

During    the  twelve    hours  following  the 


operation  we  must  not  forget  the  kidneys, 
and  if  after  twelve  or  eighteen  hours  they 
have  not  acted,  the  bladder  must  be  cathe- 
terized.  The  patient  should  always  empty 
his  bladder  just  before  going  on  the  opera- 
tion table.  In  case  the  bladder  is  found 
empty,  a  diuretic  must  be  given,  this  being 
done  per  reccum,  using  either  the  infusion 
of  digatalis,  sweet  spirits  of  nitre  or  one  of 
the  other  diuretics.  Usually  no  such  active 
measures  are  necessary. 

Now,  in  eighteen  to  twenty-four  hours 
after  operation,  providing  the  patient's 
stomach  has  become  thoroughly  settled, 
must  come  up  the  question  of  nourishment. 
For  this  we  have  nothing  better  than  milk 
which  should  be  given  in  small  quantities 
at  regular  intervals,  usually  every  tour  hours. 
If  a  tablespoonful  of  plain  or  lime  water  be 
added  to  each  teacupful  of  milk,  the  ten- 
dency to  hard  coagula  in  the  alimentary  canal 
will  be  reduced  to  almost  nothing.  Butter- 
milk is  very  refreshing  to  many  patients 
and  will  give  plenty  of  nourishment.  Egg 
albumen  and  water  is  also  another  form  of 
food  which  can  be  given.  Beef  broth  or 
tea  also  another.  This  all  must  be  carefully 
given  and  results  watched,  and  the  patient 
must  have  just  as  much  as  he  will  digest 
and  assimilate  properly. 

On  the  evening  of  the  second  day  calo- 
mel should  be  given  either  in  one  mass  dose 
of  two  to  four  grains  or  in  smaller  doses  of 
1-4  grain  every  hour  for  six  to  eight  doses 
— this  being  followed  in  the  morning  by  a 
saline  unless  the  calomel  has  acted  thorough- 
ly. Now,  on  the  morning  of  the  third  day 
if  bowels  have  acted  and  kidneys  are  acting 
freely,  and  pulse  not  over  100,  with  fair  or 
good  character,  we  may  consider  the  patient 
almost  safe  even  though  we  still  have  a  lit- 
tle rise  of  temperature. 

Our  feeding  must  be  carefully  attended 
to  gradually  increasing  quantity  at  each 
feeding,  and  lengthening  intervals  between 
same,  also  gradually  getting  on  to  more  and 
more  solid  food.  Bowels  must  be  kept 
open,  moving  at  least  once  daily  by  some 
mild  cathartic  always  choosing  the  one  most 
agreeable  to  the  patient. 

If  appetite  lags  and  tongue  remains  coated 
with  a  whitish  and  offensive  coat,  a  combi- 
nation of  dilute  hydrochloric  acid,  bi-chlo- 
ride  of  mercury,  and  Fairchild's  essence  of 
pepsin  will  clean  off  tongue  and  act  also  as 
a  tonic. 

A  chill  or  repeated  chills  with  high  tem- 
perature, tense  and  tympanitic  abdomen, and 
thready  rapid  pulse  denotes  septic  petitoni- 
tis  and  should  be  treated  heroically  with 
opium  and  cardiac  stimulants,  having  first 
cleaned  out  bowels  thoroughly. 

The  surgical  care  of  the  wound  has  been 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


discussed,  but  I  will  further  add  that  in 
case  our  granulations  are  too  active, prevent- 
ing the  formation  of  epidermis  and  puffing 
up  above  the  surface,  Monsels  powder  or 
the  sub-sulphate  of  iron  dusted  over  the  sur- 
face of  the  granulation  will  in  a  short  time 
check  the  excessive  growth  and  clean  it 
away,  allowing  the  skin  to  form  perfectly. 
The  patient  should  be  kept  in  bed  for  three 
weeks  at  least  and  longer  in  some  cases. 
Too  early  getting  out  means  ventral  hernia 
in  too  many  cases. 

In  closing  I  will  say  that  careful  attention 
should  be  given  at  all  times  to  every  detail, 
and  we  must  be  constantly  on  the  alert  for 
abnormal  conditions  and  anticipate  them 
when  we  can,  and  with  this  attention  lean 
see  no  reason  why  we  cannot  discharge  a 
very  large  percentage  of  our  patients  per- 
fectly cured. 

Hemorrhoids. 

By  H.  L.  Appleton,  M.  1).,  <  iedar  Bluff,  Ala. 

In  presenting  this  article  on  hemorrhoids, 
or  piles,  I  do  not  do  so  with  the  expecta- 
tion of  advancing  anything  new,  for  it  is  a 
subject  that  has  received  a  degree  of  its 
share  from  all  sides.  The  surgeon  has  paid 
his  respects,  the  specialist  has  spent  his 
opinion.  Hemorrhoids  is  not  a  disease,  it 
is  only  a  condition  brought  about  by  causes 
produced  in  other  parts  of  the  body,  and  is 
purely  a  local  trouble,  and  should  be  re- 
garded as  such  in  the  treatment.  It  is  a 
trouble  that  is  not  effected  by  social  condi- 
tions or  personal  hygiene.  We  find  it 
among  all  classes,  from  the  peasant  to  the 
crown  ;  from  the  black  mammy  on  the  su- 
gar plantations  to  the  mothers  of  the  noble 
sons  of  great  Americans.  It  has  heretofore 
been  left  to  the  surgeon  to  treat,  and  is  con- 
sidered in  the  surgeon's  line  by  the  general 
practitioner.  There  is  nothing  that  confronts 
the  general  practitioner  so  often  as  this  one 
trouble.  Then  why  not  study  the  cause 
and  seek  to  remove  it?  This  done  and  the 
battle  is  half  over.  It  is  not  my  intention 
to  eject  all  the  profits  and  pleasures  from 
the  specialist  of  this  organ  and  place  them 
in  the  hands  of  the  general  practitioner  ;  for 
there  are  two  classes  of  cases  ;  surgical  and 
non-surgical,  or  cases  that  yield  to  treat- 
ment, while  others  have  to  be  operated  up- 
on ;  therefore  I  will  devote  my  time  to  the 
non-surgical  cases,  or  cases  that  are  amen- 
able to  medicinal  treatment,  and  to  do  this 
it  will  be  necessary  to  take  up  the  blood 
supply  of  the  parts.  The  hemorrhoidal 
veins  distributed  to  the  lower  part  of  the 
rectum  are  very  liable  to  become  dilated  and 
varicosed,  giving  rise  to  a  condition  called 


piles  or  hemorrhoids.  When  the  plexus  be- 
neath the  mucous  membrane  within  the  ex- 
ternal sphincter  is  thus  affected,  the  pile  is 
said  to  be  internal.  When  the  veins  be- 
neath the  integument  outside  the  muscles 
are  enlarged  they  are  external.  We  may 
have  the  two  conditions  in  the  same  person 
at  the  same  time.  External  piles  are  of  two 
kinds  ;  first,  a  sanguineous  tumor  ;  second,  a 
cutaneous  excrescence,  or  outgrowth.  The 
sanguineous  tumor  consists  of  a  softish  ele- 
vation of  the  skin  near  the  margin  of  the 
anus,  and  is  of  a  roundish  form,  slightly  of 
a  blue  tinge.  On  cutting  it  we  find  a  dark 
colored  coagulum  inclosed  in  a  sac  or  cyst. 
The  cutaneous  or  excrescence  form  of  exter- 
nal piles  consists  of  a  flattened  prolongation 
of  the  skin  due  to  the  hypertrophied  condi- 
tion of  the  epidermis  pappaliea  and  cuta- 
neous layers.  Internal  piles  always  pre- 
cedes external  piles,  sometimes  without  the 
patient's  knowledge;  as  external  piles  is 
generally  due  to  the  first  form  of  a  project- 
ing fold  left  after  absorption  of  the  coagu- 
lum, having  undergone  further  growth. 
Some  cases  only  have  a  broad  flat  excre- 
scence at  the  side  of  the  anus,  while  others 
have  two  on  each  side.  In  some  rare  cases 
we  may  have  them  encircling  the  entire 
anus ;  we  only  have  the  last  named  condi- 
tion in  irritating  discharges,  stricture  or  ul- 
ceration of  the  part.  Internal  piles  seldom 
attract  attention  until  they  advance  so  far 
as  to  protrude  when  at  stool.  They  then 
exhibit  a  remarkable  diversity  of  appear- 
ances, according  to  number,  size  and  condi- 
tion. The  protrusion  may  consist  only  of 
one  large  tumor,  or  it  may  consist  of  two, 
three  or  four,  but  if  only  one  protrude  it 
will  be  near  the  perineum  and  is  always  the 
case  with  women.  In  old  cases  they  are 
apt  to  be  more  numerous. 

The  aspect  of  a  pile  depends  much  upon 
the  condition,  whether  congested,  inflamed 
or  constricted  by  the  sphincter. 

^ETIOLOGY. 

Hemorrhoids  are  a  condition  of  middle 
and  advanced  age ;  they  rarely  ever  occur 
before  puberty,  and  few  people,  in  after 
life  escape  them  ;  altogether,  they  are  mostly 
found  among  patients  of  sedentary  habits. 
Piles,  though  a  common  condition  to  both 
sexes,  occur  most  frequently  in  males. 

TREATMENT. 

This  is  the  important  part,  the  one  the 
sufferer,  as  well  as  the  doctor,  is  mostly  in- 
terested in.  When  piles  are  in  the  incipi- 
ent stage  and  cause  but  little  pain  or  incon- 
venience, the  treatment  is  very  simple  :  they 
can  be  cured  by  taking  all  the  outdoor  ex- 
ercise possible,  sitting  as  little  as  possible 
on  soft  or  cushioned   chairs  as  can  be  well 


336 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


avoided  ;  attending  to  the  bowels,  by  avoid- 
ing constipation,  and  abstaining  from  all 
drinks,  such  as  wines,  beers,  whiskeys,  &c. 
Many  never  suffer  from  piles  only  after 
coming  off  of  a  spree  of  drunkenness. 

My  mode  of  treatment,  in  all  cases  where 
surgical  interference  is  not  required,  is  to 
see  to  the  bowels,  they  must  be  kept  free 
and  open  ;  for  this  purpose,  I  prefer  Ep- 
som's salts  in  large  quantities  in  a  fresh 
glass  of  well  water  on  rising  in  the  morn- 
ing. I  caution  my  patient  about  diet  and 
habits.  I  have  the  patient  eat  regular  of 
such  foods  as  have  a  tendency  to  increase 
the  peristalic  action  of  the  bowels.  I  find 
the  fruits  and  vegetables  best  adapted  for 
this.  Then  as  a  local  application,  with  a 
hard  rubber  syringe,  that  will  hold  about 
two  ounces,  with  a  nozzle  about  one  and  a 
half  inches  long,  I  inject,  with  a  gentle 
pressure,  glyco-thymoline  one  drachm,  wa- 
ter one  drachm,  three  times  a  day  and  on 
retiring,  in  Simm's  position.  I  prefer 
Kress'  preparation  of  glyco-thymoline  as  it 
has  given  the  best  satisfaction  in  my  hands. 
I  have  never  found  a  case  of  itching  or 
bleedmg  internal  piles  that  this  mode  of 
treatment  has  not  relieved  in  forty-eight 
hours. 

Where  the  bowels  are  sluggish  and  salts 
do  not  relieve,  I  use  an  asnema  of  bi-carbon- 
ate  of  soda  one  tablespoonful  in  a  quart  of 
warm  water  with  a  teaspoonful  of  glyco- 
thymoline,  have  patient  retain  this  as  long 
as  possible,  after  it  passes  off,  then  apply 
the  treatment  as  above  indicated. 


Remarkable  Case. 

By  F.  O.  Hawley,  M.  D.,  Charlotte,  N.  C. 

On  a  recent  visit  to  Marshville,  Union 
county,  N.  C,  I  met  with  a  colored  woman, 
Leanna  Kearlock,  who  is  the  mother  of  23 
children,  the  youngest  now  one  year  old. 
.She  never  had  twins — all  single  births — 
and  says  she  was  grown  before  the  late  civil 
war,  and  carried  her  pass,  which,  of  course, 
would  make  her  near  on  to  60  years  old. 
She  weighs  99  pounds ;  small  but  quick 
motioned  and  smart ;  a  washer  woman  who 
it  is  said  does  more  and  better  washing 
than  any  one  else  in  that  thriving  town  on 
the  S.  A.  L.,  and  is  said  to  have  given  birth 
to  three  children  within  eighteen  months. 
She  told  me  she  would  not  be  satisfied  until 
she  had  25  children,  and  that  she  is  as  reg- 
ular now  as  at  any  time  in  her  life  at  her 
menstrual  periods. 

Now  the  proposition  is  how  many  children 
can  a  woman  have,  and  all  single  births? 
How  old  must  she  get  before  she  stops  men- 
struating. 


Some  of  our  good  women,  who  have  been 
looking  forward  to  45  years,  hoping  that  all 
danger  to  become  pregnant  would  then 
cease,  can  stop  and  sigh. 

A  good  joke  is  told  of  this  negro,  viz.  : 
Some  time  since  there  was  an  epidemic  of 
measles  in  the  neighborhood,  and  on  being 
asked  if  any  of  her  family  were  sick  said  : 
"Yes,  19  or  20  of  the  children  are  down 
with  measles,  and  I  don't  know  whether 
the  rest  will  take  it  or  not." 

26  West  Trade  Street. 


What  to   Do  with  Strangulated    Hernia. t 

By  Clinton  B.  Herrick,  M.  D.,  of  Troy,  N.  Y., 
Lecturer  on  Clinical  Surgery,  Albany  Medical 
College;  Attending  Surgeon  to  Troy  Hospital 
and  House  of  Good  Shepherd:  Consulting 
Surgeon,  Leonard  Hospital;  Surgeon  to  D.  & 
H-  &  Fitchburg  R.  R. 

Before  entering  directly  into  the  discus- 
sion of  the  remedies  and  means  used  in  the 
treatment  of  strangulated  hernia,  I  deem  it 
wise  to  call  your  attention  afresh  to  a  few 
of  the  anatomical  relations  of  the  parts 
concerned,  as  well  as  the  condition  in  gen- 
eral. A  loop  of  intestine,  a  vital  structure, 
is  forced  out  of  its  normal  cavity  through 
an  opening,  called  the  inguinal  ring,  into  a 
canal,  the  inguinal  canal.  The  ring,  or 
opening  through  which  it  passes,  is  circular, 
or  nearly  so,  and  its  borders  are  formed  of 
stout  muscular  and  fibrous  bands,  quite  re- 
sistant and  unyielding,  while  the  inguinal 
canal  is  pouch-shaped,  its  walls  elastic  and 
soft,  capable  of  distension.  The  intestine, 
crowded  to  its  utmost,  and  squeezed  into 
small  bulk  in  passing  through  the  definitely 
formed  opening,  finds  freedom  in  the  canal 
to  unfold  itself  and  to  occupy  more  space, 
becomes  more  bulky,  thus  rendering  its  re- 
turn through  the  opening  not  liable  to  oc- 
cur of  itself.  But  an  irritation  or  other  in- 
fluence added  to  this  bulk,  has  caused  the 
muscular  ring  to  contract  upon  the  intes- 
tine to  a  degree  of  constriction  absolutely 
shutting  off  the  canal,  and  restricting  its 
contents  from  being  returned  to  its  normal 
cavity  for  the  time  being,  if  not  perma- 
nently, if  unassisted.  Now  the  effect  of 
this  strangulation  is  immediate  and  pro- 
nounced, both  locally  and  generally,  depend- 
ing somewhat  upon  the  exact  nature  and 
degree  of  the  constricting  band,  and  the 
contents  of  the  canal  at  the  time.  Aside 
from  pain  and  local  disturbance,    as    swell- 

fA  paper  read  as  a  part  of  the  discussion  on 
Strangulated  Hernia  before  the  Union  Medical 
Society  of  New  York,  Vermont  and  Massachu- 
setts. 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


337 


ing  and  tenderness,  the  sudden  closure  of  the 
intestinal  canal  and  the  cessation  of  the 
flow  of  its  contents  is  followed  by  consti- 
tutional symptoms  varying  in  degree,  but 
severe,  and  ever  growing  more  severe. 
Vomiting  and  collapse  follow,  and  eventu- 
ally death.  The  continuance  of  constric- 
tion at  the  ring  causes  venous  congestion  in 
the  extruded  part,  followed  by  exudation 
and  swelling  of  the  walls  of  the  intestine, 
which  will  go  on  to  inflammation  or  to  per- 
foration, or  to  gangrene  of  the  entire  ex- 
truded portion. 

Now  the  severity  of  this  condition  has 
been  recognized  for  ages,  and  while  many 
remedies  have  been  suggested  and  advised 
by  many,  yet  delay  in  attending  to  the  mat- 
ter of  relief  has  always  been  urged  as  dan- 
gerous. Every  strangulated  hernia,  if  not 
relieved  in  a  variable,  but  always  brief  pe- 
riod, will  almost  inevitably  cause  the  death 
of  the  patient. 

While  this  has  been  the  accepted  belief 
for  years  and  it  has  been  known  that  the 
operation  of  herniotomy,  or  the  division  of 
the  constricting  band  by  the  knife  would 
be  radical  in  relieving  the  condition,  yet 
some  conditions  and  circumstances  warrant, 
at  times,  the  use  of  other  measures  in  the 
first  instance.  Formerly,  in  the  light  of  the 
fact  that  the  operation  was  considered  seri- 
ous, it  was  in  the  list  of  "dernier  ressorts," 
at  present  the  measure,  as  a  measure,  is  not 
considered  more  than  a  minor  operation  in 
its  performance,  per  se,  yet  a  wound  is  a 
wound,  and  not  to  be  desired  when  easily 
avoided,  in  any  condition.  In  applying  any 
remedy  short  of  this  radical  operation,  some 
time  has  to  be  taken,  and  consideration 
must  be  given  this  thought  in  order  to  es- 
tablish where  and  when  such  delay,  no  mat- 
ter how  slight,  can  be  afforded.  Firstly, 
the  nature  of  the  hernia  influences  the  con- 
dition of  severity  to  a  considerable  degree. 
If  an  acute  hernia,  or  one  never  before 
present,  becomes  strangulated,  or  upon  be- 
ing so  any  hernia  assumes  an  inflamed  con- 
dition, hot,  painful,  tender,  and  all  the 
constitutional  symptoms  prominent  and 
severe,  any  delay  of  more  than  a  few  min- 
utes is  inexcusable,  and  such  a  patient's 
bedside  should  not  be  left  by  the  attending 
physician  without  the  return  of  the  hernia 
to  the  belly  be  accomplished.  In  the  her- 
nias of  long  standing,  where,  through  a 
poor  truss,  or  otherwise,  a  mass  rather  large 
and  soft  comes  down,  the  local  and  general 
symptoms  slight  and  not  progressive,  then 
delay  can  be  entertained  for  some  longer 
time,  while  the  various  measures  to  be  ad- 
vised are  being  used  for  the  reduction  of 
the  mass.  Then  in  the  old,  large  hernias, 
with  large    openings,    rarely    tightly  con- 


stricted, but  frequently  irreducible  at  first 
instance,  with  no  more  effect  upon  the  in- 
dividual than  the  inability  to  put  back  what 
they  have  always  been  able  to  do,  are  such 
cases  that  need  not  worry  one  for  the  first 
few  hours,  while  instituting  the  various 
remedies  and  procedures  short  of  operation. 
Then,  too,  the  contents  of  the  hernia, 
whether  all  intestine  or  whether  there  be 
included  with  the  loop  of  intestine  a  mass 
of  omentum,  or  it  be  entirely  of  omentum. 
The  presence  of  the  latter  acts  to  prote*  t 
the  more  vital  intestine,  and  so  mitigates 
the  severity  of  the  local  and  general  con- 
ditions, to  the  end  of  permitting  more  de- 
lay before  the  danger  line  is  reached. 

Then  to  the  remedies  :  Ages  ago,  vene- 
section, powerful  purgatives,  infusion  of 
tobacco,  emetics,  and  opium,  were  the  gen- 
eral remedies,  with  leeches,  and  hot  water, 
as  the  local.  Then  came  the  practice  of  a 
general  hot  bath  continued  to  the  point  of 
prostration,  that  the  relaxation  of  the  ring 
might  occcur  spontaneously.  This  has  been 
advocated  even  »n  latter  days.  Then  the 
hypodermic  injection  of  morphia  in  the 
neighborhood  of  the  ring,  under  the  sup- 
position that  it  would  relieve  the  spasm  : 
and  that  of  atropia,  thinking  that  would 
cause  the  ring  to  dilate,  were  measures  of 
advice.  Then  there  were  those  who  thought 
that  by  aspiration  of  the  intestine  to  with- 
draw the  gas  or  fluid  therein  contained,  or 
even  to  remove  whatever  solid  or  semi-solid 
matter  there,  would  reduce  the  size  of  the 
mass  to  a  reducible  one.  Next  came  appa- 
ratuses of  all  sorts,  mostly  pads,  or  cots  to  fit 
over  the  tumor  with  equal  pressure  held  in 
place  by  an  elastic  belt  encircling  the  body. 
Later,  ideas  went  from  hot  to  cold  appli- 
cations, and  cold  water,  cracked  ice  and  ice 
water  was  poured  upon,  and  ether  and 
freezing  mixtures  of  ammonia  or  other  salts 
was  dropped  upon,  or  trickled  upon,  the  tu- 
mor or  its  neck,  with  the  idea  of  thus  over- 
coming the  spasm  thought  there  to  exist  as 
a  cause  of  the  strangulation.  Large  ene- 
mata  to  bring  on  an  increased  peristalsis, 
and  to  empty  the  lower  bowel,  was  another 
remedy  advised.  A  posture  of  the  body 
tending  to  relax  the  abdominal  and  other 
muscles  of  the  region  by  flexing  the  legs 
upon  the  abdomen,  and  by  raising  the  en- 
tire hips  and  lower  extremities  is,  and  has 
been  advised,  usually  in  conjunction  with 
many  of  the  above  mentioned  remedies, 
believing  that  by  gravity  acting  upon  the 
abdominal  contents,  a  drawing  inwards  of 
the  extruded  parts  would  accomplish  itself 
at  the  moment  the  spasm  let  up. 

From  the  middle  ages  down  to  the  pres- 
ent, after  dilating  upon  the  various  reme- 
dies advised  by  the  observers  of  their  times, 


338 


THE  CHARLOTTE  MEDICAL  JOURNAL 


all  authors  agree  in  advising  taxis,  as  the 
next  procedure,  and  the  one  most  frequently 
necessary  to  be  applied  in  every  case,  giving 
it  as  the  performance  "par  excellence,"  and 
the  last,  short  of  operation.  Now  it  may 
be  said  right  here  that  no  man  gets  to  a  case 
of  strangulated  hernia  but  what  he  at  once 
attempts  to  relieve  the  same  by  manipula- 
tion or  taxis.  Whether  it  is  best  to  always 
do  so,  or  not,  will  be  discussed  later  on, 
but  if  he  finds  a  resistance  to  the  return  of 
the  mass  by  an  ordinary  amount  of  this 
procedure,  he  then  adopts  either  one  of  two 
plans  :  He  decides  to  operate  at  once,  or  he 
decides  that  he  will  try  one  or  another  of 
the  remedies  for  a  time  and  then  taxis  again 
before  proceeding  further,  and  he  bases  his 
lines  for  such  treatment  upon  the  history, 
kind  of  tumor,  amount  of  disturbance,  local 
and  general,  age  and  other  conditions  which 
have  been  noted  as  influencing  the  matter 
of  justifiable  delay. 

In  case  the  latter  plan  is  to  be  carried 
out,  what  shall  we  advise  him  to  use,  and  in 
what  cases?  Setting  aside  as  obsolete,  and 
only  appearing  as  history,  the  use  of  vene- 
section, purgatives,  emetics,  apparatuses, 
depressants,  and  other  too  vigorous  and 
dangerous  remedies,  we  come  to  the  hot 
bath.  This  is  applicable  to  those  cases  oc- 
curring in  robust  persons  suffering  with 
acute  hernias,  the  posture  with  elevation  of 
the  hips,  to  be  followed  directly  thereafter. 
Cold  applications  locally,  and  anodynes  in- 
ternally are  very  rational  remedies  upon 
which  to  put  our  reliance.  I  have  heard 
my  preceptor  tell  of  many  cases  of  hernia 
that  reduced  themselves  in  front  of  his  eyes, 
by  pouring  from  a  pitcher,  ice  cold  water 
directly  upon  the  tumor.  I  have  seen  her- 
nias myself  that  at  first  instance  seemed 
positively  fixed,  yet  gave  way  upon  gentle 
pressure,  after  having  been  covered  by  an 
ice  bag  for  an  hour  or  two.  Thus  teaspoon- 
ful  applications  of  ether  frequently  made,  or 
the  application  of  refrigerant  mixtures,  are 
attended  with  benefit.  Now,  no  matter 
what  remedy  is  employed,  we  can  hardly 
expect  the  mass  to  return  without  any  as- 
sistance whatever,  so  a  gentle  pressure  of 
taxis  must  be  made  at  intervals  during  the 
application  of  any  of  these  methods,  com- 
bined with  the  elevation  of  the  hips  and 
lower  extremities.  As  to  the  adaptation 
of  any  treatment  short  of  full  taxis,  or  op- 
eration, we  may  say  that  in  the  acute  or 
inflamed  hernia  no  time  is  to  be  lost  by 
using  any  of  these  methods  for  more  than 
fifteen  minutes  to  a  half  hour.  If  no  relax- 
ation occurs  after  that  time  with  cold  appli- 
cations, and  a  full  hypodermic  dose  of  mor- 
phine, proceed  further  at  once.  In  the 
next  class  of  cases  no  urgency  is  demanded, 


and  a  day  or  a  night  might  be  safely  passed 
in  adopting  any  of  the  measures  advocated, 
provided  a  close  watch  be  given  the  case 
for  further  symptoms.  In  this  particular 
let  me  remark  that  in  the  aged  we  must  ad- 
mit that  destructive  processes  are  prone  to 
make  their  way  without  much  advance  in 
the  general  symptoms  of  prostration  or  col- 
lapse, so  we  must  not  let  these  cases  get  the 
better  of  us  in  thus  masking  the  real  state 
of  affairs. 

Then  as  to  taxis  :  As  we  have  said,  this 
procedure  is  usually  taken  up  first  in  every 
case,  and  that  there  is  a  proper  way  to  do  it 
is  dilated  upon  by  the  page  in  every  text 
book.  Knowing  that  there  is  an  infolding 
or  a  duplicature  of  the  intestine,  and  its 
walls,  and  that  a  fold  is  liable  to  be  right 
in  the  very  ring,  the  first  attempt  is  that  of 
a  drawing  down,  as  if  to  extrude  more  of 
the  intestine,  but  rather  to  tend  to  unfold 
the  duplicature,  then  with  firm,  gentle  uni- 
form pressure  upon  the  entire  mass  by  the 
hand  in  the  direction  of  the  opening,  the 
fingers  are  at  work  close  to  the  borders  of 
the  ring  in  the  endeavor  to  replace  that  part 
which  has  been  the  last  to  descend,  and 
which  is  engaged  directly  in  the  ring.  With 
the  legs  flexed  and  the  hips  elevated  upon  a 
hard  pillow,  a  gentle  kneading  is  practiced 
upon  the  tumor  in  efforts  to  reduce  the  same, 
and  this  is  usually  kept  up  constantly  for  a 
matter  of  a  few  moment,  when  a  respite  is 
exercised.  Some  tumors  are  very  sensitive, 
some  patients  are  nervous  and  without 
"grit,"  and  some,  yes  many,  tumors  fail  to 
disappear  under  this  procedure,  so  far  prac- 
ticed. Then  anaesthesia  is  advised,  so  as  to 
carry  out  this  taxis  to  its  proper  extent. 
As  to  the  anaesthetic,  we  should  use  one  that 
gives  prompt  and  thorough  relaxation,  and 
there  is  none  better  than  the  "Vienna" 
mixture,  which  is  prompt,  carrying  it  to  full 
anaesthesia,  when  with  posture  and  properly 
conducted  taxis,  now  capable  of  being  car- 
ried out  freely,  a  few  moments,  not  over 
fifteen  minutes,  may  be  consumed  in  efforts 
to  reduce  the  hernia.  Failing  after  that 
lapse  of  time  may  be  regarded  as  proving 
beyond  a  reasonable  doubt  that  the  constric- 
tion is  severe  and  lasting,  and  can  only  be 
relieved  by  herniotomy. 

Here  let  me  say  that  where  measures  are 
to  be  employed  to  this  extent  do  not  other- 
wise than  have  all  preparations  made  for  the 
operation,  so  that  in  the  event  of  failure 
by  the  taxis,  the  operation  can  be  proceeded 
with  at  once,  and  without  permitting  the 
patient  to  come  out  from  under  the  influ- 
ence of  the  anaesthetic  until  the  operation 
is  completed  and  the  constriction  is  relieved. 

Now  having  described  the  procedures  of 
taxis,  and  its  adjuncts  in  anaesthesia,  are  we 


THE  CHARLOTTE  MEDICAL  JODRNAU 


:;:',!) 


ever  justified  in  employing  taxis  in  every 
case?  Let  us  see.  Has  it  any  dangers,  and 
if  so,  what?  Firstly,  the  hernia  maybe 
returned  "en  masse,"  that  is  to  say  a  por- 
tion of  the  intestine  may  be  constricted  by 
the  sac  with  which  it  has  descended,  so  that 
the  reduction  of  the  entire  mass  is  effected 
without  relieving  the  constricted  intestine. 
In  such  a  state  the  destructive  processes 
would  go  on  in  the  parts  as  if  it  were  still 
in  the  inguinal  ring,  until  sudden  collapse 
and  peritonitis  would  denote  the  fatal  cir- 
cumstance. How  is  this  to  be  delected  and 
avoided?  We  cannot  differentiate  it  as  a 
condition  other  than  strangulated  hernia, 
but  the  absence  of  the  little  gurgle  which 
always  notes  the  return  of  the  intestine 
freed  from  constriction — the  sound  of  which 
is  sweet  music  to  the  ear  of  the  surgeon — 
but  in  its  stead  a  resisting,  murmurless  re- 
turn of  the  mass,  and  at  times  a  subsequent 
sense  of  fullness  just  within  the  ring,  felt 
either  through  it  or  just  above,  through  the 
walls  of  the  abdomen,  are  suspicious  signs 
that  all  is  not  right.  A  recent  case  of  mine 
in  which  during  the  interval  of  my  being 
called,  and  my  arrival  at  the  bed  of  the  pa- 
tient, efforts  at  reduction  of  an  inguinal 
hernia  had  apparently  proved  successful. 
As  the  mass  had  returned,  and  the  patient 
was  entirely  freed  from  pain,  he  walked 
about  feeling  perfectly  well  with  no  suspi- 
cion of  trouble.  I  learned  subsequently 
that  he  developed  symptoms  of  obstruction 
the  following  day,  and  died  of  the  same 
shortly  afterward.  This  case  speaks  vol- 
umes for  the  operation  of  herniotomy, 
rather  than  any  efforts  at  all  of  taxis. 

Another  danger  is  rupture  of  the  intes- 
tine. This  may  occur  in  very  recent  cases 
through  rough  handling,  and  in  cases  hours 
or  days  old,  through  the  fact  that  destruc- 
tive processes  have  thinned  or  weakened 
the  walls  of  the  intestine  at  one  point  to  a 
degree  as  to  permit  rupture  of  the  same 
upon  very  slight  pressure.  We  have  seen 
in  one  case  that  after  but  six  hours  of  stran- 
gulation, the  intestine  was  about  to  perfo- 
rate in  many  places,  and  rupture  could  easily 
have  occurred  by  too  great  or  prolonged 
taxis.  Then,  too,  the  intestine  is  likely  to 
be  distended  with  gas  or  fluid,  or  contents, 
making  rupture  all  the  more  liable  to  be 
produced.  Many  cases  are  cited  of  perfo- 
ration through  taxis,  and  this  misfortune 
should  be  well  guarded  against. 

Then,  remembering  this,  we  should  be 
careful  about  the  procedure  in  any  case 
where  many  hours  have  elapsed,  or  where 
the  tumor  is  tense,  painful  or  tender,  nor 
should  it  be  entertained  in  any  case  where, 
from  the  general  symptoms,  as  the  vomiting 
of  fecal  matter,   septic  temperature,  and  its 


concomitants,  we  feel  assured  that  through 
the  inflammatory  changes  in  and  around  the 
hernia,  there  is  a  probability  of  perforation 
having  already  occurred.  Here  nothing 
else  could  be  thought  of  but  opening  into 
the  sac  and  dividing  the  constricting  band 
at  the  ring. 

There  is  no  question  but  what,  in  many 
cases  and  I  may  say  in  many  hands,  herni- 
otomy is  far  safer  than  any  other  procedure 
for  the  reduction  of  a  strangulated  hernia. 
Always  a  matter  of  some  doubt  as  to  the 
exact  length  of  time  a  hernia  has  been  stran- 
gulated, the  variance  of  individuals  as  to 
their  resistant  powers,  relating  to  the  con- 
dition on  the  extruded  portion,  the  fact  that 
reduction,  no  matter  how  easily  accom- 
plished, of  a  part  of  intestine  in  imminent 
danger  of  perforation,  will  be  followed  by 
such  with  consequent  disaster;  compared 
with  the  relative  simplicity  of  the  operation 
of  herniotomy,  under  the  details  of  this 
surgical  age,  the  permissibility  of  inspec- 
tion of  the  constricted  portion  in  order  to 
be  sure  of  the  propriety  of  returning  the 
same  into  the  peritoneal  cavity,  and  lastly, 
and  by  far  a  very  important  consideration, 
that  in  the  one  operation  a  radical  cure  of 
the  hernia  through  a  proper  closure  of  the 
ring  and  sac,  can  be  accomplished,  places  the 
operation,  in  my  mind,  to  be  preferred  in 
all  cases  where  strangulation  has  actually 
existed. 

To  review,  then,  in  answer  to  the  triple 
question  assigned  me,  I  would  advise  as 
local  measures  for  strangulated  hernia,  the 
use  of  cold  water,  or  the  ice  bag,  and  a 
hypodermic  injection  of  |  gr.  of  morphine 
sulphate.  Secondly,  that  postural  treat- 
ment is  advisable  in  conjunction  with  the 
above,  and  taxis  should  never  be  given  any 
special  time  whatever,  and,  Thirdly,  that 
taxis  sufficient  to  overcome  the  strangula- 
tion is  at  all  times  fraught  with  danger  ; 
that  it  should,  in  nearly  every  case,  be  asso- 
ciated with  posture  and  anaesthesia  ;  that  in 
no  case  should  it  be  prolonged  for  a  longer 
time  than  fifteen  minutes;  and  in  cases 
down  for  more  than  six  hours  it  should  not 
be  attempted  without  the  greatest  care  ;  and 
finally,  that  it  should  give  way  to  herni- 
otomy in  the  majority  of  cases. 

In  conclusion,  the  procedure  I  have 
adopted  in  these  cases,  and  which  has 
given  greatest  satisfaction  is  as  follows  : — 
Diagnosing  the  case,  if  acute,  tender,  in- 
flamed, and  fulminate,  I  apply  an  ice  bag, 
and  give  £th  grain  morphine  hypodermic- 
ally,  while  I  proceed  at  once  to  prepare  for 
operation.  This  taking,  perhaps,  a  half 
hour,  I  again  examine  the  case.  If  unsuc- 
cessful, after  two  or  three  minutes,  I  anaes- 
thetise the  patient,  and  with  posture  make 


340 


THE  CHARLOTTE   MEDICAL  JOURNAL. 


another  attempt  to  reduce  the  hernia  by 
gentle  taxis. 

If  unsuccessful,  I  proceed  to  operate,  and 
relieve  the  constriction,  examine  the  ex- 
truded intestine,  if  to  be  returned,  do  so, 
and  close  the  canal,  ring,  and  tissues,  after 
the  method  of  Bassini,  in  a  radical  way. 
If  the  case  be  one  of  the  old  kind,  no  pain 
to  speak  of,  a  good  general  condition, 
bowels  have  but  recently  moved  off  (show- 
ing tonicity  of  this  tract)  I  apply  the  ice 
bag,  give  the  morphine,  and  wait  for  two 
or  three  hours  for  possible  change.  If  none, 
I  proeeed  as  in  the  above  manner. 

I  modify  this  plan  when  age  is  a  factor  in 
the  case,  and  in  old  people  I  permit  less 
delay  than  in  the  young.  A  large  number 
of  cases  seen  by  a  surgeon,  however,  are 
those  which  have  been  down  some  hours,  or 
perhaps  days,  attended  to  by  the  family 
physician,  who  has  been  applying  all  the 
usual  remedies  without  avail.  In  these  cases, 
if  the  general  constitution  will  permit, 
I  proceed  to  operate  at  once,  in  any  and  all 
varieties  of  cases. 

As  to  the  method  of  operating  and  the 
technique  of  the  same,  I  will  not  detail,  as 
the  gentlemen  to  follow  me  have  been  as- 
signed to  that  part  of  the  discussion,  and 
will  no  doubt  elaborate  upon  this  part  of 
the  procedure. 


A  Tablet's  Soliloquy. 

By  A.  L.  Russell.  M.  D.,  Midway,  Penn. 

I   am   only  a  little  tablet,   with  a  face  that  is 

smooth  and  round; 
No  fame  or  glory  have  I  sought,  but  in  virtue  I 

abound. 
My  parents  were  honored  pillulce  of  the  ancient 

U.  S.  P.  ; 
Some  say,  in  a  future  issue,  my  name  I'll  surely 

see. 
Capsule  is   a  distant  cousin,  and   cachet  is  my 

aunt, 
Pulveres  are  my  brothers  ;  good  lineage  you'll 

grant. 
Sprung   from  this   noble  family,    O,  pity,   'tis, 

how  sad, 
I'm  branded   by    the   pharmacist    as   wholely, 

hopelessly  bad. 

And  yet,  methinks,  the  doctor  will  bid  me  with 

him  stay ; 
For  medical  men  do  sometimes  doubt  things  that 

the  druggists  say. 
Into   pieces  of  pine   they've  driven   pills   that 

would  melt  in  a  fairy's  tear  ; 
And  every  one  knows  they've  harder  pushed  the 

"patents,"  year  by  year. 

I  often  note  this  pharmacist;  he's  a  very  pecu- 
liar man, 


While  nominally  the  doctor's  friend,  he  thwarts 

him  all  he  can. 
He's  ever  willing  to  "counter-prescribe,"  and 

anxious  to  "refill." 
Though  strongly  the  doctor  protests,  he's  slyly 

at  it  still. 

When  he's  out  of  a  prescribed  drug,  he  makes 
another  suit, 

So,  shamelessly,  in  secret,  he  employs  a  substi- 
tute. 

And  should  the  doctor  specify  any  certain  kind 
or  make, 

He'll  often  urge  the  patient  some  other  kind  to 
take. 

His  tinctures  are,  too  often,  from  fluid  extracts 

made ; 
In  show  case   and  in  window  the  nostrums  are 

displayed. 
Prescriptions,  when  presented,  are  very  quickly 

filled, 
But  seldom  are  compounded  quite  as  the  doctor 

willed. 

In  times  gone  by  on  ethics  quite  often  he  did 

prate, 
But  now  the  tale  of  his  decline,  though  sad,  I 

must  relate. 
He  retails  soaps  and  sponges,  likewise   cigars 

and  pop, 
His  former  professional  domicile  is  nothing  but 

a  shop. 

Each   one  of  these  shortcomings,  wherein  the 

druggists  err 
Is  a  covert  assault. on  the  doctor  ;  but  this  does 

not  deter. 
These  common  professional  piracies  are  nothing 

less  than  fraud, 
And  he  knows  it  well  when  tempted  "another 

make"  to  laud. 

The  druggists  have  their  grievances,  and  tell 

ffhe  story,  too, 
When  meeting  in  conventions,  as  druggists  are 

wont  to  do. 
They've  talked  the  matter  over  :  discussed  it  to 

an  end, 
But   it  never  has  occurred   to  them  to  offer  to 

make  amend. 

So  there's  nothing  left  for  the  doctor,  but  to  do 

as  others  do, 
And  I  think  of  making  this  move,  he  will  never 

have  cause  to  rue. 
I'm  now  no  longer  lonely,  for   all  my  kith  and 

kin, 
Have  been  ordered  by  the  doctor,  and  now  are 

safely  in. 

On  his  shelf  we  stand  in  imposing,  though  pro- 
fessional, array : 

And  both  the  doctor  and  patient  have  cause  to 
bless  the  day, 

That  the  doctor,  in  indignation,  attempted  to 
defend 

Himself  from  such  outrages;  thus  our  subject 
has  an  end. 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


341 


Treatment  of  Uterine  Diseases  in  Virgins. 

By  Oscar  S.  Brown,   Wildomar.    California. 

Every  regular  practitioner  finds  the  diag- 
nosis and  treatment  of  uterine  diseases  as 
occurring  in  virgins  to  be  particularly  an- 
noying and  unpleasant,  not  only  to  himself 
but  also  to  the  patient. 

The  physician  is  called  upon  by  a  patient 
complaining  of  irregular  or  suppressed  men- 
ses with  more  or  less  pain  at  the  periods. 
By  skillful  questioning  he  obtains  much  the 
following  history  :  Constipated  bowels,  fre- 
quent desire  to  urinate,  the  urine  has  burn- 
ing or  scalding  sensation  when  voided  and 
deposits  a  brick-dust  sediment  after  stand- 
ing a  few  hours.  Oftentimes  more  or  less 
tenderness  over  region  of  womb  and  ova- 
ries. Loss  of  appetite,  coated  tongue,  more 
or  less  headache,  sleeplessness,  increasing 
nervousness,  easily  worried  and  annoyed, 
fretful,  sometimes,  almost,  total  inability  to 
move  the  lower  limbs,  backache,  nape  ache» 
pulse  quick,  weak  irregular  and  occasional 
palpitations,  cold,  clammy  feet  and  hands, 
and  body  emitting  a  foul  smelling  perspi- 
ration. Shows  a  general  hysterical  condi- 
tion and  is  pale,  sallow,  and  is,  in  every 
way,  in  a  poorly  nourished  condition. 

The  physician  has  doubtless  ere  this  deci- 
ded that  the  patient  has  some  form  of 
uterine  disease  and  suggests  a  more  thorough 
examination.  To  this  the  patient  often 
objects,  and  very  frequently  flatly  refuses 
to  have  any  additional  examination  made, 
saying  that  unless  he  can  treat  her  without 
such  examination  that  she  will  not  be 
treated  at  all.  Now,  what  is  the  physician 
to  do?  Is  he  to  tell  the  patient  that  he  can 
not  treat  her  case  unless  he  is  allowed  to  do 
as  he  thinks  is  best?  No!  Tell  her  that 
he  could  much  more  intelligently  treat  her 
were  she  willing  to  be  examined  and  then 
to  take  such  treatment  as  he  thought  best. 
But  that  he  will  do  the  best  that  he  can  for 
her  under  the  circumstances. 

If  the  physician  be  a  close  observer  and 
a  careful  student  of  human  nature,  he  will 
by  this  time  have  gathered  many  little  items 
of  information,  of  which  he  can  make  good 
use  in  treatment.  He  must  have  as  thor- 
ough a  knowledge  as  possible  of  the  exact 
situation    and    surroundings  of  his  patient. 

He  should  first  attempt  to  correct  the  con- 
stipation by  suitable  diet,  consisting  of 
whole  wheat  bread,  ripe,  raw  and  cooked 
fruits,  cooked  vegetables,  no  tea  and  but 
little  coffee,  and  that  in  the  morning.  Thor- 
ough mastication  of  the  food,  meals  at  reg- 
ular hours  each  day.  For  a  time,  at  least, 
the  patient  can  be  greatly  benefited  by  tak- 
ing one  teaspoonful  of    phosphate  soda  in  a 


coffee-cup  of  water  just  as  hot  as  can 
be  sipped  one  half  hour  before  breakfast. 
This  clears  the  stomach  and  aids  liver  and 
bowels  to  better  act.  The  hot  water  can 
well  be  taken  before  each  meal.  Should 
the  above  not  be  sufficient  to  relieve  the 
constipation  give  a  tablet  at  bedtime  com- 
posed of  aloin,  belladonna,  strychnine  and 
cascara  sagrada  in  such  proportions  as  the 
special  case  requires.  To  this  may  be  added 
a  glycerine  suppository  in  the  morning  at  a 
regular  hour.  Also  to  require  patient  to 
attempt  to  empty  the  bowels  at  a  certain 
fixed  hour  each  day,  preferably  in  the  morn- 
ing. 

For  the  general  condition,  while  I  do  not 
believe  in  stereotyped  prescriptions,  I  can 
not  forego  mentioning  one  that  was  much 
used  by  the  late  Win.  Goodell  of  Philadel- 
phia. He  .called  it  "Mixture  of  Four  Chlo- 
rides." It  is  composed  of  corrosive  subli- 
mate, solution  chloride  arsenic,  U.  S.  P., 
tincture  chloride  iron  and  hydrochloric  acid  ; 
the  quantities  of  each  to  be  as  the  case  in- 
dicates. Many  cases  will  require  some  of 
the  above  to  be  omitted  and  others  added. 
Frequently  fluid  extract  hydrastis  combined 
with  strychnine  or  arsenic,  or  both,  will 
meet  the  requirements.  In  others  the  tinct- 
ure chloride  iron,  quinine  and  chloride  am- 
monium in  solution  are  required.  When 
there  is  a  tendency  to  chronic  malarial  poi- 
soning the  ammonia  and  arsenic  do  the 
most  good.  The  hydrastis  exerts  a  bene- 
ficial influence  on  the  stomach,  liver,  and 
at  t he  same  time  has  quite  an  influence  on 
the  uterine  condition. 

And  last,  but  certainly  of  great  import- 
ance is  a  course  of  local  treatment,  which 
the  physician  should  have  the  patient  her- 
self to  use.  Have  the  patient  to  provide 
herself  with  a  square  yard  ol  sheeting,  a 
fountain  syringe  of  large  size,  a  bed  cham- 
ber, one  having  a  rubber  outlet  to  discharge 
in  slop  jar  is  to  be  preferred.  Instruct  pa- 
tient, every  night  before  retiring,  to  use  at 
least  one  gallon  of  hot  water  as  a  vaginal 
injection. 

Have  her  to  commence  with  the  water  at 
105  degrees  F.  and  gradually  increase  the 
temperature  until  it  reaches  120  F.  It  will 
be  some  days  before  she  can  use  it  at  the 
higher  temperature.  Explain  to  her  the 
importance  of  having  the  hips  so  placed  that 
the  shoulders  will  be  lower.  The  hospital 
sheeting  is  to  protect  the  bed  and  over  it 
had  better  be  used  a  small  blanket  folded  so 
as  to  cover  the  sheeting  and  prevent  chill- 
ing of  the  body  while  using  the    injection. 

Every  third  or  fourth  evening  after  using 
the  injection  have  her  to  insert  well  up  in 
the  vagina  "a  uterine  tablet,"  made  by 
Micajah  &  Co.,  of  Warren,  Pa.     This  treat- 


342 


THE  CHARLOTTE  MEDICAL  JOURNAL 


ment  will  not  only  benefit  many  of  these 
uterine  cases  as  they  occur  in  virgins  but 
will  cure  a  large  per  cent  of  them,  and  will 
add  greatly  to  the  success  of  the  physician. 
But  to  be  effective,  the  local  treatment, 
as  outlined  above  must  be  closely  followed 
for  months.  Many  patients  are  tempted  to 
neglect  it  as  soon  as  they  feel  some  relief. 
They  would  much  rather  take  medicine  by 
the  mouth  than  to  use  the  injections.  The 
physician  should  try  to  impress  on  the  pa- 
tient the  great  importance  of  thoroughly 
carrying  out  every  detail  of  the  local  treat- 
ment for  months  to  get  the  best  results. 


Report  of    Cases  Treated  with   Paquin's 
Anti-Tubercle  Serum. 

By  J.  R.  Bridges,  M.  D.,  Kahoka,  Mo. 

Modern  treatment  for  tuberculosis,  in- 
cluding specific  and  organic  medication, 
lifts  from  the  once  gloomy  prospects  of 
those  who  have  the  seeds  of  destruction 
sown  in  their  system,  a  shadow  ;  and  instead 
a  bright  star  of  hope  sheds  its  cheering  lus- 
ter where  once  was  gloom  and  sadness. 

It  would  be  a  waste  of  time  for  me  to  at- 
tempt at  giving  the  pathological  conditions 
found  in  a  tuberculous  system,  that  is  too 
well  known  by  the  medical  profession  of 
to-day,  but  it  is  my  purpose  to  give  some 
of  the  modes  of  treatment  and  management, 
the  therapeutic  and  specific  medication,  for 
not  only  the  relief  but  absolute  cure  of  cases 
positively  known  to  have  tuberculosis  gen- 
eral and  pulmonary. 

It  is  not  true  in  this  day  and  age  of  scien- 
tific advancement  in  treating  diseases  of  the 
human  family,  that  "because  a  person  has 
consumption  death  is  sure  to  result  there- 
from ;"  cases  of  relief  and  cure  under  pro- 
per treatment  are  too  numerous  for  the  most 
skeptic  to  any  longer  doubt,  so  that  the  pro- 
gressive physician  can  surely  answer  that 
the  development  of  tuberculosis  can  be  pre- 
vented, and  when  once  the  disease  has  taken 
hold  some  cases  can  be  cured. 

In  testimony  of  this  I  here  report  a  few 
cases : 

Case  i. — Miss  R.  H.,  age  25,  no  tuber- 
culous family  history,  temperature  103  in 
afternoon,  profuse  night  sweats,  incessant 
coughing,  difficulty  in  breathing,  no  appe- 
tite. Left  lung  in  second  stage  of  tubercu- 
losis as  a  result  of  pneumonia  and  exposure 
about  one  year  previous  to  beginning  of 
treatment  for  tuberculosis. 

Commenced  the  hypodermic  injections  of 
Anti-Tubercle  Serum  (Paquin),  and  the  in 
ternal  administration  of  Beechwood  Creo- 
sote and  Cod  Liver  Oil  July  iSth,  1S97, 
with  marked  improvement  in  the  condition 
of  the  lung  and  her  general  health.      At  this 


time,  January  20th,  1899,  night  sweats 
disappeared  entirely,  fever  likewise  gone. 
Patient  feels  so  much  improved  she  says  she 
is  about  well. 

Case  2. — Miss  L.  T.,  age  28,  family  his- 
tory of  consumption,  both  lungs  in  second 
stage  of  tuberculosis,  temperature  102,  night 
sweats,  general  emaciation.  Commenced 
treatment  by  hypodermic  injections  of  Anti- 
Tubercle  Serum  (Paquin)  August  3d,  1897. 
Improvement  from  the  very  beginning  of 
treatment.  Increased  in  weight  30  pounds, 
lungs  entirely  clear.  With  the  exception 
of  a  slight  bronchitis  she  is  entirely  well. 

Case  3. — Mr.  O.  T.,  age  about  25, 
brother  of  case  No.  2,  general  tuberculosis 
effecting  especially  the  bone.  Received  a 
slight  injury  of  thumb  on  left  hand  over 
three  years  ago  resulting  in  tubercular  ne- 
croses, after  successive  amputations  of 
thumb,  hand  and  arm,  the  disease  was  ar- 
rested for  a  time,  then  commenced  in  foot. 
I  have  been  giving  him  Anti-Tubercle  Se- 
rum, alternating  with  Anti-Streptococcus 
Serum,  since  September  20th,  1897.  The 
foot  was  amputated  March  nth,  1898,  the 
stump  healed  and  patient  gained  his  normal 
health  completely.  Case  No.  1  and  No.  2 
took  nothing  but  serum. 

Case  4. — Mrs.  W.,  family  history  of  tu- 
berculosis. Contracted  severe  cold  about 
August  23d,  1897.  Tubercular  laryngitis 
developed,  also  pharyngo-mycoses.  Com- 
menced the  use  of  Anti-Tubercle  Serum 
(Paquin),  and  by  January  20th,  1898,  she 
seems  completely  cured,  all  symptoms  dis- 
appearing and  her  general  health  completely 
restored. 

In  giving  the  serum  treatment,  it  may  be 
necessary  in  some  cases  to  pay  strict  atten- 
tion to  internal  medication,  such  as  Cod 
Liver  Oil  and  Creosote,  also  nourishing 
food  and  warm  clothing,  plenty  of  out-door 
exercise  in  suitable  weather,  and  the  very 
best  hygienic  surroundings  possible.  My 
experience  with  serum  is,  that  the  dose 
should  be  increased  from  a  small  one  to  one 
large  enough  to  get  the  constitutional  effect 
which  may  be  much  less  with  some  patients 
than  others,  then  keep  them  on  it  only  for 
a  few  weeks  at  a  time  and  give  them  a  rest, 
as  during  this  period  of  rest  the  best  results 
are  often  gained. 


The  market  value  of  a  cough  was  the 
question  submitted  to  the  Birmingham 
(England)  County  Court.  A  barrister  sued 
a  railroad  company  for  fifty  pounds  for 
discomfort  suffered  by  smoking  being  allow- 
ed in  a  waiting-room  at  a  station  and  in 
non-smoking  carriages.  The  smoking  ag- 
gravated the  barrister's  throat,  and  he  was 
awarded  ten  pounds. 


THE  CHARLOTTE  MEDICAL    JOURNAL. 


343 


RLENNOSTASINE... 

(ftAsvva,  mucus j  dradis,  a  staying.) 

Stops  Secretion  of  Mucus 


Invaluable,  therefore,  in  grip,  influenzal,  laryngeal 
and  bronchial  colds  and  hay  fever. 

Relieves  an  influenzal  cold  in  a  few  hours  without 
injurious  after-effects.         ...... 


Full   literature  and  samples  on  application 


McKESSON  &  ROBBINS, 


-    NEW  YORK. 


The 


/T^hv 


New  Antiseptic 

CONTAINER 


n+t* 


is  more  than  filling  the  requirements  of  the  numerous  Surgeons  and 
Physicians  who,  for  some  time  past,  have  advised  us  to  dispense 
UNGUENTINE  in  COLLAPSIBLE  TUBES,  of  a  size  convenient 
for  pocket,  or  satchel  in  order  to  prevent  substitution  and  to  guaran- 
tee a  uniform  price.  The  demand  is  increasing  very  rapidly,  demon- 
strating that  the  range  of  usefulness  of  uxguentine  is  widely 
extended  by  means  of  this  new  thoroughly  antiseptic  container. 

One  Tube  Free 

to  introduce  Unguentine  in  the  new  package.  If  in  your  practice 
you  have  any  aggravated  case  of  inflammation,  we  earnestly  desire 
to  send  you  a  Tube,  prepaid,  with  one  of  the  large  books  "Clinical 
Reports  and  Notes."   Write  for  samples  mentioning  this  publication. 

Price,  2  oz.  Tube,  2nc.     Per  Doz.  $2.00. 

THE  NORWICH  PHARMACAL  CO., 

NORWICH,  NEW  YORK. 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


In  the  various  Anaemias  or  any  disease  char- 
acterized  by  a  depraved  condition  of  the 
blood  TRY  the 


Bone  Marrow 
Treatment 


Bone  Marrow  acts  as  a  stimulant  to  the  formative 
processes,  increases  the  production  of  hemoglobin  and 
red  corpuscles,  promotes  cell  proliferation  and  supplies 
the  new  born  cells  with  nutrition  causing  them  to 
proliferate  in  turn  and  restores  the  blood  to  the 
normal  standard. 


Armour's  Extract  of  Red  Bone 

irLctrrO  *V  represents  all  the  essential  ingredients 
of  Fresh  Bone  Marrow. 


ARMOUR  &  COMPANY, 
CHICAGO. 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


345 


THE 


Charlotte  Medical  Journal 

Editorial  Department. 


E.  C.   REGISTER,   M.  D.  J.  C.   MONTGOMERY,   M.  D. 

Editors  ami  Publishers. 

No.  :;fi  South  Tryon  Street,    -    -    -    - 
Charlotte,  N.  C. 


SUBSCRIPTION.  $2-50  PER  YEAR, 


NORTH  CAROLINA  MEDICAL  SOCIETY. 

The  Forty-sixth  Annual  Meeting  of  the 
North  Carolina  Medical  Society  will  be 
held  in  Asheville,  N.  C,  on  May  31st. 
The  Board  of  Medical  Examiners  will  meet 
on  Thursday,  May  25th,  and  will  be  in  ses- 
sion six  days.  Asheville  is  an  ideal  place 
for  a  medical  society  meeting.  We  remem- 
ber with  much  pleasure  the  cordial  welcome 
extended  us  in  1891.  Dr.  Rattle  is  Chair- 
man of  the  Committee  of  arrangements. 


COUNTER-PRESCRIBING  AND  OFFICE=DIS= 
PENSING. 

We  have  recently  received  a  communica- 
tion from  a  pharmacist,  in  the  line  of  dis- 
cussion on  a  topic  which  has  lately  been 
pushed  to  the  front  in  both  pharmacal  and 
medical  journals,  namely,  the  mutual  inva- 
sion of  territory  helongingto  these  two  pro- 
fessions. The  tenor  of  the  letter  is  an  ex- 
cuse for  the  practice  of  counter-prescribing, 
on  the  ground  of  lack  of  legitimate  business 
for  the  drug  store,  this  lack  arising  in  part 
fnom  the  growing  custom  of  physicians  of 
dispensing  their  own  drugs. 

While  we  grant  that  the  pharmacal  pro- 
fession has  probably  far  exceeded  in  num- 
bers the  demand  for  its  existence  and  must, 
therefore,  admit  the  temptation  to  add  to  a 
scanty  income  by  counter-practicing  or 
other  means,  we  believe  that  all  such  ques- 
tions must  be  settled  on  ethical  grounds  and 
that,  in  particular,  it  is  merely  dodging  an 
issue  to  attempt  to  discuss  this  question  on 
the  basis  of  fair  play  between  two  profes- 
sions. 

Counter-prescribing  is  a  criminal  offense, 
according  to  the  laws  of  almost  all  States 
and  countries.  The  time  was  when  the  spe- 
cious claim  that  every  man  should  be  free 
to  practice  medicine  as  he  would  any  other 
business,  had  to  receive  serious  attention. 
But  popular  opinion  has   long  ago  decided 


that  the  care  of  the  diseased  or  injured  hu- 
man being  is  too  important  a  matter  to  be 
left  open  to  the  choice  of  the  ignorant  and 
uninformed.  Medicine  is  still  free  to  any 
one  who  will  and  can  pass  through  certain 
reasonable  and  necessary  preliminaries  and 
this  is  as  free  as  any  equally  important  avo- 
cation ought  to  be.  Counter-prescribing  is 
wrong;  first,  because  it  is  illegal  and  every- 
one owes  an  allegiance  to  the  law  of  his 
country  even  if  he  disagrees  with  it  in  cer- 
tain particulars.  On  this  account  alone,  a 
druggist  who  claims  the  moral  right  to  pre- 
scribe over  the  counter,  is  on  the  same  plane 
as  a  man  who  excuses  himself  for  smuggling 
because  he  is,  politically,  a  free-trader,  or  as 
a  physician  who  performs  abortions  because 
he  does  not  believe  that  the  foetus  has  a 
soul. 

Moreover,  counter-prescribing  is  wrong 
because  the  druggist  is  not  supposed  to  have 
the  requisite  medical  knowledge  for  the 
treatment  of  disease.  If  he  has  that  knowl- 
edge, he  can,  without  much  trouble,  put  in 
his  time  in  nominal  attendance  at  a  medical 
college  and  receive  the  legal  right  to  prac- 
tice medicine.  But  the  druggist  who  has 
simply  studied  his  own  profession  in  a  first- 
class  college  of  pharmacy  and  who  has  gain- 
ed a  thorough  practical  knowledge  of  it,  is 
still  not  in  any  sense  fitted  to  prescribe  med- 
icine. If  a  comparison  may  be  allowed, 
we  would  say  that  he  is  not  so  competent 
to  prescribe  as  an  intelligent  trained  nurse 
whose  first  rule  of  ethics  is  non-interfer- 
ence with  the  domain  of  the  physician.  No 
discourtesy  is  meant  in  this  sweeping  state- 
ment. There  is  no  reason  why  the  drug- 
gist should  be  competent  to  act  as  a  physi- 
cian— no  more,  for  example  than  that  the 
physician  should  be  a  competent  lawyer. 
The  ability  to  prescribe,  depends  rather  on 
the  ability  to  make  a  correct  diagnosis  than 
on  familiarity  with  drugs,  and  the  art  of  di- 
agnosis depends  much  more  on  physical 
and  chemical  procedures  than  on  the  mere 
weighing  of  the  statements  of  the  patient. 
Thus  it  is  evident  that  the  excuse  usually 
offered  for  counter-prescribing  depends  on 
a  claim  of  knowledge  that  lies  entirely  with- 
out the  schedule  of  instruction  in  a  phar- 
macy school  and  equally  beyond  the  line  of 
experience  of  the  practicing  druggist. 
Moreover,  it  would  be  easy  to  cite  case  af- 
ter case  of  serious  harm  or  even  death,  due 
to  the  attempt  of  the  pharmacist  to  practice 
medicine  over  the  counter. 

The  fair-play  argument,  "If  you  give  out 
your  own  drugs,  I'm  going  to  prescribe 
over  the  counter,"  is  puerile  entirely  with- 
out justification,  legally  or  historically. 
Pharmacy  is,  in  the  nature  of  things,  simply 
a  branch  of  medicine.     The  art  of  prepar- 


346 


THE  CHARLOTTE  MEDICAL   JOURNAL. 


ing  drugs  is  worthless  except  as  it  follows 
the  knowledge  of  their  application  to  dis- 
ease. From  the  standpoint  of  the  laity — 
that  is  of  the  great  mass  of  the  populace  for 
whose  benefit  both  physician  and  pharma- 
cist exist — the  diagnosing  of  diseases,  the 
prescribing  and  preparing  and  even  the  ad- 
ministering of  the  remedy  are  all  one  pro- 
cess. A  break  in  the  series  is  justified  only 
on  grounds  of  economy  or  convenience. 
The  pharmacist  has  voluntarily  assumed  an 
incomplete  profession,  has  prepared  himself 
to  do  part  of  the  original  work  of  the  phy- 
sician and  has  no  claim  on  the  latter  except, 
as  for  the  reason  stated,  the  physician  vol- 
untarily yields  part  of  his  original  field.  No 
unfairness  is  involved  in  this  condition  of 
things.  If  the  pharmacist  wishes  to  have 
an  equal  voice  with  the  physician  in  the 
partition  of  the  work,  he  has  the  privilege 
of  graduating  in  the  medical  course,  then 
he  can  compete  with  the  latter  on  conditions 
of  perfect  equality. 

The  pharmacist  to  whom  we  allude  at  the 
beginning  of  this  article,  complains  of  the 
large  number  of  physicians  who  are  carry- 
ing their  own  drug  supplies  and,  naively 
enough,  explains  that  he  knows  this  to  be 
the  case  because  he  himself  acted  as  an 
agent  to  bring  about  just  such  a  state  of  af- 
fairs in  the  interest  of  a  wholesale  drug 
house.  It  occurs  to  us  that  the  pharmacal 
profession  should  look  to  its  own  ranks  to 
find  the  real  enemies  of  prosperity.  The  is- 
sue is  not  so  much  between  pharmacist  and 
physician  as  between  wholesale  pharmacist 
and  retail  pharmacist. 

Again,  let  us  see  how  far  the  retail  drug 
trade  has  justified  the  cession  of  the  dispens- 
ing of  medicine  to  a  sub-profession.  The 
separation  of  medical  and  pharmacal  art  is 
a  comparatively  recent  development.  It 
was  purely  voluntary  on  the  part  of  the  phy- 
sician, purely  a  matter  of  convenience,  en- 
tirely free  from  the  element  of  exchange  of 
values.  How  many  drug  stores  have  con- 
fined themselves  to  the  dispensing  of  drugs? 
How  many  have  followed  the  ordinary  ethi- 
cal guides  of  the  medical  profession?  How 
many  have  refused  to  handle  quack  medi- 
cines which  are  at  once  an  insult  and  an  in- 
jury to  the  medical  profession  and  a  dam- 
age to  the  laity  whose  welfare  has  always 
been  the  highest  aim  of  the  medical  profes- 
sion ?  In  how  many  drug  stores  is  the  pre- 
scription safe  from  promiscuous  refilling  or 
from  being  made  to  serve  as  a  model  of  a 
proprietary  preparation  ?  How  many  drug- 
gists are  there  who  do  not  put  forth  promi- 
nently— even  if  they  do  not  openly  indulge 
in  counter-prescribing — their  own  cough 
cures  and  diarrhoea  drops?  To  what  extent 
does  the  average  pharmacy  serve  the  inter- 


ests of  the  physician  in  compounding  medi- 
cines more  elegantly  and  more  cheaply  than 
he  can  obtain  them  elsewhere? 

We  doubt  if  there  are  five  cities  in  the 
United  States  in  which  a  drug  store  can  be 
found  which  represents  fairly,  the  dispens- 
ing fraction  of  the  original  medical  art  and 
profession — a  store  which  is  simply  a  pub- 
lic dispensary,  where  patent  medicines  are 
unknown  and  where  a  prescription  is  filled 
once  and  once  only,  with  conscientious  skill 
and  at  a  fair  price. 

We  do  not  mean  to  condemn  promiscu- 
ously, the  entire  pharmacal  profession  nor 
to  advocate  the  eradication  of  the  retail 
drug  trade.  But  we  would  remind  fair- 
minded  pharmacists  that  their  work  depends 
like  all  others,  on  laws  of  supply  and  de- 
mand, that  wholesale  pharmacy  places  very 
tempting  inducements  before  the  physician 
to  ignore  the  existence  of  the  retail  drug- 
gist and  that  the  physician  is  under  no  ob- 
ligation, moral  or  legal,  to  decide  matters 
in  favor  of  any  one  but  himself  and  his  pa- 
tient. There  are  some  physicians,  not 
amounting  to  a  large  percentage  of  the  med- 
ical profession,  who  are  so  busy  that  they 
must  place  practically  all  their  prescriptions 
in  the  hands  of  the  retail  druggist,  in  spite 
of  risk  of  refilling  or  carelessness  in  dis- 
pensing and  who  can  afford  to  ignore  any 
possible  trespassing  by  the  druggist  on  the 
field  of  medicine.  There  are  physicians, 
also  not  relatively  numerous,  so  situated  or 
so  inclined  that  they  must  or  will  be  their 
own  dispensers,  however  strictly  the  drug- 
gist confines  himself  to  his  legitimate  busi- 
ness. The  great  majority  of  the  medical 
profession  are  influenced  by  their  own  wel- 
fare and  the  interests  of  their  patients  to 
write  prescriptions  or  to  dispense,  accord- 
ing to  the  treatment  which  they  receive  from 
the  pharmacal  profession.  No  clamor  for 
"rights"  which  have  no  historic  foundation 
will  settle  the  question.  It  is  not  enough 
to  claim  that  the  majority  of  druggists  are 
just  and  fair  in  their  dealings.  The  system 
of  checks  and  drafts  would  disappear  if  one 
business  man  in  a  hundred  were  able  to  deal 
honestly  with  them.  The  system  of  pre- 
scriptions, resting  on  the  faith  of  the  medi- 
cal profession  in  the  pharmacal,  must  also 
vanish  if  a  very  small  majority  of  the  latter 
are  found  to  be  untrustworthy.  Moreover, 
if  the  wholesale  druggist  can  furnish  medi- 
cines more  cheaply  or  more  elegantly  or 
more  accurately  than  the  retailer,  no  senti- 
ment can  withstand  the  operation  of  inevi- 
table commercial  law. 


THE  DIAGNOSIS  OF    TYPHOID  FEVER. 

Probably  no  disease  presents,  at  times,  so 
many  difficulties  to  the  general  practitioner 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


347 


as  does  typhoid  fever.  Even  in  typical 
cases  the  onset  is  so  irregular  and  the  symp- 
toms so  indefinite  as  to  necessitate  several 
days  careful  observation  before  making  a 
positive  diagnosis.  But  not  all  ca«es  are 
typical.  A  recent  report  of  a  considerable 
number  of  cases  places  the  number  which 
were  atypical  at  about  one-half.  This  seems 
like  a  very  high  percentage,  but  it  should 
be  remembered  that  all  of  these  cases  are 
impossible  of  diagnosis  without  the  aid  of 
recently  discovered  methods.  And  by  their 
careful  use  it  may  be  found  that  infection 
with  the  bacillus  typhosus  is  much  more  com- 
mon than  has  formerly  been  supposed.  Many 
of  the  cases  of  "simple  continued  fever," 
"gastric  fever,"  "biliousness,"  &c,  maybe 
found  to  be  due  to  typhoid  infection.  Abor- 
tive cases  are  probably  much  more  common 
than  the  profession  in  this  country  has  re- 
cognized. A  fever  beginning  rather  sud- 
denly, running  high  for  three  or  four  days 
and  terminating  suddenly,  without  signs  of 
lung  or  intestinal  involvement,  has  not  usu- 
ally been  diagnosed  as  abortive  typhoid. 
This  disease  may  begin  and  run  its  course 
with  all  the  signs  and  symptoms  of  some 
other  disease.  The  b.  typhosus  may  enter 
the  bronchial  tubes  or  lung  and  produce 
there,  either  alone  or  in  conjunction  with 
other  micro-organisms,  inflammatory  affec- 
tions peculiar  to  that  region.  A  few  cases 
of  acute  plcuritis  have  been  shown  to  be  due 
to  that  cause.  .Some  cases  of  tonsillitis. 
pharyngitis,  laryngitis  and  otitis  media, 
can  be  attributed  to  it.  Inflammation  of 
the  kidney  and  bladder  is  frequently  pro- 
duced in  this  way  and  the  bile  ducts  and 
gall  bladder  are  a  favorite  location  for  this 
infection.  It  can  be  readily  understood  that 
inflammation  of  each  of  these  organs — and 
others  might  be  mentioned — will  produce 
its  own  peculiar  symptoms,  each  differing 
widely  from  the  other  and  from  the  classi- 
cal symptoms  of  typhoid  fever. 

I  low,  then,  are  we  to  recognize  this  dis- 
ease? There  are  three  tests  that  are  ex- 
tremely valuable  aids  in  making  the  diag- 
nosis. Erlich's  test  appears  early  in  the 
disease — from  the  first  to  the  tenth  day — 
and  is  almost  always  present  no  matter  how 
slight  the  infection.  But  this  reaction  is 
found  in  other  diseases — tuberculosis  and 
the  eruptive  diseases  of  children,  and  occa- 
sionally in  pneumonia,  especially  in  chil- 
dren. This  lessens  the  value  of  this  test 
very  greatly  but  in  connection  with  other 
means  this  test  is  extremely  useful  as  an 
early  sign  of  the  disease.  The  count  of  the 
white  blood  cells  is  an  important  means  of 
differential  diagnosis,  especially  between 
this  disease  and  pneumonia. 

The    serum    test  of  Widal    is    the    most 


important  aid  in  the  diagnosis  of  this  dis- 
ease. It  appears  in  about  95  per  cent,  of 
all  cases — perhaps  with  more  accurate  ob- 
servation it  will  be  found  to  appear  in  every 
case.  In  some  rare  instances  it  appears 
very  late  in  the  disease,  in  the  fifth  or  sixth 
week,  but  as  a  rule  it  is  found  from  the  fifth 
to  the  tenth  day.  In  some  cases  it  remits 
for  a  day  or  two  and  in  others  it  appears 
only  on  one  or  two  days;  so  that  examina- 
tions must  be  made  daily  in  order  to  exclude 
it.  With  the  use  of  these  three  tests  almost 
every  case  of  typhoid  fever,  no  matter  how 
obscure,  can  be  diagnosticated. 


CRIHINAL  ABORTIONS. 

The  three  great  causes  for  this  crime  still 
exist,  as  set  forth  by  Dr.  Storer  : 

1.  Popular  ignorance  of  the  real  nature 
of  the  crime. 

2.  Apathy  on  the  part  of  the  medical 
profession. 

3.  Defects  in  the  law,  sustained  by  long 
usage,  and  therefore  the  more  difficult  to 
overcome. 

The  time  is  truly  upon  us  when  the  med- 
ical profession  should  speak  plainly  and 
without  reserve  to  the  men  and  women  of 
this  country,  and  show  them  the  enormity 
of  the  crimes  they  are  daily  committing  by 
the  productions  of  abortions. 

Let  the  mother  understand  that  if  she 
kills,  or  permits  another  to  kill,  the  little 
helpless  creature,  that  is  by  nature  placed 
in  her  own  womb  for  life  and  protection, 
that  is  nourished  by  her  own  blood  and  is 
of  her  own  flesh,  that  she  is  equally  as 
guilty  as  if  she  should  take  a  club  and  beat 
the  brains  out  of  her  little  babe  that  she 
nurses  and  caresses  to  sleep  nightly. 

It  is  the  duty  of  the  profession  to  act  to- 
gether in  harmony  and  endeavor  to  sup- 
press this  horrible  crime.  They  should 
speak  out  upon  all  occasions  and  let  the 
people  be  educated  to  a  true  understanding 
of  the  situation,  and  collect  evidence  and 
send  to  the  penitentiary  or  have  hung,  the 
physician  that  follows  the  murder  of  inno- 
cent babes  for  a  living.  Such  a  physician 
is  not  a  man,  and  is  not  entitled  to  be  called 
a  man  ;  he  should  be  sent  back  to  nature's 
mint  and  there  killed  by  some  abortifacient 
scoundrel  of  his  own  kind. 

The  physician  that  cannot  afford  to  speak 
plainly  of  such  matters-,  because  it  injures 
his  business,  deserves  none.  The  preacher 
who  does  not  refer  to  such  crimes  for  fear 
of  trampling  upon  the  toes  of  wealthy 
church  members,  omits  to  speak  of  the  most 
damnable  crime  the  race  is  guilty  of  to-day. 
The  newspapers  that  advertise  abortifa- 
cients  and   the  druggists  that  sell   them  are 


348 


THE  CHARLOTTE   MEDICAL  JOURNAL. 


not    deserving  of    the  patronage  of    decent 
people. 

The  writer  has  made  this  solemn  promise 
to  himself,  always  to  be  fulfilled :  That 
when  any  one  applies  to  him  for  advice  in 
the  commission  of  such  a  crime,  be  they  rich 
or  poor,  white  or  black,  educated  or  ignor- 
ant, he  will  speak  as  if  before  the  judgment 
bar  pleading  in  behalf  of  an  innocent  and 
helpless  being,  confined  within  a  narrow 
cell  and  unable  to  speak  for  its  own  life  and 
liberty,  and  as  much  entitled  to  live  and 
have  freedom  as  any  one  living  upon  earth 


Oh  !      physician ! 


are     cruel     and 


without  feeling,  that  would  not  grow  elo- 
quent in  defense  of  such  a  cause.  Oh ! 
mother !  your  heart  must  be  made  of  stone 
that  would  not  turn  from  such  a  crime, 
when  once  understood.  Oh !  child-mur- 
dering wretch !  that  would  follow  such  a 
hellish  business,  the  hang-man's  noose  is  too 
good  for  you. 

THE  INTERNAL  USE  OF   CARBOLIC  ACID. 

In  an  editorial  of  the  January  number  of 
f.his  Journal,  attention  was  called  to  the  im- 
portance in  the  difference  of  therapeutic 
value  between  beechwood  creosote  and 
carbolic  acid.  The  statement  that  many 
prescriptions  calling  for  creosote  were  now- 
a-days  often  filled  by  the  druggist  with  the 
German  article,  which  being  made  from  coal 
tar  instead  of  wood,  was  in  reality  only 
carbolic  acid,  is  not  to  be  disputed  ;  neither 
can  it  be  denied  that  there  is  danger  in  such 
substitution,  as  creosote  is  capable  of  being 
administered  in  much  larger  doses  than  car- 
bolic acid  without  causing  poisonous  results. 

The  reference  to  carbolic  acid  as  a  remedy 
of  value  for  external  use  only  may,  however, 
be  qualified  to  a  large  degree. 

The  field  of  usefulness  for  carbolic  acid 
as  an  internal  remedy  is  close  adjacent  to 
that  of  creosote,  for  it  was  in  fact  the  fore- 
runner of  the  latter  in  the  treatment  of  pul- 
monary tuberculosis.  At  present  it  may  be 
said  to  lay  in  the  arrest  of  a  certain  class  of 
germ  diseases  whose  specific  organisms  are 
of  a  weak  nature  and  are  easily  inhibited 
in  growth  from  the  presence  of  carbolic 
acid.  A  fact,  well  known  to  bacteriolo- 
gists, is  that  certain  bacteria  are  highly 
sensitive  to  the  influence  of  special  media, 
either  for  their  increased  fertility  and  viru- 
lence, or  on  the  contrary,  for  their  attenua- 
tion or  absolute  arrest.  Such,  there  is  now 
good  reason  to  believe,  may  apply  to  the 
germ  of  diseases  like  influenza  and  scarla- 
tina, for  it  has  been  recognized  by  good  ob- 
servers that  these  diseases  are  easily  con- 
trolled under  the  influence  of  carbolic  acid 
internally  administered.  This  is  perhaps 
not  as  generally  known  to  the  profession  as 


it  should  be,  although  carbolic  acid  has  been 
employed  as  an  internal  remedy  both  for 
children  and  adults  for  many  years,  in  Eng- 
land and  America,  with  marked  success  in 
the  treatment  of  septicaemia,  scarlatina,  in- 
fluenza and  summer  diarrhoea  of  children. 

The  knowledge  of  its  highly  poisonous 
effects  when  given  in  too  large  a  dose,  to- 
gether with  the  large  number  of  cases  re- 
ported where  poisonous  symptoms  followed 
its  local  application  to  extensive  raw  sur- 
faces, especially  in  children,  no  doubt 
caused  the  remedy  to  loose  favor,  but  this 
alone  should  not  be  a  worthy  reason  to  the 
profession  against  its  use,  for  far  more  po- 
tent poisons  are  in  daily  use  than  carbolic 
acid. 

If  the  physician  will  associate  the  inter- 
nal use  of  carbolic  acid  in  his  mind  with  a 
one  or  two  per  cent,  solution,  and  the  dose 
as  a  teaspoonful  for  children,  and  even  a 
tablespoonful  for  adults,  it  is  fair  to  say  no 
harmful  results  will  be  likely  to  follow. 
There  are  no  cumulative  effects,  therefore 
the  dose  may  safely  be  repeated  every  two 
hours,  or  with  the  one  per  cent,  solution 
even  hourly. 

Dr.  S.  H.  Dessau,  professor  of  pediatrics 
in  the  New  York  School  of  Clinical  Medi- 
cine, in  a  paper  published  in  the  Medical 
Record,  September  12th,  1896,  pointed  out 
the  usefulness  of  carbolic  acid  as  an  inter- 
nal remedy  in  the  treatment  of  some  catar- 
rhal diseases  of  an  influenza  type  as  occur- 
ring in  children,  and  regarded  its  use  as 
safe  and  successful. 

Dr.  Arthur  Wiglesworth,  in  a  paper  re- 
published in  the  Times  and  Register  of 
February  12th,  1898,  from  the  London  Lan- 
cet, praises  carbolic  acid  in  the  highest 
terms.  Sixteen  years  experience  with  the 
treatment  led  him  to  conceive  the  plan  of 
carbolizing  the  well  children  in  a  family 
where  scalatatina  occurred,  and  thus,  ac- 
cording to  the  authority  of  Flugge,  atten- 
uating the  specific  germ  upon  its  entrance 
into  the  system.  In  this  way  those  who 
were  exposed  to  the  contagion  of  the  dis- 
ease contracted  it  in  the  mildest  form,  with 
freedom  from  the  terrible  sequels  and  com- 
plete protection  against  any  subsequent  ex- 
posure. He  even  goes  so  far  as  to  state 
that  if  the  original  case  is  mild  and  is  com- 
pletely carbolized,  he  would  allow  well 
children  to  be  exposed  to  the  disease,  feel- 
ing sure  that  they  would  receive  an  attenu- 
ated poison  similar  to  a  varioloid  after  vac- 
cination, which  would  be  shorn  of  all  dan- 
gerous sequela?,  which  in  truth  are  the  most 
dreaded  features  of  the  disease. 

These  views  appear  to  be  founded  upon 
able  bacteriological  investigation  and  are 
expressed  with  so  much  clearness  of  reason- 


THE  CHARLOTTE  MEDICAL  JOOKNAL. 


349 


ingthat  they  are  worthy  of  profound  study. 
If  others  in  the  profession  should  be  brave 
enough  to  apply  the  ideas  of  VViglesworth 
successfully  in  practice,  an  immense  and 
priceless  boon  will  be  given  to  innocent 
childhood,  to  say  nothing  of  the  glory  and 
fame  that  will  crown  the  originator. 


WHY   HAS  ALCOHOL   BEEN   SO  POPULAR 

IN    THE   TREATAENT   OF   DISEASE    IN 

THE   PAST? 

There  are  some  reasons  adduced  by  writers 
at  present  why  alcohol  has  been  prescribed 
as  a  medicine  or  beverage  in  the  past.  Aside 
from  the  moral  side  of  the  question  which 
has  been  fully  discussed,  and  we  as  physi- 
cians are  as  familiar  with  this  phase  of  the 
subject  as  any  of  the  moralists.  From  the 
relation  which  the  profession  bears  to  the 
rest  of  humanity,  being  brought  constantly 
in  contact  with  the  worst  side  of  mother 
nature,  so  to  speak.  The  darker  shades  of 
coloring  of  the  human  character,  are  brought 
out  prominently  into  the  foreground  of  hu- 
man existence,  and  are  but  familiar  subjects 
to  the  average  physician  in  his  daily  walks. 
His  acquaintance  with  the  habits  of  his  fel- 
low beings,  his  knowledge,  especially  of  the 
habits  of  eating  and  drinking,  is  sufficient 
to  enable  him  to  point  out  to  them  the  cause 
and  prevention  of  disease.  Among  the  dis- 
eased conditions  from  which  alcohol  has 
been  eliminated  from  their  treatment  in  re- 
cent years,  according  to  Dr.  August  Seibert, 
appear  prominently  among  the  diseases  of 
children,  typhoid  fever, broncho  pneumonia, 
fibrous  pneumonia,  scarlatina,  measles,  and 
in  diphtheria,  in  which  the  use  and  abuse 
of  alcohol  has  been  universal.  Although 
the  system  may  tolerate  this  drug  in  these 
diseased  conditions,  especially  in  diphtheria 
in  large  doses  at  a  critical  period,  for  a  short 
time,  in  the  nephritis  following  or  coinci- 
dent with  this  disease,  it  certainly  does  harm, 
and  after  all  may  only  serye  to  mask  the 
symptoms. 

The  greatest  cause  for  wonder  since  we 
have  studied  our  cases  with  greater  care  in 
regard  to  the  treatment  is,  that  the  true 
physiological  effect  of  the  drug,  does  not 
seem  to  have  been  fully  understood  by  the 
profession.  There  is  an  apparent  reason  to 
the  writer,  why  there  has  been  such  a  uni- 
versal resort  to  the  use  of  alcohol  in  the 
treatment  of  disease  by  both  physician  and 
laity.  And  it  may  be  found  in  the  little 
black  bottle  in  our  grandmother's  cupboard. 
The  one  whom  tradition  had  handed  down 
to  us,  hidden  away  in  dark  recesses  to  be 
brought  forth  in  all  cases  of  emergency  and 
on  all  occasions. 

Containing  as  (his   heirloom  does,  the  all 


important  medication  for  all  the  ills  of  hu- 
manity, and  to  be  loaned  to  the  neighbors 
— the  family  medicine,  a  bottle  of  whiskey. 

If  this  be  true,  and  I  believe  the  physi- 
cian has  shared  in  this  legacy,  no  wonder 
he  has  imparted  it  so  freely. 

The  almost  universal  practice  among  the 
laity  of  using  alcohol  for  all  the  ills  of  hu- 
manity is  too  well  known  to  us. 

Now  if  we  have  erred  in  sharing  in  this 
popular  delusion  of  self-medication  we  may 
reasonably  expect  to  eradicate  this  evil,  by 
educating  our  patrons  and  believing  our- 
selves in  the  dangers  of  the  habits  of  our 
ancestors. 


IMPETIGO. 


"Impetigo  faciei  contagiosa  is  character- 
ized by  an  acute  eruption  of  superficial  vesi- 
cles, from  the  size  of  a  pin's  head  to  that  of 
a  lentil,  on  the  face,  scalp,  or  neck.  They 
appear  every  few  days  to  a  week,  at  first 
disseminated,  later  aggregated,  and  dry 
very  rapidly  into  gummy  crusts,  beneath 
which  the  epidermis  forms.  Some  increase 
to  the  size  of  a  dollar  in  the  shape  of  con- 
centric rings  of  vesicles  like  herpes  tonsu- 
rans or  pemphigus  serpiginosus.  There  is 
a  great  swelling  of  the  submaxillary 
glands. ' ' — Kaposi . 

The  first  cases  of  impetigo  that  I  was  able 
to  diagnose  occurred  in  the  fall  of  1894. 
Three  families,  in  all  nine  or  ten  small  chil- 
dren, living  near  a  saw  mill  in  the  country, 
had  an  eruption  on  the  face  and  a  swelling 
of  the  submaxillary  glands — slight.  I  first 
attributed  the  difficulty  to  eating  nuts,  all 
of  them  had  indulged  and  the  similar  con- 
dition pointed  to  a  common  cause. 

In  errors  of  diet  the  eruption  following  is 
urticaria — a  wheal  should  be  distinguished 
from  a  vesicle,  and  besides  the  eruption  is 
general.  Idiopathic  urticaria,  stings  and 
bites  of  the  flea,  bedbug,  lice,  flies,  &c, 
might  be  local  because  of  only  exposed  sur- 
faces, but  the  same  distinction  is  to  be  made 
in  the  character  of  eruption.  Herpes  zos- 
ter can  be  ruled  out  because  of  its  being 
more  painful  and  is  generally  unilateral. 
The  cases  cleared  up  with  use  of  zinc  oint- 
ment. In  the  family  which  had  the  greater 
number  of  children,  the  preponderance  of 
dirt  and  in  which  clean  water  was  not  "in 
evidence"  there  was  born  another  child 
about  six  or  seven  months  after  the  others 
were  well  from  the  eruption.  This  baby  on 
the  fourth  or  fifth  day  broke  out  with  blis- 
ters on  the  face  and  scalp — commenced  size 
of  a  pinhead  to  size  of  a  split  pea,  increased 
until  they  became  confluent  and  the  cheeks 
became  each  a  solid  blister.  Having  diag- 
nosed and  treated  one  case  of  pemphigus 
my  anxiety  at    this    time   was  to    cut  down 


350 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


my  mortality  table  in  the  direction  of  pem- 
phigus to  50  per  cent.  The  child  was 
promptly  put  upon  Fowler's  solution  and 
zinc  ointment. 

It  is  said  that  doctors  can  find  what  they 
are  looking  for  as  a  rule.  So  often  with  a 
determination  to  diagnose  not  by  exclusion 
and  a  constant  looking  for  that  which  fits, 
we  fit  our  diagnosis  to  our  liking.  I  had 
reason  to  believe  afterwards  that  this  was  a 
case  of  impetigo  and  that  still  my  mortality 
remains  100  per  cent,  in  pemphigus,  which 
is  a  fatal  disease  as  a  rule. 

Conclusions  :  1st.  Acute  eruptions  can 
often  be  diagnosed  by  the  classification  of 
vesicular,  papillary  and  pustular.  2nd.  In 
a  contagious  eruption  a  common  cause 
should  be  determined  if  possible.  3rd.  Our 
patients  do  get  well  some  times  in  spite  of 
our  mistaken  diagnosis  and  treatment. 


EXERCISE   AND   PHYSIOLOGIC    CHANGES. 

Voltaire  once  predicted  that  the  end  of 
all  things  would  come  when  people  take  to 
reasoning.  This  crisis  in  our  mundane 
affairs  is  apparently  far  distant,  judging 
from  the  lacunas  of  reasoning  in  many  of 
our  educated  men  and  women.  There  is  a 
daily  increase  in  our  knowledge,  in  our  ap- 
plication of  that  knowledge,  and  a  vast  im- 
provement in  the  development  of  human 
individuality,  but  in  some  matters  relating 
to  our  physiologic  existence  there  is  an  ab- 
sence of  clear  incised  reasoning.  This  is 
particularly  marked  in  the  advice  regarding 
exercise  given  to  the  middle-aged  individ- 
ual. 

The  man  who  has  in  early  life  been  accus- 
tomed to  athletic  sports,  ceases  regular  ex- 
ercise, as  the  demands  of  a  busy  professional 
or  business  career  consume  his  time.  At  4^ 
years  of  age  he  finds  he  does  not  sleep 
well,  feels  fat  and  weak,  is  irritable,  suffers 
often  from  indigestion  and  headache,  and 
retrospectively  thinks  of  his  physically 
happy  adolescent  days.  His  physician  ad- 
vises exercise,  and  the  unreasoning  man 
starts  out  enthusiastically  to  try  and  get 
his  muscles,  heart  and  lungs  in  the  condi- 
tion they  were  when  he  was  twenty-five 
years  younger.  His  physician  has  failed 
to  warn  him  that  he  does  not  now  possess 
the  resistive  power  he  once  had  against  un- 
due strains  or  poisons.  The  excessive  ex- 
ercise he  once  undertakes  causes  his  mus- 
cles to  throw  off  a  greater  amount  of  toxic 
material  than  the  blood  can  carry  away. 
The  result  is  some  form  of  auto-intoxica- 
tion which  will  demonstrate  itself  in  one 
of  the  various  neuroses. 

The  habits  of  the  individual,  over-eating, 
use,  and  frequently  the  abuse,  of  alcohol  as 


well  as  tobacco,  have  produced  changes  in 
the  neurons  and  nerve  centers,  which  also 
have  probably  caused  an  unphysiologic 
decadence  in  these  delicate  life  units.  That 
this  has  been  the  case  is  shown  by  the  rest- 
less, uncomfortable  condition  exhibited 
when  seeking  advice.  The  neurons  are 
already  in  a  retractive,  irritable  state,  and 
to  increase  this  irritation  by  the  surplusage 
of  dead  material  thrown  off  by  the  excess- 
ive contractions  of  the  muscles,  shows  want 
of  reasoning  powers. 

The  effect  of  stimuli  and  poisons  on  the 
nutrition  as  well  as  on  the  kenesia  of  nerve 
cells  are  certainly  different  at  different  ages 
of  life,  and  to  recklessly  plunge  into  violent 
exercise  after  middle  life  is  to  invite  a  con- 
dition which  will  exhaust  completely  an 
already  depleted  nervous  system.  Men,  also, 
who  are  approaching  the  climacteric,  are 
often  told  they  need  more  exercise  when  in 
truth,  they  need  more  rest,  physiologic  rest. 

Exercise,  of  a  non-excititing,  non-exces- 
sive nature  is  necessary  throughout  life,  but 
it  should  be  adapted  to  the  age,  tempera- 
ment, heredity,  and  physiologic  condition, 
and  follow  the  immutable  changes  of  the 
inevitable  physiologic  decadence. 
This  is  the  art  which  does  mend  Nature,  but 

The  art  itself  is  Nature. 


LITTLE  THINGS  IN  MEDICINE. 

I  have  so  often  heard  physicians  comment 
upon  the  prosperity  and  success  of  men  who 
were  deficient  in  medical  education,  and 
frequently  they  remark  that  there  is  nothing 
in  our  profession  to  encourage  a  man  to  try 
to  acquire  knowledge,  for  the  student  is 
often  outstripped  by  the  man  who  never 
reads  or  studies.  Such  may  be  the  case  but 
they  do  not  realize  that  the  making  of  a 
correct  diagnosis  and  prescribing  the  proper 
drugs  is  only  a  part  of  the  things  necessary 
to  get  the  best  results  for  your  patients. 
There  are  hundreds  of  little  details  that  if 
improperly  attended  to  may  have  as  delete- 
rious an  effect  upon  the  patient  as  the  fail- 
ure to  give  them  the  correct  drug.  It  is 
only  too  true  that  the  people  in  general  are 
not  capable  of  knowing  whether  a  physi- 
cian is  a  learned  man  or  not,  they  do  the 
best  they  can  to  try  to  make  an  estimate  of 
his  knowledge,  and  their  opinions  are  not 
formed  as  much  by  the  medicine  prescribed 
or  administered  as  by  the  manner  and  action 
of  the  physician  himself.  For  instance,  as 
you  measure  out  your  powders,  or  count 
out  your  tablets,  they  have  no  idea  of  what 
they  contain,  it  may  be  morphia  or  it  may 
be  chalk  ;  but  when  you  come  to  give  them 
directions  about  taking  these  powders  or 
tablets  which    you  have  prepared   and    tell 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


351 


them  in  a  hesitating,  careless,  and  indiffer- 
ent way,  then  change  your  mind  and  direc- 
tions, they  are  very  apt  to  conclude  that 
you  did  not  know  just  what  you  did  want 
them  to  do,  and  if  you  did  not  know  that, 
you  probably  did  not  know  what  was  the 
matter,  and  they  want  a  doctor  who  does 
know  something,  and  so  you  lose  the  case, 
and  it  is  a  question  if  the  patient's  judg- 
ment is  not  a  fair  one. 


THE  SOUTHERN  MEDICAL  JOURNAL. 

This  is  the  name  of  a  new  medical  jour- 
nal published  at  La  Grange,  N.  C,  and 
edited  by  Dr.  J.  W.  P.  Smithwick.  A 
copy  of  the  first  edition  has  been  received, 
and  it  shows  that  its  editor  has  confidence 
in  the  enterprise  and  displays  evidences 
that  he  will  succeed  in  the  journal  business. 

In  commenting  on  the  appearance  of  a 
new  medical  journal  several  years  ago.  we 
mentioned  the  great  difficulty  an  editor  and 
publisher  has  when  he  undertakes  to  be 
equally  just  to  himself,  his  subscribers  and 
his  advertising  patrons.  Every  journal 
should  be  conducted  on  this  principle,  and 
those  published  with  other  ideas  in  view 
should  be  boycotted   by  the  profession. 

The  motives  of  this  .lew  journal  are  evi- 
dently pure  and  good,  and  its  object  is  not 
to  advertise  some  special  drug  house,  sani- 
tarium, or  hospital,  but  for  the  good  of  the 
profession.  We  wish  k  every  success  po 
sible. 


DR.  O.  H.  SinriONS,  OF  LINCOLN,  NEB.,  EDI- 
TOR  OF  THE  JOURNAL  OF  THE  AMERI- 
CAN MEDICAL  ASSOCIATION. 
The  Board  of  Trustees  of  the  American 
Medical    Association   has    elected  Dr.  Sim- 
mons, of  Lincoln,  Neb.,  editor  of  the  Jour- 
nal of    the  American  Medical  Association. 
Dr.  Simmons  has  for  several  years  been  edi- 
tor of  the  Western  Medical  Review,  which 
is  one  of    the   best    edited    journals    in  this 
country.      The  salary  of    the  new  editor  is 
to  be  $5,000  per  annum  and  he  is  to  devote 
his  entire  time  to  the  interest  of  the  journal. 


A  GOOD  LOCATION  FOR  A  PHYSICIAN. 

We  are  requested  to  state  that  the  people 
of  Denver,  N.  C,  want  a  good  physician 
to  locate  there.  From  what  we  know  of  the 
place  and  community  it  is  a  splendid  open- 
ing for  a  good  man.  We  will  be  pleased 
to  correspond  with  any  one  specially  inter- 
ested in  the  subject.  (Methodist  and  dem 
ocrat  preferred.) 


BOOK  REVIEWS. 

The  American  Year-Book  of  Medicine  and  Sm-- 
gery,  being  a  Yearly  Digest  of  Scientific  Pro- 
gress and  Authoritative  Opinion  in  All 
Branches  of  Medicine  and  Surgery.  Drawn 
from  Journals,  Monographs,  and  Text-Books 
of  the  Leading  American  and  Foreign  Authors 
and  Investigators,  Collected  and  Arranged 
with  Critical  Editorial  Comments  by  Twenty- 
eight  of  the  Leading  Specialists  and  Writers 
of  the  Country,  Under  the  General  Editorial 
Charge  of  George  M.  Gould,  M.  D.  Illustrat- 
ed. Price,  cloth,  $6.50;  half  morocco,  $7.50. 
For  sale  by  subscription.  Philadelphia.  W. 
B.  Saunders,  925  Walnut  street. 

This  work  represents  in  a  condensed  form 
the  latest  and  best  work  of  our  profession. 
It  hardly  seems  necessary  to  say  more  to 
those  who  have  had  copies  of  former  years. 
The  editor  of  the  work  is  a  man  who  ap- 
preciates the  wants  of  the  profession  and 
the  men  who  assist  him  as  department  edi- 
tors are  able  men  and  well  and  thoroughly 
qualified  for  the  work.  This  year  one  name 
has  been  omitted — the  name  of  Dr.  William 
Pepper.  This  calls  to  mind  the  remarka- 
ble influence  of  this  man,  the  institutions 
and  movements  founded,  inspired  or  sup- 
ported by  his  inexhaustible  energy  and 
wonderful  versatility  seem  to  be  almost 
numberless.  His  place  on  general  medicine 
is  filled  by  Drs.  Alfred  Stengel  and  D.  L. 
Edsall,  botli  of  Philadelphia.  The  subject 
of  General  Medicine  covers  222  pages  and 
the  work  has  been  well  done.  The  next 
subject  discussed  is  the  section  on  General 
Surgery  by  Drs.  W.  W.  Keer  and  J.  Chal- 
mers DaCosta.  Two  hundred  and  fifty 
pages  are  devoted  to  this  branch.  The  most 
noted  revolutionary  surgical  progress  men- 
tioned is  the  total  removal  of  the  stomach 
by  Schlatter. 

Dr.  Barton  Cooke  Hirst  and  Dr.  W.  A. 
Newman  Dorland  next  treats  the  subject  of 
obstetrics  covering  60  pages.  One  of  the 
nicest  features  of  this  section  is  the  micro- 
scopy of  obstetrics,  especially  in  foetal  path- 
ology and  the  pathology  of  the  foetal  ap- 
pendages. 

Drs.  Baldy  and  Dorland  give  us  75  pages 
on  Gynecology.  In  the  summary  of  the 
year's  work  they  say  : 

"On  looking  over  the  field  one  cannot 
but  be  strongly  impressed  with  the  striking 
change  that  has  come  over  the  sentiment  of 
the  abdominal  surgeon  during  the  past  few 
months.  The  radicalism  that  has  domi- 
nated his  work  heretofore  has  largely  given 
way  to  a  conservatism  that  will  undoubt- 
edly redound  to  the  welfare  of  womankind 
and  the  human  race.      The  aim  to-day  is  not 


:\ryl 


THE  CHARLOTTE   MEDICAL  JOURNAL. 


to  see  how  much  can  be  safely  removed, 
but  how  many  of  the  pelvic  organs  can  be 
saved.  Hence  we  see  myomectomy  sup- 
planting hysterectomy,  and  vaginal  incis- 
ions and  drainage  making  heavy  inroads 
upon  abdominal  section.",^  -rjjl||l  ^^ 

One  of  the  most  interesting  chapters  and 
one  of  the  most  important  is  that  on  Pedi- 
atrics, occupying  45  pages.  Drs.  John 
Guiteras  and  David  Risemon  edit  the  sec- 
tion on  Pathology,  and  Dr.  Archibald 
Church  that  on  Nervous  and  Mental  Dis- 
eases. 

The  other  sections  treated  are  Orthopedic 
Surgery,  Drs.  V.  P.  Gibney  and  J.  H. 
Waterman ;  Ophthalmology,  Drs.  H.  F. 
Hansell  and  Wendell  Reber ;  Otology,  Dr. 
C.  H.  Burnett;  Nose  and  Larynx,  Drs.  E. 
Fletcher  Ingals  and  H.  G.  Ohls  ;  Cutaneous 
Medicine  and  Syphilis,  Drs.  Louis  A.  Duh- 
ring  and  M.  B.  Hartzell ;  Materia  Medica, 
etc.,  Drs.  H.  A.  Griffin  and  J.  R.  Tilling- 
hast ;  Anatomy,  Dr.  C.  A.  Haman  ;  Phy- 
siology, Dr.  G.  N.  Stewart ;  Legal  Medi- 
cine, Dr.  Wyatt  Johnson  ;  Public  Hygiene 
and  Preventive  Medicine,  Dr.  S.  W.  Ab- 
bott ;  and  Physiological  Chemistry,  Dr.  J. 
J.  Abel.  Thus  is  covered  the  whole  field 
of  medicine  and  the  medical  sciences. 

It  is  impossible  to  give  too  much  praise 
to  this  excellent  work.  It  is  a  book  that 
holds  within  its  covers  a  record  of  practi- 
cally all  the  progress  that  has  been  made 
during  the  year  it  claims  to  cover.  It  is  not 
only  a  book  for  the  student,  the  teacher, 
and  the  writer,  but  for  the  "busy  physi- 
cian," for  here  he  will  find  the  latest  ideas 
on  the  treatment  of  every  disorder,  as  well 
as  the  latest  views  on  the  pathology  of  the 
most  common  as  well  as  the  most  obscure 
of  diseases.  The  work  as  a  whole  contains 
over  1,100  pages,  and  a  full  and  well  ar- 
ranged index  places  all  this  vast  amount  of 
information  in  easy  reach  of  the  student. 
The  book  is  well  illustrated,  and  the  work 
is  a  credit  to  the  enterprising  publisher. 

An  American  Text- Book  of  Diseases  of  the  Eye, 
Ear,  Nose,  and  Throat.  Edited  by  G.  E.  De- 
Schweinitz,  A.  M.,  M.  D.,  Professor  of  Oph- 
thalmology in  the  Jefferson  Medical  College, 
Philadelphia;  Consulting  Ophthalmologist  to 
the  Philadelphia  Polyclinic,  etc.,  and  B.  Alex. 
Randall,  M.  A.,  M.  D.,  Ph..  D.,  Clinical  Pro- 
fessor of  Diseases  of  the  Ear,  in  the  Univer- 
sity of  Pennsylvania,  etc.  Philadelphia — 
W.  B.  Saunders,  925  Walnut  St.  1899.  Price, 
cloth,  $7.U0  net.  Sheep,  or  half-morocco,  $8.00 
net. 

This  is  the  most  complete  and  compre- 
hensive book  we  have  reviewed  in  years, 
It  ranks  favorably  with  the  other  volumes  of 
the  "American  Text-Book   Series,"  which 


have  demonstrated  their  worth  and  have 
had  their  reward  in  the  appreciative  recep- 
tion which  has  been  accorded  to  them.  In 
the  portion  of  the  work  devoted  to  the  eye, 
its  embryology,  anatomy,  histology,  physi- 
ology, diseases  and  injuries  are  discussed  in 
twenty-four  sections  by  twenty-four  au- 
thors; its  operative  surgery  in  seven  sec- 
tions by  as  many  authors;  while  certain 
practical  details  in  the  examination  for  color 
blindness  among  railroad  employes,  etc., 
receive  attention  in  an  appendix  containing 
five  sections. 

In  the  portion  of  the  work  devoted  to 
the  Ear,  its  anatomy,  physiology,  diseases, 
and  injuries  are  discussed  in  thirteen  sec- 
tions by  fourteen  authors ;  while  the  dis- 
eases of  the  Nose  and  Throat  are  described 
in  twenty  sections  by  nineteen  authors. 

Certain  novei  features  not  usually  found 
in  text-books  may  be  noted  :  Special  arti- 
cles on  the  standards  of  form  and  color- 
vision  required  in  railway  service.  The 
Roentgen  rays  in  ophthalmic  surgery,  the 
practice  of  ophthalmic  surgery,  the  prac- 
tice of  ophthalmic  operations  on  animal's 
eyes,  the  most  important  micro-organisms 
having  etiological  relationship  to  ocular 
disorders,  etc. 

The  work  is  essentially  a  text-book  on 
the  one  hand,  and,  on  the  other,  a  volume 
of  reference  to  which  the  practitioner  may 
turn  and  find  a  series  of  articles  written  by 
men  who  are  authorities  on  the  subjects 
portrayed  by  them..  The  above  is  a  general 
outline  of  the  arrangement  of  the  work. 
One  can  see  at  a  glance  the  magnitude  of 
the  work.  The  work  is  well  arranged,  the 
type  is  clear  and  the  make-up  excellent. 
The  illustrations  are  many,  exceedingly 
fine,  and  profuse.  The  authors  and  the 
publisher  are  to  be  congratulated  upon  the 
preparation  of  this  work.  This  treatise 
may  be  regarded  as  conservative,  clear  and 
concise  exposition  of  our  present  knowl- 
edge of  the  subjects  under  discussion,  and 
can  be  conscientiously  recommended  to  the 
student,  the  general  practitioner  and  to  the 
specialist,  as  a  standard  authority  on  these 
branches  of  medical  science. 

An  Experimental  Research  into  Surgical  Shock. 
By  Geo.  W.  Crile,   A.  M.,  M.  D.,  Ph.  D.,  Pro- 
fessor of  the  Principles  of  Surgery   and  Ap- 
plied Anatomy  in  the   Cleveland    College  of 
Physicians  and  Surgeons,  &c,  Philadelphia. 
.1.  P.  Lippincott  Company. 
John  Hunter,   in  1784,  was  probably  the 
first  to    describe  shock.      William    Clowes, 
1568 ;  Wiseman,  in    1719,   and  Gavengeat, 
1723,  recognized  shock  and  attributed  it  to 
the  presence    of  some    foreign  body  in  the 
wound  or    in  the    blood.      As  Warren  has 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


said,  "though  the  literature  of  the  subject 
is  considerable  since  it  received  a  place  in 
surgery,  yet  few  writers  attempt  to  define 
the  nature  of  shock.  This  is  the  first  book, 
so  far  as  I  am  aware,  that  gives  an  account 
of  any  considerable  experimental  research 
into  surgical  shock.  In  the  opening  of  the 
work  is  given  an  interesting  and  instruct- 
ive historical  account  as  to  theories  con- 
cerning shock.  The  work  is  filled  with 
beautiful  diagrams,  giving  complete  records 
of  each  experiment,  including  the  tracings, 
description  of  the  animal,  of  the  experiment 
and  of  the  autopsy.  The  book  is  neatly 
bound  and  handsomely  printed. 

The  Practice  of  Obstetrics.  By  American  Au- 
thors. Edited  by  Charles  Jewett,  M.  D.,  Pro- 
fessor of  Obstetrics  in  Long  Island  College 
Hospital.  Brooklyn,  N.  Y.  In  one  handsome 
octavo  volume  of  1  ii'A  pages,  with  441  engrav- 
ings in  colors  and  black,  and  22  full-page  col- 
ored plates.  Cloth,  net,  $5;  leather,  net,  $6. 
Philadelphia  and  New  York:  Lee  Brothers  & 
Co.,  Publishers,  1899. 

This  work  containing  nearly  8oo  pages 
has  been  spared  no  expense  to  make  it  the 
leading  work  yet  issued  in  America.  To 
the  young  physician  just  from  college,  just 
entering  upon  his  practical  life  work,  there 
is  no  port  that  lies  before  him  of  greater 
importance  than  midwifery.  It  is  not  only 
important  to  him,  but  equally  so  to  the  wo- 
men entrusted  to  his  care.  The  work  be- 
fore us  is  a  complete  exponent  of  the  mod- 
ern views  of  every  branch  of  the  art  of  ob- 
stetrics by  specialists  in  their  particular  line. 
The  work  is  an  entirely  new  one  and  is  "a 
clear  and  practical  treatise  suited  to  the 
needs  of  medical  classes"  and  is  a  work  of 
special  value  to  the  general  practitioners 
who  do  obstetric  work.  It  has  been  writ- 
ten by  experienced  teachers  and  each  chap- 
ter is  deserving  of  the  highest  praise  for  the 
completeness  with  which  each  subject  is 
covered  and  the  conciseness  with  which  the 
whole  has  been  placed  before  us.  The  anat- 
omy of  the  parts  involved,  both  maternal 
and  f<etal  is  accurately  given  in  detail.  All 
that  relates  to  diseases  and  disorders  and  to 
the  management  of  labor  itself  shows  that 
experienced  clinicians  and  wise  professors 
are  the  authors.  The  illustrations  are  beau- 
tiful and  elegant  and  the  general  appearance 
of  the  book  and  the  thorough  manner  in 
which  the  subject  has  been  handled — all 
combined  to  reflect  great  credit  upon  the 
publishers  and  editor. 

The  following  is  a  list  of  contributors  : 
R.  L.  Dickson,  E.  H.  Bartley,  W.  W. 
Browning,  Henry  Dwight  Chapin,  J.  Clif- 
ton Edgar,  Allen  McLane  Hamilton,  Chas. 
Jewett,   J.  M.  Van  Cott,  Hiram  N.  Vine- 


berg,  of  New  York;  Augustus  H.  Buck- 
master,  Charlottesville,  Va.  ;  J.  Chalmers 
Cameron,  J.  Clarence  Webster,  Montreal, 
Canada;  Edward  P.  Davis,  Philadelphia; 
James  H.  Etheridge,  Fernand  Herotin, 
Chicago;  Walter  P.  Manton,  Detroit; 
Chauncy  D.  Palmer,  Cincinnati  ;  Hunter 
Hobb,  Cleveland,  and  J.  Whitridge  Wil- 
liams, Baltimore. 

A  Treatise  on  Fractures  and  Dislocations.  For 
Practitioners  and  Students.  By  Lewis  A.  Stim- 
son,  P..  A.,  M.  D.,  Professor  of  Surgery  in 
Cornell  University  Medical  College,  New 
York.  In  one  octavo  volume  of  823  pages, 
with  221  engravings  and  20  full-page  plates. 
Cloth,  $5.00  net.  Leather,  $6.00  net.  Just 
ready.  Lea  Brothers  &  Co..  Philadelphia 
and  New  York. 

Some  years  ago  there  appeared  the  au- 
thor's two  volume  work,  now  out  of  print, 
and  while  this  volume  in  a  certain  sense 
may  be  considered  a  second  edition,  yet  it 
has  been  so  materially  altered  and  so  largely 
re-written  it  is  practically  new.  There  is 
probably  no  man  who  has  had  a  wider  ex- 
perience in  traumatic  surgery  than  Dr.  Stim- 
son.  He  has  seen  examples  of  the  rarer 
forms  of  injury  and  some  not  heretofore  de- 
scribed. The  eminent  author  has  condensed 
his  most  comprehensive  experience  into  a 
form  adapted  particularly  to  the  needs  of 
the  student  and  practitioner,  but  the  work 
will  be  none  the  less  a  standard  reference 
book  for  the  surgeon  and  the  student  of 
special  subjects  who  will  find  the  abundant 
bibliography  of  indispensable  value. 

It  is  believed  that  in  the  elimination  of 
historical  matters  and  in  the  substitution 
of  settled  opinions  for  the  previous  discus- 
sions of  divergent  views,  the  directness  and 
applicability  of  the  knowledge  presented 
will  increase  the  favor  with  which  the  orig- 
inal work  was  received. 

The  illustrations  have  been  subjected  to 
equally  thorough  revision  and  embrace 
many  new  pictures,  notably  a  rich  and  in- 
structive series  of  X-ray  full-page  plates. 

The  mechanical  execution  is  admirable 
and  we  commend  this  volume  to  all  who 
desire  the  best  work  of  this  kind. 

Self-Examinations  for  Medical  Students,  Phil- 
adelphia :  P.  Blakiston's  Son  &  Co. 
This  little  book  has  been  prepared  by  a 
medical  man,  a  teacher  and  a  writer  of  ex- 
perience, with  special  reference  to  the  actual 
wants  of  the  medical  student.  By  its  help 
the  student  can  successfully  quiz  himself  on 
all  the  important  branches,  or  review  any 
one  subject  in  which  he  feels  himself  to  be 
particularly  deficient.  It  is  a  useful  little 
book. 


354 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


Diseases  of  the  Eye.  A  Handbook  of  Ophthal- 
mic Practice  for  Students  and  Practitioners. 
By  G.  E.  DeSchweinitz,  A.  M.,  M-  D.  Third 
Edition.  Philadelphia  :  W.  B.  Saunders,  925 
Walnut  St.     1899. 

This  is  the  third  edition  of  this  handsome 
and  valuable  book,  and  it  will  meet  the 
favorable  reception  which  has  been  accorded 
its  predecessors.  It  has  been  thoroughly 
revised  and  much  new  matter  has  been  in- 
troduced. The  writer  and  work  are  so  well 
known  by  the  medical  profession  at  large 
that  a  review  seems  entirely  out  of  order. 
The  past  record  of  the  former  two  editions 
gained  such  a  favorable  opinion  from  the 
profession  at  large  that  merely  an  announce- 
ment of  this  edition  will  be  all  that  is  neces- 
sary. In  -this  edition  particular  attention 
has  been  given  to  the  important  relations 
which  micro-organisms  bear  to  many  ocular 
disorders.  Special  paragraphs  on  the  fol- 
lowing subjects  appear  for  the  first  time  : 
Favus  of  the  Eye-lids,  Blepharochalasis, 
Koch-Weeks'  Bacillus  Conjunctivitis,  Di- 
plo-BacillusConjunctivitis,  Parinaud's  Con- 
junctivitis, &c,  &c.  It  is  thorough  and 
complete  in  every  sense.  It  gives  in  a  clear 
and  concise  manner  every  thing  pertaining 
to  the  diseases  of  the  eye  and  its  complica- 
tions and  sequelae.  It  is  handsomely  printed, 
well  bound  and  reflects  much  credit  upon 
both  the  author  and  the  publisher. 

Fever  Nursing.  By  Dr.  J.  C.  Wilson,  A.M.,  M. 
D.  J.  B.  Lippincott  Co.,  Publishers,  Phila- 
delphia. 

This  is  a  small  book  containing  several 
lectures  on  fever  nursing  delivered  before 
the  nurse  class  of  the  Philadelphia  Hospital. 
The  subject  is  presented  in  a  plain  way. 
The  directions  and  descriptions  are  intended 
to  meet  the  needs  both  of  the  profession 
and  nurse,  and  of  others  who  may  be  called 
upon  to  minister  to  fever  cases,  and  to  en- 
able each  of  these  classes  of  attendants  to 
understand  the  principles  of  treatment  upon 
which  the  directions  of  the  physician  are 
based.  The  book  is  a  useful  one,  and  should 
not  only  be  read  by  all  nurses,  but  by  phy- 
sicians as  well. 

A  Text-Book  of  Mechano-Therapy.  Especially 
prepared  for  the  use  of  Medical  Students  and 
Trained  Nurses.  By  Axel  V.  Grafstrom,  B. 
S.  C,  M.  D.  Philadelphia:  W.  B.  Saunders, 
925  Walnut  St.     1899. 

This  little  volumn  of  139  pages  contains 
much  durable  and  useful  material.  The 
subject  is  somewhat  new  and  very  interest- 
ing. It  has  been  presented  in  a  condensed 
form,  and  in  a  rational  and  popular  way, 
in  order  to  make  it  easily  understood  by  the 
student 


The  Dawn  of   Reason  or   Mental   Traits   in  the 
Lower  Animals.     By  James  Weir,  Jr.,  M.  D., 
New  York.     The  Macmillan   Company,  1899. 
Most  works  on    mind  in    the  lower  ani- 
mals are  large  and  ponderous  volumes,  re- 
plete with  technicalities,  and  unfit   for  the 
general  reader ;  therefore  the  author  of  this 
book  has  presented  the  evidences  of  mental 
action,  in  creatures  lower    than    man,  in  a 
clear,  simple  and  brief  form.   He  has  avoid- 
ed all    technicalities,   and    has  used  the  ut- 
most brevity  consistent  with  clearness  and 
accuracy.     The   book    contains    234    pages 
and  is  nicely  bound  and  neatly  printed. 

A  Compend  of  Human  Physiology.     By  Albert 

P.  Brubaker,    A.  M.,    M.  D.     Ninth  Edition. 

Philadelphia  :  P.  Blakiston's  Sons&  Co.,  1012 

Walnut  St.     1899.     Price,  80c. 

The  continued  demand  for  this  Compend 
has  been  so  very  great  as  to  call  for  the 
Ninth  Edition.  They  are  very  replete  with 
valuable  information  in  a  most  condensed 
form.  For  medical  students  they  are  of 
great  help.  For  quick  reference,  complete 
answers  they  are  very  handy.  Their  con- 
tinued demand  show  their  value. 


LITERARY    NOTES. 

It  is  a  long  time  since  The  Forum  has  had 
such  an  interesting  list  of  subjects  as  that 
offered  in  the  March  number.  Here  are 
some  of  them:  "Diplomatic  Pay  and 
clothes,"  by  Mark  Twain;  "Is  our  Army 
Degenerate?"  by  Col.  Alexander  S.  Bacon  ; 
"The  Future  of  Our  Navy,"  by  Capt.  H. 
C.  Taylor,  of  the  United  States  Battleship 
"Indiana;"  "Life  on  Other  Worlds,"  by 
Prof.  D.  T.  MacDougal;  "What  shall  we 
do  with  the  Philipines?"  by  ex-Minister 
Charles  Denby  ;and"ALost  Eden — Cuba," 
by  Dr.  Felix  L.  Oswald. 


The  event  of  the  literary  year  will  be, 
undoubtedly,  the  great  novel  upon  which 
Count  Tolstoy  has  been  laboring  in  order 
that  he  may  devote  the  proceeds  to  the  trans- 
portation to  Canada  of  three  thousand  Rus- 
sian Quakers.  It  is  generally  believed  by 
his  friends  that  this  work  will  probably 
mark  the  conclusion  of  Count  Tolstoy's 
literary  career.  Not  merely  on  this  account, 
but  because  of  the  subject  treated,  it  will 
attract  the  widest  attention  the  world  over. 
It  is  a  profound  study  of  the  life  of  man 
and  woman,  and  treats  of  the  three  phases 
of  love — that  of  the  youth,  that  of  the  young 
man,  and  that  of  the  man  in  mature  age. 
The  Cosmopolitan  Magazine  announces  that 
it  has  secured  the  sole  right  of  publication. 


THE  CHARLOTTE   MEDICAL  JOURNAL. 


355 


Lippincott's  Magazine  for  Febru- 
ary, 1899. — The  complete  novel  in  the  Feb- 
ruary issue  of  Lippincott's  is  "For  the 
French  Lilies,"  by  Isabel  Nixon  Whiteley. 
The  action  is  chiefly  in  Italy  in  1511-12, 
and  in  this  remote  period  the  author  shows 
herself  at  home. 

Wardon  Allan  Curtis  tells  "The  Tale  of 
the  Doubtful  Grandfather,"  and  a  most  ex- 
traordinary tale  it  is,  such  as  surely  was 
never  told  before.  In  "A  Night  in  Devil's 
Gully,"  Owen  Hall  records  an  Australian 
experience  of  a  kind  now  happily  rare. 

Austin  Bierbower,  in  "A  Diplomatic 
Forecast,"  predicts  that  the  leading  and 
predominant  powers  will  soon  be  England, 
Russia,  and  the  United  States,  with  Ger- 
many as  a  bad  fourth — unless  she  attacks 
and  overcomes  Russia  before  the  latter  has 
carried  out  her  Asiatic  plans. 

"Cyrano  de  Bergerac,"  the  play  now  so 
much  talked  of,  is  the  subject  of  an  article 
by  Lionel  Strachey.  H.  E.  Warner  in- 
quires, "Will  Poetry  Disappear?"  and  in- 
clines to  think  it  will. 

"Lambeth  Palace"  is  briefly  described  by 
G.  F.  Burnley.  D.  O.  Kellogg  writes  of 
"James  Wilson  and  His  Times,"  and  James 
M.  Scovel  supplies  some  "Recollections  of 
Lincoln." 

The  poetry  of  the  number  is  by  Viola 
Roseboro,  Dora  Read  Goodale,  Clarence 
Urmy,  and  Harrison  S.  Morris. 


"The  White  Man's  Burden"  gives  the 
keynote  of  the  American  Monthly  Review 
of  Reviews  for  March.  The  editor,  in 
"The  Progress  of  the  World,"  discusses 
the  Philippine  situation  and  American  pro- 
spects in  those  islands,  as  well  as  the  bear- 
ings of  the  ratification  of  the  Spanish  treaty 
on  the  future  of  the  Filipinos.  Col.  William 
Conant  Church,  editor  of  the  Army  and 
Navy  Journal,  contributes  a  sketch  of  Gen. 
Elwell  S.  Otis,  whose  efficiency  in  subjugat- 
ing the  refractory  followers  of  Aguinaldo  is 
winning  the  admiration  of  the  world.  There 
are  two  articles  on  Philippine  native  types 
and  characteristics,  one  of  which  was 
written  by  Senor  Carony  Mora,  editor  of 
Voz  Espanola,  of  Manila.  These  articles 
are  both  illustrated  from  a  remarkable  series 
of  photographs  now  published  for  the  first 
time.  Dr.  William  Hays  Ward,  who  has 
recently  returned  from  an  extended  journey 
through  Porto  Rico,  contributes  an  article 
on  present-day  conditions  in  that  island, 
with  special  reference  to  the  efffect  of 
American  occupation  on  the  welfare  of  the 
people.  Several  of  the  poung  Cuban  leaders 
in  the  reconstruction  of  their  country  are 
sketched   by   George  Reno.     This   number 


of  the  Review  also  contains  articles  on  the 
late  President  Faure,  of  *  France,  on  "An 
American  Farmer's  Balance-Sheet  for 
1898,"  and  on  "Characteristics  and  Pos- 
sibilities of  Middle  Western  Literature." 


In  the  February  number  of  the  American 
Monthly  Review  of  Reviews  the  editor 
seeks  to  apply  the  lessons  of  our  national 
failures  in  the  South  during  the  reconstruc- 
tion period  following  the  Civil  War  to  the 
present  problems  of  a  similar  nature  in 
Cuba,  Porto  Rico,  and  the  Philippines. 
His  deductions  are  interesting  and  instruc- 
tive. He  says  :  "The  true  way  to  restore 
the  South  to  the  Union  after  the  war  was 
to  restore  the  South  to  its  own  people." 
The  same  principle  applies  to-day  in  the 
new  territories  just  coming  under  our  con- 
trol. The  editor  warns  us  against  a  new 
type  of  "carpet-bagger"  who  is  threatening 
to  invade  Cuba — namely,  the  franchise- 
grabber.  A  large  proportion  of  space  in 
this  number  of  the  Review  is  given  up  to 
editorial  and  contributed  articles  on  the 
management  of  foreign  dependencies. 
Sylvester  Baxter  contributes  an  interesting 
study  of  the  Dutch  rule  in  Java,  and  Dr. 
Daniel  Dorchester  makes  a  statistical  exhibit 
of  the  recent  driftwto  dards  colonial  and 
protectorate  government. 


That  neither  patriotism  nor  good  sense  is 
yet  extinct  among  Spanish  writers  on 
public  affairs  is  clearly  proved  by  the  article 
on  True  National  Greatness  which  The 
Living  Age  publishes  in  its  number  for 
March,  4.  It  is  written  by  E.  Gomez  de 
Baquero,  and  is  translated  from  La  Espana 
Moderna.  It  is  a  very  sane  and  candid 
article,  and  shows  a  clear  perception  of  the 
needs  of  Spain. 


MISCELLANEOUS. 


The  Use  of  Morphine  in  Cardiac   Disease. 

Dr.  Alexander  Morrison  (Treatment,  Feb- 
ruary 9th,  1899).  There  can  be  no  question 
that  one  of  the  tendencies  of  a  knowledge 
of  the  wheels  of  life  is  to  render  one  at 
times  not  only  cautious,  but,  it  may  be,  too 
timid  in  the  use  of  powerful  therapeutic 
agents.  The  writer  saw  a  case  of  mitral 
valvular  disease  some  time  ago  in  consulta- 
tion, which  was  in  a  condition  of  tachycar- 
dial  and  disordered  action,  and  in  which  the 
patient  suffered  a  good  deal  from  insomnia. 
In  addition  to  other  measures  indicated, 
morphia,  in  a  moderate  dose,  was  ordered 
to  be  taken  at  bedtime,  four  doses  or  so 
being  prescribed.     The  case    certainly  im- 


356 


THE  CHARLOTTE  MEDICAL  JOURNAL 


proved  rapidly,  but  the  medical  attendant 
of  the  patient  was' good  enough  to  inform 
the  writer  afterwards  that  he  did  not  con- 
sider that  the  latter  had  rendered  very  val- 
uable assistance,  and  that  the  case  had  been 
cured  by  the  nurse !  But  for  her  sex,  we 
might  quote  the  familiar  proverb  that  fools 
at  times  rush  in  with  benefit  where  angels 
fear  to  tread.  The  nurse  administered,  not 
one  dose  of  the  hypnotic,  but  the  bottleful ! 
The  patient  slept  soundly  for  a  long  time, 
and  awoke  comparatively  well.  Needless 
to  remark,  such  heroic  treatment  has  its 
hazards,  but  very  little  experience  will  con- 
vince anyone  conversant  with  the  manage- 
ment of  cardiac  cases  that  he  who  loses  sight 
of  his  hypnotics  in  sleepless  heart  cases  may 
save  himself  the  trouble,  and  the  patient  the 
annoyance  of  taking  cardiac  stimulants. 
Digitalis  has  been  termed  under  some  cir- 
cumstances the  opium  of  the  heart,  from  a 
false  view  of  its  depressant  action,  but  un- 
der the  circumstances  mentioned  opium  it- 
self may  be  the  only  remedy  likely  to  im- 
prove the  situation.  Dr.  F.  S.  Toogood 
did  good  service,  therefore,  in  calling  atten- 
tion to  this  point  in  the  Lancet  for  Novem- 
ber 26,  1S9S.  He  there  relates  five  cases  in 
illustration  of  the  beneficial  use  of  opium  in 
heart  disease.  His  cases  included  instances 
of  obstructive  and  regurgitant  valvular 
lesion  of  the  aortic  orifice,  a  case  of  double 
mitral  disease,  and  one  of  mitral  regurgita- 
tion. In  one  of  his  cases  the  urine  was  al- 
buminous to  a  third.  In  all  the  use  of  opium 
greatly  benefited  the  case,  and  in  that  com- 
plicated with  albuminuria,  the  albumin  re- 
turned when  the  opium  was  abandoned. 
The  kidney  was  doubtless  chiefly  affected 
by  the  retrograde  stasis.  It  is  with  the  use 
of  opium  under  these  circumstances  as  it  is 
with  the  employment  of  mercury.  An  es- 
sentially renal  case,  when  the  kidney  is  in- 
volved in  a  considerable  nephritic  state, 
will  not  respond  to  opium  any  more  than  it 
will  to  mercury ;  but  when  the  disorder  is 
essentially  circulatory,  the  patient  sleepless, 
and  the  heart  overworked,  a  good  result 
may  be  expected  to  follow  the  use  of  opium 
in  moderate  doses,  repeated,  if  need  be,  at 
intervals  of  four  hours  if  the  state  of  the 
patient  and  urgency  of  his  symptoms  de- 
mand it.  Dr.  Toogood  is  inclined  to  think 
that  "the  undoubtedly  beneficial  results  in 
cardiac  disease  are  due  to  its  action  upon 
the  nervous  apparatus  of  thecardio-vascular 
system,  both  central  and  local,  bringing 
rest  to  an  overstrained  organ  and  allowing 
it  the  chance  of  developing  its  recuperative 
power."  Rest  of  brain  in  its  psychical 
sphere,  assuaging  the  local  irritability  of  an 
organ  richly  supplied  with  nerves,  and  the 
general  peripheral  relaxation  of  the  vascu- 


lar system  as  denoted  by  the  genial  surface 
warmth  of  sound  sleep,  cannot  be  other- 
wise than  beneficial  under  these  circum- 
stances. 


Nasal  Bacteria  in  Health. 

Park  and  Wright  (Journal  of  Laryngol- 
ogy) publish  the  results  of  their  experiments 
on  this  very  interesting  subject.  The  ques- 
tion of  the  bacterial  cleanliness  of  the  mu- 
cous membrane  of  the  nasal  cavities  has 
been  answered  in  widely  different  ways  dur- 
ing the  last  few  years.  It  is  generally  ad- 
mitted that  the  vestibule  is  full  of  bacteria, 
but  varying  results  have  been  obtained  by 
cultures  taken  from  the  septum  and  turbin- 
ates, well  inside  of  the  nasal  openings,  in 
healthy  persons.  In  these  experiments  the 
secretion  from  the  nasal  mucosa  of  thirty- 
six  individuals  was  examined,  the  greatest 
care  being  taken  that  it  did  not  become  con- 
taminated in  the  vestibule.  Cultures  were 
made  upon  different  media  :  in  six  cases  no 
bacteria  were  developed  ;  in  eight,  less  than 
fifty  colonies  ;  in  eight,  between  fifty  and 
one  hundred,  and  in  fourteen,  one  hundred. 
No  attempt  was  made  to  identify  the  vari- 
ous forms  of  micro-organisms,  except  to 
search  for  streptococci,  none  of  which  was 
found  in  any  case.  This  was  in  marked 
contrast  to  the  results  obtained  from  cul- 
tures of  the  nasal  mucus  from  a  number  of 
children  living  in  an  asylum,  in  60  per  cent, 
of  whom  streptococci  were  found.  The 
nasal  mucous  membrane  in  none  of  these 
was  quite  normal.  The  bactericidal  effect 
of  the  nasal  mucus  was  also  studied,  both 
by  sowing  a  culture  of  streptococcus  upon 
the  nasal  mucous  membrane  of  rabbits,  and 
by  collecting  nasal  mucus  and  noting  its  ef- 
fect upon  diphtheria  bacilli,  pseudo-dyph- 
theria  bacilli,  staphylococci,  streptococci 
and  a  coccus  obtained  from  the  normal  mu- 
cus. In  no  case  was  the  nasal  mucus  found 
to  have  any  bactericidal  action.  Although 
a  number  of  bacteria  are  found  in  normal 
nasal  cavities,  it  is  doubtless  true  that  the 
mucus  from  a  healthy  nose  is  not  as  full  of 
germs  as  might  at  first  be  supposed.  This 
comparative  scantiness  is  probably  due  ( 1 ) 
to  the  action  of  gravity,  clear  serum  drain- 
ing down  from  regions  in  the  nose  to  which 
the  inspired  air  does  not  have  free  access 
washes  away  the  bacteria  deposited  by  the 
tidal  air  ;  (2)  to  the  action  of  the  cilia  ;  (3) 
to  the  fact  that  the  nasal  mucus,  while  pos- 
sessing little  or  no  bactericidal  power  for 
most  bacteria,  is  not  a  good  medium  for 
most  bacteria  to  grow  in  ;  (4)  in  some  cases, 
to  the  filtering  action  of  the  hairs;  and  (5) 
to  the  fact  that  ordinarily  the  inspired  air 
contains  very  few  pathogenic  germs. 

The  authors    conclude  that  for    bacteria 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


357 


which  have  developed  in  the  blood  or  secre- 
tions of  other  animals,  the  bactericidal 
power  of  the  nasal  mucus  is  little  or  noth- 
ing and  cannot  be  depended  upon  to  pre- 
vent an  infection  from  virulent  bacteria  if 
they  are  carried  into  the  nose  by  instru- 
ment. 


Dysmenorrhea. 

Fry,  (American  Journal  of  Obstetrics) 
discusses  this  subject  as  follows  : 

Its  simplicity  ;  no  anaesthetics  and  no  as- 
sistants are  necessary.  The  treatment  is 
carried  out  at  the  physician's  office,  and  the 
patient  is  spared  the  mental  suffering  of 
having  to  undergo  an  operation.  Many 
will  consent  to  this  method  of  treatment 
who  will  refuse  harsher  means. 

Its  safety.  It  is  devoid  of  any  other  dan- 
ger, unless  imprudently  used.  The  elec- 
trode is  made  to  traverse  the  cervical  canal 
slowly.  It  is  arrested  at  the  contracted  por- 
tion until  the  electrolytic  action  permits  it 
to  pass  without  the  use  of  force. 

The  result  is  good.  You  must  consider 
both  the  immediate  and  the  remote  effects. 
The  immediate  effect  is  favorable,  because 
the  galvanic  current  is  in  itself  a  valuable 
therapeutic  agent,  and  often  suffices  to  cure 
attending  morbid  states  of  the  uterus.  Neu- 
ralgic pains,  uterine  fixation  and  inflamma- 
tion, hypera'sthesia,  and  atrophy  of  the 
mucous  membrane  often  disappear  without 
further  treatment.  The  relief  of  dysmenor- 
rhea follows.  What  proportion  of  cases 
of  sterility  can  be  cured  is  a  question  for 
the  future  to  decide. 


What  Shall  the  Physician  Say  to  a  Gonor- 
rheal Patient  who  Desires  to  Marry. 

Kromayer  (International  Medical  Maga- 
zine) makes  the  following  statements: 

If  the  presence  of  Neisser's  gonococci  is 
demonstrated,  the  physician's  duty  is  clear 
and  needs  no  elucidation.  But,  if  the  bac- 
teriological examination  is  negative,  his  an- 
swer should  cover  the  following  points  : 

As  a  negative  bacteriological  examination 
is  not  an  absolute  proof  of  the  absence  of  gon- 
ococci, it  is  the  patient's  first  duty  to  make 
an  earnest  and  sustained  effort  to  rid  him- 
self of  the  gonorrhea  or  chronic  inflamma- 
tion of  the  urethra  by  a  systematic  course  of 
specific  treatment.  This  is  not  to  be  neg- 
lected even  in  cases  where  the  examination 
has  for  a  long  time  repeatedly  failed  to  de- 
tect gonococci. 

If  a  complete  cure  is  found  impossible,  or 
it  the  patient  refuses  to  subject  himself  to 
further  treatment,  the  physician  should  ex- 
plain the  case  under  its  various  aspects,  and 
leave  the  decision  with  the  patient.      In  no 


case  is  the  physician  to  assume  the  respon- 
sibility of  the  gonorrhea  not  becoming  in- 
fectious. 

If  the  patient  decides  to  marry,  the  phy- 
sician should  impress  upon  him  the  fact  that 
he  is  still  capable  of  giving  the  infection, 
and  must,  therefore,  observe  the  following 
rules  in  sexual  intercourse  : 

i .  Urinate  immediately  before  sexual  con- 
gress to  expel  any  secretion  that  may  have 
accumulated  in  the  urethra. 

2.  Avoid  as  much  as  possible  having  in- 
tercourse oftener  than  once  a  day. 

3.  Never  perform  the  act  twice  in  suc- 
cession, because,  if  the  first  seminal  dis- 
charge contains  gonococci,  the  friction  at- 
tending the  second  coitus  brings  them  into 
closer  contact  with  the  urethra  and  cervix, 
thereby  increasing  the  danger  of  infection. 

If  this  rule  is  disregarded,  and  the  act  is 
performed  more  than  once  in  twenty-four 
hours,  the  vagina  should  be  thoroughly 
flushed  out  with  a  vaginal  douche,  which 
should,  in  general,  be  employed  as  often  as 
possible. 

Hemorrhage    as  a  Sign  of   Congenital 
Syphilis. 

In  the  course  of  the  description  of  a  case 
of  hemorrhagic  congenital  syphilis  appear- 
ing as  a  hemorrhagic  vesicular  eruption,  Dr. 
William  S.  Gotthell  calls  attention  to 
the  importance  of  otherwise  unexplainable 
bleedings  in  infants  as  symptoms  of  congen- 
ital lues.  They  may  be  the  only  mark  of 
the  disease,  especially  at  first ;  but  they  are 
almost  invariably  accompanied  by  a  dimin- 
ution of  the  coagulability  of  the  blood  sim- 
ilar to  that  of  haemophilia,  and  the  case 
usually  goes  on  rapidly  to  a  fatal  termina- 
tion. Disease  of  the  vascular  walls  is  one 
of  the  commonest  and  best  known  effects 
of  the  syphilitic  poison,  leading  to  hemor- 
rhagic discharges  from  the  mouth,  the 
bowels,  the  bladder,  or  the  nose;  to  blood 
accumulations  under  the  skin  and  mucosa?, 
or  in  the  serous  cavities  and  internal  or- 
gans ;  or  finally,  making  the  syphilitic  erup- 
tion itself  hemorrhagic.  The  author  em- 
phasises the  importance  of  remembering 
these  facts  in  the  treatment  of  infants  who 
have  hemorrhagic  discharges  or  a  hemor- 
rhagic   eruption  the   cause  of    which  is  ob- 


Death  of  R.  W.  Peacock.  M.  D. 

Dr.  Peacock,  of  Jersey  City,  N.  J.,  died 
February  6th,  at  the  age  of  seventy-two. 
He  was  born  at  Goldsboro,  N.  C,  and  prac- 
ticed medicine  there  for  several  years.  He 
moved  to  Jersey  City  in  1875. 


THE  CHARLOTTE  MEDICAL  JOURNAL 


Report    of   the    War    Investigating    Com- 
mittee. 

Details  regarding  the  management  of 
the  War  with  Spain,  and  its  medical  as- 
pects, which  particularly  concerns  us,  have 
been  so  thoroughly  discussed  and  from  so 
many  points  of  view  that  the  final  appear- 
ance of  the  Commission's  official  reports 
offers  comparatively  little  with  which  we 
are  not  already  familiar.  It  must,  however, 
be  of  value  in  fixing  our  ultimate  judgments 
as  to  so-called  abuses  and  incompetency  in 
the  period  during,  and  immediately  follow- 
ing war. 

The  Commission,  says  the  Boston  Med- 
ical and  Surgical  Journal,  has  decided  that 
'  'there  was  lacking  in  the  general  administra- 
tion of  the  War  Department  during  the  con- 
tinuance of  the  War  with  Spain  that  com- 
plete grasp  of  the  situation  which  was 
essential  to  the  highest  efficiency  and  dis- 
cipline of  the  army."  Apart  from  any  in- 
herent weaknesses  it  may  itself  have  had, 
it  is  now  surprising  that  the  Medical  De- 
partment should  have  came  in  for  its  share 
of  censure.  The  general  mismanagement 
of  transportation  was  in  itself  sufficient  to 
handicap  seriously  the  work  of  the  surgeons. 
As  the  report  puts  it .:  "The  loading,  ship- 
ping and  unloading  of  medical  stores  are 
not  done  under  the  orders  of  the  Medical 
but  of  the  Quartermaster's  Department, 
and  the  Medical  Department  is  not  respon- 
sible therefor."  Farther  on  in  the  report 
we  read  :  "The  responsibility  for  the  con- 
ditions at  Chickamauga  rests  upon  those 
who  assembled  over  60,000  raw  levies  and 
kept  the  great  mass  of  them  together  for 
weeks,  and  upon  those  whose  duty  it  was  to 
inspect,  advise  and  order — officers,  medical 
and  military,  regimental,  brigade,  division, 
corps,  and  of  the  camp,  and  the  higher  the 
authority  the  greater  the  responsibility."  . .  . 
"Praise  should  be  given  to  the  well-trained, 
faithful,  hard-working  and  over-worked 
surgeons,  who,  on  the  fighting  lines  and  in 
the  hospitals,  thoroughly  discharged  their 
duty,  and  who,  as  General  Young  has  said, 
'deserve  the  thanks  of  the  American  people 
for  their  splendid  work.'  " 

It  is  pointed  out  that  mistakes  were  made 
in  sending  so  large  a  number  of  men  to 
Montauk,  when  the  hospital  there  establish- 
ed was  not  properly  prepared  for  their 
accommodation  and  medical  care.  As 
Camp  Wikoff  was  to  be  a  place  of  rest  and 
recuperation  for  the  sick  army  expected 
from  Cuba,  and  at  the  same  time  a  quaran- 
tine station  for  the  protection  of  thecountry, 
it  would  certainl),  for  every  reason,  have 
been  better  if  these  thousands  of  men  and 
animals  had  not  been  ordered  to  Montauk. 


Their  arrival  and  presence  increased  the 
confusion  and  added  to  the  burdens  of  all 
officials,  military  and  railroads.  Hospitals 
established  after  the  middle  of  August  at 
various  places  were  conducted  in  such  a 
way  as  to  give  no  good  ground  for  criticism. 

A  cause  of  complaint  to  which  the  Com- 
mission refers,  and  certainly  one  to  which 
much  attention  has  been  directed,  was  the 
inexperience  of  officers  and  surgeons  as  to 
proper  methods  of  sanitation,  a  serious 
defect  which  measures  should  be  taken  to 
remedy. 

The  report  discusses  in  detail  essentially 
all  the  matters  which  have  been  occupying 
so  much  space  within  the  lay  and  profes- 
sional journals,  and,  on  the  whole,  is  judical 
in  the  statement  of  its  conclusions,  which 
are  as  follows  : 

1.  That  at  the  outbreak  of  the  war  the 
Medical  Department  was,  in  men  and  ma- 
terials, altogether  unprepared  to  meet  the 
necessities  of  the  army  called  out. 

2.  That  as  a  result  of  the  action  through 
a  generation  of  contracted  and  contracting 
methods  of  administration,  it  was  impossi- 
ble for  the  Department  to  operate  largely, 
freely,  and  without  undue  regard  to  cost. 

3.  That  in  the  absence  of  a  special  corps 
of  inspectors,  and  the  apparent  infrequency 
of  inspections  by  chief  surgeons,  and  of  of- 
ficial reports  of  the  state  of  things  in  camps 
and  hospitals,  there  was  not  such  investi- 
gation of  sanitary  conditions  of  the  army  as 
is  the  first  duty  imposed  upon  the  Depart- 
ment by  the  regulations. 

4.  That  the  nursing  force  during  the 
months  of  May,  June  and  July  was  neither 
ample  nor  efficient,  reasons  for  which  may 
be  found  in  the  lack  of  a  proper  volunteer 
hospital  corps,  due  to  the  failure  of  Con- 
gress to  authorize  its  establishment,  and  to 
the  non-recognition,  in  the  beginning,  of 
the  value  of  women  nurses  and  the  extent 
to  which  their  services  could  be  secured. 

5.  That  the  demand  made  upon  the  re- 
sources of  the  Department  in  the  care  of  the 
sick  and  wounded  was  very  much  greater 
than  had  been  anticipated,  and  consequent- 
ly, in  like  proportion,  these  demands  were 
imperfectly  met. 

6.  That  powerless  as  the  Department  was 
to  have  supplies  transferred  from  point  to 
point,  except  through  the  intermediation  of 
the  Quartermaster's  Department,  it  was  se- 
riously crippled  in  its  efforts  to  fulfil  the 
regulation  duty  of  "furnishing  all  medical 
and  hospital  supplies." 

7.  That  the  shortcomings  in  administra- 
tion and  operation  may  justly  be  attributed, 
in  large  measure  to  the  hurry  and  confusion 
incident  to  the  assembling  of  an  army  of 
untrained  officers  and  men,  ten  times  larger 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


:m 


than  before,  for  which  no  preparations  in 
advance  had  been  or  could  be  made  because 
of  existing  rules  and  regulations. 

8.  That  notwithstanding  all  the  manifest 
errors,  of  omission  rather  than  of  commis- 
sion, a  vast  deal  of  good  work  was  done  by 
medical  officers,  high  and  low,  regular  and 
volunteer,  and  there  were  unusually  few 
deaths  among  the  wounded  and  the  sick. 

The  Commission  makes  definite  recom- 
mendations for  the  future  conduct  of  the 
Medical  Department,  urging  the  necessity 
of  a  larger  force  of  commissioned  medical 
officers;  authority  to  establish  in  time  of 
war  a  proper  volunteer  hospital  corps;  the 
establishment  of  a  reserve  corps  of  selected 
trained  women  nurses  ;  extra  supplies  of  all 
sorts  to  be  held  constantly  on  hand ;  im- 
provement in  transportation  ;  less  red  tape  ; 
the  authorization  of  surgeons  to  purchase 
such  articles  of  diet  as  may  be  necessary  for 
the  proper  treatment  of  soldiers  too  sick  to 
use  the  army  ration. 

On  the  whole,  we  must  regard  the  report 
as  a  fair  statement  of  the  conditions  as  de- 
rived from  the  evidence  at  the  disposal  of 
t lie  Committee. 


On  Ocular  Affections   in  Puerperal 
Eclampsia. 

C.  Zimmerman  (Archives of  Ophthalmo- 
logy, .September,)  states  that  in  no  text- 
book on  Ophthalmology  or  Obstetrics,  nor 
in  any  treatise  on  the  relation  of  ophthalmic 
to  general  disease,  is  there  information 
concerning  ocular  affections  in  puerperal 
eclampsia. 

He  reports  a  case  at  length,  in  which 
eclamptic  attacks  began  in  the  fifth  month 
of  pregnancy,  continued  at  intervals  till  six 
months  after  delivery,  when  sudden  death 
took  place.  Examination  two  months  after 
delivery  revealed  slight,  left  hemiplegic 
symptoms  and  decided  contraction  of  the 
left  visual  fields.  At  the  post-mortem  he 
found  a  large  focus  of  white  softening  in 
the  left  occipital  lobe,  at  the  floor  of  the 
posterior  horn  of  the  lateral  ventricle. 

He  then  proceeds  to  give  a  resume  of  the 
literature  on  the  subject  for  the  past  twenty 
years,  dwelling  on  the  pathological  changes 
in  the  brain.  These  lesions  were  found  to 
be  :  hemorrhages  varying  in  size  from  micro- 
scopic to  very  large  apoplectic  foci,  embo- 
lism, thrombosis,  secondary  softening,  and 
oedema.  The  ocular  symptoms  were  found 
to  be  :  contractions  of  the  visual  field,  hemi- 
anopia,  amblyopia,  and  amaurosis.  Great 
confusion  exists  in  the  minds  of  some  ob- 
servers as  to  the  difference  between  eclamp- 
tic and  ursemic  attacks.  Zimmerman  favors 
the  theories  of  those  who  hold  that  uraemia, 


though  often  dependent  upon  eclampsia,  is 
a  secondary  affection,  the  eclamptic  seizures 
being  due  to  the  presence  of  abnormal  foetal 
or  placentar  cells  in  the  circulation. 

He  concludes  that  in  eclampsia  there  are 
chemical  changes  in  the  blood  and  anatom- 
ical changes  in  the  vessel-walls,  both  due  to 
"auto-intoxication  with  globulines  or  pro- 
ducts of  retrograde  metamorphosis  of  albu- 
minous metabolism  from  the  maternal  and 
foetal  cells."  These  substances  create  a 
tendency  to  coagulate  the  fibrine  of  the 
blood,  which  entails  thrombosis  and  embol- 
ism, and,  by  irritating  the  convulsion-cen- 
ters, give  rise  to  the  attacks.  The  convul- 
sions produce  commotion  of  the  brain,  and 
increase  the  blood-pressure,  leading  to  rup- 
ture of  the  vessels.  The  ensuing  hemor- 
rhages, foci  of  softening,  and  necrosis  of 
brain-tissue,  when  involving  the  optic  cen- 
tres or  paths,  give  rise  to  amblyopia,  amau- 
rosis, hemianopia  and  contraction  of  the 
visual  field. 


Bacteriological   Investigations  of    the  Eti- 
ology of  Ophthalmia  Neonatorum. 

Grcenouw  of  Breslau  read  a  paper  under 
the  above  heading  before  the  Ophthalmolog- 
ical  Society  at  Heidelburg,  August,  1898. 
(Archives  of  Ophthalmology,  September.) 

The  conjunctival  secretions  in  the  cases 
of  forty  newly-born  children  having  con- 
junctivitis, simple  and  blennorrhocal,  were 
used  in  the  preparation  of  cultures  in  vari- 
ous medea,  and  of  cover-glass  specimens. 
In  about  one-third  of  the  cases,  most  of 
which  were  mild,  catarrhal  cases,  no  defi- 
nite bactericidal  results  were  found ;  the 
only  bacteria  growing  in  the  cultures  being 
white  staphylococci  and  a  few  yellow  cocci 
and  xerobacilli,  together  with  several  dif- 
ferent non  pathogenic  micro-organisms. 
Diplobacilli  and  virulent  diphtheria  bacilli 
were  not  present  in  any  of  the  cases. 

Gonococci  were  found  to  be  the  cause  of 
the  conjunctivitis  in  14  cases,  pneumococci 
in  5,  staphylococcus  pyogenes  in  one  and 
bacterium  coli  in  3.  Gonococci  in  pure  cul- 
ture were  only  present  once,  while  in  the 
other  thirteen  cultures  they  were  mixed 
with  pneumococci,  Friedlander's  pneumo- 
nia bacilli,  white  staphylococci  and  xero- 
bacilli. The  gonococci  were  found  in  the 
conjunctival  sac  for  some  time  after  the  ces- 
sation of  supperation,  in  one  instance  as 
late  as  twenty-five  days ;  he  therefore  re- 
commends that  treatment  should  not  end 
when  suppuration  ceases. 

The  five  cases  in  which  the  pneumococcus 
was  present  were  of  a  milder  or  severer  form 
of  catarrh,  rather  than  blennorrhoea,  and  re- 
covered more  quickly  than  the  others.   The 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


three  cases  produced  by  the  bacterium  coli 
were  classed  as  severe  catarrhal  conjunctivi- 
tis. 

In  the  severer  cases  of  blennorrhea  the 
gonococcus  was  the  cause ;  in  the  milder 
cases,  the  gonococcus  and  the  bacterium 
coli.  In  the  severer  cases  of  catarrhal  con- 
junctivitis about  half  were  ascribed  to  the 
pneumococcus,  staphylococcus  and  bacte- 
rium coli,  while  in  the  other  half,  together 
with  the  mild  cases,  no  definite  bacteriologi- 
cal results  were  found. 

He  therefore  concludes  that  the  clinical 
picture  does  not  warrant  any  definite  con- 
clusion as  to  the  exciting  cause. 

In  the  discussion  which  followed,  Leber 
emphasized  the  existence  of  a  typical  blen- 
norrhea and  held  that,  while  mixed  infec- 
tion may  occur,  the  true  cause  was  always 
to  be  sought  in  the  gonococcus.  Schmidt- 
Rimpler  and  Bach  were  of  the  opinion  that 
true  blennorrhea  could  occur  without  the 
presence  of  gonococci. 


Dont's  for  the  Treatment  of  Pneumonia. 

Dr.  Thomas  J.  Mays, (Philadelphia  Poly- 
clinic) gives  the  following  list  of  what  not 
to  do  in  the  treatment  of  pneumonia  : 

Don't  believe  that  acute  pneumonia  is  a 
self-limited  disease  and  will  get  along  with- 
out treatment  as  with  it. 

Don't  hug  the  delusion  that  fever  in  any 
degree  is  a  benefit  to  the  patient. 

Don't  fancy  that  you  can  always  tell 
croupous  from  catarrhal  pneumonia. 

Don't  allow  pain  in  the  abdomen  to  draw 
your  attention  away  from  the  chest.  Fre- 
quently the  beginning  of  pneumonia  is  ac- 
companied by  severe  pain  in  the  right 
groin,  which  may  lead  one  to  suspect  the 
onset  of  typhoid  fever. 

Don't  direct  your  treatment  more  towards 
the  heart  than  towards  the  lungs. 

Don't  fail  to  recognize  the  great  influence 
of  the  brain  and  nervous  system. 

Don't  lose  sight  of  the  serious  indication 
of  rapid  and  laborious  breathing. 

Don't  be  afraid  of  applying  ice  to  the 
chest  in  rubber  bags.      It  will  do  no  harm. 

Don't  fail  to  apply  as  many  bags  as  are 
necessary  to  cover  the  area  of  imflammation. 

Don't  think  that  you  can  get  as  good  re- 
sults from  a  tub-bath  or  from  cold  general 
spongings,  as  you  can  from  the  local  applica- 
tion of  ice. 

Don't  become  alarmed  when  the  ice  pro- 
duces a  sudden  drop  in  the  temperature 
and  think  the  patient  is  going  into  collapse. 

Don't  fail  to  retain  the  ice  so  long  as 
fever  is  present,  and  resolution  has  not 
taken  place. 


Don't  omit  to  apply  one  or  two  ice-bags 
to  the  head. 

Don't  overlook  the  beneficial  influence  of 
strychnine  in  combating  pneumonia.  Ad- 
minister 1-20  of  a  grain  by  the  mouth  every 
three  or  four  hours,  and  besides  give  the 
same  dose  hypodermically  once  or  twice  a 
day,  until  the  system  becomes  irritable. 

Don't  omit  the  hypodermic  injection  of 
1-4  of  a  grain  of  morphine  once  or  twice  a 
day  to  secure  rest  and  sleep. 

Don't  fail  to  administer  oxygen  by  inhala- 
tion more  or  less  constantly  if  the  patient 
is  cyanotic  or  short  of  breath. 

Don't  fail  to  bleed  if  the  cyanosis  and 
dyspnea  are  not  relieved  by  oxygen  inhala- 
tion. 

Don't  lose  sight  of  the  great  value'  of 
tincture  of  capsicum  in  relieving  great 
nervous  depression,  delirium,  dry  black- 
coated  tongue,  picking  at  the  bed-clothes, 
ete.,  give  it  in  from  a  half  to  one  teaspoon- 
ful  doses  in  water  every  two  or  three  hours, 
or  oftener,  in  alcoholic  pneumonia. 

Don't  fail  to  give  sodium  salicylate,  am- 
monium acetate,  potassium  acetate,  and  po- 
tassium citrate,  three  grains  of  each,  in  a 
dessertspoonful  of  peppermint-water,  every 
three  or  four  hours,  if  there  is  the  least  evi- 
dence of  a  rheumatic  complication. 

Don't  overlook  the  important  iction  of 
quinine  in  this  disease. 

Don't  fail  to  support  the  patient  with  an 
abundance  of  nourishing  food,  such  as  milk, 
freshly  expressed  beef-juice,  etc. 


The  Education  of    the  Ophthalmologist. 

F.  B.  E.,  in  an  editorial  (Ophthalmic 
Record,  October,)  and  in  a  letter  (Decem- 
ber Ophthalmic  Record)  makes  a  strong 
plea  for  the  more  thorough  education  of 
those  expecting  to  take  up  the  practice  of 
ophthalmology  as  a  specialty.  He  says : 
"Well  balanced  medical  men  disparage  the 
tendency  to  specialism  ;  they  see  in  it  a  drift 
towards  narrowness,  superficiality  and  ig- 
norant exaggeration,  and  insist,  with  rea- 
son, that  the  best  preparation  for  following 
a  specialty  is  a  thorough  education,  supple- 
mented by  ten  years  or  more  of  general 
practice." 

While  the  years  spent  in  general  practice 
constitute  a  very  important  and  necessary 
part  of  the  preparation,  it  should  not  be 
forgotten  that  there  are  certain  other  indis- 
pensable studies  peculiar  to  the  subject, 
which  are  not  mastered  by  any  amount  of 
general  practice  and  which  are  not  in  any 
college  curriculum,  namely  :  dioptrics,  light 
and  color  perception,  binocular  vision,  oph- 
thalmoscopy,   keratometry,    perimetry,  etc. 

The  author  thinks  that  a  thorough  knowl- 


THE  CHARLOTTE  .MEDICAL  JOURNAL. 


361 


edge  of  these  branches  should  be  acquired 
in  a  preparatory  course,  similar  to  the 
"medical  preparatory  courses"  in  some  of 
the  universities,  with  additional  advantages 
of  theoretical  work  in  small  sections,  "with 
such  works  as  those  of  Donders  and  Lan- 
dolt  as  guides,  together  with  practical  work 
in  a  well  equipped  ophthalmological  or 
physiological  laboratory. ' ' 

This  work  is  to  precede  the  regular  med- 
ical course  and  the  ten  years  of  general 
practice,  because  the  author's  experience  in 
teaching  post-graduates  leads  him  to  be- 
lieve that  the  technical  skill  necessary  to 
thorough  mastery  of  the  above  mentioned 
studies  cannot  be  acquired  easily  or  success- 
fullv  after  the  age  of  thirty-five. 


Operation  for  the  Effects  of  Gastric  Ulcer. 

At  a  recent  meeting  of  the  Clinical  Soci- 
ety of  London  J.  C.  Wallis  read  notes  of 
two  cases  which  he  had  operated  on  for  the 
effects  of  gastric  ulcer.  (British  Medical 
Journal.  Dec.  5.    [898.) 

Cask  1 — A  mother's  help,  aged  ao,  was 
admitted  to  the  Metropolitan  Hospital 
on  March  11,  1898,  for  a  perforated  gastric 
ulcer.  She  was  operated  on  ten  and  a  half 
hours  after  perforation.  On  opening  the 
abdomen  the  extra vasated  contents  of  the 
stomach  were  found  limited  to  the  gastro- 
hepatic  area.  The  rent  was  in  the  posterior 
wall,  close  to  the  cardiac  end,  and  nearly 
one  inch  in  length.  This  was  sewn  up  by 
two  rows  of  Lambert  sutures,  and  a  piece 
of  omentum  was  sewn  over  this.  The  ab- 
domen was  wiped  out  with  sponges,  but  no 
irrigation  was  employed  and  no  drainage 
was  used.  The  patient  did  well  for  eleven 
days,  and  had  no  peritonitis.  On  the 
eleventh  day  she  developed  phlebitis.  On  the 
seventeenth  day  basal  pneumonia  occurred, 
which  continued  until  the  twenty-ninth  day, 
when  the  temperature  came  down  and  she 
began  to  improve.  But  on  the  thirty-first 
day  she  vomited  suddenly  six  ounces  of 
blood,  ami  died  within  an  hour.  There  was 
no  post  mortem  examination  allowed.  Dr. 
.Vallis  remarked  on  the  cause  of  death  by 
hemorrhage  thirty-one  days  after  the  oper- 
ation as  being  unusual  and  unfortunate. 
He  suggested  that  it  might  be  advisable  in 
many  cases  to  enlarge  the  opening  suffi- 
ciently so  that  an  examination  of  the  inte- 
rior of  the  stomach  might  be  made,  and 
that  a  small  electric  lamp  would  be  of  great 
service  in  such  cases.  The  fact  that 
although  the  peritoneum  was  only  wiped 
<  Kan  and  not  irrigated  there  was  no  peri- 
tonitis, was  in  keeping  with  the  now  well- 
known  resisting  powers  of  the  peritoneum. 
He  had  been  led  to  adopt  this    method    on 


account  of  the   frequent  occurrence  of  sub- 
phrenic abscesses  after  irrigation. 

Case  2. — An  unmarried  lady;  was  seen 
first  in  July  1896.  Her  history  dated  from 
December,  1882,  when  she  had  an  attack 
of  gastro-enteritis,  which  lasted  off  and  on 
until  November,  1895,  when,  on  getting  out 
of  bed  she  was  suddenly  seized  with  the 
typical  signs  of  a  perforated  gastric  ulcer. 
From  this  she  recovered,  but  from  that  time 
until  the  operation  she  was  unable,  on  ac- 
count of  pain,  to  take  exercise,  and  was 
only  able  to  take  fluid  food  in  small  quan- 
tities at  a  time.  On  examination  she  was 
seen  to  be  extremely  emaciated  and  weak, 
and  the  abdomen  was  tender  when  manip- 
ulated, especially  above  and  to  the  right  of 
the  umbilicus,  where  there  was  a  distinct 
sense  of  resistance.  Dr.  Abercrombie  and 
Dr.  Clark  saw  the  patient  with  Mr.  Wallis. 
and  it  was  agreed  that  an  exploratory  lapa- 
rotomy should  be  done.  At  the  operation  a 
strong  cord,  \  inch  broad  and  1^  inch  long, 
was  found  uniting  the  pyloric  end  of  the 
stomach  to  the  abdominal  wall.  This  was 
removed.  The  patient  made  a  complete 
recovery  after  a  long  convalescence,  and 
was  now  able  to  enjoy  her  life  after  fourteen 
years  of  invalidism.  The  pain  had  never 
returned,  and  she  had  put  on  flesh  and  was 
able  to  take  exercise,  and  as  it  was  now  two 
years  since  the  operation  there  were  fair 
grounds  for  believing  that  the  benefits  would 
be  permanent. 


Antistreptococcic     Serum. 

F.  J.  Cotton,  of  Boston,  (Boston  Medical 
and  Surgical  Journal)  states  that  no  one 
will  now  contend  that  the  antistreptococcic 
serum  is,  broadly  speaking,  effective  against 
streptococcus  infections.  Beyond  a  doubt 
a  certain  degree  of  passive  protection  is 
possible  in  the  laboratory,  and  probably 
something  of  the  sort  is  possible  in  man. 
There  seems,  in  view  of  recent  work,  no 
ground  for  drawing  sharp  distinctions  be- 
tween alleged  species  of  streptococci,  and 
though  it  would  be  a  mistake  to  assume  too 
close  a  parallel  between  the  conditions  of 
infection  in  man  and  in  animals,  yet  prob- 
ably a  serum  really  effective  in  protecting 
rabbits  against  streptococci  would  afford 
some  aid  to  the  human  organism  in  its  strug- 
gle against  a  like  infection.  It  is  likely 
enough  that  this  is  the  explanation  of  the 
temporary  relief  of  symptoms  so  often  noted. 
It  does  not  seem  that  this  represents  a 
strong  action  against  the  infection,  but  it  is 
something,  and  in  many  cases  a  very  little 
may  turn  the  tide.  This  seems  reason 
enough  to  give  the  serum  further  trial — as 
a  symptomatic  treatment  if  no  more.    There 


THE  CHARLOTTE  MEDICAL  JOURNAL 


seems  to  be  no  good  reason  against  its  use. 
Urticaria,  erythema,  joint  pains,  etc.,  are 
of  not  uncommon  occurrence,  but  of  no 
great  moment.  Abscesses  at  the  point  of 
injection,  sometimes  containing  strepto- 
cocci, are  not  rare,  and  would  indicate  care 
in  using  a  bacteriologically  tested  serum. 
If  the  serum  is  to  be  used  in  earnest  it 
should  be  used  in  considerable  doses.  Prob- 
ably in  many  cases  the  dosage  has  been  too 
small.  To  protect  a  rabbit  against  a  ten 
times  fatal  dose  needed  0.2  centimetre  of 
Marmorek's  serum  ;  this  is  one  seven-thou- 
sandth the  body  weight,  corresponding  to 
about  10  centimetres  in  man.  The  potency 
of  different  makes  of  serum  varies,  and 
they  seem  to  lose  notably  by  keeping. 
Hence  while  there  are  no  accurate  data  for 
dosage  in  man,  yet  the  problem  is  not  to 
protect  against  an  infection,  but  to  cope 
with  an  infection  in  full  swing,  and  that 
with  a  serum  of  doubtful  efficacy ;  the 
needed  dose  will  probably  be  large,  if  any- 
thing is  to  be  accomplished.  The  limit  of 
dosage  must  vary,  but  untoward  effects  are 
not  frequent,  and  plenty  of  cases  have  borne 
25  cubic  centimetre  doses.  In  one  case  a 
total  of  1,030  cubic  centimetres  was  given, 
though  this  in  a  case  of  some  duration  ; 
there  were  no  ill  effects  beyond  a  slight  ery- 
thema. There  seems,  then,  some  reason 
for  continuing  the  use  of  serum  in  cases  of 
streptococcus  infection.  Care  is  needful  in 
selecting  the  serum  to  be  used  ;  it  should  be 
used,  if  at  all,  inconsiderable  amount ;  and, 
above  all,  until  more  evidence  of  its  power 
is  forthcoming,  it  should  be  used  as  an  ad- 
junct only,  and  never  to  supplant  or  modify 
other  treatment  of  the  case. 


Tubercular    Cystitis  in   Children. 

Charles  Greene  Cumston  (Boston  Med- 
ical and  Surgical  Journal)  says  the  symp- 
tom that  is  most  prominent  in  children  is 
incontinence  of  urine.  There  may  be  true 
incontinence  when  the  urine  escapes  with- 
out any  desire  to  micturate ;  this  form  is 
due  to  a  certain  amount  of  destruction  of 
the  neck  of  the  bladder  by  an  ulcerative 
process.  A  false  incontinence  varies  in 
nature.  Sometimes  it  is  simply  a  micturi- 
tion from  overflow,  in  which  case  it  is  not 
an  incontinence,  but  is  a  retention,  and  is 
met  with  in  certain  painful  forms  of  cystitis. 
The  neck  of  the  bladder  is  closed  by  spasm, 
and  from  this  a  more  or  less  complete  reten- 
tion will  result.  A  real  false  incontinence  is 
what  is  particularly  seen  in  children,  and  is 
in  reality  a  frequent  and  very  ardent  desire 
to  pass  the  urine,  circumstances  under  which 
children  will  micturate  in  bed  at  night  and 
in  the  clothes  during  the  day.   The  escape  of 


the  urine  is  voluntary,  because  the  patient 
can  be  made  to  retain  his  urine  in  the  blad- 
der for  a  few  minutes,  but  the  desire  to 
urinate  is  so  imperious  and  constantly  pres- 
ent that  the  child  yields  to  it.  Incontinence 
of  urine  from  overflow  may  also  be  observ- 
ed along  with  a  more  or  less  complete  reten- 
tion, this  being  due  to  spasm  of  the  urethra. 
Pain  as  a  symptom  varies  and  often  is  want- 
ing, or  at  least  appears  to  be.  Severe  pain 
will  make  children  cry,  while  they  do  not 
pay  much  attention  to  little  dull  pains  or 
burning  sensation.  Hematuria  appears  as 
an  infrequent  symptom,  and  does  not 
show  itself  at  the  beginning  as  it  does  in 
adults.  Pyuria,  on  the  contrary,  is  import- 
ant in  little  ones,  because  if  the  urine  con- 
tains pus  the  disease  is  not  due  to  a  neuro- 
sis. In  exceptional  cases  the  urine  contains 
no  pus.  In  all  cases  of  suspicious  cystitis 
a  bacteriological  examination  of  the  urine 
should  be  carried  out.  The  search  for 
Koch's  bacillus  will  often  be  negative,  but 
should  be  often  repeated,  and  finally  we 
can,  perhaps,  discover  the  organism.  We 
may  say  that  the  primary  disease  in  children 
is  curable  when  the  lesions  are  not  advanced. 
If  general  treatment  and  local  application 
do  not  show  any  effect  on  the  process  after 
a  reasonable  trial,  suprapubic  cystotomy  is 
the  operation  of  choice,  and  will  be  fol- 
lowed by  as  good  results  as  those  obtained 
by  it  in  adults. 


Tuberculous  Ulcers  of  the  Rectum. 

In  a  valuable  paper,  entitled  "Practical 
Points  in  the  Management  of  Tuberculosis, ' ' 
Dr.  James  T.  Whittaker,  of  Cincinnati, 
Professor  of  Theory  and  Practice  of  Medi- 
cine, Medical  College  of  Ohio,  (Ohio  Med- 
ical Journal,  November,  1898)  states  that 
ulcerations  of  the  rectum  of  tuberculous 
origin  begin  to  granulate  slowly  but  pro- 
gressively under  the  use  of  europhen 
suppository.  Each  suppository  should  con- 
tain five  grains  of  europhen,  and  the  agent 
should  be  inserted  at  bedtime.  There  is  no 
difficulty  of  retention  after  the  first  night  or 
two.  A  fistula  should  be  split  without 
parley.  Dr.  Whittaker's  observations  of 
the  value  of  europhen  in  the  treatment  of 
ulcerations  of  tuberculous  character  have 
been  confirmed  by  a  number  of  other 
authorities.  The  careful  investigations  of 
Dr.  Christmann  undertaken  several  years 
ago  shows  that  europhen  has  a  powerful 
destructive  influence  upon  the  bacillus 
tuberculosis.  Jasinsky  (Gazeta  Lekarska) 
employed  it  in  cases  of  suppurating  tuber- 
culous ulceration  in  which,  though  other 
remedies  as  iodoform,  proved  useless,  euro- 
phen promoted  rapid  cicatrization  and  heal- 
ing   in    a  remarkably  short  time.     The  ex- 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


ceedingly  satisfactory  results  derived  from 
the  use  of  europhen  in  a  case  of  tuberculosis 
verrucosa  of  the  face  by  Dr.  DeWitt,  of 
Cincinnati,  are  also  worthy  of  mention  as 
illustrating  the  great  value  of  europhen  in 
the  treatment  of  tuberculous  ulcerative 
lesions. 


The  Western  Ophthalmologic  &  Oto-Laryn- 

f«ologic  Association. 

The  annual  meeting  of  the  Western 
Ophthalmologic  and  Oto-Laryngologic  As- 
sociation was  held  in  New  Orleans,  Feb. 
ioth  and  nth.  Owing  to  the  unavoidable 
absence  of  the  president,  Dr.  J.  Elliott 
Colburn,  of  Chicago,  the  first  vicepresident, 
W.    Scheppegrell,    of    New    Orleans, 


I) 


presided.  The  joint  sessions  and  three  ses- 
sions of  the  Ophthalmologic  and Oto-laryn- 
gologic  Sections  respectively  were  held  and 
many  important  papers  read  and  discussed. 
The  following  officers  were  elected  for 
the  ensuing  year:  Dr.W.  Scheppegrell, 
of  New  Orleans,  president:  Dr.  M.  A. 
Goldstein,  of  St.  Louis,  first  vicepresident; 
Dr.  II.  V.  Wurdeman,  of  Milwaukee, 
second  vicepresident;  Dr.  E.  C.  Elliott,  of 
Memphis,  Tenn.,  third  vicepresident  ;  Dr. 
F.  C.  Ewing,  of  St.  Louis,  secretary;  Dr 
W.  L.  Dayton,  of  Lincoln,  Neb.,  treasurer. 
St.  Louis  was  selected  for  the  next  annual 
meet  ing. 

The  following  names  were  added  to  the 
list  of  honorary  members  :  Dr.  Geo.  Stevens. 
of  New  York  ;  Dr.  St.  Clair  Thompson,  of 
London;  Dr.  \i.  Coen,  of  Vienna,  Aust.  ; 
Dr.  E.  J.  Moure,  of  Bordeaux,  France; 
Dr.  J.  Sendziak,  of  Warsaw,  Russia:  Dr. 
Marcel  Natier,  of  Paris,  France;  Dr.  C. 
Zien,  of  Dantzig,  Germany;  Dr.  A.  A. 
Guye,  of  Amsterdam,  Holland. 

The  new  members  elected  were  as  fol- 
lows: Dr.  J.  A.Caldwell,  of  McKinney, 
Tex.  ;  Dr.  O.  Joachin,  of  New  Orleans; 
Dr.  \V.  II.  Baldingor,  of  Galveston,  Tex.; 
Dr.  J.  S.  Mott,  of  Kansas  City.  Mo.  ;  Dr. 
J.  S,  Litchtenberg,  of  Kansas  Citv,  Mo.  : 
Dr.  I.  W.  Bettengen,  of  St.  Paul,"  Minn.  ; 
Dr.  ).  W.  Chamberlin.of  St.  Paul.  Minn.: 
Dr.  II.  M.  Starcky,  of  Chicago;  Dr.  R. 
Brunson,  of  Hot  Springs,  Ark.;  Dr.  Max 
Thorner,  of  Cincinnati  ;  Dr.  I.  W.  .Scales, 
of  Pine  Bluff,  Ark.  ;  Dr.  E.  M.  Singleton, 
of  Marshalltown,  la.;  Dr.  F.  C.  Eving.  of 
St.  Louis. 


The  Male  and  Female  Skull. 

M.  Lc  Bon,  the  distinguished  French  sci- 
entist, in  a  new  book  entitled  "The  Psy- 
chology of  Nations,"  has  some  curious 
things  to  say  about  progress.  He  apparently 
does  not  think  that  there  is  any  sign  of  wo- 


men becoming  the  equals  of  the  '-superior 
sex."  He  says:  "The  differentiation  of 
individuals  brought  about  by  the  develop- 
ment of  civilisation  is  also  apparent  in  the 
case  of  the  sexes.  Among  inferior  peoples 
or  the  inferior  classes  of  superior  peoples 
the  man  and  the  woman  are  intellectually 
on  much  the  same  level.  On  the  other 
hand,  in  proportion  as  peoples  grow  civilis- 
ed the  difference  between  the  sexes  is  ac- 
centuated. The  volume  of  the  male  and 
temale  skull,  even  when  the  subjects  com- 
pared are  strictly  of  the  same  age,  height, 
and  weight, presents  differences  that  increase 
rapidly  with  the  degree  of  civilisation. 
Very  slight  in  the  case  of  the  inferior  races, 
these  diferenees  become  immense  in  the  case 
of  the  superior  races.  In  them  the  feminine 
skulls  are  often  scarcely  more  developed 
than  those  of  the  woman  of  very  inferior 
races.  Whereas  the  average  volume  of  the 
skulls  of  male  Parisians  is  such  as  to  range 
them  among  the  largest  known  skulls,  the 
average  of  the  skulls  of  female  Parisians 
classes  them  among  the  smallest  skulls  with 
which  we  are  acquainted,  almost  on  a  level 
with  the  skulls  of  Chinese  women,  and 
scarcely  above  the  feminine  skulls  of  New 
Caledonia." 


Report    of    Treatment    of    Secondary 
Anemias,    with    Cases. 

J.  A.  Stoutcnburgh,  M.  D.  says:  These 
anemias  accompany  or  follow  other  ab- 
normal conditions,  and  play  an  important 
part  in  their  course.  If  not  relieved,  they 
prolong  the  original  attack,  and  when  con- 
valescence is  finally  established,  leave  the 
patient  a  shining  mark  for  those  infectious 
diseases  which  claim  for  their  victims  those 
whose  resistive  power  is  below  the  normal 
standard. 

In  most  anemias  the  blood  is  diminished 
in  volume,  the  corpuscles  in  number  and  the 
hemaglobin  sometimes  falls  to  less  than 
half  the  normal  percentage.  As  a  result 
the  oxygen-carrying  power  of  the  blood  is 
impaired,  tissue  metamorphosis  retarded 
and  nutrition  of  the  whole  body  suffers  in 
proportion  to  the  degree  of  the  anemia. 
There  is  loss  of  appetite  and  constipation, 
and   the   work  of  living  is  but  lazily  done. 

Treatment. — First.  Regulate  the  bowels  ; 
for  this  podophyllum  in  small  daily  doses  is 
effective.  Second  :  cause  patient  to  drink 
freely  of  good  water,  boiled  preferred, 
taking  a  glassful  hot  three-quarters  of  an 
hour  before  each  meal.  This  fills  up  the 
circulation  and  facilitates  excretion  of  waste 
products.  Third  :  give  appropriate  treat- 
ment lor  the  original  disease,  and  Fourth  : 
we  need  a  remedy  or  combination  of  them 
that     will     increase     the     oxygen-carrying 


364 


THE  CHARLOTTE  MEDICAL    JOURNAL. 


power  of  the  blood,  increase  the  appetite 
and  stimulate  the  stomach  and  intestines  to 
renewed  activity. 

Many  so-called  blood-makers  attempt  to 
do  too  much  for  us  by  supplying  pre-digested 
and  artificial  food.  It  is  better  to  give 
nature  a  chance,  by  coaxing  her  to  resume 
her  work,  and  then  furnishing  a  nutritious 
and  easily  digestible  diet. 

Gray's  Glycerine  Tonic  Compound  is  a 
preparation  meeting  the  fourth  requirement, 
and  it  has  done  me  excellent  service  in 
many  cases  besides  those  here  reported.  It 
is  made  by  the  formula  of  Dr.  John  P.  Gray, 
a  combination  of  sherry  wine,  phosphoric 
acid,  gentian,  taraxacum,  glycerice  and 
aromatics. 

The  following  cases  from  my  note-book 
will  best  illustrate  my  points  : 

Case  I.     Mary  P ,   age  24,  seen  first 

June  11,  1897. 

History. — Had  several  attacks  of  malaria 
during  fall  of  1896,  intermittent  and  remit- 
tent types ;  suffered  two  severe  attacks  of 
bronchitis  during  February  and  March,  and 
had  malaria  again  in  May.  Has  been  sick 
now  six  days. 

Examination  shows  a  profound  anemia, 
rapid  and  very  small  pulse,  temperature 
varying  from  99.6  deg.  to  103  deg.,  as 
shown  by  later  observations.  Diagnosis, 
remittent  malarial  fever  and  anemia. 

Treatment  began  with  calomel,  followed 
by  quinine  in  doses  of  5  grains  every  hour 
for  four  hours  each  morning,  and  small 
doses  of  podophyllin  at  night,  plenty  of 
boiled  water,  aud  a  liquid  diet  rich  in  nitro- 
genous elements.  Fever  continnes  one 
week,  but  being  convinced  that  anemia  was 
partially  responsible  for  it,  on  third  day 
ordered  Gray's  Glycerine  Tonic  Compound 
in  half-ounce  doses  every  four  hours  before 
taking  food.  This  was  continued  four 
days  with  quinine  as  above,  when  temper- 
ature was  normal.  Now  put  on  full  diet, 
tonic  continued  before  meals  and  quinine 
gr.  ii.  after  meals.  Treatment  continued 
ten  days,  when  patient  reported  a  gain  of 
four  pounds,  great  increase  in  strength  and 
growing  appetite  ;  pulse  strong,  appearance 
much  improved.  Tonic  continued  ten  days 
longer,  when  a  fine  color  and  strong  pulse 
evinced  perfect  health. 

Case    II.     Margaret     G ,     aged    36, 

widow,  first  seen  May  17,  1S97.  Took 
cold  in  March,  had  a  constant  cough,  lost 
appetite  and  flesh,  constipation  and  has 
sweats  and  fever.  Has  taken  several  pre- 
•  parations  of  cod-liver  oil,  iron,  hypophos- 
phites  and  various  cough  mixtures  without 
material  relief. 

Examination — Roughened  bronchial  re- 
spiratory   murmur,   small  moist    niles    over 


left  apex,  some  dryness  and  fine  whistling 
rales  over  right ;  no  dullness  elicited  ;  anemic 
murmur  at  base  of  heart;  pulse  soft,  100; 
expectoration  scant,  glairy. 

Treatment. — For  bowels,  same  as  Case  I., 
boiled  water  to  be  drunk  freely,  and  a  mix- 
ture containing  codeine  one-sixth  grain, 
and  beech  wood  creosote  m.i  in  3i  of  strong 
syrup  of  ginger,  to  be  taken  every  four 
hours  to  relieve  cough.  Gray's  Glycerine 
Tonic  Compound  was  begun  at  once,  taken 
after  meals  on  account  of  irritable  stomach. 

May  27. — Cough  slight,  no  expectoration 
or  sweats,  sleeps  and  eats  well ;  ausculta- 
tion-respiratory sounds  much  improved,  a 
few  moist  niles  over  left  apex,  Codeine 
mixture  given  twice  a  day.  Tonic  con- 
tinued. 

June  7. — All  symptoms  have  disappear- 
ed ;  examination  negative ;  pulse  strong, 
condition  excellent,  although  she  is  support- 
ing herself  and  children  by  hard  work. 

Case  III.   Annie  V , aged  23,  married, 

first  seen  June  23.  Aborted  at  the  third 
month,  two  weeks  ago.  Had  profuse  hemor- 
rhage then,  and  it  has  continued  in  varying 
quantity  to  date  ;  is  thin  and  pale,  has  fever, 
sweats,  severe  headache  and  pelvic  pain. 

Examination    showed    enlarged,     tender 
uterus,   with  sanguino-purulent    discharge ' 
pulse  1^0, small  and  soft, mucous  membranes 
very  pale.     Diagnosis,   sepsis  and  anemia 
following  abortion  and  hemorrhage. 

Treatment. — Thorough  curretting  with 
gauze  drainage,  changed  every  second  day 
after  irrigation  with  normal  salt  solution. 
The  glycerine  tonic  and  quinine  were  given 
as  in  latter  part  of  Case  I.  In  one  week 
the  temperature  was  normal,  no  tenderness 
or  pelvic  pain,  general  condition  much  im- 
proved, tonic  continued  before  meals  to  aid 
digestion.  On  fifteenth  day  patient  said 
she  was  almost  as  good  as  new  ;  appetite 
splendid,  digestion  and  assimilation  perfect. 
Patient  discharged  cured  July  13,  having 
gained  nine  pounds  in  twenty  days. 

Case  IV.     Mary  M ,  42,  widow,  first 

seen  June  5,  1897.  Was  operated  on  for 
fibroma  uteri  one  year  ago,  ovariotomy  and 
partial  hysterectomy  being  done.  Since 
then  has  suffered  constantly  with  stubborn 
constipation,  anorexia  and  indigestion.  Of 
late  has  had  constant  headache ;  cannot  re- 
tain food,  bowels  not  moved  for  six  days, 
has  distension  of  abdomen  coming  on  every 
afternoon,  accompanied  by  intense  pelvic 
pain. 

Examination  showed  marked  anemia, 
tympanites,  bowels  loaded  and  a  fibroid 
reaching  half-way  to  the  navel  and  nearly 
filling  hollow  of  sacrum. 

Treatment. — Enemata  to  clean  out  bowels  ; 
copious  drinking  of  hot  water;  liquid  diet; 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


hot  stoups  for  pain.  Improvement  is  rapid. 
On  the  third  day  retained  food.  Gray's 
Glycerine  Tonic  Compound  in  tablespoon- 
fuf  doses,  well  diluted,  was  given  before 
meals  and  quinine  gr.  2  afterward ;  food 
gradually  increased.  On  the  fifth  day 
bowels  moved  naturally,  distension  ceased 
and  appetite  improving.  One  week  latter 
was  much  better;  good  appetite,  bowels 
moving  daily  ;  is  now  doing  her  own  work. 
She  drank  hot  water  before  meals  and  con- 
tinued the  tonic  for  two  weeks  longer, 
when  she  reported  that  she  was  in  better 
health  than  for  years,  and  had  gained  eight 
pound  since  beginning  treatment. 

These  are  some  of  the  cases  in  which  1 
have  used  this  new  restorative  with  the  best 
satisfaction.  Tain  well  satisfied  that  we 
have  in  this  tonic  a  most  valuable  medium, 
one  sure  to  grow  in  favor  as  its  merits  be- 
come better  known. 


Diet   in    Acne. 

The  regulation  of  the  diet  in  this  trouble- 
some and  so  often  obstinate  affection,  is 
now  generally  admitted  to  be  the  most  im- 
portant element  in  the  treatment  of  the 
disease.  Patients  themselves  will  usually 
have  been  trying  various  dietary  experi- 
ments along  with  the  ordinary  home  reme- 
dies before  consulting  a  physician.  Unless, 
however,  the  most  explicit  directions  are 
given  as  to  the  proper  diet ,  serious  mistakes 
will  be  made  by  patients  in  the  selection  of 
foods,  and  especially  as  to  its  quantity. 
As  Dr.  Jackson  says,  in  his  Manual  of  Dis- 
eases of  the  Skin  :j  "The  well-to-do  are 
prone  to  eat  too  much,  ami  it  is  remarkable 
how  rapidly  their  acne  will  improve  by  re- 
ducing their  diet  to  the  simplest  elements. 
In  many  of  them  a  milk  diet,  provided 
milk  agrees  with  them,  will  accomplish  a 
marked  benefit. "  On  the  other  hand, 
many  young  girls  almost  starve  themselves, 
entertaining  the  mistaken  idea  that  a  low- 
diet  will  give  them  a  fine  complexion. 
Nothing  could  well  be  less  true  than  this. 
Especially  is  there  a  prejudice  against  but- 
ter. The  old  explanation  that  skin  erup- 
tions were  mainly  due  to  the  use  of  too 
much  butter  still  remains  absolutely  true  for 
most  non-medical  people,  and  even  for  some 
medical  men.  That  butter  should  be  used 
freely,  and  that  codliver  oil  andiron  should 
be  the  only  drugs  required  in  many  cases, 
as  Dr.  Jackson  insists,  would,  to  these  good 
old  conservatives,  seem  rank  heresy.  It  is 
evident    that    more  definite  ideas  as  to    the 


tFrora  advance  sheets  of  the  third  edition  of 
a  Ready-Reference  Hand-book  of  Skin  Diseases, 
by  George  Thomas  Jackson,  M.  D.  Lea  Broth- 
ers &  Co.,  Publishers. 


diathesis  that  underlies  the  etiology  of  acne 
have  been  acquired,  and  that  the  dietetic 
management  of  it  rather  than  any  empiric 
use  of  vaunted  specifics  constitutes  the  most 
modern  therapeusis  of  this  extremely  fre- 
quent and  bothersome  condition. 


Modern  Treatment  of    Haemorrhoids.* 

Valuable  progress  has  been  made  in  recent 
years  in  the  local  therapeutic  treatment  of 
haemorrhoids.  Hitherto,  the  practitioner 
had  found  himself  in  an  uncomfortable  po- 
sition regarding  these  troubles,  not  only  in 
the  treatment  of  newly-formed  haemorrhoids 
but  in  chronic  cases  more  or  less  developed, 
even  up  to  large  venous  knots  hanging  from 
the  rectum  ;  in  reality,  he  had  no  remedies 
at  all  at  his  disposal  to  satisfy  the  expecta- 
tions of  the  patient,  which  constitute  an 
early  and  lasting  ceasing  of  the  pain  and 
an  ultimate  disappearance  of  the  disease. 

We  may  prescribe  a  strict  diet,  bodily 
exercise,  cold  or  luke-warm  sitz-baths,  and 
massage,  we  can  administer  laxatives  and 
suppositories  containing  narcotics,  &c,  but 
all  these  give  only  temporary  relief,  or,  in 
the  case  of  narcotics,  a  quickly-passing 
stupefying  effect,  following  which  the  pains 
are  more  severe.  Besides,  all  these  precau- 
tions are  not  always  carried  out  by  the  pa- 
tient with  the  necessary  perseverance,  espe- 
cially seeing  that  haemorrhoids  appear  more 
frequently  in  that  class  of  people  who  have 
always  been  accustomed  to  good  living  and 
cannot  readily  adapt  themselves  to  a  simple 
diet  and  mode  of  life. 

Moreover,  all  these  precautions  cannot  be 
carried  out  in  practical  life,  however  will- 
ing the  patient  may  be,  in  persons  whose 
occupation  compels  a  sedentary  mode  of 
life,  and  who  suffer  from  plethora  of  the 
abdominal  organs,  as  it  would  necessitate 
neglecting  their  business. 

In  cases  of  haemorrhoids  of  the  size  of  a 
pea.  walnut,  or  more,  the  spontaneous  bleed- 
ing of  which  brings  temporary  relief,  the 
medical  attendant  can  with  good  reason  get 
rid  of  the  patient  by  telling  him  that  such 
swellings  can  only  be  removed  by  extirpa- 
tion, for  which  operation  a  surgeon  must 
be  consulted. 

If  the  patient  follows  this  advice,  a  great 
service  is  not  done  the  surgeon  by  asking 
him  to  perform  an  operation, because  haemor- 
rhoidal  operations,  owing  to  the  uncertainty 
of  result  and  mode  of  performance,  are  not 
very  pleasant  or  satisfactory. 

If,  however,  the  patient,  as  is  mostly  the 
case,  greatly  fearing  the  knife,  does  not 
consult  the  surgeon,  then  the  family  physi- 


•Dr.  R.  Timmermann,  Hanover. 


THE  CHARLOTTE   MEDICAL  JOURNAL. 


cian  has  to  put  up  with  complaints  and  re- 
proaches of  the  patient,  and  at  last,  nolens 
volens,  opium  or  belladonna  preparations  in 
increasing  doses  have  to  be  resorted  to 
as  an  ultimatum.  In  short,  the  medical 
man  had  no  remedy  which  was  capable  of 
allaying  the  pain  within  a  few  hours,  and 
at  the  same  time  check  from  the  moment  of 
treatment  the  formation  of  new  haemor- 
rhoids, thereby  effecting  a  cure.  The  prac- 
titioner, as  well  as  the  layman,  will  only  be 
too  pleased  that  a  remedy  introduced  a  short 
time  ago  has  proved  of  such  value  as  a  thera- 
peutic local  remedy  in  such  cases,  that  it 
can  be  described  as  a  specific  for  haemor- 
rhoids. This  medicament  is  a  combination 
of  bismuth  with  iodo-resorcin  sulfonic  acid, 
and  which,  owing  to  its  specific  effect  upon 
the  mucous  membrane  of  the  rectum  in  va- 
rious conditions,  is  briefly  called  Ansuol. 

Its  effect  is  manifold  :  it  acts  upon  sup- 
purating, secreting,  or  moist  surfaces,  dry- 
ing up  and  limiting  the  secretion  ;  it  is  a 
very  powerful  disinfectant  and  deodorant, 
as  well  as  an  astringent,  these  properties 
explaining  the  strong  action  of  Anusol  in 
causing  granulation  and  consequent  healing 
of  sore  parts;  and,  furthermore,  Anusol 
acts  in  a  most  suitable  manner,  when  com- 
bined with  other  substances,  in  the  treat- 
ment of  haemorrhoids,  as  it  relieves  consti- 
pation and  removes  any  hardened  faeces, 
causing  a  slippery,  pappy,  and  painless 
stool.  The  combined  action  of  these  vari- 
ous properties  is  the  cause  of  the  great  suc- 
cess of  Anusol  in  the  treatment  of  haemor- 
rhoids— as  has  been  reported  by  numberless 
patients — even  in  most  severe  cases  of  many 
years'  standing.  This  success  will  induce 
practitioners,  when  treating  haemorrhoids, 
to  adopt  a  much  simpler  and  satisfactory 
method  than  hitherto.  Previously  the  phy- 
sician tried  to  remove  the  originating  cause 
of  the  disease  by  regulating  the  diet,  by  ad- 
vising a  suitable  mode  of  living,  and  by 
creating  a  more  active  circulation  of  the 
blood,  more  especially  in  the  abdominal  or- 
gans. Often  we  succeed — although  only 
partly,  sometimes  even  after  weeks  or 
months — in  removing  the  unpleasant  symp- 
toms ;  but  even  in  such  cases  we  frequently 
had  the  sad  experience  that,  owing  to  some 
little  deviation  from  instructions,  although 
probably  done  quite  unintentionally,  the 
old  pains  suddenly  recurred  in  a  much  more 
severe  form.  On  the  other  hand,  the  exact 
following  out  of  instructions  and  the  em- 
ployment of  internal  and  local  remedies  had 
no  effect  whatever.  The  method  now 
adopted  is  a  different  one:  we  still  attacli 
much  importance  to  our  instructions  being 
carried  out  regarding  the  general  mode  of 
living,    diet,     &c.  ;   but    the  experience    of 


many  years  has  taught  us  that  success  large- 
ly depends  upon  our  efforts  in  treating  the 
local  symptoms,  disturbing  the  ordinary 
mode  of  life  of  the  patient  as  little  as  possi- 
ble. This  local  treatment  is  an  extremely 
simple  one,  and  consists  in  the  employment 
of  Anusol  suppositories. 

The  iodo-resorcin  sulfonate  of  bismuth 
(Anusol),  which  is  absolutely  non-toxic, 
and  when  not  incorporated  with  a  fatty 
basis  is  readily  decomposed  when  exposed 
to  air  and  light,  is  made  into  suppositories 
in  combination  with  Zinci  :  Ox  :  as  an  ad- 
juvant and  Cocao  Butter  and  Ung  :  Cereum 
as  constituents,  and  is  only  supplied  in  the 
form  of  suppositories.  The  following  has 
proved  to  be  the  best  formula  : 

R     Anusoli, gTS.  112. 

Zinci  Ox. , grs.  90. 

Balsam  Peru, grs.  22-i. 

Cocao  Butter, 3  v. 

Ung.  Cerei, grs.  40. 

M.  Fiat  suppositoria   No.  12. 

One  suppository  should  be  inserted  into 
the  rectum,  above  the  sphincter,  each  even- 
ing, or  in  chronic  cases  morning  and  even- 
ing. If  the  haemorrhoids  are  external,  a 
portion  of  the  suppository  should  be  well 
rubbed  into  the  parts ;  and  the  remainder 
of  the  suppository  introduced  into  the  rec- 
tum. If  the  bowels  are  moved  within  half 
an  hour  after  the  introduction,  the  effect  is 
somewhat  nullified,  and  hence  another  sup- 
pository should  be  introduced.  Although 
the  suppositories  do  not  contain  any  nar- 
cotic, the  pain  is  greatly  relieved,  even  af- 
ter the  first  suppository ;  and  after  pro- 
longed use  (one  or  two  dozen  suppositories) 
in  almost  every  case  the  whole  of  the  trou- 
blesome symptoms  had  disappeared.  Of 
course  the  treatment  is  assisted  by  keeping 
to  a  simple  and  suitable  diet,  avoiding  stim- 
ulating foods  (strong  coffee,  alcohol,  &c. ) 
and  sitting  on  damp  or  cold  places,  with- 
out, however,  incommoding  the  patient  by 
any  radical  changes  in  his  diet  or  mode  of 
life. 

The  most  important  point  is  the  local 
treatment.  »Should  there  be  at  any  time  the 
slightest  sign  of  recurrence,  then  the  imme- 
diate employment  of  the  suppositories  will 
be  found,  in  most  cases,  to  absolutely  re- 
move the  disease. 

When  we  consider  that  women  when 
pregnant  and  after  parturition  are  often 
troubled  with  haemorrhoids,  constipation, 
and  painful  evacuation  of  the  bowels,  and 
that  Anusol  can  be  given  to  anybody  under 
all  conditions  without  the  slightest  ill-effect, 
this  remedy  must  be  considered  of  great  and 
useful  belp  to  the  medical  man  in  the  treat- 
ment of  such  affections.  Anusol  supposi- 
tories are  valuable  not  only  in  the  treatment 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


367 


of  haemorrhoids,  but  have  also  been  success- 
fully employed  in  many  other  diseased  con- 
ditions of  the  rectum,  its  mucous  membrane, 
and  external  surrounding  skin,  seeing  that 
in  cases  of  constipation,  and  all  kinds  of 
painful  evacuations  of  the  bowel,  in  intes- 
tinal tubuculosis,  enlarged  prostate,  &c,  a 
painless,  pappy  evacuation  takes  place.  In 
fissure  of  the  anus  and  catarrh  of  the  mu- 
cous membrane  of  the  rectum  these  supposi- 
tories often  effect — as  a  result  of  the  afore- 
mentioned therapeutic  properties — a  radical 
cure.  Again,  their  action  is  very  prompt 
in  cases  of  oxyuris  vermicularis  in  children 
and  adulis,  and  in  cases  of  painful  pruritus 
vaginae.  In  all  cases  of  sores  of  the  external 
skin,  be  it  in  infants  or  adults,  in  prurigo, 
intertrigo,  &c,  Anusol,  when  rubbed  into 
the  affected  part  in  suppository  form,  is  a 
safe  and  never-failing  remedy. 

A  great  advantage  of  Anusol  supposito- 
ries is  that  they  can  be  had  ready-made  for 
use,  which  saves  the  chemist  the  unpleas- 
ant task  of  making  the  suppositories  and  the 
medical  man  the  trouble  of  writing  out  a 
full  prescription.  He  would  simply  have 
to  prescribe  as  follows  : 

K     Supp.  Hsemorrhoidale  Anusoli, .  .No.  12. 

Big. — One  every  evening  (in  severe  cases, 
porning  and  evening)  to  be  inserted  into  the 
rectum;  or,  the  sore  part  to  be  rubbed  with  the 
suppository  three  times  a  day. 

Of  the  numerous ' favorable  medical  re- 
ports  which  have  appeared  on  the  subject, 
that  of  Dr.  Altschul's  on  "The  Etiology 
and  Therapy  of  Haemorrhoids,"  read  in  the 
Aeztliche  Verein  at  Frankfort,  November, 
iSo/>,  and  published  in  the  Deutsche  Medi- 
r'nntl  Zeitung^  November,  [897,  should  be 
mentioned. 

Dr.  Altschul,  who  has  himself  suffered 
from  haemorrhoids  for  twenty  years,  and 
has  in  his  own  interest  tested  many  methods 
of  treatment  on  himself,  says,  at  the  end  of 
his  paper,  after  having  explained  the  vari- 
ous dietetic  methods  of  treatment  (loco 
citato)  : — "Hantel  pessaries,  which  have 
been  recommended  by  others,  have  been 
prescribed  by  me  in  some  cases,  but  no  pa- 
tient showed  sufficient  perseverance  to  wear 
them  for  any  length  of  time;  1  will,  there- 
fore, not  give  a  conclusive  judgment  upon 
them.  A  disadvantage  which  cannot  be 
obviated  with  them  is  the  removal  of  the 
flatus  which  is  generated  when  they  are 
worn.  With  these  pessaries  it  is  possible 
in  medium  cases,  not  to  cure  them,  but  to 
make  life  bearable  and  more  comfortable. 
This  I  have  personally  experienced.  Un- 
fortunately, during  the  spring  I  did  not 
keep  to  the  dietetic  and  other  limits  im- 
posed, and  the  consequence  was  a  re-appear- 
ance of  the    venous    knots,   with    tenesmus 


and  itching.  I  hoped  to  derive  benefit  by 
climbing  whilst  staying  in  the  mountainous 
district ;  however,  unfavourable  weather 
did  not  allow  me  to  carry  out  my  intentions, 
and  only  on  my  return  home  could  I  again 
resume  the  usual  restricted  mode  of  living. 
The  improvement  was  despairingly  slow, 
when  I  casually  heard  of  Anusol  supposi- 
tories. The  first  trial  with  four  supposito- 
ries was  without  success,  and  it  was  with 
difficulty  that  I  could  be  induced  to  make 
another  trial.  I  ultimately,  however,  used 
them  for  four  days — two  suppositories  per 
day,  and  then  for  a  further  four  days,  ap- 
plying only  one  suppository  per  day.  The 
result  was  completely  successful.  Since 
that  time  (two  months  ago)  I  have  complete 
comfort,  only  after  defecation  having  to  re- 
place— as  I  have  done  for  years — the  pro- 
lapsed anus.  Upon  this  last  occasion  I  had 
been  troubled  for  four  months,  and  attribute 
the  satisfactory  cure  entirely  to  the  Anusol 
suppositories.  Since  then  I  have  prescribed 
them  for  a  large  number  of  patients,  and  all 
found  great  relief  of  their  troubles,  although 
not  to  the  extent  that  I  did.  It  seems  to 
have  no  effect  upon  haemorrhage.  The  ef- 
fective agent  in  the  suppositories  is  a  new 
chemical  preparation  called  iodo-resorcin 
sulfonate  of  bismuth.  I  have  never  heard 
of  any  toxic  or  harmful  by-effects." 

This  case  is  almost  typical.  On  the  one 
hand,  we  observe  that  no  method  has  hither- 
to given  the  patient  complete  rest,  and  that 
the  old  pains  recur  immediately  after  the 
slightest  irregularity  in  the  mode  of  living 
or  diet  ;  on  the  other  hand,  we  observe  the 
almost  astounding  success  which  followed 
the  employment  of  these  suppositories  when 
used  as  prescribed,  giving  as  they  did  com- 
plete rest  and  comfort  for  over  two  months. 

We  have  in  Anusol  a  most  valuable  addi- 
tion to  our  materia  medica,  which  is  a  great 
help  to  the  medical  man,  owing  to  the  sim- 
plicity and  safety  of  its  employment,  and 
will  prove  a  blessing  to  the  large  number  of 
people  who  are  troubled  with  haemorrhoids. 
—  The    Therapist. 


Evidence  in  Favor  of  Vaccination. 

The  action  of  the  English  Government 
with  regard  to  vaccination  has  stirred  up  its 
supporters  in  all  parts  of  the  world,  and 
scarcely  a  day  passes  that  does  not  bring 
overwhelming  proof  testifying  to  its  effi- 
cacy. Pediatrics  in  one  of  its  recent  edi- 
torials thinks  that  this  temporary  set  back  in 
England  will  be  for  the  ultimate  good  of 
the  cause,  by  arousing  the  upholders  of 
vaccination  from  their  lethargy,  and  by 
welding  them  together  in  a  solid  mass,  and 
lastly,   by  improving  the  methods  of  opera- 


THE  CHARLOTTE  MEDICAL  JOURNAL 


tion.  In  a  recent  lecture,  delivered  at 
Rome,  Dr.  Bizzozzero  made  an  able  and 
impressive  argument  in  favor  of  vaccina- 
tion. He  referred  to  the  immense  benefits 
that  the  re- vaccination  law  of  1874  na<^ 
conferred  on  Germany  by  controlling  the 
ravages  of  small-pox.  In  1871,  with  a 
population  of  50,000,000,  she  lost  143,000 
lives  by  small-pox,  whereas  through  the 
effective  working  of  the  law  of  1S74  the 
mortality  decreased  at  such  a  rate  that  now 
the  disease  claims  but  116  victims  in  the 
year.  Professor  Bizzozzero  goes  on  to  say  : 
"If  it  were  true  that  a  good  vaccination 
does  not  protect  from  small-pox  we  ought 
to  find  in  small-pox  epidemics  that  the  dis- 
ease diffuses  itself  in  the  non-vaccinated 
countries.  But  it  is  not  so.  In  1870-71, 
during  the  France-German  war,  the  two 
people  interpenetrated  each  other,  the 
German  having  its  civil  population  vaccin- 
ated optionally,  but  its  army  completely 
re-vaccinated,  while  the  French  (popula- 
tion and  army  alike),  were  vaccinated  per- 
functorily. Both  were  attacked  by  small- 
pox, but  the  French  army  numbered  23,000 
deaths  by  it,  while  the  German  army  had 
only  278;  and  in  the  same  tent,  breathing 
the  same  air,  the  French  wounded  were 
heavily  visited  by  the  disease,  while  the 
German  wounded,  having  been  re- vac- 
cinated, had  not  a  single  case.  No  more 
convincing  testimony  of  the  good  wrought 
by  vaccination  has  ever  been  adduced. 
Compulsory  vaccination  should  be  in  force 
in  every  country  of  the  world,  and  ignorant 
parents  or  parents  with  a  crank  should  not 
be  allowed  to  endanger  the  lives  of  their 
young  children  or  imperil  the  health  of  the 
public  at  large.  The  principle  of  freedom 
may  be  carried  too  far. 


High   Temperature   and    Prognosis    of 
Pneumonia. 

Donier,  according  to  the  British  Medical 
journal,  has  studied  the  question  of  high 
temperature  and  prognosis  in  pneumonia. 
Some  of  the  observations  which  he  quotes 
were  received  by  him  from  Friessinger. 
From  his  investigations  he  comes  to  the 
conclusion  that  in  some  cases  of  pneumonia 
a  high  temperature  is  of  good  rather  than 
of  bad  omen.  In  some  cases  he  observed 
temperature  ranging  from  41.0  deg.  to  42.4 
deg.  C.  In  these  cases  the  mortality  reached 
13.3  per  cent.,  while  in  cases  in  which  the 
temperature  varied  between  39.5  deg.  and 
4ideg.  C.  there  were  19.85  per  cent,  deaths, 
while  in  those  between  38  deg.  and  39.5 
deg.  C.  the  mortality  was  as  high  as  23.07 
per  cent.  The  point  of  importance  in 
these   cases   is   to  note   the  character  of  the 


pulse  in  conjunction  with  the  temperature. 
A  high  temperature  with  a  good  pulse  de- 
notes that  although  the  disease  is  severe  the 
tissues  are  reacting  to  it,  and  that  probably 
it  will  exhaust  itself  in  a  short  time.  When 
however,  the  pulse  is  rapid  and  the  tempera- 
ture high,  it  shows  a  less  resistive  power  in 
the  economy.  On  the  other  hand,  should 
the  temperature  be  considerably  lower — 38 
deg.  C.,  and  the  pulse  rapid — it  points  to  a 
severe  degree  of  infection  and  little  or  no 
reaction  on  the  part  of  the  tissues.  Thus, 
high  temperature  in  pneumonia  is  not 
necessarily  an  alarming  symptom,  and 
many  such  cases  do  extremely  well. 


Massage  of  the  Abdomen. 

Reed  (Medical  News)  recommends  mas- 
sage of  the  abdomen  in  the  following  con- 
ditions :  "(1)  Chronic  gastritis  in  all  its 
forms,  excepting  those  accompanied  by 
hyperchlorhydria.  (2)  Anacidity  or  sub- 
acidity,  except  when  dependent  upon  acute 
gastritis  or  carcinoma.  (3)  Gastroectasia, 
not  dependent  on  cancer.  (4)  Atonic 
conditions  of  the  stomach  walls,  whether 
progressed  to  the  stage  of  dilatation  or  not. 
(5)  Displacements  of  the  various  abdominal 
organs,  including  («)  gastroptosis ;  (b) 
nephroptosis,  except  in  cases  where  the 
displaced  kidney  has  become  excessively 
tender  on  pressure  ;  (r)  enteroptosis.  (6) 
Chronic  intestinal  catarrh,  not  complicated 
with  deep  ulceration.  (7)  Dilatation  of 
the  intestines.  (8)  Constipation  from 
unknown  causes.  In  many  such  cases 
massage  succeeds.  (9)  In  a  group  of 
symptoms  which  comprise  especially  ten- 
derness over  a  region  three  or  four  inches 
in  diameter,  including  the  umbilicus  as  its 
center,  and  a  marked  pulsation  of  the  ab- 
dominal aorta  in  the  entire  epigastric  region. 

"These  symptoms  have  been  assumed  to 
denote  congestion  of  the  solar  plexus. 
They  are  often  met  with  in  practise,  and 
may  be  the  results  of  autoinfection  from 
the  gastro-intestinal  tract.  They  are  usu- 
ally benefited  by  gentle  kneading  of  the 
abdomen  in  connection  with  careful  atten- 
tion to  diet.  The  followingare  the  principal 
contraindications  for  massage  of  the  abdo- 
men :  (1)  Ulceration  in  any  part  of  the 
stomach  or  intestines;  (2)  cancer  or  any  of 
the  abdominal  organs;  (3)  acute  inflam- 
mation in  any  part  of  the  gastro-intestinal 
tract;  (4)  hyperchlorhydria  ;  (5)  prolapsed 
kidneys  which  are  acutely  sensitive  to  palpa- 
tion ;  (6)  aneurism  of  any  of  the  abdominal 
or  thoracic  arteries;  (7)  during  the  men- 
strual period,  when  the  flow  is  excessive, or 
when  there  is  a  tendency  to  menorrhagia. 
In  fatty  degeneration  or  marked  dilatation 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


of  the  heart  and  advanced  phthisis,  especi- 
ally with  a  tendency  to  hemoptysis,  abdo- 
minal massage  should  be  practised — if  at 
all — with  much  care  and  gentleness." 


How  to  Avoid  Tuberculosis. 

Tucker  Wise,  M.  I).,  (Medical  Record,) 
summerizes  the  precautions  against  tuber- 
culosis, as  follows  : 

A  generous   dietary  of  nitrogenous  food. 

Free  ventilation  of  dwelling — and  sleep- 
ing-rooms by  open  windows,  with  wire 
gauze  blinds. 

Adequate  house-heating  in  winter. 

Boiling  of  all  milk  and  cream  previous  to 
use. 

Try  to  obtain  eight  hours'  sleep  every 
night  ;  if  not  sound  sleep,  contract  the  hours 
to  seven,  and  rest  in  the  day. 

If  debilitated,  with  weak  digestion,  take 
a  rest  in  the  recumbent  position  a  quarter 
of  an  hour  before  and  after  meals. 

Wear  the  loosest  clothing  possible,  especi- 
ally around  the  waist  and  ribs,  to  afford 
absolute  freedom  in  respiration. 

Take  systematic  daily  exercise  in  the 
open  air  on  foot. 

If  means  and  station  in  life  admit  of  a 
long  holiday  from  time  to  time,  live  during 
line  weather  in  a  tent  in  the  open  air  or  in 
a  summer-house  for  most  of  the  day  ;  and  if 
unemployed,  pursue  a  hobby  to  occupy  the 
mind. 


The    Bacterial    Origin   of    Biliary    Calculi. 

Mignot  (British  Medical  Journal)  states 
even  those  who,  owing  to  the  discovery  by 
Gilbert  and  others  of  living  bacteria  in  the 
centre  of  biliary  calculi,  believe  that  bacte- 
ria are  the  exciting  cause,  generally  con- 
sider that  a  diathesis  is  a  necessary  predis- 
posing cause.  This,  however,  is  a  mistake. 
The  author  has  succeeded  in  producing 
typical  calculi  in  guinea-pigs  and  has  ob- 
tained the  following  results  :  (i)  Foreign 
bodies  when  introduced  into  the  gall  blad- 
der can  stay  there  for  an  indefinite  time, 
provided  they  are  aseptic,  without  causing 
intlammation  or  precipitating  the  solid.1 
from  the  bile.  (2)  Foreign  bodies  pre 
viously  impregnanted  with  virulent  micro 
organisms  causes  a  more  or  less  intense 
cholecystitis  and  precipitate  the  solids  from 
the  bile.  As  long  as  the  bacteria  retain 
their  virulence,  however,  they  cannot  form 
a  calculus,  but  only  a  sediment  mixed  with 
pus.  This  precipitate  has  no  tendency  to 
cohere  or  to  adhere  to  foreign  bodies.  (3) 
Mignot  then  shows  why  previous  attempts 
to  form  calculi  have  failed.  The  bacteria 
must    be  attenuated,   not   virulent.      This  is 


best  attained  by  growing  them  for  some 
months  in  bile  to  which  constantly  decreas- 
ing amounts  of  broth  are  added.  When 
sufficiently  attenuated  they  are  no  longer 
pathogenic  when  injected  into  the  cellular 
tissue  of  animals.  By  injecting  these  into 
the  gall  bladder  stones  are  occasionally 
formed,  but  more  often  the  bacteria  are 
washed  out  into  the  intestine.  If,  however, 
a  foreign  body,  especially  if  porous,  such  as 
cotton  wool,  be  placed  in  the  bladder  and 
fixed  to  its  wall  to  prevent  expulsion,  a 
stone  is  formed  around  it  with  the  greatest 
certainty.  Five  or  six  months  are  required 
for  the  formation  of  a  perfect  calculus. 
The  kind  of  bacteria  injected  seems  to  be 
of  quite  secondary  importance.  Mignot 
has  proved  that  the  typhoid  bacillus,  the  B. 
coli,  staphylococci,  streptococci,  and  even 
the  non-pathogenic  B.  subtilis,  are  capable 
of  giving  rise  to  calculi,  and  probably  a 
great  number  of  other  organisms  are  equal- 
ly so. 

The  Diagnosis  between  Tubercular  Syph- 
ilis   of    the  Tongue  and  Syphilitic 
Glossitis. 

The  Laryngoscope  gives  the  following. 
Tubercular  syphilis  of  the  tongue  :  1.  Be- 
gins in  the  submucous  connective  tissue, 
which  corresponds  to  the  rete  imicositm  of 
the  skin.  2.  Spreads  from  the  center  to- 
wards the  surface,  deforming  and  atrophy- 
ing the  papilla-.  3.  Profoundly  deranges 
the  disposition  of  the  elastic  fibers  and  of 
the  muscular  elements,  which  disappear, 
leaving  no  trace.  4.  Has  clearly  defined 
limits.  5.  Has  an  origin,  a  stricture  and  a 
anatomical  seat  which  do  not  differ  from 
those  of  cutaneous  tubercle.  6.  Shows  no 
tendency  to  the  formation  of  giant  cells. 
7.  Presents  vascular  alterations  consisting 
of  proliferation  and  detachment  of  the  end- 
othelium and  infiltration  of  the  external 
tunic  without  evident  traces  of  an  endarter- 
itis.     Syphilitic  glossitis  on  the  other  hand  : 

1.  Has  a  point  of  departure  notably 
deeper  and  more  exactly  in  the  muscular 
parenchyma.  2.  Has  no  defined  limits, 
and  easily  invades  the  entire  organ.  3. 
Presents  an  exuberance  of  the  mucous 
epithelium,  which  sends  irregular  processes 
into  the  corium.  4.  Consists  in  its  inflam- 
matory process  of  the  same  morphologic 
elements  as  tubercular  syphilis,  with  giant 
cells  in  addition.  5.  Shows  evident  new 
formation  of  connective  tissue.  6.  Com- 
prises a  newly  formed  connective  tissue  of 
intricate  disposition,  which  imparts  a  very 
considerable  resistance  to  the  organ.  7. 
Produces  deformity,  e.  g.,  lobulation  or 
fissures  of  the  surface,  resulting  either  from 


370 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


loss  of  substance  by  ulceration  or  from  con- 
traction of  the  newly-formed  connective 
tissue. 


Drug   Addiction. 

Dr.  J.  H.  Kellogg,  in  a  recent  paper, 
makes  the  following  clear  distinction  : 
(Medical  Record,   Jan.  14,  '99). 

"The  majority  of  persons  who  acquire 
the  disease  of  drug  addiction  are  peculiarly 
constituted  individuals,  who  may  be  divided 
into  two  classes,  as  :  ( 1 )  Those  who  live 
upon  the  sense  plain,  regarding  the  body 
as  a  harp  of  pleasure,  to  be  played  upon  so 
long  as  its  strings  can  be  made  to  vibrate 
by  force  of  will  or  the  aid  of  artificial  ex- 
citements, and  who,  when  the  natural  re- 
sources of  the  body  are  exhausted,  seek  arti- 
ficial and  unearned  felicity  through  the  aid 
of  various  nerve-tickling,  pain-and-trouble 
annihilating,  felicity-producing  drugs.  (2) 
Those  hypersensitive,  neurotic,  delicately 
organized  individuals,  a  rapidly  increasing 
class,  who  are  the  natural  result  of  the  arti- 
ficial, brain-and-nerve-destroying  and  race- 
deteriorating  conditions  of  our  modern  life. 
These  persons,  lacking  physical  capacity  for 
enduring  the  pains,  hardships,  and  tribula- 
tions of  life,  from  which  they  suffer  untold 
and  indescribable  agonies,  seek  relief  in 
some  nepenthe,  which  promises  them  ease 
from  the  present  stress  of  suffering,  over- 
looking all  considerations  respecting  what 
the  future  may  have  in  store  for  them." 


The  Use  of    Crede's    Silver  Ointment    in 
Puerperal    Sepsis. 

At  the  meeting  of  the  New  York  Acad- 
emy of  Medicine,  Section  on  Obstetrics  and 
Gynaecology,  Jan.  26,  1899,  Dr.  S.  Seabury 
Jones  read  a  paper  on  the  use  of  Crede's 
silver  ointment  in  puerperal  sepsis.  (Med- 
ical Record,  Feb.  11,  1899.)  The  author 
said  that  Dr.  Tracy,  registrar  of  the  New 
York  City  Board  of  Health,  had  kindly 
furnished  him  with  the  statistics  as  to  the 
number  of  deaths  from  puerperal  septicae- 
mia, grouped  in  periods  of  five  years,  from 
1866  to  the  present  time.  These  figures, 
together  with  the  fact  that  last  year,  in  the 
boroughs  of  Manhattan  and  the  Bronx, 
there  were  376  deaths  from  all  puerperal 
diseases,  indicated  that  there  was  much  yet 
to  be  done  in  the  line  of  making  childbear- 
ing  more  physiological  and  less  patholog- 
ical. These  statistics,  of  course,  left  en- 
tirely out  of  consideration  the  large  num- 
ber of  cases  of  puerperal  sepsis  in  which 
life  was  not  sacrificed,  though  much  dam- 
age might  have  been  done. 

In  spite  of  the  brilliant  results  claimed  to 
have  been  secured  in    Crede's   clinic  by  the 


use  of  the  new  silver  salts,  the  literature 
of  the  subject  in  this  country  was  still  very 
meager.  The  reader  of  the  paper  then 
proceeded  to  review  the  literature,  calling 
special  attention  to  the  researches,  in  this 
country  of  Carey  Lea  on  allotropic  silver. 
What  he  described  as  "gold-colored,  allo- 
tropic silver"  appears  most  nearly  to  cor- 
respond with  Crede's  soluble  silver.  Lea 
says  that  it  was  soluble  in  water,  and  that 
when  heated  on  platinum  it  was  converted 
into  ordinary  silver.  It  occurred  in  small, 
hard  pieces,  having  a  greenish  metallic  lus- 
ter, but  when  subjected  to  trituration  it 
became  pasty  and  assumed  a  yellow  tint. 
Crede  used  a  15  %  ointment  containing 
soluble,  uncombined  metalic  silver.  He 
estimated  that  of  the  three  grams  which  he 
recommended  for  the  initial  inunction, 
about  4^  grains  of  pure  silver  were  absorbed 
into  the  system.  This  investigator  used 
the  ointment  only  in  well  observed  cases 
in  which  the  diagnosis  of  severe  septic  in- 
fection was  clear.  In  local  processes  the 
inunctions  were  made  as  far  from  the  seat 
of  disease  as  possible.  He  found  that  in 
acute  and  recent  cases  one  inunction  was 
usually  sufficient  to  effect  disinfection  of  the 
system  in  from  twenty-four  to  thirty-six 
hours.  Improvement  was  usually  observed 
in  from  three  to  ten  hours — indeed  it  was 
so  sudden  as  to  astonish  both  patient  and 
physician. 

The  Alleged  Heredity  of  Consumption. 

There  is  no  doctrine  more  firmly  im- 
pressed on  the  mind  of  the  average  director 
of  a  life  assurance  company  than  the  hered- 
itary transmission  of  consumption.  Yet, 
like  other  cherished  beliefs,  this  doctrine, 
says  the  British  Medical  Journal,  is  being 
attacked  on  all  sides,  and  if  it  is  to  remain 
as  one  of  the  fundamental  principles  of  life 
assurance,  fresh  statistics  must  be  collected 
so  as  to  confute  the  statements  confidently 
made  by  its  opponents.  The  discovery  of 
the  tubercle  bacillus  and  the  confirmation 
of  the  infectious  nature  of  consumption  has 
thrown  quite  a  new  light  on  some  of  the 
questions  connected  with  the  transmission 
of  this  disease.  The  old  statistics,  which 
simply  stated  the  number  of  consumptive 
persons  who  came  of  a  consumptive  parent- 
age, will  not  now  suffice  to  convince  any 
thoughtful  physician  that  the  disease  is 
transmitted  by  inheritance.  There  can  be 
little  doubt  that  in  many  of  the  so-called 
cases  of  transmitted  phthisis  the  patient  ac- 
quired the  disease  by  contagion,  his  powers 
of  resistance  to  the  bacillus  being  enfeebled 
by  the  same  conditions  of  environment  as 
led  to  his  father  or  mother  being  affected. 
In  order,  therefore,  to  prove  that  consump- 


THE  CHARLOTTE-MEDICAL  JOURNAL. 


371 


tion  is  inherited,  it  will  be  necessary  to  show 
that  the  children  of  consumptive  parents 
when  removed  from  the  influence  of  the 
paternal  environment  succumb  to  the  dis- 
ease to  a  greater  extent  than  do  the  general 
population. 

Relation  of  Pelvic  Disorder  to  Mental 
Disease. 

C.  K.  Clark,  (Albany  Medical  Annals, 
January,  i899,)states  that  for  some  time  in 
that  Province  a  war  has  been  waged  on  the 
subject  of  gynecological  operations  as  a 
cure  for  insanity.  The  enthusiasts,  on  one 
side,  claim  that  practically  all  insane  wo- 
men have  pelvic  disease  ;  the  opponents  of 
this  theory  insist  that  pelvic  disease  is  an 
unimportant  factor  in  the  development  of 
insanity.  His  experience  has  been  that  it 
exists  in  a  small  proportion  of  patients, and 
of  those  in  whom  it  does  exist  a  majority  do 
not  require  surgical  aid.  In  those  upon 
whom  he  has  operated  surgical  results  have 
been  excellent,  but  the  result  on  the  mental 
condition  has  been  generally  disappointing 
and  in  some  instances  harmful.  Pelvic  dis- 
ease no  doubt  accounts  for  a  small  propor- 
tion of  cases  of  insanity,  and  when  it  exists 
should  receive  appropriate  treatment. 

"We  have  nothing  to  say  against  opera- 
tions of  any  kind  being  performed  on  the 
insane,  for  just  the  same  reasons  that  make 
operations  on  the  sane  advisable  or  neces- 
sary, but  we  protest  against  the  removal  of 
Uterine  appendages  for  any  other  reason. 
The  day  of  indirect  treatment  for  mental 
and  moral  deficiencies  by  heroic  operations 
has  gone  by.  Attempts  in  this  direction 
have  been  made  from  time  to  time,  but 
comprehensive  psychology  and  good  sense 
have  hitherto  triumphed  and  will  continue 
to  do  so." 


The    Surgery    of    Perforation  in  Typhoid. 

Gushing  (Johns  Hopkins  Bulletin,)  re- 
prots  4  cases.  In  the  first  perforation  oc- 
curred at  the  end  of  the  second  week.  The 
abdomen  was  opened,  and  the  perforation 
closed  by  suture ;  the  peritoneum  was 
drained.  Three  days  later  a  faecal  fistula 
developed  from  a  second  perforation,  but 
closed  spontaneously.  Seven  days  later 
there  were  no  symptoms  of  perforation. 
Once  moreabdominal  section  was  performed, 
no  perforation  found  ;  two  days  afterwards 
laparotomy  was  again  needed  for  acute  in- 
testinal obstruction  caused  by  adhesions 
about  the  second  perforation.  This  obstruc- 
tion was  relieved,  and  the  perforation 
closed.  The  patient,  a  boy  aged  9, recovered. 
The  second  case  occurred  in  a  boy  aged  iS. 
Perforation   took  place   in    the    fifth    week. 


The  patient  was  very  ill ;  laparotomy  was  un- 
dertaken under  cocaine  anaesthesia.  There 
was  general  peritonitis  and  free  extravasa- 
tion of  liquid  fasces.  Three  perforations 
were  discovered  and  sutred  ;  all  lay  in  the 
ileum.  The  patient  died  in  four  hours. 
The  patient  in  the  third  case  was  a  negro, 
aged  31.  After  prolonged  abdominal  symp- 
toms perforation  occurred  at  the  end  of  the 
fourth  week.  General  streptococcic  per- 
itonitis was  found,  the  perforation  was 
sutured,  and  Douglas's  pouch  drained  with 
gauze.  The  patient  died  at  the  end  of 
eight  hours.  The  fourth  operation  was 
undertaken  under  an  error  of  diagnosis. 
Symptoms  of  perforation  set  in  during  the 
fourth  week,  the  fever  had  relapsed.  The 
patient  was  a  girl  aged  15.  Sudden  pain 
seized  her,  with  vomiting  and  distension. 
Abdominal  section  was  performed.  There 
was  no  free  fluid  in  the  peritoneum,  which 
was  not  even  injected;  the  appendix  and 
intestines  were  free  from  adhesions.  The 
Peyer's  patches  in  the  ileum  were  swollen 
and  hard,  feeling  like  buttons.  The  pelvic 
viscera  and  lumbar  glands,  the  gall  bladder 
and  the  great  veins  of  the  pelvis  and  abdo- 
men were  apparently  free  from  lesions.  No 
ill-effects  followed  the  operation,  and  the 
relapse  subsided. 

Rebellious  Constipation  Cured  by  Massage 
of  the  Gall-Bladder. 

Berne  has  found  that  in  certain  patients 
massage  of  the  gall-bladder  gives  almost  as 
good  results  in  overcoming  constipation  as 
massage  of  the  whole  abdomen.  (Medical 
News,  Feb.  4,  1899.)  In  some  patients 
massage  of  the  whole  abdomen  is  contraindi- 
cated,  as  in  the  presence  of  an  abdominal 
tumor,  or  an  excess  of  adipose  tissue,  or  a 
particularly  sensitive  skin,  as  well  as  in 
young  women  in  whom  the  close  association 
of  the  pelvic  and  abdominal  organs,  make 
general  abdominal  massage  undesirable. 
Moreover,  constipation  is  often  due  to 
sluggishness  of  the  biliary  flow,  and  mas- 
sage over  the  gall-bladder  corrects  this. 
The  operator  sits  at  the  right  side  of  his 
patient,  and  makes  deep,  gentle  plunges 
with  his  fingers  from  below  the  false  ribs 
upward  toward  the  under  surface  of  the 
liver.  Ten  minutes  of  this  exercise,  three 
hours  after  the  midday  meal,  and  repeated 
daily  for  ten  or  twelve  days,  will  suffice  to 
bring  about  a  normal  passage  without  the 
help  of  drugs.  From  thirty  to  forty  days 
are  required  to  effect  a  permanent  cure. 
The  passage  of  bile  into  the  intestine  is 
shown  by  the  restoration  of  the  normal 
color  of  the  stools,  and  the  disappearance 
of  their  fetid  odor,  while  the  body  of  the 
patient  regains  its  natural  embonpoint. 


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THE  CHARLOTTE  MEDICAL  JOURNAL. 


Hypertrichosis. 

There  are  few  chronic  diseases  that  give 
rise  to  more  real  discomfort  than  this  cos- 
metic defect.  Numbers  of  doctors  have 
almost  piteous  appeals  from  female  patients 
on  whom  the  development  of  a  hirsute  fa: 
cial  appendage  is  a  source  of  as  much  wor- 
riment  as  it  would  be  of  joy  to  their  young 
male  relatives.  So  many  different  methods 
have  been  employed  for  its  removal  in  the 
past,  and  so  many  exaggerated  claims  made 
for  each  new  method,  and  yet  recurrence 
has  been  the  rule,  that  the  ordinary  general 
practitioner  is  apt  to  doubt  that  there  is 
really  any  effective  lasting  method  of  depi- 
lation,  and  so  advises  his  patients  against 
attempts  at  relief. 

The  electrolytic  method  of  removing  the 
superfluous  hairs  of  Trichiasis — the  inven- 
tion and  practical  development  of  which, 
by  the  way,  we  owe  entirely  to  Americans, 
has  been  now  before  the  profession  nearly 
a  quarter  of  a  century.  It  has  been  gener- 
ally adopted  in  Europe,  and  especially  in 
Paris  is  used  extensively  and  with  the  best 
satisfaction.  "The  question  is  often  asked," 
says  Dr.  Jackson,  in  his  'Manual  of  Skin 
Diseases,"*  "is  the  removal  of  the  hair  by 
this  method  permanent?"  This  question 
may  be  answered  :  "It  is  without  a  shadow 
of  a  doubt."  The  answer  has  the  advan- 
tage of  being  definitely  decisive,  something 
that  is  not  always  characteristic  of  thera- 
peutic suggestions,  especially  in  skin  dis- 
eases. With  the  refinements  in  the  use  of 
the  electrolytic  needle  that  twenty-five  years 
of  practical  experience  with  it  have  given, 
the  depilation  is  now  almost  invariably  suc- 
cessful from  the  beginning,  and  a  new 
growth  of  hair  afterwards  is  an  anomalous 
irritative  hyperplasia  which  is  extremely 
rare,  or  a  sign  of  failure  to  destroy  the  hair 
bulbs  completely  at  first.  The  danger  of 
scarring  is  also  reduced  to  a  minimum,  and 
with  reasonable  care  the  cicatrization  will 
never  be  more  than  the  minutest  points  on 
the  skin,  and  seldom  will  be  noticeable  at 
all.  There  would  really  seem  to  be  very 
little  reason  any  more  for  sensitive  people 
to  suffer  the  discomfort  they  usually  do  be- 
cause of  the  persistent  presence  of  this  un- 
desirable hirsute  adornment. 


READING  NOTICES. 


Doctor — That's  a  bad  razor  cut  in  your 
head,  Rastus.  Why  don't  you  profit  by  this 
lesson  and  keep  out  of  bad  company?  Ras- 
tus— Ah  would,  doctah,  but  Ah  ain't  got  no 
money  toe  git  er  divorce. 


*From  advance  sheets  of  the  third  edition  of 
"Jackson  on  Diseases  of  the  Skin."— Lea  Broth- 
ers &  Co.,  Publishers. 


Clinical  Experience  Showing   the  Physio- 
logical Action  of  Mercauro  and 
Arsenauro. 

Liq.  Auri  et  Arsenii  Bromidi — Arsenauro 
— Strength  10  minims  (0.6  c.c.)  contains 
1-32  gr.  each  (0.002  gm.)  Bromide  of  Gold 
and  Bromide  of  Arsenic. 

Liq.  Auri  et  Arsenii  et  Hydrargyri  Brom- 
idi— Mercauro — Strength  10  minims  contain 
(0.6  c.c)  1-32  gr.  each,  (0.002  gm.)  of  Bro- 
mide Gold,  Bromide  Arsenic  and  Bromide 
Mercury. 

Originated  and  recommended  by  Dr. 
Barclay. 

Physiological  Action — Digestive  System. 
— Five  to  ten  drops  of  either  of  these  solu- 
tions largely  diluted  with  water  stimulate 
the  flow  of  gastric  and  intestinal  juices  and 
augment  peristalsis,  improving  the  digestive 
and  nutritive  functions.  In  atony  of  the 
gastric  tubules  in  children  and  adults  Mer- 
cauro and  Arsenauro  are  invaluable. 

Circulatory  System. — Cardiac  action  may 
be  slightly  stimulated  by  the  doses  men- 
tioned— so  far  from  being  deleterious,  it  ac- 
tually tends  to  invigorate  the  system — in- 
creasing the  number  of  red  blood  corpuscles 
and  prevents  their  destruction  in  such  dis- 
eases as  Chlorosis  and  Anaemia. 

Nervous  System. — The  general  effect  of 
Arsenauro  and  Mercauro  on  the  brain  and 
nervous  system  is  that  of  a  tonic — a  pro- 
perty which  is  supposed  to  explain  their 
antiperiodic  nature,  in  which  respect  quin- 
ine alone  is  their  superior. 

In  very  large  doses,  60  to  80  drops,  the 
cerebral  functions  were  stimulated,  even  to 
the  point  of  exhiliration.  Experiments 
have  shown  that  the  sensory  nervous  appa- 
ratus is  strongly  affected.  This  action 
finally  involves  the  motor  system. 

Medicinal  amounts,  10  to  30  drops,  act 
as  a  nervous  excitant,  stimulating  the  tro- 
phic apparatus — (Lydston). 

Under  prolonged  use  these  solutions  tend 
to  accumulate  to  a  greater  extent  in  nervous 
than  in  other  tissues. 

Respiratory  System. — Ten  to  fifteen  drop 
doses  effect  special  change  in  respiration 
other  than  increased  power  and  stimulus  of 
the  respiratory  center.  It  has  been  held, 
with  authority,  that  small  doses  (5  drops) 
stimulate  endings  of  the  pulmonary  vagi. 

Absorption  ana IE li mi  11  at  ion.— Arsenauro 
and  Mercauro  are  readily  absorbed  by  the 
blood. 

Their  presence  may  be  detected  in  the 
viscera,  bile,  urine,  sweat,  the  bronchial 
and  intestinal   mucous  membrane  and   even 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


373 


in  the  parenchymatous  tissues.  It  is  elim- 
inated very  slowly  from  the  system  by  the 
intestines  and  rapidly  by  the  urine :  possi- 
bly also,  by  the  bile  and  the  skin  ;  the  sal- 
iva, milk  and  even  the  tears  are  said  to  share 
in  the  process  of  elimination. 

Ten  to  thirty  drop  doses  prevent  tissue 
change.  Their  therapeutic  action  is  cer- 
tainly to  modify  and  improve  nutrition. 

Temferature. — The  temperature  is  unaf- 
fected by  medicinal  doses  of  Arsenauro  or 
Mercauro. 

Eye. — Large  doses  of  these  solutions,  60 
to  80  drops,  in  diseases  of  the  eye  are  fol- 
lowed by  oedema  of  the  lids,  but  no  injec- 
tion of  the  conjunctiva. 

"The  puffiness  of  the  lids  produced  some- 
times by  large  doses  aggravates  no  diseases 
of  the  eye.  for  no  congestion  of  the  conjunc- 
tiva is  produced." — (.Short.) 

Untoward  Action.  —  Differing  from  the 
characteristic  symptoms  of  poisoning  pro- 
duced by  medicinal  doses  of  other  solutions 
of  Arsenic,  in  susceptible  persons,  these 
solutions  have  been  reported  without  aggra- 
vated toxic  effect. 

Frontal  Headache. — A  tendency  to  ver- 
tigo, frequent  alvine  evacuations  have  been 
reported  in  rare  instances,  but  these  idio- 
syncrasies are  easily  controlled  by  lessening 
the  dose  or  increase  the  dilution  with  a 
larger  quantity  of  water  at  t he  time  of  ad- 
ministration or  giving  it  before,  instead  of 
after  meals  or  vice  versa. 

Poisoning. — Several  cases  have  been  re- 
ported where  the  contents  of  original  bot- 
l  les  of  one  ounce  have  been  swallowed  with 
suicidal  intent,  but  except  the  >ymptoms 
mentioned  above,  under  untoward  effects, 
the  cases  promptly  recovered.  The  claim 
is  made  for  these  solutions,  that  they  have 
all  the  benefits  of  Arsenic,  but  their  com- 
bination with  Gold  and  Bromide  prevents 
toxic  effects. 

Dose There  are  two  methods  of  getting 

a  patient  thoroughly  under  the  influence  of 
Arsenauro  or  Mercauro. 

1.  Begin  with  a  small  dose,  5  drops,  and 
increase  1  minim  (0.006  c.c.)  a  day  until 
untoward  symptoms  appear,  namely,  swell- 
ing of  the  lids,  a  tendency  to  vertigo  or 
frontal  headache,  or  the  dose  has  reached 
30  drops  (1.0c.)  ;  then  decrease  the  amount 
one  minim,  or  drop,  each  dose  until  unto- 
ward effects  disappear,  and  continue  this 
dose  so  reached  for  at  least  eight  weeks. 

2.  llypodermatically. — In  the  malignant 
diseases,  carcinoma  and  the  various  cach- 
exia', it  may  be  desirable  to  obtain  a  very 
quick  saturation  of  the  system,  ami  this 
mode  of  administration  has  been  most  highly 
extolled  in  such  cases. 

The  liver  has  a  strong  elective  affinity  for 


them.  The  hypodermic  use  of  them  dis- 
tributes them  through  the  system  just  as 
mercury  is  distributed  by  inunction,  carry- 
ing it  immediately  to  all  parts  of  the  system 
by  the  circulation. 

For  hypodermic  use,  the  following  rule 
is  appropriate  : 

Dilute  with  equal  quantity  of  distilled 
water.  Use  alcohol  friction  over  the  part 
where  the  needle  is  to  be  introduced  (pre- 
ferably the  muscles  of  the  back).  Let  the 
injection  be  given  deep  into  the  muscles 
and  be  followed  by  active  friction  with  al- 
cohol after  injection, 

Note. — Dilute  at  one  time  only  sufficient 
quantity  for  each  injection. 
Incompatible*. — With  all  organic  matter. 
It  is  best  to  direct  the  patient  to  drop  the 
dose  to  be  taken  into  a  half  tumbler  of  water 
at  meal  time,  either  before  or  after  meals. 
Careful  study  of  the  effects  of  the  drug  in 
each  case  will  make  it  possible  to  guard  its 
administration  so  that  tolerance  can  be  es- 
tablished. A  result  much  to  be  desired  in 
order  to  secure  the  maxim  benefit. 

Considering  the  enormous  doses  to  which 
the  arsenocophagi  becomes  habituated,  fail- 
ure in  the  medicinal  administration  of  the 
solutions  argues  the  want  of  ability  to  em- 
ploy them  scientifically.  Their  superiority 
over  all  other  preparations  of  Arsenic  is 
rjarainount. 

Internally. — Arsenauro  is  a  peculiarly 
efficient  remedy  in  Chronic  Scaly  Skin  dis- 
eases. Like  all  other  specifics,  it  influences 
diseases  of  a  chronic  nature  more  favorably 
than  acute  disorders.  This  preparation, 
therefore,  is  a  most  valued  remedy  in  psori- 
asis, lepra,  and  squamous  eczema.  If  syph- 
ilis co-exists  preference  should  be  given  to 
Mercauro.  Pemphigus,  Prurigo,  Acne  and 
Lichen  Ruber  have  also  been  favorably  in- 
fluenced by  the  continued  administration  of 
these  solutions.  In  the  successful  manage- 
ment of  these  chronic  skin  diseases,  it  is 
necessary  that  the  preparation  employed  be 
given  in  as  large  doses  as  can  be  tolerated 
by  the  patient,  and  the  treatment  continued 
unremittingly  for  a  long  period.  It  is  well 
to  employ  these  solutions  alternately  in  these 
cases — say  6  weeks  of  Arsenauro — rest  a 
week  from  any  treatment,  then  six  weeks 
of  Mercauro — rest  a  week,  then  Arsenauro, 
and  so  on. 

Lymphoma,  whether  superficial  or  occu- 
pying the  great  cavities  is  benefitted  greatly 
by  similar  treatment. 

Asthma  and  Bronchitis,  whether  acute  or 
chronic,  accompanying  or  succeeding  scaly 
skin  diseases,  are  singularly  amenable  to 
these  solutions  when  the  dose  is  carried  to 
the  full  physiological   limit.      Another  con- 


374 


THE  CHARLOTTE    MEDICAL  JOURNAL. 


dition,  Dysmenorrhea,  frequently  noticed 
in  women  with  a  tendency  to  Asthma,  or 
subject  to  chronic  diseases  of  the  skin,  is 
often  cured  by  Arsenauro.  The  obstinate 
and  often  incurable  disease  known  as  per- 
nicious Anaemia  yield  better  to  Arsenauro 
than  to  any  other  known  remedy.  The 
effect  of  the  compound  in  this  disease  is  not 
simply  due  to  its  increasing  the  number  and 
quality  of  the  red  blood  corpuscles,  but  also 
to  its  preventing  or  delaying  their  destruc- 
tion in  the  portal  circulation. 

It  should  be  given  continuously  and  in 
gradually  increasing  doses  until  the  symp- 
toms due  to  intolerance  are  present,  when 
the  increase  should  cease  and  the  same  dose 
be  maintained  for  some  time.  By  carefully 
watching  the  indications  and  by  the  timely 
use  of  laxatives  the  dosage  may  be  easily 
adjusted,  so  that  the  full  benefit  may  be  de- 
rived from  this  valuable  product. 

The  statements  in  the  preceding  para- 
graph are  applicable  also  to  Leukemia, 
whether  splenic,  myelogenic  or  lymphatic, 
and  to  Hodgkin's  disease,  of  course  bearing 
in  mind  Mercauro  preferably,  if  .Syphilis 
co-exists. 

Arsenauro  and  Mercauro  rank  next  to 
quinine  in  the  treatment  of  Malara.  Chronic 
cases,  in  which  quinine  has  lost  its  power 
are  benefitted  in  a  marked  manner  by  these 
compounds.  It  is  a  peculiar  fact  that  re- 
lapses are  fewer  after  treatment  by  Arsen- 
auro than  after  the  use  of  Warburg's  Tinc- 
ture or  quinine.  It  can  be  employed  in 
cases  of  Malaria  at  all  times  without  regard 
to  the  presence  or  absence  of  fever  or  chills. 

It  has  remarkable  efficacy  in  the  treat- 
ment of  Neuralgia  of  the  intercostal  and 
fifth  pair  of  nerves.  Arsenauro  is  equally 
valuable  in  these  cases  whether  the  diseases 
be  due  to  Malaria  or  General  Debility. 

The  author  wishes  to  urgently  recom- 
mend the  use  of  Arsenauro  in  Pulmonary 
Phthisis.  In  certain  forms  of  this  disease 
lie  regards  it  superior  to  any  other  remedy. 
Particularly  useful  in  those  conditions  which 
are  characterized  by  excessive  expectoration 
and  a  slow  degenerative   process. 

The  good  results  of  this  treatment  in  these 
cases  is  shown  in  a  conspicuous  manner  by 
a  marked  improvement  in  the  general  condi- 
tion of  the  patient,  there  being  a  lessened 
pulmatory  secretion,  a  reduction  in  temper- 
ature, improvement  of  the  appetite  and  con- 
sequent increase  in  the  body  weight. 

In  chorea,  arsenauro  very  justly  merits 
the  name  of  specific  very  rarely  failing  to 
effect  a  cure  when  judiciously  administered. 
It  should  be  given  in  full  doses,  and  in- 
creased as  tolerance  is  established. 

This  medicine  seems  to  act  equally  well 
in  gastralgia  ;  many  irritative  conditions  of 


the  stomach  are  relieved  by  minute  doses — 
2  to  ^  drops.  It  is  particularly  valuable  in 
gastric  ulcer  and  cancer. 

It  has  proved  of  great  service  in  hay  fe- 
ver, spasmodic  asthma  and  acute  coryza. 

It  is  particularly  serviceable  in  catarrhal 
pneumonia  and  in  chronic  bronchitis.  It  is 
highly  recommneded  in    diabetes    mellitus. 

Rheumatoid  arthritis  is  more  favorably 
influenced  by  the  use  of  this  medicament 
than  by  any  other  treatment.  Its  combina- 
tion with  bromide  of  mercury — mercauro — 
has  produced  better  results  in  secondary  and 
tertiary  syphilis  than  mercury  alone  in  any 
form — and  especially  has  this  been  noted  in 
the  stigmata  of  nervous  syphilis.  Sommo- 
lence  is  a  threatening  prodrome  of  the  cere- 
bral complications  of  syphilis.  It  varies  in 
intensity  from  mere  drosiness  to  profound 
lethargy.  In  the  milder  cases  the  patient 
may  attend  to  business,  but  his  executive 
ability  is  greatly  impaired.  His  memory 
is  poor.  He  is  unable  to  concentrate  atten- 
tion upon  the  matter  in  hand,  and  often 
falls  asleep  at  work,  though  the  previous 
night  may  have  been  passed  in  deep  and 
continual  sleep. 

Circulatory  disturbance,  the  result  of  ar- 
terial disease  is  evidently  the  casual  factor 
in  these  cases.  Accordingly,  many  such 
cases  if  not  properly  treated,  eventuate  in 
thrombosis,  softening  and  hemiplegia.  The 
gold  in  the  compounds  seems  to  exert  a 
powerful  influence  in  restoring  the  circula- 
tion to  a  normal  basis  and  the  arsenic  and 
mercury  act  as  tonics  and  eliminatives. 

Certain  nervous  diseases  of  the  aged,  such 
as  melancholia  and  hypochondria,  are  often 
relieved  by  small  doses  of  arsenauro. 

Administration. — Arsenauro  and  mer- 
cauro should  be  given  ordinarily  after  meals. 
There  are  certain  conditions,  however,  re- 
quiring its  administration  in  small  doses  be- 
fore meals.  Children  are  much  less  sus- 
ceptible to  them  than  adults,  often  being 
able  to  take  adult  doses  with  impunity. 

During  a  course  of  treatment  with  these 
solutions  the  patient  should  be  instructed  to 
watch  carefully  for  the  first  outward  mani- 
festations, such  as  puffiness  about  the  eyes, 
nausea,  diarrhoea,  numbness  of  the  fingers, 
or  frontal  headache,  dizziness  or  vertigo. 
Any  one  of  these  symptoms  is  an  indication 
that  the  dose  should  not  be  increased  and  it 
may  be  necessary  to  lessen  the  dose,  or  even 
to  discontinue  the  remedy  altogether  for  a 
while — temporarily. 

Here  we  have  old  and  well-tried  remedies, 
made  infinitely   more  valuable  through  ad- 
vances in    chemistry  and    for   which  I  give 
credit  to  an  enterprising  Amercan  firm. 
W.  Ross  Thowson,  M.  D. 
170  West  130th  Street,  New  York. 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


815 


Sii/per'ior  to 

lOIDO^ORJVI. 


Odorless. 

Tasteless. 


No  more  expensive  to  use  than  Iodoform, 
being  at  least  four  times  as  voluminous. 


BSOPHEN 


Iodoform  is  universally  regarded  as  such  an  excellent  healing  agent,  that  claims  of  superiority 
over  it  for  Nosophen  may  appear  as  an  exaggeration,  but  there  is  indisputable  clinical  evidence 
that  it  causes  a  wound  to  heal  more  rapidly,  and  with  less  or  no  suppuration;  moreover,  it  never 
produces  a  dermatitis  around  the  edges  of  a  wound  as  Iodoform  always  does,  Nosophen  being 
absolutely  non-toxic  and  non-irritating.  Besides  as  a  surgical  dressing  in  major  and  minor 
surgery,  it  is  adapted  to  other  most  varied  employment,  as  an  antiseptic  in  the  treatment  of 
chancroid  and  all  abscesses  and  ulcers,  herpes,  eczema  and  other  skin  diseases,  either  as  a  powder 
or,combined  with  vasaline  and  lanoline,  as  an  ointment;  Nosophen  is  a  strong  desiccant  and  excel- 
lent results  are  obtained  with  insufflations  in  purulent  discharges  from  the  middle  ear,  in  nasal 
catarrh,  etc. 

Eudoxine  (the  Bismuth  Salt  of  Nosophen). 

This  chemical  salt  of  Nosophen  is  intended  for  employment  as  an  intestinal  antiseptic  and 
as  such  it  gives  most  excellent  results.  To  judge  from  clinical  reports,  it  is  decidedly  an  efficient 
intestinal  antiseptic,  and  has  the  great  advantage  of  being  absolutely  harmless  and  non-irrita- 
ting, odorless  and  tasteless.  Indicated  in  typhoid  fever,  chronic  intestinal  catarrh,  diarrhoea  of 
phthisis,  infantile  diarrhoea,  chronic  enteritis,  etc. 

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376 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


Orthoform  as  a  Local    Anaesthetic,    Anal- 
gesic and  Antiseptic* 

Before  the  discovery  and  use  of  cocaine 
very  little  was  accomplished  in  producing 
local  anaesthesia,  except  by  means  of  cold, 
freezing  mixtures,  etc.,  these  and  other  sim- 
ilar substances  being  used  for  the  purpose 
of  accomplishing  these  results. 

Cocaine  is  a  complex  group.  Several  ob- 
servers have  experimented  with  this  group 
to  ascertain  whether  the  complete  cocaine 
group  was  necessary  to  produce  anaesthesia, 
and  to  ascertain  whether  anaesthesia  could 
be  induced  by  eliminating  one  or  more  of 
the  poisonous  groups.  Merling  prepared  a 
substance  having  similar  properties  to  co- 
caine, called  eucaine  ;  it  is  a  benzoyl  methyl 
ester  of  methyl  piperidine.  Einhorn  and 
Heinz  submitted  the  entire  class  of  com- 
pounds to  examination,  and  prepared  nearly 
forty  compounds,  which  they  submitted  to 
physiological  tests,  and  made  the  discovery 
that  the  esters  of  the  aromatic  oxy-amido 
acids  possessed  greater  anaesthetic  action 
than  their  benzoyl  compounds.  The  one 
having  the  most  active  local  anaesthetic  ef- 
fect was  the  methyl  ester  of  the  para-ami do- 
meta  oxy-benzoic  acid.  The  name  of  Or- 
thoform has  been  given  to  this   compound. 

Orthoform  occurs  in  a  white,  voluminous 
crystaline  powder,  without  odor  or  taste. 
It  is  very  slightly  soluble  in  water.  This  is 
one  of  its  great  advantages.  It  is  so  slightly 
and  slowly  dissolved  that  only  small  por- 
tions are  absorbed.  Its  anaesthetic  action 
continues  for  hours ;  does  not  pass  off  in  a 
short  time  like  cocaine  and  other  kindred 
substances.  Orthoform  has  no  effect  when 
applied  to  the  unbroken  skin.  When  ap- 
plied to  healthy  mucous  membrane  it  only 
produces  slight  anaesthesia  after  considera- 
ble time.  But  when  applied  to  the  exposed 
nerve  it  produces  complete  anaesthesia  in  a 
short  time,  and  its  action  is  prolonged.  As 
Orthoform  is  almost  insoluble  it  must  be 
applied  in  the  form  of  dry  powder,  or  as  an 
ointment.  It  does  not  produce  anaesthesia 
beyond  the  surface  on  which  it  is  applied. 
It  takes  from  five  to  twenty  minutes  to  pro- 
duce complete  anaesthesia.  It  never  pro- 
duces any  constitutional  symptoms,  no  dif- 
ference how  much  is  applied,  or  over  how 
large  a  surface.  Orthoform  is  absolutely 
non-poisonous.  From  30  to  60  grains  have 
been  given  to  rabbits  for  several  days  in 
succession,  and  dogs  given  doses  of  45  to  90 
grains  without  giving  rise  to  any  symp- 
toms; 45  grains  introduced  under  the  skin 
of  a  dog  gave  rise  to  no  toxic  symptoms. 
Orthoform  is  also  strongly  antiseptic. 

Shortly  after  receiving  a  supply  of  Ortho- 


<John  North,  A.  M.,  M.  D.,  etc.,  Toledo,  O. 


form  I  was  called  to  see  a  case  of  advanced 
pulmonary  and  laryngeal  tuberculosis,  un- 
der the  care  of  Dr.  J.  V.  Anderson  at  the 
Toledo  Hospital.  The  patient  had  been  un- 
|  able  to  swallow  even  cold  water  without 
severe  pain  for  three  months.  I  was  called 
to  see  what  could  be  done  to  relieve  her  of 
this  severe  pain,  as  she  was  suffering  for  the 
lack  of  food  and  drink.  Now  was  a  time 
to  see  what  Orthoform  would  do,  so  I  ap- 
plied it  to  the  inflamed  and  ulcerated  sur- 
face of  both  pharynx  and  larynx  with  a 
powder  blower.  In  a  few  minutes  she  was 
free  from  pain,  and  drank  a  glass  of  milk 
without  the  least  pain.  The  anaesthesia 
lasted  for  several  hours.  The  nurse  was 
instructed  to  use  the  Orthoform  upon  the 
return  of  pain.  This  was  kept  up  and  the 
patient  experienced  no  more  pain  in  her 
throat,  and  had  no  difficulty  or  pain  in 
swallowing. 

After  getting  such  a  brilliant  result  from 
Orthoform  in  this  case  I  concluded  to  give 
it  a  thorough  trial.  I  have  used  it  in  a 
large  number  of  cases  of  rhino-laryngology, 
and  have  never  failed  to  get  complete  local 
anaesthesia  when  applied  to  exposed  sensi- 
tive terminal  nerve  endings.  In  all  forms 
and  varieties  of  ulcerations,  in  the  nose, 
mouth,  pharynx  or  larynx  it  gives  absolute 
freedom  from  pain,  the  effect  lasting  from 
several  hours  to  several  days.  It  is  so  thor- 
oughly antiseptic  that  I  find  ulcerations 
healing  much  more  rapidly  when  Orthoform 
is  used  than  when  it  is  not  used.  In  troubles 
of  the  fauces  where  there  is  no  ulceration, 
but  where  the  epithelial  layer  of  mucous 
membrane  has  been  denuded,  the  applica- 
tion of  Orthoform  relieves  the  pain  and 
reduces  the  inflammation.  It  seems  to  act 
upon  the  vaso-motor  nerves  and  empty  the 
blood  vessels  and  keep  the  parts  contracted 
for  hours  and  even  days  with  no  after  dila- 
tation. With  cocaine  we  can  empty  the 
vessels,  but  after  a  short  time,  as  soon  as 
the  effect  wears  off  the  blood  vessels  become 
dilated  more  than  before  its  application. 
The  danger  of  constitutional  effects  and  the 
danger  of  creating  a  cocaine  habit  prevents 
its  continued  use.  Neither  of  these  objec- 
tions can  be  raised  against  Orthoform. 
After  operating  in  the  nasal  cavities  under 
the  influence  of  cocaine,  I  apply  Orthoform 
freely,  and  as  the  result  have  no  pain,  and 
the- vessels  do  not  dilate  and  hemorrhage 
does  not  return,  and  the  parts  heal  very 
rapidly. 

After  the  removal  of  the  faucial  tonsils  I 
apply  Orthoform  to  the  cut  surfaces,  the 
patients  can  eat  solid  food  without  pain, 
and  the  parts  heal  quickly.  There  is  no 
pain  after  removal  of  an  elongated  uvula  if 
Orthoform  is  applied. 


THE  CHARLOTTE   MEDICAL  JOURNAL. 


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current.  This  is  the  largest  machine  made  for  this  kind  of  work  and  it  produces  its  Rays  in 

A   CLEAR   AND  POWERFUL  STREAM. 

The  latest  and   most  expensive    accessories  are    used  in  connection  with  this  machine, 
making  it  the  most  powerful  and  complete  outfit  in  the  South  at  the  present  time. 

Prices  for  Complete  and  Thorough  Examinations  will  be  $10.00  to  $25.00. 
Photographs  Furnished  if  Desired, 

For  particulars  address, 

St.  Peter's  Hospital , 

Charlotte,  N.  C. 


378 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


In  all  cases  of  painful  laryngeal  troubles 
in  which  I  apply  Orthoform,  the  pain  is  re- 
lieved at  once,  and  the  patient  experiences 
a  relief  that  lasts  for  hours  or  days. 

I  had  a  very  painful  carious  tooth.  Co- 
caine would  relieve  the  pain  for  a  short 
time.  I  packed  the  cavity  with  Orthoform, 
and  had  no  pain  in  the  tooth  for  a  week. 

A  patient  asked  me  to  go  to  a  dentist 
with  him  to  have  an  impacted  wisdom  tooth 
removed.  The  tooth  had  grown  up  against 
the  adjacent  molar  at  an  angle  of  forty  de- 
grees. Cocaine  was  applied  and  the  gum 
cut  away  from  the  tooth,  and  the  alveolar 
process  cut  away  from  the  tooth  on  both 
sides  as  far  down  as  possible.  The  tooth 
was  necrosed,  and  broke  down  under  the 
forceps.  Several  efforts  were  made  to  re- 
move the  stumps  and  roots,  and  the  soft 
parts  were  terribly  lacerated.  The  dentist 
said  that  the  jaw  would  be  very  sore  and 
painful  for  a  week.  I  packed  the  cavity 
with  Orthoform  ;  in  a  short  time  all  pain 
was  relieved,  and  the  patient  could  eat  with 
no  inconvenience.  The  relief  of  pain  lasted 
eight  hours,  when  it  was  again  packed  with 
Orthoform,  which  relieved  the  pain  for  an- 
other eight  hours,  when  the  third  applica- 
tion was  made  with  no  return  of  pain. 
Twenty-four  hours  after  the  operation  the 
dentist  examined  the  case,  and  found  no 
pain,  soreness  nor  inflammation,  the  lacer- 
ated parts  were  pale  and  shrunken,  and  did 
not  become  inflamed  in  the  least.  I  have 
applied  it  to  fresh,  paLiful  cuts,  with  re- 
moval of  all  pain. 

This  is  about  the  extent  of  my  use  of 
Orthoform.  I  am  convinced  that  it  is  a 
very  valuable  remedy  in  removing  pain 
when  applied  to  nerve  endings.  Its  anti- 
septic and  healing  properties  are  also  of 
very  great  value.  It  is  a  remedy  that  I 
could  not  dispense  with  in  my  practice  with- 
out very  great  inconvenience. — American 
Medical  Compeud,  Nov. ,  1898. 


Congratulate   You,    Gentlemen! 

When  a  House  that  is  committed  to  a 
policy  of  Medicamentavera — to  quote  its 
own  motto — finds  itself  compelled  contin- 
ually to  enlarge  its  borders,  it  is  a  standing 
rebuke  to  those  who  would  practically  deny 
that  "honesty  is  the  best  policy."  Indeed, 
the  products  of  Parke,  Davis  &  Co.  are  so 
thoroughly  and  warmly  appreciated  by  the 
medical  profession  that  this  famous  expo- 
nent of  the  "gospel  of  the  good  goods"  has 
frequent  occasion  either  to  build  new  home 
laboratories  or  to  multiply  its  distributing 
facilities. 

Not  to  speak  of  their  manufacturing  lab- 
oratories in  Walkerville,  Ontario,  and  in 
London,    England,    which    assist   in    more 


promptly  supplying  their  Canadian,  Eng- 
lish, East  India  and  Australasian  trade. 
Parke,  Davis  &  Co.,  with  a  similar  object 
in  view,  maintain  branch  establishmrnts  in 
these  United  States  in  New  York  City, 
Kansas  City,  New  Orleans  and  Baltimore 
— each  one  of  which  has  been  obliged  to 
seek  more  room  than  was  deemed  necessary 
on  its  original  installation.  Their  flourish- 
ing Baltimore  branch  is  the  latest  instance. 

Although  only  established  in  1896,  in 
what  was  then  considered  very  spacious 
premises,  the  increased  volume  of  business 
has  thus  quickly  made  it  imperative  to  seek 
larger  quarters.  A  "removal  notice"  from 
the  gentleman  in  charge  of  this  branch,  Mr. 
O.  W.  Smith,  informs  us  that  its  new  and 
commodious  home  is  now  to  be  found  at  103 
E.  German  street,  Baltimore,  Md. 

We  cannot  do  less  than  extend  our  con- 
gratulations to  Parke,  Davis  &  Co.  for  this 
substantial  evidence  of  the  rapidly  growing 
popularity  of  their  preparations  amongst 
the  physicians  and  pharmacists  in  the  popu- 
lous district  tributary  to  Baltimore.  We 
cannot  more  than  say  that  we  have  long 
since  come  to  consider  their  products  as  our 
"Ultima  Thule"  of   therapeutic   efficiency. 

In  the  treatment  of  influenza  the  relief  of 
pain,  of  insomnia,  of  fever  is  best  accom- 
plished in  most  cases  by  the  administration 
of  Kryofine.  No  coal-tar  drug  can  be  re- 
commended in  a  disease  which  in  itself  is 
characterized  by  marked  prostration  and 
depression.  And  just  in  this  respect  does 
Kryofine  prove  better  than  the  older 
remedies.  Its  influence  as  an  anodyne  is 
enhanced  by  a  distinct  euphoria  entirely 
apart  from  the  relief  of  pain.  It  may  also 
be  given  in  solution  with  alcohol,  and  com- 
bines well  with  the  drugs  usually  required 
in  these  cases. 

The  notable  thing  about  the  eminent 
public  men  now  writing  for  Scribner's 
Magazine  is  that  they  are  skillful  and  enter- 
taining writers  as  well  as  men  of  affairs. 
For  this  reason  the  contributions  of  Senator 
Hoar  and  Governor  Roosevelt  are  produc- 
tions, as  well  as  chronicles  of  action. 

The  March  number  of  Scribner's  shows 
Governor  Roosevelt  in  the  sort  of  descrip- 
tion that    he    likes    best — a    narrative    of    a 
fight.      With  his  usual  candor  he  calls  thi» 
"General  Young's  Fight  at  Las  Guasimas," 
and  pays  a  hearty    tribute    to    his    brigade 
commander  and   to   the   regulars   who  won  j 
equal  honors  with    the    Rough    Riders    in  1 
that  hot  skirmish.      Any  one  who  reads  the  j 
colonel's  account  will  have  no  belief  in  the  ; 
story    of    an    ambush.     The    advance     was 
carefully  planed  out  by  consultation  of  the 
leading  officers. 


THE  CHARLOTTE  MEDICAL  JOURNAL, 


379 


For  THE  BABY*  THE  INVALID.*THE  CONVALESCENT* THE  AGED. 


THE  BEST  PREPARED  FOOD. 


SAMPLES  for  CLINICAL  TEST 

SUPPLIED  to  PHYSICIANS 

and  TRAINED  NURSES 

ON  REQUEST. 


fOF  TO   DAY 

AND   WILL  CONTINUE 

YIELD  SATISFACTORY  RESULTS  in  NUTRITION 

FAR  INTO  THE  FUTURE,  BECAUSE  ITS  MERITS  HAVE  BEEN 

PROVED  BY  CLINICAL  SUCCESS  in  the  PAST. 


Shippinq  Depot,  JOHN  CARLE  &  SONS 


153  Water  Street  New  York 

SOLD   BY  DRUGGISTS  EVERYWHERE 


Pruiitis  Ani. 

A.  J.  Baker  Flint,  M.  D.,  102  Hunting- 
ton Ave.,  Back  Bay,  Boston,  writes  of  a 
case. 

"I  want  to,  in  the  interest  of  humanity, 
ask  you  to  lay  special  stress  upon  the  value 
of  Unguentine  in  pruritis  ani.  I  personally 
have  been  tortured  with  it  for  seven  or 
eight  years  and  never  have  found  anything 
to  act  only  as  a  palliative  until  I  used  your 
preparation,  which  has  absolutely  cured  me 
and  now  my  faith  in  it  is  such  that  I  pre- 
scribe it  for  everything  in  which  there  is  in- 
flammation or  where  it  is  necessary." 


A    Card. 

Dr.  H.  L.  Campbell,  Watauga,  Tenn., 
writes  :  I  received  the  sample  of  "Blen- 
nostasine"  you  so  kindly  sent  me.  I  was 
suffering  from  an  exteremely  severe 
"coryza,"  and  took  a  pill  once  every  hour 
untill  three  had  been  taken.  The  cold  dis- 
appeared as  if  by  magic.  I  have  prescribed 
it  in  two  or  three  other  cases  of  acute  colds, 
with  invariable  relief. 


2-Yea-rsf 


were  required  to 
perfect  our   new  ( 

"Uesta" 
tubular 

Lantern  which  we 
now  offer  as  some- 
thing extraordi- 
nary in  the  Lantern  line.  It  has  the 
Railroad  Lantern's  rugged  constitu- 
tion joined  to  the  tubular  system,  and 
the  result  is  a  splendid  light-giving, 
wear  and  abuse  resister.  We  will, 
if  desired,  mail  our  special  Circular 
of  the  "  Vesta"  Lantern;  or,  upon 
receipt  of  $1.00,  we  will  send  you 
(freight  prepaid )  the  very  best  Lan- 
tern for  general  service  you  ever  saw. 
Why  not ' '  see  it "  on  those  terms  f 
Our  Illustrated  Catalogue  Is  Mailed  Free. 

R.  E.  DIETZ  CO., 

60  Laight  St..  New  York. 


ESTABLISHES  IN  1840. 

Only  good  Lanterns  are  stamped 


dietz: 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


Creosote  in   Phthisis   Pulmonalis.* 

After  a  brief  review  of  creosote  and 
guaiacol,  and  the  various  methods  of  em- 
ploying these  products,   the  author  says  : 

In  the  treatment  of  phthisis  the  admin- 
istration of  creosote  causes  the  fever  and 
cough  to  diminish  and  the  patient  to  im- 
prove in  appetite  and  flesh.  On  examina- 
tion of  the  pulse  it  will  be  noted  there  is  a 
smallness  and  rapidity  indicating  an  in- 
creased anaemia  produced  by  the  powerful 
action  of  creosote.  When  creosote  alone  is 
used  life  is  made  more  comfortable  to  the 
patient  but  it  causes  an  earlier  termination. 
If  in  combination  with  tonics  less  anaemia 
is  produced.  It  has  antifermentative  pow- 
ers, and  though  it  may  not  kill  bacteria,  it 
destroys  their  ptomaines  and  renders  their 
action  non-toxic  and  inert.  In  the  stomach 
of  consumptives  a  pathological  fermenta- 
tion is  at  all  times  going  on,  and  this  pro- 
cess is  overcome  by  the  action  of  creosote. 
It  takes  oxygen  from  the  blood,  and  is 
changed  into  carbolates  and  oxalates,  as  a 
result  of  oxydation,  thus  causing  the  blood 
to  assume  a  deeper  color.  In  the  treatment 
of  phthisis  it  becomes  of  especial  value  if 
reinforced  by  nuclein.  Nuclein  increases 
the  number  of  white  blood  corpuscles  and  is 
therefore  a  valuable  agent  in  combating  tu- 
berculosis in  its  initial  stage.  Reviewing 
the  aforementioned  facts,  we  have  creosote, 
guaiacol,  nuclein  and  tonics  as  factors  in  the 
treatment  of  phthisis  pulmonalis.  How, 
and  in  what  proportion  can  they  be  best 
combined  to  become  efficient  in  the  treat- 
ment of  this  disease.  Beef,  milk,  and 
wheat  peptonized,  with  creosote  and  gua- 
iacol, otherwise  known  as  "liquid  pepton- 
oids"  with  creosote,  is  an  eligible  method 
of  administering  the  above  in  combination. 
Each  tablespoonful  contains  two  minims 
of  pure  beechwood  creosote  and  one  minim 
of  guaiacol  combined  with  the  nutrient  and 
reconstituent  properties  of  "liquid  pepton- 
oids.  In  two  different  hospitals  the  entire 
consumptive  wards  were  placed  on  this  rem- 
edy with  most  excellent  results  and  it  will 
be  necessary  to  quote  but  a  few  of  the  many 
cases  under  observation  : 

Case  i. — M.  P.,  female,  aged  49.  Ad- 
mitted to  the  hospital  June  2,  1898;  family 
history  tubercular.  For  some  years  patient 
has  been  troubled  with  severe  attacks  of 
cough,  resulting  from  an  attack  of  lagrippe 
in  1894.  Has  dry,  hacking  cough,  with 
gelatinous  expectoration,  containing  bron- 
chial and  alveolar  epithelium  in  a  state  of 
fatty  metamorphosis,  streaked  with  blood. 
Temperature,  101  degrees.  Loss  of  appe- 
tite and  dyspeptic  symptoms.      Inspiration, 


of  cog-wheel  character,  expiration  high- 
pitched  and  dullness  on  percussion.  Patient 
has  lost  about  30  pounds  within  last  few 
months.  Weighed,  Jan.  2d,  145  pounds. 
Blood  count,  45  per  cent.  Haem.,  3,000,000 
red  cells,  7,500  white  cells.  Treatment  be- 
gan with  one  tablespoonful  doses  of  liquid 
peptonoids  with  creosote,  every  four  hours. 
Hereafter  a  rapid  improvement  took  place. 
July  ist,  patient's  cough  has  disappeared, 
no  bacilli  in  sputum,  appetite  good,  weight 
151  pounds.  This  treatment  was  continued 
till  July  26th,  when  patient  left  the  hospi- 
tal, apparently  well.  Weight,  155  pounds, 
blood  examination,  62  per  cent.  Hasm.,  red 
cells,  3,650,000,  white  cells,  7,200,  no 
cough,  good  appetite. 

Case  2. — F.  W.,  male,  aged  20;  family 
history  tubercular.  Admitted  June  9,  1898. 
Hacking  cough,  purulent  expectoration, 
temperature  100  degrees;  night  sweats, 
loss  of  appetite  and  weight ;  blood  exam- 
ination, 43  per  cent,  haem.,  2,700,000  red 
cells,  7,000  white  cells,  weight  98;  exam- 
ination of  sputum,  bronchial  and  alveolar 
epithelium,  bacilli.  Same  treatment  as  in 
case  1  ;  began  June  9.  Patient  improved. 
June  26th,  coughs  but  little,  no  bacilli  in 
sputum,  appetite  good,  weight  103  pounds. 
July  13th,  discharged  apparently  well,  no 
cough,  no  night  sweats,  appetite  ravenous, 
weight  105  pounds;  blood  count,  61  per 
cent,  haem.,  red  cells  3,600,000,  white  cells 
6,800. 

All  tubercular  cases  under  my  observation 
improved  under  this  treatment,  while  oth- 
ers under  plain  doses  of  creosote  gtt.  V  to 
XX  showed  but  little  improvement. 


Dr.  L.  H.  Warner,  Abstract. 


Mai-Nutrition. 

"I  am  sure  the  Imperial  Granum  Food 
was  an  efficient  agent  in  restoring  the 
health  of  a  baby  boy  recently  under  my  care. 
He  was  suffering  from  mal-nutrition  with  a 
most  presistent  diarrhoea.  Many  foods 
were  tried  and  discarded,  and  I  was  begin- 
ning to  loose  heart,  when  I  happened  to 
think  of  the  Imperial  Granum.  Its  use 
proved  it  to  be  very  easily  assimilated,  and 
I  think  it  saved  the  baby's  life." M.  D. 


In  gastro  intestinal  disorders  of  whatever 
origin  the  administration  of  Bisol,  a  soluble 
bismuth  salt,  is  attended  by  the  best  results. 
It  is  of  great  service  also  in  the  diarrhoea 
of  typhoid,  of  phthisis  and  in  dysentery. 
As  it  forms  a  perfectly  clear  solution,  the 
remedy  is  specially  applicable  in  pediatric 
practice.  It  also  forms  a  ready  means  for 
preparing  a  more  powerful  tannate,  orsali- 
cylate  of  bismuth  than  has  been  available 
heretofore. 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


381 


LISTERINE 


The  Standard  Antiseptic, 


LISTERINE  is  a  non-toxic,  non-irritating  and  non-escharotic  antiseptic,  composed  of  ozonifer 

ous  essences,  vegetable  antiseptics  and  benzo-boracic  acid. 
LISTERINE  is  sufficiently  powerful  to  make  and  maintain  surgical  cleanliness  in  the  antiseptL 

and  prophylactic  treatment  and  care  of  all  parts  of  the  human  body. 
LISTERINE   has  ever  proven  a  trustworthy  antiseptic  dressing   for  operative  or  accidental 

wounds. 
LISTERINE  is  invaluable  in  obstetrics  and   gynecology  as  a  general   cleansing,   prophylactic- 

or  antiseptic  agent,  and  is  an   effective   remedy  in  the   treatment  of  catarrhal   conditions  of 

every  locality. 
LISTERINE  is  useful  in  the  treatment  of  the  infectious  maladies  which  are  attended  by  inflam 

mation  of  accessible  surfaces — as  diphtheria,  scarlet  fever  and  pertussis. 
LISTERINE  is  especially  applicable  to  the  treatment  of  scarlet  fever,  used   freely  as  a  mouth 

wash,  or  by  means  of  the  spray  apparatus. 
LISTERINE  is  extensively  prescribed  in  typhoid    fever,  both  for  its  antiseptic  effect  and  to  im- 
prove the  condition  of  the  stomach  for  the  reception  of  nourishment. 
LISTERINE  agreeably  diluted,  is  prescribed  with  very  good  results,  in  the  treatment  of  diph- 
theria, both  as  a  prophylactic  and  curative — internal  antiseptic — agent. 
LISTERINE  is  used  extensively  with  good  results  in  the  treatment  of  whooping  cough. 
LISTERINE  diluted  with   water  or  glycerine  speedily  relieves  certain  fermentative   forms  of 

indigestion. 
LISTERINE  is  indispensable  for  the  preservation  of  the  teeth,  and  for  maintaining  the  mucous 

membrane  of  the  mouth  in  a  healthy  condition. 
LISTERINE  employed  in  a  sick  room  by  means  of  a  spray,  or  saturated   cloths   hung   about,  is 

actively  ozonifying  and  imparts  an  agreeable  refreshing  odor  to  the  atmosphere. 
LISTERTNE  is  of   accurately   determined   and   uniform   antiseptic   power   and  of   positive  ori 

ginality. 
LISTERINE  is  kept  in  stock  by  the  leading  dealers  in  drugs,  everywhere. 


Lambert's  Lithiated  Hydrangea. 


Close  clinical  observation  lias 
caused  Lambert's  Lithiated 
Hydrangea  to  be  regarded  by 
Physicians  generally  as  a  very 
valuable  Renal  Alterative 
and  Antilithic  Agent. 


Albuminuria,  Lithaemia, 

Bright's  Disease,      Nephritis, 
Cystitis,  Rheumatism, 

Diabetes,  Urinary  Calculus, 

Gout,  and  all  forms  of 

Hematuria,  Vesical  Irritation 


For  Descriptive  Literature,  Address 


Lambert  Pharmacal  Co., 


ST.     I.OUIS, 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


A  Reason  and  a  Relief. 

It  is  the  boast  of  Americans  that  no  peo- 
ple in  the  world  are  as  well  fed  as  they.  It  is 
undeniably  true  that  no  nation  is  so  much 
blessed  with  such  wealth  of  food  material 
as  this.  The  present  generation  might  be 
termed  a  race  of  indiscriminate  eaters,  and 
the  problem  of  the  busy  practitioner  today 
is  not  how  to  nourish  the  body,  but  how  to 
successfully  relieve  it  of  the  effete  products 
of  waste.  To  coin  an  axiom,  we  might 
say  that  "the  secret  of  good  health  is  good 
drainage,  not  the  drainage  of  land,  but  that 
of  the  body."  The  human  body  has  been 
very  aptly  compared  to  a  machine,  and  the 
food  which  the  average  individual  appro- 
priates is  the  fuel  which  furnishes  the  en- 
ergy to  keep  the  machine  in  motion  and 
repair.  The  complicated  mechanism  of  the 
human  body  is  more  frequently  disarranged 
by  the  incomplete  combustion  and  consump- 
tion of  the  fuel  furnished  it,  than  any  defi- 
ciency of  nutritive  material.  The  result- 
ing condition  is  both  known  and  called  by 
the  profession  and  laity,  constipation.  To 
the  physician  it  is  the  unfailing  source  of 
many  complications.  It  is  the  incident  and 
the  accident,  the  cause  and  the  effect  of 
physical  degeneracy.  We  may  assert  with- 
out fear  of  contradiction  that  none  of  the 
ills,  which  flesh  is  heir  to,  is  more  intracta- 
ble than  constipation,  nor  is  there  one 
which  baffles  the  skill  of  the  average  physi- 
cian more.  It  is  not  surprising  that  the 
tendency  on  the  part  of  the  people  to  over- 
feed and  take  too  little  exercise  has  its  log- 
ical consequence  in  the  prevailing  custom 
of  taking  all  sorts  of  pills  and  purgatives. 
A  universal  cathartic  habit  is  abroad  in  the 
land.  An  indiscriminate  use  of  cathartics 
cannot  be  too  strongly  deprecated  because 
most  of  them  hold  their  victims  in  such 
bondage  by  becoming  progressively  ineffi- 
cient. They  not  only  deplete  the  system 
too  rapidly,  but  the  very  griping  which 
most  of  them  produce  is  a  signal  that  an 
affront  has  been  offered  to  nature.  The 
retaliation  is  the  pain,  the  resentment,  a 
subsequent  failure  on  the  part  of  the  abdom- 
inal viscera  to  perform  their  functions.  An 
agent  which  would  offer  to  the  busy  doctor 
the  means  of  sweeping  from  the  system  all 
waste,  with  the  corresponding  security 
against  any  of  the  objections  which  have 
been  cited,  would  be  a  boon  that  would  find 
a  warm  welcome  and  intelligent  applica- 
tion in  his  hands. 

Such  a  remedy  we  believe  exists  in  ' '  Syrup 
of  Figs."  Many  careful  general  practition- 
ers have  reported  that  Syrup  of  Figs  is  not 
open  to  the  same  criticism  as  other  cathar- 
tics. Its  action  is  potent  yet  persuasive. 
It  does  not  devitalize    the    patient  by   rob- 


bing the  blood  of  its  serum  or  by  sweating 
the  delicate  mucous  membrane  of  the  intes- 
tines. It  is  a  laxative  pure  and  simple,  and 
produces  firm  and  full-formed  stools  instead 
of  watery  evacuations.  Syrup  of  Figs  is 
as  agreeable  to  the  taste  as  it  is  satisfac- 
tory in  its  results.  It  can  be  employed  by 
the  conscientious  physician  with  every  as- 
surance that  its  use  is  certain  and  safe,  and 
is  not  followed  by  any  peristaltic  paralysis 
on  the  part  of  the  patient,  as  it  does  not  pro- 
duce the  subsequent  inertia  of  the  bowels 
common  to  other  cathartics.  It  can  be  pre- 
scribed for  women,  children,  and  people  of 
sedentary  habits,  as  a  reliable  remedy, 
which  is  maintained  at  a  uniform  standard 
of  excellence.  One  that  realizes  the  expec- 
tation of  the  doctor,  without  doubt  or  dis- 
appointment. 

The  stock  market  presents  just  now  one 
of  those  exceptional  opportunities  for  in- 
creasing small  or  large  investments  that 
does  not  happen  very  often  in  a  person's 
lifetime. 

Speculation  was  never  as  nearly  a  cer- 
tainty as  it  is  now,  because  the  country  was 
never  in  such  a  prosperous  condition. 
Values  must  increase  wonderfully  and 
stocks  and  bonds  should  be  purchased  on 
any  reaction. 

The  firm  of  Alfred  J.  Eno  &  Co.,  of  52 
Broadway,  N.  Y.,  have  exceptional  op- 
portunities for  getting  the  best  news  on 
any  probable  action  in  the  stock  market, 
and  can  transact  business  in  any  stocks  or 
Bond  issues,  or  in  grain  and  cotton.  Their 
long  connection  with  the  Consolidated 
Stock  Exchange  makes  their  advice  and 
efforts  for  intending  investors  of  excep- 
tional value.  They  will  be  pleased  to 
answer  any  communication  and  to  send  a 
book  explaining  speculation  upon  request. 


Pepsin  is  undoubtedly  one  of  the  most 
valuable  digestive  agents  of  our  Meteria 
Medica,  provided  a  good  article  is  used. 
Robinson's  Lime  Juice  and  Pepsin,  and 
Arom  Fluid  Pepsin,  (see  page  18  this 
number)  we  can  recommend  as  possessing 
merit  of  high  order. 

The  fact  that  the  manufacturers  of  these 
palatable  preparations  use  the  purest  and 
best  Pepsin,  and  that  every  lot  made  by 
them  is  carefully  tested,  before  offering  for 
sale,  is  a  guarantee  to  the  physician  that  he 
will  certainly  obtain  the  good  results  he  ex- 
pects from  Pepsin. 

The  Fortnightly  Review's  brilliant  article 
on  Lord  Rosebery  as  The  Disraeli  of 
Liberalism  will  be  reprinted  entire  in  The 
Living  Age  for  Feb.  18. 


THE  CHARLOTTE.  MEDICAL  JOURNAL.  388 


HYDROZONE 

5_>  volumes  preserved  aqueous  solution  of  H.O,) 

TI3E  "MOST    POWERFUL    ANTISEPTIC    AND    PUS    DESTROYER. 

HARMLESS  STIMULANT  TO  HEALTHY  GRANULATIONS. 

GLYCOZONE 

(C.  P.  Clycerine  combined  with  Ozone) 

THE     MOST     POWERFUL    HEALING    AGENT 
KNOWN. 

These  remedies  cure  all  diseases  caused  by  Germs. 
Successfully  used  in  the  treatment  of  diseases^  of   the  Genito- 
urinary  Organs   (Acute   or   Chronic): 

Whites,  Leucorrhoea,  Vaginitis,   Metritis, 

Endometritis,     Ulceration    of    the    Uterus, 

—  Urethritis,  Gonorhsea,  —  Cystitis, 

Ulcer  of  the  Bladder,  etc. 

Injections   of  Hydrozone   diluted    with    water,    (according    to 

the  degree  of  sensitiveness  of  the  patient)  will  cure  the  -a^t 

obstinate  cases. 

Send  for  free  240-page  book  "Treatment  of  Dis eases  cau.^d  by 
Germs,"  containing  reprints  ot  120  scientific  articles  by  leading 
contributors  to  medical  literature. 

Phvsiciviis  remitting  50  cents  will  receive  one  complimentary 
sample o^n™<Sj&ne» ^5  "Ulycozone"  by  express,  charges 
prepaid. 

Hydrozone  is  put  up  only   in   extra  Prepared  only  by 

small,  small,  medium,  and  large  size  bottles, 
hearing  a  red  label,  white  letters,  gold  and 
blue  border  with  my  signature. 

Glycozone  is  put  up  only  in  i-oz.,  8-oz. 
and  16-oz.   bottles,  bearing  a  yellow  label, 
white  and  black  letters,  red  and  blue  border                                  Graduate  of  the  "Ecole 
with  mv  signature.  ,  ,,  '    .    . . 

Marchand's  Eye  Balsam    cures   all  Centrale  des  Arts  el  Manufactures  dr 

inflammatory  and  contagions  diseases  of  the  Paris"  {France). 

lyes. 

*     Charles  Marchani  28  Prince  St.,  New  YorV 

A  by  fading  Druggists.  Avoid  L  stations.  S^  Mention  this  Publication 


384 


THE  CHARLOTTE  MEDICAL  JqURNAL. 


W    WyHrnleine    is    a     pancreatized    Emulsion   of    Cod 
*  Liver    Oil    (Lofoten)    obtained    from    fresh    livers. 

Based  on  scientific  principles.  Each  dose  contains 
pre-digested  Cod  Liver  Oil.  The  unpleasantness  of  the  oil 
is  thoroughly  disguised,  therefore  palatable,  and  well  borne 
by  weak  and  delicate  stomachs.  Increases  the  appetite,  im- 
proves digestion.  All  wasting  diseases  are  greatly  modified 
by  its  use.  Creosote  and  all  tonic  remedies  are  compatible 
with  Hydroleine,  and  is  admissible  in  all  seasons  and  climates. 
Literature  sent  to  physicians  on  application.  Sold  by 
Druggists.  Manufactured  by  The  Charles  N.  Crittenton  Co., 
Laboratory,  No.  115  and   117  Fulton  St.,  New  York. 


The  "Allenburys"  Throat  Pastilles 


THESE  PASTILLES  have  now  for  many  years  been 
widely  employed,  and  with  the  best  results,  by  the  leading 
Throat  specialists  and  physicians  generally.  Long  expe- 
rience has  shown  the  following  kinds  to  be  the  more  gen- 
erally useful  and  frequently  prescribed: 


No. 


No 

3. 

No 

9. 

No. 

10. 

No. 

11. 

No 

13. 

No. 

14. 

No. 

17. 

No 

22. 

No. 

23. 

No. 

24. 

No. 

24a 

Mo 

26. 

No, 

27. 

Ipecacuanha.  Readily  taken  by  children.  These 
Pastilles  are  of  the  same  strength  as  the  Lozen- 
ges of  the  Britisn  Pharmacopoeia. 

Morphia  and  Ipecacuanha.  (l-40th  grain  Morphia 
and  \i  grain  Ipecacuanha). 

Menthol,  Cocaine  and  Red  Gum.  (Menthol  and 
Cocaine,  aa.  gr.  l-20th  ;  Red  Gum,  gr.  ii). 

Benzoated  Voice.    Useful  to  public  speakers, etc. 

Chlorate  or  Potash.  A  more  agreeable  form 
than  the  Lozenge  of  the  Pharmacopoeia. 

Rhatany.    Astringent. 

Tannin.  Astringent,  and  of  the  same  strength  as 
the  Tannic  Acid  Lozenges  of  the  British  Phar- 
macopoeia. 

Chlorate  op  Potash  and  Borax.  Containing 
these  two  useful  remedies  in  combination. 

Red  Gum.    Astringent. 

Eucalyptus  (Gum  and  Oil).  Antiseptic,  stimu- 
lant, and  astringent. 

Cocaine.     (l-20th  grain).    Sedative  to  the  mucous 
membrane. 
.  Cocaine.     (l-10th  grain). 

Codeine.     (l-8th  grain  Codeine).     Sedative. 

Compound  Eucalyptus.  (Red  Gum,  Chlorate  of 
Potash,  and  Cubebs). 

Compound  Guaiacum.  (Guaiacum,  Chlorate  of 
Potash,  and  Red  Gum). 

The  "Allenburys"  Throat  Pastilles  are  sold  in  decorated  t 
Sent  on  receipt  of  price  to  any  address,  post  paid. 


No.  29. 


X... 


Compound  Rhatany  and  Cocaine.  (Ext.  Rhatany 

gr.  ii;  Cocaine  Hydrochlor.,  gr.  l-10th).       A  very 

efficacious  astringent  and  anodyne. 
Red  Gum  and  Chlorate  of  Potash.   Astringent. 
Chlorate  of   Potash,  Borax,  and  Cocaine.      (2 

grains  Chlorate  of  Potash.  1  grain  Borax,  l-20th 

grain  Cocaine). 

Eucalyptus  Oil.    Antiseptic  and  stimulant. 
Menthol.    (1-20  grain).  Stimulant  and  antiseptic. 


No.  43a.  Menthol.     (l-:0th  grain). 


No. 

No.  45. 

No.  48. 
No.  52. 
No.  54. 


Menthol  and  Cocaine.  (l-20th  grain  Menthol  and 
l-20th  grain  Cocaine  in  each).  Stimulant,  anti- 
septic, and  sedative. 

Menthol  and  Rhatany.  (Menthol,  1  -20th  grain; 
Extract  of  Rhatany,  2  grains).  Antiseptic,  stimu- 
lant and  astringent. 

Tannin,  Cayenne,  and  Black  Currant.  Astrin- 
gent, stimulant,  and  soothing. 

Tannin  and  Black  Currant.  Astringent  and 
soothing. 

Menthol  and  Eucalyptus  Oil. 

boxes,  at  30  cents  retail. 


ALLEN  &  HANBURYS,  LTD.,  (LONDON,  ENG.) 

U.  S.  Branch:  82  Warren  Street,  New  York. 

Agent  for  Canada  \Y.   Lloyd  Wood,  Toront 


=S2fcf5g-<? 


THE  CHARLOTTE. MEDICAL  JOURNAL. 


38S 


TABLE   OF  CONTENTS   FOR    MARCH,    1899. 


Original   Communications. 

Malignant  Tumors  of  the 
Breast,  by  Hunter  Mc- 
Guire,  M.  D. ,  LL.  D. ,  Rich- 
mond, Va 289 

Drainage  in  Abdominal  Sur- 
gery, by  J.  W.  Long,  M. 
D.,  Salisbury,  N.  C 303 

Diagnosis  and  Treatment  of 
Tubercular  Peritonitis,by 
W.  L.  Robinson,  M.  D., 
Danville,  Va 305 

Puerperal  Insanity,  by  J. 
A.  Reagan,  M.D.,Weaver- 
ville,  N.  C 308 

Pneumonia,  by  Dr.  T.  Cat- 
lett  Gibson,  Winton,N.C.  310 

Use  of  Resinol,  by  Dr.  Hor- 
ace Wardner,  M.  D.,  La 
Porte,  Indiana 311 

Accidents  from  Vaccination 
-  How  to  Prevent  Them, 
by  Isadore  Dyer,  Ph.B., 
M.  D.,  New  Orleans  ....  312 

Drug  Habit,  by  Carl  V. 
Reynolds,  M.  D.,  Ashe- 
ville,    N.  C 314 

General  Infection  by  the 
Diplococcus  Intracellula- 
ris  in  an  Infant,  by  John 
Zahorsky,  M.  D 320 

Differential  Diagnosis  of 
Diphtheria  from  Mem- 
branous Croup,  by  T.  T. 
Ferree,  M.  D.,  Asheboro, 
N.  C 321 

Membranous  Croup  (so-call- 
ed) and  Diphtheria,  by  1. 
A.McSwain,  M.D.,  Paris, 
Tennessee 322 

Prophylaxis  of  Ophthalmia 
Neonatorium,  by  Harriet 
E.  Garrison,  M.D.,  Dixon, 
Illinois 323 

Questions  and  Observations 
on  Pernicious  Malaria,  or 
Hemorrhagic  M  a  la r  i  a , 
Hemorrnagic  Fever,  Yel- 
low Chills,  Yellow  Dis- 
ease, by  E.  T.  Dickinson, 
M.  D.,  Smithfield,  N.  C. .  324 

Report  of  Three  Cases,  by 
R.  H.  Hale,  M.  D.,  York 
Station,  Ala 326 

Rheumatism,  (a)  Etiology, 
(b)  Pathology,  by  A.  A. 
Young,  M.  D. ,  Newark, 
N.Y., .'{27 

Medicine,  by  H.  Plummer, 
M.  D.,  Harrodsburg,  Ky.  329 

Appendicitis,  by  J.  H.  Van 
Eman.  M.  D.,  Kansas 
City,  Mo 330 

Hemorrhoids,  by  H.  L.  Ap- 
pleton.M.D.,  Cedar  Bluff, 
Alabama 335 

Remarkable  Case,  by  F.  O. 
Hawley,  M.D.,  Charlotte, 
N.C 336 

A  Tablets  Soliloquy,  by  A. 
L.  Russell,  M.  D.,  .Mid- 
way. N.  V 340 


What  to  Do  with  Strangu- 
lated Hernia,  by  Clinton 
B.  Herrick,  M.  D.,  Troy, 
N.  Y 336 

Treatment  of  Uterine  Dis- 
eases in  Virgins,  by  Os- 
car S.  Brown,  M.D.,Wild- 
omar,  California 341 

Report  of  Cases  Treated 
with  Paquin's  Anti-Tu- 
bercle Serum,  by  J.  P. 
Bridges,  M.  D..  Kahoka, 
Mo 342 

Editorial. 

North  Carolina  Medical  So- 
ciety    345 

Counter-Prescribing     and 

Office-Dispensing, 345 

Diagnosis  of  Typhoid  Fever  346 

Criminal  Abortions, 347 

Internal  Use    of    Carbolic 

Acid 348 

Why  has  Alcohol  been  so 
Popular  in  the  Treatment 
of  Disease  in  the  Past? . .  349 

Impetigo 349 

Exercise   and    Physiologic 

Changes, 350 

Little  Things  in  Medicine.  350 
Southern  Medical  Journal,  351 
A  Good  Location  for  a  Phy- 
sician    351 

Dr.  C.  H.  Simmons  editor  of 
the  Journal  of  the  Amer- 
ican Medical  Association.  :i."<l 

BooK    Reviews, 

American  Year-Book  of 
Medicine  and  Surgery,  by 
George  M.  Gould.  M.  D.,  351 

An  American  Text- Book  of 
Diseases  of  the  Eye,  Ear, 
Nose  and  Throat,  edited 
by  G.  E.  DeSchweinitz,  A. 
M.,  M.  D.,  Philadelphia,  352 

An  Experimental  Research 
into  Surgical  Shock,  by 
Geo.  YV.  Crile,  A.  M.,  M. 
D.,  Ph.D., 352 

The  Practice  of  Obstetrics, 
by  American  Authors. 
Edited  by  Charles  Jewett, 
M.  D.,   Brooklyn,  N.  Y..  353 

A  Treatise  on  Fractures 
and  Dislocations.  For 
Practitioners  and  S  t  u  - 
dents,  by  Lewis  A.  Stim- 
son,  B.  A.,  M.  D.,  New 
York 353 

Self-Examination  for  Medi- 
cal Students.  P.  Blakis- 
ton's  Son  &  Co.,  Phila- 
delphia,    353 

Diseases  of  the  Eye.  A 
Handbook  of  Ophthalmic 
Practice  for  Students  and 
Practitioners,  by  G.  E. 
DeSchweinitz,A.M.,M.D.  354 

Fever  Nursing,  by  .1.  C. 
Wilson,   A.  M.,  M.  D....  354 


A  Text-Book  of  Mechano- 
Therapy.by  Axel.  V.  Graf- 
strom,  B.  S.  O,  M.  D. . . .  354 

The  Dawn  of  Reason  or 
Mental  Traits  ih  the  Low- 
er Animals,  'by'James 
Weir,  M.  D ' 354 

A  Compendof  Human  Phy- 
siology, by  Albert  P. 
Brubaker,  A.  M.,  M.  D.,    354 

Literary  Notes. 

The  Forum  for  March, :if>4 

Cosmopolitan  Magazine  ...  354 
Lippincott's   Magazine  for 

March, 355 

Review  of  Reviews 355 

The  Living  Age  for  March,  355 

Miscellaneous- 

A  Card 379 

A  Reason  and  a  Relief 382 

Antistreptococcic  Serum..  361 

Bacteriological  Investiga- 
tions of  the  Etiology  of 
Ophthalmia  Neonatorum  359 

Congratulate  You,  Gentle- 
men    378 

Creosote  in  Phthisis  Pul- 
monalis 380 

Dismenorrhoea 357 

Death  of  R.   W.   Peacock, 

M.  D 357 

Don'ts  for  the  Treatment  of 

Pneumonia 360 

Education  of  the  Ophthal- 
mologist,    360 

Hemorrhage  as  a  Sign  of 
Congenital  Syphilis 357 

Mai-Nutrition 380 

Nasal  Bacteria  in  Health, .  356 

On  Ocular  Affections  in 
Puerperal  Eclampsia, . . .  349 

Operation  for  the  Effects  of 
Gastric  Ulcers 361 

Orthoform  as  a  Local  An- 
asethetic,  Analgestic  and 
Antiseptic 379 

Pruritis  Ani 379 

Progress  and  Growth  of 
Our  Oew  Orleans  Branch  387 

Report  of  the  War  Investi- 
gating Committee 358 

Report  of  Treatment  of 
Secondary  Anemias  with 
Cases 363 

Tubercular  Cystitis  in 
Children 362 

Tuberculous  Ulcers  of  the 
Rectum 363 

The  Western  Ophthalmo 
logic  and  Oto-Laryngo- 
loffic  Association 36I5 


380 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


Alleged  Heredity  of  Con- 
sumption     370 

Bacterial  Origin  of  Biliary 
Calculi 369 

Clinical  Experience  Show- 
ing the  Physiological  Ac- 
tion of  Mercauro  and  Ar- 
senauro 372 

Diet  in  Acne „ 365 

Diagnosis  between  Tuber- 
cular Syphilis  of  the 
T,on g u e „tand  Sy phil itic 

Glossitis, 369 

Drug  Addiction 370 

Dangers  of  Blisters, 386 


Evidence  in  Favor  of  V  ac- 
cination 367 

High    Temperature    and 

Prognosis  of  Pneumonia,  368 
How  to  Avoid  Tuberculosis  369 
Hypertrichosis 372 

Modern  Treatment  of  Hem- 
orrhoids,    365 

Massage  of  the  Abdomen. .  368 
Mississippi   State    Medical 
Assoiation, 386 

Relation  of  Pelvic  Disorder 
to  Mental  Disease 371 

Rebellious  Constipation 
Cured  by  Massage  of  the 
Gail-Bladder 371 


Surgery  of  Perforation  in 
Typhoid, 371 

The  Male  and  Female 
Skull 363 

Tri-State  Medical  Associa- 
tion of  Mississippi,  Ar- 
kansas and  Tennessee. . .  386 

Use  of  Morphine  in  Cardiac 
Disease    355 

Use  of  Crede's  Silver  Oint- 
ment in  Puerperal  Sepsis  370 

What  Shall  the  Physician 
Say  to  a  Gonorrheal  Pa- 
tient who  Desires  to 
Marry, 357 


Dangers    of  Blisters. 

They  often  produce  an  open  wound 
which  facilitates  secondary  infections  or 
the  absorption  of  cantharides. 

Besides  tending  to  cause  inflammation  of 
the  kidneys  and  bladder,  they  have  a  gen- 
eral congestive  action. 

Even  in  those  diseases  where  they  are 
most  frequently  used,  such  as  pneumonia 
and  pleurisy,  they  should  be  discarded,  as 
they  increase  pulmonary  congestion. 

Blisters  tend  to  arrest  excretion  by  the 
kidneys,  so  important  in  all  infectious  dis- 
eases, and  this  is  especially  harmful  in  those 
normally  causing  albuminuria.  Instead  of 
aiding  the  excretion  of  toxines,  blisters  are 
likely  to  produce  a  fresh  intoxication. 

The  only  real  use  of  blisters  is  in  their 
revulsive  and  analgesic  action,  but  the 
effect  is  better  attained  by  less  dangerous 
means,  such  as  mustard  plaster  or  cold  baths. 


Tri-State    Medical    Association  of  Missis- 
sippi, Arkansas  and  Tennessee. 

At  the  regular  annual  meeting  of  the 
Tri-State  Medical  Association,  of  Missis- 
sippi, Arkansas  and  Tennessee,  held  in 
Memphis,  December  20th,  21st  and  22nd, 
1898,  the  following  resolutions  were 
adopted  : 

Whereas,  the  medical  laws  of  the  various 
States  have  been  so  perverted  by  political 
influences  as  to  give  legislative  sanction  to 
grotesque,  ignorant  and  dangerous  sects  of 
pretenders  and  charlatans  ;  and 

Whereas,  the  privileges  granted  to  one 
of  the  most  outrageous  aberrations,  namely, 
the  so-called  Osteopathy,  constitute  a  dis- 
grace to  the  State  in  which  the  "osteopath- 
ists"  are  legally  intrenched;  and 

Whereas,  a  certain  Willian  Smith,  Osteo- 
pathist,  having  been  roundly  denounced, 
together  with  his  sect,  by  Parke,  Davis  & 
Co.,  and  the  Medical  Age,  now  brings  suit 


against  both  for  $25,000.00  damages  ;  there- 
fore, 

Be  it  declared  the  sentiment  of  the  Tri- 
State  Medical  Association,  of  Mississippi, 
Arkansas  and  Tennessee,  that  Parke,  Davis 
&  Co.,  and  the  Medical  Age  are  entitled  to 
the  sympathy  of  its  members  and  of  all 
medical  Practitioners ;  that  we  wish  and 
expect  them  to  enjoy  a  complete  triumph 
in  repelling  this  legal  assault ;  and  that 
wheresoever  a  powerful  House  takes  a 
bold  stand  in  opposition  to  quackery  it 
promotes  the  interests  of  legitimate  and 
honorable  Medicine  and  the  welfare  of 
humanity. 

Mississippi    State  Medical  Association. 

Meridian,  Miss.,  Feb.  4,  1899. 
Dear  Doctor: — The  33d  Annual  meeting 
of  the  Mississippi  State  Medical  Associa- 
tion will  convene  in  Representative  Hall, 
Jackson,  April  19,  20,  21,  1899.  Matters 
of  special  interest  to  the  profession  of  the 
State  will  be  discussed  at  this  meeting  and 
a  full  attendance  is  urgently  desired.  Fivi 
names  will  be  selected  by  the  Association, 
for  appointment  by  the  Governor,  as  mem- 
bers of  the  State  Board  of  Health.  Kindly 
forward  the  title  of  the  paper  you  will  read 
before  the  Association  by  the  1st  of  April, 
as  I  wish  to  embody  it  in  the  regular  pro- 
gramme to  be  sent  out  then. 
Very  truly, 

J.  R.  Taclett,  Secretary. 


Board  of  MedicalExaininers. 

The  Board  of  Medical  Examiners  of  the 
State  of  North  Carolina  will  meet  in  Ashe- 
ville,  N.C., Thursday  afternoon,  May  25th, 
1899  ;  all  applicants  are  urged  to  be  present 
at  this  time  to  register  and  be  ready  for  ex- 
amination on  the  following  morning. 
Thos.  E.  Anderson,  M.  D., 

Sec.  Board  Med.  Ex.,  Statesville,N.C. 


THE  CHARLOTTE- MEDICAL  JOURNAL. 


387 


GONORRHOEA 


COMPOUND 


PHENAZONE     BOUGIES 

Are  a  Specific  for  tionorrhoea  and  Gleet, 


YOUR  PATIENT  has  trouble  enough  of  his  own  already,  when  he  is  sufiering 
with  Gonorrhea  or  Gleet.  DON'T  MORTIFY  HIM  with  "tell  tale"  bottles  and 
syringes,  but  use  instead  a  system  of  treatment  which  is  practical,  attracts  no  atten- 
tion, and  will  cure  promptly.  The  remedies  used  in  the  Phenazone  Bougies  are  of 
an  astringent,  antiseptic,  alterative 'and  anodyne  character,  and,  as  the  Bougies  are 
freely  soluble  in  the  secretions  of  the  urethra,  they  are  thus  brought  into  direct, 
thorough  and  prolonged  action  upon  the  diseased  parts.  No  other  system  of  treatment 
will  do  this  as  promptly  or  as  well. 

FORMULA.— Zinc  Sulphate,  Creosote,   Hydrasis,   Antipyrin,  etc. 
LONG  SIZE,  for  Glettt  (6l/2  inches  long).    SHORT  SIZE,  for  Gonorrhoea  (3  inches  long). 

Price,  per  box  of  12  Bougies.    Retail  $1.25.     Physicians  $1.00 

SAMPLES.— We  will  mail  to  any  Physician  mentioning  The  Charlotte  Medical 
Journal  and  inclosing  25  cts.  (stamps  or  silver),  a  Large  Sample  Box  of  Phenazone 
Bougies  sufficient  to  treat  an  ordinary  case  of  Gonorrhoea  or  Gleet.  Mention  Long  or 
Short  Size  and  send  order  direct  to  us. 

THE  STANDARD  CHEMICAL  CO.,  Ltd.,  lOlfi  Cherry  Street,  Philadelphia. 

Southern  Agencies.— W.  P.IPoythress,  Richmond, V.     I.L.Lyon  &-Co.,  New  Orleans. 


CHRONIC  URETHRITIS 


Progress  and  Growth  of   our  New  Orleans 
Branch. 

The  most  tantalizing  condition  that  can 
possibly  confront  the  manufacturing  phar- 
macist is  that  formerly  prevailing,  and  now 
happily  corrected,  in  the  territory  control- 
led by  the  representatives  of  our  New  Or- 
leans Branch.  To  create  a  demand  for  our 
lines  by  extensive  advertising  and  detail 
work,  and  then  to  have  it  stifled  for  lack  of 
accessible  supplies  at  convenient  points  may 
be  described  as  simply  unendurable.  Three 
years  ago  we  accordingly  established  a  depot 
of  supplies  in  New  Orleans,  and  assigned 
a  resident  representative  to  that  important 
city.  Our  business  expanded  very  rapidly  ; 
within  a  year  we  had  a  finely  equipped  de- 
pot ;  and  at  the  present  time  we  have  a 
force  of  twenty-two  employes  and  a  stock 
that  fills  a  four-story  building. 

The  new  home  of  the  New  Orleans 
Branch  is  prominently  located  on  one  of 
the  principal  streets,  508  Camp  Street,  op- 
posite LaFayette  Square.  Every  conven- 
ience that  can  expedite  the  filling  of  orders 


is  provided-elevators,  dumb-waiters,  speak- 
ing tubes,  electric  bells,  rolling  ladders,  etc. 
For  the  benefit  of  our  friends  and  visitors 
we  have  a  nicely  furnished  reception  hall, 
provided  with  medical  and  pharmaceutical 
literature,  and  of  course  the  Branch  carries 
a  full  supply  of  literature  bearing  on  our 
products,  and  a  full  assortment  of  the  same. 
Visitors  are  always  welcome,  and  our  friends 
in  the  trade  and  profession  are  cordially  in- 
vited to  make  themselves  at  home  with  us. 
During  the  Mardi-Gras  festivities  (February 
14)  we  shall  be  pleased  to  have  our  friends 
make  their  headquarters  at  our  establish- 
ment. 

We  are  heartily  grateful  for  the  support 
accorded  our  New  Orleans  Branch  by  the 
pharmacists  and  physicians  in  the  city  of 
New  Orleans  and  in  the  adjoining  territory. 
We  propose  to  deserve  their  continued  fa- 
vor by  carefully  studying  their  needs,  and 
by  seizing  every  opportunity  to  show  our 
appreciation  of  their  good  will. 

Parke,  Davis  &  Co., 
508  Camp  St.,  opp.  Lafayette  Sq., 

New  Orleans,   La. 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


The  Baby's  Life 

Depends  on  the  food  it  gets. 

Insufficient  nourishment  is  the  cause  of 

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bowels— neither  laxative  nor  astringent. 


A  sample  can,  sufficient  for  atrial,  will  be  sent 
free  to  any  physician  requesting  it. 


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ELECTRO  MEDICAL  MANUFACTURING  CO. 

S.  E.  cor.  59th  and  Wallace  St.,  Chicago,  III. 


A  CTIVE  SOLICITORS  WANTED  EVERY- 
■^*- where  for  "The  Story  of  the  Philippines," 
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Sugar  Milk  (q.  s.) 5       grains 

WEEKS  DRUG  &  CHEMICAL  CO.,  Jackson,  Mich. 


THE  TREATMENT  OF 

Diabetes 

simplified  by  the  use  of  EULEXINE. 
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no  stomachic  disturbance. 

Eulexine  aromatized  (R -Liquor  Eulexini 
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Formula  :  Eulexine  10  per  cent.,  Rhamnus 
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Rigid    Diet    not   Essential    when   this 
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POSTAL  FOR  CLINICAL  REPORTS. 

THOMAS    PHARMACAL   COMPANY, 

95  BROAD  ST.,     NEW  YORK. 


Ruth  T.   Brockman, 

TRAINED    NURSE, 

No.  800  N.  Pine  Street,  -  CHARLOTTE,   N.  C. 


The  Charlotte  Medical  Journal. 


Vol.   XIV. 


CHARLOTTE,   N.   C,   APRIL,   i! 


No. 


Typhoid     Perforation-  -Operation— Re- 
covery.* 

By  Hugh  M.  Taylor,  M.  D.,  Professor  of   Prac- 
tice of  Surgery,  University  College  of  Medi- 
cine, Surgeon  to  Virginia  Hospital. 
Richmond,  Va.,  etc. 

Gentlemeu: — 

You  will  recall  that  we  recently,  in  con- 
nection with  perforating  gastric  and  duode- 
nal ulcer,  considered  the  subject  of  perfora- 
ting typhoid  ulcer,  and  its  surgical  treat- 
ment. Yesterday  I  had  some  interesting 
and  instructive  experience  with  a  perfora- 
ting typhoid  ulcer,  and  I  shall  be  glad,  if  I 
can  infuse  the  interest  and  impart  t lie  ex- 
perience this  case  is  capable  of  conveying. 

An  interesting  little  boy  had  been  sick 
with  enteric  fever  for  six  weeks,  was  then 
convalescent  for  two  weeks,  again  sick  with 
fever  for  ten  days,  and  again  free  from  fe- 
ver for  three  days,  and  convalescence  seem- 
ed once  more  assured.  Rut  a  death-dealing 
stroke,  from  a  seemingly  cloudless  sky, 
hurled  gratefully  uplifted  hearts  hack  into 
blackest  despair. 

In  the  onset  of  fever,  in  this  cast-,  we  had 
as  a  complication  so  much  bronchitis  that 
it  was  by  no  means  easy  to  say  which  was 
the  most  important  etiological  factor — the 
bronchitis,  or  the  enteric  fever.  In  fact,  at 
no  time  were  there  enteric  symptoms,  and 
a  diagnosis  of  enteric  fever  could  only  be 
made  by  exclusion,  and  the  existence  of  a 
long  continued  fever.  Not  for  one  moment 
was  there  the  slightest  trace  of  cerebral 
trouble.  Never  once  did  the  child  fail  to 
say  when  asked  how  he  was,  "]  am  all 
right, "  and  daily  he  begged  for  something 
to  eat,  and  to  be  allowed  to  get  up.  While 
his  fever  for  weeks  ran  high,  there  was  as- 
tonishingly little  systemic  depression,  or 
functional  disturbance.  There  .were  abso- 
lutely no  abdominal  symptoms,  no  pain  on 
pressure,  no  tympanites,  only  a  slight  tend- 
ency to  constipation,  which  yielded  satis- 
factorily to  a  simple  enemata  or  mild  laxa- 
tive. Towards  the  end  of  the  fourth  or 
fifth  week  infection  of  the  middle  ear  occur- 
red (probably  typhoid  infection,  as  may 
also  have  been  the  bronchitis)  the  abscess 


*Clinical  lecture  to  the  Graduating  Class  of 
the  University  College  of  Medicine,  Richmond, 
Va.,  Feb.  14th,  '99. 


soon  perforated  ths  drum,  and  discharged 
freely  for  a  week  or  more,  and  then  gradu- 
ally yielded  to  treatment.  You  will  recall, 
when  I  dealt  with  typhoid  affections  of 
bones, joints, otitis  media,  lymphatic  glands, 
meningitis,  and  in  fact,  suppuration  occur- 
ring in  any  part  of  the  body  during,  or 
subsequent  to  typhoid  fever.  I  told  you  it 
was  an  open  question  as  to  which  was  the 
pyogenic  organism,  the  Eberth  bacillus, 
staphylococcus,  or  mixed  infection.  Some 
writers  are  inclined  to  think  that  the  typhoid 
bacillus,  like  the  bacillus  coli  communis, 
with  changed  environment,  may  assume 
pyogenic  properties.  Others  see  in  the  in- 
testinal lesions  (ulcers)  in  the  sores  in 
mouth,  nose,  bed-sores,  etc.,  abundant  ave- 
nues for  the  entrance  of  pyogenic  organisms 
and  in  the  depression  incident  to  the  fever 
many  foci  of  diminished  resistance.  Sev- 
eral weeks  ago  the  fever  seemed  to  have 
spent  its  force,  and  the  child  convalesced 
sufficiently  to  be  up  and  around  his  room, 
but  at  no  time  were  restrictions  as  to  diet 
relaxed.  About  ten  days  ago  lie  again  had 
continued  fever  for  ten  days,  but  the  case 
was  still  atypical  in  that  there  were  no 
cerebral  or  enteric  symptom.  Two  days 
before  the  perforation  occurred  he  had 
no  fever.  This  minute  history  is  given  you 
to  impress  the  fact  that  serious  enteric  le- 
sions may  coexist  without  manifesting  them- 
selves  by  hemorrhage,  diarrhoea,  tympany, 
pain,  etc.,  and  this  knowledge  should  beget 
in  every  case  of  typhoid  fever,  typical  or 
atypical,  a  guarded  prognosis,  careful  re- 
strictions as  to  diet  and  exercise,  and  watch- 
fulness to  note  the  first  warning  symptoms 
of  perforation. 

Yesterday  morning  his  father  called  to 
tell  me  the  child  had  slept  quietly  all  night, 
but  awoke  about  six-thirty  in  the  morning 
with  sharp  pain  in  the  abdomen.  The  pain 
lasted  only  a  few  minutes,  and  was  quickly 
followed  by  a  natural  fecal  action.  Think- 
ing the  pain  was  incident  to  having  consti- 
pated action,  his  mother  at  once  gave  him 
a  teaspoonful  of  syrup  of  figs.  This,  how- 
ever, was  promptly  vomited,  and  several 
times  during  the  next  few  hours  spells  of 
vomiting  recurred.  One  more  attack  of 
sharp  pain,  which  lasted  only  a  few  min- 
utes, was  experienced,  and  after  that  time, 
the  child  insisted  that  he  was  all  right  and 
had  no  pain.      Such  was  the  clinical  history 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


given  me  on  my  visit  at  eleven  o'clock,  and 
I,  of  course,  recognized  suspicious  symp- 
toms of  intestinal  perforation.  The  child, 
however,  did  not  look  sick  enough  to  justify 
such  a  suspicion.  He  expressed  himself  as 
being  without  pain,  and  his  untroubled 
countenance  confirmed  this  assertion.  There 
were  no  evidences  of  shock,  and  those  who 
saw  him  at  the  onset  of  the  sharp  attack 
could  not  say  that  even  then  he  presented 
any  of  the  symptoms  of  shock.  His  pulse 
was  now  115,  and  his  sublingual  tempera- 
ture 101.  Respiration  was  not  noticeably 
increased,  and  his  morale  was  exceptionably 
good ;  there  was,  however,  some  apprecia- 
ble rigidity  in  the  abdominal  muscles.  An 
absence  of  fever  for  several  days,  the  sudden 
onset  of  pain  and  vomiting,  a  recurrence  of 
fever  and  rapid  pulse,  plus  the  abdominal 
rigidity,  was  the  group  of  symptoms,  which 
made  me  fear  a  perforation.  Per  contra, 
was  the  short  sharp  attack  of  pain  peristal- 
sis, incident  to  having  an  action.  Was  the 
vomiting  due  to  the  acute  intestinal  pain 
and  the  dose  of  syrup  of  figs?  Was  the 
fever,  and  increased  pulse  rate,  a  product  of 
ptomain  production  and  absorption  within 
the  intact  intestinal  tract  ?  Was  the  slight 
muscular  rigidity,  voluntary  contraction, 
incident  to  the  fear  of  pain  on  pressure,  or 
real  pain  conveyed  to  the  solar  plexus  (the 
abdominal  brain),  and  thence  back  to  the 
abdominal  muscles  and  putting  them  on 
guard.  It  is  common  experience  in  typhoid 
fever  to  have  pain,  sine  perforation,  tympa- 
nitis is  the  rule,  not  the  exception,  tender- 
ness on  pressure,  notably  in  the  ileo  caecal 
region  is  not  infrequent,  and  few  differenti- 
ations are  more  difficult  to  make  than  some 
cases  of  atypical  enteric  fever  from  chronic 
or  subacute  appendicitis,  and,  time  and 
again,  I  have  viewed  with  anxiety  just  as 
typical  symptoms  of  perforation  as  those 
mentioned  in  connection  with  this  case,  in 
which  the  results  showed  no  perforation  to 
have  occurred.  I  am  dwelling  so  minutely 
on  the  symptoms  manifested  to  impress  the 
fact  that  perforation  may  coexist  with  mi- 
nor manifestations,  or  in  fact,  as  has  been 
observed  by  others,  with  no  symptoms  at 
all.  I  envy  the  man  who,  right  or  wrong, 
has  confidence  in  his  convictions,  but  I  do 
not  envy  the  patient  whose  destiny  is  in  the 
hands  of  the  abdominal  surgeon  who  fails 
to  realize  that  he  who  makes  a  positive 
diagnosis  in  all  intra-abdominal  lesions, will 
not  infrequently  be  in  error.  What  we 
need  in  abdominal  surgery  is  an  improved 
diagnosis,  rather  than  an  improved  opera- 
tive technique. 

A  second  visit,  two  hours  later,  did  not 
lessen  my  apprehension  as  to  the  serious 
nature  of  the  case.      There  was  no  noticea- 


ble change  except  that  his  pulse  had  increas- 
ed to  125,  and  his  rectal  temperature  was 
io2|.  The  child  was  sent  to  the  Virginia 
Hospital,  and  a  consultation  arranged  with 
Drs.  Hunter,  Edward  McGuire  and  Vir- 
ginius  Harrison.  At  this  time  there  were 
more  marked  symptoms  of  serious  intra- 
abdominal trouble,  but  still  classical  symp- 
toms were  absent.  The  face  of  the  child 
was  not  expressive  of  impending  danger, 
its  respirations  were  not  embarrassed,  his 
abdomen  was  not  distended,  hepatic  dull- 
ness was  not  effaced,  and  vomiting  was  not 
at  all  frequent.  To  offset  these  favorable 
indications  his  abdomen  was  still,  to  some 
extent,  rigid,  and  what  was  especially  omi- 
nous, as  it  is  in  all  serious  intra-abdominal 
infection,  his  pulse  was  now  140,  while  his 
rectal  temperature  was  only  ioo-i.  The  de- 
creasing temperature,  and  increasing  pulse 
rate,  suggesting  ptomain  absorption  from 
asepsis  and  shock,  and  reduction  of  tempe- 
rature incident  to  shock  of  sepsis.  Another 
significant  symptom  was  no  appreciable 
movement  of  gas,  even  with  the  phonendo- 
scope,  within  the  '  intestines.  These  last 
considerations  pointed  strongly  to  direct 
infection  of  the  peritoneal  sac,  either  by 
appendicial  or  typhoid  perforation,  but  we 
must  admit  that  the  clinical  picture  was  not 
formed  by  classical  symptoms,  and  the  por- 
trayal could  easily  be  taken  for  either  ap- 
pendicial or  typhoid  perforation.  Whether 
the  infection  was  appendicial  or  typhoid, 
was  a  matter  of  minor  importance,  as  early 
operative  intervention  in  either  case  was 
fully  in  accord  with  our  conception  as  to 
what  is  best  for  the  patient.  The  moment- 
ous problem  to  solve  was  whether  the  infec- 
tion was  within  the  peritoneal  cavity,  or 
within  the  intestinal  tube.  A  majority 
happily  decided  that  the  symptoms  were 
sufficiently  pointed,  to  warrant  a  confirma- 
tory incision.  Fifteen  hours  after  the  first 
onset  of  symptoms,  assisted  by  Drs.  Edward 
McGuire  and  Virginius  Harrison,  I  made 
an  incision  over  the  cajcal  region.  This 
site  was  chosen,  as  it  would  enable  us  to 
reach  an  involved  appendix,  and  also  give 
ready  access  to  the  lower  portion  of  the 
ileum,  in  the  last  eighteen  inches  of  which 
a  large  majority  of  typhoid  perforations  are 
known  to  occur.  On  incising  the  perito- 
neum, a  quantity  of  sero-purulent  fluid  es- 
caped from  the  peritoneal  sac,  but  no  gas. 
The  caecum  was  quickly  delivered,  and  not 
more  than  twelve  inches  of  the  small  bowel 
was  examined  before  the  punched-out  look- 
ing, pencil  sized  hole  in  the  ileum  was  dis- 
discovered.  There  was  but  little,  if  any, 
appreciable  inflammatory  change  about  the 
intestinal  lesion,  in  fact  it  looked  as  if  a 
cobbler's    punch    had     been     drivn    into    a 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


healthy  bowel,  and  a  circular  section  punch- 
ed out.  To  close  the  opening  with  deep 
matress  and  Lambert  sutures,  was  the  work 
of  a  few  minutes.  In  ten  minutes  from  the 
time  the  section  was  begun,  the  abdomen 
was  opened,  the  lesion  found  and  sutured. 
This  fact,  as  to  the  time  consumed,  is  not 
mentioned  to  extol  rapid  work,  for  not  in- 
frequently rapidity  of  operating  is  at  the 
expense  of  thoroughness.  We  would,  how- 
ever, impress  the  idea  that  the  technique  of 
dealing  with  typhoid  perforations  may  be 
very  simple  and  quickly  completed.  Upon 
first  thought,  it  looks  like  desperate  surgery 
to  subject  to  celiotomy  the  cadeverous  look- 
ing patient  ill  with  typhoid  fever  for  weeks, 
with  the  added  prospect  of  prolonged  anes- 
thesia, extensive  evisceration,  etc.,  to  find 
and  suture  the  bowel  opening,  but  knowing 
the  usual  site  of  the  lesion,  near  the  ileo 
c&'cal  junction,  we  have  in  all  instances  a 
starting  point  from  which  to  begin  our 
search. 

In  addition  to  the  free  discharge  of  sero- 
purulent  fluid  from  the  peritoneal  cavity,  a 
number  of  flakes  of  lymph  were  discovered 
and  not  more  than  half  an  ounce  of  green- 
ish looking  fecal  fluid  was  found  puddled 
near  the  perforation.  Suppurative  perito- 
nitis was  obviously  quite  general,  no  effort 
at  walling  had  been  made.  No  one,  who 
saw  this  clean-cut  perforation,  with  not  the 
slightest  trace  of  adjacent  plastic  peritonitis 
could  faii  to  be  impressed  with  the  idea  that 
death  was  inevitable, without  surgical  inter- 
vention. Twenty  minutes  more  was  con- 
sumed in  eviscerating  the  patient,  and  in 
thoroughly  irrigating  with  hot  saline  solu- 
tion the  abdominal  cavity,  and  in  placing 
multiple  gauze  drainage.  In  thirty-seven 
minutes  from  the  beginning  of  the  opera- 
tion the  patient  was  removed  from  the  table 
to  his  bed.  Let  us  here  remark,  that  twenty 
minutes  of  this  time  could  probably  have 
been  saved  if  the  patient  had  been  operated 
upon  in  the  morning.  At  that  time  it 
would  probably  have  been  best,  merely  to 
have  sponged  off  the  soiled  area,  and  drain- 
age might  have  been  dispensed  with. 

Granting  that  it  is  formidable  surgery  to 
subject  a  typhoid  patient  to  an  abdominal 
section,  the  fact  has  been  impressed  that 
these  patients  are  no  worse  off  physically, 
than  are  many  cases  of  appendicitis,  which 
are  thoroughly  septicised,  and  the  same  is 
true  in  delayed  operations,  for  bullet 
wounds,  and  in  cases  of  perforating  gastric, 
duodonal  or  gall  tract  perforations.  Not 
infrequently  an  acute  toxemia,  with  a  ne- 
crotic appendix,  as  its  focus,  will  in  twenty- 
four,  or  certainly  in  forty-eight  hours, bring 
even  a  strong  patient  to  a  typhoid  state. 

You  may  naturally  ask,  what  hold   upon 


life  had  this  little  patient,  and  others  simi- 
larly situated,  without  operative  interven- 
tion ?  I  would  say,  from  the  revelations, 
absolutely  none.  As  I  have  mentioned, 
there  was  not  the  slightest  trace  of  plastic 
peritonitis,  without  which  there  was  no 
possibility  of  an  adhesion  of  the  perforation 
to  adjacent  structures  or  walling  in  of  the 
focus  of  infection.  The  discharge  of  fluid 
fecal  matter,  and  its  sequence,  septic  peri- 
tonitis, renders  impossible  a  spontaneous 
cure.  Students  of  the  phase  of  our  subject 
claim  that  f  "there  are  certainly  a  number 
of  cases  on  record,  in  which  perforation 
could  not  be  doubted, which  have  recover- 
ed," but  Fitz  has  well  said  "since  sugges- 
tive-even so-called  characteristic-symptoms 
may  occur,  without  any  perforation  having 
taken  place,  it  must  be  admitted,  that  re- 
covery from  such  symptoms  is  not  satisfact- 
ory evidence  of  recovery  from  perforation." 
We  may  well  understand  how  a  typhoid 
ulcer  may  destroy  mucosa  and  muscularis, 
and  give  rise  to  a  local  fibrino  plastic  peri- 
tonitis, and  adhesion  of  the  threatened  point 
in  the  bowel,  to  whatever  intra-peritoneal 
structure  with  which  it  may  come  in  con- 
tact. This  local  adhesive  peritonitis  may 
give  rise  to  pain,  etc.,  just  as  suggestive  of 
perforation  as  are  the  typical  symptoms  met 
with  in  some  cases  of  real  perforation.  In- 
testinal lesions,  from  other  causes,  often 
present  symptoms  just  as  vague.  It  is  im- 
possible, in  bullet  wounds  of  the  bowels,  or 
in  lacerated  wounds  from  blows,  etc.,  to 
know  by  the  symptoms  manifested  that  any 
such  lesion  has  occurred,  and  not  infre- 
quently the  perforating  gastric  or  duodenal 
ulcer  will  be  unattended  by  early  charac- 
istic  symptoms. 

*Fitz  reports  that  "in  56  cases  of  typhoid 
perforation  the  onset  was  sudden,  in  15  the 
symptoms  were  gradual  or  latent,  while  in 
5  there  were  no  symptoms  whatever  point- 
ing to  perforation." 

What  hope  does  surgery  offer  patients 
seemingly  and  really  doomed  by  the  occur- 
rence of  typhoid  perforation  ?  It  is  claimed 
by  Murchison,  that  90  to  95%  will  die,  for 
our  part  we  are  forced  to  think  that  a  ma- 
jority of  the  small  number,  supposed  to  have 
recovered  spontaneously,  were  cases  of  mis- 
taken diagnosis — cases  of  local  peritonitis, 
without  perforation.  Granting,  for  the  sake 
of  comparison  only, that  Murchison's  claims 
are  correct  and  that  from  5  to  10  per  cent, 
of  suspected  perforations  will  recover 
spontaneously,  a  knowledge  of  the  triumphs 
of  operative  surgery  in  this  field,  leaves  no 
doubt  as  to  its  efficacy. 


t/Keen,  Surgery  of  Typhoid  Fever,  page  218. 
*Keen,  Surgery  of  Typhoid  Fever,  page  217. 


392 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


fDr.  Keen  reduces  the  authenticated  cases 
operated  upon  to  60  and  13  recoveries.  Of 
the  cases  operated  upon,  within  12  hours, 
26.7  per  cent,  recovered.  Of  those  ope- 
rated upon  between  12  and  14  hours  30  per 
cent,  recovered,  while  we  may  expect  a 
total  mortality,  if  the  operation  is  delayed 
until  after  the  24  hours. 

Statistics,  as  to  early  operative  interven- 
tion impress  the  fact,  that  in  this,  as  in  so 
many  acute  intra-peritoneal  infections,  the 
"stitch  in  time  saves  nine's.  Certainly  in 
some  instances  it  is  a  simple  operation  to 
incise  the  abdomen,  draw  out  a  few  feet  of 
intestines,  apply  a  few  sutures,  dry  a  cir- 
cumscribed infected  area,  and  perhaps  close 
the  abdomen,  without  irrigation  or  drain- 
age. Such  a  procedure  should,  we  think, 
claim  a  small  mortality  from  the  operation 
per  se.  Late  operative'intervention, in  bul- 
let wounds  of  the  intestines,  and  in  perfo- 
rating ulcer  of  every  kind,  has  been  and 
will  be  attended  with  a  high  rate  of  mor- 
tality. Ideal  surgery  contemplates  an  early 
operation  to  prevent  the  occurrence  of  sep- 
tic peritonitis,  and  not  until  this  fact  is  ap- 
preciated will  the  highest  possible  ends  of 
operative  intervention  be  realized.  Success 
depends  upon  getting  into  the  abdomen 
early,  and  out  of  it  just  as  quickly  as  is  con- 
sistent with  thorough  work. 

In  the  absence  of  shock  there  was  no  reason 
why  I  should  not  have  operated  upon  this 
child,  as  soon  as  I  saw  him, which  was  four 
hours  after  the  perforation  occurred,  and  I 
should  have  done  so  if  I  had  at  that  time 
been  sure  of  my  diagnosis.  If  I  had  done 
so,  I  should  probably  anticipated  the  occur- 
rence of  septic  peritonitis.  Irrigation  and 
drainage  would  not  have  been  indicated, 
twenty  minutes  of  the  time  occupied  in 
performing  the  operation,  would  have  been 
saved.  Early  operative  intervention  in  bul- 
let wounds  of  the  intestines,  will  save  from 
65  to  75%  of  cases,  and  equally  favorable 
statistics  would  result,  from  early  surgical 
intervention  in  performing  gastric  and  duo- 
denal ulcer,  and  in  appendicial  perforations 
i.  e.,  if  we  operate  early  enough,  to  antici- 
pate, and  prevent  the  occurrence  of  diffuse 
suppurative,  or  septic  peritonitis.  It  is  not 
the  perforation  that  kills,  it  is  the  inevita- 
ble sequence  of  perforation,  peritonitis, that 
destroys  life  by  virulent  ptomain  produc- 
tion and  absorption,  and  the  perversion  of 
functions  essential  to  life.  Masterly  inac- 
tivity is  consistent  with  an  intelligent  ap- 
preciation, and  faithful  discharge  of  duty, 
only  until  a  diagnosis  is  made,  and  only 
until  the  surgeon  can  prepare  for  the  ope- 
ration  and    secure    the    needed    assistants. 


fSurgery  of  Typhoid  Fever,  page  296. 


Further  delay  has  been  designated  criminal 
inactivity.  If  shock  exists,  unless  very  pro- 
found, it  is  an  open  question,  in  my  mind, 
if  you  should  ever  wait  for  that  to  pass  off, 
as  not  infrequently  the  shock  of  perforation 
will  be  merged  into  the  shock  of  sepsis. 

In  the  case  of  this  little  boy,  although  it 
had  only  been  15  hours  since  the  perfor- 
ation, and  not  more  than  half  an  ounce  of 
intestinal  contents  had  escaped,  yet  the 
abdomen  was  full  of  sero-purulent  fluid,  no- 
ting how  quickly  suppurative  peritonitis 
supervenes.  Every  hour  of  delay  increases 
the  quantity  of  the  escaped  intestinal  con- 
tents, and  the  area  of  peritoneal  surface  in- 
fected. My  experience  in  late  operations 
for  typhoid  perforation,  has  been  as  unfa- 
vorable as  the  early  operation  is  favorable. 
A  case  met  with  in  my  own  practice,  a  few 
years  ago,  would  not  consent  to  operation, 
until  impending  death  from  general  perito- 
nitis was  only  a  question  of  a  few  hours. 
Classical  symptoms  of  perforation  made  the 
diagnosis  easy  in  its  incipiency.  Operation 
was  advised  within  a  few  hours,  after  the 
first  symptoms  of  perforation,  and  offered  a 
fair  chance  of  success,  as  the  case  had  been 
a  very  mild  type  of  enteric  fever  and  the 
patient  was  practically  convalescent.  A 
section,  four  days  after  the  perforation,  re- 
vealed diffuse  suppurative  peritonitis,  and  a 
great  sloughing  hole,  near  the  ileo  csecal 
junction.  The  patient  survived  the  opera- 
tion only  a  few  hours.  A  second  case, very 
similar  to  the  above,  was  seen  in  consulta- 
tion with  Dr.  Virginius  Harrison.  Dr. 
Harrison  and  I  did  not  see  this  case  until 
general  peritonitis  was  in  full  blast,  but  the 
symptoms  of  perforation,  we  were  told, 
were  typical,  and  were  manifested  several 
days  before  we  saw  him.  This  patient  lived 
only  a  few  hours,  after  the  operation.  A 
third  case,  seen  in  consultation  with  Dr. 
Edward  McGuire,  was  also  marked  by  un- 
mistakable symptoms  of  perforation.  Ope- 
ration was  at  once  advised,  but  was  declin- 
ed, and  this  young  mother  died  within  48 
hours  from  septic  peritonitis.  My  own 
limited  experience,  a  study  of  the  experi- 
ence of  others,  and  a  comparison  of  -the 
morbid  changes  incident  to  typhoid  perfora- 
tion,with  those  resulting  from  lacerated  and 
bullet  wounds  of  the  intestines,  and  with 
intestinal  perforations  from  other  causes, 
impress  the  conviction  that  operative  inter- 
vention "if  it  were  done,  when  'tis  done, 
then  it  were  well,  it  were  done  quickly" — 
quickly  as  to  the  time  of  beginning  the  ope- 
ration, and  quickly  as  to  the  time  of  finish- 
ing it. 

The  great  abdominal  surgeon,  Gregg 
Smith,  has  written,  f  "At  the  worst,  happen 


tAbdominal  Surgery,  Vol.  II,  Page  783. 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


393 


what  may,  the  patient  can  be  in  no  more 
deplorable  condition  than  before  operative 
interference  was  carried  out,  and  I  would 
plead  for  an  attempt  to  reduce  a  mortality 
of  one  hundred  per  cent.,"  and  we  would 
add  that  the  surgeon's  knife  alone  can  shed 
kindly  light  amid  the  encircling  gloom, 
inevitably  incident  to  typhoid  perforation. 
P.  S. — It  has  now  been  six  weeks  since 
the  date  of  the  coeliotomy,  convalescence 
has  been  uneventful  and  recovery  is  com- 
plete. .Statistics  should  now  read,  61  op- 
perations,  14  recoveries. 


Relative    Immunity  to    Toberculosis,  The 

Altitude  of  the  Ideal  Climate  and  Intra- 
Pulmonary  Medication. 

By   Charles  Denison,  M.  I)..  Denver,  Colorado. 

It  may  be  a  questionable  proceeding  to 
open  up  a  discussion  which  was  so  ably 
closed  by  the  concluding  remarks  of  Dr.  II. 
B,  Weaver,  at  the  meeting  of  the  Tri-State 
Medical  Society  held  at  Charlotte.  \.  C, 
reported  in  your  Journal  of  February, 
("Modern  Views  of  the  Nature  and  Treat- 
ment of  Pulmonary  Tuberculosis").  But 
those  of  us  who  were  not  fortunate  enough 
to  be  present  are  doing  the  best  we  can.  to 
help  ourselves  and  brother  physicians  to 
elucidate  this  important  subject,  if  we  speak 
out  as  soon  as  we  read  the  paper  and  its 
discussion. 

Three  points  in  this  excellent  paper  seem 
to  me  ought  to  be  specially  noticed  ;  how- 
ever, not  with  entire  concurrence  in  the 
conclusions  stated. 

Firstly  :  A  questionable  phase  of  the 
whole  discussion  depends  upon  the  stated 
premise  of  Dr.  Weaver's  that  tuberculosis 
"is  not  self-limited  or  self-protected,*'  and 
pbnsequently,  as  Dr.  Levy  expressed  it, 
"there  is  very  little  hope  at  any  time  from 
using  the  real  antitoxin."  How  are  we 
going  to  square  such  a  premise  with  the 
prevalence  of  tuberculosis  which  does  not 
appear  in  mortality  statistics  and  which  the 
essayist  presents,  or  with  Whittaker's  state- 
ment quoted,  "Therefore  in  one-half  of  all 
the  cases  recovery  is' complete,  or  the  dis- 
ease is  reduced  to  such  quiescence  as  to  be- 
come practically  non-existent?"  How  are 
we  to  account  for  the  very  good  results  of 
treatment  in  Dr.  von  Ruck's  78  cases  cited  ! 
It  seems  to  be  of  questionable  utility  to  base 
a  discussion  upon  such  an  ambiguous  pre- 
mise. The  self-protection  or  self-limita- 
tion, i.  e.  the  immunity  to  seek,  is  only  re- 
lative anyway,  but  who  will  deny  its  exist- 
ence in  any  degree  whatever?  Dr. von  Ruck 
and  1  went  over  this  question  several  years 


ago  when  he  visited  me  in  Denver.  He 
had  previously  claimed  that  there  was  no 
such  thing  as  "immunity"  to  tuberculosis, 
thinking  probably  of  absolute  immunity.  I 
claimed  that  the  immunity  possibly  obtained 
can  only  be  relative  and  that  an  "absolute 
cure"  is  a  questionable  term  to  use.  The 
gradual  approach  to  the  highest  immunity 
possible,  or  resistant  condition  of  the  organ- 
ism to  tubercular  action,  is  the  object  of  our 
antitoxic  or  specific  treatment.  The  con- 
ception of  the  Watery  Extract,  Dr.  von 
Ruck  writes  me,  dates  back  to  suggestions 
then  made.  The  natural  "self-limiting  or 
self-protecting"  processes  of  the  organism 
are  important  factors  explaining  the  ever 
varying  manifestations  of  tuberculosis,  and 
the  admission  of  such  a  contrary  premise  in 
the  beginning  of  the  argument  is  a  mistake 
vitiating  all  after  conclusions.  Why  is  it 
that  t he  growing  tubercle  bacilli  will  not 
use  up  all  the  nutrient  material  in  the  cult- 
ure media  before  they  themselves  begin  to 
die?  Why  is  it  that  the  chronicity  of  tuber- 
culosis is  such  an  aid,  as  it  certainly  is,  to 
what  we  call  the  cure  of  the  patient?  Time 
is  an  important  element  in  this  process,  as 
in  financial  contracts,  as  it  is  a  proof  of 
relative  immunity. 

Incidentally  1  would  call  attention  to  a 
remarkable  fact,  brought  out  by  an  analysis 
of  Dr.  von  Ruck's  78  cases  referred  to. 
This  bears  upon  the  pulmonary  area  affect- 
ed, i.  e.  that  in  only  six  or  seven  of  them 
was  t  he  disease  confined  to  one  lung.  I  can 
not  state  positively  that  my  own  records  of 
unreported  cases  would  show  as  high  a  ratio 
of  affection  in  both  lungs,  but  I  think  the 
analysis  of  his  cases  is  a  confirmation  of  my 
own  experience  in  Colorado,  strengthening 
the  belief  that  there  is  more  yet  to  learn 
about  tuberculosis  than  taught  by  the  re- 
cords in  standard  medical  books  as  to  aver- 
age area  of  lung  affected.  It  all  goes  to 
show  how  surely  tuberculosis,  as  it  becomes 
seated,  verges  into  a  general  infection. 

Secondly:  Dr.  Weaver  says,  "an  ideal 
climate  if  it  could  be  found  for  consumption 
is  one  of  moderate  elevation,  2500  or  3000 
feet."  As  the  preceding  argument  based 
upon  "dryness,  cold,  sunshine,  and  alti- 
tude" is  about  the  same  as  that  formulated 
by  me  over  twenty-two  years  aago*  and 
which  has  never  been  refuted,  why  not  go 
on  and  work  out  the  "ideal  climate"  ac- 
cording to  its  legitimate  conclusion  up  to 
as  near  "the  altitude  of  approximate  immu- 


*"The  Preferable  Climate  for  Consumption,  or 
the  comparative  importance  of  different  climatic 
attributes  in  the  arrest  of  chronic  pulmonary 
disease  "  (Reprinted  from  the  Transactions  of 
the  Ninth  International  Medical  Congress,Sept. 
1897. ) 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


nity"  as  possible?  This  extreme  height  for 
your  latitude  would  be  about  7000  feet  and 
in  Northern  New  Mexico.  An  all-the-year- 
round  climatic  home,  in  which  to  fight 
tuberculosis,  should  be  if  possible  within 
one  or  two  thousand  feet  of  this  approxi- 
mate immunity  altitude,  and  anything  less, 
so  far  as  rarification  of  the  air  is  concerned 
should  be  conceded  only  in  the  way  of  a 
compromise.  This  is  such  an  allowance  as 
can  be  made  for  personal  idiocyncracies, 
severity  and  acuteness  of  disease,  nearness 
of  good  professional  service,  advantages  of 
good  feeding  and  care,  and  a  pleasurable 
life. 

From  Central  Arizona  circling  around 
through  New  Mexico,  Colorado  and  into 
Wyoming  is  a  belt  of  land  over  a  thousand 
miles  long  and  averaging  say  one  hundred 
miles  wide,  extending  into  and  out  of  the 
mountains,  between  five  and  seven  thousand 
feet  above  sea  level  and  including  the  re- 
gions about  Flagstaff,  Tombstone  in  Ari- 
zona ;  Silver  City,  Albuquerque,  Las  Ve- 
gas in  New  Mexico;  Trinidad,  Canon 
City,  Colorado  Springs,  Denver,  Greeley, 
Fort  Collins  in  Colorado,  and  Cheyenne 
in  Wyoming.  Somewhere  in  this  belt* 
the  "ideal  climate"  in  which  to  successfully 
combat  pulmonary  consumption  can  be  best 
chosen,  if  done  without  reference  to  the 
difficulties  of  getting  there  and  the  incon- 
venience of  a  new  and  unsettled  country. 

If  you  compare  the  "preferable  attri- 
butes" of  a  climate  of  "approximate  immu- 
nity to  consumption"  with  their  counter- 
parts you  will  see  that  a  health-resort, though 
located  in  the  mountains  at  an  altitude  of 
2500  to  3000  feet  and  upon  a  partially  clay 
soil,  and  having  a  relative  humidity  avera- 
ging say  60%  of  saturation  and  cloudiness, 
rainfall,  etc,  in  like  proportion,  is  only  a 
half-way  approach  to  the  possible  prefera- 
ble choice  in  this  large  and  climatically 
varied  country  of  ours. 

Thirdly  :  As  to  Intra-pulmonary  Medica- 
tion," the  impression  is  possibly  conveyed 
in  the  main  paper  and  its  after  discussion 
that  the  inhalation  of  the  spray  "under 
high  pressure,"  as  Dr.  Burroughs  specifies 
"about  ninety  pounds  pressure"  is  what 
gives  the  benefit  from  this  treatment.  I 
think  this  is  an  error  in  that  only  sufficient 
pressure  is  of  use  to  thoroughly  work  your 
Globe  or  Devilbiss  vaporizing  apparatus. 
Without  any  other  force  being  applied  to 
draw  the  air  into  the  lungs, (as  in  the  pneu- 
matic cabinet)  except  the  pressure  which 
goes  in  through  the  wind  pipe,  I  believe  it 
is    practically   impossible    to    have  any   in- 


*See   fourth   chart   (elevations}  in  "The  Cli 
mates  of  the  United  States  in  Colors." 


creased  effect  during  inspiration.  You 
can  by  will  power  increase  the  filling  of  the 
lungs  more  than  by  any  such  aid.  Let  us 
not  be  deceived  by  trusting  in  any  such  out- 
side help.  The  finely  vaporized  inhalation 
is  all  right,  though  I  believe  that  my  own 
combination  is  to  be  preferred,  given  in  the 
paper  on  "The  Modern  Treatment  of  Tu- 
berculosis" Journal  A.  M.  A.,  Sept.  24, 
1898,  because  of  its  strong  acid  reaction 
(carbolic  acid)  and  formalin  contained,  but 
the  idea  of  this  outside  added  pressure  is 
misleading.  It  is  only  during  expiration 
that  you  can  fully  distend  the  collapsed  and 
diseased  air  spaces.  The  total  average  of 
intra-thoracic  pressure  is  negative  during 
life,  as  Einthoven  has  shown,  and  it  is  more 
so  during  unconscious  breathing  (involun- 
tary state)  and  always  decidedly  negative 
during  inspiration.  The  voluntary  aid  of 
the  individual,  during  his  own  expiratory 
acts,  is  the  only  means  to  increase  the  dis- 
tension and  use  of  his  tardy  air-cells.  I 
classify  altitude  and  exercise  under  this 
voluntary  aid.  High  altitude,  exercise  and 
the  proper  method  of  inhaling,  which  is 
inhaling  with  the  out-going  air  regularly 
restrained  under  pressure,  all  work  to  the 
same  end  i.e..  the  rythmical  and  mechani- 
cal distention  of  the  air-cells.  Let  the  phy- 
sician, who  uses  for  his  office  treatments  this 
antiseptic  and  germicidal  mixture,  instruct 
his  patient  to  completely  fill  his  lungs  and 
then  hold  back  expiration  and  by  straining 
crowd  this  retained  air  into  every  unused 
part,  and  the  good  results  will  be  much  en- 
hanced. It  is  easy  enough  to  teach  him  by 
example.  But  this  daily  office  treatment  is 
not  enough  and  when  required  there  is  a 
possible  substitute  for  it.  A  like  effect 
ought  to  be  produced  every  hour  in  the  day. 
For  this  purpose  the  In  &  Exhaler*  is  spe- 
cially devised  with  valve-work  arranged  so 
that  the  expiration  air  pressure  can  be  easily 
adjusted  to  what  a  given  invalid  can  stand, 
and  made  of  a  size  to  be  easily  carried  in 
the  vest  pocket,  always  ready  for  a  five  or 
ten  minute's  vigorous  use  every  hour  or 
two.  That  an  intra-pulmonary  air  pressure 
equivalent  to  breathing  at  an}  altitude  of 
two  to  ten  thousand  feet  above  sea  level  is 
thus  possible  to  obtain  at  will  may  seem  to 
be  an  extravagant  statement  to  make,  yet  a 
considerable  personal  experience  with  this 
method,  as  well  as  that  of  many  other  phy- 
sicians who  appreciate  it,  fully  justifies  the 
claim.  Even  an  invalid,  too  ill  to  leave  his 
or  her  bed,  can  through  a  soft  rubber  tube, 
attached  to  the  inhaler  and  passed  under- 
neath a  slightly  raised  window  sash, breathe 
the  oul-door  air  medicated  to  suit  and  ad- 

*The  Denver  Surgical  Inst.  Co. 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


justed  to  the  proper  pressure  for  the  case  in 
hand. 

Other  phases  of  this  important  discussion 
are  very  interesting  to  me,  but  I  have  taken 
up  enough  of  your  space  at  this  time. 


Uterine  Tonics. 
By  W.  F.  Milroy,  M.  D.,  Omaha,  Neb. 

At  the  meeting  of  the  Nebraska  State 
Medical  Society  in  Lincoln,  in  1897,  as 
chairman  of  the  section  on  Materia  Medica, 
1  introduced  a  general  discussion  upon  that 
subject.  One  of  the  questions  which  I  sug- 
gested on  that  occasion,  was  this  :  What  is 
meant  by  the  term  uterine  tonic  as  distinguish- 
ed from  those  remedies  which  we  are  accus- 
tomed to  speak  of  simply  as  tonics?  Seve- 
ral answers  to  the  query  were  offered  but 
they  were  all  of  a  very  indefinite  character 
and  appeared  to  be  an  attempt  to  embody 
in  words  an  idea  which  had  but  the  most 
hazy  existence. 

Undoubtedly  it  is  not  possible  in  the  pre- 
sent stale  of  our  knowledge  to  limit  our- 
selves to  the  use  of  terms  that  are  so  scien- 
tifically exact  as  to  be  beyond  criticism. 
On  the  contrary  we  are  in  the  daily  use  of 
terms  whose  meaning  is  so  indefinite  and 
uncertain  that  the  idea  conveyed  by  them 
varies  greatly  according  to  the  understand- 
ing of  the  user.  Possibly  some  reader  of 
the  Charlotte  Medical  Journal  will  be  sur- 
prised should  he  stop  to  consider  how  near- 
ly this  statement  comes  to  be  applicable  to 
our  word  tonic  used  in  its  most  approved 
fashion. 

White,  of  London,  in  1898  edition  of  his 
work  on  Materia  Medica  says  of  the  word 
tonic  (page  no)  :  "So  ill-defined  is  it  that 
it  is  advisable  never  to  use  it  if  it  can  be 
avoided.  As  commonly  employed,  it  means 
a  drug  which  makes  the  patient  feel  in  more 
robust  health  than  he  did  before  he  took  it. 
Obviously  this  may  happen  in  many  ways, 
such  as.  for  instance,  by  improving  the  di- 
gestion or  t he  quality  of  the  blood." 

The  question  concerning  uterine  tonics 
was  suggested  to  my  mind  by  the  great 
number  of  samples  of  medicine  with  volumi- 
nous literature  accompanying  them,  which 
continually  find  their  way  to  my  office  and 
which  are  said  by  their  manufacturers  to 
possess  the  most  remarkable  value  as  uterine 
tonics.  It  is  a  fact  beyond  dispute  that  the 
meaning  of  the  word  tonic  is  ill-defined  but 
it  is  also  a  fact  that  in  the  minds  of  many 
it  has  a  distinct  meaning  though  perhaps  of 
a  general  character.  Is  it  not  true  that  the 
uncertainty  relates  not  so  much  to  the  work 


accomplished  by  the  tonic  as   to  the   mode 
of  its  accomplishment? 

Etymologically  considered,  the  word  is 
derived  from  the  Greek  verb  tonos,  mean- 
ing to  stretch,  and  it  doubtless  acquires  its 
significance  from  the  idea  of  the  tone  de- 
rived from  a  stringed  instrument  being 
modified  by  the  tension  to  which  the  string 
is  subjected. 

This  derived  meaning  which  we  give  the 
word  in  using  it  in  physiology  or  medicine, 
when  applied  in  a  concrete  way  would  indi- 
cate if  referred,  for  example,  to  a  nerve  that 
it  transmitted  stimuli  or  impressions  witli 
force  and  precision  ;  of  muscles  that  they 
had  the  power  of  firm  contraction  ;  of  glan- 
dular organs  that  their  cells  were  able  to 
generate  their  proper  secretion  in  correct 
amount  and  quality  so  that  their  work  can 
be  properly  performed.  In  short  improved 
tone,  I  apprehend,  signifies  increased  pow- 
er of  each  several  organ  to  perform  its 
physiological  function  and  is  similar  or 
identical  with  the  idea  of  improved  nutri- 
tion. After  all  is  said  it  seems  to  me  the 
fact  is  that  so  long  as  our  knowledge  of 
conditions,  of  processes  or  things  remains 
incomplete  ami  indefinite  we  shall  find  it 
convenient  to  make  use  of  terms  to  express 
our  ideas,  imperfect  though  they  may  be. 
The  fault,  is  less  in  the  expression  than  in 
the  idea  expressed. 

Returning  to  the  matter  of  uterine  tonics, 
so-called,  and  consulting  the  afore-mention- 
ed literature  bearing  upon  the  subject,  we 
observe  among  the  diseases  and  symptoms 
which  are  said  to  be  amenable  to  their  be- 
nign influence,  the  following  :  Chronic 
inflammation  of  the  uterus  or  any  part  of  it 
•'granulated  os,"  leucorrhcea,  disordered 
menstruation,  pelvic  pains,  subinvolution, 
displacements,  relaxed  and  flabby  condi- 
tions of  the  pelvic  viscera,  etc.,ete.  Now, 
many  of  these  conditions  either  depend 
upon  or  cause  a  depreciation  of  the  general 
health  or  do  both.  The  indication  there- 
fore for  their  relief  is  the  use  of  such  means 
as,  acting  upon  the  nerve  supply  of  the 
heart,  will  produce  a  firmer  cardiac  con- 
traction and  thus  supply  more  nourishment 
to  the  digestive  organs  and  thus  enable 
them  in  turn  to  obtain  from  the  food  which 
is  eaten  a  greater  abundance  of  the  materi- 
als which  every  tissue  requires  for  its  own 
growth  and  the  accomplishment  of  its 
healthy  life  processes. 

This,  I  take  it,  is  about  the  sum  and  sub- 
stance of  what  may  be  hoped  from  the  ad- 
mistration  of  tonics  when  indicated  for  the 
relief  of  pelvic  disorders  or  of  any  other  ill. 
We  gtive  many  other  substances  under  the 
name  tonic,  but  these  may,  for  the  most 
part,  be  also  properly  classed  as  foods. 


396 


THE  CHARLOTTE   MEDICAL  JOURNAL. 


Asking  pardon  for  the  same,  if  it  shall 
appear  to  be  a  digression,  I  wish  to  call  at- 
tention in  this  connection  to  an  elemental 
principle  that  is  frequently  overlooked  in  the 
administration  of  tonics.  One  of  the  early 
and  inevitable  results  of  the  occurrence  of 
anaemia  is  loss  of  power  in  the  heart  muscle 
owing  to  the  poor  nutrition  of  that  organ. 
The  weakened  contraction  which  then  oc- 
curs reduces  arterial  tension,  and  as  this  con- 
dition of  things  develops  by  slow  degrees  and 
during  a  long  period  of  time,  the  lumen  of 
the  small  arteries  becomes  habitually  small- 
er. In  consequence  of  this,  if  the  heart 
later  on  receives  a  new  impulse  from  any 
source,  it  finds  itself  unable  to  l'espond 
owing  to  the  increased  resistance  in  the 
periphery.  A  consideration  of  these  facts 
would  suggest  the  necessity  of  administer- 
ing a  remedy  which  has  the  power  to  cause 
a  dilitation  of  the  small  arteries  and  so  per- 
mit the  weakened  heart  to  convey  more 
blood  to  the  tissues  for  their  better  nutri- 
tion. Now  this  is  not  a  fine-spun  theory, 
simply.  I  have  many  times  demonstrated 
its  correctness  clinically.  In  typical  cases 
of  chlorosis,  which  had  been  treated  unsuc- 
cessfully for  months  or  years,  according  to 
the  orthodox  methods,  I  have  seen  the  color 
return  to  the  skin  and  mucous  membranes, 
the  abnormal  appetites  and  numberless  ner- 
vous and  other  symptoms  disappear  with 
astonishing  quickness  simply  by  the  addi- 
tion of  such  a  remedy  as  I  have  indicated. 
I  am  accustomed  to  use  under  these  circum- 
stances, the  U.  S.  P.  Sol.  of  nitro-glycerine, 
given  to  the  physiological  limit. 

It  is  true  that  certain  drugs  have  a  par- 
ticular action  upon  the  uterus;  and  some  of 
them,  as  ergot,  cotton  root  and  rue,  cause  a 
contraction  of  the  uterine  muscle  during  the 
pregnant  state  and  possibly  at  all  times.  I 
do  not  deny  that  there  are  cases  of  pelvic 
disease  which  seem  to  be  benefited  by  the 
remedies  to  which  I  have  alluded  as  uterine 
tonics,  but,  after  a  careful  consideration  of 
the  matter  and  a  certain  amount  of  personal 
experience  in  the  use  of  these  mixtures  I  am 
persuaded  that  the  chief  good  to  be  derived 
in  this  way  is  due  to  improvement  of  the 
general  health  and  not  to  any  direct  action 
upon  the  uterus. 

Though  this  paper  is  already  longer  than 
I  intended  it  to  be,  there  is  one  further  point 
of  which  I  wish  to  speak.  Because  I  would 
cast  aside  the  scores  of  concoctions  which 
promise  to  help  the  physician  out  of  all  his 
gynaecological  difficulties  but  which  in  re- 
ality leave  him  but  the  more  hopelessly  dis- 
couraged. I  would  not  imply  that  I  am  one 
of  those  who  would  condemn  every  diseased 
woman  to  an  operating  table.  It  seems  to 
me,  however,  as  a    suggestion   of    common 


sense  confirmed  by  experience,  that  the 
more  directly  to  the  diseased  part  any  medi- 
cament can  be  applied  the  more  surely  will 
it  reach  the  part  for  which  it  is  designed 
and  the  less  likely  will  it  be  to  exert  an  ill 
effect  upon  another  portion  of  the  body. 
For  this  reason,  barring  such  remedies  as 
are  of  recognized  value  in  improving  the 
general  condition,  I  hope  for  more  satisfac- 
tion rn  the  treatment  of  pelvic,  and  especi- 
ally uterine,  diseases  from  applications 
through  the  vagina  than  through  the  gen- 
eral circulation. 

To  discuss,  even  superficially,  the  whole 
subject  of  vaginal  medication  is  out  of  the 
question  at  present.  The  well-trod  paths 
have  been  followed  by  me,  some  times  with 
satisfaction,  often  with  discouragement  and 
ill  success.  It  has  often  appeared  to  me 
that  a  wide  field  remained  for  study  and 
experimentation  in  this  department  of 
gynaecology  which,  having  been  cultivated 
would  yield  a  great  harvest.  While  this 
may  not  have  been  done  to  the  limit  of 
what  is  possible,  it  has  certainly  been  ac- 
complished to  a  very  great  degree  by  the 
originator  of  Micajah's  wafers  which  are 
manufactured  by  Micajah  &  Co.,  of  War- 
ren, Pa.  My  attention  was  called  to  this 
preparation  some  time  ago.  Like  most 
men,  I  suppose,  who  have  been  practicing 
medicine  for  a  good  many  years,  I  am  not 
in  the  habit  of  spending  my  time  looking 
for  some  new  thing  in  therapeutics.  Con- 
trary to  my  custom  in  regard  to  new  reme- 
dies and  upon  the  recommendation  of  a 
friend,  I  used  a  specimen  of  the  wafers  in 
the  case  of  a  valued  private  patient.  I  have 
been  more  than  pleased  with  the  result. 
The  combination  is  certainly  most  fortu- 
nate. I  have  not  yet  had  suitable  cases  for 
their  use  in  all  the  conditions  for  which  the 
wafers  have  been  recommended  but  I  am 
free  to  confess  that  I  have  been  greatly  sur- 
prised at  the  prompt  improvement  which 
has  followed  their  use  where  I  have  em- 
ployed them.  These  wafers  are  in  the  form 
of  a  tablet  which  is  introduced  by  the  pa- 
tient every  second  or  third  day,  to  the  cer- 
vix uteri.  I  do  not  know  how  their  salu- 
tary influence  is  exerted.  It  appears  to  be 
by  modifying,  in  some  way,  the  circulation 
of  the  parts.  I  have  seen  the  blue  color  of 
passive  congestion,  the  boggy  cervix,  the 
cervical  catarrh,  the  erosion  about  the  os, 
the  flabby  and  relaxed  vaginal  walls,  patho- 
logical conditions  that  are  so  common  and 
often  so  annoying  to  physicians  as  well  as 
patient,  yield  to  treatment  by  these  wafers 
as  they  have  not  done  in  my  hands  under 
older  treatment. 

I  do  not  venture  to  hope  that  I  have  founi 
an  infallible  remedy  for  all  these  ills,  but 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


397 


judging  from  my  experience  with  these  tab- 
lets thus  far,  I  feel  that  they  shall  be  my 
sheet  anchor  in  this  line  of  work  for  the 
future. 


The  Early  Diagnosis    and   Treatment  of 
rielancholia. 

By  E.  O.  Crossman,  M.  I>..   Medical  Direc- 
tor of  Markleton  Sanatorium.  Markle- 
ton,  Pennsylvania. 

It  is  not  the  purpose  of  the  writer  to  dis- 
cuss melancholia  from  the  standpoint  of  an 
alienist,  but  to  consider  the  disease  as  it 
comes  under  the  observation  of  every  gen- 
eral practitioner  who  is  called  upon  to  diag- 
nose and  treat  it  in  connection  with  other 
diseases,  real  and  imaginary. 

No  less  than  thirty  varieties  of  melan- 
cholia have  been  described  by  various 
writers.  However,  all  sub-divisions  are  un- 
important until  a  diagnosis  is  made  and  the 
patient  is  under  treatment. 

The  necessity  of  an  early  diagnosis  is 
most  important,  as  many  tragedies  may  In- 
averted  if  the  physician  immediately  recog- 
nizes the  symptoms  as  incipient  melancho- 
lia, which  is  a  grave  condition  and  may  be 
followed  in  a  day  by  delusions  homicidal. 
suicidal,  or  both.  The  pathology  is  some- 
what obscure.  It  was  supposed  by  the  an- 
cients to  have  been  caused  by  ''black  bile," 
from  the  fart  that  the  principal  svmptoms 
were  gloom,  ill  grounded  fear,  etc. 

Modern  science  demonstrates,  however, 
that  any  lowering  of  the  vigor  of  the  motor 
currents  to  any  muscle  or  gland  reduces  the 
activity  of  the  part  supplied.  Hence  when 
all  the  motor  or  out-going  currents  from 
the  central  nervous  regions  are  lowered  the 
system  will  be  poorly  nourished  and  its 
whole  activity  impaired  and  diminished. 
Bodily  secretions  are  not  copious,  excretions 
are  inefficient,  the  skin  lax,  the  eves  dull. 
the  hair  ami  nails  grow  slowly  and  unevenly, 
urine  loaded,  tongue  coated,  bowels  consti- 
pated. The  whole  body  presents  evidence 
of  lack  of  vigor  and  of  feebleness.  When 
the  motor  currents  are  great  the  nutritive 
processes  are  correspondingly  great.  So 
melancholia  is  not  due  to  a  complication  of 
pathological  conditions,  but  to  a  lessening 
of  the  motor  currents  which  diminishes  the 
nutritive  functions  of  the  body,  hence,  it  is 
a  definite  disease  from  the  outset. 

In  his  excellent  work  on  "Diseases  of  the 
Nervous  System,"  Dr.  C.  L.  Dana  speaks 
of  "anxiety  neurosis,  or  neurasthenia  with 
fixed  ideas."  These  cases  are  probably  the 
most  difficult  to  diagnose  from  true  melan- 
cholia.     Hut  on  thorough    investigation  the 


true  mental  and  physical  symptoms  of  mel- 
ancholia will  not  be  found.  They  are  loss 
of  flesh,  insomnia,  anorexia,  anemia,  con- 
stipation, usually  lowering  of  the  tempera- 
ture, and  constant  and  profound  depression. 
There  may  or  may  not  be  delusions  early  in 
the  disease.  The  patient  always  depreciates 
self  and  there  is  constant  introspection  with 
perhaps  suicidal  suggestions  which  are  not 
as  a  rule  considered  seriously  by  the  family, 
but  in  connection  with  the  above  symptoms 
should  be  considered  with  as  much  alacrity 
as  hemorrhage  following  the  severing  of  an 
artery.  Vigilant  measures  should  be  em- 
ployed promptly  on  the  slightest  intimation 
of  suicide  ;  indeed,  this  symptom  should  be 
sought  as  the  patient  is  reticent  in  nearly 
every  instance,  and  the  physician  must  be 
on  the  alert  with  the  utmost  diplomacy. 
Any  one  of  the  major  symptoms,  however 
mild,  should  be  considered,  and  the  fullest 
investigation  made,  as  it  may  be  the  begin- 
ning of  melancholia,  and  much  good  will 
come  to  the  patient  if  a  prompt  diagnosis 
is  made  and  proper  treatment  applied  early. 
There  is  one  special  form  of  this  disease 
that  should  be  mentioned  in  this  connection, 
namely,  oxaluria. 

The  urine  should  be  examined  in  all  cases 
and  should  the  case  prove  to  be  this  form 
the  treatment  is  simple  and  recovery  as  a 
rule  speedy. 

Undiluted  nitro-muriatic  acid  should  be 
given  in  gtts  v  doses  in  half  glass  of  water 
t.  i.  d.  after   eating. 

Aside  from  neurasthenia  the  physician 
differentiates  incipient  melancholia  from 
hysteria,  hypochondriasis  and  dementia. 

The  hysterical  patient  is  emotional,  often 
laughing  and  crying  in  alternation,  with- 
out adequate  cause,  sometimes  attempting 
to  simulate  other  diseases  and  always  mag- 
nifying his  trouble.  The  dement  is  usually 
buoyant  of.  spirits  at  first  with  loss  of  mem- 
ory and  growing  more  or  less  sluggish  as 
the  disease  progresses. 

The  self-accusatory  symptom  of  melan- 
cholia is  absent  and  emaciation  is  not 
marked. 

The  hypochondriac  studies  his  pulse, 
tongue  and  bodily  functions,  while  the  mel- 
ancholic is  occupied  with  his  own  thoughts. 
Weakness  of  will  and  restlessness  are  also 
symptoms  of  this  disease.  The  neurasthenic 
has  slight  attacks  of  vertigo,  complains  of 
weakness,  irritability  and  unrest,  is  unable 
to  concentrate  his  mind  and  worries  much 
about  himself.  Many  cases  suffer  from 
headache.  Women  usually  have  spinal 
pains  with  tremor  of  hands  and  tongue. 

The  treatment  of  melancholia  should  be 
hygienic  so  far  as  practicable,  as  the  dys- 
peptic symptoms    which    invariably  accom- 


THE  CHARLOTTE    MEDICAL  JOURNAL. 


pany  it  render  it  imperative  that  as  little 
medicine  be  given  as  possible.  First,  the 
physician  should  secure  absolute  control  of 
the  patient,  complete  change  in  his  environ- 
ments should  be  made,  and  an  experienced 
nurse  employed,  who  should  watch  the  pa- 
tient incessantly.  In  view  of  his  suicidal 
tendency  he  must  never  be  left  alone  for 
one  moment  until  he  is  well.  He  should 
not  be  allowed  knives,  scissors,  or  anything 
that  could  be  converted  into  a  weapon, 
lie  must  be  nourished,  and  this  is  often  the 
most  difficult  part  of  the  treatment.  Nour- 
ishing food  should  be  administered  at  least 
every  four  hours.  "Maltine  with  wine  of 
pepsine"  can  be  given  with  excellent  results 
immediately  after  food  is  taken.  This 
remedy  gives  tone  to  the  digestion  and  is  a 
most  satisfactory  "tissue  builder"  in  this 
disease.  If  necessary  the  physician  should 
not  hesitate  to  resort  to  artificial  feeding. 
The  bowels  should  be  kept  open  by  the  use 
of  mineral  waters,  accompanied  if  necessary 
by  enemas,  three  or  four  times  a  week. 

Opium  should  be  tried,  it  can  in  nearly 
all  cases  be  employed  to  advantage  ;  indeed 
I  have  seen  a  few  cases  of  early  melancholia 
aborted  by  its  use.  It  seems  to  regulate  the 
motor  nerve  currents  and  relieve  the  mental 
anguish.  The  deodorized  tincture  has 
proven  the  most  satisfactory  in  20  git  doses 
every  six  hours.  This  may  be  combined 
with  bromide  of  strontium  gr.  xv. 

The  patient  should  not  be  allowed  to  re- 
main awake  at  night,  but  every  poesible 
means  should  be  employed  before  resorting 
to  drugs  to  produce  sleep.  If  they  are  em- 
ployed, however,  full  doses  should  be  given. 
Galvanism,  massage,  and  mild  Turkish 
baths  should  constitute  a  portion  of  the  rou- 
tine treatment. 

The  patient  should  be  diverted  and  a 
moderate  amount  of  exercise  should  be 
taken.  Cycling  is  a  good  form  as  it  fur- 
nishes both  mental  and  physical  occupa- 
tion. 


Typhoid  (Enteric)  Fever— In  the  Past   and 
at  the  Present  Tune. 

By  Franklin  Staples,  M.  D.,  Winona,  Minn. 

THE     NAME. 

The  names  which  for  various  reasons  in 
times  past  have  been  given  to  diseases,  are 
found  in  many  instances  to  have  an  histori- 
cal significance,  and  to  afford  some  infor- 
mation concerning  the  status  of  medical 
science  at  the  time  ot  their  origin.  The 
term,  typhoid  {like  typhus),  in  its  applica- 
tion to  the  disease  now  more  properly 
known  as  enteric  fever,  was    made  known 


by  the  French  physician,  Louis,  whose 
work  on  "Typhoid,  Putrid  and  Adynamic 
Fever,"  appeared  in  Paris  about  the  year 
1830;  but  another  French  teacher,  Gaspard 
Laurent  Bayle,  whose  Works  antedated  Those 
of  Louis  by  a  few  years,  has  been  called 
the  "god-father"  of  typhoid  fever*  because 
of  the  importance  of  his  investigations  coti^ 
cerning  this  affection.  The  name,  entero- 
incscutcric  fever,  had  been  given  to  the 
disease  by  M.  Petit,  and,  notwithstanding 
the  fact  that  the  tendency  in  the  French 
school  at  the  time  of  Bayle,  Louis,  Andral, 
Chomel,  and  Cruveilhier,  was  to  seek  for 
the  pathology  of  diseases  by  means  of  dis- 
sections and  clinical  study,  yet  the  name, 
typhoid,  meaning  simply  a  tendency  to 
stupor,  came  into  existence  and  Was  allow- 
ed to  stand  ■  although  in  significance  it  re- 
lated  only  to  what  appeared  of  the  disease 
outwardly,  without  regard  to  any  patholo- 
gical condition  or  organic  lesion;  French 
physicians  seem  to  have  had  the  right  of 
way  in  the  early  nomenclature  of  this  dis- 
ease. The  term,  doihinenteritis ,  meaning 
pustule  of  the  intestine,  was  given  by  Bre- 
tonneau,  and  at  the  same  time  follicular  en- 
teritis came  into  use ;  both  terms  relating 
to  the  characteristic  lesion  found  in  the  mu- 
cous membrane  of  the  small  intestine.  It 
has  been  called  nervous  fever,  principally 
by  the  Germans,  and  continued  fever  and 
winter  fever,  because  it  does  not  result  from 
paludal  poisons,  causing  a  distinctly  inter- 
mittent form  of  fever,  and  may  prevail  in 
the  temperate  zones  during  the  cold  season. 
It  remained  for  our  countryman,  the  late 
Professor  George  B.  Wood,  of  Philadelphia, 
in  his  teachings  in  the  University  of  Penn- 
sylvania, and  in  his  work  on  the  Practice 
of  Medicine,  first  published  in  1847,  to  an- 
nounce the  simple  name,  Enteric  Fever. 
In  declaring  in  favor  of  this  title,  Dr.  Wood 
observed:  "It  is  merely  intended  to  ex- 
press the  fact  that  this  fever  is  distinguished 
from  all  other  idiopathic  fevers  by  the  fre- 
quency and  extent  of  the  intestinal  disease. 
Other  fevers  are  attended  occasionally  with 
disease  of  the  bowels  ;  this  almost  always, 
if  not  essentially." 

GENERAL    DESCRIPTION. 

The  general  account  and  description  is 
given  in  brief  as  follows  : 

Adults  are  more  liable  to  the  disease  than 
young  children,  although  the  latter  are  by 
no  means  exempt.  Its  invasion  is  generally 
insidious,  its  development  gradual.  There 
is  languor,  some  headache,  increased  tem- 
perature, pulse  accelerated.  In  the  forma- 
tive stage  slight  chilliness  may  alternate 
with  the  febrile  action  with  some  regularity 
each    day.      The    tongue   may    be    slightly 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


coated  white  at  first,  and  later  may  be  dry 
and  glazed,  sometimes  with  a  brown  stripe 
in  the  middle  ;  (concerning  this  further  on) . 
If  the  disease  increases  in  severity,  existing 
symptoms  become  intensified  and  others  are 
added.  The  abdomen  becomes  distended 
and  tympanitic,  and  on  the  surface  peculiar 
rose  colored  spots  are  often  found.  There 
is  frequently  a  tendency  to  diarrhoea,  and 
occasionally  hemorrhages  occur  from  the 
bowels  ;  dark  sordes  form  on  the  teeth  and 
lips,  and  a  low  form  of  delirium  supervenes. 
There  is  apt  to  be  a  certain  degree  of  deaf- 
ness, and  a  cough  from  bronchial  irritation. 
.Some  of  these  symptoms  are  seen  to  result 
from  the  direct  effect  of  the  disease-cause 
on  different  parts  of  the  nervous  system. 
This  brief  outline  of  the  course  of  the  dis- 
ease and  a  few  of  its  leading  symptoms  are 
given  to  be  reviewed  by  the  reader,  in  the 
light  of  what  is  now  known  of  its  patho- 
logy— the  bacteriology. 

FORMER     MANAGEMENT     AND     PATHOLOGY. 

It  was  learned  from  observation  that  cer- 
tain remedies  are  useful  in  the  management 
of  enteric  fever.  In  the  later  light  of  science 
we  have  not  only  learned  the  reason  for 
good  results  experienced  in  the  past,  not 
before  understood,  but  have  found  ourselves 
in  possession  of  important  vantage  ground 
for  progress  in  the  future.  The  following 
illustrates:  More  than  seventy  years  ago, 
in  a  paper  published  in  the  North  Ameri- 
can Medical  and  Surgical  Journal  (April, 
1826),  Professor  Wood  advocated  the  use 
of  turpentine  in  the  treatment  of  enteric 
fever  in  certain  conditions  and  stages.  For 
other  remedial  means  and  agents  then  used 
in  treatment,  the  following  among  others 
are  mentioned  :  first,  evacuation  of  the 
bowels,  to  be  secured  in  the  onset  if  possi- 
ble, the  use  of  refrigerant  diaphoretics,  cold 
ablutions,  minute  doses  of  mercury  in  some 
form,  poultices  and  counter-irritation  over 
the  abdomen,  and,  in  cases  that  require  it, 
supporting  and  perhaps  stimulating  meas- 
ures. Concerning  the  use  of  turpentine 
the  words  of  Dr.  Wood  were  as  follows  : 
"But,  should  the  symptoms  not  yield,  es- 
pecially, should  the  tongue  become  very 
dry,  and  the  abdominal  distension  remain 
undiminished,  the  oil  of  turpentine  will 
prove  an  excellent  remedy."  In  empha- 
sizing his  recommendation,  he  says:  "I 
cannot  too  strongly  impress  upon  the  pro- 
fession my  convictions  of  the  importance  of 
this  medicine.  It  may  be  employed  in  all 
cases,  in  the  advanced  stages  of  the  disease, 
when  the  tongue  is  dry."  This  condition 
of  the  tongue,  in  the  advanced  stage  of  the 
disease,  was  found  to  indicate  the  existence 
of  inflammation  or  ulceration  of  the  glands 


in  the  mucous  membrane  of  the  ilium, 
known  as  Peyer's  glands.  Concerning  the 
therapeutic  action  of  the  oil  of  turpentine 
in  the  disease,  the  author  observes:  "It 
acts  in  some  measure  as  a  stimulant,  but 
chiefly,  I  believe,  as  an  alterative  to  the 
ulcerated  surfaces  in  the  intestinal  mucous 
membrane." 

BACTERIOLOGY. 

It  may  now  be  said  that  our  present  prac- 
tical knowledge  of  specific  germs  as  factors 
in  different  diseases,  and  of  the  germicidal 
action  of  certain  remedies,  has  done  much 
in  late  years  to  render  the  term,  alterative, 
quite  obsolete  as  applied  in  therapeutics. 
Explanation  of  the  so-called  alterative  ac- 
tion of  the  oil  of  turpentine  and  other  rem- 
edies of  this  class,  in  conditions  such  as 
exist  in  the  intestinal  canal  and  elsewhere 
in  the  system  in  cases  of  enteric  fever,  can 
now  be  made.  The  turpentine  with  its 
stimulant,  diuretic,  and  anthelmintic  pro- 
perties, now  comes  to  the  front  as  a  disin- 
fectant and  germicide  remedy,  whose  pro- 
perties render  it  especially  useful,  not  only 
in  the  destruction  of  the  typhoid  germ,  but 
in  aiding  the  repair  of  lesions  caused  by  in- 
fection, not  only  on  mucous  surfaces,  but 
in  tissues  of  various  organs.  It  is  readily 
taken  into  the  tissues,  is  found  in  the  urine 
and  other  excretions  and  is  exhaled  from 
the  lungs.  Our  present  knowledge  of  spe- 
cific germs  as  disease-causes  affords  an  un- 
derstanding of  much  in  pathology  and  ther- 
apeutics which  before  could  be  known  only 
in  part ;  this  from  external  appearances  and 
apparent  results.  The  advance  of  our 
knowledge  of  diseases,  of  which  the  one  at 
hand  is  an  example,  has  been  from  a  theo- 
retical basis  to  the  more  satisfactory  and 
substantial  foundation  in  pathology.  We 
have  in  this  case  the  bacillus  typhosus. 
Much  laboratory  work  by  scientists  for  sev- 
eral years  has  taught  us  something  of  the 
character  of  this  specific  disease  germ — 
what  may  be  its  habitat  outside  the  body, 
its  methods  of  approach,  the  results  of  its 
pathogenic  action  in  the  tissues,  and  some- 
thing of  the  therapeutic  means  for  its  des- 
truction. 

The  serum  therapy  of  enteric  fever  has 
not  yet  sufficiently  advanced  to  be  of  prac- 
tical value;  but  what  has  come  to  light  in 
recent  times  concerning  the  etiology  and 
pathology  of  the  disease,  has  furnished  val- 
uable direction  not  only  for  treatment,  but 
for  prevention  by  suitable  sanitation. 

The  disease  is  now  known  to  result  from 
an  infection  caused  by  a  specific  germ,  the 
bacillus  typhosus.  The  nature  and  behavior 
of  this  pathogenic  germ  is  now  well  shown 
in  the  current  literature  on  bacteriology. 


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THE  CHARLOTTE  MEDICAL  JOURNAL 


The  entrance  of  the  germ  infection  is  by 
direct  passage  into  the  stomach  in  articles 
of  food  or  drink ;  and  from  the  stomach  it 
finds  its  way  into  the  small  intestines,  into 
the  tissues  of  various  organs,  and  into  the 
blood. 

Although  until  late  years  a  definite  knowl- 
edge of  the  etiology  of  this  disease  was 
wanting,  yet  for  a  long  time  the  conditions 
favoring  the  production  of  the  specific 
cause  were  so  well  understood,  that,  as  now 
seen,  little  advance  was  required  to  make 
the  practical  knowledge  of  the  whole  com- 
plete. A  distinguished  American  author, 
a  half  century  ago,  wrote  of  the  fever  as 
follows:  "It  is  certainly  often  generated 
in  situations  where  human  beings  are  crowd- 
ed together,  with  insufficient  or  unwhole- 
some food,  and  a  confined  and  vitiated  air. 
Hence  it  appears  to  originate  especially  in 
prisons,  badly  ventilated  hospitals,  large 
cities,  camps  and  ships."  To  this  may  be 
added  the  statement  that  the  infection  may 
be  taken  from  water  used  for  domestic  pur 
poses,  whose  sources  of  supply  have  suf- 
fered from  sewage  pollution,  from  milk  and 
from  other  articles  of  food  which  have  been 
infected.  The  light  of  our  present  knowl 
edge  helps  to  verify  the  correctness  of  this 
account,  and  points  to  the  kind  of  sanitary 
measures  necessary  to  prevent  the  existence 
or  the  passage  of  infection.  For  this,  chief 
importance  is  given  to  securing  absolute 
cleanliness  of  the  patient  and  the  surround- 
ings, and  the  careful  disinfection  and  dis- 
posal of  excretions.  Unlike  many  other  in- 
fectious diseases,  the  danger  of  contagion 
in  this  is  from  the  lodgment  of  excrementi- 
tious  matter  on  persons  and  clothing,  from 
which  it  finds  its  way  to  the  ingesta,  rather 
than    by  readily  infecting  the    atmosphere. 

DIAGNOSIS. 

As  important  aids  in  diagnosis,  we  now 
have  what  is  known  as  the  Widal- Johnson 
serum  diagnosis  of  typhoid,  in  which  a  drop 
of  the  patient's  blood  is  made  to  show  the 
characteristic  reaction,  even  at  the  incep- 
tion of  the  disease  ;  and  the  Ehrlich's  diazo- 
reaction  test  by  chemical  examination  of  the 
urine.  Of  this  test,  it  may  be  said  that, 
while  the  specific  reaction  may  be  obtained 
in  the  urine,  principally  of  typhoid  cases, 
it  is  also  found  in  that  of  persons  suffering 
from  certain  other  diseases,  viz.  :  pneumo- 
nia and  pulmonary  tuberculosis,  acute  artic- 
ular rheumatism,  certain  forms  of  menin- 
gitis, and  a  few  other  acute  inflammatory 
diseases.  These  tests  are  based  upon  what 
appears  in  the  bacteriology  of  the  disease, 
and  are  found  to  be  reliable,  especially  when 
made  by  competent  operators. 


PRESENT    TREATMENT. 

A  summary  of  the  treatment  in  use  at  the 
present  time,  based  upon  the  germ  theory 
of  the  disease,  may  be  given  as  follows  : 

In  the  early  stage  of  the  disease  the  ali- 
mentary canal  should  be  cleansed  by  means 
of  suitable  evacuents.  Later  in  the  pro- 
gress of  the  disease  caution  is  to  be  observed 
in  the  use  of  cathartics.*  .Small  doses  of 
mercury  are  admissible.  The  use  of  suit- 
able germicide  remedies  is  of  principal  im- 
portance. Beechwood  creosote  with  the 
chloride  of  gold,  so  useful  in  certain  forms 
of  tuberculosis,  is  found  to  be  an  effectual 
germicide  remedy  in  cases  affected  by  the 
bacillus  typhosus.  The  oil  of  turpentine  as 
a  remedy  in  the  disease  has  been  noticed. 
It  is  best  given  in  emulsion. 

Concerning  the  effect  of  the  cold  bath  in 
the  treatment  of  typhoid  fever,  it  has  been 
shown  by  experiment  that  the  beneficial 
effect  may  be  measured  by  the  degree  of  the 
decline  in  temperature  effected  by  the  bath. 
It  has  been  found  by  the  French  physician, 
Robin,  that  with  the  temperature  lowered, 
a  better  oxidation  takes  place  in  the  process 
of  respiration,  and  thereby  the  toxic  pro- 
ducts of  tissue  destruction  are  reduced  to 
harmless  excrementary  bodies. 

In  the  matter  of  the  Woodbridge  method 
of  treatment,  of  which  much  has  been  heard, 
the  fact  that  the  author  in  his  work  recog- 
nizes a  germ  infection  as  the  disease  cause, 
and  advocates  antiseptic  and  eliminative 
treatment,  is  of  much  greater  importance 
than  are  the  objections  relating  to  his  method 
of  presenting  his  claim  to  the  profession  or 
to  the  public. 

Finally,  whatever  medication  may  be 
brought  into  use  in  the  management  of  this 
disease,  by  the  use  of  such  articles  of  diet 
as  are  found  to  be  the  best  digested,  and 
the  nutritive  principles  of  which  are  best 
assimilated,  must  not  be  overlooked.  The 
nervous  system,  the  vital  energy  of  which 
is  diminished,  and  may  be  overcome  by  the 
toxins  of  the  disease,  requires  a  supporting 
and  sometimes,  for  a  time,  a  stimulating 
treatment. 


Peritonitis — Its  Pathology  and  Treatment. 

By  Hal.  C.  Wyman,  M.  S  ,   M.  I).,  Professor  of 

Surgery  in  the  Michigan  College  of  Sur- 
gery.   Detroit,  Michigan. 

.Surgical  literature  has  contained  so  much 
about  operations  involving  the  peritoneum, 
and  the  results  of  operations  have  often 
been  so  unsatisfactory  that  many  physicians 


*For  the  proper  use  of  cathartics  in  typhoid 
fever,  see  paper  by  E.  C.  Register,  M.  D..  in 
The  Charlotte  Medical  Journal  for  April,  1898. 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


401 


who  have  had  a  large  bedside  experience 
are  very  much  dissatisfied  and  do  not  care 
to  read  or  hear  anything  more  about  the 
matter. 

But  there  are  others  who  have  not  lost 
faith  in  surgical  art,  and  are  interested  in 
every  thing  which  offers  a  reasonable  chance 
of  saving  or  prolonging  the  lives  of  their 
patients. 

Now,  while  it  is  in  some  quarters  the 
custom  to  say  that  there  is  no  such  thing  as 
peritonitis,  I  want  to  use  the  term  in  this 
paper  and  use  it  with  a  broad  and  liberal 
meaning — to  indicate  a  disease  which  has  a 
definite  mechanical  cause,  and  which  kills 
usually  in  one  of  two  ways,  viz.  :  either  by 
obstruction  of  the  bowels  or  by  inflamma- 
tory toxaemia. 

You  will  kindly  notice  that  1  say  -'kills 
usually,"  because  you  know  very  well  that 
it  sometimes  disappears  and  leaves  the  pa- 
tient well  and  sound,  and  that  medicinal 
treatment  cures  as  many,  if  not  more,  cases 
of  peritonitis  than  surgical  treatment. 

The  mechanical  causes  of  peritonitis  at  - 
fecting  the  alimentary  canal,  the  billiary 
passages  and  receptacle,  the  uterus  and  Fal- 
opian  tubes,  and  the  urinary  bladder,  an 
ulceration  of  the  stomach,  intestines  or  ap- 
pendix vennifonnis  terminates  in  perfora- 
tion ;  a  wound,  a  hernia,  a  valvulus  or  an 
intussusception  obstructs  the  bowels  and 
peritonitis  results.  Poisonous  material  es- 
capes from  the  free  end  of  the  Falopian 
tubes  and  peritonitis  is  the  result. 

Infecting  matter  passes  from  the  uterine 
mucosa  through  the  folds  of  the  broad  liga- 
ments into  the  utero-peritoneal  lymphatics 
and  peritonitis  (puerperal  sometimes)  is  the 
result.  The  bladder  ruptures  and  the  es- 
caping urine  carries  into  the  abdomen  the 
causes  of  peritonitis.  A  stone  in  the  gall 
bladder,  cystic  or  common  duct  may  allow 
a  definite  and  tangible  materies  morbi  to 
invade  the  peritoneum,  and  a  wound  of 
these  organs  may  do  the  same  thing. 

Now,  what  is  this  peritonitis  as  we  see  it 
in  the  sick  room?  It  is  pain  more  or  less 
local  in  some  part  of  the  abdomen.  Pain 
that  the  patient  complains  of  and  calls  us 
to  see.  Pain  that  we  notice  when  we  press 
in  certain  regions  of  the  abdomen  over  par- 
ticular organs,  and  pain  that  hangs  on  and 
cuts  and  bores  with  more  or  less  persistence 
when  not  controlled  by  anodynes.  There 
is,  usually,  fever  ranging  from  ioo  deg.  to 
105  deg.  F.  The  heart's  action  is  acceler- 
ated and  the  pulse  sometimes  has  a  peculiar 
running  feel  as  if  t lie  heart  that  is  driving 
it  had  beats  of  equal  length.  Respiration 
is  quickened,  abdomen  may  be  distended, 
tense  and  drum-like.  There  may  be  nausea, 
want  of    appetite,  and    usually  the    bowels 


have  not  moved  recently.  The  patient  feels 
sick,  looks  sick,  and  is  sick.  After  pre- 
scribing we  are  quite  likely  to  say  to  him 
we  will  see  you  again  in  a  few  hours;  for 
there  is  something  about  his  symptoms — 
tout  ensemble — that  makes  us  apprehensive 
that  our  remedies  may  need  to  be  re-en- 
forced. When  we  make  the  second  visit, 
if  the  cathartic  has  not  operated,  and  we 
find  him  vomiting  or  raising  gas  and  slime 
from  his  stomach,  we  are  still  more  uneasy 
about  his  condition. 

Perhaps  we  gave  him  an  anodyne  instead 
of  a  cathartic,  and  we  find  the  pain  subdued, 
but  the  pulse  is  not  right,  the  skin  does  not 
feel  normal — although  relieved  of  pain,  he 
is  still  sick.  An  enema  may  move  his 
bowels  :  we  will  feel  easier  about  him  then. 
But,  gentlemen,  suppose  the  bowels  do  not 
move,  and  he  is  still  prostrated?  We  know 
that  this  condition  cannot  last  many  hours. 
In  true  sense  a  condition  and  not  a  theory 
confronts  us.  What  is  it?  We  must  run 
over  the  history  of  the  case  again,  make  a 
more  thorough  physical  examination  and 
learn  the  cause,  find  the  perforation  and 
close  it;  find  the  appendix  and  remove  it; 
find  the  leaking  tube  and  remove  it.  But, 
most  important  of  all,  we  should  find  the 
obstructed  bowel  and  release  it. 

I  think  there  is  little  doubt  about  the  re- 
covery of  the  average  case  of  peritonitis  if 
the  patency  of  the  alimentary  canal  is  main- 
tained. In  some  cases  when  the  history 
and  the  physical  signs  point  almost  uner- 
ringly to  a  perforated  appendix,  and  we  cut 
down,  evacuate  the  pus,  remove  the  appen- 
dix, and  clean  the  infected  region  thorough- 
ly, our  patient  keeps  right  on  from  bad  to 
worse.  His  pulse  gets  quicker  and  smaller, 
he  vomits  and  refuses  food,  is  tormented  by 
tantalizing  thirst.  His  face  grows  pinched 
and  anxious,  hands  clammy  and  cold.  His 
bowels  have  not  moved,  the  obstruction  due 
to  peritonitis;  the  inflammatory  exudate 
binding  coils  of  intestine  was  not  loosened 
by  the  operation.  He  dies.  All  this  hap- 
pens in  the  sick  room.  The  town  talks. 
People  are  reluctant  to  submit  to  operation. 
The  next  case  the  doctor  has  he  will  be 
quite  likely  to  hold,  because  he  does  not 
operate  except  as  a  last  resort,  and  then, 
perhaps,  does  not  do  the  right  thing.  For 
surely  a  man  cannot  get  well,  even  if  you 
do  remove  his  appendix,  whose  intestine  is 
flattened  and  bound  down  by  more  or  less 
organized  lymph,  so  that  nothing  can  pass 
through  it.  The  operator  should  be  reason- 
ably sure  of  having  restored  the  the  contin- 
uity of  the  alimentary  canal  before  conclud- 
ing his  work.  If  separation  of  the  adhe- 
sions which  bind  and  obstruct  the  intestines 
is    impracticable,  then    make  an    intestinal 


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THE  CHARLOTTE  MEDICAL  JOURNAL. 


fistula  at  a  point  in  the  distended  gut  just 
above  the  obstruction.  This  will  enable 
the  patient  to  live  until  the  obstructing  ad- 
hesion is  absorbed.  Such  a  fistula  com- 
monly closes  spontaneously. 

In  most  all  cases  of  peritonitis  in  which 
the  cause  is  a  lesion  of  the  alimentary  canal 
an  operation  is  necessary.  Perforations  re- 
sulting from  typhoid  and  tuberculous  ulcer- 
ations are  not  exceptions.  Gun  shot  and 
stab  wounds  should  not  be  neglected  until 
the  escaping  contents  have  had  time  to  set 
up  the  disease,  but  on  the  contrary,  peri- 
tonitis should  always  be  anticipated  by  a 
careful  closure  of  all  wounds  of  intestine 
and  stomach.  Some  surgeons  would  make 
an  exemption  in  favor  of  the  latter  organ, 
and  have  cited  the  case  of  Alexis  St.  Martin 
as  an  example  of  successful  issue  of  a  case 
of  shot  wound  of  the  stomach  treated  with- 
out operation.  But  it  is  an  exception  that 
proves  the  rule,  for  the  wound  was  so  large, 
including  much  of  the  abdominal  wall,  that 
the  contents  of  the  stomach  poured  out  and 
were  not  pent  up  in  the  cavity  of  the  perito- 
neum— a  condition  quite  different  from  that 
obtaining  in  the  usual  case  of  gun-shot 
wound  of  the  stomach. 

Again,  hernias  may  often  be  reduced  by 
taxis.  Intussusception  may  be  relieved  by 
copious  enemas  of  water.  Volvulus  may 
untwist  itself.  But  that  is  another  matter. 
We  do  not  want  to  deal  with  the  abstract 
features  of  peritonitis  in  this  paper.  The 
concrete  aspect  of  the  disease  implies  a 
copious  exudation  of  material  which  is  ca- 
pable of  doing  a  great  deal  of  damage  by 
obstructing  the  intestines  while  at  the  same 
time  its  purpose  is  the  repair  of  leaks  in  the 
hollow  viscera.  Many  of  the  cases  of  vol- 
vulus are  caused  by  old  peritoneal  adhesions, 
the  result  of  peritonitis  caused  by  leaky  Fal- 
opian  tubes.  Such  cases  are  diagnosed 
quite  clearly  by  the  squirming  of  the  intes- 
tine, its  sudden  onset,  obstruction,  vomit- 
ing, and  a  history  of  an  attack  of  periton- 
itis which  may  have  occurred  years  before, 
and  which  was  at  that  time  successful  in 
closing  the  tube  so  that  its  infecting  con- 
tents could  not  enter  the  peritoneal  cavity. 

The  concrete  aspect  of  peritonitis  com- 
pells  us  to  recognize  a  condition  in  which 
escaping  contents  of  some  viscus  threatens 
the  life  of  our  patient,  and  it  is  clear  that  if 
the  channel  through  which  this  material 
escapes  is  small  and  the  quantity  is  small 
and  feeble  in  inflammation  producing  power 
then  the  attack  will  be  mild  and  of  short 
duration. 

The  toxic  effects  of  the  disease,  apart 
from  the  features  we  have  just  discussed, 
are  very  much  less  dangerous  usually  ;  and 
there  is   generally  plenty  of    time  to    make 


a  diagnosis  safe  and  sure  by  bi-manual 
methods  of  examination.  In  peritonitis, 
unaccompanied  by  symptoms  of  intestinal 
obstruction,  I  think  it  is  rarely  necessary  to 
make  an  exploratory  operation  for  purely 
diagnostic  purposes.  The  febrile  symptoms, 
the  pain,  the  swelling  distinctly  felt  in  some 
part  of  the  pelvis  or  the  retro-peritoneal 
regions,  the  waxy  appearance  of  the  skin, 
with  the  history  of  the  attack  provide  ma- 
terial sufficient  for  a  diagnosis  and  to  justify 
an  operation  for  removal  of  pus  from  any 
part  of  the  peritoneum  in  which  it  may  be 
found. 

Why  ovaries  and  tubes  should  be  removed 
just  because  they  happen  to  be  implicated 
in  an  accumulation  of  pus  located  in  the 
pelvis,  I  do  not  understand.  There  can 
certainly  be  no  harm  in  removing  the  pus 
which  is  the  sole  source  of  the  general  sepsis 
in  many  of  the  cases  and  leaving  the  ovaries 
and  even  the  tubes  behind  when  the  surgeon 
has  the  skill  to  separate  the  abscess  wal 
from  these  very  useful  organs. 

In  those  cases  the  patient  must  be  sus- 
tained by  the  most  vigorous  resources  of 
foods  and  drink. 

If  the  system  is  so  far  infected  that  heat 
centers  are  overwhelmed,  and  the  condition 
known  as  general  sepsis  is  present,  removal 
of  pus  sacks  and  drainage  of  abscesses  is 
often  like  locking  the  stable  door  after  the 
horse  is  stolen.  Under  such  circumstances 
we  usually  find  the  patient  exhausted  by 
copious  sweats  and  diarrhoea  as  well  as 
fever.  Water  in  quantities  is  often  a  sov- 
ereign remedy.  It  dilutes  the  poison,  and 
should  be  used  pure  both  internally  and  ex- 
ternally. It  seems  to  act  like  a  food  some- 
times and  can  be  taken  readily  by  patients 
who  cannot  tolerate  a  glass  of  milk  or  an 
egg  or  the  gruels. 

I  have  spoken  of  peritonitis  resulting 
from  infection  of  the  uterine  mucosa  passing 
into  the  broad  ligament  lymphatics.  Such 
cases  are  not  uncommon  in  lying-in  practice 
and  many  of  the  cases  following  abortion, 
and  specific  endometritis  and  vaginitis  are 
of  this  class. 

The  woman  usually  has  a  chill  a  week  or 
ten  days  after  her  accouchement.  There  is 
some  fever,  ranging  in  different  cases  from 
ioo  deg.  to  105  deg.  F.  The  pulse  is  typi- 
cal of  peritonitis.  The  abdomen  may  be 
tender  and  tympanitic.  There  is  anorexia, 
often  copious  perspiration  and  free  move- 
ments of  the  bowels.  Often,  too,  micturi- 
tion is  frequent  and  painful.  The  physical 
examination  per  vaginam  reveals  the  uterus 
mobile.  There  may  be  a  doughy  feel  to 
the  right  or  left  of  the  uterus. 

One  or  the  other,  or  both  lumbar  regions 
I  may  be  the    seat  of   constant  pain.     Some- 


THE  CHARLOTTE  MEDICAL  JOURNAL, 


403 


times  she  will  complain  of  pain  in  the  side 
over  the  crest  of  the  ileum.  Pressure  will 
increase  the  pain.  There  is  a  marked  dis- 
position to  lie  with  the  thighs  drawn  up. 
In  some  cases  but  one  limb  will  be  drawn  up. 

With  the  patient  under  anaesthesia  the 
surgeon  can  sometimes  feel  a  deep  swelling 
behind  the  intestine  below  the  kidney,  or 
in  the  iliac  fossa.  These  cases  will  generally 
recover  after  drainage  of  the  retro-perito- 
neum, pushing  that  organ  aside  after  the 
method  of  reaching  the  external  iliac  artery 
and  if  pus  is  not  found  carrying  the  wound 
upward  and  backward  along  the  ureter  to- 
ward the  kidney,  when,  whether  pus  is 
foundor  not, draining  by  gauze,  which  should 
be  introduced  and  the  wound  allowed  to 
heal  from  the  bottom  by  granulation. 

The  evacuation  of  pus,  in  my  cases,  of 
this  type,  has  not  been  essential  to  a  cure. 
But  the  fever  has  stopped,  the  pain  has 
ceased,  the  skin  has  cleared,  and  the  patient 
has  recovered  well  and  sound. 


A  Study 


i    Metaphysics   Through  Drugs 
and  Dream   States. 


Ry  F.  Savary  Pearce,  M.  1)..  Instructor  in  Phys- 
ical Diagnosis,  University of  Pennsylvania; 
Chief  of  the  Medical  Clinic,  St.  Agnes 
Hospital.  Philadelphia,  Pa. 

In  The  Charlotte  Medical  Journal  for 
December,  1896,  the  writer  expressed  him- 
self on  "Hygiene  and  Therapeutics," 
and  in  January,  1897,  on  "  Confidence 
in  Medicine,"  subjects  which  must  neces- 
sarily be  considered  largely  physically,  but 
yet  with  a  skirting  upon  the  domain  of  the 
mind  if  a  wise  ultimate  judgment  is  to  be 
reached — greatest  relief  given  to  human  ills. 

The  field  of  general  medicine  is  so  ineffa- 
bly broad  that  every  incitement  of  sincere 
observation  of  mental  or  material  physiolo- 
gical or  pathogenic  states  observed  is  worth 
record.  The  action  of  mind  over  matter  is 
frequently  reiterated,  but  the  action  of 
material  upon  mental  processes  is  more  apt 
to  escape  attention.  The  contention  is  made 
that  while  generalities  are  accepted  almost 
universally  by  enlightened  people,  yet  the 
finer  delineations  are  apt  to  be  less  sought 
for  than  their    bearing  on  health    warrants. 

By  a  now  timely  stimulus  in  the  study  of 
psychology  the  physician  will  most  aid  the 
cause  of  the  higher  medicine  (tempus fugit) , 
and  win  over  better  intellectual  support  to 
the  finest  art  by  the  legacies  of  thought  en- 
gendered in  men,  as  for  example,  legisla- 
tors, who  will  then,  in  truer  understanding, 
never  more    hand    over  the  keys  of    physic 


to  shrewd  purveyors  of  panaceas  at  so  much 
a  patient. 

The  effect  of  will,  judgment,  volition  and 
imagination  should  be  well  distinguished, 
and  still  there  will  be  left  unsolvable  mys- 
teries. '-Cast  your  bread  upon  the  waters 
and  it  shall  return  to  you  in  many  days." 
Give  all  you  know  well,  then  will  confi- 
dence in  life  be  ascending  ever.  I  am  not 
sure  Napoleon  was  complimenting  the  race 
when  he  said  "imagination  rules  the  world. ' ' 
At  all  events  what  a  prosaic  and  indeed 
impracticil  sphere  this  would  be  without 
fully  governed  imagination  to  lead  on  to- 
ward the  goal,  desiring  to  tread  on  no 
ground  lower  than  the  stars. 

DREAM    STATES. 

An  intelligent  woman,  aet  63  years,  came 
to  me  in  December,  1896,  a  person  of  very 
acute  perceptions  in  all  channels  of  thought, 
and  one  whose  energies  are  wrought  to  the 
highest  pitch  in  mental  and  physical  en- 
ergy. This  woman  had  no  organic  disease, 
was  suffering  from  general  nervousness  due 
to  exhaustion  from  pleasurable  duties.  I 
at  once  saw  the  usual  composure  had  left 
the  countenance ;  she  was  dubious  as  to 
whether  her  mind  was  "leaving"  her — very 
earnestly  so. 

Her  own  statement  well  expresses  the 
spell  labored  under  for  about  a  month  to 
her  great  distress:  "On  about  November 
23d,  1896,  I  retired  very  late  and  also  tired. 
I  hurried  into  bed  and  my  head  had  scarcely 
touched  the  pillow  when  a  panoramic  vision 
began  to  pass  before  my  eyes.  I  opened 
my  eyes  to  assure  myself  I  was  quite  awake. 
Doing  so  had  no  effect  on  the  vision,  as  it 
continued  with  my  eyes  open.  I  closed 
them  again  and  the  view  was  as  I  shall 
now  describe  it. 

"First,  a  broad  expanse  of  ground  having 
the  appearance  of  grass  being  scorched  by 
the  sun,  and  tall  trees  scattered  here  and 
there  with  but  few  leaves  upon  them,  and 
they  too  looked  as  if  sun-burned,  the  scene 
branching  off  to  a  river  with  bushes  grow- 
ing alongside,  and  continuing  until  it  was 
only  a  narrow  stream  of  water,  followed 
by  rich  green  fields  with  low  trees  and 
plenty  of  flowers  around.  The  fields  grew 
narrower  and  again  the  water  appeared ; 
this  time  the  ocean,  and  far  away  in  the 
distance  were  many  sails,  but  very  small, 
increasing  in  size  as  they  came  nearer,  until 
the  foremost  one  was  seen  at  full  size  with 
sails  all  set,  and  the  waves  breaking  against 
the  ship  seemed  tinged  with  the  peculiar 
blue-green  shade  that  autumn  clouds  cast 
upon  the  water.  In  the  distance  was  a  light 
house,  from  which  a  continuous  flow  of 
sparks  were  emitted,  such  as  one  sees  fly 
from  the  car-tracks  sometimes. 


404 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


"Then  the  ocean  seemed  merged  into  more 
green  fields,  and  further  on  to  another 
stream  of  water  about  the  width  of  a  street, 
and  I  saw  no  more,  having  dropped  off  to 
sleep. 

"I  can  not  tell  the  exact  time  it  took  for 
this  panorama  to  pass  before  me,  but  it  was 
two  o'clock  when  I  went  to  my  room  and 
about  the  last  thing  I  remembered  was  the 
clock  striking  three.  I  brooded  over  my 
vision  for  a  month,  thinking  my  mind  was 
astray,  and  at  last,  on  December  23d,  I  con- 
sulted Dr.  Pearce,  relating  the  above,  and 
he  asked  me  to  write  it  down  for  him,  so  I 
have  written  it  to-day,  more  than  two  years 
later,  from  memory,  but  it  was  as  if  paint- 
ed on  my  brain,  every  thing  so  clear  and 
distinct." 

The  above  case  was  undoubtedly  a  waking 
dream  as  shown  by  the  fact  that  it  persisted 
when  the  eyes  were  open,  and  then  it  con- 
tinued on  into  the  predormition.  Explan- 
ation of  such  states  may  possibly  be  in  an 
exhausted  vaso-motor  control  of  vessels  of 
the  brain,  especially  of  the  eye  centres,  and 
of  a  rapid  stimuli  given  to  neurons  ready  for 
extra  nutriment,  to  give  exit  to  conceptions 
from  these  uninhibited  centres.  So  soon 
as  this  patient  was  "rested  up"  the  phe- 
nomenon did  not  recur. 

The  time  limit  for  the  above  described 
visual  hallucination  (one  hour)  shows  that 
mental  processes  are  more  nicely  defined, 
i.  e.,  are  slower  for  the  rational  order  of  ser- 
vice; as  in  full  mental  power  it  takes 
much  longer  for  even  realities  (perceptions) 
to  eventuate ;  while  in  dreams  we  are  at 
the  most  rapid  tide  of  rushing  heterogeneous 
ungoverned  mental  action.  This  rapidity 
is  shown  in  the  dream  of  a  sleeper,  or  in 
abeyed  mind  control  in  unconsciousness,  as 
by  the  case  of  a  young  lady  who  had  fainted 
but  for  a  few  moments,  and  yet  during  that 
time  she  recited  at  once,  afterward,  that 
she  had  lived  vivid  happenings  of  years  of 
active  life  in  the  illusion.  These  phenom- 
ena should  be  carefully  weighed,  for  a  well 
meaning  person  might  be  won  over  to  the 
subtle  subterfuge  of  the  clairvoyant  should 
a  neurotic  faint  come  over  such  a  subject 
seeking  hypnotic  influence  for  the  elixir  of 
life. 

Another  marvellous  example  of  synchron- 
ous action  of  two  minds  upon  the  same  sub- 
ject, which  I  know  to  be  a  fact,  and  I  with- 
draw from  natural,  (if  they  be)  dream-states  : 
A  very  intelligent  lady  recited  to  me  the  fol- 
lowing. She  and  an  uncle  living  in  distant 
cities  had  never  met, but  had  frequently 
heard  and  passed  greetings  through  mutual 
relatives.  Upon  one  night  it  transpired  that 
each  had  dreamed  of  the  other,  and  that 
they  had    met  in  the   uncle's  house,  the  re- 


alities of  which  were  so  striking  that  it  was 
difficult  to  dispel  on  waking. 

Depending  on  the  idiosyncracy  of  the  in- 
dividual as  to  characteristics,  in-born  or  ac- 
quired, does  much  of  this  vague  and  facin- 
ating  study  in  metaphysics  hinge  ;  but  we 
can  hardly  expect  to  ever  go  searching  be- 
yond these  possible  predisposing  or  exciting 
causes  which  as  psychological  medicine  ad- 
vances will  be  put  to  practical  import ;  al- 
beit thefons  ct  origo  mali  be  indeterminate. 
I  have  a  child,  6  years  old,  in  mind,  preco- 
cious to  a  degree,  who  could  sail  in  descrip- 
tions from  earthly  scenes  to  the  clouds  with 
as  much  real  animation  in  the  unreal View  as 
if  things  "were  that  doth  not  even  seem." 
This  child's  mother  I  treated  for  a  most 
serious  double  pneumonia,  and  after  the 
crisis  was  over,  as  oxygen  inhalations  with- 
drew ;  so  strong  was  her  imagination  that 
death  must  come,  that  even  my  experienced 
consultant  could  not  for  days  feel  sure  of 
recovery,  so  much  did  the  mind  influence 
the  not  seriously  diseased  body. 

What  explanation  can  be  given  to  this? 
A  male  patient  neurasthenic,  dreams  of 
"flitting  about  from  one  chimney-top  to  an- 
other like  a  bird,  or  of  the  grotesque  feel- 
ing of  being  ground  under  the  wheels  of  a 
box-car  on  which  he  was  acting  as  brake- 
man." 

DRUGS. 

In  the  best  standard  drugs  there  is  with- 
in limits  a  fairly  wide  variation  upon  dif- 
ferent persons  depending,  of  course,  much 
on  absorption,  and  when  within  the  blood 
of  proper  metabolism.  This  brings  up  the 
whole  subject  of  physiological  chemistry, 
which,  in  future,  must  yield  interesting 
facts.  The  work  of  Ira  Van  Gieson,  M. 
D.,*  is  in  point. 

Behind  this  will,  no  doubt,  glare  the  wall 
of  vital  action.  Dr.  S.  Weir  Mitchell's  in- 
structive paper  upon  the  action  of  "Mescal 
Button"  upon  the  visual  centres,  has  inter- 
ested me  much.  Dr.  Mitchell  took  3vi  of 
the  tincture  of  this  cactus  and  obtained 
visual  color  effects  that  were  beautifully 
kaleidoscopic.  Those  colors  the  author  was 
not  fond  of,  as  red  were  never  prominent 
in  the  field.  The  feeling  of  physical  well- 
being  was  a  general  symptom  and  there  was 
little  after  effect  save  mild  gastritis.  We 
tried  to  obtain  a  healthy  blind  congenital 
case  to  give  the  drug  to,  but  in  the  examin- 
ation of  180  childrenf,  I  have    been  unable 


*The  Formation  and  Excretion  of  the  Meta- 
plasm  Granules  of  the  Neuron. — Journal  of  Ner- 
vous and  Mental  Diseases,  Feb.,  IS99. 

fBritish  Medical  Journal,   December  5,   1896. 

fA  study  of  the  Blind,  Transactions  College  of 
Physicians,  Vol.  xix,  1897. 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


405 


to  find  a  suitable  subject,  so  have  tried  the 
experiment  myself,  it  requiring,  in  my  own 
case,  3vii  (dram)  to  produce  marked  visual 
hallucinations.  Experimented  February  4, 
1899,  my  pulse  was  78  per  minute  ;  tempera- 
ature  normal,  and  respirations  20  per  min- 
ute. I  then,  at  3  130  p.  m.,  took  3i  of  tr.  of 
Mescal  Button,  another  at  3  140  p.  m.,  one  at 
4  p.  m.,  when  a  vague  feeling  of  stimulated 
buoyancy  came  over  me,  though  the  pulse 
did  not  go  above  80.  At  4  130  p.  m.  I  took 
a  fourth  drachm,  and  by  5  o'clock  could  get 
faint  color  effects  of  widening  circles  of 
pink  and  blue  gradually  closing  in  and  re- 
curring, to  soon  disappear  when  the  eyes 
were  opened.  The  feeling  of  stimulation 
continued,  and  I  searched  carefully  for  other 
effects,  but  found  constant  reiteration  of 
the  indeterminable  numbers  of  rapidly  pass- 
ing beautifully  colored  circles,  with  now  and 
then  flashes  of  light  and  gold,  as  from  an 
arc  light.  I  took  three  more  doses  between 
8  and  10  p.  m.,  but  the  beauty  did  not  vary 
in  its  adornment,  and  after  doing  some  cor- 
respondence with  apparent  ease  and  in  full 
faculty  it  seemed,  I  retired  at  midnight 
and  dreamed  of  the  same  colors,  but  less 
distinct  as  to  being  in  circular  array,  al- 
though it  did  not  at  all  arouse  dreaming 
of  other  things.  1  hail  ;i  smart  gastro-en- 
teritis  all  next  day. 

The  lesson  personally  gotten  leads  a  will- 
ing patient  and  friend  of  the  writer's  to 
wish  to  try  the  experience,  the  lady  con- 
tending that  her  imaginative  faculty  was 
not  large,  so  we  began  on  February  12th  by 
giving  the  usual  drachm  dose  at  7  130  a.  m. 
and  repeated  this  dosage  at  8  130,  9  130  and 
10:30,  when  the  pulse  was  74,  temperature 
98 1,  and  respirations  slowed  to  16  per  min- 
ute, full  and  synthenic,  the  pulse  remaining 
full  but  compressible.  Teaspoonful  doses 
were  repeated  until  by  12  135  p.  m.  ten  (10) 
drachms  had  been  administered.  The  pa- 
tient by  3  p.  m.,  after  eating  a  fair  dinner, 
simply  felt  as  a  madatne  sans  gene.  She 
had  no  visions,  hearing  was  very  acute. 
The  following  is  an  abstract  of  the  lady's 
notes:  "At  dinner  time  it  was  hard  work 
to  eat,  for  there  was  not  the  slightest  craving 
for  food,  and  my  mind  seemed  wandering 
off  to  some  unknown  land.  Only  once  was 
there  any  display  of  color.  As  I  sat  facing 
the  window,  eyes  closed,  there  came  across 
my  vision  a  horizontal  bar  of  blue-grav ; 
this  changed  and  became  as  a  kaleidoscope, 
the  colors  gleaming  and  flashing  very  vivid- 
ly, but  it  was  only  just  the  shades  and  tints 
of  blue  ;  at  least,  that  seemed  to  be  predom- 
inant. I  felt  after  dinner  a  slight  feeling 
of  depression,  and  there  was  afterward  only 
a  slight  disturbance  of  the  stomach. 

As  I  took  more  of  the  drug  I  could  feel  a 


general  languor  taking  possession  of  me, 
and  both  head  and  body  felt  light.  I  did 
not  sleep,  yet  I  felt  dull  and  had  an  utter 
indifference.  I  did  not  dream  that  night. 
I  was  restless,  faculties  keenly  alert  and  it 
was  several  hours  before  I  travelled  into  the 
"Land  of  Nod."  The  next  morning  the 
patient  awoke  feeling  now  quite  exhilara- 
ted and  "ready  to  walk  miles."  Then  the 
effect  wore  away. 

In  the  realm  of  peculiar  actions  of  the 
mind  largely  in  visual  lines  I  have  in  the 
above  desultory  way  made  notes  of  some 
personal  experiences.  For  much  insight 
into  this  psychological  study,  as  a  whole, 
the  excellent  books  given  below  should  be 
read  : 

I.  "Sleep  and  Its  Derangements,"  by 
Wm.  A.  Hammond,  M.  D.,  1869. 

II.  "Insomnia  and  Hypnotics,"  by  Ger- 
main See,  M.  D.,  translated  by  E.  P.  Hurd, 
1891. 

III.  Arbeiten  Ans  dem  Gesammtgebiet 
der  Psychiatrie  und  Neuropathologie  von 
R.  v.  Krafft-Ebing,  1898.  Article  II. 
"Waking  and  Dream  States." 

1407  Locust  St. 


The  Paliative  Treament  of  Hemorrhoids. 

By  II.  (J.  Thomas,  B.  Sc,  M.D.,  Kirkman,  Iowa. 

That  physicians  are  not  even  yet  patron- 
ized for  rectal  diseases  is  a  legacy  to  our 
present  generation  from  the  dark  ages  when 
the  itinerant  charlatan  only  attempted  to 
treat  such  affections. 

Medical  progress  has  been  wonderful  in 
the  past,  and  the  least  progress  has  not  been 
made  in  the  treatment  of  this  part  of  the 
human  body  which  has  proven  so  profitable 
both  to  the  specialist  in  this  particular  de- 
partment and  to  the  general  practitioner 
who  carefully  considers  these  diseases.  The 
newest  neophyte  knows  the  disease  to  be 
very  common,  yet  no  other  part  of  the  body 
when  diseased  yields  more  readily  to  treat- 
ment. This  is  especially  true  of  hemor- 
rhoids. The  veins  returning  the  blood  from 
the  rectum,  because  of  the  absence  of  valves, 
the  erect  position  of  man  and  the  function 
of  rectum  are  liable  to  become  dilated,  vari- 
cose, congestion  follows  with  inflammatory 
exudate  in  the  tissure  and  a  tumor  results  ; 
if  above  the  external  sphicter  it  is  an  internal 
hemorrhoid  ;  if  below  that  muscle,  it  is  an 
external  hemorrhoid.  No  class  of  people  is 
exempt  from  this  affection,  whether  much 
out  of  doors  and  given  to  healthy  exercise, 
or  one  of  sedentary  habits.  Nor  can  we 
say  that  diet  or  manner  of  dress,  or  even 
constipation,  are    potent   causes,  yet  either 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


may  prolong  the  trouble  when  once  formed 
and  after  relief  is  secured  may  cause  its  re- 
turn, as  may  pressure  on  the  veins  by  the 
uterus,  whether  from  pregnancy  or  other- 
wise, in  the  male  enlargement  of  the  pros- 
tate gland  or  obstruction  to  the  portal  sys- 
tem, or  again  a  general  morbid  state  of  the 
circulatory  system,  caused  commonly  by  a 
valvular  lesion  of  the  heart  causing  stagna- 
tion of  all  the  veins  with  obvious  results  in 
the  rectum,  or  pulmonary  disease  may  pro- 
duce like  results.  It  is  not  now  believed 
that  heredity  plays  a  part  in  the  causation 
of  the  disease  except  as  wealth  and  its  at- 
tending evils — luxury  and  idleness — are 
transmitted  from  generation  to  generation. 

The  connection  between  the  symptoms 
of  rectal  distress  and  the  lesion  of  hemor- 
rhoids is  quite  irregular.  There  may  be 
great  complaint  with  little  local  change,  or 
much  varicosity  of  the  hemorrhoidal  vein 
and  little  distress.  But  pain  is  what  relief 
is  sought  for  in  the  external  variety.  The 
distress  may  be  constant,  as  caused  by  a 
foreign  body,  or  the  sensation  of  burning 
and  smarting ;  it  may  be  accompanied  by 
spasmodic  muscular  contraction  of  the  rectal 
muscles.  Such  symptoms  are  induced  or 
greatly  aggravated  by  long  continued  sitting, 
horseback  riding,  gormandizing  or  worship- 
ing too  frequently  at  the  shrines  of  Bacchus 
or  Venus. 

In  contrast  with  pain  in  external  piles 
the  internal  varieties  most  prominent  symp- 
tom is  a  constant  leaking  through  the  anus 
of  a  sanguineous  discharge  from  the  in- 
flamed mucosa,  later  they  protrude  at  stool 
and  return  of  themselves  to  their  natural 
place,  but  after  a  while  they  do  not  return 
of  themselves  as  formerly,  but  the  patient 
must  push  them  back  after  each  defecation. 
If  pain  exists  with  the  protrusion  an  abra- 
sion, fissure  or  ulceration  exists  as  a  com- 
plication. 

While  these  symptoms  are  characteristic 
of  each  class  to  be  sure  of  the  diagnosis  an 
examination  must  be  made  in  every  case, 
external  piles  can  be  inspected  and  internal 
piles  readily  seen  with  the  speculum. 

Only  by  strangulation  and  gangrene  is 
their  danger  to  life ,  but  without  proper 
treatment  there  may  be  prolonged  dis- 
comfort. 

Operation  gives  the  most  satisfactory  re- 
sults, but  in  many  instances  it  is  unneces- 
sarily hazardous  and  again  many  can  not 
spare  the  time  to  be  operated  on,  or  the 
facilities  may  not  be  at  hand,  and  the  pa- 
tient may  refuse  to  be  operated  on  even 
when  such  operation  is  clearly  indicated. 
Paliative  treatment  in  such  cases  is  our  only 
refuge,  and  often  results  in  cure, 

If    we  know  one    to  be   disposed    to  this 


trouble,  prophylactic  measures  are  to  be 
employed,  out-door  exercise  advised,  eschew 
highly  seasoned  food,  avoid  constipation, 
and  alcoholics  prohibited.  If  cirrhosis  is 
suspected,  treat  accordingly.  We  must  ac- 
cept it  as  a  fact  that  smoking  is  a  fruitful 
cause  of  the  trouble,  hence  advise  that  habit 
to  be  discontinued.  In  the  internal  variety 
an  enema  of  a  pint  of  cold  water  twice  a 
week  will  do  good. 

These  are  unusual  cases  for  physicians. 
More  commonly  inflammation  exists  when 
a  physician  is  first  consulted,  and  prompt 
relief  is  desired.  An  ointment  of  bella- 
donna and  opium  is  usually  applied  and  we 
all  agree  with  negative  results.  If  cocaine 
is  used,  little  benefit  is  received.  It  is  now 
my  practice  to  give  10  grains  of  calomel, 
and  follow  in  a  few  hours  with  a  dose  of 
Rochelle  salts  in  a  glass  of  water;  this  has 
a  paliative  effect,  and  advise  a  restricted 
diet  and  rest.  Three  or  four  times  daily 
bathe  the  piles  in  a  50  per  cent,  solution  of 
Glyco-Thymoline  (Kress)  and  a  piece  of 
absorbent  cotton  dipped  in  it  and  applied 
to  the  inflamed  tumor  during  the  interval, 
allays  pain  and  discomfort  almost  like 
magic. 

Should  this  treatment  fail,  as  it  may  when 
the  tumors  are  large  and  much  inflamed, 
first  make  the  patient  go  to  bed  and  apply 
a  large  hot  flaxseed  poultice.  Repeat  as 
often  as  it  cools.  This  will  relieve  the 
trouble,  relaxing  the  tissues.  After  such 
condition  is  relieved  use  the  Glyco-Thymo- 
line as  directed. 

The  paliative  treatment  for  internal  piles 
are  much  the  same  as  given  above.  The 
constipation,  if  it  exists,  must  be  relieved, 
and  habits  regulated. 

In  the  milder  cases,  three  or  four  drachms 
of  a  ^o  per  cent,  solution  of  Glyco-Thymo- 
line (Kress)  should  be  injected  into  the 
rectum  by  means  of  a  hard  rubber  rectal 
syringe.  Here  it  produces  exosmosis,  re- 
duces the  engorgement,  softens  the  feces, 
stops  pain  and  bleeding. 

If  the  hemorrhoids  are  protruding  apply 
large  hot  flaxseed  poultices  as  above,  and 
give  a  hypodermic  of  morphia  if  necessary. 
When  the  engorgement  is  relieved  and  the 
protruding  part  is  replaced  follow  with  the 
injection  of  Glyco-Thymoline  as  described 
above. 

The  following  usually  difficult  case  will 
illustrate  results.  A  liveryman  came  to  me 
with  large  protruding  internal  piles  which 
could  not  be  replaced.  They  had  been 
down  since  the  morning  of  the  previous 
day.  He  would  not  go  to  bed  and  was 
compelled,  so  he  thought,  to  attend  his 
usual  avocation.  I  prescribed  calomel  with 
the  saline  as  described,  and   ordered  the  in- 


THE  CHARLOTTE1  MEDICAL  JOURNAL 


407 


flamed  protrusion  bathed  in  a  50  per  cent. 
Glyco-Thymoline  solution  as  described, 
every  three  hours,  and  a  piece  of  absorbent 
cotton  dipped  in  the  solution  applied  to  the 
anus  in  the  interval.  I  did  not  see  him 
until  next  morning,  when  I  was  able  to 
press  in  place  the  protrusion.  Now  the 
injection,  as  described  for  internal  piles, 
gave  efficient  relief.  He  lost  no  time  what- 
ever from  his  work,  nor  has  he  had  subse- 
quent trouble. 

Dressing  in  Minor  Surgery.* 

By  Frank  IT.  Hancock,  M.  D.,  Port  Norfolk,  Va. 

I  have  entered  the  field  of  minor  surgery 
merely  to  record  my  experiences  in  wet 
dressings,  not  to  discuss  the  several  heads 
which  under  this  text  might    be  legitimate. 

It  is  admitted,  I  believe,  that  surgical 
wound  dressings  should  be  absorbent ;  that 
they  may  be  readily  impregnated  with  med- 
icinal substances,  and  that  they  absorb  dis- 
charges. 

Along  this  line  authorities  tell  us  that  in 
wet  dressings  some  covering  impervious  to 
heat  and  moisture  should  be  used  ;  as  rub- 
ber dam,  oiled  silk.  These  are  to  retain 
heat  and  prevent  evaporation. 

It  seems  that  such  dressings  art-  required 
in  mashes,  bruises,  lacerations,  contusions 
and  abscesses. 

Wherever  extensive  surfaces  arc  infected, 
degenerating,  sloughing,  there  oiled  silk 
finds  its  use.  There  the  surgeon  wishing 
to  overcome  the  lethargy  of  the  affected  tis- 
sues, hopes  to  do  it  through  the  influence  of 
heat,  artificially  applied. 

Remembering  the  devitalized  state  of  the 
wound  tissue,  and  the  loss  of  heat  from  de- 
ficient oxidation,  the  surgeon  attempts  a 
corrective,  and  this  he  is  believed  to  find  in 
the  impervious  moist  dressing.  That  the 
dressing  is  kept  warm  and  moist  by  means 
of  its  oiled  silk  cover,  is  a  fact  that  inspec- 
tion will  readily  demonstrate. 

The  appearance  of  such  a  dressing  after 
twenty-four  hours  exposure  bears  well  its 
significant  name  of  impervious  moist  dress- 
ing. 

Soddened  and  soaked,  the  gauze,  designed 
and  used  for  its  lightness,  and  the  ease  with 
which  it  maybe  cleaned,  lies,  a  mass  of 
matted  dampness,  upon  the  tissue  it  is  in- 
tended to  protect.  Unable  to  evaporate,  to 
pass  through  the  impenetrable  coat  of  silk, 
the  moisture  is  in  part  taken  up,  and  the 
shreds  of  the  gauze  swell  to  a  point  of  dis- 
solution. 


*Read  before   the   Norfolk  Medical   Society. 
March  14,  1899. 


Boggy  and  misshapen  from  weight  this 
dressing  adapts  itself  to  the  irregularities  of 
the  diseased  area  as  a  jelly  fish  does  to  in- 
dentations in  the  sand. 

Limp,  and  supersaturated,  it  hangs  its 
dead-weight  upon  the  smouldering  tissue 
as  though  it  was  soldered,  so  closelv  does 
it  fit. 

Every  depression,  fissure,  and  crevice,  re- 
ceives its  complement  of  this  stagnant  mass, 
burrowing  into  the  receptacles  as  the  villi 
of  the  chorian  fromdosum  burrow  into  the 
cripts  of  the  mucous  membrane  of  a  preg- 
nant uterus. 

The  analogy,  however,  goes  no  further, 
for  unlike  the  placental  tufts,  these  moisture- 
laden,  slime-coated,  prolongations  of  gauze, 
receive  nothing,  by  way  of  osmosis  or  other- 
wise, from  the  cripts  into  which  they  fit,  or 
the  field  upon  which  they  rest. 

The  gauze  cannot  appropriate  the  slough 
of  the  tissue,  or  absorb  the  excretion  of  the 
wound  area,  because  of  the  occupation  of 
its  meshes,  and  the  prevention  of  evapora- 
tion by  an  oiled  silk  cover. 

This  fact  may  be  demonstrated. 

Examination  of  a  dressing  twenty-four 
hours  old  will  show  the  layer  of  gauze  near- 
est the  wound  surface  to  be  coated  with  a 
tenacious  slime,  the  amount  depending  upon 
the  character  of  the  wound,  while  in  the 
next,  and  succeeding  layers,  there  can  be 
detected  no  traces  of  putrefactive  material. 

1  have  particularly  observed  this  point, 
and  have  in  some  instances  seen  this  slough- 
ing material  adhere  to  the  first  layer  of 
gauze  as  plastering  does  to  a  wall. 

The  effete  matter  cannot  permeate  a  dress- 
ing already  saturated,  a  dressing  from  which 
no  moisture  is  allowed  to  escape.  The 
moisture  must  stay  where  it  is  to  form  col- 
lections of  miniature  cess  pools. 

It  may  be  remembered  that  while  the  ap- 
plication of  oiled  silk  to  such  a  dressing  pre- 
vents the  escape  of  moisture,  it  also  makes 
the  dressing  itself  impervious  to  the  dis- 
charges of  the  wound — a  point  I  wish  to 
italicize. 

The  surgeon  attempts  to  confine  the 
moisture. 

He  must  remember  that  in  doing  so,  he 
absolutely  stays  the  process  of  absorption, 
and  defeats  the  very  purpose  for  which  his 
treatment  was  instituted. 

On  January  4th,  189S,  I  dressed  the 
thumb  of  a  man  that  had  been  injured  the 
nth  of  December,  '97. 

The  thumb  had  been  struck  by  a  heavy 
hammer  and  was  burst  from  the  articulation 
to  the  distal  end  of  the  last  phalanx ;  the 
internal  lateral  surface  being  involved. 

It  was  wound  in  roller  bandage,  and  un- 
derneath was  a  spread  of  oiled  silk,  so  laid 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


as  to  carefully  envelop  the  folds  of  gauze 
which  were  in  apposition  to  the  wound. 

The  gauze  heavily  soaked  in  water  had 
shifted  somewhat — shifted  as  the  stupend- 
ously weighted  cargoes  of  ships,  shift  in  re- 
sponse to  certain  positions  of  the  vessel — 
and  was  giving  rise,  at  the  point  of  con- 
tact, to  the  most  intense  pain — pain  pro- 
duced by  the  accentuated  pressure  of  this 
water  charged  mass. 

Removal  disclosed  a  slimy  appearance  of 
the  coat  nearest  the  wound,  a  condition  to 
which  reference  has  been  made. 

The  wound  looked  putrid.  The  split  had 
widely  separated. 

It  seemed  verily  to  have  been  fallowed 
from  the  combined  effects  of  disintegration 
and  the  presence  of  a  redundant  dressing 
which  it  was  required  to  support. 

The  lower  segment  involving  the  palmer 
surface  of  the  thumb  swung  down  ;  a  space 
of  from  twelve  to  fifteen  m.m.  being  be- 
tween the  upper  and  lower  margins  of  the 
wound. 

Stretched  along  the  center  of  the  gap 
was  a  putrid  rope  of  slime,  probably  three 
m.m.  thick. 

Along  the  surfaces  of  the  wound  were 
dense  masses  of  agglutinated  pus,  resem- 
bling in  some  places  collections  of  frost 
upon  red  clay  banks. 

Beyond  and  to  the  radial  side  of  the 
metacarpophalangeal  articulation  was  a 
wound  of  bullet  hole  appearance. 

The  tissue  was  burst  here  by  the  terrific 
force  of  the  blow,  as  in  the  more  extensive 
wound  beyond. 

It  had  been  bored  out  by  infected  mate- 
rial— material  retained  by  the  superimposed 
layers  of  watei -logged  gauze. 

The  appearance  of  the  thumb  throughout 
its  whole  extent  was  bad. 

Infection  was  extending,  pus  rapidly 
forming  was  massing  along  the  fleshy,  or 
metacarpal  portion,  the  whole  of  which  was 
swollen  and  indurated. 

The  palmer  surface  seemed  particularly 
affected.  Pain  was  marked,  the  mere  ap- 
proach of  the  finger  being  productive  of  the 
most  acute  suffering. 

The  skin,  from  the  tip  of  the  thumb  to 
the  carpus,  from  the  radial  side  to  where  it 
crossed  the  index  finger,  presented  a  seethed, 
soggy,  whitish,  bulky,  appearance;  and 
this  corresponded  in  extent  and  outlines  to 
exactly  the  boundaries  of  the  impervious 
dressing: 

Emphasis  cannot  sustain  the  weight  I 
would  like  this  sentence  to  carry. 

The  appearance  was  a  map,  as  accurately 
portraying  the  dressing,  as  photographic 
rays  portray  upon  a  negative  the  object 
photographed. 


The  whitish  porus  look  of  the  skin  may 
be  familiar,  but  its  otherwise  extensive  ap- 
pearance upon  the  loose  skin,  as  the  dorsum 
of  the  hand,  is  unusual. 

It  is  due  to  the  prolonged  application  of 
moisture,  to  the  fact  that  the  functions  of 
the  skin  are  destroyed,  and  instead  of  evap- 
oration, instead  of  discharging  the  products 
of  its  own  infection,  it  absorbs  the  moisture 
of  the  dressing  above,  and  becomes  the  re- 
cipient of  its  own  pus  accumulation. 

An  incision  was  made  over  the  metacar- 
pus, through  which  some  pus  escaped. 

The  parts  were  immersed  in  warm  bich- 
loride, and  a  light  dressing  of  gauze  and 
cotton  applied. 

This  routine  was  continued  for  several 
days,  with  the  following  results  : 

Pain  had  lessened — the  patient  finding  it 
no  longer  necessary  to  express  himself  in 
tears  while  his  hand  was  being  dressed ; 
the  exqisite  tenderness  of  the  preceding 
week  was  gone  ;  the  whitishness  of  the  first 
dressing,  so  distinct,  so  unnatural,  had  dis- 
appeared, with  the  limited  exception  of  the 
marginal  surfaces :  the  depression  of  the 
wound  area,  seen  before,  had  become  ef- 
faced, or  the  dressing — impression  which 
so  carefully  mapped  the  lineaments  of  the 
oiled  silk  application  was  not  now  detecta- 
ble ;  the  thumb  seemed  no  longer  to  reek 
in  putrid  moisture  ;  its  cut  surfaces  were 
not  bursting  with  putrefective  gasses,  and 
the  debris  of  decomposed  tissue ;  the  sag- 
ging margins  appeared  to  approach  each 
other,  and  the  radical  adoption  of  the  am- 
putating knife  was  less  imminent. 

The  under  surface  of  the  dressing  was  not 
coated,  as  of  soft  plaster-of-paris.  The 
gauze  seemed  to  be  fulfilling  its  part  as  an 
absorptive  material,  and  %vas  equally  affect- 
ed throughout. 

The  cotton  was  soaked — soaked  as  cotton 
some  times  is  in  front  of  an  appendicular 
abscess,  and  the  pus,  if  I  mistake  not,  had 
in  spots  penetrated  the  roller  bandage  be- 
yond. 

For  absorptive  media  could  there  be  a 
more  ideal  dressing?  Certainly  it  would 
seem  that  the  results  appear  in  imposing 
contradistinction  to  the  oiled  silk  fiasco. 

Here,  the  pus  leaves  the  wound  as  it  is 
formed,  spreads  through  all  parts  of  the 
dressing,  is  held  in  the  interstices  of  the 
gauze,  the  intertexture  of  the  cotton. 

The  dressing  imbibes,  as  it  were,  and  the 
wound  is  relieved  of  the  presence  of  its  own 
excrement. 

In  the  other,  or  what  we  are  taught  the 
improved  arrangement,  exactly  the  oppo- 
site is  true.  The  dressing  is  a  foreign 
boby,  impervious  and  impenetrable . 

It  drags,  wallows,  and   tears  the   tissues, 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


bathes  them  in  slough,  and  brings  about  a 
condition  much  resembling  the  appearance 
of  swine  immersed  in  quagmire. 

Experimenting,  I  reapplied  the  oiled  silk. 
There  was  a  return  to  the  old  symptoms — a 
species  of  atavism  which  nearly  cost  me  my 
patient. 

The  oiled  silk  was  taken  away,  and  the 
hand,  with  the  simple  aid  of  its  natural 
functions,  healed. 

This,  and  other  experiences  of  an  almost 
similar  nature,  have  led  me  to  discard  from 
my  reportoire  the  impervious  moist  dress- 
ing-   

Random   Sketches.* 
By  I.  W.  Costen,  M.  1).,  Gatesville,  X.  C. 

Feeling  assured  from  the  reputation  and 
distinguished  abilities  of  our  brotherhood, 
that  the  science  of  medicine  will  be  dis- 
cussed with  all  competency  and  fitness,  and 
that  we  will  enjoy  a  ricli  feast. 

With  your  permission,  I  will  deviate 
from  the  regular  routine,  just  a  little,  and 
present  in  my  feeble  effort  a  few  Random 
Sketches.  Every  lineament  of  your  bright 
countenances  bespeaks  a  generous  heart,  and 
I  feel  that  my  boon  is  already  granted.  We 
call  our  proposed  lucubrations.  Random 
Sketches,  and  will  be  disappointed  if  we  do 
not  prove  them  such  before  leaving  them. 
We  hail  this  association,  as  the  herald  of  a 
work,  which  is  to  do  great  homage  to  the 
science  it  is  intended  to  promote,  as  well  as 
a  great  benefit  to  the  public.  The  entering 
upon  which,  we  trust,  too,  will  constitute 
a  bright  and  eventful  period  in  our  own 
history,  and  from  which  great  good  will 
emanate. 

Glancing  over  this  assembly,  we  find 
some  present  who  have  long  been  laboring 
in  the  pursuit  of  medical  knowledge,  while 
there  are  others,  like  myself,  it  may  be, 
just  stepping  upon  the  threshold  of  their 
profession.  While  our  minds  are  being 
improved,  our  intellects  expanded,  I  ask 
for  all  congeniality,  and  that  attachments, 
the  warmest  and  most  tenacious,  may  be 
formed — such  as  cannot  be  broken  by  the 
common  jars  and  discords  of  the  present 
day.  I  am  reminded,  while  contemplating 
my  theme,  of  the  great  improvements  that 
are  rapidly  developing  in  every  phase  of 
business.  This  medical  body  comes  under 
that  head.  May  the  expectations  it  awakens 
in  the  hearts  of  its  membership  be  realized, 
and  as  the  bland  sunshine  diffuses  its  happy 
influence  over  the  face  of  the  natural  world, 


*Read  before   the  Seaboard  Medical  Associa- 
tion of  Eastern  Virginia  and  North  Carolina. 


calling  forth  new  beauties,  so  may  the  in- 
fluence emanating  from  this  fraternity, 
awaken  new  energy  in  our  efforts  for  ex- 
tended knowledge. 

That  our  people,  the  American  people, 
are  celebrated  for  an  ingenious,  inventive 
spirit,  as  well  as  considerable  tact  in  devel- 
oping their  plans  of  improvement,  and  pro- 
fiting by  their  advantages,  many  proofs 
attest.  Notwithstanding  our  inventive 
genius,  we  are,  nevertheless,  fond  of  im- 
ported theories,  and  will  encourage  and  re- 
ceive foreign  talent  with  much  greater 
eagerness  than  we  encourage  home  efforts. 
It  is  rather  unfortunate,  too,  for  American 
enterprise,  that  there  is  such  a  fondness  for 
imported  opinions,  and  a  tendency  to  neg- 
lect home  talent.  Many  of  the  useful  in- 
ventions of  the  day  have  been  made  in  our 
country,  and  it  was  only  after  controlling 
popular  prejudices  that  they  were  rendered 
successful.  In  other  instances,  the  emi- 
nence of  foreign  authorship  has  secured 
them  success. 

These  last  remarks  were  suggested  while 
reading  some  extracts  from  a  physician's 
diary,  in  which  it  was  recorded  that  an 
eminent  physician  of  Baltimore  made  some 
valuable  discoveries  relative  to  medical 
science,  which  were  entirely  overlooked  by 
the  profession,  or  treated  with  marked  in- 
difference. It  was,  in  vain,  that  he  en- 
deavored to  illustrate  his  position,  which, 
however,  to  some  was  acknowledged  to 
possess  a  degree  of  interest.  In  the  course 
of  events,  the  said  discoveries  found  a  pas- 
sage across  the  Atlantic,  and  were  examin- 
ed and  admired  by  a  certain  physician  in 
one  of  the  English  medical  schools,  and  he, 
not  having  the  magnanimity  to  give  credit 
to  whom  it  belonged,  in  true  piratical  spirit, 
seized  upon  the  subject  and  published  it  as 
his  own,  in  one  of  the  foreign  medical 
journals,  and  having  gained  a  high  starting 
point,  the  matter  was  taken  up  and  ex- 
hibited to  the  world  as  English  property. 
Recrossing  the  ocean  it  was  hailed  in  Amer- 
ica as  a  valuable  acquisition  to  the  medical 
profession.  The  subject  has  been  treated 
upon  and  is  incorporated  into  late  publica- 
tions, credited,  of  course,  to  British  author- 
ship. 

We  are  in  the  enjoyment  of  better  days. 
We  find  that  the  productions  of  American 
genius  will  no  longer  be  compelled  to  take 
a  voyage  across  the  Atlantic  in  order  to  be 
indorsed  and  commended  before  they  can 
find  currency  in  the  land  of  their  nativity. 
It  is  a  very  consoling  thought  that  the 
science  of  medicine  has  made  almost  in- 
credible advancement  and  improvement, 
although  quackery  does  exist  to  some  ex- 
tent.    Pretenders    do   spring    up    in   many 


THE  "CHARLOTTE  MEDICAL  JOURNAL. 


places,  and  much  mischief  done ;  probably 
more  than  by  imposters  of  other  professions. 
We  should  not  deem  it  strange,  however, 
when  we  remember  that  in  every  branch  of 
business,  science,  literature,  and  in  every- 
thing, the  public  is  imposed  upon. 

A  century  ago  the  "healing  art,"  as  it 
was  termed  at  that  time,  was  in  a  strange, 
confused  state.  In  Europe,  too,  it  con- 
tained every  conceivably  kind  of  practi- 
tioner, from  the  humble  adviser  in  the  sub- 
urbs, living  and  acting  in  the  capacity  of 
the  grocer,  selling  his  lotions  or  lucifer 
matches,  and  "giving"  his  advice  for  noth- 
ing— estimating  it,  probably,  at  its  true 
value — up  to  the  fashionable  physician  of 
the  fashionable  square,  visiting  only  fash- 
ionable patients  and  prescribing  the  last 
fashionable  remedy  in  vogue.  In  those 
days,  too,  the  barber  was  the  surgeon.  At 
that  time  the  whole  country  was  flooded 
with  medical  quackery.  They  argued  that 
if  disease  is  a  unit,  that  it  should  be  treated 
by  one  general  systematic  course — either 
bleeding,  opium,  and  calomel — the  treat- 
ment of  the  regular  ;  or  lobelia,  pepper,  and 
steam — the  steamers  or  quack's  remedy. 

We  have  only  to  revert  to  those  days  of 
barbarism  and  brutality,  which  robbed  earth 
of  her  families,  and  time  of  his  generations, 
ere  we  can  with  fullness,  appreciate  our 
own  period.  A  night  of  profound  and  im- 
penetrable darkness  was  shrouding  much  of 
the  world's  glories.  The  arts  and  sciences 
reposed  in  an,  almost,  undisturbed  slumber. 
The  mind  groped  in  vain  to  find  truth,  fol- 
lowing the  glimmering  "ignus  fatuis"  of 
error.  The  night  was  not  to  last  forever, 
however.  The  sun  of  knowledge  ascended 
the  horizon,  science  burst  the  bands  which 
had  so  long  retained  her.  The  arts  awoke 
from  their  slumbers.  Science  and  knowl- 
edge never  fail  to  shed  a  hallowed  glory 
over  the  ages  in  which  they  have  existed. 
There  is  no  profession  in  life  which  has  not 
received  benefit  from  scientific  research.  It 
has  enabled  us  to  detect  the  deadly  poison 
which  lurking,  like  a  serpent,  often  among 
the  most  beautiful  of  nature's  foliage,  and 
to  counteract  its  deleterious  influences.  ' '  By 
its  aid,  too,  the  mechanic  and  artisan  govern 
all  their  operations  by  rules,  as  unerring  as 
the  laws  of  nature  herself ;  and  even  the 
tempest  tossed  marriner  is  often  saved,  from 
a  watery  grave,  by  the  simple,  yet,  scien- 
tific discovery  of  the  life  preserver. 

Yet,  why  should  I  attempt  a  survey  of 
the  immense  regions  of  learning — I  cannot 
do  it.  Still  it  is  said  "that  the  wisest  only 
stand  on  wisdom's  threshold."  If  the  in- 
terior of  her  temple  is  yet  to  be  explored, 
the  veil  of  her  mysteries  yet  to  be  drawn 
aside,  wherefore,  then    should  we    despair, 


or  be  discouraged.  Native  genius  has  flour- 
ished upon  our  own  soil,  and  our  own  peo- 
ple may  justly  claim  equal  honors  with  the 
oldest  nations  of  Europe.  Behold  a  Fulton 
"rendering  steam  subservient  to  the  wants 
of  man."  Think  of  Adams,  Jefferson, 
Rush,  Hamilton,  et  ed  omnc  genus,  sub- 
limely irradiating  the  dark  provinces  of 
mind,  with  the  bright  and  sparkling  rays 
of  light  and  intelligence.  It  is  at  our  own 
doors,  as  it  were,  that  we  view  the  mighty 
changes  which  have  been  accomplished 
within  the  last  half  century,  by  the  powers 
of  education  as  applied  to  the  arts  and 
sciences,  and  even  in  the  more  ordinary 
avocations  of  life,  we  find  abundant  reason 
for  congratulation  and  joy. 

When  we  remember  that  every  age 
stamps  its  impress,  indellibly,  upon  all  sub- 
sequent time,  and  in  no  way  does  a  nation 
make  itself  felt,  so  surely,  as  in  its  literature. 
This  should  serve  to  stimulate  us  to  nobler 
efforts  in  our  profession. 


The  Radical  Cure  of  Writer's  Cramp  and 
Other  Occupation  "Palsies." 

By  6.  H.  Monell,  M.  D.,  Brooklyn,   N.  Y. 

In  the  interest  of  medical  progress  will 
you  kindly  publish  this  letter  in  your  valued 
journal,  for  the  information  both  of  Special- 
ists and  of  the  great  body  of  general  family 
practitioners  who  are  most  apt  to  see  occu- 
pations palsies  or  "lame  arms"  in  their  ad- 
vanced stages  when  "rest"  is  useless  and  a 
true  remedy  is  important. 

Of  writer's  cramp  Tyson  says:  "Cura- 
tive treatment  consists  chiefly  in  lresfi 
promptly  adopted.  Mechanical  devices 
have  not  accomplished  much."  He  refers 
to  the  use  of  electricity  by  Berger,  Bene- 
dict, Eulenberg,  Erb,  Onimus,  Meyer,  Alt- 
house,  and  Gowers,  and  adds  that  his  own 
experience  has  not  been  encouraging. 

Gowers  has  "little  confidence  in  elec- 
tricity." 

Osier  says  :  "Rest  is  essential;  no  mea- 
sures are  of  value  without  this.  In  very 
obstinate  cases  the  condition  remains  in- 
curable." 

Duchenne  with  "faradism"  never  cured 
a  case. 

Dana  states  :  "The  most  essential  thing 
is  rest."  He  mentions  the  usual  text-book 
recommendations  and  places  electricity  "se- 
cond to  massage." 

Poore's  "combined  movements  with  gal- 
vanism" are  often  cited.  Shaw  describes 
the  disease,  but  omits  treatment  altogether. 
A  marked  sameness  runs  through  the  other 
literature  of    the    subject  as    regards    treat- 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


411 


ment,  and  the  impression  is  general  that 
decisive  and  scientific  treatment  is  not 
known,  the  usual  advice  being  to  "rest," 
"change  vocation,"  or  "try  massage  or 
electricity." 

As  opposed  to  this  general  impression  it 
may  be  stated  that  for  many  years  I  had 
writer's  cramp  myself  and  began  a  persis- 
tent experimental  research  into  its  proper 
treatment  which  has  involved  records  of 
more  than  five  thousand  electrical  applica- 
tions in  between  one  and  two  hundred 
cases,  mostly  telegraphers.  I  soon  learned 
to  restore  arms  in  commencing  stages.  In 
three  years  I  was  able  to  feel  confidence  in 
"curing"  an  advanced  stage,  but  it  took  a 
long  while.  Early  in  1898  my  continuous 
study  and  greatly  increased  experience  en- 
abled me  to  do  much  better  than  formerly, 
but  I  still  sought  methods  of  conquering 
extreme  cases  and  reducing  the  time  re- 
quired. By  January,  1899,  these  methods 
were  worked  out.  Electricity  is  the  rem- 
edy tested  and  found  successful,  but  instead 
of  employing  it  with  reference  to  described 
"galvanizing,"  &c,  1  utilize  clinical  elec- 
tro-therapeutics and  all  currents  and  dosage, 
to  the  end  of  producing  indicated  therapeu- 
tic actions  within  the  tissues.  That  is  the 
sole  secret  of  success.  A  complete  radical 
and  lasting  cure  is,  therefore,  demonstrated 
to  the  medical  profession.  Every  case  of 
writer's  cramp,  telegraphers  paralysis,  pian 
ists  wrist  drop,  ball  players  lame  arms  and 
other  varieties  of  "occupation  palsies"  ii 
curable  in  any  stage,  and  in  a  very  reason 
able  time  if  not  complicated  by  some  othe 
disabling  disease  that  is  not  curable.  The 
lapse  of  years  confirms  my  results,  and  timi 
has  not  only  confirmed  but  improved  them, 
and  to  anything  I  have  written  on  this  sub- 
ject in  the  past  I  must  now  add  that  my 
results  are  more  certainly  and  more  quickly 
obtained  than  before. 

The  indications  have  become  better  un- 
derstood and  "empiricism"  has  given  place 
to  an  accurate  plan  of  treatment  which 
practically  restores  every  case. 

To  any  physician  enclosing  stamp  1  will 
be  pleased  to  forward  a  reprint  of  my  arti- 
cle (giving  fuller  details)  published  in 
July,  1898. 

865  Union  Street. 


The  Ultimate  Results  of  Mechanical  and 
Operative  Treatment  in  Hip  Disease. 
Drs.  Gibney,  Waterman  and  Reynolds 
have  published  the  results  of  the  study  of 
150  cases  of  disease,  on  all  of  which  per- 
sonal examinations  of  the  patients  had  been 
made.  The  article  says  the  Boston  Medical 
and    Surgical    Journal,     gives    a    series    of 


tables,  in  which  the  shortening,  its  relation 
to  abscess,  the  amount  of  deformity  and  the 
necessary  correction  of  deformity  is  com- 
pared, and  also  the  relation  of  mechanical 
and  operative  treatment.  Of  the  150  cases, 
107  were  cured,  25  under  treatment,  7 
advised  readmission  for  correction  of  de- 
formity, 11  deaths.  The  article  is  a  valu- 
able contribution  to  our  information  in  re- 
gard to  the  later  stages  of  hip  disease.  The 
following  deductions  are  given  by  the 
authors  : 

Hygienic  and  constitutional  measures 
exert  a  powerful  influence  in  the  control  of 
the  disease. 

The  early  diagnosis  of  hip-joint  disease 
represents  a  very  important  factor  in  attain- 
ing a  successful  ultimate  result. 

During  the  acute  stage  rest  in  bed,  asso- 
ciated with  the  usual  mechanical  appliances, 
is  preferrable  to  ambulatory  treatment. 

In  the  first  stage  it  is  essential  to  procure 
absolute  immobilization  by  fixation  and 
traction  (extension),  and  also  to  furnish 
protection  to  the  joint. 

In  the  second  stage  the  deformity  must 
be  corrected,  and  operative  procedures  re- 
sorted to  if  mechanical  methods  fail  after  a 
reasonable  length  of  time — usually  six 
months. 

Early  correction  of  the  deformity  is 
advised,  using  as  little  force  as  is  consistent 
with  the  individual  case. 

Adduction   with  flexion  is  the  deformity 
which  most  frequently  calls  for   correction. 
Flexion  without  adduction  rarely  requires 
correction. 

Forcible  correction,  followed  by  fixation, 
should  be  tried  before  attempting  reposi- 
tion by  femoral  osteotomy. 

Where  there  is  absolute  anchylosis  or 
only  a  few  degrees  of  motion,  and  all 
manifestations  incident  to  an  acute  condi- 
tion have  subsided,  the  operation  of  sub- 
trochanteric osteotomy  for  the  correction  of 
the  deformity  is  indicated,  supplemented, 
if  necessary,  by  tenotomy,  myotomy  and 
fasciotomy. 

The  injection  of  various  chemical  sub- 
stances into  abscesses  and  sinuses  has  not 
proved  beneficial. 

When  an  abscess  does  not  disappear  after 
repeated  aspirations  radical  operative  pro- 
cedures are  clearly  indicated,  to  be  followed, 
if  necessary,  by  resection  of  the  joint. 

When  the  disease  is  complicated  by  pus 
formation  in  young  children,  most  especially 
in  the  first  years  of  life,  there  is  less  need 
of  fearing  a  poor  result  than  in  adults,  as 
the  former  frequently  recover  with  a  mov- 
able joint,  a  condition  which  may  be  ex- 
plained by  the  fact  that  the  head  of  the 
bone  at  this  time  is  cartilaginous. 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


Long-standing  and  profuse  suppuration 
retards  the  process  of  reparation  and  gives 
rise  to  a  grave  prognosis;  furthermore,  the 
absorption  of  pus  is  associated  with  great 
danger  and  frequently  results  in  acute 
septicemia  and  amyloid  degeneration. 

Treatment  should  be  continued  not  only 
during  the  acute  and  subacute  stages,  but 
also  during  the  convalescent  period. 

Internal  Application  of  Antiseptics. 

One  who  watches  current  medical  litera- 
ture cannot  fail  to  be  impressed  with  the 
enthusiasm  with  which  the  profession  turns 
to  the  use  of  internal  antiseptics.  The 
changes  are  rung  on  antiseptic  inhalations 
in  phthisis,  antiseptic  injections  in  gonor- 
rhea, and  antiseptic  drugs  in  treatment  of 
typhoid  fever.  Medicine  in  one  of  its  re- 
cent issues  comments  on  this  as  follows  : 

The  dismal  failures  attending  the  use  of 
antiseptics  in  the  treatment  of  the  tubercu- 
losis of  the  skin  and  of  the  larynx  seem  to 
be  devoid  of  potent  analogy,  when  the  tu- 
bercular process  appears  in  the  lung.  There 
is  no  reason  to  believe  that  lung  tubercu- 
losis is  different  in  its  pathological  anatomy 
from  that  of  the  skin,  excepting  in  so  fat- 
as  lung  tissue  differs  in  its  anatomical  ar- 
rangement from  that  of  the  skin.  There  is 
no  reason  for  believing  that  the  process 
there  is  more  easily  reached  by  the  direct 
application  of  antiseptics  than  it  is  upon  a 
free  mucous  surface  such  as  that  of  the 
larynx. 

In  the  treatment  of  gonorrhea  changes 
are  rung  on  various  antiseptic  injections 
with  tiresome  frequency,  yet  all  writers 
practically  agree  that  the  gonococcus  is  not 
free  upon  the  epithelial  surface,  but  is  found 
deep  in  the  epithelium,  beyond  the  direct 
action  of  antiseptics. 

The  difficulty  of  making  an  ancient  ulcer 
of  the  leg  aseptic  has  been  recognized  ever 
since  we  have  had  exact  knowledge  of  the 
relation  of  infection  to  these  conditions. 
There  is  no  reason  for  believing  that  a  ty- 
phoid ulcer  of  the  intestine  could  be  more 
easily  disinfected  if  it  were  amenable  tu  di- 
rect application  of  antiseptics. 

The  above  is  not  written  with  a  view  of 
setting  up  the  opinion  that  antiseptics  are 
of  no  value  in  the  treatment  of  these  infec- 
tions. It  is  possible  that  they  may  be  of 
service  in  aiding  the  struggle  of  the  normal 
tissues  in  combating  an  infective  process, 
and  they  may  aid  in  preventing  the  exten- 
sion of  such  infection  to  healthy  tissues. 
But  it  is  written  with  the  idea  of  combat- 
ing the  commonly  exploited  notion  that 
such  substances  act  directly  upon  the  germs 
of  disease  and  that  they  act  as  antiseptics 
in  the  same  way  that  the  term  would  be  ap- 


plied to  describe  the  killing  of  the  anthrax 
bacillus  in  a  test-tube  with  bi-chloride  of 
mercury. 

Salt    and     Bright's    Disease. 

It  has  long  been  suspected  that  salt  used 
in  excess  might  be  a  cause  of  nephritis. 
The  kidneys  are  taxed  to  eliminate  a  portion 
of  it,  and  the  strain,  if  kept  up  a  long  time, 
is  more  than  they  are  able  to  bear.  Some 
studies  recently  made  seem  to  confirm  this 
opinion.  That  is  to  say,  too  large  an  amount 
of  common  salt  in  our  food  acts  as  an  irrit- 
ant, and  may  be  one  of  the  factors  in  caus- 
ing inflammation  of  the  kidneys.  Those 
who  take  this  condiment  in  large  quantities 
should  bear  this  in  mind  and  take  less  of  it. 
The  salt  habit  is  so  strong  in  many  persons 
that  they  can  enjoy  no  food  not  highly  sea- 
soned with  it.  This  is  certainly  a  hygienic 
error.  With  a  well-chosen  diet,  no  great 
amount  of  salt  is  required,  and  the  natural 
flavor  of  many  things  is  lost  when  much  of 
it  is  added.  Especially  is  little  salt  required 
when  a  large  amount  of  flesh  is  consumed. 
Carnivorous  animals  do  not  require  salt  at 
all.  There  are  races  of  men  who  live  mainly 
on  animal  food,  and  though  salt  abounds 
around  them  they  do  not  use  it.  It  is  the 
vegetable-eating  animals  and  races  of  men 
that  seem  to  require  salt  as  a  part  of  their 
diet.  Bearing  this  in  mind,  we  ought  to  be 
able  to  compose  our  food  and  condiments 
more  scientifically. 


Treatment  of  Eclampsia. 

Dr.  B.  C.  Hirst  (Medical  Record,  March 
4,  1S99).  During  the  attack  itself,  admin- 
ister chloroform.  As  soon  as  the  attack 
passes  off  give  hypodermically  fifteen  drops 
of  the  fluid  extract  of  veratrum  viride,  and 
a  drachm  of  chloral  in  solution  by  enema. 
Place  upon  the  tongue  two  drops  of  croton 
oil  diluted  with  a  little  sweet  oil.  Induce 
diaphoresis  by  hot  packs  and  extra  bed- 
clothing.  Inject  by  gravity  under  the  breast 
a  pint  or  more  of  deci normal  salt  solution, 
or  several  quarts  of  the  solution  by  enema. 
If  convulsions  recur,  repeat  the  veratrum  in 
five-drop  doses  if  the  pulse  is  quick  and 
strong.  If  the  face  is  congested  and  the 
pulse  full,  employ  venesection  enough  to 
reduce  the  pulse.  The  chloral  may  be  re- 
peated during  the  attack  two  or  three  times. 
Use  stimulants  if  the  pulse  is  weak  and 
rapid.  If  the  convulsions  cease  and  the 
patient  is  in  a  stupor  but  can  be  aroused 
enough  to  swallow,  give  dessertspoonfuls 
of  concentrated  solution  of  Epsom  salts 
every  fifteen  or  thirty  minutes  until  free 
catharsis  takes  place.  These  condensed 
directions  should  be  carried  in  the  pocket- 
case  of  every  obstetrician. 


THE  CHARLOTTE  MEDICAL    JOURNAL. 


413 


RLENNOSTASINE... 

((iXevva,  mucus;  6ratii8,  a  staying.) 

Stops  Secretion  of  Mucus 


Invaluable,  therefore,  in  grip,  influenzal,  laryngeal 
and  bronchial  colds  and  hay  fever. 

Relieves  an  influenzal  cold  in  a  few  hours  without 
injurious  after-effects.         .         .         .         . 


Full  literature  and  samples  on  application 


McKESSON  &  ROBBINS,    -  -  -    NEW  YORK. 


For  All  External  Dressings 

the  highest  fulfillment  of  modern  aseptic  or  antiseptic  surgery  is 
found  in  I'nguentine.  which  satisfies  all  the  requirements;  for  it  is 
Antiseptic,  Permanent,  Non-Irritating  and  Constructive.  It  is  the 
most  economical  and  least  expensive. 

THE  CONTAINER 

is  thoroughly  antiseptic,  clean,  convenient;  can  be  carried  in  pocket; 
always  at  hand  for  minor  work  ;  or  maybe  thrown  in  satchel  with 
no    risk    of    soiling   anything. 

THE   DRESSER 

is  the  ideal  antiseptic;  compounded  of  Ichthyol,  Carbolic  Acid,  and 
Alum,  after  the  modified  formula  of  Sir  Astley  Cooper,  but  with  a 
pure  Petrolatum  base.  The  irritating  effects  of  ordinary  alum  are 
entirely  eleminated,  rendering  a  dressing  of  marvelous  healing  quali- 
ties, i.e.  astringest,  but  non-irritating.  Unguentine  is  used  daily  in 
practice  by  a  majority  of  the  physicians  and  surgeons  of  America  and 
lias  been  reviewed  scientifically  by  more  medical  publications  than 
have  all  other  dressings  combined. 

Price,  2  oz.  Tube,  25c.     Per  Doz.  $2.00. 

To  introduce  Unguentine  in  the  Collapsible  Tube  we  will  send  to  yon,  on 

request,  one  tube  free,  prepaid. 

THE  NORWICH  PHARMACAL  CO,  Sole  flan'f'rs, 

NORWICH,  NEW  YORK. 


414  THE  CHARLOTTE  MEDICAL  JOURNAL. 


Predigested 
Beef 


Is   the   basis  of    Armour's     Nutrient    Wine    of 

Beef  Peptone,  a  preparation  presenting  the  entire 
digestible  substance  of  prime,  lean  Beef,  in  a  form  re- 
quiring no  effort  of  the  digestive  organs  to  render  it 
diffusible. 


Nutrient  Wine 


Is  especially  indicated  in  the  treatment  of  all  cases  of 
faulty  nutrition  occasioned  by  gastric  weakness,  Ulcera- 
tion of  the  Stomach,  Phthisis,  Typhoid  Fever  and 
wherever  a    readily  assimilable  food  is  required. 


Manufactured  by 


ARMOUR  &  COMPANY, 
CHICAGO. 


THE  CHARLOTTE  MEDICAL  JOURNAL 


415 


THE 


Charlotte  Medical  Journal. 

Editorial  Department. 


E.  C.   REGISTER,   M.  D.  J.  C.   MONTGOMERY.   M.  D. 

Editors  and  Publishers. 

No.  36  South  Tkyon  Street,    -    -    -    - 
Charlotte,  N.  C. 


SUBSCRIPTION.  $2-50  PER  YEAR, 


LIFE    EXAHINATIONS    AQA1N. 

We  recently  had  occasion  to  inquire  into 
the  causes  for  defective  certificates  of  life 
risks  as  shown  by  the  avowedly  high  mor- 
tality of  insured,  especially  from  chronic 
diseases,  soon  after  insurance  is  taken.  We 
justly  eliminated  dishonesty  on  the  part  of 
the  examiner  as  a  frequent  cause  ;  also  in- 
capacity, although  that  is  doubtless  more 
prevalent  among  examiners  than  the  former. 
It  seems  certain,  also,  that  such  examiners 
are  found  not  seldom  among  good,  success- 
ful practitioners.  They  simply  cannot  see 
the  relation  of  things.  They  cannot  under- 
stand why  a  well  man  should  not  be  entitled 
to  the  benefits  of  life  insurance,  regardless 
of  the  health  of  ancestors  and  collateral  re- 
lations, and  so  they  do  not  probe  deeply 
into  the  family  history.  They  may  record 
one  vital  event,  like  consumption  or  apo- 
plexy, and  leave  unrecorded  related  vital 
events  of  equal  importance,  or  report  them 
casually  as  typhoid  fever,  kidney  disease. 
and  the  like.  More  commonly  they  accept 
unchallenged  the  stereotyped  answer  of- the 
applicant,  "don't  know,"  and  they  might 
fittingly  add  for  themselves,  "I  don't  care." 

But  this  kind  of  examiner  belongs  to  a 
relatively  small  class,  like  the  other ;  and, 
like  the  other,  cannot  be  helped  or  reformed 
by  advice  or  censure. 

We  are  speaking  for  that  large,  prepon- 
derating class  of  examiners,  the  honest, 
capable,  if  sometimes  careless,  ones ;  and 
we  place  the  stigma  for  defective  certifi- 
cates where  it  belongs — on  the  applicant — 
though  not  forgetting  an  admonition  to  the 
careless  examiner.  In  general  terms  it  is 
this  :  Suspect  an  ambuscade  from  every  ap- 
plicant for  insurance.  Many  of  them  will 
surely  be  lying  in  wait  to  deceive  you. 
There  are  countless  men  who  would  not 
wrong  a  neighbor  for  the  world,  who  will 
yet  cheat   the  government   or  a  corporation 


without  remorse.  So  there  are  men  who  never 
lie  till  they  apply  for  life  insurance,  and 
then  the  truth  is  not  in  them.  They  will 
lie  both  by  evasion  and  direction.  They 
will  say  they  are  "laborers"  when  they  may 
be  saloon  roustabouts.  They  will  say  they 
take  stimulants  "seldom,"  or  "moderately," 
when  they  may  be  full  of  all  sorts  of  drinks 
all  the  time.  They  will  say  they  are  never 
sick,  or  only  with  a  "little  cold,"  or  "dys- 
pepsia," too  trifling  to  remember,  when 
very  likely  you  have  yourself  attended  them 
in  some    serious    illness. 

They  "don't  know"  the  causes  of  death  of 
dead  relations,  nor  the  duration  of  last  sick- 
ness. They  will  make  a  "fever,"  or  "blood 
poisoning,"  do  duty  for  a  well  known  tu- 
berculosis. They  will  make  a  "touch  of 
the  grippe"  cover  up  all  sorts  of  grave 
troubles,  or  soften  the  blackness  of  the  list, 
when  tuberculosis  has  already  been  ad- 
mitted. 

Ignorance  of  remote  family  history  may 
be  genuine,  particularly  of  those  dying  in 
the  old  world,  for  correspondence  lags;  and 
by-and-by  ceases.  Native  Americans  do 
not  always  know,  although  their  far  ances- 
tors may  have  been  colonists  of  Jamestown 
or  Plymouth  Rock;  but  they  always  know 
something,  and  that  something  should  al- 
ways be  drawn  out  of  them.  The  flippant 
Frenchman  who  said  that  few  Americans 
have  grand-fathers,  may  have  been  an  ex- 
aminer for  life  insurance,  but  even  he  could 
have  exhumed  many  a  grand-father  by  pa- 
tient digging.  We  must  help  these  agnos- 
tic orphans  to  construct  a  family  tree,  and 
when  it  is  raised  we  must  scrutinize  closely 
its  roots  and  its  branches. 

Most  application  blanks  are  sufficiently 
full,  if  we  but  get  answers  to  all  questions. 
This  is  important.  Don't  answer  a  ques- 
tion with  a  dash.  If  the  question  seems 
unimportant,  or  seems  a  repetition,  get  an 
answer  to  it.  That  information  is  needed 
in  the  records  of  the  home  office,  even  if  it 
does  not  affect  the  individual  risk.  Often 
these  questions  recall  diseases  that  the  ap- 
plicant has  forgotten,  and  they  are,  there- 
fore, a  help  to  honesty.  At  the  worst  the 
dishonest  are  left  to  the  resource  of  plain 
lying,  and  even  these  are  sometimes  admon- 
!  ished  by  the  casual  hint  that  the  validity  of 
'  their  insurance  depends  on  the  truthfulness 
1  of  their  replies.  On  the  other  hand  tactful 
adroitness  will  often  draw  out  the  reluctant 
f  truth  where  a  bolder  method  would  be  baf- 
1  fled  or  beaten.  This  applies  not  only  to 
'  personal  and  collateral  diseases,  but  to  the 
'commonest  questions  of  fact,  e.  g.,  as  to 
I  whether  there  has  ever  been  a  rejection  of  a 
former  application.  On  all  points  we  must 
j  be  patient  but  thorough  inquisitors,  if  only 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


to  avoid  the   mortification  of  a  too  easy  de- 
ception. 

Specific  enumeration  of  the  many  errors 
of  the  deceiver,  and  omissions  of  the  exam- 
iner, has  been  purposely  omitted  for  lack  of 
space ;  but  one  of  the  former  may  be  speci- 
fied to  bring  out  in  brilliant  illumination  a 
virtue  as  rare  as  it  is  tender  and  even  ro- 
mantic. 

Venereal  disease  is  almost  never  admit- 
ted. Applicants  will  deny  this  who  have 
been  treated  for  it  by  the  very  examiner 
who  is  questioning  them.  If  this  is  per- 
plexing what  shall  be  said  of  the  candor  of 
one  who  admits  that  he  has  had  it,  who 
wants  the  insurance  for  the  protection  of 
his  family,  but  who  would  rather  go  with- 
out it  than  have  his  wife  see  the  cold  histor- 
ical fact,  in  black  and  white,  in  his  con- 
tract, when  she  comes  to  collect  his  death 
benefit  ? 

Returning  to  the  place  of  starting  :  The 
present  high  mortality  of  all  kinds  of  life 
insurance  risks  is  a  result  not  mainly  of  de- 
fective objective  methods  of  examination, 
as  is  too  often  charged,  but  from  the  sub- 
jective history,  particularly  that  of  family 
morbidity  and  mortality  ;  and  this  is  nearly 
always  to  be  charged  to  the  applicant  and 
not  to  the  examiner.  When  some  infalli 
ble  method  of  extracting  the  truth  from  a 
reluctant  or  dishonest  witness  can  be  found 
there  will  be  fewer  deaths  from  consump- 
tion, Bright's  disease,  and  the  like,  dating 
but  a  few  months  or  years  from  that  of  the 
policy,  and  there  will  be  far  less  undeserved 
obloquy  resting  on  the  medical  examiner. 


WHY  IS  IT? 


When  our  nation  decided  to  go  to  war 
witli  Spain,  and  a  call  was  made  for  volun 
teers,  the  one  thing  which  we  made  a  mat- 
ter of  congratulation  was  the  supposed  fact 
that  sanitary  science  was  nearly  in  a  state 
of  perfection.  Surgery  was  no  longer  the 
haphazzard  matter  of  experiment,  which 
characterized  it  formerly,  but  a  thorough 
knowledge  of  antiseptics  and  the  germ 
theory  would  reduce  the  per  cent,  of  army 
losses  to  a  minimum.  The  surgeon  of  the 
sixties  did  the  best  he  could,  of  course,  but 
under  the  new  order  of  things  the  large 
death  rate  of  all  former  wars  was  not  to 
prevail  in  this  one. 

Well,  the  army  was  readily  formed  and 
organized,  and  finished  the  war  with  honor 
in  one  hundred  days.  What  did  we  find  as  a 
sequal?  A  howl  in  every  newspaper  in  the 
land  about  the  murderous  unsanitary  condi- 
tions of  all  the  camps.  Fifty  thousand 
soldiers  sick  in  the  hospitals  ;  sick  soldiers 
dying  by  the  hundreds  for  want  of  the  com- 


monest remedies ;  charges  of  inefficiency, 
drunkenness,  and  neglect  against  many 
medical  officers ;  governors  of  States  de- 
manding that  their  regiments  be  disbanded 
and  sent  home  for  care  and  civilized  treat- 
ment. 

Is  this  because  politics  dictated  too  many 
appointments?  Is  it  because  the  greed  of 
contractors  has  emulated  the  corruption  of 
the  Turk?  Or  might  it  not  be  true  that 
modern  sanitary  and  surgical  science  is  yet 
far  from  perfection  ? 

The  old  army  doctor  had  few  remedies. 
He  knew  nothing  of  the  germ  theory.  He 
had  absolutely  no  known  aseptics ;  but  he 
went  to  the  front  with  his  men  and  used 
his  old  fashioned  judgment  in  caring  for 
them,  and  it  is  a  fact  that  cannot  be  denied 
that  there  were  greater  manifestations 
of  righteous  indignation  against  the  medi- 
cal department  of  the  army  in  the  last 
thirty  days  of  the  war  in  Cuba,  than  could 
be  heard  during  the  whole  five  years  of  our 
late  unpleasantness. 

Perhaps  it  would  be  well  for  the  modern 
medical  optimist  to  ask  himself  if  the  old 
army  surgeon,  even  if  he  were  ignorant  of 
the  nature  of  the  streptococcus  pyogenus, 
might  not  have  filled  a  place  in  army  affairs, 
which  too  unfortunately  is  vacant. 


ANTITOXIN. 

Since  commercialism  is  to  rule  the  des- 
tiny, apparently,  of  the  great  discovery  of 
antitoxin  in  this  country,  we  are  brought 
to  realize  fully  the  influence  of  corporate 
greed. 

In  the  granting  of  patents  to  the  foreign 
manufacturers,  the  stigma  of  this  peculiar 
trait  of  humanity  falls  upon  the  science  of 
medicine. 

While  the  immortal  Jenner  rests  upon 
the  high  pedestal  of  honor,  to  which  the 
science  of  medicine,  and  the  gratitude  of 
humanity  have  elevated  him,  we  may  truly 
deprecate  the  disgrace  of  witnessing  in  this 
modern  era  of  medicine,  the  lowering  of 
true  scientific  discovery  to  the  base  and  ig- 
noble interests  of   manufacturing  chemists. 

It  is  not  possible  that  the  medical  profes- 
sion will  submit  tamely  to  this  disgracerul 
usurping  of  their  rights,  since  the  discovery 
of,  and  application  of  antitoxin  in  the  treat- 
ment of  diphtheria  has  been  the  result  of 
the  scientific  labors  of  so  many  of  those 
eminent  in  the  profession. 

The  use  of  antitoxin  having  been  followed 
by  such  brilliant  results  in  this  country,  as 
a  curate  agent,  and  as  a  preventative  has 
no  doubt  led  enthusiastic  physicians,  to  rely 
wholly  upon  it.  Although  the  granting  of 
patents  may  not  seriously  interfere  with  the 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


individual  rights  of  physicians  in  its  use, 
there  are  certainly  some  reasons  to  believe 
that  in  the  treatment  of  diphtheria  the  ad- 
juvants, which  may  be  used  in  connection 
with  antitoxin  should  be  borne  in  mind, 
and  in  treating  every  case  of  diphtheria 
these  remedies  should  be  used.  As  nutri- 
tious food  and  sufficient  diluents  are  very 
necessary  in  all  cases  where  the  vitality  is 
lowered  and  the  system  has  to  eliminate 
diseased  products. 

When  the  soreness  of  the  throat  is  suffi- 
cient to  prevent  the  swallowing  of  nourish- 
ment, a  remedy  that  will  annul  the  pain 
and  allow  food  to  be  taken,  even  tempora- 
rily, does  help. 

In  cocaine  we  have  such  a  remedy.  Ap- 
plied with  a  swab  or  spray  it  benumbs,  to  a 
great  extent,  the  soreness  of  mucous  sur- 
faces, irritated  by  the  process  of  swallow- 
ing. While  we  do  not  have  a  sine  qua  non 
in  antitoxin  for  the  treatment  of  diphtheria 
it  has  lessened  the  mortality  largely  in  cura- 
ble cases,  preventing  to  some  extent,  and 
curing  a  larger  per  cent.,  than  any  other 
known  remedy  when  applied  early. 

Of  the  various  sequelae  they  are  the  same 
as  of  yore,  and  require  systemic  and  syste- 
matic treatment  at  (he  hands  of  the  physi- 
cian. Further  experimentation  may  reveal 
methods  of  preparation  and  modes  of  appli- 
cation that  will  give  it  the  pre-eminence 
which  the  most  enthusiastic  adherents  could 
desire. 


RECTAL  IRRIGATIONS  IN  DISEASES  OF 
CHILDREN. 

It  is  peculiarly  striking  how  often  some 
old-time  practice  is  again  revived  in  a  new 
and  taking  form,  and  at  once  is  found  to 
fit  many  indications  that  were  before  re- 
garded as  perplexing.  Such  may  be  truly 
said  of  rectal  irrigation.  There  is  abso- 
lutely nothing  new  in  the  idea  of  its  medi- 
cal working,  for  the  rectum  has  been  used 
for  medication  from  time  immemorial,  but 
the  technique  of  its  use  has  gained  for  rectal 
irrigation  a  field  that  broadens  with  such 
experience  of  its  results.  Cantani  recom- 
mended it  for  cleaning  out  the  large  intes- 
tines in  Asiatic  cholera  some  15  years  ago, 
and  since  that  time  its  application  to  other 
disorders  has  so  rapidly  extended,  that  to- 
day, few  medical  journals  can  be  found  that 
do  not  contain,  in  some  issue,  a  reference 
to  its  use. 

Evidently  rectal  irrigation  has  proven  a 
successful  means  of  giving  relief  in  the  field 
of  its  fitness.  It  can  be  used  with  either 
hot  or  cold  water,  medicated  with  mild  and 
inoffensive  antiseptics,  such  as  boric  acid, 
peppermint,   soda  bicarbonate,  quinine  and 


chammomile,  or  with  astringents  and  alter- 
atives as  nitrate  of  silver  in  weak  solution, 
tannin  or  sulphate  of  copper.  Perhaps  the 
most  valuable  menstruum  for  rectal  irriga- 
tion is  the  decinormal  salt  solution,  contain- 
ing one  drachm  of  sodium  chloride  to  two 
pints  of  boiled  water,  employed  at  about  a 
temperature  of  105  deg.  to  112  deg.  F.  A 
fountain  syringe  is,  perhaps,  the  readiest 
apparatus  for  general  use,  and  while  the 
colon  rubber  tube  was  formerly  found  use- 
ful, the  shorter  tube  made  of  either  hard  or 
soft  rubber  and  also  of  metal,  providing  for 
a  recurrent  flow,  as  devised  by  Kemp,  of 
New  York  city,  will  now  be  found  more 
effective  and  almost  perfect,  when  proper 
attention  to  its  use  is  regarded.  The  secret 
of  this  is  to  have  the  pelvis  of  the  patient 
elevated  to  the  highest  angle  possible,  while 
laying  on  the  side,  when  the  tube  can  be 
introduced  the  whole  length,  even  in  in- 
fants, sometimes  dropping  into  place  with- 
out the  slightest  force  being  used. 

It  is  in  certain  disturbances  peculiar  to 
children  that  rectal  irrigation  as  thus  pre- 
sented is  most  happily  adopted.  In  convul- 
sions it  affords  relief  most  rapidly,  the  child 
often  falling  asleep  before  the  irrigation  is 
completed.  It  is  more  specially  prepared 
than  the  hot  bath  and  will  clean  out  the 
lower  intestine  at  the  same  time  it  exerts 
its  sedative  effect. 

In  collapse  from  cholera  infantum  the 
hot  rectal  irrigation  to  the  extent  of  one  or 
two  quarts  of  decinormal  salt  solution  will 
restore  the  peripheral  circulation  and  relieve 
renal  suppression,  besides  washing  out  all 
decomposed  intestinal  detritus.  In  acute 
dysentery  it  keeps  the  mucous  membrane 
clean,  relieves  pain  and  prepares  the  way 
for  the  local  use  of  bismuth  or  quinine  with 
rapid  success. 

In  ordinary  attacks  of  severe  intestinal 
colic  from  acute  or  chronic  intestinal  indi- 
gestion, it  acts  with  magic  promptness,  and 
even  in  shock  from  hemorrhage  it  will  re- 
vive the  patient  until  intravenous  infusion 
can  be  used. 

The  great  advantages  of  the  hot  salt  irri- 
gation may  be  considered  to  be  its  inoffen- 
siveness  towards  the  mucous  epithelium, 
causing  no  irritation  or  denudation  of  the 
mucous  membrane,  and  the  readiness  with 
which  it  seems  to  be  absorbed  into  the  capil- 
lary blood-vessels  without  disturbing  the  re- 
lations of  the  red  blood  corpuscles.  In  this 
latter  manner  it  refills  the  partially  emptied 
blood-vessels,  consequently  restoring  the 
normal  blood  pressure. 

In  summer  diarrhoea,  with  high  temper- 
ature, cold  rectal  irrigation,  with  the  deci- 
normal salt  solution  at    about  80  deg.  F.  to 


418 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


S^  deg.  F.,  will    reduce  the   body  tempera- 
ture decidedly. 

Once  or  twice  daily  is  often  enough  for 
their  employment,  and  frequently  only  one 
or  two  irrigations  are  sufficient  to  effect  a 
cure. 


A  STATE  OF  THINGS. 

It  is  rather  interesting  to  consider  the  po- 
sition of  a  physician  who  has  the  misfor- 
tune to  be  called  to  a  case  which  develops 
symptoms  of  small-pox.  It  is  self-evident 
that  the  patient  is  to  be  pitied.  If  it  occurs 
in  a  city  too  small  to  support  a  regular  hos- 
pital for  contagious  diseases,  the  sugges- 
tions for  his  management  will  vary  from 
shooting  him  to  a  shanty  in  the  suburbs.  It 
is  not  to  his  predicament,  however,  that  we 
would  call  attention,  but  to  the  less  mani- 
fest troubles  of  his  medical  attendant. 

They  begin  with  the  question  of  report- 
ing the  case  to  the  health  board.  In  all 
probability,  in  these  days  of  quite  general 
vaccination,  it  is  a  case  of  varioloid.  There 
is  no  history  of  contagion — volunteered — 
and  the  symptoms  are  irregular.  The  medi- 
cal student  sticks  a  pin  into  the  fact  that  a 
patient  with  excruciating  backache  should 
be  suspected  of  having  variola ;  unfortu- 
nately the  first  case  of  it  he  meets  may  not 
complain  of  backache  at  all.  What  he  does 
have  is  a  patient  with  fever,  developing  a 
suspicious  rash.  What  about  reporting  it 
to  the  Board  of  Health? 

It  is  a  clear  case  of  damned  if  you  do  and 
damned  if  you  don't.  You  hardly  expect 
the  gratitude  of  the  patient  or  his  family.  If 
the  diagnosis  should  be  erroneous,  human 
nature  is  not  yet  up  to  the  plane  of  forgetting 
it  the  next  time  any  members  of  the  family 
are  sick.  Reporting  an  undoubted  case  will 
bring  upon  you  the  maledictions  of  the  busi- 
ness men  because  the  trade  of  the  town  is 
seriously  injured  at  once.  The  one  case  is 
magnified  to  twelve  in  the  neighboring 
towns,  and  farmers  dare  not  drive  through 
the  place. 

Nevertheless,  as  a  conscientious  physi- 
cian you  cannot  do  otherwise  than  do  your 
best  to  preserve  the  health  of  the  commu- 
nity ;  at  your  next  visit  a  red  card  is  on  the 
house.  You  feel  repaid  for  the  lamenta- 
tions of  the  family,  and  the  bad  feelings  of 
the  business  men  by  the  satisfaction  of 
knowing  that  you  are  a  public  benefactor, 
and  that  you  have  by  your  timely  warning 
kept  the  dread  disease  from  claiming  many 
other  victims. 

How  does  the  public  express  to  you  its 
appreciation  and  gratitude?  In  all  sorts  of 
fashions,  giving  you  glimpses  of  human 
nature  you  had  not  before  experienced.      A 


respectable  number  see  nothing  surprising 
or  worth  mentioning  in  the  whole  matter. 
They  expect,  of  course,  that  you  always  do 
so.  Some  friends  continue  to  come  into 
the  office  and  you  feel  that  they  will  stand 
by  you  though  you  are  in  trouble.  But 
certain  ones  will  maintain  that  it  is  shame- 
ful that  you  go  on  the  street  after  coming 
out  of  a  pest  house.  Many  will  back  away 
from  you  if  they  find  themselves  by  chance 
in  proximity.  Your  practice  will  be  al- 
most limited  to  the  few  who  have  not  heard 
that  you  are  the  small- pox  doctor.  You  can 
not  play  whist  in  your  club,  you  can  not  go 
to  church, you  can  not  go  anywhere  for  there 
are  sure  to  be  some  nervous  bodies  there 
whose  misery  would  spoil  your  comfort. 

Of  course  you  have  changed  all  your 
clothing  and  left  your  old  suit  to  be  burned  ; 
you  have  scrubbed  up  with  bichloride  but  you 
get  to  have  a  very  active  sympathy  with 
the  lepers  of  Palestine.  However,  this  is 
all  a  part  of  a  doctor's  life,  and  the  moral 
is  that  you  ought  not  to  have  been  a  doctor. 

You  are  finally  able  to  cheerfully  answer 
all  sortsof  fool  questions  about  small-pox, and 
to  be  contented  with  your  one  patient,  but 
you  do  finally  lose  your  temper  over  a  thing 
unworthy  of  your  notice.  Somebody  who 
objects  to  the  compulsory  vaccination  of  his 
children  proclaims  that  the  whole  affair  has 
been  gotten  up  by  the  doctors  who  have 
faked  a  case  because  their  business  got  dull. 


THE  CURETTE  IN  SUPPURATIVE  OTITIS. 

While  some  cases  of  suppurative  otitis 
media  recover  under  any  or  no  treatment 
whatever,  there  is  as  a  rule  no  class  of  cases 
that  give  the  physician  more  trouble  and 
worry.  All  chronic  cases  which  are  not 
benefitted  by  the  ordinary  routine  treatment 
or  if  benefitted  are  not  cured  are  proper  sub- 
jects for  the  curette.  Each  operator  must 
choose  for  himself  the  shape  of  instrument 
to  be  used.  I  find  Denche's  curettes  suit  me 
the  best  as  they  are  small  and  only  a  small 
instrument  can  be  properly  manipulated  in 
such  confined  space.  Then  they  are  so 
shaped  as  to  reach  the  margins  of  the  cavity 
all  around. 

When  a  case  has  gone  on  a  few  weeks 
with  little  or  no  improvement  under  ordina- 
ry treatment,  or  where  dead  or  uncovered 
bone  can  be  felt  I  resort  to  curettement. 
The  small  straight  curette  is  used  for  all  that 
part  of  the  cavity  exposed  to  view.  Then 
the  curettes  bent  at  an  angle  are  called  into 
service  and  the  remaining  part  of  the  cavity 
thoroughly  scraped,  care  being  exercised  to 
remove  all  thickened  membrane  wherever 
found.  The  ear  must  be  thoroughly  clean- 
sed, both  before   and    after    the    operation. 


THE  CHARLOTTE  MEDICAL  JOURNAL, 


Saturated  solution  of  boric  acid  in  alcohol  is 
then  injected  into  the  cavity  once  a  day  and 
the  patient  is  instructed  to  use  the  syringe 
with  any  simple  antiseptic  sufficiently  often 
to  keep  the  canal  as  free  from  secretion  as 
possible.  I  would  not  recommend  the  cu- 
rette as  a  routine  treatment  any  more  than  I 
would  ossiculotomy,  but  I  would  say  this, 
an  early  curettement  will  save  more  than  one 
ossiculotomy  and  mastoid  operation  as  well 
and  give  just  as  good  results  as  far  as  hear- 
ing is  concerned,  besides  saving  the  patient 
the  worry  in  thinking  of  ,the  graver  opera- 
tion and  the  danger  in  undergoing  it. 


THE  TITLE  DOCTOR. 

The  title  "Doctor" '  has  so  long  been  as- 
sociated with  the  medical  profession,  that 
we  have  come  to  look  upon  it  as  the  special 
property  of  a  physician,  and  when  any  one 
else  is  called  Doctor  we  immediately  begin 
to  enquire  into  his  right  to  the  title.  No 
one  ever  questions  the  right  of  a  Doctor  of 
Philosophy  or  of  Divinity  to  its  use,  but 
there  are  other  people  often  called  Doctor, 
who  cannot  show  so  good  a  claim  to  the  ti- 
tle in  its  original  sense. 

The  term  "Doctor"  means,  as  we  all 
know,  "learned  one,"  and  was  originally 
conferred  by  the  colleges  on  men  especially 
well  qualified  in  certain  branches  of  learn- 
ing. This  signification  implied  a  superi- 
ority over  the  generality  of  mankind,  and 
as  such  received  universal  respect.  To  win 
the  confidence  of  the  public,  it  became  al- 
most necessary  that  a  physician  should  first 
study  long  enough  to  obtain  the  title  of  one 
"learned  in  medicine."  In  this  way  the 
title  became  so  common  among  physicians 
that  the  laity  lost  sight  of  its  true  signifi- 
cance and  began  to  use  the  terms  as  synony- 
mous. 

Finally  "Doctor"  began  to  be  applied  to 
anyone  who  dealt  in  physic  or  in  drugs. 
Thus  different  classes  of  people,  who  would 
certainly  never  think  of  calling  themselves 
learned,  have  been  termed  Doctor.  First 
came  the  dentist,  then  the  veterinary,  then 
theoptician,  and  finally.the  druggist.  Some- 
times even  the  bartender  and  the  butcher 
rejoice  among  their  friends  under  the  pseu- 
donym of  Doctor.  Hut,  one  may  ask,  have 
not  these  men  as  good  a  right  to  the  title 
as  the  physician?  Are  they  not  as  skilled 
in  their  work  as  he  in  his?  This,  however, 
is  a  misconception  of  the  meaning  of  the 
term.  The  title  "Doctor"  does  not  mean 
skilled,  it  means  /earned.  It  applies  not 
to  the  man  will)  well  trained  hands,  but  to 
the  man  with  a  broad  ami  cultivated  mind 
— a  mind  raised  to  a  level  well  above  the 
ordinary.      Viewed     from    this    standpoint 


the  title  should  not  be  applied  to  these 
"professions,"  though  individual  men  in 
them  may  be  learned  in  directions  beyond 
the  scope  of  the  class  to  which  they  belong. 
But  it  may  be  asked,  do  then  the  physicians 
as  a  class  deserve  the  title  of  "learned?" 
This  is  indeed  a  hard  question  for  a  physi- 
cian to  answer.  We  can  say  that  all,  or  al- 
most all,  have  degrees  from  some  college 
stating  that  the  title  of  Doctor  of  Medicine 
has  been  conferred  upon  them.  If  these 
college  degrees  are  all  that  they  claim  to  be, 
we  can  answer  the  question  in  the  affirma- 
tive and  establish  before  all  men  a  good 
right  to  the  title  of  Doctor  in  its  original 
meaning.  Now  how  does  the  thinking 
public,  and  how  do  our  law-makers  regard 
these  degrees?  The  law  regards  the  degree 
of  Doctor  of  Medicine  as  of  so  little  value, 
that  it  is  not  even  considered  in  granting  a 
physician's  license.  The  man  without  a 
degree,  who  has  passed  the  necessary  ex- 
amination, is  the  perfect  equal  of  him  with 
a  college  title,  and  the  former  is  now  dubbed 
Doctor  as  well  as  the  latter.  Thus  the  true 
meaning  of  the  word  has  been  completely 
pushed  to  the  side. 

If  this  is  the  case,  what  has  the  title 
"Doctor"  come  to  mean?  Has  it  any  real 
significance?  As  we  have  seen,  its  origi- 
nal meaning  of  learned  one  is  now  rarely 
even  considered.  To  the  people  it  is  merely 
a  short  term  tor  physician  and  in  thai  sense 
it  carries  milch  meaning  with  it.  The  phy- 
sician himself  will  after  a  time  be  forced  to 
view  the  term  Doctor  in  this  way.  But 
having  set  aside  its  true  meaning  of  "learn- 
ed one,"  he  will  be  unable  to  contend  that 
uneducated  people  should  not  be  addressed 
as  Doctor,  but  must  be  willing  to  share 
with  anyone  the  title  which  he  now  so  jeal- 
ously guards. 


COnriERCIALISM   IN  MEDICINE. 

Of  all  quacks  the  one  described  as  above 
is  the  most  reprehensible.  The  man  who 
stands  on  the  inside  of  the  gate  into  the 
medical  world  and  is  there  for  the  cold  cash 
he  can  get  out  of  it  is  an  enemy  both  to  the 
world  and  to  the  profession  he  dishonors. 
The  man  who  keeps  a  case  of  astigmatism 
for  instance,  coming  to  his  office  every  day 
for  four  or  five  weeks,  running  up  a  big 
doctor's  bill  when  he  could  prescribe  just 
as  well  in  as  many  days,  is  no  better, 
no  more  honest  or  honorable  than  the  high- 
wayman who  holds  up  his  victim  in  a  dark 
alley  and  demands  his  money  or  his  life. 
My  sympathies  are  rather  with  the  high- 
wayman. 1  instance  a  case  as  above,  be- 
cause it  seems  to  me  there  is  more  of  that 
kind  of  quackery  in  eye  work  than  in  any 
other    department    of  medicine.      Sight    is 


420 


THE  CHARLOTTE    MEDICAL  JOURNAL. 


precious,  but  that  is  no  reason  one  should 
trade  upon  it  just  as  the  merchant  does  in 
dry  goods  or  the  speculator  in  stocks. 

We  expect  nothing  better  than  commer- 
cialism from  the  lost-manhood  specialist 
who  advertises  in  the  daily  press  of  all  our 
large  cities,  but  one  does  expect  more  from 
those  of  our  own  number  who  pretend  to 
be  honest  practitioners  of  medicine.  To 
this  same  class  belongs  the  man  who  repre- 
sents a  case  as  very  grave  when  in  reality  it 
is  far  better  than  it  looks  to  the  eye  of  a 
layman.  This  man  trades  on  his  patient's 
susceptibilities,  and  this  is  not  honest.  A 
physician  should  in  the  nature  of  things  be 
an  honest  man,  and  an  honest  man  will  not 
be  drawn  into  commercialism  in  medicine. 


WHO  IS  RESPONSIBLE? 

For  the  last  several  mnoths  the  whole 
country  has  been  busy  finding  fault  with 
the  way  in  which  the  Spanish  war  was  man- 
aged, and  in  trying  to  shove  off  the  respon- 
sibility upon  some  one  else's  shoulders. 
Every  one  has  to  acknowledge  that  things 
did  not  run  as  smoothly  as  they  should 
have,  and  that  there  was  much  suffering 
which  might  have  been  prevented. 

Still  I  am  inclined  to  believe  that  we 
should  blame  ourselves  as  a  nation,  rather 
than  make  a  scape-goat  of  the  administra- 
tion or  of  any  especial  officer  or  officers. 
Never  was  there  a  nation  more  thoroughly 
unprepared  than  ours,  when  it  plunged  in- 
to this  war ;  and  never  was  there  a  people 
which  expected  more  of  its  soldiers.  Now, 
when  the  war  is  over,  we  are  surprised  that 
there  was  mismanagement,  a  mismanage- 
ment which  any  one  without  the  conceit  of 
the  average  American  would  have  foreseen 
to  have  been  almost  inevitable,  so  hurriedly 
were  we  obliged  to  prepare  ourselves. 

No  department  of  the  army  has  been 
more  blamed  than  the  medical  corps,  and, 
though  this  abuse  is  often  deserved,  the 
fault  seems  to  lie  more  with  our  general 
system  than  with  the  men.  A  physician, 
absolutely  without  military  training  and 
knowing  nothing  of  the  daily  routine  of  a 
camp,  is  made  regimental  surgeon  and  is 
expected  to  understand  and  perform  all  of 
his  military  duties  by  intuition.  This  is  not 
all.  The  volunteer  colonel  may  know  how 
to  drill  his  men  in  an  armory,  but  he  prob- 
ably knows  but  little  more  than  his  surgeon 
about  arranging  a  sanitary  camp,  and  very 
naturally  the  two  together  make  a  mess  of 
it.  Another  difficulty  which  confronts  the 
surgeon  is  that  our  volunteers  are  not  used 
to  discipline.  They  do  not  recognize  the 
necessity  of  following  the  regulations,  es- 
pecially those  in    regard  to  keeping  them- 


selves and  their  camps  clean.  Often,  too, 
they  have  known  their  surgeon  in  private 
life  and  look  upon  him  as  most  people  look 
upon  a  physician,  as  a  person  upon  whom 
they  can  call  at  all  times,  and  who  must  do 
all  they  require  of  him.  Under  such  con- 
ditions, is  it  surprising  that  the  men  should 
complain  of  the  surgeon  who  has  tried  to 
do  his  duty,  or  that  sickness  should  have 
broken  out  in  the  camps? 


ARMY  flEDICAL  DEPARTflENT. 

There  are  few  if  any  papers  in  the  coun- 
try that  have  not  criticised  the  conduct  of 
the  Army  Medical  Department,  but  they 
all  seem  to  confine  themselves  strictly  to 
criticism.  It  is  very  easy  to  criticise,  but 
much  harder  to  find  a  remedy.  As  so 
much  fault  has  been  universally  found 
with  the  Medical  Corps,  a  suggestion  here 
may  be  tolerated. 

It  is  generally  conceded  that  a  very  large 
proportion  of  the  difficulties  experienced 
could  have  been  avoided  if  we  had  had 
trained  officers  for  our  militia.  This  is  the 
case  in  all  branches  of  the  service, but  mark- 
edly so  with  the  Medical  Corps.  Now  is 
there  no  remedy  for  this  lack  of  training, 
no  way  to  prevent  a  recurrence  of  the  diffi- 
culties due  to  it  ? 

The  men  themselves  are  capable  enough 
and  generally  well  able  to  take  care  of  sick- 
ness under  ordinary  conditions.  But  in  a 
camp  everything  is  new  to  them,  and  it 
naturally  takes  a  long  time  for  them  to  get 
into  that  routine  so  necessary  for  a  success- 
ful performance  of  their  duties.  What 
they  need  is  some  previous  training  to  fa- 
miliarize them  with  their  surroundings  and 
their  work.  If  the  Government  would 
yearly  take  from  each  State  from  two  to  five 
recent  medical  graduates  (the  number  being 
fixed  according  to  the  State's  population), 
and  give  them  a  six  months  training  as 
medical  officers,  we  would  soon  have  a 
number  of  surgeons  skilled  in  routine  army 
work  who  could  act  as  surgeons  in  our  vol- 
unteer regiments.  It  would  be  a  compara- 
tively easy  matter  to  get  the  necessary 
number  of  young  men  to  serve  the  six 
months,  say  with  the  rank  of  acting  second 
lieutenant,  if  during  that  time  they  were 
paid  a  salary  large  enough  for  their  support. 
These  men  should  pledge  themselves  to  act 
as  surgeons  in  the  militia  of  their  respective 
States  for,  say,  five  years.  For  another  five 
years  they  should  be  subject  to  call  in  case 
of  emergency,  but  otherwise  free  from  mili- 
tary service.  After  this  they  would  be  en- 
tirely free.  The  duties  of  a  volunteer  sur- 
geon in  time  of  peace  would  not  be  one- 
rous, nor  would  they  interfere  with  private 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


421 


practice.  Indeed  the  position  should  be  of 
great  help  to  a  young  man  just  starting  into 
practice,  as  through  it  he  would  be  brought 
before  the  eyes  of  the  public.  The  six 
months'  service  as  an  army  officer  should 
be  both  pleasant  and  profitable.  It  is  cer- 
tainly considered  so  by  the  German  physi- 
cians, all  of  whom  must  thus  serve. 

The  government,  too,  would  not  suffer 
from  this  arrangement.  These  men  could 
be  made  use  of  as  assistants  during  their  six 
months  of  training,  and  from  them,  by 
means  of  a  competitive  examination,  sur- 
geons could  be  selected  for  the  regular  ser- 
vice. It  is  not  meant  that  they  alone  should 
have  the  privilege  of  coming  before  the  Ex- 
amining Board,  but  their  previous  experi- 
ence should  give  them  some  advantage  over 
men  who  had  not  thus  served.  Then  there 
would  be  throughout  the  country  a  corps  of 
trained  men  directly  under  the  influence  of 
the  Army  Medical  Department  though 
members  of  the  .State  Militia.  Thus  we 
would  obtain  a  body  of  men  in  whom  the 
public  could  put  confidence  and  who  would 
be  raised  above  the  sphere  oi  political  in- 
fluence. These  men  acting  as  Militia  offi- 
cers would  combine  the  experience  of  the 
private  practitioner  with  the  fundamental 
training  of  the  army  surgeon. 

We  all  agree  that  some  change  is  neces- 
sary  to  make  our  Medical  Corps  efficient. 
The  improvement  cannot  be  accomplished 
in  a  day.  .So  let  us  start  now  to  remedy  its 
most  glaring  faults,  so  that  we  will  not  be 
.  again  caught  with  such  a  lamentable  lack 
j  of  preparation  as  when  the  last  war  broke 
out.  Let  us  keep  in  mind  the  motto.  "Pace 
para  bellum." 


UNION  OF  HEDICAL  MEN. 
The  abuse  of  hospital  privileges  and  lodge 
practice  has  reached  such  an  extent  in  our 
large  cities  that,  to  put  it  mildly,  it  is  seri- 
ously affecting  the  income  of  nearly  every 
physician  whether  or  not  lie  is  connected 
,  with  hospital  or  has  a  lodge  practice,  can- 
I  not  be  gainsaid,  and  strange  as  it  may  seem 
!  the  abuse  continues  to  grow  through  the 
assistance  and  co-operation  of  some  of  the 
ablest  men  of  the  profession,  notwith- 
standing most  of  the  leading  medical  journals 
of  the  country  have  repeatedly  called  the 
attention  of  the  profession  to  this  condi- 
tion of  affairs.  The  reason  for  this  is  be- 
cause no  one  has  suggested  a  proper  solu- 
tion of  this  difficulty.  Dr.  D.  L.  Walmsley, 
in  a  paper  read,  recently  before  the  Detroit 
Medical  and  Library  Association,  suggests 
that  the  profession  become  more  closely 
united  in  an  organization  whose  sole  pur- 
pose shall  be  to   further  the   financial   inter- 


ests of  the  profession, and  in  this  way  would 
do  away  with  these  and  any  other  evils 
which  tend  to  injure  or  impoverish  the  pro- 
fession. He  does  not  advocate  the  doing 
away  with  hospitals  or  the  gratuitous  treat- 
ment of  the  worthy  poor,  but  the  proper 
regulation  of  them  through  the  united  pro- 
fession, and  thinks  we  may  learn  many  use- 
ful lessons  from  the  various  labor  organiza- 
tions. This  suggestion  seems  like  a  very 
rational  and  business-like  way  of  handling 
the  difficulty,  and  if  once  the  one  hundred 
thousand  physicians  of  this  country  were 
properly  organized,  what  a  powerful  influ- 
ence they  would  be;  then,  instead  of  being 
the  laughing  stock  of  wilely  politicians  and 
business  men,  they  would  be  in  a  position 
to  demand  their  rights  whenever  their  in- 
terests were  being  sacrificed,  either  for  the 
glory  of  the  over-zealous  philanthropist,  or 
for  the  pecuniary  benefit  of  the  greedy  stock 
companies.  Such  an  organization  would 
necessitate  a  great  amount  of  time  and  labor 
to  make  it  effective  and  would  seem  to  be 
an  impossibility,  but  strong  organizations 
have  been  effected  among  laboring  men 
where  the  difficulties  to  overcome  were 
much  greater,  why  not  among  the  medical 
men. 


COCAINE  HABIT. 


Fifteen  or  twenty  years  ago  the  careful 
and  conscientious  physicians  began  to  sound 
the  alarm  and  to  caution  the  profession 
against  the  indiscriminate  use  of  opium  and 
its  alkaloids,  and  through  their  efforts  and 
with  the  aid  of  the  new  coal  tar  derivatives, 
we  have  many  less  chronic  opium  users  to- 
day in  proportion  to  the  inhabitants  than  at 
that  time.  Now  there  is  a  new  danger, and 
one  that  is  much  more  serious  in  its  results 
than  the  opium  habit,  and  that  is  the  co- 
caine habit.  As  physicians  were  formerly 
principally  to  blame  for  the  opium  habit, so 
they  are  to-day  very  largely  to  blame  for 
the  course  of  the  cocaine  habit, and  it  is  time 
the  profession  awoke  to  the  danger  and  stop 
putting  the  remedy  in  the  hands  of  their 
patients,  or  writing  prescriptions  contain- 
ing cocaine.  Many  of  the  patent  medicines 
advertised  for  the  cure  of  catarrh  contain 
more  or  less  cocaine,  and  even  in  our  medi- 
cal journals  we  frequently  see  recommended 
for  treatment  of  hypertrophial  turbenated 
bones  snuffs  and  sprays  containing  cocaine. 
This  is  all  wrong,  though  it  may  give  tem- 
porary relief,  it  often  aggravates  the  diffi- 
culty, and  causes  the  cocaine  habit.  Since 
druggists  as  a  rule  refill  prescriptions,  phy 
sicians  should  be  very  careful  about  writing 
prescriptions containingcocaine, and  so  keep 
it  entirely  under  their  control.  The  South 
seems  to  be  in  greater  danger  from  the   co- 


422 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


caine  habit  than  the  North,  and  the  public's 
attention  has  been  direcfed  to  the  danger 
from  the  fact  that  druggists  were  selling 
large  quantities  of  cocaine  to  the  negroes 
done  up  in  five  and  ten  cent  packages,  and 
as  a  result  crime  was  very  much  on  the  in- 
crease. This  has  caused  two  States,  Louisi- 
ana and  Texas,  to  enact  laws  regulating  the 
sale  of  cocaine,  which  would  be  a  wise  ex- 
ample to  follow  in  every  State,  then  with 
the  co-operation  of  the  physicians  it  would 
be  a  comparatively  easy  thing  to  check  this 
growing  evil. 


flENTAL  EXPECTANCY. 

In  his  address  in  the  section  of  medicine 
at  the  Denver  meeting  of  the  American 
Medical  Association,  referred  to  in  the 
July  number  of  this  Journal,  Dr.  J.  H. 
Musser  made  use  of  the  following  language  : 
"Drugs  have  no  doubt  an  action  in  health 
and  disease.  Their  use  may  be  of  advan- 
tage, but  usually  are  not  necessary.  Some 
say  we  are  robbed  of  the  power  of  mental 
expectancy  if  drugs  are  not  given." 

This  doctrine  of  mental  expectancy  is  by 
no  means  a  modern  one.  Old  doctor  Den- 
ton, of  the  chair  of  Theory  and  Practice  in 
the  University  of  Michigan  in  1858,  was 
wont  to  give  us  a  lecture  on  typhoid  fever 
which  would  be  a  revelation  to  modern 
medical  students.  After  carrying  his  pa- 
tient through  the  preliminary  stages  with 
the  usual  calomel  and  turpentine  treatment, 
he  was  wont  to  advise  us  somewhat  as  fol- 
lows :  "You  have  now  no  doubt  discovered 
that  you  have  on  hand  a  genuine  case  of 
typhoid,  and  if  you  are  honest  you  will  ad- 
mit that  it  is  beyond  your  power  to  cut  it 
short  a  single  day. 

Medication  as  such  does  no  good  for  the 
next  two  weeks.  But  if  you  betray  this 
fact  to  the  patient's  friends,  they  will  merely 
give  you  credit  for  ignorance  and  employ  a 
more  enterprising  physician."  He  then 
recommended  us  to  arrange  two  vials  on 
the  shelf,  one  containing  spts.  nit.  dulc, 
the  other  containing  spts.  lav.  comp.  Then 
to  give  very  explicit  directions  to  adminis- 
ter ten  drops  of  the  one  every  four  hours, 
alternating  with  six  drops  of  the  other, 
changing  the  size  of  the  doses  from  day  to 
day  according  to  the  condition  of  the  pa- 
tient. After  the  time  for  this  expectant 
treatment  had  passed,  he  would  describe 
the  treatment  for  the  remaining  period  of 
the  disease,  which  was  mainly  of  a  support- 
ing nature. 

Could  modern  "mental  expectancy"  be 
carried  any  further  than  this?  Probably 
Prof.  Denton  never  heard  the  expression, 
but  to    those  who  believe    with  Dr.  Musser 


that  the  employment  of  drugs,  merely  be- 
cause you  have  been  called  to  attend  pro- 
fessionally upon  a  patient  is  harmful,  Prof. 
Denton's  advice  may  serve  as  a  placebo  to 
a  tender  conscience  and  at  the  same  time  to 
allow  the  physician  to  collect  an  honest 
bill. 


THE  ANTITOXIN  PATENT  TROUBLE. 

Notwithstanding  the  grasping  expecta- 
tions of  Behring,  financially  speaking,  we 
are  apprehensive  that  he  will  be  greatly 
disappointed  in  his  expected  income  from 
this  country  from  the  sale  of  his  production. 

It  is  a  very  encouraging  consideration 
that  we  have  such  determined  men,  with 
us,  as  Messrs.  Parke,  Davis  &  Co.,  who 
will  stand  up  and  defend  the  interests,  both 
of  the  prefession  and  the  afflicted,  in  their 
endeavor  to  defeat  the  monopoly  aiming  to 
be  enforced  upon  us ;  especially  by  a  for- 
eigner, when  his  claims  to  priority  are 
doubtful. 

The  above  named  firm  proposes  to  con- 
tinue the  manufacture  of  the  antitoxine  of 
diphtheria,  and  binds  itself  to  defend  all 
physicians  who  may  use  it,  against  pro6e- 
cution. 

And  as  their  manufacture  stands  as  well, 
if  not  better  in  the  estimation  of  the  profes- 
sion, than  the  foreign  article,  it  is  to  be 
hoped  that  its  use  will  be  continued. 


PYOKTANIN,  OR  C.  P.  METHYLENE    IN 
DISEASES  OF  THE  EYE. 

Medical  men  of  to-day  are  almost  over- 
whelmed with  the  constantly  increasing 
number  of  new  remedies,  and  new  prepa- 
rations, some  of  them  good,  but  by  far  the 
greater  number  are  absolutely  worthless, 
and  are  thrown  aside  after  the  first  trial, 
and,  as  a  result, many  of  the  more  conserva- 
tive members  of  the  profession  refuse  to 
consider,  or  try,  any  new  preparation  or 
remedy,  preferring  to  have  others  do  the 
experimenting, consequently  it  usually  takes 
a  long  time  for  a  really  valuable  remedy  to 
establish  itself  with  the  profession. 

This  would  not  be  the  case  if  the  profession, 
before  recommending,  or  reporting  a  reme- 
dy, would  be  more  careful  about  investiga- 
ting it,  see  in  exactly  what  conditions  it  is 
applicable,  and  where  it  is  not,  and  only 
recommend  it  in  the  condition  in  which  it 
has  proven  to  be  useful. 

Such  a  study  seems  to  have  been  made  of 
"Pyoktanin,"  or  C.  P.  Methylene  blue,  by 
Dr.  J.  D.  Riker,  of  Pontiac,  Mich. 

He  states  that  he  first  used  Pyoktanin  on 
a  case  of  serpigenous  ulceration  of  the  cor- 
nea, accompanied  with  such  severe  pain, 
that  all  the  ordinary  remedies  failed  to  give 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


the  least  relief,  and  thinking  of  the  physio- 
logical action  of  Methylene  blue,  how  it  had 
a  decided  affinity  for  nerve  tissue,  staining, 
and  after  a  short  time  anesthetizing  exposed 
nerves,  it  seemed  to  him  particularly  adapt- 
ed to  a  case  in  which  the  nerves  of  the  cor- 
nea were  exposed,  and  were  evidently  caus- 
ing the  pain. 

He  accordingly  applied  a  2%  solution  of 
Pyoktanin  at  8  a.m.,  the  patient  getting  the 
first  night's  sleep  in  several  days  and  mak- 
ing, from  that  time  on,  a  complete  and 
rapid  recovery. 

After  trying  Pyoktanin  in  nearly  all  the 
inflammator)'  and  painful  diseases  of  the 
eye,  he  has  come  to  the  conclusion  that 
Pyoktanin  is  limited  in  usefulness,  in  dis- 
eases of  the  eye,  to  cases  of  ulceration,  ac- 
companied with  pain,  due  to  irritation  of 
the  nerve  involved  in  the  ulceration,  and  in 
such  cases  it  is  truly  a  great  remedy  and 
worthy  much  more  consideration  than  it  is 
at  present  receiving. 

OLD  AGE. 

It  seems  that  Great  Britain  is  prolific  in 
the  maintainauce  of  longevity.  Thirty-eight 
centenarians  were  reported  last  year  ;  fifteen 
men  and  twenty-three  women. 

Mrs.  Henry,  of  Gortree,  who  died  at  the 
age  of  112,  was  the  oldest.  She  left  a 
daughter  aged  90. 

The  St.  James  Gazette  has  reported  378 
centenarians  within  the  last  ten  years,  of 
whom  235  were  women.  It  would  seem 
from  the  Gazette's  statistics  that  women  in 
that  country  have  decidedly  the  advantage 
over  men,  as  to  long  life.  We  can  only 
account  for  this  difference  on  the  ground  of 
the  intemperate  habits  of  the  male  sex. 


BOOK  REVIEWS. 


Annual  and  Analytical  Cyclopaedia  of  Practica 
Medicine.  By  Charles  E.  de  M.  Sajous.  M.  IX. 
and  LOO  associate  editors,  assisted  by  corre- 
sponding editors,  collaborators  and  correspon- 
dents.  Illustrated  with  ehromo-lithographs. 
engravings  and  maps;  Volume  I.  Philadel- 
phia, New  York.  Chicago:  The  F.  A  Davis 
Company.     1898. 

The  issue  of  the  Annual  in  this  new  form 
will  be  welcomed  by  the  medical  profes- 
sion as  an  improvement  over  that  which 
has  prevailed  during  the  last  ten  years.  To 
say  that  this  is  a  great  improvement  of  the 
original  Sajous'  Annual  is  giving  it  faint 
praise  in  one  sense  ;  but  in  another  it  speaks 
loudly  in  its  favor,  because  the  latter  was 
really  one  of  the  most  useful  compilations 
of  medical  literature  that  had  ever  been 
printed. 

This  first  volume  embraces  subjects  from 


abdominal  injuries  to  and  including  Brights 
disease. 

The  first  article  is  on  Injuries  of  the  Ab- 
domen. Forty-six  pages  are  devoted  to 
this  subject,  including  one  hundred  and 
fifty  excerpts.  The  next  subject  taken  up 
is  Abortion  in  its  different  forms,  with  de- 
scriptions, etiology,  symptomatology  prog- 
nosis, diagnosis  and  treatment.  The  ex- 
cerpts under  these  subjects  will  give  an  idea 
as  to  the  exhaustive  nature  of  the  refer- 
ences. The  abstracts  interpolated  in  the 
text  are  controversially  arranged,  and  aimed 
to  sustain  the  views  advanced  by  authors, 
or  indicate  fields  as  yet  insufficiently  ex- 
plored. 

The  next  subject  of  importance  herein 
treated  is  that  of  Abscess,  giving  the  dif- 
ferent varieties,  pathology,  diagnosis,  treat- 
ment, &c. 

The  work,  when  completed,  will  present 
all  the  general  diseases  described  in  text- 
books on  practical  subjects — medicine,  sur- 
gery, theraputics,  obstetrics,  &c,  and  in- 
serted in  their  logical  order  in  the  text,  all 
the  progressive  features  of  value  presented 
during  the  last  decade.  This  will  remove 
the  cause  of  dissatisfaction  caused  by  the 
absence  of  general  subjects  in  the  older 
work.  If  the  year  brings  forth  nothing 
new  upon  any  particular  disease,  the  latter 
will,  at  least,  appear  as  it  was  when  last 
studied,  whether  this  be,  one,  two,  five  or 
twenty  years  before.  The  general  arrange- 
ment adopted  will  make  it  possible  to  cover 
the  entire  field  in  six  volumes.  As  mav  be 
seen  in  any  medical  directory,  the  subjects 
treated  in  the  first  volume  will  represent 
exactly  one-sixth  of  the  whole.  As  to  the 
therapeutics  or  remedies,  only  those  that 
are  being  generally  utilized  in  a  manner 
compatible  with  scientific  precision  and  in 
accordance  with  professional  ethics  have 
been  incorporated.  The  list  includes  a  few 
new  agents  which  seem  to  merit  further 
trial.  To  facilitate  the  use  of  the  work, 
the  subjects  have  been  arranged  in  alpha- 
betical order,  the  references  being  given  in 
full  at  the  end  of  each  abstract. 

The  book  contains  numerous  illustrations, 
is  printed  in  double-columed  pages  with 
new  clear-faced  type,  and  is  handsomely 
bound. 

Annual  and  Analytical  Cyclopaedia  of  Practical 
Medicine.  By  Charles  E.  de  M.  Sajous,  M.D., 
and  one  hundred  Associate  Editors,  assisted 
by  Corresponding  Editors,  Collaborators,  and 
Correspondents.  Volume  2.  Illustrated  with 
chromo-lithographs,  engravings  and  maps. 
Published  by  P.  A.  Davis  «fc  Co.,  Philadelphia. 
1899. 
This  second  volume  of  this  valuable  "An- 


424 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


nual  and  Cyclopedia"  compares  most  favo- 
rably to  the  high  standard  of  excellence  at- 
tained by  the  first.  In  the  method  of  pre- 
paring the  articles  there  has  been  a  change 
made ;  instead  of  being  prepared  under  the 
immediate  supervision  of  the  editor,  and 
submitted  to  members  of  the  associate  staff 
for  revision  and  correction,  as  in  the  first 
volume, ^all  the  articles  in  the  second  vol- 
ume have  been  prepared  by  their  respective 
editors  themselves.  The  articles  are  alpha- 
betically arranged,  beginning  with  Bromide 
of  Ethyol.  Following  the  bromides  cere- 
bral hemorrhage  and  chloral  are  taken  up, 
and  there  is  an  extensive  article  on  chloro- 
form. This  latter  article  is  even  worth  the 
price  of  the  book,  as  it  describes  not  only 
the  history  of  chloroform  and  its  discover- 
ers, but  also  its  administration,  the  various 
mixtures,  as  well  as  the  accidents  and  emer- 
gency treatments. 

Articles  which  may  be  mentioned  as  espe- 
cially complete  and  valuable  are  those  on 
"Cerebral  Hemorrhage,"  by  Dr.  William 
Browning,  of  Brooklyn;  "Cirrhosis  of  the 
Liver,"  by  Prof.  Adams,  of  Montreal; 
"Cholera,"  by  Prof.  Rubino,  of  Naples; 
"Cholilithiasis."  by  Prof.  Graham,  of  To- 
ronto ;  "Diabetes,"  by  Prof.  Lepine,  of  Ly- 
ons, etc.  The  better  known  affections  have 
also  been  edited  by  writers  of  special  abili- 
ty. Among  the  articles  of  this  kind  is  that 
on  "Diphtheria,"  by  Drs.  Northrop  and 
Bovaird,  of  New  York,  who  contribute  a 
masterly  review  of  our  present  knowledge 
of  this  affection  from  every  standpoint. 
The  papers  by  Prof.  Eskridge,  of  Denver, 
on  "Catalepsy;"  Prof.  Bondurant,  of  Mo- 
bile, on  "Chorea ;"  Dr.  Norman  Kerr,  of 
London,  on  "Cocainomania  ;"  Dr.  Oliver, 
of  Philadelphia,  on  "Cataract;"  Prof.  Na- 
than S.  Davis,  of  Chicago,  on  "Constipa- 
tion;" Dr.  Vickey,  of  Boston,  on  "Dilita- 
tion  of  the  Heart,"  are  among  others,  par- 
ticularly entitled  to  the  reader's  special  at- 
tention. 

The  principle  of  wise  and  judicious  selec- 
tions have  been  applied  to  the  illustrations 
throughout  the  volume,  and  the  publishers' 
work  has  been  successful  in  making  the 
book  handsome  as  well  as  useful. 

The  Ready  Refferenee  Handbook  of  Diseases  of 
the  Skin.  By  Geo.  Thos.  Jackson,  M.  D.. 
(col.)  Prof,  of  Dermatology  in  the  Womans 
Medical  College  of  the  New  York  Iniirrnary 
and  in  the  Medical  Department  of  the  Univer- 
sity of  Vermont;  Chief  of  Clinic  and  Instruc- 
tor in  Dermatology,  College  of  Physicians  and 
Surgeons,  New  York,  &  c. ,  &c.  With  Se  verity  - 
five  illustrations,  Third  Edition,  Revised  and 
Enlarged.  Lea  Brothers  &  Co.,  1899. 
The  following  pages  represent  the  art  of 


dermatology  as  it  now  exists.  This  is  the 
third  edition  of  the  work  in  a  reasonably 
short  time.  The  early  exhaustion  of  the 
second  edition  of  this  work  is  a  gratifying 
indication  of  the  favor  with  which  it  is  re- 
garded by  students  and  practitioners.  All 
dermatological  advances  made  in  the  inter- 
val are  fully  presented  in  the  new  edition 
by  revision  and  by  the  addition  of  new 
matter  and  illustrations. 

The  work  is  considered  in  two  divisions. 
Part  I  is  devoted  to  General  Considerations, 
the  Anatomy  and  Physiology  of  the  Skin, 
the  Diagnosis  and  Leisons  of  the  Skin, 
Theraputic  Notes  and  some  "Dermatologi- 
cal Don'ts." 

Part  II  gives  a  clean,  clear  description  of 
the  Diseases  of  the  Skin  and  their  Treat- 
ment, beginning  with  Abscess  and  ending 
with  Zoster.  This  work  represents  all 
dermatological  advances  made  in  the  inter- 
val between  the  third  and  first  edition,  and 
entirely  new  sections  will  be  found  on  Bul- 
piss,  Bunion,  Dermatitis  from  Roentgen 
Rays,  Blastomycetic  dermatitis,  Ecphyma 
Globulers,  Lupus  Pernio,  Pityriasis  alba 
atrophicans,  and  Idiopathic  multuple  pig- 
mented sarcoma.  The  work  contains  a 
fine  appendix. 

The  alphabetical  arrangement  of  the  book 
having  proved  so  acceptable,  has  not  been 
changed,  and  practitioners,  students  and 
specialists  will  find  it  as  heretofore  a  most 
concise  and  readily  available  source  of 
knowledge  on  all  dermal  affections,  their 
etiology,  symptoms,  diagnosis,  treatment, 
prognosis,  etc. 

The  work  is  well  bound  and  neatly 
printed. 

Progressive  Medicine.— A  Quarterly  Digest  of 
Advances,  Discoveries,  and  Improvements  in 
the  Medical   and  Surgical   Sciences.     Edited 
by  Hobart  Amory  Hare,  M,  D.,  Professor  of 
Therapeutics  and  Materia  Medica  in  the  Jef- 
ferson Medical  College  of  Philadelphia.     Oc- 
tavo, handsomely  bound  in  cloth,   490  pages. 
28   illustrations   and   3   colored  plates.      Lea 
Brothers  &  Co.,  Philadelphia  and  New  York. 
"Progressive  Medicine"  will  be  publish- 
ed in  4  volumes,  and  w'll   cover   the   entire 
round  of  practical  medicine  in  the  broadest 
sense,  and  their  appearance  at    intervals  of 
three  months,  instead  of  annually,  will  in- 
sure the  more  rapid  diffusion  of  knowledge, 
which  is  a  requirement  of  our  times.       The 
first  volume,  now  before  us,  is  a  substantial 
octavo  of  nearly  500  pages,  illustrated  with 
engravings  and  colored    plates,  and,  as  the 
yearly  price  for  the  set   of  four  volumes   is 
$10,  it  is  evident  that  an  exceedingly  large 
demand  is  anticipated.     This  volume  is  a 
well-told  tale  of  medical  progress  in  all  its 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


425 


lines  of  thought,  told  in  each  line  by  one 
well  qualified  to  cull  only  that  matter  which 
is  worthy  of  his  attention  and  necessary  to 
his  success.  This  work  treats  of  surgery  of 
the  Head,  Neck,  and  Chest,  by  J.  Chal- 
mers D.  A.  Costa,  M.D.  ■  Diseases  of  Chil- 
dren, by  Alexander  D.  Blockader,  M.  D.  ; 
Pathology,  by  Ludwig  Hektoen,  M.  D.  ; 
Infectious  Diseases, including  Crupous  Pneu- 
monia, by  William  Sidney  Thayer,  M.  D.  ; 
Laryngology  and  Rhinology,  by  A.  Logan 
Turner,  M.D.  ;  Otology,  by  Robert  L.  Ran- 
dolph, M.D.  The  work  closes  with  a  good 
index.  These  men  are  all  men  of  promi- 
nence and  experience  and  their  articles  con- 
tain all  that  the  master  of  a  specialty  knows 
of  the  year's  work,  and  possess  great  intrin- 
sic value.  It  gives  us  great  pleasure  to 
commend  the  work  to  the  profession. 

A  Text-Book  on  Practical  Obstetrics.     By   Eg- 
bert II.  Grandin,  M.  I).,  Gynaecologist  to  the 

Columbus  Hospital;  Consulting  Gynaecologist 
to  the  French  Hospital;  late  Consulting  Ob- 
stetrician and  Obstetric  Surgeon  of  the  New 
York  Maternity  Hospital:  I'd  low  of  the  Amer- 
ican Gynaecological  Society,  etc.  With  the 
Collaboration  of  George  W.  James,  M.  D.. 
Gynaecologist  to  the  Cancer  Hospital;  Instruc- 
tor in  Gynaecology  in  the  Medical  Department 
of  the  Columbia  University;  late  Obstetric 
Surgeon  of  the  New  York  Maternity  Hospital; 

Fellow  of  the  American  Gynaecological  Soci- 
ety, etc.  Second  Kdition.  Revised  and  En- 
larged. Illustrated  with  Sixty-four  Full-page 
Photographic  I  Mates  and  Eighty-six  Illustra- 
tions in  the  Text,  <>Ax94  inches.  Pages  xiv- 
401.  Extra  Clotb,  $4.00  net;  Sheep,  $4.75. 
The  F.  A.  Davis  Co.,  Publishers,  L914-16 
Cherry  St.,  Philadelphia. 

This  is  the  most  practical  and  useful  book 
that  we  have  reviewed  in  some  time.  It  is 
a  splendid  guide  to  practice.  It  is  clinical 
in  its  teaching.  It  is  direct  in  its  statement 
wherever  facts  warrant  such  directness. 
The  book  is  divided  into  four  divisions  : 
Pregnancy,  Labor,  the  Puerperal  State  and 
Obstetric  Surgery. 

Under  Pregnancy  is  considered  the  Diag- 
nosis, Duration  and  Ilygine  of  Pregnancy, 
Pathology  of  Pregnancy  and  the  Diagnosis 
of  the  Presentation  and  of  the  Position  of 
the  Fcetus.  Finder  Labor  is  considered  the 
Mechanism  of  Labor,  the  Clinical  Course 
of  Labor,  the  Management  of  Labor,  and 
the  Care  of  the  New  Born  Infant. 

Under  the  Puerperal  State  is  considered, 
the  Normal  Puerperium,  the  Pathological 
Puerperium.  Under  Obstetric  Surgery,  all 
the  important  Obstetrical  Operations  are 
clearly  and  accurately  given. 

The  illustrations  are   the    finest  and  best 


we  have  yet  seen,  and  will  serve  a  most 
useful  purpose.  The  entire  work  is  filled 
with  practical  every-day  needed  informa- 
tion. There  is  nothing  formal  or  stiff  about 
the  work.  It  is  printed  in  large  clear  type 
and  neatly  bound.  We  commend  the  work 
to  the  student  in  the  acquisition  of  knowl- 
edge and  to  the  practitioner  as  a  reliable 
guide. 

The  Pathology  and  Treatment  of  Sexual  Impo- 
tence. By  Victor  G.  Vecki,  M.  D.  Philadel- 
phia: W.  B.  Saunders,  925  Walnut  Street. 
1899.     Price,  $2.00  net. 

This  is  a  very  interesting  and  important 
work.  It  is  important  from  the  fact  that 
our  literature  upon  this  subject  is  very  lim- 
ited. In  this  treatise  the  writer  speaks 
very  openly  and  frankly. 

Chapter  I.  is  devoted  to  an  interesting 
introductory  showing  the  great  importance 
of  a  thorough  knowledge  of  this  subject. 
Chapter  II.  gives  a  short  discussion  on  the 
anatomy  of  the  male  organs  of  reproduction. 
Chapter  III.  is  devoted  to  the  physiology 
of  the  sexual  act.  Chapters  IV.,  V.,  VI., 
VII.  and  VIII.  to  the  Etiology,  Forms  of 
Impotence,  Diagnosis  and  Prognosis.  The 
remaining  portion  of  the  work  is  devoted 
to  the  all  important  subject  of  treatment  of 
impotence.  The  work  closes  with  a  good 
index.  We  are  glad  this  book  has  been 
written.  If  properly  read  and  applied  the 
good  that  will  come  out  of  it  can  hardly  be 
estimated.  The  work  has  been  carefully 
printed  and  well  bound. 

Nervous  aud  Mental  Diseases.  By  Archibald 
Church,  M.  I).,  Professor  of  Clinical  Neuro- 
logy and  Mental  Diseases  and  Medical  Juris- 
prudence in  the  Northwestern  University 
Medical  School  (The  Chicago  Medical  Col- 
lege), Chicago,  &c.,&c,  and  Frederick  Peter- 
son, M.  D.,  Clinical  Professor  of  Mental  Dis- 
eases in  the  Woman's  Medical  College,  New 
York,  &c,  &c;  with  305  Illustrations.  Phil- 
adelphia :  \V .  I !.  Saunders.  925  Walnut  Street. 
1899. 

This  is  a  most  excellent  work  for  medical 
students  and  general  practitioners.  It  is  a 
most  carefully  prepared  text-book.  The 
literature  of  neurology  and  psychiatry  has 
been  sifted  by  the  authors,  and  such  digest 
revised  in  the  light  of  their  own  experience 
in  practice  and  in  teaching.  The  work  has 
been  divided  into  two  great  divisions — 
Nervous  Diseases  and  Mental  Diseases. 
Under  Nervous  Diseases  are  considered  the 
following  sections  with  their  sub-divisions  : 
Part  I.  Examination  of  Patients. 
Part  II.  Diseases  of  the  Cerebral  Menin- 
ges and  Cranial  Nerves. 

Part  III.   Diseases  of  the  Brain   Proper. 


THE  CHARLOTTE  MEDICAL  JOURNAL 


Part  IV.  Diseases  of  the  Spinal  Menin- 
ges and  Spinal  Nerves. 

Part  V.   Diseases  of  the  Cord  Proper. 

Part  VI.  Diseases  of  the  General  Nervous 
System,  with  known  Anatomical  Basis. 

Part  VII.  Diseases  of  the  Nervous  Sys- 
tem, without  known  Anatomical  Basis. 

Part  VIII.   Symptomatic  Disorders. 

Under  the  subject  of  Mental  Diseases  are 
given  a  general  description  of  Insanity  in 
its  varied  forms.  The  writers  have  pre- 
sented their  facts  clearly,  directly,  and  with 
brevity,  despite  the  difficulty  of  condensing 
two  great  subjects  within  the  limits  of  a 
single  volume.  The  work  is  handsomely 
bound,  beautifully  illustrated,  and  well 
printed.  The  authors  and  publishers  are 
both  to  be  congratulated  on  the  handsome 
appearance  of  their  work. 

Nursing:  Its  Principles  and  .Practice,  for  Hos- 
pital   and    Private   use.     By    Isabel    Adams 
Hampton,  Graduate  of  the  New  York  Train- 
ing-  School  attached    to   Bellevue    Hospital; 
Late  Superintendent  of  Nurses  and  Principal 
of  the  Training  School  for  Nurses,  Johns  Hop- 
kins Hospital,  Baltimore,  Md.,  &c,  &c.     Re- 
vised  and  Enlarged.     Illustrated.     Philadel- 
phia: W.  B.  Saunders,  925  Walnut  St.,  1898. 
This  is  a  very  practical  and  useful  book. 
To  those  who  contemplate  becoming  a  pro- 
fessional nurse   we    cannot  too    highly    re- 
commend this   book.      In   the   beginning  is 
given  a  general  outline  of  the  work.     The 
work  then  goes  into  detail  as  to  the  general 
requirements  and  duties  of  the  nurse.     The 
chapters  on    Hemorrhage,    Anaesthesia,  the 
care  after  Labor   are   specially  fine  and  de- 
serve special  mention.     The  work   is   very 
complete.     The   illustrations   and  cuts  are 
superb.     The  work  contains  512  pages  very 
neatly  and    substantially   prepared    from  a 
mechanical  standpoint.      We  commend  the 
work  in  the  highest  possible  terms. 

Diseases  of  the  Ear,  Nose  and  Throat  and  their 
Accessory  Cavities.  By  Seth  Scott  Bishop, 
M.  D.,  D.  C.  L.,LL.  D.  Professorof  Diseases 
of  the  Nose,  Throat,  and  Ear  in  the  Illinois 
Medical  College;  Professor  in  the  Chicago 
Post-Graduate  Medical  School  and  Hospital; 
Surgeon  to  the  Post-Graduate  Hospital,  one 
of  the  Editors  of  the  Laryngoscope,  etc.  Sec- 
ond Edition.  Thoroughly  Revised  and  En- 
larged. Illustrated  with  Ninety-four  Chromo- 
Lithographs  and  Two  Hundred  and  Fifteen 
Half-tone  and  Photo-engravings.  6ix9i  inches. 
Pages  xix-554.  Extra  Cloth,  $4.00  net;  Sheep 
or  Half-Russia,  $5.00  net.  The  F.  A.  Davis 
Co.,  Publishers.  1914-16  Cherry  St.,  Phila- 
delphia. 
The  author  states  in  his  preface  that  this 

work  was   designed,   first,    to   help  the  stu- 


dents in  preparing  for  their  degree  ;  second, 
for  those  progressive  practitioners  who  wish 
to  acquire  the  proficiency  necessary  to  prop- 
erly treat  those  patients  who  are  unable  to 
visit  specialists;  and,  third,  for  those  who 
are  gradually  exchanging  their  general 
practice  for  special  work  in  these  features. 
The  latest  developments  concerning  diph- 
theria, the  blood-serum  therapy,  the  medi- 
cal and  surgical  management  of  mastoid 
diseases,  the  related  diseases  of  the  eye  and 
nose,  the  most  successful  treatment  of  hay 
fever,  the  improved  compressed-air  instru- 
ments, vaporizing  apparatus,  inhalents, 
etc.,  have  been  given  especial  prominence. 
The  opinions  and  experiences  of  a  large 
number  of  eminent  authors  have  been  given 
on  the  subjects  of  diphtheria,  antitoxin 
therapy,  and  hay  fever. 

The  work  contains  554  pages,  including 
a  good  appendix.  It  is  well  printed,  pret- 
tily illustrated  and  well  bound,  making  a 
very  handsome  volume. 

Seventh  Biennial  Report  of  the  North  Carolina 
Board  of  Health.  1897-1898. 
This  volume  is  well  arranged,  well  bound, 
and  printed  with  care,  showing  the  super- 
vising work  of  an  experienced  secretary. 
It  is  a  record  that  will  bear  the  closest  scru- 
tiny and  sustain  the  severest  test  of  criti- 
cism. Its  contents  abound  in  interesting 
papers  and  admirable  discussions.  It  con- 
tains 222  pages,  and  it  is  a  contribution  to 
the  cause  of  preventive  medicine.  It  is  a 
credit  to  the  health  authorities  of  the  State. 

Transactions  of  the   New    Hampshire   Medical 
Society  at  the  One  Hundred  and  Seventh  An- 
niversary, held  at  Concord,  May  26-27,  1898. 
A  society  which  can  hold  a  hundred  and 
seventh  anniversary  is   too  well    known  to 
call  for  an  extensive  review.     These  trans- 
actions   come    to    us     well    bound,    neatly 
printed  on  first-class    white    paper.     There 
are  no  transactions   published   that  contain 
better  material  than  the  one  before  us.  The 
article  entitled  "The   Doctor  and  Lawyer" 
is  very    fine  and    would    do   credit  to    the 
pages  of  any  volume.     There  are  others  of 
equal  merit. 

Transactions  of  the  Michigan  State  Medical  So- 
ciety for  the  Year  1898.  Vol.  XXII.  Pub- 
lished by  Society. 

The  publication  of  these  transactions 
make  a  useful  .and  nice  volume. 

Many  papers  are  now  before  this  Society 
and  published  in  these  transactions  that  are 
worthy  of  special  mention,  viz  :  Sleepless- 
ness, its  Cause  and  Treatment,  by  Elmore 
S.  Pettyjohn,  M.  D.  ;  Vitality  and  Thera- 
peutics, by   Wm.  J.  Herdman,  M.  D.,  and 


THE  CHARLOTTE'  MEDICAL  JOURNAL. 


427 


man)  others.  Dr.  Ernest  L.  Shurley,  of 
Detroit,  is  president,  and  Collins  H.  John- 
ston, of  Grand  Rapids,  is  secretary.  The 
volume  is  neatly  printed  and  bound. 


LITERARY   NOTES. 

Lippincott's  Magazine  for  April, 
1899. — The  complete  novel  in  the  April  is- 
sue of  Lippincott's  is  "The  House  of  ran.1' 
a  romance  of  the  eighteenth  century,  by 
Anna  Robeson  lirown.  The  reader's  in- 
terest is  sustained  throughout  by  the  thrill- 
ing adventures  of  a  young  French  girl  and 
the  American  hero,  valiant  and  true. 

"Confessions  of  a  Butcher,"  by  William 
S.  Walsh,  has  entertaining  reminiscences 
of  the  author's  experience  in  a  publishing 
house. 

Frank  A.  Burr's  article  on  "The  Men 
who  Impeached  Andrew  Johnson"  is  es- 
pecially good  reading  at  this  time. 

In  "A  Question  of  Precedence,"  by  Hen- 
ry Holcomb  Bennett,  we  have  a  vivid  war 
story. 

Frederick  II.  Dewey  tells  us  "How  an 
Earthquake  Looks  and  Feels;"  while  other 
interesting  and  instructive  papers  arc  "An 
Ignoble  Nobleman,"  by  Charles  Morris, 
dealing  with  the  Duke  of  Buckingham; 
"Legends  of  Lost  Mines,"  by  Mary  E. 
Stickney,  and  "Over,  Under,  and  Through 
Boston,"  an  accurate  and  entertaining  ac- 
count of  t he  new  subway,  by  George  L 
Varney. 

William  Ward  Crane  writes  of  "Our  Na- 
turalized Names,"  which  is  both  timely 
and  helpful,  and  Charles  C.  Abbott  has  one 
of  his  attractive  talks  about  nature,  under 
the  title  of  "Views  Afoot." 

Paul  Lawrence  Dunbar  is  represented  by 
a  pathetic  little  sketch  entitled  "The  End 
of  the  Chapter,"  and  Will  N.  Ilarben  by  a 
sympathetic  story,  "The  Convicts  Return."" 

The  poetry  of  the  number  is  contributed 
by  Elizabeth  C.  Gardozo,  Marion  Marville 
Pope,  Clinton  Scollard,  Julie  M.  Lipmann, 
Martha  T.  Tyler. 


The  February  Forum. — The  current 
number  of  The  Forum  completes  the  twen- 
ty-sixth volume;  and  it  may  with  propriety 
be  said  that  the  magazine,  with  increasing 
years,  shows  no  sign  of  decadence,  but,  on 
the  contrary,  preserves  its  virility  unim- 
paired. In  the  February  issue  there  are 
two  articles  of  especial  importance  at  the 
present  time.  One  is  by  Commander  R. 
B.  Bradford  on  "Coaling- Stations  for  the 
Navy."  This  officer,  as  is  well  known, 
has  seen  much  active  service,  and  in  bring- 


ing the  necessity  of  coaling-stations  before 
the  public  his  effort  has  been,  as  he  says,  to 
deal  with  facts.  The  other  paper  is  by 
Hon.  David  J.  Hill,  Assistant  Secretary  of 
State,  and  is  entitled  "The  War  and  the 
Extension  of  Civilization."  Mr.  Hill  ap- 
proaches his  subject  from  a  new  standpoint, 
and  claims  that  the  terms  "imperialism" 
and  "expansion"  do  not  meet  the  case.  A 
more  fitting  phrase,  he  considers,  to  desig- 
nate the  aims  and  achievements  of  the  na- 
tion is  "the  extension  of  civilization;"  for 
it  expresses  the  motive  and  controlling  prin- 
ciple of  the  war  and  of  the  treaty  by  which, 
when  ratified,  it  is  to  be  concluded.  Hon. 
Charles  Denby  contributes  to  the  same  num- 
ber some  further  arguments  "Why  the 
Treaty  should  be  ratified." 


In  the  American  Monthly  Review  of  Re- 
views for  April  the  editor  reviews  the  work 
of  the  Fifty-fifth  Congress,  examines  the 
present  status  of  the  various  plans  for  inter- 
oceanic  ship  transit,  discusses  the  latest  de- 
velopments in  the  Philippine  situation,  and 
comments  on  the  other  news  topics  of  the 
day  in  home  and  foreign  politics,  including 
the  cabinet  change  in  Spain  and  the  altered 
relations  of  Germany,  England,  and  the 
United  .States. 


Scribner's  Magazie  for  February  brings 
forward  several  more  of  its  attractive  fea- 
tures for  1899.  It  is  not  a  "War  Number," 
although  it  contains  one  of  the  most  graphic 
things  yet  written  about  the  war — the  sec- 
ond instalment  of  Governor  Roosevelt's  se- 
rial on  "The  Rough  Riders." 


The  article  on  The  Resurrection,  which 
The  Living  Age  for  March  18  reprints  from 
the  Contemporary  Review  is  a  thoughtful 
and  noble  study  of  the  evolution  of  religion, 
which  is  peculiarly  appropriate  to  the 
closing  days  of  Lent. 

The  Quarterly  Review's  striking  paper 
on  Women  Poets  is  to  be  reproduced  in  The 
Living  Age,  the  first  half  of  it  in  the  num- 
ber for  April  1. 


MISCELLANEOUS. 


Board  of  Medical  Examiners. 

The  Board  of  Medical  Examiners  of  the 
State  of  North  Carolina  will  meet  in  Ashe- 
ville,  N.C., Thursday  afternoon,  May  25th, 
1899;  all  applicants  are  urged  to  be  present 
at  this  time  to  register  and  be  ready  for  ex- 
amination on  the  following  morning. 
Thos.  E.  Anderson,  M.  D., 

Sec.  Board  Med.  Ex.,  Statesville,N.C 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


Pain  in    the  Fallopian  Tubes. 

Dr.  Ernest  Hall  (Canadian  Practitioner, 
January,  1899).  Chronic  salpingitis  is 
painful  for  two  reasons  :  first,  on  account 
of  the  exudations  causing  adhesions  with 
the  neighboring  organs  ;  second,  on  account 
of  distention  of  the  tube,  usually  at  the 
menstrual  period.  One  fact  appears  to  us 
to  be  beyond  dispute,  that  small  and  lax 
adhesions  no  more  than  the  existence  of 
serous  exudations  are  insufficient  in  them- 
selves to  cause  pain.  It  seems  that  active 
inflammation  and  the  presence  of  infection 
are  needed  to  make  this  condition  painful. 
The  prolapse  of  the  tube  toward  the  cul-de- 
sac  is  always  troublesome,  and  at  least 
causes  slight  pain  and  uneasiness.  We 
should  notice  the  probability  of  making  a 
wrong  diagnosis  in  salpingitic  pain.  The 
patient  might  complain  of  pain  in  one  side 
of  the  pelvis,  when  upon  examination  in- 
flammatory exudation  or  a  tumor  may  be 
discovered  upon  the  other  side.  We  have 
seen  a  displaced  tube  iying  across  the  pos- 
terior face  of  the  uterus  in  such  a  position 
that  its  pavilion,  extended  by  exudation, 
formed  a  tumor  which  was  fixed  to  the  pel- 
vis on  the  opposite  side.  The  pain  in  this 
case  was  located  in  the  fine  nerves  which 
are  distributed  upon  the  tube  through  the 
corresponding  ligament.  The  pain  of  sal- 
pingitis is  generally  fixed,  and  undergoes 
increase  during  menstruation,  not  previous 
to  it,  as  in  ovaritis.  But  after  menstrua- 
tion it  undergoes  marked  decrease,  and  re- 
appears two  or  three  days  later.  This  lat- 
ter pain  is  caused  by  the  traction  of  the  ad- 
hesions which  fix  the  tube  to  the  pelvis. 


The  Indications  for  Operation  in  Renal 
Tuberculosis. 

Park  (University  Medical  Magazine, 
February,  1899,)  says  that  when  the  kid- 
ney is  affected  with  tuberculosis  the  sooner 
it  is  removed  the  better,  provided  there  is 
no  similar  lesion  in  the  other  kidney,  or 
elsewhere  in  the  body. 

It  is  only  in  rare  instances  that  a  diagno- 
sis can  be  made  so  early  that  any  treatment 
but  the  surgical  can  be  depended  upon,  and 
it  would  be  exceeding  rare  to  find  a  kidney 
where  the  tuberculous  lesion  was  so  isolated 
that  it  could  be  eradicated  without  remov- 
ing the  whole  organ.  The  first  point  to  be 
considered  is  the  general  propriety  of  the 
operation.  The  second  point  is  as  to  exact 
diagnosis,  whether  one  or  both  kidneys  are 
involved.  If  both  are  affected  only  harm, 
and  no  good,  can  come  from  the  operation. 
The  third  point  for  consideration  is  as  to 
whether  the  lungs  or  any  other  organ  of  the 
body  are  involved. 


If  the  ovaries  are  involved,  they  may  be 
removed  at  the  same  time  with  the  kidney, 
but  if  other  organs  are  involved,  the  opera- 
tion is  contraindicated.  If  the  peritoneum 
is  involved,  it  may  perhaps  be  proper  to 
remove  the  kidney  by  the  abdominal  route, 
for  the  purpose  of  exposing  the  peritoneal 
cavity  to  the  air. 

The  danger  of  the  operation  itself  is  in 
proportion  to  the  gravity  of  the  condition 
requiring  operation,  and  should  be  so  repre- 
sented to  the  patient. 

The  simple  removal  of  the  kidney  in  an 
ordinary  case  is  not  a  long  or  difficult  oper- 
ation. But  when  it  becomes  necessary  to 
remove  a  diseased  ureter,  the  operation  is 
greatly  extended,  and  requires  extensive 
dissection,  so  that  the  operation  is  often 
protracted  to  the  point  of  endangering  life. 

What  is  necessary  to  be  done  should  be 
left  to  the  judgment  of  the  operator  at  the 
time  of  operation,  and  no  fixed  plan  be 
agreed  upon  in  advance. 

Partial  nephrectomy  is  contraindicated  in 
theory,  although  apparently  successful  some- 
times in  practice. 

The  experience  of  a  number  of  competent 
observers  seems  to  show  that  after  the  early 
removal  of  a  tuberculous  kidney  the  pro- 
gress of  the  disease  in  the  remainder  of  the 
genito-urinary  track  is  at  least  delayed,  and 
in  some  cases  entirely  arrested. 

The  writer  prefers  the  extraperitoneal 
operation  of  Konig  in  almost  all  cases  when 
there  is  not  some  special  indication  for  the 
selection  of  the  abdominal  route.  In  some 
instances  it  may  be  advisable  to  perform 
the  operation  at  two  sittings. 


Traumatisms  of  the  Urethra. 

G.  Frank  Lydson  (Railway  Surgeon  for 
December,  1898,)  says  that  all  of  the  severe 
varieties  of  urethral  trauma  are  likely  to  be 
followed  by  serious  results.  In  general  the 
results  of  urethral  trauma  are  as  follows  : 
(1)  Hemorrhage;  (2)  retention  of  urine; 
(3)  urethritis:  (4)  cellulitis  and  gangrene  ; 
(5)  extravasation  of  urine,  causing  (a)  cel- 
lulitis, (b)  gangrene,  (c)  peritonitis  ;  (6) 
septicemia;  (7)  such  remote  results  as  (a) 
fistula,  (b)  stricture,  (c)  false  passages 
from  attempts  to  introduce  instruments 
through  the  lacerated  canal. 

Hemorrhage  is  rarely  fatal  because  of  the 
lacerated  quality  of  the  wound,  and  because 
the  same  ecchymotic  swelling  that  shuts  off 
the  urinary  way  also  prevents  escape  of 
Wood,  per  urethra  in  and  via  the  vesical  neck 
into  the  bladder. 

Retention  of  urine  is  always  a  serious 
matter,  but  can  always  be  relieved  by  sur- 
gical measures. 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


42!) 


The  danger  of  extravasation  and  simple 
contact  of  the  urine  with  the  injured  sur- 
faces largely  depends  upon  the  condition  of 
the  urine  and  the  length  of  exposure  of  the 
tissues  to  its  influence.  Normal  urine, 
with  free  escape,  is  in  no  wise  injurious  to 
the  tissues.  If  septic,  either  primarily  or 
from  being  pent  up  in  the  tissues  for  a 
time,  it  is  exceedingly  dangerous,  not  only 
locally,  but  generally. 

Urethritis  from  urethral  trauma  is  sim- 
ple, easily  cured,  and  demands  no  attention 
here. 

Urinary  antisepsis,  local  and  per  os,  is 
indicated  during  the  course  of  urethral  in- 
juries. Boric  acid  irrigations,  with  salol 
and  oil  of  eucalyptus  internally,  accomplish 
the  desired  result  better  than  anything 
known  to  the  author.  Severe  hemorrhage 
demands  perineal  section,  perineal  and  ure- 
thral packing,  and  drainage. 


Systematic  Exercise  in  the  Treatment  of 
Locomotor  Ataxia. 

P.  II.  Zenner  (Cincinnati  Lancet  Clinic). 

i.  All  cases  should  be  benefited  by  the 
exercise  treatment ,  many  to  the  degree  of 
apparent  recovery,  unless  there  be  special 
contraindications  to  the  treatment.  fail- 
ures under  these  circumstances  usually 
mean  faulty  method,  or  that  the  treatment 
has  not  been  persevered  in  sufficiently  long. 

2.  Contraindications  are  loss  oi  vision, 
mental  impairment,  bone  and  joint  disease, 
spasticity,  and  muscular  atrophy,  the  pre- 
sence of  strong  irritation-symptoms,  rapid 
progress  of  the  disease,  a  state  of  great  ex- 
haust ibility,  and  serious  organic  disease. 

3.  In  cases  of  anemia,  poor  nutrition, 
and  lax  joints,  these  general  and  local  con- 
ditions should  be  remedied  before  the  treat- 
ment is  instituted. 

4.  The  conditions  most  favorable  for  the 
treatment  are  a  stationary,  or  almost  sta- 
tionary, state  of  the  disease,  good  general 
health,  intelligence,  hopefulness,  and  per- 
severance. 

5.  Light  cases  are  more  amenable  to  a 
practical  cure,  but  bad,  even  bed-ridden, 
cases  often  give  brilliant  results. 

6.  The  necessary  duration  of  treatment 
varies  from  a  month  or  more  for  the  light- 
est, to  six  months  or  a  year  for  bad  cases; 
but  the  exercises  must  be  kept  up  in  order 
to  insure  the  continuance  of  the  improve- 
ment. 

7.  Success  of  treatment  depend 
thorough  knowledge  of  the  method 
is  especially  true  in  bail  cases. 

8.  Fxerciscs    should    be   chosen    thai    a 
most  suitable  to  remedy  the  existing  ataxi 


and  every  effort  should  be  made  to  do  them 
with  the  greatest  precision. 

9.  The  sense  of  fatigue  is  often  blunted 
in  ataxies,  while  over-fatigue  injures  them. 
The  patient  should,  therefore,  be  guarded 
against  too  taxing  or  too  prolonged  exer- 
cises, or  other  unnecessary  efforts. 

10.  To  obtain  most  benefit  from  the 
treatment  the  constant  supervision  of  the 
physician,  at  least  in  its  early  periods,  is 
absolutely  necessary. 


upon 
This 


Vaccination. 

The  Public  Health  Reports  issued  each 
week  by  the  United  States  Marine  Hospital 
Service,  have  for  several  months  shown  the 
increasing  prevalence  of  small-pox  in  this 
country.  From  January  1,  189S,  to  No- 
vember 25,  1898,  j, 553  cases  of  this  disease 
were  reported  to  the  Supervising  Surgeon- 
General.  And  this  does  not  include  all. 
For  there  are  many  points  which  simply  re- 
port "small-pox  present"  or  "prevalent" 
and  do  not  indicate  the  number  ot  cases. 

By  far  the  greatest  portion  of  cases,  ac- 
cording  to  the  Annals  of  Gynecology,  are  in 
thi'  States  of  Alabama,  Georgia,  Arkansas 
and  Mississippi.  But  there  is  a  sufficient 
sprinkling  of  them  everywhere  to  have  made 
it  seem  wise  to  the  department  to  issue  a 
special  bulletin  styled  a  "Precis  upon  the 
diagnosis  and  treatment  of  small-pox" — 
Vol.  XI V., No.  1.  It  is  interesting  and  in- 
structive, but  we  wish  to  call  the  attention 
of  our  readers  only  to  that  part  which  treats 
of  vaccination.  For  we  are  hearing  alto- 
gether too  much  in  these  days  of  the  useless- 
ness  and  dangers  of  this  procedure.  A  no- 
ble literary  attempt  to  combat  this  fallacy 
is  II.  Rider  Haggard's  "Dr.  Therne."  If 
you  are  living  in  a  nest  of  "Antis,"  get  a 
copy  and  circulate  it  among  your  friends. 

But  to  establish  the  truth  of  vaccination, 
the  predis  quotes  from  Dr.  Bizzozozirs,  of 
Rome,  who  in  a  recent  lecture  said  :  "Ger- 
many stands  alone  in  fulfilling  in  a  great 
measure  the  demands  of  hygiene,  having  in 
consequence  of  the  calamitous  small-pox 
epidemic  of  1870-71  enacted  the  law  of  1874, 
which  makes  vaccination  obligatory  in  the 
first  year  of  life,  and  revaccination  obliga- 
tory at  the  tenth  year.  What  was  the  re- 
sult ?  With  a  population  of  50,000,000, 
having  in  187 1  lost  143,000  lives  by  small- 
pox, she  found  by  her  law  of  1874  the  mor- 
tality diminished  so  rapidly  that  to-day  the 
disease  numbers  only  116  victims  in  a  year. 
These  cases,  moreover,  occur  almost  exclu- 
sively in  towns  on  her  frontier.  If  it  were 
true  that  a  good  vaccination  does  not  pro- 
tect from  small-pox,  we  ought  to  find  in 
small-pox  epidemics,  that  the  disease  diffu- 


430 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


ses  itself  in  the  well  vaccinated  no  less  than 
in  the  non-vaccinated  countries.  But  it  is 
not  so.  In  1870-71  during  the  Franco-Ger- 
man war,  the  two  peoples  interpenetrated 
each  other,  the  German  having  its  civil 
population  vaccinated  optionally,  but  its 
army  completely  vaccinated,  while  the 
French  (population  and  army  alike)  were 
vaccinated  perfunctorily.  Both  were  attack- 
ed with  small-pox.  The  French  army  num- 
bered 23,000  deaths  by  it, while  the  German 
army  had  only  278  and  in  the  same  tent 
breathing  the  same  air,  the  French  wound- 
ed were  heavily  visited  by  the  disease, while 
the  German  wounded,  having  been  vaccina- 
ted, had  not  a  single  case." 

Truly,  that  is  powerful  evidence  if  we 
need  to  quote  beyond  our  own  experience  ? 

Probably  all  of  us  have  had  examples  of 
very  sore  arms,  obstinate  indolent  ulcers, 
vaccinia  rashes,  etc.,  and  may  have  been 
puzzled  as  to  their  cause.  It  may  not  there- 
fore be  amiss  to  present  methods  recom- 
mended by  these  United  States  government 
experts.  If  they  are  our  own,  well  and 
good.      If  not,  they  may  be  suggestive. 

Bovine  virus  is,  of  course,  the  only  kind 
employed  and  it  must  come  from  an  accred- 
ited source  and  only  the  glycerinized  lymph 
should  be  used.  .Surely  we,  none  of  us, 
have  intended  to  buy  poor  points,  but  now 
we  are  advised  not  to  use  points  at  all,  but 
the  little  sterile  tubes.  Having  then  the 
suitable  material,  the  part  to  be  vaccinated 
— usually  the  left  arm — is  bared  and  the 
skin  rendered  antiseptic  (probably  they 
mean  aseptic)  by  means  of  soap  and  water 
or  alcohol.  The  needle  or  lancet  is  sterili- 
zed in  alcohol  or  the  flame  and  the  part 
scarified  in  one  or  more  places;  the  virus  is 
then  robbed  in.  The  same  needle  is  not 
used  on  more  than  one  person.  A  lancet  is 
sterilized  each  time  used.  (Why  not  a 
needle  as  well?)  "If  the  vaccination  has 
been  successful  it  will  be  found  that  in  the 
course  of  three  or  four  days  a  small  papule 
will  appear,  which  soon  after  becomes  vesi- 
cular, and  is  surrounded  by  a  circumscribed 
areola ;  this  gradually  increases  till  the 
seventh  or  eighth  day  ;  in  the  meantime  a 
crust  forms  which  in  due  course  falls  off, 
leaving  the  characteristic  scar  resembling 
the  pits  of  small-pox,  the  whole  process  oc- 
cupying about  three  weeks." 

Due  care  should  be  exercised  to  prevent 
the  vaccination  from  being  irritated  or  the 
"seal"  from  being  broken  and  to  prevent 
the  wound  from  being  infected.  A  vaccine 
shield  is  best  for  this  purpose,  and  it  is  rec- 
ommended that  either  one  provided  by  the 
dealers  or  improvised  be  used,  but  if  a  vac- 
cination shield  is  not  used  care  should  be 
taken,  as  above  stated,  to  prevent  the  break- 


ing of  the  "seal"  and  undue  rubbing  of  the 
part  by  the  clothing.  Adhesive  plaster 
should  not  be  used  for  this  purpose. 

Now  that  does  not  cover  all  that  one 
wishes  to  know,  or  will  practice  in  this  pro- 
cedure, but  it  may  contain  some  useful 
hints.     Try  them  and  see. 

Skin  Eruptions  Caused  by  Antipyrin. 

Wechnelmans  (Edinburgh  Med.  Journal) 
gives  a  brief  description  of  the  varieties  of 
skin  eruptions  met  with  in  cases  of  antipy- 
rin poisoning,  and  also  relates  the  condi- 
tions which  he  had  observed  in  5  cases  :  (1) 
In  a  man  aged  36,  who  had  suffered  from 
attacks  of  migraine  for  several  years,  and 
had  been  in  the  habit  of  taking  antipyrin 
pretty  freely  without  medical  advice, a  vesi- 
cular eruption  suddenly  occurred  round  the 
mouth  and  front  part  of  the  tongue  ;  the 
penis,  scrotum,  and  anus  were  similarly 
attacked.  The  eruption  was  extremely 
painful.  When  the  antipyrin  was  discon- 
tinued the  patient  soon  recovered.  As  an 
experiment  a  small  dose  was  again  adminis- 
tered, and  in  an  hour  and  a  half  the  erup- 
tion reappeared.  (2)  A  woman,  aged  40, 
had  taken  antipyrin  for  migraine.  The  lips, 
eyelids,  tongue,  and  dorsal  aspect  of  both 
hands  were  attacked  with  a  painful  vesicu- 
lar eruption.  On  inquiry  she  admitted 
having  taken  antipyrin  for  her  headaches. 
At  a  later  date  she  took  \  gr.  of  antipyrin  ; 
this  small  dose  was  sufficient  to  cause  an 
eruption  identical  in  every  respect  to  the 
former  one.  (3)  A  man,  aged  62,  suffering 
from  diabetes,  after  taking  antipyrin  for  a 
time,  noticed  a  hemorrhagic  eruption  on 
the  dorsal  surface  of  his  left  hand ;  the  skin 
was  oedematous.  The  drug  was  discontin- 
ued, and  the  eruption  immediately  began  to 
subside ;  pigmentation  was  noticed  for  a 
considerable  time  after  the  eruption  had 
disappeared.  (4)  A  diabetic  man,  aged  65, 
for  six  years  had  suffered  from  a  vesicular 
eruption, which  occurred  every  second  year. 
The  parts  attacked  were  the  dorsal  aspect 
of  both  hands,  the  lower  lip,  anus,  and  scro- 
tum. After  a  short  time  the  vesicles  burst, 
leaving  a  scale  which  gradually  died  away. 
(5)  A  man,  aged  29,  had  suffered  from  pe- 
riodic attacks  of  "eczema,"  which  one  doc- 
tor had  called  syphilitic.  In  May,  1893, he 
took  3  gr.  of  antipyrin  for  headache,  and  in 
half  an  hour  he  began  to  feel  a  burning  sen- 
sation in  the  perineal  region,  also  between 
the  fingers  and  on  the  dorsal  aspect  of  the 
hands  ;  later  the  toes  became  affected.  Ve- 
sicles formed,  and  the  whole  progress  of  the 
case  coincided  with  his  former  attacks  of 
so-called  eczema.  The  patient  was  advised 
never  to  take  antipyrin  ;  he  had  no  further 
skin  trouble. 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


431 


Mechanism  of  the  Contraction  of  the  Peri- 
pheral   Bloodvessels  Under  Hydrothe- 
rapeutic  Treatment. 

Onimus  at  the  International  Congress  on 
Hydrology  held  at  Liege  in  1898,  referred, 
says  "Treatment,"  January  12,  '99,  to  the 
classical  doctrine  that  the  circulatory  phe- 
nomena resulting  from  hydrotherapeutic 
applications  must  be  explained  as  due  to 
vaso-motor  nervous  reflex  action.  He  points 
out  how  the  relative  amount  of  muscle  in 
the  walls  of  the  arteries  increase  with  the 
distance  from  the  heart.  Owing  to  the 
contractile  function  of  the  arterioles,  he 
thinks  the  term  "cceur  peripherique"  is 
almost  justified  when  applied  to  the  peri- 
pheral circulatory  mechanism.  The  un- 
striped  muscular  tissue  of  the  vessel-walls 
is  capable  of  two  sorts  of  action  :  (a)  spas- 
modic contraction,  when  the  stimulus  is 
sudden  and  intense;  (b)  peristaltic  contrac- 
tion (like  that  of  the  intestine,  bill  at  more 
frequent  intervals),  when  the  stimulus  is 
less  sudden  and  more  gentle.  Through  the 
microscope  the  contractile  action  of  the 
bloodvessels  may  be  watched  in  the  inter- 
digital  web  of  a  frog.  Even  in  the  human 
subject,  when  the  central  artery  of  the  retina 
is  obstructed  by  a  clot,  the  arterioles  which 
help  to  establish  a  collateral  circulation  may, 
by  the  aid  of  an  ophthalmoscope, be  observed 
to  contract  peristaltically.  Nobody,  says 
Dr.  Onimus.  who  has  once  observed  this 
phenomenon,  will  have  any  doubt  about  the 
power  of  spontaneous  contraction  possessed 
by  bloodvessels.  Onimus  and  the  late  C. 
Legros  made  a  series  of  experiments  on  the 
subject,  and  found  that,  when  the  aorta 
was  ligatured,  or  when  the  heart's  action 
was  arrested,  so  long  as  the  arteries  main- 
tained their  contractility,  innocuous  liquids 
(such  as  milk),  when  introduced  into  the 
arteries,  requrned  by  the  veins.  Onimus 
acknowledges  that  the  sudden  contraction 
of  the  vessels  which  immediately  follows  the 
application  of  cold  water  to  the  skin  is  really 
I  nervous  reflex;  but  he  thinks  that  the  sub- 
sequent vascular  dilatation  and  tonic  effects 
are  produced  in  the  vessels  themselves  inde- 
pendently of  the  nervous  system — in  fact, 
that  the  vascular  dilatation  is  not  a  neuro- 
paralytic phenomenon, or  due  to  vaso-dilator 
nerve-fibres.  In  the  same  way  Onimus 
argues  that  the  vascular  dilatation  following 
hot  applications  ("hydrotherapeutic  reac- 
tion to  heat")  must  not  be  regarded  as  a 
vaso-motor  nervous  phenomenon,  but  as  a 
reaction  originating  in  the  vascular  walls 
themselves.  He  points  out  that  the  action 
of  hydrotherapeutics  is  not  confined  to  the 
bloodvessels  alone,  but  that  the  activity  of 
the  urinary   bladder,   of  the  intestines,  and 


of  all  organs  more  or  less  composed  of  un- 
striped  muscular  fibres,  can  be  promoted  by 
the  use  of  douches. 


Clinical  Study   of  Nervous   Dyspepsia. 

Dr.  Ludwig  Herzog  has  made  the  follow- 
ing statement,  says  the  Medical  Record  : 

The  pathologic,  anatomical  examination 
in  these  cases  should,  in  so  far  as  possible, 
be  directed  to  the  mesentery  and  splanchnic 
nerves  as  well  as  to  the  stomach. 

In  nervous  dyspepsia  there  exist  an  in- 
creased irritability  in  the  course  of  the  vagus 
(and  the  sympathetic)  and  an  action  upon 
the  entire  nervous  system. 

The  term  nervous  dyspepsia  is  up  to  the 
present  day  the  most  correct  and  best  that 
can  be  applied.  Neurasthenia  is  but  one  of 
the  many  etiological  factors. 

Nervous  dyspepsia  is  not  a  symptom,  but 
a  uniform  and  indeed  characteristic  clinical 
picture. 

Nervous  dyspepsia  is  a  chronic  affection. 

Nervous  dyspepsia  is  not  only  a  pure 
sensory,  but  mostly  a  mixed,  neurosis,  and 
indeed  oftimes  in  connection  with  a  sensory 
neurosis  there  exists  a  neurosis  of  motility 
and  secretion. 

Body  weight  and  the  amount  of  acidity 
often  increase  or  decrease  in  inverse  pro- 
portion. 

Nervous  dyspepsia  with  motor  insuffi- 
ciency of  the  stomach  and  simultaneous 
hyperacidity  is  an  especially  important  form  ; 
this  leads  in  part  to  motor  insufficiency  with 
subnormal  or  normal  acidity. 

Nervous  dyspepsia  with  good  motor 
power  may  be  associated  with  hyperacidity 
and  subacidity. 

Nervous  dyspepsia  as  a  pure  sensory  neu- 
rosis is  not  so  common.  A  thorough  ex- 
amination of  the  chemical  and  motor  func- 
tions of  the  stomach  will  tend  to  narrow  this 
group  very  materially. 

Nervous  dyspepsia  may  be  the  results  of  a 
gastroptosis  (enteroptosis),but  not  the  cause 
of  it.  The  maladie  de  Clenard  does  not 
at  all  belong  to  the  category  of  nervous  dys- 
pepsia,  nor  is  it  a  variety  of  this  affection. 

An  aggravation  of  the  dyspepsia  shows 
itself  in  a  strong  reaction  of  the  nervous 
system.  The  subjective  symptoms  often 
remain  in  severe  form  for  a  considerable 
length  of  time.  A  simultaneous  oscilla- 
tion of  the  subjective  symptoms  and  the 
functions  of  the  stomach  is  not  frequent.  On 
t  heother  hand, accordingto  my  observations, 
a  change — that  is,  an  increase  of  the  dys- 
pepsia— often  takes  place  at  certain  fixed 
periods  of  the  day,  namely,  when  the  maxi- 
mum daily  physical  and  mental  resistance 
has  been  reached  or  exceeded. 


432 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


In  nervous  dyspepsia  even  the  empty 
stomach  may  be  the  seat  of  disturbances, 
which  are  for  the  most  part  irritations  in 
the  sensory  sphere. 

In  a  very  large  number  of  cases  we  are 
in  a  position  to  definitely  diagnose  nervous 
dyspepsia. 

In  the  differential  diagnosis  chronic  gas- 
tritis and  ulcer  of  the  stomach  are  mainly 
to  be  considered. 


Appendicitis  or  Epityphlitis? 

Kuster  (Edenburgh  Medical  Journal)  pro- 
tests against  the  use  of  the  term  "appendi- 
citis, which  he  regards  as  most  unsatisfac- 
tory both  in  meaning  and  in  form.  Ger- 
man anatomists  do  not  use  the  term  "ap- 
pendix" in  describing  the  vermiform  pro- 
cess of  the  caecum,  and  are  unwilling  to 
adopt  a  term  which  in  its  multiple  sense  is 
already  generally  applied  to  the  small  fatty 
processes  met  with  on-  the  large  intestine. 
The  form  of  the  term  "appendicitis"  is 
held  to  be  particularly  objectionable,  as  it 
consists  of  a  Latin  word  with  a  Greek  end- 
ing. Such  a  term,  Kuster  holds,  would  be 
hardly  tolerable  even  if  it  could  not  be  re- 
placed by  another.  It  is  not  difficult,  how- 
ever, he  states,  to  find  a  good  substitute. 
The  Greek  anatomists,  whose  definitions 
were  made  chiefly  on  animals  which  with 
some  few  exceptions  do  not  possess  a  ver- 
miform process,  left  no  term  for  this  struc- 
ture, but  it  would  have  been  in  accordance 
with  the  spirit  of  the  Greek  language  to 
have  given  to  it  the  name  of  "epityphlon" 
as  indicating  a  something  attached  to  the 
outer  surface  of  the  caecum.  On  these 
grounds  Kuster  would  advocate  the  substi- 
tution of  the  term  "epityphlitis"  for  that 
of  appendicitis.  The  former  term,  which 
he  has  long  used  in  his  clinical  lectures, 
will,  he  anticipates,  be  preferred  by  those 
acquainted  with  Greek  to  the  older  and 
more  frequently  used  term. 


Diphtheria. 

D.  C.  Bowen,  M.  D.,  (Louisville  Jour- 
nal of  Medicine  and  Surgery). 

The  period  of  incubation  may  last  but 
few  hours  to  days  and  even  a  month.  The 
symptoms  are  both  local  and  constitutional. 
The  symptom  of  localized  inflammation  has 
nothing  to  do  oftentimes  with  the  intensity 
of  the  disease.  The  pulse  may  be  normal 
throughout  or  accelerated.  The  fever  irreg- 
ular. Visual  examination  of  the  throat  re- 
veals one  or  two  gray  or  yellowish  spots  on 
tonsils  or  i.i  vault  of  pharynx.  They  may 
remain  for  a  few  days  as  isolated  spots,  or 
they  may  coalesce  and  deepen  and  become 
more  adherent,  and  a  continuous  membrane 


is  formed.  The  chain  of  lymphatic  glands 
may  become  swollen,  and  I  believe  it  is 
Page  who  said,  when  the  gland  at  angle  of 
jaw  becomes  involved  and  is  indurated  and 
wollen,  we  may  look  for  post-nasal  inva- 
sion, which  should  always  cause  us  to  treat 
that  surface  as  well  as  the  throat.  The 
fetid  breath  is  a  symptom  I  always  look[for 
in  all  suspected  cases  of  diphtheria. 

When  the  nares  are  involved,  we  gen- 
erally have  a  thin  muco-purulent  discharge 
from  the  nose.  The  pain  may  be  very 
slight  or  intense,  radiating  toward  the  ear 
on  the  side  corresponding  to  infected  part 
of  throat;  I  have  noticed  this  symptom 
more  often  in  the  unilateral  cases  (where 
only  one  side  of  throat  was  affected). 

The  duration  in  the  cases  I  have  had  was 
about  ten  days.  The  treatment  I  will  give 
as  I  used  it  in  the  cases  I  am  about  to  re- 
port. I  tried  to  isolate  all  my  infected  cases 
by  placing  them  in  a  room  with  sun  expo- 
sure and  ventilation,  and  cleanliness  was 
insisted  upon.  All  clothes  used  about  the 
bed  were  burned.  I  gave  the  well  children 
a  round  of  calomel,  quinine,  and  tincture 
chloride  of  iron,  and  had  them  use  powder- 
ed sulphur.  All  the  well  children  were 
examined  every  day,  and  on  the  slightest 
redness  of  throat  the  child  was  removed  to 
other  quarcers  and  treated.  I  generally 
gave  as  a  routine  broken  doses  of  mild 
chloride  of  mercury  and  subnitrate  of  bis- 
muth for  a  few  days,  then  substituted  the 
following  prescription  : 

R     Bichloride  of  mercury gr.  I 

Tr.  chloride  of  iron z  i. 

Glycerine,  U.  S.  P I  i. 

Aquas  dest.  q.  s.  ad 5  iv. 

Sig  :  Use  with  mop  once  a  day,  and  give  a  tea- 
spoonful  every  four  hours. 

I  also  have  patients  to  inhale  about  ten 
grains  of  publimed  mercury  three  times  in 
twenty-four  hours.  I  also  have  a  spray 
used  three  or  four  times  a  day  of  per  oxide 
of  hydrogen  and  lime  water,  equal  parts. 
I  treat  complications  as  they  arise.  I  have 
used  the  antitoxine  in  some  half  a  dozen 
cases  with  satisfaction  to  myself.  In  two 
of  these  cases  it  was  used  as  a  last  resort. 
I  injected  two  thousand  units  in  each  case 
subcutaneously  in  the  thigh  ;  after  the  re- 
active stage  they  went  on  to  an  uninter- 
rupted recovery. 


Somatose    in   Syphilis. 

Fournier  (Edenburgh  Medical  Journal) 
advocates  the  administration  of  somatose  in 
cases  of  secondary  syphilis,  particularly 
those  in  which  marked  wasting  occurs,  or 
profound  blood  changes.  The  "syphilis 
denutritive  secondaire"  described  by  Laval- 
lee  (which  is  characterised  by  loss  of  appe- 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


4.33 


tile,  wasting,  loss  of  body  weight,  and  a ,  perature  seems  to  be  most  held  by  those 
feeling  of  great  depression  and  weakness)  j  having  large  outdoor  clinics, where  the  diffi- 
seems  to  be  treated  by  somatose.  Cases  culty  of  enforcing  details  is  greatest.  Those 
only  in  which  the  blood  shows  a  decreased  |  having  affairs  more  in  hand  see  the  other 
percentage  of  haemoglobin,  associated  with  j  side  more  clearly.     There  is  no  doubt  that 


vertigo,  insomnia,  and  gastralgia  are  suit 
able.  These  symptoms  sometimes  resist 
every  kind  of  treatment.  The  author 
showed  a  case  at  the  Berlin  Dermatological 
Society  in  which  somatose  had  practically 
cured  the  patient  after  all  other  remedies 
had  failed.  The  man  was  40  years  of  age,  j 
and  suffered  from  ulceration  of  the  skin  in 
the  inguinal  region,  oedema  of  the  feet, 
epistaxis,  and  a  purpuric  eruption  which 
started  in  the  pharynx,  and  rapidly  spread 
to  the  gums  and  buccal  mucous  membrane. 
The  case  was  complicated  by  mercurial 
stomatitis  and  swelling  of  the  tongue 
Respiration  and  deglutition  became  diffi- 
cult. Milk  caused  indigestion,  and  had  to 
be  discontinued.  For  twenty  days  the 
patient  was  fed  on  soup  and  .|  teaspoonfuls 
of  somatose  per  diem.  With  this  diet  the 
patient  gained  in  strength.  lie  continued 
to  take  somatose  for  several  weeks.  The 
syphilitic  symptoms  abated  when  the  patient 
began  to  assimilate  more  food.  The  addi- 
tion of  somatose  to  cow's  milk  facilitates 
the  digestion  of  the  milk  in  many  other 
syphilitic  conditions.  Somatose  is  best 
given  in  small  doses  of  12  grams.  The 
author  has  also  found  somatose  to  be  of  use 
in  chlorosis  and  the  anaemia  caused  by 
malaria.  Its  chief  use,  however,  is  in  cases 
of  mercurial  stomatitis,  and  in  conditions 
producing  a  diminution  in  the  amount  of 
haemoglobin. 


The  Heating  of  Milk  Used  for  Feeding 
Infants. 

Dr.   L.  M.   Vale    (Canada 


lcet. 


898. 
No.  6). 

Whether  the  mixture  shall  be  sterilized  is 
a  vexed  question.  On  the  one  hand  are 
presented  bacteriological  studies  and  some 
clinical  experiences  to  show  that  milk  can- 
not be  made  safely  sterile  for  infant  feeding 
below  yodeg.  C.(i84  deg.  F.),and  that  100 
deg.  C.  (212  deg.  F.)  is  better;  that  with 
pasteurization,  75  deg.  0.(167  deg.  F.),  or 
lower,  accidents  frequently  happen  to  the 
milk,  and  infrequently  gastro-enteric  dis- 
turbances, more  or  less  acute,  occur,  due  to 
milk  poisoning.  On  the  other  hand,  there 
is  a  growing  distrust  of  sterilization  and 
even  of  pasteurization,  as  a  possible  cause 
of  malnutrition,  especially  of  scurvy. 

There  is  no  doubt  that  both  sides  present 
tacts,  but  it  seems  to  the  author  that  much 
depends  upon  the  point  of  view.  The  ne- 
cessity of  thorough  sterilization  at  high  tem- 


the  one  party  can  show  cases  of  peculiar 
susceptibility  where  uncooked  milk  pre- 
pared in  the  best  laboratories  cannot  be  di- 
gested. The  other  party  produces  cases  of 
scurvy  in  which  the  cessation  of  symptoms 
followed  the  cessation  of  the  sterilization. 
Whatever  increases  the  chance  of  bacte- 
rial contamination  or  multiplication, wheth- 
er poor  milk-supply,  want  of  reliability  of 
those  in  charge  of  the  food,  heat,  unsanitary 
surroundings,  or  what  not,  is  an  argument 
in  favor  of  sterilization,  and  the  thorough- 
ness of  the  sterilization  is  to  be  in  propor- 
tion to  the  probabilities  of  contamination. 
Practically,  in  cities,  the  ordinary  milk-sup- 
ply must  all  be  sterilized,  at  least  in  warm 
weather. 


Acute  Cervical  Adenitis   in  Childhood. 

Dr.  G.  W.  Moran  (The  Physician  and 
Surgeon,  1S98.     Vol.  xx.,  No.  8). 

This  is  an  acute  local  disease  resulting 
almost  invariably  from  secondary  infection. 
The  most  frequent  causes  are  traceable  to 
catarrh  of  the  nose  and  throat,  adenoids, 
decayed  teeth,  unhealthy  tonsils,  stomatitis, 
and  middle-ear  disease. 

The  glands  most  commonly  involved  are 
those  belonging  to  the  submaxillary,  upper 
deep  cervical,  parotid,  superficial  cervical, 
sublingual,  retropharyngeal,  and  postcer- 
vical  sets.  Usually  one,  and  rarely  more 
than  two  glands  undergo  acute  inflamma- 
tion at  the  same  time.  The  gland  rapidly 
enlarges,  and  is  attended  with  more  or  less 
pain,  depending  upon  its  location,  and  the 
amount  of  periglandular  cellulitis. 

The  prognosis  is  always  favorable,  unless 
in  some  severe  cases  of  acute  adenitis  of  the 
retropharyngeal  glands  ending  in  suppur- 
ation. 

The  treatment  of  acute  cervical  adenitis 
divides  itself  into  :  (1)  Prophylactic — Care 
should  be  taken  to  keep  a  clean  membrane 
in  all  catarrhal  diseases  of  the  nose  and 
throat.  Unhealthy  conditions  of  the  vault 
should  be  corrected,  unusually  large  tonsils 
should  be  removed,  and  last,  but  far  from 
least,  the  teeth  should  be  attended  to.  In 
some  seventy-eight  cases  of  acute  adenitis, 
about  sixty  per  cent,  were  directly  tracea- 
ble to  bad  teeth  and  suppurating  gums,  and 
twenty  per  cent,  to  enlarged  tonsils  and 
disease  of  the  nose  and  throat ;  hence,  the 
necessity  for  removal,  or  attempt  at  proper 
disinfection  of  decayed  teeth  and  inflamed 
gums.  (2)  Medicinal — When  the  acute  in- 
flammatory stage  develops,  hot  applications 


434 


THE  CHARLOTTE    MEDICAL  JOURNAL. 


should  be  made  for  the  relief  of  pain.  Cold 
is  also  recommended,  but  it  is  rare  to  find 
a  child  who  will  tolerate  its  constant  appli- 
cation. To  prevent  the  formation  of  pus, 
very  little  can  be  done.  The  early  local 
application  of  the  liniment  or  ointment  of 
belladonna  combined  with  opium  also  proves 
gracious  in  the  relief  of  pain,  and  undoubt- 
edly does,  in  many  cases,  check  the  process 
from  going  on  to  suppuration.  When  pus 
is  present,  some  authorities  advocate  wait- 
ing until  pointing  takes  place,  which,  it 
seems  to  me,  is  applicable  only  in  very  su- 
perficial glands,  and  is  even  then,  bad  prac- 
tice. As  a  rule,  pus  is  present  in  greater 
or  lesser  quantity  for  some  time  before  it  is 
possible  to  detect  it,  particularly  when  cel- 
lulitis extends  for  some  distance  around  the 
inflamed  node ;  and  to  wait  after  you  are 
sure  of  its  presence,  thus  allowing  it  time 
to  burrow,  is  dangerous.  After  evacuation 
of  pus,  curretting  may  be  necessary  if  heal- 
ing does  not  progress  rapidly.  When  sup- 
puration does  not  take  place,  but  the  gland 
remains  large  and  tender,  the  local  applica- 
tion of  potassium  iodide  ointment  has  acted 
better  for  me  than  other  ointments,  or  the 
iodide  internally. 


Treatment  of  Exophthalmic  Goitre. 

Dr.  Frank  Oliphant  (The  Birmingham 
Medical  Review)  discusses  this  subject  un- 
der the  following  heads  :  (i)  The  general 
hygenic  treatment, which  consists  of  rest  in 
bed  for  a  certain  period  of  time,  and  the 
regulation  of  the  diet,  embracing  non-stim- 
ulating and  easily  digestible  foods;  (2)  of 
the  drugs,  belladonna  in  large  doses  does 
the  most  good,  by  restraining  the  action  of 
the  heart,  and  by  decreasing  (probably)the 
secretory  activity  of  the  gland.  Ung.  hydr. 
lod.  externally  tends  to  decrease  the  size  of 
the  goitre;  digitalis  is  effective  as  cardiac 
tonic.  Phosphate  of  soda,  so  highly  praised 
by  some  has  been  attended  with  no  results 
in  the  author's  hands;  (3)  electricity,  so 
much  relied  upon  formerly,  has  now  given 
place  to  more  effective  means ;  (4)  the  au- 
thor failed  to  obtain  any  results  from  the 
administration  of  either  the  thymus  or  the 
thyroid  extract ;  the  first  one  is  probably 
somewhat  more  efficacious.  Pancreatic 
emulsion,  suprarenal  gland  and  spleen  have 
all  been  used  with  varying  success;  (5)  op- 
erative treatment  by  Kocher  consists  in  lig- 
ature of  the  thyroid  arteries;  other  methods 
are:  removal,  by  excision,  of  half  or  more 
of  the  gland,  and  exothyreopexy — the  lay- 
ing bare  and  bringing  out  of  the  gland, 
leaving  it  in  this  position,  the  usual  result 
being  thrombosis  of  the  veins  and  shriveling 
up  of  the  gland.       The  most  recent  opera- 


tion is  that  by  Jaboulay,  which  consists  in 
the  division  of  the  cervical  sympathetic. 
The  mortality  in  all  the  operative  proced- 
ures being  rather  high — fully  12  per  cent — 
the  tendency  is  making  itself  felt  to  resort 
to  operative  interference  only  after  medi- 
cinal means  have  been  exhausted  and  prov- 
ed futile. 


Curettement    in    Puerperal   Fever. 

Henry  Perry,  M.  D.,  (Annals  of  Gyne- 
cology). Admitting  that  puerperal  fever 
is  produced  by  an  intra-uterine  infection, 
we  believe  that  the  best  means  to  prevent 
I  he  extension  of  the  germs  of  infection  is  to 
combat  them  at  their  starting  point,  either 
by  a  complete  and  oft  repeated  disinfection 
of  the  uterine  and  vaginal  cavities  by  anti- 
septic irrigations  or  by  scraping  away  the 
diseased  mucosa. 

Nevertheless,  should  we  at  once  take  up 
the  curette  at  the  least  rise  of  temperature 
in  a  post-partum  case?  We  do  not  believe 
so.  In  some  cases  a  few  intra-uterine  irri- 
gations will  be  quite  sufficient,  and  it  is 
only  in  those  instances  in  which  this  means 
has  remained  without  effect  that  we  resort 
to  curettement,  which,  in  spite  of  the  only 
slight  danger  when  it  is  done  according  to 
all  the  rules  of  the  most  strict  antisepsis,  is 
none  the  less  a  disagreeable  operation  for 
the  patient. 

We  shall  point  out  farther  on,  apropos 
of  the  objections  that  have  been  made  re- 
garding curettement,  what  are  the  com- 
plications to  be  feared  in  curetting  a  puer- 
peral uterus. 

The  following  is  the  treatment  carried 
out  at  the  maternity  of  Lausanne  when 
there  is  a  threatening  puerperal  infection 
or  when  the  infection  has  appeared.  As 
soon  as  a  rise  in  temperature  has  been, 
found  after  labor  an  antiseptic  intra-uterine 
irrigation  (preferably  a  1  in  1,000  or  2,000 
sublimate  solution)  preceded  by  a  thorough 
vaginal  irrigation.  The  next  morning(rise 
in  temperature  usually  occurs  in  the  even- 
ing) another  irrigation  is  given  and  is  re- 
peated several  times  during  the  day.  If  on 
the  next  day  the  temperature  has  become 
frankly  febrile,  if  the  lochi  are  thick  with  a 
tendency  to  fetor,  curettement  is  done.  The 
following  days  we  continue  the  intra-uterine 
irrigations,  at  first  morning  and  evening, 
then  only  once  a  day.  When  the  fever  has 
completely  disappeared,  the  temperature 
no  longer  showing  any  tendency  to  go  up 
in  the  evening,  simple  vaginal  irrigations 
are  begun. 

It  is  well  to  change  the  nature  of  the  solu- 
tion employed  as  frequently  as  possible,  as 
the  organism  becomes  used  to  antiseptics 
just    as   it   does   to   any  medicine,  and  still 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


435 


more,  a  certain  number  of  antiseptics  can 
not  be  employed  with  impunity  on  account 
of  their  toxic  effects. 

As  to  danger  from  hemorrhage, experience 
has  demonstrated  that  it  is  a  pure  illusion. 
On  the  contrary,  curettement  arrests  uterine 
hemorrhage  instead  of  producing  it,  and  if 
the  patient  is  a  bleeder  the  operation  may 
be  completed  by  an  intra-uterine  gauze 
packing. 

Can  the  uterus  be  curetted  in  cases  where 
there  is  an  acute  inflammation  of  the  adnexa 
(acute  puerperal  parametritis)  with  or  with- 
out abscess  formation?  The  opinion  of 
specialists  is  very  devided  on  this  question. 
While  some  recommended  abstaining  in 
cases  of  abscess  of  the  adnexa,  beleiving 
that  the  curette  only  spreads  the  infectious 
germs,  others,  far  from  abstaining,  advise 
curettement.  Thus,  Berlin  of  Nice,  is  very 
categorical  on  this  point  and  says:  "I 
have  for  my  part  often  curetted  patients 
whose  adnexa  were  painful,  and  others  who 
manifestly  had  foci  of  parametritis  ;  what  I 
can  say  is  that  in  these  cases  where  there  is 
a  pre-existing  lesion  of  the  adnexa,  I  have 
never  seen  curettement  the  cause  of  the 
slightest  septic  complication."  Professor 
Rapin  believes  that  where  there  is  inflam- 
mation of  the  adnexa,  curettement  is  not  to 
be  advised  ;  it  is  only  exceptionally  that  it 
is  to  be  employed  when,  for  example,  there 
is  a  retention  of  the  placenta,  and  using  it 
with  extreme  prudence.  He  has  employed 
and  has  seen  it  employed  in  several  cases  of 
inflammation  of  the  adnexa,  and  if  in  the 
majority  of  these  cases  the  operation  had  no 
bad  results,  it  certainly  did  increase  the  in- 
tensity of  some  of  the  symptoms. 

We  have  done  it  in  two  cases  of  puerperal 
parametritis,  in  one  of  which  an  abscess 
had  already  formed,  without  remarking  any 
result, bad  or  good.  In  the  first  case,  how- 
ever, the  temperature  dropped  quite  a  little 
after  the  operation,  but  went  up  a  few  days 
latter.  Consequently  we  believe  that  this 
operation,  without  being  dangerous,  if  per- 
formed with  sufficient  precaution,  is  useless 
as  regards  a  cure,  because  if  infection  has 
started  in  the  mucous  of  the  uterus,  it  will 
have  long  ago  passed  the  limits  of  the  or- 
gan and  have  become'localized  in  the  adnexa. 
This  question  has  for  that  matter  been  well 
studied  recently  by  Marney,  of  Bordeaux. 

From  what  has  been  said  I  may  here 
draw  the  following  conclusions  : 

i.  Puerperal  fever  being  a  disease  whose 
origin  is  an  infected  wound,  should  be 
treated  by  an  antisepsis  of  the  organ  con- 
taining this  wound — the  uterus. 

i.  The  treatment  should  consist  in  the 
first  place  of  antiseptic  irritations  of  the 
Vagina  and  uterus,  frequently  repeated. 


3.  If  in  spite  of  this  treatment  fever  per- 
sists, curettement  is  indicated. 

4.  When  there  are  acute  lesions  of  the 
adnexa  (parametritis)  it  is  better  to  abstain 
from  curettement  unless  there  are  absolute 
indications  for  the  operation. 


The  Liquor  Trade  in  America, 

It  is  rather  remarkable  that  the  consump- 
tion of  wines  has  not  increased  of  late  years 
since  America  itself  has  become  a  wine-pro- 
ducing country.  Perhaps  the  use  of  home — 
i.  e,  American-made — wines  has  interfered 
with  the  importation  of  foreign  ones.  Cer- 
tainly the  importation  of  wines  has  not  in- 
creased during  the  last  fifty  years.  The 
•'Hospital"  states  that  in  1840  it  was 4,748, - 
.$42  gallons,  and  in  1896  it  was  only  4,101, - 
049  gallons.  This,  even,  was  an  increase  of 
a  million  gallons  or  so  over  the  consumption 
of  1895;  while  it  is  to  be  noted  that  from 
i860  to  1870  the  average  annual  consump- 
tion of  foreign  wines  was  about  nine  million 
gallons.  Thus,  while  the  consumption  of 
wines  per  head  of  the  population  has  varied 
very  little,  it  is  obvious  that  the  new  con- 
sumers have  largely  used  wines  made  in 
their  own  country.  This  is  shown  by  the 
fact  that  while  in  1840  the  consumption  of 
American  wines  was  only  124,734  gallons, 
in  1896  it  stood  at  14,599,757  gallons.  And 
this  was  by  no  means  the  largest  figure  that 
domestic  wines  had  to  show.  In  1888  their 
consumption  stood  at  the  figure  of  31,680,- 
523  gallons,  since  which  time  it  has  been 
diminishing  along  with  that  of  spirits.  All 
this  time  the  consumption  of  beer  has  risen 
steadily.  This  seems  to  imply  that  while 
absolute  abstinence  is  less  universal  than  it 
was  half  a  century  ago,  temperance  is  much 
more  common.  Not  so  many  people  in  pro- 
portion to  a  largely  increased  population 
eschew  every  form  of  intoxicating  liquor, 
but  far  more  avoid  those  which  contain  a 
considerable  proportion  of  alcohol. 

Teetotalism  is  less  common  ;  but  so  also  is 
drunkenness.  American  literature  of  a 
comparatively  recent  date  shows  always  the 
two  extremes.  There  was  the  severe  puri- 
tan type  which  looked  upon  the  man  who 
took  a  modest  glass  of  beer  with  his  dinner 
(to  correct  the  superabundance  of  pie)  as 
foredoomed  to  a  drunkard's  grave ;  and 
there  was  the  literature  which  showed  the 
miner  celebrating  the  find  of  a  pocket  of 
gold,  or  the  death  (by  revolver  or  other- 
wise) of  a  comrade,  by  endless  drinking  of 
the  rawest  whiskey.  Both  these  types  seem 
to  be  vanishing  from  literature,  as  from  life. 
The  temperance  crusade  does  not  grow 
weaker;  but  it  takes  a  larger  view.  Drunk- 
enness  is   held    in   greater  abhorrence  than 


436 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


before ;  but  there  is  no  longer  the  same 
conviction  that  no  one  can  drink  the  mild- 
est of  fermented  liquors  without  falling 
into  absolute  drunkenness.  In  the  increas- 
ing consumption  of  beer  in  the  United 
States,  combined,  as  it  is,  with  a  decrease 
in  the  consumption  of  all  other  liquors,  we 
may  read  the  fact  that  the  Americans  are 
beginning  to  appreciate  the  value  of  some- 
thing that  will  stimulate  digestion  without 
tempting  to  bad  habits,  somethimg  more 
harmless  to  the  digestion  than  candy,  and 
less  harmful  to  the  moral  nature  than  the 
drugs  which  are  apt  to  become  a  substitute 
for  intoxicants. 


Locomotor   Ataxy   in    Its  Modern  Aspect. 

There  being  no  syphilitic  exudation  in 
true  tabes,  anti-syphilitic  treatment  is  un- 
called for.  Diet,  hygiene,  rest,  are  the 
main  factors  in  the  successful  management 
of  the  disease.  Digestion,  assimilation, 
elimination,  must  be  promoted.  Climate, 
medicines,  and  electrotherapy  are  of  dis- 
tinct value. 

Distressing  symptoms,  the  "lightning 
pains,"  "ataxia,"  &c,  are  to  be  alleviated 
without  impairing  the  general  nutrition. 
Opiates  had  better  be  avoided. 

Rest  in  bed  is  a  valuable  measure  when 
obtainable.  The  patient  should  sleep  much 
and  work  little.  When  complete  rest  is 
not  practicable,  a  few  extra  hours  daily  in 
the  horizontal  position  is  advisable. 

The  diet  should  be  liberal — meats,  fats, 
milk,  water  in  abundance,  and  fruits,  with 
a  minimum  allowance  of  starchy  and  sac- 
charine foods.      Alcohol  is  to  be  prohibited. 

The  patient  should  wear  warm  clothing, 
and,  if  possible,  spend  his  winters  in  a 
warm  climate.  Measures  addressed  to  the 
elimination  of  auto-toxines  generally  by 
the  skin,  kidneys,  and  bowels  should  be 
instituted. 

Drugs  of  more  or  less  use  in  the  treat- 
ment are  those  of  nutritional  value,  mainly 
phosphorus,  iron,  cod-liver  oil,  with  tonics 
such  as  strychnine. 

For  the  lightning  pains  aluminum  chlo 
ride  (dose,  two  to  four  grains  in  water)  is 
a  drug  of  considerable  value.  Dr.  Gowers 
originated  its  use  for  this  purpose. 

Electricity  is  of  a  distinct  value  in  a  large 
proportion  of  cases.  Ordinary  faradism  is 
useless,  galvanism  better.  The  writer's  ex- 
perience has  led  him  to  value  highly  the 
sinusoidal  current.  It  is  a  current  of  "high 
potential"  (voltage),  rapid  alteration  (480 
to  1920  per  second),  and  comparatively 
small  "quantity"  (amperage).  Its  appli- 
cation is  simple  and  controllable,  as  well  as 
pleasant  to  the  patient.      It  is  administered 


by  means  of  a  "foot-plate"  and  a  neck  elec- 
trode for  from  five  to  fifteen  minutes  every 
alternate  day  for  six  weeks.  Under  its  use, 
with  simple  hygiene  and  often  without 
drugs,  the  lightning  pains  cease,  the  ataxia 
of  gait  and  station  disappears,  and  the  well- 
being  of  the  patient  is  promoted.  These 
effects  would  seem  to  indicate  an  actual 
improvement  in  the  nutrition  of  the  peri- 
pheral sensory  neuron,  with  capacitv  for 
better  function  in  some,  possible  restoration 
of  damaged  nerve  endings  in  others. 


Microbial!  Origin  of  Eclampsia. 

Bar,  while  not  antagonizing  the  micro- 
bian  hypothesis,  holds  that  its  truth  is  not 
yet  demonstrated.  The  adherents  of  the 
view  are  influenced  to  their  belief  by  the 
following  parallelism  between  eclampsia 
and  the  known  infectious  diseases  of  micro- 
bian  origin  (Obstetrics,  January,  1899)  : 

1.  Stage  of  prodromes;  2.  more  or  less 
nephritis  and  albuminuria;  2.  postmortem 
rise  of  temperature ;  4.  clinical  evidences 
of  infection — several  authors  have  attempted 
to  show  that  eclampsia  occurs  in  groups, 
quasi-epidemic ;  others  point  out  a  grest 
similarity  throughout  between  eclampsia 
and  tetanus  ;  5.  convulsions — some  diseases 
of  bacterial  origin,  e.  g.  :  scarlatina,  often 
begin  with  this  phenomenon  ;  6.  high  mor- 
tality. 

Bar  admits  that  this  course  of  argumen- 
tation is  seductive,  but  that  before  it  can  be 
accepted  as  final  much  must  be  done  in  the 
direction  of  studying  the  urine,  blood,  and 
tissues  of  the  mother,  and  the  placenta  and 
tissues  of  the  fetus. 

With  regard  to  the  urine  in  eclampsia, 
there  is  but  one  conclusion,  viz,  :  that  cul- 
tures may  or  may  not  be  prepared  from  it. 
While  the  urine  of  healthy  pregnant  wo- 
men has  been  reported  as  sterile,  Bar  has 
been  able  to  cultivate  germs  from  it  in  cer- 
tain cases,  precisely  the  same  germs  that 
can  be  cultured  from  the  urine  of  eclamp- 
tics. It  is  certain  that  these  urines  are  but 
feebly  toxic  when  injected  subcutaneously 
in  massive  doses  into  animals. 

As  for  the  maternal  blood  and  viscera, 
cultures  could  be  developed  in  some  cases, 
i  in  others  not  at  all;  nor  is  there  any  evi- 
dence to  show  that  the  staphylococcus  which 
has  often  been  cultivated  is  disease-pro- 
ducing under  these  circumstances.  These 
conclusions  are  applicable  only  to  ante- 
partum convulsions  or  those  which  occur  at 
the  time  of  labor,  for  it  is  well  known  that 
in  puerperal  infection  many  kinds  of  germs 
are  pathogenic,  and  that  they  may  at  times 
produce  anomalies  in  connection  with  some 
form  of  general  infection. 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


437 


The  results  obtained  from  examination  of 
the  placenta  and  fetal  viscera  are  not  much 
more  satisfactory.  The  author  relates  a 
ca'se  of  eclampsia  and  jaundice  which  re- 
covered. The  child  survived  but  a  few 
days,  and  there  was  found  on  autopsy  a 
peritonitis  due  to  the  bacillus  coli.  The 
case  may  have  been  one  of  prenatal  infec- 
tion of  the  child  by  the  mother. 

Entrance   of   Air  into    the    Uterus    during 
Labor. 

Teuffel  advises  (Obstetrics, January, 1S99) 
that  the  term  physometra,  which  is  generic 
and  applicable  to  any  kind  of  gas  in  the 
uterus,  should  be  restricted  to  the  spontane- 
ous formation  of  gas  within  the  uterus, 
while  the  word  aerometra  should  be  used  to 
designate  the  presence  of  atmospheric  air 
which  has  entered  the  uterine  cavity. 

From  a  case  related  by  the  author  it 
would  appear  that  the  following  combina- 
tion of  circumstances  make  it  possible  for 
air  to  enter  the  womb  :  First  premature 
rupture  of  membranes  and  escape  of  am- 
niotic fluid  ;  second,  movable  infantile  head, 
the  cervix  being  in  full  dilatation  ;  third 
sudden  change  of  position  on  the  part  of 
the  mother,  involving  the  tilting  of  the 
uterus.  Under  these  circumstances  the  air 
suddenly  entered  the  uterus  through  the 
ruptured  membranes,  and  caused  an  exten- 
sive balloon-like  swelling.  Labor  was  not 
much  interfered  with,  and  after  the  child 
was  born,  the  air  rushed  from  the  womb 
with  a  considerable  sound.  The  author 
concludes  that  there  is  no  danger  of  air 
embolism  in  these  cases,  because  air  does 
not  get  between  the  membranes  and  uterus. 
He  believes  further  that  cases  of  this  sort 
are  not  so  infrequent  in  practice  and  are 
commonly  overlooked.  Finally  he  wonders 
whether  aerometra  could  ever  be  a  cause  of 
post-mortem  delivery  which  is  occasionally 
observed.  There  is  no  doubt  that  phy- 
sometra  is  able  to  cause  this  phenomenon. 


Senile   Changes   in   the    Fallopian    Tubes. 

Schnaper  (London  Lancet)  points  out 
that  while  the  senile  changes  in  the  uterus 
and  ovaries  have  been  fully  investigated, 
little  has  been  discovered  regarding  those 
in  the  Fallopian  tubes,  lie  has  been  able 
to  find  references  to  these  changes  only  in 
the  researches  of  Ballantyne  and  Williams 
and  of  Grusdew.  He  had  examined  the 
tubes  from  20  women,  varying  in  age  from 
47  to  90  years.  In  each  case  he  investigated 
the  structure  of  the  uterine  end,  of  the 
middle  part,  and  of  the  abdominal  extremity 
of   the  tube.    He  found  in  the  mucous  mem- 


brane changes  very  similar  to  those  which 
occur  in  colpitis  senilis  :  there  was  partial 
loss  of  the  surface  epethelium,  more  or  less 
marked  growth  of  connective  tissue,  and  a 
bridging  across  or  complete  closure  of  the 
lumen  of  the  organ.  Unlike  Ballantyne  and 
Williams,  Schnaper  did  not  find  an  almost 
complete  withering  of  the  longitudinal  mus- 
culature of  the  tube,  but  there  was  nearly 
complete  disorganization  of  both  the  circu- 
lar and  longitudinal  layers.  An  ingrowth 
of  the  connective  tissue  splits  the  muscula- 
ture up  into  islands,  and  there  is  more  or 
less  marked  thinning  of  the  wall  of  the  tube. 
Two  neighbouring  tubal  folds  which  have 
lost  their  epithelial  covering  in  part  may 
become  united  by  their  apices,  and  so  give 
rise  to  the  appearance  of  glands.  In  the 
adventitia  of  the  vessels,  just  as  in  the  mus- 
culature, there  is  seen  a  process  of  growth 
of  granulation  tissue  followed  by  shrinking. 
As  a  result  of  these  senile  changes,  it  is  no 
longer  possible  to  recognize  a  clear  distinc- 
tion between  the  three  parts  of  the  Fallo- 
pian tube. 

The  Treatment  of  Pneumonia  in  Children. 

Chapin  (Medical  News,  Nov.  19,  1898,) 
says  that  it  is  quite  possible  that  a  certain 
grade  of  fever  may  have  a  beneficial  action 
when  it  accompanies  the  reaction  of  the 
tissues  to  infective  and  inflammatory  irrita- 
tion. It  is  also  a  clinical  fact  that  children, 
as  a  rule,  stand  high  temperature  well. 
When  this  is  the  case  it  is  folly  to  upset  the 
stomach  by  drugs,  or  weaken  the  heart  by 
antipyretics  in  combating  a  temperature 
that  is  not  doing  any  great  harm.  In  such 
a  case  the  treatment  may  do  more  harm  than 
the  symptom  against  which  it  is  directed. 
There  are  times,  however,  when  high  tem- 
perature calls  for  special  treatment.  Some 
children  bear  high  temperatures  well ;  others 
very  poorly.  In  the  latter,  interference  is 
promptly  called  for,  and  the  indication  for 
treatment  is  not  so  much  the  exact  degree 
of  temperature  as  a  disturbance  which  is 
being  caused  by  fever.  In  one  case  the 
temperature  of  102  deg.  to  103  deg.  F.  may 
require  special  treatment,  in  another  one 
the  fever  needs  no  special  treatment  until 
104  deg.  or  105  deg.  is  reached.  High 
temperature  may  result  in  extreme  cerebral 
irritation,  causing  restlessness,  or  even  con- 
vulsions ;  in  others,  stupor  and  even  coma. 
The  heart  becomes  weak  and  rapid;  the 
respiration  becomes  rapid ;  digestion  and 
assimilation  always  suffer  more  or  less.  It 
has  been  shown  by  experience  that  control 
of  the  high  fever  gives  a  certain  measure  of 
relief  to  these  symptoms. 

In  croupous  pneumonia  the  indications 
for  interference  in   hyperpyrexia  are  not    so 


43S 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


important  as  in  bronchopneumonia,  as  the 
former  runs  a  short  course  and  tends  to  re- 
cover. The  first  point  in  the  management 
of  fever  is  to  avoid  any  measures  that  will 
leave  a  bad  effect,  and  thus  hinder  the  fu- 
ture chances  of  recovery.  All  depressing 
remedies  come  under  this  head  :  as  the  coal- 
tar  derivatives.  The  application  of  water 
is,  on  the  whole,  the  safest  and  the  most 
satisfactory  method  of  controlling  danger- 
ous hyperpyrexia.  Much  may  be  accom- 
plished by  a  thorough  application  of  cold 
to  the  head.  This  not  only  reduces  the 
temperature,  but  relieves  to  a  certain  extent 
its  bad  effect  upon  the  brain  and  nervous 
system.  In  order  to  be  effectual  it  must  be 
applied  continuously  and  thoroughly. 

Finely  cracked  ice  placed  in  bladders, 
from  which  the  surplus  air  is  expelled,  may 
be  moulded  around  the  head,  especially  at 
the  vertex  and  occiput.  If  this  does  not 
suffice,  compresses  should  be  applied  direct- 
ly to  the  chest.  The  child  is  stripped, 
wrapped  in  a  blanket,  and  placed  on  a 
table  ;  a  stimulant  is  given  and  the  feet  are 
placed  in  contact  with  hot  bottles.  A  com- 
press sufficiently  large  to  surround  the  chest 
is  plunged  into  water  from  70  deg.  to  95 
deg.  F.  and  applied  to  the  chest.  This  is 
changed  every  fifteen  or  twenty  minutes. 
If  this  does  not  cause  a  reduction  of  tem- 
perature the  temperature  of  the  water  can 
be  lowered.  The  addition  of  about  one- 
fourth  part  of  alcohol  seems  to  heighten  its 
effect.  The  author  invariably  employs  the 
tub,  on  account  of  the  fright  to  the  child 
and  the  exhaustion  which  it  causes.  In 
cases  of  cyanotic  children,  he  has  used  a 
warm  bath  of  100  deg.  with  friction  of  the 
surface. 

The  treatment  of  pneumonia  in  very 
young  children  by  Holt  is  summed  up  as 
follows  : 

1.  No  depleting  measures  are  ever  ad- 
missible. 

2.  Hygienic  treatment,  including  fresh 
air,  proper  feeding,  and  intelligent  care,  is 
of  the  utmost  importance. 

3.  No  unnecessary  medication  should  be 
permitted. 

4.  Many  annoying  symptoms  may  be  re- 
lieved by  local  treatment,  such  as  the  cough 
by  inhalations,  pain  by  counter-irritation, 
restlessness  by  the  ice-cap  or  sponging. 

5.  Stimulants  should  be  deferred  until 
demanded  by  the  condition  of  the  pulse. 

6.  High  temperature  is  much  more  safely 
and  effectively  controlled  by  the  use  of  cold 
than  by  drugs. 

7.  Greater  caution  is  necessary  in  the  use 
of  powerful  stimulants  than  is  generally 
observed. 


8.   Rest  is  quite  as  important  as  in  other 
serious  diseases. 


The  Serum  Diagnosis  of  Diphtheria. 

Bruno,  of  Vieordt's  Clinic  (Berl.  klin. 
Woch.,  December  19,  1898),  says  that  the 
agglutinating  action  of  diphtheria  serum 
upon  the  diphtheria  bacillus  have  been  few. 
Bruno,  according  to  Gaillard's  Medical 
Journal,  has  investigated  from  this  point  of 
view  serums  obtained  from  experimentally 
infected  animals,  and  from  patients  suffer- 
ing from  diphtheria.  Quite  recent  broth 
cultures  of  the  diphtheria  bacillus  must  be 
used,  as  old  cultures  readily  show  a  pseudo- 
agglutination.  It  should  be  remembered 
that  the  diphtheria  bacillus  has  a  tendency 
at  the  commencement  of  its  growth  to  fall 
to  the  bottom  of  the  vessel  without  any  gen- 
eral turbidity  of  the  fluid.  This  tendency 
may  be  overcome  by  making  successive  cul- 
tures when  in  the  third  to  the  sixth  genera- 
tion the  bacillus  causes  a  general  turbidity 
and  a  diffuse  growth  in  the  bouillon. 

If  the  reaction  is  positive  a  purely  passive 
collection  of  the  bacilli  in  small  masses  takes 
place.  The  reaction  requires  a  longer  time 
than  Widal's  serum  test  owing  to  the  non- 
motility of  the  diphtheria  bacillus.  If  the 
bacilli  are  too  abundant  in  the  hanging  drop 
the  reaction  is  obscured,  as  they  tend  to 
collect  in  the  most  dependent  part  of  the 
drop.  After  examining  the  effect  of  the 
curative  serum  upon  the  diphtheria  bacillus, 
Bruno  made  use  of  the  serum  from  44  diph- 
theria patients  as  well  as  from  12  normal 
individuals. 

While  some  normal  serums  were  without 
action,  others  produced  agglutination  in 
solutions  of  1  in  10  up  to  1  in  30,  whereas 
the  specific  serum  produced  agglutination 
up  to  1  in  400.  The  serum  from  some  cases 
gave  the  reaction  in  twenty-four  hours. 
Two  cases  gave  quite  negative  results  on 
the  first  and  third  days  of  the  disease,  10 
did  not  succeed  in  a  dilution  above  1  in  30, 
31  no  longer  reacted  in  a  dilution  of  1  in 
100,  and  13  reacted  above  that  dilution. 
The  author  then  investigated  the  questions 
of  the  specificity  and  constancy  of  this  re- 
action. He  concludes  (1)  that  the  occur- 
rence of  agglutination  is  not  constant  for  all 
diphtheria  cultures  and  serums,  (2)  the 
clinical  serum  diagnosis  is  for  this  reason 
impossible,  (3)  the  distinction  between  the 
true  and  false  diphtheria  bacillus  is  not  to 
be  effected  by  this  means,  and  (4)  that  pure 
undiluted  diphtheria  serum  possesses  in  vitro 
a  slight  growth-restraining  action,  but  has 
no  bactericidal  action  on  the  diphtheria  or 
pseudo-diphtheria  bacillus. 


THE  CHARLOTTE  'MEDICAL  JOURNAL. 


Paris   Exposition. 

Many  members  of  the  medical  profession 
will  be  pleased  to  learn  that  if  they  visit 
Paris  with  their  families  next  year  for  the 
purpose  of  seeing  the  famous  exposition 
there  will  be  an  American  "pension," 
intended  for  their  especial  benefit,  at  which 
straight  American  will  be  spoken,  and 
they  will  have  an  opportunity  of  meeting 
with  their  fellow  countrymen.  It  will  be 
under  the  charge  of  Professor  Wisner  and 
his  wife  who  are  well  and  favorably  known 
to  many  professional  men  in  New  York, 
Chicago,  Cincinnati,  and  other  American 
cities.  They  have  taken  a  mansion  in  the 
neighborhood  of  the  Bois  de  Boulogne,  and 
will  have  it  fitted  up  in  such  a  way  as  to 
provide  a  comfortable  home  for  their  guests. 
Professor  Wisner  has  already  made  engage- 
ments with  a  number  of  prominent  doctors 
who  intend  staying  at  his  establishment, 
and  he  would  like  to  hear  from  others 
before  he  leaves  for  Paris.  For  the  pre- 
sent he  may  be  addressed  at  605  Madison 
Avenue,  New  York. 


Some  Conditions  Necessary  for  the  Spread 
of  Tuberculosis. 
Arthur  Ransome  eight  years  ago,  in  con- 
junction with  Dreschfeld,  found  that  spu- 
tum containing  quantities  of  tubercle  ba- 
cilli retain  ted  its  pathogenic  properties  for 
months  when  exposed  to  the  air  in  a  small 
unhealthy  hut,  built  without  a  basement  on 
a  clay  soil;  while  another  sample,  exposed 
in  a  well-ventilated  house  built  on  a  sandy 
soil,  and  with  good  sanitary  arrangements, 
lost  its  virulence  completely.  In  1894,  con- 
jointly with  Delepine,  he  found  that  over 
three  days'  exposure  to  free  ventilation 
alone  was  required  to  disinfect  sputum  or 
pure  cultures,  while  a  very  short  time  suf- 
ficed when  they  were  exposed  to  air  plus 
sunshine.  These  experiments  suggested 
that  there  must  be  some  substance  in  the 
air  of  confined  spaces  which  faxored  the 
growth  of  the  bacillus.  Ransome  has  now 
Obtained  a  liquid  containing  such  a  sub- 
stance :  ( 1 )  by  freezing  the  expired  air  both 
of  healthy  and  phthisical  subjects,  and  (2) 
by  condensing  the  vapours  arising  (a)  from 
the  contaminated  soil  of  a  town,  (l>)  from 
a  clayey,  and  (r)  from  a  sandy  soil.  After 
estimating  the  free  and  saline  and  the  albu- 
minoid ammonia  contained  in  these  liquids, 
he  thoroughly  sterilized  them,  and  then 
soaked  pieces  of  folded  filter  paper  or  of 
ordinary  wall-paper  in  them.  Paper  thus 
treated,  whatever  the  original  source  of  the 
liquid  might  be,  proved  to  be  an  excellent 
culture  medium  when  inoculated  with  a 
pure  culture  of   the  tubercle   bacillus.      Out 


of  18  specimens,  16  produced  more  or  less 
vigorous  colonies,  and,  of  a  second  series  of 
37,  only  1  failed  to  grow  even  when  kept 
at  ordinary  temperatures.  In  the  first  series 
a  little  glycerine  was  added  to  the  liquid, 
but  in  the  second  equally  good  growths 
were  obtained  on  the  soaked  paper  without 
this  addition.  These  experiments  prove 
conclusively  that  the  tubercle  bacillus  is  a 
saprophyte  as  well  as  a  parasite,  and  that  it 
can  gruw  in  the  organic  matter  contained 
in  expired  air  or  in  the  vapour  arising  from 
the  soil.  They  indicate  also  the  nature  of 
the  danger  of  insanitary  houses,  and  how 
the  peril  is  to  be  avoided  by  the  disinfect- 
ing action  of  sunlight  and  fresh  air. 


Ocular  Troubles  in  Diabetes. 

Dianoux  (Annales  d'Oculistique,  Octo- 
ber, 1898). 

As  regards  the  lens  loss  of  transparency 
may  occur,  leading  surely  to  cataract,  soft 
or  hard,  according  to  the  patient's  age;  he 
lias  not  noticed  variations  in  vision  consen- 
taneously with  the  evolution  of  the  diabetes. 
The  soft  cataract  develops  exclusively  in 
young  people  attacked  with  acute  or  pan- 
creatic diabetes,  and  becomes  complete  in  a 
few  months.  Rapid  cataract  in  an  adoles- 
cent should  make  us  suspect  diabetes.  The 
grave  form  of  diabetes  has  not  the  same  ac- 
tion on  the  lens  in  the  adult,  in  his  expe- 
rience ;  and  he  is  doubtful  whether  in  the 
chronic  form  cataract  is  of  more  frequent 
occurrence  than  in  elderly  people  who  are 
not  diabetic.  For  senile  cataract  in  the  dia- 
betic, operation  may  be  perfectly  success- 
ful ;  whereas  operation  for  diabetic  soft 
cataract  is  frequently  followed  seven  or 
eight  days  later  by  pulmonary  apoplexy  and 
death,  and  in  any  case  the  patient  rarely 
survives  twelve  or  fifteen  months. 

Vascular  lesions  :  retinal  hemorrhages  in 
diabetes  are  found  exclusively  in  old  people  ; 
the  fact  of  their  non-occurrence  in  the  young 
makes  him  doubt  their  direct  dependence 
on  the  diabetes ;  he  would  rather  attribute 
them  to  arterio-sclerosis.  By  direct  exam- 
ination the  hemorrhages  are  seen  to  proceed 
from  small  veins  or  capillaries  ;  he  has  never 
seen  one  originating  from  an  artery.  The 
blood  is  absorbed  in  the  course  of  some 
months,  and  vision  may  become  normal 
again.  But  prognosis  is  bad;  a  fatal  issue 
from  cerebral  softening  is  ever  imminent, 
though  health  may  be  maintained  for  years. 
Albuminuric  retinitis  may  be  associated 
with  diabetic  changes. 

Central  scotoma  :  the  principal  symptom 
is  progressive  failure  of  central  vision,  par- 
ticularly for  reading ;  with  the  loss  of  form 
vision  goes  loss  of  color  vision.      As  diabe- 


440 


THE  CHARLOTTE   MEDICAL  JOURNAL. 


tics  are  often  alcoholic  and  indulge  in 
smoking  it  is  often  difficult  to  attribute  the 
scotoma  to  the  one  factor  ;  but  Dianoux  had 
seen  central  scotoma  in  women  and  young 
people  who  did  not  take  alcohol,  but  who 
passed  large  quantities  of  sugar.  Unlike 
alcoholic  and  tobacco  scotoma,  diabetic  sco- 
toma never  disappears. 


Diagnosis  of  Mammary  Abscess. 

Dr.  A.  M.  Shield  (Clinical  Journal, 
January  4,  1899).  ^  may  ^e  thought  that 
the  ordinary  diagnostic  symptoms  of  acute 
mammary  inflammation  and  abscess  are  so 
evident,  that  mistake  would  be  out  of  the 
question.  On  some  exceptional  occasions 
a  diagnostic  difficulty  arises  in  these  cases 
which  is  of  very  great  import,  namely,  the 
confusion  between  abscess  and  acutely  in- 
flamed, rapidly  growing  carcinoma  or  sar- 
coma. This  is  especially  likely  to  occur  if 
the  growth  be  breaking  down  in  the  cen- 
tre, or  if  it  be  of  the  nature  of  an  inflamed 
carcinomatous  cyst.  Precisely  the  same  di- 
agnostic difficulties  are  found  in  suppura- 
tion in  connection  with  carcinomatous 
glands  of  the  neck,  or  suppurating  epithe- 
liomatous  cysts  in  this  locality.  If  an  in- 
cision is  made  in  this  type  of  case,  blood 
and  broken-down  debris  escape,  but  seldom 
any  pus.  Fungation  follows,  with  its  at- 
tendant drain  of  bleeding  and  discharge, 
and  the  termination  of  such  a  case,  where 
the  diagnosis  of  abscess  has  been  confident- 
ly given,  may  be  very  disastrous  to  the 
reputation  of  the  surgeon  who  has  commit- 
ted the  error. 

The  symptoms  and  diagnosis  of  chronic 
mammary  abscess  have  long  been  notorious 
for  their  uncertainty.  There  are  probably 
few  surgical  disorders  which  have  been  as- 
sociated with  more  deplorable  errors.  The 
reader  will  do  well  to  bear  in  mind — (1) 
That  fluctuations  may  be  quite  absent  in 
deep-seated  chronic  abscess,  and  local  heat 
or  general  fever  may  be  wanting.  (2)  That 
the  leading  signs  of  such  deceptive  accu- 
mulations of  pus  are  mainly  as  follows  : — 
(a)  There  is  often  a  soreness  or  abrasion 
of  the  nipple  to  be  found  on  careful  inspec- 
tion, (b)  Firm  pressure  with  the  pulp  of 
the  index  finger  upon  the  centre  of  the 
swelling  usually  gives  a  sensation  of  yield- 
ing or  elasticity ;  when  the  finger  is  re- 
moved slight  oedema  may  be  observed. 
Pain  of  a  throbbing  nature  is  not  uncom- 
mon, (c)  Exploratory  incision  is  the  only 
certain  diagnostic  means  of  discovering  a 
chronic  abscess  of  the  breast  when  deeply 
seated. 


Treatment  of  Haematemesis. 

Raymond  Tripier  (London  Lancet)  gives 
in  detail  the  results  of  his  own  investigations 
into  the  microscopic  anatomy  of  simple  gas- 
tric ulceration,  especially  those  forms  ac- 
companied by  hemorrhage.  Briefly,  they 
go  to  prove  that  haematemesis  arises  from 
primary  inflammatory  changes  in  the  gastric 
arteries,  leading  to  their  obliteration  or 
thrombosis,  and  to  subsequent  necrosis  of 
tissue.  He  believes  that  repeated  hemor- 
rhages are  due,  not  to  the  gradual  destruc- 
tion of  one  artery  after  another  by  the  gas- 
tric juice,  but  to  a  continuation  of  the 
same  inflammatory  process  in  and  round  the 
vessels.  The  form  of  superficial  ulceration 
described  by  Dieulafoy  under  the  name  of 
exulccratio  simplex  is  also,  in  his  opinion, 
due  to  a  primary  rupture  of  a  vessel.  This 
explains  how,  when  operations  have  been 
undertaken  for  the  arrest  of  the  bleeding,  in 
some  cases  no  ulcerative  lesions  have  been 
discovered,  and  why  in  the  intervals  be- 
tween the  attacks  of  haematemesis  there  may 
be  no  gastric  symptoms  whatever.  Con- 
sidering the  risk  of  not  being  able  to  find 
the  bleeding  point,  the  writer  is  unable  to 
agree  with  Dieulafoy  that  operation  is  the 
best  treatment  in  these  cases.  Even  when 
the  ulcer  is  easily  found,  the  results  of  ope- 
rations for  the  arrest  of  gastric  hemorrhage 
are  not  very  encouraging,  the  mortality  be- 
ing 66  percent.  The  routine  medical  treat- 
ment with  astringents,  etc.,  also  frequently 
fails,  and  Tripier  has  been  led  to  try  a  new 
method  of  combating  haematemesis,  and  has 
had  such  success  that  he  thinks  it  worthy  of 
extensive  trial.  This  consists  in  the  reflex 
vaso-constrictor  action  of  hot  water  applied 
as  enemata.  The  same  principle  is  used 
when  the  hands  are  thrust  into  hot  water  as 
a  remedy  for  epistaxis.  He  first  tried  it  in 
a  case  of  recurring  melaena,  where  it  was 
uncertain  whether  the  hemorrhage  was 
of  gastric  or  duodenal  origin  ;  then  in  a  case 
of  alarming  intestinal  hemorrhage  during 
typhoid  fever,  and  lastly  in  an  undoubted 
case  of  recurrent  gastric  hemorrhage, where 
everybody  else  was  agreed  that  surgery  off- 
ered the  only  chance  of  life — in  all  with 
complete  success.  It  is  probable  that  the 
method  may  be  equally  useful  in  any 
hemorrhage,  whether  internal,  for  example, 
haemotysis,  or  external.  The  details  are  as 
follows  :  As  soon  as  melaena  or  haematem- 
esis appears,  enemata  of  hot  water  at  1 18.5 
deg.  F.  to  120  deg.  F.  must  be  given  three 
times  a  day  or  oftener  if  the  hemorrhage 
continue,  with  as  little  disturbance  to  the 
patient  as  possible.  For  some  days  feeding 
should  be  entirely  rectal,  and  this  should  be 
kept  up  as  long  as  possible  after  the  hemor- 
rhage has    ceased.        The  enemata,  which 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


441 


have  the  additional  advantage  of  allaying 
thirst,  should  be  continued  morning  and 
evening  for  eight  days  at  least  after  the  ces- 
sation of  hemorrhage,  and  once  a  day  until 
the  health  is  quite  restored.  Even  if  the 
first  hemorrhage  is  very  slight,  the  treat- 
ment should  be  begun  at  once,  since  it 
might  ward  off  a  serious  or  fatal  hemorrhage 
of  which    the    first  was   a  forerunner. 


Puerperal  Eclampsia. 

Baron  and  Castaigne  (London  Lancet) 
have  carried  out  an  important  series  of  ex- 
periments with  a  view  of  proving  the 
foetal  origin  of  puerperal  eclampsia.  With- 
in recent  years  pathologists  have  come  to 
the  conclusion  that  puerperal  eclampsia  is 
not  due  to  material,  renal,  or  hepatic  dis- 
eases, at  any  rate  wholly,  but  that  absorp- 
tion of  toxic  products  from  either  the  foetus 
or  its  annexre,  as  to  whether  the  foetus  or 
the  amnion  is  most  to  blame,  forms  the  sub- 
ject of  the  writers'  investigations.  They 
find  that  certain  substances  injected  directly 
into  the  foetus  or  the  amnion  are  rapidly 
absorbed  by  the  maternal  organism,  pro- 
vided the  foetus  is  living,  but  much  more 
rapidly  from  the  foetus  than  from  the  am- 
nion. From  this  it  would  seem  that  the 
ketUS  secretes  certain  toxic  substance  into 
the  blood  and  amniotic  fluid.  What  these 
toxins  are  is  to  form  the  subject  of  s  sub- 
sequent investigation.  Secondly,  if  the 
fo'tus  he  dead,  subtsancrs  injected  into 
either  amnion  or  foetus  do  not  seem  to  pass 
into  the  maternal  circulation.  This  would 
seem  to  throw  considerable  light  upon  the 
various  phenomena  of  eclampsia,  and  espe- 
cially as  showing  that  the  death  of  the  foetus 
is  followed  by  cessation  of  the  convulsive 
seizure. 


Csesarean  Section  in  the  Philippines. 
Dr.  Lobti  (British  Med.  Journal,  January 

4,  '99).  Owing  to  well-known  religious 
prejudices,  craniotomy  is  doubtless  rarely, 
if  ever,  practiced,  but  Ciesarean  section 
after  the  death  of  the  mother  is  not  rarely 
performed  as  a  religious  duty.  In  1821, the 
year  when  a  deadly  epidemic  of  cholera 
ravaged  the  Philippines,  six  post-mortem 
Ca'sarean  sections  were  undertaken  in  Bo- 
hol  alone.  The  parish  register  contains  a 
notification  of  the  baptism  of  the  children, 
two  being  reported  as  strong,  and  the  re- 
maining four  likely  to  live.  No  serious 
comment  need  be  made  on  this  alleged  sav- 
ing of  all  the  six  infants  who  survived  the 
algid  stage  of  cholera  and  the  deatli  of  the 
parent.  In  another  village  the  same  opera- 
tion  was  undertaken  in  one  case,  and  the 
child  lived,  it   is   said,  seven   hours.      Even 


more  incredible  is  the  case  of  a  woman  in 
Cabancalan,  Isle  of  Negros,  who  died  preg- 
nant ;  her  abdomen  was  opened  twenty-four 
hours  after  death.  The  child,  it  is  related, 
showed  every  sign  of  life.  Six  years  later, 
at  Mandana,  a  child  is  said  to  have  been 
extracted  seven  hours  after  the  death  of  its 
mother.  Not  only  was  it  reported  as  living 
but  it  is  said  to  be  yet  alive  to  witness  the 
truth  of  the  report.  In  the  Isle  of  Negros 
a  living  female  foetus  was  removed  from  the 
body  of  a  woman  who  had  been  murdered 
two  hours  previously.  Lastly  comes  an  an- 
nouncement— as  long  ago,  we  must  observe, 
as  December  12th,  1S54 — in  the  Official 
Bulletin  of  Manila.  Cassarean  section  was 
performed  on  the  body  of  a  woman  five 
months  pregnant  five  hours  after  her  death. 
The  foetus  lived  for  half  an  hour.  Of  the 
above  statements,  reproduced  in  the  Jour- 
nal d'Hygiene,  it  may  be  confidently  assert- 
ed that  they  include  two  facts  mixed  up 
with  a  mass  of  what  we  may  gently  term 
inaccuracies  :  first,  that  post-mortem  Caesa- 
rean  section  is  often  undertaken  in  the 
Philippines,  no  doubt  more  frequently  than 
above  reported;  and  secondly,  that  there  is 
an  extreme  prejudice  in  its  favour  which 
makes  the  natives  eager  and  ready  to  believe 
that  the  aim  of  the  proceeding  is  not  missed. 


Hemorrhages   from   Anatomically    Unalt- 
ered  Kidneys. 

S.  (irosglik,  according  to  the  Internation- 
al Medical  Magazine,  states  that  renal  hem- 
orrhage is  mostly  of  a  symptomatic  nature 
depending  on  an  inflammation  of  the  organ 
or  renal  calculus,  renal  tuberculosis  and  re- 
nal tumors.  However,  a  number  of  cases 
have  been  observed  in  which  the  most  care- 
ful examination  excluded  any  of  the  above- 
mentioned  pathologic  conditions,  and, 
except  simple  hemorrhage,  no  anatomic 
changes  were  found.  In  these  cases  we 
must  speak  of  an  essential  renal  hematuria . 
The  cases  so  far  observed  agree  as  to  the 
fact  that  there  is  more  or  less  of  a  hemor- 
rhage from  a  kidney,  the  integrity  of  which 
could  be  well  established  either  by  operation 
or  other  means  of  clinical  diagnosis.  In 
single  instances  the  hematuria  was  a  local 
manifestation  of  a  general  dyscrasia-hemo- 
philia.  In  others,  it  was  observed  that  the 
hemorrhages  resulted  from  excessive  bodily 
exercise  (horseback-riding,  cycling,  etc.) 
which  produced  a  hyperemia  of  the  renal 
blood  vessels  and  consequent  slight  rupture 
of  the  smaller  ones.  But  there  remain  many 
cases  in  which  neither  the  one  nor  the  other 
etiologic  factor  could  serve  as  an  explana- 
tion. Leguen  in  189 1  described  a  morbid 
condition    of  the   kidneys   which   he  called 


442 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


"neuralgies  renales,"  colic-like  pains,  often 
accompanied  by  hematuria,  occurring  in  the 
kidneys  of  nervous,  hysteric  individuals, 
not  dependent  on  any  organic  renal  lesion. 
This  symptom  Leguen  explains  by  the 
hyperemia  induced  by  the  neuralgia.  Later, 
Broca  associated  these  hemorrhages  not  ac- 
companied by  pain  with  disturbance  of  the 
vasomotor  nerves,  and  here  comes  into  con- 
sideration mainly  a  fault  in  the  vasomotor 
centers,  which  leads  to  a  weakening  of  the 
vessel  walls  and  overfilling  of  the  small 
blood  vessels  resulting  in  a  "vasomotor 
hematuria." 


The  Reaction  of  Syphilitic  Blood  to  Mer- 
cury. 

Kuperwasser  (Edenburgh  Medical  Jour- 
nal) instead  of  comparing  syphilitic  and 
non-syphilitic  blood  directly,  with  a  view 
to  determining  what  modifications  the  for- 
mer undergoes  during  the  disease — a  method 
which  has  ulways  yielded  negative  or  con- 
tradictory results — has  investigated  the 
changes  which  occur  in  healthy  and  syphi- 
litic blood  after  the  administration  of  mer- 
cury. He  classifies  the  white  corpuscles, 
which,  according  to  Ouskoff,  all  arise  from 
one  and  the  same  element,  namely,  the 
small  mononucleated  lymphocyte,  into  (i) 
young,  (2)  mature,  and  (3)  old  leucocytas. 
The  writer  then  shows  (1)  the  blood  of 
healthy  people  is  modified  by  mercury  in 
the  following  direction  :  The  proportion  of 
young  leucocytes  present  is  considerably 
increased  and  that  of  the  old  considerably 
diminished  ;  (2)  the  blood  of  syphilitics  re- 
acts to  mercury  by  a  considerable  diminu- 
tion in  the  proportion  of  young,  and  a  cor- 
responding increase  in  that  of  old  leuco- 
cytes. This  reaction  is  independent  of  the 
stage  of  the  disease,  and  takes  place  whether 
the  patient  has  or  has  not  previously  been 
subjected  to  specific  treatment  of  mercury 
and  iodides.  Those  who  have  undergone 
treatment  by  mercury  within  four  months 
of  applying  the  blood  test  form  the  only 
exceptions  to  this  rule.  In  such  cases  the 
reaction  of  syphilitic  is  replaced  by  that  of 
healthy  blood,  possibly  because  the  patient 
still  retains  a  considerable  quantity  of  mer- 
cury, or  because  under  its  influence  the  dis- 
ease has  become  so  attenuated  that  the  blood 
gives  a  normal  reaction.  Kuperwasser  be- 
lieves that  this  reaction,  based  on  the  ob- 
servation of  4S  cases,  will  prove  to  be  one 
of  the  most  certain  methods  of  diagnosing 
syphilis,  and  suggests  that  many  disputed 
points,  such  as  the  relation  of  those  diseases 
called  by  Fournier  "parasyphilitie"  to  syph- 
ilis, might  be  solved  by  its  general  appli- 
cation. 


Indications  for  Hysterectomy, 

Dr.  H.  J.  Boldt  (Medical  Record,  Feb. 
4th,  1899).  The  question  arises,  what 
should  be  considered  an  absolute  indication 
for  removal  of  the  entire  uterus?  1.  Any 
woman  who  has  a  living  child  in  utero,  at 
term  or  nearly  so,  in  whom  the  pelvic  diam- 
eters are  too  small  for  the  delivery  of  a 
living  child  per  vias  naturales.  2.  When 
the  child  in  utero  is  dead  and  an  infection 
of  the  organ  has  taken  place.  3.  In  cica- 
tricial contraction  of  the  vagina  to  such  an 
extent  as  to  prevent  delivery  through  the 
normal  route.  4.  When  a  neoplasm  is  pre- 
sent in  the  collum  uteri,  preventing  the 
passage  of  a  living  child,  and  the  enuclea- 
tion of  such  neoplasm  is  not  feasible  at  the 
time  of  the  Cesarean  section  with  safety  to 
the  mother.  5.  In  such  cases  of  rupture  of 
the  uterus  in  which  an  abdominal  section  is 
indicated  and  suture  of  the  uterine  wound 
is  unsafe.  6.  In  some  cases  of  hemorrhage 
from  atony  of  the  uterus  subsequent  to 
Caesarean  section,  as  in  a  case  reported  by 
Clivio,  in  which  he  had  completed  the 
uterine  suture,  and,  although  no  blood  oozed 
from  the  stitch-holes,  the  hemorrhage  per 
vaginam  was  so  terrific  that  he  found  it 
necessary  to  change  the  ordinary  Cesarean 
section  to  a  Porro  operation.  This  author 
collected  sixteen  cases  of  similar  character. 
Perhaps  an  intra-uterine  gauze  tamponade 
or  steam  vaporization  may  answer  in  some 
such  cases.  In  cases  of  advanced  cancer  of 
the  cervix,  however,  the  Porro  operation 
should  receive  the  preference  over  total  ex- 
tirpation or  the  modified  Caesarean  section. 

Calomel    in  Typhoid   Fever. 

Andrievsky  has  made  in  the  Russian 
military  hospital  of  Krasnoie-Sielo  a  series 
of  therapeutic  experiments  with  the  object 
of  determining  the  value  of  calomel  in  typ- 
hoid fever.  In  71  cases  he  gave  calomel  in 
a  dose  of  30  eg.  thrice  daily,  while  for  the 
purpose  of  comparison  he  gave  quinine  in 
the  same  doses  in  40  cases.  The  patients 
in  the  first  group  continued  to  take  the 
calomel  till  their  evening  temperature  be- 
came normal ;  this  result  was  obtained  after 
a  total  amount  of  the  drug  varying  from  8 
to  20  grams  had  been  taken.  Stomatitis 
never  occurred,  nor  was  diarrhoea  aggrava- 
ted. Moreover,  the  disease  in  all  these  pa- 
tients was  mild  in  type,  and  often  aborted. 
The  fever  abated  more  quickly,  and  the 
mortality  (2.S2  per  cent),  was  less  than  in 
the  cases  treated  with  quinine.  No  patient 
who  was  put  on  the  calomel  treatment 
within  the  first  week  of  the  illness  died. 
Andrievsky  states  that  although  calomel  is 
not  a  specific,  it  is  a  most  useful  remedy  in 
typhoid  fever. 


THE  CHARLOTTE  MEDICAL  JOURNAL, 


443 


The  Cause  of  Bright's  Disease. 

That  Bright's  disease  is  rapidly  increas- 
ing is  a  question  concerning  which  there  is 
no  doubt  in  the  minds  of  observing  medi- 
cal men.  The  cause  of  the  increase  of 
chronic  Bright's  disease  is  a  subject  that 
has  been  much  discussed,  and  variously  at- 
tributed to  clinic  conditions,  alcohol,  to- 
bacco, and  so  on.  It  is  more  probable, 
however,  that,  as  Dr.  Gus  Johnson  has  sug- 
gested, real  degeneration  is  a  consequence 
of  long-continued  elimination  of  the  pro- 
ducts of  faulty  digestion  through  the  kid- 
neys. 

Fothergill  affirmed  that  the  starting-point 
of  Bright's  disease  is  liver  incapacity. 
These  two  conditions  are  closely  related. 
When  the  stomach  fails  properly  to  elabor- 
ate the  food,  and  when  the  fermentations 
taking  place  in  it  are  producing  quantities 
of  poisonous  substances,  such  as  ptomaines 
and  toxines,  the  blood  is  flooded  with  these 
dangerous  substances,  and  the  liver,  which 
has  for  one  of  its  functions  the  duty  of  de- 
stroying poisons,  is  overwhelmed  by  the 
immense  quantity  of  toxic  substances 
brought  to  it  in  the  portal  blood.  The  in- 
cesant  and  exagerated  labour  required  of  it 
exhausts  it,  and  it  becomes  chronically  in- 
capacitated for  work.  When  to  these  poi- 
sons is  added  a  considerable  quantity  of 
half-digested  proleid  matter,  which  must 
likewise  be  treated  as  so  much  toxic  sub- 
stance, it  is  no  wonder  that  the  liver  breaks 
down. 

It  must  be  remembered  that  the  liver  is  a 
closed  door  to  poisons,  while  the  kidneys 
are  an  open  door.  So  long  as  the  liver- 
door  is  shut,  toxic  substances  absorbed  from 
the  alimentary  canal  cannot  get  access  to 
the  general  circulation.  The  kidneys  are 
thus  protected  from  the  injurious  influence 
of  contact  with  these  poisonous  substances. 
But  when  the  liver-door  is  broken  down  as 
a  result  of  long-continued  indigestion,  es- 
pecially by  the  free  use  of  flesh  foods,  which 
add  to  the  poisons  of  the  human  system 
those  produced  in  an  animal's  body,  and  at 
the  same  time  furnish  material  out  of  which 
the  largest  possible  amount  of  poisons  may 
be  produced  in  the  alimentary  canal,  the 
resistance  of  the  liver  is  destroyed,  and  as 
the  result  such  large  quantities  of  poison- 
ous matters  are  poured  through  the  kidneys 
into  the  urine  that  degeneration  takes  place 
in  these  organs  as  the  result  of  their  con- 
tact with  these   intestinal    toxic  substances. 

The  researches  of  Bouchard,  Rogers,  and 
others  point  very  conclusively  to  the  fail- 
ure of  the  stomach  and  the  liver  as  the 
primary  causes  of  Bright's  disease.  First 
the    stomach    fails,   then    the    liver    breaks 


down,  then  the  kidneys  collapse,  then  come 
heart  disease,  dropsy,  death.  The  use  of 
tobacco  and  alcohol,  and  excesses  of  all 
sorts,  by  impairing  digestion  and  breaking 
down  the  general  resistance  of  the  body, 
prepare  the  way  for  Bright's  disease  as  well 
as  for  other  chronic  maladies.  Bright's 
disease  may  be  fairly  considered  simply  as 
nature's  penalty  for  heavy  dinners,  Christ- 
mas and  New  Year  feasts,  and  other  forms 
of  gormandizing. 


Treatment  of  Chronic  Morphinism. 

Hirt  (Boston  Medical  and  Surgical  jour- 
nal) recommends  first  of  all  total  abstinence 
from  morphine.  The  first  three  days  are 
the  most  difficult  for  the  patient  to  over- 
come ;  but  once  passed  there  is  hope  for 
recovery.  During  these  three  days  chloral 
(forty-five  grains)  or  trional  must  be  ad- 
ministered to  combat  the  insomnia  conse- 
quent upon  the  withdrawal  of  the  drug. 
If  the  sleep  is  restless,  patient  is  given  a 
warm  bath  of  thirty  minutes'  duration,  fol- 
lowed by  a  cold  douche.  On  the  fourth 
day  begins  the  treatment  by  suggestive 
therapeutics  carefully  conducted,  at  first 
suggesting  general  harm  from  morphine, 
and  eventually  creating  in  the  patient  a 
feeling  of  horror  and  repugnance  towards 
the  poison.  Out  of  thirty-five  patients 
treated  in  this  manner,  twenty-seven  were 
entirely  cured,  two  committed  suicide  dur- 
ing the  first  three  "terrible"  days,  the  rest 
were  lost  track  of  or  relapsed. 


Medical  Progress. 

Old  Dislocations  oe  the  Elbow. — 
Dislocations  nowhere  becomes  inveterate 
and  irreducible  sooner  than  at  the  elbow. 
This  is  especially  true  in  the  young,  where 
the  developmental  osteogenetic  power  of  the 
periosteum  is  in  full  play,  and  where,  con- 
sequently, the  slightest  injury  or  chronic 
irritation  of  the  periosteum  causes  new 
bone-formation,  the  presence  of  which  pre- 
cludes the  possibility  of  the  joint  surfaces 
reassuming  their  old  relations.  The  soft 
parts,  too,  in  growing  individuals  are  much 
more  easily  modified  in  their  development 
by  irritative  factors  than  later  in  life,  so 
that  hindrance  to  the  reduction  of  a  dis- 
location soon  supervenes  in  the  course  of  a 
case  from  faulty  evolution  of  the  involved 
soft  tissues.  Finally,  the  ultimate  bone 
relations  in  joints  and  the  nice  correspond- 
ence of  apposing  surfaces  are  *me  results  of 
pressure  and  counterpressure  of  the  parts 
upon  each  other  during  growth,  and  this 
being  absent,  deformity  of  the  bony  parts 
of  the  joints  necessarily  follows. 

The  importance  of  the  movements  of  the 
elbow-joints    is    very    great,    and,    besides, 


THE  CHARLOTTE  MEDICAL  JOURNAL 


from  an  aesthetic  stand-point,  freedom  of 
motion  here  is  very  desirable,  since  limita- 
tion of  it  always  causes  a  striking  pecu- 
liarity in  the  holding  of  the  limb  and  awk- 
wardness in  the  movement  of  it  that  are 
very  noticeable.  As  stated  before,  reduc- 
tion even  by  force  soon  becomes  impossible. 
The  necessity  for  early  diagnosis  and 
prompt  reduction  is  greatly  emphasized. 
Where  inveteracy  is  once  established,  if  the 
deformity  is  considerable,  arthrotomy  is  in- 
dicated. The  results  of  operative  interven- 
tion have  frequently  in  the  past,  however, 
been  extremely  unsatisfactory,  and  for  two 
reasons  :  either  too  little  of  the  abnormal 
structures  that  caused  persistence  of  the 
dislocation  were  removed,  in  which  case 
inevitably  it  recurred  (often  under  the 
operation  bandage)  ;  or  too  much  of  the 
bony  structure  was  removed,  an  excision  of 
the  elbow  being  practically  done,  when  a 
frail  joint  resulted — an  eminently  undesir- 
able result. 

Professor  Stimson,  in  his  new  book  on 
"Fractures  and  Dislocations,"*  treats  the 
subject  with  his  well-known  practical  con- 
versatism.  He  gives  a  sketch  of  new  for- 
mation of  bone  on  an  old,  unreduced  disloca- 
tion of  the  elbow,  as  he  has  seen  it  in  a 
number  of  cases.  He  advises  operation  for 
the  condition  by  a  long  incision  on  the 
outer  side,  exposing  the  radius  and  the  mass 
of  new  bone.  This  should  be  freely  chisel- 
led away  and  the  capitellum  exposed  by 
free  division  of  the  soft  parts,  keeping  the 
knife  at  a  little  distance  from  the  bone,  so 
as  not  to  damage  the  periosteum.  The 
sigmoid  fossa  is  then  cleared  of  fibrous 
tissues.  A  second  incision  is  now  made  on 
the  inner  side,  curving  close  behind  the 
epitrochlea  or  its  site,  the  ulnar  nerve  is 
drawn  forward,  and  the  olecranon  freed. 
If  the  epitrochlea  has  been  broken  off  and 
displaced  upward  and  backward  it  must  be 
detached  from  the  humerus,  preserving  its 
relations  with  the  lateral  ligament.  The 
clearing  of  the  sigmoid  cavity  is  then  com- 
pleted. The  only  obstacle  to  reduction, 
then,  if  there  be  one,  will  be  the  shortening 

*A  Treatise  on  Fractures  and  Dislocations, 
by  Lewis  A.  Stimson,  A.  B.,  M.  D.,  Professor  of 
Surgery  in  Cornell  University  Medical  Cellege, 
New  York.      Lea  Brothers  &  Co.      Just  issued. 


of  the  flexor  muscles  of  the  hand,  induced 
by  their  action  in  the  abnormal  position 
caused  by  the  dislocation.  If  necessary 
they  must  be  partly  divided  close  to  the 
humerus.  Professor  Stimson  gives  a 
picture  of  one  of  his  results,  which  we  pro* 
duce.  Altogether  he  has  operated  upon 
some  ten  cases  by  this  method,  and  the  re- 
sults have  all  been  flexion  within  a  right 
angle  and  extension  varying  from  120  to 
170  degrees,  with  preservation  of  rotation. 


New  formation  of  bone  on  an  old.    unreduced 
dislocation.     (From  Stimson  on  Fractures 
and  Dislocation 


Result  of  operative  reduction  of  old  dislocations. 
(From  Stimson  on  Fractures  and  Dislocations.) 


Result  of  operative- reduction  of  old  dislocations.     (From  Stimson 
omFractures  and  Dislocations.) 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


445 


Tuberculosis  of    the  Nose. 

Dr.  Moll  reported  before  the  last  meeting 
of  the  Netherlands  Society  of  Laryngolo- 
gists  two  interesting  cases  of  tuberculosis 
of  the  nose  (Medical  Age).  The  first,  a 
woman  thirty  years  of  age,  complained  of 
nasal  obstruction.  The  right  naris  was 
filled  with  a  red,  smooth  tumor  arising  from 
the  posterior  part  of  the  cartilaginous  sep- 
tum. At  a  corresponding  point  in  the  left 
nasal  fossa  there  was  a  small  ulceration. 
After  removal  of  the  tumor  with  a  snare 
the  septum  was  seen  to  be  perforated.  The 
perforation  border  was  treated  with  phenol. 
Microscopical  examination  of  the  prepara- 
tion showed  a  rich  cellular  stroma  with 
many  giant  cells. 

The  second  case  was  also  a  woman.  Moll 
found  the  left  nasal  fossa  obstructed  by  a 
large  granular  mass  arising  from  the  lower 
turbinate,  which  at  first  glance  gave  the 
impression  of  a  carcinoma.  Under  narcosis 
the  mass  was  removed  with  a  sharp  spoon 
and  the  galvano-cautery.  The  microscopic 
diagnosis  established  the  tuberculous  char- 
acter of  the  specimen.  The  recovery  was 
very  rapid,  but  the  writer  had  been  recent- 
ly informed  by  the  patient's  physician  that 
she  was  again  suffering  from  some  trouble 
in  the  nose,  probably  tubercular.  Usually 
such  tuberculoma  frequently  recur. 

In  the  discussion  following  this  report 
Tervaert  reported  three  cases  of  nasal  tuber- 
culosis, and  Iluysman  also  gave  the  history 
of  a  woman  sixty  years  of  age  who  had  de- 
veloped tuberculosis  of  the  nose  while  act- 
ing as  nurse  to  a  case  of  pulmonary  disease. 


A  House  Epidemic  of  Syphilis. t 

Thanks  to  a  better  knowledge  of  the  dan- 
gers and  modes  of  transmission  of  syphilis, 
and  to  superior  habits  of  cleanliness,  epi- 
demics of  the  disease  are  rare  in  America  ; 
yet  they  occur  among  the  lower  classes  of 
our  population  with  greater  frequency  than 
is  generally  supposed.  In  the  New  York 
Medical  Journal,  of  March  26th,  the  writer 
records  one  in  which  the  disease  was  intro- 
duced into  the  family,  according  to  the  his- 
tory, by  vaccination,  and  in  which  every 
member  of  the  family  of  eight  was  ulti- 
mately infected.  The  first  case  was  a  child 
of  2  years  ;  then  the  mother,  aged  34  ;  then 
two  girls,  aged  9  and  14  respectively  ;  then 
a  boy  of  4;  then  a  girl  of  7;  and  then  a 
nurseling,  aged  6  months.  The  father  es- 
caped until  the  last;  but  late  in  the  spring 
he  came  to  the  clinic  with  a  characteristic 
eruption,  alopecia,  &c.      The  cases  were  all 


Abstract   by    William  S.  Oottheil, 


severe ;  there  were  several  irites ;  all  had 
obstinate  and  some  very  extensive  mucous 
patches;  and  the  2  year  old  child  had  a 
syphilitic  pneumonia.  The  site  of  inocula- 
tion was  discoverable  in  two  cases  only, 
probably  on  account  of  the  lateness  and 
irregularity  with  which  the  patients  were 
brought  to  the  clinic.  In  the  mother  it  was 
upon  the  center  of  the  cheek,  and  in  one 
girl  it  was  upon  the  eyelid.  The  family 
was  very  poor,  living  in  one  room,  and 
their  habits  were  very  uncleanly. 


Ringworm   of  the   Scalp. 

Dr.  J.  C.  Gilchrist  (Gaillard's  Medical 
Journal.      1898.  Vol.  lxix.,  No.  5). 

This  disease  is  due  to  the  presence  of  a 
parasite  known  as  tinea  tonserans.  This 
disease  is  limited  to  children  and  is  prac- 
tically never  met  with  in  adults.  The 
usual  typical  appearances,  such  as  a  distinct 
circular  patch,  covered  with  light  scales 
and  stumpy  hairs,  which  are  usually  pulled 
out  or  almost  fall  out  by  themselves,  are 
always  recognized.  The  variety  which  is 
difficult  to  diagnose  and  yet  is  comparatively 
common  is  characterized  by  a  scaly  condi- 
tion of  the  scalp  in  patches,  though  no 
circular  areas  are  met  with.  On  careful 
examination  of  these  areas  a  few  stumpy 
hairs,  or  hairs  which  are  broken  off  near 
the  scalp,  can  usually  be  found,  and  the 
diagnosis  is  easily  confirmed  by  soaking 
one  or  more  of  them  in  liquor  potassae  and 
examining  with  a  high  power  of  the  micro- 
scope, when  numbers  of  spores  will  be 
found  invading  and  clinging  to  the  hair- 
shaft. 


Balsam  of  Peru  in  Scabies. 

M.  Descouleurs,  says  the  Medical  Age, 
has  published  a  series  of  cases  (300)  of  itch 
treated  successfully  by  frictions  with  Peru- 
vian balsam,  following  the  method  recom- 
mended by  Petters,  Nothnagel,  and  Ross- 
bach. 

Peruvian  balsam  seems  to  act  as  a  tonic 
on  the  acarus.  Placed  on  a  watch-glass 
and  in  contact  with  sulphurous  vapors,  these 
insects  die  only  at  the  end  of  sixteen  hours, 
while  in  flour  of  sulphur  or  the  classical 
ointment  they  can  live  one  hour  or  more. 
Descouleurs  having  placed  le  acara  in  con- 
tact with  Peruvian  balsam,  found  that  two 
died  after  ten  minutes,  and  the  remainder 
after  twenty.  The  mode  of  application  is 
simplicity  itself.  It  suffices  to  rub  in  the 
balsam  gently  over  the  surface  of  the  body. 
No  preliminary  soap-bath  is  necessary. 
However,  a  bath  is  recommended  the  fol- 
lowing morning  more  for  cleanliness  than 
from  any   therapeutic    purpose.      Generally 


446 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


one  application  is  sufficient,  but  the  remedy 
may  be  employed  two  or  three  times  if  nec- 
essary, as  it  causes  no  irritation  of  the  skin. 
M.  Descouleurs  believes  that  the  balsam 
should  take  the  place  of  every  other  agent 
where  the  skin  is  unusually  tender,  and  the 
seat  of  impetigo,  ecthyma,  eczema,  and  in 
cases  of  young  children.  It  is  also  particu- 
larly useful  in  pregnant  women,  who  can- 
not generally  take  baths.  There  exists  no 
counter-indication  to  its  employment,  and 
it  is  particularly  appreciated  by  the  patients 
in  private  practice,  not  only  on  account  of 
its  simplicity,  but  also  for  its  agreeable 
odor. 


The  Craze  of    the  Medical    Profession  to 
Affix  Titles  to   their  Names. 

Dr.  T.  J.  Hillis  (Medical  Record.  Feb- 
ruary 18,  1899).  This  must  be  a  subject  of 
deep  concern  to  all  who  have  the  interest  of 
the  medical  profession  at  heart.  The  craze 
of  the  doctor  of  to-day  to  have  himself 
dubbed  as  a  professor  or  lecturer  somewhere 
or  other — any  place  is  better  than  none,  if 
it  were  only  to  go  in  and  lecture  to  dry 
bones  in  a  graveyard  or  to  trees  in  a  forest 
— the  name  of  lecturer,  only  the  name.  It 
will  give  him  an  opportunity  to  write  about 
something  he  does  not  understand,  and  have 
people  read  it,  by  prefixing  professor  or 
lecturer.  If  it  could  be  professor  of  practice 
or  professor  of  surgery,  so  much  the  better ; 
but,  as  was  said  before,  professor  of  any- 
thing is  better  than  nothing.  We  really 
must  make  him  professor  of  something  or 
other,  somewhere,  anywhere,  to  a  Barren, 
a  Blackwell,  or  some  other  island,  other- 
wise he  will  pine  away  and  die. 

Once  upon  a  time,  travelling  in  Kentucky 
or  the  Carolinas,  about  every  second  man 
one  met  on  the  highway  was  a  colonel  or 
a  brigadier-general.  To-day  in  the  City  of 
New  York,  and  doubtless  other  cities  of  the 
Republic,  every  other  doctor  one  meets  in 
the  streets  or  the  sick-room  is  a  professor  or 
lecturer  in  some  hospital,  infirmary,  or  dis- 
pensary. It  may  be  further  observed  in 
looking  around  and  visiting  the  haunts  of 
the  doctor,  that  the  younger  the  physician 
the  more  likely  is  he  to  be  a  professor. 
Take  up  a  journal,  a  provincial  one  prefer- 
red, in  which  it  can  be  seen  that  most  of 
the  articles  are  decorated  at  the  top  with 
professorships,  honorary  degrees,  etc.  This 
rider  the  writer  displays  at  the  head  of  his 
article  probably  because  it  has  no  other 
merit  to  recommend  itself  to  the  reader,  or 
he  may  wish  by  it  to  draw  away  the  reader's 
attention  from  the  neighboring  article  by 
some  medical  man  who  makes  no  preten- 
sion to  be  anything  more  than  a  plain  doc- 


tor— a  recorder  of   facts  and  experiences  as 
they  present  themselves  to  him. 

It  is  foreign  to  the  writer's  intention  to 
do  anybody  a  wrong,  or  to  strike  at  honor- 
able and  manly  efforts  on  the  part  of  every 

[  member  of  the  profession  to  which  he  be- 
longs.     It  should    be  the   ambition,  as  it  is 

I  their  privilege  and  their  right,  to  lead  in 
their  chosen  calling  and  run  in  the  race  for 

I  honors  in  the  greatest  of  all  professions,  and 
no  man  has  a  right  to  ask  them  to  desist 
from  such  honorable  purpose  ;  but  he  does 
object,  and  very  decidedly  too,  to  hippo- 
droming  and  the  back-door  entrance,  and 
other  underhanded  and  crooked  work  in  the 
race  for  place  in  the  grand  medical  handi- 
cap to  which  we  are  all  subscribers,  and  so 
few  of  us  beneficiaries. 


J  The  Treatment  of  Incontinence  of   Urine 
in  Children  with  Rhus  Aromatica. 

Freyberger    (Treatment.   1898,  No.  5). 

This  was  first  used  in  the  treatment  of  in- 
continence of  urine  caused  by  an  atonic 
j  state  of  the  bladder.  Burvenich  believed 
that  it  was  a  powerful  tonic  for  the  bladder, 
i  acting  similarly  to  nux  vomica.  According 
1  to  Numa,  it  stimulates  the  unstriped  muscle 
of  the  bladder  as  well  as  that  of  the  uterus 
and  rectum.  During  the  past  three  years 
one  hundred  and  ten  instances  of  enuresis 
have  been  under  observation.  Leaving  out 
those  in  which  the  symptom  was  due  to 
phimosis,  preputial  adhesions,  hypospadia, 
urinary  hyperacidity,  cystitis,  nephritis,  or 
glycosuria,  there  remained  altogether  sixty 
instances  of  the  use  of  this  drug.  Of  these, 
thirty  are  tabulated,  because  a  sufficiency 
long  time  has  elapsed  since  their  discharge 
(nine  months  to  two  years)  to  enable  an 
opinion  to  be  given  as  to  a  permanent  cure. 
Patients  who  had  previously  received  bella- 
donna, strychnine,  or  tonics  without  suc- 
cess were  at  once  put  upon  this  treatment. 
Others  underwent  a  preparatory  treatment, 
which  consisted  of  regulation  of  the  diet, 
sleeping  upon  a  hard  mattress,  the  use  of 
light  coverings,  and  cold  sponging  along 
the  spine.  The  children  were  taken  up 
once  or  twice  during  the  night  and  made 
to  pass  water.  The  formula  is  :  Fluid  ex- 
tract of  rhus  aromatica,  1  ;  aromatic  syrup, 
2  ;  distilled  water,  6,  which  conceals  the 
astringent  taste  and  disagreeable  odor.  The 
dose  varies  from  five  to  ten  minims  (two  to 
five  years)  ;  ten  to  fifteen  minims  (five  to 
ten  years),  with  a  maximum  of  twenty 
minims  for  older  children.  Of  the  thirty 
instances  recorded,  twelve  boys  andeighteen 
girls,  cure  followed  in  eighteen,  eleven  boys 
and  seven  girls;  improvement  in  ten,  one 
boy  and  nine  girls  ;  and  no  improvement  in 


TITE  CHARLOTTE  MEDICAL  JOURNAL. 


447 


two  girls.  "Cure"  is  intended  to  mean 
that  at  least  nine  months  have  elapsed  since 
enuresis  has  occurred  for  the  last  time. 
The  average  duration  of  treatment  was 
thirty-four  days  in  boys  and  forty-five  in 
girls.  Thirty-three  days,  on  an  average, 
were  sufficient  to  produce  a  permanent  cure, 
fifty-three  to  effect  a  permanent  improve- 
ment. It  would  be  rash  to  claim  this  rem- 
edy as  a  specific,  but  it  certainly  appears  to 
be  as  efficacious  as  belladonna,  may  be  given 
for  a  long  time  without  the  slightest  ill  ef- 
fect, and  good  results  may  be  obtained  when 
the  latter  proves  ineffective. 


Forced  Examination  of  the  Larynx  in 
Children. 

It  is  sometimes  extremely  desirable  to 
have  a  chance  to  make  a  detailed  laryngo- 
scopic  examination  of  young  children.  (  )ne 
is  apt  to  hesitate,  however,  to  employ  gen- 
eral anaesthesia,  and  parents  will  object  to 
ana'sthetics  unless  some  operative  procedure 
is  intended  at  the  same  time.  Besides, 
laryngoscopic  examination  under  an  anaes- 
thetic is  usually  unsatisfactory.      For  a  phy- 


gestions,  and  is  instrumental-.  He  lias  de- 
vised a  peculiar  form  of  tongue  depressor, 
as  shown  by  the  acompanying  figure.  As 
may  be  seen  in  the  illustration,  the  instru- 
ment is  curved  so  as  to  adapt  itself  exactly 
to  the  base  of  the  tongue.  On  the  distal 
extremity  a  blunt  fork  is  fixed,  of  which 
the  two  branches  descend,  one  on  either 
side  of  the  epiglottis,  ending  in  two  rounded 
points  which,  when  the  instrument  is  used, 
are  supposed  to  lodge  in  the  pyriform  sin- 
uses on  each  side  of  the  laryngeal  orifice. 
The  instrument  serves,  therefore,  not  only 
to  control  the  tongue,  but  to  pull  forward 
the  rima  glottidis  from  the  posterior  wall 
of  the  pharynx,  and  so  to  provide  good 
conditions  for  the  employment  of  the  laryn- 
goscopy mirror.  It  is  probable  that  on  the 
principles  used  by  Kirstein,  in  what  he  calls 
autoscopy.  i.  e.,  laryngeal  examination 
without  a  mirror,  the  examiner  will  be  en- 
abled with  a  little  practice,  to  see  a  good 
deal  of  the  larynx  (especially  its  posterior 
part,  which  is  the  more  important  one),  by 
direct  vision,  and  without  the  use  of  the 
mirror.  The  method  of  the  manipulations 
with  the  new  instrument  is  well   illustrated 


sician  who  does  special  work  on  the  throat 
some  method  of  accomplishing  this  purpose 
of  laryngoscopic  examination  of  children  is 
absolutely  necessary. 

In  the  forthcoming  number  of  "Progres- 
sive Medicine,"|  the  new  quarterly  review 
of  current  medical  progress,  Dr.  A.  D. 
Hlackader,  of  Montreal,  will  describe  two 
novel  methods.      The   first  is    Escat's    sug- 


fProgressive  Medicine.  A  quarterly  Digest 
of  new  methods,  discoveries  and  improvements 
in  the  Medical  and  Surgical  sciences,  edited  by 
Hobart  Amary  Hare,  M.  I>.     Volume  I,  March, 

1  «!)!>.      Lcii  Brothers  ,v  Co.,   New  York  and  Phil- 
adelphia. 


in  a  diagram  presented.  In  the  second 
diagram  the  position  of  the  instrument  in 
the  throat  is  well  shown.  It  will,  as  a  rule, 
be  necessary,  even  with  the  instrument,  to 
have  the  movements  of  the  child  restrained 
by  a  sheet  rolled  around  its  arms  and  legs 
in  the  usual  way,  and  to  have  it  carefully 
held  on  the  knees  of  an  assistant,  but  with 
this  the  examination  of  the  larynx  can  be 
made  much  more  satisfactorily  than  with 
the  ordinary  tongue  depressor. 

A  simple  method  for  the  examination  of 
young  children  is  also  given  in  the  same 
number  of  "Progressive  Medicine,"  which 
seems  extremely  practical    and  well    worth 


448 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


noting.  It  was  demonstrated  by  Lack,  at 
a  meeting  of  the  Laryngological  Society  of 
London,  about  a  year  ago.  The  advantage 
of  this  second  method  is  that  no  special  in- 
struments are  required  and  no   force  is  em- 


tion  from  severe  entero-colitis  in  the  absence 
of  tumor  may  be  quite  impossible.  Fortu- 
nately tumor  is  present  in  over  80%  of  cases. 
Often  it  has  not  been  found  because  search 
has  not  been  made  for  it.      Sudden  and  vio- 


ployed.  It  is  described  by  Dr.  Blackader 
as  follows  :  "The  infant  is  placed  in  the 
usual  position  for  laryngoscopy,  the  index 
finger  of  the  left  hand  is  passed  well  into 
the  mouth,  and  the  terminal  phalanx  hooked 
around  the  hyoid  bone,  which  is  pulled  for- 
ward. The  rest  of  the  finger  acts  as  a 
tongue  depressor,  the  knuckle  as  a  gag, 
while  the  left  thumb  under  the  chin  serves 
to  steady  the  head.  With  the  use  of  a  small 
mirror  the  larynx  can  now  be  easily  seen. 
The  method  causes  no  pain,  and  requires  no 
anaesthetic,  while  the  younger  the  infant 
the  less  is  the  resistance  and  the  easier  the 
examination."  These  manipulations  cer- 
tainly commend  themselves  by  their  ease 
and  simplicity,  and  it  would  seem  that  the 
method  deserves  thorough  trial  that  its 
merits  may  be  tested  in  practical  use. 


Intussusception  in  Children. 

Dr.  Edward  Martin  (Therapeut.  Gazette) 
thinks  the  following  conclusions  are  justi- 
fiable : 

1.  The  affection  is  a  rare  one  in  any  one 
locality  or  in  any  individual  experience. 
The  general  impression  among  medical  men 
to  the  affect  that  it  is  common  has  not  the 
support  of  either  hospital  records,  vital  sta- 
tistics or  personal  inquiry. 

3.  Gastro-enteritis  is  a  distinct  predispo- 
sing factor. 

3.  The  diagnosis  of  infantile  intussuscep- 


lent  onset,  frequent  small  blood-stained  mu- 
cous passages,  and  the  rapid  minimizing  of 
the  quantity  of  feces  passed  would  suggest 
intussusception.  Lender  such  circumstances 
palpation  should  be  practiced,  one  finger  be- 
ing passed  into  the  rectum,  the  other  fingers 
of  the  other  hand'being  applied  to  the  abdom- 
inal surface.  When  there  is  reasonable  doubt 
the  child  should  be  relaxed  by  ether  before 
such  an  examination  is  made.  The  tumor 
is  necessarily  on  the  left  side,  being  found 
in  a  small  percentage  of  cases  to  the  right. 

4.  The  first  attempt  at  reduction  should 
be  thorough  and  final.  This  is  most  likely 
to  be  successful  if  practiced  upon  the  thor- 
oughly anesthetized  child.  The  method  of 
choice  is  the  slow  injection  of  normal  saline 
solution  by  gravity  at  a  temperature  of  about 
102  degrees  F.,  and  under  a  pressure  of  at 
first  four  feet,  not  greater  than  eight  feet, 
after  ten  to  fifteen  minutes.  Inversions  and 
gentle  massage  aid  in  accomplishing  reduc- 
tion. 

5.  Reduction  by  injection  should  not  be 
attempted  in  hyperacute  cases  which  have 
lasted  more  than  twenty-four  hours.  Nor 
in  acute  cases  which  have  lasted  twice  this 
time.  Immediate  operation  is  safer  for  such 
cases. 

6.  Reduction  by  injection  having  failed, 
there  should  be  immediate  recourse  to  celio- 
tomy and  direct  disinvagination,  or  if  this 
procedure  is  impossible,  ligation  and  resec- 
tion of  the   adherent  and   sloughing    mass 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


practiced  through  a  small  incision  through 
the  intussusception,  and  union  of  the  divi- 
ded bowel  as  in  the  Mounsell  method.  The 
portion  of  the  gut  cut  away  may  be  deliver- 
ed through  the  anus. 


Artificial  Dilatation  of  the  Mouth  of  the 
Uterus  During  Labor. 

Demelin  (Journal  Med.  Sciences)  con- 
tributes a  paper  upon  this  subject,  giving 
the  results  of  his  experience  in  artificial 
dilatation  of  the  mouth  of  the  womb  during 
labor.  The  method  which  he  advocates  is 
bimanual  dilatation,  inserting  one  or  more 
fingers  of  each  hand  within  the  cervix  and 
gently  enlarging  the  os,  until  all  the  fingers 
can  be  introduced. 

He  employed  this  method  in  treating 
eleven  cases  of  vicious  insertion  of  the  pla- 
centa and  had  among  these  patients  no 
deaths.  In  eclampsia  the  method  has  given 
him  satisfactory  results.  It  is,  of  course, 
to  be  employed  only  when  labor  has  already 
begun.  If  the  patient  shows  no  signs  of 
labor,  the  eclampsia  and  toxic  condition 
present  must  be  treated  independently  <>l 
labor.  If,  however,  such  treatment  pro- 
duces no  improvement  after  a  reasonable 
time,  labor  ought  to  be  induced. 

He  recommends  this  method  in  sudden 
death  or  threatened  demise  of  the  mother, 
in  place  of  Cesarean  section.  In  the  inter- 
ests of  the  fetus,  this  method  may  also  be 
employed  with  a  good  chance  of  success. 
This  is  especially  true  where  the  cord  is 
compressed  or  where  the  amnion  has  be- 
come infected. 

This  treatment  is  especially  indicated  in 
abnormal  presentations,  such  as  the  brow, 
the  parietal  bone,  and  cross  births.  It  may 
occasionally  be  employed  together  with 
other  operations,  as  before  symphysiotomy 
and  often  before  the  high  application  of 
axis-traction  forceps.  When  labor  is  so 
prolonged  that  maternal  exhaustion  is  threat- 
ened, this  method  is  also  indicated. 

Demelin  lost  two  of  his  forty-nine  pa- 
tients, one  from  eclampsia  and  one  from 
apoplexy.  He  urges  caution  lest  the  oper- 
ator extract  the  child  before  complete  dila- 
tation has  been  secured. 


Frequency  of  Rickets. 
J.  L.  Morse  (Boston  Medical  and  Surgi- 
cal Journal,  Feb.  16,  1899)  discussed  this 
subject  at  a  recent  meeting  of  the  Suffolk 
District  Med.  Society.  He  states  that  four 
hundred  consecutive  infants  under  two  years 
ol  age,  medical  out-patients  of  the  Infant's 
Hospital,  were  examined  for  evidence  of 
rickets.      Eighty  per  cent  showed  more  or 


less  marked  signs.  A  rosary  was  present 
in  every  case.  Only  the  enlargements  were 
considered  as  rosaries  which  could  be  felt 
both  parallel  and  vertical  to  the  long  axis  of 
the  rib.  It  was  the  only  symptom  in  40%. 
The  single  associated  symptom  most  often 
delayed  dentition  ;  next,  enlargement  of  the 
cranial  eminences.  Delayed  dentition  oc- 
curred in  more  than  50%.  Large  fontanel, 
large  eminences,  retraction  at  the  dia- 
phragm, ami  enlargement  of  the  epiphyses 
of  the  extremities  were  each  present  in 
about  15%,  but  were  symptoms  of  later  de- 
velopment. Marked  rachitic  deformities 
were  rare.  About  40%  of  the  cases  were 
Russian  and  Polish  Jews.  Only  12%  came 
from  the  Southern  races.  Breast  milk  was 
a  part  of  the  diet  in  43%.  and  formed  the 
whole  in  18%.  The  only  influence  acting 
on  all  alike  was  improper  hygienic  sur- 
roundings; these,  therefore,  must  be  con- 
sidered as  the  most  potent  cause  of  rickets 
in  Boston  and  vicinity.  Race  and  diet  are 
unimportant  causes. 

In  conclusion  the  author  says  that  80%  of 
the  children  under  two  years  of  the  poorer 
classes  of  Boston  and  the  adjucent  cities 
have  rickets.  A  rosary  is  not  a  normal 
phenomenon,  but  is  in  evidence  of  rickets. 
It  is  the  earliest  and  most  constant  symp- 
tom of  rickets.  In  40%  of  all  cases  under 
two  years  it  is  the  only  symptom.  Other 
symptoms, while  they  may  show  themselves 
at  any  age,  do  not,  as  a  ride,  develop  earlier 
than  the  tenth  month. 


Treatment  of  Hip  Disease. 

B.  E.  McKensie  (Canadian  Practitioner 
and  Rev.)  gives  an  interesting  review  of 
this  topic.      I  le  says  : 

Hip  disease  is  a  local  manifestation  of  a 
constitutional  disease. 

Early  operative  interference  is  seldom 
justifiable. 

As  soon  as  softening  can  be  determined 
the  surgeon  should  operate  and  obey  indi- 
cations, observing  all  care  not  to  injure 
needlessly  the  mechanical  integrity  of  the 
joint,  and  knowing  that  he  is  but  aiding 
nature  by  removing  tissue  that  she  has  al- 
ready cast  off. 

In  the  management  of  the  wound  the 
principles  of  asepticism  and  antisepticism 
must  be  carefully  observed. 

From  the  earliest  moment  efficient  pro- 
tection for  the  joint  should  be  secured  and 
constantly  maintained  by  a  well-fitting  me- 
chanical appliance. 

Constitutional  treatment  is  indicated  as 
in  other  tubercular  affections.  Great  em- 
phasis should  be  laid  on  obtaining  the  freest 
exposure  to  sunlight  and  fresh  air. 

After  excision  a  perfect  recovery  is  never 


450 


THE  CHARLOTTE    MEDICAL  JOURNAL. 


effected,  the  mechanical  integrity  of  the 
joint  having  been  interfered  with. 

Following  mechanical  and  constitutional 
treatment,  perfect  restoration  of  function  is 
sometimes  secured. 

Even  when  softening  of  tissue  occurs  and 
necessitates  incision,  there  is  sometimes  a 
perfect  restoration  and  frequently  a  highly 
useful  return  of  joint  function. 


Tumors  of  the  Kidney  in  Children. 

Dr.  J.  H.  Morgan  (Lancet,  No.  3S87). 
Tumorsof  the  kidney  in  childhood  are  almost 
without  exception,  malignant,  and  the  great 
majority  are  of  the  nature  of  sarcomata, 
though  a  few  bear  affinities  to  the  adenoma- 
ta, and  in  rare  instances  show  pigmenta- 
tion. They  are  by  far  the  most  frequent  of 
all  malignant  tumors  occurring  in  the  abdo- 
men in  childhood,  and  originate  either  from 
the  cortex  and  invade  the  gland  or  in  the 
perirenal  tissue.  Very  rarely  they  com- 
mence in  the  adrenals,  sometimes  surround- 
ing, sometimes  infiltrating,  the  whole  of 
the  kidney.  By  pressure  the  tumor  may 
cause  hydronephrosis,  and  adhesions  may 
be  found  to  other  structures.  The  pressure 
effects  may  cause  ascites  or  oedema  of  the 
lower  extremities.  They  are  frequently  bi- 
lateral. Neither  traumatism  nor  antecedent 
disease  has  much  to  do  with  their  origin. 

Occurring  for  the  most  part  in  very  early 
life,  and  confined  at  first  to  one  side  of  the 
abdomen,  they  present  a  smooth,  rounded 
outline  as  distinguished  from  the  sharp  edge 
of  an  enlarged  liver  or  the  notched  surface 
of  an  hypertrophied  spleen.  On  bimanual 
examination  they  are  found  to  be  movable 
but  attached  to  the  neighborhood  of  the 
lumbar  spine.  They  grow  forwards  and  do 
not  bulge  in  the  lumbar  region.  Though 
dull  on  percussion,  except  where  crossed  by 
intestine,  they  are  often  so  soft  as  to  give 
an  obscure  sense  of  fluctuation,  and  have 
thus  been  mistaken  for  ovarian  cysts.  They 
are  invariably  crossed  by  a  portion  of  the 
colon,  and  in  an  early  stage  are  influenced 
by  the  movements  of  respiration.  There  is 
generally  a  space  into  which  the  fingers  can 
be  pressed  between  the  upper  margin  of  the 
renal  growth  and  the  ribs. 

So  rapid  is  usually  the  advance  of  these 
neoplasms  that  they  present  only  two  symp- 
toms in  their  earliest  onset,  viz  :  that  of  a 
large,  rounded  tumor  commencing  in  the 
loin,  which  most  often  is  the  first  indication 
and  haematuria.  In  13%  this  latter  is  said 
to  be  the  primary  symptom.  Both  might 
well,  in  the  earliest  onset,  be  mistaken 
as  due  to  hydronephrosis  or  the  pres- 
ence of  calculi  in  the  pelvis  of  the  kidney. 
But  the  nature  of  the  swelling  is  soon  evi- 


denced by  the  rapidity  of  its  increase,  and 
the  haematuria  differs  from  that  resulting 
from  calculous  or  scrofulous  pyelitis  in  its 
abundance  and  its  internr'ttence,  the  urine 
in  the  intervals  being  clear.  It  may  be  so 
abundant  as  to  form  clots  in  the  bladder  or 
ureter,  when  pain  will  occur  as  an  addi- 
tional symptom.  If  haematuria  occur  with- 
out an  assignable  cause  the  patient  should 
be  strictly  watched  for  several  weeks.  By 
this  means  Israel  found  a  growth  very  early 
and  removed  it  successfully.  Cachexia  does 
not  appear  until  late,  and  then  the  wasting 
is  rapid  and  the  effects  of  pressure  become 
evident  in  dyspnoea,  vomiting  and  indi- 
gestion. 

Points  in  the  Arsenical  Caustic  Treatment 
of  Cutaneous  Cancers. 

Dr.  William  S.  Gottheil  arrives  at  the 
following  conclusions  :  (St.  Louis  Medical 
and  Surgical  Journal). 

1.  The  arsenious  acid  caustic  treatment 
of  skin  cancers  does  not  contemplate  or  de- 
pend upon  the  actual  destruction  of  the  new 
growth  by  the  caustic. 

3.  The  method  is  based  upon  the  fact 
that  newly  formed  tissue*  of  all  kinds  has 
less  resisting  power  than  the  normal  struc- 
ture when  exposed  to  an  irritation  and  its 
consequent  inflammation.  Hence  the  former 
breaks  down  under  an  "insult"  which  the 
latter  successfully  resists. 

3.  If,  therefore,  the  whole  affected  area 
can  be  subjected  to  the  influence  of  an  irri- 
tant of  just  sufficient  strength  to  cause  a 
reactive  inflammation  intense  enough  to 
destroy  the  vitality  of  the  new  cells,  the 
older  normal  cells  will  survive. 

4.  Arsenious  acid  of  properly  mitigated 
strength  is  such  an  agent,  and  its  applica- 
tion causes  an  inflammation  of  the  required 
intensity. 

5.  It,  therefore,  exercises  a  selective  in- 
fluence upon  the  tissues  to  which  it  is 
applied  and  causes  the  death  of  the  cancer- 
cells  in  localities  outside  the  apparent  limits 
of  the  new  growths,  where  there  is  as  yet 
no  evidence  of  disease. 

6.  It  is  superior,  in  suitable  cases,  to  any 
method,  knife  or  cautery,  which  requires 
the  exercise  of  the  surgeon's  judgment  as 
to  the  extent  to  which  it  is  to  be  carried. 
That  that  judgement  is  often  wrong,  and 
necessarily  so,  is  shown  by  the  frequency  of 
recurrence  under  these  methods  even  in  the 
best  hands. 

7.  It  is  applicable  to  all  cutaneous  car- 
cinomata  in  which  the  deeper  structures  are 
not  involved,  and  which  do  not  extend  far 
on  to  the  mucous  membranes. 

8.  It  is  easy  of  application;  it  is  safe;  it 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


451 


is  only  moderately  painful ;  and  its  results 
compare  favorably  with  those  obtained 
with  other  methods. 


The  Causes  of  Albuminuria. 

Dr.  F.  Taylor  (Med.  Record,  April  ist, 
1899,)  in  considering  the  reason  why  albu- 
min appears  in  the  urine  in  Bright's  disease 
we  must  remember  that  the  occurrence  of 
albuminuria  is  not  limited  to  cases  of  neph- 
ritis, but  accompanies  a  variety  of  other 
disorders.  The  different  conditions  under 
which  albuminuria  has  been  observed  may 
be  enumerated  as  follows  : 

I.  Arising  in  the  kidney — 1.  Acute  and 
chronic  nephritis  and  contracted  kidney, 
forming  Bright's  disease ;  consecutive  ne- 
phritis and  cystic  kidney.  2.  Supurative 
nephritis.  3.  Degenerative  changes,  such 
as  lardaceous  disease  and  tuberculous  kid- 
ney. 4.  Acute  febrile  processes,  probably 
causing  temperary  degeneration  of  the  renal 
cells.  5.  Venous  obstruction  in  diseases  of 
the  heart  and  lungs,  and  local  disturbances 
of  the  circulation.  6.  Malignant  endocar- 
ditis and  embolism  and  renal  arteries.  7. 
New  growths  and  parasites.  S.  Temporary 
obstruction  of  the  ureters.  9.  Nervous  dis- 
orders, such  as  apoplexy,  convulsions,  and 
concussion.  10.  Chronic  general  disorders, 
like  leukaemia,  diabetes,  and  anaemia.  11. 
Dirturbances  of  digestion,  and  disorders  of 
a  temporary  nature,  including  so-called 
cyclic  and  physiological  albuminuria.  12. 
The  influence  of  certain  poisons,  and  the 
presence  in  the  blood  of  forms  of  albumin 
other  than  serum  albumin. 

II.  Arising  in  the  urinary  passages  below 
the  kidney — 1.  Disease  of  the  pelvis  of  the 
kidney,  calculous  pyelitis,  and  tuberculous 
disease.  2.  Tuberculous  disease  of  the  ure- 
ter. 3.  Cystitis  and  tuberculous  disease  of 
the  bladder. 

Thrombosis   and    Embolism    After    Child- 
birth. 

Singer  shows  that  thrombosis  and  embol- 
ism is  an  important  complication  of  child- 
birth, and  one  which  is  often  overlooked. 
He  reports  thirty-five  instances  of  its  occur- 
rence. From  a  study  of  these  cases  the  fol- 
lowing conclusions  are  drawn  :  (Medical 
Standard,  April  1S99.) 

Formation   of   the   thrombus    is  preceded 

■  by  an  irregular  rise  in  the  pulse  rate.      This 

1  rise  is  associated   with   the  development  of 

!  the  thrombus,  and  the  maximum  is   reached 

when  the  thrombus  is  completely  formed  or 

symptoms  develop  in  the  lungs. 

The  curve  of  the   pulse  is  characteristic. 

In  a  typical  pulse-curve  in  thrombosis  the 
pulse  rises,  while  the  temperature  remains 
normal.      It  remains  high  until  the  develop- 


ment of  edema  or  a  palpable  hard  cords  or 
symptoms  referable  to  the  lungs  cause  the 
temperature  to  rise.  If  in  the  next  few 
hours  or  days  the  temperature  falls  the 
pulse  still  remains  high  for  some  days 
longer. 

A  variation  from  this  type  is  found  in 
those  patients  in  whom  other  causes  have 
produced  high  temperature  before  the  de- 
velopment of  thrombus. 

In  such  cases  the  thrombus  is  apt  to  be 
an  infected  one,  and  the  discharges  of  the 
patient  should  be  carefully  examined  in 
order  to  ascertain  the  character  of  the  in- 
fection. 

Such  examination  will  often  reveal  the 
presence  of  gonococci. 

The  good  results  from  the  treatment  of 
thrombosis  follow  its  early  direction,  hence 
it  is  of  importance  to  note  carefully  the 
pulse-curve  as  well  as  that  of  the  tempera- 
ture. 

Rest  in  bed  is  the  most  important  part 
of  the  treatment.  Above  all  things  the  pa- 
tient must  not  be  allowed  to  sit  up  or  stand 
up.  The  pulse  is  the  absolute  guide.  The 
patient  ought  to  be  kept  in  bed  at  least 
three  weeks  after  the  pulse  has  become 
normal. 


The  Use  of  Quinine  inTopieal  Leucorrhea. 

Dr.  Hardwicke  (Canadian  Practitioner) 
speaks  as  follows  about  the  topical  applica- 
tion of  quinine  to  the  mucous  membrane  of 
the  cervix  uteri  and  vagina  in  cases  of 
leucorrhea  :  A  patient,  the  mother  of  six 
children,  who  had  been  a  sufferer  from  the 
above  complaint  for  some  years,  having 
used  the  various  remedies  usually  prescribed 
in  such  cases  but  with  only  temporary  bene- 
fit, her  trouble  sooner  or  later  recurring, 
adopted  the  use,  from  prudential  motives, 
of  what  proved  to  be  quinine  pessaries. 
Since  using  them  not  only  had  her  leucor- 
rhea dissapeared  but  her  general  health  had 
improved.  I  have  since  used  quinine 
topically  in  several  cases  of  simple  leucor- 
rhea always  with  great  success — in  fact,  I 
do  not  know  of  a  single  instance  in  which 
it  has  failed  or  in  which  quinism  has  been 
produced.  It  may  be  used  in  the  form  of 
douche  or  pessary.  I  adopt  the  latter  form 
as  being  obviously  the  better  one ;  the  drug 
has  a  better  chance  of  closer  and  more  con- 
tinuous contract  with  the  congested  mem- 
brane. I  prescribe  three  grains  of  the 
hydrobromate  in  a  half-drachm  pessary  in 
combination  with  oleum  theobromatis,  but 
the  pessus  quininaeof  the  "Extra  Pharmaco- 
peia"containing  the  hydrochloride  answers 
just  as  well.  One  insertion  a  day  is  gen- 
erally sufficient. 


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THE  CHARLOTTE  MEDICAL  JOURNAL. 


The  North  Carolina  Medical  Society. 

This  Society  will  meet  in  Asheville,  Tues- 
day, May  30th.  The  railroads  will  give 
reduced  rates,  beginning  May  24th.  This 
will  enable  the  members  of  the  Board  of 
Medical  Examiners  to  take  advantage  of 
the  low  rates. 


Limits  of    Usefulness   of    the    X-Rays  for 
the  Diagnosis  of    Fractures. 

On  their  first  introduction  it  was  thought 
that  the  X-rays  would  give  absolute  and 
immediate  assurance  of  the  presence  of  frac- 
tures in  bones  and  make  it  possible  to  dis- 
pense with  the  ripe  clinical  experience 
usually  considered  so  necessary  for  exact 
diagnosis  in  the  matter  of  certain  fractures. 
Most  of  this  promise  has  been  fulfilled,  but 
practical  experience  and  the  collation  of 
expert  opinions  have  shown  that  the  X-rays 
have  their  limit  of  usefulness,  and  clinical 
experience  is  still  of  the  greatest  service  in 
the  diagnosis  of  these  difficult  conditions. 
The  greatest  care  is  necessary  in  the  appli- 
cation of  the  X-rays  in  these  cases,  so  that 
the  position  of  the  limb  will  not  produce 
on  the  plate  an  impression  of  seeming  de- 
formity. Familiarity  with  skiagrams  of 
the  part  is  indispensable  to  the  formation 
of  an  opinion  in  many  cases  as  to  the  char- 
acter of  the  displacement  or  solution  of  con- 
tinuity that  seems  to  be  present  in  a  given 
case.  As  a  rule,  practical  expert  knowl- 
edge of  skiagraphy  is  necessary  for  reliable 
results  in  difficult  cases,  and  even  then  the 
best  results  can  only  be  secured  by  one  who 
has  a  thorough  clinical  experience  in  the 
matter  of  fractures  and  dislocations,  and 
who  is  able  to  decide  intuitively,  as  it  were, 
what  is  the  position  that  will  bring  out  the 
deformity  present.  Under  the  circumstan- 
ces the  courts  have  done  well  to  decide,  in 
several  cases  where  X-ray  pictures  were  in- 
troduced as  important  evidence  in  damage 
suits,  that  as  yet  surgical  opinion  is  not 
clear  as  to  their  absolute  value  in  any  given 
case,  the  angle  at  which  they  may  be  taken, 
the  distance  of  the  tube  of  origin  of  the 
rays  and  of  the  object  to  be  skiagraphed 
from  the  sensitive  plate,  and,  finally,  the 
position  of  the  part  being  factors  in  the 
production  of  appearances  in  the  resultant 
skiagram  that  is  impossible  to  properly 
value  with  absolute  certainty.  Recent 
series  of  skiagrams  tend  to  confirm  these 
opinions,  and  Professor  Stimson  has  done 
well  to  illustrate  this  important  point  in  an 
excellent    series  of    skiagrams  presented  in 


*A  Treatise  on  Fractures  and  Dislocations, 
by  Lewis  A.  Stimson,  A.  B.,  M.  D.,  Professor  of 
Surgery  in  Cornell  University  Medical  Cellege, 
New  York.      Lea  Brothers  &  Co.      Just  issued. 


his  new  work    on  "Fractures    and  Disloca- 
tions.* 

We  note  among  them  a  bimalleola  Pott's 
fracture  by  inversion  in  a  boy  of  fourteen 
years.  The  external  malleolus  is  separated 
at  the  epiphyseal  line,  and  the  fracture 
shows  very  clearly.  The  fracture  of  the 
internal  malleolus  does  not  show  in  the 
skiagram,  though  recognized  clinically  by 
indubitable  signs. 


Typhoid  Fever  in  the  United  States. 
Professor  Osier's  brilliant  address  on  the 
above  subject,  delivered  before  the  Medical 
Society  of  the  State  of  New  York  on 
February  1st,  is  one  that  should  be  read 
carefully  and  digested  slowly  by  the  sani- 
tarians of  this  country.  The  Medical  Re- 
cord of  April  1st,  1899,  refers  to  the  ad- 
dress editorially.  The  following  are  a  few 
of  the  favorable  comments.  After  referring 
to  the  splendid  work  accomplished  by  the 
medical  men  of  America  in  investigating 
typhoid  from  the  beginning  of  the  century 
to  the  present  time,  and  after  alluding  to  the 
fact,  not  generally  recognised,  that  it  was 
American  scientific  men  and  not  Sir  Wil- 
liam Tenner  who  first  distinguished  between 
typhus  and  typhoid  fever,  Dr.  Osier  briefly 
reviews  a  few  points  in  regard  to  the  in- 
crease of  knowledge  of  infectious  diseases 
during  the  past  half  century.  He  shows 
how  effectually  sixty  years  of  sanitary  re- 
form have  swept  away  typhus  and  cholera, 
that  we  have  learned  to  fight  cholera  and 
diphtheria,  that  in  a  hundred  other  ways 
the  prevalence  of  infectious  diseases  has 
been  lessened,  and,  lastly,  that  with  a  clean 
soil  and  pure  water  typhoid  fever  disap- 
pears. Regarding  the  lethargy  of  Ameri- 
cans as  to  public  sanitation,  Dr.  Osier 
remarks:  "This  is  a  nation  of  contradic- 
tions and  paradoxes.  A  clean  people,  by 
whom  personal  hygiene  is  carefully  cultivat- 
ed, displays  in  matters  of  public  sanitation 
a  carelessness  which  is  simply  criminal.  A 
sensible  people,  among  whom  education  is 
more  widely  diffused  than  in  any  other 
country  in  the  world,  supinely  acquiesces 
in  conditions  shameful  beyond  expression." 
Dr.  Osier  has  this  to  say  concerning  the 
solution  of  the  problem  of  typhoid  fever : 

"The  problem  will  be  solved  when,  first, 
every  city  in  the  Union  has  a  supply  of 
pure  water  (including  ice)  and  is  properly 
drained ;  secondly,  when  suburban  and 
rural  hygiene  is  systematically  organized. 
The  responsibility  for  the  widespread  pre- 
valence of  the  disease  rests  directly  upon 
the  wanton  carelessness  of  the  people. 
God's  own  country,  with  man's  own  back- 
yards  and  the   devil's  own   cesspools,    ex- 


THE  CHARLOTTE  MEDICAL  JOURNAL, 


453 


presses  the  existing  conditions.  A  three- 
fold duty  devolves  upon  the  members  of  our 
profession — first,  to  preach  cleanliness!! 
cleanliness!!!  second,  to  give  a  loyal  and 
willing  support  to  the  State  health  officials  ; 
and,  third,  to  guard  every  case  of  typhoid 
fever  as  a  centre  and  possible  source  of 
further  infection." 

These  stinging  words  will  find  an  echo 
in  the  heart  of  every  medical  man  in  the 
country.  When  the  people  have  been 
brought  to  understand  the  absolute  necessity 
of  public  hygiene,  then,  and  not  till  then, 
will  the  typhoid  pestilence  be  stayed. 


A    Memorial   of   the    Late    Dr.    Joseph 
O'Dwyer. 

A  committee  of  over  forty  physicians, 
representing  sixteen  different  medical  so- 
cieties of  the  city  of  New  York  and  includ- 
ing representatives  of  both,  schools  of  med- 
icine, has  been  formed  for  the  purpose  of 
doing  honor  to  the  memory  of  Dr.  Joseph 
< )'  I  )\vyer. 

The  first  meeting  was  held  at  the  New 
York  Academy  of  Medicine,  on  November 
22,  [898,  under  the  chairmanship  of  Dr. 
Joseph  I).  Bryant,  and  was  mainly  devoted 
to  organization.  Dr.  George  F.  Shrady 
was  elected  permanent  chairman,  and  Dr. 
Alfred  Meyer  permanent  secretary,  and  the 
following  committee  on  scope  and  plan  was 
appointed  :  Dr.  Dillon  Brown  (chairman), 
Dr.  Robert  Abbe,  Dr.  R.  G.  Freeman,  Dr. 
L.  Einmetl  Holt,  and  Dr.  Louis  Fischer. 
At  the  second  meeting,  held  at  the  Acade- 
my of  Medicine  on  March  [3,  1899,  the  re- 
port of  the  committee  on  scope  and  plan 
was  adopteil  and  now  only  awaits  final  ac- 
tion of  a  meeting  of  the  full  committee. 

The  memorial  to  Dr.  O'Dwyer  will  pro- 
bably take  an  educational  form,  for  hy  the 
plan  now  outlined  it  is  proposed  to  raise  a 
fund  of  thirty  thousand  dollars,  the  interest 
of  which  shall  support  two  O'Dwyer  fel- 
lowships in  paediatrics,  open  to  competition 
by  physicians  who  graduate  in  the  United 
States  and  to  be  held  by  the  successful  com- 
petitors for  a  period  of  two  years.  During 
this  period  they  must  furnish  satisfactory 
proof  of  their  engagement  in  original  re- 
search work  to  a  committee  of  five,  one  of 
whom  shall  be  appointed  by  the  president 
of  Harvard  University,  one  by  the  dean  of 
the  Johns  Hopkins  Medical  School,  one  by 
the  president  of  the  University  of  Pennsyl- 
vania, one  by  the  president  of  the  Univer- 
sity  of  Chicago,  and  one  by  the  president 
of  the  New  York  Academy  of  Medicine. 

Many  details  of  this  general  plan  are  still 
to  be  arranged,  which  the  secretary  will 
furnish  to  the  medical  press  of    the  country 


so  soon  as  they  are  finally  decided  upon. 
This  preliminary  notice  has  for  its  object 
merely  to  acquaint  the  profession  with  the 
fact  that  a  movement  of  this  nature  is  on 
foot,  and  that  an  effort  will  be  made  to  give 
it  the  international  character  so  fitting  as  a 
memorial  to  an  investigator  of  international 
reputation. 


Protective  Action  of  the  Liver  Against 
Microbes. 

Roger  (Paris  Society  of  Biology,)  in  1897 
found  that  certain  cultures  of  anthrax  bacil- 
lus introduced  into  a  branch  of  the  portal 
vein  did  not  kill  rabbits,  whereas  cultures 
of  the  same  virulence  injected  into  other 
blood-yessels  did  cause  death.  He  then 
found  that  the  lungs  possessed  a  protective 
action  against  the  streptococcus,  while  the 
liver  possessed  none.  The  staphylococcus 
aureus  grows  rapidly  in  the  brain,  but,  like 
the  antrax  bacillus,  is  destroyed  by  the  liver. 
The  liver  seems  to  be  powerless  against  ba- 
cillus coli,  and  even  to  favor  the  growth  of 
this  microbe.  Both  liver  and  kidney  arrests 
the  growth  of  oidium  albicans.  Recently 
Roger  has  made  further  experiments  on 
rabbits  to  determine  what  conditions  modi- 
fy the  protective  action  of  the  liver.  This 
protective  action  is  less  marked  when  the 
animal  is  kept  without  food,  but  remains 
observable  even  after  three  days  of  fasting. 
If  three  fourths  c.cm.  of  a  sterilized  culture 
of  bacillus  prodigiosus  injected  into  an  in- 
testinal vein,  the  liver  loses  all  its  protective 
power  against  staphylococcus  aureus.  Large 
dose?  of  glucose — given  by  the  mouth — 
weaken  the  protective  power  of  the  liver, 
whereas  small  doses  increase  it.  The  effect 
of  ether  is  most  striking ;  five  drops  of  ether 
injected  into  the  portal  vein,  or  two  c.  cm. 
given  by  the  mouth,  abolish  the  protective 
action  of  the  liver,  whereas  small  doses  by 
the  mouth — two  or  three  c.cm.  of  a  solution 
of  ether  in  alcohol  and  water — increase  it. 
When  the  ether  is  injected  subcutaneously 
its  effect  is  much  less  marked.  Perhaps  the 
beneficial  action  of  potions  containing  ether, 
in  the  case  of  patients  with  infectious  dis- 
eases, may  be  explained  on  the  supposition 
that  dilute  doses  of  ether  given  in  this  way 
increase  the  protective  action  of  the  hepatic 
cells  against  microbes. 


Removal  Notice. 

On  April  1,  1899,  Messrs.  Reed  &  Carn- 
rick  removed  their  business  from  their  for- 
mer location  to  their  commodious  new  fac- 
tory building,  Nos.  42,  44  and  46  Germania 
Avenue,  Jersey  City,  N.  J.  Their  post- 
office  address,  until  further  notice,  will  be 
P.  O.  Box  No.  3042,  New  York  City. 


454 


THE  CHARLOTTE   MEDICAL  JOURNAL. 


The  Bacillus  of  Syphilis. 

Van  Neissen  has  made  some  interesting 
experiments  on  the  cultivation  of  a  micro- 
organism from  the  tissues  and  blood  of 
syphilitic  patients,  and  the  production  of 
symptoms  resembling  syphilis  in  animals 
after  inoculation  of  the  cultivated  microbes. 
He  claims,  says  Treatment,  March  23,  '99, 
to  have  found  a  strepto-bacillus  in  the  secon- 
dary stage.  For  purposes  of  cultivation  he 
employed  bone  marrow  and  the  cartilagi- 
nous parts  of  the  epiphyses  of  the  long  bones 
and  ribs  from  infants  with  hereditary  syph- 
ilis, and  also  from  secondary  syphilitic  pro- 
ducts. The  pieces  removed  were  washed  in 
percloride  of  mercury,  split  longitudinally, 
and  scraped  with  a  spoon  sterilized  by  heat ; 
and  portions  removed  by  the  spoon  were 
cultivated  on  bouillon,  and  afterwards  on 
agar,  serum  and  gelatin.  A  small  strepto- 
bacillus  or  streptococcus  was  found  regu- 
larly, this  being  identical  with  an  organism 
Van  Neissen  had  formerly  found  in  the 
blood  in  cases  of  paralytic  dementia  and 
tabes  dorsalis.  Van  Neissen  considers  this 
organism  specific  of  syphilis.  Inoculations 
were  made  subcutaneously  and  by  intrave- 
nous injection  in  pigs  and  rabbits.  In  the 
former  there  was  slight  induration  at  the 
point  of  inoculation,  followed  in  eight  or 
ten  days  by  bright  red  spots  on  the  skin, 
which  disappeared  in  about  a  week.  In  the 
rabbits  there  was  typical  induration  at  the 
point  of  inoculation,  after  which  the  ani- 
mals were  paired,  and  the  female  gave  birth 
to  seven  dead  foetuses,  two  of  which  had 
the  appearance  of  syphilitic  maceration. 

Examination  of  the  blood  in  the  seconda- 
ry stage  of  syphilis  gave  mainly  negative 
results,  and  from  this  the  author  assumes 
that  the  contagium  is  at  this  time  for  the 
most  part  confined  to  the  skin. 

The  Preparation  Needed    for  a  Case  of 
Labor. 

Dowling  Benjamin,  M.  D.  (Internation- 
al Medical  Magazine,  Feb.,  1899). 

Fully  half  of  the  deaths  that  occur  at  the 
confinement  period  are  due  to  infection, 
septicemia,  or  blood-poisoning,  in  conse- 
quence of  germs  getting  into  the  system 
through  the  abrasions  caused  by  parturition. 
Aside  from  any  other  lesion,  there  is  al- 
ways, after  every  confinement,  a  large,  raw 
surface  left  on  the  interior  of  the  womb  by 
the  separation  of  the  afterbirth,  which  is 
one  of  the  most  dangerous  culture  fields  for 
the  growth  of  disease  germs,  and  permits 
their  ready  entrance  into  the  woman's  sys- 
tem. 

For  the  proper  and  successful  care,  there- 
fore, of  a  mother  at    this  important    period 


of  her  life,  it  is  of  the  greatest  consequence 
that  we  not  only  understand  but  apply  the 
principles  of  asepsis. 

Since  the  alert  members  of  the  profession 
have  thoroughly  comprehended  this  subject, 
child-bed  fever  has  been  so  rapidly  dimin- 
ished in  frequency  as  to  arouse  the  hope  of 
causing,  ultimately,  a  case  to  be  considered 
a  rare  curiosity. 

How  shall  we  proceed  to  secure  our  pa- 
tients against  the  dangers  of  sepsis?  Call 
upon  your  patient  shortly  after  having  been 
engaged,  and  explain  to  her  the  importance 
of  this  subject,  and,  as  well  as  you  can, 
briefly  the  principles  involved.  Then  give 
her  the  following  directions  : 

1.  Keep  away,  if  possible,  from  all  con- 
tagious and  infectious  diseases. 

2.  Avoid  sores  (wounds  included),  and 
especially  erysipelas. 

3.  Warn  her  to  advise  you  if  any  abnor- 
mal symptoms,  such  as  headache,  dizzy 
spells,  swelled  feet,  etc.,  which  might  point 
to  albuminuria  or  other  dangers. 

4.  Tell  her  to  have  on  hand,  as  soon  as 
the  first  symptoms  of  labor  begin,  or  before, 
if  possible,  two  or  three  gallons  of  sterilized 
water  (either  boiled  or  distilled)  in  a  steri- 
lized boiler  or  pitcher,  properly  covered 
from  the  dust.  This  must  not  be  cool- 
ed by  adding  cold,  unsterilized  water — 
a  thing  that  unskilled  attendants  will  be  very 
apt  to  do  unless  you  watch  them.  Even 
the  baths  that  a  patient  takes  before  or  af- 
ter confinement  should  be  in  sterilized  wa- 
ter, or,  at  least,  aseptic  water,  and  since 
many  cities  take  their  water  supply  from 
streams  into  which  their  sewage  is  emptied 
this  is  difficult  to  do  unless  the  infected  wa- 
ter be  boiled. 

5.  All  water  used  in  the  lying-in  room 
must  be  sterilized.  Also  remember  that 
your  hands  or  anything  else  can  be  washed 
much  cleaner  in  a  stream  that  is  poured  from 
a  pitcher,  than  if  they  are  dipped  into  a  ba- 
sin containing  the  dirty  water  in  which 
they  have  been  washed,  even  though  no 
discoloration  can  be  seen  in  the  water. 

6.  Everything  to  be  used  about  the  pa- 
tient and  bed  in  the  way  of  clothing,  etc., 
must  be  washed,  boiled,  and  ironed,  wrap- 
ped up  from  the  dust  in  a  paper  and  put 
away  to  be  ready  for  use  when  the  time 
comes.  (The  conditions  present,  and  the 
antiseptic  preparations,  are  essentially  the 
same  as  you  would  expect  to  have  in  a  sur- 
gical operation.) 

7.  She  must  have  at  least  one  dozen  asep- 
tic pieces  of  muslin,  about  fifteen  inches 
square,  boiled,  washed,  and  ironed  (an  old 
sheet  torn  up  will  do), wrapped  up  in  paper 
and  put  away  to  be  used  for  wiping  away 
the  discharges,  for  wash  rags,  napkins,  etc. 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


4&5 


8.  One  large  pad,  about  one  yard  and  a 
half  square,  made  of  cheese-cloth,  that  has 
been  boiled  in  water  containing  a  small 
quantity  of  soda,  and  stuffed  with  new  cot- 
ton, or,  what  is  better,  absorbent  cotton.  If 
ordinary  cotton  is  used,  it  will  have  to  be 
baked  for  an  hour,  to  secure  sterilization. 

About  a  pound  and  a  half  of  cotton  will 
be  enough,  although  two  pounds  would  not 
be  too  much.  This  is  to  place  under  the 
patient  during  confinement,  first,  second 
and  third  stages  ;  and  must  be  removed  soon 
after  the  first  stage, to  be  replaced  by  a  light- 
er one,  also  sterilized.  Everything,  of 
course,  if  the  least  bit  soiled,  must  be"  re- 
moved from  the  patient,  bed  and  child, 
promptly,  lest  culture  fields  be  formed  for 
germs. 

9.  One  sheet  of  impervious  cloth,  about 
a  yard  and  a  half  square,  to  be  put  next  to 
the  mattress  for  its  protection. 

10.  One  maternity  binder,  about  eighteen 
inches  wide  and  long  enough  to  go  around 
the  patient,  sterilized. 

11.  One  piece  of  sterilized  soap,  hydro- 
napthol  or  carbolized. 

12.  One  new  sterilized  syringe,  "House- 
hold No.  3"  or  "Fountain"  will  do. 

13.  Two-ounce  box  of  antiseptic  cosmo- 
line  or  sweet  oil. 

14.  One  skein  of  sterilized  silk  floss. 


Movable    Kidney    with   Special    Reference 

to     its     Influence     on     the     Nervous 

System. 

Suckling,  in  the  Edinburgh  Medical 
Journal,  tells  how  to  diagnosticate  a  mov- 
able kidney.  He  says  it  can  only  be  made 
by  palpation  of  the  abdomen.  The  abdo- 
men should  be  uncovered  and  the  patient 
lying  down.  To  feel  the  right  kidney,  the 
right  hand  should  be  placed  on  the  abdomen, 
the  thumb  being  on  the  last  rib  at  the  back 
and  fingers  in  front  below  the  costal  margin. 
The  kidney  may  be  felt  with  slight  pressure 
of  the  fingers  to  be  down,  but,  if  not,  when 
the  patient  draws  a  deep  breath,  the  kidney 
will  slip  into  the  fingers  and  can  be  slipped 
back  easily.  A  common  mistake  is  to  pal- 
pate the  abdomen  with  the  flat  of  the  hand  ; 
this  simply  pushes  the  kidney  in  front  of 
the  hand.  The  best  way  is  to  get  the  kid- 
ney in  between  the  thumb  and  fingers,  and 
not  to  press  too  heavily.  It  is  necessary, 
before  concluding  that  the  kidney  is  not 
movable,  to  examine  the  patient  sitting  or 
standing.  In  these  two  positions  the  pa- 
tient should  lean  forward  and  try  to  relax 
the  muscles.  In  examining  the  left  kidney, 
the  left  arm  should  be  placed  around  the 
body,  the  physician  standing  on  the  right 
side  of  the  patient,  the  fingers  being  placed 


under  the  last  rib ;  the  right  hand  should 
be  placed  under  the  left  costal  margin.  On 
drawing  the  breath  or  on  sitting  or  stand- 
ing, if  the  kidney  be  movable,  it  will  be 
felt  between  the  fingers  and  can  be  made  to 
slide  up  in  a  most  characteristic  way.  The 
left  kidney  rarely  falls  to  the  same  degree 
as  the  right.  The  right  kidney  frequently 
falls  into  the  iliac  fossa  and  even  into  the 
pelvis,  but  the  author  has  never  seen  a  case 
where  the  left  fell  below  the  umbilicus.  It 
is  remarkable  that  the  left  kidney  feels 
much  smaller  than  the  right. 


Significance  of  Mouth-Breathing. 

At  the  recent  meeting  of  the  Medical  So- 
ciety of  the  State  of  New  York  Dr. Clarence 
C.  Rice,  of  New  York,  read  a  paper  on 
The  Importance  of  Early  Examination  and 
Treatment  of  Catarrhal  Mouth-Breathing 
in  the  Public  Schools  (Gaillard's  Medical 
Journal,  April,  1899).  Ninety  per  cent,  of 
the  class  of  cases  termed  "mouth-breathers" 
in  children  are  not  simple  ailments  of  catar- 
rhal disease  of  the  nose,  but  are  evidences 
of  obstruction  which  prevents  nasal  respira- 
tion. This  obstruction  is  largely  due  to  the 
presence  of  enlarged  tonsils.  It  is  impossi- 
ble for  children  to  clear  their  nostrils  by 
blowing,  for  the  post-nasal  space  is  com- 
pletely blocked.  Most  authorities  do  not 
recognize  the  fact  that  90%  of  mouth- 
breathing  occur  in  children  as  a  result  of 
this  cause.  Small  hypertrophies  in  this 
situation  produce  a  chronic  rhinitis  and  a 
general  catarrhal  condition.  Enlargement 
of  the  post-nasal  tonsil  is  often  a  very  im- 
portant factor.  To  diagnose  this  the  finger 
is  a  very  unreliable  guide  unless  the  physi- 
cian has  made  many  such  examinations. 
The  doctor  makes  a  diagnosis  with  the  post- 
nasal curette  if  he  cannot  use  the  mirror, 
this  being  often  impossible  in  fractious 
children.  With  the  curette  the  vault  is 
found  to  be  slippery  as  glass  or  polished 
wood  ;  no  tissue  can  be  taken  away  ;  if  there 
is  a  soft,  spongy  tonsil  it  can  be  pulled 
down  with  the  curette.  It  is  much  easier 
to  use  the  curette  than  a  finger  in  the  small 
space  in  small  children.  In  9  to  10%  of 
older  children  there  is  some  enlargement  of 
the  posterior  nasal  tonsil,  frequently  small 
but  often  of  most  importance.  It  is  present 
in  60%  of  all  deaf  mutes.  The  importance 
of  these  lies  in  the  fact  that  mouth-breathing 
is  neglected  in  school  children.  The  pre- 
serrce  of  this  condition  in  school  children  is 
a  constant  menace  to  their  companions. 
Decomposing  nasal  secretions  cause  an  acute 
rhinitis,  etc., and  every  physician  who  treats 
many  of  these  cases  has  difficulty  in  keep- 
ing his  own  nose  in  good  condition;  he 
must  neutralize  his  own  nasal  passages. 


456 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


Syphilis  in  Relation  to  Obstetrics. 

Dr.  Egbert  H.  Grandin  read  a  paper  on 
this  subject  at  the  New  York  Academy  of 
Medicine,  March  9,  '99  (Med.  News, April 
8,  '99).  He  insists  on  thorough  inspection 
of  the  genitals  before  gynecological  or  ob- 
stetric examination  is  made.  It  seems  al- 
most providential  that  more  doctors  are  not 
infected  from  a  neglect  of  this  rule.  Ex- 
aminations are  sometimes  almost  completed 
in  cases  where  inspection  does  not  precede, 
before  the  doctor  finds  to  his  uter  disgust 
and  subsequent  mental  discomfort  that  his 
patient  is  undoubtedly  syphilitic,  and  that 
great  risk  of  infection  has  been  run  need- 
lessly. As  it  is  many  a  doctor  in  the  city 
and  in  the  country  are  suffering  from  syphi- 
lis acquired  in  this  way.  The  necessity  for 
the  greatest  precautions  and  of  frequent  re- 
minders, for  a  certain  familiarity  with  the 
danger  begets  forgetfulness,  is  evident. 

Syphilis  is  the  great  cause  of  sterility 
whether  relative  or  absolute,  i.e.,  sterility 
either  with  conception  occurring  but  inevi- 
tably followed  by  abortion  each  time,  or 
positive  absence  of  conception.  It  would 
seem  at  times  when  the  menstruation  ap- 
pears to  recur  regularly,  that  what  really 
takes  place  at  each  or  at  least  at  certain 
menstrual  periods  is  an  abortion.  The  ute- 
rine mucosa,  owing  to  syphilitic  alterations 
in  it,  not  having  sufficient  vitality  to  retain 
the  ovum  during  the  recurring  monthly 
nervous  impulse,  proliferation,  and  fatty 
degeneration  asserts  itself.  Habitual  abor- 
tion is  a  misnomer  if  really  considered  to  be 
a  faulty  habit  of  the  organism  as  it  is  always 
syphilitic  in  origin. 

Specific  treatment  in  all  cases  of  preg- 
nancy where  syphilis  is  known  to  exist  in 
either  parent  is  of  the  utmost  importance. 
Active  antisyphilitic  treatment  may  even 
save  an  affected  fetus,  especially  if  the  in- 
fection has  come  after  the  sixth  month.  No 
wet  nurse  can  justifiably  be  allowed  to  nurse 
a  child  no  matter  how  clean  seemingly  its 
personal  bill  of  health  if  either  parent  has 
had  syphilis.  The  mother  should  be  en- 
couraged to  nurse  her  own  child  especially 
in  these  cases  of  lowered  vitality. 

Syphilis  constitutes  the  great  menace  to 
households,  and  while  the  speaker  was  not 
Utopian  in  his  hopes  for  improvement  in 
present  conditions  from  legal  enactment  he 
is  sincerely  of  the  opinion  that  legal  regula- 
tion will  yet  have  to  be  appealed  to  to  pre- 
vent the  spread  of  specific  disease.  Legis- 
lation is  much  more  needed  in  this  matter 
than  for  tuberculosis  which  is  at  present  at- 
tracting so  much  attention.  Certain  States, 
as  Texas  and  Massachusetts,  already  have 
laws  against  syphilis.      A    notable  attempt 


was  made  recently  in  a  western  State  to  se- 
cure proper  certification  of  the  health  of 
people  before  marriage.  This  may  yet  be 
considered  as  Quixotism,  but  some  such 
legal  regulation  will  surely  come  in  the  not 
distant  future. 

It  is  absurd  to  quarantine  as  we  do  against 
other  and  much  less  dangerous  diseases  and 
allow  syphilis  to  spread  absolutely  without 
let  or  hindrance.  It  is  a  strange  inconsist- 
ency due  to  certain  mistaken  notions  of. 
modesty  and  so-called  propriety  that  when- 
ever sexual  questions  assert  themselves  they 
are  simply  ignored.  But  this  state  of  affairs 
cannot  and  will  not  be  allowed  to  continue 
much  longer  without  a  serious  attempt  to 
solve  the  serious  questions  involved. 


Tubercular  Tonsils  and   Adenoids  as  the 

Etiology  of  Enlarged  Cervical  Lymph 

Glands. 

One  of  the  most  interesting  and  difficult 
problems  for  specialists  in  children's  dis- 
eases, (and  as  some  one  has  well  said  this  is 
the  specialty  of  the  general  practitioner,) 
has  been  the  etiology  of  enlarged  cervical 
glands,  or  cervical  lymphadenitis  as  our  ul- 
tra-scientific friends  like  to  call  it.  The 
tonsils  have  long  been  suspected  as  one  of 
the  points  of  entrance  for  the  infection. 
The  review  of  the  recent  literature  of  the 
subject  in  "Progressive  Medicine,"  the  new 
quarterly  digest  of  progress  in  medicine, 
edited  by  Professor  Hare,*  shows  that  not 
only  has  the  role  of  the  tonsils  in  this  mat- 
ter been  clear,  but  that  it  now  seems  cer- 
tain from  the  investigation  by  a  number  of 
observers,  that  the  adenoid  and  faucial  ton- 
sillar tissues  at  the  upper  part  of  the  pha- 
rynx are  quite  often  the  seat  of  chronic  tu- 
berculous processes. 

Prof.  Dieulafoy,  the  distinguished  French 
clinician  of  the  Hotel  Dieu,  Paris,  could 
demonstrate  the  presence  of  tuberculous  tis- 
sue histologically  in  excised  adenoids  in 
only  about  six  per  cent,  of  the  cases, but  the 
much  more  delicate  biological  test  of  inject- 
ing portions  of  the  excised  tissues  into 
guinea  pigs  gave  positive  results  by  the 
death  of  the  animals  from  tuberculosis  in 
20%  of  the  cases.  These  biological  results, 
Dieulafoy  considers  as  suggesting  the  true 
conclusions  to  be  drawn.  A  number  of 
other  observers  confirm  these  results,  and  it 
adds  to  the  weight  of  the  confirmation  to 
know  tha^  there  have  been  no  national  lines 
in  the  matter.      Investigations  in  England, 


*"Progressive  Medicine, "  a  Quarterly  Digest 
of  New  Methods.  Discoveries,  arid  Improve- 
ments in  the  Medical  and  Surgical  Sciences. 
Edited  by  H.  A.  Hare,  M.  D.  Vol.  1,  No.  1, 
March,  1899.  Lea  Brothers  &  Co.,  Philadelphia. 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


457 


in  various  parts  of  Germany,  in  Russia, and 
in  Austria,  have  come  to  practically  the 
same  conclusions  as  to  the  frequency  of  tu- 
bercle in  these  tissues. 

How  important  these  observations  are 
for  prophylaxis  is  evident  at  once.  We 
have  long  known  that  when  these  tonsillar 
adenoid  tissues  were  enlarged  they  should 
not,  for  certain  physical  and  mechanical 
obstructive  rensons,  be  allowed  to  remain, 
but  there  is  now  added  the  realization  of 
the  danger  that  tissues  of  such  low  vital  re- 
sistance to  the  invasion  of  bacteria  may  fre- 
quently, owing  to  the  presence  of  an  abun- 
dant pathogenic  flora  in  the  mouth,  become 
the  ports  of  entrance  for  serious  disease. 

These  considerations  will  better  enable 
us  to  convince  parents,  too,  of  the  necessity 
for  the  removal  of  these  enlargements  be- 
fore they  have  become  infected,  or  at  least 
before  they  have  passed  the  infection  on 
along  the  lymph  paths.  The  whole  of  this 
subject  is  in  the  line  of  the  best  advance  in 
present-day  medicine,  and  is  especially  im- 
portant because  of  its  intimate  connection 
with  prophylaxis  in  early  years,  of  tubercu- 
lar processes,  against  which  until  now,  our 
hands  have  been  practically  tied. 


Urine  Examinations   in  Insanity. 

Dr.  Edwin  (i.  Klein  (N.  Y.  Medical 
Journal,  March  18,  1899,)  has  examined 
the  urine  of  208  cases  of  insanity.      1  le  says  : 

The  average  total  amount  of  urine  was. 
for  males,  11 25  c.c,  for  females,  1020  c.c.  ; 
average  specific  gravity,  1019,  minimum, 
1005,  maximum,  1035.  Urea  varied  with 
specific  gravity,  but  was  on  the  whole 
rather  decreased.  Phosphates  were  de- 
creased in  the  excited  patients,  but  the  re- 
verse in  the  depressed  cases.  Oxalates 
were  in  excess  in  six  of  the  depressed  cases, 
and  in  two,  treatment  directed  to  this 
symptom  was  followed  by  complete  or  ap- 
proximate recovery.  Chloride  were  in- 
creased after  epileptic  attacks  in  three  out 
of  four  cases  examined,  also  in  one  case  of 
paresis  after  a  convulsive  attack.  Trie  acid 
in  excess  was  common  in  dementia  and  was 
observed  several  times  in  paresis.  Urates, 
when  in  excess,  were  generally  associated 
with  dyspepsia.  Peptone  was  found  twice 
in  twelve  cases  of  paresis,  the  tests,  how- 
ever, were  not  implicitly  trusted,  and  it 
might  possibly  have  been  more  frequent. 
Albumin  was  found  four  times  only  in  202 
cases,  in  one  of  these  only  transient.  Yet 
in  the  majority  of  autopsies  of  the  insane, 
chronic  kidney  disease  is  found  to  exist. 
Dr.  Klein  thinks  that  if  often  enough  sought 
for  albumin  would  be  more  generally  found. 
In  six  cases  glucose  was  discovered,  not  as 


large  a  proportion  as  others  have  reported, 
but  the  tests  seem  to  have  been  thorough. 
The  report  is  only  a  preliminary  one,  and 
the  author  hopes  in  the  future  to  investi- 
gate many  of  the  points  more  thoroughly. 
It  is,  however,  of   interest  as  far  as  it  goes. 


Otitis. 


Dr.  Hugh  Blake  Williams  (The  Alka- 
loidal  Clinic,  January,  1S99.) 

The  more  I  see  of  chronic  suppurative  in- 
flammation of  the  ear,  the  more  convinced 
do  I  become  that  the  element  of  chronicity 
is  due  to  lack  of  thoroughness  in  treatment. 
The  method  of  procedure  mapped  out  below 
will  not  succeed  in  cases  where  necrosis  has 
occurred,  but  in  all  others  it  will  reduce  the 
duration  of  treatment  from  months  and 
weeks  to  days. 

The  patient  is  placed  upon  the  side  with 
the  affected  ear  up.  The  concha  is  filled 
with  Marchand's  Hydrozone,  which  is  al- 
lowed to  remain  until  it  becomes  heated  by 
contact  with  the  skin,  when,  by  tilting  the 
auricle,  the  fluid  is  poured  gently  into  the 
external  canal.  The  froth  resulting  from 
the  effervescence  is  removed  with  absorbent 
cotton  from  time  to  time  and  more  Hydro- 
zone  added.  This  is  kept  up  until  all  bub- 
bling ceases.  The  patient  will  hear  the 
noise  even  after  the  effervescence  ceases  to 
be  visible  to  the  eye. 

Closing  the  external  canal  by  gentle  pres- 
sure upon  the  tragus  forces  the  fluid  well 
into  the  middle  ear,  and  in  some  instances 
will  carry  it  through  the  Eustachian  tube 
into  the  throat.  When  effervescence  has 
ceased  the  canal  should  be  dried  with  ab- 
sorbent cotton  twisted  on  a  probe  and  a 
small  amount  of  pulverized  boracic  acid  in- 
sufflated. 

The  time  necessary  for  the  thorough  clean- 
sing of  a  suppurating  ear  will  vary  from  a 
few  minutes  to  above  an  hour,  but  if  done 
with  the  proper  care  it  does  not  have  to  be 
repeated  in  many  cases.  •  However,  the  pa- 
tient should  be  seen  daily  and  the  Hydro- 
zone  used  until  the  desired  result  is  ob- 
tained. 

Care  is  necessary  in  opening  the  bottle 
for  the  first  time,  as  bits  of  glass  may  fly. 
Wrap  a  cloth  about  the  cork  and  twist  it 
out  by  pulling  on  each  side  successively. 

In  children  and  some  adults  the  Hydro- 
zone  causes  pain, which  can  be  obviated  by 
previously  instilling  a  few  drops  of  a  warm 
solution  of  cocaine  hydrochloride.  In  this 
note  it  has  been  the  intention  to  treat  sup- 
puration of  the  ear  rather  as  a  symptom  and 
from  the  standpoint  of  the  general  practi- 
tioner. 


458 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


The  Non-Medicinal  Treatment  of  Habitual 
Constipation. 

Lock  wood  (Medical  Record,  Nov., 1898). 

The  use  of  drugs  is  prejudicial,  as  it  inflicts 
serious  damage  to  the  gastro-intestinal  tract 
by  the  lessening  of  digestive  and  motor 
powers  of  the  stomach  and  the  irritation  of 
the  intestinal  mucous  membrane.  The 
contraindications  to  the  use  of  saline  and 
vegetable  cathartics  are  :  (1)  All  the  con- 
ditions characterized  by  diminished  secre- 
tory power;  (2)  all  conditions  of  impaired 
muscular  power  of  the  stomach  and  intes- 
tine;  (3)  all  conditions  of  inflammation  of 
the  stomach  or  intestines;  and  (4)  in  child- 
ren, owing  to  the  pr0neness  in  them  to  in- 
flammation of  the  intestinal  mucosa.  En- 
emas facilitate  the  absorption  of  ptomaines 
by  the  liquefaction  of  the  feces.  The  arti- 
cles of  diet  most  useful  are  coarse  vege- 
tables, such  as  spinach,  turnips,  and  sprouts 
(these  are  best  taken  in  the  form  of  puree)  ; 
coarse  breads  one  day  old,  and  cereals. 
Sugars  are  also  useful,  but  should  be  taken 
in  the  form  of  honey  or  lactose.  Buttermilk 
or  Kumyss,  3  glasses  a  day ;  fats  in  the 
form  of  butter,  one-eighth  to  one-half 
pound  daily,  or  cod-liver  oil,  and  organic 
acids  are  useful  as  peristaltic  excitors.  An- 
other excellent  remedy  is  made  up  of  2 
parts  of  prunes  and  one  of  figs.  Raw 
fruit  is  not  desirable.  Huckleberries  and 
cranberries  should  be  especially  avoided. 
In  general,  the  diet  should  be  dry.  Exer- 
cise, massage,  abdominal  gymnastics,  elect- 
ricity, abdominal  belt  and  hydrotherapy 
are  all  very  important  adjuvants  to  the 
treatment.  Massage  is  contraindicated  in 
all  inflammatory  and  spastic  conditions. 
Sedative  remedies  are  indicated  in  intestinal 
spasm,  a  quite  frequent  condition,  caused 
primarily  by  hyperacidity.  The  author  has 
also  found  Kussmaul's  oil  irrigations  very 
beneficial. 


Commencement  Exercises. 

The  tenth  Commencement  exercises  of 
the  Chattanooga  Medical  College  took  place 
at  the  Auditorium,  in  Chattanooga,  Tenn., 
March  2 1st,  1899.  The  spacious  structure, 
with  a  seating  capacity  for  five  thousand 
persons,  was  well  filled  with  a  representa- 
tive audience  of  citizens,  and  the  affair  was 
an  entertainment  of  high  merit.  There  was 
instrumental  music  by  Cadek's  Orchestra, 
and  charming  vocal  numbers  by  local  musi- 
cians of  note.  Dean  Cobleigh,  after  prayer 
by  Rev.  A.  J.  Fristoe,  of  the  Central  Bap- 
tist church,  presided  and  opened  the  exer- 
cises with  appropriate  introductory  remarks 
concerning  the  college  history  and  its  pres- 
ent    prosperous    condition.       Hon.   C.   D. 


Mitchell,  President  of  the  Erlanger  Hospital 
Board,  followed  with  the  main  address  of 
the  evening.  Dr.  Jo.  J.  Harrison  then  de- 
livered the  class  valedictory,  and  Professor 
Holtzclaw  addressed  the  class  on  behalf  of 
the  faculty.  Thirty-one  graduates  were 
called,  by  name,  by  the  Secretary — Prof. 
Rathmall — and  advanced  to  the  front  of  the 
stage  attired  in  Oxford  caps  and  gowns, 
presenting  a  very  striking  and  pleasant  ap- 
pearance. President  Rice,  of  Grant  Uni- 
versity— of  which  the  college  is  the  medical 
department — then  conferred  the  "degrees" 
with  a  brief  "talk"  to  the  recipients.  Hon- 
ors were  bestowed  as  follows  :  Faculty  gold 
medal  to  the  Valedictorian,  Dr.  Jo.  J.  Har- 
rison ;  a  case  of  surgical  instruments  to  Dr. 
E.  M.  Russell,  this  being  the  second  prize; 
a  medical  book — third  prize — to  Dr.  O.  G. 
Hughes  ;  and  honorable  mention  was  made 
of  Drs.  J.  B.  Hughes,  R.  O.  Kibler,  H.  P. 
Larimore,  and  C.  S.  Wilkerson,  the  four 
students  grading  next  to  the  prize  men  in 
general  proficiency. 

The  Dean  stated  that  the  session  just 
closed  had  been  the  most  prosperous  in  the 
college  history,  that  the  evening's  exercises 
marked  the  close  of  the  first  decade  of  such 
history,  that  nearly  two  hundred  students 
had  been  enrolled  in  the  college  class  during 
the  past  term,  and  that,  with  the  comple- 
tion of  the  new  city  hospital  which  had  just 
been  accomplished,  the  general  outlook  of 
the  institution  was   particularly  promising. 


Sleep  in  the  Treatment  of  Disease. 

Wm.  Evart  (British  Medical  Journal)  : 
Sleep  has  two  offices,  both  fulfilled  in  the 
long  sleep  of  the  night, which  it  is  our  usual 
endeavor  to  secure  for  our  patients, namelv, 
that  of  favoring  the  slow  changes  of  repair, 
and  that  of  interrupting  consciousness  or 
uncoupling  the  chain  of  neurons,  or  by  re- 
laxing protoplasmic  tension  or  tone.  This 
relief  of  tension  is,  it  would  seem,  the  only 
office  performed  by  the  shorter  spells  of 
sleep,  and  therefore  the  two  forms  of  sleep 
suggest  two  therapeutic  objects.  The 
night's  sleep  which  comes  without  any 
drugs  may  need  to  be  bettered,  and  in  im- 
proving the  quality  of  spontaneous  sleep  our 
help  is  often  of  value.  It  might  also  need 
to  be  prolonged. 

The  symptematic  prolongation  of  sleep 
for  the  cure  of  disease  is  one  of  our  opportu- 
nities hitherto  little  used.  In  chorea,  sleep 
entirely  subdues  the  muscular  agitation, and 
this  observation  has  led  to  the  attempt  to 
arrest  the  disease  by  prolonged  sleep  for  con- 
siderable periods.  A  complication  arises  in 
connection  with  alimentation  which  in  this 
disease,  as  in  most  other  nervous  troubles, is 
of    primary   importance.       Partly    for    this 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


reason,  and  because  more  than  rest  may  be 
needed  for  a  cure,  the  results  hitherto  re- 
ported have  not  sufficiently  recommended 
the  method. 

Prolonged  narcosis  has  also  been  suggest- 
ed in  excessive  wear  and  tear  of  the  nervous 
system  ;  and  in  various  nervous  affections, 
including  the  mental,  its  renewed  trial, com- 
bined with  suitable  methods  of  feeding, 
lead  to  encouraging  results. 

Best  suited,  perhaps,  to  our  every-day 
needs  is  a  systematic  resort  to  the  shorter 
sleep.  Like  the  light  installments  of  food 
which  restores  the  lost  function  of  appetite 
and  digestion,  short  sleep  in  the  day  may  be 
essential  to  the  cure  of  nocturnal  insomnia. 
Our  growing  wealth  in  hypnotics  warrants 
a  hope  that  a  suitable  agent  may  yet  be  found 
which  in  that  direction  would  minister  to 
the  health  of  the  invalid,  ami  might  com- 
mand the  luxury  of  sleep  at  any  opportune 
time  for  the  convenience  of  the  worker. 

Body  rest  as  a  systematic  therapeutic 
agent  has  long  found  its  place  in  our  treat- 
ment for  patients  whom  weakness  alone,  in 
the  absence  of  medical  advice,  would  not 
have  been  compelled  to  lake  to  their  bed. 
To  that  class  belong  the  frail  women  in 
whom  the  debility  of  anemia,  of  dyspepsia, 
and  of  over-fatigne  develop  symptoms  often 
mistaken  for  hysteria.  Rest  in  bed  is  their 
first  need.  In  the  treatment  of  chlorosis 
this  is  now  recognized  as  the  essential  ele- 
ment for  a  rapid  recovery.  Its  methodical 
employment  forms  an  essential  part  of  the 
Weir  Mitchell  plan.  But  its  most  striking 
instance  is  that  of  the  open-air  rest  for 
phthisis,  which  within  quite  recent  years 
has  largely  replaced  at  foreign  sanatoria  the 
previous  method  by  muscular  exercise. 


The  Toxtcmie  Factor  in   Diahetes  Mellitus* 

McCaskey  (Medicine,  January,  1899, 
p.  1).  All  cases  of  persistent  glvcosuria 
are  cases  of  diabetes  mellitus  of  varying 
grade.  '  Diabetes  mellitus  is  a  disease  of 
diverse  origin,  but  the  unity  of  the  clinical 
picture  being  for  the  most  part  dependent 
upon  the  glycaemia  and  the  glycosuria. 
which  are  mere  incidents,  although  domin- 
ating factors  of  the  disease.  Phloridzin- 
diabetes  is  not  essentially  different  from 
clinical  diabetes ;  it  renders  plausible  the 
assumption  of  a  chemical  factor,  either  as  a 
primary  or  as  an  important  secondary 
element  in  the  clinical  type  of  the  disease. 
Normal  sugar  transformation  in  the  blood, 
failure  of  which  is  responsible  for  the  gly- 
cainia  and  the  glycosuria,  results  from  the 
presence  in  the  blood  of  a  chemical  product, 
derived  in  man  principally,  if  not  exclu- 
sively,    from     the     pancreas     and     thrown 


directly  into  the  blood  from  the  pancreatic 
cells,  without  the  intervention  of  a  duct. 
The  direct  chemical  antagonism  of  this  sub- 
stance by  another  is  no  more  improbable 
than  such  an  antagonism  of  a  toxin  by  an 
antitoxin.  It  is  probable,  on  both  clinical 
and  experimental  grounds,  that  certain 
chemical  poisons,  for  the  most  part  of  gas- 
trointestinal origin,  but  possibly  also  re- 
sulting from  faulty  tissue  metabolism,  or  as 
a  perverted  internal  secretion  from  glands 
not  necessarily  ductless,  either  directly  or 
indirectly  antagonize,  in  whole  or  in  part, 
the  sugar-destroying  substance  in  the  blood, 
thus  giving  rise  to  glycaemia  and  glycosuria, 
and  thus  in  a  certain  group  of  cases  either 
primarily  causing  or  at  least  exaggerating 
the  clinical  phenomena  of  diabetes  mellitus. 
If  further  investigation  should  corroborate 
the  conclusions  here  provisionally  set  forth, 
it  would  be  advisable  hereafter  to  investi- 
gate the  bacteriology  of  the  stomach  and 
the  intestines  in  cases  of  diabetes  mellitus  ; 
and  if  evidences  of  virulent  bacterial,  pro- 
tozoan, or  other  parasitic  growth  are  found, 
these  conditions  should  be  met  by  suitable 
treatment — not  with  the  expectation  of 
entirely  supplanting  dietetic  treatment,  but 
as  an  important  auxiliary  to  the  latter, 
possibly  rendering  its  restrictions  less  sev- 
ere, with  less  resulting  impairment  of 
nutrition. 


Proposed  Changes  in  the  New  York  State 
.Medical   Examinations. 

The  following  recommendations  have 
been  made  to  the  regents  by  the  board  of 
medical  examiners  of  NewYork  State  :  "1. 
That  as  soon  as  practicable  the  subjects  of 
examination  be  rearranged  as  follows  :  (a) 
Pathology  and  diagnosis,  now  grouped  un- 
der one  head,  to  be  divided  into  :  1,  patho- 
logy; 2,  diagnosis,  (b)  Therapeutics,  prac- 
tice, and  materia  medica,  now  grouped  un- 
der one  head,  to  be  divided  into  :  1 ,  practice 
of  medicine;  2,  materia  medica  and  thera- 
peutics, (c)  Anatomy  and  physiology, now 
grouped  as  two  topics,  to  be  united  on  one 
sheet,  the  number  of  questions  in  both  topics 
not  to  exceed  fifteen.  (</)  Chemistry  and 
hygiene,  now  grouped  as  two  topics,  to  be 
united  on  oue  sheet, the  number  of  questions 
not  to  exceed  fifteen.  2.  That  the  State 
medical  schools  be  requested  to  furnish  for 
the  use  of  the  question  committee  thirty 
questions  on  each  branch  taught  by  each 
member  of  their  respective  faculties.  3. 
That  with  his  application  each  candidate 
submit  an  unmounted  photograph  to  insure 
identification." — Medical  Record,  April  J. 
1899. 


460 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


Demonstrating    the  Malarial    Parasite    in 
the  Blood. 

Dr.  C.  E.  Simon  (Md.  Med.  Journal). 
Prepare  blood  films  in  the  usual  way  and  let 
dry  in  the  air ;  then  fix  for  a  tew  minutes  in 
absolute  alcohol.  After  drying,  the  fixed 
blood  films  are  exposed  to  the  vapors  of  io- 
dine for  from  ten  to  fifteen  minutes.  To 
this  end  some  metallic  iodine  is  placed  in  a 
small  glass  dish  provided  with  a  well-fitting 
cover,  and  the  specimens,  blood-side  down 
upon  little  tripods  of  glass  or  a  similar  con- 
trivance, so  as  not  to  come  in  direct  contact 
with  the  iodine.  When  the  specimens  pre- 
sent a  well-marked  yellow  color  they  are 
removed,  carefully  dusted  off  with  a  camel- 
hair  brush  and  mounted  in  a  drop  of  syrup 
of  levulose.  The  color  of  the  red  blood  cor- 
puscles is  now  very  like  that  of  the  fresh 
blood  somewhat  intensified  and  the  malarial 
organisms  appear  as  in  fresh  specimens.  If 
the  finger  has  been  carefully  cleansed  and 
clean  glasses  have  been  used,  no  foreign 
material  will  be  present  to  interfere  with 
the  examination.  Unfortunately  the  color 
of  the  red  corpuscles  fades  after  twelve  to 
twenty-four  hours,  so  that  the  preparations 
cannot  be  preserved.  For  teaching  purpo- 
ses the  method  will  be  found  very  con- 
venient at  times  when  fresh  specimens  of 
malarial  blood  connot  be  readily    procured. 


Observations   on   the   Treatment    of    Hay 
Fever. 

Dr.  Beman  Douglas  (Med.  Record,  April 
ist,  '99,)  read  a  paper  at  the  New  York 
Academy  of  Medicine  on  this  subject.  He 
said  that  the  disorder  seemed  to  have  been 
far  more  severe  last  summer  than  in  previ- 
ous years.  He  had  seen  all  the  well-mark- 
ed symptoms  of  an  attack  of  hay  fever  de- 
velop within  the  space  of  two  minutes.  The 
general  symptoms  were  often  overlooked, 
but  they  were  nevertheless  very  important, 
in  his  opinion,  and  indicated  a  deeper  seat 
for  the  affection  than  simply  the  local  pro- 
cess in  the  nose.  The  characteristics  usual- 
ly began  about  August  20th,  in  this  climate, 
and  reached  their  maximum  in  two  weeks. 
There  were  two  grand  divisions  of  these 
cases,  viz.,  (1)  Those  having  nasal  lesions, 
and  (2)  those  free  from  such  lesions.  There 
was  but  little  difference  in  the  course  and 
duration  of  the  disease  in  these  two  forms, 
but  the  cases  presenting  no  nasal  lesions 
were  decidedly  in  the  minority.  It  was 
difficult  indeed  to  understand  why  some  peo- 
ple suffering  from  nasal  obstruction  were 
not  in  the  least  affected  by  dust  irritation  or 
pollen  of  flowers,  while  others,  with  no  dis- 
coverable   nasal    defects,  could  not  tolerate 


such  irritation  at  all.  It  would  seem  proba- 
ble that  some  cases  of  hay  fever  resulted 
from  the  action  of  outside  irritants  on  nerve 
filaments  rendered  hypersensitive  by  vicari- 
ous elimination.  It  was  not  difficult  to  be- 
lieve that  the  removal  of  obvious  nasal  le- 
sions would  afford  some  relief  in  hay-fever 
patients,  but  it  should  not  be  forgotten  that 
even  then  a  hypersensitive  condition  stil  1 
remained  and  demanded  treatment. 


Malaria  and  Mosquitoes. 

Dr.  Amico  Bignami  illustrates,  according 
to  Treatment,  March  9/99,  how  he  obtain- 
ed experimental  proof  of  the  connection  of 
mosquitoes  with  malaria.  An  individual 
who  had  never  had  malarial  fever,  sleeping 
in  a  healthy  place  where  no  one  had  ever 
previously  taken  fever,  sickened  with  ma- 
laria of  a  grave  type  after  being  bitten  by 
certain  species  of  the  mosquito  brought  in 
the  aduit  state  from  some  distant  locality  of 
highly  malarious  character.  Everything 
points  to  the  conclusion  that  inoculation  is 
the  only  mode  by  which  infection  is  acqui- 
red, since  air  and  water  as  carriers  of  infec- 
tion may  be  excluded,  and  because  argu- 
ments based  on  analogy  all  tend  in  the  same 
direction.  It  appears  that  it  is  only  certain 
species  of  mosquito  which  act  as  carriers  of 
infection,  for  Professor  Grassi,  in  the  study 
which  he  made  during  last  summer  of  the 
distribution  of  mosquitoes  in  malarious  and 
non-malarious  localities,  came  to  the  con- 
clusion that  in  malarious  places,  in  addition 
to  the  species  which  are  found  in  non-mala- 
rious districts,  there  are  others  which  are 
absolutely  unknown  in  these  latter.  In 
non-malarious  districts  the  predominating 
species  is  the  Culcx  pipiens;  in  malarious 
places,  on  the  other  hand,  are  found  the 
Anopheles  claviger  (maculipennis) ,  the  Cu- 
lcx penicillaris ,  and  other  species,  which 
therefore  appear  to  have  an  intimate  rela- 
tion with  malaria.  One  "of  these  species, 
apparently  not  yet  described,  Grassi  found 
at  Maccares,  and  he  named  it  Culex  ma- 
la rict. 


Lung  Gymnastics. 

Direct  gymnastics  for  the  lungs,  to  in- 
crease their  capacity  and  elasticity,  are  al- 
most a  safeguard  against  consumption  if 
taken  in  time. 

Dr.  Otis  advises  people  with  weak  lungs 
to  stand  erect  in  a  well  ventilated  room, 
place  the  hands  on  the  hips  and  take  long, 
deep,  slow  breaths,  varying  the  rythms,and 
at  times  taking  short,  jerky  breaths  for  va- 
riety. The  breath  should  be  drawn  only 
through  the  nose. 

Better  yet,  combine  the  breathing  exerci- 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


461 


ses  with  the  setting  up  drill  or  other  arm 
exercises.  Dr.  Otis  gives  these  exercises, 
to  which  others  might  be  added  : 

i.  Slowly  raise  the  arms  from  the  sides 
until  they  meet  above  the  head,  breathing 
deeply.   Breathe  out  while  slowly  lowering. 

2.  Raise  the  arms  in  front ;  carry  them  as 
far  back  as  possible  ;  then  down.  Breathe 
as  before. 

3.  Slowly  rise  upon  the  toes,  breathing 
deeply. 

4.  Extend  the  arms  in  front  ;  carry  one 
leg  back  as  far  as  possible. 

5.  Lie  on  the  back  ;  raise  the  arms  back- 
ward and  over  the  head,  while  breathing 
deeply. 

People  with  plenty  of  lung  capacity  can 
stand  even  bad  air  without  suffering. 

It  is  well  known  that  women  whose  lung 
capacity  is  interfered  with  by  corsets  are 
much  more  apt  to  faint  in  close,  ill-venti- 
lated rooms  than  men. 


The   Pathology   of   Diphtherial    Paralysis. 

Dr.  Batton  (British  Medical  Journal. 
1898.     No.  1977). 

Although  various  views  have  been  held 
with  regard  to  the  pathology  of  diphtherial 
paralysis,  it  is  at  the  present  time  generally 
recognized  that  the  lesion  most  commonly 
found  is  a  parenchymatous  degeneration  of 
the  myelin  sheath  of  the  nerves,  and  Mar- 
tin has  shown  thai  this  condition  affects 
primarily  the  liner  nerve  branches.  More 
recently  the  work  of  Mouravjeff  would  tend 
to  show  that  the  primary  alteration  occurs 
in  the  cells  of  the  anterior  horn,  and  this 
was  demonstrated  by  Nissl's  method — a 
method  which  Martin  did  not  use.  The 
same  condition  had  been  previously  des- 
cribed by  Crocq,  though  he  describes  the 
primary  condition  as  a  myelitis. 

In  the  experiments  of  Mouravjeff  the  an- 
imals which  had  been  allowed  to  live  for 
the  longest  time  after  infection  showed 
well-marked  changes  in  the  peripheral 
nerves,  although  no  change  could  be  dem- 
strated  in  the  granules  of  the  nerve  cells. 
Some  of  the  cells  may,  however,  have  un- 
dergone atrophy.  In  the  present  series  of 
cases  the  cells,  not  only  of  the  anterior 
horn,  but  also  of  the  posterior  root  ganglia, 
appeared  normal.  It  may,  however,  be  that 
the  cells  in  these  cases  had  had  time  to  re- 
cover. 

With  regard  to  the  affection  of  tin-  pos- 
terior roots,  Meyer,  in  [881,  showed  that 
they  were  degenerated,  and  also  that  this 
defeneration  existed  on  both  sides  of  the 
Spinal  ganglion.  This  has  been  noted  again, 
more  recently  by  Preiz,  Crocq,  and  Mou- 
ruvjeu',  and  among  others  by  Bikeles,  who 
describes    the    occurrence  of    masses  of    fat 


globules  in  the  posterior  root  at  its  entrance 
into  the  spinal  cord ;  this,  however,  is  a 
normal  condition  certainly  in  children,  and 
probably  to  a  lesser  extent  in  adults,  and 
hence  localized  granules  of  fat  in  this  re- 
gion should  not  be  regarded  as  evidence  of 
degeneration. 

The  cranial  nerves  have  been  found  af- 
fected by  Meyers,  Bristowe,  and  others; 
Crocq,  however,  failed  experimentally  to 
find  any  degeneration.  The  nerves  des- 
cribed as  being  affected  are  the  third,  fourth, 
fifth,  sixth,  seventh,  eighth  (Moos),  ninth, 
tenth,  eleventh,  twelfth. 

In  conclusion,  then,  i  is  probable  that 
the  dominant  lesion  in  diphtherial  paralysis 
is  a  parenchymatous  degeneration  of  the 
myelin  sheath  of  the  nerves,  and  that  this 
degeneration  affects  both  motor  and  sensory 
fibres  alike. 


Nephritis   of    Malarial   Origin. 

\V.  S.  Thayer,  (American  Journal  of 
Medical  Science).  It  is  safe  to  assume  that 
any  infection,  the  toxicity  of  which  is  suffi- 
cient to  produce  as  large  a  percentage  of 
serious  acute  nephritides  as  malarial  fever, 
must  play  a  certain  part  in  the  etiologv  of 
chronic  renal  changes.  Such  changes"  are 
due  to  circulating  toxic  substances  produced 
either  directly,  by  the  growth  of  the  infec- 
tious organism,  as  in  diphtheria,  or  set  free 
from  the  bodies  of  the  dead  bacteria,  as  in 
typhoid  fever,  or  resulting  secondarily 
from  the  action  of  such  substances  on  the 
iluids  and  tissues  of  the  body. 

The  suprising  frequency  of  acute  nephri- 
tis in  our  cases  of  malarial  fever  would 
appear  to  be  an  indication  of  the  extreme 
toxicity  of  the  circulating  poisons  present, 
evidence  of  the  existence  of  which  is  shown 
in  the  grave  changes  noted  in  the  spleen, 
liver  and  brain.      Conclusions  : 

1.  Albuminuria  is  a  frequent  occurrence 
in  malarial  fevers. 

2.  It  is  considerably  more  frequent  in 
ajstivo-autumnal  infections  than  in  other 
forms,  as  58.3  per  cent,  is  to  38. 6  per  cent. 

3.  Acute  nephritis  is  a  not  unusual  com- 
plication of  malarial  fever. 

4.  The  frequency  of  acute  nephritis  in 
gestivo-autumnal  fever  is  much  greater  than 
in  the  regularly  intermittent  fevers. 

5.  The  frequency  of  albuminuria  and 
nephritis  in  malarial  fever,  while  some- 
what below  that  observed  in  the  more 
severe  acute  infections,  such  as  typhoid 
fever,  scarlet  fever,  and  diphtheria,  is  yet 
considerable. 

6.  There  is  reason  to  believe  that  malarial 
infection,  especially  in  the  more  tropical 
countries,  may  play  an  appreciable  part  in 
the  etiology  of  chronic  renal  disease. 


462 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


Drug  and  Food  Diseases. 

Dr.  William  Ewart  (British  Med.  Jour- 
nal, December  10,  1898)  : 

"There  is  a  source  of  nervous  ailments 
entirely  special  to  this  age,  and  the  unex- 
pected outcome  of  our  nineteenth  century 
chemistry  and  advertising.  Intemperance 
in  drugs  is  becoming  more  common,  and  it 
may  possibly  outstrip  the  abuse  of  alcohol 
in  its  evil  results.  The  manufacture  of  new 
chemical  products  is  supplying  the  public 
with  endless  carbon  derivatives  of  high  mo- 
lecular power,  and  of  imperfectly  known 
physiological  action.  Fortunately,  many 
advertised  medicines  are  harmless, but  their 
prolonged  use  is  detrimental  if  only  by  de- 
laying the  treatment  required  by  the  origi- 
nal affection.  Others  are  most  dangerous, 
and  their  continued  indulgence  leads  to  con- 
firmed neurosis  or  hopeless  neurasthenia, 
and  it  thus  comes  to  pass  that  as  the  thera- 
peutic activity  of  the  profession  tends  to 
abolish  disease,  that  of  the  public  is  manu- 
facturing it.  While  the  increasing  purity 
of  natural  foods  has  reduced  our  mortality, 
modern  ingenuity  has  been  the  unintended 
means  of  occasionally  supplying  poison  in 
food.  Fortunately,  ptomain  poisoning  is 
an  unusual  accident.  A  much  more  serious 
and  wide  spread  evil  has  been  the  undis- 
criminating  substitution  by  mothers  of  con- 
densed milk  and  manufactured  foods  for  the 
fresh  supply  of  milk.  This  neglect  of  fresh 
milk  and  the  untutored  administration  of 
artificial  foods,  even  of  the  best  kind,  with- 
out due  regard  to  proportion  and  to  suita- 
bility, have  been  disastrous.  To  this  cause 
may  be  attributed  the  fact  that,  in  spite  of 
modern  hygiene,  infantile  mortality  from 
diarrhoea  and  marasmus  has  shown  no  ade- 
quate decrease,  and  sometimes  an  increase 
over  that  noted  before  these  modern  inven- 
tions. 


Massage  of  the  Abdomen. 

Reed  (Medical  News)  recommends  mas- 
sage in  the  following  conditions  : 

Chronic  gastritis  in  all  its  forms,  except- 
ing those  accompanied  by  hyperchlorhydia. 

Anacidity  or  subacidity,  except  when  de- 
pendent upon  acute  gastritis  or   carcinoma. 

Gastroectasia,  not   dependent  on   cancer. 

Atonic  conditions  of  the  stomach  walls, 
whether  progressed  to  the  stage  of  dilata- 
tion or  not. 

Displacements  of  the  various  abdominal 
organs,  including  (a)  gastroptosis ;  (b) 
nephroptosis,  except  in  cases  where  the 
displaced  kidney  has  become  excessively 
tender  on  pressure  ;    (c)   enteroptosis. 

Chronic  intestinal  catarrh,  not  complica- 
ted with  deep  ulceration. 


In 


Dilatation  of  the  intestines. 

Constipation  from   unknown  causes 
many  such  cases  massage  succeeds. 

In  a  group  of  symptoms  which  comprise 
especially  tenderness  over  a  region  three  or 
four  inches  in  diameter,  including  the  um- 
bilicus as  its  center,  and  a  marked  pulsation 
of  the  abdominal  aorta  in  the  entire  epigas- 
tric region. 

These  symptoms  have  been  assumed  to 
denote  congestion  of  the  solar  plexus.  They 
are  often  met  with  in  practice,  and  may  be 
the  result  of  auto-infection  from  the  gastro- 
intestinal tract.  They  are  usually  benefited 
by  gentle  kneading  of  the  abdomen  in  con- 
nection with  careful  attention  to  diet.  The 
following  are  the  principal  contra-indica- 
tions  for  massage  of  the  abdomen  :  Ulcera- 
tion in  any  part  of  the  stomach  or  intes- 
tines; cancer  of  any  of  the  abdominal  or- 
gans ;  acute  inflammation  in  any  part  of 
the  gastro-intestinal  tract ;  hyperchlorhy- 
dria  ;  prolapsed  kidneys  which  are  acutely 
sensitive  to  palpation  ;  aneurism  of  any  of 
the  abdominal  or  thoracic  arteries;  during 
the  menstrual  period,  when  the  flow  is  ex- 
cessive, or  when  there  is  a  tendency  to 
menorrhagia.  In  fatty  degeneration  or 
marked  dilatation  of  the  heart  and  advanced 
phthisis,  especially  with  a  tendency  to  he- 
moptysis, abdominal  massage  should  be 
practiced — if  at  all — with  much  care  and 
gentleness. 


Confederate  Veterans'  Reunion. 

Charleston,  S.  C,  May  10-13.  J§99- 

On  account  of  the  Confederate  Veterans' 
Reunion,  the  Seaboard  Air  Line  will  sell 
tickets  to  Charleston  and  return  at  very  low 
rates,  based  on  one  cent  per  mile,  traveled. 
Tickets  on  sale  May  8th,  9th  and  10th,  good 
until  May  3ist. 

For  information  in  regard  to  rates,  sched- 
ules, &c,  apply  to  Ticket  Agents  or  address 
L.  S.  Allen,  Gen'l  Pass'r  Agent, 
Portsmouth,  Va. 


In    Cholera    Infantum. 

The  Imperial  Granum  Food  has  proved 
of  priceless  value  being  often  the  only 
nutriment  found  suitable  and  capable  of 
being  retained.  Thousands  of  lives  have 
apparently  been  saved  by  its  use,  and  it  has 
seemed  to  possess  not  only  nutritive  but 
medicinal  value,  so  immediately  soothing 
and  quieting  was  its  effect.  This  shows 
the  vital  importance  of  such  a  nutriment, 
one  that  is  pure,  natural  and  unsweetened 
and  that  can  be  easily  and  quickly  assimi- 
lated even  when  the  digestive  powers  are 
impaired  by  disease. 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


463 


Syphilis  of  the  Brain  and  Spinal  Cord. 

This  was  the  subject  of  a  paper  read  at  a 
recent  meeting  of  New  York  Academy  of 
Medicine  by  Dr.  Sachs. 

Up  to  a  comparatively  short  time  since, 
the  diagnosis  was  made  by  a  process  of  ex- 
clusion, and  it  was  often  incorrect.  As  to 
the  frequency  of  syphilis  of  the  central 
nervous  system,  it  had  been  asserted  that 
this  occurred  in  from  15  to  25  out  of  every 
thousand  cases  of  syphilitic  disease,  exclu- 
sive of  those  in  which  tubes  or  paresis  re- 
sulted. The  statement  was  often  seen  that 
syphilitic  nervous  disease  was  on  the  in- 
crease, but  perhaps  this  was  due  to  the  fact, 
on  which  neurologists  were  apt  to  pride 
themselves,  that  our  knowledge  was  greater 
than  formerly.  Some  years  ago  he  had 
been  taken  to  task  for  the  statement 
that  the  nervous  system  was  more  apt 
to  be  affected  in  cases  characterized  by 
mild  initial  disease  than  in  those  in 
which  t he  latter  was  more  severe.  Of  late, 
however,  many  observers  had  agreed  as  to 
the  correctness  of  this  view.  It  was  true 
that  many  of  the  cases  were  improperly 
treated  in  the  early  stages,  but  still  many 
others  were  met  with  which  had  received 
appropriate  treatment.  It  was  now  well 
known  that  serious  lesions  of  the  nervous 
system  might  occur  simultaneously  with  the 
rash  of  secondary  syphilis. 

The  pathological  characters  of  syphilitic 
disease  of  the  nervous  system  were  not  un- 
like those  met  with  in  other  parts  of  the 
body.  The  formation  of  gummata  was  the 
most  common  manifestation,  ami  at  an  ear- 
ly period  these  growths  began  to  undergo  a 
retrograde  process.  A  solitary  gumma  was 
rarely  observed.  Not  only  were  the  capil- 
lary blood-vessels  concerned  in  syphilitic 
lesions,  but  the  larger  vessels  were  also  aff- 
ected. Occlusion  of  the  vessels  was  liable 
to  result,  but  this  was  not  always  perma- 
nent. It  was  to  be  regretted,  for  diagnos- 
tic purposes,  that  the  bacillus  of  syphilis 
had  not  as  yet  been  differentiated  with  suffi- 
cient  clearness.  Among  the  characteristics 
of  syphilitic  disease  was  the  multiplicity  of 
symptoms,  with  alternate  exacerbations  and 

_  retrogressions.  The  fact  was  also  to  be  no- 
ted that  there  was  no  other  disease  which  so 

I  frequently  gave  rise   to   paresis   rather  than 

jj  paralysis.  While  there  was  a  vast  variety 
of  symptoms,  none  of  them  was    pathogno- 

I  monic.  The  question  of  localization  of  the 
lesion  had  been  much  overdone  in  compari- 

I  son  with  the  more  important  matter  of  its 
character.      The   multiplicity  of  lesion   met 

"  witli  need  not  imply  that  all  the  lesions  co- 
existed. An  important  point  in  the  diag- 
nosis of  syphilis  of  the  nervous  system  was 


the  fact  that  in  this  disease  symptoms  oc- 
curred which  were  not  apt  to  be  met  with 
in  individuals  in  adolescence  or  in  mid- 
dle life. 

The  most  valuable  guide  at  our  command, 
however,  is  the  condition  of  the  pupils. 
The  pupils  of  the  subjects  of  syphilis  pre- 
sented at  least  four  characteristic  peculiari- 
ties.    These  are  : 

1.  Irregularity  in  contraction. 

2.  Unequal  responsiveness,  one  respond- 
ing readily  to  light  and  the  other  not. 

3.  Immobility;  presenting  a  marked  con- 
trast to  the  Argyll-Robertson  pupil  com- 
monly met  with  in  ordinary  tabes. 

4.  Marked  departure  from  the  circular 
form,  in  cases  where  there  had  been  no  pre- 
vious iritis. 

It  had  been  often  said  that  the  history  of 
syphilis  was  almost  always  "written  on  the 
skin,"  but  if  we  suspected  a  person  of  syphi- 
lis on  whose  skin  such  history  was  not  too 
clearly  written,  we  would  receive  most  val- 
uable assistance  from  a  careful  study  of  the 
pupils.  At  the  present  day  we  should  be 
able  to  make  the  diagnosis  of  syphilitic  dis- 
ease without  having  to  resort  to  a  course  of 
specific  treatment.  Chronic  headache,  par- 
ticularly vertigo,  is  in  many  cases  the  only 
sign  of  cerebral  syphilis.  The  occurrence 
of  this  should  therefore  always  excite  suspi- 
cion. He  mentioned  the  case  of  a  physi- 
cian who  for  a  considerable  time  had  suffer- 
ed from  repeated  attacks  of  vertigo,  without 
appreciable  cause,  and  who  had  traveled 
extensively  and  consulted  many  eminent 
members  of  the  profession  without  securing 
relief.  The  probability  that  he  was  suffer- 
ing from  syphilitic  brain  trouble  occurred 
to  him,  and  the  affection  entirely  disappear- 
ed under  syphilitic  treatment.  Apoplexy 
in  syphilitics,  if  the  symptoms  were  those 
characteristic  of  thrombosis,  was  to  be  attri- 
buted to  endarteritis.  In  cases  of  double 
optic  neuritis  it  is  well  to  bear  in  mind  the 
possibility  of  the  existence  of  syphilis  be- 
fore giving  a  positively  fatal  prognosis. 

He  referred  to  some  of  the  anatomical 
peculiarities  of  the  cord,  especially  as  re- 
gards its  vascular  supply,  and  said  that  in 
disease  of  the  posterioV  columns  it  was  very 
important  to  differentiate  between  true  tabes 
and  syphilitic  pseudo-tabes.  Here  the  con- 
dition of  the  pupils  would  offer  valuable  as- 
sistance, for  if  the  latter  affection  was  pre- 
sent we  would  have  immobility  of  the  pu- 
pils in  contradistinction  to  the  Argyll-Rob- 
ertson pupil.  He  was  inclined  to  the  opin- 
ion that  specific  endarteritis  has  much  to  do 
with  the  early  stages  of  posterior  spinal 
sclerosis.  In  all  lesions  of  the  nervous  sys- 
tem disease  of  the  blood-vessels  was  the  first 
stage  of  development.   Whether  the  disease 


464 


THE  CHARLOTTE  MEDICAL  JOURNAL 


affected  the  cervical,  dorsal  or  lumbar  por- 
tion of  the  cord,  the  eye  symptoms  would 
be  the  same. 


The  Treatment  of  Harelip  and  Cleft  Palate. 

This  much-discussed  topic  continues  to  be 
the  subject  of  a  good  deal  of  doubt  in  many 
minds  as  to  when  and  how  to  operate  for 
the  various  conditions  that  present  them- 
selves. Many  of  the  procedures  necessary 
are  entirely  within  the  range  of  the  general 
practitioner,  but  there  always  remains  a 
feeling  of  hesitation  as  to  the  methods  most 
advisable  to  employ,  and  the  most  suitable 
time  for  operation.  Towards  solving  such 
doubts  an  authoritative  review  of  the  recent 
literature  on  the  subject,  and  conclusive 
statements  as  to  what  seems  best  in  the  the- 
rapeutic suggestions  that  have  been  recent- 
ly offered  by  various  writers  will  be  of  the 
greatest  value  to  the  busy  practitioner. 

Such  a  review  of  the  treatment  of  Harelip 
and  Cleft  Palate  is  given  by  Dr.  J.  Chalm- 
ers DeCosta,  in  "Progressive  Medicine,"* 
the  new  Quarterly  Review  of  Advances  in 
Medicine,  of  which  Professor  Hare  is  the 
editor.  From  it  we  gather  that  the  tendency 
is  more  and  more  towards  early  operation. 
The  third  or  fourth  month  used  to  be  con- 
sidered the  earliest  suitable  time  to  operate. 
Murray  now  counsels  operation  in  the 
fourth  week  ;  Mumford  and  Heath  think  it 
should  be  undertaken  not  later  than  from 
the  sixth  to  the  eighth  week.  Where  cleft 
palate  exists  it  is  not  operated  upon  so  ear- 
ly. The  harelip  is  operated  upon  alone, and 
the  persistent  pressure  made  by  the  closed 
lip  helps  to  lesson  the  gap  in  the  growing 
bone.  The  operation  on  the  cleft  palate  is 
put  off  for  awhile,  but  this,  too,  not  nearly 
so  long  as  it  used  to  be.  If  the  closure  of 
the  defect  is  delayed  until  the  child  has 
learned  to  talk,  the  peculiarities  of  speech, 
especially  its  offensive  nasal  character,  will 
never  be  corrected.  The  authorities  are 
agreed,  then,  that  a  cleft  in  the  soft  palate 
should  be  closed  about  the  sixth  month,  and 
in  the  hard  palate  during  the  second  year. 

The  practical  suggestions  collected  from 
the  recent  literature  of  the  subject  by  Dr. 
DeCosta  are  very  valuable  to  the  ordinary 
practitioner.  Space  will  permit  us  to  give 
but  a  few  of  them.  The  use  of  the  knife  in 
operation  rather  than  the  scissors,  because 
the  latter  crushes  tissue  more,  leaving  its 
vitality  impaired,  especially  at  the  edges 
where  this  is  so  important  for  subsequent 


union  ;  the  avoidance  of  pins  or  heavy  su- 
tures in  securing  proper  apposition  after  the 
operation  is  advised,  though  these  are  faults 
of  technique  in  this  matter  that  we  fear 
have  been  so  ground  into  the  present  gene- 
ration by  text-book  and  teacher  that  fail- 
ures of  union  due  to  these  crude  early  meth- 
ods will  still  continue  to  be  frequent.  The 
suggestion  by  Mumford  as  to  anchoring  the 
nares  with  shotted  wire  will  remove  a  very 
common  cause  of  failure  due  to  the  child's 
inevitable  tendency  to  "turn  up  its  nose" 
at  and  after  the  proceedings. 

In  double  harelip  it  is  advised  to  remove 
the  intermaxilliary  bone  by  sub-periosteal 
operation  a  week  before  the  operation  on 
the  lip.  If  left  it  is  liable  to  undergo  necro- 
sis. Its  removal  leads  to  some  flattening, 
but  this  will  not  be  great  if  the  bone  be  re- 
moved by  sub-periosteal  operation,  and  if 
but  one  side  of  the  harelip  be  operated  upon 
at  a  time.  Among  the  directions  for  the 
operation  for  cleft  of  the  hard  palate, 
we  note  these  pre-operative  measures  of 
precaution  from  Owen,  which  are  some- 
times forgotten,  but  of  which  the  practical 
value  it  is  easy  to  see  :  never  to  operate  un- 
less the  child  is  in  the  best  possible  health  ; 
remove  carious  teeth,  adenoids  and  enlarged 
tonsils  before  operating,  and  operate  when- 
ever possible  in  fine  weather,  so  that  the 
patient  can  get  out  of  doors  soon  afterwards. 
The  neglect  to  remove  such  ready  sources 
of  infection  as  carious  teeth  and  those  har- 
borers  of  microbes,  the  irresistive  tissues  of 
adenoids  and  enlarged  tonsils,  is  very  proba- 
bly the  source  of  a  good  many  of  the  fail- 
ures in  uranoplastic  osteo  resection. 


* -'Progressive  Medicine, "  a  (Quarterly  Digest 
(if  New  Methods.  Discoveries,  and  Improve- 
ments in  the  Medical  and  Surgical  Sciences. 
Kdited  by  H.  A.  Hare,  M.  D.  Vol.  1,  No.  1, 
Mareb.1899.  Lea  Brothers  &  Co.,  Philadelphia. 


A  Hypnotic  for  Confirmed  Insomnia. 

The  following  taken  from  the  Interna- 
tional Medical  Annual  and  Practitioner's 
Index  for  1898,  with  reference  to  trional, 
will  prove  of  interest  :  Dr.  J.  Arthur 
Browne  speaks  in  the  highest  terms  of  the 
value  of  this  drug  as  a  hypnotic.  He  says: 
"I  have  given  it  to  produce  sleep  in  cases 
of  pneumonia,  bronchitis,  alcoholism  with 
delirium,  insomnia  from  mental  worry,  and 
other  forms  of  nervous  insomnia,  and  I  have 
invariably  found  it  satisfactory.  It  is  rapid 
in  its. action,  and  it  has  these  advantages 
over  sulfonal  or  the  bromides,  that  it  is 
certain  and  does  not  produce  the  disagreea- 
ble sequalre  of  sleepiness,  lassitude,  and  de- 
pression on  the  day  following  its  exhibition. 
Nor  have  I  observed  any  derangement  of 
the  digestive  system  in  connection  with  its 
administration.  An  initial  dose,  20  or  24 
grains,  may  usually  be  reduced  to  1^  grains 
or  less,  and  in  this  way  trional  becomes  in- 
valuable for  breaking  a  pernicious  habit  of 


THE  CHARLOTTE  MEDICAL  JOURNAL 


465 


sleeplessness,  where  a  few  good  refreshing 
nights  may  restore  the  normal  habit  of  sleep. 
Even  in  cases  of  confirmed  insomnia, which 
have  been  treated  unsuccessfully  by  chloral, 
paradehyde,  and  the  whole  gamut  of  hyp- 
notics, each  drug  having  in  turn  to  be  in- 
creased in  dose  until  it  finally  loses  all  pow- 
er or  becomes  dangerous,  trional  in  my 
hands  has  afforded  marked  relief  without 
apparently  any  ill-effect,  and  has  given 
tranquil  refreshing  sleep  without  any  in- 
crease of  the  initial  dose.'" 

Ruhemann  has  employed  trional  without 
inconvenience  in  all  doses, to  the  extent  that 
as  much  as  nearly  3,500  grains  have  been 
given  during  a  period  of  six  months.  He 
has  also  used  it  in  the  treatment  of  children 
with  good  effect.  The  doses  to  be  given  to 
children  are  as  follows  :  fo 
month  to  one  year,  3  to  5  grains;  one  to 
two  years,  6  to  12  grains  :  two  to  six  years, 
12  to  20  grains;  six  to  ten  years,  20  to  25 
grains.  He  uses  it  with  advantage  in  the 
treatment  of  chorea  and  conditions  associa- 
ted with  cerebral  excitement  in  childhood. 
In  adults  the  dose  as  a  maximum  one  is  30 
grains.  .Should  the  patient  be  suffering 
from  dyspepsia  he  advises  the  administra- 
tion of  trional  by  the  rectum  in  milk  in  the 
dose  of  20  grains.  As  a  rule  its  iniluence 
under  these  circumstances  is  prompt,  sleep 
coming  on  in  from  fifteen  to  thirty  minutes 
and  lasting  from  six  to  nine  hours.  Trional 
has  no  cumulative  influence,  and  cardiac 
affections  do  not  contra-indicate  its  admin- 
istration. 


Aseptic   Midwifery. 

Dr.  Jardine  read  a  paper  on  this  subject 
at  the  Edinburgh  meeting  of  the  British 
Medical  Association.  Me  points  out,  says 
the  "Hospital,"  that  parturition  may  be 
said  to  be  a  physiological  act,  but  among 
highly  civilized  women  it  is  dangerously 
near  a  pathological  one,  and  very  little  may 
turn  the  scale.  In  the  vast  majority  of  cases 
at  the  onset  of  labour  the  genital  tract  is 
perfectly  aseptic  ;  by  this  we  do  not  mean 
that  it  is  free  from  organisms;  on  the  con- 
trary, it  is  swarming  with  them,  at  least  the 
vagina  and  lower  part  of  the  cervical  canal, 
but  these  organisms  are  not  only  non-path- 
ogenic but  they  are  actually  protective,  pre- 
venting the  pathogenic  ones  gaining  a  foot- 
hold by  rendering  the  vaginal  secretion 
acid.  The  vagina  has  within  it  a  self- 
cleansing  power.  The  cervical  canal  has  a 
plug  of  mucus — the  operculum  —  which 
shuts  off  as  it  were  the  uterine  contents  from 
I  he  vagina.  The  different  layers  of  this 
plug  have  been  examined  bacteriologically, 
and  tin;  upper    or    uterine    layer    has    been 


found  to  be  perfectly  free  from  organisms. 
We  therefore  start  with  an  aseptic  uterus 
and  genital  tract;  the  discharges  which 
come  from  within,  the  liquor  amnii  and 
blood  will  not  in  any  way  interfere  with 
that  condition,  but  tend  rather  to  assist  it 
by  flushing  out  to  a  certain  extent  anything 
which  may  get  into  the  lower  part  of  the 
genital  tract.  Our  whole  aim  is  to  conduct 
the  labour  so  that  at  the  end  the  tract  will 
be  as  aseptic  as  when  we  began.  The 
treatment  during  the  puerperium  must  also 
aim  at  the  same  thing.  He  points  out  that 
the  genital  tract  may  be  infected  first  and 
most  frequently  from  the  examining  finger  : 
secondly,  from  the  use  of  septic  instrument ; 
thirdly,  from.aseptic  fingers  or  instruments 
carrying  in  infection  from  the  external  parts 
fants  of  one  I  of  the  patient  or  the  surrounding  clothing. 
The  attendant's  hands  must  be  surgically 
clean,  the  external  genitals  must  be  thor- 
oughly cleansed,  and  vaginal  examinations 
must  be  as  few  as  possible.  As  to  douch- 
ing in  an  ordinary  case,  it  is  unnecessary, 
and  in  fact  as  likely  to  do  harm  as  good  by 
removing  the  normal  secretion  from  the  va- 
gina. He  considers  it  necessary  under  the 
following  conditions  :  (1)  if  there  is  any 
purulent  or  putrid  discharge  from  the  vagina 
such  as  from  gonorrhoea  or  cancer  of  the 
cervix;  (2)  if  any  operation  is  to  be  per- 
formed when  the  hand  or  any  instruments 
have  to  be  introduced  into  the  uterus.  Post 
partum  douching  is  not  necessary  in  ordi- 
nary cases,  and  should  not  be  done  as  a  rou- 
tine. Under  the  following  conditions  one 
should  douche  immediately  after  labor  :  ( 1 ) 
in  post  partum  hemorrhage,  then  it  should 
be  given  very  hot ;  (2 )if  there  has  been  any 
purulent  discharge  previous  to  labor;  (3)  if 
the  foetus  has  been  putrid;  (4)  if  the  hands 
or  instruments  have  been  introduced  into 
the  uterus;  (5)  if  the  parts  have  been  lace- 
rated to  any  extent  and  if  the  labour  has 
been  a  very  prolonged  one.  During  the 
puerperium  douching  is  quite  unnecessary 
unless  the  lochia  become  putrid  and  the 
temperature  rises.  The  second  stage  of  la- 
bour must  not  be  allowed  to  drag  on  indefi- 
nitely. Dr.  Jardine  thinks  two  hours  for 
the  second  stage  in  a  multipara  and  three 
hours  for  a  primipara  is  quite  long  enough  ; 
if  no  advance  is  then  being  made  it  is  time 
to  interfere.  The  third  stage  must  be  con- 
ducted very  carefully  to  make  sure  that 
nothing  is  left  behind  in  the  uterus.  As 
soon  as  the  third  stage  is  complete  and  the 
uterus  remains  firmly  contracted  all  soiled 
things  must  be  removed  from  the  bed  and 
the  patient  thoroughly  washed  with  an  anti- 
septic. During  the  puerperium  no  soiled 
things  should  be  allowed  to  remain  under 
the   patient    or   in    the    room  ;   the   napkins 


THE  CHARLOTTE   MEDICAL  JOURNAL. 


must  be  changed  when  soiled,  and  the  soil- 
ed ones  burnt.  The  external  genitals  wash- 
ed frequently  with  a  warm  antiseptic.  If 
a  douch  should  become  necessary  perchlo- 
ride  of  mercury  1-2,000,  followed  by  stiril- 
ized  water  is  the  best. 


Premature  Baldness. 

Someone  said,  not  long  ago,  that  the 
ideal  symbol  of  faith  was  not  the  tradi- 
tional maiden  clinging  to  the  Rock  of  Ages, 
but  the  bald-headed  men  confidently  con- 
sulting the  bald-headed  specialist  and  faith- 
fully looking  for  relief  for  his  bald-headness. 
It  is  a  very  suggestive  symbol  of  human 
limitations,  but  when  hair  follicles  are  gone 
it  would  take  a  special  creative  act  to  re- 
place them  and  the  hirsute  appendage  they 
furnish.  The  treatment  of  premature  bald- 
ness, however,  is  not  so  hopeless  if  it  is 
taken  in  time, and  skin  specialists  are  agreed 
that  much  can  be  done  for  the  condition  if 
properly  treated  by  prophylaxis,  and  early 
attention.  In  these  preliminary  stages, and 
before  the  real  beginning  of  the  alopecia, 
properly  so  called,  the  cases  come  into  the 
hands  of  the  general  practitioner.  Too 
often  he  is  prone  to  make  little  of  them,  or 
to  consider  that  they  are  inevitably  proges- 
sive  anyhow,  and  so  a  deformity  is  allowed 
to  supervene  that  is  unslightly,  and  a  cause 
of  a  great  deal  of  annoyance  to  the  patients. 
Prophylaxis  is  especially  important.  Dr. 
Jackson,  in  his  Manual  of  Skin  Dieseases* 
insists  on  two  things :  the  influence  of 
heredity  in  these  cases,  and  the  aetiological 
importance  of  dandruff.  Farthers  and  sons 
for  generations  may  grow  bald  early,  or  the 
inherited  peculiarity  may  have  to  be  traced 
to  the  grand-parents  or  some  collateral  line. 
Not  all  the  children  in  one  family  in  which 
baldness  is  hereditary  are  bald,  but  it  will 
manifest  itself  in  two  or  three  of  the  child- 
ren. The  necessity  for  prophylaxis  in  these 
cases  in  evident.  Hygiene  of  the  Scalp 
must  begin  at  the  very  beginning  of  life 
and  be  continued  persistently.  Its  details, 
as  given  by  Dr.  Jackson,  are  irksome,  but 
most  mothers  whose  sons  are  threatened 
with  their  father's  early  baldness,  will  be 
perfectly  willing  to  take  the  additional 
trouble,  and  as  far  as  the  sons  themselves, 
as  soon  as  they  come  to  the  years  of  indis- 
cretion (or  vanity), which  is  generally  con- 
sidered to  be  about  the  age  of  fifteen,  they 
can  usually  be  depended  on  to  take  for 
themselves  all  necessary  precautions  to  stave 
off  the  unwelcome  parental  inheritance. 
As  to  dandruff,  it  constitutes,  according 


*The  Ready-Reference  Hand-book  of  Skin 
Diseasas,  by  Geo.  Thomas  Jackson,  M.  D. 
Third  edition,  just  issued.— Lea  Brothers  &  Co. 


to  Dr.  Jackson,  the  cause  of  70%  of  the  pre- 
mature baldness  that  occurs.  Not  that 
everyone  that  has  dandruff  will  become 
bald;  experience  is  against  that,  but  it  is 
very  often  true  that  an  error  in  the  nutri- 
tion of  the  sebaceous  glands  causes  symp- 
athetic trophic  disturbances  in  the  hair 
follicles,  and  hair  production  ceases.  In 
this  class  of  cases  early  treatment  is  of  the 
utmost  importance.  Lassar's  method  re- 
quires the  taking  of  a  good  deal  of  trouble 
on  the  part  of  the  patient, but  it  is  deservedly 
popular  because  of  its  frequent  success.  In 
general,  however,  the  cure  of  the  condition 
causing  the  dandruff,  which  is  now  con- 
sidered to  be,  in  all  cases,  a  form  of  eczema, 
seborrhoicum  will  stop  the  loss  of  hair. 
Persistence  of  treatment  for  months  is 
necessary,  but  will  nearly  always  be  crown- 
ed with  success  if  the  condition  was  not  too 
far  advanced  when  treatment  was  begun. 
When  there  is  absolute  baldness,  it  is  ex- 
tremely doubtful  if  anything  can  make  the 
hair  grow. 

The  Treatment  of  Chronic  Bronchitis. 

There  is  no  more  common  affection  en- 
countered by  the  general  practitioner,  than 
chronic  bronchitis.  The  affection  is  met 
in  varying  degrees  of  advancement,  and 
the  prognosis  in  some  instances  is  as  grave 
almost  as  phthisis. 

Chronic  bronchitis,  we  may  observe,  is 
necessarily  a  resultant  affection,  and  the 
case  which  we  are  called  upon  to  treat  may 
be  a  mild  bronchial  inflammation  which 
has  existed  only  a  few  months  and  which 
carries  in  its  train  but  little  annoyance  to 
the  patient,  or  it  will  present  histories,  that 
will  carry  us  back  in  our  search  for  the 
cause  to  exposure  in  an  attack  of  the  mea- 
sles or  other  eruptive  disease.  Other  cases 
present  themselves  where  the  patient  has 
taken  no  systematic  treatment,  and  has 
dragged  on  for  years  with  the  disease  and 
is  now  in  a  condition  almost  as  serious  as  a 
patient  with  phthisis.  In  truth,  all  physi- 
cians will  readily  agree  that  in  many  of 
these  patients  the  results  of  the  disease  are 
the  same  whether  we  are  able  f.o  find  the 
Koch's  Bacillus  in  the  sputum  or  not.  The 
treatment  of  chronic  bronchitis  is  best  con- 
sidered under  three  heads.  First,  hygienic 
treatment ;  second,  treatment  of  promi- 
nent symptoms ;  third,  the  administration 
of  agents  which  exert   a  curative  influence. 

In  carrying  out  the  first  indication,  it  will 
be  necessary  to  have  our  patient  dress  in 
such  a  manner  as  to  thoroughly  protect 
himself  against  the  viscissitudes  of  the 
weather.  The  feet  should  be  kept  warm 
and  dry.  Warm  clothing,  and  especially 
clothing  which  protects  the  chest  should  be 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


467 


worn.  I  make  it  a  rule  to  have  my  patients 
wear  a  sleeveless  chamois  jacket  next  to  the 
skin,  or  over  the  undershirt  on  all  patients 
whose  occupation  entail  exposure.  The 
paper  vests  sold  in  the  drug  stores  are  ex- 
cellent for  ladies  and  those  who  go  out  oc- 
casionally. Attention  also  to  diet  is  most 
important.  Such  foods  as  are  known  to 
tax  the  digestive  organs  and  foods  that  do 
not  adequately  nourish  the  patient  are  to 
be  avoided.  In  a  word,  much  can  be  done 
to  improve  the  condition  of  the  patient,  if 
attention  be  paid  to  these  details. 

The   treatment   of    prominent  symptoms 
will  next  claim  our   attention.      Of    course 
these  patients  come  to  us  for  relief  of  cough, 
j  That  symptom  is  the  most  prominent  of  all 
|  and    will    therefore    demand   special   atten- 
;  tion.     The    administration    of    cough  mix- 
j  tures  will  do  little  to  affect  a  cure  in  these 
|  cases,  and  the  best  measures  are  those  winch 
mitigate  the  severity  of  the  cough.      Nearly 
all  cough  mixtures  contain  opium  in  vary- 
'  ing  proportion,  and  upon  this  agent  the  ef- 
ficacy of  many  cough    remedies   are  depen- 
i  dent.     I  employ    opium    for    the    relief   of 
cough  in    such    cases  as    are  attended  with 
very  irritable  cough.      Some    patients    will 
remain  awake  half  of  the  night  coughing  if 
they  do    not  receive    something  to    soothe 
[them.      In  these  Cases  it  is  well  to  give  co- 
jdeine,  in  doses    of    half    grain  every  hour, 
i  until  relieved.      This  remedy   is  superior  to 
(other  opiates  since  it  does  not  produce  con- 
stipation and    interference    with  the  secre- 
tions, yet  I  never  give  it  for  a  long  period, 
never    longer    than    a    few  days.      In  fact, 
such  agents  become   useless,   in  most  cases, 
.if  we  give  well  directed  remedies  to  exert  a 
curative  influence.     These   agents    we    di- 
rect the  patient  to  use  with  caution  and  only 
'when  the  cough  is  aggravating,  or  when  it 
ikeeps  him    awake   and   in   that   way   cause 
him  loss  of  strength. 

!  Night  sweats  and  dyspepsia  are  also  com- 
plications, or  rather  prominent  symptoms 
'of  this  affection,  which  demand  attention." 
Belladonna,  (the  fluid  extract)  given  at  bed 
time  will  relieve  the  night  sweats,  until  by 
iproper  constitutional  treatment  we  can  so 
reconstruct  the  patient  he  will  not  have  the 
symptoms. 

Dyspepsia  is  in  this  and  all  other  affec- 
tions attended  with  lowered  vital  resistance, 
a  symptom  which  may  be  exceedingly  trou- 
blesome. The  digestive  ferments  will  of- 
ten prove  efficacious  in  bringing  a  cessation 
bf  this  symptom  until  the  patient  has  re- 
gained his  strength.  Other  symptoms  may 
;be  met  and  will  have  to  be  met  on  rational 
grounds.  Hut  what  can  be  done  in  the  way 
[of  exerting  a  curative  influence  on  the  dis- 
ease process? 


Cod  Liver  Oil  formerly  was  the  chief  re- 
liance of  the  profession  for  the  relief  of 
this  affection.  Yet,  all  along,  many  of  the 
ablest  and  most  practical  men  in  the  medi- 
cal profession  refused  to  employ  this  agent 
on  account  of  its  indigestibility,  its  dis- 
gusting taste  and  failure  to  get  good  results 
from  it.  These  and  other  reasons  stand 
against  Cod  Liver  Oil,  while  we  have  an- 
other agent  that  has  none  of  these  draw- 
backs and  is  at  the  same  time  pleasant  to 
the  palate,  is  a  reconstructive,  exerts  an  an- 
tiseptic and  sedative  action  on  the  inflamed 
tubes,  and  is  a  tissue  builder  of  a  degree 
not  surpassed  by  any  agent  at  our  com- 
mand. 

The  remedy  I  refer  to  is  Terraline.  It 
is  a  preparation  of  petroleum,  very  palata- 
ble and  I  have  employed  it  for  years  with 
happy  results.  This  remedy  is  given  to  an 
adult  in  doses  of  one  to  two  teaspoonfuls 
after  each  meal.  I  usually  mix  this  with  a 
wine  glass  or  half  a  wine  glass  of  port  or 
sherry  wine.  I  also  have  patients  to  take 
a  dose  the  last  thing  on  retiring  to  bed. 
This  makes  four  doses  daily,  which  soon 
causes  the  cough  to  become  looser,  less 
abundant  expectorations,  and  the  patient 
soon  ceases  to  have  irritation  of  the  tubes, 
with  protracted  attack  of  coughing. 

In  some  cases,  we  will  find  that  other 
disease  influences  may  be  present,  as  syph- 
ilis, struma,  anaemia  and  other  factors  of  a 
like  nature.  Manifestly,  it  is  important 
for  the  physician  to  take  these  factors  into 
account  and  treat   his   patient  accordingly. 

In  a  word  the  physician  must  never  fail 
to  weigh  carefully  all  the  factors  in  the 
case  under  his  treatment  and  give  his  pa 
tient  those  remedies  which  are  rationally 
indicated. 

Below  I  give  in  a  brief  manner,  the  his- 
tories of  several  patients  who  have  been 
treated  on  these  lines. 

Miss  A.  Y.  W.,  age  20,  consulted  me  for 
a  cough,  which  had  been  present  for  about 
eighteen  months.  She  had  lost  flesh  very 
considerably,  was  pale,  weak  and  low  spir- 
ited. She  very  frequently  stayed  awake 
half  the  night  coughing  and  every  morning 
had  a  coughing  spell  that  racked  her  very 
much.  She  had  a  cough,  too,  that  was 
characterized  by  "hacking"  and  the  bring- 
ing up  of  tenacious  mucous.  Very  often 
she  had  night  sweats  but  these  were  not 
constant.  Her  appetite  was  indifferent  and 
capricious. 

She  was  put  on  Terraline  in  doses  of  two 
teaspoonfuls  in  sherry  wine  after  meals  and 
on  going  to  bed.  She  was  given  a  few 
powders  of  codeine,  but  was  told  not  to  use 
one  unless  her  cough  was  particularly  trou- 
blesome. 


468 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


After  using  these  remedies  for  ten  days 
she  felt  improved  and  after  six  weeks  her 
cough  had  been  so  mitigated  and  her  gen- 
eral condition  so  greatly  improved  that  she 
might  leave  off  the  remedy.  But  I  had  her 
to  take  it  two  weeks  longer.  She  is  now 
entirely  well  and  has  not  taken  any  medi- 
cine for  several  months. 

S.  G.,  age  13,  was  brought  to  me  for  a 
cough  that  had  been  present  for  two  years. 
She  had  two  years  ago  suffered  with  mea- 
sles and  every  fall  and  winter  she  suffered 
with  a  cough  of  a  most  irritating  and  dis- 
tressing character.  She  was  put  on  Ter- 
raline  in  doses  of  a  teaspoonful  four  times 
daily.  The  girl's  mother  was  cautioned  to 
see  that  her  hygienic  conditions  were  look- 
ed after,  and  the  girl  had  all  the  attention 
possible.  On  this  treatment  her  cough  be- 
came gradually  less,  she  gained  in  flesh  and 
in  a  period  of  six  weeks,  was  pronounced 
cured.  The  girl  wore  a  chamois  jacket. 
She  never  missed  school  a  day. 

Mr.  J.  Y.  M.,  age  29,  had  been  a  sufferer 
from  bronchitis  for  two  years  and  was 
weak  and  depleted  in  flesh  and  apprehen- 
sive lest  he  was  going  into  consumption. 
His  expectoration  was  scant  and  he  cough- 
ed a  great  deal  at  night.  He  was  put  on 
Terraline,  two  teaspoonfuls  four  times  daily 
in  sherry  wine.  A  chamois  jacket  was 
worn  over  the  undershirt,  and  he  was  cau- 
tioned to  use  the  best  hygienic  rules.  He 
was  given  nothing  for  the  cough  fer  se. 
On  this  treatment  he  got  along  well  and  in 
three  months  presented  the  appearance  of 
a  well  nourished  man  with  no  cough.  He 
has  no  recurrence  of  symptoms  now  after  a 
year. 

These  are  only  a  few  of  the  many  cases 
treated  on  this  principle,  and  were  selected 
at  random  from  my  notes. 

Dr.  Robert  C.  Kenner, 

Louisville,  Ky. 


Holocain  in  Ophthalmic  Surgery  ;   Its  Su- 
periority Over  Cocaine ;    Its   Ther- 
apeutic Value,  t 
The    new  local    anesthetic,    holocain,    to 
which  the  writer  called  attention  more  than 
a  year  ago  (Boston  Med.    and  Surg.  Jour., 
June  3,  1897),  has    not  yet  come    into  very 
general  use,  judging   from    the  little    refer- 
ence made  to  it  in  the  medical  press,  as  well 
as  the  indifference    manifested    by  so  many 
of  those  who  have  become  habituated  to  the 
employment  of  cocaine.      Believing  as  I  do 
that    the  latter  drug    is  in    many  important 
respects  distinctly  inferior  to  holocain,  and 


fDr.  H.  Derby,   Archives  of  Ophthalmology, 
Vol.  xxviii,  No.  1.  1899. 


having  used  the  new  agent  almost  exclu- 
sively for  the  past  sixteen  months,  I  have 
thought  that  a  brief  record  of  my  own  per- 
sonal experience  might  not  be  without 
value. 

In  the  operation  for  the  extraction  of 
senile  cataract  it  is  a  most  efficient  anesthe- 
tic. While  not  superior  to  cocaine  in  its 
superficial  effect,  it  undoubtedly  causes  a 
greater  degree  of  insensibility  of  the  iris.  ; 
Where  a  simple  extraction  is  not  performed 
and  an  iridectomy  has  to  be  done,  we  are 
all  familiar  with  the  start  the  patients  may 
give,  as  well  as  the  pain  they  complain  of, 
at  this  stage  of  the  operation.  Under  hol- 
ocain, applied  after  the  corneal  cut  has  been 
made  and  the  anterior  chamber  evacuated, 
it  is  my  experience  that  the  iris  very  gen- 
erally allows  itself  to  be  seized  with  the  for- 
ceps and  excised  without  much  if  any  suf- 
fering. This  is  a  very  great  practical  ad- 
vantage.     In  connection  with  the  operation 


of  extraction,  however,  it  is  but  fair  to  r& 
mark  on  the  fact  that  the  holocain  does  not 
control  hemorrhage  as  cocaine  does,  and 
that  where  the  litter  agent  is  not  used  we 
are  liable  to  meet  with  a  troublesome  amount  ! 
of  bleeding. 

For  the  removal  of  a  foreign  body  from 
the  cornea,  holocain  is  decidedly  preferable 
to  cocaine,  as  it  neither  affects  the  accom- 
modation nor  enlarges  the  pupil,  thus  ren- 
dering its  use  possible  in  the  case  of  people 
with  a  tendency  to  increase  of  ocular  ten- 
sion. In  other  operations  on  the  cornea  or 
iri6,  such  as  that  of  Saemisch  for  ulcus  ser- 
pens or  iridectomy  for  glaucoma,  it  is  a  well 
known  fact  that  a  degree  of  inflammation 
that  prevents  the  absorption  of  cocaine  will 
often  yield  to  holocain,  thus  rendering  the 
use  of  ether  or  chloroform  unnecessary. 
Had  cocaine  alone  been  at  our  command, 
general  anesthesia  would  have  been  the  only 
resort. 

In  the  various  operations  on  the  muscles 
of  the  eye,  no  local  anesthetic  has  been 
found  to  give  entire  satisfaction.  It  can 
only  be  claimed  for  holocain  in  this  connec- 
tion that  it  is  at  least  as  efficient  as  cocaine, 
and  can  be  used  in  cases  where  distressing 
constitutional  symptoms  have  been  produced 
by  the  latter. 

In  probing  the  lacrymal  passage  I  still 
make  a  preliminary  injection  of  cocaine, 
the  poisonous  effects  of  holocain,  when  ad- 
ministered internally,  rendering  it  unsuita- 
ble for  such  a  purpose.  For  the  same  rea- 
son no  subcutaneous  injection  of  the  drug 
can  be  made.  But  in  the  numerous  cases 
where  I  have  used  it  locally  and  superficial- 
ly I  have  never  seen  the  slightest  general 
disturbance, 


THE  CHARLOTTE 'MEDICAL  JOURNAL. 


469 


To  sum  up,  then,  the  advantages  of  holo- 
cain  over  cocaine  : 

i.  It  does  not  cause  mydriasis,  and  may 
therefore  be  used  without  danger  of  bring- 
ing about  increase  of  tension. 

2.  It  does  not  affect  the  accommodation. 

3.  It  brings  about  a  greater  degree  of 
anesthesia  of  the  iris  than  does  cocaine. 

4.  In  cases  of  severe  and  painful  inflam- 
mation which  resist  cocaine,  holocain  often 
proves  efficient. 

5.  Unless  swallowed  or  injected  subcu- 
taneously  it  produces  no  constitutional 
effects. 

6.  It  has  no  effect  on  the  corneal  epithe- 
lium. 

7.  It  is  strongly  bactericidal  in  its  action. 
Per  contra,  cocaine  distinctly  reduces  the 

tendency  to  hemorrhage,  and  it  can  be  in- 
jected into  the  lacrymal  sac,  and  often  sub- 
cutaneously,  with  comparative  impunity. 

Such  being  the  facts,  it  would  certainly 
seem  that,  in  the  great  majority  of  cases, 
holocain  should  supersede  cocaine  as  a  local 
anesthetic  in  ophthalmic  surgery. 

A  single  word  in  regard  toeucaine,  which 
has  also  been  proposed  as  a  substitute  for 
cocaine.  My  opinion  of  its  efficiency  is 
based  on  the  following  occurrence.  I  had 
operated  in  January  of  the  present  year  on 
a  lady  of  eighty  for  the  extraction  of  cata- 
ract. Holocain  was  used,  and  the  opera- 
tion passed  off  well,  causing  little  or  no 
pain.  A  month  ago  I  undertook  to  remove 
the  cataract  on  the  second  eye.  My  nurse, 
agraduateof  the  Infirmary  Training  School, 
had  been  used  to  cocaine,  and  had  never 
seen  anything  else  employed  at  an  extrac- 
tion. I  was- pleased  to  be  able  to  call  her 
attention  to  the  advantages  of  holocain,  and 
promised  her  a  proof  of  its  anesthetic  value 
on  the  present  occasion.  Greatly  to  my 
mortification,  as  well  as  astonishment,  the 
patient  complained  bitterly  of  the  pain,  and 
asked  me  after  the  operation  why  it  hurt  so 
much  more  than  it  did  the  first  time.  On 
my  reaching  home  the  mystery  was  ex- 
plained. I  had  taken  by  mistake  a  bottle 
of  a  two  per  cent,  solution  of  eucaine  B, 
and  had  not  noticed  the  substitution  until 
my  return. 

But  I  have  found  a  possible  use  for  holo- 
cain that,  as  far  as  I  am  aware,  has  not  yet 
been  adverted  to.  It  is  based  on  its  bacte- 
ricidal properties,  which  were  so  carefully 
investigated  by  Heinz  and  Schlosser  (Klin- 
ische  Monatsblatter,  Jahrg.  xxxv.,  S.  117). 
If  the  immediate  cause  of  corneal  ulcera- 
tion is,  in  accordance  with  the  present  the- 
ory of  suppuration,  the  invasion  of  the  ter- 
ritory by  micro-organisms  (Fuchs)  ;  if  the 
ulcus  serpens  arises  through  infection  of  the 
cornea    by  organisms  which    give    rise  to  a 


purulent  inflammation  (Fuchs)  ;  if  so  se- 
vere a  remedy  as  the  actual  cautery  has 
sometimes  been  efficient  in  bringing  about 
a  cure,  why  may  not  germicidal  action  be 
induced  through  milder  means  than  the  ap- 
plication of  a  high  degree  of  heat,  or  the 
clumsy  and  round-about  method  of  the  sub- 
conjunctival injection  of  corrosive  sub- 
limate? 


"On  the  development  of  bacteria,"  say 
Heinz  and  Schlosser  (loc.  cit.),  "holocain 
exerts  an  energetic  restrictive  influence.  A 
0.1  per  cent,  solution  plainly  retards  putre- 
faction and  fermentation  ;  a  half  per  cent, 
solution  prevents  any  development  of  bac- 
terial germs  ;  multiplying  fission  fungi  are 
killed  by  a  one  per  cent,  solution.  One 
percent,  holocain  is  therefore  an  active 
antiseptic." 

The  use  of  holocain  in  ulcers  of  the  cor- 
nea seemed  to  be  sufficiently  indicated  by 
the  foregoing,  and  I  began  to  employ  it 
during  the  past  year.  My  observations 
have  been  limited  in  extent,  but  thus  far 
they  have  gone  to  convince  me  that  holo- 
cain has  a  therapeutic  value  previously  un- 
suspected. 

A  middle-aged  man,  in  good  health,  had 
been  for  three  weeks  under  my  care  for 
progressive  corneal  ulcer.  He  had  used 
pilocarpine,  cocaine,  atropine,  fomentations 
and  the  compressive  bandage  without  bene- 
fit. The  pain  had  become  excessive  and 
the  process  had  begun  to  take  on  the  char- 
acter of  an  ulcus  serpens.  I  had  begun  to 
entertain  thoughts  of  Saemisch's  operation 
or  the  application  of  the  actual  cautery.  I 
applied  holocain,  which  I  had  never  before 
used  in  a  similar  case,  with  the  idea  of  re- 
lieving the  nocturnal  pain.  Employed  at 
first  in  connection  with  the  other  remedies, 
it  was  finally  used  alone,  an  immediate  im- 
provement seeming  to  follow  its  applica- 
tion. In  the  course  of  ten  days  the  cornea 
had  almost  entirely  cleared  and  the  patient 
was  discharged.  There  has  been  no  re- 
lapse. 

Another  patient,  also  a  man  of  middle 
age,  had  been  under  my  care  since  Decem- 
ber 10,  1897,  with  small  corneal  ulcers. 
These  were  peripheric,  involved  but  slight 
loss  of  substance,  but  were  extremely  pain- 
ful and  very  obstinate,  yielding  but  slowlv 
to  treatment  and  constantly  recurring. 
Finally,  June  12th,  I  applied"  holocain  to 
relieve  the  pain.  Three  days  later  the  pa- 
tient was  well.  At  a  subsequent  attack, 
he  himself  applied  cocaine,  with  the  result 
of  distinctly  aggravating  all  the  symptoms. 
Holocain  was  then  substituted,  and  the  at- 
tack was  cut  short.  In  five  days  he  was 
well,  and  has  had  no  attack  since  June  21st. 


470 


THE  CHARLOTTE   MEDICAL  JOURNAL. 


My  brother,  Dr.  R.  H.  Derby  of  New 
York,  writes  me  as  follows  : 

"In  June  last  I  had  a  case  of  purulent 
conjunctivitis  that  had  been  treated  for 
three  days  with  ice  and  nitrate  of  silver, 
the  usual  remedies.  When  I  was  called  in, 
the  conjunctival  symptoms  had  largely 
abated.  There  was  on  the  left  cornea  a 
central  ulcer,  deep  and  threatening.  The 
patient  was  a  girl  of  sixteen  and  was  found 
to  have  a  leucorrheal  discharge.  The  secre- 
tions from  the  eye  had  been  examined  twice, 
and  the  diagnosis  of  gonorrheal  ophthal- 
mia had  been  made.  I  was  told,  however, 
that  no  gonococcus  had  been  found.  It  was 
about  that  time  that  you  wrote  me  of  the 
value  of  holocain  in  cases  of  infected  cor- 
neal ulcer.  I  made  instillations  of  this 
drug,  together  with  atropine  and  occasional 
warm  compresses  of  camomile.  The  im- 
provement in  the  corneal  process  was  very 
rapid  and  the  eye  shows  to-day  a  small 
central  corneal  macula,  with  a  vision  of 
ten-tenths." 

For  the  following  case  I  am  indebted  to 
Dr.  Myles  Standish  of  Boston,  in  whose 
practice  it  occurred  : 

"Mrs.  E.  M.  H.,  married,  forty  years  old, 
came,  June  i,  1897,  v^ith  two  infiltrated 
ulcers  of  cornea  in  the  right  eye,  pin-head 
in  size,  and  at  about  the  margin  of  its  pupil 
when  moderately  dilated,  also  with  a  gray 
infiltration  just  below  pupil  in  the  left  eye. 
The  ulcerations  failed  to  heal,  did  not  great- 
ly extend  in  area ;  for  several  weeks  new 
blebs  appeared  in  each  cornea  which  soon 
became  ulcers,  and  about  February  1,  1898, 
the  ulcers  increased  in  size  on  both  cornea?. 
Patient  up  to  this  time  had  been  treated 
with  some  antiseptic  ointments,  having  for 
their  active  principle  either  the  yellow  oxide 
or  the  red  iodide  of  mercury.  Had  also  had 
atropine  and  at  times  pilocarpine  and  hot 
fomentations. 

About  February  5th  patient  was  put  on  a 
solution  of  holocain  and  all  other  treatment 
omitted.  There  was  immediate  improve- 
ment, and  new  herpetic  blebs  ceased  to  ap- 
pear. Eyes  steadily  improved.  April  4th 
holocain  was  omitted,  and  on  April  12th 
the  patient  returned  with  a  new  ulcer  on 
the  cornea  of  right,  which  did  well  when 
holocain  was  resumed.  This  experience 
was  repeated  on  two  subsequent  occasions, 
and  holocain  was  only  finally  omitted  on 
June  15,  1898. 

While  so  brief  a  series  of  cases  convey  no 
certain  proof  of  the  value  of  holocain  as  a 
therapeutical  agent,  it  distinctly  encourages 
additional   investigations  in    this  direction. 

That  holocain  has  its  limitations,  even  as 
an  analgesic,  is  shown  by  my  recent  expe- 
rience in  a  protracted  and  most  painful  case 


of  double  scleritis.  While  cocaine  had  ab- 
solutely no  effect,  holocain  caused  a  dis- 
agreeable, burning  sensation,  lasting  some 
hours  after  each  application,  and  obliging 
its  discontinuance.  Relief  was  only  ob- 
tained by  leeching  the  temples  and  the  use 
of  fomentations. 


Operations  on  Syphilitics. 

Dr.  Michailow  is  credited  as  saying(Med. 
Record,  April  8/99)  that  he  has  within  the 
last  three  years  operated  upon  two  hundred 
syphilitic  individuals,  mostly  women,  and 
has  observed  that  in  these  patients  there 
exists  a  certain  diathesis  which  exerts  an 
unfavorable  influence  upon  the  ultimate  re- 
sult of  the  operation  ;  the  diathesis  consists 
especially  in  changes  of  the  vascular  system, 
morphological  alterations  in  the  quality  of 
the  blood,  and  specific  changes  in  the  skin 
itself.  These  changes  naturally  play  an 
important  part  in  the  process  of  cure.  The 
syphilitic  diathesis  lacks  uniformity  in  the 
various  organs  and  tissues,  and  is  more 
marked  in  the  gummatous  stage.  In  opera- 
tingupon  syphilitic  individuals,  hemorrhage 
of  the  tissues,  namely, in  the  gumatous  stage 
occurs  very  easily ;  even  in  extraction  of 
teeth  profuse  hemorrhages  may  occur.  In 
certain  instances  pigmented  infiltration  of 
the  edges  of  the  wound  is  observed,  so  that 
the  latter  are  elevated  above  the  skin  sur- 
face. Primary  infection,  even  with  the 
most  scrupulous  asepsis,  frequently  fails, 
and  even  the  healing  of  granulations  are 
scarce,  mostly  in  the  stage  of  fatty  degene- 
ration, occasionally  large,  osdematous.  and 
colorless.  The  wound  gives  off  a  profuse, 
stinking  secretion,  and  its  edges  become 
atrophic.  Elastic  bandages  or  washing 
carbolic  acid  easily  lead  to  necrosis  in  the 
region  of  the  wound, whereas  the  local  ap- 
plication of  warmth  exerts  a  very  favorable 
influence  upon  it.  In  the  codylomatous 
stage  the  great  development  of  scar  tissue 
is  frequently  observed.  Plastic  operations 
are  often  without  results  in  syphilitics. 
This  syphilitic  diathesis  is  very  slight,  at 
times  not  at  all  marked  in  persons  who  have 
a  mild  form  of  the  disease  or  in  those  who 
have  through  it  many  years  before,  as  well 
as  in  individuals  who  have  been  subjected 
to  an  energetic  specific  treatment.  It  must 
be  accepted  as  a  rule,  however,  to  subject 
all  syphilitics  to  a  specific  line  of  treatment 
before  an  operation  is  undertaken. 


Statistict  show  that  chloroform  is  less 
dangerous  in  warm  than  in  cold  countries. 
It  is  advisable,  therefore,  whenever  for  any 
reason  chloroform  is  to  be  preferred  to  other 
anesthetics,  to  see  that  the  operating  room 
has  a  high  temperature. 


THE  CHARLOTTE  MEDICAL  JOURNAL, 


THE  SANITARIUM, 


INCORPORATED  1867- 


CHE  largest,  most  thoroughly  equipped  and  one  of  the  most  favorably  located  in  the  United  States. 
It  is  under  strictly  regular  management.  Eight  physicians,  well-trained  and  of  large  experience. 
A  quiet  homelike  place,  where  "  trained  nurses,"  "rest-cure,"  "massage,"  "  faradization,"  "  gal- 
vanization," "static  electrization,"  "Swedish  movements,"  "dieting,"  "baths,"  "  physical  train- 
ing," and  all  that  pertains  to  modem  rational  medical  treatment  can  be  had  in  perfection  at  reasonable 
prices.  Special  attention  given  to  the  treatment  of  chronic  disorders  of  the  stomach,  and  diseases  pecul- 
iar to  women.    A  special  hospital  building  (ioo  beds)  for  surgical  cases  with  finest  hospital  facilities  and 

Large  fan  for  winter  and  summer  ventilation.  Absolutelv  devoid  of  usual  hospital  odors.  Delight- 
ful surroundings.  Lakeside  resort.  Pleasure  grounds,  steamers,  sailboats,  etc.  Trained  nurses  of 
either  sex  furnished  at  reasonable  rates. 

J.  H.  KELLOGG,  fl.  D.,  Supt.,  Battle  Creek,  Mich. 


R 


meal.    The  only  food  on  the 
I  freely,  v,  it  limit  ilaiwer.     l"iv*i;ribeil  and  endorsed  by  the  physicians 


till'  from  the  purest  wheat  gluten  and  l 


NUT-GLUTEN  BISCUIT: 

■narketto-diM  that  diabetics  may  . 

,t  th,    Cattle  Creek  Sanitarium.     Samples  free  to  physicians  wilt  I 

may  have  th,  m  |,.r  tw.,  V  stamps. 

BATTLE  CREEK  SANITARIUM  HEALTH  FOOD  CO.,  Battle  Creek,  Mich 


ird  is  enclosed  with  the  request.    Others 


Measurements  of  Pain. 

Arthur  MacDonald,  in  an  article  read  be- 
fore the  American  Psychological  Associa- 
tion, concluded  as  follows  (Medical  Record, 
April  8th,  1899)  : 

1.  In  general  the  sensibility  to  pain  de- 
creases as  age  increases.  The  left  temple  is 
more  sensitive  than  the  right.  This  accords 
with  former  experiments,  that  the  left  hand 
is  more  sensitive  to  pain  than  the  right 
hand.  There  is  an  increase  of  obtuseness 
to  pain  from  ages  ten  to  eleven  ;  then  a  .de- 
crease from  eleven  to  twelve  ;  then  an  in- 
crease from  twelve  to  thirteen.  From  thir- 
teen to  seventeen,  while  the  right  temple 
increases  in  obtuseness,  the  left  temple  in- 
creases in  acuteness.  This  is  in  the  post- 
puberal period.  There  is  a  general  varia- 
tion, which  experiments  on  larger  numbers 
might  modify. 

2.  Girls  in  private  schools,  who  are  gen- 
erally of  wealthy  parents,  are  much  more 
sensitive  to  pain  than  girls  in  the  public 
schools.  It  would  appear  that  refinements 
and  luxuries  tend  to  increase  sensitiveness 
to  pain.  The  hardihood  which  the  great 
majority  must  experience  seems  advanta- 
geous. This  also  accords  with  our  previous 
measurements,  that  the  non-laboring  classes 


are  more  sensitive  to  pain  than  the  laboring 
classes. 

3.  University  women  are  more  sensitive 
than  washerwomen,  but  less  sensitive  than 
business  women.  There  seems  to  be  no  ne- 
cessary relation  between  intellectual  develop- 
ment and  pain  sensitiveness.  Obtuseness 
to  pain  seems  to  be  due  more  to  hardihood 
in  early  life. 

4.  Self-educated  women  who  are  not 
trained  in  universities  are  more  sensitive 
than  business  women.  Giving,  then,  the 
divisions  in  the  order  of  their  acuteness  to 
the  sense  of  pain,  they  would  stand  as  fol- 
lows :  1st,  girls  of  the  wealthy  classes;  2d. 
self-educated  women  ;  3d,  business  women  ; 
4th,  university  women;  5th,  washer-wo- 
men. The  greater  sensitiveness  of  self- 
educated  women  as  compared  with  univer- 
sity women  may  be  due  to  the  overtaxing 
of  the  nervous  system  of  the  former  in  their 
unequal  struggle  after  knowledge. 

5.  The  girls  in  the  public  schools  are  more 
sensitive  at  all  ages  than  the  boys.  This 
agrees  with  the  results  of  our  previous 
measurements,  that  women  are  more  sensi- 
tive to  pain  than  men.  These  measurements 
of  least  disagreeableness,  or  of  threshold  of 
pain,  are  approximate  measurements  of  the 
combination  of  nerve,  feeling,  and  idea. 


472 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


The  Vitality  of   Epithelial   Cells,  and  the 
Etiology  of  Cancer. 

What  the  nature  of  the  irritant  may  be 
that  causes  the  localized  overgrowth  of  epi- 
thelial cells  which  we  call  cancer,  we  are 
yet  no  nearer  knowing  than  we  were  be- 
fore the  demonstration  of  its  exact  patho- 
logy, more  than  half  a  century  ago.  Not- 
withstanding all  the  claims  that  have  been 
made  of  the  causal  influence  of  external 
biologic  factors,  parasites  from  bacteria, 
and  fungi,  schizomycetes,  and  blastomy- 
cetes  to  various  forms  of  animal  parasites, 
gregarines  and  protozoa  generally,  we  are 
no  nearer  the  solution  of  the  problem  than 
we  were  before. 

Of  late  the  subject  has  been  approached 
from  the  other  side,  the  essential  vitality  of 
epithelial  cells  and  their  reaction  to  various 
irritants,  and  some  most  interesting  results 
have  been  obtained  by  various  observers. 
In  Dr.  Hektoen's  review  of  this  subject  for 
the  first  number  of  "Progressive  Medi- 
cine"! (the  advance  sheets  of  which  are  in 
our  hands),  we  find  some  striking  observa- 
tions on  the  subject  collated.  Ljunggren, 
a  Scandinavian  physician,  for  instance, 
found  to  his  surprise  that  he  could  preserve 
carefully  sterilized  bits  of  human  s^in  in 
sterile  human  ascitic  fluid  for  months,  and 
that  the  cells  of  the  tissues  retained  their 
vitality.  Three  months  after  their  removal 
from  the  body  the  cells  of  the  deeper  layers 
showed  well  stained  nuclei,  and  good  pro- 
toplasmic structure.  Successful  transplan- 
tation was  made  with  pieces  kept  in  such 
sterile  fluid  for  a  month.  Small  pieces  of 
the  transplanted  skin  were  removed  at  vary- 
ing intervals,  and  it  was  found  that  a 
marked  proliferation  of  epithelial  cells 
showing  many  nuclear  figures  had  occurred. 
Special  precautions  were  taken,  which  ab- 
solutely assured  the  absence  of  cells  that 
might  have  grown  in  from  the  surrounding 
cutaneous  margin  and  so  vitiated  the  con- 
clusions. The  transplanted  cells  not  only 
grew  over  the  raw  surface,  but  penetrated, 
also,  into  the  granulation  tissue  beneath, 
after  the  manner  of  a  beginning  carcino- 
matous growth. 

Almost  more  interesting  and  suggestive 
than  this  are  the  observations  made  by  Loeb 
here  in  America  on  epithelial  regeneration. 
The  abstract  of  them  by  Dr.  Hektoen  in 
"Progressive  Medicine"  is  so  clear  and  suc- 
cinct that  we  copy  part  of  it  verbatim  : 
"From  the  margin  of    a  tissue-defect  huge 


fProgressive  Medicine, "a  Quarterly  Digest 
of  New  Methods,  Discoveries  and  Improvements 
in  the  Medical  and  Surgical  Sciences.  Volume 
I,  No.  1,  March,  1899.  Edited  by  Hobart  A. 
Hare,  M.  D.  Lea  Brothers  &  Co.,  New  York 
and  Philadelphia. 


epithelial  protoplasmic  or  plasmodial  masses 
move  in  a  sliding  manner  over  the  naked 
surface,  inclosing  and  dissolving  the  crust 
and  other  obstacles.  Regenerating  epithe- 
lium readily  removes  such  substances  as 
cartilage  when  placed  in  its  way.  Below 
the  protoplasmic  layer  epithelial  cells  wan- 
der in  from  the  margins  of  the  defect,  and 
often  grow  down  into  the  connective  tissue, 
apparently  checking  the  growth  of  the 
latter.  The  process  is  closely  allied  to 
changes  in  carcinoma.  At  the  same  time 
active  changes,  such  as  mitoses,  occur  in 
the  epithelial  cells  removed  some  distance 
from  the  margins  of  the  wound.  Loeb  be- 
lieves that  the  wandering  of  the  cells,  as 
outlined,  is  in  response  to  stereotropism, 
and  forms  a  determining  in  inducing  mitosis 
in  the  remaining  cells."  The  pregnant  sig- 
nificance of  these  observations,  especially 
the  apparent  action  at  a  distance  of  epithe- 
lial elements  in  arousing  epithelial  cells  into 
reproductive  and  germinal  activity,  can 
scarcely  be  over-estimated.  This  is  the 
essence  of  carcinoma,  though  in  healthy 
subjects  the  vital  resistance  may  be  sufficient 
to  restrain  the  morbid  overgrowth  that 
would  otherwise  result. 

According  to  Loeb,  "if  a  small  bit  of 
epithelium  is  placed  in  the  centre  of  the 
crust  covering  a  defect  in  the  skin,  it  be- 
gins to  send  out  processes  in  all  directions 
into  the  crust,  the  cells  acting  as  separate 
organisms,  independent  of  blood  supply  or 
nervous  influence."  We  are  evidently 
closely  in  touch,  in  these  manifestations, 
with  the  as  yet  inexplicable  vital  forces  that 
we  see  at  work  in  all  their  untrammelled 
energy  and  power  in  cancer.  Further  ob- 
servations are  needed  to  give  the  deductions 
from  these  observations  practical  applica- 
tion. They  constitute,  however,  the  most 
hopeful  aspect  of  the  present  pathological 
work  on  cancer  as  far  as  regards  the  near 
prospect  of  discovering  etiology.  Their 
value  as  additions  to  biological  science, 
especially  to  that  mysterious  problem,  the 
struggle  for  life  among  the  various  cells  of 
the  body  tissues,  can  scarcely  be  over-esti- 
mated. 


Tri-State  Medical  Society  of  Iowa,  Illinois, 
and  Missouri. 

The  seventh  annual  meeting  of  this  socie- 
ty will  be  held  at  Quincy,  111.,  on  April  4th 
and  5th.  The  officers  of  the  society  are  as 
follows  :  President,  Dr.  C.  E.  Ruth,  Keo- 
kux,  Iowa;  First  Vice-President,  Dr.  J.  C. 
Murphy,  St.  Louis,  Mo.  ;  Second  Vice- 
President,  Dr.  George  L.  Eyster,  Rock  Is- 
land ;  Treasurer,  Dr.  D.  S.  Fairchild,  Clin- 
ton, Iowa;  Secretary,  Dr.  J.  W.  Fowler, 
Dubuque,  Iowa. 


THE  CHARLOTTE  MEDICAL  JOURNAL.  47:s 


VISKOLEIN 


ABORTS 
TYPHOID 


FEVER 


That  VISKOLEIN  aborts 
Typhoid  and  other  forms 
of  fever,  Pneumonia,  In- 
fluenza, Pyemia,  Septiee-         i^^^^MBi^^^^^^^^M 
,      «    ,.  r  v  4.-  (VITAL  FORCE) 

mia  and  all  diseases  ol  Zymotic 

origin,  results  obtained  by  hun- 
dreds of  physicians  prove  be- 
yond a  shadow  of  a  doubt. 

VISKOLEIN  is  used  hypo- 
dermically  and  per  orem. 

Full  clinical  reports,  formula 
and  other  literature  with  sam- 
ples, will  be  sent  to  any  phy- 
sicians desiring  them. 

A  sample  consists  of  Hypodermic 
Solution,  Capsules  and  Tablets,  suffi- 
cient   for  an   average  case. 

Addr  ess  THE  VISKOLEIN  CO,  22L™^- 


IlliiilinilliniiininnmninniimimmninB 

I A  Therapeutic  Recourse  of  § 
§         Wide  Application.         § 


ThISuon 

A  Laxative  Salt  of  Lithia. 


I 

q  a 

m  INDICATIONS.— Gout  and  all  of  those  diseases  arising  from  a  gouty  condition  of  the  sys-  2 

^    tem,  rheumatism  and  all  of  those  diseases  arising  from  a  general  rheumatic  condition,  chronic  2 

A    constipation,  hepatic  torpor  and  obesity.    In  all  cases  where  there  is  a  pronounced  leaning  to  m 

^    corpulency,  it  reduces  to  a  minimum  the  always  present  tendency  to  apoplexy.    In  malaria  a 

^    because  of  its  wonderful  action  on  the  liver,  increasing  twofold  the  power  of  quinine.  m 

Inasmuch  as  some  difficulty  is  experienced  by  physicians  in  procuring  Thialion,  we  will,  on  R 

n   receipt  of  one  dollar,  send  one  bottle  containing  four  ounces,  sufficient  for  three  weeks'  treat-  ^ 

n    ment,  prepaid  to  any  address.  R 

Q   Literature  on  Application.  1*1 

2  m  THE  VASS  CHEMICAL  CO.,  5 

&    b        *>  DANBURY,  CONN.  A 

*  i  >  »  *  inmn  i>>>>>>>>>)>>>>  m  *  *  j  j  j  jxijxmxjj  j  :m»  jb 


Prepared  only  for  the  Medical  Profession. 


474 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


Toxines   in   Dermatology. 

Hallopean,  according  to  the  Maryland 
Medical  Journal,  believes  that  toxines  play 
a  very  important  part  in  the  production  of 
dermatoses,  and  he  even  goes  so  far  as  to 
assert  that  they  are  the  immediate  cause  of 
the  great  majority  of  cutaneous  diseases. 
He  applies  the  term  toxines  to  "all  morbific 
substances  produced  by  living  organisms," 
so  that  stings  of  insects,  jelly-fish,  certain 
vegetable  poisons,  etc..  are  regarded  as 
toxines.  He  explains  the  pruritus  of  jaund- 
ice, the  eruptions  and  pruritus  of  diabetes 
and  the  eruptions  caused  by  abnormal  renal 
secretions  as  being  due  to  alteration  in  the 
quality  of  or  excessive  variation  in  the 
quantity  of  the  normal  products  of  secretion. 
The  toxines  of  microbic  origin  which  are 
produced  in  the  alimentary  canal  are  a  fre- 
quent cause  of  cutaneous  diseases.  The 
eruptions  which  sometimes  occur  in  the 
course  of  diphtheria,  gonorrhea  and  the  ex- 
anthematous  eruptions  are  probably  pro- 
duced by  the  toxines  resulting  from  the  re- 
spective micro-organisms.  Hallopean  thinks 
that  toxines  may  be  the  cause  of  such  dis- 
eases as  acute  eczema,  psoriasis,  pemphigus, 
etc. 


Further  Uses  of  Ureteral  Catheter. 

At  a  recent  meeting  of  the  Johns  Hop- 
kins Medical  Society,  Dr.  Kelly  spoke  of 
some  further  uses  of  the  ureteral  catheter. 
(University  Medical  Magezine.)  He  said 
that  it  seemed  some  month  ago  that  certain 
disceveries  would  limit  very  much  the  use 
of  the  renal  and  ureteral  catheter.  It  was 
found  to  be  possible  to  separate  the  urines 
and  retain  them  separated  in  the  bladder 
until  discharged  from  that  organ  by  tubes. 
This  was  done  by  means  of  an  instrument, 
which  consisted  of  i  tube  with  a  solid  sep- 
tum running  down  the  centre  and  project- 
ing beyond  the  end  of  the  glass  tube,  so 
that  urine  running  down  from  one  ureter 
remained  on  its  own  side  of  the  septum, 
while  that  from  the  other  ureter  was  con- 
fined to  the  opposite  side.  This  method 
was  published  in  the  Deutsche  medicinische 
Wochenschrift  of  October,  1898,  and  not 
long  after  Dr.  Harris,  of  Chicago,  was  able, 
by  the  use  of  an  instrument,  to  form  two 
little  pockets  in  the  bladder  for  the  accu- 
mulation of  the  urines  from  each  side,  which 
could  then  be  drawn  off  by  a  suitable  cath- 
eter. At  first  it  looked  as  if  these  methods 
might  limit  very  much  the  further  use  of 
the  high  catheter,  but  a  new  and  very  im- 
portant use  for  them  has  developed. 

In  a  certain  number  of  cases  we  have  to 
deal  with  vague  but  depressing  pains  in  the 
side,  particularly  the  right,  and  one  is  long 


in  doubt  as  to  whether  they  are  renal,  he- 
patic, or  intestinal  in  character,  or  whether 
they  are  really  hysterical.  He  has  been  able 
to  include  or  exclude  the  kidney  as  a  cau- 
sative factor  by  the  use  of  the  catheter. 
When  the  ureteral  catheter  presses  upon  the 
pelvis  of  the  kidney  the  patient  will  some- 
times say  that  that  is  the  very  point  where 
she  had  the  pain.  Further  than  that,  he 
has  been  able  to  produce  an  attack  of  arti- 
ficial renal  colic  by  injecting  a  solution  of 
boracic  acid  into  the  kidney  through  the 
catheter. 

The  doctor  referred  to  a  recent  case  which 
illustrates  well  the  value  of  the  catheter. 
The  condition  was  so  like  a  floating  kidney 
that  he  unhesitatingly  made  that  diagnosis, 
but  passed  in  a  catheter  first  and  produced 
an  attack  of  colic,  which  the  patient  did 
not  locate  in  the  lump  which  was  felt  in 
front,  but  insisted  that  it  was  in  the  back. 
At  the  operation  he  found  an  enlarged  gall- 
bladder in  front  of  the  kidney,  which  was 
in  its  normal  position,  so  that  the  location 
of  the  pain  by  the  patient  outside  of  the 
kidney  when  artificial  colic  was  produced 
was  correct. 


Ocular  Evidence   of  Hysteria. 

Casey  Wood,  in  a  recent  issue  of  the 
American  Journal  of  the  Medical  Sciences, 
draws  the  following  conclusions  from  a 
study  of  this  subject  : 

1.  Most  cases  of  hysteria  present  well- 
marked,  easily  detected  eye-signs  and  symp- 
toms. 

2.  A  few  ocular  symptoms,  such  as  a 
reversal  of  the  relation  of  the  colorfields 
and  the  field  for  white,  the  tonic  form  of 
blepharospasm,  spasm  of  accommodation 
and  convergence,  and  pseudoparalytic,  may 
be  regarded  as  pathognomonic  of  hysteria. 

3.  Defects  of  vision  (in  the  absence  of 
refractive  errors,  accommodative  anomalies, 
and  fundus  lesions)are,  generally  speaking, 
hysterical,  if  accompanied  by  photophobia 
and  any  form  of  blepharospasm. 

4.  No  examination  of  a  patient  for 
hysteria  should  be  regarded  as  complete 
without  considering  the  condition  of  his 
ocular  apparatus. 

5.  Where  there  is  no  conclusive  external 
evidence  of  the  neurosis  present  the  per- 
imeter should  be  carefully  used,  the  range 
of  accommodation  should  be  noted,  and  the 
ophthalmoscope  employed. 

6.  It  should  always  be  remembered  that 
ocular  hysteria  is  common  in  children  and 
men. 

7.  Organic  disease  (traumatism  espe- 
cially) of  the  eye  may  accompany  functional 
disturbances  of  that  organ. 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


475 


A  SIMPLE  AND  MOST  EFFECTIVE 


Treatment  of  Chronic  Leg  Ulcers 


Thoroughly  wash  and  irrigate  the  ulcer  and  adjacent  parts: 
after  drying  apply  Antinosine  (pulv.),  distributing  the  powder 
rightly  over  the  entire  surface.  Over  this  place  a  nosophen- 
gauze  dressing,  the  whole  held  in  place  by  a  roller  bandage. 
In  cases  with  hard  infiltrated  borders,  precede  the  above  treat- 
ment by  curetting. 


(the  sodium  salt  of  tetraiodo-phenolphtalein)  has  been  proven 
by  extensive  and  most  severe  clinical  tests  to  be  beyond  ques- 
tion the  most  efficient  of  all  existing  antiseptics  in  the  treat- 
ment of  ulcers  and  abscesses  generally,  infected  wounds  of 
any  natuae,  very  useful  in  palative  treatment  of  cancerous 
ulcerations,  lupus,  etc.  Antinosine  is  absolutely  non-toxic, 
non-irritating  and  odorless.  It  is  freely  soluble  in  water  and 
in  solutions  of  1  to  2+  per  cent,  gives  most  excellent  results  in 
cystitis,  as  an  injection  in  gonorrhoea,  as  an  antiseptic  fluid  in 
ear,  nose  and  throat  practice,  etc. 

Literature  on  request. 

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476 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


Infection  of   the  Mother    from    the  Fetus. 

Salomon  (Obstetrics,  January,  1899)  says 
that  infection  of  the  fetus  from  the  mother 
has  long  been  an  accepted  fact.  It  must 
necessarily  follow,  he  believes,  that  the 
fetus  under  certain  circumstances  may  in 
turn  at  a  later  date  reinfect  the  mother.  In 
each  instance  infection  occurs  through  the 
placenta. 

He  relates  a  case  in  which  a  healthy  young 
woman,  four  months  pregnant,  exhibited 
signs  of  intoxication  resembling  meningitis, 
the  condition  terminating  a  month  later  in 
abortion.  The  maternal  symptoms  imme- 
diately vanished. 

A  hitherto  undescribed  bacillus  was  cul- 
tivated from  the  blood,  liver,  spleen  and 
bone  marrow  of  the  fetus,  and  the  cultures 
were  fatal  to  mice. 

Salomon  cites  a  few  cases  from  literature 
which  seem  to  illustrate  the  existence  of  the 
following  cycle  :  infection  of  mother,  sub- 
sequent infection  of  fetus,  and  at  a  later 
date  re-infection  or  intoxication  of  the 
mother,  perhaps  from  the  germs  or  toxines 
formed  during  the  fetal  disease. 


Report  of  78  Cases  of  Pulmonary  Tubercu- 
losis Treated  with  Watery  Extract 
of  Tubercle  Bacilli. 

A  report  of  78  cases  of  Pulmonary  Tu- 
berculosis, treated  at  The  Winyah  Sanita- 
rium, at  Asheville,  N.  C.  in  1898,  with 
Watery  Extract  of  Tubercle  Bacilli,  by  Dr. 
Karl  von  Ruck,  appears  in  the  February 
number  of  the  Therapeutic  Gazette. 

The  author  giving  due  credit  to  the  ad- 
vantages of  the  favorable  climate  of  the 
Asheville  plateau  as  well  as  to  the  syste- 
matic employment  of  hygienic  and  dietetic 
methods,  in  a  special  institution,  shows 
nevertheless  by  his  results  the  unmistakable 
influence  of  this  preparation,  which  he  per- 
fected in  his  Laboratory  in  February,  1896. 

He  with  many  others,  notably  Professor 
Koch,  have  long  realized  that  the  bodies  of 
tubercle  bacilli  contain  a  soluble  substance, 
a  proteid  upon  which  the  curative  action  of 
all  tuberculin  preparations  and  modifica- 
tions must  depend,  small  and  variable  quan- 
tities of  which  were  thought  to  enter  into 
the  culture  fluid  from  which  the  tuberculin 
preparations  are  made. 

Experiments  upon  animals  have  shown 
that  the  injection  of  dead  tubercle  bacilli 
produce  both  curative  and  immunizing  ef- 
fects, but  they  have  always  produced  ab- 
scesses at  the  point  where  they  were  inject- 
ed and  often  spurious  tubercle  in  the  ani- 
mals experimented  upon,  conditions  which 
seemed  to  preclude  their  use  in  the  treat- 
ment of  human  tuberbulosis. 


A  solution  of  the  tubercle  bacilli,  without 
injury  to  the  curative  proteids  was  there- 
fore naturally  sought  for,  and  in  April, 
1897,  Professor  Koch  announced  that  he 
had  accomplished  this  in  the  production  of 
Tuberculin  R.,  which  was  then  given  to  the 
profession. 

Several  weeks  later  Dr.  von  Ruck  an- 
nounced his  success  in  also  making  fehe  de- 
sired solution  and  communicated  his  experi- 
ments and  methods  in  a  paper  read  before 
the  American  Climatological  Association 
and  published  in  its  transactions  for  1897 
and  also  in  the  Therapeutic  Gazette  for 
June,  1897.  His  method  of  preparation 
differs  from  that  published  by  Professor 
Koch  and  is  briefly  as  follows  : 

The  tubercle  bacilli  are  filtered  out  of  the 
rapidly  growing  and  highly  virulent  cul- 
ture. After  washing  with  distilled  water 
for  the  removal  of  the  remains  of  the  cul- 
ture fluid,  they  are  dried  in  a  vacuum  des- 
sicator.  Next  they  are  provided  in  an  agate 
mortar  and  then  extracted  with  sulphuric 
ether.  This  extraction  removes  the  fats. 
They  are  again  dried  and  powdered  as  be- 
fore and  their  further  extraction  takes  place 
in  sterilized  distilled  water  over  a  water 
bath  with  a  temperature  of  120  F.  The 
proteids  becoming  dissolved  in  the  distilled 
water,  the  fluid  is  then  decanted  and  filter- 
ed through  porcelain,  when  finally  the 
amount  of  proteids  is  determined  and  the 
preparation  standarized  to  a  certain  per 
cent. 

Prof.  Koch  simply  triturated  his  tubercle 
bacilli  and  then  put  them  into  distilled  wa- 
ter and  separated  the  undissolved  germs 
with  a  centrifugal  machine.  His  prepara- 
tion did  however  not  pass  through  a  porce- 
lain filter  and  it  was  subsequently  shown 
that  when  an  attempt  of  filtering  through 
porcelian  was  made,  a  residue  collected  in 
the  filter  consisting  of  Tubercle  Bacilli. 

Virulent  infection  followed  the  injection 
of  this  residue  in  animals  and  for  this  reason 
Professor  Koch  was  obliged  to  withdraw 
his  Tuberculin  R.,  it  being  an  emulsion  of 
tubercle  bacilli  and  fragments  of  such, 
rather  than  a  true  solution. 

Koch's  claim  that  in  a  true  solution  of 
the  tubercle  bacilli  the  final  perfection  of  a 
specific  remedy  was  attained,  would  appear 
to  be  verified  by  the  results  which  Dr.  von 
Ruck  reports. 

He  treated  with  his  Watery  Extract  30 
cases  in  the  early  stages,  all  of  which  re- 
covered, with  an  average  gain  of  11  pounds 
in  weight,  and  subsidence  of  all  symptoms. 

Of  37  cases  in  a  more  advanced  stage  27 
recovered,  7  were  greatly  improved,  3  im- 
proved, and  none  grew  worse,  gaining  on 
an  average  nearly  13  pounds  each. 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


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XV 


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^rwo  sizes^     A  Desideratum  as  a 
7  .    Vegetable  Alterative. 
Lajzative  Tonic  and  antacid. 


/-(,-)  Indicated  in  all  sKin  Diseases,  chronic  Constipation 
{^/  disorders  of  Digest/on  etc. 


and 


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An  absolutely  pure 
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and  Preservative  detergent. 


THE  BEST  SOAP  FOR  THE  SHIN,  THE  HAIR,  SCALP  ETC 

for  sale  by  all  Druggists,  or sent on  receipt  of  price. 
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X-Ray  Work  at  St.  Peter's  Hosoital. 

CHARLVOTTB,   IV.  O. 

A  room  has  been  fitted  up  at  .ST.  PETER'S  HOSPITAL  with  the  most  improved 
X-Ray  apparatus.  An  eight-plate  thirty-inch  static  machine  is  used  to  generate  its 
current.  This  is  the  largest  machine  made  for  this  kind  of  work  and  it  produces  its  Rays  in 

A   CLEAR   AND  POWERFUL  STREAM. 

The  latest  and   most  expensive    accessories  are    used  in  connection  with  this  machine, 
making  it  the  most  powerful  and  complete  outfit  in  the  South  at  the  present  time. 

Prices  for  Complete  and  Thorough  Examinations  will  be  $10.00  to  $25.00. 
Photographs  Furnished  if  Desired, 


For  particulars  address. 


St.  Peter's  Hospital, 

Charlotte,  N.  C. 


478 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


Twenty-one  cases  in  a  seriously  advanced 
stage  were  also  treated,  of  which  3  recov- 
ered, 9  were  greatly  improved,  7  were  im- 
proved, only  2  grew  worse  or  died,  there 
being  an  average  gain  in  weight  of  ioi 
pounds  each. 

The  remedy  was  also  given  for  trial  to 
Dr.  Denison,  of  Denver;  Dr.  Taylor,  of  St. 
Paul,  and  Dr.  Williams,  of  Asheville,  all 
of  which  obtained  good  results.  Dr.  Wil- 
liams supplying  the  date  of  12  cases  treated 
by  him  with  von  Kuck's  extract,  shows  7 
early  stage  cases,  all  of  which  recovered  ; 
of  3  cases  in  the  second  stage,  1  recovered, 
and  2  were  greatly  improved,  and  of  2  far 
advanced  cases,  1  recovered  and  one  grew 
worse. 

Comparing  his  previous  results  with 
those  obtained  with  the  watery  extract  in 
von  Ruck's  institution  he  shows  the  results 

as  follows  : 

Cases.  Recov'd.  Imp'vd. 
pr.  ct.   pr.  ct. 
Treated  without  Specific  |     K^       1,  ^      oj  q 

Remedies, \ 

Treated  with  Koch's  on-  >     3?9       K§      3?  fi 

ginal  Tuberculin, \ 

Treated  with  Antiphthi-  /     ,0.,       go  5      4^  a 

sin  Tubereulocidin, . . . .  \ 
Treated   with   Tuberculi-  ) 

num    Purificatum    (von  -    166       43.4      39.2 

Ruck)  ) 

Treated  with  Watery  Ex-  ) 

tract  of  Tubercle  Bacilli  -      78       64.1       33.3 

(von  Ruck) \ 

Among  other  matters  of  interest,  the  re- 
port also  contains  mention  of  Dr.  von 
Ruck's  efforts  to  produce  a  serum,  as  sug- 
gested by  Professor  Koch,  in  his  paper  by 
using  Tuberculin  R.  and  his  Watery  Ex- 
tract for  immunization.  Dr.  von  Ruck  used 
goats  for  the  purpose  and  injected  them  in 
increasing  doses  reaching  70  c.  c.  per  sin- 
gle dose  in  the  course  of  six  months. 

Serum  taken  from  these  animals  failed  to 
protect  or  cure  guinea  pigs,  and  finding  his 
results  entirely  at  variance  with  the  claims 
of  Dr.  Fisch,  he  purchased  serum  from  Dr. 
Fisch's  laboratory  and  treated  a  number  of 
guinea  pigs,  all  with  negative  results. 

These  experiments  are  given  in  detail  and 
it  does  not  appear  that  the  degree  of  tuber- 
culosis or  its  course  was  in  any  way  modi- 
fied by  the  injection  of  this  serum  ;  the  con- 
trol animals  showing  no  greater  progress  in 
the  disease  than  did  those  which  were 
treated. 

Full  directions  are  given  for  the  use  of 
the  Watery  Extract,  the  beginning  dose  be- 
ing 10-1000  of  a  milligram,  and  this  is  grad- 
ually increased  to  5  milligrams.  There  are 
three  solutions.  No.  1  containing  1-100  of 
one  per  cent.  No.  2  i-ioof  one  per  cent., 
and  No.  100  containing  1  per  cent,  of  the 
anhydrous  extracts. 


Edema  in  Bright's  Disease. 

Reic'iel,  according  to  the  University 
Medical  Magazine,  states  that  several  years 
ago  he  expressed  the  opinion  that  impaired 
functional  activity  of  the  kidney  led  to  a 
physical  alteration  in  the  tissues,  owing  to 
the  retention  of  toxic  substances  in  the 
blood;  this  produces  the  edema,  and  also 
cardiac  hypertrophy,  as  a  result  of  the  in- 
creased arterial  tension.  Reichel  has  un- 
dertaken a  series  of  experiments  to  support 
this  view.  He  has  compared  the  power  of 
absorption  in  renal  patients  with  that  in 
patients  with  cardiac  disease,  as  well  as 
with  that  in  healthy  subjects.  After  the 
injection  of  fifty  cubic  centimeters  of  saline 
solution  in  these  cases,  he  found  that  ab- 
sorption occupied  a  much  longer  time  (some- 
times eight  or  ten  days)  in  renal  patients. 
The  normal  transudation  and  resorption  of 
the  tissue  fluids  depends  on  metabolism  and 
the  functional  activity  of  the  kidneys. 
Reichel  claims  that  the  dropsy  of  renal  dis- 
ease is  due  to  an  alteration  in  the  power  of 
absorption. 


Sanmetto    in   Imitations. 

I  have  used  Sanmetto  extensively  for  the 
last  five  or  six  years  in  both  old  and  young, 
male  and  female,  in  all  forms  of  irritation 
of  the  urinary  organs,  from  nocturnal 
enuresis  in  the  young  to  cystitis  in  the 
aged,  and  have  been  disappointed  in  but 
few  cases  in  obtaining  good  results.  Have 
tried  imitations  (owing  to  their  cheapness). 
The  results  were  unsatisfactory.  Have  re- 
turned to  the  use  of  Sanmetto  as  a  sheet 
anchor  in  both  acute  and  chronic  conditions 
of  the  urinary  tract.  I  obtained  speedier 
and  more  satisfactory  results  when  given 
four  times  a  day  in  drachm  doses  in  hot 
water. 

T.  B.  Gullefkr,  M.  D. 

Greensburg,  Ind.  Coroner. 


Maltine. 

Extract  from  a  lecture  delivered  at  the 
Michigan  College  of  Medicine  and  Surgery, 
By  Dr.  J.  F.  Bennett, Professor  of  Dietetics. 

Maltine  is  a  pure  extract  of  malted  barley, 
wheat  and  oats  (instead  of  being  made 
from  only  one  of  the  cereals),  containing 
all  of  the  nutritive  properties  of  these  three 
grains,  in  addition  to  the  valuable  digestive 
agents,  diastase.  You  will  find  it  parti- 
cularly valuable  where  you  wish  to  get  a 
bone-producing  and  fat-making  substance 
combined  with  the  digestive  agent  diastase. 
I  use  it  daily  in  my  practice,  both  alone 
and  with  the  various  tonics  and  reconstruc- 
tives  with  which  it  is  combined,  with  very 
satisfactory  results. 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


479 


THE  BEST  PREPARED  FOOD. 


-For  THE  BABY.* THE  INVALID,*THE  CONVALESCENTS E  AGED. if 


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Gray's  Glycerine  Tonic. 

Charles  15.  White,  M.  I).,  m7  West  72c! 
Street,  New  York, Visiting  Physician,  Har- 
lem Hospital,  says  :  I  have  used  Gray's 
Glycerine  Tonic  in  cases  of  so-called  nerv- 
ous debility,  following  grippe  or  tonsilitis. 
It  has  acted  particularly  well  in  cases  where 
an  inactive  liver  prevented  the  use  of  cod 
liver  oil  or  cream.  Patients  who  coidd  not 
take  either  having  no  trouble  in  digesting 
the  Tonic  and  improving  rapidly  while  un- 
der its  use.  In  anaemic  cases  have  combin- 
ed small  proportion  of  the  peptonate  of  iron 
with  excellent  results.  For  the  ordinary 
cough  with  a  dry  throat  have  found  it  very 
useful  in  teaspoonful  doses  during  the  day, 
or  combined  with  five  or  ten  drops  of  spir- 
its of  chloroform  to  quiet  the  tickling  and 
allow  the  patient  to  sleep  at  night. 

Case  I.  Male,  aged  30,  formerly  addict- 
ed to  alcoholic  stimulants  and  a  year  ago 
confined  for  a  short  time  as  a  suspected  case 
<>l  paresis,  due  to  over-indulgence  in  bro- 
mide, consulted  me  for  the  nervous  depres- 
sion following  the  use  of  morphine  taken 
to  relieve,  while  traveling,  the  pain  of  a 
fractured  wrist.  He  was  unable  to  sleep, 
had  lost  his  desire  for  food,  and  complained 
ot  an  uncertain  feeling  in  the  head  that  pre- 


vented his  attending  to  his  business  or  think- 
ing connectedly  on  any  subject.  Occasional 
doses  of  sulfonal  at  night  relieved  the  in- 
somnia, and  for  some  days  hypodermics  of 
strychnia  were  required,  after  which  he 
went  on  to  complete  recovery  under  the 
Glycerine  Tonic,  which  improved  his  appe- 
tite and  increased  his  weight. 

Case  II.  Child,  aged  eight,  growing  rap- 
idly, brought  to  me  with  the  history  of  a 
cough  lasting  several  weeks,  found  on  ex- 
amination bronchial  respiration  over  both 
lungs,  more  marked  on  right  side,  where 
there  were  also  piping  niles,  and  over  all 
prolonged  expiration.  The  child  was  list- 
less, no  fever,  pulse  120.  Under  the  use  of 
the  Gray's  Tonic,  given  every  three  hours, 
her  cough  has  ceased,  respiration  has  be- 
come normal,  appetite  improved,  and  she 
feels  and  acts  perfectly  well. 

Caies  III  and  IV  were  typhoid  fever  with 
very  slow  convalescence  and  occasionally 
rises  of  temperature  of  a  degree  above  nor- 
mal in  the  evening.  One  of  the  patients,  a 
young  lady,  had  had  several  severe  hemor- 
rhages. The  other  one  was  fifty  years  of 
age.  Two  teaspoonfuls  of  the  Tonic  were 
given  three  times  a  day,  and  both  patients 
made  rapid  recoveries. 


480 


THE  CHARLOTTE  MEDICAL  JOURNAL 


Diuretin. 

Dr.  Dreschfeld  read  a  paper  on  Diuretin 
at  the  fifth  meeting  of  the  Manchester 
(England)  Therapeutical  Society. 

After  referring  to  the  experimental  re- 
sults and  clinical  experiences  of  this  drug 
recorded  by  some  continental  observers  Dr. 
Dreschfeld  stated  that  he  had  employed 
Diuretin  in  many  cases  during  the  past 
eight  years,  and  he  considered  it  a  valuable 
remedial  agent.  He  had  found  it  act  well 
in  acute  Bright's  disease,  especially  in  cases 
in  which  the  urine  was  scanty.  He  had 
frequently  seen  the  urine  increase  in  amount 
from  12  or  15  to  80  or  100  oz.  in  the  twenty- 
four  hours.  In  post-scarlatinal  nephritis 
the  drug  did  not  seem  to  give  such  good  re- 
sults. In  chronic  parenchymatous  nephritis 
he  had  found  it  act  when  digitalis  and 
other  drugs  had  not  succeeded,  but  the 
effects  were  only  temporary.  There  was 
no  definite  reduction  of  the  amount  of 
albumin.  On  the  other  hand,  there  was  no 
evidence  of  irritating  action.  In  inter- 
stitial nephritis  the  results  had  been  disap- 
pointing and  in  these  cases  toxic  effects 
were  more  liable  to  occur.  As  regards  its 
use  in  heart  disease  Dr.  Dreschfeld  had 
found  Diuretin  of  great  value  in  cases  of 
mitral  diseases,  especially  when  the  dropsi- 
cal symptoms  had  come  on  suddenly.  In 
aortic  disease  the  results  had  not  been  so 
satisfactory :  there  was  no  relief  to  the 
anginal  symptoms,  no  great  diuresis,  and 
the  drug  was  not  always  well  borne.  In 
simple  dilatation  without  valvular  lesion 
where  digitalis  had  failed  diuretin  had 
sometimes  succeeded.  In  cirrhosis  of  the 
liver  the  effects  of  diuretin  were  sometimes 
startling.  He  had  seen  diuresis  amounting 
to  four  or  five  quarts  of  urine  in  the  twenty- 
four  hours.  The  cases  which  seemed  to 
respond  best  to  diuretin  were  those  in  which 
dropsy  had  developed  suddenly.  In  older 
people  with  ascites  coming  on  gradually 
diuretin  had  failed.  In  two  cases  of  pleur- 
itic effusion  Dr.  Dreschfeld  had  observed 
rapid  recovery  under  the  use  of  diuretin, 
but  in  other  cases  no  marked  effect  was 
observed.  In  cases  of  peritonitis  no  relief 
had  been  obtained ;  he  had  not  tried  the 
drug  in  pericarditis  and  did  not  think  it 
likely  to  be  of  much  use.  Dr.  Dreschfeld 
considered  diuretin  to  be  a  useful  and 
powerful  diuretic,  acting  probably  on  the 
epithelium  of  the  convoluted  tubules  of  the 
kidney.  He  gives  it  in  from  10  to  12  gr. 
doses  three  times  a  day  at  first,  increasing 
to  30  gr.  doses  if  necessary.  As  regards  its 
ill-effects,  sometimes  Diuretin  is  not  well 
borne,  producing  nausea,  vomiting,  and 
occasionally  signs  of  collapse.     Often  when 


diuretin  alone  does  not  answer  it  succeeds 
on  combining  it  with  digitalis. 

In  the  discussion  which  followed,  the 
Secretary  of  the  Society  on  behalf  of  Dr. 
Steell,  showed  a  series  of  charts  illustrating 
the  Diuretic  Effect  of  Diuretin  in  cases  of 
aortic  disease,  mitral  disease,  functional 
heart-  disease,  cirrhosis  of  the  liver,  and 
pleurisy.  One  of  the  charts  showed  a 
marked  diuretic  effect  obtained  three  times 
in  succession  in  the  same  patient.  Dr. 
Steell  gives  diuretin  in  2  gr.  doses  every 
hour  day  and  night.  In  two  cases  of 
Bright's  disease  he  had  observed  haematuria 
following  the  use  of  diuretin  and  had  not 
employed  the  drug  in  such  cases  since. 

Dr.  J.  Dixon  Mann,  the  President  of  the. 
Society,  had  observed  similar  results  to 
those  described  by  Dr.  Dreschfeld,  but  he  • 
had  obtained  no  good  effects  in  cases  of 
large  white  kidney.  In  heart  cases  he  had  I 
found  diuretin  very  useful.  In  cirrhosis 
of  the  liver  he  had  observed  little  result, 
perhaps  because  the  cases  were  of  more 
gradual  onset.  He  had  found  theobromine 
alone  very  useful  and  suggested  that  theo- 
bromine in  some  soluble  form  might  be 
more  advantageous  ihan  diuretin,  which 
was  sometimes  depressing  owing  to  the 
salicylate  of  sodium  which  it  contained. — 
London  Lancet . 


Is  Eczema  a  Parasitic  Disease  ? 

Torok  in  a  critical  study  of  the  monograph 
upon  eczema, recently  published  by  Leredde, 
concludes  as  follows  :  (University  Medical 
Magazine).  In  the  consideration  of  eczema, 
in  order  to  avoid  confusion,  it  is  always 
necessary  to  employ  the  terms  used  in  the 
same  sense  as  the  authors  cited.  The  im- 
petiginoid  lesion,  which  Unna  calls  true 
vesicular  eczema  or  eczema  from  inocula- 
tion, is  not  an  eczematous  lesion,  but  a 
lesion  belonging  to  impetigo.  Consequently, 
if  one  succeeded  in  demonstrating  that  the 
morococcus,  which  Unna  claims  is  the  true 
cause  of  eczema,  is  a  well-individualized 
coccus,  and  that  it  is  the  cause  of  the  above- 
mentioned  impetiginoid  lesion,  one  would 
not  yet  have  proved  that  it  is  the  cause  of 
common  vesicular  eczema.  And  this  so 
much  the  less  since  the  vesicles  of  ordinary 
eczema  contain  but  rarely  morococci.  The 
presence  of  morococci  in  the  scales  of 
chronic  eczema  only  proves  the  saprophytic 
— not  the  parasitic — role  of  these  organisms. 
The  clinical  facts  invoked  in  favor  of  the 
parasitic  theory  admit  of  other  interpreta- 
tions ;  and  there  is  not,  so  far,  a  single 
established  fact  in  favor  of  the  parasitic 
nature  of  eczema. 


THE  CHARLOTTE  MEDICAL  JOURNAL, 


Always  Reliable.  No  Detrimental  After  Effects 

It  has  been   proven   by  clinical   tests  that   Neurosilie    is   the   most   effective   and 

safest  hypnotic  yet  known  to  the  profession,  and  whereas  it  contains  no  Mor- 
phine, Chloral  or  Opium,  there  can  be  no  detrimental  after-effects.  Always  of 
the  same  consistency,  therefore  may  be  relied  upon  to  produce  the  same  results  under 
similar  conditions.  It  is  only  necessary  for  Physicians  to  give  NEUROSINE  a  trial 
and  they  will  be  convinced  that  it  is  THE  STANDARD  REMEDY  in  the  treat- 
ment of  all  forms  of  nervous  disturbances.  In  uterine  troubles  it  should  be  combined 
with   Dioviburnia-      Beware  of  substitution.      When  prescribing,  signify  (Dios.)  ] 

Dose  :   One  teaspoonful  to  a  tablespoonful  three  or  more  times  a  day,  as  indicated. 

Our  new  illustrated  booklet  "Treatise  on  Neurasthenia"  mailed  en  application. 

DIOS  CHEMICAL  COMPANY. 

St.    Louis,   Ho.,    U.   S.   A. 


IMPROVED    McDANNOLD 

Surgical  -  and  -  Gynecological  -  Chair. 

SIMPLE,    STRONG,    ORNAMENTAL. 

In  the  McDANNOLD  Surgical  and  Gynascological  Chair  we  have 
endeavored  to  combine  all  the  elements  necessary  to  the  successful 
examination  and  treatment  of  surgical,  gynecological  and  rectal 
diseases,  besides  its  value  as  a  general  utility  chair,  for  examination 
of  the  eye,  ear,  nose,  throat,  chest,  abdomen,  and  many  other  uses 
that  will  suggest  themselves  to  the  practical  physician. 

PRACTICALLY  INDESTRUCTIBLE, 


The  motions  of  this  Chair  are  universal,  including  the  Ro- 
tary motion,  and  there  are  no  complicated  mechanism,  noisy 
or  intricate  fastenings.  One  important  feature  is  the  universal 
head  rest  which  can  be  put  to  any  position  with  a  single  set 
screw. 

Send  for  catalogue  and  prices  of  this  Improved  Chair. 
Manufactured  by 


1416  Sarah  Street. 


ST 


LOUIS.  MO. 


Animal  and  Vegetable  Ferments. 
Dr.  A.  E.  Austin  (Boston  Medical  and 
Surgical  Journal,  No.  23,  1S98).  Taka- 
diastase  possesses  a  greater  power  of  con- 
verting starches,  in  proportion  to  its  weight, 
than  does  saliva  or  pancreatin,  though  per- 
haps the  test  was  not  fair  to  saliva,  as  the 
amount,  one  cubic  centimetre,  was  arbi- 
trarily taken  as  an  equivalent  to  one-tenth 
gram  pancreatin  and  taka-diastase ;  since, 
however,  only  five  and  one-half  parts  per 
thousand  of  saliva  are  solid,  5.5  milligrams 
are  compared  with  one  hundred  milligrams. 
All  of  ,  these  digestants  are  practically 
nullified  in  an  acidity  equivalent  to  that   of 


gastric  juice,  so  that  practically  no  diges- 
tion can  take  place  in  the  stomach  from  any 
of  these  digestants.  These  digestants  are 
not  destroyed  by  the  acidity  of  the  gastric 
juice  and  there  is  no  practical  reason  why 
their  activity  should  not  go  on  after  they 
have  passed  into  the  intestines  and  alkalin- 
ity is  re-established.  Taka-diastase  appa- 
rently carries  the  process  of  amylaceous 
digestion  a  step  farther  than  the  other  two, 
forming  dextrose  instead  of  maltose.  In 
how  far  this  is  of  value  we  cannot  say  until 
we  know  more  about  the  condition  attend- 
ing the  secretion  of  succus  entericus,  which 
contains  the  major  part  of  the  invertin,and 
whether  it  is  ever  absent. 


482 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


Caution  in  the  Use  of   Proprietary 
Remedies. 

However  great  the  opposition  on  the  part 
of  manv  members  of  the  medical  profession 
to  the  employment  of  proprietary  prepara- 
tions, most  physicians  realize  that  justice 
to  their  patients  as  well  as  to  themselves 
demands  the  use  of  such  remedies.  Such 
proprietary  preparations  do  not,  of  course, 
include  the  secret  nostrums,  which  no  self- 
respecting  physician  will  employ.  The  fact 
cannot  be  disputed  that  firms  backed  by 
abundant  capital  and  employing  skilled 
chemists,  pharmacists,  and  even  physiolo- 
gists, are  in  a  better  position  to  discover 
new  and  valuable  remedies  than  are  private 
individuals  without  capital,  system,  or 
equipment.  Nor  can  such  firms  be  expect- 
ed, after  the  expense  and  time  involved  in 
their  labors,  to  make  public  the  exact  meth- 
ods employed  by  them  in  the  manufacture 
of  their  products.  The  medical  profession 
demands  that  the  composition  of  such  rem- 
edies shall  be  known,  and,  this  much  being 
told,  we  cannot  refuse  to  employ  a  remedy 
because  the  precise  mode  of  making  it  is 
not  divulged,  any  more  than  we  would  be 
justified  in  looking  with  suspicion  upon  the 
natural  organic  substances  of  the  pharma- 
copoeia, because  we  are  ignorant  of  the 
manner  in  which  the  elements  composing 
them  have  been  brought  together  and  com- 
bined in  the  laboratory  of  nature.  The 
honesty  of  the  manufacturing  chemist  must, 
however,  be  beyond  question,  for  this  is  our 
only  guarantee  that  the  preparation  which 
we  prescribe  to-day  is  the  same  as  that 
which  was  used  in  the  investigations  that 
have  given  the  remedy  its  standing.  More- 
over, in  order  to  obtain  similar  results  to 
those  of  the  original  investigators,  it  is  ab- 
solutely essential  that  the  same  product  be 
employed,  and  not  one  which  in  name  is  a 
palpable  imitation  of  some  really  meritori- 
ous preparation.  The  imitation  may  in 
truth  be  "just  as  good,"  but  it  must  be 
proved  to  be  so  by  actual  tests,  precisely  as 
in  the  case  of  the  original,  and  not  by  as- 
suming that  what  was  demonstrated  regard- 
ing the  original  is  true  of  the  imitation  un- 
less absolute  identity  of  composition  can  be 
shown. 

Whenever  a  preparation  of  value  is  per- 
fected by  the  enterprise  and  patient  inves- 
tigation of  any  manufacturing  chemist, 
there  immediately  appear  upon  the  market 
a  score  of  imitations,  the  manufacturers  of 
which  have  expended  upon  their  product 
a  minimum  of  time,  capital,  and  brains.  To 
trade  thus  upon  the  reputation  of  an  estab- 
lished remedy  by  similarity  of  name  is  cul- 


pable enough,  but  to  go  further  and  appro- 
priate for  the  imitation  the  literature  of  the 
original,  making  it  appear  that  certain  in- 
vestigations which  have  proved  the  value  of 
a  given  remedy  apply  not  to  this  particular 
product,  but  to  the  crude  ingredients  -which 
it  contains,  regardless  of  the  special  man- 
ner in  which  they  are  combined,  is  a  form 
of  imposition  which  should  not  be  tolerated. 
Yet  just  such  a  case  has  recently  appeared, 
and  it  so  emphasizes  this  point  that  we  re- 
fer to  it  specifically,  even  at  the  risk  of  ! 
having  it  appear  that  the  foregoing  remarks 
are  intended  merely  to  lead  up  to  an  adver- 
tisement of  this  preparation.  No  proprie- 
tary preparation  in  recent  years  has  attain- 
ed greater  or  better  deserved  popularity 
than  Glide's  pepto-mangan,  nor  has  any 
been  handled  in  a  more  ethical  manner. 
The  natural  consequence  has  been  that  in- 
numerable preparations  in  imitation  of  this 
product  have  been  placed  on  the  market, 
all  with  more  or  less  similarity  of  name, 
and  all  clearly  intended  to  be  sold  on  the 
merits  of  the  original.  The  last  of  these  is 
put  up  by  a  house  whose  circular  quotes 
many  physicians  as  attesting  the  therapeu- 
tic value  of  peptone  combined  with  iron 
and  manganese.  As  a  matter  of  fact  nearly 
all  the  authorities  thus  quoted  stated  spe- 
cifically in  their  reports  that  their  observa- 
tions were  carried  on  with  pepto-mangan. 
The  agents  of  Dr.  Gude's  preparation  in 
this  country  have  since  received  from  most 
of  the  physicians  whose  statements  were 
thus  perverted  written  assurance  to  the  ef- 
fect that  this  is  the  case,  and  that  they  re- 
gard as  gross  injustice  to  themselves  any  at- 
tempt to  make  their  statements  apply  to 
another  iron  and  manganese  preparation 
which  they  have  never  used. 

Occurrences  similar  to  the  above  are  not 
infrequent,  and  the  profession  can  protect 
itself  against  such  impositions  only  by  hold- 
ing fast  to  the  remedies  whose  value  has 
been  proved,  not  obstinately  refusing  to 
consider  the  claims  of  new  preparations 
along  the  same  line,  but  demanding  that 
these  latter  shall  go  solely  on  their  own 
merits,  as  shewn  by  tests  applied  to  them, 
and  not  assuming  that  the  imitation  pos- 
sesses all  the  virtues  of  the  original. 


Dr.  L.  E.  Schell,  Assistant  to  Chair  of 
Physiology,  Detroit  College  of  Medicines, 
and  Surgeon  to  the  Polyclinic,  Harper 
Hospital  Detroit,  Mich.,  speaks  highly  of 
the  diastasic  properties  of  Maltine.  Clinic- 
ally he  finds  that  the  efficacy  of  the  diastase 
is  neither  retarded  nor  impaired  by  the 
addition  of  an  acid.  One  of  his  favorite 
prescriptions  in  certain  indications  is  HCI 
in  combination  with  Maltine. 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


483 


The  "Allenburys"  Throat  Pastilles 


THESE  PASTILLES  have  now  for  many  years  been 
widely  employed,  and  with  the  best  results,  by  the  leading 
Throat  specialists  and  physicians  generally*  Long  expe- 
rience has  shown  the  following  kinds  to  be  the  more  gen- 
erally useful  and  frequently  prescribed: 


No 


Ho 

3. 

No 

9. 

No. 

10. 

No 

11. 

No 

IS. 

No 

14. 

No 

17. 

No 

82. 

No 

23. 

No. 

24. 

No 

24a 

Mo 

'.'!!. 

No 

27. 

No 

38, 

Ipecacuanha.     Readily  taken  by  children.   These  I 
Pastilles  are  of  the  same  strength  as  the  Lozen- 
ges of  the  Britisn  Pharmacopoeia. 

Morphia  and  Ipecacuanha.  (l-40th  grain  Morphia 
and  !4  grain  Ipecacuanha). 

Menthol,  Cocaine  and  Red  Gum.  (Menthol  and 
Cocaine,  aa.  gr.  l-20th  ;  Red  Gum,  gr.  ii). 

Benzoated  Voice.     Useful  to  public  speakers, etc. 

Chlorate  of  Potash.  A  more  agreeable  form 
than  the  Lozenge  of  the  Pharmacopoeia. 

Rhatany.     Astringent. 

Tannin.  Astringent,  and  of  the  same  strength  as 
the  Tannic  Acid  Lozenges  of  the  British  Phar- 
macopoeia. 

Chlorate  op  Potash  and  Borax.  Containing 
these  two  useful  remedies   in   combination. 

Red  Gum.    Astringent. 

Eucalyptus  (Gum  and  Oil).  Antiseptic,  stimu- 
lant, and  astringent. 

Cocaine.  (l-'_'0th  grain).  Sedative  to  the  mucous 
membrane. 

Cocaine.     (l-10th  grain). 

Codeine.     (l-8th  grain  Codeine).     Sedative. 

COMPOUND  EUOAXYPTUB.  (Red  Gum,  Chlorate  of 
Potash,  and  Cubebs). 

Compound  Guaiactj 


latany 


No.  29.  Compound  Rhatany  and  Cocaine.  (Ext. 
gr.  ii;  Cocaine  Hydroehlor.,  gr.  l-10th). 
efficacious  astringent  aud  anodyne. 

No.  32.    Red  Gum  and  Chlorate  op  Potash.   Astringent 

No.  38.  CHLORATE  of  Potash,  Borax,  and  Cocaine.  (■> 
grains  Chlorate  of  Potash.  1  grain  Borax,  l-20th 
grain  Cocaine). 

No.  41.     Eucalyptus  Oil.     Antiseptic  and  stimulant. 

No.  43.     Menthol.    (1-20  grain).  Stimulant  and  antiseptic 

No.  43a.  Menthol.     (110th  grain). 

No.  44.  Menthol  and  Cocaine.  (l-20th  grain  Menthol  and 
l-20th  gram  Cocaine  in  each).  Stimulant,  anti- 
septic, and  sedative. 

No.  45.  Menthol  and  Rhatany.  (Menthol,  l-20th  grain- 
Extract  of  Rhatany,  2  grains).  Antiseptic,  stimu- 
lant and  astringent. 

No.  48.  Tannin,  Cayenne,  and  Black  Currant.  Astrin- 
gent, stimulant,  and  soothing. 

No.  52.  Tannin  and  Black  Currant.  Astringent  and 
soothing. 

No.  54.    Menthol  and  Eucalyptus  Oil. 


(Guaiacum,    Chlorate  of 
Potash,  and  Red  Gum). 

The  "Allenburys"  Throal  Pastilles  are  sold  in  decorated  tin  boxes,  at  30  cents  retai 
Sent  on  receipt  of  price  to  any  address,  postpaid. 

ALLEN  &  HANBURYS,  LTD.,  (LONDON,  ENG.) 

U.  S.  Branch:  82  Warren  Street,  New  York. 

Agent  for  Canada  W.   Lloyd  Wood,  Toronto. 


Epileptic  Insanity. 

J.  II.  MeBride  (Southern  California  Prac- 
titioner. December,  [899,)  discusses  this 
subject  as  follows  : 

All  forms  or  varieties  of  epilepsy  are 
liable  to  lead  to  insanity. 

Nocturnal  epilepsy  and  mental  or  cerebral 
epilepsy  produce  more  rapid  mental  dete- 
rioration than  other  varieties. 

Epileptic  insanity  may  precede,  take  the 
place  of,  or  follow  a  fit. 

It  may  be  a  quiet  type  of  insanity  or  t  he 
most  violent  mania. 

The  mania  may  occur  only  once  in  the 
course  of  the  life  of  an  epileptic  who  has 
the  disease  from  childhood. 

Epileptic  insanity  is  a  most  dangerous 
form  of  mental  disorder,  as  the  subjects  of 
it  are    suspicious,  irritable,   and   impulsive, 


g   conspicuously  weakened   in  self-con- 


be  in 
trol 

A  condition  of  mental  automatism  may 
follow  an  epileptic  lit  and  may  last  for  days, 
during  which  a  person  may  transact  busi- 
ness or  buy  a  ticket  and  travel  long  dis- 
tances, converse  intelligently,  an'd  yet  after- 
wards have  no  recollection  of  anything  that 
occurred  during  the  period. 

Epileptic  attacks  may  occur  during  sleep 


and  not  at  any  time  or  rarely  during  the 
waking  state,  and  this  nocturnal  epilepsy  is 
apt  to  be  associated  with  violence  and  ulti- 
mate mental  weakness. 

Insanity  is  rather  more  liable  to  be  asso- 
ciated with  mild  fits  than  with  those  in 
which  the  convulsions  are  violent. 

Habitual  epilepsy,  if  continued  over  a 
period  of  years,  produces  mental  failure  in 
some  degree  in  all  cases.  Those  who  have 
a  fit  at  long  intervals,  say  once  a  year,  do 
not,  of  course,  come  under  the  designation 
of  habitual  epileptics  as  the  term  is  used 
here. 


Acute  Coryza. 

In  this  unpleasant  affection  the  action  of 
Blennostasine  is  "magical."  It  arrests  the 
sneezing  and  mucous  discharge  without 
producing  serious  after  effects.  Its  superi- 
ority over  quinine  lies  in  the  fact  that  it  is 
a  vaso-motor  constrictor.  Blennostasine  is 
superior  to  belladonna,  atropine,  &c,  as  a 
blennostatic,  is  non-toxic,  and  can  conse- 
quently be  given  in  large  doses  if  necessary 
without  fear  of  after  effects.  It  exerts  a 
tonic  effect  on  the  vocal  mechanism,  and  is 
especially  valuable  in  colds  of  public  speak- 
ers and  singers. 


484 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


Ocular  Troubles  in  Diabetes. 

Dianoux  (Annales  d'Oculistique,  October 
1898)  gives  the  impressions  which  23  years 
of  practice  have  left  :  ( 1 )  As  regards  the 
lens  loss  of  transparency  may  occur,  leading 
surely  to  cataract,  soft  or  hard,  according 
to  the  patient's  age;  he  has  not  noticed  va- 
riations in  vision  consentaneously  with  the 
evolution  of  the  diabetes.  The  soft  cataract 
develops  exclusively  in  young  people  attack- 
ed with  acute  or  pancreatic  diabetes,  and 
become  complete  in  a  few  months.  Rapid 
cataract  in  an  abdolescent  should  make  us 
suspect  diabetes.  The  grave  form  of  dia- 
betes has  not  the  same  action  on  the  lens  in 
the  adult,  in  his  experience  ;  and  he  is 
doubtful  whether  in  the  chronic  form  cata- 
ract is  of  more  frequent  occurrence  than  in 
elderly  people  who  are  not  diabetic.  For 
senile  cataract  in  the  diabetic  operation  may 
be  perfectly  successful ;  whereas  operation 
for  diabetic  soft  cataract  is  frequently  fol- 
lowed seven  or  eight  days  later  by  pulmo- 
nary apoplexy  and  death  ;  and  in  any  case 
the  patient  rarely  survives  twelve  or  fifteen 
months.  (2)  Vascular  lesions;  retinal  hem- 
orrhages in  diabetes  are  found  exclusively 
in  old  people ;  the  fact  of  their  non-occur- 
rence in  the  young  makes  him  doubt  their 
direct  dependence  on  the  diabetes  ;  he  would 
rather  attribute  them  to  arterio-sclerosis. 
By  direct  examination  the  hemorrhages  are 
seen  to  proceed  from  small  veins  or  capilla- 
ries ;  he  has  never  seen  one  originating  from 
an  artery.  The  blood  is  absorbed  in  the 
course  of  some  months,  and  vision  may  be- 
come normal  again.  But  prognosis  is  bad  ; 
a  fatal  issue  from  cerebral  softening  is  ever 
imminent,  though  health  may  be  maintain- 
ed for  years.  Albuminuric  retinitis  may  be 
associated  with  diabetic  changes.  (3)  Cen- 
tral scotoma  :  the  principal  symptom  is  pro- 
gressive failure  of  central  vision,  particu- 
larly for  reading  ;  with  the  loss  of  form  vis- 
ion goes  loss  of  colour  vision.  As  diabetics 
are  often  alcoholic  and  indulge  in  smo- 
king it  is  often  difficult  to  attribute  the 
scotoma  to  the  one  factor ;  but  Dianoux 
had  seen  central  scotoma  in  women  and 
young  people  who  did  not  take  alcohol,  but 
who  passed  large  quantities  of  sugar.  Un- 
like alcoholic  and  tobacco  scotoma,  diabetic 
scotoma  never  disappears. 


Iodia. 

Case  I. — M.  S.,  fifty-two  yearsofage, 
male,  was  some  years  afflicted  with  an 
obstinate  form  of  erythema,  probably  of 
specific  origin,  which  heretofore  had  re- 
sisted the  usual  constitutional  and  local 
treatments.  The  itching  of  the  eruption 
was  intolerable,  the  anemia  very  pronounc- 
ed— the  whole  constitution  run  down.      Six 


weeks  medication  with  Iodia,  supplemented 
by  extract  of  malt  and  cod-liver  oil,  brought 
the  case  under  control.  I  attribute  the 
good  effect  of  Iodia  in  this,  as  in  other  cases, 
not  so  much  to  its  mineral  ingredients 
(potass,  iodide  and  ferri  phosphate)  as  to 
their  combination  with  the  fresh  principles 
of  vegetable  alteratives.  I,  for  my  part, 
believe  that  only  the  extracts  of  the  green 
or  fresh  plants  are  reliable  for  therapeutic 
effects,  the  common  fluid  extracts  of  the 
dried  plants  having  proven  mostly  inert  in 
my  hands. 

Case  II. — R.  W.,  aet.  38;  female;  pre- 
sented glandular  enlargements  complicated 
with  functional  disorders  (dysmenorrhoea). 
The  persistent  administration  of  Iodia 
brought  marked  improvement  and  patient 
is  on  a  fair  way  to  recovery. 

Case  III. — J.  P.,  male;  aet.    60;    blood-  j 
poisoning   with  chemicals  used  for   dying, 
manifesting   itself  in  a  rupia-like  erpution 
and  general   malaise,     Iodia   promptly  eli-  , 
initiated  the  morbid  matter. 

Allegheney,  Pa.         A.  Ziegler,  M.  D. 

An  Excellent  Uric  Acid  Solvent. 

Individuals  with  a  marked  uric  acid  dia- 
thesis,  who  exhibit  the  various  symptoms 
produced  by  this  effete  product  of  disturbed 
metabolism,  are  promptly  benefitted  by  the 
use  of  Tongaline  and  Lithia  Tablets  and  j 
eventually  cured. 

The  high  colored  urine  which  deposits  a 
thick,  reddish  sediment  is  soon  restored  to 
a  normal  light  color;  the  urinous  odor  of 
the  breath  and  the  hyperacidity  of  the  sys- 
tem are  no  longer  manifested.  The  urinary 
canal  recovers  tone  and  all  traces  of  irrita-' 
tion  then  disappear. 

In  a  word,  as  a  uric  acid  solvent  Tonga- 1 
line  and  Lithia  Tablets  are  unexcelled,  a 
conclusion  which  is  not  the  result  of  expe- 
riments in  vitro  but  of  actual  experience. 

Samples  of  Tongaline  and  Lithia  Tablets 
can  be  obtained  by  applying  to  Mellier, 
Drug  Company,  2 112  Locust  St.,  St.  Louis,  i 

Grip  and  Its  Allies 

The  prevalence  of  grip  and  pulmonary 
troubles  leade  us  to  call  special  attintion  to 
the  value  of  Blennoetasine  in  treating  these 
affections.  When  this  remedy  is  given  in! 
the  earliet  stages  of  grip,  the  artack  is; 
usually  absorbed ,  and  in  any  case  it  is 
duration  is  cut  remarkably  short.  Blen-, 
nostatine  relieves  the  excessive  mucous 
discharge  in  a  few  hours,  and  also  the; 
headache  which  frequently  accomdanies 
colds  of  the  influenzal  type.  Its  antifebrile; 
action  is  particularly  valuable  in  severe 
cases  of  grip,  and  its  free  from  the  toxic: 
character  of  belladonna  and  the  synthetic 
drugs. 


THE  CHARLOTTE  MEDICAL  JOURNAL.  485 

IT  IS  IMPORTANT 

For  the  dispensing  pharmacist  to  recognize  the  right  of  the  physician 
to  dictate,  not  only  what  remedy  he  shall  use  in  a  given  case,  but  whose 
preparation  he  prefers,  for  the  quality  of  the  medicine  is  often  as  much 
a  factor  in  the  cure  of  disease  as  a  correct  diagnosis. 

Most  druggists  appreciate  this  fact,  some  are  indifferent  to  it, 
A  few  ignore  it,  specification  is  therefore  a  necessity. 

Syrup  Albuminate  of  Iron. 

An  organic  compound  of  Iron,  representing  in  a  purified  and  soluble  form  the  albumin- 
ate and  salts  (phosphates)  present  in  the  blood.  It  contains  0.7  per  cent,  metallic  iron  in  a 
form  readily  absorbed  and  is  very  efficient  in  medicinal  action.  This  combination  of  iron 
approximates  the  natural  forms  in  which  the  metal  is  present  in  the  animal  system,  and 
possesses  a  marked  value  in  anemia  and  chlorotic  neurasthenia  where  prolonged  adminis- 
tration of  iron  is  indicated.  It  is  not  only  free  from  all  tendency  to  cause  digestive  distur- 
bances, but  is  of  positive  value  in  these  conditions  during  convalescence.  One  part  of  this 
syrup  represents  about  fifteen  parts  fresh  bullock's  blood. 

Cordial  Pas=Carnata=Merrell. 

DARTMOUTH  PHARMACY.  "BY  ALL  MEANS  TRY  IT." 

Established  1798. 

L.   B.  DOWNING,  Box  444.  HANOVER,  N.  H.,  July  17,  1895. 

WM.  S.  MEJRRELL  CHEMICAL  CO.: 

Gents: — In  June  I  ordered  your  11.  Ext.  Passion  Flower,  as  an  experiment,  for  a  son  of  12 
Sears,  who  has  made  very  rapid  growth,  and  was  at  the  time  very  nervous,  and  several  physicians 
had  tried  in  vain  to  help  him,  one  an  uncle  in  whose  family  he  staid  for  a  month.  My  wife  hap- 
pened to  see  your  circular  on  Pas-Carnata,  and  on  consulting  the  doctors  who  had  treated  him. 
they  said,  "by  all  moans  try  it." 

The  result  was  truly  marvelous. 

There  was  a  change  for  the  better  in  four  days.  Facial  and  shoulder  muscles  were  twitching 
when  we  commenced  using  it.  In  a  few  days  they  disappeared,  and  on  15  drop  doses  three  times 
a  day  he  keeps  all  right,  apparently. 

I  shall  speak  a  good  word  for  the  medicine,  a>  I  have  already  done.  Will  you  please  send 
me  some  circulars  to  give  to  my  physicians'.-'  Very  truly  yours,  L.  R.  DOWNING. 

NATURAL===from  oil  of  wintergreen. 

TRUE  SALICYLIC  ACID  in  Crystals==Merrell. 
TRUE  SALICYLATE  SODIUM  ^°r^§Ts-Meirell. 

The  investigations  of  Professor  Latham  (Cambridge,  England),  confirmed  by  Drs.  Char- 
tens  and  MacLennon  (University  of  Glasgow),  warn  the  prof ession  against  the  use  of  arti- 
ficial acid  of  commerce  and  its  Sodium  salt. 

They  conclude   thai     i  are  slow,  but  certain  poisons. 

-,  •     l         'i  Produce  symptoms  closely  resembling  delirium  tremens. 

COllllllCrCnil  patients  become  delirious. 

j,     .  .         . .  .       .  -  J  dangerous  to  human  life. 

oallCyllC    ACIU  \  have  to  be  watched  and  not  to  be  trusted. 
VND  ITS  retard  convalescence. 

, .  '     . ,  should  not  be  administered  internally,  however  much  they  may 

SOUlUm    Salt        [         have  been  dialized  or  purified. 

For  internal  use  the  true  Salicylic  acid  and  its  Sodium  salt  should  only  be  dispensed. 


THE  Wm.  S.  MERRELL  CHEMICAL  CO. 

Cincinnati.  New  York,  San  Francisco. 

MERRELI.  products  are  supplied  through  professional  channels  ONLY. 
JOHN  M    SCOTT  &  CO.,  Charlotte,  N.  C, 


48(J 


THE  CHARLOTTE   MEDICAL  JOURNAL. 


A  Curious  Pocket  Piece. 

In  the  New  York  Medical  Journal  of 
February  4th.  1899,  Dr.  William  S.  Gottheil 
describes  a  case  in  which  a  woman  carried 
a  peice  of  her  own  skull  in  her  pocket  for 
years  "for  good  luck."  She  applied  for 
treatment  for  a  different  affection,  and  it 
was  discovered  incidentally  that  a  syphilitic 
periostitis  had  begun  again  around  the  scar 
left  by  the  ulceration  from  which  her  piece 
of  bone  had  come  twelve  years  before.  As 
in  the  present  case,  she  had  not  at  that 
time  attached  sufficient  importance  to  the 
matter  to  consult  a  physician  about  it.  The 
sequestrum,  of  which  she  was  quite  proud, 
was  an  ovoid  piece  of  bone  measuring  2\  x 
2  inches,  and  was  composed  of  two  adjacent 
portions  of  the  two  parietal  bones,  the 
sagittal  suture  in  the  middle  showing 
beautifully.  Its  upper  convex  surface 
showed  the  outer  table  of  the  skull  intact. 
The  under  concave  surface  was  composed 
mostly  of  cancellous  tissue ;  but  all  along 
the  middle  line,  at  the  suture,  the  inner 
table  was  present,  showing  that  at  that 
place  the  entire  thickness  of  the  skull  had 
been  lost. 

Apart  from  its  curiosity,  the  case  is  of 
intrest  as  showing  the  very  extensive  des- 
truction of  important  organs  that  can  take 
place  in  syphilis  without  systemic  reaction 
or  much  personal  inconvenience.  The  en- 
tire thickness  of  the  skull  had  been  destroy- 
ed, and  the  meninges  necessarily  exposed  ; 
yet  the  inflammation  had  not  spread  to 
those  membranes,  and  the  patient  had  hardly 
considered  herself  sick. 


Vapor   Massage. 

Patents  covering  medical  and  surgical 
appliances  were  formerly  looked  upon  with 
much  disfavor  by  the  medical  profession. 
This  rather  narrow  view  has  given  place 
to  a  more  liberal  one  which  recognizes  the 
right  of  the  inventor  to  the  same  protec- 
tion as  is  given  in  a  copy  right  to  the  author 
of  a  medical  book. 

A  very  valuable  invention  of  this  class  is 
the  subject  of  a  recently  issued  U.  S.  patent. 
The  object  of  this  invention  is  to  supply  a 
ready  means  for  the  treatment  of  respiratory 
and  aural  affections  with  compressed  Neb- 
ulized Vapor,  to  which  the  inventor  has 
applied  the  name,  Vapor  Massage. 

The  apparatus,  which  is  manufactured 
by  the  Globe  Manufacturing  Company  of 
Battle  Creek, Michigan, has  been  thoroughly 
tested  by  many  prominent  specialists.  The 
marked  success  which  has  attended  its  use 
has  already  resulted  in  the  appearance  of 
several  imitations  which  are  infringements 
of  the  patent  referred  to  above. 


Intending  purchasers  will  do  well  to 
write  the  Globe  Manufacturing  Company 
for  full  information  before  placing  orders. 


An  Emulsion. 

Dunglison's  Medical  Dictionary  defines 
Emulsions  as  follows:  "Pharmaceutical 
preparations  of  a  milky-white  opaque  ap- 
pearance, composed  of  oil  divided  and  held 
in  suspense  in  water  by  means  of  mucilage. 

Worcester  says  :  "A  medicinal  prepara- 
tion of  milky  appearance  composed  of  a 
fixed  oil  divided  and  held  suspended  in  wa- 
ter by  means  of  mucilage." 

There  seems  to  be  a  very  general  agree- 
ment that  mucilage  is  the  essential  part  of 
oil  emulsions.  When  the  physician  pre- 
scribes an  emulsion  of  fat,  he  attempts  to 
present  fat  to  the  absorbing  vessels  of  the 
bowels  ready  for  immediate  absorption. 
Gum  Arabic  and  Gum  Tragacanth  (the  lat- 
ter is  generally  used,  and  which  is  insoluble 
in  water),  are  not  foods.  But  when  emul- 
sions are  prescribed,  you  are  compelled  to 
give  not  less  than  fifty  per  cent,  of  these 
substances,  which  are  known  to  be  inert, 
and  which  increase  the  difficulties  of  ab- 
sorption. In  an  emulsion  each  oil  globule 
receives  an  envelope  or  coating  of  gum, 
consequently  the  digestive  fluids  are  not 
only  compelled  to  break  up  the  globules 
anew,  but  are  first  compelled,  in  order  to 
reach  the  oil,  to  dissolve  the  envelop  of 
gum. 

Hagee's  Cordial  Cod-liver  Oil  Comp,  is 
not  an  emulsion,  but  an  elegantly  aroma- 
tized cordial  containing  all  the  active  prin- 
ciples of  Cod-liver  Oil  taken  from  Cod- 
liver  Oil,  without  the  grease. 


Vin  Mariani  in   Exhaustion. 

We  have  had  occasion  in  numerous  in- 
stances to  administer  "Vin  Mariani"  to 
business  and  professional  men  who  com- 
plained of  being  gradually  run  down.  The 
work  of  the  office,  the  cares  and  worry  en- 
tailed by  business  and  the  physical  flaccidity 
brought  on  by  overwork,  all  seemed  to  give 
way  completely  in  a  marvelously  short 
space  of  time,  despite  the  fact  that  the  sub- 
jects continued  uninterruptedly  at  their 
usual  occupations.  The  notable  fact  to  be 
observed  is  that  in  each  instance  the  effect 
was  permanent.  But  it  must  not  be  for- 
gotten that,  in  order  to  make  this  result  a 
lasting  one,  it  is  necessary  to  keep  the  pa- 
tient upon  a  prolonged  course  in  the  use  of 
"Vin  Mariani."  There  is  no  doubt  what- 
ever that  this  preparation  has  proven  itself 
a  boon  to  mankind. —  7 he  St.  Louis  Med- 
ical and  Surgical  Journal,  March,    1899. 


THE  CHARLOTTE  MEDICAL  JOURNAL.  487 


HYDROZONE 

30  volumes  preserved  aqueous  solution  of  HuO..) 

TdE  ^lOST    POWERFUL    ANTISEPTIC    AND    PUS    DESTROYER. 
HARMLESS  STIMULANT  TO  HEALTHY  GRANULATIONS. 

GLYCOZONE 

(C.  P.  Clycerine  combined  with  Ozone) 

THE     MOST     POWERFUL    HEALING    AGENT 
KNOWN. 

These  remedies  cure  all  diseases  caused  by  (Terms. 
Successfully  used  iu  the  treatment  of  diseases^  of   the  Genito- 
urinary  Organs   (Acute   or   Chronic) : 

Whites,  Leucorrhoea,  Vaginitis,   Metritis, 

Endometritis,     Ulceration    of    the    Uterus, 

—  Urethritis,  Gonorhsea,  —  Cystitis, 

Ulcer  of  the  Bladder,  etc. 

Injections   of  Hydrozone   diluted   with    water,    (according    to 

the  degree  of  sensitiveness  of  the  patient)  will  cure   the  m--^ 

obstinate  cases. 

Send  for  free  240-page  book  "Treatment  of  Diseases  cai*^d  by 
Germs,"  containing  reprints  ot  1UO  scientific  articles  by  leading 
contributors  to  medical  literature. 

Physicians  remitting  50  oeuts  will  receive  one  complimentary 
sample  of  each,  "Hydr  ozone"  and  "Glycozone"  by  express,  charges 
prepaid. 

Hydrozone  is  put  up  only  iu  extra  Prepared  only  by 

small,  small,  medium,  aud  large  size  bottles, 
bearing  a  red  label,  -white  letters,  gold  and 
blue  border  with  my  signature. 

Glycozone  is  put  up  only  in  4-oz.,  8-oz. 
and  16-oz.   bottles,  bearing  a   yellow  label, 

white  and  black  letters,  red  and  blue  border  «bw. 

with  my  signature.  CAtmut  and  Graduate  of  the  "Ecole 

Marchand's  Eye  Balsam   cures   all  Central*  des  Arts  el  Manufactures  J 

I'llammatory  and  contagious  diseases  of  tho  Paris"  {France). 

»yes. 

*    Charles  Marchand,  28  Prince  St.,  New  YoA 

,d  by  fading  Druggists.  Avoid  L  Stations.  K*~  Mention  this  Publicatto* 


488 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


LISTERINE 


The  Standard  Antiseptic, 


LISTERINE  is  a  non-toxic,  non-irritating  and  non-escharotic  antiseptic,  composed  of  ozonifer 
.ous  essences,  vegetable  antiseptics  and  benzo-boracic  acid. 

LISTERINE  is  sufficiently  powerful  to  make  and  maintain  surgical  cleanliness  in  the  antisepti 
and  prophylactic  treatment  and  care  of  all  parts  of  the  human  body. 

LISTERINE  has  ever  proven  a  trustworthy  antiseptic  dressing  for  operative  or  accidental 
wounds. 

LISTERINE  is  invaluable  in  obstetrics  and  gynecology  as  a  general  cleansing,  prophylactic- 
or  antiseptic  agent,  and  is  an  effective  remedy  in  the  treatment  of  catarrhal  conditions  of 
every  locality. 

LISTERINE  is  useful  in  the  treatment  of  the  infectious  maladies  which  are  attended  by  inflam 
mation  of  accessible  surfaces — as  diphtheria,  scarlet  fever  and  pertussis. 

LISTERINE  is  especially  applicable  to  the  treatment  of  scarlet  fever,  used  freely  as  a  mouth 
wash,  or  by  means  of  the  spray  apparatus. 

LISTERINE  is  extensively  prescribed  in  typhoid  fever,  both  for  its  antiseptic  effect  and  to  im- 
prove the  condition  of  the  stomach  for  the  reception  of  nourishment. 

LISTERINE  agreeably  diluted,  is  prescribed  with  very  good  results,  in  the  treatment  of  diph- 
theria, both  as  a  prophylactic  and  curative — internal  antiseptic — agent. 

LISTERINE  is  used  extensively  with  good  results  in  the  treatment  of  whooping  cough. 

LISTERINE  diluted  with  water  or  glycerine  speedily  relieves  certain  fermentative  forms  of 
indigestion. 

LISTERINE  is  indispensable  for  the  preservation  of  the  teeth,  and  for  maintaining  the  mucous 
membrane  of  the  mouth  in  a  healthy  condition. 

LISTERINE  employed  in  a  sick  room  by  means  of  a  spray,  or  saturated  cloths  hung  about,  is 
actively  ozonifying  and  imparts  an  agreeable  refreshing  odor  to  the  atmosphere. 

LISTERTNE  is  of  accurately  determined  and  uniform  antiseptic  power  and  of  positive  ori 
ginality. 

LISTERINE  is  kept  in  stock  by  the  leading  dealei-s  in  drugs,  everywhere. 


Lambert's  Lithiated  Hydrangea, 


Close  clinical  observation  has 
caused  Lambert's  Lithiated 
Hydrangea  to  be  regarded  by 
Physicians  generally  as  a  very 
valuable  Renal  Alterative 
and  Antilithic  Agent. 


Albuminuria,  Lithaeinia, 

Blight's  Disease,      Nephritis, 
Cystitis,  Rheumatism, 

Diabetes,  Urinary  Calculus, 

Gout,  and  all  forms  of 

Hematuria,  Vesical  Irritation 


For  Descriptive  Literature,  Address 

Lambert  Pharmacal  Co., 


ST.     LOUIS. 


THE  CHARLOTTE   MEDICAL  JOURNAL. 


489 


GONORRHOEA 


COMPOUND 


PHENAZONE     BOUGIES 

Are  a  Specific  for  Gonorrhoea  and  Gleet, 


Long  Size.      6J4  inches  long. 

YOUR  PATIENT  has  trouble  enough  of  his  own  already,  when  he  is  suffering- 
with  Gonorrhea  or  Gleet.  DON'T  MORTIFY  HIM  with  "tell  tale"  bottles  and 
syringes,  but  use  instead  a  system  of  treatment  which  is  practical,  attracts  no  atten- 
tion, and  will  cure  promptly.  The  remedies  used  in  the  Phenazone  Bougies  are  of 
an  astringent,  antiseptic,  alterative  and  anodyne  character,  and,  as  the  Bougios  are 
freely  soluble  in  the  secretions  of  the  urethra,  they  are  thus  brought  into  direct, 
thorough  and  jjrolonyed  action  upou  the  diseased  parts.  No  other  system  of  treatment 
will  do  this  as  promptly  or  as  well. 

FORMULA.— Zinc  Sulphate,  Creosote,   H.vdrasis,   Antipyrin,   etc. 
LONG  SIZE,  for  Gleet  (6J4  inches  long).    SHORT  SIZE,  for  Gonorrhoea  (3  inches  long). 

Price,  per  box  of  12  Bougies.     Retail  $1.25.     Physicians  $1.00 

SAMPLES.— We  will  mail  to  any  Physician  mentioning  The  Charlotte  Medical 
Journal  and  inclosing  25  cts.  (stumps  or  silver),  a  LARGE  Sample  Box  of  Phenazone 
Bougies  sufficient  to  treat  an  ordinary  case  of  ( lonorrhoea  or  Gleet.  Mention  Long  or 
Shott  Size  and  send  order  direct  to  us. 

THE  STANDARD  CHEMICAL  CD.,  Ltd.,  1016  Cherry  Street,  Philadelphia. 

Southern  Agencies. — W.  P.  Poythress,  Richmond, V.     I. L.Lyon  &•  Co.,  New  Orleans. 


CHRONIC  URETHRITIS 


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Quickly  secured.  OUR  FEE  DUE  WHEN  PATENT 
OBTAINED.  Send  model,  sketch  or  photo,  with 
description  for  free  report  as  to  patentabilitv.  48-PAGE 
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OFFER.  It  is  the  most  liberal  proposition  ever  made  by 
a  patent  attorney,  and  EVERT  INVENTOR  SHOULD 
READ    IT    before    applying    for  patent.     Address : 

H.B.WILLSOrUCO. 

PATENT  LAWYERS, 
LeDroltBldg,    WASHINGTON.    D.  C. 


There  is  no  question,  Neurosine  is  posi- 
tively the  most  powerful  and  safest  Neurotic, 
Anodyne  and  Hypnotic  known  to  the  pro- 
fession. There  can  be  no  detrimental 
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Morphine,  Chloral  or  Opium.  Par-excel- 
lence in  the  treatment  of  Epilepsy,  Chorea, 
Neurasthenia,  Migraine,  Neuralgia  and  all 
forms  of  Convulsive  and  Reflex  Neurosis. 
Produces  natural  sleep.  Beware  of  sub- 
stitution. 


SO  YEARS' 
EXPERIENOE. 


TRADE   MARKS* 

DESIGNS, 
COPYRICHTS   Ac. 

Anyone  sending  a  sketch  and  description  may 
quickly  ascertain,  free,  whether  an  invention  !• 
probably  patentable.  Communications  strictly 
confidential.  Oldest  agency  for  securing  patent* 
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special  notice  in  the 

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beautifully  illustrated,   largest  circulation   of 
any  scientific  journal,  weekly,  terms  13.00  a  rear ; 

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361  Broadway.  New  York. 


"Robinson's  Lime  Juice  and  Pepsin"  is 
an  excellent  remedy  in  the  gastric  derange- 
ments particularly  prevalent  at  this  season. 
It  is  superior  as  a  digestive  agent  to  many 
other  similar  goods.  (See  page  18,  this  is- 
sue). See  remarks  on  their  Arom.  Fluid 
Pepsin  also. 


4  90 


THE  CHARLOTTE  MEDICAL  JqURNAL. 


¥-J|ydroleine    is    a     pancreatized    Emulsion   of    Cod 

Liver    Oil    (Lofoten)    obtained    from    fresh    livers. 

Based  on  scientific  principles.  Each  dose  contains 
pre-digested  Cod  Liver  Oil.  The  unpleasantness  of  the  oil 
is  thoroughly  disguised,  therefore  palatable,  and  well  borne 
by  weak  and  delicate  stomachs.  Increases  the  appetite,  im- 
proves digestion.  All  wasting  diseases  are  greatly  modified 
by  its  use.  Creosote  and  all  tonic  remedies  are  compatible 
with  Hydroleine,  and  is  admissible  in  all  seasons  and  climates. 

Literature  sent  to  physicians  on  application.  Sold  by 
Druggists.  Manufactured  by  The  Charles  N.  Crittenton  Co., 
Laboratory,  No.   115  and   117  Fulton  St.,  New  York. 


The  Winkley  Artificial  Limb  Go. 


M.  C.  PIERCE, 

Hutchinson,  Minn. 


Largest 
Manufacturers 
of  Artificial 


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PATENT  ADJUSTABLE  DOUBLE  SUP-SOCKET  Artificial  Limb  S 
Warranted  NOT  to  CHAFE  THE  STUMP. 


PERFECT   FIT   GUARANTEED 

From  CASTS  and  MEASUREMENTS. 

Send  for  New  1899  Catalogue  and  Self  Measuring  Sheet. 

(Department  A.)     MINNEAPOLIS,    MIN 


Old  Age  and  Sleep. 
Dr.  Gooch  mentions  the  case  of  a  man 
who  lived  to  the  age  of  seventy-three,  in 
excellent  health,  although  he  could  never 
sleep  for  more  than  fifteen  minutes  in  each 
twenty-four  hours.  This  case,  however,  is 
not  well  supported  by  evidence.  General 
Pichegon  assured  an  English  gentleman 
that  for  a  whole  year,  during  important 
campaigns,  he  had  restricted  himself  to  one 
hour's  sleep  in  twenty-four.  Jeremy  Taylor 
maintained  that  three   hours'   sleep  a  night 


was  enough.  The  celebrated  General 
Elliott,  who  defended  Gibraltar,  never 
slept  more  than  four  hours.  Lord  Broug- 
ham was  generally  content  with  less. 
Frederick  the  Great  and  John  Hunter 
were  satisfied  with  five.  The  Duke  of 
Wellington  and  John  Wesley  took  six. 
The  explanation  of  their  variations  seems 
to  lie  in  the  fact  that  the  amount  of  sleep 
cannot  be  measured  by  duration,  and  those 
who  do  not  sleep  very  long  enjoy  a  much 
deeper  sleep  than  others. 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


TABLE   OF  CONTENTS   FOR    APRIL,    1899. 


Original   Communications- 
Typhoid    Perforation— Op- 
era ti  o  n— Recovery,    by 
Hugh  M.  Taylor,    M.  D., 

Richmond,    Va 389 

Relative  Immunity  to  Tu- 
berculosis, the  Altitude 
of  the  Ideal  Climate  and 
Intra-PulmoDary  Medica- 
tion, by  Charles  Denison, 
M.  D.,  Denver,  Colorado.  393 
Uterine  Tonics,  by  W.  F. 
Milroy,    M.    D.,   Omaha, 

Nebraska 39S 

The  Karly  Diagnosis  and 
Treatment  of  Melancho- 
lia, by  K.  ( >.  ( >ossman,M. 

D.,  Markleton.  Pa 397 

Typhoid  (Enteric)  Fever — 
In  the  Fast  and  at  the 
Present  Time,  by  Frank- 
lin Staples.  M.  D.,  Wino- 
na.  Minn 398 

Peritonitis— Its  Pathology 
and  Treatment,  by  Hal. 
C.  Wnnan,  M.  S.,  M.  !>.. 

Detroit,  Michigan 400 

A  Study  in  Metaphysics 
Through  Drugs  and 
I  (mum  States,  by  F.  Sa- 
vary  Pearce,  M.D.,  Phil- 
adelphia,  Pa 403 

The  1'aliative  Treatment  of 
Hemorrhoids,  by  H.  (;. 
Thomas,    B.  Sc,    M.  D., 

Kirkman,  Iowa 405 

Dressingin  Minor  Surgery, 

by  Frank  H.  Hancock, M. 

I)'..  Port  Norfolk,  Va....  407 

I  landom  Sketches,  by  I.  W. 

Costen,  M.D.,  Gatesville, 

N.  ( ' 409 

Radical  Cure  of  Writer's 
Cramp  and  Other  Occu- 
pation Palsies,  by  S.  H. 
Monell,  M.  D,  Brooklyn. 
N.  Y 410 

Editorial. 

Life  Examinations  Again . .  415 

Why  Is  It? 416 

Antitoxin 41B 

Rectal  Irrigations  in  Dis- 
eases of  Children 417 

A  State  of  Things 418 

The  Curette  in  Suppurative 

Otitis, 418 

The  Title  Doctor 419 

Commercialism  in  Medicine  419 

Who  is  Responsible? 420 

Army  Medical  Department  420 

Union  of  Medical  Men, 421 

Cocaine  Habit 421 

Mental  Expectancy 422 

Antitoxin  Patent  Trouble.  422 
Pyoktanin,  orC.  P.  Methy- 
lene in  Diseases  of  the  Eye  422 
Old  Age, 42.H 

Book    Reviews, 

A  Text-Book  on  Practical 
<  obstetrics,  by  Egbert  II. 
Grandin,  M.  D 425 


Annual  and  Analytical  Cy- 
clopaedia of  Practical 
Medicine,  by  Charles  E. 
de  M.  Sajous,  M.D.  Vol- 
ume 1  and  2 423 

The  Ready  Reference  Hand- 
book of  Diseases  of  the 
Skin,  by  Geo.  Thos.  Jack- 
son. M.  D 424 

Progressive  Medicine  —  A 
Quarterly  Digest  of  Ad- 
vances, Discoveries,  and 
Improvements  in  the  Med- 
ical and  Surgical  Sciences. 
Edited  bv  Hobart  Amory 
Hare,  Mi  D '.   424 

Pathology  and  Treatment 
of  Sexual  Impotence,  bv 
Victor  G.  Vecki,  M.  D...  425 

Nervous  and  Mental  Dis- 
eases, by  A  r c h i  b a  1  d 
Church,  M.  D 425 

Nursing:  Its  Principles  and 
Practice,  for  Hospital  and 
Private  Use,  by  Isabel 
Adams  Hampton, 426 

Diseases  of  the  Ear,  Nose 
and  Throat,  and  their  Ac- 
cessory Cavities,  by  Seth 
Scott  Bishop,  M.  D 426 

Seventh  Biennial  Report  of 
the  North  Carolina  Board 
of  Health.     1897-1898....  426 

Transactions  of  the  New 
Hampshire  Medical  So- 
ciety    425 

Transactions  of  the  Michi- 
gan State  Medical  Society 
for  the  Year  1898 426 

Literary  Notes- 

Lippincott's  Magazine  for 

April,  1899 427 

The  February  Forum 427 

American  Monthly  Review 
of  Reviews  for  April,. . . .  427 

Soribner's  Magazine, 427 

The  Living  Age 427 

Miscellaneous- 
Appendicitis  or  Epityphlitis  432 
Acute  Cervical  Adenitis  in 

Childhood 433 

A  House  Epidemic  of  Syph- 
ilis   445 

Board  of  Medical  Exam- 
iners    427 

Balsam  of  Peru  in  Scabies,  445 

Clinical  Study  of  Nervous 

Dyspepsia 431 

Curettement  in    Puerperal 

Fever 4:U 

Cesarean    Section    in    the 

Philippines 441 

( 'alomel  in  Typhoid  Fever,  442 
Cause  of  Bright's  Disease, .  443 
Craze  of  the  Medical  Pro- 
fession to  Affix  Titles  to 
their  Names, 446 

Diagnosis  of  Mammary  Ab- 

440 


Diphtheria 432 

Entrance  of  Air  into  the 
Uterus  during  Labor 487 

Heating  of  Milk  Used  for 
Feeding  Infants 433 

Hemorrhages  from  Ana- 
tomically Unaltered  Kid- 
neys-     141 

Internal  Application  of 
Antiseptics 4p_; 

Indications  for  Operation 
in  Renal  Tuberculosis. . .  428 

Indications  for  Hysterec- 
tomy    440 

Liquor  Trade  in  America, .  435 
Locomotor    Ataxy     in    Its 
Modern  Aspect 436 

Mechanism  of  the  Contrac- 
tion of  the  Peripheral 
Bloodvessels  Under  Hy- 
drotherapeutic  Treat- 
ment    434 

Microbian  Origin  of  Ec- 
lampsia    436 

Medical  Progress 443 

Ocular  Troubles  in  Dia- 
betes    43!) 

Pain  in  the  Fallopian  Tubes  428 

Paris  Exposition 439 

Puerperal  Eclampsia 441 

Reaction  of  Syphilitic  Blood 

to  Mercury 444 

Ringworm  of  the  Scalp 445 

Salt  and  Bright's  Disease.  412 

Systematic  Exercise  in  the 
Treatment  of  Locomotor 
Ataxia 429 

Skin  Eruptions  Caused  by 
Antipyrin 430 

Somatose  in  Syphilis 432 

Senile  Changes  in  the  Fal- 
lopian Tubes 437 

Serum  Diagnosis  of  Diph- 
theria   438 

Some  Conditions  Necessary 
for  the  Spread  of  Tuber- 
culosis    439 

Treatment  of  Eclampsia . . .  412 
Traumatisms  of   the   Ure- 
thra   428 

Treatment  of  Exophthal- 
mic Goitre 434 

Treatment  of  Pneumonia  in 

Children 437 

Treatment  of  llaematemesis  440 
Treatment  of  Chronic  Mor- 
phinism    443 

Tuberculosis  of  the  Nose. .  445 
Treatment  of  Incontinence 
of  Urine  in  Children  with 
Rhus  Aromatica 446 

Ultimate  Results  of  Mech- 
anical and  Operative 
Treatment  in  Hip  Dis- 
ease     411 


492 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


A  Hypnotic  for  Confirmed 

Insomnia 4(i4 

Aseptic  Midwifery 465 

Artificial  Dilatation  of  the 
Mouth  of  the  Uterus  Dur- 
ing Labor 449 

A  Memorial  of  the  Late  Dr. 

Joseph  O'Dwyer 453 

Acute  Coryza 4S3 

An  Emulsion 486 

Animal  and  Vegetable  Fer- 
ment    481 

An  Excellent  Uric  Acid 
Solvent 484 

Bacillus  of  Syphilis, 454 

Causes  of  Albuminuria. . . .  451 
Confederate  Veterans'  Re- 
union    455 

Commencement  Exercises .  458 
Caution  in  the  use  of  Pro- 
prietary Remedies 482 

Curious  Pocket  Piece 486 

Demonstrating  the  Malari- 
al Parasite  in  the  Blood.  460 
Drug  and  Food  Diseases. . .   462 
Diuretin 480 

Edema  in  Bright's  Disease  478 
Epileptic  Insanity 483 

Further  Uses  of  Ureteral 
Catheter 474 

Forced  Examination  of  the 
Larynx  in  Children 447 

Frequency  of  Rickets 449 

Gray's  Glycerine  Tonic. .. .  479 
Grip  and  its  Allies 484 

Holocain  in  Ophthalmic 
Surgery;  Its  Superiority 
over  Cocaine;  Its  Thera- 
peutic Value 468 

Intussusception  in  Children  448 

In  Cholera  Infantum 462 

Infection  of  the  Mother 
from  the  Fetus 476 


Is  Eczema  a  Parasitic  Dis- 
ease    480 

Iodia 484 

Limits  of  Usefulness  of  the 
X-Rays  for  the  Diagnosis 
of  Fractures, 452 

Lung  Gymnastics 460 

Movable  Kidney  with  Spe- 
cial Reference  to  its  In- 
fluence   on    the   Nervous 

System 455 

Malaria  and  Mosquitoes. . .  460 
Massage  of  the  Abdomen. .  462 
Measurements  of  Pain, ....  471 
Maltine 478 

North  Carolina  Medical  So- 
ciety    452 

Non-Medicinal  Treatment 
of  Habitual  Constipation.  458 

Nephritis  of  Malarial  Ori- 
gin   461 

Otitis 457 

Observations  on  the  Treat- 
ment of  Hay  Fever 460 

Operations  on  Syphilitics, .  470 
Ocular    Evidence   of    Hys- 
teria     474 

Old  Age  and  Sleep 490 

Ocular  Tubercles  in  Dia- 
betes    4g4 

Points  in  the  Arsenical 
Caustic  Treatment  of  Cu- 
taneous Cancers 450 

Protective  Action  of  the 
Liver  against  Microbes. .  453 

Preparation  Needed  for  a 
Case  of  Labor 454 

Proposed  Change  in  New 
York  State  Medical  Ex- 
aminations     459 

Pathology  of  Diphtherial 
Paralysis 461 

Premature  Baldness, 466 

Removal  Notice 453 


Report  of  78  Cases  of  Pul- 
monary Tuberculosis 
Treated  with  Watery  Ex- 
tract of  Tubercle  Bacilli,  476 

Syphilis  in  Relation  to  Ob- 
stetrics    456 

Sleep  in  Treatment  of  Dis- 
ease    458 

Syphilis  of  the  Brain  and 
Spinal  Cord 463 

Sanmetto  in  Imitations. . .  .  47S 

Treatment  of  Hip  Disease.  449 

Tumors  of  the  Kidney  in 
Children 450 

Thrombosis  and  Embolism 
After  Childbirth 451 

Use  of  Quinine  in  Topical 
Leucorrhea 451 

Typhoid  Fever  in  the  Uni- 
ted States 452 

The  Significance  of  Mouth- 
Breathing,  .    455 

Tubercular  Tonsils  and  Ad- 
enoids as  the  Etiology  of 
Enlarged  Cervical  Lymph 
Glands 456 

Toxaemic  Factor  in  Diabe- 
tes Mellitus 459 

Treatment  of  Harelip  and 
Cleft  Palate 464 

Treatment  of  Chronic  Bron- 
chitis,    466 

Tri-State  Medical  Society 
of  Iowa,  Illinois  and  Mis- 
souri    472 

Toxines  in  Dermatology, . .   474 

Urine  Examinations  in  in- 
sanity    457 

Vaccination 429 

Vitality  of  Epithelial  Cells 
and  the  Etiology  of  Can- 
cer   472 

Vapor  Massage 4S6 

Vin  Mariani  in  Exhaustion  486 


Conservative  Surgery. 

The  following  is  a  part  of  an  editorial 
recently  appearing  in  the  Medical  Review 
of  St.  Louis.      It  is  to  the  point. 

"Scientific  conservatism  in  surgery  is  an 
exaction  which  it  is  pre-eminently  just  to 
demand  form  every  surgeon.  The  term, 
scientific  conservatism,  as  far  as  surgical 
operations  are  concerned,  implies  that  ex- 
ploratory operations  should  not  be  resorted 
to  excepting,  perhaps,  under  unusual  condi- 
tions. Exploratory  incisions  are  to  be  dis- 
couraged if  they  are  the  result  of  a  lack  of 
skill  in  diagnosis  or  inadequate  knowledge 
of  pathology.  This  is  true  of  all  operations, 
but  especially  so  of  those  concerning  vital 
organs.  Truly  scientific  surgeons  are  usually 
also  conservative.  The  pros  and  cons, 
based  upon  a  careful  diagnosis  and  the 
knowledge  of  pathology,  must  be  carefully 
weighed    before    an    operation    is    decided 


upon.  The  severing  of  the  Gordian  knot 
by  operating  where  the  exact  indications 
can  not  be  based  upon  the  necessary  found- 
ation of  a  thorough  knowledge  of  pathology 
and  a  pretty  certain  diagnosis,  should  be 
discouraged.  Excepting  under  unusual 
conditions,  strictly  scientific  indications  are 
the  requisites  in  determining  the  propriety 
of  operating.  It  is  a  fallacy  to  believe  that 
a  practical  knowledge  of  anatomy  and  a 
skillful  handling  of  the  knife  are  the  only 
requisites  in  the  education  of  a  surgeon.  It 
is  at  least  equally  necessary  to  be  able  to 
make  a  correct  diagnosis  for  which  a  knowl- 
edge of  pathology  is  a  sine  qua  //on.  Any 
operative  surgical  procedure  is  not  so  harm- 
less as  some  venturesome  or  impulsive 
persons  seem  to  think.  Discretion  in 
operating  increases  with  thorough  knowl- 
edge and  experience — attributes  which  must 
necessaril/  be  supplemented,  however,  by  a 
keen  sense  of  moral  responsibility." 


The  Charlotte  Medical  Journal. 


Vol.   XIV. 


CHARLOTTE,  N.  C,   MAY,   1899. 


No.  5. 


The  Internal  Use  of  Carbolic  Acid. 

By  E.  R.  Maxson,   M.  D.,   A.  M.,   LL.D.,  Syra- 
cuse, New  York. 

Messrs.  Editors  of  The  Charlotte  Medical 
Journal,  Charlotte,  N.  C.  : 

Your  late  editorial,  headed  "The  Internal 
Use  of  Carbolic  Acid,"  in  which  you  give 
good  authorities,  in  relation  to  its  use  in 
typhoid  fever,  scarlatina,  etc.,  abortive 
and  preventive;  suggesting,  also,  what 
"bravery"  might  possibly  do,  for  the  pro- 
fession, in  that  direction  ;  has  impressed  me 
to  offer  you  some  of  my  experience,  in  that 
line  of  effort.  But  I  have  used  it,  internal- 
ly, in  the  form  of  the  sulphocarbolate  of 
sodium;  being  efficient  as  an  antiseptic; 
soluble  and  convenient,  for  use  in  solution  ; 
and  in  reasonable  doses,  without  the  dan- 
gers, of  toxic  effects,  attending  the  internal 
administration  of  the  crude  article. 

My  experience  in  this  direction  has  ex- 
tended from  observations  in  the  Royal  In- 
firmary of  Glasgow,  in  1867  with  Professor, 
now  Lord  Lister,  to  the  present  time.  And 
though  my  first  efforts  were  with  typhoid 
or  enteric  fever  ;  as  I  have  freely  published, 
in  medical  journals,  and  elsewhere,  it  has 
been  extended  to  all  putrid,  septic,  and 
contagious  diseases,  that  have  come  under 
my  treatment,  in  a  wide  field  of  medical 
practice. 

Having  been  dissatisfied  with  the  former 
idea,  still  too  prevalent,  I  think,  that  ty- 
phoid or  enteric  fever ;  and  all  contagious 
diseases  must  necessarily  run  on,  for  some- 
thing near  a  limited  time ;  and  reasoning 
on  what  appeared  to  me  to  be  a  fact,  that 
the  different  stages  of  what  we  formerly 
supposed  to  be  self-limited  contagious  dis- 
ease, could  only  be  the  disturbance  of  the 
system,  while  eliminating  the  microbial  or 
other  cause  operating,  and  its  consequences  ; 
I  have  been  seeking  measures  for  prevent- 
ing, aborting,  cutting  short,  or  rendering 
lighter  such  diseases. 

This  I  have  published,  from  time  to  time, 
in  the  New  York,  and  other  medical  jour- 
nals; attempting  to  ascertain  and  destroy 
the  microbial,  or  other  cause  operating,  by 
safe  and  suitable  antiseptics;  in  addition 
to  what  1  had  done  in  typhoid,  and  all  con- 
tagious diseases,  that  have  come  under  my 
treatment. 


While  I  have  used  various  antiseptics, 
with  a  degree  of  success,  I  have  had  the 
best  results  in  the  use  of  the  sulphocarbolate 
of  sodium,  in  doses  of  from  two  to  four 
grains,  in  solution,  for  adults,  with  two  or 
three  drops  of  tincture  of  nux  vomica, every 
six  hours;  at  6  and  12  o'clock;  alternating 
with  from  two  to  four  grains  of  cinchoni- 
dine,  for  adults ;  and  proportional  doses 
for  children,  according  to  the  age ;  this 
too,  dissolved  or  suspended  in  pure  rain 
water;  in  typhoid  or  enteric  fever,  and  all 
putrid,  septic  and  contagious  diseases. 

This  has  been  the  general  treatment ;  ex- 

pt  such  local  measures  as  have  been  ap- 
parently indicated ;  as,  warm  foot-baths, 
sinapisms,  warm  toast-water  and  milk,  only 
as  a  drink,  and  toast,  egg  or  other  plain 
food  at  meals;  being  kept  out  of  bed,  as 
far  as  safe  days,  to  secure  better  rest  at 
night.  In  all  cases  with  a  coated  tongue, 
an  improved  cathartic  pill  at  evening  if 
constipated,  or  a  grain  leptandrin  pill  if 
lot,  till  the  coating  is  off. 

For  sore  throat  of  diphtheria  or  scarlatina, 
etc.,  a  dry  flannel  folded,  is  pinned  around 
the  neck,  and  a  gargle  of  chloride  of  am- 
monium, about  two  drachms  to  eight  ounces 
of  water,  with  five  drops  of  carbolic  acid, 
early  ;  and  later,  of  eucalyptol,  in  a  strong 
sage  tea,  with  a  drachm  or  two  of  alum  and 
borax  to  half  a  pint,  sweetened. 

This  general  and  local  treatment  has  been 
modified,  of  course,  to  meet  the  indications 
in  different  diseases ;  and  more  or  less  in 
different  conditions  in  the  same  form  of 
disease  ;  and,  except  the  antiseptic,  corres- 
ponds, very  nearly,  with  the  treatment  I 
had  followed,  before  I  knew  of,  or  used  the 
sulphocarbolate  of  sodium,  or  other  anti- 
septics, as  such. 

The  average  duration  of  typhoid  or  en- 
teric fever,  under  my  former  treatment,  was 
about  twenty-one  days,  I  think,  with  more 
or  less  complications;  very  few,  if  any 
cases,  having  been  aborted,  strictly  speak- 
ing. Since  using  the  antiseptic,  in  addi- 
tion to  what  I  did  before ;  many  cases  seen 
early  have  appeared  to  be  aborted ;  cases 
seen  a  trifle  later,  the  microbial  or  other 
cause  having  poisoned  the  system  more 
generally;  and  especially  involved  the  in- 
testinal glands,  in  congestion  and  incipient 
inflammation,  the  disease  has  generally  de- 
veloped no  complications  ;  the  patients  have 


494 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


mostly  been  able  to  keep  out  of  bed,  days ; 
and  many  of  them  to  get  about  light  busi- 
ness, in  about  a  week.  But  cases  first  seen, 
at  a  much  later  stage ;  an  incipient  ulcera- 
tion threatening;  with,  perhaps,  cerebral 
meningeal  inflammation,  with  the  addition 
of  a  wet-cup  to  the  back  of  the  neck,  my 
cases  have  been  out  in  about  two  weeks,  as 
nearly  as  I  can  calculate,  as  an  average. 
Hence  leaving  out  of  the  estimate,  cases 
apparently  aborted,  which  I  think  may  have 
been  about  one-third,  all  seen  early  ;  taking 
the  cases  seen  a  little  too  late  for  abortion, 
getting  out  in  about  one  week  ;  and  those 
seen  later  still,  out  in  about  two  weeks, 
would  make  the  average  duration,  since 
using  antiseptics,  about  ten  or  eleven  days, 
instead  of  the  twenty-one  days  before  I 
used  them,  with  an  otherwise  similar  treat- 
ment ;  thus  cutting  short  the  disease,  about 
one-half,  as  nearly  as  I  can  estimate.  And 
as  nearly  as  I  can  estimate,  my  death  rate 
has  been  less  than  one-half  what  it  was  be- 
fore I  used  antiseptics  ;  and  confined  mostly 
to  cases  far  advanced,  with  either  intestinal 
hemorrhage,  or  a  wasting  diarrhoea,  with 
or  without  intestinal  perforation.  I  should 
state,  that  in  all  cases,  aborted  or  not,  I 
have  invariably  continued  the  tonics  to  keep 
up  the  strength,  and  antiseptics  to  destroy 
the  germinating  spores,  in  gradually  de- 
creasing doses,  for  at  least  one  week.  For 
the  spores  cannot  be  destroyed  before  ger- 
minating, "their  envelop  or  shell  being  the 
most  resisting  substance  in  the  material 
world."      [Sec  Ball,  on  Bacteriology.} 

Thus  enough  has  been  accomplished,  to 
prove  that  the  cause  out  of  the  way,  there 
is  not  necessarily  any  self-limitation  to  the 
duration  of  typhoid  or  enteric  fever  ;  though 
the  cause  continuing  to  operate,  the  elimi- 
tation  of  the  poison,  with  no  complications, 
except  intestinal,  may  usually  require  twen- 
ty-one days,  perhaps. 

My  observations  in  the  treatment  of  strict- 
ly contagiozis  diseases;  as  diphtheria,  scar- 
latina, rubeola,  and  all  others,  that  I  have 
treated,  correspond  very  nearly  with  those 
above  described  in  typhoid ;  several  cases, 
under  antiseptics,  treated  early  having  been 
apparently  aborted  ;  two  at  least  of  scarla- 
tina ;  several  of  diphtheria,  and  some  among 
the  other  diseases  treated,  as  appeared. 
And,  using  antiseptics,  with  tonics,  either 
instead  of,  or  in  addition  to  what  I  had 
formerly  used,  I  am  satisfied  that  the  aver- 
age duration  of  all  contagious  diseases  treat- 
ed by  me,  has  been  less  than  one-half  what 
it  was  before  I  used  antiseptics.  The  com- 
plications have  been  fewer,  and  the  death- 
rate  much   lower,  especially  in  diphtheria. 

In  view  of  the  foregoing  facts,  in  relation 
to  typhoid    or  enteric  fever,   and   all  conta- 


gious diseases,  that  have  fallen  under  my 
observation,  I  am  thoroughly  convinced, 
that  none  of  them  have  necessarily,  self- 
limitation,  as  was  formerly  supposed.  And 
hence,  if  true,  it  evidently  becomes  our  duty 
to  treat  the  patients  to  cure,  not  merely  to 
get  them  through  an  imaginary  self-limited 
disease,  as  we  formerly  did,  to  some  extent, 
because  we  did  not  know  the  cause,  or  how 
to  destroy  it,  in  any  case,  as  we  do,  or 
should  now. 

And  further,  as  all  contagious  diseases 
originated,  at  first,  without  an  exposure  to 
a  person  thus  diseased,  as  we  all  know ; 
there  having  been  none  other  thus  affected, 
in  the  first  case  ;  we  have  a  right  to  infer, 
at  least,  that  they  now  have  a  similar  origin, 
as  well  as  by  contagion,  from  one  to  another 
person,  in  many  cases  ;  and  especially  does  it 
appear  to  be  the  case  in  phthisis  pulmonalis, 
now  regarded  as  contagious.  I  fear  this 
may  be  true,  in  all  contagious  diseases,  to  a 
far  greater  extent,  than  has  formerly  been 
supposed. 

If  so,  this  is  important.  For,  in  addition 
to  our  duty  to  abort,  cut  short,  and  cure 
disease,  as  best  we  can  ;  and  responsibility 
in  protecting  the  well  from  exposure  to 
contagion  from  those  suffering  with  conta- 
gious disease ;  an  even  higher  or  broader 
responsibility  devolves  upon  us,  as  special 
guardians  of  health,  to  impress  upon  those 
under  our  influence,  to  avoid  all  personal 
and  general  influences  of  an  unsanitary 
character,  liable  to  produce,  as  well  as  to 
predispose  to  contagious  and  all  other  dis- 
eased conditions. 

818  Madison  Street. 


Chronic  Gastritis— Resting  a  Plea  for  more 

Careful  Consideration  in  the  Diagnosis 

and  Treatment  of  the  Same  by  the 

General  Practitioner.* 

By  Eugene  R.  Morris,  M.  D.,   Asheville,   N.  C. 

I  come  before  you  this  evening  with  noth- 
ing new  or  startling;  no  patent  medicine 
like  chionia,  seng,  &c,  with  which  to  work 
miraculous  cures.  It  shall  be  my  aim  to 
suggest  something  practical  in  regard  to 
the  care  and  treatment  of  this  class  of  cases, 
which  are  rather  numerous,  and  ought  to 
receive    more    consideration  at  our   hands. 

Chronic  gastritis  is  common  in  people  of 
35  years  and  older.  I  shall  say  nothing  of 
the  pathology,  except  to  state  that  the  mu- 
cous membrane  is  constantly  congested, 
causing   changes    in  the    gastric   juice,  in- 


*Read  before  the  Buncombe  County  Medical 
Society  at  regular  meeting  held  February  6th, 
1899. 


THE  CflARLOTTE  MEDICAL  JOURNAL. 


creased  secretion  of  thick  alkaline  mucous, 
diminished  peristalsis  of  the  stomach,  all 
favoring  fermentation  and  decomposition 
of  the  food,  followed  by  symptoms  of  indi- 
gestion. The  mucous  membrane  becomes 
hypertrophied  from  constant  engorgement, 
infiltration  of  the  peptic  glands,  followed 
by  granular  degeneration,  and  finally,  atro- 
phy of  the  cells. 

The  causes  are  too  numerous  to  mention. 
Some  of  the  most  frequent  are  :  Repeated 
attacks  of  acute  gastritis,  excessive  use  of 
alcoholics,  tea,  coffee,  ice  water  freely  dur- 
ing and  after  meals  ;  irregularity  of  eating 
and  imperfect  mastication  ;bad  and  improp- 
erly prepared  food  ;  anaemia,  malaria,  ex- 
cessive tobacco  chewing;  diseases  of  the 
heart,  lungs  and  pleura,  liver  and  kidneys, 
producing  chronic  congestion  of  all  the 
stomachic  vessels  ;  cancer  and  other  degen- 
erative diseases  of  the  stomach. 

Bad  hygiene,  favoring  repeated  conges- 
tions of  the  mucous  membrane,  sudden 
checking  of  the  cutaneous  function,  due  to 
improper  or  insufficient  clothing,  poor  ven- 
tilation and  damp  rooms  are  frequent  causes. 

With  chronic  gastritis  we  may  have  either 
a  normal  or  slightly  diminished  quantity  of 
acid,  or  with  other  changes  in  the  secretions 
an  excess  of  acid,  followed  by  the  atropine 
form,  which  is  simply  the  finale  of  either 
of  the  other  forms. 

Remembering  certain  facts  we  should  not 
be  surprised  if  our  patients  often  complain 
more  of  symptoms  referred  to  the  heart, 
lungs,  kidneys,  or  some  other  organ,  than 
the  stomach.  Persistent  indigestion,  anor- 
exia, tenderness  and  fullness  over  the  epi- 
gastrium, nausea  and  occasional  vomiting 
after  food,  coated  tongue,  obnoxious  breath, 
thirst,  constipation,  scant,  high  colored 
urine,  with  excess  of  phosphates,  urates,  or 
oxilate  of  lime,  weak  circulation,  insomnia, 
melancholia  and  stomachic  vertigo.  With 
hyper-acidity,  we  have  in  addition  to  the 
above  named  symptoms,  acid  eructations, 
known  as  "heart-burn"  or  pyrosis. 

In  those  past  middle  life  the  atrophic 
stage  usually  begins,  and  once  well  ad- 
vanced, the  digestive  function  is  much  im- 
paired, sometimes  almost  entirely  lost,  small 
quantities  of  liquid  food  causing  pain  and 
vomiting,  followed  by  anaemia  and  progres- 
sive loss  of  weight  and  vitality. 

A  diagnosis  of  chronic  gastritis  can  only 
be  made  by  exclusion.  Even  by  this  meth- 
od a  diagnosis  is  often  difficult  or  impossi- 
ble, for  the  reason  the  symptoms  may  be 
confounded  with  those  of  gastric  cancer, 
gastric  ulcer,  and  gastric  dilatation,  diseases 
of  the  liver,  kidneys,  cardiac  disease  and 
cerebral  vertigo,  the  symptoms  of  which  are 
not  always  clear,  and  also   because  chronic 


gastritis  is  often  associated  with  one  or  the 
other  of  these  conditions. 

The  out-come  of  our  cases  is  what  most 
concerns  us  as  practitioners.  We  do  not 
expect  complete  recovery  often,  but  with 
proper  care,  selected  diet  and  [mode  of  life, 
considerable  amelioration  of  symptoms  will 
follow,  and  the  patient  may  live  out  a  good 
life  and  die  of  some  intercurrent  trouble. 

In  the  treatment  the  first  important  symp- 
tom indicated  for  correction  is  indigestion, 
which  is  usually  the  most  noticeable  and  dis- 
tressing; this  indication  is  best  met  by 
throwing  worry  to  the  wind  at  meal  hours, 
carefully  regulating  the  quantity  and  char- 
acter of  food,  which  should  be  taken  regu- 
larly and  thoroughly  masticated,  avoiding 
starchy,  fatty,  saccharine,  and  all  highly 
seasoned  foods  and  stimulants. 

An  occasional  case  will  take  small  quan- 
tities of  wine  kindly. 

A  milk  diet  is  the  ideal,  but  in  most 
cases  is  best  left  off  the  first  two  or  three 
weeks  of  treatment. 

Where  milk  is  not  digested  well  it  may 
be  diluted  one-third  with  soda  or  vichy 
water.  Later  on  a  little  beef,  eggs,  oysters 
and  ripe  fruits  are  welcome. 

Fresh  air  and  exercise,  short  of  exposure 
and  fatigue,  are  essential. 

Cold  sponge  baths,  followed  by  brisk 
rubbing,  improves  the  peripheral  circulation 
and  increases  the  tonicity  of  the  skin. 

Pleasant  surroundings,  a  change  of  cli- 
mate and  associations  are  beneficial  where 
the  tendency  is  to  mental  despondency. 

The  medical  treatment  is  .divided  into 
such  measures  as  aim  at  replacing  certain 
essential  elements  in  the  digestive  fluids, 
and  those  that  stimulate  weakened  glandu- 
lar activity.  In  the  former  class  are  HC1 
and  the  ferments. 

HC1  is  the  most  important  and  the 
most  generally  deficient  ingredient  of  the 
gastric  juice. 

It  is  not  only  necessary  for  its  action  as 
an  acid,  but  is  essential  to  the  conversion  of 
pepsinogen  into  pepsin. 

Ewald  recommends  large  doses  of  the 
dilute  acid — 90  drops — after  meals  ;  while 
Leube  and  Reigel  advise  small  doses,  10-20 
drops. 

I  prefer  the  small  doses  to  the  large.  It 
is  onlv  in  selected  cases  that  benefit  will 
follow  the  administration  of  large  or  small 
doses,  as  in  gastritis  per  se,  any  acid  is  a 
positive  irritant  to  the  inflamed  mucous 
membrane. 

Probably  the  best  results  are  obtained 
from  the  judicious  use  of  HC1  in  the 
atrophic  and  neurotic  forms,  while  the  bit- 
ter tonics  act  more  effectually  in  other  cases 
of  chronic  gastritis. 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


Of  all  the  bitter  tonics,  strychnia  in  some 
form,  stands  at  the  head,  and  will  prove 
the  most  satisfactory.  It  may  act  by  in- 
fluencing the  appetite  rather  than  stimulat- 
ing the  secretions  of  the  stomach. 

Alcohol  and  NaCl  kindly  influence  diges- 
tion, proving  good  stomachics  when  pro- 
perly used. 

Alcohol  in  moderation  is  supposed  by 
some  to  act  by  increasing  acid  in  the  gastric 
juice,  and  with  it  the  pepsin,  while  others 
claim  it  is  the  motor  instead  of  the  secre- 
tory function  stimulated  by  the  alcohol.  I 
maintain  it  is  both.  The  importance  of 
NaCl  in  gastric  digestion  is  demonstrated 
from  the  fact  that  its  presence  is  necessary 
to  the  production  of  HC1. 

Hence,  it  is  indicated  in  dyspepsia  due  to 
chronic  gastritis  with  diminished  acid  secre- 
tion. 

A  carefully  kept  record  of  some  chronic 
cases  treated  by  the  writer,  shows  all  the 
bitter  tonics,  such  as  strychnia,  .  columbo, 
gentian,  quasia,  ipecac,  and  condurango, 
used  without  any  appreciable  benefit. 

Two  patients,  recently  treated,  had  every 
thing  to  no  advantage. 

This  might  be  accounted  for  on  the 
grounds  that  they  were  both  tubercular, 
and  had  no  thought  of  their  stomach  trouble 
being  influenced  by  this  active  process  in 
the  lung,  for  which  they  were  taking  no 
treatment  except  climate.  When  explained 
they  did  not  seem  to  understand  how  it 
could  be. 

So  much,  gentlemen,  for  plenty  of  fresh 
air  and  fresh  water  internally,  externally, 
and  eternally,  with  proper  food  and  little 
medicine. 

I  come  now  to  the  consideration  of  me- 
chanical measures  to  stimulate  glandular 
activity.  I  refer  to  stomach  lavage  or 
stomach  washing. 

I  want  to  stick  a  pin  here  and  state  pos- 
itively this  very  valuable  method  should  be 
used  more  extensively  by  the  general  prac- 
titioner. Because  it  may  have  been  abused 
by  some  enthusiast  is  no  reason  why  we 
should  not  employ  it  in  selected  cases,  espe- 
cially where  there  is  a  profuse  secretion  of 
tenacious  mucous  coming  from  the  stomach. 
Luke-warm  water  may  be  used,  but  if  there 
is  much  thick  mucous,  a  i  per  cent  salt  solu- 
tion, or  3  per  cent,  solution  of  bicarb,  soda 
is  preferable. 

With  fermentation  a  3  per  cent,  boric 
acid  solution  acts  beautifully. 

Elect  morning,  on  an  empty  stomach, 
except  when  there  is  nocturnal  disturbance 
with  flatulency,  when  it  should  be  prac- 
ticed three  or  four  hours  after  the  last  meal. 

Lavage  may  be  repeated  once  a  day,  unless 
the  patient  be  delicate,  when    every  second 


or  third  day  will  be  often  enough.  Con- 
tinue till  the  fluid  comes  back  clear,  remem- 
bering it  is  not  necessary  that  all  the  fluid 
be  removed  after  the  washing. 

Remember  not  to  use  nasty  oils  on  the 
tube,  but  warm  water  or  sweet  milk,  having 
the  patient  swallow  as  you  gently  manipu- 
late the  tube,  and  it  slips  comfortably  down 
home. 

If  the  patient  will  not  submit  to  lavage, 
the  next  best  thing  is  to  order  one-half  to 
one  pint  of  hot  water  taken  slowly  one  hour 
before  meals. 

Alkaline  drinks  maybe  used  beneficially. 
A  class  of  cases  are  benefited  by  the  free 
use  of  the  different  mineral  waters. 

Special  conditions,  such  as  flatulency, 
vomiting  and  constipation  should  receive 
proper  treatment. 

In  conclusion,  let  me  say,  that  in  chronic 
pulmonary  tuberculosis  the  first  symptoms 
mav  be  those  of  chronic  gastric  troubles. 
The  local  gastric  symptoms  may  be  so 
marked  that  chronic  gastritis  is  easily  diag- 
nosed without  considering  the  possibility 
of  tuberculosis. 

Let  us  be  careful,  therefore,  not  to  make 
this  mistake  where  there  is  chronic  gastric 
trouble  associated  with  anaemia  and  pro- 
gressive loss  of  weight  and  strength,  for  it 
may  mean  the  initial  stage  of  chronic 
phthisis. 

DISCUSSION. 

DR.PuREFOY.-It  iscustomary  to  say  some- 
thing complimentary  in  reference  to  the  pa- 
per, but  I  will  not  say  that  to-night  if  it  is  the 
custom.  The  only  thing  that  I  could  add 
to  the  paper  is  this,  The  subject  is  a  trite 
one,  the  disease  is  exceedingly  common, 
probably  because  we  are  faulty  in  our  meth- 
ods of  diagnosis.  One  of  the  first  things 
to  do  in  gastritis  is  to  find  out  whether  it 
be  primary  or  whether  it  is  secondary. 
Suppose  we  have  a  case  of  chronic  gastritis. 
Then  the  question  arises,  what  variety  of 
the  disease  is  it.  It  is  absolutely  necessary 
to  make  a  clear-cut  diagnosis  as  to  the  va- 
riety of  the  disease  with  which  we  are  con- 
tending lest  we  will  not  be  able  to  apply 
intelligently  our  therapeutics.  It  is  not 
necessary  here  to  go  over  the  methods  of 
diagnosis.  I  might  briefly  say  that  we  re- 
sort to  the  stomach  pump,  for  instance  be- 
fore breakfast  to  find  just  what  there  is  in 
the  stomach,  then  probably  five  or  six  hours 
before  eating  on  another  day  we  resort  to 
the  stomach  pump  and  examine  the  contents 
of  the  stomach  to  see  just  what  we  have. 
Often  we  want  to  know  whether  there  is 
an  excess  or  deficiency  of  acid,  in  other 
words,  we  want  to  examine  the  contents  of 
the    stomach  to    get  a  fine-cut    diagnosis  if 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


possible,  and  our  treatment  depends  largely 
upon  the  diagnosis.  It  is  hardly  worth 
while  to  discuss  the  treatment.  The  doctor 
covered  that  pretty  thoroughly.  If  I  had  a 
criticism  it  would  be  this,  and  it  is  a  criti- 
cism you  can  apply  to  almost  every  text- 
book, and  that  is  that  we  do  not  find  those 
nice  divisions.  For  instance,  we  find  in 
the  books  that  ipecac  and  the  salines,  etc., 
are  first-class  remedies  for  dysentery.  We 
want  to  know  what  stage  to  give  those,  we 
want  to  know  when  to  do  this  and  the 
other.  The  doctor  is  not  to  be  criticised. 
This  paper  has  been  written  very  hurriedly, 
I  know  that,  but  in  the  treatment  of  these 
things,  we  must  get  that  thing  down,  and 
we  do  not  know  just  how  to  treat.  Some- 
times I  give  a  little  phosphate  of  soda  and 
a  glass  of  hot  water  before  breakfast.  Now 
1  believe  that  we  have  very  few  remedies 
that  are  specially  serviceable.  Take  the 
mucous  form,  after  the  stomach  has  been 
thoroughly  cleansed.  I  believe  in  the  use 
of  nitrate  of  silver,  either  in  the  pill  form, 
or  preferably  in  solution,  one-half  or  one- 
fourth  grain  to  the  ounce,  put  into  the 
stomach  after  the  mucous  has  been  washed 
away. 

There  is  only  one  other  point  I  wish  to 
make,  and  that  is  the  indiscriminate*  use  of 
pepsin.  There  is  only  one  form  of  the  dis- 
ease in  which  1  believe  pepsin  is  worth  any- 
thing. 1  believe  there  is  more  pepsin  used 
by  the  profession  than  almost  any  other 
remedy  we  have — 1  don't  know  of  another 
that  is  more  so.  It  is  only  probably  in  one 
form  of  that  disease  where  pepsin  would  be 
specially  advisable.  I  believe,  too,  that  we 
make  another  mistake.  The  hydrochloric 
acid  ought  to  be  given  after  meals,  one  dose, 
and  then  often  where  there  is  that  deficien- 
cy we  need  to  repeat  in  an  hour  or  two 
hours.  I  think  that  the  paper  is  a  good 
one,  and  the  subject  one  that  we  need  to 
discuss  more  and  study  more. 

Dr.  Sawyer. — I  would  like  to  say  that 
1  am  very  much  interested  in  this  subject, 
because  1  myself  suffer  from  gastritis  in  a 
mild  form.  1  eat  too  much  and  too  quickly. 
I  have  made  quite  a  study  of  it  myself,  and 
1  find  that  Dr.  Purefoy  is  very  nearly  right 
in  what  he  says.  There  is  no  disease  which 
is  so  iil-treated  as  gastritis.  A  man  comes 
to  you  and  says  he  has  indigestion.  Ten  to 
one  you  will  give  him  pepsin,  or  it  may  be 
rhubarb,  and  tell  him  to  report  to  you  in  a 
few  days.  There  is  nothing  so  essential  as 
to  make  an  accurate  diagnosis,  not  only  the 
condition  of  the  stomach  and  the  organs, 
but  also  the  cause  of  that  condition,  and 
this  has  to  be  looked  into  and  reguleted 
first,  and  then  the  condition  itself  must  be 
treated.      When    we  have   thoroughly  mas- 


tered the  diagnosis,  and  know  precisely 
what  is  the  matter  with  the  patient,  then 
we  can  know  what  we  are  doing  and  can 
do  it  in  a  scientific  way  and  get  good  re- 
sults, but  unless  we  do  so  we  certainly 
cannot. 

Dr.  S.  W.  Battle. — I  wish  to  add  one 
word  in  regard  to  the  treatment.  Lots  of 
people  who  eat  too  much  and  have  any 
amount  of  discomfort  have  no  inflammatory 
process  going  on  in  the  mucous  membrane 
of  the  stomach.  In  regard  to  the  treatment 
the  doctor  did  leave  out  one  remedy  which 
has  been  of  great  service  to  me,  hydrastis. 
I  believe  hydrastis  is  one  of  the  best  reme- 
dies for  catarrhs  of  the  mucous  membrane 
and  along  the  alimentary  tract  especially. 
I  have  had  more  satisfaction  from  giving 
fluid  extract  of  hydrastis  before  meals  in 
good  big  doses,  from  one-half  to  one  tea- 
spoonful,  than  any  one  single  remedy. 
Along  with  it  I  have  found  that  H.,02  per- 
oxide of  hygrogen  is  a  capital  thing.  We 
all  know  the  effect  of  H202  on  mucous, 
how  it  seems  to  destroy  it  and  carry  it  away 
from  the  stomach,  and  I  have  recommended 
H.,02 ,  a  teaspoonful  or  so  of  peroxide  of  hy- 
drogen and  hydrastis  taken  a  half  hour  be- 
fore breakfast  in  warm  water.  If  you  can- 
not take  as  much  as  that  at  first,  try  a  little 
less,  and  follow  along  that  line.  I  have 
used  hydroguret,  which  is  peroxide  of  hy- 
drogen, only  it  has  more  volume  of  oxygen 
than  the  peroxide  as  we  see  it.  I  would 
like  to  hear  some  of  the  members  on  that 
point. 

Dr.  Ambler. — I  believe  I  was  dubbed 
about  a  year  ago  the  washwoman  of  the 
Society.  I  think  my  mantle  will  fall  on 
Dr.  Morris  now.  I  read  a  paper  here  on 
the  voice  some  time  ago,  and  I  am  pleased 
to  see  Dr.  Morris  is  working  on  the  same 
lines.  He  has  stated  that  diagnosis  of 
stomach  troubles  is  the  most  important 
part,  and  I  believe  that  in  the  stomach  we 
have  our  most  successful  means  of  arriving 
at  a  diagnosis.  I  was  a  little  suprised  to 
hear  him  say  that  three  or  four  hours  after 
a  meal  he  used  the  tube  to  see  what  had  be- 
come of  the  meal.  It  has  been  my  experi- 
ence of  giving  a  test  breakfast  of  a  roll  and 
milk,  at  least  four  hours  must  elapse.  If 
you  give  the  patient  a  hearty  meal  and 
attempt  to  use  a  stomach  tube  after  three 
or  four  hours  you  will  very  often  get  into 
trouble.  An  ordinary  meal  requires  four 
or  five  hours  in  order  to  be  digested.  In 
these  catarrhal  conditions  I  think  the  doctor 
is  perfectly  right  in  using  the  tube  before 
breakfast  to  find  out  if  there  is  an  accumula- 
tion of  mucous  in  the  stomach.  I  do  not 
believe  the  doctor  has  gone  into  the  lactic 
juices  as  closely  as  might  be.      With  a  little 


THE  CHARLOTTE  MEDICAL  JOURNAL 


care  and  a  little  patience  there  is  no  trouble 
in  the  use  of  the  stomach  tube.  Another 
thing  is  the  use  of  the  stomach  bucket  for 
diagnosis.  I  think  that  was  first  brought 
out  by  Ewald?  Almost  any  patient  can 
swallow  a  good  sized  capsule,  and  if  that 
capsule  has  a  silk  thread  fastened  to  it,  that 
cuts  no  figure,  and  I  find  that  there  is 
almost  no  discomfort  in  the  swallowing  of 
the  stomach  bucket.  This  bucket  is  simply 
withdrawn  by  the  thread,  and  is  a  very 
satisfactory  method.  As  to  the  frequency 
of  the  washings,  I  would  differ  from  the 
doctor  somewhat.  I  believe  that  in  ag- 
gravated cases  the  washings  should  be  re- 
peated at  first  daily,  and  the  patient  in  the 
mean  time  put  upon  the  most  restricted 
diet,  and  experiment  and  see  what  he 
digests  and  what  he  does  not  digest.  If 
you  are  not  going  to  keep  a  record  of  what 
he  eats  and  what  he  does  with  it  you  are 
not  going  to  know  how  to  feed  him  after 
you  know  what  the  trouble  is.  I  think  that 
is  one  of  the  most  important  points,  there- 
fore I  always  have  him  write  down  exactly 
what  he  eats,  and  in  using  the  tube  I  always 
make  a  note  under  that  of  what  I  found, 
and  in  following  up  the  case  in  that  way  it 
is  one  of  the  best  methods  we  have  in  our 
hands.  In  regard  to  medication,  I  am  not 
much  of  a  believer  in  it.  I  believe  the 
majority  of  cases  are  due  to  overindulgence, 
and  the  treatment  of  the  case  becomes  one 
of  diet  and  the  exclusion  of  certain  things. 
It  is  not  a  question  of  medication,  but  of 
common  sense.  I  confess  that  in  my  hands 
medication  and  the  stomach  have  not  been 
very  successful,  but  I  believe  I  have  been 
fairly  successful  in  my  cases. 

I  believe  the  doctor  is  right  about  the 
tubercular  cases,  and  a  great  number  of  our 
tubercular  patients  have  preceding  the  tu- 
bercular state  a  state  of  gastric  irritation. 

Dr.  Chapman. — I  quite  agree  with  Dr. 
Morris  and  Dr.  Ambler  about  the  stomach 
tube.  I  find  it  quite  as  efficient  as  any- 
thing I  have  ever  used,  but  on  one  point  I 
differ  a  little.  I  have  often  used  what  is 
known  as  Ewald's  test  breakfast,  consisting 
of  a  roll  and  of  a  cup  of  tea,  but  I  fre- 
quently wash  it  out  in  two  hours  to  see 
what  has  been  done  with  it.  I  believe  that 
the  various  drugs  may  some  times  be  used 
to  advantage.  As  to  washing  the  stomach,  I 
very  often  have  used  as  a  last  washing  a 
solution  of  fluid  extract  of  hydrastis,  but  I 
simply  used  that  to  wash,  and  remove  as 
much  as  I  can.  Another  point  brought  out 
is  the  influence  of  tuberculosis  on  chronic 
gastritis.  It  is  easy  to  see  why  we  have 
chronic  gastritis.  This  condition  very  often 
continues  for  years.     The  blood  cannot  get 


to  the  stomach.  It  is  a  common  thing  to 
see  a  case  of  chronic  gastritis  which  has 
received  no  treatment,  but  attendant  pul- 
monary conditions  being  actively  and  suc- 
cessfully treated. 

Dr  Morris. — I  wish  to  thank  the  gentle- 
men very  much  for  their  discussion,  and 
some  who  have  discussed  the  paper  have 
brought  out  the  weak  points,  which  I  ex- 
pected them  to  do,  and  have  enlarged  on  it, 
for  which  I  am  very  grateful  to  them. 

Dr.  Ambler  and  myself,  I  think,  differ 
very  little,  if  any  at  all.  I  did  not  advise 
the  use  of  the  tube  in  my  paper,  three  or 
four  hours  after  eating  for  the  purpose 
alone  of  finding  out  what  was  going  on  in 
the  stomach,  but  where  a  condition  of 
flatulency,  pain  and  distress  occurred,  to 
give  the  patient  rest  it  might  be  used.  Of 
course  we  use  the  tube  to  determine  the 
condition  of  the  stomach.  As  to  the  daily 
use  of  the  tube,  I  suggested  that  it  might 
be  used  except  with  weak  patients,  debil- 
itated patients  or  very  delicate  patients 
who  could  not  submit  to  the  use  of  the 
tube  every  day.  If  your  patient  is  in  con- 
dition to  use  the  tube  every  day  I  would  do 
so  until  I  had  finished  the  use  of  the  tube. 
As  to  the  question  of  the  time  of  digestion 
taking  place,  I  don't  believe  it  occurs  in 
four  hours.  What  I  wanted  to  do  in  this 
paper  was  simply  to  call  attention  to  the 
fact  that  we  are  very  careless  and  negligent 
in  treating  stomach  troubles.  I  believe  we 
give  it  less  attention  than  any  other  trouble 
we  have  as  much  of.  Another  thing 
is  the  medication — the  use  of  drugs 
in  these  stomach  troubles.  What  I  want 
to  do  is  to  look  after  these  troubles  properly, 
giving  as  little  medicine  as  we  can,  and  re- 
gulate the  patients  eating,  and  their  mode 
of  living  and  their  clothing  and  their  drink- 
ing, which  will  give  us  far  better  results 
than  so  much  medicine.  The  next  point  I 
wanted  to  encourage  was  the  use  of  the 
stomach  tube,  and  as  Dr.  Ambler 
says,  this  is  not  difficult  in  most  cases. 
If  you  simply  ask  your  patient  to 
open  his  mouth  and  take  the  tube 
and  do  not  instruct  him  how  to  take 
it,  you  have  two  forces,  one  acting  against 
the  other.  Of  course,  the  tube  is  forced 
back  when  you  are  forcing  it  down.  You 
will  never  succeed  in  that  way.  The  only 
point  I  want  to  impress  is  to  not  use  oils. 
Use  the  tube  very  gently,  and  instruct  your 
patient  what  you  want  to  do  and  in  most 
cases  you  will  succeed.  Another  point  I 
simply  mentioned  for  the  doctors  to  bring 
out  was  that  of  differentiation  of  lung 
troubles  when  associated  with  these  stomach 
troubles. 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


Tuberculosis — Prevention  and  Treatment, 

with  Some  Personal  Observations  on  the 

use  of  Anti-Tubercle  Serum.* 

By  A.  E.  Powell,  M.  D.,  Marion,  Ind. 

In  presenting  this  paper  on  a  subject  of 
such  great  importance,  I  cannot  hope  to  add 
much  that  is  new  to  the  sum  of  knowledge 
upon  the  subject.  However,  a  new  group- 
ing of  facts  and  a  fresh  presentation  may  be 
all  that  is  needed  to  stimulate  discussion  and 
facilitate  the  exchange  of  ideas  and  experi- 
ences. 

We  are  greatly  alarmed  when  we  are  told 
by  the  daily  press  that  our  country  is  liable 
to  an  invasion  of  yellow  fever,  cholera,  or 
smallpox.  We  spend  great  sums  of  money 
annually  and  tax  human  ingenuity  to  invent 
new  methods  of  protecting  ourselves  from 
these  dreaded  diseases.  We  think  nothing 
of  quarantining  a  ship-load  of  foreigners 
until  we  are  satisfied  that  they  will  not  de- 
velop any  contagious  disease,  and  if  people 
of  our  own  nationality  happen  to  be  among 
them,  they  are  not  excepted.  Many  civili- 
zed States  have  enacted  compulsory  vacci- 
nation laws,  in  their  efforts  to  prevent  the 
introduction  or  spread  of  smallpox,  and 
nearly  every  State  in  the  Union  has  on  its 
statute  books  more  or  less  stringent  laws  for 
the  protection  of  its  citizens  from  diphthe- 
ria, scarlet  fever,  typhoid  fever,  etc.,  yet 
we  pay  practically  no  attention  to  the 
spread  of  tuberculosis  in  the  human  race 
every  year. 

We  are  inconsistent  and,  more  than  that, 
almost  criminal  in  our  neglect  of  proper 
precautions  to  prevent  the  spread  of  this 
disease.  We  should  turn  our  attention  to 
this  matter  and  not  rest  until  we  have  se- 
cured the  enactment  of  laws  requiring  at 
least  the  precautions  that  we  enforce  in  ty- 
phoid fever,  to  be  insisted  upon  by  our 
boards  of  health,  in  all  cases  of  tubercu- 
losis, as  regards  the  disposal  of  excrements 
infected  with  the  disease. 

When,  in  1883,  Robert  Koch  announced 
his  discovery  that  tuberculosis  was  caused 
by  a  pathogenic  micro-organism,  the  bacil- 
lus tuberculosis,  he  placed  in  our  hands  in- 
formation of  the  utmost  importance  in  the 
prevention  and  treatment  of  this  disease. 

The  fact  that  tuberculosis  is  a  contagious 
disease,  every  case  acquiring  its  infection 
from  a  previous  case  either  human  or  ani- 
mal, is  now  an  established  fact,  after  years 
of  discussion  pro  and  con. 

It  would  require  too  much  time  for  me  to 
even  attempt  to  enumerate  in  a    oaper  like 


*Read  before  the  meeting  of  the  Indiana  State 
Medical  Society  at  Layfayette,  Ind.,  May.;1899. 


this,  all  the  means  by  which  the  tubercle 
bacilli  is  conveyed  from  one  individual  to 
another;  suffice  it  to  mention  a  few.  (a) 
Dust  infected  by  sputum  of  consumptives ; 
(b)  infected  meat  and  milk;  (c)  infected 
domestic  animals  or  birds;  (d)  infected  clo- 
thing or  instruments;  (e)  intimate  associa- 
tion with  those  affected. 

Dust  as  a  source  of  infection  is  most  to  be 
feared  in  dwellings  which  have  been  for  a 
long  time  occupied  by  those  suffering  from 
this  disease,  especially  among  the  poorer 
classes  where  the  surroundings  are  frequent- 
ly unhygienic  and  often  filthy,  patients  ex- 
pectorating on  walls,  carpet  or  floor  indis- 
criminately. Dust  from  the  street  no  doubt 
often  contains  tubercle  bacilli,  but  as  it  has 
been  exposed  to  the  bactericidal  action  of 
sunlight  and  fresh  air,  it  can  not  be  as  dan- 
gerous as  dust  from  any  confined  space. 
Recently  while  examining  an  applicant  for 
life  insurance  I  discovered  him  to  be  suffer- 
ing from  incipient  tuberculosis  of  the  lungs. 
On  questioning  him  I  found  that  his  busi- 
ness was  that  of  a  laborer  in  a  pulp-mill 
where  he  was  compelled  to  sort  waste  paper 
previous  to  its  reduction  to  pulp.  This  pa- 
per, he  said,  was  frequently  dusty  and  very 
often  in  a  filthy  condition,  and  there  is  no 
doubt  that  his  disease  was  acquired  from 
infected  dust,  which  he  breathed  while  sort- 
ing filthy  paper. 

Infected  meat  or  milk  are  both  a  source 
of  danger,  milk  being  the  most  liable  to 
cause  the  disease,  from  the  fact  that  it  is 
often  the  sole  food  for  several  years  of  in- 
fant life.  Many  kinds  of  cattle  bred  with  the 
sole  object  of  securing  a  breed  that  will  pro- 
duce the  most  milk,  are  so  feeble  that  when 
kept  in  unhygienic  surroundings,  such  as 
damp,  ill-ventilated  stables  with  little  or 
no  light,  they  readily  become  tuberculous. 
Many  families  depend  for  their  milk  supply 
on  some  such  single  animal  where  they 
would  be  far  safer  to  buy  the  mixed  milk 
sold  by  any  reputable  milkman. 

Birds  readily  acquire  tuberculosis,  cats 
have  often  been  demonstrated  to  be  carriers 
of  Diphtheria,  and  there  are  cases  of  pneu- 
monia on  record  that  have  been  acquired 
from  parrots  kept  as  pets ;  why,  therefore, 
may  not  these  animals  be  conveyors  of  tu- 
berculosis. At  least  it  seems  a  safe  precau- 
tion to  prevent  children  from  "kissing"  the 
pretty  birds  or  animals  which  are  so  often 
given  them  for  playthings,  or  to  see  that 
they  do  not  occupy  the  same  bed  at  any 
time. 

There  are  cases  on  record  where  tubercu- 
losis has  been  conveyed  to  a  healthy  subject 
by  infection  from  the  washing  of  handker- 
chiefs soiled  with  the  sputum  of  a  consump- 
tive relative. 


500 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


Instruments  or  dressings  used  in  opera- 
tions or  after  treatment  of  tuberculous  cases 
are  often  as  dangerous  sources  of  infection 
as  those  used  on  cases  of  septic  infection. 

How  to  control  intimate  personal  contact 
between  tuberculous  individuals  and  those 
who  are  not  affected,  especially  when  mem- 
bers of  the  same  family,  is  one  of  the  most 
delicate  and  perplexing  questions  that  the 
physician  is  called  upon  to  meet.  May  a 
tuberculous  mother  nurse  her  child?  How 
shall  we  prevent  other  members  of  the  fam- 
ily or  servants  who  may  he  infected  from 
kissing  and  fondling  children?  What  is 
the  amount  of  danger  from  sexual  contact 
between  those  sound  and  those  affected? 
These  and  many  other  questions  have  to  be 
answered  by  the  conscientious  physician. 
They  may  appear  trival,  but  great  results 
often  hang  on  the  way  in  which  they  are 
answered. 

The  heredity  of  tuberculosis  is  a  question 
that  after  much  discussion  has  been  pretty 
well  decided  in  the  negative;  while  there 
may  be  a  few  cases  that  are  directly  inheri 
ted,  by  the  transmission  of  the  germs  of 
the  disease  through  the  placental  circula- 
tion, or  by  infected  seminal  fluid,  nearly  all 
cases  are  acquired  by  some  of  the  means 
mentioned. above.  In  many  instances  sev- 
eral persons  may  be  exposed  to  infection, 
and  of  the  number  only  one  or  two  acquire 
the  disease.  In  this  the  inherited  tendency 
to  the  disease  no  doubt  plays  a  prominent 
part,  the  person  affected  having  had  a  weak 
constitution  and  less  powers  of  resistance 
from  the  beginning,  while  his  stronger 
neighbors  escape. 

The  identification  of  tuberculosis  in  its 
incipiency  is  second  only  to  proper  methods 
of  treatment ;  for,  in  order  to  treat  the  dis- 
ease with  any  hope  of  success,  it  is  absolute- 
ly necessary  that  a  correct  diagnosis  be 
made  at  the  earliest  possible  moment. 
Many  cases  are  not  seen  by  the  physician 
until  the  tuberculous  process  is  well  estab- 
lished, and  in  this  class  of  cases  the  fever, 
cough,  etc.,  are  so  marked  that  no  special 
skill  is  needed  to  recognize  the  character  of 
the  complaint. 

At  a  very  early  stage  the  physical  evi- 
dences are  so  slight  that  they  may  be  easily 
overlooked  or  disregarded.  In  order  to  ar- 
rive at  a  correct  diagnosis  the  clinical  pic- 
ture of  an  incipient  case  must  be  considered 
as  a  whole,  without  placing  too  much  stress 
on  the  presence  or  absence  of  single  symp- 
toms which  are  supposed  to  be  character- 
istic. 

The  presence  of  a  cough  in  a  given  case 
is  not  positive  evidence  of  the  presence  of 
the  disease  ;  neither  is  its  absence  to  be  im- 
plicitly   relied    upon    as    an    indication    of 


death.  A  case  subject  to  paroxysms  of 
coughing  in  the  morning  or  evening  should 
be  looked  upon  with  suspicion  if  the  cough 
lasts  for  more  than  three  weeks. 

Hemorrhage  is  also  among  the  very  early 
symptoms  in  some  cases;  it  is  alarming  to 
the  patient,  and  even  slight  hemorrhages 
should  be  investigated  carefully.  Hemop- 
tysis in  a  person  otherwise  apparently 
healthy  is  positive  evidence  of  tuberculosis. 

One  of  the  earliest  symptoms  is  fever ; 
this  is  usually  so  slight  that  it  is  easily  over- 
looked unless  the  patient  is  kept  under  ob- 
servation for  several  days.  A  good  plan  is 
to  take  the  temperature  at  8  a.m.,  12  m.,  4 
p.  m.  and  8  p.  m.  for  three  or  four  days  in 
succession.  If  a  tuberculosis  process  be 
going  on  in  the  lungs  there  will  be  found  in 
nearly  all  cases  a  slight  rise  of  temperature, 
from  .1  to  2  deg.  F.  This  rise  is  not  pres- 
ent every  day  and  is  not  always  alike;  it  is 
usually  increased  by  exertion,  which  also 
gives  rise  in  many  cases  to  dyspnoea  and 
palpitation.  The  pulse  rate  is  always  in- 
creased in  the  early  stages  of  this  disease, 
even  if  the  patient  be  quiet. 

These  manifestations  are  the  results  of 
ptomaine  absorption  and  this  should  be 
borne  in  mind  when  investigating  a  suspi- 
cious case,  hence  malaise,  anorexia,  heavy 
urine  with  traces  of  albumen,  enlarged 
glands  are,  with  other  symptoms  of  toxe- 
mia, valuable  aids  to  forming  a  correct  con- 
clusion. 

Positive  and  unmistakable  evidence  of  the 
presence  of  consumption  in  a  given  case  is 
the  presence  of  the  specific  germ  in  the  spu- 
tum. Unfortunately  it  often  happens  that  at 
the  stage  of  which  we  are  speaking  no  spu- 
tum can  be  obtained,  or  if  obtained  it  does 
not  contain  any  bacilli.  It  is  well  in  col- 
lecting sputum  that  the  physician  should  be 
sure  that  the  sputum  comes  from  the  respi- 
ratory tract;  that  which  is  raised  by  cough- 
ing in  the  morning  is  preferable.  If  the 
quantity  is  small  and  ordinary  methods  do 
not  reveal  the  germ,  the  sputum  should  be 
boiled  with  twice  its  quantity  of  water,  con- 
taining in  solution  a  small  amount  of  Na 
OH,  evaporated  to  a  small  amount  and  then 
precipitated  either  by  standing  or  by  the 
use  of  a  centrifuge.  Failure  to  find  the 
germ  is  not  positive  evidence  of  the  benign 
nature  of  the  case. 

When  Koch's  tuberculin  was  first  used  it 
was  found  that,  following  the  injection 
of  the  remedy,  about  twenty-four  hours,  a 
more  or  less  severe  reaction  took  place, con- 
sisting of  a  chill,  followed  by  a  temperature 
of  101  to  103  F.,  with  malaise,  aching  in 
the  bones,  etc.,  which  after  a  few  hours 
passed  aw  ay,  leaving  the  patient  in  the  or- 
dinary condition. 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


501 


This  characteristic  reaction  has  been  uti- 
lized, first  as  a  test  for  the  presence  of  tu- 
berculosis in  cattle  and  lately  in  the  human 
subject.  In  a  suspected  case  a  first  dose  of 
.005  (1  mg.)  is  given,  and  if  this  is  follow- 
ed by  no  reaction  the  next  day,  upon  the 
third  day  a  dose  of  .01  (leg.)  is  given  ;  if 
there  is  still  no  reaction  upon  the  fifth  day, 
a  third  dose  of  .02  (2  eg.)  is  given.  The 
absence  of  any  reaction  after  three  injec- 
tions positively  excludes  the  presence  of 
tuberculosis  in  the  case  tested. 

This  method  of  diagnosis  permits  us  to 
discover  the  disease  in  those  cases  where  its 
presence  could  not  otherwise  be  demon- 
strated. 

It  has  been  objected  to  on  the  ground  that 
it  causes  a  dissemination  of  tuberculous  ma- 
terial, one  observer  going  so  far  as  to  say 
that  where  tuberculine  had  been  used,  41% 
of  cases  showed  miliary  tubercules  at  post 
mortem,  where  only  6%  were  affected  in 
this  manner  of  those  not  injected  with  tu- 
berculin. The  investigations  of  Guttman 
and  Ehrlich,  in  Germany,  and  of  Trudeau, 
Denison,  Klebs  and  Whittaker.of  America, 
give  evidence  to  the  contrary,  however. 
The  bad  results  sometimes  seen  are  due  to 
the  use  of  too  large  doses,  or  to  the  use  of 
tuberculin  in  well  developed  cases  of  the 
disease,  where  large  ureas  of  lung  are  aff- 
ected. 

The  experience  of  physicians  with  the 
treatment  of  Tuberculosis  in  the  past  has 
been  unfortunate,  which  no  doubt  accounts 
for  the  pessimistic  attitude  of  the  profession 
to-day. 

No  one  line  of  treatment  will  be  suitable 
for  all  cases  of  this  disease.  We  must  take 
into  consideration  the  age,  duration  of  the 
disease,  physical  resistance,  power  of  recu- 
peration, together  with  the  family  and  per- 
sonal history.  Those  cases  in  which  the 
patients  have  acquired  the  disease,  not  hav- 
ing an  inherited  tendency  from  tuberculous 
ancestors,  but,  becoming  infected  in  later 
life,  are  usually  more  amenable  to  treatment 
than  those  with  a  bad  family  history.  The 
various  complications  of  each  case  should 
be  carefully  studied  in  order  that  the  treat- 
ment may  be  adapted  to  the  individual  case. 

The  primary  essentials  are  proper  nour- 
ishment, even  temperature  and  pure  air. 
By  proper  nourishment  I  mean  such  food 
as  will  be  easiest  digested  and  furnish  most 
energy  to  the  body.  Nearly  every  patient 
suffering  with  this  disease  sooner  or  later 
becomes  a  dyspeptic. 

For  this  reason  the  greatest  attention 
should  be  paid  to  the  digestive  apparatus,  as 
upon  the  degree  of  its  effectiveness  depends 
the  success  or  failure  of  any  line  of  treat- 
ment.     Each  patient  must  be  nourished  ac- 


cording to  his  or  her  individual  require- 
ments. In  a  general  way,  broiled  steak  or 
roast  beef,  medium  rare  done ;  lamb,  mut- 
ton, eggs,  fish,  beef  broth,  oyster  broth, 
clam  broth,  milk,  cream,  bread,  with  small 
quantities  of  vegetables  that  do  not  disagree 
should  be  the  staple  articles  of  food. 

Fried  foods,  pastry  and  sweetmeats  are 
not  desirable  articles  of  food  for  consump- 
tive patients.  Fruits  are  valuable, but  should 
not  be  eaten  to  the  exclusion  of  more  nour- 
ishing articles  of  food. 

The  whites  of  one  to  three  eggs  may  be 
beaten  and  mixed  with  a  glass  of  milk  or 
cream  and  given  to  weak  patients  two  or 
three  times  a  day.  Cream  has  a  fat  as  good 
as  cod-liver  oil  and  more  palatable. 

Pure,  fresh  air  is  of  the  greatest  impor- 
tance in  these  cases;  and  if  the  patient  is 
too  weak  to  go  about  it  should  be  secured 
by  ventilation.  The  chief  value  of  climatic 
treatment  is  the  fact  that  the  air  of  some 
places  contains  more  ozone  and  less  moist- 
ure than  others. 

In  patients  too  weak  to  take  much  exer- 
cise the  judicious  use  of  massage,  using 
some  of  the  vegetable  oils  as  a  lubricant, and 
following  the  massage  by  a  salt  rub,  with 
brisk  friction  with  a  dry  towel,  is  very 
beneficial. 

In  the  climatic  treatment  of  this  disease 
there  is  room  for  a  great  deal  of  improve- 
ment. To  send  a  patient  hastily  away  thou- 
sands of  miles  from  friends,  as  soon  as  a 
diagnosis  of  tuberculosis  is  made  and  with- 
out due  consideration  of  his  case  or  the  cli- 
mate that  he  may  find,  is  a  procedure  that 
causes  a  wanton  waste  of  money  and  life, 
and  needless  sorrow  to  friends.  Not  only 
must  the  best  climate  for  a  particular  case 
be  selected,  but  the  patient  should  be  direct- 
ed to  visit  some  reputable  practitioner  when 
he  reaches  the  end  of  his  journey  and  place 
himself  under  his  care.  This  will  prevent 
many  mistakes  which  so  often  discourage 
the  patient  and  either  hasten  his  decline  or 
send  him  home  disgusted  with  the  whole 
affair.  "Fresh  air,  fresh  air,  fresh  air," 
should  be  endlessly  preached  to  these  peo- 
ple. This  can  be  obtained  as  well  in  Indi- 
ana as  in  California.  Fresh  air  and  sun- 
shine are  natures  own  remedies  for  the  treat- 
ment of  this  disease,  and  if  the  patient  goes 
to  a  tourist's  hotel  and  shuts  himself  up  in- 
stead of  getting  out  of  doors  he  is  worse  off 
than  he  would  be  at  home.  I  believe  the 
only  climate  of  much  value  is  the  dry,  mod- 
erately elevated  region  of  western  Texas 
and  portions  of  New  Mexico.  The  patient 
should  be  instructed  to  live  out  of  doors  as 
much  as  he  possibly  can,  even  in  this  cli- 
mate. 

Climatic  treatment  is  most  valuable  in  the 


502 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


very  earliest  stage  of  the  disease,  ami  the 
patient  should  be  cautioned  against  return- 
ing to  a  damp  climate  too  soon.  It  is  much 
better  for  them  to  remain  permanently  in  a 
climate  that  is  suited  to  their  condition. 

In  treating  these  cases,  like  others,  I  have 
tried  many  remedies.  I  prefer  some  prepa- 
ration containing  codeine  for  the  cough 
and  strychnia  for  its  tonic  effects,  combined 
as  the  needs  of  the  case  seem  to  indicate 
with  other -general  tonics.  Diarrhoea  result- 
ing from  dyspepsia  is  best  controlled  by 
some  digestive  agent,  such  as  peptonzyme 
or  taka-diastase.  Lately  I  have  seen  good 
results  from  a  preparation  known  as  a  syn- 
thetic cod-liver  oil.  It  seems  to  be 
well  borne  by  patients  when  other 
food  is  rejected.  The  needs  of  every 
case  should  be  studied  and  treatment  insti- 
tuted in  accordance  wsth  the  indications  of 
the  various  complications. 

Ever  since  the  introduction  of  antitoxins 
into  the  treatment  of  disease,  it  was  hoped 
that  the  principle  could  be  applied  to  the 
treatment  of  tuberculosis.  Matagliano,  in 
Italy,  first  used  the  natural  blood  serum  of 
the  ass,  and  in  1S85  and  '86  he  reported 
some  of  the  results  of  his  experimentation 
with  the  blood  of  this  animal.  In  his  ex- 
periment? the  animals  were  treated  to  in- 
crease their  resistance  to  the  disease.  Before 
this  time,  Richet,  Hericourt  and  others  in 
Europe  had  used  the  blood  serum  of  the 
dog  in  similar  experiments. 

Dr.  Paul  Paquin,  of  St.  Louis,  Mo.,  made 
the  first  reports  of  the  results  of  patients 
treated  by  serum  from  the  blood  of  immu- 
nized horses  in  December,  1894,  and  in 
January,  1895.  Since  that  time  a  number 
of  men  have  used  this  form  of  treatment  in 
tubercular  troubles  in  almost  every  part  of 
the  civilized  world.  This  form  of  treat- 
ment seems  to  come  the  nearest  to  the 
natural  method  of  treatment  of  disease. 
When  a  poisonous  material  is  thrown  into 
the  system  of  an  animal  the  body  reacts 
against  it,  and  after  a  time  the  original 
dose  many  times  multiplied  can  be  given 
with  impunity  to  the  animal  that  at  the  be- 
ginning would  easily  have  been  destroyed 
by  such  a  dose. 

This  condition  of  the  animal  economy  is 
known  as  "immunity,"  and  the  process  of 
treatment  that  the  animal  undergoes  to 
reach  this  condition  is  called  "Immuniza- 
tion." Blood  serum  taken  from  an  animal 
that  is  immune  to  a  certain  toxin  and  in- 
jected into  one  that  is  not  will  protect  it 
against  an  otherwise  fatal  dose  of  the  toxin 
for  which  animal  No.  1  has  been  immuniz- 
ed, but  not  against  another  poison. 

For  this  reason  it  becomes  necessary  to 
use  different   animals  to    produce   different 


antitoxins  or  serums,  as  diphtheria  anti- 
toxin would  not  protect  against  tuberculosis, 
nor  tetanus  antitoxin  against  diphtheria. 

It  has  been  found  that  the  tubercle  bacil- 
lus contains  in  its  substance  several  deadly 
toxins  aside  from  those  that  it  forms  during 
its  growth  in  cultures.  These  toxins  can 
not  very  well  be  isolated  and  used  alone,  so 
it  becomes  necessary  in  order  to  secure  a 
high  state  of  immuniration  to  inject  the 
substance  of  the  germs  themselves  into 
the  animal  being  treated.  A  mixture  of 
pulverized  germ  substance  and  tuberculin 
is  injected  into  a  horse  in  doses  of  1  c.c.  to 
30  c.c.  daily  for  several  months,  and  then, 
after  a  period  of  rest  to  allow  all  of  the 
toxins  to  be  excreted  from  the  system,  blood 
is  drawn  from  the  animal  and  the  serum 
used  in  treatment  of  human  tuberculosis. 
The  aim  of  this  form  of  treatment  is  to 
neutralize  the  effect  of  tubercle  toxin  pre- 
sent in  the  system,  stop  the  growth  of  the 
germs  or  modify  their  virulence  and  to  sup- 
plement the  natural  antitoxic  powers  of  the 
system  and  greatly  increase  them,  thus  aid- 
ing natures  natural  recuperative  powers  to 
throw  off  the  disease.  Its  effectiveness 
can  be  greatly  increased  by  attention  to  the 
surroundings  of  the  patient  and  the  proper 
treatment  of  any  complication  that  may  be 
present.  As  in  diphtheria  and  other  dis- 
eases treated  by  this  method  (antitoxins), 
the  wise  physician  will  not  fail  to  assist 
the  system  of  his  patient  in  every  way 
possible,  by  proper  food,  fresh  air,  atten- 
tion to  digestion,  etc.,  to  throw  off  the 
disease.  I  wish  to  report  briefly  a  few 
cases  that  have  fallen  under  my  observa- 
tion, and  which  have  been  treated  with 
antitubercle  serum  made  by  the  Paul  Paquin 
Laboratories,  at  St.  Louis,  Mo. 

Case  I. — Male,  American,  aged  28, 
married,  horse  trainer.  Family  history 
good.  Personal  history  up  to  previous 
autumn,  four  months  before,  good.  At 
that  time  he  suffered  an  attack  of  la  grippe, 
and  from  that  time  a  rapid  decline  ensued 
Physical  examination  showed  both  lungs, 
seriously  involved,  having  cavities  and 
much  tubercular  infiltration.  Sputum  was 
abundant,  and  contained  many  bacilli.  He 
suffered  dyspnoea  on  slight  exertion  and 
had  frequent  streaks  of  blood  in  the  sputum. 
Diagnosis,  pulmonary  tuberculosis,  second 
stage. 

He  was  given  antitubercle  serum  by  an- 
other pyhsician  for  about  two  months,  and 
under  its  use  showed  marked  improvement, 
gained  several  pounds  in  body  weight,  and 
showing  a  general  improvement.  His  case 
was  brought  to  a  fatal  termination  before 
it  could  be  decided  how  much  improve- 
ment he  would  eventually  make,  by  expo- 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


503 


sure   to  a  rain,   which   caused  a  sudden  ex- 
acerbation  of  the  disease,  and  death. 

Case  II. — Male,  American,  aged  25 
married,  physician.  Family  history  nega 
tive.  Personal  history,  good  up  to  two 
years  before,  when  he  suffered  from  a 
severe  attack  of  la  grippe.  After  having 
had  la  grippe,  he  had  several  hemorrhages 
from  time  to  time,  with  slight  occasional 
rises  of  temperature.  Attention  was  first 
called  to  his  lungs  by  an  examination  for 
life  insurance  shortly  after,  which  showed 
considerable  infiltration  of  the  lower  rear 
portion  of  the  left  lung. 

At  this  time  he  was  in  ill  health,  but  with 
no  especial  symptoms  pointing  to  pulmon- 
ary tuberculosis.  These,  however,  devel- 
oped later.  An  examination  at  this  time 
showed  tubercles  scattered  through  both 
lungs,  with  several  cavities  in  the  anterior 
portion  of  the  upper  lobe  of  the  left  lung. 
Tubercle  bacilli  in  the  sputum,  chills,  fever, 
hemorrhages  and  rapid  decline  called  for 
immediate  attention.  The  diagnosis  was 
plain. 

He  was  treated  with  serum  injections  for 
about  three  months  nearly  every  day.  Chills 
and  fever  disappeared  almost  entirely  dur- 
ing the  first  month,  appetite  increased,  ex- 
pectoration  diminished,  hemorrhages  be- 
came less  frequent,  and  the  cough  finally 
disappeared.  Now,  about  t luce  years  alter 
taking  treatment,  his  health  is  good  ami  he 
does  his  ordinary  work  of  general  practice. 
All  signs  of  tuberculosis,  as  far  as  external 
appearances  are  concerned,  have  disap- 
peared. 

Cask  III. — Male,  American,  aged  35, 
glass-blower,  married.  Suffered  from  pul- 
monary tuberculosis  for  six  months  before  I 
saw  him.  Both  lungs  contained  large  cav- 
itives,  and  he  had  profuse  expectoration, 
containing  many  bacilli.  Treated  with  se- 
rum daily  for  one  month  with  only  very 
slight  improvement.      Died. 

Cask  IV. — Female,  white,  American, 
single,  aged  24.  Family  history  bad.  I 
had  no  opportunity  to  make  a  physical  ex- 
amination in  this  case,  but  she  undoubtedly 
had  cavities  of  considerable  size,  as  she  had 
quite  a  large  amount  of  muco-purulent  spu- 
tum that  contained  large  numbers  of  the 
tubercle  bacilli,  with  chills,  fever  and  other 
symptoms  of  secondary  infection.  She  was 
given  the  serum  for  about  six  months,  and 
at  the  last  time  I  heard  from  her  she  wrote 
that  she  had  gained  her  normal  weight  and 
that  her  friends  considered  her  well.  She 
still,  however,  had  some  cough  and  expec- 
toration. This  was  two  years  after  she  had 
taken   the  treatment. 

Case  V. — Female,  white,  American, 
aged  22,  single,  nurse  in  sanitarium.      Seen 


in  consultation  after  return  to  her  home. 
Family  history  good.  Personal  history  good 
up  to  the  time  of  her  illness.  Had  been  ill 
two  months.  Physical  examination  showed 
much  infiltration  of  the  lung  tissue  and  sev- 
eral cavities  in  the  right  lung.  She  had 
chills,  fever  and  was  very  weak.  Tubercle 
bacilli  were  present  in  the  sputum  in  large 
numbers.  .She  was  treated  by  serum  for 
several  weeks  with  no  results,  and  after 
lingering  for  a  few  months  succumbed  to 
the  disease. 

Case  VI. — Female,  white,  American, 
married,  aged  47,  house-keeper.  Family 
history  bad.  All  of  the  family  on  her 
mother's  side  had  died  with  tuberculosis, 
her  own  sisters  and  several  of  her  children. 
Had  been  ill  one  year.  Both  lungs  badly 
affected.  Many  bacilli  in  the  sputum. 
Chills  and  fever  present  every  day.  Severe 
cough.  Treated  with  serum  for  three 
months.      No  improvement. 

Cask  VII. — Female,  American,  white, 
single,  house-keeper.  Good  family  history. 
Had  been  ill  two  years;  before  that  her 
health  had  been  fair.  .Started  with  la 
grippe.  She  had  severe  cough,  with  quite 
a  good  deal  of  expectoration,  fever  and  oc- 
casional chills.  Occasional  streaks  of  blood 
in  the  sputum.  Left  lung  mostly  involved, 
with  a  large  cavity.  Bacilli  present.  Treat- 
ed for  two  months  with  serum  ;  slight  im- 
provement in  weight  and  other  symptoms 
modified,  but  no  benefit  of  any  moment 
obtained. 

Case  VIII. — Male,  American,  white, 
single,  book-keeper.  Family  history  bad. 
Mother  and  three  aunts  had  died  of  con- 
sumption. Personal  history  good  up  to  three 
years  ago,  when  he  had  an  attack  of  what 
he  called  la  grippe;  since  that  time  he  had 
been  ill  several  times  with  what  he  had  pro- 
nounced the  same  disorder,  but  his  lungs 
seemed  to  be  chiefly  affected  each  time. 
Had  one  severe  hemorrhage  and  several 
times  noticed  blood  in  his  sputum.  Coughed 
at  night  and  morning,  and  had  (  small 
amount  of  sputum,  but  little  pus.  Physical 
examination  showed  the  lower  rear  portions 
of  both  lungs  to  be  most  affected;  no  cavi- 
ties of  any  size  or  much  consolidation  pre- 
sent. Treated  with  serum  for  about  two 
months,  when  he  felt  so  well  that  he  stop- 
ped taking  injections  in  spite  of  the  fact 
that  he  was  told  that  he  could  hardly  be 
cured  in  so  brief  a  length  of  time.  Cough 
and  expectoration  disappeared  and  he  gained 
about  ten  pounds  in  weight. 

Other  cases  might  be  cited,  but  I  have 
not  space  in  this  paper  to  give  more.  These 
are  sufficient  to  point  out  some  of  the  con- 
clusions which  follow  at  the  end  of  this 
paper       These  cases  were  mostly  treated  by 


504 


THE  CHARLOTTE   MEDICAL  JOURNAL. 


serum  alone,  without  the  aid  of  other  rem- 
edies. I  think  every  one  finds  it  hard  to 
treat  advanced  cases  in  ordinary  practice  as 
successfully  as  in  sanitaria,  where  baths, 
massage,  proper  diet,  etc.,  can  be  secured. 
By  this  I  mean  cases  in  the  second  and  third 
stages,  where  they  can  get  around  with  dif- 
ficulty. Exercise  in  the  open  air  with  a 
proper  diet  are  two  invaluable  adjuncts  to 
the  treatment  of  this  disease,  and  these  are 
often  hard  to  secure,  the  first  on  account  of 
the  aversion  of  the  patient  to  exercise,  and 
the  second  on  account  of  his  friends  to  cook- 
ing food  out  of  the  ordinary  methods. 

I  wish  to  call  attention  to  the  fact  that 
no  great  benefit  was  derived  from  serum 
treatment  in  cases  where  there  is  a  bad 
family  history,  coupled  with  a  disease  of 
two  or  three  years'  standing.  The  cases 
which  received  the  most  benefit  were  those 
that  received  treatment  early  in  the  course 
of  the  disease  before  there  was  much  weak- 
ening of  the  system  by  absorption  of  septic 
material. 

Antitubercle  serum  seems  to  exert  a  decided 
antitoxic  effect  that  can  not  be  obtained 
from  any  other  remedy.  This  is  noticeable 
in  its  effects  on  the  chills  and  fever  in  many 
cases,  especially  where  they  are  not  of  long 
standing.  In  old  cases  there  is  such  a  pro- 
found poisoning  from  prolonged  secondary 
infection  that  it  is  hard  to  get  any  reaction, 
yet  I  have  seen  some  of  these  cases  that 
were  greatly  benefited  by  it.  With  proper 
precautions  it  never  gives  rise  to  serious 
trouble.  I  have  never  seen  an  abscess  pro- 
duced by  its  use  or  anything  like  one.  The 
chief  trouble  I  have  experienced  is  from  an 
urticaria  that  usually  appears  three  or  four 
days  after  its  use  is  begun,  but  yields  read- 
ily on  stopping  the  injections  for  a  day  or 
two  and  giving  laxatives  and  diuretics.  It 
never  occurs  again  in  the  same  patient.  If 
injections  are  painful  when  given  hypoder- 
mically,  it  can  be  given  by  the  rectum,  by 
a  syringe  that  has  been  specially  devised 
for  that  purpose.  There  are  usually  no  skin 
troubles  following  its  use  per  rectum. 

In  giving  remedies  of  this  description  we 
must  be  on  the  lookout  for  peculiar  idiosyn- 
cracies  of  those  treated.  Some  patients  are 
very  nervous,  and  the  use  of  a  spray  of 
ethyl-chloride  before  making  the  injection 
under  the  skin  of  the  back  will  be  a  valua- 
ble procedure. 

In  female  patients  it  is  a  great  bother  to 
get  at  the  proper  place  to  make  the  injec- 
tion in  the  back  on  account  of  clothing.  I 
have  found  that  if  the  patient  wears  a  loose 
outer  garment,  and  has  the  underclothing 
cut  down  the  back,  and  supplied  with  but- 
tons and  buttonholes   it    greatly  facilitates 


matters,  and    adds    to    the   comfort    of  the 
patient. 

Injections  are  usually  given  at  about  10 
minims  at  the  start,  gradually  increasing 
the  dose  so  that  at  the  end  of  a  week  30  to 
40  minims  are  given  every  day,  using  the 
skin  under  the  right  shoulder  blade  on  one 
day,  and  that  of  the  other  side  upon  tl 
next,  and  so  on. 

Once  or  twice,  I  have  had  patients  faint 
becoming  very  cyanotic  after  giving  an  ir 
jection.      In  such  cases  I  give  whiskey,  anc 
strychnia  hypodermically,  allowing  them  to i| 
rest  for  a  time    before   standing    or    sitting 
erect.     The   attack   usually  passes  off    in  a;[ 
few   minutes,  and    seldom    occurs   twice  in 
the  same   patient.     This   is  not  due   to  theU 
serum,  per  se,  as  the    same    condition    mayj 
follow  an  injection  of  water. 

All  hypodermics,  needles,  etc.,  should  be 
kept  as  clean    as   possible    and  washed    oul| 
with    sterile     water    after    each    patient    is 
treated. 

It  is  well  to  disinfect  the  skin  before  the ; 
injection  is  made  with  a  mild  antiseptic,, 
such  as  listerine,  borolyptol  or  euthymol,or| 
a  3  to  4  per  cent,  solution  of  carbolic  acid 
may  be  used. 

To  conclude:  Tuberculosis  is  an  infec- 
tious disease  whose  ravages  could  be  con-j 
trolled  and  the  disease  finally  exterminated 
b\-  improved  sanitary  regulations,  both  pub- 
lic and  private.  It  should  be  the  endeavor 
of  the  medical  profession  toeducate  the 
public  to  this  end. 

The  majority  of  cases,  if  detected  in  their; 
incipiency,  are  curable.  This  calls  for] 
more  accurate  and  careful  methods  of  diag- 
nosis. 

Antitubercle  serum  is  a  valuable  agent 
in  the  treatment  of  this  disease,  espe-; 
cially  in  early  cases,  and  is  worthy  of 
careful  trial.  In  cases  treated  with  it  we 
should  endeavor  to  place  the  patient  in  the 
most  favorable  attitude  by  proper  attention 
to  the  complications  of  his  case  and  to  his 
surroundings-  By  so  doing  we  will  get  thej 
best  results. 


Treatment   of    Eclampsia.* 

By  Louis   D.  Barbot,    M.   D.,  Charleston,   S.  C- 

For  the  treatthent  of  Eclampsia  there  is| 
no    specific. 

Each  case  that  presents  itself  must  be 
more  or  less  a  law  unto  itself.  Possibly, 
the  best  rule  would  be  to  forget  all  theories 
and  to  use  those  remedies  which  your  ex- 
perience has   proven    most    valuable.     Our 


*Read  before  the   Medical   Soeietv  of    South ;.. 
Carolina,  April  1,  1899. 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


505 


method  of  treatment  must  vary  according 
to  circumstances.  I  make  this  assertion 
knowing  there  are  eminent  authorities  who 
are  wedded  to  this  or  that  line  of  treatment 
in  almost  every  case  that  presents  itself. 
A  Gooch  will  tell  you  "to  take  care  of  the 
convulsions  and  let  the  uterus  take  care  of 
itself." 

A.  Duhrssen  does  not  shrink  from  end- 
ing the  pregnancy,  even  when  the  child  is 
not  viable,  overcoming  all  obstacles,  incis- 
ing cervix,  perinaeum  and  vulva,  to  insure 
rapid  delivery.  The  great  divergent  views 
of  treatment  are  to  be  accounted  for  by  the 
obscurity  of  the  pathogenesis  of  the  disease. 

It  is  not  the  province  of  this  paper  to 
enter  into  a  discussion  of  the  etiology  of 
eclampsia  with  its  many  theories,  however 
interesting  and  enticing  this  field  may  be; 
yet,  to  discuss  intelligently  the  treatment 
of  any  disease,  we  must  consider  its  cause. 
To  my  mind,  eclampsia  is  dependent  upon 
a  toxaemia,  due  to  an  over-production  of 
toxins  and  an  under-elimination  by  the 
emunctories.  This  theory  is  sustained  by 
the  clinical  history  of  the  disease  and  by 
post-mortem  appearances.  It  is  further 
sustained  by  the  investigation  of  Bouchard, 
who  has  proven  that  the  toxicity  of  the 
urine  is  greatly  lessened  in  the  eclamptic, 
whilst  that  of  the  blood  serum  is  notably 
increased. 

My  views  regarding  the  treatment  of 
eclampsia,  therefore,  will  be  based  upon 
this  theory. 

The  treatment  of  eclampsia  is  either 
prophylactic  or  curative.  The  prophylac- 
tic treatment  is  called  for  by  those  precur- 
sory phenomena  which  we  should  ever  be 
on  the  lookout  for  in  the  pregnant  woman, 
namely — excessive  nausea  and  vomiting, 
alhuminuria  with  casts,  edema,  headache, 
mental  disturbance,  obscurity  of  vision, 
ringing  in  the  ears,  great  restlessness,  epi- 
gastric pain  and  lumbago. 

If  these  symptoms  are  present  to  any 
great  extent,  convulsions  will  surely  ensue, 
unless  the  proper  means  are  taken  to  avert 
them.  Considering  the  etiology,  we  readily 
find  the  requisite  means.  They  consist 
mainly  in  securing  free  action  of  the  skin, 
bowels  and  kidneys.  All  the  emunctories 
must  be  opened.  For  the  skin,  I  would 
recommend  a  hot  bath,  daily,  at  a  tempera- 
ture of  ioo  deg.  F.  for  fifteen  minutes. 
For  the  kidneys  I  would  give  the  alkaline 
mineral  waters  freely,  with  i-ioo  gr.  of 
nitro-glycerine  three  times   a    day. 

Vinay  speaks  highly  of  chloral.  He  re- 
fers to  a  primigravida,  having,  at  the  end 
:  of  the  eighth  month,  twenty-two  grams  of 
|  dried  albumen  in  the  urine  in  twenty-four 
hours,  who  took,  during  the   ninth    month, 


one  hundred  and  twenty  grams  of  chloral, 
or  four  grams  per  day.  Patient  had  no 
convulsions,  and  was  delivered  of  a  living 
child  at  term. 

For  the  bowels  we  should  have  free 
catharsis  by  the  extracts  of  aloes  and  colo- 
cynth.  In  addition  to  the  above  we  should 
insist  on  a  strict  milk  diet.  Milk  is  "a 
complete  aliment,  reconstituant,  and  is 
usually  digested  more  easily  and  quickly 
than  any  other"  ;  and,  besides,  as  Riviere 
suggests,  does  not  leave  a  toxic  residue  in 
the  intestines  which  may  be  absorbed,  and 
from  the  blood  pass  to  the  kidneys. 

I  do  not  approve  of  the  induction  of  pre- 
mature labor  as  a  prophylactic  measure, 
under  any  circumstances,  as  less  than  six 
per  cent,  of  those  showing  premonitory 
symptoms  develop  the  disease. 

The  curative  treatment  may  be  either 
medical,  obstetrical  or   surgical. 

Given  a  case  of  puerperal  convulsions, 
it  would  be  well  to  remember  the  observa- 
tion of  Vinay,  '"that  there  are  maglignant 
cases  of  eclampsia  in  which  death  is  in- 
evitable, all  means  of  cure  failing." 

The  first  thing  to  be  done  is  to  see  that 
the  patient  does  not  harm  herself;  a  napkin 
should  be  inserted  between  the  jaws  to 
keep  her  from  protruding  her  tongue  and 
biting  it;  her  clothing  should  be  loose;  her 
movements  should  not  be  restrained  except 
to  keep  her  from  falling  out  of  bed.  Draw 
forward  the  tongue  if  it  falls  back  after  a 
convulsion,  arresting  respiration;  cleanse 
the  pharynx  of  secretions  by  means  of  a 
sponge  in  a  holder,  lest  the  patient  die  af- 
terwards of  what  our  German  friends  call 
schluckpneumonien  or  deglutition  pne- 
monia. 

As  soon  as  possible  administer  chloro- 
form by  inhalation  to  control  the  convul- 
sions and  give  us  time  to  make  our  prepa- 
rations for  the  further  management  of  the 
case. 

Remembering  the  etiology  of  the  disease 
we  should  stimulate  all  the  emunctories  at 
once  to  action  ;  and  what  should  be  done 
needs  to  be  done  quickly.  A  drop  or  two 
of  croton  oil  placed  upon  the  tongue  will 
prove  most  efficacious  in  relieving  the 
bowels  and  depleting  the  system.  We  have 
not  the  time  for  any  drug  that  acts  more 
slowly ;  copious  rectal  injections  of  a  hot 
saline  solution  will  also  prove  efficacious 
and  will  prepare  the  rectum  for  tbe  admin- 
istration of  drugs.  Next,  I  would  wrap 
the  patient  in  three  or  four  blankets,  wrung 
out  in  very  hot  water,  and  cover  with  dry 
blankets  to  produce  thorough  diaphoresis; 
then,  I  would  place  an  ice  cap  to  her  head 
to  prevent  congestion  of  the  brain. 

The    advisability  of    blood-letting    is    a 


506 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


much  mooted  question.  In  former  times  it 
was  the  favorite  remedy  in  the  hands  of  all 
practitioners.  Now  it  is  but  seldom  used. 
Winckel,  Martin,  and  the  profession  gen- 
erally, condemn  it ;  but  Kaltenbach  says 
wisely,  that  in  strong  plethoric  women 
with  great  cyanosis,  bleeding  has  imme- 
diately a  favorable  effect.  It  removes  in- 
stantly a  certain  amount  of  toxic  material 
from  the  system  and  relieves  renal  and  ce- 
rebral congestion,  and  diminishes  bronchial 
and  salivary  secretions.  To  bleed,  or  not 
to  bleed,  must  be  determined  by  the  indi- 
vidual case,  and  such  cases  are,  I  believe, 
very  few  and  far  between,  particularly  as 
we  have  other  means  now  of  depleting  the 
system  without  robbing  it  of  its  red  corpus- 
cles. But  if  the  case  be  so  desperate  that, 
in  your  opinion,  blood-letting  is  called  for, 
I  would  advise  you  to  use  the  treatment 
suggested  by  Bozzolo  for  uraemia,  which 
consists  of  a  removal  of  a  fair  quantity  of 
blood,  (about  twelve  ounces)  by  opening  a 
vein  in  the  arm,  after  which,  a  weak  steril- 
ized saline  solution  is  injected  with  the  view 
of  diluting  the  remainder  of  the  blood  in 
the  system.  The  medicinal  agents  suggested 
for  the  relief  of  eclampsia  are  many.  Each 
has  its  strong  advocates,  and  almost  as 
many  opponents.  Such  must  necessarily 
be  the  case  until  the  pathology  of  the  af- 
fection is  cleared  up. 

Chloroform  was  once  considered  a  spe- 
cific for  the  disease,  now  we  only  regard  it 
as  a  necessary  adjuvant.  Its  continuous 
administration  readily  leads  to  fatty  de- 
generation of  the  heart  and  other  organs, 
and  impairs  the  activity  of  the  kidneys. 
But  Vinay  refers  to  a  number  of  patients 
who  have  been  kept  under  its  influence 
from  six  to  twenty-four  hours.  Gelli  re- 
ports six  cases  with  but  one  death.  Gilbert 
reported  twenty  cases  with  no  deaths.  Hurd 
twenty-one  with  no  deaths,  Charpentier 
sixty-three  with  seven  deaths,  a  mortality 
of  only  eleven  per  cent.  These  reports 
speak  much  for  the  great  value  of  the  drug  ; 
but,  on  the  other  hand,  it  should  be  men- 
tioned that  its  use  in  the  Maternity  of 
Philadelphia  gave  a  mortality  of  fifty  per 
cent. 

Chloral  I  regard  as  one  of  our  most  val- 
uable agents  in  the  treatment  of  eclampsia. 
It  meets  the  indication  clearly.  It  is  an 
antiseptic  and  sedative ;  it  produces  an 
anaemic  condition  of  the  brain  and  weakens 
the  reflex  activity  of  the  spinal  centres;  it 
lowers  arterial  pressure  and  dilates  superfi- 
cial vessels.  There  is  a  remarkable  varia- 
tion in  the  quantity  of  this  drug  capable  of 
producing  a  fatal  effect.  A  dose  of  thirty 
grs.  has  been  known  to  produce  death, 
whilst  one  ounce  has  been  taken    with    im- 


punity.     I  believe  that   many  of  the  ill   ef- 
fects attributed  to  chloral  are  due  to  impuri-     j 
ties  in  the  drug.      In  eclampsia  thirty    grs.    ' 
of  chloral  ought  to  be  given  by  the  rectum,     : 
mixed  with  the  yelk  of  an  egg  and    two  or     < 
three  ounces  of  milk.     I  would  repeat   the 
dose  after  each  convulsion.     Plant    reports   . 
a  case  after  delivery  in  which  he    gave  two   j 
hundred    and    fift/  grains  in    twenty-four    j 
hours.     Pinard  at  the  Hospital  Lariboisiere    l« 
in  18S3  treated  eight  cases  with  one    death,   ji 
He  gave  six  to  eight    grams    at    one    injec-   f 
tion.      Winckel  employs  one  to  two  grams  II 
after  each  attack    until    twelve    grams    are 
taken    in     twenty-four     hours.      He       has  \\ 
achieved  the  low  mortality  of  7.6  per    cent  1 
by  the  combined  method  of  chloroform  and  j 
chloral — probably  the   two    best    medicinal  { 
agents    we     have    at    our  command  in  the 
treatment  of  this  affection. 

If  I  had  a  case  to-day  in  which  I  did  not  \\ 
think  that  obsterical  interference  was  called  1 
for,  these  two  drugs  would  be  my  sheet-  j 
anchors. 

Morphine  is  another  drug    much    lauded 
for  its  effects.      Clarke,  of  Oswego,  N.  Y., 
claims  brilliant  results    from    its    use.      He  jj 
gives  1  1-2  grains  at  a  dose,  and  repeats  the 
same  in  two  hours  if  the  paroxysm  returns,  ;j 
Veit,  of  Germany,  reports  sixty  cases  with  I 
two  deaths,  giving  a  remarkable    mortality  1 
of  3.3  per  cent,  but  he  also   makes    use    of 
hot   baths,    which    I   regard  as  greatly  re- 
sponsible for  his  good  results.     Personally,   | 
I  am  opposed  to  the  use  of   morphine,    for,   fl 
whilst  it  quiets  the  brain,  it  may  excite  the 
spinal  column,  even  to    the   extent    of  pro- 
ducing convulsions.     Moreover,  as  it  checks    1 
all  secretions  except  that  of  the  skin,  I  con- 
sider it  contra-indicated  in  a  disease  where   1] 
we  have  an  insufficiency  of  the  eliminative 
organs  present ;   besides,  its   administration 
has  been  known    to    produce    the    death  of 
the    foetus.     Veratrum     viride     is     another 
favorite  with  many    practitioners.      I    have 
had  no  personal  experience  with  it,    but  of 
late    it    has    been  used    hypodermically  in 
large  doses  with  great    success,     Love    has 
reported  twenty-three  cases  with  no  deaths. 
Jewett  gives  ten  to  twenty    minims    hypo- 
dermically and  repeats  it  in   an    hour    in    a 
reduced  dose.      He  asserts  that    no    convul- 
sion will  occur  if  patient  is  sufficiently  un- 
der veratrum  to  keep  the  cardiac  pulsations 
below  sixty.      Other   authorities    give    half 
dram  doses  of  the  fluid  extract  every  fifteen 
minutes  until  vomiting  is  produced  or  con- 
vulsions cease.     The    drug   is    contra-indi- 
cated in     depression     and    exhaustion.     It 
should    be    used    with  care,   lest    excessive 
doses    paralyse  the   muscles    of  respiration 
and    produce     death  by    asphyxia.      Death 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


507 


from  the  drug  may  also  be  produced  by 
syncope. 

Bromide  of  potash  has  its  adherents,  it 
being  frequently  administered  in  conjunc- 
tion with  chloral,  but  it  should  be  rejected, 
as  it  is  too  slow,  uncertain  and  feeble  in  its 
action.  Moreover,  potash  is  the  most  toxic 
of  the  mineral  salts,  and  J.  C.  Simpson 
regards  it  as  one  of  the  convulsive  princi- 
ples found  in  urine.  Elaterium,  or  better, 
its  active  principle,  elaterin,  is  sometimes 
given  to  reduce  the  volume  of  circulation 
by  draining  water  from  the  vessels,  or 
"bleeding  through  the  tissues."  It  is  a  ser- 
viceable drug  but  needs  to  be  used  with 
caution.  Pilocarpine  has  had  its  day,  but 
is  now  generally  abandoned  by  the  profes- 
sion on  account  of  its  depressing  effect  on 
the  heart.  It  increases  saliva  and  bronchial 
secretion  and  may  produce  pulmonary 
edema.  Its  use  is  condemned  by  such  au- 
thorities as  Fordyce  Marker,  Winckel,  Kal- 
tenbach,  Vinay  and  others.  About  seven 
years  ago  at  the  request  of  a  confrere,  I  in- 
jected I -8  of  a  grain,  hypodermic-ally,  and 
had  the  mortification  of  seeing  his  patient 
die  in  twenty  minutes. 

Nitrite  of  Ainyl  is  useful  in  checking 
convulsions,  but  is  said  to  produce  post- 
partum hemorrhage. 

Obstetric  intervention  is  the  vital 
point  upon  which  authorities  dif- 
fer. The  medical  profession  gener- 
ally are  agreed  that  if  labor  has  begun  it  is 
our  duty  to  hasten  it  by  artificial  means  ; 
but  there  is  considerable  divergence  of 
opinion  just  at  what  stage  of  pregnancy 
or  labor  such  intervention  is  justifiable, and 
how  such  intervention  should  take  place. 
In  my  opinion,  it  is  our  duty,  if  the  patient 
be  in  labor  to  thoroughly  anaesthetize  her, 
dilating  the  os  if  necessary,  and  deliver  at 
once,  either  by  turning  or  by  the  forceps. 
The  steps  to  be  taken  are  dependent  upon 
the  stage  to  which  labor  has  advanced. 
Gradual  dilatation  is  worse  than  time  wast- 
ed. It  means  a  continuous  irritation  of  the 
uterus,  provoking  the  frequency  and  severi- 
ty of  the  convulsions.  Such  a  course  is 
only  pursued  at  great  risk  to  the  life  of  the 
mother  and  child.  If  the  cervix  is  not  al- 
ready sufficiently  dilated  for  the  introduc- 
tion of  the  forceps, dilate  with  your  fingers, 
if  possible,  and  if  this  is  not  successful  do 
not  hesitate  to  use  your  Goodell's  dilator; 
if  necessary  incise  the  cervix  to  insure  rapid 
delivery.  Of  course,  it  is  understood  that 
the  patient  is  thoroughly  narcotized  by 
chloroform  during  this  procedure,  other- 
wise the  necessary  irritation  of  the  uterus 
will  only  increase  the  convulsions.  Nor 
do  I  limit  obstetrical  interference  to  the 
eclamptic  who  is  in  labor.     I  would  extend 


it  to  any  woman  in  puerperal  convulsions, 
who  has  completed  her  seventh  month  of 
pregnancy,  and  take  the  chances  of  the 
child  being  viable,  eminent  authorities  to 
the  contrary  notwithstanding. 

I  should  mention  that  Pajot  has  con- 
demned obstetrical  interference  as  unreas- 
onable and  more  dangerous  than  eclampsia 
itself,  and  Winkel  considers  it  as  obsolete, 
because  of  its  dangers  to  mother  and  child. 
But  I  cannot  see  the  force  of  their  argu- 
ments. Parvin,  who  pins  his  faith,  as  a 
rule,  to  the  maxim  of  Gooch  "to  take  care 
of  the  convulsions  and  let  the  uterus  take 
care  of  itself,"  admits  that  in  about  one- 
third  of  the  cases  of  eclampsia  convulsions 
cease  if  the  uterus  be  emptied.  I  believe 
that  in  the  majority  of  cases  the  convul- 
sions will  cease  if  the  uterus  be  emptied, 
provided  the  patient  is  thoroughly  under 
an  anaesthetic  during  the  delivery.  For 
eclampsia,  I  hold,  is  but  a  sign  that  the 
uterus  is  intolerant  of  the  presence  of  the 
foetus.  Other  authorities,  such  as  Barker, 
Busey,  and  Lusk  induce  labor,  provided 
the  mother's  life  is  in  danger  and  the  dis- 
ease has  resisted  the  best  directed  medical 
treatment.  Such  procrastination  I  feel 
confident  has  been  the  cause  of  the  death 
of  many  mothers  and  many  more  infants. 
But  if  the  patient  has  not  completed  her 
seventh  month,  what  then?  In  this  case  I 
would  rely  solely  on  medicinal  agents  as 
mentioned  above.  Under  no  circumstances 
would  I  sanction  Duhrssen's  method  of 
emptying  the  uterus  at  any  and  all  stages 
of  pregnancy,  whether  the  child  is  viable 
or  not.  I  would  consider  such  action  as 
unnecessary  sacrifice  of  human  life,  embryo 
though  it  be.  I  have  seen  puerperal  con- 
vulsions subside  in  the  fourth  month  of  a 
pregnancy  which  was  completed  to  term 
under  approprite  treatment ;  and  I  believe 
that  the  majority  of  cases  in  the  early 
months  of  pregnancy  would  do  likewise 
if  permitted.  Caeserian  section  in  eclamp- 
sia I  consider  only  justifiable  when  there  is 
some  mechanical  obstruction  to  the  passage 
of  the  foetus,  although  Halbertsma  has 
done  the  operation  twelve  times  in  grave 
cases  with  a  mortality  of  only  thirty-six 
per  cent.  If  eclampsia  comes  on  after 
labor  I  would  pin  my  faith  to  the  elimina- 
tory  treatment,  assisted  by  chloral.  In  all 
cases,  the  medicinal  treatment,  directed 
towards  stimulating  the  emunctories  to  ac- 
tion, is  to  be  continued  after  delivery. 

SUMMARY. 

If  called  to  a  case  of  eclampsia  in  the 
early  months  of  pregnancy,  i.  e.  before  the 
completion  of  the  seventh  month,  I  would 
immediately    control  the  convulsions  with 


THE  CHARLOTTE  MEDICAL  JOURNAL 


chloroform  and  proceed  to  eliminate  the 
toxins  from  the  system  by  catharsis,  dia- 
phoresis and  diuresis  as  quickly  as  possi- 
ble and  in  as  large  quantities  as  possible, 
giving,  at  the  same  time,  some  drug,  pre- 
ferably chloral,  to  control  the  nervous  sen- 
sibility and  diminish  arterial    pressure. 

If  the  seventh  month  of  pregnancy  has 
been  completed,  I  would  thoroughly  narco- 
tize my  patient  with  chloroform  and  pro- 
duce delivery  as  quickly  as  possible.  If 
occurring  after  delivery  I  would  use  the 
eliminative  treatment  with  chloral. 


The  Principles  of    Conservative  Surgery.* 

By  Irving  S.  Haynes,  Ph.  B.,  M.    D.,    Professor 
of  Practical  Anatomy  in  the   Cornell   Uni- 
versity  Medical  College;  Visiting  Sur- 
geon to  the  Harlem  Hospital;  Mem- 
ber of  the  New  York   Academy 
Of   Medicine,  etc.,  etc. 

Although  it  has  cost  me  considerable  ef- 
fort to  be  present  at  this  meeting,  I  am  free 
to  say  that  I  am  glad  I  accepted  your  Presi- 
dent's invitation  to  present  a  paper  for  your 
consideration. 

Instead  of  entering  into  the  discussion  of 
a  single  abstract  surgical  condition,  it  has 
seemed  to  me  that  it  would  be  more  inter- 
esting to  the  majority  of  the  members  of 
this  Society  if  we  were  to  briefly  consider 
some  one  or  two  of  the  principles  which 
underlie  the  surgery  of  the  present  time  il- 
lustrated by  cases  taken  from  every  day 
practice.  This  will  result  in  producing  a 
more  or  less  rambling  survey  of  several 
surgical  conditions. 

The  dramatic  and  spectacular  appeal  to 
every  one.  The  dramatic  and  spectacular 
events  of  medicine  and  surgery  hold  the  at- 
tention, not  only  of  the  profession  but  also 
of  the  laiety,  as  much  now  as  in  the  olden 
times. 

A  young  doctor,  fresh  from  the  hospital, 
is  at  once  asked  by  his  interested  friends 
how  many  legs  and  arms  he  has  amputated. 
They  plainly  show  their  disappointment 
when  he  explains  to  them  that  surgery  to- 
day seeks  to  save  limbs,  instead  of  remov- 
ing them  and  that  while  he  has  not  been 
amputating  very  many  he  has  been  instru- 
mental in  saving  several. 

The  laiety  do  not  wish  to  lose  their  hered- 
itary conception  of  a  surgeon  as  a  man  with 
bloody  apron  and  gory  arms,  flourishing  a 
large  knife.  They  like  to  imagine  such  a 
surgeon   severing    a    limb  with  one   grand 


*Read  by  invitation  January  10th,    '99,  at  the 
Medical  Society  of  the  County  of  Clinton,  N.  Y. 


sweep  of  the  knife"and  a  few  hard  saw  cuts. 
These  ideas  are  the  natural  heritage  from 
former  generations  before  the  discovery  of 
anaesthesia, when  the  patient  had  to  endure 
the  agonies  of  all  operations,  his  mind  | 
blunted  only  by  opium.  Here  haste  was 
the  sine  qua  non — the  great  aim  of  the 
surgeon — attention  to  details  and  beauty  of 
execution  only  came  later  after  anaesthetics 
had  been  discovered.  With  the  pa- 
tient quietly  sleeping  under  his  knife, 
the  surgeon  could  turn  his  attention 
to  refining  the  various  operations  and  divis- 
ing  new  and  remarkable  ones.  Neverthe- 
less hands,  arms,  feet  and  legs  came  off, 
patients  died  from  simple  herniotomies, and 
the  field  of  abdominal,  thoracic  and  cran- 
ial surgery  remained  a  terra  incognita. 

It    was  not  until  the    causes  of    wound 
fever,  suppuration,  septicaemia  and  pyaemia    jl 
had  been  discovered    and   their    prevention     ] 
made  possible  by  antiseptic  and  aseptic  meas- 
ures that  surgeons   were   placed  in   posses- 
sion of  weapons  with  which  to  successfully     jl 
meet  and  overcome  obstacles  hitherto  insur-     ' 
mountable     The  older    surgeons,    ignorant 
of  the  causes  of  infection,  preferred  to  take 
their    chances    in    a    clean  cut     wound    in 
healthy  tissues  to  the  fearful  possibility  and     \ 
as  a  rule,  probability  of  a    fatal    suppura- 
tion   in  crushed    and    lacerated    members. 
Too  much  honor  cannot  be  given    to    those     ' 
pioneers    Tyndall,   Pasteur  and    Koch     by 
whom  the  germ   nature    of    infection     was     j 
proven,  nor  to  Lord  Lister,  who  first  made     \ 
a  practical  application    of  this    knowledge 
to  surgery.     His    '"antiseptic    system"     so 
crude  and  cumbersome  and  difficult  of  exe- 
cution has  been  modified  by  those  who   fol- 
lowed   him    until    the  aseptic  system — the 
system    of   absolute  cleanliness — has    come 
to  be  the  practice  with  all  surgeons    at    the 
present  time. 

The  surgical  infections  of  less  than  fifty 
years  ago  which  carried  off  the  great  ma- 
jority of  patients  subjected  to  operations, 
and  that  in  the  hands  of  the  most  skillful 
surgeons,  are  practically  abolished  to-day. 
Such  immunity  from  fatal  results  lead  to 
the  common  performance  of  operations 
which  were  unjustifiable  under  the  old 
regime.  Every  part  of  the  human  body 
has  been  invaded  by  the  enthusiastic  and 
venturesome  surgeons. 

Surgical  achievements  have  quickly  fol- 
lowed one  another, until  at  present  the  ques- 
tion is  being  asked,  what  will  the  end  be? 
I  venture  to  predict  that,  great  as  have 
been  the  advances  in  the  past  generation 
and  especially  during  the  last  ten  years, 
still  more  wonderful  results  will  be  achieved 
in  the  future.  In  the  development  period 
of  every  new  undertaking  many  things  are 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


said  and  done  that  sober  judgment  later 
condems  as  unnecessary  and  even  unjusti- 
fiable 

By  the  furor  of  excitement  the  pendu- 
lum of  common  sense  has  been  urged  be- 
yond the  limits  of  reason.  Already  our 
more  advanced  surgeons  are  questioning 
the  propriety  of  many  surgical  procedures. 
Sober  criticism  does  not  retard  progress,  it 
rather  advances  it.  The  conscientious  sur- 
geon may  cut  as  deeply  and  widely  at  times 
as  his  most  radical  brother,  but  he  first 
must  feel  in  his  own  mind  that  it  is  neces- 
sary. And  the  same  man  at  times  feels 
that  under  the  guize  of  necessity  or  per- 
haps really  of  opportunity,  many  opera- 
tions done  by  the  ultra  radical  are  unneces- 
sary and  consequently  unjustifiable, 

I  wish  therefore  to  invite  you  to  consider 
the  principles  which  underlie  conservative 
surgery.  Conservative  in  this  connection 
is  illustrated  through  that  line  of  action  by 
which  parts  are  preserved.  Conservative 
is  then  in  this  sense  preservative.  The 
preservation  of  parts  is  secured  in  two  dia- 
metrically opposite  procedures.  In  one 
series  of  cases,  paradoxical  as  it  may  seem, 
our  conservatism  is  shown  by  early  and 
thorough  interference. 

To  cite  a  case  under  this  class  I  would 
ask  you  to  consider,  for  instance,  an  infec- 
tion of  the  palm  of  the  hand.  Such  cases 
usually  follow  a  slight  wound  of  the  palm 
or  fingers.  When  you  see  the  patient,  the 
hand  and  fingers  are  swollen  ;  the  dorsum  of 
the  hand  cedematous, and  the  palm  distended 
with  retained  pus.  Attending  the  usual 
local  symptoms  of  swelling,  pain,  heat  and 
redness  there  are  signs  of  beginning  sys- 
temic infection.  Now,  true  conservative 
surgery  means  free  incisions  for  the  im- 
mediate and  unrestricted  escape  of  the  pus. 
Were  you  to  withhold  the  knife  from  this 
case,  or  to  trifle  with  it  by  making  small 
punctures  here  and  there,  most  alarming 
results  are  possible.  The  infection  may 
readily  extend  beneath  the  annular  ligament 
of  the  wrist  along  the  flexor  tendons  into 
the  region  of  the  forearm  where  the  pus  is 
pent  up  beneath  the  dense  fascia-  which  en- 
velope the  extremity.  If  recovery  follows 
j  after  such  extensive  involvement  it  will  be 
i  at  the  expense  of  the  function  of  the  hand 
and  fingers  and  such  disability  is  very  apt 
;  to  be  permanent.  In  such  neglected  cases 
\  amputation  may  be  demanded  to  save  a  life 
j  poisoned  by  the  absorption  of  the  products 
of  suppuration.  Fatal  terminations  are 
not  very  rare  also  in  such  severe  cases. 
When  synovial  bursa'  and  tendons  are  in- 
volved in  a  suppurative  process  true  con- 
servative surgery    demands  that  you    shall 


at  once  provide  a.  free  exit  for  the  purulent 
fluid. 

I  remember,  very  vividly,  one  case  in 
this  connection.  A  woman,  while  doing 
her  housework,  scratched  the  outer  border 
of  the  palmar  surface  of  the  thumb  on  a 
galvanized  iron  pail.  She  thought  nothing 
of  it  at  the  time.  In  a  few  hours,  however, 
the  thumb  began  to  swell  and  pain  her. 
The  infection  gradually  extended  until, 
when  I  saw  her  about  the  second  or  third 
day,  the  process  had  involved  the  long 
flexor  sheath  of  the  thumb  and  the  great 
synovial  bursa  in  the  palm  of  the  hand. 
The  fingers  and  dorsum  of  the  hand  were 
cedematous  and  pus  was  pointing  at  the 
inner  palmar  border.  Free  incisions  were 
made  into  the  thumb  at  the  site  of  the 
original  wound  and  along  the  inner  border 
of  the  hand.  The  irrigating  fluid  flowed 
freely  from  one  cut  beneath  the  palmar  tis- 
sues and  out  through  the  other,  thus  beau- 
tifully demonstrating  the  extent  and  close 
anatomical  relations  of  the  synovial  bursas 
of  the  long  flexor  tendons  in  the  palm.  It 
is  sufficient  to  say  that  under  free  drainage 
and  wet  carbolic  dressings  the  woman  re- 
covered from  the  infection  and  she  escaped 
with  very  slight  restriction  of  motion  in 
the  hand  and  fingers. 

A  case  of  a  personal  friend  of  mine,  a 
physician  in  active  practice,  did  not  result 
so  satisfactorily.  Although  he  was  under 
the  care  of  one  of  our  best  surgeons,  the 
infection  originally  starting  from  his  finger 
spread  to  the  hand  and  then  into  the  fore- 
arm and  did  not  stop  until  the  arm  itself 
was  involved.  He  barely  escaped  with  his 
life.  The  heritage  bequeathed  him  by  the 
germs  includes  bony  anchylosis  of  the 
elbow  and  restricted  movements  in  all 
the  parts  below.  As  if  this  were  not  bad 
enough,  it  is  his  right  arm  that    suffered. 

Another  class  of  cases  where  conserva- 
tism is  best  shown  by  being  radical  is  in 
cases  of  extravasated  urine,  where  you  find 
a  man  with  the  perineal  and  scrotol  tissues 
infiltrated  and  distended  by  urine  which 
has  escaped  through  a  ruptured  urethra. 
A  case  from  private  practice  will  serve  as  a 
type  of  this  condition.  Mr.  H.,  a  German 
about  60,  with  wife  living,  but  not  content 
in  his  own  pastures  had  gone  browsing 
around  in  outside  fields,  as  a  result  of  his 
perverseness  he  contracted  a  lively  gonor- 
rhoea, which  left  him  with  a  tight  stricture. 
About  a  week  before  I  saw  him  some  doc- 
tor had  forcibly  attempted  to  dilate  the 
stricture  with  the  result  of  rupturing  the 
urethra  and  forming  a  false  passage.  The 
urine  escaped  through  the  rent  and  filled 
the  perineum,  the  scrotum,  until  it  was  as 
large  as  a  child's  head,  the  penis  and    even 


510 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


the  lower  abdominal  zone,  demonstrating 
better  than  a  whole  volume  of  print  the  in- 
fluence that  the  perineal  fascia  has  in 
determining  the  course  of  extravasa- 
ted  urine.  The  knife  was  freely  used, 
the  perineum  first  opened  and  the  blad- 
der drained  externally,  the  scrotum  and 
penis  and  inguinal  regions  opened  up 
with  long  incisions — down  to  the  deeper 
parts — the  urine  squeezed  out  of  the  tis- 
sues, the  stricture  then  located  and  cut. 
Recovery  progressed  satisfactorily,  as  it 
usually  does  in  these  cases,  when  thorough- 
ly treated.  The  incisions  which  look  so 
formidable  at  the  time  they  are  made, shrink 
into  insignificant  cutaneous  scars.  Al- 
though the  skin  over  the  entire  region  was 
a  dusky  blue  and  in  places  on  the  scrotum 
was  black  and  looked  as  if  already  at- 
tacked by  gangrene,  it  entirely  recovered 
its  normal  condition. 

I  will  illustrate  tliis  principle  of  saving 
by  early  cutting  in  another  class  of  cases 
with  which  our  thought  and  practice  are 
very  extensively  occupied  at  the  present 
time,  namely,  cases  of  appendicitis.  We 
have  all  seen  cases  where  death  claimed  its 
victim  because  surgery  was  given  no  op- 
portunity of  saving  the  patient.  Conser- 
vatism is  best  shown  by  affording  the  suf- 
ferer the  advantages  of  modern  treatment 
and  that  at  an  early  hour. 

"When  in  doubt,  operate"  is  a  safe 
maxim,  because  early  operations  performed 
at  a  time  of  the  surgeon's  selection  and 
with  sufficient  preparation  to  secure  all  the 
benefits  of  aseptic  surgery,  with  the  patient 
in  good  physical  condition  and  the  foul  ap- 
,  pendicular  contents  still  pent  up  within  the 
tube,  yield  brilliant  results.  The  appendix 
is  removed  with  ease — the  adhesions  being 
few — the  operation  can  be  thoroughly  done, 
as  haste  is  unnecessary,  hernias  can  be  pre- 
vented as  no  drainage  is  needed,  the  edges 
of  the  tissues  are  not  infected,  and  hence 
grow  together  when  carefully  sutured  in 
opposition  and  finally  the  mortality  is  al- 
most nil,  being  that  of  the  anaesthetic  itself. 
Of  course,  after  the  indications  for  the 
operation  are  imperative,  surgical  inter- 
ference is  the  only  possible  treatment,  but 
surgery  at  this  time  should  not  be  called 
conservative,  it  is  the  dernier  resort.  It  is 
at  the  beginning  of  the  case,  before  it  is-a 
question  of  must  that  true  conservatism  can 
be  practiced  by  the  doctor  in  charge,  while 
he  still  has  two  alternatives  to  pursue, with- 
out immediate  detriment  to  his  patient. 

Into  this  same  class  fall  those  cases  of 
herniae  in  which  it  is  still  an  open  question 
whether  strangulation  has  occurred  or  not. 
The  right  plan  is  to  propose  operation  be- 
fore not  after  strangulation   exists,  as    sur- , 


gery  is  robbed  of  its  conservatism  when 
the  operation  becomes  a  necessity  and  the 
patient  is  confronted  with  the  dangers  of  a 
gangrenous  coil  of  intestine,  that  he  would 
have  escaped  had  operative  treatment  been 
instituted  earlier. 

I  will  add  one  more  case,  namely,  puer- 
peral septicaemia  from  delay  in  cleaning  out 
a  foul  uterus.  This  is  so  important  that  I 
must  pause  a  moment  to  insist  that,  as  a 
rule,  chills  in  the  purpereum,  especially 
from  the  third  to  the  tenth  day  or  later,  do 
not  mean  taking  cold  but  septic  absorption 
from  retained  secundines  or  decomposing 
blood  clots  and  that  only  one  plan  is  really 
justifiable  and  that  is  to  clean  out  the  ute- 
rus at  once.  It  can  usually  be  done  easily 
and  without  an  anaesthetic  and  with  the  as- 
sistance only  of  the  nurse.  After  you  have 
the  uterus  clean  then  give  all  the  quinine 
you  choose  or  not  give  it  at  all.  Your  patient 
is  safe  either  way. 

The  same  rule  of  action  applies  to 
cancers,  obstruction  of  the  bowels,  foreign 
bodies  in  the  throat,  retention  of  urine,  and 
many  similar  conditions  which  will  readily 
occur  to  you  but  which,  for  lack  of  time, 
we  cannot  dwell  upon. 

To  recapitulate  then,  the  principle  which 
underlies  this  first  class  of  cases  is  that  true 
conservatism  in  surgery  means  early  radi- 
calism, a  paradox  apparently,  but  on  close 
examination  a  self-evident  axiom. 

In  the  second  class  of  cases  conservatism 
means  more  nearly  what  we  ordinarily  un- 
derstand by  the  term,  in  that  it  is  opposed 
to  radicalism — radicalism  as  applied  to 
surgery— meaning  its  practice  in  an  ex- 
treme and  reckless  manner.  This  prin- 
ciple will  be  illustrated, in  one  class  of 
cases  by  the  history  of  David  A.,  who  was 
brought  to  the  Harlem  Hospital  July  9th, 
'98,  with  his  left  hand  crushed  by  a  street 
car.  The  fourth  and  fifth  fingers  were 
crushed  to  a  pulp,  up  to  the  web  of  the 
hand.  The  skin  was  torn  from  the  base  of 
the  thumb  downward  and  across  the  back 
of  the  hand  to  the  knuckle  of  the  fourth 
finger.  The  extensor  tendons  were  visible 
when  this  flap  wa6  raised.  Winding  about 
the  base  of  the  thumb  in  the  palm  was  a 
lacerated  wound,  some  two  and  a  half  in- 
ches long.  Another  lacerated  wound  was 
across  the  inner  part  of  the  palm  of  the 
hand  near  the  web  of  the  fingers.  All  the 
tissues  comprising  the  palm  of  the  hand, 
fascia,  vessels,  nerves,  tendons,  were  badly 
bruised  and  stripped  clean  away  from  the 
interossei  muscles.  The  superficial  palmar 
arch  was  torn  by  the  wound  at  the  base  of 
the  thumb.  The  hand  was  swollen,  bluish 
and  full  of  street  dirt.  Only  amputation 
at  the  wrist  seemed   justifiable    with  such  a 


THE  CHARLOTTE  MEDICAL  JOORNAL. 


5U 


mass  of  crushed  tissue  already  infected,  yet 
I  determined  to  make  an  attempt  to  save 
some  part  of  his  hand,  a  hooked  finger  be- 
ing better  than  one  of  iron. 

It  is  unnecessary  to  give  the  details  of 
treatment,  except  to  say  that  the  crushed 
ring  and  little  fingers  were  amputated 
through  the  end  of  the  metacarpal  bones. 
All  dirt  and  dead  tissues  removed,  free 
drainage  assured  by  six  or  seven  rubber 
tubes  carried  up  among  the  anterior  and 
posterior  tendons  and  the  limb  treated  to  a 
continuous  irrigation  of  i-ioo  carbolic  acid 
and  water.  Healing  was  rapid — suppura- 
tion rather  rapid  at  first — soon  died  out. 
The  man  was  in  the  office  a  short  time  since 
and  the  result  is  most  gratifying.  He  has 
the  power  to  flex  and  extend  his  two 
fingers  and  thumb  through  about  two-thirds 
of  their  normal  range  of  motion,  notwith- 
standing all  the  tendons  to  them  were  laid 
bare  and  granulation  tissues  must  have 
formed  about  them  all.  No  artificial  limb 
maker  could  devise  anything  that  would  at 
all  compare  to  the  preserved  parts,  defec- 
tive and  limited  in  motion  though  they  be. 

Such  results  as  I  his  were  almost  impos- 
sible before  the  nature  of  infection  was 
known  and  measures  discovered  to  combat 
it.  Amputation  was  a  necessity  in  the 
olden  times  and  some  surgeons  seem  to 
think  that  it  is  at  present,  but  careful  at- 
tention to  the  details  of  the  antiseptic  and 
aseptic  treatment  of  crushed  hands  and  feet 
will  save  many  members  heretofore  con- 
demned to  the  Potter's  field. 

Another  field  which  has  been  the  ground 
of  contention  between  the  extreme  radicals 
and  consei  vatives,  is  that  of  pelvic  surgery 
in  the  female. 

It  has  been  demonstrated  by  Polk, 
Barrows,  Dudley  and  others  that  in  a  tube 
not  wholly  diseased  the  healthy  part  could 
be  left  behind  and  its  lumen  preserved, that 
when  an  ovary  was  not  entirely  degene- 
rated it  was  wise  to  leave  the  unaffected, 
though  small,  part.  Conception  and  feli- 
eitious  chilil-bearing  have  resulted  in  some 
of  these  cases  from  such  wise  conservatism. 

Arrangements  have  been  recently  offered 
for  the  simultaneous  removal  of  the  uterus 
with  the  diseased  adnexa,  even  though  in 
itself  the  uterus  did  not  need  removal.  If 
the  tubes  and  ovaries  have  to  be  removed  on 
account  of  their  diseased  condition,  the  re- 
moval of  the  uterus  also  is  not  justified  by 
any  argument  from  theory  or  pratice,for  it  is 
proved  that  even  though  infected,  by  curet- 
ting free  drainage  and  proper  local  treat- 
ment, it  will  return  to  a  normal  state  and  so 
preserve  the  integrity  of  the  pelvic  floor. 

After  removal  of  all  the  internal  genera- 
tive organs  the  woman  is  forever  incapable 


of  her  true  function — of  reproduction — 
but  with  wise  selection  and  conservative 
operations  we  know  that  she  can  retain  the 
reproductive  function  in  many  instances. 
Castration  is  now  no  longer  advocated  for 
hypertrophied  prostrates  —  the  diseased 
gland  itself  is  attacked.  Floating  kidneys 
are  not  removed  but  sutured  in  their  proper 
position.  In  short,  true  conservatism  has 
held  ultra-radicalism  in  check  and  supplied 
reason  for  conjecture  and  facts  for    fancies. 

We  are  all  working  together  for  a  com- 
mon purpose — for  benefitting  our  fellow 
men.  We  all  make  mistakes — for  we  are 
all  very  human— yet  we  should  not  make 
the  same  mistakes  twice  if  possible,  and 
we  should  learn  by  the  mistakes,  as  well  as 
the  successes  of  others.  Honest  criticism 
of  our  own  work  as  well  as  that  of  others, 
is  helpful  to  all  concerned,  for  we  thereby 
learn  the  best  way  to  secure  results  that 
shall  benefit  the  patient  and  honor  the 
operator. 

I  wish  to  thank  you  all  for  your  patience 
under  these  wandering  remarks.  If  I  have 
said  anything  worthy  of  your  consideration 
or  that  shall  induce  a  fresh  interest  in  true 
conservatism  in  surgery,  I  shall  feel  more 
than  repaid  for  the  undertaking. 


The  Weak  Heart  in  Pneumonia. 

By  F.  R.  Millard,  M.  D.,  San  Diego,  Cal. 

The  death  of  Congressman  Dingley,  in 
Washington  recently,  again  illustrates  how 
small  a  chance  an  American  statesman  has 
when  he  enters  into  a  contest  with  pneu- 
monia. The  result  can  almost  as  certainty 
be  foretold  as  when  a  Spanish  warship  en- 
counters Admiral  Dewey's  or  Admiral 
Sampson's  fleet. 

When  one  reads  the  bulletins  sent  daily 
from  the  one  statesman's  sick  room,  they 
are  so  like  all  the  others  that  one  wonders 
why  the  associated  press  company  does  not 
advise  the  newspapers  that  receive  its  dis- 
patches to  post  up  in  their  rooms  a  complete 
list  of  the  bulletins  of  one  typical  case,  and 
then  when  a  new  one  came  on  they  could 
telegraph  his  name,  age  and  any  particulars 
that  would  be  of  general  interest,  and  after- 
ward all  that  need  be  sent  would  be,  say 
Dingley,  pneumonia,  second  day's  bulletin, 
and  the  compositor  could  reproduce  the 
second  bulletin  on  the  card,  and  so  for  each 
succeeding  day.  Of  course,  it  would  occa- 
sionally be  necessary  to  repeat  the  bulletin 
one  or  more  times,  and  also  to  omit  one  or 
more,  skipping  from  say  5th  to  7th  or  8th, 
depending  on  how  soon  or  late  alarming 
weakness  of  the  heart  came  on,  and  this 
might    depend  a  good    deal    on  the  doctor. 


512 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


If  he  aspired  to  a  seat  among  the  scientific, 
and  early  bled  the  patient  into  his  own 
blood  vessels  it  would  come  on  early.  If 
his  aspiration  was  higher,  to  a  seat  among 
the  only  scientific,  and  used  strychnine  free- 
ly, it  would  come  on  later.  But  come  it 
does,  and  the  end  is  peace. 

There  is  a  plentiful  lack  of  appreciation 
of  the  first  cause  why  the  heart  is  weak 
during  pneumonia.  It  is  said  that  part  of 
the  lung  being  useless  the  heart  tries  to  send 
the  usual  amount  of  blood  through  the  re- 
stricted area  and  fails  to  do  so,  and  what  is 
sent  through  is  imperfectly  oxygenized  and 
the  heart  is  not  only  overworked,  but  is 
badly  nourished  also,  and  at  last  is  exhaust- 
ed. That  this  exhaustion  does  not  always 
prove  fatal,  is  due  to  that  wise  provision  of 
nature,  who  foreseeing  what  fools  her  child- 
ren would  be,  wisely  planned  that  if  a  toxin 
were  slowly  introduced  into  the  system,  a 
certain  degree  of  tolerance  would  be  estab- 
lished to  such  an  extent  that  no  permanent 
harm  would  result  from  an  amount  which, 
if  it  was  rapidly  introduced  would  prove 
fatal.  The  toxins  of  pneumonia  are  no  ex- 
ception to  this  rule,  and  as  in  other  diseases, 
if  she  is  not  prevented  by  viscious  treat- 
ment or  surroundings  nature  will  form  an 
antitoxin  and  cure  the  patient  in  about  88 
per  cent,  of  cases. 

There  is  a  wide  difference  between  the 
statement  of  doctors  as  to  the  per  cent,  that 
does  recover  under  modern  treatment.  One 
giving  72  percent.,  another  56  percent. 
A  large  proportion  of  those  dying  die  from 
the  heart.  There  is  a  cause  antedating  the 
one  mentioned,  and  one  that  is  continually 
acting  as  any  one  can  know  who  will  care- 
fully observe  a  pneumonia  from  its  incep- 
tion. At  a  tmie  when  air  and  blood  enter 
and  leave  the  lung  freely,  the  pulse  rate  be- 
gins to  rise,  and  not  until  the  rate  has  in- 
creased 10  or  15  beats  per  minute  do  the 
patient's  sensations  direct  his  attention  to 
the  chest,  and  it  is  usually  some  hours  later 
before  by  auscultation  we  can  detect  the 
beginning  of  the  pneumonic  process.  Now 
this  rise  can  be  from  no  cause  but  toxins  in 
the  blood. 

Once  we  were  told  that  the  only  scientific 
course  to  pursue  when  the  heart  became 
embarrassed  was  to  perform  the  brilliant 
operation  of  bleeding  the  patient  into  his 
own  blood  vessels.  This  scientific  feat  is 
accomplished  by  introducing  into  the  circu- 
lation another  poison  in  addition  to  the  one 
under  which  the  heart  is  already  stagger- 
ing. If  this  added  poison  neutralized  the 
pneumo-toxin,  or  if  it  aided  its  elimination, 
or  assisted  nature  in  forming  the  pneumo- 
antitoxin,  common  sense  might  approve  the 
treatment.      But  it  does   neither.      What  it 


does  do  is  to  dilate  the  capillaries  and  thus 
slow  the  current  through  them,  and  so  a 
smaller  amount  of  blood  reaches  the  right 
heart  in  a  given  time,  and  there  is  appar- 
ently temporary  relief,  and  what  blood  does 
pass  through  the  lungs  is  better  oxygenated. 
But  the  total  of  oxygen  absorbed,  and  of 
C02  given  off  is  unchanged. 

Now  what  is  this  blood  doing  while  we 
have  it  stowed  away  in  the  capillaries?  It 
is  taking  up  an  increased  amount  of  that 
same  toxin  which  caused  the  pulse  rate  to 
rise  10  to  15  beats  above  the  normal  rate, 
and  this  blood  must  at  last  return  to  tor- 
ment the  heart.  The  science  in  this  plan  is 
fairly  well  matched  by  the  plan  a  scientist 
proposed  by  which  to  help  a  tired  burden- 
bearer  over  a  hill,  at  the  foot  of  which  he 
found  himself  so  exhausted  that  he  despair- 
ed of  ever  reaching  the  summit.  Scientists 
in  every  age  have  been  noted  for  benevo- 
lence, and  this  one  was  no  exception  to  the 
rule.  He  advised  the  burden-bearer  to  pick 
up  a  stone  about  half  as  heavy  as  he  could 
lift,  put  it  on  top  of  his  load,  carry  it  to  the 
top  of  the  hill,  then  throw  it  off,  and  he 
would  be  wonderfully  refreshed,  and  could 
go  on  his  way  rejoicing. 

Our  history  does  not  tell  us  how  the  bur- 
den-bearer got  over  the  hill,  but  it  does  tell 
us  that  so  many  pneumonics  died  from  the 
heart  that  we  were  more  than  willing  to 
welcome  the  true  heart  tonic,  strychnine, 
and  to  follow  the  advice  of  a  voluminous 
writer  and  self-appointed  highpriest  of  the 
only  scientific  temple  of  inner  medicine. 
He  reasons  that  since  the  heart  would  cer- 
tainly get  weak,  the  only  scientific  should 
forestall  this  weakness  by  giving  strych- 
nine both  through  the  mouth  and  through 
the  needle.  Not  only  this,  but  give  it  like 
we  vote,  early  and  often.  So  we,  desiring 
above  all  else  to  be  only  scientific,  relega- 
ted the  mouth  route  to  the  nurse,  while  we 
kept  the  needle  hot  with  use  and  antisep- 
tics. We  have  not  found  that  the  ratio  of 
pneumonics  dying  from  the  heart  is  any 
less  than  before  ;  but  the  period  at  which 
fatal  collapse  comes  on  is  postponed  more 
than  one  full  day,  and  we  rejoice  with  ex- 
ceeding great  joy,  and  experience  a  soulful 
satisfaction  that  is  only  equaled  by  the  sat- 
isfaction which  the  fashionable  woman  ex- 
periences when  she  realizes  that  she  is  the 
best  dressed  woman  in  church. 

Let  us  look  at  this  so-called  only  scientific 
treatment  in  the  light  of  common  sense. 
Strychnine  in  the  hand  of  the  doctor  is  very 
like  the  spur  on  the  horseman's  bootheel. 
The  spur  does  not  add  one  particle  to  the 
strength  of  the  horse,  but  it  does  enable  the 
rider  to  keep  the  horse  at  the  top  of  his 
speed  until  he  falls    exhausted.      So  strych- 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


513 


nine  enables  the  doctor  to  get  the  last  par- 
ticle of  reserve  force  out  of  the  heart.  But 
the  horseman  who  must  ride  his  horse  ioo 
miles  during  the  day  does  not  bury  the 
rowels  in  his  horse's  side  as  soon  as  he  is 
mounted,  and  no  matter  what  the  only 
scientific  may  say,  it  is  not  common  sense 
to  give  strychnine  until  it  is  needed,  and  it 
is  not  needed  in  every  case,  nor  in  fact  does 
every  patient  ill  from  pneumonia  need  drug 
treatment  at  all,  as  I  proved  in  my  own 
person  almost  fifty  years  ago.  I  assured 
my  medical  friends  that  if  a  man  had  been 
perfectly  healthy  pneumonia  was  a  very 
simple  disease,  which  nature  would  cure  in 
about  a  week  if  she  was  permitted  to  do  so. 
Acting  on  this  theory  I  took  water  and 
nothing  else  until  the  fever  was  gone  and  I 
was  ravenously  hungry. 

The  day  on  which  I  took  pneumonia  four 
others  in  the  vicinity  took  it  also.  Before 
I  had  broken  my  fast,  three  of  them  had 
been  buried,  and  before  the  fourth  one  was 
out  of  the  doctor's  care,  my  strength  was 
so  far  recovered  that  I  ran  a  foot  race  of 
150  yards,  and  won  it  over  the  local  cham- 
pion, and  this  in  spite  of  the  fact  that  near- 
ly, if  not  all,  of  the  left  lung  had  been  in- 
flamed. Since  then  1  have  attended  many 
pneumonics  who  took  very  little  medicine. 
But  I  have  not  prohibited  all  food.  But 
even  this  would  be  better  than  constant 
stuffing  that  some  think  necessary.  Of 
course  I  mean  in  a  well  nourished  patient. 
If  all  food  is  withheld  the  patient  will  feel 
very  weak,  but  if  the  heart  has  not  been 
poisoned  with  drugs  recovery  is  surprising- 
ly rapid. 

•Since  fictitious  bleeding  has  usurped  the 
place  formerly  held  by  venesection  in  treat- 
ing pneumonia,  the  ratio  of  those  dying 
from  the  heart  has  greatly  increased.  A 
little  consideration  will  enable  one  to  ex- 
plain this  fact.  We  can  approximately  es- 
timate the  ratio  of  CO,  in  venous  blood  to 
what  it  is  in  arterial  blood,  but  we  cannot 
tell  what  is  the  ratio  of  pneumo-toxin  in 
venous,  to  that  in  arterial  blood.  Probably 
it  is  higher  than  is  the  ratio  of  CO.,.  Now 
it  is  all  venous  blood  that  we  remove  by 
venesection;  while  when  we  resort  to  ficti- 
tious bleeding,  the  blood  that  we  tempora- 
rily remove  from  the  current  is  all  arterial 
blood — the  kind  of  blood  the  heart  most 
needs. 

I  have  never  seen  a  man,  either  doctor  or 
layman,  who  did  not  express  surprise  when 
he  first  observed  how  venesection  early  in 
pneumonia  strengthened  the  heart  and  pulse 
if  it  was  judiciously  performed.  This  means 
that  the  volume  of  blood  was  reduced  to  an 
amount  that  the  heart  could  manage.  If 
this   early  venesection    is    followed    by  the  | 


continued  application  of  ice,  or  snow,  and 
the  hourly  administration  of  chloride  of 
calcium,  the  patient  will  often  be  conva- 
lescent in  36  or  48  hours  and  be  at  his  usual 
work  in  a  week.  Later  in  the  course  of 
the  disease  it  is  not  very  infrequent  that  the 
life  of  the  patient  depends  on  a  prompt 
venesection,  and  the  free  use  of  strychnine. 
If  we  tell  the  only  scientific  that  the  ratio 
of  pneumonics  dying  from  the  heart  is  five 
times  as  great  as  it  was  75  years  ago,  they 
say  that  medicine  is  a  progressive  science. 
If  we  tell  them  that  the  mortality  rate  from 
pneumonia  has  increased  300  per  cent,  in 
three-quarters  of  a  century,  they  answer 
that  the  science  of  medicine  is  advancing 
with  strides  that  are  truly  gigantic.  If  we 
ask  them  to  abandon  a  treatment  founded 
on  theories  that  do  not  accord  with  facts, 
and  that  is  condemned  by  its  want  of  suc- 
cess, and  in  place  of  it  adopt  a  treatment 
founded  on  common  sense  and  recommend- 
ed by  its  success,  they  answer,  the  treat- 
ment you  recommend  is  unscientific  and  an- 
tiquated, and  our  aesthetic  souls  revolt 
against  its  barbarity.  Between  the  lines 
we  read — and  if  we  should  adopt  it  and  so 
reduce  our  mortality  rate  even  one-half  of 
300  per  cent,  we  should  thereby  prove  that 
we  had  been  d —  fools,  and  that  we  will 
never  do. 


The  Treatment  of  Whooping  Cough. 

By  Robert  C.  Kenner,  A.  M.,  M.  D., 
Louisville,   Ky. 

The  treatment  of  whooping  cough  along 
the  lines  followed  in  the  past  is  most  unsat- 
isfactory. If  we  will  but  make  an  examin- 
ation of  the  literature  of  whooping  cough, 
we  shall  find  that  the  number  of  remedies 
which  have  been  employed  for  this  affection 
have  not  only  been  numerous  indeed,  but 
they  have  been  diverse.  They,  too,  have 
been  lauded  as  specifics.  In  truth,  thera- 
peutic history  is  filled  with  accounts  of  rem- 
edies that  have  had  a  brief  period  of  popu- 
larity and  then  sunk  into  oblivion. 

Delicate  children  must  be  well  watched 
during  the  continuance  of  this  affection. 
There  being  existent  a  catarrhal  condition 
of  the  bronchial  tubes,  exposure  to  inclem- 
ent weather,  or  allowing  children  to  go 
without  sufficient  clothing  is  very  likely  to 
be  attended  with  the  supervention  of  pneu- 
monia. We  will  defeat  our  best  efforts  to- 
ward affecting  a  successful  result,  if  we  fail 
to  give  attention  to  this  detail.  Another 
important  matter  worthy  of  our  attention 
is  feeding.  We  will  find  that  paroxysms 
come  on  very  frequently,  and  in  many 
children    emesis    supervenes.     Often    this 


514 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


leads  to  considerable  emaciation,  and  in 
many  this  insufficiency  of  food  forms  an 
element  that  gives  us  serious  trouble.  The 
weakness  induced  by  inadequate  feeding 
makes  an  attack  of  pneumonia  or  other 
complications  a  possibility.  When  it  is 
necessary  we  will  have  to  give  liquid  pre- 
digested  foods — those  that  are  quickly  as- 
similated. In  the  manner,  suited  to  the 
particular  case,  we  shall  have  to  see  that  the 
patient  is  fed  adequately. 

The  therapeutic  indications  are  those 
looking  to  the  correction  of  the  bronchial 
catarrh,  the  control,  or,  amelioration  of  the 
paroxysmal  seizures  and  the  inhalation  of 
antiseptics  that  directly  tend  to  produce  an 
annihilation  of  the  causative  factors. 

An  old  time  remedy,  which  has  found 
favor  for  several  generations  with  the  most 
practical  men,  has  been  belladonna.  I  rely 
upon  this  as  one  of  my  steadfast  and  most 
reliable  remedies.  It  tends  to  lessen  the 
severity  of  the  paroxysms  of  coughing,  and 
tends,  I  am  sure,  to  materially  abridge  the 
duration  of  the  affection.  I  give  it  through- 
out the  course  of  the  disease.  I  give  it 
along  with  ipecacuhana,  and  the  syrup  of 
tolu.  These  last  mentioned  agents  exert  a 
favorable  action  on  the  catarrhal  condition 
of  the  tubes.  It  is  my  custom  to  exhibit  all 
of  these  agents  in  one  prescription  as  fol- 
lows, (for  a  child  one  year  old)  : 

R  Tinct.  bellad.,  gtt.  xvj. 
Vin.  ipecac,  gtt.  xij. 
Syr.  tolutan.,  gij. 

Misce.  Sig :  Teaspoonful  every  three 
hours. 

Children  are  not  awakened  to  take  the 
remedy,  but  are  given  it  only  when  awake. 

As  a  means  of  making  the  coming  of  the 
paroxysms  far  apart,  and  of  ameliorating 
their  severity,  1  give  along  through  the 
course  of  the  disease,  the  bromide  of  am- 
monia. This  I  give  in  doses  of  four  grains 
dissolved  in  water.  This  I  order  four  times 
daily,  and  an  hour  before  meal  time,  and 
just  before  retiring  at  night. 

In  the  course  of  twenty  years,  I  have 
found  no  internal  remedies  so  successful  as 
these.  But  along  with  this  internal  treat- 
ment we  must  carry  our  antiseptic  inhala- 
tion. 

Conjoined  with  internal  remedies  we  can 
by  using  inhalation  bring  about  a  cure  in 
less  than  half  the  time  usually  occupied  in 
the  treatment  of  this  affection.  A  thorough 
study  of  the  disease  has  convinced  me  that 
the  disease  is  not  a  self-limited  affection. 

I  believe  proper  treatment  will  bring 
about  a  cure  in  ten  to  fifteen  days. 

Coming  back  to  that  part  of  the  treat- 
ment comprehended    under  the  name  of  in- 


halation of  antiseptics,  I  may  say  I  rely 
upon  vapo-cresolene — this  is  vapor  kept 
up  in  the  patient's  room  during  the  night, 
and  I  am  sure  it  very  materially  assists  in 
bringing  about  a  cure  of  the  disease.  In 
fact,  I  have  found  the  remedies  here  advo- 
cated to  come  short  of  producing  rapid 
cures  when  this  was  omitted.  I,  therefore, 
include  it  as  an  essential  part  of  my  treat- 
ment, and  insist  upon  it  in  every  case.  It 
is  very  simple  of  application,  and  patients 
will  experience  no  trouble  in  using  it. 

I  have  not  taken  time  to  give  clinical  his- 
tories of  patients  treated  by  the  method  here 
advocated,  since  that  is  of  little  value  com- 
pared with  the  explanation  of  the  treatment, 
and  the  statistics  based  upon  the  method 
advocated. 

According  to  the  method  here  advocated 
I  have  treated  ioo  cases,  with  an  average 
duration  of  fifteen  days. 

I  have  thrown  doubt  above  on  the  "old 
time"  idea,  as  I  regard  it,  of  this  affection 
being  a  self-limited  disease,  and  requiring 
six  weeks  or  longer  for  its  complete  evolu- 
tion. That  view,  I  am  persuaded,  will  soon 
have  no  advocates.  My  cases,  as  well  as 
other  observers,  prove  this  an  erroneous 
view. 


Abscess  of  the  Lung— with  a  Reference  to 
Its  Surgical  Treatment. 

By  E.  M.  Dooley,  M.D.,  Buffalo,  N.  Y.,  Attend- 
ing- Surgeon    Buffalo    Hospital,    Sisters  of 
Charity,  and  Emergency  Hospital ;  Sur- 
geon to  the  Erie  Railroad  Company. 

Abscess  of  the  lung  presents  a  peculiar 
interest  both  to  the  physician  and  to  the 
surgeon  ;  to  the  former  on  account  of  the 
many  difficulties  surrounding  its  early  diag- 
nosis, and  to  the  latter  on  account  of  the 
varied  obstacles  in  the  way  of  active  treat- 
ment. 

Contributing  not  a  little  to  this  peculiar 
condition  is  the  relation  which  the  lung 
bears  to  its  surroundings. 

For  being  necessarily  a  delicately  formed 
structure  nature  has  protected  it  with  a  firm 
bony  framework,  capable  it  is  true,  of  a 
considerable  elasticity  of  movement,  when 
struck  or  pressed  upon,  yet  firm  enough  to 
resist  a  comparatively  large  degree  of  vio- 
lence. 

Within  the  chest  cavity  are  the  folds  of 
the  pleura,  with  layers  so  arranged  as  to 
afford  a  not  less  important  protection,  in 
lessening  the  friction  between  the  chest 
wall  and  the  lung,  which  the  act  of  respir- 
ation makes  imperative. 

When  called  upon  to  diagnose  or  to  treat 
a  pathological  condition  of    the  lung,    it  is 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


515 


necessary  to  do  so  through  the  pleural  sac. 
It  is  well,  therefore,  in  discussing  this  im- 
portant subject  before  us,  to  remember  what 
the  pleura  is,  and  to  consider  its  adaptabil- 
ity for  absorption,  especially  when  septic 
infection  is  so  apt  to  penetrate.  Our  friend, 
the  anatomist,  tells  us  "it  is  now  regarded 
as  a  large  lymph-space,  like  that  of  the  peri- 
toneum, and  communicates  by  stomata  with 
the  surrounding  subpleural  lymphatic  ves- 
sels  The  pulmonary  plura  is  very 

delicate  and  transparent,  and  is  also  attach- 
ed to  the  lung  tissue  by  elastic  connective 
tissue,  which  serves  as  a  nidus  for  a  plexus 
of  capillaries  from  the  bronchial  arteries 
and  a  plexus  of  lymphatic  vessels  which 
communicate  with  the  lymph  spaces  in  the 
areolar  tissue  of  the  lobules  of  the  lung." 

Fortunate  then  is  the  surgeon  who  suc- 
ceeds in  preventing  an  empyema  by  remov- 
ing the  abscess  without  infecting  the  large 
pleural  sac.  For  having  noted  the  relation 
between  lung  and  pleura,  it  is  easily  seen, 
how  readily  an  abscess  of  the  lung  can 
empty  its  collection  of  pus  into  the  pleural 
cavity.  When  we  remember  the  large  ab- 
sorbing surface  there,  we  can  understand 
wliy  the  patient  should  then  show  such  pro- 
found symptoms  of  septic  infection. 

I  do  not  wish  to  imply  that  all  abscesses 
of  the  lung  are  necessarily  fatal.  Here  as 
elsewhere  in  pathological  conditions,  we 
have  what  might  be  termed  some  curious 
anomalies. 

I  have  seen  an  abscess  of  the  lung  in  a 
boy  of  nine  years,  whose  parents  would  not 
allow  an  operation  of  any  kind,  recover 
without  surgical  treatment,  after  a  pro- 
longed illness.  The  abscess  had  pointed 
between  the  fourth  and  fifth  rib  on  the  right 
side  of  the  chest  midway  between  the  ster- 
num and  axillary  line. 

I  have  seen  cases  where  the  pus  has  found 
its  exit  through  the  bronchus  to  the  trachea 
and  the  patient  make  a  tedious  recovery. 

Indeed  there  are  cases  where,  owing  to 
its  situation,  and  possibly  to  the  condition 
of  the  patient,  operative  procedures  are  not 
advisable,  and  we  may  hope  for  such,  a  then 
fortunate  termination. 

With  regard  to  the  diagnosis  we  must 
admit  that,  despite  the  many  methods  used 
in  attempts  to  locate  an  abscess  of  the  lung, 
it  lias  as  yet  no  positive  sign  to  make  us 
assured  of  its  presence. 

It  is  hardly  to  be  wondered  at  then,  in 
quite  a  number  of  cases,  the  treatment  has 
been  what  has  been  aptly  termed  "unpre- 
meditated." 

A  case  presents  itself  with  all  the  symp- 
toms of  an  empyema,  even  to  the  presence 
of  pus  in  the  aspirating    syringe,  and  when 


an  incision  is  made  through  the  chest  wall, 
no  pus  is  found  in  the  pleural  cavity. 

In  some  cases  there  are  no  adhesions  of 
the  pleural  sac.  but  we  may  see  a  bulging 
in  the  lobe  of  the  lung,  and  the  presence  of 
a  large  pulmonary  abscess  is  discovered. 

During  the  past  year,  in  this  line,  I  have 
had  no  less  than  three  interesting  cases.  In 
one  of  them  in  particular,  there  was  exten- 
sive cedema  of  the  integument  over  the  en- 
tire affected  side.  The  aspirating  needle 
showed  the  presence  of  pus,  the  barrel  of 
the  syringe  being  nearly  filled.  I  made  an 
incision  and  resected,  superiosteal,  a  por- 
tion of  the  fifth  and  sixth  rib,  and  opened 
the  chest  cavity.  Instead  of  pus  I  found 
the  pleura  in  a  healthy  condition,  and  I 
noticed  the  lung  did  not  entirely  collapse. 
Near  the  lower  lobe  was  a  firm  rounded 
portion,  which,  to  the  finger,  showed  evi- 
dence of  containing  pus. 

Introducing  a  drainage  tube  into  the 
pleural  cavity  I  cleansed  the  entire  surface 
of  the  pleura  with  sol.  per.  oxide  of  hydro- 
gen. My  object  in  doing  this  was  to  have 
the  oxidizing  effect  of  the  per.  oxide  act  as 
a  mild  caustic  to  the  surface  of  the  pleura, 
which  it  does  readily  when  it  comes  into 
contact  with  the  serious  secretion.  This 
renders  the  cavity  aseptic,  and  at  the  same 
time  lessens  the  absorbing  power  of  the 
pleura.  About  the  center  of  the  abscess  I 
inserted  an  aspirating  needle  and,  for- 
tunately, removed  about  three  ounces  of 
pus.  Closing  the  valve  of  the  syringe,  and 
having  thoroughly  cleansed  it  with  steriliz- 
ed water,  I  was  able  then  to  force  two 
drams  of  per.  oxide  into  the  abscess  cavity, 
without  removing  the  needle.  This  served 
the  double  purpose  of  partially  disinfect- 
ing the  cavity  and  expanding  the  swelling 
to  its  former  size. 

Under  these  circumstances  I  was  enabled 
to  make  an  incision  large  enough  to  in- 
troduce a  drainage  tube,  protecting  the 
opening  with  sterilized  gauze.  With  the 
tube  into  the  cavity  it  was  an  easy  matter 
to  cleanse  it  with  the  per.  oxide  solution. 
Owing  to  the  wall  of  the  abscess  being 
somewhat  thin  the  bleeding  from  the  inci- 
sion was  comparatively  slight.  The  drain- 
age tube  was  allowed  to  remain  in  the 
pleural  cavity  covered  externally  with  gauze 
and  absorbent  cotton.  Through  this  tube 
the  pleural  cavity  was  washed  with  per 
oxide  solution  twice  daily. 

There  was  a  slight  pleuritis  on  the  affect- 
ed side  which  subsided  on  the  fifth  day. 
The  tube  was  then  removed,  a  strip  of 
gauze  inserted  and  the  external  wound 
allowed  to  close  on  the  tenth  day. 

Six  months  after  this  patient  had  gained 


516 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


twenty  pounds  in  weight  and  had  returned 
to  his  regular  employment. 

In  another  case  however,  where  the  as- 
pirating needle  failed  to  locate  the  abscess, 
on  account  of  its  being  more  deeply  seated, 
a  piece  of  rib  having  been  resected,  I  in- 
troduced a  drainage  tube  into  the  pleural 
cavity  and  treated  it  with  per  oxide  solu- 
tion as  before.  The  abscess  ruptured  into 
the  bronchial  tube  and  the  patient  made  a 
happy  though  more  tedious  recovery. 
Whether  the  collapsed  condition  of  the 
lung  hastened  the  discharge  of  pu6  I  am 
unable  to  say,  but  my  impression  was  that 
it  did. 

In  the  third  case  although  the  abscess 
could  be  located  near  the  surface  of  the 
lung,  in  attempting  to  use  the  aspirating 
needle,  some  troublesome  bleeding  occurred, 
and  it  was  not  thought  advisable  to  incise 
the  lung  tissue.  A  drainage  tube  was  in- 
serted and  the  pleural  cavity  treated  with 
per  oxide  solution  every  four  hours.  On 
the  second  day  the  abscess  ruptured  into 
the  pleural  cavity  and  was  drained  thorugh 
the  tube  and  beyond  what  might  be  called 
a  mild  pleuritis  no  complications  followed. 

In  this  case  as  in  the  former  convalesence 
was  prolonged. 

In  casually  reviewing  these  cases  which 
have  so  recently  come  under  personal  ob- 
servation, it  is  my  impression  that  our 
surgery  in  this  direction  should  be  conserva- 
tive rather  that  too  radical  if  we  would 
hope  for  good  results. 

In  this  short  paper  it  is  not  possible  to  do 
justice  to  this  important  subject.  I  have 
endeavored  to  merely  refer  to  a  few  inter- 
esting points  in  connection  with  it. 

It  is  a  subject  which  occupies  the  border- 
land of  medicine  and  surgery,  and  where 
the  physician  and  the  surgeon  must  work 
in  harmony  to  accomplish  what  must  ever 
be  our  highest  aim,  to  shape  our  course  of 
treatment  that  the  patient  may  have  the 
shortest  route  to  recovery  with  the  least 
possible  amount  of  suffering. 

406  Louisiana  St. 


The  Philosophy  of  Maternal  Impressions. 

By  William  Matthews  Ogle,  Ph.B.,  M.S.,M.D., 
Delaware  City,  Del. 

From  the  earliest  times  there  has  been  a 
widespread  belief  that  it  is  possible  for  a 
mental  impression  received  by  a  female, 
enceinte,  to  be  conveyed  in  some  unaccount- 
able way  to  the  foetus  in  utero,  producing 
a  lasting  blemish  that  is  afterwards  recog- 
nized as  conforming  in  some  particular 
with  the  maternal  mental  impression  that 
had  occurred  during    the  pregnnncy.     This 


belief   has  by  common   consent   come  to  be 
termed  "maternal  impressions." 

Whether  maternal  impressions  should  be 
labeled  a  fact,  a  theory,  an  hypothesis  or  a 
speculation,  has  for  a  long  time  engaged 
the  mind  of  the  medical  profession,  and  as 
yet  with  individual  convictions  only,  and 
these  individual  convictions  range  through 
all  the  degrees  between  fact  and  the  wildest 
speculation,  so  that  the  diversity  of  opin- 
ion, one  might  almost  say,  is  limited  only 
by  the  number  of  opinions  expressed,  and 
moreover  this  difference  is  not  limited  to 
any  one  class,  the  most  scholarly,  the  most 
careful  thinker  and  honest  reasoner  is  as 
varied  in  his  beliefs  as  his  indifferent 
brother,  and  more  or  less  doubt  seems  to  be 
in  the  minds  of  all. 

In  Mr,  Nordhoff's1  intelligent  and  sug- 
gestive treatise  on  the  reasonableness  of 
Christianity,  he  takes  the  atomic  theory  as 
an  illustration.  Mr.  Nordhoff  shows  that 
while  no  one  has  seen  or  in  any  other  way 
physically  apprehended  an  atom  or  a  mole- 
cule, or  can  possibly  see  or  apprehend 
either,  yet  the  defender  of  this-theory  sup- 
ports it  because  it  is  not  possible  to  demon- 
strate the  contrary,  and  also  because  he 
finds  that  it  gives  a  sensible  and  reasonable  \ 
explanation  and  justification  of  a  multitude 
of  well  known  phenomena  that  cannot  be 
explained  by  any  other  hypothesis  and  is 
consistent  with  well  ascertained  natural  1 
laws.  Maternal  impressions  is  more  than  a 
speculation,  and  we  are  hardly  justified  in 
declaring  it  to  be  a  fact,  but  reasoning  from  j 
analogy  we  can  apply  Mr.  Nordhoff's  argu- 
ment with  equal  force  and  consider  it  as  a 
theory.  "Follow  the  middle  path,"  taught 
Kwang-tsze,  "avoid  extremes,  be  moder- 
ate;" and  the  importance  this  Chinese 
sage  set  upon  the  precept  may  be  gathered  ,1 
from  the  fact  that  Confucius  had  already 
enunciated  it  and  Kwang-tsze  hated  to  agree 
with  Confucius. 

2Bishop  Vaughn  says  :"Science  has  noth- 
ing to  do  with  belief,  but  with  experiment  | 
and  verification  after  having  taken  a  num- 
ber of  things  for  granted.  When  science 
speaks  the  word  matter,  it  well  knows  that  !i 
back  of  the  word  there  is  something  un- 
known, unknowable  and  undefinable." 

3 Spencer  says,  "every  inference  depends     | 
on  premise,    every  premise,  if   it  admits  of 
proof,  depends    on  other    premises ;  and  if 
the  proof    of    the  proof    be  continually  de-     1 
manded,  it  must  either  end  in  an  unproved     il 
premise    or    in    the    acknowledgment    that     I 
there    can  not   be   reached    any  premise  on 
which  the  entire  series  of    proof  depends." 

And  again,    4Peabody  says :     "We   talk     I 
indeed  of    gravitation,    caloric,    electricity, 
magnetism,  etc.,  as  if   we  knew  what  they     j 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


517 


are,  yet  these  are  but  exphemisms  for  our 
ignorance — fence-words  set  up  at  the  outer- 
most limit  of  our  knowledge." 

A  theory  of  maternal  impressions  like  any 
other  legitimate  theory  could  not  pretend 
to  be  a  finite  expression  of  truth,  but  rather 
should  appear  as  an  attempt  to  summarize 
the  probabilities  of  the  question,  and  to  in- 
dicate the  direction  in  which  the  search  for 
further  knowledge  should  be  pursued.  Cer- 
tain facts  are  presented  to  our  view,  and 
the  theory  is  only  the  cord  on  which  we 
endeavor  to  string  the  facts  in  an  order  and 
arrangement  which  shall  make  their  other- 
wise dubious  meaning  and  their  relations 
to  one  another  clear  to  our    understanding. 

The  demonstrations  made  by  Professor 
Ercoloni,  of  Barcelona,  show  that  the  pla- 
centa in  mammals  is  a  gland  especially  de- 
veloped for  the  purpose,  quite  similar  in  its 
action  to  the  mammary  glands,  and  that  the 
foetus  in  its  circulation  and  nerve  system  is 
as  independent  of  the  mother  before  as  after 
birth.  There  is  always  contact  between  the 
mother  and  embryo,  and  from  the  earliest 
age  there  is  a  communication  between  them 
by  which  absorption  from  one  to  the  other 
takes  place.  If  a  maternal  impression  is 
transferred,  it  must  be  by  means  of  this 
contact  or  absorptive  communication  how- 
ever simple  or  complex  it  may  be. 

5Edmund  Willson  Roberts  says:  "The 
majority,  perhaps  all,  of  the  huma.i  race 
possess  the  faculty  of  reading  the  thoughts 
of  others  without  recourse  to  speech  or  to 
outward  signs;"  and  Mr.  Roberts  goes  on 
to  explain  that  distance  is  not  to  be  con- 
sidered— an  intervention  of  say  two  hun- 
dred miles  not  interfering  with  the  process. 
Now  if  "thought  transferrence"  between 
adults  does  occur  without  the  ordinary 
means  of  communication  as  Mr.  Roberts 
and  the  "Society  for  Psychical Researchs" 
report  from  their  recent  investigations,  why 
may  not  a  maternal  impression  be  trans- 
ferred from  mother  to  embryo  when  the 
conditions  and  connections  between  them 
are  so  infinitely  more  complete  and  favor- 
able for  it  than  they  could  be  at  any  time 
for  "mind  transferrence"  between  adults. 
And  moreover,  if  this  transferrence  is  pos- 
sible by  means  of  contact  or  the  absorptive 
communication  between  mother  and  em- 
bryo, why  may  not  the  impression  occur  at 
any  time  during  foetal  life.  Just  here  it 
may  be  well  to  remember  that  from  the 
lacral  plexus  of  the  cerebro-spinal  system 
are  derived  several  branches,  one  of  which, 
the  ileo-inguinalis,  goes  to  the  skin  of  the 
labia1;  another,  the  crural  branch,  to  the 
round  ligament  and  to  the  inguinal  skin  ; 
another,  the  hemorrhoidal,  goes  to  the  fun- 
dus of    the  womb   and  to  the    bladder;  an- 


other, the  perineal,  to  the  sphincters  and  to 
the  perineum,  and  there  is  still  another  that 
goes  to  the  clitoris  and  to  the  nymphae. 
Now  all  of  these  nerves  are  of  the  cerebro- 
spinal system,  and  a  very  important  fact 
besides  is,  that  this  system  commingles 
through  the  instrumentality  of  the  anterior 
communicating  branches,  and  in  instances, 
by  more  direct  anastomosis  with  the  great 
sympathetic  system.  This,  the  great  sym- 
pathetic, which  presides  so  directly  over  the 
entire  process  of  nutrition,  also  furnishes  an 
abundant  supply  of  branches  directly  to  the 
womb,  the  ovaries,  the  vagina  and  external 
genitalia.  As  6Dr.  Reed  says  :  "The  gen- 
ital organs  of  woman,  considered  in  the 
aggregate  are  nothing  more  or  less  than  a 
central  telegraphic  office,  from  which  wires 
radiate  to  every  nook  and  corner  of  the 
system,  and  over  which  are  transmitted 
messages,  morbific  or  otherwise,  as  the  case 
may  be ;  and  it  should  be  remembered  that 
telegraphic  messages  travel  both  ways  over 
the  same  wire,  that  there  are  both  receiving 
and  sending  offices  at  each  end  of  the  line, 
and  the  great  physiological  manifestation  of 
this  fact  is  to  be  found  in  pregnancy." 

That  which  seriously  disturbs  a  mother's 
health,  which  deprives  her  of  sleep,  takes 
away  her  appetite,  interferes  with  the  assim- 
ilation of  her  food,  makes  the  secretion  ab- 
normal and  leads  to  emaciation,  can  scarcely 
do  this  and  leave  the  progress  of  growth 
and  development  in  the  foetus  to  be  pursued 
in  a  vigorous  and  normal  way.  The  oppo- 
site, indeed,  appears  to  be  almost  necessa- 
rily true ;  and  it  is  impossible  to  estimate 
the  measure  of  the  ultimate  misfortune 
which  may  arise  from  even  a  temporary 
check  to  the  intra-uterine  development  of 
the  child,  because  that  development  takes 
place  in  the  healthy  state  with  extraordinary 
rapidity.  Bodily  disease  affecting  the 
mother  during  pregnancy  may  in  like  man- 
ner lead  to  inperfection  in  her  offspring. 
The  proper  nutrition  of  the  foetus  is  inter- 
rupted by  her  bodily  disease,  and  something 
beyond  a  mere  retardation  of  growth  may 
be  the  result.  It  does  not  appear  to  be  dif- 
ficult to  understand  how  misdirection  as 
well  as  arrest  or  delay  may  thus  be  given  to 
foetal  growth. 

Loug  ago  in  natural  history  science,  raa- 
turnal  impressions  excited  the  attention  of 
thoughtful  minds.  A  writer  on  the  subject 
in  the  seventeenth  century,  terminates  his 
article  with,7  "Hac  de  re  scribimus eo  con- 
jidentius  quod  adhuc  supersunt  homines 
honest i  coDiplurcs  qui  keve  viderint,'1'' — (on 
this  we  write  the  more  confidently  as  there 
are  still  alive  many  respectable  individuals 
who  actually  saw  what  I  have  been  describ- 
ing).     8 Aristotle,   the  intellect   of    Plato's 


518 


THE  CHARLOTTE   MEDICAL  JOURNAL. 


school,  so  distinguished  by  Plato  himself — 
was  not  only  the  great  authority  on  logic 
and  rhetoric,  but  the  very  father  of  zoology 
and  botany  and  hence  biology — refers  to  it 
in  his  history  of  animals.  And  in  the  oldest 
history  we  find,9 

"And  Jacob  took  him  rods  of  green  pop- 
lar and  of  the  hazel  and  chestnut  tree  ;  and 
piled  white  stakes  in  them  and  made  the 
white  appear  which  was  in  the  rods." 

"And  he  set  the  rods  which  he  had  piled 
before  the  flocks  in  the  gutter  in  the  water- 
ing troughs  where  the  flocks  came  to  drink, 
that  they  should  conceive  when  they  came 
to  drink." 

"And  the  flocks  conceived  before  the 
rods  and  brought  forth  cattle  ring-streaked, 
speckled  and  spotted." 

The  folk-lore  of  every  country  contains 
numerous  examples  of  cases  in  which  ma- 
ternal impressions  are  believed  to  account 
for  the  deformities  which  appear  in  the 
offspring;  and  this  remark  holds  true,  not 
of  man  alone,  but  also  of  the  animals  which 
are  most  closely  associated  with  him  in  his 
daily  life. 

In  English  history  we  find  a  classical  in- 
stance of  a  mental  peculiarity  apparently 
traceably  to  maternal  influence  in  the  case 
of  King  James  I.  Sir  Kenelm  Digby  stated 
that  the  King  had  a  great  dread  of  a  drawn 
sword  and  attributes  it  to  the  fright  which 
Queen  Mary  received,  while  pregnant,  when 
she  witnessed  the  murder  of  Rizzio.  When 
Sir  Kenelm  was  knighted  by  James,  the 
latter,  he  said,  "could  not  look  at  the  sword, 
and  he  had  almost  thrust  the  point  into  my 
eye,  had  not  the  Duke  of  Buckingham 
guided  his  hand  aright." 

It  might  be  advanced  as  an  argument 
against  maternal  impressions,  that  so  many 
women  in  different  stages  of  pregnancy, 
undergo  violent  mental  disturbance — anx- 
iety, abhorrence,  terror,  etc.,  without  any 
noticeable  effect.  But  is  it  not  very  com- 
mon to  find  that  intense  excitement  of  the 
maternal  mind  is  fatal  to  foetal  life,  or  what 
is  worse  productive  of  idiocy? 

One  of  the  strangest  things  in  regard  to 
maternal  impressions,  is  that,  in  most  cases 
that  have  heen  reported,  it  is  to  be  noticed 
that  the  predisposing  mental  impression 
was  what  we  may  term  mild,  perhaps  but 
the  thought  of  a  moment,  as  instanced  in 
the  following  case  related  to  the  writer  by 
the  late  10Dr.  Wallace.  Some  women  in 
idle  talk  were  discussing  the  subject  (ma- 
ternal impressions)  and  one  of  them,  preg- 
nant at  the  time,  said  :  "When  mine  comes, 
if  it  is  marked,  I  hope  it  will  be  here," 
placing  a  hand  on  one  of  her  hips.  When 
the  child  was  born,  the  mark  of  an  extended 
hand  was    plainly    delineated    on   the    hip, 


corresponding  apparently  with  the  laughing 
gesture  of  the  mother. 

lxDr.  Black  tells  me  of  the  following 
which  occurred  in  his  practice.  A  lady, 
strong,  healthy  and  usually  well,  six  months 
pregnant,  was  driving  with  a  female  com- 
panion. They  came  suddenly  upon  a  de- 
formed man  in  the  road,  and  the  companion 
not  wishing  her  to  see  him,  grasped  her  by 
the  forearm,  but  too  late  to  stop  her  from 
looking.  Herchildborn  at  term,  normally, 
had  the  mother  mark  on  the  spot  where  she 
had  been  grasped  by  her  friend. 

In  these  cases  we  have  no  reason  to  think 
that  the  maternal  mind  was  affected,  in  any 
degree,  more  than  we  would  expect  to  find 
in  the  trivial  happenings  of  every-day  life, 
except  that  in  Dr.  Black's  case,  the  dura- 
tion of  foetal  life  had  reached  "six  months," 
at  which  time  women  are  prone  to  depres- 
sion and  fanciful  forebodings.  We  notice 
in  a  majority  of  the  cases  reported,  that 
when  the  period  in  the  pregnancy  is  stated, 
it  is  early.  There  is  one  case  on  record  in 
which  the  maternal  impression  was  received 
on  the  twenty-first  day  of  embryonic  life, 
almost  two  months  before  the  woman 
thought  that  she  was  pregnant.  And  Dr. 
Black's  case  leads  to  the  thought  that  the 
maternal  impression  can  be  transmitted  as 
late  as  the  sixth  month  of  gestation. 

A  most  remarkable,  interesting  and  con- 
vincing case  is  that  of  12Dr.  Bass,  who  re- 
lates :  "Shortly  before  I  was  born,  I  do  not 
know  how  long,  while  my  mother  was  iron- 
ing, her  little  girl,  two  or  three  years  old, 
came  up  behind  her  and  laid  her  hand  on 
the  table.  My  mother  set  the  heated  iron 
back  on  her  right  hand,  resting  on  nearly 
the  whole  of  the  little  finger  and  about  two- 
thirds  of  the  next  finger,  with  the  point  of 
the  iron  resting  about  half-way  across  the 
middle  finger  just  behind  the  nail.  Upon 
hearing  the  screams  of  her  child,  my  mother 
took  her  up  and  tried  to  pacify  her.  She 
found  the  fingers  as  described,  very  red  but 
not  vesicated.  When  I  was  born,  the  same 
fingers  on  the  right  hand  were  reddened, 
corresponding  in  color,  shape,  etc.,  with 
those  of  the  little  girl,  and  I  have  retained 
that  color,  etc.,  for  more  than  fifty  years." 

We  know  that  a  woman  will  often  jump 
to  a  conclusion  to  which  a  man  would  re- 
fuse agreement  without  deliberate  reason- 
ing, and  whether  this  is  owing  to  intuitive 
knowledge  or  to  an  obscure  congenital  fac- 
ulty, we  do  not  know,  but  the  fact  is  not 
to  be  denied.  And  most  women  are  very 
ready  to  believe  in  maternal  impressions. 
With  some  the  strength  of  the  belief  may 
vary,  and  indeed  it  is  possible  to  find  one 
who  scorns  the  reasonings  of  other  women, 
declaring  her  belief,  that  all  cases  of  mater- 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


nal  impressions  are  either  products  of  super- 
stition or  founded  on  mistaken  observation 
or  unwarranted  interpretation  of  facts. 

The  writer  had  an  opportunity  recently 
to  question  two  midwives  in  Philadelphia 
and  was  surprised  to  find  them  of  exactly 
different  opinions.  One  said  she  had  given 
hirtli  to  eight  children  and  each  of  them 
had  a  birth-mark  for  which  she  had  a  pre- 
vious history.  "There's  my  Jimmie!  when 
I  was  carrying  him  a  chicken  pecked  me 
on  the  hand,  and  when  he  was  born  he  had 
a  perfect  immitation  of  a  chicken  on  his 
back,"  &c.  The  other  was  as  positive  in 
declaring  her  negative  belief,  and  related 
that  when  she  was  in  her  first  pregnancy, 
she  met  on  the  street  a  man  who  had  a 
"horrible  face,"  so  repulsive  that  she  shud- 
dered and  thought  of  her  expected  child. 
The  man  evidently  lived  near  her  home,  as 
she  saw  him  afterwards  several  times  and 
always  with  dismay  and  forebodings.  Final- 
ly she  avoided  the  windows  lest  perhaps 
she  would  see  him  passing.  The  thought 
preyed  on  her  mind  until  she  was  delivered 
and  assured  that  the  child  had  no  unusual 
mark. 

Whether  an  acquired  condition  of  a  pa- 
rent can  be  inherited  by  the  offspring  is  a 
long  standing  subject  for  disagreement 
among  writers  on  heredity.  But  why?  It 
is  a  matter  of  certainty  that  certain  parental 
malformations  (which  are  certainly  acquir- 
ed states)  can  be  handed  down  to  the  next 
generation.  Statistics  show  that  the  proba- 
bility of  deaf-mutism  being  inherited  is  as 
seven  to  one,  ami  is  this  not  irrefutably  ex- 
emplified in  the  oft-quoted  case  of  the  pro- 
geny of  the  man  ((initio  Kelleia)  who  had 
six  lingers  on  each  hand  and  six  toes  on 
each  foot.  While  we  have  a  complete  re- 
cord of  the  malformations  in  this  (Kelleia) 
family,  it  is  strange  that  the  keepers  of  this 
record  make  no  mention  of  the  part  that 
maternal  impressions  played.  That  they 
were  chiefly  instrumental  we  cannot  say, 
but  it  is  quite  possible  as  it  would  be  very 
natural  for  a  deformed  parent  to  dread  the 
prospect  of  imperfection  in  the  coming 
child.  It  is  certainly  to  be  expected  that 
the  malformation  was  a  frequent  subject  for 
conversation  and  much  thoughtful  specula- 
tion among  the  Kelleia  women.  And  what 
woman,  being  pregnant,  after  having  given 
birth  to  a  child  with  a  congenital  blemish, 
would  not  in  her  self  communings  dwell  on 
that  blemish  and  fret  about  its  possible  re- 
producl  ion. 

What  is  more  probable  than  that  the 
pregnant  deaf-mute  would  often  wonder  if 
her  child  would  have  its  faculties  intact, 
and  we  can  understand  howr  she  would  long 
for  her   child's  deliverance    from    her  afflic- 


tion, and  this  continued  dread  and  mental 
distress  would  perhaps  lead  to  the  much  de- 
plored condition. 

There  is  a  current  belief  among  women 
that  an  ungratified  desire,  what  they  term 
"a  longing,"  is  often  liable  to  leave  a  ma- 
ternal impression.  A  poor  negress  (laun- 
dress) gave  birth  to  a  child,  diagonally 
across  whose  face  there  was  a  mark  some- 
what more  than  an  inch  in  width  and  sev- 
eral inches  long,  terminating  in  a  point  on 
the  forehead.  When  the  mother  saw  this 
mark,  she  ejaculated  :  "If  I  could  only  had 
bananas,"  in  explanation  of  which  the 
grandmother  informed  me  that  during  her 
pregnancy,,  she  had  a  continual  craving  for 
bananas. 

That  a  child  is  liable  to  be  disfigured  as 
the  result  of  an  unreasonable,  perhaps  sill}', 
longing  on  the  part  of  the  mother,  is  not  a 
pleasant  thought,  and  now  when  the  prac- 
tical trained  nurse  is  taking  her  place  in 
the  lying-in  room,  it  is  to  be  hoped  that  as 
the  garrulous  old  mid-wife  goes  further  into 
the  back-ground,  this  longing  superstition, 
which  she  originated,  will  fade  with  her. 

In  this  consideration  of  maternal  impres- 
sions we  have  taken  facts  as  they  stand  and 
feel  justified  in  claiming  that  any  other 
theory  would  necessitate  a  much  less  reason- 
able explanation.  At  the  same  time  to  the 
question,  how  is  this  variation  inaugurated? 
How  without  direct  nerve  communication 
a  maternal  mental  impression,  aye  perhaps 
trivial,  can  be  written,  as  it  were,  on  the 
foetus  in  utero,  that  will  last  with  the  life 
of  the  receiver?  We  must  answer  in  the 
language  of  Du  Hois  Reymond,  '•'•Ignora- 
w/c.s"  (we  know  not),  " Ignorabimus''''  (we 
shall  never  know). 

REFERENCES. 

i.  God  and  the  Future  Life,  Charles 
Nordhoff. 

2.  Science  and  Religion,  Bishop  Vaughn. 

3.  Psychology,  Vol.  II., Herbert  Spencer. 

4.  Christianity  the  Religion  of  Nature, 
Prof.  A.  P.  Peabody. 

5.  The  Cosmopolitan  (March,  1899),  Ed- 
mund Willson  Roberts. 

6.  Gaillard's  Med.  Journal  (Jan.,  '99), 
Prof.  Chas.  A.  L.  Reed,   A.  M.,  M.  D. 

7.  Historia  Rerum  Scoticarum,  George 
Buchanan. 

8.  Aristotle  on  the  Parts  of  Animals, 
translated  with  introduction  and  notes  by 
W.  Ogle,  M.  D.,  etc. 

9.  Genesis,  chap,  xxx,  verses  37~39- 

10.  Prof.  Ellerslie  Wallace,  loved  in  the 
memory  of  so  many  Jefferson  Medical  Col- 
lege men. 

11.  Dr.  John  Janvier  Black,  New  Castle, 
Del.      (Dr.  Black  has   had  a  large  practice 


THE  CHARLOTTE  MEDICAL  JOURNAL, 


and  been  much  sought  by  other  physicians 
in  consultation  for  many  years,  and  is  pro- 
bably the  best  informed  medical  man  in 
Delaware). 

12.   Robert   E.  Bass,    M.  D.,    Rices  De- 
pot, Va. 


The  Practical  Advantages  of  Modern  Stan- 
dardized Preparations.* 

By  F.  O.  Hawley,  M.  D.,  Charlotte,  N.  C. 

It  has  been  the  custom  hitherto  to  speak 
of  "the  art  of  pharmacy,"  but  the  numer- 
ous applications  of  scientific  methods  and 
principles  to  the  materia  medica  of  to-day 
make  it  now  almost  obligatory  for  us  to 
speak  of  "the  science  and  art  of  pharmacy." 

It  is  not  much  more  than  a  quarter  of  a 
century  since  the  medical  profession  was 
made  aware  of  the  great  variation  which 
was  manifested  by  many  potent  drugs  in  the 
matter  of  content  of  therapeutic  constit- 
uents. This  variation  was  found  to  be  due 
to  the  action  of  so  mauy  causes  that  were 
largely  beyond  the  control  of  man — such  as 
heat,  amount  of  moisture  and  other  climatic 
conditions  of  growth,  character  of  soil  in 
which  the  plants  were  grown,  weather  dur- 
ing the  gathering,  changes  occurring  during 
the  curing  process,  etc. — that  it  was  long 
considered  quite  sufficient  for  the  pharma- 
cist to  see  that  the  drug  appeared  to  be  in 
good  condition  and  that  it  was  not  too 
moldy  nor  too  worm-eaten.  Considerable 
elasticity,  we  may  say,  was  practiced  if  not 
permitted  in  the  judgment  employed  to  de- 
cide the  latter  points. 

When  morphine,  quinine,  strychnine  and 
the  other  alkaloids  began  to  be  isolated  and 
used  by  themselves,  instead  of  the  crude 
opium  or  the  crude  bark,  as  the  case  might 
be,  the  manufacturers  of  these  substances 
very  quickly  perceived  that  it  would  be 
money  in  their  pockets  to  buy  only  such 
opium  as  contained  at  least  9%  of  morphine  ; 
that  it  was  their  loss  to  buy  a  cinchona  bark 
that  was  deficient  in  quinine.  Samples  of 
these  began  to  be  bought,  and  prices  accord- 
ingly ruled  by  results  of  analyses.  Thus 
standardization  was  first  instituted. 

From  this  point  to  the  securing  of  an 
analytical  safeguard  for  opium  for  thera- 
peutic purposes  was  but  a  step.  If  the  man- 
ufacturers of  morphine  for  the  protection  of 
their  own  pockets  were  forced  to  see  that 
their  crude  opium  was  up  to  grade,  it  was 
demanded  that  pharmacists  also  should  do 
so  in  the  interests  of  medical  science,  when 


*Read   before   the    North   Carolina    Medi 
College,  April  17th,  1899. 


manufacturing  their  laudanum.  Hence, 
opium  preparations  came  to  be  the  first  to 
be  made  by  truly  scientific  methods — the 
first  to  be  "standardized." 

Of  course  it  is  needless  to  say  that  phar- 
maceutical preparations  of  opium,  before 
the  official  adoption  of  a  standard,  varied 
fully  as  widely  in  therapeutic  effects  as  the 
opium  itself  varies  in  morphia ;  similarly 
so  do  we  find  many  other  powerful  and  im- 
portant drugs  (and  their  preparations)  to 
vary,  which  have  not  yet  had  this  process 
extended  to  them.  To  the  medical  profes- 
sion, as  onlookers,  it  appeared  to  be  a  hard 
fight  against  conservative  know-nothing- 
ism,  to  secure  the  standardization  of  two 
additional  drugs,  cinchona  and  nux  vomica, 
in  the  last  edition  of  the  U.  S.  P.    • 

The  trouble  seems  to  be  not  so  much  that 
drugs  are  capable  or  incapable  of  being 
standardized,  for  the  attainment  of  thera- 
peutic accuracy,  and  the  benefit  of  human- 
ity in  general,  but  that  the  pharmacists — 
who,  by  the  way,  have  a  good  deal  to  say 
in  editing  the  U.  S.  P. — feel  that  they,  as  a 
body,  and  on  their  small  scale,  are  not  able 
to  accomplish  standardization  economically. 
Their  reluctance  to  officially  assist  therapeu- 
tics in  this  matter  is,  therefore,  felt  by  the 
medical  profession  to  be  an  attempt  to  de- 
lay their  "evil  day"  of  confessing  this  in- 
ability. 

If  pharmacy  in  its  standard  work  of  au- 
thority, the  Pharmacopoeia,  still  hesitates  to 
carry  the  good  work  forward,  it  is  with 
much  pleasure  that  we  medical  men  see 
some  of  the  more  reputable  manufacturing 
houses  willing  to  meet  us  much  more  than 
half  way  in  this  matter.  In  addition  to 
those  already  mentioned — opium,  cinchona, 
nux  vomica — there  are  for  instance  stan- 
dardized preparations  to  be  found  on  the 
market  of  Belladonna  leaves  and  roots, 
calabar  bean,  coca,  colchicum,  root  and 
seed,  conium,  gelsemium,  hydrastis,  hyo- 
scyamus,  ipecac,  kola,  podophyllum,  stra- 
monium leaves  and  seed,  veratrum  viride — 
all  of  them  assayed  by  chemical  methods. 

If  chemical  tests  involving  comparatively 
little  outlay  in  apparatus  and  comparatively 
little  trained  skill  have  been  so  slowly  re- 
cognized as  available  to  pharmacy  in  its 
presentation  of  medicaments,  what  pros- 
pects are  there,  pray,  of  the  ready  and  will- 
ing adoption  of  physiological  tests  which 
involve  much  more  capital  and  demand 
more  elaborate  technique?  No  doubt  what- 
ever now  exists  in  the  minds  of  the  most 
competent  chemists  that  only  a  physiologi- 
cal test  is  capable  of  discriminating  thera- 
peutic value  in  many  drugs.  Chemistry  in 
many  cases  is  either  unable  to  discover  the 
active  principle,  as  in  the  case  of  cannabis 


THE  CHARLOTTE   MEDICAL  JOURNAL. 


521 


indica,  or  to  isolate  it  from  others  present 
when  there  is  a  plurality  of  them,  as  in  the 
case  of  digitalis,  aconite,  etc.  Of  powerful 
drugs  at  present  recognized  as  not  amenable 
to  chemical  assay,  may  be  mentioned  aco- 
nite, cannabis  indica,  cantharides,  ergot, 
digitalis,  strophanthus,  convallaria  majalis, 
squills,  elaterium,  and  probably  others. 

We  believe  that  we  may  truthfully  state 
that  since  the  advent  of  the  chemical  test 
no  more  important  advance  has  been  advo- 
cated in  the  history  of  pharmacy  than  the 
physiological  system  of  assaying  drug  pro- 
ducts to  which  we  have  just  referred.  All 
honor  to  such  firms  as  Parke,  Davis  &  Co., 
who  were  the  first  to  put  this  system  of 
standardization  into  practice,  and  who  al- 
ready have  large  laboratories  actively  en- 
gaged in  carrying  out  its  principles.  By 
this  method  the  physiological  effect  of  such 
cardiacs  as  strophanthus  and  digitalis  are 
tested  by  administering  them  in  fluid  form 
to  frogs  and  other  animals,  and  subsequently 
vividly  demonstrating  their  therapeutic 
value  through  the  medium  of  Fraser's  per- 
fusion apparatus,  and  of  graphic  tracings 
on  the  Ludwig  kymograph  and  similar  in- 
struments. The  oxytocic  power  of  ergot  is 
^demonstrated  upon  pregnant  animals,  ami 
its  related  hemostatic  act  ion  estimated  by 
feeding  it  to  cocks  and  noting  the  reaction 
manifested  by  the  comb  and  wattles — 
an  active  drug  being  able  to  pro- 
duce such  action  on  the  arterioles  as  to  cause 
•incipient  or  even  complete  gangrene  of  these 
[parts.  Cannabis  indica  may  be  physiolo- 
jgically  tested  upon  dogs  or  other  animals, 
and  its  therapeutic  activity  measured  by  the 
[consequent  staggering  gait,  loss  of  muscu- 
lar control,  reduction  of  temperature,  etc., 
'which  it  manifests,  followed  by  insensibil- 
ity. We  might  enumerate  more,  but  these 
instances  are  sufficient  to  indicate  the  phy- 
siological channels  by  which  medicinal  ac- 
tion may  be  tested  upon  respiration,  blood- 
vessels, kidneys,  intestines,  muscle  fibre, 
[nerve  centers  and  nerve  endings,  etc. 
1  As  showing  the  importance  to  therapeu- 
tics which  this  new  method  possesses,  we 
may  be  permitted  to  refer  to  a  paper  read 
'by  Dr.  E.  M.  Houghton,  before  the  Denver 
imeeting  of  the  American  Medical  Associa- 
tion, on  "The  Pharmacologic  Assay  of  the 
Heart  Tonics."  In  this  paper  are  stated 
the  results  of  a  number  of  physiological  tests 
[of  tincture  of  strophanthus  found  commer- 
cially on  the  open  market.  Considering  the 
toxic  value  of  the  weakest  as  the  unit  (as 
established  by  direct  test  upon  animals),  the 
strongest  was  found  to  be  no  less  than  equal 
to  ninety!  Chemically  examined  the  sam- 
l>li ■-.  \vc  are  informed,  were  not  found  to  be 
appreciably  different.     This    is    equivalent 


to  saying  that  a  chemical  test  of  such  a  drug 
could  not  differentiate  between  an  inert  and 
an  actively  toxic  sample.  If  the  patient 
had  been  receiving  the  weaker  preparation 
and  then  had  his  prescription  filled  at  an- 
other store  or  from  a  fresh  bottle  represent- 
ing the  stronger  preparation,  we  would  not 
wonder,  as  Dr.  Houghton  remarks,  at  it 
affording  such  a  "splendid  opportunity  for 
a  sudden  termination  of  a  favorably  pro- 
gressing heart  disease!" 

I  would  be  simply  wasting  your  time  to 
dilate  upon  the  advantages  which  accuracy 
and  uniformity  confer  upon  our  materia 
medica,  but  if  nature  does  not  herself  sup- 
ply us  with  standardized  drugs,  let  us,  by 
all  means,  improve  upon  nature  when  the 
ways  and  means  of  doing  this  are  so  evi- 
dently within  the  reach  of  modern  scientific 
appliances. 

The  convenience  of  modern  pharmaceu- 
tical preparations  when  compared  with  the 
olden-time  black  draught,  emulsion  of  asa- 
footida,  and  other  nauseating  mixtures  and 
infusions,  the  majority  of  them  without  at- 
tempt at  palatability,  is  certainly  a  matter 
for  congratulation  as  well  from  the  physi- 
cian's as  the  patient's  point  of  view.  The 
blue  pill  and  powdered  opium  were  for  a 
long  time  the  most  condensed  representation 
of  medicinal  activity  which  the  doctor  could 
carry  with  him.  Alkaloids  and  their  con- 
venient exhibition  in  every  form  of  phar- 
maceutical embodiment  have  made  the  old 
saddle-bags  of  the  country  practitioner 
dwindle  down  in  these  latter  days  to  the 
dimensions  of  a  pocket-case.  Nor  can  it  be 
said  that  the  condensation  has  been  any- 
thing but  a  direct  gain  to  therapeutics. 

In  the  matter  of  elegance,  pharmacy 
claims  that  her  products  of  to-day  are  much 
better  prepared  and  more  palatably  exhibi- 
ted than  they  have  ever  been.  Elegance, 
however,  to  our  knowledge  is  not  an  un- 
mixed blessing.  If  a  newer  method  of  ex- 
hibiting some  familiar  but  disagreeable- 
tasting  article,  some  new  pharmaceutical, 
is  brought  to  our  notice,  have  we  not  a  right 
to  expect  that  the  contents  medicinal  are  not 
sacrificed  to  the  mistura grata  of  the  con- 
fectioner? We  have  seen  cases  where  the 
amount  of  medicament  claimed  on  the  label 
was  not  to  be  found  present  even  to  the  ex- 
tent of  50%  !  A  concern  which  is  willing 
to  falsify  in  one  will  do  so  in  all  products 
where  it  may  dare  to ;  but  we  cannot  go 
farther  into  this  matter  without  being 
tempted  to  instance  some  specific  cases, and 
this  is  not  our  intention.  Elegance  and 
palatibility  are  however  not  always  synony- 
mous with  therapeutic  worth. 

At  this  point  we  come  to  a  decision  with 
regard   to    our    medicines   sinrlar     to     that 


522 


THE  CHARLOTTE   MEDICAL  JOURNAL. 


which  our  patients  reach  when  selecting 
their  doctor.  We  do  not  very  frequently 
find  them  employing  us  if  they  have  no 
confidence  in  our  ability.  Neither  do  we 
willingly  employ  preparations  of  the  Mate- 
ria Medica  of  whose  quality  we  are  doubt- 
ful, or  in  whose  makers  we  have  lost  confi- 
dence. 

But  how,  it  may  be  asked,  are  we  to  learn 
of  the  manufacturers  who  make  the  best 
products?  How  are  we  to  know  that  we 
are  placing  our  confidence  in  the  best  pre- 
paration obtainable?  Should  we  simply 
trust  to  our  individual  experiences?  No, 
life  is  too  short  for  that.  Even  our  patients 
do  not  try  us  individually ;  they  select  us, 
generally  speaking,  because  they  have  been 
recommended  by  friends  who  have  had  pre- 
vious experience  with  us.  We  expect  then, 
nay  indeed,  demand  that  the  experience  of 
the  entire  medical  profession  be  made  com- 
mon property  for  the  benefit  of  all. 

This  demand  was  but  little  necessary  re- 
specting Materia  Medica  when  every  manu- 
facturer was  on  the  same  footing  and  all 
made  strong  or  weak,  good  or  worthless 
preparations  of  drugs  just  as  the  crude  ar- 
ticles varied.  When  chemical  standardiza- 
tion was  initiated  it  became  more  necessary 
than  ever  that  the  profession  at  large  should 
realize  the  benefit  from  standardized  prepa- 
rations should  they  be  observed  to  posses 
the  reliability  claimed.  Then  followed  the 
newer  physiological  standards  of  quality 
in  drugs,  which  are  not  so  readily  tested  by 
the  average  physician,  consequently  the  re- 
sponsibility rests  upon  the  few,  who  have 
the  facilities  for  doing  so  to  make  their 
worth  known  to  the  profession,  that  we 
may  all  understand  what  are  the  points  of 
superiority  which  such  standardized  drugs 
possess.  Lastly,  come  the  blood-serum 
remedies  for  diphtheria,  tetanus,  etc.  Only 
a  very  few  can  hope  to  thoroughly  and 
scientifically  test  these  preparations  apart 
from  the  knowledge  acquired  in  their  clini- 
cal use,  since  such  tests,  to  be  of  value, 
would  require  such  extensive  laboratory 
facilities  as  State  or  National  institutions 
can  alone  provide.  Collective  clinical  evi- 
dence, therefore,  is  all  that  we  have  to  de- 
pend upon.  Is  it  not  then  as  much  a  duty, 
in  reporting  epidemics  of  diphtheria,  for  in- 
stance, to  name  the  maker  of  the  antidiph- 
theritic  serum  employed,  as  it  is  to  report 
in  the  first  place  that  serum  itself  was  the 
remedy  used?  There  appears  to  be  a  dread 
of  advertising  the  manufacturer  in  such  a 
case,  when  in  reality  the  medical  profes- 
sion and  the  cause  of  humanity  in  general 
receive  the  greater  benefit. 

To  give  an  instance  of  what  I  mean  in 
this  connection,  let  me  refer  to   the    official 


reports  of  the  health  boards  of  some  of  our 
large  cities.  I  have  in  mind,  as  an  ex- 
ample coming  under  my  observation,  the 
published  experience  of  the  Health  Bureau 
of  the  city  of  Denver,  Col.  In  1895,  when 
antitoxin  was  first  used  in  that  city,  7.3  per 
cent  of  diphtheria  mortality  was  reported, 
many  different  makes  of  serum  being  em- 
ployed. In  1896  the  product  of  one  maker 
only  was  employed  and  the  mortality  was 
6.5  per  cent.  In  1897,  the  product  of  an- 
other manufacturer  was  selected  and  ex- 
clusively employed,  and  the  mortality  was 
reduced  to  4.1  per  cent.  If  some  entirely 
new  remedy  had  been  employed  that  af- 
fected this  50  per  cent  reduction  in  mortal- 
ity, the  report  would  have  enthusiastically 
praised  the  medicament  and  the  name  would 
have  been  given  free  publicity.  Is  it  not 
equally  as  important  a  point  of  professional 
information  to  be  told  the  brands  of  the 
antitoxin  employed  when  they  are  found  to 
differ  quite  as  widely  in  efficiency?  Are 
the  good,  the  indifferent  and  the  worthless 
antitoxins  all  to  continue  to  meet  upon  com- 
mon ground  when  human  lives  are  in  the 
balance,  and  especially  when  we  may  profit 
from  collective  experience  if  it  be  not  de- 
nied us?  No  squeamish,  false  modesty 
should  prevent  such  public  statistics  stating 
all  the  facts  instead  of  only  a  part  of  them, 
when  their  publication  is  of  so  material 
value  to  therapeutics. 

In  conclusion,  the  scientific  obligations  of 
pharmacy  and  of  pharmaceutical  prepara- 
tions to  the  science  and  art  of  medicine 
lead  us  to  expect,  if  not  indeed  demand, 
that  the  "personal  equation"  of  the  manu- 
facturer disappear  from  all  the  therapeutic 
weapons  of  our  warfare  with  disease.  Some 
of  these  we  have  seen  to  be  extremely  diffi- 
cult to  test  before  they  are  used  at  the  bed- 
side;  so  difficult  that  no  private  individual 
can  be  expected  to  do  it  alone.  Our  safest 
course,  therefore,  would  seem  to  be  the 
adoption  of  accurately  standardized  thera- 
peutic products,  from  the  laboratories  of  a 
responsible  house,  whose  honest  aim  is  to 
supply  the  medical  profession  through 
legitimate  channels,  with  the  best  and  most 
approved  agents  for  the  treatment  of  dis- 
ease. Thus,  alone,  can  we  feel  assured  that 
we,  as  physicians,  are  giving  our  patients 
the  benefit  of  all  that  science  has  done 
or  can  do  to  ameliorate  human  suffering  and 
promote  the  welfare  and  happiness  of  the 
human    race. 


Marriage  between  epileptics  is  forbidden 
by  the  laws  of  Texas  and  Massachusetts. 
In  the  latter  State  syphilitics  and  alcohol- 
ics are  also  prohibited  from  indulging  in 
matrimony. 


THE  CHARLOTTE  MEDICALIJOURNAL. 


523 


A  Report  of  Three  Abdominal  Sections  on 

the  Same  Woman  in  Five  Years.    The 

Second  being  Cassarean  Section,  the 

Mother  and  Child  both  Living.! 

By  S.  W.  Pryor,  M.  D.,  Chester,  S.  C. 

Mrs.  B.  (white),  age  31,    (June,    1893). 
Three  months  after  marriage  was   admitted 
to  the  Chester  Sanitarium    for  the    purpose 
of  having  a  tumor  removed.      After  a  few 
days   preparation    she  was   operated   on  by 
Drs.  Marion  and  Henry,  assisted  by  myself. 
They  removed  a  four  and  a  half  pound  pe- 
,  dunculated  fibroid  tumor.      It  was  attached 
to  the   fundus  of   the   uterus,  a  little  to  the 
left  of    the  center    by  a  pedicle,    about  the 
1  size  of   the  wrist.      The   stump  was   treated 
;  extra-peritoneal,  and   healed   without  a  sin- 
gle   interruption.      .She   was    sent    home  in 
f  eight  weeks  well  and  comparatively  strong. 
Twelve  months  later   (August,  1894,)   she 
was    delivered  of    a  good    sized    boy  child. 
I   Labor  was  normal,  without  a  bad  symptom 
following.     The  ventral  fixation  or  abdom- 
inal adhesion  of  stump  not  interfered  with. 
Nineteen   months  from   that    date  (1896) 
she  was  again  delivered  of  a  boy  baby.     This 
labor  was  normal  also.      July  7th,   4  A.  m., 
1898,  she  again  felt  herself  in  labor  and  sent 
for  the    family  physician,   Dr.    15.     E.    Kell. 
He  came  and  on   attempting  to   make  a  va- 
ginal   examination    found   it    impossible    to 
j  enter  even  the  index  linger  without  consid- 
l  erable  force.      Further  examination  revealed 
I  a  tumor  almost  filling  the  vagina.      R_ealiz- 
i  ing  that   something   had  to   be  done  or  lose 
I  the  mother   and    child   he   wrote    me  a  note 
stating  the  facts.      I,  with  Drs.  McCunnell 
I  and    Lindsay,    drove    fifteen    miles  and  ar- 
rived at    the  patient's  home    at  2  o'clock  p. 
m.,  same  day. 

I  examined  the  case  carefully  and   found 

:  it  out  of  the  question  to   remove   the  tumor 

per  vagina,  as  there  was  a  larger   bulk  of  it 

above  the  brim  of  the^elvis   than  down    in 

the   pelvis. 

Csesarean  section  was  decided  upon,  and 
patient  prepared  in  the  usual  way  for  lapor- 
otomy,  anesthetised  with  ether  and  put  on 
the  table.  I  made  the  incision  on  the  right 
of  the  median  line,  one  inch  from  the  old 
scar,  beginning  about  two  inches  above  tha 
umbilicus,  extending  down  about  ten  inches. 
After  entering  the  abdominal  cavity,  ex- 
amination revealed  a  very  large  tumor  at- 
tached to  the  posterior  and  lower  two-thirds 
of  the  pregnant  uterus.  I  decided  that  it 
would  not  do  to  try  and  remove  the  child 
and  tumor  both  for  fear  of  losing  the  mother, 


tRead  before  the  South  Carolina  Medical  As- 
sociation, April  5,  1899. 


as  the  time  it  would  have  taken  and  the  loss 
of  blood  would  necessarily  cause  more  shock 
than  the  patient  could  have  stood.  Think- 
ing the  tumor  was  attached  to  the  uterus  by 
a  fibroid  attachment  as  well  as  adhesion,  I 
decided  to  remove  the  ovaries  with  a  hope 
of  the  tumor  atrophying  and  saving  its  be- 
ing removed  later.  I,  with  the  assistance 
of  Drs.  Kell  and  McConnell,  elevated  the 
uterus  out  of  the  abdominal  cavity,  so  far  as 
we  could,  as  the  abdominal  adhesion  due  to 
the  first  operation  was  holding  the  upper 
end,  and  the  adhesions  and  tumor  to  the 
lower  end,  made  it  very  difficult.  The 
ovaries,  just  at  this  stage  of  the  operation, 
being  very  accessible,  was  ligated  and  taken 
off,  after  which  a  rubber  tube  was  passed 
around  the  uterus  as  low  down  as  the  tumor 
would  allow,  (by  my  third  assistant,  Dr. 
Lindsay,)  and  was  crossed  and  held  at  each 
end  until  he  was  requested  to  tighten  it,  at 
the  same  time  sterilized  gauze  was  packed 
around  the  uterus  to  prevent  amneotic  fluid 
from  draining  in  the  abdominal  cavity. 
Now,  with  one  swipe  of  the  scalpel,  I  laid 
the  fundus  of  the  uterus  open  for  about  eight 
inches.  This  incision  was  to  the  left  of  the 
adhesion  attached  to  the  fundus  and  abdo- 
minal wall,  at  the  same  time  the  rubber  tube 
wis  drawn  tight  enough  to  cut  off  the  flow 
of  blood  from  the  incision.  Instantly  drop- 
ping the  scalpel,  I  cielivered  the  child  and 
placenta.  The  child  was  handed  to  Drs. 
Marion  and  Wylie,  who  soon  resusitated  it 
and  dressed  the  cord,  etc.  I  proceeded  to 
wipe  out  the  uterus  and  put  iodoform  drain- 
age down  through  the  os.  After  this  was 
completed  I  sutured  the  uterus  first  every 
half  inch  with  strong  silk  sutures,  extend- 
ing down  to  the  endometrum,  then  I  placed 
a  Lembert  suture,  of  medium  size  silk,  in 
the  peritoneal  coat  over  and  between  each 
one  of  the  former  sutures.  She  was  closed 
without  drainage,  with  the  through  and 
through  silk  worm  gut  suture,  wound  dress- 
ed with  iodoform,  iodoform  gauze,  cotton 
and  flannel  bandage. 

She  was  put  to  bed  with  a  very  good 
pulse,  in  fact  a  very  encouraging  condition 
ill  round.  She  was  after  this  looked  after 
and  treated  by  the  family  physician,  Dr. 
Kell,  who  deserves  a  great  deal  of  credit  for 
her  smooth  and  rapid  recovery.  She  was 
up  and  about  the  house  in  six  weeks,  though 
she  noticed  that  there  was  a  growing  dis- 
tention of  the  abdomen,  and  began  to  suffer 
with  pains  in  the  left  hip  and  lower  part  of 
the  bowels,  the  pressure  was  so  great  against 
the  rectum  that  the  motions  had  to  be  liqui- 
fied with  enema  of  hot  water  and  glycerine 
before  she  could  relieve  herself.  This  passed 
on  until  about  three  months  had  elapsed 
since    the   caesarean    section.      I   was   again 


524 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


called  to  see  her  and  decided  that  the  re- 
moval of  the  tumor  was  inevitable.  After 
aTew  days  preparation  she  was  again, and  for 
the  third  time,  prepared  in  the  usual  way, 
anaesthetised  and  put  on  the  table  at  her 
home  as  before. 

September,  1898,  this  time  with  the  same 
assistance  made  the  incision  on  the  left  of 
the  median  line,  one  inch  and  a  half  from 
the  first  incision,  beginning  opposite  the 
umbilicus,  extending  down  within  two  in- 
ches of  the  sympathis-pubis. 

After  drawing  the  incision  open  with  re- 
tractors it  revealed  a  much  larger  tumor  than 
we  had  left  there  three  months  before, 
though  soft  instead  of  hard.  After  locating 
the  uterus,  which  was  very  easily  done,  by 
tracing  down  the  right  side  of  the  abdom- 
inal wall  and  finding  the  pedicle  attached 
to  the  fundus  and  abdominal  wall,  result  of 
first  tumor;  we  then  turned  the  patient  on 
the  right  side  and  with  the  scalpel  opened 
the  upper  end  of  the  tumor,  letting  out  two 
gallons  of  decomposed  fibroid  fluid,  the 
opening  was  then  closed  by  a  medium  size 
broad  ligament  clamp,  I  proceeded  to  sepa- 
rate the  tumor  and  uterus  which  had  become 
more  intimately  adhered  by  adhesion  ex- 
tending over  the  entire  uterus.  After  free- 
ing all  of  them  the  tumor  sack  was  removed, 
though  in  separating  posterior  wall  of  the 
tumor  sack  from  the  intestine  it  was  found 
that  one  of  the  large  intestines  had  become 
gangrenous  for  about  two  inches  on  the  side 
attached  to  the  tumor.  This  was  pared  off 
with  scissors,  then  closed  with  twelve  Lem- 
bert  sutures.  Now  the  uterus  was  removed 
by  first  ligating  each  uterine  artery,  apply- 
ing broad  ligament  clamp  on  either  side, 
then  the  uterus  was  cut  out,  leaving  about 
one  inch  of  the  cervix,  and  quilting  it  over 
with  silk. 

I  now  pass  it  around  to  show  you  how  im- 
portant it  is  to  make  Porros  operation 
(which  is  my  preference)  when  you  can. 
As  you  plainly  see  that  such  a  bunch  of  silk 
would  be  better  out  of  the  abdomen  than  in 
it,  besides  it  leaves  a  good  place  for  more 
adhesions,  and  that  means  more  trouble. 
It  is  useless  to  tell  you  that  I  would  have 
made  Porros  operation  at  first,  had  not  it 
been  for  the  tumor  attachment,  and,  of 
course,  would  have  necessitated  my  remov- 
ing the  tumor  also,  which  I  did  not  consider 
prudent  at  this  time,  as  I  stated  before.  She 
was  washed  out  several  times  with  normal 
salt  water,  iodoform  gauze  drainage  put  in, 
incision  closed  with  silk  worm  gut,  as  in 
previous  operation,  the  dressing  was  the 
same  also.  She  was  put  to  bed  in  a  fair 
condition,  pulse  good,  but  extremities  a  little 
cold.  I  advised  hot  bricks  to  be  put  in  the 
bed;  this  was  done,  though  to  my  sorrow, 


as  they  put  one  against  the  plantar  surface 
of  the  left  big  toe  and  burnt  it  to  the  bone. 
This,  of  course,  gave  her  a  great  deal  of 
pain  and  trouble,  especially  when  she  began 
to  walk  around,  though  it  is  now  entirely 
well. 

Abdominal  wound  healed  very  nicely, 
but  about  the  fourteenth  day  we  found  some 
little  suppuration  going  on  just  at  the  lower 
end  of  the  incision.  This  was  opened  and 
a  considerable  quantity  of  fluid  escaped, 
though  by  no  means  an  offensive  fluid.  I 
attributed  this  suppuration  to  infection  from 
the  opening  in  the  intestine  that  allowed  an 
escape  of  faecal  matter  into  the  abdominal 
cavity,  before  it  could  be  prevented.  There 
being  so  many  ends  of  adhesion  that  had 
been  torn  and  tied  off  that  it  was  very  diffi- 
cult to  wash  them  antiseptically  clean. 
With  this  exception,  and  the  burnt  toe,  she 
made  a  very  smooth  and  quick  recovery, 
and  at  this  time  is  enjoying  good  health, 
with  a  bright  nine  months  old  child  on  her 
lap.  I  will  pass  a  few  of  their  photographs 
aronnd  that  you  may  see  them. 

Now,  gentlemen,  I  have  done  my  best  to 
give  you  the  exact  clinical  report  of  these 
operations,  and  hope  you  will  pardon  me 
for  consuming  so  much  of  your  valuable 
time,  and  thank  you  for  your  kind  atten- 
tion. 


The  Care  of  the  Digestive  Tract  in  Tuber- 
cular Patients.* 

By    H.   J.  Chapman,  M.  D.,    House  Physician 
Winyah  Sanitarium,  Asheville,  N.  C. 

One  of  the  most  important  predisposing 
causes  of  turberculosis  is  the  lessening  of 
the  natural  resisting  power  of  the  organism, 
and  this  is  but  another  way  of  saying  that 
the  nutritive  processes  are  deficient. 

If  such  a  state  is  not  apparent  at  the 
onset,  the  subsequent  pathological  changes 
tend  strongly  toward  it,  ^nd  invariably  in- 
creases it  if  already  present.  Indeed  the 
prognosis  in  a  given  case  very  often  de- 
pends upon  the  patient's  ability  to  assimi- 
late food  in  sufficient  quantity  not  only  to 
supply  the  demands  upon  the  system  each 
day,  hut  also  to  increase  the  amount  of  de- 
fensive proteids  for  that  individual.  Many 
cases  with  only  a  moderate  amount  of  lung 
involment  fail  to  recover  for  the  lack  of  as- 
similative power.  With  a  good  stomach, 
our  chances  of  success  are  favorable.  With- 
out it  we  can  do  little  or  nothing,  no  mat- 
ter what  may  be  our  method  of  treatment 
of  the    tuberculosis.      Among  the     various 


*llead  before   the   Buncombe    County  Medical 
Society,  at  Asheville,  N.  C,  March  20,  1899. 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


525 


causes  that  give  rise  to  defective  nutrition 
improper  feeding  stands  at  the  head.  In 
many  instances  this  fault,  commenced  early 
in  childhood,  tends  to  gradually  impair  di- 
gestion and  assimilation,  and  though  per- 
haps not  to  such  a  degree  as  to  occasion  any 
serious  alarm,  yet  sufficient  to  account  for  a 
greater  predisposition  to  the  infection  of 
tuherculosis.  Habits  of  excessive  use  of 
sweets,  appetizers,  and  articles  of  difficult 
digestion,  lay  the  foundation  for  impaired 
health  in  later  years,  and  when  the  indi- 
vidual is  overtaken  with  disease,  the  first 
functions  to  show  impairment  are  those  of 
digestion  and  assimilation.  When  in  the 
presence  of  the  disease  under  consideration 
we  desire  to  increase  the  amount  of  food, 
we  are  very  apt  to  over-crowd  the  digestive 
organs,  which  rebel,  and  indigestion  oc- 
curs. These  attacks  last  from  a  few  hours 
to  several  days,  during  which  time  little  or 
no  food  is  taken,  and  we  lose  more  than 
has  been  gained  by  the  forced  feeding.  A 
repetition  of  such  attacks  frequently  leads 
to  cartarrhal  gastritis,  and  then  the  in- 
creased secretion  of  mucus  and  the  fer- 
mentation of  the  food,  lead  to  further 
changes  in  the  mucus  membrane,  and  some- 
times in  the  muscular  coats  of  the  stomach, 
which  eventually  become  chronic  and  ex- 
tremely obstinate  to  treatment. 

All  such  cases  require  careful  individu- 
alization and  regulation  of  diet.  In  some 
the  amount  of  simple  and  very  digestible 
food  may  be  pushed  even  beyond  the  pa- 
tient's desire  for  it.  In  others  we  must 
proceed  with  great  care  and  avoid  any  tem- 
porary reversals  and  thereby  loss  of  weight 
which  is  always  an  unfavorable  symptom. 
But  in  those  cases  where  the  disgestion  is 
still  good,  the  possible  impairment  that 
may  result  from  excessive  feeding,  improper 
food,  internal  medication,  or  alcoholic 
stimulation,  must  never  be  lost  sight  of. 
Our  first  duty  is  toward  the  preservation  of 
good  digestion  and  assimilation. 

Speaking  now  more  particularly  of  the 
causes  of  impairment  of  the  digestive 
functions,  aside  from  these  which  arise 
from  improper  feeding,  I  will  call  your  at- 
tention first  to  the  use  of  alcoholic  stimu- 
lants. 1  am  aware  that  I  shall  not  meet 
with  a  concensus  of  opinion  on  this  subject, 
for  many  physicians  see  in  alcohol  not  only 
a  stimulant  but  also  a  food  ;  perhaps  because 
they  have  seen  some  old  toper  who  has  lived 
a  long  time  with  his  tuberculosis,  or  has 
even  partially  recovered  from  it.  We  have 
all  seen  such  cases,  neverthless  one  should 
not  lose  sight  of  the  fact  that  alcohol  is  a 
stimulant  and  only  to  a  limited  extent  a 
food,  and  that  its  injudicious  use  is  known 
to  be  harmful.      It  is  therefore  not  the  ques- 


tion how  well  some  patients  may  get  along 
under  abuses,  but  what  will  be  the  best  for 
each  one  under  our  care.  I  do  not  wish  to 
be  understood  to  be  entirely  averse  to  the 
use  of  alcohol,  but  I  hold  that  its  use  should 
be  limited  to  those  cases  requiring  a  stimu- 
lant. 

There  are  some  cases  where  small  doses 
of  alcohol  increases  the  appetite  and  stimu- 
late digestioii  so  that  more  food  is  taken 
and  assimilated.  But  ?s  soon  as  our  pur- 
pose is  accomplished  the  alcohol  should  be 
discontinued.  We  have  other  drugs  that 
for  continued  stimulation  are  to  be  prefer- 
red to  alcohol,  and  we  can  afford  to  reserve 
the  latter  for  emergency.  I  refer  more  par- 
ticularly to  strychnine  and  camphor.  Cam- 
phor has  a  special  value  on  account  of  its 
tendency  to  lower  temperature.  It  is  best 
given  in  does  of  one-fifth  to  one-half  grain 
dissolved  in  olive  oil  and  administered  hy- 
podermatically. 

Among  remedies  which  endanger  the  di- 
gestive function  next  to  the  abuse  of  alco- 
hol, I  would  place  creosote  and  its  deriva- 
tives. It  is  true  that  small  doses  of  creosote 
preparations  seem  to  stimutate  digestion 
and  to  prevent  fermentation,  and  that  they 
may  be  given  with  benefit  for  a  considera- 
ble length  of  time ;  but  it  is  equally  true 
that  as  we  increase  the  doses  we  soon  reach 
a  point  where  in  many  cases  digestion  suf- 
fers, and  we  are  forced  to  discontinue  the 
drug  until  the  stomach  recovers  its  tone. 
The  first  few  attacks  of  indigestion  so  in- 
duced are  usually  of  a  mild  type  and  readily 
yield  to  simple  suspension  of  this  exciting 
cause.  Subsequent  attacks  from  the  con- 
tinued use  of  the  drug  are  however  more 
serious  and  usually  give  rise  to  structural 
changes  in  the  mucous  membrane  and  mus- 
cular walls  of  the  stomach.  Atrophic  gas- 
tritis is  not  an  uncommon  result  of  the  con- 
tinued use  of  creosote.  Indeed  some  of  the 
worst  cases  of  gastric  catarrh  which  have 
come  under  my  notice  were  induced  by 
creosote  and  their  pecular  obstinacy  to  treat- 
ment, including  lavage  and  electricity,  has 
tempted  me  to  distinguish  them  as  creosote 
catarrh. 

The  difficulty  of  giving  creosote  by  the 
stomach  in  large  doses,  supposed  to  directly 
influence  the  tubercular  disease, led  many 
physicians  to  administer  it  hypodermeti- 
cally ;  and  those  who  still  believe  in  its 
power  to  influence  tubercular  disease  should 
certainly  adopt  the  hypodermatic  method 
of  administering  it,  which  is  entirely  pain- 
less even  when  given  in  full  strength. 
Iodine  and  its  salts  are  equally  injurious  to 
the  digestive  tract,  but  fortunately  have 
fallen  into   deserved  disuse,    although  there 


52(3 


THE  CHARLOTTE  MEDICAL  JOURNAL 


are  cases  where  they  are  valuable  expec- 
torants. 

Opium  and  the  various  mineral  and  vege- 
table expectorants  which  form  the  base  of 
the  many  popular  cough  syrups,  are  often 
accountable  for  at  least  a  part  of  the  gastric 
disturbance  in  this  class  of  patients,  and  it 
would  be  well  to  bear  in  mind  that  most 
expectorants  are  emetics  if  given  in  suffi- 
cient doses,  and  the  greater  part  are  dis- 
tinctly irritant. 

In  summing  up  these  few  remarks,  I  de- 
sire to  emphasize  the  fact  that  one  of  the 
most  important  points  in  the  treatment  of 
tuberculosis  either  in  its  incipiency  or  in  its 
more  advanced  stages,  is  the  care  of  the  di- 
gestive functions,  and  that  the  physician 
should  never  himself  contribute  to  their  im- 
pairment by  medication  through  the 
stomach  with  remedies  which  experience 
has  shown  to  be  capable  of  doing  harm  to 
those  organs.  It  is  a  good  rule  to  follow 
in  the  choice  of  remedies  in  tuberculosis  to 
be  governed  by  their  effect  upon  nutrition  ; 
if  favorable  they  should  be  continued,  if 
not,  their  use  should  be  forbidden,  unless 
the  indications  for  their  employment  are 
transient  or  extremely  urgent. 

DISCUSSION. 

Dr.  J.  H.  Williams. — I  have  listened  to 
the  doctor's  paper  with  a  great  deal  of 
pleasure.  Errors  in  digestion  and  errors  in 
assimilation  are  at  the  bottom  of  our  failures 
to  treat  properly  and  successfully  troubles 
of  tuberculosis.  I  have  always  made  it  my 
rule  to  inquire  particularly  and  especially 
into  any  error  of  digestion,  to  find  whether 
or  not  I  had  any  condition  of  atony  of  the 
stomach  or  of  the  glands  of  the  stomach, 
whether  or  not  I  had  fermentation  with  pro- 
duction of  lactic  acid,  and  any  or  all  things 
indicating  a  departure  from  a  proper  con- 
dition of  the  stomach,  and  then,  further,  to 
trace  the  digestion  after  leaving  the  stomach 
into  the  intestines,  to  find  out  what  sort  of 
intestinal  troubles  I  had. 

As  to  the  effect  of  forced  feeding,  that 
will  depend  very  largely  upon  whether  you 
have  an  atonic  condition  of  the  stomach. 
We  can,  by  the  use  of  our  digestive  aids, 
pepsin,  hydrochloric  acid,  etc.  , increase  our 
patient's  ability  to  take  care  of  the  food  en- 
tirely beyond  the  capacity  of  the  system  it- 
self, but  I  am  sorry  to  say  we  cannot  keep 
that  up  very  long.  Some  years  ago  my  at- 
tention was  drawn  to  the  internal  adminis- 
tration of  ichthyol.  Under  that  I  found  a 
stimulating  effect  upon  the  glands  of  the 
stomach,  1  found  I  was  able  to  accomplish 
more  in  the  way  of  intestinal  digestion,  and 
under  the  influence  of  moderate  doses  I 
found  I  got  better  assimilation  of  food,  and 


an  increasing  weight,  which  is  very  much 
to  be  desired  always  in  combatting  the  great 
white  plague.  I  have  used  creosote.  I  use 
it  now.  I  use  some  of  the  later  chemical 
successes  in  the  way  of  eosote  and  geosote, 
and  carbonate  of  guaiacol,  and  I  think  with 
much  better  success  than  the  crude  creosote 
itself.  As  I  said,  I  have  a  certain  amount 
of  success  through  the  use  of  ichthyol,  sim- 
ply because  it  improved  the  condition  of  the 
whole  digestive  tract.  I  found  in  my  prac- 
tice that  where  I  had  a  catarrhal  condition 
of  the  stomach  that  turpentine,  one  of  the 
natural  products  of  North  Carolina,  was 
one  of  the  finest  stimulants  in  our  therapeu- 
tic list.  A  combination  of  pancreatis,  pep- 
sin and  turpentine,  given  in  proper  doses, 
will  accomplish  some  times  more  than  any 
remedy  I  have  found.  I  do  not  know  in 
cases  of  tubercular  diarrhoea,  or  what  is 
sometimes  called  catarrhal  diarrhoea,  that 
this  preparation  will  control  this  diarrhoea. 
I  have  found  that  it  does  stimulate  the  ab- 
sorption of  food.  I  have  found  under  the 
administration  of  it  that  my  diarrhoea  sub- 
sided. I  found  that  often  a  turpentine  mix- 
ture took  the  place  of  alcohol.  I  have  long 
since  ceased  to  prescribe  alcohol  in  any  way 
for  tubercular  patients.  I  have  found  that 
turpentine  absolutely  takes  the  place  of 
alcohol  as  a  stimulant.  As  to  camphor — I 
have  never  used  it.  I  have  used  camphoric 
acid  for  night  sweats.  1  have  never  used 
camphor  for  special  effect  upon  the  diges- 
tive tract.  A  careful  regulation  of  the  pa- 
tient's diet  is,  of  course,  the  first  thing. 
To  allow  patients  to  select  a  diet  for  them- 
selves and  to  say  they  cannot  eat  what  is 
prescribed  is  all  nonsense.  We  know  if  we 
carefully  study  our  patients  we  can  give 
them  a  diet  that  will  be  in  every  way  con- 
ducive to  their  welfare.  We  run  over  the 
gamut  of  various  foods.  I  am  speaking  of 
eggs  and  milk,  and  rare  roast  beef,  fish, 
mutton  chops,  lamb  cutlets,  and  things  of 
that  sort.  Those  are  the  things  our  patients 
need  to  build  up  the  tissues  that  are  torn 
down  and  destroyed  by  the  action  of  the 
tubercular  bacilli  in  the  body,  and  by  the 
destructive  process  caused  by  the  high  tem- 
perature, and  1  think,  by  studying  our  pa- 
tients carefully,  and  varyinghis  food  from 
day  to  day,  that  we  can  force  feeding  in 
that   line. 

Dr.  C.  P.  Ambler. — There  is  not  very 
much  left  to  say,  except  to  endorse  what 
has  been  said.  I  can  heartily  endorse  every- 
thing that  both  physicians  have  said.  There 
is  no  doubt  that  the  digestive  tract  occupies, 
if  not  first,  at  least  very  near  first,  place  in 
the  treatment  of  tuberculous  patients.  I 
look  upon  tubercular  patients  under  three 
heads;   first,  hygienic  care,  second  climate, 


THE  CHARLOTTE'  MEDICAL  JOURNAL. 


527 


and  in  the  third  place  medication.  I  be- 
lieve a  patient  will  do  better  under  good 
hygienic  supervision  than  he  will  under 
anything  else,  and  if  it  is  a  question  of 
sending  a  patient  away  from  home  simply 
for  the  benefit  of  the  climate,  or  of  keep- 
ing him  at  home  and  looking  after  his  gen- 
eral hygienic  life  I  certainly  believe  the 
physician  would  take  the  better  course  if 
he  would  keep  his  patient  at  home  and 
look  carefully  into  his  hygienic  life.  An- 
other thing  is  where  the  patient  is  sent 
away  from  home  with  directions  for  cer- 
tain medication,  and  in  the  meantime  with 
no  care  as  to  his  general  hygienic  condition. 
A  great  many  of  the  patients  who  come 
here,  and  also  to  other  resorts,  are  practi- 
cally without  the  care  of  a  physician.  They 
come  and  go  as  they  please.  Many  of 
them  are  far  advanced.  I  sincerely  believe 
that  these  people  would  be  better  oft'  at 
home  with  t he  right  kind  of  hygienic  care 
than  they  would  in  the  climate  of  Ashe- 
ville  and  under  the  medication  of  a  phy- 
cian.  Medication  occupies  but  a  small 
place.  The  question  of  diet  is  a  great  one. 
Dr.  Chapman  went  very  carefully  into  the 
catarrhal  condition  of  the  digestive  tract, 
and  there  is  but  little  1  can  add.  In  the 
first  place,  as  to  the  time  of  the  heaviest 
meal.  Take  our  tubercular  patients  run- 
ning a  high  temperature.  Sometimes  they 
arc  having  a  temperature  of  ioo,  ioo  1-2, 
101  or  even  higher.  1  believe  that  if  this 
patient  lias  high  temperature  from  one  to 
three  or  four  in  the  afternoon  he  must  not 
be  allowed  to  eat  his  heaviest  meal  from 
twelve  to  one.  It  is  a  well  known  fact  that 
the  stomach  is  not  going  to  take  care  of  a 
solid  food  when  the  patient  is  running  a 
high  temperature.  Let  the  meal  preceding 
the  high  temperature  be  a  light  one.  An- 
other mistake  is  as  to  the  amount  of  time 
allowed  bet  ween  meals.  Many  of  our  board- 
ing houses  have  their  breakfasts  between 
nine  and  ten,  dinner  at  one,  and  many  have 
their  supper  early  in  the  evening.  This  is 
all  wrong.  If  we  expect  a  patient  to  digest 
his  meal  and  assimilate  it,  I  believe  we 
must  have  five  hours  between  meals. 

In  regard  to  creosote,  I  endorse  what  Ur. 
Chapman  has  stated,  and  I  believe  I  go  a 
little  further.  I  formerly  used  creosote 
with  the  rest,  but  have  almost  discarded  it. 
A  great  per  cent,  of  the  tubercular  patients 
I  have  give  a  history  of  creosote  poisoning. 
Many  come  here  with  very  little  assimila- 
tion and  give  a  history  of  creosote  poison- 
ing. I  believe  that  creosote  will  answer 
certain  requirements.  I  believe  it  will  re- 
duce temperature  to  a  certain  extent.  It 
may  have  some  influence  upon  expectora- 
tion, but  this  thing  of   pushing  the  creosote 


up  as  high  as  the  patient  can  tolerate  is  not 
only  nonsense  but  ridiculous.  Sooner  or 
later  it  ruins  digestion.  If  you  are  going 
to  make  a  rule  of  either  pushing  your  creo- 
sote or  giving  no  creosote,  I  certainly  say 
give  no  creosote,  and  I  think  the  same  holds 
true  of  almost  any  internal  medication.  I 
find  the  less  the  patient  puts  in  his  stomach 
the  better  he  gets  along. 

As  to  alcohol,  I  do  not  believe  I  agree 
with  Dr.  Williams  in  not  using  it.  I  do 
believe  that  alcohol  fills  the  bill  in  many  of 
our  tubercular  patients,  and  I  do  not  mean 
by  that  the  taking  of  large  quantities  of  it. 
As  a  rule,  those  who  run  a  high  tempera- 
ture late  in  the  day  have  a  corresponding 
low  temperature  early  in  the  morning.  I 
believe  that  alcohol  at  that  time,  in  the 
shape  of  an  eggnog  or  even  a  hot  toddy, 
stimulates  the  patient  and  puts  him  in  bet- 
ter shape  for  his  breakfast,  and  he  will  get 
along  better  throughout  the  day.  I  also 
believe  in  the  use  of  pepsin,  but  in  very 
few  cases.  These  pepsin  preparations  are 
simply  to  help  the  tide  over.  The  usual 
prescription  I  believe  is  to  take  a  certain 
amount  after  meals.  I  get  a  better  result 
by  giving  a  tablespoonful  to  an  adult  one 
minute  after  meals,  repeating  an  hour  and 
a  half  later. 

Dr.  J.  A.  Watson. — We  may  talk  as 
much  as  we  please  about  diet,  which  is  the 
sheet  anchor  in  the  treatment  of  tubercu- 
losis, but  what  are  we  going  to  do  with 
our  boarding  houses  which  furnish  the  diet. 
Take  these  people  that  come  here  from  all 
over  the  country  and  are  turned  loose  in  the 
boarding  house,  and  the  boarding  house 
keeper  has  no  more  conception  of  what  is 
needed  than  a  Hottentot.  Some  of  them 
even  spend  more  money  than  they  take  in 
in  their  earnest  efforts  to  please  their  pa- 
trons. I  think  if  we  could  have  some  diet 
of  very  little  expense  and  dispense  with  all 
this  worthless  thing  they  do  have  we  would 
be  accomplishing  some  good.  What  course 
we  would  pursue  to  accomplish  that  I  don't 
know,  but  I  think  the  medical  men  of  Ashe- 
ville  ought  to  be  able  to  devise  some  means. 
In  the  resorts  in  Europe  the  diet  is  pre- 
scribed, and  if  the  boarding  house  people 
do  not  conform  to  the  prescribed  diet  of 
the  physicians  they  do  not  get  any  patrons. 
If  a  lecture  on  this  subject  could  be  written 
out  and  put  into  the  hands  of  these  people 
we  would  simplify  their  methods  and  re- 
duce their  expense.  Many  of  these  board- 
ing houses  set  a  more  elaborate  dinner  than 
some  of  the  hotels,  and  yet  when  you  eat 
everything  they  have  on  the  table  you  do 
not  get  any  nourishment. 

Dr.  M.  H.  Fletcher. — Along  this  line 
I  have  been  very  much  interested    in  an  in- 


528 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


stitution  started  in  Massachusetts  under  the 
control  of  the  State,  which  takes  patients 
and  prescribes  a  regular  diet,  and  feeds 
them  oftener  than  we  feed  our  patients,  and 
so  far  the  reports  seem  to  bear  out  the  re- 
cent thought  on  this  subject.  The  institu- 
tion, as  I  understand,  is  run  at  a  loss.  Every 
one  is  required  to  pay  a  certain  amount, but 
it  costs  more  to  run  it  than  the  amount  re- 
quired to  be  paid.  From  what  I  can  learn 
the  results  are  most  marvelous.  It  is  lo- 
cated in  a  healthy  locality.  The  diet  is  not 
the  only  thing.  They  depend  also  on  air 
and  exercise.  The  patients  are  required  to 
get  up  early  in  the  morning  and  have  some- 
thing to  eat.  It  is  located  somewhere  out- 
side of  Boston,  and  under  control  of  the 
State  of  Massachusetts. 

I  don't  agree  with  Dr.  Williams  entirely 
about  alcohol.  I  think  a  few  patients  can 
drink  alcohol  and  get  along  well  on  it,  and 
others  cannot  take  it.  Where  it  is  pleasant 
and  agreeable  and  aids  digestion  I  think 
we  ought  to  give  it.  I  always  prescribe  it 
for  my  patients  if  it  is  agreeable,  and  it 
does  good  up  to  a  certain  point.  When 
we  get  it  beyond  that  it  is  doing  harm. 
How  turpentine  can  take  the  place  of  al- 
cohol as  a  stimulant  I  cannot  conceive. 
You  can't  get  it  in  them.  They  don't  take 
it,  and  when  you  do  get  it  in  them  it  is  go- 
ing out  through  the  kidneys  and  skin. 

Dr.  James  Sawyer. — One  point  I 
would  like  to  mention  is  that  of  getting 
your  patients  in  the  habit  of  taking  regu- 
lar, systematic  exercise.  Of  course  there 
are  many  systems,  but  I  think  if  we  make 
each  one  take  at  least  a  certain  amount  of 
exercise  we  will  aid  ourselves  and  the  pa- 
tients too ;  and  of  course,  after  all,  it  is 
reduced  to  one  thing,  individuality.  You 
must  treat  each  patient  by  himself  or  her- 
self. We  cannot  lay  down  any  cast  iron 
rules.  We  can  give  alcohol  or  creosote  to 
some  and  others  we  cannot.  But  first  of 
all,  as  the  doctor  said,  hygiene  comes  in, 
and  of  course  the  climate  with  it. 

Dr.  L.  B.  McBrayer, — I  have  enjoyed 
the  discussion  very  much,  and  believe  that 
it  has  been  the  most  practical  and  at  the 
same  time  most  scientific  discussion  that  I 
have  ever  heard  here  on  the  subject  of  tu- 
berculosis. I  am  heartily  in  accord  with 
most  of  the  views  expressed,  and  I  will 
just  tell  a  little  story  with  regard  to  alcohol. 
On  one  occasion,  when  I  was  a  medical 
student  in  Louisville,  I  went  out  to  Ken- 
tucky, and  on  the  train  happened  to  meet 
a  physician,  and  he  advanced  the  idea  that 
alcohol  was  the  specific  for  tuberculosis, and 
I  laughed  a  little,  and  he  went  on  to  cite  a 
case  or  two  that  happened  to  fall  under  his 
notice  where  the  patient  filled  up  and    pro- 


ceeded to  keep  full  and  got  well,  and  he  was 
prescribing  that  mode  of  treatment  regu- 
larly with  great  success.  But  one  great 
trouble  in  the  treatment  of  tuberculosis  in 
this  town  among  a  certain  class  ot  patients 
is  the  advice  given  them  by  physicians  be- 
fore they  leave  home.  I  agree  thoroughly 
with  Dr.  Ambler  and  others  who  have  ex- 
pressed themselves  as  to  the  order  in  which 
the  different  treatments  come,  hygiene  first, 
and  under  the  term  hygiene  I  should  class 
not  only  the  foods  but  I  should  place  exer- 
cise and  the  amount  of  exercise  and  the 
time  exercise  should  be  taken,  and  all  those 
things,  as  Dr.  Sawyer  has  touched  upon. 
Then  next  would  come  climale,  and  last  and 
least,  medication.  I  am  sorry  to  be  of  the 
opinion,  but  I  am,  that  we  have  not  found 
the  specific  nor  the  panacea  for  tubercu- 
losis yet.  But  as  I  said,  one  great  trouble 
that  we  have  in  treating  patients  here  was 
the  advice  given  them  by  physicians  when 
they  are  sent  here.  It  seems  to  be  the  opin- 
ion of  a  great  many  physicians  that  all  they 
have  to  do  is  to  send  a  man  here  and  let 
him  take  in  the  ozone  and  get  well.  Steer 
clear  of  the  doctors.  And  the  doctor  at 
home  continues  to  write  to  them  and  tell 
them  to  take  the  creosote  and  cod  liver  oil 
probably  and  take  exercise,  and  above  all 
things  those  men  need  is  to  consult  a  good 
physician  and  get  advice  as  to  what  they 
should  do  with  themselves,  and  how  to  do 
it.  Asheville  climate  is  a  good  thing,  but 
they  need  some  good  doctors  along  with 
the  patients  every  time. 

Dr.  J.  A.  Burroughs — 

I  have  been  very  much  interested  in  the 
discussion.  I  have  never  listened  to  a  bet- 
ter discussion,  in  particular,  that  of  Dr. 
Williams'  remarks.  He  has  covered  the 
ground  very  thoroughly.  1  fail,  though, 
to  understand  how  a  dose  of  turpentine  will 
compensate  for  a  dose  of  whiskey.  There 
is  no  question  in  my  mind  about  every  case 
of  tuberculosis  having  its  origin  in  malnu- 
trition, and  one  of  the  first  things  we  have 
to  do  is  to  see  that  the  food  is  properly 
digested  and  assimilated.  This  is  fre- 
quently a  difficult  matter  to  accomplish, 
from  the  simple  fact  that  we  already  have 
tuberculosis  of  the   stomach  and  intestines. 

I  must  differ  with  Dr.  Ambler  in  regard 
to  creosote.  I  have  found  no  one  drug  in 
the  treatment  of  tuberculosis  that  has 
afforded  me  so  much  benefit  as  creosote,  and 
I  think  that  Dr.  Ambler's  dissappointment 
in  the  management  of  cases  of  tuberculosis 
with  creosote  has  been  due  to  the  fact  that 
a  poor  grade  of  creosote  was  used.  I  have 
found  the  same  condition  of  affairs  existing 
in  patients  who  have  come  under  my  care 
that  had  been  on    creosote,    they    thought, 


THE  CHARLOTTE  MEDICAL  JOURNAL 


529 


had  really  been  taking  nothing  but  carbolic 
acid.  I  have  found  stomachs  irritated  and 
kidneys  torn  all  to  pieces  with  carbolic  acid, 
when  they  thought  they  were  taking  creo- 
sote. If  you  will  use  Morson'sBeechwood 
Creosote,  made  from  the  distillation  of 
beechwood  tar,  you  will  get  rid  of  the  ir- 
ritating properties  possessed  by  commer- 
cial creosote,  and  get  all  the  antiseptic  and 
germicidal  properties  of  the  drug.  By 
giving  this  creosote  you  increase  the  oxygen 
carrying  power  of  the  blood  corpuscles. 
You  get  a  direct  effect  upon  the  mucous 
membrane  of  the  alimentary  tract.  Besides, 
this  creosote  is  largely  eliminated  by  the 
lungs,  and  you  get  a  direct  effect  where  you 
want  it.  There  is  another  point.  In  nearly 
all  these  cases  of  tuberculosis,  if  they  have 
been  standing  for  any  length  of  time  you 
will  have  some  tubercular  trouble  with  the 
kidneys. 

In  regard  to  giving  Morson's  Creosote, 
made  from  beechwood  tar,  some  patients 
will  take  more  than  others.  I  have  a  pa- 
tient to-day  taking  90  drops  of  this  creo- 
sote. She  has  come  from  84  lbs.  to  153 
lbs.  and  is  now  teaching  school.  She  had 
laryngitis  so  bad  she  could  not  talk  so  you 
could  hear  her  across  this  room.  Now  she 
can  talk  through  ;t  telephone,  or  talk  to  her 
class.  She  says  she  feels  better  in  every 
way. 

All  patients  will  not  assimilate  creosote. 
I  find  ichthyol  a  valuable  adjunct.  But 
When  we  find  patients  who  have  a  very 
feeble  stomach  and  very  feeble  digestion, 
and  you  cannot  get  them  to  take  much  medi- 
cine I  rub  them  with  pigs  lard,  rub  from  a 
quarter  to  a  half  pound  into  them  every  day 
and  practically  rest  the  stomach.  I  have 
put  to  bed  patients  who  had  a  high  temper- 
ature and  whose  stomach  would  not  digest 
food,  and  rubbed  them  with  this,  some  times 
as  much  as  a  pound,  never  less  than  half  a 
pound,  and  they  have  not  only  held  their 
own  with  practically  no  food  in  their 
stomach  for  days  and  days,  but  they  have 
gained  weight.  I  have  never  gotten  any 
results  from  cod  liver  oil  or  olive  by  inunc- 
tion, but  I  believe  we  have,  in  a  majority 
of  cases,  in  pigs  lard  something  superior 
to  almost  any  nutrition  we  have. 

I  believe  that  the  prejudice  against  creo- 
sote is  for  the  want  of  the  proper  knowledge 
of  the  kind  to  give.  Morson  gives  his  form- 
ular  to  the  United  States  Pharmacopoeia 
and  strunge  to  say,  they  cannot  make  this 
creosote.  Although  Morson  says  :  This  is 
the  formula,  chemists  have  been  unable  to 
make  it.  If  you  will  look  up  the  United 
States  Pharmacopoeia  you  will  find  the  above 
statement.      I  cannot  explain  how  it  is,  but 


it  is  a  fact  that  the  skin  takes  up  this  pigs 
lard  and  it  is  evidently  appropriated  be- 
cause the  patients  hold  up,  even  weigh 
more  after  three  or  four  weeks  treatment 
than  they  did  when  they  went  to  bed. 

Dr.  C.  V.  Reynolds. — I  want  to  em- 
phasize the  point  brought  out  by  Dr. 
Battle  in  regatd  to  the  mixed  infection.  I 
think  in  nearly  every  case  we  have 
mixed  infection  to  a  certain  extent.  By 
means  of  these  antiseptics  I  believe  we  have 
an  antiseptic  effect  directly  upon  the  strep- 
tococci destroying  them,  thereby  aiding  the 
white  corpuscles  to  tackle  these  tubercular 
bacilli,  and  aid  is  the  very  thing  they  need. 
We  have  never  yet  found  anything  that 
will  destroy  the  tubercular  bacilli  in  the 
body.  I  read  an  article  in  some  magazine 
about  atmospheric  conditions  of  tubercular 
bacilli.  I  believe  it  stated  that  in  the 
higher  atmospheric  conditions  the  tubercular 
bacilli  found  on  the  walls  of  the  various 
hospitals  were  gotton  and  injected  into  a 
guinea  pig,  and  failed  to  induce  tuber- 
culosis making  the  statement  that  tubercu- 
losis was  not  communicable  in  higher 
climes. 

Dr.  Chapman. — There  is  not  very  much 
more  to  say.  I  have  appreciated  the  re- 
marks made  very  much.  I  agree  with  Dr. 
Watson  in  this,  that  I  think  all  diets 
should  be  prescribed,  and  I  think  it  is  much 
more  important  than  to  prescribe  medicines. 
1  think  the  patient  should  be  told  not  only 
the  kind  of  his  food,  but  the  amount,  and 
1  think  we  should  lay  out  a  diet  and  see 
how  it  affects  them,  and  I  think  the  board- 
ing houses  will  very  soon  get  to  the  point 
where  they  will  adopt  that.  We  find  that 
the  diet  of  a  great  many  patients,  especially 
young  girls  has  been  pickles  and  pre- 
serves and  •  condiments,  and  when 
we  want  them  to  take  beef  or  mutton  or 
chops  they  say  they  do  not  want  them. 
They  want  chicken  salad  and  that  sort  of 
thing.  There  may  be  something  in  that, 
but  the  average  stomach  cannot  stand  it.  I 
believe  much  of  the  benefit  gotten  from 
lard  is  from  the  massage.  When  the  circu- 
lation is  bad  we  are  not  going  to  get  much 
assimilation,  and  I  think  the  massage  helps 
us  there. 


An  elegant  method  of  giving  bismuth 
in  the  treatment  of  infantile  diarrhoea,  that 
of  dysentery,  phthisis  or  typhoid  in  adults, 
is  to  prescribe  bisol  in  solution.  It  is  more 
efficient  than  the  older  bismuth  salts  in  all 
gastrio-intestinal  disorders  and  is  prescribed 
in  smaller  doses.  Combined  with  salicylic 
acid,  it  forms  a  salicylate  of  bismuth  more 
powerful  than  any  heretofore   known. 


530 


THE  CHARLOTTE   MEDICAL  JOURNAL 


Dress  as  a  Factor  in  the  Causation  of 
Catarrhal  Diseases.* 

By  C.  P.  Ambler,  M.  D.,  Asheville,  N.  C. 

The  increase  in  the  number  of  drug  man- 
ufactories, and  the  great  amount  of  time 
and  thought  expended  by  our  chemists  and 
physicians  upon  the  production  of  new 
drugs,  of  simple  or  complex  formulae,  goes 
to  prove  to  a  great  extent  that  even  with 
these  later  scientific  productions  we  are  in 
a  certain  measure,  still  striving  after  some- 
thing which  appears  about  as  far  in  the 
distance  as  we  advance,  viz.  :  health.  We 
are  able  to  cut  short  the  course  of  certain 
diseases,  we  no  doubt  are  more  successful 
in  the  lessening  of  pain,  and  probably  our 
mortuary  tables  will  show  a  balance  in  our 
favor  over  that  of  our  forefathers,  but  we 
must  admit  that  in  our  hurry  to  cure  dis- 
ease, in  our  attempt  to  reduce  and  allay  the 
symptoms  of  certain  maladies,  we  are,  many 
of  us,  not  doing  our  full  duty  toward  our 
fellowmen,  in  not  making  our  greatest  aim 
toward  preventing  disease  rather  than  cur- 
ing it. 

Our  State  and  local  boards  of  health  are 
awakening  to  their  duty  all  over  the  land, 
and  while  they  are  cleaning  our  streets,  see- 
ing to  our  water  supply  and  sewerage,  and 
attempting  to  give  us  the  greatest  possible 
hygienic  surroundings,  we  as  individual 
physicians  should  strive  to  demonstrate  the 
cause  of  certain  maladies  due  more  particu- 
larly to  ignorance  on  the  part  of  the  indi- 
vidual regarding  his  own  personal  needs. 

There  is  no  doubt  but  what  the  most 
common  illness  in  our  country  is  that 
acute  catarrhal  condition  of  the  upper  re- 
spiratory tract,  which  is  commonly  called 
a  "cold."  Moreover,  it  is  the  repetition 
of  this  condition  which  frequently  lowers 
the  vitality  of  the  patient  to  such  an  extent 
that  the  more  serious  disorders  of  the  tract 
mentioned,  follow  what  was  in  the  begin- 
ning, simply  the  manifestation  of  some  hy- 
gienic irregularity  on  the  part  of  the  patient. 

In  this  paper  we  do  not  propose  to  dis- 
cuss all  the  factors  in  the  production  of  a 
cold,  and  neither  do  we  intend  to  enter  into 
what  actually  constitutes  a  common  cold, 
but  only  to  refer  to  one  cause  and  give  a 
few  facts  as  they  have  appeared  to  us  dur- 
ing the  past  few  years ;  I  refer  to  the  ques- 
tion of  clothing,  and  more  particularly,  to 
that  which   should    be  worn  next  the  skin. 

It  is  a  well  established  fact  that  disorders 
of  the  digestive  tract  usually  precede  a  com- 
mon cold.      In  other  words,  when  secretion 


*Read  before   the  Buncombe  County  Medical 
Society,  April  3d,  1899. 


and  excretion  are  interferred  with,  the  pa- 
tient becomes  very  susceptible.  As  physi- 
cians we  have  all  recognized  this,  and  yet 
how  many  of  us  give  sufficient  thought  in 
this  connection  to  that  excretory  organ,  the 
skin. 

Whether  man's  skin  required  more  pro- 
tection in  ages  past  is  an  interesting  ques- 
tion, but  one  we  do  not  need  to  discuss. 
We  have  got  to  dress  him  as  we  find  him 
now,  and  considering  how  fashion  demands 
of  him  that  he  live  the  greater  number  of 
his  hours  in  over-heated  and  under-ventila- 
ted rooms,  dressing  him  scientifically  and 
comfortably  becomes  a  question  none  too 
insignificant  for  even  an  able  body  of  scien- 
tific physicians  to  discuss. 

We  are  taught  that  the  function  of  the 
skin  is  manifold,  and  among  the  most  im- 
portant functions  is  excretion  and  the  loss 
of  heat  by  either  radiation,  evaporation,  or 
conduction. 

The  production  of  heat  is  constant,  as  is 
likewise  the  elimination.  This  elimination 
takes  place   in  most    part  through  the  skin. 

The  old  experiment  of  varnishing  the 
skin  of  an  animal  and  noting  how  rapidly 
death  ensues,  proves  to  us  that  the  covering 
we  apply  to  the  greater  part  of  our  body 
should  be  selected  with  a  view  to  assisting 
rather  than  retarding  the  functions  of  the 
same. 

The  person  who  wears  flannel  in  the  win- 
ter time  to  keep  the  heat  in,  should  theo- 
retically wear  the  same  in  the  summer 
to  keep  the  heat  out.  In  doing  this, 
however,  he  would  be  interfering  with 
excretion  and  evaporation,  from  the 
fact  that  wool  is  a  poor  conductor  of 
moisture,  and  the  excess  of  heat  produced 
in  the  body  in  summer  is  lost  both  by  radia- 
tion, evaporation  and  conduction,  we  would 
necessarily  have  increased  evaporation  to 
the  point  of  perspiration  ;  now,  as  wool  is 
a  poor  conductor,  the  surface  of  the  skin 
remains  moist,  the  person  is  bathed  more 
or  less  continually  in  moisture,  this  macer- 
ates his  skin,  softens  it,  if  you  like,  weak- 
ens it  certainly,  and,  moreover,  as  his  un- 
derclothing cannot  freely  conduct  the  mois- 
ture outward,  it  interferes  with  excretion, 
evaporation  and  radiation. 

The  same  thing  holds  true  in  winter. 
Wool  underclothing  retains  heat,  but  also 
retains  all  those  impurities  in  and  on  the 
skin  which  should  be  lost  by  evaporation 
and  conduction. 

We  have  said  that  wool  is  a  poor  conduc- 
tor of  either  heat  or  moisture.  It,  there- 
fore, fills  the  requirements  perfectly  for  out- 
side winter  clothing.  It  retains  heat  and 
protects  our  body  from  damp  cold  air,  but 
if    placed    directly  upon    the    skin    will   be 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


531 


found  absolutely  lacking  in  the  require- 
ments it  so  admirably  fills  when  worn  over 
some  better  conductor  of  moisture. 

Woolen  underclothing  becomes  saturated 
with  perspiration  as  all  can  attest,  but  this 
does  not  prove  that  it  is  a  good  conductor. 
The  simple  experiment  of  washing  one's 
hands  and  attempting  to  dry  them  upon  a 
woolen  cloth  shows  that  wool  has  but  very 
little  affinity  for  moisture.  To  go  further, 
when  under  excessive  exertion  or  over- 
dressing, the  woolen  underwear  does  be- 
come damp,  this  same  woolen  underwear 
has  very  little  power  to  give  up  the  mois- 
ture ;  consequently  both  moisture  and  ex- 
cretion are  retained  upon  and  near  the  skin, 
wherein  if  the  undergarment  was  a  better 
conductor,  evaporation  would  be  more 
rapid. 

It  is  the  person  who  habitually  keeps  his 
skin  moist  and  surrounded  by  such  excre- 
tion and  damp  retaining  underwear  who  al- 
ways feels  every  draught.  He  piles  on  more 
clothing  in  the  fond  belief  that  by  so  doing 
he  is  to  keep  these  draughts  from  reaching 
his  body.  The  more  he  piles  on  the  more 
he  aggravates  the  trouble,  and  is  it  any 
wonder  that  where  the  skin  is  thus  macer- 
ated, kept  damp,  and  where  cutaneous  ex- 
cretion is  interferred  with,  that  disturbances 
of  circulation  and  nutrition  manifest  them 
selves  upon  the  most  exposed  mucous  mem- 
branes? 

A  "draught"  to  our  patient  simply  means 
that  lie  is  presenting  a  limited  area  of  his 
cutaneous  covering  to  air  in  motion  ;  this 
same  cutaneous  surface  being  in  a  more  or 
less  humid  state,  by  cause  of  the  relaxation 
of  the  vasor  motors  of  the  greater  part  of 
the  body  following  excessive  coverings. 
Rapid  evaporation  results  with  the  neces- 
sary marked  abstraction  of  heat.  Such  a 
6tate  of  affairs  continuing  over  a  limited 
area  while  the  remainder  of  the  skin  is 
bathed  in  moisture,  results  in  disturbance 
of  circulation  in  the  part  and  organs  adja- 
cent ;  following  this  disturbance  of  circula- 
tion, nutrition  is  interferred  with  and  vari- 
ous inflammatory  results  follow. 

I  well  remember  the  first  time  I  saw  an 
old  Indian  hunter  determine  the  direction 
of  imperceptible  wind,  simply  by  moisten- 
ing his  finger  and  holding  it  over  his  head. 
The  increased  radiation  with  temperature 
loss  on  the  windward  side  thus  instantly  re- 
veals the  direction  of  the  air  current. 

Our  patient  who  finds  a  "draught"  does 
the  same  thing  under  different  circum- 
stances. 

When  wool  is  placed  next  the  skin  it 
does  produce  a  feeling  of  warmth  and  com- 
fort, and  this  will  continue  so  long  as  the 
evaporation    from  the    skin  is  not    so  rapid 


but  what  the  wool  can  absorb  the  moisture 
and  again  free  it ;  but  under  increased  ex- 
ercise or  where  great  radiation  of  heat,  as 
in  summer  time,  causes  a  much  greater 
relative  humidity  of  the  air  next  the  surface, 
the  wool  fails  to  absorb  as  rapidly  as  elim- 
ination takes  place  from  the  body,  and 
evaporation  and  radiation  from  the  skin 
surface  become  greatly  interferred  with. 

The  protective  feature  of  underwear  is 
always  dependent  upon  its  air  holding  qual- 
ities, or  in  other  words,  upon  its  porosity, 
while  at  the  same  time  having  the  power  of 
readily  conducting  moisture. 

The -woolen  garment  has  the  porosity, 
but  is  entirely  lacking  in  the  moisture  con- 
ducting quality,  hence  it  retains  heat  in 
winter  very  well  as  long  as  the  person 
avoids  perspiration.  When  once  perspira- 
tion has  resulted,  and  the  underwear  be- 
comes damp  on  account  of  its  poor  evapor- 
ative quality,  it  then  becomes  a  good  con- 
ductor of  heat  and  the  person  rapidly  elim- 
inates heat  to  a  point  of  detriment.  The 
woolen  underwear  in  the  meantime  is  slow 
to  dry  and  the  rapid  heat  elimination  is 
prolonged,  hence  the  wool,  which  under 
normal  condition  was  a  good  protection 
becomes  for  the  time  being  exactly  the  op- 
posite. 

Again,  in  summer,  wool  under  normal 
conditions  will  keep  out  heat  because  it  is  a 
poor  conductor,  but  let  the  garment  become 
damp  and  the  heat  conducting  quality  in- 
creased by  presence  of  the  moisture  and  the 
garment  becomes  almost  unbearable. 

Engaged  as  I  am,  in  a  practice  limited  to 
diseases  of  the  respiratory  tract,  I  have  for 
years  noticed  that  "colds"  were  in  great 
part  the  result  of  improper  dress. 

We  have  chronic  catarrhal  conditions  due, 
of  course,  to  nasal  deformities  and  constitu- 
tional diseases,  but  in  my  opinion  the  great 
number  of  the  cases  of  simple  catarrh  of  the 
nasal  mucous  membrane  are,  in  a  great 
measure,  the  result  of  some  improper  dress. 

This  is  also  one  reason  why  these  cases 
are  so  unsuccessfully  treated  by  local  appli- 
cations. 

Moreover,  in  a  practice  composed  large- 
ly of  tubercular  patients,  I  find  they  inva- 
riably give  a  history  of  repeated  colds  pre- 
ceding their  tuberculous  state  ;  meaning  that 
these  colds  have  produced  a  ripe  condition 
for  infection. 

Further,  in  no  class  of  people  do  I  find 
that  proper  underwear  is  a  necessity  more 
than  among  my  tubercular  patients.  They 
particularly  are  daily  liable  to  more  or  less 
sensible  perspiration,  and  no  matter  whether 
in  winter  or  summer  they  are  invariably 
better  off  without  wool  underwear. 

I  make  this   statement  well  knowing  that 


532 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


certain  of  my  professional  friends  (See  Dr. 
Minor  in  the  N.  Y.  Medical  Journal,  Jan- 
uary, 1899,)  advise  wool  the  year  around. 
I  formerly  did  myself,  wore  it  too,  and 
stand  ready  to-day  with  Dr.  J.  H.  Tilden, 
of  Denver,  to  apologise  to  the  many  unfor- 
tunates I  have  so  advised. 

But  I  hear  you  ask:  "What  shall  we 
wear?"  I  am  indebted  to  Dr.  R.  H.  Bab- 
cock,  of  Chicago,  111.,  for  many  profession- 
al pointers,  and  it  gives  me  pleasure  to  state 
that  it  was  upon  his  advice  that  I  first 
abandoned  wool  as  underwear  and  adopted 
linen. 

In  linen,  we  have  a  woof  which, -if  pro- 
perly woven,  fills  all  the  requirements.  By 
properly  woven  I  mean  if  it  is  so  woven  as 
to  be  porous. 

In  such  a  garment  we  have  a  perfect 
conductor  of  moisture  and,  moreover,  one 
as  free  to  give  it  up.  It  is  true  that  the 
fibre  of  wool  and  the  fibre  of  flax  show  no 
difference  so  far  as  the  conducting  of  heat 
is  concerned,  and  a  porous  woolen  garment 
will  keep  the  body  much  warmer  than  one 
made  of  plain  smooth  linen,  but  offers  no 
better  protection  against  the  loss  of  heat  by 
radiation  than  a  porous  linen  garment  of 
the  same  air  holding  capacity. 

The  ancients  understood  perfectly  the 
wearing  of  porous  linen  underwear.  Par- 
ticularly in  Greece,  Egypt  and  India,  such 
garments  were  worn  almost  exclusively 
thousands  of  years  ago.  It  was  worn  by 
the  Anglo  Saxons,  and  the  Mormons  are 
also  so  credited. 

Hippocrates  states  that  "  pure  linen 
should  be  worn  next  the  skin,"  and  Moses 
states  the  same. 

In  Russia,  one  of  the  coldest  countries, 
very  few  inhabitants  wear  anything  next 
the  skin  but  linen,  while  foreigners  wear- 
ing wool  are  forced  to  make  the  change 
when  residing  long  under  such  conditions. 

The  difficulty  in  weaving  linen  has  been 
always  to  make  a  garment  that  would  be 
porous,  but  this  difficulty  is  now  entirely 
overcome. 

In  this  country,  at  least,  the  common  and 
extensive  use  of  woolen  underwear  is  caused 
in  great  part  by  the  judicious  use  of  prin- 
ters' ink,  and  of  late  years  has  become  a 
fad,  many  of  our  most  reputable  physicians 
falling  into  the  way  of  advising  the  same, 
without  having  ever  fully  investigated  the 
merits  of  other  fabrics. 

I  expect  to  be  "jumped  onto"  here  in 
this  meeting  for  advocating  anything  so 
radically  different  from  what  is  custom,  but 
I  want  to  say  I  am  fully  prepared  to  take 
the  stand  I  have,  and  am  here  to  confess 
that  I  relieve    more  catarrhal  cold  sufferers, 


since  adopting  linen  than  I  have  ever  been 
able  to  do  before. 

I  am  not  arguing  from  theory,  but  from 
practice,  practice  in  the  case  of  myself,  my 
child,  my  brother,  my  friends  and  my 
patients,  having,  during  the  past  two  years, 
put  some  70  patients  in  linen  underwear, 
and  in  not  one  single  instance  have  I  had 
cause  to  regret  it,  or  had  a  word  of  com- 
plaint from  the  patient.  They  invariably 
declare  they  would  not  return  to  wool  for 
anything;  they  wear  fewer  wraps,  lighter 
clothes,  and  particularly  they  cease  to  have 
"colds." 

I  have  changed  the  underwear  of  children 
7,  8  and  9  years  old,  and  of  men  above  60, 
upon  our  coldest  winter  days,  and  so  far 
without  bad  effect. 

Linen  when  first  put  on  gives  the  skin 
an  impression  of  chilliness,  but  this  almost 
instantly  passes  off  and  leaves  the  skin  in  a 
glow,  a  feeling  which  must  be  tried  to  be 
appreciated.  Moreover,  it  is  absolutely 
non-irritating,  and  persons  to  whom  wool 
is  a  torment,  it  is  a  comfort. 

It  is  particularly  indicated  in  those  who 
perspire  easily,  from  the  fact  that  it  absorbs 
rapidly  and  dries  just  as  readily. 

One  of  the  most  convincing  arguments 
in  its  favor  was  told  me  by  a  gentleman, 
one  of  those  unfortunates  who  perspire 
freely,  who  noticed  that  if  he  wore  wool 
underwear  for  a  week,  bathing  daily,  that 
at  the  end  of  this  time  there  was  always  an 
odor  about  the  woolens.  He  now  states 
that  in  wearing  his  linen  he  has 
never  noticed  such  objection,  thus 
showing  that  the  woolen  retained  certain 
excretory  matter. 

Linen  does  not  shrink,  and  if  properly 
washed  will  outlast  any  other  form  of  gar- 
ment. 

Engaged  as  I  am  in  tubercular  work,  the 
treatment  of  rheumatism  is  something  I 
rarely  have  to  prescribe  for,  but  to  my  cer- 
tain knowledge  there  are  some  forms  of 
rheumatism  which  are  almost  instantly  re- 
lieved simply  by  taking  the  person  out  of 
flannel  underwear  and  putting  him  in  linen, 
thus  favoring  cutaneous  excretion.  These 
patients  are  of  the  same  class  who  are  bene- 
fited by  diuretics. 

After  having  tried  the  product  of  various 
mills,  the  most  satisfactory  linen  underwear 
found  has  been  that  produced  by  Dr.  Diemel 
of  New  York,  and  sold  under  the  name  of 
"Diemel  Linen  Mesh." 

DISCUSSION. 

Dr.  Paquin. — I  think  the  paper  of 
vast  importance,  and  Dr.  Ambler's  views 
coincide  with  mine.  I  have  not  had,  how- 
ever, the  experience  he  has  had  with  linen, 


THE  CHARLOTTE-  MEDICAL  JOURNAL. 


533 


but  I  am  quite  sure  from  my  experience 
that  colds  are  very  frequently  produced  by 
the  fact  of  perspiration  being  produced  on 
the  skin.  And  as  I  have  also  had  some  ex- 
perience in  diseases  of  the  lungs  I  am  quite 
sure  that  those  patients,  particularly  those 
who  bundle  in  woolens,  are  the  ones  who 
suffer  from  attacks  of  so-called  colds.  I 
have  noted  frequently  that  those  patients 
who  have  had  chronic  tuberculosis  for  any 
time  come  to  the  office  with  sometimes  two 
or  three  undershirts  of  wool,  sometimes 
even  in  the  summer,  and  those  are  the  pa- 
tients for  whom  it  is  difficult  to  find  any 
treatment,  climatic  or  otherwise.  I  am  also 
quite  certain  that  the  same  condition  of 
things  exist  in  rheumatism.  In  institution- 
al work  I  notice  that  those  patients  who  do 
have  rheumatism  almost  always  keep  them- 
selves bundled  up,  and  they  are  more  sen- 
sitive to  draughts  than  almost  anybody  else. 
I  am  not  competent  to  speak  of  treatment 
by  the  use  of  linen,  but  it  strikes  me  very 
rationally.  It  certainly  is  rational  to  ex- 
plain the  cause  of  colds  when  one  sees  the 
results  obtained  so  frequently  with  those 
who  keep  themselves  bundled  up  summer 
and  winter.  I  myself  have  discarded  woolen 
long  ago,  not  for  linen,  because  I  did  not 
know  so  much  about  that,  but  for  cotton. 
I  think  Dr.  Ambler's  paper  is  an  impor- 
tant one,  and    should   be  carefully  studied. 

Dk.  E.  R.  Morris. — I  want  to  say  that 
although  I  have  not  studied  the  paper,  still 
I  appreciate  it  very  much.  I  am  prepared 
to  accept  that  paper  for  the  most  part  very 
favorably.  I  believe  it  is  scientific  and 
logical,  and  I  believe  in  the  course  of  a  few 
years  physicians,  as  such,  as  a  rule,  will 
adopt  that  more  largely.  Ten  years  ago 
more,  objection  would  probably  have  been 
made  to  the  application  of  cold  baths  than 
we  would  have  now  from  changing  the 
woolen  underwear  on  our  patients.  I  be- 
lieve the  doctor  is  in  as  good  form  as  could 
be,  and  certainly  when  it  comes  to  stating 
the  heat  radiation  and  the  functions  of  the 
skin  we  can  see  the  point  clearly.  I  see 
more  than  one  point  in  the  paper  that  I 
never  thought  of  before,  and  I  shall  study 
the  subject  more  than  I  have.  The  paper 
is  certainly  a  good  one  and  deserves  a  full 
discussion. 

Dr.  Minok. — I  have  had  the  misfortune 
of  missing  the  majority  of  the  paper,  so  can 
hardly  discuss  it  justly.  While  there  is  much 
of  the  part  1  heard  that  I  would  agree  with 
I  would  not  be  willing  to  give  to  the  wear- 
ing of  linen  the  universal  application  the 
author  seems  to  think  wise.  Unquestion- 
ably those  of  us  who  have  recommended 
woolen  underclothing  have  often  done  so 
without  a  proper  realization  of   the  reasons 


for  that  advice,  to  too  many  the  fact  that  it 
has  been  generally  used  has  been  their  only 
reason  for  advising  it,  a  most  irrational 
procedure.  That  there  are,  however,  ex- 
cellent reasons  in  its  favor  is  undeniable, 
nor  need  one  suppose  that  it  has  been  used 
all  these  years  without  any  reason  being 
sought  for  its  justification. 

To  those  wishing  to  know  the  reasons 
for  its  use  I  would  refer  to  an  admirably 
studied  article  by  Prof.  Rubner,  of  Berlin, 
in  the  first  number  for  1S98  of  Leydens 
Zeitschrift  fur  Diatetische  find  Physika- 
lische  Therapie.  In  this  the  scientific  rea- 
sons are  carefully  gone  over  and  he  who 
wonders  whether  he  has  not  been  doing  an 
injustice  to  his  patients  will  find  comfort, 
while  at  the  same  time  no  extreme  "wool 
at  any  cost"  attitude  is  taken.  To  quote 
his  final  words  :  "One  can  rationally  clothe 
onesself  with  other  articles  also  if  one  keeps 
in  view  the  chief  rules  of  a  rational  cloth- 
ing ;  no  overwarm  clothes,  good  ventilla- 
tion  of  them,  homogenous  evenly  woven 
tissue,  the  layer  next  the  skin  not  too  thin, 
good  isolation  of  the  skin  and  as  little  dif- 
ference as  possible  in  conductivity  in  the 
tissue  in  its  dry  and  moist  conditions." 

Dr.  Ambler  asks  me  why  in  a  recent 
article  I  have  recommended  for  consump- 
tives woolen  clothing  (of  proper  weight 
and  not  too  heavy)  and  1  would  say  that 
not  only  the  theoretical  reasons  given  in  the 
article  referred  to,  but  the  results  of  clinical 
experience  have  justified  that  advice.  At 
the  same  time  there  may  well  be  cases  in 
which  linen  may  do  admirably,  and  I  can 
imagine  that  in  summer,  and  possibly  in 
winter  as  well,  it  will  prove  excellent,  cer- 
tainly the  fact  that  it  goes  against  our  pre- 
conceptions is  no  argument,  and  I  shall  try 
it  on  myself  first  and  then  on  my  patients. 
Nevertheless,  I  am  satisfied  that  the  wear- 
ing of  wool  next  the  skin,  if  properly  done, 
is  an  excellent  thing,  though  my  experience 
teaches  me  that  So  per  cent,  of  consumptives 
wear  a  far  too  thick  grade  of  wool,  and  I 
often  have,  as  a  first  thing,  to  order  a  lighter 
weight. 

I  would  here  say  that  I  believe  that  in 
many  cases  where  Dr.  Ambler  believes  that 
linen  has  helped  him  so  much,  and  where 
he  attributes  the  bad  effects  to  the  wearing 
of  wool,  I  can,  while  the  patient  is  still 
wearing  wool,  get  the  same  effects,  in  stop- 
ping catarrhs  and  colds,  and  in  lessening 
chilliness,  by  the  careful  use  of  cold  water 
to  the  surface  of  the  body  ;  in  this  case,  as 
in  so  many  others  over  which  doctors  have 
discussed,  mistakes  are  made  in  connecting 
cause  and  effect,  Dr.  Ambler  would  banish 
colds  by  giving  up  wool  and  regards  linen 
as   a   necessity,   I,  while    my    patients    still 


534 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


wear  it,  get  the  same  results  by  hydrother- 
apy, and  am  unwilling,  therefore,  to  believe 
my  old  friend  wool  so  great  a  curse  as  he 
would  have  me  believe. 

Personally,  I  have  found  that  in  the  hot- 
test summers  I  am  fully  as  cool  in  very  thin 
wool  as  in  the  best  gauze  and  am  also  saved 
from  the  chilling  which  one  feels  if,  while 
in  a  cotton  undershirt,  one  perspires,  thus 
satisfying  me,  that  linen  of  which  I  have  no 
experience  is  bad,  but  that,  properly  used, 
wool  is  good. 

The  doctor's  paper  has  interested  me  so 
much,  however,  that  I  shall  proceed  to  col- 
lect, at  first  on  my  own  person,  some  expe- 
rience on  the  subject,  and  if  that  final  tribu- 
nal, clinical  proof,  is  convincing  I  shall  be 
glad  to  come  over  to  his  side. 

Dr.  Purefoy.-— I  enjoyed  the  reading  of 
the  paper  very  much.  It  is  not  a  new  ques- 
tion at  all.  It  is  one  that  the  profession 
has  been  discussing  for  quite  a  number  of 
years,  and  one  that  the  laity  has  been  dis- 
cussing quite  as  long.  There  is  a  promi- 
nent man  here  in  Asheville  who  says  he  had 
rheumatism  as  long  as  he  wore  flannel,  and 
he  says  when  he  dropped  flannel  he  drop- 
ped his  rheumatism.  He  has  continued  to 
wear  his  cotton  and  he  insists  he  has  had 
no  more  rheumatism.  I  confess  that  I  am 
not  prepared  to  discuss  the  paper  intelli- 
gently, but  I  would  agree  with  Dr.  Minor 
that  I  am  open  to  conviction,  and  would  be 
glad  to  look  into  this  thing  and  give  it  a 
fair  trial. 

Dr.  Sawyer. — I  do  not  know  that  I  can 
add  anything.  I  noticed  some  little  time 
ago  that  those  patients  wearing  heavy  flan- 
nels complained  of  cold  more  than  those 
who  did  not  wear  them  so  heavy,  and  I  even 
found  that  those  who  wore  cotton  did  not 
have  as  much  cold  as  those  who  wore  flan- 
nel, but  I  have  only  recently  been  telling 
my  patients  to  wear  linen.  I  believe  this 
porous  linen  to  be  better  than  the  flannel. 
I  think  Dr.  Minor  is  right  in  one  respect, 
that  is,  about  patients  piling  on  entirely  too 
much  flannel  or  wool.  I  have  seen  them 
with  several  shirts  on,  and  they  shivered 
around  even  then  ;  but  if  you  can  only  in- 
duce them  to  take  off  those  heavy  woolen 
garments  and  put  on  a  thin  one  of  good 
quality  of  cotton  or  linen,  the  results  will 
be  better. 

Dr.  C.  V.  Reynolds. — Theoretically 
speaking,  this  is  a  very  fine  paper;  practi- 
cally speaking,  I  have  had  no  experience 
with  it.  I  received  one  of  those  little  pam- 
phlets and  read  and  studied  it.  It  is  the 
only  thing  I  have  ever  received  on  the  sub- 
ject, and  it  brings  out  some  very  fine  points 
relative  to  evaporation  and  conduction  of 
heat,  and  especially  do  I  think  it  would  be 


advisable  for  tubercular  patients  to  be  placed 
in  linen,  for  in  those  patients  we  have  so 
much  perspiration.  We  all  know  that 
woolen  clothing  will  take  up  a  certain 
amount  of  moisture.  I  perspire  very  little. 
In  my  case,  therefore,  I  think  that  wool 
would  answer  the  purpose,  in  that  it  would 
keep  me  warm,  because  there  is  not  much 
evaporation  going  on.  But  it  is  a  very 
pretty  subject,  one  that  I  said  in  the  begin- 
ning I  had  had  no  experience  with,  but 
have  made  up  my  mind  to  give  it  a  trial, 
and  will  first  begin  by  putting  it  on  myself. 
It  is  very  expensive,  a  great  deal  more  so 
than  wool. 

Dr.  Tennent. — I  do  not  know  whether 
I  can  make  any  remarks  from  a  professional 
point  of  view,  but  as  a  matter  of  common 
experience  I  might  say  something.  It  seems 
to  me  that  it  is  out  of  reason  for  a  thing  of 
that  kind  to  be  universally  applicable.  The 
man  who  lives  in  a  steam-heated  house  and 
who  sits  in  his  office  all  day,  and  gets  on 
the  car  at  night  and  rides  home,  lives  in  an 
entirely  different  climate,  you  might  say, 
from  the  man  who  leads  an  out-door  life. 
I  do  not  think  a  man  out  doors  all  winter 
can  get  along  without  wearing  woolen  un- 
derwear. I  am  out  of  doors  a  great  deal 
myself.  I  have  tried  cotton  in  the  winter 
and  never  have  been  able  to  wear  it.  One 
winter  I  tried  cotton  until  about  the  middle 
of  January,  and  I  had  a  cold  for  about  three 
weeks,  and  1  adopted  heavy  woolen  under- 
wear and  did  not  have  any  more  cold  that 
winter.  I  am  out  of  doors  a  great  deal  of 
the  time,  and  am  probably  different  from 
the  usual  run  of  tubercular  patients. 

Dr.  McBrayer. — 1  was  taken  somewhat 
by  surprise  at  the  tenor  of  the  paper. 
When  we  were  young  and  had  a  call  to  a 
case  we  made  the  diagnosis  before  we  got 
there.  Sometimes  we  had  to  change  it 
after  we  reached  there.  After  I  read  the 
title  to  the  paper  I  thought  the  doctor  was 
going  to  pay  his  respects  to  the  ladies. 
Sometimes,  you  know,  they  cut  their 
dresses  off  at  the  top  and  sometimes  at  the 
bottom. 

I  enjoyed  the  doctor's  paper  very  much 
indeed,  but  I  am  not  prepared  to  discuss  it 
fully.  Some  of  the  theories  that  he  ad- 
vanced are  very  well  known  and  I  suppose 
admitted  by  all.  As  for  myself,  I  have  not 
worn  any  woolen  underclothes  for  a  number 
of  years,  and  I  never  suffer  from  the  cold. 
I  have  been  wearing  cotton,  and  find  it  per- 
fectly comfortable  in  the  winter.  I  never 
feel  the  need  of  wool.  I  perspire  quite 
freely  upon  every  little  exertion,  and  I 
think  for  that  reason  the  cotton  or  linen 
would  be  much  more  pleasant  for  me.  I 
doubt  if  it  would  be    as    pleasant     for    Dr. 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


535 


Reynolds  as  wool.  I  enjoyed  the  paper 
very  much,  and  think  that  it  has  done  most 
of  the  Society  a  great  deal  of  good,  in  that 

jit  will  set  us  to  thinking.  I  will  give  the 
subject  more  thought  than  I  have    done    in 

,  the  past,  and  I  have  no  doubt  that  the  ma- 
jority of  the  other  members  of  the   Society 

■  will  do  the  same  thing. 

Dr.  C.  S.  Jordan. — Dr.  Ambler's  pa- 
per, as  far  as  the  linen  question  went,  was 
rather  new  to  me  as  to  the  ideas  it  brought 
forward,  but  it  set  me  to  thinking  of  the 
difference   in    the     radiating  properties    of 

j  wool   and    cotton    which  was  brought  out 

I  this  summer.      As  you  know,  nearly   all  of 

,  the  soldiers  were  provided  with  heavy  blue 
shirts.     They  were  quite  heavy,  and    were 

I  good  wool,  and  after  exercising  any,  walk- 
ing or  riding  in  Florida,  you  got  thorough- 
ly   soaked    and    your  shirts  would  be  wet 

i  through  and  through,  and  after  stopping 
in  the  shade  for  some  time  you  would  be 
chilled  from  your  waist  down,  but  from 
there  up  you  would  hardly  feel  it  at  all. 
We    wore    cotton  from  the    waist     down. 

,  Finally  all  of  us  that  could  wear  wool  next 
to  the  skin  wore  just  the  plain  blue  shirt 
without  drawers,  owing  to  that  fact,  be- 
cause the  radiation  was  sufficiently  great  to 
cool  off  and  at  the  same  time  they  chill  to 
the  body.  I  was  certainly  decidedly  more 
comfortable    to  have  one    of  those     heavy 

'  shirts  on.      As  for  the  doctor's  paper,  1  am 

;  perfectly  willing  to  believe  in  the  value    of 

i  linen  to  such  an  extent  that  I  am  going    to 

'  try  it  myself. 

Dr.  Van  Bergen. — I  would  like  to  ask 
a  question.  What  is  the  objection  to  spun 
silk?  It  is  not  much  more  expensive.  I 
had  a  case  of  asthma.      1  changed    the    pa- 

jtient  to  flannel.  It  was  fifty  times  worse 
than  it  would  be.  The  athletes  in  England 
came  to  the  conclusion  that  if  they  wore 
flannel  next  to  the  skin  it  was  all  right.  I 
knew  a  good  many  among  the  athletes,  and 
when  rowing  or  running  they  wear  flannel. 

'At  other  times  they  wear  spun  silk.  They 
say  if  they  are  not  in  motion  the  evapora- 
tion is  not  quick  enough  and  they  wear 
silk.  In  thib  question  of  wool  next  to  the 
skin  in  tubercular  or   asthmatic    patients    I 

1  would  absolutely  discard  wool  and  go 
back  to  silk. 

Dr.  Minor. — Every  doctor  feels  the 
temptation  to  fall  into  routine  treatment 
and  just  so  soon  as  he  yields  to    this    temp- 

itation  he  is  doing  an  injustice  to  himself  as 
well  as  to  his  patient.  To  apply  linen  or 
woolen  indiscriminately  to  every  case  must 
at  times  be  a  mistake  and  I   cannot    believe 

r  whatever  the  advantages  of  linen  that  it    is 

■  universally  applicable  as  he  claims.  It  is 
!  essential  in  all  practice  but    especially  so  in 


phthisis  to  individualise,  and  I  doubt  not 
that  there  are  cases  and  probably  more  than 
I  am  now  prepared  to  admit  which  can  be 
benefited  by  linen,  but  I  cannot  think  that 
every  case  will  fit  one  rule.  What  we  wish 
to  avoid  is  the  too  rapid  chilling  of  the 
body  by  a  rapid  passing  to  the  surface  of 
the  body  heat.  Certainly  in  my  experience 
wool  has  protected  the  body  from  this  bet- 
ter than  the  commoner  cotton.  If  linen 
can  be  proven  better  than  either  by  all 
means  let  us  determine  that  fact  and  adapt 
ourselves  to  the  new  truth. 

Dr.  Reynolds. —  Dr.  Van  Bergen 
brought  up  the  question  of  silk.  Dr.  Jor- 
dan brought  up  the  question  of  cotton 
and  Dr.  McBrayer  brought  up  the 
question  relative  to  too  much  perspiration 
and  too  little  in  the  use  of  linen.  Dr. 
Ambler  claims  that  linen  is  warmer,  as  I 
understand,  for  me,  whether  I  perspire  or 
not,  and  it  is  cooler  for  Dr.  McBrayer, 
whether  he  perspires  or  not,  and  I  want 
him  to  explain  that  and  the  relative  differ- 
ence between  silk,  cotton  and  wool.  It 
seems  to  me.  that  if  flannel  is  bad  silk  would 
be  worse.  Take  a  piece  of  woolen  and  try 
to  wipe  your  hands  on  it,  as  Dr.  Ambler 
says  ;  you  cannot  do  it.  If  you  take  a  silk 
handkerchief  you  can  dry  your  hands  on 
it,  but  not  nearly  so  quickly  as  on  cotton. 

Dr.  Paquin. —  .Some  thoughts  oc- 
curred to  me  during:  the  discussion  which 
have  mostly  been  covered  since.  One  point 
impressed  me  very  much  in  Dr.  Minor's 
discussion,  and  that  was  about  caution  in 
using  woolen  underwear.  There  is  no  pos- 
sibility, it  seems  to  me,  to  be  able  to  prac- 
tice medicine  properly  by  putting  the  pa- 
tients on  a  routine  basis.  However,  I  un- 
derstand the  paper  to  be  in  a  general  way 
to  utilize  clothing  as  much  as  a  preventive 
as  a  cure.  With  reference  to  treating  cer- 
tain cases,  it  is  the  very  caution  we  must 
impress  upon  our  patients  and  that  caution 
is,  not  to  perspire  too  much.  It  is  the  very 
point  I  wanted  to  bring  out,  that  if  we 
find  that  linen  can  be  used  with  less  cau- 
tion, that  patients  do  not  always  have  to 
have  explained  what  thickness  they  must 
wear,  and  how  they  must  wear  it,  and 
what  temperature  they  must  have  their 
houses;  if  linen  can  do  away  with  that  it 
would  be  very  much  advantage.  I  believe 
very  much  in  hydrotherapy,  but  it  would 
be  equally  as  good  with  any  other  under- 
wear, and  if  woolen  is  good  and  linen  is 
better  it  would  be  better.  I  have  tried  the 
Jasger  woolen  underwear  and  have  dis- 
carded that.  I  have  used  silk  and  have 
discarded  that.      I  shall  now  try  the    linen. 

Dr.  C.  P.  Amblfr- I  read  this  paper 
thinking  perhaps  some  of  the    members  are 


536 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


not  conversant  with  the  usage  of  linen.  It 
has  only  been  two  years  since  I  have  my- 
self, and  I  will  confess  that  when  Dr.  Bab- 
cock  first  told  me  the  best  thing  I  could  do 
was  to  burn  my  woolen  underwear  I 
thought  he  was  crazy.  But  having  so  much 
regard  for  his  word  I  acted  upon  his  ad- 
vice, and  where  for  the  past  ten  years  I  had 
been  repeatedly  having  catarrhal  cold,  and 
wearing  the  heaviest  kind  of  wool  next  to 
my  skin,  and  wearing  heavy  overcoats, 
since  that  time  I  have  not  had  one  single 
cold.  Some  of  the  points  I  might  have 
touched  on  have  been  brought  out  in  the 
discussion.  I  must  certainly  say  to  Dr. 
Purefoy  that  I  make  no  claim  to  priority  in 
this  matter.  I  do  not  wish  to  be  under- 
stood as  claiming  anything  radically  new. 
It  is  older  than  the  hills.  It  is  a  fact  that 
the  patient  who  begins  to  bundle  himself 
never  gets  through,  and  the  one  who 
bundles  himself  most  is  the  one  who  feels  the 
draught,  and  feeling  a  draught  he  imagines 
he  has  to  pile  on  more ;  the  more  he  piles 
on  the  more  he  macerates  the  skin,  and  the 
more  perspiration  is  retained  on  his  skin, 
the  vaso-motors  of  the  entire  body  are  di- 
lated, and  he  feels  the  least  little  draught. 
As  to  cotton  being  better  than  linen,  I 
do  not  believe  it,  for  the  simple  reason  that 
while  cotton  does  absorb  moisture  it  is  not 
as  free  to  give  it  up  as  linen.  Linen  is  the 
best  conductor  of  moisture  we  have  and  at 
the  same  time  it  is  equally  free  to  give  it 
up.  Take  your  underwear  and  saturate  it 
with  moisture  you  will  find  linen  will  dry 
in  much  less  time  than  cotton  or  wool  of 
the  same  weight.  Linen  is  the  best  ab- 
sorber and  also  the  best  evaporator.  I  am 
sorry  Dr.  Battle  is  not  here.  I  had  some 
elaborate  experiments  which  I  had  con- 
ducted to  answer  some  of  his  charges. 
Among  other  things  he  made  the  remark 
the  other  night  that  the  reason  my  linen 
underwear  was  of  value,  and  the  only 
thing  in  favor  of  it  was  that  it  was  so  al 
mighty  thin  that  it  left  my  wool  clothing 
to  come  in  contact  with  the  skin,  and  there 
fore  I  get  the  benefit  of  the  wool.  That 
will  not  hold  at  all.  To  go  into  the  theory 
of  the  thing,  the  reason  we  want  to  wear 
linen  next  to  the  body  is  this  :  Linen  ab- 
sorbs the  moisture  as  it  comes  from  the 
body  and  the  wool  will  not.  Put  the  wool 
directly  in  contact  with  the  body  and  the 
moisture  is  retained  on  the  body.  Put  the 
linen  next  to  the  skin  and  the  linen  rapidly 
takes  the  moisture  up  from  the  skin,  and 
being  a  fabric  which  will  give  up  the  mois- 
ture it  is  passed  off.  The  wool  is  the  ideal 
garment  for  protection,  I  admit,  but  the 
place  for  the  wool  is  on  the  outside. 
The  wool  is    a  non-conductor  of  moisture. 


Put  it  on  the  outside  for  the  reason  that, 
being  a  non-conductor  of  moisture  it  keeps 
the  moist,  damp  air  away  from  the  body, 
Dr.  C.  V.  Reynolds. — Suppose  you 
have  the  linen  on  the  inside  and  the  woolen 
on  the  outside.  You  say  the  wool  prevents 
the  damp  air  from  striking  the  body. 
Doesn't  it  prevent  the  moist  air  on  the  in- 
side from  getting  out. 

Dr.  Ambler. — The  linen  is  a  porous 
garment.  The  moisture  is  thus  in  a  fabric 
which  freely  gives  it  up  in  the  form  of 
humid  air,  that  is,  air  of  high  relative  hu- 
midity, while  if  the  wool  is  directly  in  con- 
tact with  the  body  the  latter  is  kept  damp 
by  the  poor  drying  quality  of  the  wool ;  mois- 
ture is  evaporated  from  your  linen  under- 
wear in  the  way  of  humid  air,  which  passes 
through  the  wool,  not  by  fabric  conduction. 

Now  as  to  Dr.  Jordan's  point  that  the 
woolen  shirt  kept  him  warm.  So  it  does. 
Wool  next  to  the  skin  is  all  right,  but  if 
you  cover  it  you  lose  what  you  would  other- 
wise gain.  Take  a  woolen  under-shirt  per- 
fectly dry  and  sprinkle  over  it  two  ounces 
of  water.  Take  the  ordinary  linen  under- 
shirt and  sprinkle  over  it  the  same  amount 
of  water,  spread  them  as  far  as  you  can, 
hang  them  in  the  air,  and  at  the  end  of  two 
hours  the  woolen  shirt  is  practically  dry, 
while  the  linen  shirt  is  dry  in  forty-five 
minutes. 

I  do  believe  that  wool  answers  the 
requirements  as  long  as  it  keeps  dry,  but 
the  moment  the  wool  becomes  damp  it  is 
exactly  the  opposite.  Wool,  as  long  as  it 
is  dry,  is  a  good  protector,  but  the  moment 
it  becomes  damp  it  is  an  extremely  poor 
protector  on  account  of  rapid  heat  conduc- 
tion. Water,  as  you  all  know,  is  one  of 
our  best  conductors  of  heat.  It  is  not  the 
fibre  of  the  wool  which  conducts  the  mois- 
ture away.  It  is  the  air  in  the  porous  gar- 
ment, which  conducts  it,  and  in  that  way 
the  wool  is  a  protection. 

In  regard  to  silk.  I  believe  that  still  fails 
in  the  requirements  of  underwear  in  the 
same  way  that  cotton  does.  The  silk  is  not 
a  conductor  of  moisture,  and  I  believe  that 
when  the  silk  does  become  damp  it  is  not 
free  to  give  it  up  again  in  the  same  way. 
What  we  want  in  the  way  of  underwear 
is  underwear  that  will  take  the  moisture 
up  most  quickly  and  give  it  up  most  rapidly. 

There  is  another  point.  You  all  come 
across  patients  who  complain  that  their  feet 
always  perspire  and  are  cold.  There  if 
nothing  that  will  answer  as  nicely  as  linen 
stockings.  That  is  a  very  small  point,  but 
one  easily  tried.  But  I  want  to  say  it  de- 
pends on  the  weaving  of  the  linen.  A  linen 
woven  hard  and  heavy,  as  you  would  weave 
a  linen  towel,  will  not  answer  the  require; 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


537 


merits.  It  has  to  be  a  porous  linen.  The 
best  thing  I  have  found  is  the  Diemel  Linen 
Mesh. 

I  think  lean  show  you  pretty  conclusive- 
ly, by  means  of    experiments  I  have   tried, 
that  when  you  put  wool  over  any  substance 
to  keep  the  heat  either  in  or  out  of  that  sub- 
stance the  main    thing   resolves    itself    into 
this.      You  must    keep  that  wool    covering 
dry.      For    instance,  we    protect  a  piece  of 
ice  by    putting  a  woolen    covering  over  it, 
but  if  that  woolen  becomes  wet  the  ice  will 
melt  more   rapidly.      You  have  got  to  keep 
the  wool  dry  to  answer  your  rrquirements. 
In  regard  to  Dr.  Reynold's  remarks  about 
his  wearing  wool  and  Dr.  McBrayer  wear- 
ing linen.      In    the  first    place,  if    Dr.  Mc- 
Brayer will  wear  linen  next   to  his  skin  the 
perspiration    will    be  conducted  away  from 
his  body  and  eliminated  much  more  rapidly. 
If  Dr.  Reynolds  wears  it  he  is  going  to  have 
a  garment  as  warm  as  wool.      What  makes 
wool  warm  is   the   air-containing  capacity. 
If  t lie  linen  has  an  equal  air-containing  ca- 
pacity, in    other  words,  if   it   is  equally   as 
i    porous,  then  it  will  be  equally  as  warm,  and 
at  the  same  time    have    the   power  of   more 
rapidly     conducting    off    and     eliminating 
moisture.      We  are  all   perspiring   patients. 
!    Insensible   perspiration  is   constantly  going 
;    on.      I  believe   it  is  a  settled  fact   that  there 
is  more  weight  in  the  way  of  excrct  ion  given 
I   off  from    the  body  through    the    skin    than 
(    from  the   bowels  or  kidneys.      To  give  you 
an  instance  about  the  linen.    During  our  cold 
weather    here  I  was  out    hunting    one  (.lay, 
!    tramping  over   the  hills.      I  came    back   to 
'   the  house    at  night  wet    through  with    per- 
>   spiration,  and  found  that  one  of  my  patients 
wanted    me  in  a  hurry,    and  I  changed  my 
1   outer  clothing,  but  had  to  leave  my  under- 
wear on  and  it  was  perfectly  damp.     I  drove 
altogether  about    six  miles    over  the   frozen 
!   ground,      1  took   no   overcoat,    and   when  I 
got  back  to  the  house  in  about  three  hours, 
;  my  underwear   was  as  dry  as  it   ever  was, 
and  I  took  no  cold.      Lip  to  the  time  I  wore 
linen  I  could  not  find  a  heavy  enough  over- 
coat to    keep  me    warm,  but    since  I    have 
taken  my  wool  off   it  is  only  in  exceptional 
(  cases  I  wear  an  overcoat  at  all. 


The   Diagnosis  of  Appendictis. 

By  Frank  T.  Meriwether,  M.  D.,  U.   S.   A.,    Re- 
tired, Asheville,  N.  C. 

The  appendicitis  is  not  so  easily  diagnosed 
as  it  is  thought,  is  a  fact  patent  to  those 
who  see  much  abnominal    work.      How  of- 


tRead  before  the  Southern  o'urgical  and  Gyn- 
ecological Association- 


ten  are  we  called  of  late  for  an  operation 
when  the  patient  has  been  treated  for  other 
diseases?  And  it  is  not  always  to  the  phy- 
sician's discredit,  for  I  recall  a  case  oper- 
ated upon  by  me  some  time  ago  that  had 
been  diagnosed  by  the  great  Pepper,  ex- 
cellent clinician  that  he  was,  as  indigestion, 
during  a  previous  attack,  but  in  which  the 
adhesions  and  conditions  found  showed 
must  have  been   appendicitis. 

The  difficulties  in  diagnosis  also  explains 
why  certain  physicians  having  larger  prac- 
tices sees  so  few  cases,  while  others  cure 
large  numbers  by  a  strictly  medical  treat- 
ment. It  is  much  like  the  obstretrician  who 
delivers  hundreds,  or  it  may  be  thousands, 
without  a  perineal  tear.  He  does  not  look 
for  them,  in  the  right  way,  or  else 
is  not  skillful  enough  to  discover  them. 

There  are  undoubtedly  many  cases  of  ap- 
pendicitis in  which  the  diagnosis  is  very 
clear,  the  patient  himself  making  the  diag- 
nosis, but  many  cases  demand  the  most 
profound  thought  and  judgment.  I  know 
I  see  cases  in  which  a  diagnosis  seems 
almost  impossible  to  make  with  certainty, 
though  thus  far  I  have  not  operated  un- 
necessarily. We  often  say  with  confidence 
that  an  acute,  localized  pain  and  tender- 
ness in  the  right  iliac  fossa,  accompanied 
with  fever  and  a  rapid  pulse,  after  exclud- 
ing ovarian  disease,  is  very  likely  appen- 
dicular, but  so  often  there  is  at  first  no 
localized  pain,  or  if  localized,  it  is  not  in 
the  right  fossa. 

In  my  experience  the  most  frequent  seat 
of  pain  is  at  or  about  the  umbilicus;  and 
the  temperature  is  very  uncertain  in  one 
case  with  peritonitis,  it  being  only  98  4.5 
at  its  highest,  with  a  pulse  of  from  74  to 
So  and  good  in  quality;  and  this  was  a  case 
of  perforation. 

Appendicitis  may  be  confounded  with 
almost  anything,  and  while  the  members  of 
this  particular  society  are  undoubtedly  fully 
able  to  differentiate  in  this  disease, it  may  be 
well  to  refresh  our  minds  a  little.  The  va- 
rious diseases  of  the  female  sexual  organs, 
particularly  those  of  the  right  ovary,  are 
all  very  likely  to  be  confounded  with  ap- 
pendicitis. 

I  believe  that  in  the  majority  of  cases 
examination  of  the  abdomen,  combined 
with  vaginal  and  bi-manual  palpation  will 
enable  one  to  detect  the  offending  organ, 
and  establish  a  correct  diagnosis.  The  ex- 
amination of  the  right  fossa  is  the  most  im- 
portant means  of  diagnosis,  or  if  from  rigi- 
dity or  tenderness,  a  thorough  examination 
cannot  be  made,  the  character  of  the  tense- 
ness of  the  abdominal  muscles. 

In  my  experience,  in  ovarian  or  uterine 
troubles,  if  rigidity  is  marked,  it  is  general, 


538 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


that  is,  both  recti  muscles  are  involved,  while 
in  appendicitis  it  is  the  right  lower  quad- 
rant only.  Even  during  examination  under 
an  anesthesia  this  one-side  rigidity  often 
remains,  and  I  have  seen  cases  in  which  the 
right  muscle  did  not  become  relaxed  until 
some  time  after  the  operation.  Also,  the 
cases  of  exudate  and  pus  from  the  pelvis 
rarely  rise  above  the  level  of  the  anterior 
superior  spine,  while  in  appendicular  trou- 
ble the  tumor,  if  any,  is  apt  to  be  above  and 
rather  internal,  towards  the  umbilicus. 

Ovarian  Abscess. — Quite  a  number  of 
times  ovarian  abscess  have  been  met  with  in 
which  the  infection  come  from  the  appen- 
dix, the  end  of  which  is  adherent,  to  the 
abscess  wall.  I  have  met  with  one  case,  in 
which  an  abnormally  long  and  acutely  flex- 
ed appendix  was  adherent  to  the  ovary,  in 
infection  occurred,  the  result  of  which  was 
an  abscess  the  size  of  a  walnut.  Differen- 
tiated diagnosis  in  this  case  was  practically 
impossible. 

As  a  rule,  however,  the  history  of  the 
case,  the  character  of  the  pain,  vaginal  and 
bi-manual  examination,  the  history  of  peri- 
odicity, and  its  relation  to  the  menstrual 
flow,  usually  clears  the  diagnosis.  The  at- 
tacks are  less  explosive  than  in  appendi- 
citis, and  the  relation  between  pulse  and  the 
temperature  are  less  disturbed. 

In  cases  of  ovaritis  the  character  of  the 
pain,  tenderness  not  being  so  marked  except 
upon  very  deep  pressure,  the  tenderness  and 
pain  being  lower  in  the  pelvis,  the  history 
and  vaginal  examination  should  suffice.  Of 
course  attacks  of  appendicitis  may  be  ag- 
gravated at  the  time  of  the  menstrual  crisis, 
as  in  a  case  of  mine,  the  excess  of  blood  in 
the  pelvis  causing  a  subacute  attack  of  the 
appendicular  trouble  in  a  fibrous  appendix. 

In  acute  salpingitis  there  is  often  a  mark- 
ed resemblance  to  acute  catarrhal  appendi- 
citis, but  the  history  of  possible  infection, 
the  different  kind  of  pain,  the  lack  of  rigid- 
ity of  the  right  rectus  muscle,  and  the 
combined  and  vaginal  examination  should 
differentiate. 

In  acute  salpinx  the  examination  usually 
reveals  the  condition,  but  if  the  appendix  is 
at  fault  and  peritonitis  has  supervened,  the 
rigidity  of  the  vaginal  vault  from  inflamma- 
tory deposit  and  muscular  rigidity  makes  it 
impossible  to  map  out  anything. 

Chronic  pyo-salpinx  should  be  easily  dif- 
ferentiated by  its  history  and  an  examina- 
tion, a  confusion  arising  only  when  the  tu- 
mor is  very  large  and  if  appendicular  the 
appendix  pointing  southwardly,  the  abscess 
tending  to  burrow  towards  the  rectum 
or  vagina. 

In  extra  uterine  pregnancy  the  history  of 
cessation  of  the  menses,  and  other   signs  of 


pregnancy,  the  discharge  per  vagina,  the 
character  of  the  pain,  the  relation  of  the 
pulse  and  temperature  and  the  combined 
and  vaginal  examination  should  reveal  the 
nature  of  the  trouble,  though  in  a  case  of 
mine  there  were  no  signs  of  pregnancy  and 
no  vaginal  discharge.  In  this  case  as  in 
many  we  see,  a  positive  diagnosis  was  im- 
possible, but  the  necessity  of  operative 
measures  being  present  in  the  event  of  either 
diagnosis  the  patient  did  not  suffer  for  want 
of  proper  diagnosis. 

A  somewhat  rare  condition  may  be  mis- 
taken for  a  chronic  appendicitis,  but  should 
be  easily  differentiated.  This  is  a  varicose 
condition  of  the  broad  ligament.  In  it,  the 
dull  aching  pain,  always  present,  no  his- 
tory of  an  acute'  attack,  no  localized  pain 
or  dullness  over  the  region  of  the  appendix, 
and  the  absence  of  inflammatory  symptoms 
should  be  sufficient. 

In  a  fibroid  a  mistake  might  arise,  but 
history  and  age,  with  examination  should 
make  the  diagnosis.  Cases  have  been  re- 
ported of  a  twisted  pedicle  of  an  ovarian 
cyst  in  which  diagnosis  seemed  very  diffi- 
cult if  not  impossible,  but  the  character  of 
the  pain  is  so  different,  the  history,  and  ex- 
amination, but  the  character  of  the  rigidity 
of  the  muscle,  if  any,  should  clear  it. 

In  infection  following  an  early  miscar- 
riage, the  infection  travelling  up  the  right 
tube,  and  causing  local  peritonitis,  the  diff- 
erence in  muscular  rigidity,  careful  exami- 
nation,no  interference  with  the  bowel  func- 
tion, no  vomiting,  and  the  pulse  and  tem- 
perature, should  differentiate. 

Occasionally  peritonitis  from  a  small 
leaking  pus  tube  will  give  rise  to  symptoms 
simulating  appendicitis. 

In  these  cases,  the  muscular  rigidity,  if 
any,  is  more  or  less  general,  the  bowel 
symptoms  of  appendicular  diseases  are  not 
present, nausea  and  vomiting  are  not  promi- 
nent, the  history,  and  the  pulse  and  temper- 
ature record  are  not  those  of   appendicitis. 

Cancer  of  the  ileo-cecal  region  may  be 
mistaken  for  appendicitis,  or  vice  versa. 
The  principal  points  of  differentiation  are, 
the  age,  history,  cachexia,  temperature  re- 
cord, and  careful  physical  examination. 

Pott's  abscess  should  be  easily  differen- 
tiated, but  mistakes  have  often  occurred. 
In  fact,  I  am  cognizant  of  one.  In  it  and 
nephritic  and  peri-nephritic  abscess  the 
lumbar  examination  will  usually  show  the 
source  of  the  tumor  and  pus,  and  with  the 
history  of  the  case  and  the  pulse  and  tem- 
perature record,  should  differentiate. 

In  nephritic  and  hepatic  colic  the  relation 
of  the  pulse  and  the  temperature  are  not  so 
distorted  as  is  apt  to  be  in  appendicitis,  and 
it  is  more  likely  to  be  the  upper  rather  than 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


5U9 


the  lower  portion  of  the  right  rectus  which 
is  rigid.  The  localization  of  the  pain  in 
the  right  fossa  is  almost  certain  to  obtain 
within  a  few  hours  in  appendicitis. 

In  nephritic  colic,  the  tenderness  over 
the  kidney,  the  history,  the  very  distinct 
paroxysmal  character  of  the  pain,  no  coat- 
ing of  the  tongue,  and  no  bowel  symptoms, 
the  pulse  being  only  accelerated,  as  a  rule, 
during  the  attack  of  pain,  the  examination 
of  the  urine,  and  the  palpation  of  the  ab- 
domen, together  with  the  absence  of  tem- 
perature changes  should  make  up  a  diagno- 
sis. In  hepatic  colic  the  history  of  the 
former  gastric  disturbance,  the  icterus, 
tumor  and  the  location  of  the  pain  and  the 
tenderness,  the  temperature  and  pulse  re- 
cord, should,  in  most  cases,  exclude  appen- 
dicitis. 

Typhoid  of  a  fulminating  character,  may 
be  confounded,  but  the  usual  prodromata, 
prolonged  fever,  possible  infection,  diar- 
rhoea, excessively  high  temperature,  should 
distinguish  it.  The  cerebral  symptoms  of 
typhoid  of  this  type  are  apt  to  be  marked. 
I#do  not  think  that  appendicitis  should  be 
confounded  with  typhoid  with  perforation, 
but  1  know  of  two  cases  of  perforative  ap- 
pendicitis in  which  the  diagnosis  of  typhoid 
perforation  had  been  made. 

The  history  of  a  necessary  previous  illness 
of  two  weeks,  before  pain  and  the  symp- 
toms of  perforation,  for  typhoid  perforation 
rarely  occurs  before  the  end  of  the  com- 
mencement of  the  third  week,  should  suffice. 
Even  in  a  walking  case  the  illness  without 
pain  would  be  noticed.  I  believe  that  it  is 
frequent  that  a  narrowing  of  the  ilieum 
from  typhoid  ulceration  may  produce  symp- 
toms resembling  appendicitis,  but  the  his- 
tory of  the  manner  of  the  recurrence  not 
accompanied  by  fever,  with  negative  pal- 
pation and  the  history  of  typhoid  fever 
preceding,  and  the  pulse  record  should  dif- 
ferentiate. 

Ordinary  colic,  from  indigestion  or  the 
ingestion  of  some  article  of  diet  often  ren- 
ders the  diagnosis  very  obscure  during  the 
first  few  hours.  The  history  of  the  indis- 
cretion in  diet,  tendency  to  diarrhoea,  con- 
stipation being  the  rule  in  appendicitis,  no 
tenderness  over  the  appendix,  examination 
showing  no  enlarged  appendix,  no  temper- 
ature, and  the  rate  and  quality  and  charac- 
ter of  the  pulse  should  lead  one  to  make  a 
proper  diagnosis.  The  pain,  however,  is 
often  of  the  same  character,  and  it  not  in- 
frequently is  the  case  that  the  pulse  and  the 
temperature  in  appendicitis  is  normal.  The 
following  case  is  one  of  particular  interest 
in  this  connection. 

A  negro  boy.  of  sixteen,  had  what  was 
supposed  to  be    an    attack  of   colic  Monday 


evening,  which  was  relieved  by  a  small 
hypodermic  of  morphia.  He  was  advised 
to  take  some  salts,  which  he  did,  with  the 
result  that  he  felt  about  well  the  next  morn- 
ing. He  had  no  fever  and  his  pulse  was 
72.  He  did  his  work,  which  was  that  of  a 
hostler,  the  next  day,  getting  around  fairly 
well.  Upon  Wednesday  night  he  com- 
plained again  and  was  given  another  hypo- 
dermic. Still  no  fever  or  pulse  derange- 
ment. Thursday  morning  he  had  a  little 
tympany,  and  quite  a  little  pain,  it  being 
most  marked  about  the  umbilicus.  Thurs- 
day noon  the  pain  became  localized  at  Mc- 
Burney's  point.  I  saw  the  case  that  after- 
noon, at  which  time  the  pulse  was  72  and 
the  temperature  9&|.  Tympany  was  mark- 
ed, the  tongue  slightly  coated,  some  ten- 
derness over  the  right  iliac  fossa,  total  loss 
of  liver  dullness,  bowels  had  moved  that 
morning,  no  nausea,  and  the  patient  was 
fairly  comfortable. 

An  operation  made  showed  a  large  per- 
foration, with  free  fecal  matter  in  the  ab- 
dominal cavity,  and  about  a  pint  of  very 
foul  pus  free,  no  attempts  on  the  part  of 
nature  having  been  made  to  wall  it  off. 
This  patient  had  at  no  time  shown  signs  of 
shock,  and  went  off  the  table  with  a  pulse 
of  80,  and  a  temperature  of  99. 

In  differentiating  between  chronic  ap- 
pendicular disease  and  tubercular  perito- 
nitis the  points  are  the  temperature  record, 
the  history,  and  the  lesion  to  be  found  else- 
where in  tuberculosis.  No  mass  is  found 
in  tubercular  peritonitis,  as  would  be  found 
in  chronic  appendicular  abscess,  but  the 
other  symptoms  may  be  very  confusing. 
In  a  case  I  Ijad  some  time  ago  the  history 
was  that  of  recurrent  appendicitis,  with  a 
temperature  pointing  towards  pus  some- 
where, but  at  the  time  of  operation  a  local- 
ized tubercular  peritonitis  was  found,  with 
several  enlarged  glands  containing  the  tu- 
bercle bacilli.  There  was  a  sense  of  resis- 
tance in  the  right  fossa,  though  no  distinct 
tumor  was  felt. 

In  intestinal  obstruction  the  temperature 
is  more  apt  to  be  subnormal,  there  is  no 
historv  of  a  previous  attack,  and  the  ob- 
struction of  the  bowel  is  usually  absolute. 
In  one  case  seen  the  diagnosis  of  appendi- 
citis was  made  upon  the  fact  that  after  per- 
sistent endeavor  the  bowels  were  moved, 
though  the  former  physicians  had  consider- 
ed the  obstruction  absolute,  and  the  opera- 
tion proved  the  correctness  of  the  diagnosis. 

There  is  not  apt  to  be  a  local  rigidity  of 
the  rectus,  and  the  character  of  the  pain 
and  the  vomiting  and  of  the  tumor,  and 
the  temperature  record  should  show  in  most 
cases  the  trouble  to  be  strangulation. 


540 


tfHte  cfiARLofTfi  Medical  journal 


The  Preventive  and  Curative  Treatment 
of    Eclampsia.* 

By  S.  M.  Davega,  M.  D.,  Chester,  S.  C. 

Gentlemen  and  members  of  the  South 
Carolina  Medical  Association  :  You  have 
my  apology  for  presenting  to  you  a  subject 
which  has  been  so  long  and  so  ably  discus- 
sed, not  only  by  the  different  associations  in 
the  country  and  abroad,  but  by  the  leading 
journals  of  the  land.  However,  I  consider 
it  a  subject  of  vital  interest  to  each  and 
every  one  of  us,  and  one  which  cannot  re- 
ceive too  much  attention. 

While  discussions  have  been  full  and 
free,  I  am  sorry  to  say  that  the  exact  na- 
ture and  source  of  eclampsia  is  no  nearer 
fixed  than  it  was  twenty  or  thirty  years  ago. 
Many  theories  have  been  advanced  and  just 
as  many  have  been  discarded.  It  is  not  my 
purpose  to  offer  you  a  resume  of  the  many 
theories  advanced.  It  is  simply  my  aim  to 
offer  the  data  which  justify  a  line  of  treat- 
ment, which  is  in  accord  with  the  hypothe- 
sis which  now  rallies  the  greater  number  of 
supporters,  and  one  which  I  believe  time 
will  prove  correct. 

I  am  thoroughly  convinced  that  eclampsia 
is  neither  epileptic,  apoplectic,  nor  hysteri- 
cal in  character,  but  is  due  to  a  toxaemia 
confined  to  the  pregnant  or  puerperal 
state.  Urea  which  has  been  for  a  long  time 
the  scare-crow  of  physicians,  was  asserted 
to  be  the  toxic  substance,  and  the  convul- 
sions were  naturally  and  very  properly 
called  uremic.  This  theory  was  soon 
thrown  aside,  as  observation  proved  urea  to 
be  a  diuretic,  and  that  the  intra-venus  in- 
jections of  it  failed  to  produce'  any  morbid 
phenomena.  This  substance  urea,  which 
was  for  a  long  time  considered  a  poison,  can 
be  used  as  a  medicament,  and  is  capable 
more  than  any  other  of  encouraging  the 
secretion  of  urine.  So  we  cannot  attribute 
eclampsia  to  ureas,  for  it  certainly  combats 
it  by  forcing  the  renal  barrier.  Neither 
can  I  accept  the  theory  that  eclampsia  is 
due  to  albuminuria,  for  repeated  examina- 
tions of  the  urine  have  failed  to  reveal  the 
sl.ghest  trace  of  albumen.  One  author  re- 
ports several  cases  where  eclampsia  began 
several  days  before  labor,  and  continued 
several  days  after  delivery  without  the  urine 
being  albuminous.  On  the  contrary,  we  all 
have  had  many  cases  with  albuminous  urine 
which  failed  to  develop  eclampsia.  While 
I  do  not  believe  eclampsia  is  due  to  albumi- 
nuria, I  would  not  have  you  understand 
that  I  attach  no  importance  to  its  presence, 


*Ilead  before  the  South  Carolina  Medical  As- 
sociation. 


for  most  assuredly  it,  taken  together  with 
other  existing  conditions,  warns  us  that 
there  is  a  faulty  relationship  between  nu- 
trition and  excretion,  and  that  something 
must  be  done  to  correct  this.  It  is  very 
certain,  therefore,  not  only  that  renal  dis- 
ease is  very  far  from  being  a  constant  fore- 
runner of  eclampsia,  on  the  one  hand,  but 
that  its  absence,  on  the  other  hand,  is  no 
certain  proof  that  such  convulsions  will 
not  occur.  Neither  does  the  amount  of  al- 
bumen bear  any  relationship  to  the  gravity 
of  the  case.  I  believe  that  eclampsia  is 
due  to  the  over-production  and  retention  of 
toxic  products  that  the  kidneys  and  other 
emunctories  cannot  eliminate.  I  further 
believe  that  these  toxins  are  principally  de- 
veloped in  the  intestinal  tract  as  the  result 
of  exaggerated  intestinal  fermentation  or 
putrefaction.  Without  doubt  the  stools 
eliminate  the  greatest  part  of  these  toxins 
which  are  expelled  with  them,  but  owing 
to  the  slow  movement  of  the  intestinal  con- 
tents a  large  quantity  of  these  toxins  are 
re-absorbed  by  the  intestinal  mucous  sur- 
face, are  carried  to  the  liver  which  fails  ,to 
arrest  or  transform  them,  and  finally  goes 
to  that  faithful  servant,  the  kidney,  in  ex- 
cess of  its  activity.  This  over-production 
and  under-elimination  results  in  a  toxaemia 
of  intestinal  origin  which  irritates  the  brain 
and  nerve  centers  to  such  a  degree  that  an 
explosion  in  the  form  of  convulsions  oc- 
curs. It  is  a  well-known  fact  to  all  of  us 
that  the  organism  in  its  healthy  state  is  a 
receptacle  and  laboratory  of  poisons,  and 
at  every  moment  there  is  a  risk  of  being 
overpowered  by  poisons  generated  in  the 
system.  There  are  continual  attempts  at 
self-destruction,  and  this  self-poisoning,  or 
intoxication  is  only  prevented  by  the  ac- 
tivity of  the  excretory  organs,  chiefly  the 
kidney,  and  by  the  watchfulness  of  the 
liver,  which  acts  the  part  of  a  sentinel  to 
the  material  brought  to  it  by  the  portal 
vein,  from  the  alimentary  canal.  We  thus 
see  that  in  order  that  intoxication  be  avoid- 
ed, it  is  necessary  that  the  emunctory  of- 
fices should  be  in  a  state  of  anatomical  and 
functional  activity  that  the  blood,  the  cir- 
culatory apparatus  ,and  the  nervous  sys- 
tem should  functionate  normally.  If  the 
chances  of  self-poisoning  or  destruction, 
are  so  great  in  the  healthy  human,  I  would 
ask  how  much  greater  are  they  in  the  preg- 
nant woman  with  her  nervous  forces  exag- 
gerated, her  resisting  power  diminished, 
and  her  physical  energy  lessened,  whereby 
all  the  emunctory  organs  are  severely  ham- 
pered in  the  performance  of  their  duties. 

Admitting  the  toxasmic  origin  of  eclamp- 
sia, also  that  the  toxins  are  developed  prin- 
cipally in  the  intestinal  canal,  and  that  this 


THE  CHARLOTTE  MEDICAL  JODRNAL. 


541 


toxaemia  belongs  alone  to  the  pregnant  or 
puerperal  state,  I  shall  at  once  proceed  to 
consider  what  I  think  the  most  rational, 
and  in  my  hands,  the  most  successful 
treatment.  The  preventive  treatment  of 
eclampsia  must  of  course  be  addressed  to 
the  pre-eclamptic  state,  and  it  is  very 
important  that  we  early  recognize  this 
toxemic  condition.  Whenever  a  pregnant 
woman  comes  to  us  complaining  of  some 
slight  departure  from  ordinary  health, 
such  as  malaise  with  slight  headache  and 
indigestion,  we  should  at  once  become 
suspicious  of  the  advent  of  general  tox- 
aemia, and  we  should  promptly  make  a 
thorough  investigation  and  give  thorough 
treatment.  If,  after  making  a  thorough 
examination  of  the  urine,  you  fail  to  find 
albumen,  don't  be  deceived,  and  at  the 
same  time  deceive  your  patient  by  say- 
ing to  her,  "you  are  alright,  you  are  simply 
going  through  just  what  all  women  in  your 
condition  have  to  do."  The  absence  of 
albumen  proves  absolutely  nothing,  and 
very  frequently  it  makes  its  first  appear- 
ance after  an  eclamptic  seizure  of  great 
severity.  1  repeat  that  these  slight  depar- 
tures from  ordinary  health  in  the  pregnant 
woman,  such  as  malaise,  indigestion  and 
scintillation  of  light,  mark  the  beginning 
of  toxaemia,  and  1  urge  that  each  and  every 
one  of  us  give  them  due  consideration,  for 
otherwise  the  halcyon  moment  will  be  lost 
and  we  will  look  back  with  regret  when  we 
are  probably  called  to  face  this  woman  in 
an  eclamptic  seizure.  On  the  other  hand, 
if,  after  examination  of  a  pregnant  woman, 
complaining  of  headache,  constipation,  dis- 
ordered vision,  irritability,  oedema,  dys- 
pnoea and  nervous  disturbances,  you  should 
find  albumen  and  diminished  urinary  se- 
cretion, don't  decide  at  once  that  she  is  a 
victim  of  kidney  disease,  and  begin  to 
abuse  and  punish  these  faithful  and  already 
over- worked  organs,  by  pouring  in  digitalis 
and  potass  salts.  The  potassium  salts 
should  be  avoided,  first,  because  they  favor 
the  production  of  intestinal  toxins,  thus 
contributing  a  large  share  in  producing  in- 
toxication; second,  because  tbey  always 
tend  to  produce  anaemia,  a  condition  which 
we  desire  to  correct,  and  not  to  foster; 
third,  because  they  are  particularly  poison- 
ous and  when  retained  in  the  blood,  are 
themselves  capable  of  producing  convul- 
sions. .The  consensus  of  opinion  is,  that 
meat  should  be  absolutely  forbidden  this 
class  of  patients,  and  >vhv  so?  Simply  be- 
cause it  is  full  of  potass  salts.  If  it  is 
wrong  to  give  meat  because  of  the  potass, 
it  i>  doubly  wrong  to  give  potass  as  a  medi- 
cine. Digitalis  should  only  be  given  when, 
beyond  a  doubt,  we  have  a  chronic    kidney 


disease  associated  with  cardiac  disorders. 
If  the  kidney  no  longer  has  the  power  to 
eliminate  the  toxic  substances  formed  in 
the  organism,  I  hold  that  there  is  then  re- 
tained the  therapeutic  poisons,  and  that 
the  employment  of  toxic  medicines  in  such 
cases  has  the  effect  of  bringing  about  an 
association  of  medical  intoxication  with  the 
already  existing  toxasmia.  In  the  disease 
under  consideration  I  would  advise  that  the 
kidneys  be  left  severely  alone,  except  that 
we  have  the  subjects  drink  water  in  large 
quantities,  by  which  means  we  dilute  the 
toxins  and  thus  restore  the  functional  activi- 
ty of  these  organs.  In  order  that  my  thera- 
peutic views  be  thoroughly  intelligible,  I 
will  here  repeat  that  we  have  to  deal  with  a 
toxaemia  confined  to  the  pregnant  or  puer- 
peral state,  and  that  this  toxaemic  condi- 
tion is  due  to  alimentation,  intestinal  fer- 
mentation and  putrefaction,  together  with 
the  sluggish  or  suspended  action  of  the 
liver.  By  carefully  watching  the  pregnant 
woman  and  early  recognizing  the  symp- 
toms and  signs  of  intoxication,  we  may, 
with  reason,  expect  that  hygienic  and  medi 
cinal  measures  will  correct  the  errors  that 
rapidly  tend  toward  eclampsia.  The  wo- 
man should  have,  daily,  a  warm  bath  at 
bedtime,  and  in  order  to  maintain  the 
warmth  of  the  body  and  at  the  same  time 
encourage  a  healthy  action  of  the  skin, 
flannel  should  be  worn  next  to  the  skin. 
She  should  also  be  urged  to  take  active  out- 
door exercise  as  it  has  been  demonstrated 
that  a  day  of  muscular  activity  spent  in  the 
open  air  diminishes  the  toxicity  of  the 
urine  one-third,  and  on  that  .  day  the  toxi- 
city does  not  diminish  only  during  the  time 
devoted  to  muscular  exercise.  Our  chief 
aim  must  be  to  diminish  the  source  of  the 
toxins  and  at  the  same  time  hasten  their 
elimination.  The  m^ns  at  our  command 
to  limit  the  supply  of  toxins  is  the  selection 
of  food  which  is  quickly  digested  and  ab- 
sorbed, and  which  will  also  have  the  ad- 
vantage of  not  giving  over  to  the  agents  of 
intestinal  putrefaction  undigested  and  easily 
putrescible  material.  In  milk  we  have  an 
ideal  food  which  produces  the  very  desira- 
ble result ;  that  is  to  say  faecal  matter  scanty 
and  solid,  besides  it  increases  the  fluids  of 
the  body,  thus  diluting  the  circulating 
toxins  and  promoting  renal  activity.  Elim- 
ination of  these  toxins  from  the  organism 
is  effected  by  the  persistent  use  of  saline 
purgatives  together  with  the  administering 
of  large  quantities  of  water.  Saline  pur- 
gatives hasten  intestinal  movements, 
sweep  out  the  intestinal  canal  removing 
toxic  substances  which  otherwise  would  be 
absorbed,  and  they  also  aid  the  liver  and 
kidneys.      They  also  dehydrate    the    blood, 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


consequently  the  tissues.  This  dehydra- 
tion causes  a  diminution  of  cedemas ;  this 
will  remove  water  from  the  cells,  and  along 
with  this  water  a  large  portion  of  the  toxic 
substances.  But  remember  there  will  only 
result  from  this  a  favorable  effect  if  we  im- 
mediately restore  to  the  tissue  the  water 
removed.  Otherwise  we  will  only  have 
displaced  the  poison  by  making  it  pass 
from  the  cells  into  the  plasma.  So  after 
dehydration,  in  order  that  we  may  ob- 
tain favorable  and  lasting  results,  we  must 
proceed  at  once  to  bring  about  hydration, 
by  forcing  our  patient  to  drink  water  in 
sufficient  quantity,  either  plain  or  charged. 
Beyond  a  doubt,  water  is  the  only  safe  and 
sure  diuretic  to  use  in  these  cases.  By  di- 
luting the  toxins  it  arouses  the  kidneys  to 
functional  activity,  thus  giving  a  speedy 
exit  to  the  toxins  from  the  body.  My  rule 
is  to  begin  purgation  in  the  same  way  that 
I  do,  preparatory  for  abdominal  sections. 
That  is,  I  give  two  teaspoonsful  of  epsom 
salts  in  hot  water;  this  is  followed  in  \ 
hour  with  four  grains  calomel,  and  this  is 
followed  with  two  teaspoonsful  salts  every 
hour  until  two  doses  are  given.  After  the 
bowels  have  been  freely  moved,  smaller 
doses  are  given  daily  to  produce  three  or 
four  watery  movements.  Without  any  hesi- 
tation I  tell  you  that  this  treament  can  with 
safety  and  marked  benefit  be  continued  for 
days  and  weeks  until  the  premonitory  sym- 
toms  abate  or  disappear,  when  the  purga- 
tion may  be  discontinued.  Instead  of  pro- 
ducing anaemia,  as  some  claim,  you  will  see 
the  blood  daily  improve  as  the  means  adopted 
are  removing  from  the  body  toxic  material 
which  produces  anaemia.  I  have  never 
practiced  bleeding,  as  all  the  cases  that 
have  come  under  my  observation  have  been 
decidedly  anaemic.  Where  I  have  high  ar- 
terial tension,  1  give  nitro-glycerine  1.50 
grain  doses,  every  hour  until  effect  is  pro- 
duced. If,  after  carrying  out  the  above 
simple  but  very  effective  methods,  we 
should  find  all  the  premonitory  symptoms 
and  signs  of  eclampsia  intensified,  we  then 
have  an  earnest  appeal  on  the  part  of  na- 
ture for  obstetrical  aid.  She  says,  in  un- 
mistakable language,  that  I  have  carried  an 
offending  foetus  just  as  long  as  my  economy 
will  tolerate  it  without  disastrous  results, 
and  I  beg  to  be  relieved  of  the  offending 
member  before  I  am  severely  handicapped 
by  an  eclamptic  seizure.  The  induction  of 
premature  labor  before  the  beginning  of  an 
eclamptic  seizure  is  a  phase  of  this  subject 
that  I  think  should  have  our  careful  con- 
sideration. 

My  idea  of  premature  delivery  before  the 
eclamptic  seizure,  is  that  it  should  be  done 
ip  all  cases  where,  in  spite  of  careful  dietetic, 


hygienic,  and  medicinal  precautions,  we 
have  a  daily  diminution  of  urine  and  urin- 
ary solids,  combined  with  certain  premoni- 
tory symptoms,  indicating  the  close  prox- 
imity of  convulsions. 

Possessing  the  facts  that  eclampsia  dur- 
ing pregnancy  is  far  more  fatal  than  either 
the  intra-partum  or  post-partum  form, 
and  also  that  the  foetus  absorbs  the 
toxins  transferred  to  it  from  the  mater- 
nal blood,  I  fail  to  appreciatethe  wis- 
dom of  delaying  to  empty  the  uterus. 
In  fact  it  reminds  me  too  much  of  the 
sleepy  flagman  who  fractured  his  leg  hasten- 
ing to  place  a  torpedo  signal  on  the  railroad 
track  after  the  trains  had  collided. 

During  the  past  two  years  I  have  been 
several  times  consulted  as  to  the  advisability 
of  emptying  the  uterus  for  patients  who 
had  previously  suffered  from  an  attack  of 
eclampsia.  Until  recently  this  was  a  very 
perplexing  question,  as  I  believed  it  to  be 
both  legally  and  professionally  wrong  to 
empty  the  uterus  under  such  conditions 
unless  I  was  sure  there  existed  an  undoubted 
kidney  trouble.  However,  a  very  sad  ex- 
perience during  the  past  two  years  has  led 
me  to  conclude  that  once  a  woman  has  ex- 
perienced the  horrible  ordeal  of  an  eclamp- 
tic seizure,  and  where  almost  demented 
with  fear  she  dreads  encountering  the  dan- 
ger of  eclampsia  the  second  time,  her  feel- 
ings deserve  consideration,  and  that  empty- 
ing the  uterus  is  a  justifiable  procedure.  I 
shall  now  dismiss  the  pre-eclamptic  state 
and  take  up  eclampsia  itself. 

Suppose  that  we  are  hastily  called  to  the 
bedside  of  a  woman  where  convulsions  have 
commenced,  what  is  to  be  done?  The  reply 
brings  us  face  to  face  with  the  most  inter- 
esting and  important  question  in  the  man- 
agement of  eclampsia,  concerning  which 
there  is  quite  a  diversity  of  opinion.  Ob- 
servation and  personal  experience  warrant 
my  advocating  speedy  delivery,  under  pro- 
found anaesthesia  as  I  feel  that  by  so  doing 
1  am  assisting  nature  to  accomplish  her  own 
desire.  The  simple  assertion  that  convul- 
sions don't  always  stop  after  delivery,  must 
by  no  means  be  considered  a  valid  argument 
against  speedy  delivery.  Neither  does  post- 
partum hemorrhage  always  check  after  emp- 
tying the  uterus,  still  I  am  sure  we  all  agree 
that  the  removal  of  the  placenta  and  mem- 
branes is  the  first  and  very  important  thing 
to  be  done.  So  it  is  with  eclampsia,  after 
the  uterus  has  been  emptied,  we  can  with 
less  danger  and  greater  expectations  push 
the  various  medicinal  means  at  our  com- 
mand. Remembering  that  in  the  majority 
of  cases  eclampsia  leads  to  expulsion  of  the 
foetus  and  that  with  each  succeeding  con- 
vulsion the  life  of  the  child  is  directly  im- 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


543 


perilled,  also  that  the  mother  is  growing 
weaker  and  weaker  at  the  same  time  risking 
an  aggravation  of  symptoms  ;  disturbances 
of  vision  more  or  less  permanent,  puerperal 
mania  or  paralysis,  I  consider  delay  a  very 
hazardous  procedure,  while  in  speedy  de- 
livery is  to  be  found  a  rational  application 
of  a  scientific  procedure  to  a  very  alarming 
condition.  Having  reached  the  bedside  of 
eclamptic  patient,  the  first  indication  is  to 
control  the  convulsions,  which  I  endeavor 
to  do  by  chloroform  inhalation  together 
with  rectal  administration  of  chloral  in  one- 
dram  doses.  The  second  and  all-important 
indication  is  to  at  once  begin  preparations 
for  speedy  delivery.  The  bowels  should  be 
emptied  as  thoroughly  as  possible  by  high 
enema.  The  importance  of  thoroughly  ca- 
theterizing  the  bladder,  I  will  demonstrate 
by  citing  an  experience  that  I  had  in  North 
Carolina  last  December.  While  waiting 
for  a  train  I  was  called  to  a  woman  having 
one  convulsion  after  another.  The  attend- 
ing physician  informed  me  that  she  was 
about  six  months  pregnant ;  at  the  same  time 
stated  that  he  had  used  the  catheter  twice, 
each  time  failing  to  get  a  drop  of  urine.  A 
glance  at  the  abdomen  told  me  that  its  con- 
tour was  not  that  of  six  months  pregnancy. 
On  examination  I  found  a  fluctuating  tumor 
extending  from  the  simphysis  to  the  umbili- 
cus. In  addition  to  this  I  outlined  a  preg- 
nant uterus.  1  introduced  a  soft  rubber 
male  catheter  and  drew  oft'  three  quarts  of 
urine  after  which  the  convulsions  ceased, 
and  the  woman  went  on  to  term.  This  pro- 
fuse evacuation  of  urine  proved  the  convul- 
sions to  be  reflexes  due  to  an  enormously 
distended  bladder.  Having  emptied  the 
bowels  and  bladder  our  attention  should 
next  be  directed  to  cleansing  the  external 
genitals  and  vagina.  This  is  accomplished 
while  the  patient  is  under  chloroform,  by 
first  scrubbing  with  soap  and  water,  next 
with  Bichloride  solution  and  finally  with 
pure  alcohol.  While  cleansing  the  parts 
and  while  patient  is  under  chloroform,  I 
give  subcutaneously  one  pint  warm  saline 
solution.  This  rapidly  enters  the  circula- 
tion, dilutes  the  toxins,  diminishes  their 
power,  thus  acting  as  a  sedative  to  the  nerv- 
ous system,  at  the  same  time  relieving  arte- 
rial tension  without  in  any  way  depressing 
the  vital  forces.  This  solution  can  be  re- 
peated with  marked  benefit  at  the  end  of 
delivery.  With  surgically  clean  hands  I 
next  proceed  to  dilate  the  uterus  with  my 
fingers  and  when  sufficient  dilation  has  been 
effected  1  complete  delivery  either  by  ver- 
sion or  forceps. 


About  75  percent,  of  cases  of  acute  articu- 
lar rheumatism  are  ushered  in  by  sore  throat. 


Clinical  Experience  Showing  the   Physio- 
logical Action  of  Mercauro  and 
Arsenauro. 

By  W.  Ross  Thompson,  M.D.,  New  York. 

Liq.Auri  et  Arsenii  Bromide — Arsenauro 
— Strength  io  minims  (o.6  c.  c.)  contains 
1-32  gr.  each  (0.002  gm.)  Bromide  of  Gold 
and  Bromide  of  Arsenic. 

Liq.Auri  et  Arsenii  et  Hydrargyri  Brom- 
idi — Mercauro — Strength  10  minimscontain 
(0.6 c.c.)  1-32  gr.  each,  (0.002  gm.)  of  Bro- 
mide Gold,  Bromide  Arsenic  and  Bromide 
Mercury. 

Originated  and  recommended  by  Dr. 
Barclay. 

Physiolog  ical  A ction — Digestive  System . 
— Five  to  ten  drops  of  either  of  these  solu- 
tions largely  diluted  with  water  stimulate 
the  flow  of  gastric  and  intestinal  juices  and 
augment  peristalsis,  improving  the  digestive 
and  nutritive  functions.  In  anatomy  of  the 
gastric  tubules  in  children  and  adults  Mer- 
cauro and  Arsenauro  are  invaluable. 

Circulatory  System. — Cardiac  action  may 
be  slightly  stimulated  by  the  doses  mention- 
ed— so  far  from  being  deleterious,  it  actually 
tends  to  invigorate  the  system — increasing 
the  number  of  red  blood  corpuscles  and  pre- 
vents their  destruction  in  such  diseases  as 
Chlorosis  and  Anaemia. 

Nervous  System. — The  general  effect  of 
Arsenauro  and  Mercauro  on  the  brain  and 
nervous  system  is  that  of  a  tonic — a  proper- 
ty which  is  supposed  to  explain  their  anti- 
periodic  nature,  in  which  respect  quinine 
alone  is  their  superior. 

In  very  large  doses,  60  to  80  drops,  the 
cerebral  functions  were  stimulated,  even  to 
the  point  of  exhiliration.  Experiments 
have  shown  that  the  sensory  nervous  appa- 
ratus is  strongly  affected.  This  action 
finally  involves  the  motor  system. 

Medicinal  amounts,  10  to  30  drops,  act  as 
a  nervous  excitant,  stimulating  the  trophic 
apparatus — (Lydston). 

Under  prolonged  use  these  solutions  tend 
to  accumulate  to  a  greater  extent  in  nervous 
than  in  other  tissues. 

Respiratory  System. — Ten  to  fifteen  drop 
doses  affect  special  change  in  respiration 
other  than  increased  power  and  stimulus  of 
the  respiratory  center.  It  has  been  held, 
with  authority,  that  small  doses  (5  drops) 
stimulate  endings  of  the  pulmonary  vagi. 

Absorption  and  Elimination. — Arsenauro 
and  Mercauro  are  readily  absorbed  by  the 
blood. 

Their  presence  may  be  detected  in  the 
viscera,  bile,  urine,  sweat,  the  bronchial  and 
intestinal  mucous  membrane  and  even  in  the 
parenchymatous  tissues.       It   is  eliminated 


544 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


very  slowly  from  the  system  by  the  intes- 
tines and  rapidly  by  the  urine  ;  possibly  also, 
by  the  bile  and  the  skin  ;  the  saliva,  milk 
and  even  the  tears  are  said  to  share  in  the 
process  of  elimination. 

Ten  to  thirty  drop  doses  prevent  tissue 
change.  Their  therapeutic  action  is  cer- 
tainly to  modify  and  improve  nutrition. 

Temperature. — The  temperature  is  unaf- 
fected by  medicinal  doses  of  Arsenauro  or 
Mercauro. 

Eye. — Large  doses  of  these  solutions,  60 
to  80  drops,  in  diseases  of  the  eye  are  fol- 
lowed by  oedema  of  the  lids,  but  no  injec- 
tion of  the  conjunctiva. 

"The  puffiness  of  the  lids  produced  some- 
times by  large  doses  aggravates  no  diseases 
of  the  eye,  for  no  congestion  of  the  conjunc- 
tiva is  produced." — (Short.) 

Untoward  Action. — Differing  from  the 
characteristic  symptoms  of  poisoning  pro- 
duced by  medicinal  doses  of  other  solutions 
of  Arsenic,  in  susceptible  persons,  these 
solutions  have  been  reported  without  aggra- 
vated toxic  effect. 

Frontal  Headache. — A  tendency  to  ver- 
tigo, frequent  alvine  evacuations  have  been 
reported  in  rare  instances,  but  these  idio- 
syncrasies are  easily  controlled  by  lessening 
the  dose  or  increase  the  dilution  with  a 
larger  quantity  of  water  at  the  time  of  ad- 
ministration or  giving  it  before,  instead  of 
after  meals  or  vice  versa. 

Poisoning. — Several  cases  have  been  re- 
ported where  the  contents  of  original  bot- 
tles of  one  ounce  have  been  swallowed  with 
suicidal  intent,  but  except  the  symptoms 
mentioned  above,  under  untoward  effects, 
the  cases  promptly  recovered.  The  claim 
is  made  for  these  solutions,  that  they  have 
all  the  benefits  of  Arsenic,  but  their  com- 
bination with  Gold  and  Bromide  prevents 
toxic  effects. 

Dose. — There  are  two  methods  of  getting 
a  patient  thoroughly  under  the  influence  of 
Arsenauro  or  Mercauro. 

1.  Begin  with  a  small  dose,  5  drops,  and 
increase  (  minim  0.006  c.c.)  a  day  until  un- 
toward symptoms  appear,  namely,  swelling 
of  the  lids,  a  tendency  to  vertigo  or  frontal 
headache,  or  the  dose  has  reached  30  drops ; 
then  decrease  the  amount  one  minim,  or 
drop,  each  dose  until  untoward  effects  dis- 
appear, and  continue  this  dose  so  reached 
for  at  least  eight  weeks. 

2.  Hypodermatically. — In  the  malignant 
diseases,  carcinoma  and  the  various  cach- 
exia, it  may  be  desirable  to  obtain  a  very 
quick  saturation  of  the  system,  and  this 
mode  of  administration  has  been  most  high- 
ly extolled  in  such  cases. 

The  liver  has  a  strong  elective  affinity  for 
them.     The    hypodermic  use  of  them   dis- 


tributes them  through  the  system  just  as 
mercury  is  distributed  by  inunction,  carry- 
ing it  immediately  to  all  parts  of  the  system 
by  the  circulation. 

For  hypodermic  use,  the  following  rule 
is  appropriate  : 

Dilute  with  equal  quantity  of  distilled 
water.  Use  alcohol  friction  over  the  part 
where  the  needle  is  to  be  introduced  (pre- 
ferably the  muscles  of  the  back).  Let  the 
injection  be  given  deep  into  the  muscles  and 
be  followed  by  active  friction  with  alcohol 
after  injection. 

Note. — Dilute  at  one  time  only  sufficient 
quantity  for  each  injection. 

])icompatibles. — With  all  organic  matter. 

It  is  best  to  direct  the  patient  to  drop  the 
dose  to  be  taken  into  a  half  tumbler  of  water 
at  meal  time,  either  before  or  after  meals. 
Careful  study  of  the  effects  of  the  drug  in 
each  case  will  make  it  possible  to  guard  its 
administration  so  that  tolerance  can  be  es- 
tablished. A  result  much  to  be  desired  in 
order  to  secure  the  maxim  benefit. 

Considering  the  enormous  doses  to  which 
the  arsenocophagi  becomes  habituated,  fail- 
ure in  the  medical  administration  of  the  so- 
lutions argues  the  want  of  ability  to  emplov 
them  scientifically.  Their  superiority  over 
all  other  preparations  of  Arsenic  is  para- 
mount. 

Internally. — Arsenauro  is  a  peculiarly 
efficient  remedy  in  Chronic  Scaly  Skin  dis- 
eases. Like  all  other  specifics,  it  influences 
diseases  of  a  chronic  nature  more  favorably 
than  acute  disorders.  This  preparation, 
therefore,  is  a  most  valued  remedy  in  psori- 
asis, lepra,  and  squamous  eczema.  If  syph- 
ilis co-exists  preference  should  be  given  to 
Mercauro.  Pemphigus,  Prurigo,  Acne  and 
Lichen  Ruber  have  also  been  favorably  in- 
fluenced by  the  continued  administration  of 
these  solutions.  In  the  successful  manage- 
ment of  these  chronic  skin  diseases,  it  is 
necessary  that  the  preparation  employed  be 
given  in  as  large  doses  as  can  be  tolerated 
by  the  patient,  and  the  treatment  continued 
unremittingly  for  a  long  period.  It  is  well 
to  employ  these  solutions  alternately  in  these 
cases — say  6  weeks  of  Arsenauro — rest  a 
week  from  any  treatment,  then  6  weeks  of 
Mercauro — rest  a  week,  then  Arsenauro, 
and  so  on. 

Lymphoma,  whether  superficial  or  occu- 
pying the  great  cavities  is  benefitted  greatly 
by  similar  treatment. 

Asthma  and  Bronchitis,  whether  acute  or 
chronic,  accompanying  or  succeeding  scaly 
kin  diseases,  are  singularly  amenable  to 
these  solutions  when  the  dose  is  carried  to 
the  full  physiological  limit.  Another  con- 
dition, Dysmonorrhcea,   frequently    noticed 

women  with   a  tendency  to  Asthma,  or 


THE  CHARLOTTE  MEDICAL  JOURNAL 


545 


subject  to  chronic  diseases  of  the  skin,  is 
often  cured  by  Arsenauro.  The  obstinate 
and  often  incurable  disease  knows  as  perni- 
cious Anaemia  yield  better  to  Arsenauro 
than  to  any  other  known  remedy.  The  ef- 
fect of  the  compound  in  this  disease  is  not 
simply  due  to  its  increasing  the  number  and 
quality  of  the  red  blood  corpuscles,  but  also 
to  its  preventing  or  delaying  their  destruc- 
tion in  the  portal  circulation. 

It  should  be  given  continuously  and  in 
gradually  increasing  doses  until  the  symp- 
toms due  to  intolerance  are  present,  when 
the  increase  should  cease  and  the  same  dose 
be  maintained  for  some  time.  By  carefully 
watching  the  indications  and  by  the  timely 
use  of  laxatives  the  dosage  may  be  easily 
adjusted,  so  that  the  full  benefit  may  be 
derived  from  this  valuable  product. 

The  statements  in  the  preceding  para- 
graph are  applicable  also  to  Leukemia, 
whether  splenic,  myelogenic  or  lymphatic, 
and  to  Hodgkin's  disease,  of  course  bearing 
in  mind  Mercauro  preferably,  if  Syphilis 
co-exist. 

Arsenauro  and  Mercauro  rank  next  to 
quinine  in  the  treatment  of  Malaria.  Chron- 
ic cases,  in  which  quinine  lias  lost  its  power 
are  benefitted  in  a  marked  manner  by  these 
compounds.  It  is  a  peculiar  fact  that  re- 
lapses are  fewer  after  treatment  by  Arsen- 
aurio  than  after  the  use  of  Warburg's  Tinc- 
ture of  Quinine.  It  can  be  employed  in 
cases  of  Malaria  at  all  times  without  regard 
to  the  presence  or  absence  of  fever  or  chills. 

It  has  remarkable  efficacy  in  the  treat- 
ment of  Neuralgia  of  the  intercostal  and 
fifth  pair  of  nerves.  Arsenauro  is  equally 
valuable  in  these  cases  whether  the  diseases 
be  due  to  Malaria  or  General  Debility. 

The  author  wishes  to  urgently  recom- 
mend the  use  of  Arsenauro  in  Pulmonary 
Phthisis.  In  certain  forms  of  this  disease 
he  regards  it  superior  to  any  other  remedy. 
Particularly  useful  in  those  conditions  which 
are  characterized  by  excessive  expectoration 
and  a  slow  degenerative   process. 

The  good  results  of  this  treatment  in  these 
cases  is  shown  in  a  conspicuous  manner  by 
a  marked  improvement  in  the  general  con- 
dition of  the  patient,  there  being  a  lessened 
pulmonary  secretion,  a  reduction  in  temper- 
ature, inprovement  of  the  appetite  and  con- 
sequent increase  in  the  body  weight. 

In  chorea,  arsenauro  very  justly  merits 
the  name  of  specific,  very  rarely  failing  to 
effect  a  cure  when  judiciously  administered. 
It  should  be  given  in  full  doses,  and  in- 
creased as  tolerance  is  established. 

This  medicine  seems  to  act  equally  well 
in  gastralgia;   many  irritative  conditions  of  | 


the  stomach  are  relieved  by  minute  doses — 
2  to  5  drops.  It  is  particularly  valuable  in 
gastric  ulcer  and  cancer. 

It  has  proved  of  great  service  in  hay 
fever,  spasmodic  asthma  and    acute  coryza. 

It  is  particularly  serviceable  in  catarrhal 
pneumonia  and  in  chronic  bronchitis.  It  is 
highly    recommended  in    diabetes  mellitus. 

Rheumatoid  arthritis  is  more  favorably 
influenced  by  the  use  of  this  medicament 
than  by  any  other  treatment.  Its  combina- 
tion with  bromide  of  mercury — mercauro — 
has  produced  better  results  in  secondary  and 
tertiary  syphilis  than  mercury  alone  in  any 
form — and  especially  has  this  been  noted  in 
the  stigmata  of  nervous  syphilis.  Somno- 
lence is  a  threatening  prodrome  of  the  cere- 
bral complications  of  syphilis.  It  varies  in 
intensity  from  mere  drosiness  to  profound 
lethargy.  In  the  milder  cases  the  patient 
may  attend  to  business,  but  his  executive 
ability  is  greatly  impaired.  His  memory 
is  poor.  He  is  unable  to  concentrate  atten- 
tion upon  the  matter  in  hand,  and  often 
falls  asleep  at  work,  though  the  previous 
night  ma}  have  been  passed  in  deep  and 
continual  sleep. 

Circulatory  disturbance,  the  result  of  ar- 
terial disease  is  evidently  the  casual  factor 
in  these  cases.  Accordingly,  many  such 
cases,  if  not  properly  treated,  eventuate  in 
thrombosis,  softening  and  hemiplegia.  The 
gold  in  the  compounds  seems  to  exert  a 
powerful  influence  in  restoring  the  circula- 
tion fo  a  normal  basis,  and  the  arsenic  and 
mercury  act  as  tonics  and  eliminatives. 

Certain  nervous  diseases  of  the  aged,  such 
as  melancholia  and  hypochondria,  are  often 
relieved  by  small  doses  of  arsenauro. 

Administration. — Arsenauro  and  mer- 
cauro should  be  given  ordinarily  after  meals. 
There  are  certain  conditions,  however,  re- 
quiring its  administration  in  small  doses  be- 
fore meals.  Children  are  much  less  sus- 
ceptible to  them  than  adults,  often  being 
able  to  take  adult  doses  with  impunity. 

During  a  course  of  treatment  with  these 
solutions  the  patient  should  be  instructed  to 
watch  carefully  for  the  first  outward  mani- 
festations, such  as  puffiness  about  the  eyes, 
nausea,  diarrhoea,  numbness  of  the  fingers, 
or  frontal  headache,  dizziness  or  vertigo. 
Any  one  of  these  symptoms  is  an  indication 
that  the  dose  should  not  be  increased  and  it 
may  be  necessary  to  lessen  the  dose,  or  even 
to  discontinue  the  remedy  altogether  for  a 
while — temporarily. 

Here  we  have  old  and  well-tried  remedies, 
made  infinitely  more  valuable  through  ad- 
vances in  chemistry   and   for  which  I  give 
credit  to  an  enterprising  American  firm. 
170  West  130th   Street. 


546 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


Picric  Acid  in  Eczema. 

F.  Radaeli  (British  Medical  Journal, 
March,  1899).  The  affected  part  was  first 
freed  from  scabs,  etc.,  the  hair  cut  as  short 
as  possible,  and  the  whole  region  thorough- 
ly washed  with  boracic  acid  solution.  When 
the  part  had  been  dried,  applications  of  a 
saturated  watery  solution  of  picric  acid 
were  made  with  pledgets  of  cotton  ;  then  a 
compress  wrung  out  of  the  same  solution 
was  applied,  and  over  this  was  placed  a 
layer  of  cotton-wool,  the  thickness  of  which 
was  proportionate  to  the  abundance  of  the 
secretion.  The  whole  was  kept  in  place  by 
a  bandage.  The  dressing  was  left  on  for 
one  or  two  days,  The  author  points  out 
the  special  convenience  of  the  picric  acid 
dressing  in  acute  eczemas  where  there  is 
much  "weeping,"  as  it  does  not  require 
frequent  changing.  On  the  other  hand, 
the  remed/  has  the  disadvantage  that  it 
causes  great  smarting  in  the  parts  to  which 
it  is  applied.  This,  however,  ceases  com- 
pletely in  ten  or  fifteen  minutes,  giving 
place  to  a  sense  of  relief  which  is  mainly 
due  to  the  cessation  of  itching.  Details  are 
given  of  a  number  of  cases  (acute  eczema 
of  scalp,  chronic  eczema,  diffuse  acute  ecze- 
ma, eczema  impetiginoides  of  the  face, 
"varicelloid"  eczema,  etc.),  in  all  of  which 
the  results  of  the  picric  acid  treatment  were 
satisfactory. 

The  Circulation  of    the  Blood  while  Sick. 

Dr.  T.  L,  Putman  (Medical  Association 
of  the  Mississippi  Valley,  March,  1899,) 
said  : 

The  sole  object  in  selecting  this  subject 
for  a  short  paper,  was  merely  to  condense  a 
few  very  important  facts  as  observed  by  a 
busy  practitioner  in  his  daily  rounds.  Dur- 
ing the  winter  of  1898  and  '99,  the  lagrippe 
was  very  prevalent  throughout  the  State  of 
Iowa,  and  especially  was  it  difficult  to  man- 
age with  elderly  people.  The  writer  inva- 
riably observed  that  the  "old  folks"  were 
sitting  about  the  house  every  day  from  the 
first  of  November  until  the  first  of  March. 
Through  the  inclemency  of  the  weather 
they  were  necessarily  confined  to  the  house, 
sitting  around  with  their  heads  full  of  blood, 
the  blood  vessels  on  the  surface  of  the  body 
empty,  and  the  internal  organs  burdened 
with  excess  of  blood.  The  one  principal 
treatment  that  was  most  useful  consisted  in 
establishing  an  equalization  of  the  circula- 
tion of  the  blood,  so,  in  order  to  accomplish 
this,  the  writer  found  it  necessary  to  put 
his  patients  to  rest  in  a  recumbent  position. 

The  next  principle  set  forth  was  the  fact 
that  the  skin  and  its  blood  vessels  are  capa- 
ble of  containing   one-half 'of   the   blood  of 


the  human  body,  and  in  order  to  relieve  the 
congested  condition  of  the  internal  organs, 
and  the  brain,  it  was  necessary  to  utilize 
some  safe  means  to  invite  the  blood  to  the 
surface  of  the  body. 

Histologically,  the  points  touched  upon 
were,  viz.  :  The  general  distribution  of  mi- 
crobic  infection  throughout  the  body,  inde- 
pendent of  the  blood  currents,  the  rapid 
and  mysterious  circulation  of  the  leucocyte 
carrying  with  it  coloring  matter  and  bac- 
teria. The  responsibility  of  the  leucocyte 
in  carrying  infection  in  this  way,  makes  it 
easy  to  understand  the  phenomenon  of  me- 
tastatic inflammation — that  the  red  corpus- 
cle being  less  active  in  its  migrations  is  not 
so  responsible  for  the  distribution  of  micro- 
bic  infection.  Another  point  mentioned 
was  the  rapidity  with  which  the  capillaries 
of  any  given  part  will  enlarge,  that  is, 
double  their  ordinary  calibre  within  from 
two  to  four  hours.  Hence  the  rapid  swell- 
ing of  any  part,  as  the  tonsil,  etc. 


Treatment  of  Fibroids  of  the  Uterus. 

Martin  (  Amer.  Jour,  of  Surg,  and  Gyne.) 
summarizes  an  article  on  the  treatment  of 
uterine  fibroids  as  follows  : 

The  only  sure  cure  for  fibroid  tumors  of 
the  uterus  to-day  is  the  total  removal  of  the 
uterus. 

The  total  removal  of  the  uterus,  while 
curing  the  tumor,  leaves  frequently  a  string 
of  unpleasant  sequelae,  causes  death  from 
the  operation  in  at  least  5  per  cent,  of  the 
cases  in  the  hands  of  experts,  and  deprives 
the  woman  of  the  possibility  of  bearing 
children. 

Conservative  methods  of  treatment  which 
should  be  pushed  to  the  legitimate  possibil- 
ities are  :  Medicinal  and  electrical  measures, 
and  vaginal  ligation  of  the  broad  ligament. 

Fibroids  would  rarely  destroy  life  if  never 
submitted  to  a  radical  operation  if  submit- 
ted to  the  conservative  treatment. 

Electricity  should  be  employed  as  a  rem- 
edy for  fibroids  in  all  women  over  40  or  45 
years  of  age  in  which  the  tumor  is  intersti- 
tial. It  should  be  employed  in  all  inopera- 
tive cases  of  whatever  age. 

Vaginal  ligation  of  the  broad  ligament 
may  be  employed  as  a  conservative  remedy 
in  all  bleeding  fibroids  of  whatever  age, 
especially  in  the  few  years  preceding  the 
menopause.  It  should  be  employed  in  all 
cases  of  desperate  hemorrhage  when  life  is 
threatened,  because  of  the  loss  of  blood. 

Removal  of  appendages  should  only  be 
resorted  to  after  the  abdomen  has  been 
opened  for  a  hysterectomy,  and  the  latter  is 
found  inadvisable. 


THE  CHARLOTTE  MEDICAL    JOURNAL. 


547 


McK,  &  R. 

Compound  Stearates 


Compound  Stearate  of  Zink  (McK.  &R.) 

is  the  most  satisfactory  dusting  powder  for  almost  all  purposes.  It  does 
not  cake,  never  becomes  rancid  nor  "sticky,"  resists  moisture  and  does 
not  soil  the  clothing. 

It  can  be  applied  to  the  nose*  throat  or  other  passages  without  causing 
irritation  or  discomfort. 

Compound  Stearate  of  Zinc  with  Ichthyol  (McK.  &R.) 

Ichthyol  is  of  undoubted  value  in  many  forms  of  skin  disease.  In  some 
cases  it  gives  results  which  no  other  agent  will  produce.  The  objections  to 
its  use  on  account  of  its  odor,  etc.,  are  largely  overcome  in  our  combination 
of  Compound  Stearate  of  Zinc  with  Ichthyol. 


We  shall    be   pleased   to  send   samples   of  this  or  other  combination,  together  with  Pamphb 
containing  full  list  of  combinations  and  uses,  on  application, 


McKESSON  &  ROBBINS, 


New  York. 


For  All  External  Dressings 

the  highest  fulfillment  of  modern  aseptic  or  antiseptic  surgery  is 
found  ill  Unguentine,  which  satisfies  all  the  requirements;  for  it  is 
Antiseptic,  Permanent,  Non-Irritating  and  Constructive.  It  is  the 
most  economical  and  least  expensive. 

THE  CONTAINER 

is  thoroughly  antiseptic,  clean,  convenient;  can  be  carried  in  pocket; 
always  at  hand  for  minor  work;  or  may  be  thrown  in  satchel  with 
no   risk   of    soiling  anything. 

THE   DRESSER 

is  the  ideal  antiseptic  ;  compounded  of  Ichthyol,  Carbolic  Acid,  and 
Alum,  after  the  modified  formula  of  Sir  Astley  Cooper,  but  with  a 
pure  Petrolatum-  base.  The  irritating  effects  of  ordinary  alum  are 
entirely  eleminated,  rendering  a  dressing  of  marvelous  healing  quali- 
ties, i.e.  astringest,  but  non-irritating.  Unguentine  is  used  daily  in 
practice  by  a  majority  of  the  physicians  and  surgeons  of  America  and 
has  been  reviewed  scientifically  by  more  medical  publications  than 
have  all  other  dressings  combined. 

Price,  2  oz.  Tube,  25c.     Per  Doz.  $2.00. 

To  introduce  Unguentine  in  the  Collapsible  Tube  we  will  send  to  yon,  on 

request,  one  tube  free,  prepaid. 

THE  NORWICH  PHARMACAL  CO,  Sole  flan'frs, 
NORWICH,  NEW  YORK. 


548  THE  CHARLOTTE  MEDICAL  JOURNAL. 

bfllJOflflHh 

The  astringent  and  hemostatic  properties  of  the 

Aqueous  Extract  of 
Suprarenal  Capsules 

render  it  invaluable  in  Eye,  Nose  and  Throat  opera= 
tions.  A  preparation  made  by  placing  5  grains  of 
Desiccated  Suprarenals  in  1  drachm  of  cold, saturated 
Boric  Acid  solution  and  allowing  the  mixture  to  stand 
ten  minutes  before  filtering,  applied  locally  relieves 
congested  mucous  membrane  and  prevents  hemor= 
rhage,  thus  enhancing  and  prolonging  cocaine  anes= 
thesia.  Its  full  effect  is  noticed  in  a  few  seconds  and 
lasts  from  one  to  to  two  hours.  The  Extract  is  not 
antiseptic  or  anesthetic  and  no  tolerance  is  established 
by  its  use.  Fresh  solutions  should  be  prepared  for 
each  operation. 


We  offer    Powdered    Desiccated    Suprarenal    Capsules    of  the 

Sheep,  1  grain  representing  S  grains  of  the  fresh  substance,  in  ounce 
bottles,  at  $2.00  per  ounce.      Samples  to   physicians  upon  request. 


ARMOUR  &  COMPANY, 
CHICAGO. 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


THE 


Charlotte  Medical  Journal. 

Editorial.  Department. 


E.  C.   REGISTER,   M.  D.  J.  C.   MONTGOMERY,   M.  0. 

Editors  and  Publishers. 

No.  36  South  Tryon  Street,    -    -    -    - 
Charlotte,  N.  C. 


SUBSCRIPTION.  $2-50  PER  YEAR, 


THE  MORPHINE    HABIT. 

Pain,  in  its  primary  manifestation,  is  a 
blessing.  It  is  a  conservative  instinct.  It 
is  a  danger  signal.  It  is  a  fire-alarm  mes- 
senger, telling  of  existing  conflagration  in 
some  ward  or  precinct  of  the  human  cor- 
poration, and  it  wisely  keeps  on  ringing  up 
the  "central"  until  the  engine  and  hose 
have  subdued  the  flames.  It  is  a  messenger 
to  the  train  dispatcher  of  "slips,"  "wash- 
outs," "obstruction  on  the  track"  or  wreck- 
age somewhere."  But  due  notice  having 
once  been  given,  it  sometimes  becomes 
necessary  to  quiet  the  persistent  clamor  of 
the  messenger  in  order  that  headquarters 
be  not  distracted  in  its  efforts  to  direct  and 
enforce  relief  measures.  To  this  end  mor- 
phine is  frequently  prescribed.  Used  with 
discretion,  it  is  a  blessing.  Used  without 
discretion,  it  becomes  a  curse.  It  is  an 
angel.  It  is  also  a  demon.  It  says  to  the 
purturbed  nervous  system,  "Go  slow,"  till 
we  get  over  this  piece  of  "bad  track,"  or 
till  this  obstruction  is  removed";  but  it 
must  not  be  forgotten  the  section  men  must 
mend  the  track — going  slow  will  not  do  it. 
If  the  track  is  all  bad,  and  the  "corporate 
system"  bankrupt  of  material  for  repair, 
then  it  is  proper  to  go  slow  all  the  way. 
What  1  mean  by  these  analogies  is  this. 
that  in  acute  painful  affections,  not  liable 
to  become  chronic,  use  it.  Here  it  is  a 
blessing,  and  may  be  safely  administered, 
but  it  should  be  given  very  discretely — 
something  on  the  "kiss  and  never  tell" 
line,  for  if  the  patient  knows  what  it  was 
that  kissed  away  the  pain,  he  or  she  may 
come  to  like  it,  and  then   "the    devil    is    to 

pay-" 

In  chronic  painful  affections  that  are 
curable, avoid  its  useasyou  would  a  serpent  ; 
but  where  the  affection  is  incurable,  and  the 
pain  intense,  then  in  mercy,  combined  with 
discretion,  use  it.  The  indiscret  practice 
of  telling  a  patient  the  name  of  a  drug  that 


brings  to  them  such  deadning  of  the  sensi- 
bility to  pain,  such  as  morphine,  cocaine  or 
chloral,  is  I  believe,  largely  responsible  for 
the  rapidly  increasing  number  of  victims 
to  the  "habit."  It  never  cures.  It  comes 
as  an  angel,  in  its  tisc.  It  becomes  trans- 
formed into  a  demon,  in  its  abuse.  De- 
Quincy  and  Coleridge  are  examples  of  its 
power  to  wreck  the  most  brilliant  of  men, 
but  the  world  heeds  not  such  warning.  Not 
so  much  to  the  world,  which  is  not  always 
observent,  but  fearfully  so  to  the  victim 
himself,  is  the  despairing  consciousness  of 
utter  wretchedness  induced  by  the  habit 
made  manifest.  It  brings  a  temporary 
calmness  to  the  physical ;  it  increases,  for  a 
brief  period,  the  brilliancy  of  the  mental, 
then  a  torpor  of  the  whole  system  ensues, 
and  the  awakening  from  the  somnolence  is 
only  to  greater  misery.  It  never  brings  re- 
freshing sleep.  It  is  not  sleep  at  all ;  it  is 
only  a  coma-vigil,  followed  by  stupor,  and 
the  system  is  daily  more  and  more  exhausted 
by  its  previous  excitement.  The  eye  is  dull 
and  perhaps  tinged  with  bile,  because  the 
functions  of  the  liver  has  been  interferred 
with.  The  blood  is  darker  than  before,  and 
the  mind  is  also  darker.  There  is  a  restless- 
ness, an  ill-defined  sense  that  things  are  all 
out  of  sorts,  and  that  something  must  be 
done  to  restore  the  system  to  its  proper 
balance.  It  is  presumed  now  that  only  a 
few,  perhaps  necessary  doses  have  been 
taken,  but  the  danger  line  has  already  been 
reached.  This  temporary  dullness,  which 
by  the  proper  exercise  of  will  power,  may 
be  shaken  off  in  a  few  hours,  is  to  become 
permanent  if  the  use  of  the  drug  is  resumed, 
just  as  sure  as  the  stupidity  of  the  confirmed 
drunkard  follows  the  prolonged  use  of  the 
wine  of  the  first   debauch. 

How  can  this  tendency  to  the  formation 
of  the  habit  be  broken  up?  I  can  speak 
from  a  limited  experience,  in  a  few  cases. 
First.  Warn  the  patient  of  the  immi- 
nent danger  and  fearful  results,  so  as  to 
enlist  /lis  will  power. 

Second.  Throw  on  the  tongue  is  much 
salt  as  would  lay  on  a  nickle,  and  wash  it 
down  with  a  tumbler  of  cold  water  every 
morning  half  an  hour  before  breakfast. 
This  cleanses  the  stomach,  brightens  up  the 
blood,  and  acts  as  a  laxative. 

Third.  A  vegetable  diet.  Banish  pork 
in  any  form.  Avoid  yeast  bread.  Eat 
freely  of  ripe  fruits,  especially  apples. 
Drink  nothing  during  the  meal,  and  but 
sparingly  of  tea  or  coffee  at  its  conclusion, 
then  within  an  hour,  take  an  additional 
pinch  of  salt  to  complete  digestion.  Let 
this  apply  to  every  meal.  If  already  par- 
tially enslaved,  and  cannot  completely  dis- 
card   the    drug    at     once,     cut     down    the 


550 


THE  CHARLOTTE   MEDICAL  JOURNAL. 


dose  one-tenth,  each  time  it  is  taken, and  the 
morbid  craving  for  it  will  soon  be  gone,  if 
this  course  is  rigidly  followed.  As  a  tonic 
to  assist  in  bracing  the  system  against  its 
depressing  effects,  I  know  of  nothing  bet- 
ter than  small  doses  of  strychnine. 


IS  GENIUS    A  FORM  OF  INSANITY? 

It  is  an  exceedingly  difficult  matter  to 
draw  the  line  which  separate  the  sane  from 
the  insane. 

When  we  study  the  diagnostic  traits  of 
mental  disease  we  begin  to  doubt  whether 
some  of  our  associates,  whose  mental  pro- 
cesses we  have  hitherto  held  in  the  highest 
respect,  are  not,  to  put  it  mildly,  in  a  ques- 
tionable condition. 

If  this  is  true  of  the  average  man,  how 
much  more  of  the  genius,  martyrs,  heroes 
and  devotees,  whose  acts  make  history. 
For  example  : 

Martin  Luther  had  hallucinations;  Peter 
the  Great  and  Napoleon  I.  were  both  epi- 
leptics ;  as  was  Julius  Caesar  ;  Raphael  was 
afflicted  with  suicidal  mania  ;  Richelieu  on 
occasions  imagined  himself  a  horse ;  Des- 
cartes was  followed  by  a  spectre  ;  Cromwell 
was  a  hypochondriac  and  had  visions  ;  J.  J. 
Rosseau  was  a  melancholy  madman  ;  Swe- 
denborg  imagined  that  he  went  to  heaven 
on  a  white  horse ;  Mohammed  was  an  epi- 
leptic ;  Dean  Swift  was  partially  insane  by 
inheritance;  Shelly  had  hallucinations; 
Charles  Lamb  and  his  sister  were  both  vic- 
tims of  insanity;  Coleridge  was  a  morbid 
maniac  ;  Milton  was  of  a  morbid  tempera- 
ment. Modern  ideas  of  hell  being  formed 
by  his  descriptions  of  a  diseased  imagina- 
tion. 

But  probably  the  most  marked  example 
of  insanity  combined  with  a  sagacity,  per- 
severance and  bravery,  unequalled  in  his- 
tory, is  that  of  Joan  of  Arc.  The  picture 
of  an  ignorant  peasant  girl,  going  about 
with  a  standard  in  her  hand,  and  announc- 
ing to  the  world  that  she  would  rescue 
France  from  her  enemies,  because  the  Vir- 
gin Mary  appeared  to  her  every  day  and 
commanded  her  to  do  so.  There  is  not  an 
alienist  living  to-day  who  would  have  hesi- 
tated a  moment  as  to  the  question  of  her 
sanity. 

Many  a  person  whose  mental  poise  is  illy 
balanced  becomes  eminent  through  a  com- 
bination of  circumstances  and  a  time  favor- 
able for  radical  measures  joined  to  an  ig- 
norance of  the  forces  they  combat  against. 

The  mere  audacity  of  the  act  stamps  them 
as  madmen  or  genius,  as  you  please,  while 
the  results,  whether  for  good  or  bad,  de- 
pending on    the  train  of  circumstances  fol- 


lowing  the  act ;  canonize  them  or  relegate 
them  to  oblivion. 

The  day  for  genius  has  passed  with  the  ig- 
norance of  past  ages.  The  hard-working, 
intelligent  plodder,  whose  temperament  is 
balanced,  is  the  man  of  the  hour. 


PSEUDO    NEURASTHENIA. 

Of  all  obstinate  and  unsatisfactory  cases 
that  fall  to  the  lot  of  physicians  pseudo 
neurasthenia  probably  takes  the  lead.  Its 
symptoms  do  not  differ  materially  from  true 
neurasthenia,  and  require  all  your  tact  and 
diagnostic  ability  to  differentiate  between 
the  two  conditions.  If  you  inquire  into 
her  earlier  life  you  will  find  she  was  a  bad 
tempered  child,  whose  care-takers  allowed 
her  to  have  her  own  way,  fretful,  hysterical, 
sulky  and  having  no  sympathy  for  others. 
She  is  usually  the  product  of  our  false  sys- 
tem of  bringing  up  children. 

Solomon's  precepts  regarding  the  rod 
may  be  ancient,  but  they  are  as  efficient 
to-day  as  when  he  wrote  them.  She  gives 
you  a  train  of  symptoms  in  most  forcible 
language. 

Like  the  orator,  ''Her  speech  is  at  first 
low-toned  and  slow,  sometimes  her  voice 
will  deepen  like  the  far  off  thunder  of  the 
coming  storm  and  anon,"  &c,  &c.  She 
can  neither  eat  nor  sleep;  is  entirely  help- 
less and  is  frequently  bedfast ;  has  the  most 
awful  pains,  horrible  headache  and  fright- 
ful spasms  ;  you  cannot  touch  any  part  of  her 
body  that  she  does  not  declare  is  exquisitely 
tender  and  the  seat  of  the  most  excruciating 
pain. 

While  she  recounts  her  tale  of  woe  her 
face  shows  no  sign  of  the  agony  she  depicts, 
and  if  you  watch  her  you  find  she  overacts 
her  part.  She  is  entirely  indifferent  to  the 
anxiety  of  parents  or  friends  and  seems  to 
find  a  sort  of  pleasure  in  watching  those 
about  her  in  their  unwearied  efforts  to  com- 
fort her  and  minister  to  her  many  wants. 
These  cases  not  only  succeed  in  deceiving 
every  one  of  their  friends,  but  usually  end 
in  deceiving  themselves.  We  often  find 
some  disappointed  affection  or  ungratified 
whim  at  the  bottom  of   their  maligning. 

These  are  the  cases  that  a  decade  or  less 
ago  were  cured?  by  splaying — a  mutilation 
that  at  least  prevented  a  propagation  of 
their  kind.  They  are  also  the  stock  in  trade 
of  Christian  scientists.  The  treatment  will 
suggest  itself  from  the  following  story  of 
the  greatest  neurologist  of  the  day,  and  we 
may  add  whose  home  is  in  Philadelphia. 
A  very  wealthy  bed-ridden  case,  of  two 
years  standing,  was  brought  to  his  private 
hospital  for  treatment.  The  case  was  one 
of  false  neurasthenia.  On  her  absolute  re- 
fusal to  leave  her    bed    under    any  circum- 


THE  CHARLOTTE-  MEDICAL  JOURNAL. 


551 


stances  the  eminent  scientist  threw  a  lighted 
newspaper  under  her  bed  and  told  her  to 
burn  up  and  be  d — nd. 

She    left    the     hospital      cured     in     six 
weeks. 


RECENT  DISPENSARY  LEGISLATION, 

Through  the  untiring  efforts  of  Dr.  E.  E. 
Harris,  Chairman  of  the  Committee  on 
Legislation  of  the  New  York  .State  Medical 
Association,  a  bill  has  just  passed  the  legisla- 
ture regulating  the  conduct  of  dispensaries  in 
that  State.  The  agitation  looking  toward 
this  end  had  been  carried  on  in  a  more  or 
less  desultory  manner  for  a  number  of  years. 
Owing  to  lack  of  united  effort  and  the  dis- 
inclination of  any  one  to  give  up  their  entire 
time  to  the  matter,  no  relief  was  obtained. 
The  scornful  remark  made  by  a  prominent 
politician  that  "the  doctors  did  not  repre- 
sent anybody,"  certainly  was  a  factor  in 
bringing  about  an  united  effort  to  remedy 
the  dispensary  abuses.  As  a  consequence 
of  the  effort  made  to  pass  this  bill,  certain 
other  legislation  pertaining  to  the  medical 
profession  was  easily  secured,  and  several 
pernicious  measures  were  prevented  from 
becoming  laws.  Tin's  success  should  stim- 
ulate the  profession  to  greater  efforts  to 
secure  the  establishment  of  a  Department  of 
Health  in  the  National  Government. 


MEDICAL    LITERATURE. 

In  tliis  rapidly  moving  age  a  great  deal 
of  crude  material  is  necessarily  or  otherwise 
sent  forth  annually  from  our  schools  and 
colleges. 

The  demands  of  our  constantly  widening 
and  expanding  country,  which  is  so  rapidly 
increasing,  both  by  an  American  born  pop- 
ulation and  foreign  immigration  may,  to  a 
certain  extent,  excuse  the  hurry  with  which 
we  turn  out  our  medical  men  ;  not  by  any 
means  deficient  in  a  mass  of  facts  and  figures 
but  so  jumbled  together  as  to  require  the 
most  active  mind  and  vigorous  constitution 
to  digest  and  assimilate  them. 

But  we  are  young  and  vigorous  as  a  na- 
tion ;  we  are  untrammeled  by  theories  and 
impractable  ideas,  that  are  the  bane  of  older 
nations,  and  in  spite  of  earlier  disadvant- 
ages we  are  struggling  upward  to  a  medical 
standing  and  a  medical  literature  that  shall 
be  a  standard  for   the  xvorld. 

In  current  literature  we  lead  the  world  at 
the  present  time  ;  while  in  medical  litera- 
ture the  indications  grow  stronger  and 
stronger  every  day  that  foreigners  will  ere 
long  as  eagerly  seek  our  productions  as  we 
formally  sought  theirs.  We  are,  however, 
somewhat  deficient  in  our  periodical  medi- 


cal literature.  Is  it  the  fault  of  the  profes- 
sion, or  are  the  publishers  to  blame? 

Probably  both — the  publishers  in  some- 
times catering  to  some  special  drug  house, 
sanitarium,  hospital  or  medical  school ;  the 
profession  in  lacking  the  energy  and  indus- 
try to  record  their  observations  and  practi- 
cal experience  at  the  bed-side.  We  do  not 
mean  by  this  that  we  have  a  dearth  of 
writers — there  is  always  a  class,  with  no 
higher  motive  than  a  cheap  notoriety,  who 
are  always  rushing  into  print. 

But  we  refer  particularly  to  the  old  "war 
horses"  who  have  borne  the  brunt  of  many 
a  hard  fight,  men  who  have  not  had  the 
time  or  money  with  which  to  investigate 
abstruse  or  rare  subjects. 

The  modest  men  of  the  profession,  the 
men  of  experience,  whose  words  are  as 
"apples  of  gold  in  pitchers  of  silver." 
These  are  the  men  at  whose  feet  we  would 
sit  and  be  taught. 


"KNOWLEDGE      COHES,       BUT      WISDOM 
LINGERS." 

The  belief  in  primal  and  ultimate  good- 
ness is  universal.  Pessimism  that  doubts 
the  providence  of  nature  gets  no  hearing, 
and  he  who  announces  that  sort  of  infideli- 
ty is  self-exiled  from  the  common  aims  of 
humanity.  Worn  and  broken  in  the  per- 
sonal struggle,  and  bewildered  though  we 
may  be  by  futile  theologies,  we  yet  rest  in 
the  belief  that  the  universe  was  conceived 
in  good  and  the  power  that  made  it  will  not 
fail  to  bring  it  to  a  due  conclusion. 

Of  course,  we  each  have  our  specific  that 
we  would  like  to  apply  to  the  slow-moving 
"mills  of  God,"  for  life  is  but  a  span  and 
before  it  closes  we  would  use  the  talent 
that  is  in  our  keeping  and  rest  our  eyes 
upon  a  world  enriched  by  a  saving  knowl- 
edge of  tar-water,  Christian  science,  single 
tax,  or  uric  acid  diathesis. 

Now  and  again  a  word  is  spoken  that 
takes  its  place  among  the  cosmic  forces 
and  society  is  definitely  influenced  ;  life  is 
never  quite  the  same  after  that.  The  great 
poems  have  this  quality,  but  avowed  homi- 
letics  fail,  and  scientific  exposition  gets  but 
a  cold  hearing  when  it  seeks  to  impose  re- 
straint upon  human  conduct, 

Our  habits  in  regard  to  food,  clothing 
and  lodging  do  not  at  all  represent  our 
knowledge  of  sanitation  ;  we  live  in  hourly 
contradiction  of  such   knowledge. 

Our  civic  relations  are  no  better.  The 
man  who  burns  with  honest  patriotism  on 
the  Fourth  of  July  will  sell  his  vote  at  the 
next  election. 

We  have  developed  nothing  in  ethics    to 


552 


THE  CHARLOTTE  MEDICAL  JOURNAL 


match  the  splendid  achievements  in  the  arts 
and  sciences. 

And  now  we  think  of  it,  man  himself  is 
not  nearly  so  well  made  as  are  many  of  the 
animals  over  which  he  is  given  dominion  ; 
but  this  is  God's  world,  and  He  must  know 
how  to  fetch  it   along. 


KEEP  THE  BABY  WARH. 

Of  all  extrinsic  conditions  affecting  the 
viability  of  the  new-born  child  probably  that 
of  temperature  is  the    most   important. 

The  results  of  the  use  of  the  couveuse  in 
the  care  of  the  most  unpromising  class  of 
infants,  the  prematurely  born,  points  to  the 
inadvisability  of  the  immediate  bath. 

It  is  important  to  lessen  in  any  degree  the 
shock  to  which  the  new-born  child  must  be 
exposed  in  the  series  of  changes  that  take 
place  at  birth.  The  feeble  child  is  taxed  to 
the  utmost  to  maintain  the  functions  of  the 
heart  and  lungs.  The  cutaneous  irritation 
and  the  loss  of  heat  in  the  first  bath  must 
often  be  the  straw  too  much  in  the  case  of 
the  infants  that  succumb  soon  after  birth. 
To  defer  the  bath  for  twenty- four  hours 
should  be  the  rule  in  all  cases  and  for  a 
longer  time  than  that  in  the  case  of  the  pre- 
mature or  poorly  developed  child. 

Except  for  the  care  of  the  eyes  in  suspi- 
cious cases,  the  first  toilet  should  be  no  more 
than  the  washing  of  the  mouth  and  the  rapid 
cleansing  of  the  skin  with  oil,  which  is  a 
better  detersive  than  water,  and  it  adds 
something  to  the  nutrition  of  the  child. 

A  daily  bath  of  oil  would  be  of  great  im- 
portance in  the  care  of  delicate  children  be- 
fore the  secretion  of  the  mother's  milk  is 
established. 

To  maintain  the  animal  heat  and  to  keep 
up  nutrition  is  the  problem  to  be  solved  in 
the  care  of  the  infant  and  nothing  is  unim- 
portant that  helps  to  do  either.  The  cloth- 
ing should  be  of  the  simplest  kind  until 
after  the  circulation  is  well  established  in 
order  to  avoid  the  fatigue  and  exposure  of 
dressing. 

It  should  be  remembered  that  the  child 
has  suddenly  experienced  a  fall  of  about  30 
deg.  F.  in  its  surroundings. 


DIABETES    riELLITUS. 

Saundby  truly  says  of  diabetes,  "There 
is  probably  no  disease  which  is  so  over- 
weighted by  theoretical  consideration."  *  * 
The  striking  clinical  features  of  this  disease 
has  been  a  theme  for  medical  writers  from 
the  early  history  of  medicine.  The  term 
diabetes  occurred  in  150,  A.   D. 

Sydenham,  in  the  seventeenth  century, 
wrote,  "Let  the  patient  eat  food  of  easy 
digestion,    such    as     veal,   mutton  and  the 


like,  and  abstain  from  all  sorts  of  fruit  and 
garden  stuff."  Osier,  in  his  Practice  of 
Medicine,  quotes  this  injunction  and  says 
it  has  lost  none  of  its  force  to-day ;  yet 
there  is  not  wanting  much  strong  dissent, 
supported  by  evidence. 

The  tendency  to  uraemia  and  acetonemia 
in  diabetic  patients  on  the  meat  diet  has 
been  indisputably  shown.  It  is  just  as  easy 
to  prove  a  reduction  in  the  amount  of  the 
glycosuria  on  the  withdrawal  of  the  car- 
bohydrates from  the  diet ;  not  so  easy  to 
prove  a  corresponding  gain  in  the  well- 
being  of  the  patient.  Theoretically  the  dia- 
betic should  be  able  to  eat  the  fruits  con- 
taining levulose.  Practically  they  affect 
the  patient  just  as  unfavorably  as  do  the 
fruits  containing  dextrose. 

Leaving  theories  aside,  the  particular 
case  will  thrive  best  on  a  wisely-selected 
mixed  diet,  varied  from  time  to  time  with 
the  ability  of  the  organism  to  use  one  or 
the  other  class  of  foods.  The  freest  use 
possible  should  be  made  of  the  fats. 
Whether  a  given  case  is  susceptible  of  es- 
sential improvement  under  any  form  of 
treatment,  dietetic  or  therapeutic,  depends 
upon  the    type  of  the  disease  in  that  case. 

Diabetes  may  be  induced  experimentally 
by  several  unrelated  procedures.  Except 
for  the  mild  form  of  alimentary  glycosuria 
we  are  yet  in  the  dark  as  to  the  real  nature 
of  diabetes  mellitus  as  it  occurs  in  practice. 


We  regret  that  in  our  last  issue  the  very 
interesting,  original  article  by  Dr.  W.  Ross 
Thompson  was,  through  an  error  of  our 
press  foreman,  placed  in  the  wrong  depart- 
ment of  our  journal.  It  is  for  this  reason 
that  we  reproduce  it  in  present  issue, placing 
it  where  it  belongs  among  the  original  ar- 
cles. 


BOOK  REVIEWS. 

Chemistry:  General,  Medical  and  Pharmaceu- 
tical, including  the  Chemistry  of  the  U.  S. 
Pharmacopoeia.  By  John  Attfield,  F.  R.  S. 
New  (16th)  Edition.  In  one  Royal  12mo.  vol- 
ume of  784  pages  with  88  illustrations.  ( 'loth. 
$2.50,  net.  Lea  Brothers  &  Co.,  Philadelphia 
and  New  York. 

There  is  very  little  need  for  a  review  or 
an  introduction  for  a  work  which  has  reach- 
ed its  sixteenth  edition,  and  this  new  edition 
of  Attfield's  Chemistry  will  no  doubt  meet 
with  a  warm  welcome.  There  has  not  been 
a  book  published  within  the  past  thirty 
years  that  has  reached  the  great  popularity 
that  has  fallen  to  Attfield's  Chemistry.  It 
has  been  a  household  word  for  years  and 
years.  ,;  It  has  been  the  safe  and  trustworthy 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


55.-? 


guide  of  medical  and  pharmaceutical  stu- 
dents throughout  English  speaking  coun- 
tries, and  the  demand  for  edition  after  edi- 
tion from  year  to  year  made  it  possible  al- 
ways to  keep  the  work  strictly  up  to  date. 
The  present  edition  is  no  exception,  and  a 
comparison  with  the  previous  issue  will 
show  on  every  page  the  changes,  additions 
and  elisions  made  to  present  to-day's  status 
of  its  ever-developing  science.  This  work 
is  a  systematic  exponent  of  (he  science  of 
chemistry  written  mainly  for  pupils,  assis- 
tants, and  those  engaged  in  medicine  and 
pharmacy.  The  introductory  pages  are  de- 
voted to  a  few  leading  properties  of  the 
elements.  A  consideration  in  detail  of  the 
relations  of  the  elementary  and  compound 
I  radical  follows,  synthetical  and  analytical 
j  bearing  being  pointed  out,  and  attention 
frequently  directed  to  connecting  or  under- 
lying truths  or  general  principles.  The 
chemistry  of  substances  met  with  in  vege- 
tables and  animals  are  next  considered. 
Chemical  toxicology  and  the  chemical  as 
well  as  the  microscopical  character  of  mor- 
bid urine  arc  then  given.  The  concluding 
sections  form  a  laboratory  guide  to  begin- 
ners in  the  chemical  and  physical  study  of 
quantitative  analysis.  The  chemical  nota- 
tion and  nomenclature  of  the  work  are  in 
accordance  with  modern  views.  Both  the 
metric  and  avoirdupois  weights  and  meas- 
ures are  used.  There  are  many  other  points 
of  interest  which  might  be  discussed,  but 
space  will  not  permit.  In  conclusion,  he 
who  wishes  to  study  chemistry,  from  an  up 
to  date  standpoint,  will  certainly  accom- 
plish his  purpose  by  selecting  At t field's. 

Tlii'     International    Medical     Annual,   L899.    A 
Work  of  I leference  for  Medical  Practil Loners, 
(Alphabetically  arranged)  combines  the  fea- 
tures of  an  annual  retrospect  with  those  of   a 
Medical  Encyclopaedia,   copiously   illustrated 
with   elegant  plates,  in  colors  and  black   and 
white.     Bach  volume   contains   entirely   new 
Matter.     Price  in  cloth,  $3.00.     E.  B.  Treat  & 
Co.,  publishers,  241-243  West  St.,  New   York. 
We  have    before    this  expressed  our  ad- 
miration of  this  Annual    and    our    surprise 
at  its  comprehensiveness.      This,  the  seven- 
teenth   year  of  this     well-known    work,  is 
superior  in  excellence  to    any  of  its    prede- 
cessors.     It  is  larger  by  760    pages,    better 
illustrated,  15  full  page  colored  plates,   and 
12  full  half-tone  plates,  beside    numerous  il- 
lustrations in  the  text.      While  the   book    is 
condensed  very  carefully ,  yet  it  is  sufficient- 
ly explicit   to  gfve  a  clear  idea    of  the    sub- 
ject   presented.      Part  I.  considers    the  Dic- 
tionary    of      New      Remedies.      Part     II., 
which  is  by  far    the  greater  portion    of  the 
book,  is  devoted  to  New   Treatment.     The 


remaining  portion  is  devoted  to  pathogenic 
bacteria,  Legal  Decisions  and  Sanitary 
Science.  The  arrangement  of  the  work  is 
alphabetical,  and  with  its  complete  index, 
makes  it  a    reference    book   of  rare   worth. 

In  short,  the  "Annual"  is  what  it  claims 
to  be — a  recapitulation  of  the  year's  pro- 
gress in  medicine,  serving  to  keep  the  prac- 
titioner abreast  of  the  times  with  refer- 
ence to  the  medical  literature  of  the  world. 
The  price  of  the  book   is  $.^.00 

No  physician  can  afford  to  omit  this 
work  from  his  library,  as  he  will  find  it 
continually  of  the  highest  value  in  refer- 
ence and  in  obtaining  approved  and  suc- 
cesssful  modes  of  treatment.- 

The  Anatomy  of  the  <  entral  Nervous  System  of 
Man  and  of  Varieties  in  General.     By  Prof. 
Ludwig    Edinger,    M.    D.,   Frankfort-on-the- 
Main.      Translated    from    the    Fifth    German 
Edition    by   W infield  S.    Hall.    Ph.D.,  M.  D., 
Professor  of  Physiology  in  the  Northwestern 
Medical  School,  Chicago.    Assisted  by  Philo 
Leon    Holland,  M.  D.,    instructor  in    Clinical 
Neurology    in    the    Northwestern  University 
Medical    School,    Chicago,    and    Edward    P. 
Carleton.    B.  S.,   Demonstrator    of  Histologic 
Neurology   in   the   Northwestern    University 
Medical    School,    Chicago.      Illustrated   with 
258  Engravings.     6fx9-i  inches.     Pages  xi-446. 
Extra    Cloth,   $3.00.       The   F.  A.  Davis   Co., 
Publishers,  L914-16   Cherry  St..  Philadelphia. 
This  large  and  most  comprehensive  work 
is  divided   into  three  great  divisions.      Part 
I  is  devoted   to  an  introductory,  giving  the 
fundamental  ideas  accepted  at   the   present 
time.      It  takes  into  consideration  also  func- 
tion, which   was   not   considered   in   earlier 
editions. 

Part  II  is  devoted  to  a  Review  of  the  Em- 
bryology and  the  comparative  Anatomy  of 
the  Vertebrate  Brain. 

Part  III  is  devoted  to  the  special  Anato- 
my of  the  Mamalian  Brain,  with  special 
consideration  of  the  Human  Brain.  The 
work  closes  with  an  Index  of  Authors  ;  an 
Index  of  Corporative  Neurology  and  a  Gen- 
eral Index.  The  first  chapter  gives  a  fine 
review  of  the  history  and  the  methods  of 
investigation  of  the  central  nervous  system. 
"As  our  century  dawned  there  was  scarcely 
anything  of  importance  to  be  added  to  the 
gross  anatomy  of  the  organs  of  the  central 
nervous  system.  Little  progress  had  been 
made,  however,  in  what  we  must  now  re- 
cognize as  the  most  important  part  of  the 
morphology  of  the  central  nervous  system, 
namely,  in  the  knowledge  of  the  finer  rela- 
tions of  the  parts — of  the  course  of  the 
fibers."  The  above  is  a  section  taken  from 
the  first  chapter,  thus  showing  the  advance- 
ment made  up  to  the  present  time. 


554 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


In  each  chapter  the  complexity  of  the 
subject  is  made  plain.  There  is  no  one  who 
will  doubt  but  that  this  is  a  very  deep  sub- 
ject to  master,  and  he  who  views  and  studies 
this  work  will  readily  see  the  author  is  mas- 
ter of  his  subject.  This  somewhat  dry  sub- 
ject has  been  made  charmingly  interesting. 
The  illustrations,  diagrams  are  splendid  and 
assist  very  materially.  The  book  is  beauti- 
fully printed  on  fine  paper  and  concludes 
with  an  index  of  over  36  pages,  which  in 
itself  is  an  indication  of  the  care  with  which 
it  has  been  prepared. 

The  Principles  of  Bacteriology.  A  Practical 
Manual  for  Students  and  Physicians.  By  A. 
C.  Abbott,  M.  D.,  Professor  of  Hygiene  and 
Director  of  the  Laboratory  of  Hygiene,  Uni- 
versity of  Pennsylvania,  Philadelphia.  New 
(5th)  edition,  enlarged  and  thoroughly  re- 
vised. Handsome  12mo.,  585  pages,  109  illus- 
trations, of  which  26  are  colored.  Cloth,  $2.75. 
net  Philadelphia  and  New  York,  Lea  Broth- 
ers &  Co. 

This  book  is  recognized  to-day  as  the 
leading  text-book  on  Bacteriology.  Until 
recently  this  department  in  medicine  has 
been  sadly  neglected,  scarcely  an  allusion  to 
its  importance,  but  to-day  its  importance  is 
seen  by  its  being  in  the  curricula  of  all 
Medical  Colleges.  As  the  advances  went 
on  from  year  to  year  in  this  branch,  so  im- 
provements, additions  and  revisions  went 
on  in  this  work,  until  to-day  it  is  as  com- 
plete as  time,  energy  and  ability  can  make 
it.  The  author  presents  the  important 
ideas  and  methods  as  concisely  as  is  com- 
patible with  clearness  and  at  the  same  time 
to  accentuate  throughout  the  underlying 
principles  which  govern  the  work. 

The  reason  of  the  great  popularity  of  this 
work  is  made  clear  by  reading  its  pages. 
The  author  has  chosen  just  that  knowledge 
which  is  practically  important  to  the  stu- 
dent and  practitioner  and  has  presented  it 
with  an  unusual  clearness.  The  work  con- 
tains ample  instruction  for  laboratory  work. 
The  illustrations,  both  black  and  colored, 
are  excellent,  notwithstanding  that  much 
new  matter  has  been  added  and  the  book 
much  enlarged,  the  price  remains  the  same. 

An  Essay  on  The  Nature  and  Consequences  of 
Anomalies  of  Refraction.  By  F.  C.  Donders, 
M.  D.,  Late  Professor  of  Physiology  and  Oph- 
thalmology in  the  University  of  Utrecht.  Re- 
vised and  Edited  by  Chas.  A.  Oliver,  A.  M., 
M.D.,  (Univ.  Pa.)  Phil.:  P.  Blakiston's  Son 
&  Co,,  1012  Walnut  St.     1899.     Price,  $1.25. 

In  the  preface  of  this  book  it  is  stated  that 
the  Editor  has  not  attempted  in  any  way  to 
draw  a  comparison  between    the    author's 


and  his  own  thoughts  and  beliefs  on  the 
subjects  treated  in  this  volume.  It  has  been 
his  sole  desire  to  give  a  great  man  greater 
honor,  and  to  offer  such  a  man's  work  an 
increased  amount  of  usefulness.  It  is  re- 
markable that  this  man's  work  should  have 
so  much  real  truth  in  it,  and  that  his  deduc- 
tions should  be  so  certain  of  application  to 
newly  acquired  facts  that  were  unknown 
at  the  time  he  gave  his  results  to  the  physio- 
logic world.  The  little  work  is  beautifully 
gotten  up,  handsomely  bound,  and  printed 
on  elegant  white  paper, 

Maisch  \s  Materia  Medica — New  (7th)  Edition. 
A  Manual  of  Organic  Materia;  Being  a  Guide 
to  Materia  Medica  of  the  Vegetable  and  Ani- 
mal Kingdoms.  For  the  use  of  Students, 
Druggists,  Pharmacists  and  Physicians.  By 
John  M.  Maisch,  Phar.  D.,  Professor  of  Mate- 
ria Medica  and  Botany  in  the  Philadelphia 
College  of  Pharmacy.  New  (7th)  Edition, 
thoroughly  revised  by  H.  C.  C.  Maisch,  Ph. 
G.,  Ph.  D.,  Professor  of  Materia  Medica  and 
Botany  in  ihe  Medico-Chirurgical  College  of 
Philadelphia,  Department  of  Pharmacy.  In 
one  very  handsome  12mo.  volume  of  512  pages, 
with  285  engravings.  Cloth,  $2.50,  net.  Lea 
Brothers  &  Co.,  Publishers,  Philadelphia  and 
New  York. 

Maisch's  Materia  Medica  has  long  enjoy- 
ed the  position  of  a  standard  text-book 
throughout  the  Colleges  of  Pharmacy  of 
this  country.  This,  the  seventh  edition, 
comes  to  us  thoroughly  revised,  enlarged, 
and  incorporates  all  recent  advances,  and 
introduces  such  substances  as  have  attained 
medical  importance  since  the  last  issue. 

This  work  is  divided  into  Part  I,  which 
considers  Animal  Drugs.  Under  this  sec- 
tion is  considered  animals,  eggs,  anastomo- 
sing fibrous  tissue,  membranous  tissue  and 
gelatins.  Secretions  and  excretions  and 
calcareous  skeletons  and  concretions.  Part 
II  treats  of  Cellular  Vegetable  Drugs.  Be- 
gins with  Roots  and  closes  with  Cellular 
Drugs  not  readily  recognized  as  distinct 
organs  of  plants.  Part  III  considers  Drugs 
without  cellular  structure  ;  beginning  with 
extracts  and  inspissated  juices  and  closing 
with  fixed  oils  and  waxes.  This  work  ena- 
bles us  to  recognize  drugs,  determine  their 
quality,  detect  their  adulteration, and  to  dis- 
tinguish the  characteristic  elements  of  those 
which  are  closely  allied.  The  author  touches  j 
but  slightly  upon  medical  properties  and  j 
doses  of  various  drugs  and  the  treatment  of 
poisoning  from  excessive  doses  of  poisonous 
drugs.  This  work  fulfills  every  require- 
ment of  a  work  of  this  nature.  The  illus- 
trations are  many  and  fine.  The  printing 
clear,  and  binding  substantia]. 


THE  CHARLOTTE  MEDICAL?JOURNAL. 


555 


Saunders'  Medical  Hand-Atlases,    Atlas  of  the 
External   Diseases   of  the   Eye,  Including    a 
brief  Treatise   on    the   Pathology  and  Treat- 
ment     By  Prof.  Dr.  O.  Hoab,  of  Zurich,  Au- 
thorized Translation  from  the  German.     Edi- 
ted by  G.  E.  deSchweinitz,  A.M.,M.  D.,  Prof, 
of  Ophthalmology    in    Jef.    Med.   Col.,    Phil. 
With  76  colored  plates.     Philadelphia:  W.  B. 
Saunders.     1899.     Price,  $3.00,  net. 
Saunders'  Hand-Atlases  are   growing  in 
popularity  every  day.      Their  utility  from  a 
practical  and  clinical  standpoint  is  the  cause 
of  so  great  a  success.      This  volume,  along 
with   the    preceding   Atlases,  will    prove  a 
thoroughly   practical   manual   for  the  every 
day  use  of  the   practising   physician.      The 
author  begins    with  the    examination  of   the 
teye,  with  functional  testing,  the    student  is 
'easily  and  gradually  led  from  one  examina- 
tion to  another  until  at  t he  close  the  reader 
I  almost  feels  he  has  been  to  a  clinic.     Follow- 
ing this  are  the  chapters  on  the   diseases  of 
ithe  eye,  the    most    important    of  which    are 
ivery  clearly  described,  and  the  best  thera- 
peutic measures  given. 

The  work  contains  an  admirable  series  of 
plates  to  which  is  appended  a  brief  clinical 
I  history  which  beautifully  illustrates  the  text. 
A  good  index  closes  the  volume. 

David  Harum,  A  Story  of  American  Life.  By 
Edward  Noyes  Westcott.  New  York :  D. 
Applet0U'&  Company.  1899. 
This  is  the  most  readable  book  that  has 
been  written  in  many  years.  It  is  not  only 
full  of  genuine  interest  from  beginning  to 
end,  but  it  also  contains  more  common 
sense,  real  "boss"  sense  than  any  book  we 
have  read.  The  reader  has  only  to  begin 
the  book,  and  he  will  be  certain  to  finish  it. 
It  is  a  model  book,  a  gem.  The  character, 
David  Harum,  is  perfectly  splendid.  The 
rich,  uncouth,  seemingly  selfish  and  hard- 
hearted, though  quite  the  reverse,  old 
banker,  is  the  prominent  character  in  the 
work.  "The's  as  much  human  nature  in 
some  folks  as  the'  is  in  others,  if  not  more" 
—  Das  id  Harum.  "Do  unto  the  other  fel- 
low the  may  he'd  like  to  do  unto  you — an' 
do  it  fust."  These  are  two  trite  sayings  of 
David  Harum.  David  Harum  was  not  only 
a  rich  liberal-hearte.'  banker,  but  he  was 
| the  best  horseman,  the  best  judgeof  a  horse, 

Ithe  best  horse  trader  in  Homeville,  his  na- 
tive village.  His  one  prevailing  theme  was 
the  "/loss."  John  Lenox  is  also  a  fine 
•  character.  He  was  David's  trusted  and 
►  confidential  banking  clerk.  The  mutual 
attachment  and  fondness  that  grew  between 
|John  Lenox  and  David  Harum  was  very 
igreat.  The  sign  that  hung  before  Harum's 
Bank  before  John  became  his  clerk  was 
simply  David  Harum,  Banker.      Under  the 


successful  management  of  the  affairs  by 
John  Lenox — the  sign  afterwards  read, 
Harum,  Lenox  &  Co.,  Bankers.  Through- 
out the  book  runs  a  most  beautiful  love 
story,  and  John  Lenox  is  the  leading  man. 
For  pleasure,  for  recreation,  for  edification, 
for  valuable  suggestions  and  information 
we  beg  every  physician  to  read  David 
Harum.  It  is  tastefully  and  prettily  print- 
ed and  bound  by  D.  Appleton  &  Co. 

A  Practical  Hand-Book  on  the  Muscular  Anoma- 
lies of  the  Eye,  bj  Howard  H.  Hansell,  A.  M., 
M.  P.,  and  Wendell  Reber,    M.    D.,   28  illus- 
trations and  1  plate.    Philadelphia:  P.  Blakis- 
ton's  Son  &  Co.,  1012,  Walnut  St.,  1899. 
This  work  will  serve  a  most    useful    pur- 
pose to  beginners  in   ophthalmic  work.      It 
presents  the  principal  facts  in  the  diagnosis 
and  treatment  of  abnorml  states  of  the  eye- 
muscles.      It    is    an    elaboration  of  a  short 
series  of  lectures    delivered    in     successive 
winter  courses    at    the   Philadelphia    Poly- 
clinic.     The     authors  have     clothed     their 
thoughts   in    language    easily    understood ; 
they  have    avoided    discussions  and  specu- 
lations;  have  employed  methods  that   have 
stood  the  test  of  their  own  experience,  and 
without  giving  the  volume  the   proportions 
of  a  book  of  reference  have  omitted  no  im- 
portant data  that  have  been    recognized    as 
trustworthy. 

Relinoscopy  (or  Shadow  List)  in  the  Determina- 
tion of  Refraction  at  one  meter  Distance,  with 
Phone   Mirror,  by   James  Thorington,  M.  P. 
Third  Edition,  Revised  and  Enlarged.   Forty- 
three   Illustrations,  twelve  of  which  are  col- 
ored.    Philadelphia:      P.    Blakiston's   Son  & 
Co.,  1012  Walnut  St.     1899.     Price,  $1.00. 
This  little   work  contains  84  pages  with 
a   good   index.     It   elucidates  in  as  concise 
a  manner  as  possible,  the  method  of  apply- 
ing   relinoscopy     which     has    given    most 
satisfaction  at  the  author's  hands.      It  not 
only  can  be  used  with  advantage  by  college 
students  and  post-graduates  but  there  is  also 
in  it  ample  material  given  whereby  the  oph- 
thalmologist  at   a  distance  may  acquire   a 
working    knowledge    of     the     method,    by 
study  and  practice  in  his  own  office.       The 
volume  is  neatly  printed  and  bound. 

Practical  Materia  Medica  for   Nurses   with   an 

Appendix,  by  Emily  A.  M.  Strong,   Graduate 

of  the  Training  School  for  Nurses,  Lawrence, 

Mass.,  &c.    Philadelphia:  W.  B.  Saunders,  925 

Walnut  St.,  1899.     Price  $1.50. 

The  first  part  of  this  book  is    devoted    to 

the  general  consideration  and    classification 

of  drugs.      Under  this  head  is  given   Local 

Remedies;    the    six   principal     avenues     of 

medication ;      Absorption    of     Medicines ; 


556 


THE  CHARLOTTE   MEDICAL  JOURNAL. 


Dosage.  Under  the  head  of  Classification 
of  Drugs  is  given  alteratives,  anaethesis,  &c. 
The  second  part  is  devotsd  to  the  subject 
matter  proper,  the  Materia  Medica.  Each 
drug  is  very  briefly  and  concisely  tested, 
with  the  proper  dose  and   uses. 

The  third  part  or  appendix  contains 
poison-emergencies,  poisons  and  their  anti- 
dotes, emetics,  mineral  waters,  weights  and 
measures,  dose-list,  glossary,  &c.  The 
doses  of  all  drugs  have  been  given  in  both 
the  apothecaries  and  metric  weights.  The 
book  contains  306  pages  with  a  neat  sub- 
stantial binding. 

Surgical  Nursing-.  By  Bertha  M.  Voswinkel, 
Graduate  of  Episcopal  Hospital, Philadelphia. 
&c.  Second  Edition,  Revised  and  Enlarged, 
with  112  Illustrations.  Phil.:  P.  Blakiston's 
Son  &  Co.,  1012  Walnut  St.  1899.  Price,  $1.00. 

Those  who  wish  to  become  familiar  with 
the  art  of  nursing  can  do  so  by  purchasing 
this  book  at  the  nominal  sum  of  $1.00.  It 
gives  a  concise  and  clear  outline  of  surgical 
nursing  in  general,  together  with  a  list  of 
antiseptic  agents,  the  mode  of  preparation 
of  the  various  materials  used  in  antiseptic 
and  aseptic  surgery,  and  the  application  of 
splints  and  fixed  dressings.  Under  each 
chapter  where  it  is  necessary  will  be  found 
excellent  illustrations.  It  is  neatly  printed 
and  nicely  bound,  and  is  a  very  practical 
and  useful  book. 

Gerrish's  Anatomy  by  American    Authors. 

Gerrish's  forthcoming  Anatomy  by 
America)/  Authors  promises  to  be  the  work 
for  which  teachers  and  students  have  long 
been  looking.  Its  editor,  Prof.  F.  H.  Ger- 
rish,  of  Portland,  has  selected  as  his  fellow- 
contributors  leading  anatomists  throughout 
the  country,  wisely  restricting  their  num- 
ber to  accord  with  the  best  division  of  the 
subject,  gaining  thereby  unity  in  result 
joined  with  the  highest  authority.  The  list 
includes  Professors  Bevan,  of  Rush,  in 
Chicago, Keller,  of  the  University  of  Texas, 
McMurrich,  of  the  University  of  Michi- 
gan, Stewart,  of  the  University-Bellevue 
College  in  New  York,  Woolsey,  of  Cornell 
Medical  College,  likewise  in  New  York, and 
Gerrish  himself,  who  is  not  only  editor,  but 
perhaps  the  largest  contributor. 

The  plan  of  the  work  judiciously  avoids 
the  unimportant  and  exceptional,  reserving 
its  space  for  those  portions  of  anatomical 
knowledge  which  are  necessary  to  the  in- 
telligent study  of  physiology,  surgery  and 
internal  medicine.  The  authors  have  en- 
deavored to  stand  in  the  place  of  a  living 
teacher  to  the  student,  selecting  such  por- 
tions as  will  be  of  actual  service  to  the  pu- 
pil in  his  study  and  to    the    practitioner    in 


his  subsequent  clinical  work,  clarifying 
obscurities,  giving  most  difficult  parts,  and 
illustrating  everything  by  all  available 
methods.  Pictorially  Gerrish's  Anatomy 
will  be  by  far  the  most  lavish  work  ever  of-  : 
fered  on  a  subject  which  can  already  boast  ; 
of  many  elaborately  illustrated  text-books. 
The  engravings  number  about  one  thousand, 
their  size  is  large  enough  to  make  visible 
every  detail,  colors  have  been  employed 
more  liberally  than  ever  before,  and  lastly 
the  labels  of  the  parts  have  been  conspicu- 
ously engraved  upon  them  whereby  a  glance 
gives  hot  only  their  names  but  also  their 
position,  extent  and  relations,  obviating  en- 
tirely the  slow,  toilsome  and  wasteful  men- 
tal processes  necessitated  where  only  refer-  \ 
ence  letters  are  employed. 

In  an  early  issue  we  shall  give  our  rea- 
ders a  review  of  the  book  itself. 

Transactions  of  The  American  Pediatric  So- 
ciety, Tenth  Session,  held  in  Cincinnati  June 
12th  and  13th,  1898,  with  an  Index  of  Vols.  I 
to  x,  Edited  by  Floyd  M.  Cransdall.  M.  D.. 
Vol.  x:  Repiiuted  from  The  Archives  of 
Pediatrics,    1898. 

The  papers  presented  at  this  Society  are 
very  fine.  The  collective  investigation  on 
infantile  scurvy  in  North  America  is  an  in- 
teresting and  valuable  synopsis  and  will  be 
well  worth  any  physician's  time  to  read  it. 
The  «ubject  of  milk  used  in  infant  feeding 
is  also  a  valuable  and  suggestive  article  by 
Freman.  Many  other  most  excellent  pa- 
pers are  found  in  the  volume.  L.  Emmett 
Holt  is  President  and  Samuel  S.  Adams  is 
Secretary.  The  volume  is  neatly  printed 
and  nicely  bound. 

Transactions   of  the  American   Surgical   Asso-    ; 
ciation.     Volume   the   Sixteenth.     Edited  by   j 
De  Forest  Willard,,  A.  M.,  M.  D.,  Phil. 
This  volume  contains  an  excellent  portrait   ; 
of    Dr.     Hayes     Agnew     as     frontispiece. 
These  transactions  form  an  elegant  volume    1 
of  over  300  pages,  and  are  filled  with  mate- 
rial  of   the    very  highest  order.     The    men    1 
who   govern    this   society    are    the    leading 
lights  of  the  world  and  as  a   natural  conse- 
quence   their   writings   are    highly    prized. 
William  W.  Keen,  A.M,,  M.D.,  LL.D,,  is 
President,  and  Herbert  Burwell,  M.  D.,  is 
Secretary. 


LITERARY   NOTES. 

"Princess   Nadine,"   by  Christian   Reid,  j 

the    complete    novel    in    the    May  issue  of  I 

Lifpiucotf  s  Magazine,  appeals  strongly  to  ! 

every  lover  of  romance.      The  introduction  | 

of  the  Russo- American  Princess  at  the  Mi-  | 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


557 


Careme  and  Battle  of  Roses  at  Nice, where 
she  is  fittingly  framed  by  a  pink-tinted  sea- 
shell  of  roses,  and  where  she  is  seen  for  the 
first  time  by  a  wealthy  Central  American, 
who  is  to  influence  her  after-life,  surely 
compels  attention.  That  this  man,  whose 
indifference  to  the  fair  sex  is  exceptional, 
should  imperil  his  life  for  her  seems  but 
natural,  as  we  see,  combined  with  the 
charming  personality,  a  character  unspoiled 
by  adulation;  sympathetic,  faithful,  and 
brave.  The  story  can  be  said  truly  to  be 
among  the  best  work  of  this  popular 
writer. 


The  American  monthly  Review  of  Re- 
views of  May  devotes  considerable  space  to 
a  survey  of  recent  developments  in  Ameri- 
can cities.  The  editor  comments  on  the 
re-election  of  Mayor  Carter  Harrison  in 
Chicago,  on  Mayor  Jones'  remarkable  tri- 
umph in  Toledo,  on  the  Detroit  project  of 
the  municipal  ownership  of  the  street  rail- 
ways, and  on  the  general  situation  in  Bos- 
ton, San  Francisco,  Minneapolis,  Cleve- 
land, Denver,  St.  Louis,  Philadelphia, 
jntttsburg,  and  New  York.  Dr.  Shaw  also 
contributes  a  special  stiulv  of  the  new  .San 
Francisco  charter — a  remarkable  document 
in  its  way,  and  Mr.  George  E.  Hooker 
gives  some  interesting  facts  about  Mayor 
Quincy's  administration  of   Boston. 


Scribner's  Magazine  for  May  has  secured 
from  Major-General  Leonard  Wood,  the 
military  governor  of  Santiago,  the  first  offi- 
cial account  of  the  great  work  which  has 
been  accomplished  in  that  province.  It  is 
practically  the  making  of  a  State  by  a  mili- 
tary dictator,  all  of  whose  purposes  are  ben- 
evolent, ami  who  has  no  legislature  or  other 
authority  to  consult — deriving  his  power 
directly  from  the  President  of  the  United 
States.  General  Wood's  narrative,  which 
is  the  only  thing  that  he  has  written,  is 
marked  by  a  forcible  directnessjind  mod- 
esty in    telling  of    the  things  accomplished. 

The  way  in  which  the  city  was  cleansed, 
the  indigent  relieved,  the  streets  repaved, 
schools  established,  and  all  of  the  machin- 
ery of  a  civilized  government  instituted,  is 
a  remarkable  record  of  achievement  in  mil- 
itary government.  The  illustrations  con- 
trast the  old  Santiago  witli  the  new,  and 
show  the  work  of  regeneration. 

The  leading  characteristic  of  The  Forum 
during  the  thirteen  years  of  its  existence 
has  been  its  impartial  discussion  of  ques- 
tions of  the  day.  The  May  number  admir- 
ably illustrates  this  feature  by  the  presenta- 
tion of    two  articles  on    the  Trust  problem. 


Aldace  F.  Walker,  formerly  an  Interstate 
Commerce  Commissioner,  and  now  chair- 
man of  the  Atchison,  Topeka  and  Santa  Fe 
Railway  Company,  writes  on  "Anti-Trust 
Legislation;"  and  Wilhelm  Berdrow,  the 
eminent  German  economist,  discourses  on 
"Trusts  in  Europe."  The  temperate  tone 
of  these  papers  is  excellent  ;  and  they  form 
a  valuable  contribution  to  the  discussion  of 
this  burning  question. 


The  authorship  of  the  Etchingham  Let- 
ters, which  has  been  running  anonymously 
as  a  serial  in  The  Living  Age  since  the  first 
of  January,  is  now  disclosed.  The  letters 
are  the  joint  work  of  Mrs.  Fuller  Maitland 
and  Sir  Frederick  Pollock,  a  combination 
which  goes  far  to  account  for  their  range 
and  cleverness.  The  publication  in  The 
Living  Age  is  by  a  special  arrangement 
with  the  authors.  The  Letters  will  soon  be 
published  in  book  form. 

MISCELLANEOUS. 


Board  of  Medical  Examiners. 

The  Board  of  Medical  Examiners  of  the 
State  of  North  Carolina  will  meet  in  Ashe- 
ville,  N.C., Thursday  afternoon,  May  25th, 
C899  ;  all  applicants  are  urged  to  be  present 
at  this  time  to  register  and  be  ready  for  ex- 
amination on  the  following  morning. 
Thos.  E.  Anderson,  M.  D., 

Sec.  Board  Med.  Ex.,  Statesville,N.C 


Malaria. 

Thayer  says  :  Malarial  fever  is  a  specific, 
infectious  disease,  due  to  parasites  which 
exist  in  the  blood  of  the  infected  individual 
in  great  groups  and  give  rise  to  paroxysms 
at  the  periods  of  their  sporulation. 

There  are  three  varieties  of  malarial  par- 
asites— one  associated  with  quartan  fever, 
one  with  tertian,  and  one  with  paroxysms, 
which  occur  usually  about  forty-eight  hours 
apart,  but  occasionally  at  more  frequent  in- 
tervals, while  often  the  fever  is  irregular  or 
continued — the  estivo-autumnal  parasite. 

Either  of  the  first  two  varieties  of  para- 
sites may  also  give  rise  to  quotidian  fever, 
owing  to  the  presence  of  multiple  groups  of 
organisms  undergoing  sporulation  on  suc- 
cessive days. 

The  paroxysms  in  infections  with  the  ter- 
tian and  quartan  parasites  are  usually  reg- 
ularly periodical  in  their  time  of  onset.  In 
infections  with  the  estivo-autumnal  organ- 
ism they  are  often  irregular  and  associated 
with  continued   fever. 

We  do  not  know  how    the  parasites   live 


558 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


outside  of  the  body,  or  how  infection  takes 
place. 

Experiments  tend  to  show  that  it  is  im- 
probable that  infection  occurs  through  the 
gastro-intestinal  tract.  It  is  possible,  though 
not  proven,  that  it  may  occur  through  the 
respiratory  apparatus  or  through  the  skin, 
being  introduced  by  the  bites  of  insects, 
especially  the  mosquito.  By  analogy  with 
the  course  of  events  in  similar  infections  in 
birds,  it  is  highly  probable  that  the  mos- 
quito may  play  the  part  not  only  of  an  in- 
termediate host  of  the  malarial  parasite,  but 
also  of  a  direct  transmitter  of  the  infection 
from  one  individual  to  another. 

Quinine,  properly  administered,  is  a  true 
specific  against  the  disease. 

Relapses  may  occur  after  weeks  or  months, 
but  they  are  in  turn  amenable  to  treatment. 


How  to  Limit  the  Over-Production  of  De- 
fectives and  Criminals. t 

Upon  the  solution  of  this  problem  hangs 
the  fate  of  home,  nation,  and  civilization. 
It  is  the  concern  of  all  good  citizens  to  do 
something  to  improve  posterity.  During 
the  past  ten  years  the  population  of  the 
United  States  has  increased  25  per  cent., 
but  during  the  same  period  crime  increased 
60  per  cent.  The  cost  to  the  public  for  the 
care  of  defectives  and  for  the  prosecution 
and  support  of  criminals  is  enormous,  to 
say  nothing  about  the  destruction  of  life 
and  property,  confidence  and  morality.  We 
go  on  building  asylums,  hospitals,  reforma- 
tories and  prisons,  and  we  keep  them  full. 
Imbecility,  idiocy,  insanity,  epilepsy,  deaf- 
ness, blindness,  incorrigibility,  youthful 
waywardness,  adolescent  vice,  immorality, 
and  adult  criminality  multiply  apace  in  the 
land.  It  is  high  time  to  improve  the  method 
of  preventing  over-production  of  defectives 
and  criminals.  We  are  too  prone  to  assail 
results  or  salve  over  the  surface  of  our  so- 
cial sore,  leaving  the  roots  untouched.  No 
one  can  afford  to  ignore  this  subject.  It 
concerns  every  taxpayer,  and  every  one 
who  makes  his  own  living  is  a  taxpayer, 
whether  he  own  real  estate  or  not.  The 
problem  consists  of  prevention,  reformation 
and  extinction.  The  basic  causes  of  crime 
must  be  attacked. 

The  ancient  uncivilized  nations  knocked 
their  old  men  and  old  women  in  the  head ; 
strangled  the  superfluous  babes  between 
thumb  and  finger  or  left  them  to  perish 
upon  the  mountainside;  and  threw  their 
defectives  into  the  water  or  fed  them  on  the 
juice  of  the  poppy  as  a  less  brutal  means  of 

tDr.  J.  H.  McCassy,  Dayton,  Ohio.  Abstract 
from  Journal  of  Amer.  Med.  Association. 


effecting  their  exit  from  this  world.  Crim- 
inals among  inferior  peoples  are  compara- 
tively fewer  and  are  not  dealt  with  tender- 
ly. A  dose  of  tomahawk  ends  their  career. 
They  are  little  or  no  tax  upon  the  public, 
and  they  are  very  little  in  evidence.  The 
lower  stratum  of  development  in  savagery 
and  barbarism  produces  comparatively 
fewer  defectives  than  do  the  enlightened 
and  educated  strata.  While  the  highest 
types  of  individual  and  national  growth, 
power,  education  and  excellence  are  attain- 
ed in  our  modern  social  development,  never- 
theless, the  wayside  is  strewn  with  failures; 
although  defectives  and  criminals  are  large- 
ly bred  from  the  same  classes,  a  great  many 
recruits  come  from  families  of  high  stand- 
ing. It  is  not  necessary  to  scan  very  far 
along  even  good  family  lines  until  you  come 
to  a  stray  sheep,  and  often  a  black  one  at 
that.  A  defective  and  a  genius  may  be 
found  in  the  same  family. 

The  Roman  and  the  Greek  laws  did  not 
bother  much  with  moral  improvement.  The 
best  test  of  modern  civilization  is  shown  by 
the  way  the  defectives  are  treated.  Society 
admits  that  the  criminal  has  some  rights 
which  it  is  bound  to  respect ;  and  not  the 
least  of  these  is  the  right  to  reform.  The 
defectives  must  be  cared  for  in  the  most 
humane  and  conservative  manner.  Barbar- 
ism and  brutality  are  not  economical  for 
up-to-date  nations. 

PSYCHOLOGY     OF    CRIME. 

Although  criminal  offenses  appear  to  be 
spontaneous  and  impulsive,  yet  if  they 
could  be  traced  they  would  be  found  to  be 
due  to  a  variety  of  causes.  Modern  science 
teaches  that  nothing  happens.  Everything 
that  comes  to  us  is  pushed  from  behind.  In 
society,  as  organized  at  present,  there  are 
constantly  at  work  forces  which  germinate 
crime  and  disorder.  Seven  thousand  mur- 
ders take  place  annually  in  the  United 
States.  Ninety  per  cent,  of  the  reading 
matter  upon  which  the  community  feeds 
tends  to  disintegrate  character  and  bring 
disorder  and  abnormity  into  prominence. 
Our  daily  and  weekly  papers  are  devoted 
largely  to  illustrating  crime  and  immorality. 
The  sediment  left  after  the  reading  of  mur- 
ders, suicides,  thefts,  and  immoralities, 
poisons  the  youthful  minds  and  leaves  in- 
delible scars  upon  their  tender  souls.  All 
pictures  thrown  upon  the  mental  canvas 
modify  their  recipient  accordingly  as  they 
are  good  or  evil.  Persons  are  swayed  by 
the  character  of  the  pictures  before  which 
they  linger.  The  scientific  way  to  destroy 
evil  is  not  to  hold  up  and  analyze  it  in  order 
to  make  it  hateful,  but  rather  to  let  it  pass 
out  of  consciousness.      If   we  hope  for  im- 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


559 


provement  in  the  generation  unborn  we 
must  dull  the  appetite  for  "blood-and-thun- 
der"  fiction.  It  is  useless  to  ask  the  pub- 
lisher? to  abandon  a  paying  business.  By  a 
crusade  of  education  against  vice,  we  must 
lift  the  minds  of  our  generation  above  the 
present  demand  for  sensational  reading 
matter. 

All  education,  physical,  mental  or  moral, 
is  primarily  a  cultivation  of  powers  of  re- 
sistance. Cares,  anxieties,  business  and 
social  difficulties  prey  upon  the  mind;  and 
if  they  are  not  repelled  insanity  is  the  re- 
sult. Depraved  natural  appetites,  if  unre- 
stricted, result  in  crime.  We  guard  against 
physical  disease  by  building  up  the  tissues 
and  selecting  healthful  environment.  We 
guard  against  mental  disease  by  educating 
the  mind  and  avoiding  pursuits  that  bring 
excessive  intellectual  strain  and  dissipation. 
We  may  guard  against  crime  by  educating 
the  higher  ethical  sense  and  by  removing 
the  temptations  to  wrong-doing.  Certain 
mental  equipments  are  suitable  for  certain 
occupations.  When  a  person  selects  proper 
pursuits  in  life  success  and  happiness  will 
likely  follow,  hut  a  wrong  selection  brings 
misery  and  crime.  There  came  to  my  no- 
tice a  case  which  illustrates  one  phase  of 
this  subject.  Two  brothers,  many  of  whose 
relatives  had  gone  insane,  started  to  study 
medicine.  The  strain  on  both  to  keep  up 
with  the  class  was  great.  When  they  were 
bearing  the  end  of  the  second  term,  one  of 
them  went  hopelessly  insane.  The  other 
studied  the  literature  of  his  case,  and  when 
he  found  inherited  insanity  in  his  family 
history  he  concluded  to  abandon  further 
study  of  medicine.  He  went  to  farming 
and  made  a  great  success  in  raising  cattle 
and  hogs.  lie  said  that  the  nearer  he  got 
to  the  simple  ways  of  living  the  better  he 
felt.  He  became  a  good  and  prosperous 
farmer. 

The  criminal  differs  from  the  normal  be- 
ing in  the  fact  that  he  has  less  power  of  re- 
sisting crime.  We  all  have  the  criminal 
tendency  more  or  less,  but  it  is  suppressed 
by  cultivating  higher  instincts.  If  the  child 
of  the  criminal  is  allowed  to  grow  up  under 
the  tutorage  of  crime  he  will  be  a  criminal. 
If  the  same  child  is  brought  up  in  a  good 
family,  the  results  will  be  better.  It  will 
not,  however,  do  to  depend  too  much  on 
environment.  Favorable  environment  will 
overcome  imbred  propensities  to  a  certain 
extent,  but  in  many  cases,  where  there  is 
too  much  to  overcome,  the  over-mastering 
criminal  propensities  will  land  the  unfor- 
tunate victim  outside  of  the  pale  of  good 
organized  society.  In  this  fact  lies  the 
great  responsibility  of  childless  families  in 
procuring  recruits  from  the  Orphans'  Home. 


Years  of  unremitting  toil  and  loving  care 
may  be  reduced  to  naught  by  the  explosion 
of  their  inheritance  of  vice.  Take,  for  ex- 
ample, Bessie  Little,  of  Dayton,  Ohio,  who 
was  taken  from  the  Orphans'  Home  and 
reared  in  a  good  family.  .She  got  along 
very  well  until  she  reached  full  maturity. 
Then  her  born  erratic  tendencies  and  insa- 
tiable egotism  took  possession  of  her.  She 
loved  Franz,  her  slayer,  in  his  presence  and 
hated  him  in  his  absence,  because  her  judg- 
ment was  dethroned  by  her  passions.  In 
this  case  the  best  environment  was  inade- 
quate to  overcome  her  inheritance  of  vice  ; 
she  broke  down  and  became  a  criminal. 

Heredity  is  nearly  everything.  "Blood 
will  tell,"  and  blood  does  tell.  A  born 
idiot  can  never  be  more  than  an  idiot,  but 
these  form  only  a  very  small  percentage  of 
the  defectives.  Of  all  the  streams  of  evil 
that  flow  into  the  national  blood  none  is 
more  virulent  than  that  of  imbecility.  It  is 
the  legitimate  offspring  of  the  jail,  the  in- 
firmary and  the  insane  asylum.  What  a 
remarkable  lesson  there  is  in  the  case  of 
Max  Jukes  of  New  York  State.  He  was  a 
Dutch  settler,  born  about  1740,  a  hunter 
and  fisherman.  He  was  a  great  drunkard, 
and  the  progenitor  of  1200  persons,  nearly 
all  criminals,  vagabonds,  paupers  and  pros- 
titutes. In  seventy-five  years  the  descend- 
ants of  Jukes  committed  115  criminal  offen- 
ses. Not  more  than  20  of  them  were  skill- 
ed workmen,  and  ten  of  these  learned  a 
trade  in  prison.  This  family  cost  the  State 
of  New  York  one  million  dollars.  Crime, 
imbecility  and  insanity  are  due  in  60  to  75 
per  cent,  of  cases  to  heredity.  We  do  not 
expect  to  entirely  eliminate  bad  blood  from 
the  race,  but  that  we  can  greatly  lessen  it  is 
both  possible  and  probable. 

Insanity  is  much  more  prevalent  among 
the  Quakers  or  Friends  than  any  other  reli- 
gious sect,  perhaps,  because  of  their  sadness 
and  gloom  in  religious  worship.  Insanity 
is  less  prevalent  among  the  colored  people 
than  any  other  race,  because  of  their  simple 
wants  and  happy  disposition.  The  general 
causes  of  insanity  are  :  heredity,  50  to  60 
percent.;  whisky,  12  percent.;  religious 
perversion,  10  per  cent.  ;  disappointment 
in  love,  10  per  cent.  Eighty  per  cent,  of 
drunkenness  is  due  to  heredity;  alcohol 
causes  33  per  cent,  of  the  diseases,  75  per 
cent,  of  the  crimes,  and  50  per  cent,  of  the 
poverty  that  afflicts  our  race.  Intemper- 
ance of  parents  causes  34  per  cent,  of  the 
imbecility  in  children.  Drunkenness  in  the 
parent  may  not  be  followed  by  drunkenness 
in  the  offspring,  but  epilepsy  or  kleptoma- 
nia, hysteria  or  apoplexy  in  the  mother 
may  be  followed  by  some  form  of  insanity 
in  the  offspring.     Parents  transmit  not  alone 


560 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


their  inherited  tendencies,  but  their  acquir- 
ed peculiarities  as  well.  There  are  100,000 
orphans  in  the  United  States.  One-fourth 
of  these  are  classed  as  juvenile  delinquents 
or  defectives.  It  costs  ten  million  dollars  a 
year  to  care  for  those  orphans.  Dr.  John 
S.  Billings,  in  charge  of  the  Census  Office, 
gave  us  the  following  figures  for  the  whole 
United  States  in  1S90 :  Insane,  106,254; 
imbeciles  and  idiots,  95,57 1  ;  blind,  50,411  ; 
deafmutes,  41,283;  paupers,  73,045;  pris- 
oners, 86,000. 

SEX    IN    RELATION  TO  CRIME. 

Females,  being  physically  weaker  than 
males,  are  addicted  to  crime  only  one-fifth 
as  frequently,  and  only  excel  the  males  in 
the  commission  of  poisoning  and  infanticide. 
Woman's  natural  form  of  retrogression  is 
prostitution. 

SEASON    IN   RELATION  TO  CRIME. 

Crime  against  property  are  more  preval- 
ent during  the  cold  season  of  the  year  and 
in  cold  climates,  while  crimes  of  passion 
and  against  the  person  are  more  prevalent 
in  warm  climates  and  during  the  hot  season 
of  the  year.  Intemperance  is  prevalent  in 
the  temperate  zone.  The  boy  asked  his 
farther  how  it  happened  that  people  drank 
so  much  beer  and  whisky  in  the  temperate 
zone. 

CAUSE     OF     CRIMINALITY    AND    DEFECTIVE- 
NESS. 

Population  has  increased  too  rapidly. 
More  children  have  been  born  to  poor  peo- 
ple than  they  could  rear  properly.  To 
raise  and  educate  properly  one  child  requires 
enormous  outlay.  To  raise  properly  one 
child  would  be  a  big  task  for  most  husbands 
and  w;ves,  to  say  nothing  about  six  or  ten 
children.  Parents  of  education  and  means 
rarely  have  more  than  two  children.  If 
they  have  a  third  child,  it  is  a  mistake. 
This  is  the  cause  of  a  lack  of  growth  of  the 
population  at  the  top  and  of  an  excessive 
growth  of  the  population  at  the  bottom. 
According  to  vital  statistics  it  takes  on  an 
average  about  3^  children  to  each  couple  to 
propagate  their  kind.  Too  many  people 
are  heedless  of  all  Biblical  commands  except 
"multiply  and  replenish  the  earth."  The 
next  great  basic  cause  of  crime  and  defec- 
tiveness is  the  implied  inferiority  of  women. 
The  idea  of  woman's  inferiority  has  come 
down  to  us  from  a  barbarous  past.  The 
man-made  laws  have,  all  along  the  line, 
accorded  the  male  sex  dominion  over  the 
female,  which  has  placed  millions  of  girls 
and  women  at  a  disadvantage  in  the 
struggle  for  bread,  and  which  compels 
thousands  of  them  yearly  to  accept  de- 
gradation   or    starvation.     This     has     kept 


the  normal  fabric  of  society  weak.  Im- 
provement in  our  race  is  an  idle  dream  nutil 
woman  is  accorded  perfect  justice  and 
placed  squarely  on  equality  with  man. 
The  helpless  slavery  of  woman,  with  the 
attendant  evils  of  enforced  motherhood 
must  be  relegated  to  the  rear  as  a  crum- 
bling relic  of  barbaric  injustice.  If  the  father 
be  the  head  and  the  hands  of  the  family, 
the  mother  is  the  heart. 

A  child  has  a  right  to  be  well  born.  The 
man  whose  destiny  is  unfavorably  formed 
for  him  by  his  ancestors  is  to  be  pitied. 
Many  of  the  rich  and  poor  are  alike  born 
into  this  world  with  an  inheritance  of  vice 
and  degradation.  They  are  crippled  from 
the  very  beginning,  and  have  only  half  a  . 
chance  for  health  and  prosperity.  The  end 
and  aim  of  sex  and  sex-relation  is  simply 
the  perpetuation  of  the  species.  Sex  rela- 
tion has  been  diverted  from  its  proper  mis- 
sion. As  an  example,  40,000  abandoned 
women  are  to  be  found  in  the  city  of  New 
York.  The  Arena  for  January,  1898, 
gives  the  following  figures  for  Massachu- 
setts, New  York  and  Illinois  :  Sixteen  per 
cent,  of  the  married  men  desert  their  wives 
after  the  birth  of  the  first  child,  and  28  per 
cent,  after  the  birth  of  the  second  child. 
The  children  of  such  parents  are  placed  at 
an  immense  disadvantage.  Add  to  this  the 
work  of  the  wholesale  divorce  mill  and  it 
will  be  apparent  that  marriage  to  a  consider- 
able extent  is  a  failure.  Women  have  open- 
ed their  eves  to  this  condition,  and  as  a  re- 
sult 18  per  cent,  of  women  of  marriageable 
age  in  the  United  States  have  equipped 
themselves  for  earning  a  living  independ- 
ent of  man.  She  is  a  worthv  competitor 
of  man  today  in  manufacturing, mercantile, 
professional  and  other  pursuits.  When 
women  can  completely  assert  their  inde- 
pendence there  will  be  improvement  in 
motherhood.  Improved  motherhood  is  the 
safeguard  of  the  generation  unborn. 

Our  civilization  has  developed  so  rapidly 
that  it  has  retained  many  of  the  elements 
of  barbarism  and  savagery.  A  relic  of  sav- 
agery ♦  is  inculcated  in  this:  "He  who 
would  not  avenge  an  insult  is  no  man." 
"Manly  dignity  can  be  preserved  by  exe- 
cuting justice  himself,  not  waiting  for  the 
medium  of  the  law."  In  this  way  violence 
comes  to  be  regarded  as  a  virtue,  revenge 
as  a  duty,  and  crime  as  heroic.  In  this 
there  is  a  tendency  to  return  to  barbarism 
which  blunts  the  moral  sense.  The  second 
phase  of  modern  civilization  is  character- 
ized, not  by  violence  and  crimes  of  blood, 
but  by  craft  and  deceit,  as  adulterations  in 
commerce,  tricks  of  exchange  and  official 
fraud.  There  is  a  choice  of  becoming 
either  hammer  or   anvil  ;    the    person     who 


THE  CHARLOTTE  MEDICAL  JOURNAL 


561 


caanot  crush  another  without  feeling  pain 
must  remain  an  anvil.  Still  the  weak  must 
serve  the  strong.  The  world  bows  to  him 
who  possesses  more  than  others.  This  is 
the  state  of  society,  notwithstanding  the 
bombastic  and  hypocritical  assurance  of 
brotherly  love.  Never  before  in  the  world's 
history  has  a  person  needed  keener  wit, 
greater  frugality  and  prudence  to  make  a 
living  than  now.  The  struggle  is  fierce  and 
many  are  falling  by  the  wayside. 

Heredity  is  the  great  causal  factor  of 
crime.  Next  to  this  comes  intemperance, 
which  depends  largely  upon  the  former. 
It  is  not  encouraging  to  note  that  the  legal 
or  legislative  handling  of  intemperance  has 
been  a  failure  either  in  prevention,  restric- 
tion or  cure.  The  drink  habit  is  still 
spreading.  The  greater  portion  of  crime 
arises  out  of  our  social  conditions  and  is 
amenable  to  reformatory  measures.  Only 
about  20  to  25  per  cent,  of  criminals  are 
born  criminals.  Three- fourths  of  the  crime 
in  our  land  is  caused  by  neglected  educa- 
tion. 

Another  source  of  the  multiplication  of 
crime  in  this  country  is  the  almost  unre- 
stricted immigration  ol  the  lower  classes 
of  foreigners  from  all  lands.  Our  popula- 
tion has  20  per  cent,  of  foreigners  in  it,  but 
they  furnish  more  than  half  the  inmates  of 
our  reformatories,  one-third  of  our  convicts 
and  three-fifths  of  the  paupers  supported 
in  almshouses  (F.  11.  Wines,  |).  I).  ;  Re- 
port in    1  lth   Census). 

Another  cause  of  crime  and  pauperism 
is  the  undue  flocking  of  the  urban  popula- 
tion to  the  cities.  Our  jails  and  prisons 
are  simply  high  schools  of  depravity  and 
nurseries  of  criminals.  In  the  jails  our 
courts  hustle  ravishers,  corrupters  of  youth, 
murderers,  burglars,  thieves,  drunkards  and 
all  the  foul  members  of  society,  with 
children  convicted  of  petty  larcenies  or  of 
incorrigibility,  with  detained  witnesses  and 
people  accused  of  misdemeanors  or  crimes 
not  yet  tried.  The  inmates  of  the  jail  are 
liberally  supplied  with  tobacco  and  cards. 
The  junior  offenders  soon  become  "assimi- 
lated to  their  hardened  companions,  and 
join  the  ranks  of  crime.  The  very  air  about 
the  jail  or  prison  reeks  with  crime.  The 
criminal  serves  out  his  sentence  in  com- 
paratively comfortable  quarters,  or  he  is 
pardoned  out  and  turned  loose  upon  a  long- 
suffering  public,  upon  which  he  preys  and 
commits  atrocities  with  increased  skill.  It 
is  said  that  only  about  one-tenth  of  the 
criminal  offenses  are  detected  and  pun- 
ished. 

In  our  advanced  state  of  civilization,  ex- 
cessive culture  has  introduced  new  forms 
of  crime,  such  as  homicide    for    life    insur- 


ance and  the  abuse  of  alcohol,  cocain,  opi- 
um and  other  narcotics.  The  negro  was 
transplanted  on  American  soil  against  his 
will  by  the  whites  and  kept  in  slavery  260 
years.  The  negro  forms  12  per  cent,  of 
the  population  of  the  United  States  ;  com- 
mits 32  per  cent,  of  the  crimes;  contrib- 
utes 8  per  cent,  of  the  paupers  and  only  5 
per  cent,  of   the  lunatics. 

To  sum  up  the  cause  of  the  over-produc- 
tion of  defectives  and  criminals,  it  can  be 
stated  in  one  sentence,  viz  :  Disobedience 
to  the  laws  of  nature  and  of  physical  hy- 
giene during  the  present  or  preceding  gen- 
erations. From  the  cradle  to  the  grave  man 
is  in  constant  danger  from  the  effects  of 
violated  laws. 

now    TO      REMEDY     THE     OVER-PRODUCTION 
OF  CRIMINALS  AND  DEFECTIVES. 

This  will  involve  a  removal  of  the  causes 
just  enumerated.  Society  concerns  itself 
too  much  with  the  punishment  of  crime 
and  not  enough  with  the  prevention  of  it. 
The  lessening  of  crime  is  as  much  a  subject 
for  education  as  for  legislation.  There  is 
little  use  in  passing  laws  in  advance  of  pub- 
lic sentiment.  Only  one  person  in  ten  who 
has  an  opportunity  to  steal  is  restrained  by 
thought  of  law.  His  conscience  declares 
that  it  is  wrong  and  that  is  enough.  Good 
healthy  sentiment  needs  to  be  awakened 
with  a  view  to  the  suppression  of  crime. 
Wholesome  laws  will  follow  in  the  wake 
of  public  sentiment.  A  law  without  the 
moral  support  of  the  community  is  useless. 
If  society  stamps  out  crime  it  will  not  be 
the  work  of  one  generation,  or  of  any  single 
specific.  A  great  many  remedies  must  be 
tried.  Punishment  holds  crime  in  check 
only,  but  does  not  put  an  end  to  it.  Crime 
is  more  formidable  than  pauperism  and  is 
almost  as  costly.  Only  a  small  percentage 
of  the  evils  afflicting  society  spring  from 
want.  A  small  number  of  crimes  are  due 
to  sheer  want  of  food.  But  prosperity  gen- 
erates criminal  inclinations  as  well  as  does 
adversity,  and  on  the  whole  the  rich  are 
about  as  much  addicted  to  crime  as  the  poor. 
Increase  of  material  prosperity  may  reduce 
crime  against  property,  but  it  increases 
drunkenness  and  crimes  against  the  person. 
Increase  of  wealth  must  be  accompanied 
by  a  healthy  growth  of  morals  to  be  a  bene- 
fit to  society.  Our  educational  institutions 
could  accomplish  more  if  more  prominence 
was  given  to  instruction  in  conduct  and 
morality,  but  it  is  more  essential  that  these 
should  be  taught  and  practiced  in  the 
homes ;  and  to  this  end  improvement  of 
motherhood  is  indispensable.  In  the  proper 
training  of  young  children  lies  the  best  means 
of  the  prevention  of  defectives  and  crimin- 


562 


THE  CHARLOTTE  MEDICAL  JOURNAL 


als.  A  child  at  the  age  of  five  or  six  years 
has  imbibed  many  ideas  that  cling  to  him 
during  life.  I  lay  great  stress  upon  the 
training  of  the  rising  generation,  because 
more  can  be  accomplished  by  preventing 
the  formation  of  bad  habits  in  the  young 
than  by  trying  to  reform  confirmed  trans- 
gressors. 

PRISON     REFORM. 

The  treatment  of  the  criminal   should    fit 
him  rather  than  the  crime.     The    nature  of 
the  criminal  should  be  studied,  and  suitable 
chastisement  meted  out  to  him.      It    should 
be    corrective     rather     than    punitive.      A 
course    of  instruction    in  conduct  and    the 
duties  of  citizenship  should  be  part    of  the 
prison  work.      The  youthful  offender  should 
be  dealt  with  kindly.     The  efficacy  of  fines 
should  be  well  tried   before  resorting  to  im- 
prisonment.    Junior  offenders    should    not 
be  classed   with    old    offenders.      Offenders 
for    the    second    and  third  time  should  be 
classed  as  life  convicts,    and    be    compelled 
to  "work  out  their  own  salvation."     There 
should  be  rewards  for  toil  and    punishment 
for  idleness.     Labor    organizations    are  on 
record  that  convicts   should    work,  but  for 
thirty  years  they    have     protested     against 
convict  labor  coming  into  competition  with 
free  labor.   Convicts  should  work,  but  how 
to  employ  them  judiciously  without  having 
their  labor  come  into  competition  with  free 
labor  is  difficult  to  solve.     The    product    of 
their  labor  should  go  in     the    direction    of 
manufacturing   articles  for    the    charitable 
and  penal  institutions.      No  one  should  ob- 
ject to  this.    Capital  punishment  is  a  crumb- 
ling relic  of  barbarism.     The  murder  is  not 
put  to  death  as  frequently  as  formerly.     In 
another  generation    the  death  penalty    will 
be  abolished.     Two  wrongs  do  not  make  a 
right.      It  is  folly  to  slander    the    slanderer 
or  to  steal  from  the  thief.     The   death  pen- 
alty used  to  be    inflicted    in    public,  but  it 
was  found  that  publicity  of  crime  was  det- 
rimental to  the  suppression  of  crime.   Many 
people  commit  crime  from  imitation  by  see- 
ing it  illustrated  in  the    newspapers.     The 
term  sentence  for  prisoners  should  be  abol- 
ished.    The    curable    should  be  cured  and 
the  incurable  should  be  kept  for  life  in    se- 
clusion, at  self-sustaining  labor.      It    would 
be  ridiculous    to    sentence   a    lunatic  to  an 
asylum  for  one  or  two  years.     The  criminal 
should  be  given  an  immediate  sentence  and 
his  liberty    should  be  abridged     until     he 
proves  himself  worthy  of  the  confidence  of 
the    community.     The    board    of  pardons 
should  be  made  up  of  the  sentencing  judges, 
the  warden  of  the  prison    and    one    of  the 
chief    justices  of  the     State.     This    board 
should  meet   quarterly,    hear   evidence    and 
correct  mistakes  of  sentence. 


According  to  sanitary  laws,  your  house 
may  be  quarantined  and  the  family  pro- 
hibited from  mingling  with  the  public.  Ac- 
cording to  the  school  laws  your  children  are 
taken  from  you  five  hours  per  day,  from 
the  age  8  to  14  years,  for  educational  pur- 
poses. In  view  of  all  this,  it  seems  reason- 
able that  laws  could  be  enforced  to  keep 
poison  out  of  the  blood  of  the  nation.  The 
State  should  abridge  the  liberty  of  criminals 
and  defectives  earlier  in  their  career  of  de- 
struction. The  truest  kindness  to  the  de- 
fective is  to  prevent  him  from  being  born, 
because  he  is  his  own  greatest  curse.  Often 
the  greatest  liberty  is  the  greatest  curse  and 
danger.  The  issuing  of  marriage  license 
should  be  restricted  by  requiring  medical 
and  other  affidavits  to  be  filed  with  the  pro- 
bate court  showing  that  the  applicants  for 
marriage  license  are  free  from  insanity, 
criminality  and  other  hereditary  taints. 
The  great  majority  of  defectives  and  crim- 
inals can  earn  their  own  living  under  effi- 
cient supervision.  There  should  be  more 
institutions  in  the  land  like  the  Elmira  Re- 
formatory, and  colonies  for  the  care  and 
keeping  of  defectives.  The  outlay  now 
would  prove  a  great  saving  in  the  future. 
Prevention  is  better  than  cure.  It  is  bet- 
ter to  keep  the  murderer  from  coming  into 
existence  than  to  smooth  his  pathway  to 
the  gallows.     It  cost  the  State  about   $20,- 

000  to  try  Durant ;  $20,000  to  try  Jackson 
and  Walling:  $25,000  to  try  Luetgert. 
The  cost  to  the  State  for  trying  an  alleged 
murder,  if  put  on  interest,  would  keep  a 
person  a  whole  lifetime  in  comparative 
luxury. 

ASEXUALIZATION. 

I   have  given  this  subject  much  thought. 

1  have  felt  the  pulse  of  the  public  for  a  long 
time  in  the  radical  and  conservative  arte- 
ries. I  think  the  treatment  would  be  ef- 
fectual, but  the  difficulties  lying  in  the  way 
are  at  present  insurmountable,  except  for 
friendless  paupers.  It  would  be  impossible 
to  follow  it  out  through  all  the  ramifica- 
tions of  heredity  when  genius  and  insanity, 
brilliancy  and  imbecility  are  found  in  the 
same  family.  Society,  as  organized  at 
present,  accepts  the  proposition  of  reform- 
ing the  whole  man,  not  part  of  a  man. 
Amputation  of  a  thief's  both  legs  would 
incapacitate  him  from  being  a  successful 
robber,  but  society  will  not  accept  such 
treatment.  Asexualization  of  adults  often 
leaves  a  troublesome  amount  of  sexual  de- 
sire, and  even  if  it  is  done  in  childhood, 
there  is  by  no  means  a  total  absence  of  it, 
though  it  is  much  lessened.  Oriental  peo- 
ple, including  the  Turks,  have  tried  this 
treatment  among  the  Eastern  eunuch  and 
have  no  confidence  in  it  as  an    agency     for 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


563 


moral  reform.  The  eunuchs  were  shame- 
less, melancholic  and  often  suicidal,  as  well 
as  defective  in  courage,  gentleness  and  re- 
morse. Although  the  valleys  are  deep  and 
dark,  we  must  not  dwell  in  an  atmosphere 
of  gloom,  but  must  move  on  and  up  toward 
the  greater  light,  realizing  that  with  every 
step  taken  vision  becomes  clearer  and  more 
comprehensive,  and  that  positions  occupied 
to-day  with  safety  were  yesterday  inacces- 
sible. The  hilltops  of  science  are  lumin- 
ous, and  the  public  sentiment  of  the  future 
is  destined  to  be  more  and  more  informed 
by  science  and  will  eventually  adopt  its 
suggestions  in  matters  of  statecraft  and 
social  economics. 

Rape  is  frequently  caused  by  diseased 
sexual  passions.  Surgeons  daily  remove 
tumors  and  limbs  for  the  cure  of  disease. 
To  asexualize  the  rapist  would  protect 
against  repetition  of  the  offense.  The  pun- 
ishment would  be  none  too  severe.  The 
rapist  should  take  the  radical  treatment. 
How  many  rapists  under  sentence  for  five 
to  twenty  years  would  accept  this  opera- 
tion as  the  price  of  freedom,  would  be  diffi- 
cult to  say.  If  this  class  of  criminals  were 
given  one  year  after  sentence  had  been 
pronounced  in  which  to  accept  this  opera- 
tion as  the  price  of  their  liberty,  only  a 
small  percentage  of  them  would  remain  in 
prison. 

Asexualization  of  defectives  and  crimin- 
als, both  male  and  female,  would  speedily 
limit  the  dissemination  of  disease,  vice  and 
crime.  It  woidd  remove  their  obliquities 
and  transform  many  of  them  into  useful  and 
productive  citizens.  By  eliminating  their 
productive  capacity  it  would  diminish  their 
numbers  and  permit  a  rise  in  the  physical, 
intellectual  and  moral  standard  of  the  race. 
Owing  to  the  innate  repugnance  toward 
this  condition,  as  a  penalty  for  crime,  it 
would  be  a  powerful  deterrent  and  thereby 
diminish  crime,  protect  against  many  rav- 
ages, and  satisfy  the  vengeance  of  the  out- 
raged community.  Ignorance,  intemper- 
ance, poverty,  disease  and  defects  are  symp- 
toms indicating  a  social  state  or  condition 
of  crime  and  pauperism  rather  than  the 
cause  of  them.  Society  maintains  alive 
those  that  would  perish  without  its  aid.  It 
is  folly  to  permit  the  breeding  of  social 
gangrene. 

The  reproductive  organs  have  no  func- 
tion in  the  human  organism  except  the 
creation  and  gratification  of  desire  and  the 
reproduction  of  the  species.  Their  loss  has 
no  effect  upon  the  health  and  longevity  of 
man.  Their  removal  would  destroy  desire 
and  diminish  the  wants  of  nature.  A  want 
removed  is  equivalent  to  a  want  supplied. 
It  would  be  a  kindness  rather  than  an  injury 


to  abnormal  persons.  The  operation  is  sim- 
ple, safe  and  painless.  It  would  confer 
upon  inmates  of  prisons,  reformatories  etc., 
immunity  from  evil  practices,  and  give 
them  health  and  strength,  satisfaction  and 
comfort  for  discontent  and  insatiable  de- 
sire. The  prevention  of  reproduction 
should  not  be  objectionable  to  this  class,  be- 
cause idiotic,  insane  or  criminal  children 
are  of  no  comfort  to  parents.  Such  sur- 
gery is  as  wise  and  merciful  as  vaccination 
or  the  extraction  of  a  decayed  and  aching 
tooth.  * 

In  the  Cincinnati  Lancet-Clinic.  Oct.  3, 
1S96,  will  be  found  a  description  of  an  oper- 
ation invented  by  the  writer  for  the  cure  of 
certain  cases  of  insanity.  The  operation 
consists  in  cutting  or  exsecting  from  one- 
fourth  to  one-half  inch  of  certain  branches 
of  the  pudic  nerve.  This  causes  a  suspen- 
sion of  the  sexual  activities  for  a  period  of 
from  one  to  four  years,  with  a  return  of 
same  as  soon  as  the  nerves  are  reunited. 
This  operation  has  not  been  in  use  long 
enough  to  judge  of  its  usefulness.  The 
sexual  instinct  was  implanted  for  the  pro- 
pagation of  the  race,  not  for  its  degenera- 
tion and  destruction.  Humanity  sins  against 
the  Creator  by  contributory  neglect  in  th;s 
matter.  Society  arrests  and  confines  the 
lepers,  the  victims  of  smallpox,  yellow  fever 
or  cholera,  and  treats  them  as  it  sees  fit.  It 
shuts  up  the  imbecile,  the  criminal  and  the 
insane  for  the  protection  of  the  public.  No 
one  questions  its  right  to  do  so.  Yet  it  al- 
lows the  deformed  and  diseased  in  mind  and 
body  and  soul  to  disseminate  social  leprosy 
and  cancer.  This  could  be  prevented  by 
the  adoption  of  an  operation  almost  as  sim- 
ple and  painless  as  vaccination.  It  seems 
strange  that  the  matter  should  be  delayed 
so  long.  Asylums,  prisons,  and  jails  can 
not  be  built  fast  enough  to  meet  the  require- 
ments of  social  neglect.  Society  is  work- 
ing at  the  wrong  end  of  the  subject.  It 
should  get  at  the  rottenness  of  the  root  of 
the  tree  of  humanity.  The  upper  tenth  in 
society  has  remained  about  the  same  for 
3000  years.  There  used  to  be  no  submerged 
tenth,  but  today  we  have  a  largely  increas- 
ing submerged  tenth.  There  is  a  lack  of 
growth  at  the  top.  Stature  and  health  are 
decreasing.  Weak  nerves  and  weak  stom- 
achs are  on  the  increase,  as  the  result  of 
faulty  breeding.  The  decay  of  the  Repub- 
lic is  due  to  the  degeneracy  of  the  people. 
It  is  an  outrage  that  the  State  and  Nation 
stand  idly  by  and  permit  the  intermarriage 
of  criminals,  paupers  and  defectives,  thus 
becoming  a  party  to  the  wholesale  manu- 
facture of  probable  criminals.  The  State 
has  the  right  and  power  to  prevent  the  pro- 
bable from  becoming  the  positive  criminal. 


564 


THP]  CHARLOTTE  MEDIC ALn JOURNAL. 


History  records  that  many  cities  have 
been  built  on  this  earth,  some  of  them  near- 
ly as  large  and  as  rif  h  as  any  of  the  present 
age,  yet  through  internal  disease  they  went 
down  in  ruin,  and  nothing  but  potsherds 
and  broken  brick  remain  to  mark  their  for- 
mer existence.  It  is  time  to  put  up  the 
signboard  and  suggest  whither  we  are 
drifting. 

Let  the  nation  adopt  the  plan  of  treat- 
ment herein  suggested  for  one  generation, 
and  the  result  would  be  that  all  the  inheri- 
ted rottenness  and  corruption  of  ages  would 
be  purged  out  of  the  people.  The  criminal 
and  pauper  class  would  become  extinct. 
Asylums,  prisons  and  jails  would  become 
depopulated.  The  great  burden  of  taxa- 
tion would  be  lifed  from  the  people.  Doc- 
tor's bills  vvould  be  less  of  a  drain  upon  the 
family  and  chronic  disease  would  be  dimin- 
ished. -  Let  the  sword  of  justice  cut  the 
knot  of  bondage  and  society  take  control 
of  its  own  destiny  and  regulate  reproduc- 
tion with  the  wisdom  of  experience,  and 
t he  "ills  which  flesh  is  heir  to"  will  van- 
ish before  the  glorious  dawn  of  the  day  of 
comfort,  hope,  peace  and  promise. 

Fifth  and  Wilkinson  streets. 

BIBLIOGRAPHY. 

Havelock  Ellis:     The  Criminal. 

Morrison:     The  Criminal. 

Morrison:  Female  Offender,  and  Juvenile 
Offenders. 

Morrison:     Civilization:  Cause  and  Cure. 

Fairbanks:     Introduction  to  Sociology. 

F.  M.  Sprague:  The  Laws  of  Social  Evolu- 
tion. 

Boies:    Criminals  and  Paupers. 

Reporis  from  Elmira  Reformatory. 

Clous  ton:    Mental    Diseases. 

Bevan-Lewis:     Mental  Diseases. 

Take:     Mental    Diseases. 

Sterns:     Mental  Di?eases. 

Sterns:     Insanity:  Its  Causes  and  Prevention. 

Lombroso:     Insanity  and  Genius. 

Enteralgia  of  Infants. 

Enteralgia,  or  colic  of  infants,  is  most 
common  between  the  first  and  fourth  months 
of  infantile  life,  and  is  not  only  a  cause  of 
great  distress  and  fatigue  to  the  mother,  but 
of  much  pain  and  suffering  to  the  infant. 
Usually  the  infant  has  one  attack  in  twenty- 
four  hours,  and  the  attack  may  recur  at 
regular  periods,  either  in  the  morning  or 
in  the  evening,  and  may  vary  not  only  in 
duration  but  in  severity.  The  attacks  are 
always  sudden,  and  the  infant,  while  ap- 
parently comfortable,  will  suddenly  utter 
sharp,  piercing  screams,  which  continue  for 
twenty  minutes,  or  perhaps  an  hour,  and 
are  then  interrupted  by  a  few  moments  of 
ease,  only  to  have  all  the  symptoms  of  colic 
return  with  increased  pain  and  distress. 
The  efforts  of  the  mother  to  soothe  or  calm 


her  babe  are  of  no  avail ;  the  babe  continues 
to  cry  and  scream  ;  it  will  take  the  breast 
for  a  minute,  and  then  quickly  let  it  go, 
and  will  throw  itself  violently  back  upon 
its  mother's  arm,  and  continue  its  distress- 
ing and  piercing  cries  until  every  one  about 
the  nursery  becomes  nervous,  and  anxious 
to  do  something  to  relieve  the  little  sufferer. 
During  a  paroxysm  the  infant  will  rapidly 
draw  up  its  legs  and  knees,  then  as  rapidly 
extend  them,  and  if  the  hand  of  the  mother 
or  nurse  is  placed  upon  the  abdomen,  it  will 
be  found  to  be  swollen,  hard,  and  knotted; 
and  gas  can  be  heard  moving  about  in  the 
intestines.  Passage  of  this  gas,  either  by 
the  mouth  or  anus,  is  usually  a  sign  for  an 
abatement  of  the  paroxysm.  Generallv  the 
hands  and  feet  become  cold,  and  drops  of 
cold  perspiration  break  out  upon  the  face. 
/The  bowels  are  sometimes  constipated,  but 
most  frequently  they  are  loose,  and  the 
evacuations  present  a  thin  and  frothy  ap- 
pearance. The  face  often  indicates,  by  its 
expression,  the  severe  suffering  of  the  babe, 
and  is  either  pale  or  flushed.  While  these 
distressing  symptoms  always  end  without 
serious  injury  to  the  babe's  general  health, 
they  occur  and  recur  regularly  at  about  the 
same  time  every  day  for  weeks,  and  some- 
times months;  and  in  order  to  mitigate  the 
suffering  the  mother  or  nurse  usually  gives 
the  babe  stimulating  potions  or  opiates. 
As  a  rule  I  have  regarded  these  attacks  as 
pure  colic,  arising  from  altered  or  vitiated 
secretions  of  the  intestinal  canal,  but  cases 
are  now  and  then  met  with  which  are  neu- 
ralgic, and  the  distinction  which  I  make 
between  colic  or  enteralgia  and  neuralgia 
in  infants  consists  in  the  symptoms.  In 
infantile  neuralgia  of  the  bowels  there  is 
no  escape  of  gas,  the  bowels  are  not  dis- 
tended or  the  secretions  altered,  and  the 
abdomen  is  not  distended  with  gas  or  flat- 
ulence. 

Treatment. — Nothing  affords  a  mother 
more  delight  than  to  have  prescribed  for  her 
babe  something  that  will  relieve  and  cure 
these  terrible  attacks.  If  of  a  purely  neu- 
ralgic character,  these  attacks  can  be  not 
only  cured  but  prevented  by  the  adminis- 
tration of  cinchona,  or  some  suitable  form 
of  one  of  its  various  preparations,  but  when 
the  attacks  are  colic  or  enteralgia,  I  rely 
for  its  cure  upon  a  mixture  of  equal  por- 
tions of  Lactopeptine  and  subnitrate  of  bis- 
muth. During  the  first  month  of  infantile 
life  I  usually  give  a  half  grain  each  of  Lac- 
topeptine and  subnitrate  of  bismuth  every 
hour  during  the  attacks.  I  direct  the  mother 
to  place  the  powder  made  of  this  combina- 
tion upon  the  babe's  tongue  every  hour, 
and  continue  it  whenever  the  child  is  awake 
until  the    recurrence  of  the  colic  is  entirely 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


565 


prevented.  After  the  first  month  I  give 
two  grains  each  of  the  Lactopeptine  and 
bismuth  every  hour.  I  commence  this  treat- 
ment during  the  attacks,  and  after  a  few 
doses  the  babe  soon  gets  quiet  and  goes  to 
sleep.  I  instruct  the  mother  or  nurse  to 
persevere  in  the  administration  of  these 
powders,  and  in  a  few  days  she  will  be  re- 
warded by  the  pleasure  of  finding  that  her 
babe  escapes  the  daily  attacks  of  terrible 
colic. — J.  B.  Johnson,  M.  D.,  of  Wash- 
ington, in  Southern  Clinic. 


Malarial  Peripheral    Neuritis. 

Highet  has  recorded  the  results  of  a  study 
of  ten  cases  of  malarial  neuritis  (Interna- 
tional Medical  Magazine).  Intermittent 
fever,  persisting  for  a  long  time,  or  remit- 
tent fever  with  frequent  exacerbations,  is 
followed  after  some  months  by  attacks  of 
pain  in  the  legs  and  knees.  These  pains 
are  worse  at  night,  and  are  sometimes  asso- 
ciated with  cramp  of  the  muscles.  Later 
the  knees  feel  weak  and  give  way,  the 
limbs  become  painful  in  the  daytime  as  well 
as  at  night,  and  the  pain  extends  to  the 
thighs,  the  back  and  the  arms.  Fever  per- 
sists, the  pain  interferes  with  sleep,  the 
weakness  may  become  paralysis,  cutaneous 
sensibility  is  blunted,  and  paresthesia  are 
marked.  The  loss  of  muscular  power  may 
assume  a  remittent  character.  Ilemeralopia 
may  occur.  The  spleen  and  liver  are  en- 
larged. Deep  pressure  over  the  muscles 
causes  pain.  The  tissues  become  flabby  and 
may  atrophy.  Effusion  into  the  joints 
sometimes  occurs.  The  condition  of  the 
heart  is  variable;  at  one  time  it  is  quiet, 
and  again  it  is  rapid,  with  arhythmia. 
Angina  and  tachycardia  have  been  observed. 
Anemia,  cardiac  dilatation  and  hemic  mur- 
murs are  noted  in  some  cases.  Occasional- 
ly there  is  some  edema  of  the  feet.  Highet 
considers  malarial  peripheral  neuritis  to  be 
a  toxic  affection  of  the  nerves,  the  toxin 
being  the  product  of  the  malarial  germ.  A 
single  attack  of  fever  rarely  causes  well- 
marked  neuritis ;  the  cumulative  action  of 
the  poison  on  the  nerves  being  required  to 
bring  about  the  pathological  changes  which 
give  rise  to  the  symptoms.  The  period  of 
incubation  extends  on  an  average  over  eight 
months.  Removal  of  the  cause  and  efficient 
hygienic  and  medicinal  treatment  usually 
give  good  recovery.  The  diagnosis  of  the 
affection  must,  in  most  cases,  be  made  from 
beri-beri.  The  principal  points  of  differ- 
ence are  that  in  malarial  peripheral  neuritis 
we  have  marked  anemia,  mild  or  absent 
heart  symptoms,  enlarged  spleen,  neuritis 
preceded  by  fever  and  often  associated  with 
it,  the  long  incubation,  the    remittent  char- 


acter, the  presence  of  plasmodium,  the  shuf- 
fling gait  when  loss  of  power  is  marked, 
and  the  readiness  of  cure.  In  beri-beri  af- 
fection of  the  heart  is  a  regular  feature, 
local  edema  and  serous  effusions  occur,  the 
onset  is  rapid  and  usually  attended  with 
fever,  there  is  no  plasmodium,  the  gait  is 
equine  and  typical,  and  sudden  death  is 
common.  As  the  diseases  occur  in  the  same 
regions,  one  must  think  of  mixed  infection. 


Syphilis  of   the  Respiratory  Passages. 

Dr.  Francke  H.  Bosworth  read  a  paper 
on  this  subject,  at  the  N.  Y.  Academy  of 
Medicine,  April  7th  ,  1899,  (Medical  Re- 
cord, April  15th,  1899).  He  said  that  his 
experience  had  taught  him  that  there  was 
practically  but  one  syphilitic  manifestation 
in  the  nose,  and  that  was  the  gumma. 

In  the  very  large  majority  of  cases  it  was 
not  recognized  until  the  gumma  had  broken 
down,  and  had  resulted  in  the  formation  of 
a  deep  ulcer  and  in  necrosis  of  the  bone. 
It  was  rare  to  meet  with  necrosis  of  bone 
in  the  nose,  aside  from  its  association  with 
malignant  disease,  except  as  a  result  of 
syphilis.  There  seemed  to  be  no  adequate 
explanation  of  the  frequency  with  which 
syphilis  of  the  nose  resulted  in  necrosis  of 
bone,  except  that  the  manifestations  of  this 
disease  in  the  nose  belonged  to  the  tertiary 
period.  Syphilis  of  the  fauces  consisted  in 
a  deposit  of  inflammatory  material  in  the 
superficial  layers.  Mucous  patches  deman- 
ded exceedingly  vigorous  local  treatment. 
The  patient  should  be  seen  daily,  and  the 
patches  cauterized  with  the  solid  stick  of 
nitrate  of  silver  until  they  had  healed.  If 
the  outbreak  occurred  two  or  three  years 
after  the  primary  sore,  the  result  was  a 
superficial  ulcer;  if  it  occurred  after  six  to 
ten  years,  the  ulcer  would  be  deep.  This 
ulcer  manifested  a  marked  hesitancy  in  pass- 
ing beyond  anatomical  barriers.  He  knew 
of  no  morbid  process  occurring  in  the  air 
tract  which  resembled  the  manifestations  of 
syphilis.  Syphilitic  ulcers  of  this  region 
should  be  distinguished  from  tuberculosis 
and  malignant  disease.  The  term  "ulcer?' 
was  very  commonly  used  loosely  and  vague- 
ly in  medicine.  The  best  definition  of  an 
ulcer  that  he  knew  of  in  the  English  lan- 
guage was  that  of  Erichsen,  viz.  :  "A  solu- 
tion of  continuity  with  progressive  waste 
of  tissue."  The  local  medication  was  of 
secondary  importance  as  compared  with  the 
internal  administration  of  iodide  of  potas- 
sium in  the  treatment  of  syphilis  of  the 
pharynx.  The  peculiarity  of  syphilis  of  the 
nose  was  its  "explosive  action" — in  other 
words,  a  deposit  of  gummatous  material, 
and  ics  sudden  breaking  down,  resulting  in 


566 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


ulceration  and  necrosis  limited  to  the  area 
of  the  original  gumma.  After  this,  the 
constitutional  virus  seemed  to  become  quies- 
cent for  a  longer  or  shorter  time,  and  then 
a  new  outbreak  occurred.  The  indication 
was  to  remove  all  the  necrosed  bone  as  soon 
as  possible.  A  marked  feature  of  syphilis 
of  the  pharynx  was  the  degree  of  contrac- 
tion occurring  during  the  process  of  heal- 
ing. It  often  seriously  interfered  with  deg- 
lutition or  respiration.  This  severe  ulcera- 
tive process,  it  seemed  to  him,  belonged 
essentially  to  the  food-tract.  Syphilitic 
ulcers  of  the  larynx  were  usually  limited  in 
extent,  and  superficial.  The  usual  type  of 
laryngeal  syphilis  was  a  mild  one,  there  be- 
ing perhaps  one  severe  case  to  twenty  mild 
ones.  Local  treatment  was  of  some  impor- 
tance, though  secondary  to  the  internal  ad- 
ministration of  remedies.  The  indication 
was  promptly  to  arrest  the  local  process  of 
ulceration  by  the  administration  of  iodide 
of  potassium,  and  after  this  the  long-con- 
tinued use  of  mercurials. 


Rheumatic    Tonsillitis. 

Abrahams  (Med.  Press  and  Cir.)  read  a 
paper  on  this  subject  at  a  recent  meeting  of 
the  Clinical  Society  of  London.  The  au- 
thor said  : 

The  material  upon  which  this  paper  is 
based  is  mainly  composed  of  cases  of  rheu- 
matic tonsillitis  observed  by  the  author  dur- 
ing the  last  three  years.  A  large  number 
of  cases  of  chorea,  rheumatism,  and  cardiac 
diseases,  both  in  adults  and  children,  have 
been  investigated  and  tabulated,  and  the 
resulting  statistics  compared  with  those  of 
previous  observers,  in  order  to  ascertain  as 
accurately  as  possible  the  relation  of  the 
throat  affection  to  the  rheumatism.  The 
bacteriology  of  many  of  the  cases_has  also 
been  studied  with  a  view  to  obtaining  some 
light  upon  the  etiology  of  the  disease  itself. 
The  bulk  of  the  work,  in  so  far  as  it  relates 
to  children,  was  done  in  the  out-patient  de- 
partment of  the  Evelina  Hospital  for  Chil- 
dren. Dr.  George  Carpenter  was  kind 
enough  to  permit  the  use  of  the  material, 
and  also  to  allow  the  results  to  be  compared 
with  his  own  works  for  the  last  ten  years. 
Details  are  given  in  the  paper  of  a  number 
of  cases  illustrating — (i)  The  occurrence 
of  endocarditis  after  non-scarlatinal  tonsil- 
litis without  the  intervention  of  arthritis  or 
chorea;  (2)  tonsillitis  immediately  follow- 
ed by  a  first  attack  of  chorea  ;  (3)  repeated 
attacks  of  chorea,  each  preceded  by  tonsil- 
litis ;  (4)  the  occurrence  of  sore  throats  at 
various  points  in  the  rheumatic  series.  Clin- 
ically, five  varieties  of  sore  throat  affection 
may  be  distinguished.  (1)  Faucial  erythe- 
ma, the  pharyngeal  inflammation  described 


by  Trousseau  as  ushering  in  an  attack  of 
acute  rheumatism.  (2)  Follicular  tonsil- 
litis. (3)  Quinsy.  Between  these  latter 
no  pathological  distinction  can  be  at  pre- 
sent drawn,  though  it  is  notable  that  wheu 
a  patient  has  repeated  attacks,  they  are  al- 
most always  solely  of  one  kind  or  the  other,  | 
an  alternation  being  rarely  observed.  As  | 
is  also  the  case  with  non-rheumatic  forms, 
the  follicular  variety  is  commoner  in  chil- 
dren, the  quinsy  in  adults.  (4)  The  abor- 
tive form  described  by  Singer  (angine  rhu- 
matismale  of  French  authors),  in  which  the  ■ 
joint  and  muscle  pains  are  vague,  is  not  so 
frequent  as  he  states.  No  case  should  be 
included  under  this  head  in  which  there  is 
not  adequate  personal  or  family  history  of 
rheumatism.  After  making  this  observa- 
tion a  considerable  number  of  instances  re- 
main, the  most  noteworthy  point  about 
which  is  their  liability  to  die  suddenly  from 
cardiac  failure.  (5)  Chronic  rheumatic 
tonsillitis  is  described  by  Dr.  Max  Thorner  : 
this  affection  is  more  probably  gouty  in  na- 
ture. A  stitistical  inquiry  was  made  into 
consecutive  cases  of  three  distinct  affections, 
namely,  248  of  chorea,  43  of  acquired  heart 
disease  in  children  unassociated  with  chorea, 
and  66  of  rheumatic  fever  in  adults  :  Of  the 
choreas  in  which  a  reliable  history  was  at- 
tainable, 53.4  per  cent,  had  a  family  or  per- 
sonal one  of  sore  throat.  This  history  was  ' 
not  associated  with  any  marked  predispo-  ; 
sition  to  either  arthritis  or  heart  disease. 
Of  the  cardiac  cases  66. S  per  cent,  gave  a 
history  of  throat  affections.  Among  the 
adults  45.5  per  cent,  had  a  definite  throat 
history,  21.2  per  cent,  had  suffered  from 
ulcerated  throats  within  three  weeks  of  the 
attack  of  acute  rheumatism,  and  47.2  per 
cent,  showed  faucial  erythema  within  two 
days  from  its  onset.  In  children,  where 
the  commencement  is  insidious,  faucial  ery- 
thema is  extremely  rare.  On  the  other  j 
hand,  a  large  proportion  of  them  had  folli- 
cular tonsillitis  when  first  seen,  several  be- 
ing brought  up  on  its  account  and  either  I 
revealing  cardiac  disease  when  examined  or 
developing  chorea  while  under  observation. 
There  seems  little  reason  to  doubt  that  in 
many  of  these  cases  the  tonsils  may  have 
been  the  channel  of  infection ;  this  is, 
of  course,  by  no  means  invariably  true,  as  1 
the  sore  throat  is  often  a  late  term  in  the 
rheumatic  series.  Bacteriological  examin- 
ation of  the  tonsils  and  their  exudation  in  a 
large  number  of  cases  revealed  the  constant 
presence  of  strepto-  and  staphylococci,  the 
former  more  frequently,  but  the  latter  of- 
tener  in  pure  culture.  Similar  organisms 
were  found  in  the  urine  drawn  from  the 
bladder  with  all  antiseptic  precautions. 
Taking    these    results    together  with    the 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


discovery  of  the  same  microbes  in  the  blood 
and  affected  joints  in  acute  rheumatism  bv 
Sahli  and  others,  the  probability  of  the  oc- 
currence of  infection  through  the  tonsil  be- 
comes very  strong.  It  is  believed  by  many 
that  the  rheumatic  patient  is  poisoned  by 
the  attenuated  virus  of  a  germ  which  when 
fully  active  leads  to  pyemia.  The  follow- 
ing conclusions  are  put  forward  : 

i.  The  more  common  varieties  of  rheu- 
matic sore  throat  fall  into  two  main  cate- 
gories— faucial  erythema  and  tonsillitis  pro- 
per. 

2.  Faucial  erythema  is  most  common  in 
adults,  rheumatic  tonsillitis  in  children,  in 
whom  it  usually  assumes  the  follicular  type, 
quinsy  being  more  frequent  in  older  sub- 
jects. 

3.  Faucial  erythema  is  an  initial  mani- 
festation of  acute  rheumatism  ;  tonsillitis 
may  be  the  actual  primary  lesion. 

4.  Many  cases  are  now  definitely  on  re- 
cord in  which  endocarditis  has  followed  a 
non-scarlatinal  tonsillitis  unaccompanied  by 
joint  pains.  In  numerous  other  instances 
the  tonsillitis  has  immediately  preceded  an 
attack  of  arthritis  or  chorea. 

5.  The  presence  of  the  same  micro-organ- 
isms in  the  tonsils,  joints,  blood  and  urine 
16  evidence  in  favor  of  the  participation  of 
pyogenic  cocci  in  the  etiology  of  rheuma- 
tism. 


The  Diagnosis  of  Scarlet  Fever. 

The  Medical  Age  suggest  the  following 
points  in  the  diagnosis  of  this    disease. 

Initial  vomiting,  very  constant  in  child- 
ren under  ten,  less  so  above  that  age,  and 
rare  in  measles,  German  measles  and  diph- 
theria. 

Undue  frequency  of  pulse — says  140  to 
150 — out  of  proportion  to  the  other  symp- 
toms. 

The  rash  beginning  on  the  upper  part  of 
the  chest,  over  the  clavicles  and  about  the 
flexures  of  the  neck,  often  will  marked  on 
the  back  of  the  waist. 

To  discriminate  between  scarlatina  and 
German  measles,  Lindsay  is  in  the  habit  of 
relying  on  the  following  points  :  In  scar- 
latina there  is  initial  vomiting;  a  brief  but 
well  marked  prodromal  stage,  with  vomit- 
ing, chills,  headache  and  sore  throat,  some- 
times going  on  to  ulceration  ;  no  early  en- 
largement of  the  post-cervical  glands.  In 
German  measles  there  is  no  vomiting,  no 
prodromal  stage,  the  rash  being  often  the 
first  symptom  and  always  appearing  on  the 
face;  little  or  no  constitutional  symptoms; 
no  ulceration  of  the  throat ;  a  very  character- 
istic early  enlargement  of  the  post-cervical 
glands. 


Medical     Society  of     the    State  of     North 
Carolina. 

Primary  Announcement  of  the  Forty- Sixth 
Annual  Meeting,  Tuesday,  Wednes- 
day ,   Th u rsday  and  Fr iday ,  May 
SO,  81,  June  1  and  2,  1S<><>. 

OFFICERS    AND    COMMITTEES. 

President— L.  J.  Picot,  M.  D.,  Little- 
ton. 

Vice  Presidents — I.  W.  Faison,  M.  D.. 
Charlotte;  H.  H.  Dodson,  M.  D.,  Milton; 
J.  W.  White,  M.  I).,  Wilksboro;  W.  C. 
Brownson,  M.  D.,  Asheville. 

Secretary — George  W.  Pressly,  M.  D., 
Charlotte.  • 

Treasurer — G.  T.  Sikes,  M.  D.,  Grissom. 

Orator— H.  S.  Lott,  M.  D.,  Salem. 

Essayist — C.  L.  Minor,  M.  D.,  Ashe- 
ville. 

Leader  of  Debate — J.  P.  Munroe,  M.  D., 
Davidson. 

Board  of  Censors — W.  O.  McDowell, 
M.  D.,  Scotland  Neck;  H.  H.  Harris,  M. 
D.  Wake  Forest ;  J.  H.  Tucker,  M.  D., 
Henderson. 

Publication  Committee — R.  J.  Brevard, 
M.  D.,  Charlotte;  T.  C.  Montgomery,  M. 
D.,  Charlotte;  R.  D.  Jewett,  M.  D.,  Win- 
ston; H.  T.  Bahnson,*M.  D.,    Salem. 

Legislative  Committee — R.  H.  Lewis, 
M.  D.,  Raleigh  ;  G.  T.  Sikes,  M.  D.,  Gris- 
som ;  Abner  Alexander,  M.  D.,  Columbia; 
James  McKee,  M.  D.,  Raleigh;  H.  A. 
Royster,  M.  D.,  Raleigh. 

Obituary  Committee — George  W.  Long, 
M.  D.,  Graham;  L  A.  Reagan,  M.  D., 
Weaversville ;  K.'P.  Battle,  M.  D.,  Ra- 
leigh. 

OFFICERS    OF    SECTIONS. 

Pathology  and  Microscopy. — E.  B. 
Glenn,  M.  D.,  Chairman,  Asheville. 

Anatomy  and  Surgery — Goode  Cheat- 
ham, M.  D.,  Chairman,   Henderson. 

Medical  Jurisprudence  and  State  Medi- 
cine  Thos.   F.    Costner,    Chairman,    Lin- 

colnton. 

Obstetrics— W.  W.  McKenzie,  M.  D., 
Chairman,   Salisbury. 

Gynecology — W.  A.  Graham,  M.  D., 
Chairman,   Charlotte. 

Practice  of  Medicine— Ben.  K.  Hays, 
M.  D.,  Chairman,  Oxford. 

Materia  Medica  and  Therapeutics — C.  S. 
Mangum,  M.  D.,  Chairman,   Chapel    Hill. 

Chemistry  and  Physiology— Joshua 
Tayloe,  M.  D.,    Chairman,  Washington. 

ORDER    OF    EXERCISES. 
THURSDAY,       3      P.     M.,     MAY     25th. 

Board  of  Examiners  meet. 


568 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


TUESDAY,    IO  A.   M.,   MAY  3OTH. 

Society  called  to  order  by  M.  H.  Flet 
cher,  M.  D.,  of  Asheville,  Chairman  Local 
Committee  of  Arrangements.  Prayer  by 
Rev.  W.  M.  Vines,  Pastor  of  the"  First 
Baptist  Church  of  Asheville. 

Address  of  Welcome'  by  Locke  Craig, 
•Esq. 

Response  by  Benj.  K.  Hays,  M.  D.,  of 
Oxford. 

The  President  takes  the  chair. 

Roll  call. 

President's  Annual  Address. 

Appointment  of   Committees. 

Program  : 

WEDNESDAY,   MAY     3IST. 

Appointment  of  Committee. 

11  a.  m.,  Report  of  Board  of  Examiners. 

12  m. — Conjoint  Meeting  with  the  N.  C. 
State  Board  of  Health. 

2  130  p.  m. — Election  of  Officers  for 
1900. 

8  130  p.  m . — Annual  Oration ,  ' '  The  Prac- 
tice of  Medicine,"  by  H.  S.  Lott,  M.  D., 
of  Salem.  Annual  Essay  by  Chas.  L. 
Minor,  M.  D.,  of  Asheville. 

THURSDAY,  JUNE    1ST. 

Morning — Selection  of  Place  and  time 
for  next  meeting. 

Afternoon — Annual  Discussion,  J.  P. 
Munroe,  M.  D.,  of  Davidson,  Leader, 
"Conservatism  in  Surgery." 

FRIDAY,    JUNE     2ND. 

The  Pittman  Prize  Essay,  by  the  Au- 
thor. 

Unfinished  Business. 
Adjournment. 

SECTIONS. 

Practice  of  Medicine. 

Chairman's  Report. 

Benj.  K.  Hays,  M.  D.,  Oxford— "The 
Continued  Fevers  of  N.  C." 

J.  Howell  Way,  M.  D.,  of  Waynesville, 
— "Pernicious  Malaria." 

W.  L.  Robinson,  M.  D.,  of  Danville, 
Va. — "Treatment  of  Typhoid  Fever. 

James  M.  Parrott,  M.  D.,  of  Kingston — 
"Hemorrhagic  Fever." 

J.  F.  Highsmith,  M.  D.,  of  Fayetteville, 
— "Typhoid  Fever,  as  met  with  in  Fay- 
etteville and    surroundng  country." 

Jno.  E.  S.  Davidson,  M.  D.,  of  Lowes- 
ville — "Meningitis. ' ' 

R.  E.  Zachary,  M.  D.,  of  Wilmington, 
— "Pernicious  Malarial  Fever. 

Wm.  J,  McAnally,  of  High  Point.— 
"Chronic  Gastro-Intestinal  Catarrh." 

PATHOLOGY     AND     MICROSCOPY. 

Chairman's    Report. 

E.  B.  Glenn,  M.   D.,    of  Asheville— "A 


Study    of     the    Bacteriology    of     Specific" 
Urenthritis." 

Paul  Pacquin,  M.  D.,  of  Asheville—! 
"Biology  and  Pathology  of  Mixed  Infec-' 
tion  in  Tuberculosis." 

OBSTETRICS. 

Chairman's  Report. 

W.  W.  McKenzie,  M.  D.,  of  Salisbury. 
— Antiseptic  Midwifery." 

J.  W.  Long,  M.  D.,  of  Salisbury— | 
"Ectopic  Pregnancy." 

I.  W.  Faison,  M.  D.,  of  Charlotte— "The! 
Management  of  Normal  Labor." 

David  A.  Staunton,  M.  D.,  of  High 
Point — "The  Application  of  Forceps  in  '■ 
H.gh  Presentations." 

MEDICAL        JURISPRUDENCE        AND      STATE! 
MEDICINE. 

Chairman's  Report. 

Thos.  F.  Costner,  M.  D.,  of  Lincoln-; 
ton — "Juvenile  Criminals." 

G.  A.  Ramsaur,  M.  D.,  of  China  Grove, 
— "Propagation  of  Typhoid  Fever"  and! 
other  Diseases." 

Robert  L.  Gibbon,  M.  D.,  of  Charlotte,  I 
— "Juvenile  Criminals." 

GYNECOLOGY. 

Chairman's  Report. 

Wm.  A.  Graham,   M.  D.,    of  Charlotte. 

Joseph  Price,  M.  D.,  of  Philadelphia, 
— The  Importance  of  Early  Operation  in 
Pelvic   Disease." 

ANATOMY    AND    SURGERY. 

Chairman's  Report. 

Goode  Cheatham,  M.  D.,  of  Henderson, 
— "Asepsis  and  Antisepsis  in   Surgery." 

F.  T.  Meri weather,  M.  D.,of  Asheville, 
— "Some  Remarks  Upon  Coley's  Treat- 
ment of  Malignant  Growths." 

M.  Bolton,  M.  D.,  of  Rich  Square— "In- 
teresting case  of  Renal  Calculus." 

R.  E.  Zachary,  M.  D.,  of  Wilmington, 
— "Chronic  Ulcers  of  the  Leg  and  the  Dif- 
ferent Methods  of  Treatment." 

MATEIA         MEDICA        AND       THERAPEUTICS. 

Chairman's    Report. 

C.  S.  Mangum.  M.  D.,  of  Chapil  Hill, 
"Progress  in  Serium  Theraphy." 

E.  A.  Moye,  M.  D.,  of  Greenville—  "Ac- 
nite  Poisoning.  It's  Diagnosis  and  Treat- 
ment, with  Report  of  a  Case." 

J.  C.  Rodman,  M.  D.,  of  Washington— 
"The  Use  of  the  Normal  Salt  Solution  in 
the  Treatment  of  Disease. 

E.  B.  Goelet,  M.  D.,  of  Saluda— "Elec- 
tricity as  an  Aid  to  the  Physician  and  Sur- 
geon." 

CHEMISTRY   AND    PHYSIOLOGY. 

Chairman's  Report. 

Joshua  Tayloe,  M.   D.,    of  Washington. 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


THE     PITTMAN     PRIZE. 

A  prize  of  $100  will  be  given  for  the  best 
essay  on  a  subject  pertaining  to  medicine. 
Provided,  ist,  That  it  shows  some  original- 
ity on  the  part  of  the  author.  2nd,  That 
it  comes  up  to  a  standard  of  excellence  de- 
termined by  the  committee.  3rd,  That  the 
author  write  under  an  assumed  name,  that 
he  shall  place  this  assumed  name  upon  the 
outside  of  a  sealed  envelope  within  which 
envelope  is  contained  the  real  name  of  the 
author,  that  the  envelope  so  arranged  shall 
be  handed  into  the  committee  along  with 
the  essay.  4th,  That  the  contestant  be  a 
member  of  the  State  Medical  Society  of 
North  Carolina.  Essays  may  be  handed  to 
the  Secretary  during  the  meeting  or  sent  to 
him  at  any  time  previous. 

This  prize  is  the  gift  of  one  who  honored 
the  Society  by  his  life  and  character,  the 
late  Dr.  Pittman,  and  it  is  worth  striving  for 
not  only  for  the  reward  and  honor,  but  also 
in  memory  of  the  giver  and  for  the  interest 
of  the  vSociety. 

We  urge  this  matter  upon  the  attention 
of  every  member  of  the  Society,  and  hope 
that  we  may  have  a  number  of  essays  for 
consideration  by  the  committee. 

TRANSPORTATION. 

Mr.  W.  H.  Fitzgerald,  commissioner  for 
the  Associated  Railways  of  Virginia  and 
the  Carolinas.  lias  kindly  granted  the  fol- 
lowing rates  : 

Blacksburg,   S.  C,      -  -  -       $4-^5 

Charlotte,  -         -  -  6.35 

Danville,  Va.,       -  -      9.60 

Fayetteville,     -  -  -  -  11.75 

Forest    City,  -  -  -  -         4.50 

Greensboro,       ...  -  7.75 

Goldsboro,  ....         12. So 

Henderson,        ...  -  11. So 

Hickory,        ....  -      4.05 

Lattimore,         ....  5.25 

Maxton, 11.75 

Marion,  .....      2.25 

Mooresboro,  ....  5*°° 

Durham,  .....         9.80 

Newton, 4.45 

Norfolk,  Va.,  ....        1S.45 

Raleigh,  -  -  -  -  11.00 

Rutherfordton,       ...  -      4.25 

Rural   Hall,       ....  9.40 

Sanford,  .....       11.00 

Selma,  ....  .  12.00 

Shelby, 5.75 

Suffolk,  Va,,      ---  -  17.85 

Wilmington,  ....        14.85 

Winston-Salem,  ....     S.80 

Weldon,  -  ...       15.20 

for  the  round  trip  to  Asheville  and    return. 

Tickets  will    be    on    sale    May   24th  and 


25th  for  the  Board  of  Examiners  and  ap- 
plicants;  May  28th,  29th  and  30th  for  the 
meeting  of  the  Society.  All  tickets  good 
until  June  14th.  Your  local  ticket  agent 
can  give  you  any  other  information.  The 
above  prices  from  junctional  points;  pro- 
portional rates  from  any  point  in  the  State. 

Special  rates  will  be  given  at  the  hotels  : 
Battery  Park  ....  $2.50 
Berkeley  .....  2.00 
Swannanoa           -          -           -           -  i.c;o 

Oaks 1.50 


Management  of  Labor. 

Milo  B.  Ward  (Montreal  Medical  Jour- 
nal) says:  The  most  trying  problem  in 
connection  with  our  duties  as  obstetricians 
is  the  one  which  relates  and  has  to  do  with 
one's  own  person.  To  keep  clean.  What 
a  herculean  task! — I  may  say  an  im- 
possible thing  to  do.  It  is  our  duty  to  make 
every  endeavor  known  to  science  to  keep 
our  hands  free  from  septic  micro-organisms. 
To  do  this  we  must,  so  far  as  possible, 
avoid  contact  with  known  virulent  infec- 
tion. If  we  are  called  upon  to  care  for  a 
woman  suffering  from  puerperal  septicemia, 
we  should  positively  refuse  to  attend  in 
confinement  any  other  woman  until  suffi- 
cient time  has  elapsed  to  make  certain  that 
our  hands  are  clean.  This  may  require 
three  or  four  days,  and  a  week  would  be 
still  better.  One  of  the  ways  of  keeping 
our  hands  contaminated  is  to  wear  the  same 
gloves  for  weeks  and  perhaps  months. 
What  could  be  more  septic  than  a  glove 
which  is  worn  until  it  cannot  be  kept  on 
the  hand,  when  all  sorts  of  septic  condi- 
tions have  been  under  their  treatment?  A 
word  to  the  wise  is  all-sufficient.  It  would 
not  seem  necessary  to  make  mention  of 
such  a  trifling  thing  as  the  nails  of  the  ac- 
coucheur, but  careful  investigation  would 
develop  the  fact  that  frequently  we  are 
found  attending  the  parturient  woman  with 
finger  nails  which  have  not  been  properly 
trimmed.  There  is  but  one  way  to  prepare 
our  nails,  namely,  cut  them  so  close  to  the 
finger  ends  that  there  will  be  no  possible 
chance  for  them  to  abrade  the  tender  tissues 
or  carry  infection.  I  do  not  believe  any 
good  is  derived  from  the  vaginal  douche  as 
commonly  used.  It  has  been  quite  well  es- 
tablished that  the  vaginal  mucous  membrane 
does  not  contain  septic  germs,  except  in  rare 
instances.  However,  granting  that  the  va- 
gina is  septic,  how  much  good  can  be  ex- 
pected to  result  from  a  small  stream  of  med- 
icated water  forced  into  the  vagina  with  an 
ordinary  syringe?  If  we  are  to  prepare 
the  vagina  for  the  ordeal  by  any  douching, 
we  should  be  as  thorough  as  though  we  ex- 


570 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


pected  to  perform  a  colpohysterectomy. 
We  should,  therefore,  either  thoroughly  dis- 
infect the  vagina  or  leave  it  as  we  find  it. 
Quite  different  are  the  conditions  of  the  ex- 
ternal genitalia.  Here  one  should  be  very 
cautious.  The  pubes  should  be  thoroughly 
scrubbed  in  every  case.  Not  only  should 
we  carefully  prepare  the  external  organs, but 
we  should  use  every  endeavor  to  keep  these 
parts  from  contact  with  sepsis.  The  pre- 
paration of  the  patient  is  no  more  impor- 
tant than  it  is  to  have  the  envionments  as 
ideal  as  circumstances  will  admit.  It  is  not, 
then,  the  vagina  but  the  external  parts 
which  should  receive  the  most  scrupulous 
preparation.  After  labor  it  is  of  para- 
mount importance  that  every  tear,  however 
slight,  should  be  immediately  closed,  in  or- 
der to  prevent  absorption  of  sepsis  and  at 
the  same  time  put  the  parts  in  their  proper 
relation.  It  does  not  require  any  unusual 
skill  to  repair  and  make  the  vaginal  outlet 
as  good  as  before  the  injury,  and  it  is  our 
duty  to  do  this  for  many  reasons,  not  the 
least  of  these  being  the  future  functions  of 
these  important  organs. 

Boric- Acid  Intoxication. 

R.  B.  Wild  (The  London  Lancet)  dis- 
tinguishes two  forms  of  intoxication  from 
boric  acid — one  in  which  a  large  quantity 
of  the  drug  is  rapidly  absorbed  from  the 
alimentary  canal,  from  a  serous  or  other 
cavity,  or  from  an  extensive  raw  surface  ; 
in  these  cases  vomiting  and  diarrhea,  gen- 
eral depression,  and  partial  paralysis  of  the 
nervous  and  muscular  systems  occur,  and 
may  cause  death.  A  rash  is  noted  in  many 
instances,  especially  when  the  patient  re- 
covered or  lived  some  days  after  the  absorp- 
tion of  the  drug.  The  other  class  of  cases 
results  from  the  administration  of  boric 
acid  or  borax  in  comparatively  small  doses 
for  long  periods,  and  the  symptoms  appear 
at  a  variable  time  after  the  commencement 
of  the  drug.  In  some  of  these  cases  it  is 
mentioned  that  the  kidneys  were  diseased, 
and  the  author  gives  as  a  possible  reason 
for  the  immunity  to  the  injurious  effects  of 
boric  acid  its  very  rapid  elimination  by 
healthy  kidneys. 

Furthermore,  it  is  possible  that  cases  of 
intoxication  occur  more  frequently  than  is 
at  present  recognized.  Boric  acid  may  un- 
wittingly be  taken  in  food  and  cause  a  toxic 
skin-eruption  which  may  be  mistaken  for 
eczema,  psoriasis,  or  exfoliative  dermatitis. 
It  may  be  noted  that  a  i  :5oo  solution  cor- 
responds to  17.5  grn.  per  pint  of  the  acid, 
a  very  large  dose  for  an  infant  on  milk  diet 
and  one  likely  in  some  cases  to  produce  dis- 
turbance of  the  alimentary  canal.  It  should 
also  be  ascertained  that  the  milk  ordered  in 


cases  of  kidney  disease  is  free  from  excess 
of  boric  acid  or  borax.  The  use  of  boric 
acid  or  the  borates  in  surgery  and  their  in- 
ternal administration  ought  to  be  carefully 
guarded  in  patients  with  diseased  kidneys, 
and  immediately  discontinued  on  the  ap- 
pearance of  dermatitis  or  other  toxic  symp- 
toms. In  suspected  cases  examination  of 
the  urine  may  afford  valuable  evidence  of 
the  presence  of  the  drug. 


Lactation   During  Pregnancy. 

Dr.  Capart  has  recently  written  a  thesis 
upon  this  subject  and  says  that  the  litera- 
ture upon  this  subject  is  relatively  small. 
(Obstetrics,  April,  1899).  Poirier,  who 
published  his  researches  in  1890,  says  that 
in  the  great  majority  of  cases  children  who 
nurse  from  mothers  who  are  again  pregnant 
do  not  suffer  in  any  way. 

In  veterinary  practice  breeders  attempt 
to  improve  their  stock  for  various  purposes 
by  having  the  females  covered  during 
lactation. 

Examination  of  human  milk  secreted 
during  pregnancy  shows  no  material  change 
as  compared  with  ordinary  breast  milk.  In 
only  two  of  twenty-nine  cases  was  the 
amount  of  milk  somewhat  reduced. 

As  for  the  nurslings  who  have  nursed 
mothers,  Capart  did  not  find  the  slightest 
evidence  of  rickets  nor  of  gastro-inteetinal 
troubles,  which  lead  to  emaciation. 

Capart  concludes  that  pregnancy  is  not 
incompatible  with  lactation,  and  that  neither 
the  nursling  nor  the  pregnant  mother,  nor 
the  child  in  course  of  development,  has 
ever  been  known  to  suffer  from  this  coinci- 
dence ;  and  that  in  all  cases  where  weaning 
ought  to  be  postponed,  the  nursling  has 
everything  to  gain  by  being  permitted  to 
continue  to  nurse  the  pregnant  mother. 


Quinine  in  Malaria. 

H.  A.  Hare  (Medical  Record).  So  far 
as  the  infecting  organism  is  concerned,  qui- 
nine acts  as  a  specific.  He  says  that  qui- 
nine sometimes  produces  hematuria  in  ma- 
larial disease ;  malarial  disease  often  con- 
gests, irritates,  or  inflames  the  kidney ; 
quinine  is  capable  of  doing  likewise. 

He  does  not,  however,  advise  that  no 
quinine  be  given  in  malarial  nephritis  or 
hematuria,  but  that  it  be  given  wisely.  Its 
administration  during  an  attack  of  hema- 
turia is  equivalent  to  "shutting  the  door 
after  the  horse  is  stolen."  In  hemoglobin- 
uria occurring  with  the  paroxysm  there  is 
probably  less  danger  than  when  true  hema- 
turia is  present,  since  the  kidneys  are  not 
so  clogged  by  blood-clots.  In  a  prolonged 
hemoglobinuric   attack,  indicating  that  the 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


571 


malarial  poison  is  destroying  the  blood-cor- 
puscles independent  of  the  chills,  quinine 
may  be  needed.  If  given,  cholagogues,  fol- 
lowed by  a  brisk  purge,  should  be  used  to 
aid  in  eliminating  the  coloring-matter 
through  the  liver  and  bowels,  and  to  relieve 
the  kidneys.  When  through  the  frequency 
of  the  intermittent  paroxysms  quinine  must 
be  administered,  the  same  attention  to  the 
bowels  should  be  given  and  the  kidneys 
flushed  with  diuretics,  as  the  vegetable 
potassium  salts.  In  cases  of  severe  hema- 
turia associated  with  jaundice  and  general 
hemorrhages  from  the  stomach,  bowels,  and 
nose,  the  virulence  of  the  infection  calls 
for  quinine,  though  the  contraindications 
are  stronger  than  ever.  This  malignant 
form  comes  on  either  suddenly  with  the  ac- 
cess of  a  malarial  attack  in  a  patient  already 
broken  down  or  as  an  attack  of  hematuric 
jaundice,  without  any  evidence  of  another 
dose  of  malarial  poison.  Quinine  will  be 
needed  in  the  first  of  these,  but  not  in  the 
second,  which  should  be  treated  by  other 
measures  for  relief  of  the  dyscrasia  and  he- 
maturia. 


Medical  Journals  Consolidated. 

In  view  of  the  large  number  of  medical 
journals  appealing  for  aid  and  support  it 
has  been  deemed  expedient  to  consolidate 
the  two  most  influential  medical  journals 
of  Kansas  City,  viz  :  The  Kansas  City 
Medical  Index  and  The  Kansas  City  Lancet, 
under  one  management.  By  this  arrange- 
ment Dr.  John  Punton  becomes  Editor-in- 
Chief  and  associated  with  him  are  twelve 
well  known  physicians  and  surgeons  of 
Kansas  City. 

In  future  all  correspondence,  exchanges, 
etc.,  intended  for  these  consolidated  jour- 
nals should  be  sent  to  the  Editor,  600  Alt- 
man  Building,  Kansas  City,   Mo. 


Writers'  Cramp- 

Editors  Charlotte  Medical  Journal : 

Sirs  : — The  remarks  of  Dr.  Monell  on  the 
radical  cure  of  writers'  cramp,  in  the  April 
number  of  the  Journal,  recalls  a  case  occur- 
ring in  this  city,  the  cure  of  which  present- 
ed at  least  some  novel  features.  The  gen- 
tleman affected  was  a  book-keeper,  and  at 
times  very  seriously  annoyed  by  the  condi- 
tion known  as  writers'  cramp.  He  had 
been  the  rounds  of  nearly  all  of  the  doctors 
seeking  relief,  and  had  had  all  kinds  of 
things  done  for  him — rest,  massage,  elec- 
tricity, drugs — and  all  without  avail.  One 
day,  a  little  over  a  year  ago,  he  met  with  a 
slight  accident  in  which  the  end  of  the  in- 
dex finger  was  mashed.  From  the  day  of 
the  injury  to  this  he  has  never  been  troubled 


any  more  with  writers'  cramp.  I  will  not 
undertake  to  explain  the  process  of  cure  in 
this  case.  Whether  the  intense  stimulation 
of  the  peripheral  terminations  of  the  nerve 
by  the  bruising  of  the  finger  may  have 
caused  trophic  changes  to  take  place  in  the 
nutrition  of  the  nerve,  or  in  its  motor  con- 
ducting power,  I  do  not  know  ;  and  while 
the  cure  may  be  a  novel  one,  it  would  hard- 
ly be  a  pleasing  process  to  suggest  to  most 
sufferers  from  this  aggravating  condition. 
The  case  is  interesting,  however,  from  its 
obstinacy  under  all  measures  and  from  its 
relief  in  this  wholly  unlooked  for  manner. 
Wm.  Edgar  Darnall. 
Atlantic  City,  N.  J.,  April  24,  1899. 


Enlargement  of  the  Lingual  Tonsil  as  the 
Cause  of    Cough. 

B.  Robinson,  before  the  American  Laryn- 
gological  Association,  referred  to  enlarge- 
ment of  the  lingual  tonsil  as  a  cause  of 
cough  being  poorly  understood  by  the  gen- 
eral practitioner.  (Boston  Medical  and 
Surgical  Journal). 

The  beginning  of  this  condition  is  in- 
sidious, especially  in  young  adults.  Those 
of  a  sluggish,  or  lymphatic  temperament 
are  more  subject  to  it.  If  the  cough  lasts 
but  a  short  time  the  general  practitioner 
usually  ascribes  it  to  the  stomach  or  reflex 
cause.  Possibly  he  may  think  of  laryngeal 
inflammation,  and  the  larnygeal  mirror  may 
reveal  an  enlarged  tonsil.  In  children  of 
from  two  to  three  years  of  age  a  laryngeal 
cough,  without  resasonable  cause  is  usually 
due  to  pressure  on  an  enlarged  tonsil.  An 
irritative  cough  is  often  the  only  symptom 
of  acute  congestion  of  the  lingual  tonsil ; 
there  is  little  to  be  found  on  inspection.  All 
the  systoms  are  worse  at  night.  Impaired 
condition  of  the  general  health  or  the  contin- 
uance of  a  catarrhal  relexation  are  the  pre- 
disposing causes.  The  trouble  may  be  also 
due  to  anemia,  constipation,  habitually  ir- 
regular habits  as  regards  food  and  rest,  as 
also  overfeeding  and  indulgence  in  pastry 
in  young  children. 


The  Tennessee  State  Medical  Society 
elected  the  following  officers  at  Nashville, 
April  n-13,  1899  : 

President — Dr.  D.  E.  Nelson,  of  Chat- 
tanooga ;  Vice-President  for  East  Tennessee 
— Dr.  G.  M.  Bezemore,  of  Cleveland  ;  Vice- 
President  for  Middle  Tennessee — Dr.  G.W. 
Moody,  Shelbyville ;  Vice-President  for 
West  Tennessee— Dr.  M.  M.  Smith,  Cedar 
Chapel;  Treasurer— W.  C.  Bilbro,  Mur- 
freesboro;  Secretary — U.  D.  Haggard,  812 
N.  High,  Nashville. 


572 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


A    Contribution     to     the       Crede     Silver 
Method' of  Wound  Treatment. 

Dr.  Paul  Meyer,  (Deutsche  Militararz 
tliche  Zeitschrift,  No.  i,  Berlin,  January 
1899). 

Practical  experimentation  with  the  Crede 
Silver  Method  has  been  made  for  about  a 
year  past  at  the  Naval  Hospital  at  Wilhelms- 
haven.  I  have  employed  the  Citrate  of  Silver 
Crede  as  a  dusting  powder  ;  the  Argentum 
Solubile  Crede  in  0.5  :  200.0  solutions 
(7!  grains  to  6|  ozs.)  with  2.0  (30  grains) 
of  albumin  for  internal  use  ;  the  Lactate  of 
Silver  Crede  in  solutions  of  1  :  2000  for  ir- 
rigations ;  the  Unguentum  Crede;  Citrate 
of  Silver  suppositories,  2  per  cent.,  and 
Silver  Silk,  Silver  Catgut,  and  Silver 
Gauze. 

In  the  absence  of  personal  experience 
with  the  method,  I  at  first  followed  Crede's 
directions  with  exactitude.  The  usual  pre- 
paratory methods  with  hot  water  and  soap, 
shaving,  green  soap  tincture,  alcohol  and 
benzine  were  employed.  Wounds  were  ir- 
rigated first  with  water,  and  then  with  the 
Lactate  of  Silver  solution.  The  powdered 
Citrate  was  employed  as  a  dry  or  moist 
dressing ;  the  Citrate  of  Silver  supposito- 
ries were  used  for  the  orifices  of  wounds ; 
and  for  spreading  inflammatory  conditions 
or  general  infection  the  Silver  Salve  was 
employed  by  inunction,  or,  more  rarely, 
.Soluble  Silver  was  administered   internally 

The  following  operative  procedures 
healed  per  primam  :  One  radical  hydrocele 
operation  ;  one  hydrocele  puncture  ;  seven 
removals  of  great  toe  nails  for  ingrowing 
toe  nails ;  five  phymosis  operations ;  one 
paraphymosis  operation  ;  one  removal  of  a 
hazelnut-sized  pedunculated  fibroma  from 
the  rectum  with  the  thermo-cautery ;  one 
enucleation  of  a  cherry-sized  sebaceous 
cyst  from  the  temple,  one  of  an  egg-sized 
cystic  tumor  from  the  capsule  of  the  knee 
joint,  one  of  an  egg-sized  fibro-myoma  of 
the  thigh  under  the  fascia  lata,  and  one  of 
a  walnut-sized  hard  indurated  lymphatic 
gland  from  the  neck ;  one  removal  of  a 
potato-sized  pedunculated  exostosis  from 
the  lower  third  of  the  femur,  and  one  of  a 
smaller  exostosis  from  the  left  calcaneus ; 
one  exarticulation  of  the  right  little  finger 
at  metacarpophalangeal  joint ;  one  ampu- 
tation of  the  left  ring  finger  at  its  middle  ; 
one  removal  of  a  splinter  of  glass  5  cm. 
(2  inches)  long,  seated  for  8  years  on  the 
tibia  ;  and  one  transplantation  on  an  ulcer- 
ated surface  the  size  of  a  hand  on  the  right 
knee. 

In  the  following  cases  an  abundant  serous 
secretion  lengthened  the  time  of  healing  : 
One  removal  of  an    egg-sized    sarcomatous 


lymphatic  tumor  from  the  right  side  of 
the  neck,  with  massive  non-purulent  secre- 
tion during  the  first  two  weeks,  the  tissues 
having  been  greatly  damaged  during  the 
operation,  and  the  sutures  cutting  their  way 
out  through  the  separated  edges  of  the 
wound;  one  removal  of  a  walnut-sized 
cystic  goiter,  with  a  similar  result  after 
four  weeks ;  one  exarticulation  of  the  left 
index  finger  at  the  metacarpo-phalangeal 
joint,  with  a  similar  result  after  fourteen 
days,  and  an  irritation  eczema  appeared  in 
the  neighborhood  of  the  wound ;  one  ex- 
ternal urethrotomy,  with  urinary  infiltra- 
tion and  cutting  out  of  the  perineal  sutures, 
but  with  little  irritation  of  the  surround- 
ing tissues  and  healthy  granulations  prom- 
ising a  good  final  cicatrization  ;  one  skin 
transplantation  on  an  ulceration  of  the  left 
leg  half  the  size  of  one's  hand,  with  adhe- 
sion of  the  transplanted  skin,  but  abund- 
ant serous  secretion  and  exuberant  granula- 
tion of  the  surrounding  areas. 

Pronounced  suppuration  occurred  in  the 
following  cases  :  One  paraphymosis  opera- 
tion with  suppurative  extrusion  of  a  gang- 
renous portion  of  mucous  membrane  at  the 
site  of  constriction  :  one  removal  of  a  wal- 
nut-sized cystic  goiter,  where  the  ligatured 
stump  suppurated  for  twenty  days. 

Most  of  the  foregoing  cases  went  on  to 
undisturbed  primary  healing,  though  the 
wounds  were  in  many  cases  in  situations 
very  liable  to  become  contaminated.  The 
absence  of  irritative  effects  was  very  no- 
ticeable, even  in  cases  where  the  tissues 
were  soaked  with  urine  for  weeks. 

The  following  injuries  healed  per 
primam  :  One  punctured  wound  of  the 
back  with  a  pocket  knife  through  the 
clothes,  and  a  similar  one  in  a  very  dirty 
palm  ;  one  contused  wound  of  a  dirty  index 
finger,  one  behind  the  ear  from  a  blow  with 
a  beer  bottle,  another  of  two  dirty  fingers 
in  a  machine,  and  another  of  the  head  with 
splintering  of  the  bone;  one  incised  wound 
of  the  little  finger  made  with  atbread  knife  ; 
one  complicated  fracture;  one  incised 
wound  of  the  upper  arm  with  division  of 
three  tendons. 

Abundant  serous  secretion  appeared  in 
the  following  cases  :  One  burn  of  the  third 
degree  of  almost  the  whole  hand,  in  which 
other  treatment  had  to  be  employed  on  ac- 
count of  disintegration  of  the  tissues;  one 
contused  wound  of  the  index  finger,  with 
secretion  for  seventeen  days ;  one  punc- 
tured wound  of  the  shoulder  with  much 
haemorrhage  and  nine  days'  serous  secre- 
tion. 

The  following  injuries  suppurated  : 
Punctured  wound  of  the  temple  and  injury 
to  a  vessel  of  the   dura,    with    suppuration 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


573 


for  several  weeks  after  trepanning  and  ex- 
trusion of  a  necrotic  portion  of  the  external 
table;  one  incised  wound  of  the  lower  arm 
in  an  attempt  at  suicide,  with  division  and 
necrosis  of  two  tendons ;  one  contused 
wound  of  the  index  finger, with  gangrene; 
one  contused  wound  of  the  middle  finger, 
with  the  same  result ;  one  complicated  dis- 
location of  the  left  distal  thumb  joint,  with 
infection. 

In  most  of  these  wounds  the  silver  dis- 
infection was  satisfactory ;  the  inflamma- 
tory symptoms  retrogressed  and  became 
localized.  In  nine  panaritiums  suppura- 
tion ceased  with  the  extrusion  of  the  ne- 
crotic bone  two  to  thirteen  days  after  the 
incision.  The  granulations  were  good  and 
functions  were  retained. 

In  five  cases  of  suppurating  lymphatic 
glands  of  the  neck,  the  axilla  and  the  groin, 
healing  per  primam  took  place  twice  ;  in 
the  other  three  cases  the  separation  of  ne- 
crotic gland  tissue  caused  suppurations 
lasting  from  four  to  fourteen  days. 

Twenty  cases  of  cellulitis,  most  begin- 
ning in  the  hand,  were  incised  and  the 
lesion  remained  localized  under  the  silver 
treatment.  The  same  is  true  of  nine  cases 
of  furuncle. 

In  one  case  of  chronic  leg  ulcer  the  serous 
secretion  interferred  with  the  healing;  an- 
other one  was  cured  in  seven  days  under 
the  treatment,  after  having  been  handled 
by  other  methods  for  four  weeks  without 
result. 

In  two  cases  of  tubercular  disease  of  the 
lumbar  vertebra'  and  ribs  the  silver  treat- 
ment did  no  good.  Both  did  better  under 
iodoform. 

As  regards  general  infection,  only  one 
pronounced  case  of  septicemic  nature  was 
treated.  The  patient  was  an  officer,  forty 
years  old,  corpulent,  with  a  fattily  degen- 
erated heart,  and  was  admitted  at  n  A.  M., 
in  a  stuporous  condition  and  with  high 
fever.  Infection  had  taken  place  from  a 
small  wound  of  the  finger,  and  the  whole 
forearm  was  swollen  and  doughy.  The 
flexor  muscles  of  the  forearm  were  incised 
under  Schleich's  ana'thesia ;  no  pus  was 
found,  but  the  muscle  bundles  were  soft  and 
discolored.  At  half-past  eleven  of  that 
morning  an  inunction  of  4 grams  (  1  drachm) 
of  the  Silver  Salve  was  administered ; 
crisis  occurred  with  sweating  between  5 
and  6  p.  m.  ;  the  temperature  fell  from 
39.2  deg.  C.  (102.6  deg.  F)  to  38.7  deg.  C. 
(101.7  deg.  F.),  and  at  10  p.  M.,  it  was 
3^.0  deg.  C.  (100.4  ^-eS-  F.)  The  dyspnoea 
got  better,  the  heart  stronger,  the  senso- 
rium  cleared,  the  general  condition  became 
satisfactory,  and  the  outlook  very  hopeful. 
At  11  o'clock  the  patient  asked    for  water; 


after  he  had  drank  it  he  fell  back  dead  of 
cardiac  paralysis.  In  this  case  there  was 
an  energetic  reaction  to  the  silver,  and  I  am 
convinced  that  with  a  more  resistant  heart 
the  outcome  would  have  been  a  happier 
one. 

A  second  case  of  a  wound  of  the  foot 
with  beginning  general  infection  in  a  strong 
young  man  reacted  very  plainly  to  a  silver 
inunction,  as  was  shown  by  retrogression 
of  the  fever  and  a  very  noticeable  improve- 
ment in  his  subjective  condition. 

In  the  various  cellulites  the  temperatures 
fell  after  the  inunctions  ;  but  the  inflamma- 
tions did  not  extend  further  than  the  near- 
est lymphatic  vessels  and  glands,  the  sub- 
jective condition  was  unaffected,  and  gen- 
eral infections  could  hardly  be  present. 
The  course  of  the  affections  was  the  same 
as  after  the  usual  incisions  and    antiseptics. 

The  conclusions  to  be  drawn  from  the 
above  cases  may  be  stated  as  follows  : 

The  course  of  wounds  under  the  silver 
treatment  is  in  general  similar  to  that  under 
the  usual  aseptic  and  antiseptic  procedures. 
But  it  possesses  two  important  advantages. 
Rapid  and  reliable  heali?ig  can  be  obtained 
without  asepticism  and  with  less  rigorous 
antiseptic  measures,  and  thus  with  simpler 
means  and  less  trouble.  Hence  it  is  espe- 
cially suitable  for  the  sick  bays  of  ships, 
for  use  in  the  field,  and  for  hospitals  where 
the  facilities  for  aseptic  wound  treatment 
are  deficient  and  suppurative  affections  and 
fresh  wounds  have  to  be  handled  in  the 
same  room  or  very  hurriedly,  or  with  inex- 
perienced assistants.  As  far  as  my  mate- 
rial permit  me  to  judge,  I  have  found 
Crede's  statement  to  be  correct ;  I  consider 
his  method  an  efficacious  and  handy  one. 

The  second  advantage  is  the  marked  ten- 
dency of  the  method  to  effect  the  localiza- 
tion of  inflammatory  processes,  as  Crede 
claims.  In  most  cases  the  inflammation  of 
the  tissues  surrounding  the  lesion  subsided 
in  the  shortest  time.  And  even  when  it 
progressed  along  the  lymphatics  a  general 
infection  was  prevented. 

Poisoning  by  the  metal,  or  any  special 
pain  from  its  use  was  not  noticed;  eczemas 
did  occur.  The  course  of  healing  was  not 
noticeably  shortened ;  and  primary  union 
took  about  the  same  time  as  with  aseptic 
treatment.  Necrotic  tissue  when  present 
was  cast  off  with  a  non-irritating  suppura- 
tion before  actual  union  began.  The  cases 
of  general  infection  and  of  burns  were  too 
few  to  permit  of  a  definite  judgment ;  but 
a  favorable  reaction  of  the  system  to  the 
inunctions  was  readily  recognizable.  Gran- 
ulations under  the  citrate  were  almost  al- 
ways remarkable  for  their  vivid  color  and 
vigorous  growth. 


574 


THE  CHARLOTTE  MEDICAL  JOURNAL 


The  abundant  serous  secretion  from  the 
tissues  was  apparently  a  disadvantage  in 
the  cases  where  a  primary  union  was  de- 
sired ;  but  whether  this  was  dependent 
upon  the  citrate  itself  or  upon  other  cir- 
cumstances I  cannot    decide. 

The  cost  of  the  silver  treatment  I  did  not 
find  to  exceed  that  of  other  methods.  The 
Citrate  of  Silver  is  dearer  than  iodoform  ; 
but  it  is  used  in  very  much  smaller  quanti- 
ty, as  a  very  thinly  dusted-on  covering. 
The  Silver  Gauze  is  too  expensive  for  uni- 
versal use  ;  but  I  believe  that  common  gauze 
with  citrate  will  do  just  as  well.  The  price 
of  ointment  is  of  no  importance,  on  ac 
count  of  the  small  quantities  that  are  em- 
ployed. 

The  following  is  the  method  that  I  now 
employ  for  ambulant  patients,  in  view  of 
the  very  reliable  anti-inflammatory  and 
localizing  properties  of  the  Crede  Silver 
preparations  : 

Injuries  and  inflammatory  processes  are 
treated  with  silver  until  all  traces  of  in- 
flammation have  disappeared,  and  until 
healing  by  adhesion  and  granulation  for- 
mation has  begun  in  the  depths  of  the 
wound.  Cicatrization  may  be  promoted 
by  cauterizations  and  salves.  Operative 
wounds  in  which  primary  union  is  not  ab- 
solutely necessary  are  treated  with  silver  if 
it  does  not  appear  that  the  abundant  serous 
secretion  interferes  with  the  healing.  For 
febrile  symptoms  I  employ  the  salve  by  in- 
unction ;  more  rarely  I  administer  the  silver 
internally. 

In  conclusion  I  may  state  that  the  silver 
treatment,  whilst  not  equal  to  the  aseptic 
treatment  of  wounds,  is  reliable  where 
the  latter  cannot  be  carried  out ;  as  in  non- 
aseptic  hospital  operating  rooms,  in  dressing 
rooms,  in  ship  bays,  in  private  practice, 
and  especially  in  the  field.  In  the  latter 
case  the  removal  of  the  first  dressing  need 
not  be  a  matter  of  such  anxiety  as  it  now 
is,  even  if  it  is  soaked  with  secretion  from 
the  wound.  For  it  is  proven  that  the  bac- 
teria cannot  develop  in  secretion  impreg- 
nated with  silver. 

Mv  experience  leads  me  to  place  the 
fullest  reliance  upon  the  silver  treatment  of 
wounds,  and  I  can  recommend  it  in  every 
respect  in  the  most  emphatic  manner. 


The   Postpartum   Douche. 

In  this  case  we  did  not  swing  with  the 
pendulum.  The  following,  which  is  taken 
from  the  Physician  and  Surgeon,  is  in  line 
with  our  views  : 

It  is  interesting  to  watch  the  swing  of 
the  pendulum  of  opinion  in  any  depart- 
ment  of  science  or    art.      From  the     mid- 


point, where  its  motion  scarcely  attracts 
attention,  it  proceeds  to  the  extremity  of 
ostentation  and  dogmatism  only  to  return 
again  into  obscurity  of  moderation.  Such 
has  been  the  history  of  the  postpartum 
douche  and  other  antiseptic  frills  of  the 
lying-in  chamber.  We  are  all  quite  fami- 
liar with  the  precise  rules  of  practice  only 
recently  proclaimed  as  it  were  from  every 
housetop,  and  now,  when  they  have  been 
learned,  are  cautioned  lest  we  too  zealously 
observe  them.  According  to  the  Philadel- 
phia Polyclinic  the  postpartum  douche  has 
already  been  discarded  even  in  the  out- 
patient obstetric  service  of  the  Polyclinic. 
Their  treatment,  following  which  they  re- 
port no  cccurrence  of  septic  infection,  is  as 
follows  :  The  patient's  body  is  thoroughly 
cleansed  before  she  is  put  to  bed.  A  va- 
gainal  douche  of  lysol  or  creolin  is  then 
given.  After  labor  the  patient  is  again 
cleansed  but  no  douche  is  administered. 
This  practice,  the  result  of  both  theory  and 
art,  corresponds,  we  doubt  not,  with  that 
now  most  generally  in  vogue.  Labor  is 
the  culmination  of  a  physiological  act  and 
is  itself  a  physiological  occurrence.  Unless 
it  be  as  a  result  of  meddlesome  artifice 
there  is  no  apparent  reason  why  a  normal 
process  under  normal  conditions  should  be 
made  laborious  and  uncomfortable  as  has 
sometimes  been  the  case. 

Cystitis  and  Urine  Infection. 

Max  Melchor  (New  York  Medical  Re- 
cord). Every  cystitis  is  due  to  microbes, 
with  the  exception  of  rare  poisoning  with 
chemical  substances. 

In  general  we  find  in  the  urine  of  cystitis 
a  pure  culture  of  a  single  species,  generally 
in  large  amounts. 

The  bacillus  which  is  found  most  fre- 
quently in  cystitis  is  identical  with  a  very 
common  intestinal  parasite,  the  bacterium 
coli  commune  ;  it  is  pyogenic  and  infectious 
and  of  varying  virulence. 

In  the  urethra,  the  male  prepuce,  and  the 
vagina  pathogenic  bacteria  are  frequently 
found — bacteria  which  when  conveyed  into 
the  urinary  bladder  can  give  rise  to  cystitis. 

The  microbe  itself  does  not  give  rise  to 
cystitis  ;  still  there  is  a  bacterium — proteus 
of  Hauser,  which  by  simply  entering  the 
urinary  bladder  may  give   rise  to  a  cystitis. 

The  microbes  can  produce  a  cystitis  only 
when  the  urinary  bladder,  on  account  of 
the  influence  of  various  predisposing  cir- 
cumstances, especially  retention  or  trauma, 
is  made  susceptible  to  the  infection. 

Retention  of  urine,  as  well  as  trauma 
pure  and  simple,  is  incapable  of  producing 
a  cystitis.  The  microbe  is  always  the  de- 
ciding cause. 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


575 


The  varying  nature  of  the  cystitis  de- 
pends upon  pre-existing  lesions  and  upon 
the  character  of  the  substrata  in  connection 
with  the  various  peculiarities  of  the  bacte- 
rium, among  which  the  virulence  must  be 
rendered  prominent. 

In  every  cystitis  the  urine  contains  pus 
cells,  but  in  varying  amount.;  the  existence 
of  the  catarrhal  cystitis  is  to  be  looked  upon 
as  doubtful.  Even  non-pyogenic  microbes 
may  cause  a  suppuration  of  the  urinary 
bladder. 

The  ammonuria  may  be  a  necessary  con- 
dition for  the  occurrence  of  a  cystitis  ;  most 
frequently,  however,  it  is  but  a  subordinate 
phenomenon  which  appears  in  the  course 
of  cystitis  or  remains  away  altogether.  The 
majority  of  cases  are  acid. 

Besides  tubercle  bacilli,  an  acid  cystitis 
may  depend  upon  the  bacterium  coli  com- 
mune, the  streptococcus  pyogenes,  and  on 
rare  micro-organisms  (gonococcus  of  Neis- 
ser,  bacillus  typhi  abdominalis).  If  the 
sterile  urine  does  not  produce  any  culture 
upon  the  ordinary  media,  the  great  proba- 
bility is  that  a  tuberculous  cystitis  exists. 

There  exists  a  real  gonorrheal  cystitis, 
caused  by  the  gonococcus  of   Neisser. 

The  urinary  fever  is  partly  due  to  trans- 
mission of  the  urinary  microbes  into  the 
blood,  partly — and  certainly  more  frequent- 
ly— to  an  absorption  of  the  soluble  toxins 
which  occur  in  the  urine. 

To  prevent  a  cystitis,  we  must  not  only 
be  certain  of  a  thorough  asepsis  of  the 
urethal  orifice,  but  we  must  also  irrigate  the 
uretha  with  boric  acid   solution. 

In  the  local  treatment  of  cystitis  nitrate 
of  silver  is  the  sovereign  remedy, 


Serum  treatment  is  useful  as  a  preventive 
and  also  in  the  developed  disease  when  it  is 
possible  to  apply  it  early  or  when  the  pro 
duction  of  toxins  is  still  going  on.  But 
the  results  of  this  method,  if  they  cannot 
be  ignored,  are  neither  convincing  nor  bril- 
liant. Even  if  it  were  the  most  efficacious 
method,  symptomatic  treatment  must  not 
be  neglected.  (7)  A  patient  suffering 
from  tetanus  must  be  treated  eclectically, 
regard  being  had  to  the  wound,  to  the  in- 
tensity of  the  intoxication  and  its  duration, 
and  to  the  special  conditions  present  in  the 
case.  The  injections  cause  no  inconveni- 
ence. The  dose  is  three  to  four  centigram- 
mes of  a  2  to  3  per  cent,  solution,  several 
times  in  the  twenty-four  hours.  In  certain 
cases  a  daily  amount  of  thirty-five  centi- 
grammes has  been  administered  without 
any  sign  of  intolerance  being  manifested. 


Injections   of  Carbolic  Acid  in   the  Treat- 
ment of  Tetanus. 

Ascoli  (British  Medical  Journal).  Of 
forty-seven  cases  treated  with  Tizzoni's 
serum,  ten  died,  and  of  thirty-three  treated 
with  Behring's  serum  thirteen  died.  After 
a  full  consideration  of  the  results  obtained 
by  serum-therapy  in  tetanus,  Ascoli  sums 
up  his  conclusions  as  follows  :  ( 1 )  Statistics 
show  better  results  from  the  carbolic  acid 
than  from  the  use  of  serum.  (2)  The 
carbolic  acid  must  be  given  hypodermically 
and  in  large  doses.  (3)  Under  its  influ- 
ence the  muscular  contractions  and  spasms 
diminish  in  a  marked  degree.  (4)  The 
acid  acts  in  tetanus  particularly  as  an  anti- 
toxic and  a  moderator  of  the  reflex  activity 
of  the  nerve  centres.  (5)  The  energetic 
local  disinfection,  combined  with  the  sup- 
port of  the  patient's  strength,  are  the  cardi- 
nal points  in  the  treatment  of  tetanus.     (6) 


Period  of  Isolation  of  School-Children  for 
Contagious  Diseases. 

The  Medical  Council  of  the  Russian 
Empire  has  established  the  following  per- 
iods of  time  for  the  isolation  of  school- 
children who  have  been  exposed  to  an  in- 
fectious disease  or  have  themselves  suffered 
from  such  a  disease  : 

Scarlatina. — After  exposure,  and  with- 
out development  of  symptoms,  an  isolation 
of  from  twelve  to  fourteen  days  is  required. 
A  child  that  has  been  ill  may  be  allowed  to 
return  to  school  six  weeks  after  the  appear- 
ance of  the  eruption,  provided  there  is  after 
a  time  no  trace  of  desquamation. 

Measles. — Fifteen   days   after  exposure  ; 
or,    in   case   the   disease   has  been   present, 
four  weeks  from  the  beginning  of  the  erup- 
tion,  if  there  is  no  trace  of  desquamation. 

Rubella. — Sixteen    days ;    or    after    two 
weeks  from  the  beginning  of  the  eruption. 
J'aricella. — Seventeen  days;  or  after  the 
fall  of  the  crusts. 

Pertussis. — Fifteen  days  to  twenty  days  ; 
or  after  six  weeks  from  the  beginning  of 
the  cough,  if  kinks  have  ceased,  and  there 
is  no  expectoration. 

Mumps,. -Twenty-two  days  ;  or  after  three 
weeks  from  the  beginning  of  the  parotid 
swelling. 

Diphtheria. — Seventeen  days  ;  or  three 
weeks  after  recovery,  and  after  the  disap- 
pearance of  hyperemia  of  the  pharynx, 
larynx,  and  nose;  if  bacteriological  exami- 
nation is  possible,  only  after  the  disapear- 
ance  of  the  bacilli. 

Variola. — Fourteen  days  ;  or  after  the  fall 
of  the  crusts. 

All  convalescent  patients  should  receive 
two  or  three  warm  bath  at  35  deg.  C. 


576 


THE  CHARLOTTE  MEDICAL  JOURNA.L. 


A  Case  of  Salpingitis,  Ulcerative  Endome- 
tritis and  Proctitis,  Issuing  in  Ova- 
rian Abscess. 

Miss  L R ,  Crotona,   N.  Y.  ; 

admitted  November  25,  1897.  Patient  was 
brought  to  the  hospital  in  extremity  with 
left  salpingitis  and  ulcerative  endometritis  ; 
greatly  debilitated  from  the  influence  of 
opiates  employed  during  two  months  pre- 
vious for  relief  of  pain,  and  having  been 
blistered  and  rubbed,  and  douched  and 
drugged  to  a  condition  little  short  of 
nervous  prostration.  Examination  per 
vaginam  revealed  a  uterus  much  enlarged, 
retroflexed,  tender  and  giving  out  a  pro- 
fuse muco-purulent  discharge.  On  the 
left  side,  the  ovary  could  be  felt  much  en- 
larged, soft,  and  prolapsed.  From  this  ex- 
amination began  to  fear  that  laparotomy 
would  be  necessary,  and  so  advised  the  pa- 
tient. This  she  firmly  refused,  declaring 
that  she  would  rather  die  than  be  unsexed. 
Consequently,  I  could  only  do  the  best  thing 
for  her :  merely  a  thorough  curettement 
and  treatment  of  the  womb,  with  tampon- 
ing of  the  prolapsed  ovary.  On  account 
of  the  patient's  prostrated  condition,  how- 
ever, this  was  delayed,  not  deeming  it  ad- 
visable to  proceed  surgically  until  the  sys- 
tem could  be  properly  built  up.  After  her 
bowels  had  been  thoroughly  regulated,  and 
stomach  washed  out,  she  was  put  on  a  tea- 
spoonful  of  bovinine  every  three  hours,  in 
old  port  wine  and  milk  alternately,  with  a 
light  general  diet,  and  so  continued  to  De- 
cember 6th,  when  the  curettement  was  per- 
formed, the  womb  was  antiseptically 
cleansed  by  the  bovinine-peroxide  reaction 
so  often  described,  with  Thiersch  irriga- 
tion, and  packed  with  gause  saturated  with 
iodoform-bovinine.  This  treatment  was  im- 
mediately followed  by  the  entire  cessation 
of  pain  that  usually  results  from  the  appli- 
cation of  the  blood  treatment,  and  also  by 
a  return  to  almost  normal  temperature. 
The  bovinine-peroxide  depuration, Thiersch 
irrigation,  and  iodoform-bovinine  packing, 
were  repeated  daily,  until  in  ten  days  the 
womb  was  in  a  healthy  condition.  But 
digital  examination  revealed  the  ovary  still 
abnormally  enlarged,  soft,  and  very  sensi- 
tive. In  the  erect  posture,  pain  became 
extremely  severe,  but  diminished  on  lying 
down.  It  seemed  clear  that  the  organ 
could  not  be  saved,  unless  some  novel  way 
of  reaching  it  with  topical  treatment  could 
be  devised  that  might  possibly  be  success- 
ful ;  but  being  reluctant  to  experiment  in 
this  new  field,  I  again  strongly  advised  re- 
moval. The  patient  again  positively  re- 
fused at  all  hazards  to  have  any  such  opera- 
tion performed.      Meanwhile  the  condition 


of  the  ovary,  with  severe  elevations  of 
temperature,  caused  hours  of  intense  effort 
and  anxiety  to  avert  a  sudden  catastrophe. 
So  the  case  see-sawed  between  intervals  of 
danger  and  relief,  with  great  and  increas- 
ing pain,  until  by  January  26th  the  condi- 
tion of  the  ovary  become  so  serious  that  a 
rupture  of  abscess  into  the  peritoneal  cavi- 
ty was  hourly  imminent ;  while  nothing  in 
the  line  of  precedent  could  be  done  to  save 
the  patient,  owing  to  her  determined  re- 
jection of  operation.  As  a  last  effort,  I  now 
told  the  patient  that  I  could  take  no  fur- 
ther responsibility  in  her  case  unless  she 
would  submit  it  to  my  control.  Neverthe- 
less, she  stubbornly  refused  to  allow  her 
ovary  to  be  removed.  I  then  consulted  with 
her  father  on  a  compromise  course  which 
would  test  the  practicability  of  topical 
treatment  for  healing.  This  was,  to  do  a 
laparatomy  for  the  purpose  of  bringing  the 
ovary  to  the  surface  of  the  abdominal 
wound,  where  it  could  be  drained,  depura- 
ted with  the  bovinine-peroxide  reaction, 
and  topically  nourished  with  the  bovinine 
blood.  This  was  agreed  to,  and  'on  the 
27th,  under  A.  C.  E.  mixture,  laparotomy 
was  performed.  The  ovary  was  found 
thoroughly  diseased  and  filled  with  pus,  as 
expected.  The  broad  ligament,  however, 
was  in  a  normal  condition  except  consider- 
able hyperemia. 

The  ovary  was  now  brought  forward  and 
stitched  to  the  abdominal  wound,  incised, 
drained,  scoured  of  septic  matter  by  perox- 
ide-on-bovinine  washed  out  with  iodoform- 
bovinine  gauze.  The  surrounding  tissues 
were  protected  with  iodoform  gauze,  and  the 
wound  was  covered  with  a  wet  Thiersch 
dressing.  This  procedure  was  repeated 
every  day  to  February  9th,  when  no  further 
evidence  of  pus  could  be  perceived,  and 
the  ovary  had  taken  on  a  healthy  appear- 
ance. Meanwhile,  I  had  made  a  plaster 
cast  of  a  funnel  shape,  or  hollow  cone,  the 
large  end  of  which  was  applied  to  cover 
and  protect  the  wound  of  the  ovary,  and 
a  strip  of  gauze  saturated  with  bovinine 
was  passed  into  the  small  end,  excluding 
air,  yet  so  that  the  liquid  should  drip  into 
the  wound.  As  often  as  necessary,  more 
bovinine  was  poured  on  the  gauze  to  keep 
up  the  dripping  blood  supply.  At  suitable 
intervals,  the  cone  was  removed  and  the 
cleansing  of  the  wound  was  repeated.  This 
alternate  cleansing  and  feeding  was  con- 
stantly continued  until  March  2d,  when 
the  ovary  was  entirely  filled  out  with  new 
normal  tissue,  and  practically  restored  to 
health. 

March  3d,  the  edges  of  the  abdominal 
wound  were  freshened ;  the  ovary  was  re- 
leased   from    its    attachment  thereto,     and 


THE  CHARLOTTE  MEDICAL  JOURNAL 


577 


dropped  into  its  place;  the  wound  was 
closed  with  continuous  silk  sutures,  and 
dressed.  March  14th,  the  wound  was  en- 
tirely healed.  The  patient  was  of  course 
still  weak  ;  but  considering  all  she  had 
gone  through,  the  sustentation  of  her  sys- 
tem by  the  internal  blood  supply  continued 
ali  through,  was  a  wonder  for  any  who 
have  not  become  accustomed  to  witnessing 
it.  From  February  1st,  the  dose  had  been 
a  wineglas-sful  every  three  hours.  From 
now  on,  she  pick«l  up  rapidly,  and  on 
March  31st,  having  adjusted  a  proper  ab- 
dominal support,  I  allowed  her  to  leave 
her  bed.  April  1st,  she  took  a  little  walk 
out  of  doors,  and  came  back  feeling  well. 
April  5th,  she  had  a  drive  of  an  hour, 
without  inconvenience. 

On  the  nth  of  April,  this  case  was  dis- 
charged absolutely  well,  a  "new  woman," 
and  a  whole  woman  ;  six  and  a  half  pounds 
heavier  than  she  had  ever  been   in    her  life. 

THE    PROCTITIS    ULCERATIONS. 

Complicating  the  case  there  had  been  a 
severe  ulcerative  proctitis  of  four  years 
standing.  This  case  had  been  under  treat- 
ment at  five  different  New  York  hospitals 
and  in  the  hands  of  five  private  physicians 
besides,  but  no  positive  results  were  ob- 
tained, beyond  a  partial  relief  from  pain 
for  short  periods  only.  After  properly 
washing  out  the  bowels,  under  a.  c.  c.  mix- 
ture a  thorough  examination  of  rectum  was 
made.  It  was  tremendously  congested, 
with  about  twenty  poincs  of  ulceration, 
scattered  irregularly ;  the  largest  on  the 
posterior  wall.  Anteriorly,  one  point  had 
almost  penetrated  into  the  vagina  ;  the  mu- 
cous membrane  of  the  vagina  being  the 
only  part  of  the  dividing  wall  intact.  The 
sphincters  were  very  tight.  Treatment  : 
After  thoroughly  dilating  the  sphincters, 
the  return  was  depurated  with  bovinine- 
peroxide  reaction  and  Thiersch  irrigation. 
The  points  of  ulceration,  with  the  excep- 
tion of  the  one  in  the  anterior  wall  be- 
tween the  rectum  and  vagina,  were 
touched  up  with  the  small  point  of  a  Pa- 
quelin  cautery.  My  reason  for  using  the 
Paquelin  cautery  in  this  case,  instead  of 
pyrozone  or  nitrate  of  silver,  was  that  as 
the  edges  of  ulcers  were  hard,  hypertro- 
phied  masses,  with  no  absorptive  property, 
their  destruction  was  necessary  to  prepare 
proper  surfaces  for  the  reception  of  the 
healing  blood.  The  anterior  ulcer, after  be- 
ing gently  but  thoroughly  scraped,  and  its 
edges  freshened,  these  were  brought  in  op- 
position by  a  continuous  catgut  suture. 
The  rectum  was  now  washed  out  again 
with  Thiersch  and  gently  with  gauze  satura- 
ted with  iodoform  bovinine.  This  was  re- 
moved,  and    the  return  cleansed  as   before, 


and  a  large  gelatin  capsule  filled  with  bo- 
vinine, pure,  was  inserted  three  times  daily 
and  the  rectum  depurated  every  morning  as 
at  first,  for  one  week.  At  the  end  of  this 
time,  the  ulcers,  laterally,  and  the  one  sewn 
up  anteriorly,  had  entirely  healed.  Pos- 
teriorly, they  had  been  reduced  to  about 
one-half  their  original  size,  and  presented 
healthy  granulating  surfaces.  The  bo- 
vinine-gelatin  capsules  were  now  inserted 
night  and  morning,  with  morning  cleansing 
as  before.  At  the  end  of  sixteen  days  from 
the  beginning  of  the  treatment,  the  ulcers 
were  found  entirely  healed,  and  'he  rectum 
in  its  normal   condition. 


North  Carolina  Board  of  Health, 

The  following  complimentary  notice  is 
taken  from  the  Sanitarian  of  New  York  : 

No  narrow  idea  of  its  field  of  work  is 
entertained  by  the  State  Board  of  Health 
in  North  Carolina.  It  does  not  confine  it- 
self to  building  legal  cordons  around  plague 
spots,  or  to  giving  good  advice  in  health 
bulletins  which  nobody  reads,  but  it  uses  a 
large  portion  of  its  annual  appropriation  in 
direct  teaching  of  the  people.  Possibly 
local  conditions  of  a  large  proportion  of 
illiterate  negro  inhabitants  suggested  the 
plan,  but  it  is  undoubtedly  a  good  one. 
"Health  conferences  with  the  people,"  as 
the  board  calls  them,  are  held  frequently  in 
different  parts  of  the  State.  All  in  the 
vicinity  are  invited  to  attend,  and  special 
efforts  are  made  to  secure  the  presence  of 
the  women,  who  are  regarded  as  the  health 
officers  of.the  family.  At  these  conferences 
papers,  adapted  in  language  to  the  hearers, 
are  read  on  questions  of  disease  and  sanita- 
tion. Unclean  premises,  impure  water, 
germ-laden  milk,  and  the  simple  principles 
of  physiology  and  hygiene  are  discussed 
before  these  audiences  by  the  best  physi- 
cians of  the  State. 


As  an  antidote  to  the  toxic  effects  of  cor- 
rosive sublimate  albumen  in  the  form  of 
egg  white  is  most  efficient,  an  insoluble 
precipitate  being  formed.  The  albuminate 
of  mercury  combined  in  the  form  of  a  neu- 
tral soap  known  as  Sapodermin,  forms  a 
powerful  antiseptic  and  germcide  which  is 
not  only  not  poisonous,  but  absolutely  solu- 
ble as  well,  and  not-irritant.  It  does  not 
corrode  metals.  It  possesses  unusual  pene- 
trating power  and  renders  excellent  service 
in  all  parasitic  skin  diseases.  It  i6  com- 
mended for  general  use  by  the  physician, 
and  is  a  reliable  safe-guard  against  infec- 
tion in  making  physical  examinations. 
Mercurialization  seems  not  to  follow  even 
its  continuous  and  prolonged  use. 


578 


THE  CHARLOTTE  MEDICAL  JOQRNAL. 


Chancre  of    the  Tonsil. 

Dieulafoy,  according  to  the  New  York 
Medical  Journal,  states  that  chancre  of  the 
tonsil  is  of  frequent  occurrence,  polymor- 
phous in  character,  and  indued  with  mani- 
fold aspects ;  it  is  sometimes  accompanied 
by  herpes.  At  times  it  stimulates  acute 
amygdalitis.  The  analogy  between  chancre 
of  the  tonsil  and  acute  amygdalitis  is  all 
the  greater  from  the  fact  that  the  symptoms 
are  nearly  identical.  Sore  throat  even  to 
the  extent  of  accentuated  dysphagia,  rigors, 
fever,  and  extreme  lassitude  are  symptoms 
common  to  both  diseases.  Whatever  be 
the  appearance  of  chancre  of  the  tonsil, 
whether  it  presents  the  appearance  of  a 
large  follicular  amygdalitis,  is  erosive,  ul- 
cerative, vegetating  diphtheroid,  whether 
it  is  accompanied  or  not  by  rigors,  fever, 
malaise,  etc.,  symptoms  not  noticed  as  oc- 
curring in  chancres  of  other  regions,  there 
are  three  signs  which  justify  a  diagnosis  of 
chancre  of  the  tonsil.  These  three  signs 
are  :  (a)  the  unilateral  nature  of  the 
lesion;  (6)  the  induration  of  the  tonsil; 
and  (f)  the  presence  of  the  characteristic 
glandular  induration.  In  face  of  a  leison 
of  the  tonsil  which  appears  suspicious — 
eroded  excrescent,  or  ulcerated — in  face  of 
an  acute  amygdalitis  whose  characters  are 
any  way  unusual,  we  should  always  think  of 
a  syphilitic  chancre  of  the  tonsil  if  we  wish 
to  avoid  a  serious  error  of  diagnosis.  The 
diagnosis  is  definitely  confirmed  by  the  ap- 
pearance of  the  roseola  and  mucous  syphi- 
lides. 


The  Action  of    Diphtheria    Toxin  on  the 
Nervous    System. 

Luisada  and  D.  Pacchinoi  (Medical 
Monograph)  report  the  results  of  a  number 
of  experiments  on  dogs  with  the  diphtheria 
toxin.  Their  results  are  substantially  as 
follows  : 

The  diphtheria  toxins  applied  directly  to 
the  nervous  system  provoke  a  profound 
lesion  at  the  point  of  application,  character- 
ized by  an  inflammatory  and  degenerative 
action. 

These  lesions  are  propagated  more  or  less 
extensively  from  the  point  of  application. 

In  non-immunized  dogs,  which  had  been 
injected  by  a  dose  sufficiently  toxic,  the 
phenomena  of  local  reaction  were  noted. 

In  immunized  dogs  the  toxins  constantly 
produced  alterations  in  the  central  nervous 
system,  intense,  localized,  but  of  less  ex- 
tent than  those  produced  in  dogs  non-im- 
munized. 

The  toxin  applied  directly  to  the  medulla 
is  propagated  rapidly  in  all  directions,  pre- 
ferring the  posterior  columns,  the  gray  mat- 
ter, and  the  central    canal,    as     routes.      In 


consequence  of  the  bulbar  invasion,  death 
occurred  in  the  animals  more  rapidly  when 
the  toxins  were  introduced  into  the  medul- 
la than  when  applied  to  any  other  portion 
of  the  cerebro-spinal  axis.  When  the  toxins 
were  introduced  into  the  cerebral  cortex, 
characteristic  leisons  of  these  regions  were 
manifested.  Death  occurred  later, through 
propagation  of  the  poison  to   the    medulla. 

Toxins  introduced  into  the  sheath  of  the 
sciatic  nerve  provoked  an  inflammatory 
process  more  or  less  intense,  but  more  cir- 
cumscribed than  in  the  central  nervous  sys- 
tem. From  the  nerves  the  poison  ascended 
to  the  medulla,  chiefly  through  the  posterior 
columns,  and  thus  provoked  an  ascending 
myelitis. 

The  leisons  produced  upon  the  neuroglia 
by  the  direct  action  of  the  toxins  are  simi- 
lar to  those  reported  by  Vassale,  Donaggio, 
and  others  in  the  various  intoxications  and 
infective  processes.  In  the  oblongato  the 
prevalent  alterations  are  found  in  the  pyra- 
midal tracts  and  posterior  columns. 

The  alterations  produced  by  the  toxins  af- 
fect the  nerve-fibres  more  than  anyother  part 
of  the  nervous  tissue.  These  lesions  affect 
principilly  the  myelin,  and  consist  of 
a  physical  modification  of  it  whereby  the 
connections  between  the  various  nerves 
are  lost.  There  is  partially  a  chemical 
modification  of  the  myelin  also  present. 

The  local  action  of' the  toxins  has  much 
importance  in  the  genesis  of  various  paraly- 
ses as  seen  in  the  human  family,  attacking 
first  the  sheaths  of  the  nerves,  then  the 
nerves,  and  then,  later,  the  nerve  centers 
of  the    medulla. 


Picric  Acid  Dressing  of  the  Umbilical  Cord- 

Rochon  (Canada  Medical  Record)  points 
out  that  three  kinds  of  dressing  are  applied 
10  the  umbilical  cord, the  oily,  the  moist  and 
the  dry.  To  the  first  he  object  that  it  is  im- 
perfectly antiseptic,  and  is  opposed  to  the 
{teratogenic  transformation  of  the  young 
epidermic  elements;  the  second  (moist) 
method  is  sufficiently  antiseptic,  but  it  de- 
lays the  fall  of  the  cord,  and  often  leaves 
an  imperfect  cicatrix  ;  while  the  third  (dry), 
by  the  rapid  desiccation  of  the  cord  which 
it  causes,  produces  the  danger  of  prema-. 
ture  separation  and  haemorrhage.  To  meet 
these  objections  Rochon  proposes  the  use  of 
picric  acid  in  solution.  The  cord  is  sur- 
rounded by  a  piece  of  absorbent  cotton 
soaked  in  a  i  to  200  solution  of  picric  acid. 
Thus  the  decomposition  of  the  cord  is  pre- 
vented and  cicatrisation  of  the  umbilicus  is 
aided.  A  single  dressing  may  suffice,  but 
it  is  best  to  repeat  it  on  the  second  or  third 
day. 


TRF,  CHARLOTTE  MEDICAL  JOURNAL. 


579 


r 

(the  sanitarium, 


BATTLE  CREEK,  j 
MICH. 


INCORPORATED  1867. 


kHE  laigcsl,  most  thoroughly  equipped  and  one  of  the  most  favorably  located  in  the  United  States. 
It  is  under  strictly  regular  management.  Eight  physicians,  well-trained  and  of  large  experience. 
A  quiet  homelike  place,  where  "  trained  nurses,"  "rest-cure,"  "  massage,"  "faradization,"  "  gal- 
*  vanization,"  static  electrization,"  "Swedish  movements,"  "dieting,"  "baths,"  "physical  train- 
S  ing  "  and  all  that  pertains  to  modern  rational  medical  treatment  can  be  had  in  perfection  at  reasonable 
prices  Special  attention  given  to  the  treatment  of  chronic  disorders  of  the  stomach,  and  diseases  pecul- 
iar to  women.     A  special  hospital  building  (ioo  beds)  for  surgical  cases  with  finest  hospital  facilities  and 

Large  fan  fot  winter  and  summer  ventilation.  Absolutely  devoid  of  usual  hospital  odors.  Delight- 
ful surroundings.  Lakeside  resort.  Pleasure  grounds,  steamers,  sailboats,  etc.  Trained  nurses  of 
either  se.x  furnished  at  reasonable  rates. 

J.  H.  KELLOGG,  J1.  D.,  Supt.,  Battle  Creek,  Mich. 


R 


NUT-GLUTEN  BISC 


UIT  :    Made  from  the  purest  wheat  gluten  and  nut  meal.    The  only  food  o 

s  innv  eiit  of  freelv.  without  Manner.     I'i escribed  and  endorsed  hy  the  physi 


;  free  to  phys 


.1  is  enclose. I  with  the  "request.    Others 


BATTLE  CREEK  SANITARIUM  HEALTH  FOOD  CO.,  Battle  Creek,  Mich. 


The  Cause  and  Cure  of  Hiccough. 

Hiccough  usually  attacks  persons  of  nerv- 
ous temperament,  and  young  children  who 
have  overloaded  the  stomach  ;  it  may  also 
be  induced  by  eating  foods  which  have 
been  too  highly  seasoned.  A  variety  of 
means  have  been  suggested  to  stop  hiccough 
among  the  most  efficacious  being  the  fol- 
lowing : 

It  is  recommended  to  distract  the  atten- 
tion of  the  persons  who  are  seized  with  the 
paroxysm  ;  they  are  advised  to  count  the 
flies  on  the  ceiling,  &c.  ;  sometimes  an  at- 
tempt is  made  to  frighten  them,  or  to  sur- 
prise them,  and  if  this  is  successful  the  hic- 
cough is  stopped.  Another  of  the  means 
adopted  is  to  hold  the  breath,  either  by 
counting  up  to  thirty  or  by  repeating  loudly 
and  with  volubility  the  same  sentence  ;  or 
what  is  much  better,  in  drinking  a  glass  of 
cold  water  in  little  sips,  at  the  same  time 
pinching  the  nostrils.  A  good  thing  is  to 
provoke  a  sneezing  fit,  either  by  tickling 
the  inside  of  the  nose,  or  by  the  aid  of  snuff  ; 
■  a  sneeze  is  induced  the  hiccough  is  at 
once  arrested.  The  most  useful  remedy  to 
employ,  and  perhaps  the  most  inoffensive 
and  the  best,  consists  in  sucking  a  piece  of 


sugar  which  has  previously  been  steeped  in 
vinegar  or  drinking  a  spoonful  of  good 
vinegar  in  which  some  sugar  has  been  dis- 
solved. If  this  is  not  at  once  successful,  a 
second  spoonful  is  certain  to  be  so. 


Tuberculosis   in   the  Colored  Race. 

J.  A.  Faison,  (Medical  Record,  March 
II,  1899),  says : 

The  antecedent  tuberculous  diathesis  is 
not  so  characteristic  as  in  the  Caucasian. 

The  susceptible  period  for  the  negro  is 
from  eighteen  to  twenty-five  years  of  age. 

Tuberculous  lymphadenitis  in  children 
and  young  adults  is  not  increasing  in  equal 
ratio  with  phthisis  pulmonalis. 

The  dark  members  of  the  race  are  as 
liable  to  tuberculosis  as  mulattoes. 

Phthisis  runs  a  more  rapid  course  in  the 
negro  than  in  the  Caucasian,  conditions  be- 
ing similar. 

Hereditary  predisposition  does  not  play 
so  important  a  part  with  the  negro  as  with 
whites. 

Scrofula  following  the  law  of  atavism 
has  not  been  observed. 


580 


THE  CHARLOTTE  MEDICAL  JOURNAL.. 


Familiar  Clinical    Picture. 

One  of  the  most  common  class  of  cases  is 
that  in  which  there  are  no  well  denned 
characteristic  symptoms  of  organic  disease, 
but  in  which  there  are  disturbances  of  prac- 
tically all  the  functions  of  the  body.  This 
condition  is  variously  termed  general  debil- 
ity, malnutrition,  general  atony,  etc.  The 
symptom-group  is  an  exceedingly  complex 
and  varied  one,  but  the  most  striking  dis- 
turbances are  those  connected  with  the  pro- 
cesses of  metabolism  ;  the  patient  is  unable 
to  replace  by  food  the  active  waste  occa- 
sioned by  the  physiologic  functions.  In 
consequence  of  this,  nutrition  suffers,  vital 
force  becomes  diminished  and  there  is  func- 
tional disturbance  of  practically  all  the  or- 
gans of  the  body.  The  stomach  and  the 
processes  of  digestion  become  particularly 
enfeebled  and  as  a  consequence  there  arise 
the  symptoms  of  atonic  dyspepsia,  with  lack 
of  appetite  and  inability  of  the  digestive 
organs  to  prepare  the  food  for  assimilation. 
The  patient's  vital  powers  are  at  a  low  ebb 
and  nature's  method  of  recuperation,  that 
is,  by  assimilation  of  food,  is  effectually  in- 
hibited by  inability  of  the  organs  to  furnish 
the  required  properly  prepared  nourishment. 
Every  phvsician  has  many  times  realized 
the  absolute  uselessness  in  these  cases  of  the 
ordinarily  employed  tonics,  iron,  arsenic 
and  strychnine.  It  is  soon  apparent  that 
the  remedies  are  either  not  absorbed  or  if 
they  do  enter  the  system,  they  fail  absolute- 
ly to  re-establish  the  proper  ratio  of  meta- 
bolic waste  and  repair.  It  is  now  univer- 
sally conceded  by  authorities  that  the  first 
requisite  in  the  treatment  of  this  class  of 
cases,  is  to  foster  the  patient's  nutritive 
functions  so  that  food  will  become  assimi- 
lated and  thus  restore  wasted  tissue  and  im- 
paired vital  forces.  The  stomach  is  the  or- 
gan of  prime  importance  and  its  normal 
functional  activity  must  be  re-established 
by  remedies  which  have  a  direct  tonic  alter- 
ative and  stimulant  influence  upon  its  en- 
feebled, inactive  mucous  membrane.  Stom- 
achics— gentian,  taraxacum,  phosphoric 
acid,  etc. — are  the  agents  of  most  service. 
When,  however,  these  stomachics  are  com- 
bined in  a  certain  manner  with  a  remedy 
which,  according  to  the  highest  medical 
authorities,  is  the  best  promoter  of  assimi- 
lation, the  indications  for  treatment  are 
completely  met.  Gray's  Glycerine  Tonic 
Comp.  combats  malnutrition  upon  the  most 
rational  scientific  basis,  that  is,  it  re-estab- 
lishes normal  nutritive  processes  by  its  stim- 
ulant and  alterative  influence  upon  the  di- 
gestive organs  and  also  furnishes  the  where- 
withall — glycerine — to  cause  the  assimila- 
tion of  food  and  medicines.  It  gives  nature 
the    needed    chance    to  resume   its    normal 


work  of  repairing  exhausted  vitality  and 
wasted  tissue.  While  primarily  a  stom- 
achic Gray's  Glycerine  Tonic  Comp.  is  of 
greatest  value  in  all  conditions  of  systemic 
depression  or  exhaustion  occurring  either 
independently  or  as  a  consequence  of  severe 
organic  diseases  such  as  tuberculosis, 
Bright's  disease,  etc.  It  antagonizes  de- 
pression by  propping  the  natural  functions 
of  the  body,  by  engendering  appetite  and 
ensuring  the  absorption  and  assimilation  of 
food — nature's  method  of  repairing  w;iste. 


Toxic  Effects  of    Boracic  Acid. 

Dr.  J.  J.  Evans,  (British  Medical  Jour- 
nal). The  increasing  use  of  boracic  acid 
for  medicinal  and  preservative  purposes  is 
sufficient  reason  for  a  further  record  of  some 
untoward  effects  which  have  been  produced 
by  the  drug  when  given  internally.  About 
five  years  ago  I  had  occasion  to  treat  a  case 
of  cystitis  with  boracic  acid  in  increasing 
doses  of  gr.  x  to  gr.  xx  three  times  a  day. 
When  it  had  been  given  for  about  three 
weeks  an  erythematous  rash  spread  over 
the  man's  neck,  face  and  head.  This  was 
followed  by  some  subcutaneous  edema  and 
a  fine  scaly  dermatitis.  His  salivary  glands 
became  enlarged,  and  eventually  the  hair 
on  the  face  and  head  fell  out,  so  that  in 
about  a  fortnight  he  was  perfectly  bald. 
The  drug  was  discontinued,  but  it  took 
about  six  weeks  before  there  was  any  reap- 
pearance of  hair  on  the  face  and  head.  He 
eventually  made  a  complete  recovery. 

I  have  since  administered  boracic  acid  in 
many  cases  of  cystitis  and  urethritis,  and 
when  it  has  been  given  for  some  time  and 
in  the  above  doses  I  have  observed  similar 
effect — that  is,  an  erythema  followed  by  a 
fine  scaly  exfoliation.  Immediate  discon- 
tinuance of  the  drug  has  prevented  the  de- 
velopment of  the  more  severe  symptoms. 
In  one  case,  however,  in  which  it  was  in- 
advertently continued  the  hair  fell  out  to  a 
slight  extent,  and  there  was  marked  exfoli- 
ation of  the  skin,  especially  on  the  hands, 
with  onychia  and  splitting  of  the  nails. 
As  syphilitic  infection  could  be  excluded 
with  some  certainty,  and  as  the  symptoms 
disappeared  when  the  drug  was  dropped, 
I  can  only  conclude  that  this  was  entirely 
due  to  the  action  of  boracic  acid  on  the 
skin  and  appendages. 

"I  have  given  your  Neurosine  (Dios)  a 
thorough  trial  in  a  severe  case  of  Neurosine 
with  'Tachycardia'  and  it  has  given  entire 
satisfaction.  In  a  case  of  Epilepsy  which  I 
had  in  my  outdoor  Clinic,  the  results,  so 
far,  are  excellent." 

C.   H.  Holzhausen,  M.  D., 

352  w.  2 1  st  St.,  New  York  City. 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


581 


VISKOLEIN 


ABORTS 
TYPHOID 


FEVER 


That  VISKOLEIN  aborts 
Typhoid  and  other  forms 
of  fever,  Pneumonia,  In- 
fluenza, Pyemia,  Septice-         ^■^^^■^■^■■■■■i 

j      u  j.  r  r,  ..  (VITAL  FORCE) 

mia  and  all  diseases  ol  Zymotic 

origin,  results  obtained  by  hun- 
dreds of  physicians  prove  be- 
yond a  shadow  of  a  doubt. 

VISKOLEIN  is  used  hypo- 
dermically  and  per  orem. 

Full  clinical  reports,  formula 
and  other  literature  with  sam- 
ples, will  be  sent  to  any  phy- 
sicians desiring  them.  ^m 

A  sample  consists  of  Hypodermic 
Solution,  Capsules  and  Tablets,  suffi- 
cient for  an  average  case. 

Address  THE  VISKOLEIN  CO.,  aM?ttF 


I A  Therapeutic  Recourse  of  3 


Wide  Application. 

"ThIalioiv 


P  A  Laxative  Salt  of  Lithia. 


m 

h 
h 

a 

I 

s 

h 
m 

h 

2  Prepared  only  for  the  Medical  Profession.  2 

A  INDICATIONS.— Gout  and  all  of  those  diseases  arising  from  a  gouty  condition  of  the  sys-  U 

A    tem,  rheumatism  and  all  of  those  diseases  arising  from  a  general  rheumatic  condition,  chronic  w 

f*    constipation,  hepatic  torpor  and  obesity.    In  all  cases  where  there  is  a  pronounced  leaning  to  m 

m    corpulency,  it  reduces  to  a  minimum  the  always  present  tendency  to  apoplexy.    In  malaria  * 

m    because  of  its  wonderful  action  on  the  liver,  increasing  twofold  the  power  of  quinine.  * 

R  Inasmuch  as  some  difficulty  is  experienced  by  physicians  in  procuring  Thialion,  we  will,  on  R 

receipt  of  one  dollar,  send  one  bottle  containing  four  ounces,  suffloient  for  three  weeks'  treat-  I* 

men  t ,  prepaid  to  any  address.  >  a 

2  a 

H    Literature  on  Application.  jjj 

S"~THE  VASS  CHEMICAL  CO.,  § 

3       *  DANBURY, CONN.  M 


§82 


THE  CHARLOTTE  MEDICAL-JOURNAL. 


A  Case  of  Nasal  Vertigo. 

Dr.  Lacroix  mentions  this  case  (Journal 
of  Laryngology)  : 

As  many  physicians  are  reluctant  to  ac- 
cept the  nasal  lesion  as  the  cause  of  vertigo 
in  certain  cases  in  which  the  symptom  ceases 
after  intranasal  treatment,  the  author  relates 
the  following  example,  in  which  it  is  im- 
possible to  put  down  the  happy  result  either 
to  mere  counter-irritation  or  mental  sugges- 
tion. The  patient  was  a  lady  of  thirty- 
eight,  who  consulted  the  author  for  some 
trivial  throat  affection.  Three  small  polypi 
were  found  in  the  right  middle  meatus,  and 
were  removed  under  cocaine  without  more 
ado.  The  patient  experienced  no  pain  at 
all,  and  the  whole  affair  was  of  the  most 
trivial  character.  Ten  days  later  the  patient 
returned  and  stated  that  she  had  been  a  new 
woman  since  the  previous  visit.  She  then 
related  for  the  first  time  that  for  more  than 
a  year  she  had  suffered  with  giddiness  on 
making  the  least  movement,  and  this  had 
been  very  marked  when  walking.  On  sev- 
eral occasions  she  had  fallen.  A  variety  of 
treatment  had  failed  to  give  relief,  and  sup- 
posing the  trouble  to  be  intractable,  the  pa- 
tient had  accepted  it  as  the  inevitable.  She 
was  therefore  quite  unprepared  for  the  com- 
plete suppression  of  the  vertigo,  which  took 
place  immediately  after  the  removal  of  the 
polypi.  There  is,  therefore,  no  question 
here  of   suggestion  or  of  counter-irritation. 


'Vin   Mariani.' 


is  essentially  the  brain  and  nerve  tonic  of 
those  who  have  talent  and  genius.  These 
it  is  who  compose  the  great  army  of  intel- 
lectual workers,  and  the  ravages  made  upon 
their  nervous  systems  by  the  demands  made 
upon  them  are  at  times  truly  appalling. 
This  damage  and  consequent  drain  yield  to 
nothing  more  quickly  than  to  "Vin  Mari- 
ani." The  most  noted  European  physi- 
cians, literateurs,  musicians,  singers,  artists 
and  diplomats  have  sent  the  most  flattering 
letters  to  M.  Mariani  extolling  his  product. 
Not  only  these  but  crowned  heads  as  well 
have  been  mentally  invigorated  and  reju- 
venated by  "Vin  Mariani"  and  never  tire 
of  speaking  words  in  its  praise.  It  must 
be  acknowledged  that  unsolicited  testimo- 
nials, couched  in  such  glowing  terms,  from 
such  sources,  are  the  best  evidence  possible 
that  can  be  offered  for  the  merits  of  the 
preparation.  When  "Vin  Mariani"  be- 
comes as  well  known  in  this  country  as  it 
is  in  Europe,  it  will  be  adopted  as  one  of 
the  indispensable  remedies  in  the  household. 
—  The  St.  Louis  Medical  and  Surgical 
"Journal,  May.  1899.     . 


The  Management  of  Patients   Before   and 
After  Laparotomy. 

In  the  course  of  an  interesting  and  prac- 
tical paper  with  the  above  title,  read  before 
the  New  York  Medico-Surgical  Society,  by 
Dr.  Frederick  Holme  Wiggin,  Visiting 
Gynecologist  to  the  City  Hospital  ;Surgeon 
to  St.  Elizabeth's  Hospital,  it  is  advised  : 

"If  the  operation  is  to  be  performed  at  an 
earley  morning  hour  (i.  e.,  8  A.  m).,  the 
patient  should  be  given  a  peptonized  milk 
punch  at  eleven  o'clock  the  previous  even- 
ing, and  if  he  awakens  at  5  or  6  a.  m.  one 
ounce  of  Liquid  Peptonoids  may  be  given, 
but  nothing  more.  It  has  been  the  writer's 
experience  that  a  small  amount  (one  ounce) 
of  stimulating  and  concentrated  food,  ad- 
ministered about  two  hours  prior  to  the 
taking  of  the  anaesthetic,  diminishes  the 
liability  to  heart  failure,  and  also  lessens 
the  nausea  and  vomiting  which  frequently 
follow  the  return  to  consciousness.  If  an 
afternoon  hour  has  been  decided  upnri,  an- 
other peptonized  milk  punch  may  be  given 
the  patient  when  he  awakes,  and  one  ounce 
of  Liquid  Peptonoids  at  11  a.  m." 

In  considering  the  after  treatment,  the 
distinguished  author  says  : 

"With  the  passing  of  these  first  twelve  or 
eighteen  hours,  if  the  patient  is  not  suffer- 
ing from  nausea  or  vomiting,  and  the  pulse 
rate  is  much  the  same  as  before  the  opera- 
tion, a  drachm  of  Liquid  Peptonoids  or  of 
some  other  similar  preparation  may  be  given, 
and  repeated,  if  well  borne,  every  twenty 
minutes  until  four  doses  have  been  taken, 
when  after  an  interval  of  two  hours  a  small 
quantity  of  equal  parts  of  milk  and  lime 
water  or  of  peptonized  milk  may  be  given 
from  time  to  time,  until  four  ounces  has 
been  taken.  After  this  there  should  be  an 
interval  of  two  hours  and  then  an  ounce  of 
Liquid  Peptonoids  may   be  administered." 


Wet  dressing  made  by  saturating  sterile 
gauze  with  menthoxol  are  recommended 
very  highly  in  the  treatment  of  all  wound 
surfaces.  Healthy  granulation  is  stimulat- 
ed, pus  destroyed  and  its  further  formation 
prevented.  Camphoroxol  in  the  same  way 
makes  a  superior  dressing  for  the  umbilicus 
in  the  new  born.  Both  are  non-irritant, 
harmless,  and  besides  being  powerful  germ- 
icides exert  this  action  for  a  longer  period 
than  most  antiseptics  of  this  nature.  They 
are  stable  and  retained  their  undiminished 
activity  for  months. 


"I  am  meeting  with  every  success  to  be 
asked  for  in  the  administration  of  Neuro- 
sine  (Dios)  in   Epilepsy." 

R.  E.  Calhoun,  M.  D., 

Chesterville,  Ills. 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


583 


A  SIMPLE  AND  MOST  EFFECTIVE 


Treatment  of  Chronic  Leg  Ulcers 


Thoroughly  wash  and  irrigate  the  ulcer  and  adjacent  parts; 
after  drying  apply  Antinosine  (pulv.),  distributing  the  powder 
Mghtly  over  the  entire  surface.  Over  this  place  a  nosophen- 
gauze  dressing,  the  whole  held  in  place  by  a  roller  bandage. 
In  cases  with  hard  infiltrated  borders,  precede  the  above  treat- 
ment by  curetting. 


(the  sodium  salt  of  tetraiodo-phenolphtalein)  has  been  proven 
by  extensive  and  most  severe  clinical  tests  to  be  beyond  ques- 
tion the  most  efficient  of  all  existing  antiseptics  in  the  treat- 
ment of  ulcers  and  abscesses  generally,  infected  wounds  of 
any  nature:  very  useful  in  palliative  treatment  of  cancerous 
ulcerations,  lupus,  etc.  Antinosine  is  absolutely  non-toxic, 
non-irritating  and  odorless.  It  is  freely  soluble  in  water,  and 
in  solutions  of  1  to  24  per  cent,  gives  most  excellent  results  in 
cystitis,  as  an  injection  in  gonorrhoea,  as  an  antiseptic  fluid  in 
ear,  nose  and  throat  practice,  etc. 

Literature  on  request. 

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584 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


Uterine    Cough. 

Schaeffer  makes  the  following  statement 
(Medical  Standard)  : 

In  those  predisposed,  such  as  neuropaths 
and  sufferers  from  genital  diseases  (espe- 
cially during  menstruation  and  pregnancy), 
cough  may  at  times  be  induced  by  isolated 
contract  with  the  fornix  vaginae. 

In  those  so  predisposed,  pathological 
processes  which  involve  the  board  liga- 
ments, and  especially  Douglas'  pouch,  may 
cause  reflex  cough,  just  as  they  cause  reflex 
acne  and  hyperemesis.  In  the  latter  condi- 
tions abnormal  fermentation  and  auto-in- 
oculation are  probably  also  present. 

In  those  predisposed  to  cough  as  above 
stated,  irritation  of  the  lower  third  of 
vagina  and  vulva  can  occasion  only  local 
reflexes — nothing  remote,  such  as  a  cough, 
can  occur. 

Uterine  cough  is  produced  by  irritation 
on  one  side  of  the  utero-vaginal  fibers  of  the 
hypogastric  plexus  which  supply  the  fornix 
vaginas  and  collum  uteri,  and,  on  the  other 
side,  the  spermatic  plexus,  hemorrhoidal 
nerves  and  ganglia  imbedded  in  the  broad 
ligament  which  supply  the  fundus  uteri 
and  ovaries. 

Irritants  which  affect  the  nervous  puden- 
dus  are  at  first  localized  in  their  reflex  ef- 
fects. 

Reflex  phenomena  may  be  (a)  essential 
physiological  reflexes  in  remote  motor  and 
vaso-motor  territories,  which,  through  the 
neuropathic  basis  are  easily  set  in  motion  ; 
(b)  radiation  in  the  case  of  neuropaths, 
where  resistance  is  weakened;  (c)  irregular 
radiation  in  high  degrees  of  neuropathy. 

Cases  of  tuberculous  habitus,  or  predom- 
inance of  stomach  symptoms,  play  a  sepa- 
rate part  in  the  genesis  of  nervous  cough. 

Local  treatment,  especially  by  pessaries, 
acts  promptly  when  pathological  conditions 
are  complicated,  as  in  the  case  of  retro- 
flexion and  prolapse,   etc. 


Accidents  in  Laparotomy. 

Poroschin  (British  Medical  Journal)  re- 
lates two  cases  of  injury  to  the  urinary  tract 
occurring  in  the  course  of  laparotomy.  The 
first  case  was  that  of  a  woman  aged  53,  who 
was  operated  on  for  a  cystic  tumor  of  the 
right  ovary  and  a  cyst  of  the  broad  liga- 
ment on  the  same  side.  In  separating  the 
latter  from  its  adhesions  the  right  ureter 
was  cut  across.  This  was  noticed  during 
the  operation  through  the  escape  of  urine 
from  the  renal  end  of  the  duct.  The  two 
ends  were,  therefore,  freed  from  the  adhe- 
rent tissues  and  joined  together  by  four  fine 
silk  sutures.  The  stitches  were  passed 
through  the  serous  and  muscular  coats  only, 


leaving  the  inner  layer  intact.  For  greater 
security  a  piece  of  peritoneum  was  put 
round  the  ureter  and  fixed  in  position  by  a 
few  stitches.  The  abdomen  was  closed  in 
the  ordinary  way,  no  drainage  being  pro- 
vided. The  patient  made  an  uninterrupted 
recovery,  getting  up  on  the  twentieth  day 
and  leaving  the  hospital  on  the  thirty- 
seventh  day  after  the  operation.  The  other 
case  was  that  of  a  peasant  woman,  aged  43, 
who  underwent  laparotomy  for  a  large  sub- 
serous fibromyoma  uteri.  In  this  case  the 
fibromyoma  was  firmly  attached  to  the 
bladder  walls,  which  were  torn  in  the  at- 
tempt to  separate  the  tumor  from  them. 
After  the  removal  of  the  growth  the  rent 
in  the  bladder  was  repaired  by  uniting  the  : 
edges  of  a  series  of  sutures  in  layer ;  the 
mucous  coat  was  stitched  together  by  con- 
tinued sutures  while  the  muscular  and  serous 
coats  were  united  by  interrupted  sutures. 
A  catheter  was  left  in  the  urethra  for  the 
first  four  days.  This  patient  also  made  a 
good  recovery. 

Post-Partuni  Management  of  Uterine  Dis- 
placements. 


(Ne 


York 


Eugene  Coleman   Sav: 
Medical  Journal),  says  : 

All  post-partum  displacements  of  the 
uterus  are  of  the  same  general  nature.  The 
question  of  their  prevention  is  one  of  the 
gravest  importance,  having  a  bearing  upon 
longevity  itself.  In  some  few  cases,  *'no 
matter  what  you  do,"  the  womb  will  ob- 
stinately remain  displaced.  Trusting  any 
post-partum  case  to  nature  is  the  wrong 
thing  to  do.  Doing  the  right  thing  will 
obviate  most  of  the  displacements  and  rob 
those  that  persist  of  their  danger. 

This  malady  (of  uterine  displacement) 
is  the  most  prevalent  ill  among  women.  It 
can  largely  be  prevented  when  both  laity 
and  profession  appreciate  its  frequency,  its 
gravity,  our  limitations  in  coping  with  it, 
and  the  ease  with  which  it  can  be  prevented 
in  most  cases.  Trusting  post-partum  cases 
to  nature  is  the  wrong  thing  to  do.  And, 
moreover,  "meddlesome  midwifery" — so- 
called — is  the  only  midwifery  a  scientific 
man  should  deign  to  practice. 

He  advises  :  Termination  of  the  second 
stage  of  labor  before  the  muscles  forming 
on  the  pelvic  floor  have  been  permanently 
deranged  by  over-stretching.  Keeping  the 
woman  from  going  about  until  involution 
is  complete.  Closing  carefully  all  tears  in 
the  pelvic  floor  or  perineal  body.  Support- 
ing the  uterus  in  position  by  pessaries  or 
tampons  when  it  is  heavy  and  tends  to  dis- 
placement. To  administer,  in  proper  doses, 
iron,  ergot  and  digitalis  when  subinvolu- 
tion exists. 


THE  CHARLOTTE   MEDICAL  JOURNAL. 


.585 


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X-Ray  Work  at  St.  Peter's  Hosoital. 

charlotte,  iv.  e. 

A  room  has  been  fitted  up  at  ST.  PETER'S  HOSPITAL  with  the  most  improved 
X-Ray  apparatus.  An  eight-plate  thirty-inch  static  machine  is  used  to  generate  its 
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For  particulars  address. 


St.  Peter's  Hospital, 

Charlotte,  N.  C. 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


A  Case  of    Puerperal  Fever  Treated   with 
Uuguentum   Crede. 

In  the  Deutche  Medicinische  Wochen- 
schrift  of  March  9th,  1899,  Dr.  Peters,  of 
Eystrup,  Hanover,  records  a  case  in  which 
the  ointment  was  employed  with  excellent 
effect.  The  patient  was  a  VII.  para,  thirty- 
three  years  old.  During  the  confinement  a 
manual  separation  of  the  incarcerated  pla- 
centa had  to  be  undertaken,  occasioning 
great  hemorrhage  and  a  very  dangerous  col- 
lapse lasting  for  several  hours.  Thirty-six 
hours  thereafter  there  was  a  temperature  of 
40.5  deg.  C.  (104.9  deg.  F.),  with  violent 
headache  and  anorexia.  There  were  no 
local  symptoms.  On  the  next  day  her 
symptoms  were  the  same,  and  her  fever 
continued. 

On  November  8th,  1898,  the  lochia  had 
become  very  foul  smelling ;  the  tempera- 
ture was  39.4  deg.  C.  (102.9  deg.  F.).  An 
inunction  of  3  grams  (45  grains)  of  Un- 
guentum  Crede  was  given.  In  the  after- 
noon her  temperature  was  39.2  deg.  C. 
(102.5  deg.  F.).  On  the  morning  it  had 
fallen  to  38.6  deg.  C.  (101.5  deg.  F.),  and 
another  inunction  of  similar  amount  was 
administered  ;  in  the  afternoon  her  temper- 
ature was  38.2  deg.  C.  (100.8  deg.  F.). 
From  the  10th  to  the  15th  her  temperature 
varied  between  38.6  deg.  C.  (101.5  deg. 
F.)  and  37.2  deg.  C.  (99  deg.  F.).  From 
the  15th  to  the  18th,  there  was  a  gradual 
rise  to  39.7  deg.  C  (103.5  deg.  F.),  occa- 
sioned by  a  phlegmasia  alba  dolens  of  the 
left  leg,  which  was  treated  locally  with  wet 
compresses  (Priessnitz),  and  disappeared 
without  abscess  formation.  A  third  simi- 
lar inunction  was  given,  and  the  tempera- 
ture fell  by  the  19th  to  38.5  deg.  C.  (101.3 
deg.  F. ) .  Another  inunction  was  given  on 
the  19th  ;  but  the  temperature  rose  again 
on  that  afternoon  and  the  next  day,  and  on 
the  afternoon  of  the  21st,  it  was  39.4  deg. 
C.  (102.9  deg.  F.)  again.  A  fifth  inunc- 
tion was  then  given,  and  the  temperature 
fell  to  37.8  deg.  C.  (100  deg.  F.)  on  the 
morning  of  the  23d.  A  sixth  inunction 
was  then  administered. 

A  similar  inflammation  of  the  right  leg 
was  cured  during  December  2d  to  5th,  by 
similar  treatment,  three  further  inunctions 
being  given.  The  patient  has  now  entirely 
recovered.  It  is  worthy  of  remark  that  the 
prognosis  was  rendered  worse  by  the  acute 
anaemia  and  chronie  bronchial  catarrh  from 
which  the  patient  suffered,  and  by  the  bad 
nutrition  of  the  patient,  who  lived  in  very 
poor  surroundings. 

A  quicker  cure  might  probably  have  been 
obtained  by  a  more  prompt  and  energetic 
employment  of    the  salve  ;   but   on  the    one 


hand  it  was  difficult  to  obtain  it  here,  and 
on  the  other  argyrosis  was  feared.  No  sign 
of  the  latter  occurred,  however,  although 
27  grams  (7  drachms)  of  the  salve  was  in- 
uncted. 

It  was  interesting  to  note  the  very  visible 
influence  of  the  inunctions  upon  the  sub- 
jective condition  of  the  patient.  Always 
mentally  dull,  she  was  apathetic,  ill  tem- 
pered, monosyllabic,  and  hardly  opened  her 
eyes.  On  the  day  following  the  inunction 
she  always  greeted  the  physician  with  a 
smile  when  he  came  in,  even  if  the  fever 
continued,  No  other  antipyretic  or  anti- 
septic measures  were  employed. 


Tonsillitis  with  Albuminuria. 

Dr.  Keiper  (The  Laryngoscope)  describes 
the  case  of  a  man,  32  years  of  age,  the  sub- 
ject of  albuminuria,  and  who  was  attacked 
by  sore  throat.  Upon  the  upper  part  of  the 
left  tonsil  there  was  seen  an  ulcer  as  large 
as  a  gold  dollar,  covered  by  an  exudate 
similar  to  that  of  diphtheria.  The  exudate 
could  be  removed  without  causing  the  sub- 
jacent surface  to  bleed.  The  tonsil  then 
appeared  as  if  it  had  been  curetted.  It  was 
treated  locally  with  a  12.5  per  cent,  solu- 
tion of  silver  nitrate.  On  the  next  day, 
after  the  second  application  of  the  silver, 
there  was  a  hemorrhage  from  the  ulcer.  A 
mixture  of  dry  tannic  acid  and  antipyrine 
was  made  use  of  and  the  hemorrhage  was 
arrested,  but  was  renewed  three  hours  later 
and  this  time  with  more  severity.  It  per- 
sisted in  spite  of  all  efforts  to  check  it,  and 
finally  stopped  spontaneously.  The  patient 
died  nine  days  later  without  any  repetition 
of  hemorrhage. 

The  author  explains  these  hemorrhages 
by  an  alteration  in  the  walls  of  the  vessels 
of  the  tonsils  under  the  influence  of  albu- 
minuria. This  alteration  is  similar  to  that 
met  with  in  the  same  circumstances  in  the 
vessels  of  the  retina  and  choroid. 


Skin  Diseases. 

Luigi  Galvani  Doane,  M.  D.,  formerly 
physician  to  Department  of  Public  Charity 
and  Correction,  New  York,  N.  Y.,  finds 
Unguentine  a  remedy  per  sc.  It  is  soft, 
easily  applied,  its  absorptive  powers  are 
good  and  its  antiseptic  properties  are  better. 

"I  have  used  Unguentine  with  satisfac- 
tory results  in  a  large  number  of  cases  of 
eczema,  comedones,  psoriasis,  and  lepra 
vulgaris  and  find  it  especially  adapted  in 
all  such  cases. 

"I  am  well  satisfied  with  the  use  of  Un- 
guentine in  general  practice  in  cases  where 
it  is  indicated,  such  as  fresh  burns,  cuts, 
bruises,  boils,  felons  and  sore  nipples." 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


587 


A  Progressive  System  of 


...Infant  Feeding 

O  single  Food  is  suitable  for  the  Infant  for    the    whole   period    of   the    first 
nine  months.     At  birth,   the  digestive  powers  are  only   able   to  assimilate 
I     human  milk  or  its  physiological  equivalent ;  and  it  ie  not  until  the  child  is 
six   months  old  that   any   starchy   Food   is   admissible. 


N 


ALLEN  &  HANBURYS  have  introduced  a  SERIES  OF  FOODS  to  meet  the  increasing 
requirements  of  the  infant  economy. 


The  "Allenburys"  Milk  Food,  No.  1 

is,  as  far  as  possible,  an  exact  equivalent  of 
human  milk.  It  is  prepared  in  the  form  of  a 
dried  powder,  from  fresh  and  carefully  selected 
cow's  milk,  at  their  Factory  at  Ware.  The 
proximate  composition  of  the  cow's  milk  having 
been  ascertained,  the  excess  of  casein  is  remov- 
ed  aud  the  deficiency  in  fat  and  milk-sugar  made 
good.  The  mixture  is  then  sterilized  aud  con- 
centrated in  runt/,.  Sterilized  ({totted)  water  is 
then  added  in  the  proportions  indicated  on  the 
labels,  and  a  perfect  humanized  milk  is  obtain- 
ed. The  portability,  ease  oi  mixing,  and  free- 
doin  from  bacterial  contamination  render  this 
preparation  invaluable  not  only  for  general  use 
but  for  delicate  infants  Buffering  from  diarrhoea, 
and  also  in  those  eases  w  here  the  milk  supply  is 
not  above  suspicion,  or  where  long  journeys 
have  to  be  taken.  «  hel  her  by  land  or  sea.  This 
■ood,  as  well  as  the  •  Allenburys"  No.  2,  is  now 
being  extensively  used  in  India  aud  tropical 
climates,  and  is  found  to  keep  perfectly  in  the 
hermetically  sealed  tins. 

This  Food  should  be  given  for  the  first  three 
months. 


The  "Allenburys"  Milk  Food,  No.  2 

is  identical  with  No.  1,  but  contains  in  addition 
small  quantities  of  maltose,  dextrine,  and  solu- 
ble phosphates,  derived  from  the  digestion  of 
whole  meal.  These  are  included  to  meet  the 
increasing  requirements  of  the  infant  economy: 
but  it  should  be  understood  that  there  is  no 
unaltered  starch  present. 

This  Food  is  designed  for  infants  from  three 
to  six  months  of  age. 

The  "Allenburys"  Malted  Food,  No.  3. 

This  preparation  is  a  perfectly  assimilab'e  fa- 
rinaceous Food.  Tt  is  prepared  on  Baron  von 
Liebig'S  principle  of  malting,  but  by  greatly 
improved  methods.  It  differs  from  other  form's 
of  malted  food  in  that  the  malt  is  present  in  a 
soluble,  concentrated,  and  most  active  form. 

The  basis  of  the  Food  is  fine  wheaten  Hour, 
rich  in  nitrogen,  with  this  advantage,  that  a 
large  proportion,  but  not  all,  of  the  starch  is 
converted  by  the  action  of  Malt  Extract.  The 
Food  is  rich  in  soluble  phosphates  and  albume- 
noids,  for  the  formation  of  firm  muscle  and  solid 
bone. 

It  is  prepared  for  use  by  the  addition  of  cow's 
milk.  With  delicate  children,  however,the  tran- 
sition from  No.  2  to  No.  3  Food  is  too  great,  if 
cow's  milk  be  used;  it  is  better,  therefore,  to  em- 
ploy the  No.  1  Food  as  a  substitute  for  the 
cow's  milk,  thus  ensuring  the  preparation  being 
made  with  a  true  humanized  milk. 


A  Sample  of  any  or  all  of  the  Foods,  and  full  descriptive  pamphlet,  will  be  sent 
free  to  any   physician    upon   reqnest.       Address   82    Warrem    Street,    New    York. 

Please  specify  on   prescription  the   NUMBER  of  the   Food  desired 

Allen  &  Hanburys  Ltd.,  (London,  Eng.) 

(est.   a.   d.,    i 7 15. ) 

82  Warren  Street,  New  York. 


Agent  for  Canada:     W.  Lloyd  Wood,  Toronto. 


588 


THE  CHARLOTTE  MEDICAL  JOURNAL 


Treatment  of  Asthma. 

Goldschmidth  closes  an  essay  on  this  sub- 
ject with  a  consideration  of  the  treatment 
of  the  affections.  (London  Lancet).  He 
divides  it  into  (i)  purely  medicinal,  (2)  the 
physical,  and  (3)  the  inhalation  treatment. 
He  attaches  great  value  to  the  use  of  mor- 
phine in  some  cases,  especially  where  the 
attacks  are  infrequent  but  pronounced.  If 
morphine  is  not  well  borne  then  chloral 
may  be  used  in  a  dose  of  2  grammes, 
to  be  repeated  in  doses  of  0.5  gramme 
every  quarter  of  an  hour  until  sleep  is  in- 
duced. More  than  5  grammes  should  not 
be  given  in  this  way.  In  cases  of  prolonged 
asthma  with  expectoration,  iodides  combin- 
ed with  expectorants  and  opium  are  often 
useful.  Amyl  hydrate  also  acts  extremely 
well,  but  sulphonal  and  trional  are  useless. 
Stramonium  fumigation  may  be  of  great 
value,  but  sometimes  fails.  Occosionally 
antipyrine  and  quinine  may  be  useful.  The 
attacks  return  after  the  chloroform  narcosis 
passes  off.  Expectoration  must  be  encourag- 
ed, and  here  the  iodides  are  of  most  service  ; 
they  may  be  given  over  long  periods  of  time. 
In  cases  where  expectoration  is  abundant 
iodides  may  not  only  be  useless  but  harmful. 
Goldschmidt  discusses  the  value  of  the  com- 
pressed air  cabinet. 

This  is  useful  in  some  of  the  sequelae  of 
asthma  but  not  in  the  actual  acute  attack, 
which  may  indeed  be  made  worse  by  it. 
Inhalations  are  far  too  little  appreciated  in 
asthma.  Irritating  inhalations  which  pro- 
duce cough  must  be  avoided.  The  author 
attaches  some  value  to  hydro-therapeutic 
treatment  in  some  cases  of  asthma.  The 
patient  should  gradually  be  accustomed  to 
colder  baths  of  short  duration  with  douches. 
Even  when  catarrhal  symptoms  are  present 
the  body  may  be  vigorously  sponged  with 
water  at  18  deg.  C.  Warm  drinks  should 
be  given  at  the  same  time.  In  some  cases 
of  permanent  asthma  baths  at  27  deg.  C. 
with  douches  at  12  deg.  C.  may  be  of  ser- 
vice. When  these  fail,  vapour  baths  may 
be  of  great  value,  but  they  are  sometimes 
followed  by  untoward  symptoms ;  they 
should  be  limited  to  two  in  the  week. 
Finally,  in  case  of  an  acute  attack  or  an 
exacerbation  the  treatment  is  commenced 
with  stramonium  fumigation.  If  this  fails, 
strong  stimulation  of  the  skin  with  hot 
water  should  be  tried.  If  these  measures 
have  previously  proved  ineffective  morphine 
or  choral  should  be  given. 


Tongaline    and  Quinine  Tablets. 

"One  evening  I  was  called  to  attend  a 
gentleman,  a  member  of  my  own  family, 
who  had  just  returned  from  a  trip  during 
which  he  had  contracted  a  well-developed 
case  of  catarrhal  fever  as  a  result  of  a  sev- 
ere cold.  His  pulse  was  120  degrees,  tem- 
perature 102  2-10  degrees,  skin  hot  and  dry, 
pain  all  over  the  body  and  a  splitting  head- 
ache ;  all  the  mucous  tissues  were  inflamed, 
involving  the  nasal  tract,  throat  and  bron- 
chial tubes ;  the  eyes  were  watery,  and  the 
nose  was  running,  throat  sore, — in  fact  his 
whole  system  was  thoroughly  congested. 

It  was  very  important  that  he  should  be 
able  to  travel  within  a  day  or  two.  I 
ordered  him  to  take  a  hot  foot  bath,  then 
drink  a  hot  lemonade  and  go  to  bed.  I 
left  him  six  Tongaline  and  Quinine  Tablets 
with  instructions  to  take  one  every  half 
hour,  washing  it  down  with  plenty  of  hot 
water. 

I  saw  him  about  seven  o'clock  the  next 
morning  and  received  the  following  report : 
about  one  hour  after  going  to  bed  he  com- 
menced perspiring  and  began  to  experience 
a  feeling  of  drowsiness,  so  that  before  he 
had  taken  all  of  the  Tongaline  and  Quinine 
Tablets  he  fell  into  a  refreshing  sleep,  from 
which  he  did  not  awake  until  five  o'clock. 
I  found  his  pulse  was  normal,  temperature 
99  degrees,  skin  moist,  the  pain  entirely 
gone  and  all  the  unfavorable  symptoms  de- 
cidedly improved  ;  in  fact  the  trouble  was 
thoroughly  under  control.  I  prescribed  a 
mild  cathartic  and  by  the  folio  whig  day  he 
was  able  to  go  on  his  way  rejoicing. 

Since  then  I  have  frequently  given  Ton- 
galine and  Quinine  Tablets  in  similar  con- 
ditions with  marked  success  each  instance." 
Frank  A.  Barber,  M.  D., 

Chicago,  Ills. 


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


A  Non-Depressing  Analgesic. 

Dr.  W.  Gray,  (Medical  Press  and  Cir- 
cular) states  that  the  experience  which  he 
has  had  with  Salophen  leads  him  to  believe 
that  its  greatest  value  and  efficacy  lie  in  its 
employment  for  relief  of  muscular,  gastric, 
gastro-intestinal,  joint  and  head  pains  as- 
sociated with  influenza.  As  to  its  anti- 
pyretic value  he  regards  it  as  inferior  t% 
phenacetin,  for  the  reason  that  its  action  is 
more  delayed  and  the  effect  passes  off  sooner. 
For  affording  relief  for  influenza  headache, 
especially  when  associated  with  giddiness 
and  noises  in  the  ears,  salophen  in  doses  of 
15  grains,  three  or  four  times  a  day,  is 
particularly  valuable.  Dr.  Gray  states  that 
he  has  never  noticed  any  depression  follow- 
ing upon  its  administration. 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


IT  IS  IMPORTANT 

For  the  dispensing-  pharmacist  to  recognize  the  right  of  the  physician 
to  dictate,  not  only  what  remedy  he  shall  use  in  a  given  case,  but  whose 
preparation  he  prefers,  for  the  quality  of  the  medicine  is  often  as  much 
a  factor  in  the  cure  of  disease  as  a  correct  diagnosis. 

Most  druggists  appreciate  this  fact,  some  are  indifferent  to  it, 
A  few  ignore  it,  specification  is  therefore  a  necessity. 

Syrup  Albuminate  of  Iron. 

An  organic  compound  of  Iron,  representing  in  a  purified  and  soluble  form  the  albumin- 
ate and  salts  (phosphates)  present  in  the  blood.  It  contains  0.7  per  cent,  metallic  iron  in  a 
form  readily  absorbed  and  is  very  efficient  in  medicinal  action.  This  combination  of  iron 
approximates  the  natural  forms  in  which  the  metal  is  present  in  the  animal  system,  and 
possesses  a  marked  value  in  anemia  and  chlorotic  neurasthenia  where  prolonged  adminis- 
tration of  iron  is  indicated.  It  is  not  only  free  from  all  tendency  to  cause  digestive  distur- 
bances, but  is  of  positive  value  in  these  conditions  during  convalescence.  One  part  of  this 
syrup  represents  about  fifteen  parts  fresh  bullock's  blood. 

Cordial  Pas=Carnata=Merrell. 

DARTMOUTB  PHARMACY,-  "BY  ALL  MEANS  TRY  IT." 

Established  1798. 
L.  B.  DOWNING,  Box  444.  Hanover,  N.  H.,  July  17,  1895. 

WM.  S.  MERRELL  CHEMICAL  CO.  : 

(Jents: — In  June  I  ordered  your  Fl.  Ext.  Passion  Flower,  as  an  experiment,  for  a  son  of  12 
years,  who  has  made  very  rapid  growth,  and  was  at  the  time  very  nervous,  and  several  physicians 
had  tried  in  vain  to  help  him.  one  an  uncle  in  whose  family  he  staid  for  a  month.  My  wife  hap- 
pened to  see  your  circular  on  Pas-(  'arnata,  and  on  consulting  the  doctors  who  had  treated  him, 
they  said,  "by  all  means  try  it.'* 

The,  result  was  truly  marvelous. 

There  was  a  change  lor  the  better  in  four  days.  Facial  and  shoulder  muscles  were  twitching 
when  tire  commenced  using  it.  In  a  few  days  they  disappeared,  and  on  15  drop  doses  three  times 
a  day  he  keeps  all  right,  apparently. 

I  shall  speak  a  good  word  for  the  medicine,  as  1  have  already  done.  Will  you  please  send 
me  some  circulars  to  give  to  my  physicians'.-'  Very  truly  yours,  L.  B.  Downing. 

NATURAL===from  oil  of  wintergreen. 

TRUE  SALICYLIC  ACID  in  Crystals==Merrell. 
TRUE  SALICYLATE  SODIUM  MXSE§rs--Merrell. 

The  investigations  of  Professor  Latham  (Cambridge,  England),  confirmed  by  Drs.  Char- 
teris  and  MacLennon  (University  of  Glasgow),  warn  the  profession  against  the  use  of  arti- 
ficial acid  of  commerce  and  its  Sodium  salt. 

They  conclude   that     |  are  slow,  but  certain  poisons. 
*~i  •     J         I  produce  symptoms  closely  resembling  delirium  tremens. 

dOllllliCrClcll  patients  become  delirious. 

c     .  .         . .  .       .   ,  !  dangerous  to  human  life. 

oH  I  ICy  llC    A  CI  11     have  to  be  watched  and  not  to  be  trusted. 
VXD  ITS  I  retard  convalescence 

c     -  .        |  should  not  be  administered  internally,  however  much  they  may 
SOUlUlll    oalt        (         have  been  dialized  or  purified. 

For  internal  use  the  true  Salicylic  acid  and  its  Sodium  salt  should  only  be  dispensed. 


THE  Wm.  S.  MERRELL  CHEMICAL  CO. 

Cincinnati.  New  York,  San  Francisco. 

MERRELL  products  are  supplied  through  professional  channels  ONLY. 
JOHN  M.  SCOTT  &  CO.,  Charlotte,  N.  C, 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


The  Vomiting  of  Pregnancy. 

Dr.  Bacon  says  (Amer.  Jour,  of  Med. 
Science,  June,  1898)  : 

The  abnormal  irritability  of  the  nervous 
system,  including  the  vomiting  center,  is  to 
be  allayed  by  keeping  the  patient  in  the 
horizontal  position,  by  attention  to  the 
skin,  bowels,  and  kidneys,  using  rectal, 
and,  if  necessary,  hypodermic  injection  of 
salt-solution. 

The  hysterical  condition  which  is  so  com- 
monly present  should  be  controlled  by 
strengthening  the  will  and  influencing  the 
dominant  idea  of  the  patient. 

All  sources  of  peripheral  irritation  should 
be  discovered  and  treated. 

In  extreme  cases  subcutaneous  saline  in- 
jections serve  the  three-fold  purpose  of  (a) 
diluting  the  blood  and  increasing  vasular 
tension;  (b)  eliminating  toxins  through 
renal  and  intestinal  emunctories ;  (c)  fur- 
nishing two  most  important  kinds  of  food. 

Induction  of  abortion  is  never  indicated. 
At  a  stage  when  it  is  safe  and  efficient  it  is 
not  necessary,  and  in  extreme  cases  it  adds 
greatly  to  the  danger,  rarely  stops  the  vom- 
iting, and  can  be  replaced  by  the  artificial 
serum. 


Veratrum   Viride  in  Pneumonia. 

Called  to  a  case  previously  healthy,  with 
history  of  distinct  chill  or  chilly  feelings, 
followed  by  sudden  rise  of  temperature 
ranging  from  103  to  105,  pulse  full  and 
strong,  but  breathing  rate  quickened  in  a 
marked  degree  beyond  its  normal  ratio  to 
the  pulse  rate,  with  cough,  rusty  sputa  and 
subcrepitant  rales,  we  may  confidently  dia- 
gnose pneumonia.    Now  what  shall  we  do? 

There  is  fire  in  the  lungs  and  it  heats  up 
the  whole  house.  The  proper  thing  to  do 
in  case  of  a  fire  is  to  turn  on  the  hose.  The 
fire  must  be  drowned  out  and  our  action 
must  be  prompt  and  decisive.  A  "weary 
wandering  Willie"  saw  a  school  house  on 
fire,  and  he  said  to  his  partner — "I  will  be 
a  fire  brigade  and  go  and  put  out  that  fire." 
He  moved  slowly  toward  it,  and  after  a 
long  time  returned  to  his  companion  and 
reported  the  fire  "out."  "Did  you  put  it 
out!  Inquired  his  partner.  "No, — it 
burned  out,"  was  his  reply.  The  pneu- 
monia patient  expects  the  doctor  to  drown 
out  the  fire  in  his  lungs,  and  not  let  it 
"burn  out"  his  whole  respiratory  tissue, 
and  the  doctor  can  do  it  very  promptly  if 
he  is  rightly  "onto"  his  job. 

Norwood's  Tincture  is  the  remedy,  and 
it  will  do  its  work  with  almost  mathemati- 
cal precision  if  given  in  a  proper  method 
and  with  a  definite  object  in    view.     Re- 


I  gardless  of  the  stage,  if  there  is  brickdust 
sputa,    give    four    drops    at    once,    (for  an 

J  adult)   and  add  two  drops  to  each  succeed- 

j  ing  dose,  the  intervals  between  doses  being 
about  two  hours,  and  the  ratio  of  increase, 
being  from  four  to  six,  eight,  ten.  twelve 
drops  and  so  on  till  the  definite  object  in 
view  is  accomplished,  viz.  :  nausea  to  relax- 
ation, and  vomiting,  Nothing  short  of 
this  will  completely  terminate  the  inflam- 

i  matory  process  that  is  going  on  in  the  lungs. 
It  may  take  from  six  to  twenty  hours  to 
produce  this  desired  effect,  but  once  pro- 
duced, the  work  is  done.  It  may  require  a 
little  stimulant  and  perhaps  a  small  dose  of 
opium  to  counteract  the  nausea  and  prostra- 
tion, but  this  soon  passes  away,  leaving  the 
patient  with  a  slow  pulse  and  a  temperature 
but  little,  if  any,  above  normal.  In  this 
brief  period  the  fire  has  been  drowned  out, 
and. all  the  patient  has  to  do  is  to  get  rid  of 
the  inflammatory  exudate  by  expectoration 
or  absorption. 

It  will  not  do  to  simply  hold  down  the 
pulse  with  the  Veratrum.  The  disease, 
like  a  man  held  down,  is  not  conquered 
until  it  cries  "enough,"  and  this  it  does 
when  the  induced  "sea  sickness"  compels 
it  to  disgorge  its  pulmonary  accumulation 
of  blood  back  into  the  veins,  through  the 
thorough  relaxation  of  the  vaso-motor  and 
sympathetic  system. 

E.  II.  Trickle,  M.  D. 
Cutler,  Ohio. 


The    "Allenburys"   Foods. 

Allen  &  Hanburys,  the  oldest  and  largest 
firm  of  manufacturing  chemists  in  England, 
was  established  in  London,  A.  D.  1715, 
and  for  more  than  100  years  have  been  the 
recognized  leaders  in  their  line,  their  numer- 
ous preparations  being  known  throughout 
Europe  and  the  English  colonies  as  the  very 
finest  that  pharmaceutical  science  and  skill 
can  produce.  Their  Infants'  Foods,  which 
they  are  now  introducing  into  the  United 
States,  are  not  only  composed  of  the  purest 
and  most  suitable  ingredients,  but  are  based 
on  Allen  &  Hanburys  original  System  of  A 
Progressive  Dietary.  This  sensible  Dietary, 
which  is  heartily  endorsed  by  physicians 
wherever  it  is  known,  provides  the  proper 
food  for  the  several  stages  of  infancy, 
giving  to  the  infant  all  the  nourishment  it 
needs  and  can  assimilate,  but  no  more; 
thus  neither  starving  it,  nor  weakening  its 
digestive  powers  by  over-feeding,  as  is 
often  the  case  with  the  ordinary  foods. 

The  "Allenburys"  System  and  Foods, 
once  they  become  known,  will  no  doubt 
appeal  as  strongly  to  the  physicians  of  this 
country  as  they  do  to  those  of  the  old. 


THE  CHARLOTTE  MEDICAL  JOURNAL.  591 


HYDROZONE 

(30  volumes  preserved  aqueous  solution  of  H302) 

JS  THE  MOST   POWERFUL   ANTISEPTIC  AND    PUS  DESTROYS*. 
HARMLESS  STIMULI  f  TO  HEALTHY  GRANULATIONS. 

GLYCOZONE 

(C.  P.   G/yc»rine  combined  with  Ozone) 

THE  MOST  POWERFUL  HEALING 
AGENT  KNOWN. 

These  Remedies  cure  all  Diseases  caused  by  Germs. 

Successful! 7   used   in  the  treatment   of    Diseases  of   the  Nose, 
Throat  a»3  '-\iest: 

Diphtheria,  Croup,  Scarlet  Fever,  Sore  Throat,  Catarrh  of 

the  Vf)se,  Ozcena.  Hay  Feves\  LaGrippe,  Bronchitis, 

>sthma   Laryngitis,  Pharyngitis,  Whooping  Cough,  Etc. 

"Vnd  for  f  ee  240-page  book  "Treatment  of  Diseases  caused   by 
Germs,"'  ontaining  reprints  of  120  scientific  articles  by  leading 

contributors  to  medical  literature. 

Physicia  is  remitting  50  cents  will  receive  one  complimentary 

Mmple  of  tnch,  "Hydrozone"  and  "Glycozone  "  by  express,  charges 

prepaid. 


Prepared  only  bt 


1fc#cucW^>, 


Hydrozone  is  put  up  only  in  extra  small, 
Small,  medium  aad.  large  size  botiles,  bearing  a 
red  label,  white  letters,  gold  and  blue  border 
•ith  my  signature 

Glycozone  is  put  up  only  in  4-oz.,  8-oz. 
•nd  16-oz.  bottles,  bearing  a  yellow  label,  white 
and  black  letters,  r«»d  ami  blue  border  with  my 
Signature.  Chemist  and  Gradualt  o/t*e  "Ecole  Ctntrate 

Marchand'S  Eye  Balsam  cures  all  inflar   .        **  ^  "  •  *'  Manufactures  de  Fa**"  IAwi). 
Vatory  and  contagious  diseases  of  the  eyes- 

Charles  Marrhand,  28  Prince  St.,  New  iork 

•Old  l>y  leading  Druggists.  AToid  iiwttaAious.  ^  Mention  /nis  PublicttOMU 


5C)2 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


LISTERINE 


The  Standad    Antisptic 


LISTERINE  is  a  non-toxic,  non-irritating1  and  non-escharotic  antiseptic,  composed  of  ozonifer 

ous  essences,  vegetable  antiseptics  and  beuzo-boracic  acid. 
LISTERINE  is  sufficiently  powerful  to  make  and  maintain  surgical  cleanliness  in  the  antisepti 

and  prophylactic  treatment  and  care  of  all  parts  of  the  human  body. 
LISTERINE   has   ever   proven  a  trustworthy  antiseptic   dressing   for  operative   or  accidental 

wounds. 
LISTERINE  is  invaluable  in  obstetrics  and   gynecology  as  a  general   cleansing,    prophylactic- 

or  antiseptic  agent,  and  is  an   effective   remedy  in  the   treatment  of  catarrhal   conditions  of 

every  locality. 
LISTERINE  is  useful  in  the  treatment  of  the  infectious  maladies  which  are  attended  by  inflam 

mation  of  accessible  surfaces— as  diphtheria,  scarlet  fever  and  pertussis. 
LISTERINE  is  especially  applicable   to  the  treatment  of  scarlet  fever,  used   freely  as  a  mouth 

wash,  or  by  means  of  the  spray  apparatus. 
LISTERINE  is  extensively  prescribed  in  typhoid    fever,  both  for  its  antiseptic   effect  and  to  im- 
prove the  condition  of  the  stomach  for  the  reception  of  nourishment. 
LISTERINE  agreeably  diluted,  is  prescribed  with  very  good  results,  in  the  treatment  of  diph- 
theria, both  as  a  prophylactic  and  curative — internal  antiseptic — agent. 
LISTERINE  is  used  extensively  with  good  results  in  the  treatment  of  whooping  cough. 
LISTERINE  diluted  with   water  or  glycerine  speedily  relieves   certain  fermentative   forms  of 

indigestion. 
LISTERINE  is  indispensable  for  the  preservation  of  the  teeth,  and  for  maintaining  the  mucous 

membrane  of  the  mouth  in  a  healthy  condition. 
LISTERINE  employed  in  a  sickroom  by  means  of  a  spray,  or  saturated   cloths   hung   about,   is 

actively  ozonifying  and  imparts  an  agreeable  refreshing  odor  to  the  atmosphere. 
LISTERINE  is  of    accurately   determined   and   uniform    antiseptic   power   and  of   positive  ori 

ginality. 
LISTERINE  is  kept  in  stock  by  the  leading  dealers  in  drugs,  everywhere. 


Lambert's  Lithiated  Hydrangea, 


Close  clinical  observation  has 
caused  Lambert's  Lithiated 
Hydrangea  to  be  regarded  by 
Phvsicians  generally  as  a  very 
valuable  Renal  Alterative 
and  Antilithic  Agent. 


Albuminuria,  Lithaemia, 

Blight's  Disease,      Nephritis, 
Cystitis,  Rheumatism, 

Diabetes,  Urinary  Calculus, 

Gout,  and  all  forms  of 

Haematuna,  Vesical  Irritation 


For  Descriptive  Literature,  Address 


Lambert  Pharmacal  Co., 


ST.     LOUIS, 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


593 


MICA 
PLATES 

are  made  from  the  best  India  Mica, 
split  to  the  thinnest  lamina,  put  into 
dies  with  cement  and  turned  out 
under  hydraulic  pressure,  with  the 
moulds  at  a  temperature  of  700 
degrees  Fahrenheit. 

As  used  in  our  Static  Machines 
they  can  be  run  2,000  revolutions  a 
minute  ;  Glass  plates  the  same  size 
would  break  at  a  higher  speed  than 
300  and  as  the  current  depends  upon 
the  speed  at  which  the  machine  is 
run,  our  4 -plate  MICA  Machine  will 
give  better  results  and  do  better 
X-Ray  work  than  the  largest  Glass 
plate  machine  in  the  market. 

We  are  the  only  Manufacturers 
who  can  make  a  MICA  Plate  Static 
Machine.  It  is  our  Invention  and 
we  have  it  fully  covered  by  Letters 
Patent,  catalogue  on  application 
R.  V.  WAGNER  A.  CO.,  inc. 
308   DEARBORN   ST. 


CHICAGO 


Resinol   as  an   Application  to  Septic 
Wounds. 

I  have  been  using  Resinol  with  marked 
success  for  sometime.  It  is  seldom  that  1 
commend  in  writing  any  medicine  or  phar- 
maceutical products,  but  the  time  has  come 
when  I  would  show  my  ingratitude  were  I 
not  to  speak  a  good  word  for  Resinol  and 
cite  my  own  case. 

About  four  weeks  ago  I  received  a  very 
slight  cut  on  my  finger  while  performing 
an  operation.  I  thought  nothing  of  it  at 
the  time,  supposing  it  would  heal  rapidly 
as  my  flesh  usually  does,  but  to  the  contrary 
I  found  in  about  five  days  that  I  had  blood 
poison.  I  used  everything  I  could  think  of 
for  two  weeks,  but  the  finger  was  growing 
worse.  The  wound  would  heal  over  every 
night  but  the  inflammation  and  pus  were 
increasing  every  day.  I  happened  to  take 
up  a  sample  box  of  Resinol  that  lay  in  my 
office  and  on  the  first  application,  I  found  a 
great  change.  Applied  for  three  days  and 
effected  a  complete  cure.  Would  time  and 
space   permit   would  give  full  details  of  the 


A.  C.  Buxton,  M.  D. 


Salem,  Mass. 


The  Memphis,  Tenn.,  Scimitar  of  April 
24th  says  that  :  the  Seaboard  Air  Line  and 
the  Nashville,  Chattanooga  &  St.  Louis 
railroad  brought  into  Memphis  yesterday 
two  cars  of  freight  which  had  made  an  ac- 
tual running  time  of  four  and  one-half  days 
from  New  York.  This  is  the  fastest  time 
made  up  to  date  in  this  city  by  a  rail  and 
water  line,  and  is  close  to  the  time  made 
by  the  all  rail  lines,  none  of  which  run  it  in 
less  than  four  days. 


The  Woman's  Medical  College  of  St. 
Petersburgh  accepts  no  student  without 
written  premission  from  parents  or  husband. 


50   YEARS' 
EXPERIENCE. 


TRADE  MARKS, 
DESIGNS, 
COPYRIGHTS  &.c. 
Anyone  sending  a  sketch  and  description  may 
quickly  ascertain,  free,  whether  an  invention  is 
probably  patentable.  Communications  strictly 
confidential.  Oldest  agency  for  securing  patents 
in  America.     We  have   a  Washington  office. 

Patents  taken  through   Munn  &  Co.  recelT« 
special  notice  iu  the 

SCIENTIFIC   AMERICAN, 

beautifully  illustrated,    largest   circulation   of 
any  scientific  journal,  weekly,  terms $3.00  a  year; 
$1.50  six  months.     Specimen  copies  and  HAtfD 
Book  on  Patents  sent  free.    Address 
MUNN    &    CO., 
361  Broadway.  New  York. 


594 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


Colden's 


LIQUID     BEEF    TONIC. 


.  .  .  SPECIAL  ATTENTION  .  .  . 

of  the  Medical  Profession  is  directed  to  this  remarkable  Curative 
Preparation,  as  it  has  been  endorsed  by  THOUSANDS  OF  THE 
LEADING  PHYSICIANS  OF  THE  UNITED  STATES,  who  are  using 
it  in  their  daily  practice. 

COLDEN'S  LIQUID  BEEF  TONIC  is  invaluable  in  all  forms  of  Wasting 
Diseases  and  in  cases  of  convalescence  from  severe  illness.  It  can  also  be  de- 
pended upon  with  positive  certainty  of  success  for  the  cure  of  Nervous  Weakness, 
Malarial  Fever,  Incipient  Consumption,  General  Debility,  etc. 

COLDEN'S   LIQUID   BEEF  TONIC 

Is  a  reliable  Food  fledicine ;  rapidly  finds  its  way  into  the  circulation  ;  arrests 
Decomposition  of  the  Vital  Tissues,  and  is  agreeable  to  the  most  delicate 
stomach.  To  the  physician,  it  is  of  incalculable  value,  as  it  gives  the  patient  assurance 
of  return  to  perfect  health.     Sold  by  Druggists  generally. 


The   CHARLES   N.   CRITTENTON  CO.,  General  Agents, 
Nos.  115  and  117  Fulton  Street,  NEW  YORK. 


*Hf  f  If  f  »f  ff  »f  f  W  Iflfl 


THE  WINKLEY  ARTIFICIAL  LIMB  CO. 

Largest  Manufacturers  of  Artificial  jUgs  '"  the  World. 

DoZie-siipfocL  ARTIFILIAL  LIMB. 

Warranted  not  to  Chafe  the  Stump. 


PERFECT  FIT  guaranteed 

■       ■■  ■  ■  ■     ■.  ^^    ■  ■     ■     ■        From  Casts  and  Measurements. 


Send  for  New  1899  Catalogue  and  Self  Measuring  Sheet. 

(Department  A.)      MINNEAPOLIS,   MINN. 


Acute  Gonorrheal    Meningitis. 

J.  S.  Wooten  (Journal  American  Medi- 
cal Association)  reports  this  case  : 

The  patient  was  thirty-six  years  of  age, 
weighed  175  pounds,  and  was  in  perfect 
health  up  to  the  contraction  of  an  acute 
gonorrhea,  the  proper  treatment  of  which 
was  entirely  neglected  until  he  sought  med- 
ical advice  with  a  well-developed  gonocys- 
titis.  Improvement  was  marked  and  satis- 
factory after  a  few  days'  treatment.  The 
patient  was  not  seen  for  three  days,  and  the 
doctor,  when  called,  found  that  he  had  had 
a  rigor,    temperature    was    103    deg.,    skin 


bathed  in  perspiration,  pulse  full,  quick, 
and  bounding.  He  was  hilarious,  excited, 
and  talked  at  random  ;  complained  of  head- 
ache, vertigo,  and  nausea.  He  was  fairly 
rational  when  his  attention  was  attracted, 
but  this  gave  place  to  an  increasing  drowsi- 
ness, which  deepened  into  coma  and  death 
at  the  end  of  about  ten  days.  Toward  the 
close  of  the  period  a  gonorrheal  arthritis 
developed  in  the  left  elbow  and  right  knee- 
joint.  Marked  trismus,  deafness,  hiccoughs 
and  muttering  delirium  preceded  the  end, 
the  meningitis  having  lasted  twenty-one 
days. 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


TABLE   OF   CONTENTS   FOR  MAY,    1899. 


Original   Communications. 

The  Internal  Use  of  Car- 
bolic Acid,  by  E.  R.  Max- 
son,  M.  D.,  A.  M.,LL.D., 
Syracuse,   New  York....  493 

Chronic  Gastritis — Resting 
a  Plea  for  more  Careful 
Consideration  in  the  Di- 
agnosis and  Treatment  of 
the  Same  by  the  General 
Practitioner,  by  Eugene 
R,  Morris,  M.  D.,  Ashe- 
ville,  N.  C 494 

Tuberculosis —  Prevention 
and  Treatment  with  Some 
Personal  <  )bservations  on 
the  Use  of  Anti-Tuber- 
cle Serum,  by  A.  E.  Pow- 
ell, M.  D.,  Marion,  Ind.. .   499 

Treatment  of  Eclampsia, 
by  Louis  I).  Barbot,  M.D., 
Charleston,  S.  C 504 

The  Principles  of  (  'onset- v- 
ative  Surgery,  by  Irving 
rJ.Haynes,  Ph.  B.,  M.  D., 
Professor  of  Anatomy  in 
the  Cornell  University 
Medical  College;  Visiting 
Surgeon  of  the  Harlem 
Hospital:  Member  of  the 
New  York  Academy  of 
Medicine,   etc ' 508 

The  Weak  Heart  in  Pneu- 
monia, by  P.  i;  Millard, 
M.  I)..  San  Diego,  Cal. .  .  -Ml 

Treatment  of  Whooping 
Cough,  by  Robert  < '.  Ken- 
ner,  A.  M.,  M.  I)..  Louis- 
ville,  K'y 513 

Abscess  of  the  Lung  with 
Reference  to  Its  Surgical 
Treatment.  by  P.  M. 
Doolcy,  M.  !>.'.  Buffalo, 
N.  Y..  Attending  Sur- 
geon Buffalo  Hospital. 
Sisters  of  Charity,  and 
Emergency  Eospital;Sur- 
geon  to  Erie  Railroad 
Company  ."14 

The  Philosophy  of  Mater- 
nal Impressions,  by  Wil- 
liam Mathews<  >gle,Ph.  B., 
M.  S..  M.  I).,  Delaware 
City,  Del :,lti 

The  Practical  Advantages 
of  Modern  Standardized 
Preparations,  by  P.  ( >. 
Hawley,  M.  D..(  iharlotte, 
N.  C 520 

The  Report  of  Three  Ab- 
dominal Sections  on  the 
Same  Woman  in  .r>  Years 
The  Second  Being  Cesar- 
ean Section,  the  Mother 
and  Child  both  Living. 
by  s.  W.  Pryor,  M.  D. . 
<  Ihester,  S.  C 523 

press  as  a  Factor  in  the 
Causation  of  Catarrhal 
Diseases,  by  C.  1'.  Amb- 
ler, M.  I).  Asheville.N.  C  530 


The  Care  of  the  Digestive 
Tract  in  Tuburcular  Pa- 
tients, by  H.  J.  Chap- 
man, M.  D.,  Asheville, 
N.  C 524 

The  Diagnosis  of  Appendi- 
citis, by  Frank  T.  Meri- 
wether, M.  D.,  U.  S.  A., 
Retired,   Asheville,  N.  C  537 

The  Preventive  and  Cura- 
tive Treatment  of  Ec- 
lampsia, byS.  M.  Davega 
M.  D. ,  Chester,  S.  C 540 

Clinical  Experience  Show- 
ing the  Physiological  Ac- 
tion of  Mercauro  and  Ar 
senauro,  by  W.  Doss 
Thompson,  New  York. . .   543 

Editorial. 

The  Morphine  Habit 549 

1.-  <  ienius  a  Form  of  Insanity  550 

Pseudo  Neurasthenia 550 

Recent  Dispensary  Legisla- 

tion 551 

Medical   Literature 551 

"Knowledge     Comes      but 

Wisdom  Lingers" 551 

Keep  the  Baby  Warm 552 

Diabetes  Mellitus 552 

Book    Reviews, 

Chemistry:  General,  Medi- 
cal and  Pharmaceutical, 
including  the  Chemistry 
of  the  TJ.  S.  Pharmaco- 
poeia, by  John  Attfield, 
P.  P.  S....~— 552 

The  International  Medical 
Annual,  1899.  A  Work 
of  Reference  for  Medi- 
cal Practitioners,  E.  B. 
Treat  &   Co..  New  York.  553 

The  Anatomy  of  the  Central 
Nervous  System  in  Gen- 
eral, by  Prof.  Ludwig 
Pdinger 553 

The  Principles  of  Bacteri- 
ology, by  A.  C.  Abbott, M. 
D  . .- 554 

An  Essay  on  the  Nature  and 
Consequences  of  Anoma- 
lies of  Refraction,  by  F. 
C.  Ponders.  M.  D.,  Phil- 
adelphia    554 

Saunders'  Medical  Hand- 
Atlases,  by  Prof.  Dr.  O. 
Hoab,  of  Zurich 555 

David  Harum,  by  Edward 
Noves  Westcott,  New 
York 555 

A  Pratical  Hand-Book  on 
the  Muscular  Anomalies 
of  the  Eye,  by  Howard  H. 
Ilansell,  A.  M.,M.  P....  555 

Pelinoscopy  (or  Shadow 
List)  in  the  Determina- 
tion of  Refraction  at  one 
meter  Distance,  with 
Phone  Mirror,  by  James 
Thorington,  M.  D 555 


Maisch's  Materia  Medica,  by 

John  M.  Maisch,  Phar.  D .    554 
Practical   Materia    Mediea 
for  Nurses  with    an    Ap- 
pendix,  by  Emily    A.  M. 

c,  Strong ' 555 

Surgical  Nursing,  by  Ber- 
tha M.  Voswinkel 55(j 

Transactions  of  The  Ameri- 
can Pediatric  Society,  by 
Floyd  M.  Cransdall.  M.  D  556 
Transactions  of  the  Ameri- 
can Surgical  Association, 
by  De  Forest  Willard,  A. 

M.,  M.  D.,  Phi 556 

Literary  Notes. 

Lippincott's   Magazine 556 

The     American      Monthly 

Review  of  Reviews 557 

Scribner's  Magazine 557 

The  Forum 557 

The  Living  Age 557 

Miscellaneous- 

A  Contribution  to  the  Crede 
Silver  Method  of  Wound 
Treatment 572 

A  Case  of  Salpingitis,  Ul- 
cerative Endometritis  and 
Proctitis,  Issuing  in  Ova- 
rian Abscess 576 

Action  of  Diphtheria  Toxin 
on  the  Nervous  System. .  578 

A  ( 'ase  of  Nasal  Vertigo, . .  582 

Accidents  in  Laparatomy. .  582 

A  Case  of  Puerperal  Fever 
Treated  with  Unguentum 
Crede 586 

A  Non-Depressing  Anal- 
gesic    588 

Acute  Gonorrheal  Menin- 
gitis,    594 

Allenbury's  Kood 590 

Board  of  Medical  Examin- 
ers     557 

Boric-Acid  Intoxication...   570 

Cystitis  and  Urine  Infection  574 

Chancre  of  the  Tonsil 578 

Cause  and  Cure  of  Hiccough  579 

Diagnosis  of  Scarlet  Fe- 
ver   567 

Enteralgia  of  Infants 564 

Enlargement  of  the  Lin- 
gual Tonsil  as  to  the 
Cause  of  Cough, 571 

Familiar  Clinical  Picture..  580 

Bow  to  Limit  the  Over-pro- 
duction of  Defectives  and 
Criminals 558 

Injections  of  Carbolic  Acid 
in  the  Treatment  of  Te- 
tanus,      575 

Lactation  During  Preg- 
nancy      570 

Malaria 55" 


596 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


Malarial  Peripheral  Neu- 
ritis   565 

Medical  Society  of  the 
State  of  North  Carolina.  567 

Management  of  Labor, ....  569 

Medical  Journals  Consoli- 
dated     571 

Management  of  Patients  be- 
fore and  afterLaparotomy  582 

North  Carolina  Board  of 
Health 577 

Picric  Acid   in  Eczema. .. .   546 

Post-Partum  Management 
of  Uterine  Displacements  584 

Picric  Acid  Dressing  of  the 
Umbilical  Cord 578 


Period  of  Isolation  of  School 
Children  for  Contagious 
Diseases, 575 

Postpartum  Douche 574 

Quinine  in  Malaria. . . 


.  570 

Rheumatic    Tonsillitis 566 

Resinol  as  an  Application 
to  Septic  Wounds, 593 

Syphilis  of  the  Respiratory 

Passages ;   565 

Skin  Diseases 586 

The  Circulation  of  the 
Blood  while  Sick 546 

Treatment  of  Fibroids  of 
the  Uterus 546 


Tuberculosis  in  the  Colored 
Race 579 

Toxic  Effects  of  Boracic 
Acid 580 

Tonsillitis  with  Albumin- 
uria    586 

Tongaline  and  Quinine 
Tablets, 588 

Treatment  of  Asthma 588 

Uterine  Cough 584 

Vin  Mariani, 582 

Vomiting  of  Pregnancy, . . .   590 
Veratrum  Viride  in  Pneu- 
monia    590 


Writers'  Cramp. 


571 


The  Causation  and  Treatment  of  Con- 
sumption.* 

I  have  little  faith  in  specifics  in  the  treat- 
ment of  tuberculosis.  I  believe  it  is  entirely 
a  disease  of  malnutrition,  as  a  result  of  de- 
fective elimination,  and  all  therapeutic 
measures  must  be  directed  toward  the  im- 
provement of  the  digestion  and  assimilation. 
Consequently  I  am  explicit  in  my  instruc- 
tions as  to  diet,  forbidding  absolutely  the 
use  of  alcohol,  syrups,  potatoes  in  any  form, 
pork,  veal  and  all  such  dishes  as  are  diffi- 
cult of  digestion  and  prone  to  fermentation. 
In  many  of  these  cases  of  alimentation  I 
have  found  it  beneficial  to  give  some  good 
diastasic  extract  of  malt,  that  known  as 
Maltine  proving  most  satisfactory,  for  the 
reason  that  it  is  the  only  malt  extract  known 
to  me  which  gives  generous  proportions  of 
nitrogenous  and  phosphatic  matter,  with 
a  proper  proportion  of  carbohydrates  ;  be- 
ing made,  as  it  is,  from  wheat  and  oats,  in 
conjunction  with  barley,  instead  of  barley 
alone.  Tonics,  stimulating  the  nervous 
system  and  digestive  organs,  and  assisting 


Abstract  of  paper  by  Dr.  John  R,  Kestell. 


in  the  reconstruction  of  blood  and  tissue, 
are  impoitant.  Stimulating  baths  may  be 
used  with  good  results.  It  is,  in  my  opin- 
ion, a  mistake  to  overwhelm  the  body  with 
frequent  injections  of  undetermined  animal 
serum,  thereby  producing  either  a  severe 
reaction  or  possible  accumulative   toxemia. 


Meat  and  Fruit. 

The  majority  of  people  eat  more  meat 
than  they  require.  Meat  eaten  once  a  day 
is  sufficient  for  a  person  not  engaged  in 
manual  babor  or  who  does  not  take  much 
strong  outdoor  exercise.  A  large  number 
of  complaints  contracted  owe  their  origin 
to  the  consumption  of  food  which  entails 
a  greater  drain  on  the  gastic  juices  than 
the  system  is  able  to  withstand.  The  cures 
attributed  to  the  grape  occur  for  the  most 
part  with  those  who  are  accustomed  to  high 
living,  and  are  really  owing  to  the  fact  that 
the  organs  of  digestion  are  given  a  much 
needed  rest.  Semi-starvation  would  an- 
swer the  purpose  almost  as  well.  For  the 
person  whose  work  lies  chiefly  indoors  a 
mixed  and  varied  diet  is  most  conducive  to 
good   health. 


Always  Reliable.  No  Detrimental  After  Effects 

It  has  been  proven  by  clinical  tests  that  Neurosine  is  the  most  effective  and 
safest  hypnotic  yet  known  to  the  profession,  and  whereas  it  contains  no  Mor- 
phine, Chloral  or  Opium,  there  can  be  no  detrimental  after-effects.  Always  of 
the  same  consistency,  therefore  may  be  relied  upon  to  produce  the  same  results  under 
similar  conditions.  It  is  only  necessary  for  Physicians  to  give  NEUROSINE  a  trial 
and  they  will  be  convinced  that  it  is  THE  STANDARD  REMEDY  in  the  treat- 
ment of  all  forms  of  nervous  disturbances.  In  uterine  troubles  it  should  be  combined 
with   Dioviburnia-     Beware  of  substitution.     When  prescribing,  signify  (Dios.) 

Dose  :   One  teaspoonful  to  a  tablespoonful  three  or  more  times  a  day,  as  indicated. 

Our  new  illustrated  booklet  "Treatise  on  Neurasthenia"  mailed  ?n  application. 

DIOS  CHEMICAL  COMPANY. 

St.    Louis,   no.,    U.   S.   A. 


The  Charlotte  Medical  Journal. 


Vol.   XIV. 


CHARLOTTE,  N.   C.,  JUNE,   ii 


No.  6. 


A  Study  "of   the  Bacteriology  of   Specific 
Urethritis.* 

By  Eugene  B.  Glenn,  M.  D.,  Asheville,  N.  C. 

This  is  a  study  which  is  bound  to  interest 
the  general  practitioner  as  much  as  any 
other  with  which  we  have  to  deal  to-day. 

By  the  gonococcus  alone,  or  aided  by 
other  pyogenic  organisms,  serious  and  even 
fatal  results  may  follow  its  attack  on  the 
kidneys,  eyes,  heart  and  its  mombranes,  and 
the  coverings  of  the  spinal  cord,  brain,  etc. 
Taken  as  a  whole,  we  are  certainly  war- 
ranted in  saying  that  the  infection  of  the 
gonococcus  is  one  of  the  most  formidable 
and  far-reaching  infections  by  which  the 
human  race  is  to-day  attacked. 

Recently  I  had  the  opportunity  of  seeing 
a  case  of  specific  urethritis  in  one  of  the 
Philadelphia  hospitals,  of  twenty-five  years' 
duration.  The  patient  had  an  organic  heart 
lesion,  produced  by  this  disease,  and  a  well 
known  physician,  Professor  J.  C.  Nilson, 
said  in  speaking  of  this  case  that  he 
was  more  impressed  every  day  with  the 
truthfulness  of  the  saying  lie  heard  when 
he  was  a  young  man  that  "gonorrhea 
is  a  greater  menace  to  society  and  to  t he 
patient  than  is  syphilis."  It  is  regarded 
very  lightly  by  the  laity,  and  we  often  hear 
the  remark  made  by  liars,  fools,  or  both, 
that  they  care  no  more  for  a  case  of  gonor- 
rhea than  a  bad  cold,  and  that  five  cents' 
worth  of  this  and  ten  cents'  worth  of  that 
in  a  pint  of  water  will  cure  them  in  a  week. 
But  very  frequently  we  have  these  patients 
come  to  us  after  having  tried  all  the  "sure 
cure  remedies"  in  the  land.  He  tries  phy- 
sician after  physician  until  the  physicians 
all  become  disgusted  and  the  poor  sufferer 
gives  up  in  despair,  and  sometimes  death  is 
produced  by  some  lesion  of  kidney,  nervous 
system,  uterine  appendages,  etc. 

In  order  that  we  as  physicians  may  be 
able  to  treat  this  terrible  disease  more  intel- 
ligently it  is  necessary  for  us  to  know  some- 
thing of  its  bacteriology. 

It  wasn't  until  the  year  1879,  just  twenty 
years  ago,  that  the  micrococcus  now  known 
to  be  the  cause  of  gonorrhea,  and  often 
spoken  of   as  the  gonococcus,  was  first  des- 


*Read  before  the  North  Carolina  Medical  So- 
ciety, at  Asheville,  N.  C.  May  30,  1899. 


cribed  by  Neisser.  Six  years  later  it  was 
cultivated  on  blood  serum  by  Bumm.  Earlier 
announcements  were  made  of  the  obtaining 
of  pure  cultures  on  peptone-gelatine  and 
other  media,  which  was  certainly  erroneous, 
because  it  is  now  known  that  it  does  not 
really  grow  on   such  media. 

The  relationship  has  been  so  conclusively 
established  to  the  disease,  by  means  of  in- 
oculations and  cultures  in  the  human  sub- 
ject, that  there  is  no  room  to  doubt  the 
diplococcus  of  Neisser  being  the  specific 
cause  of  gonorrhea. 

The  organism  is  a  small  micrococcus,  of 
o.S  to  1.6  mm.  in  length  and  0.6  to  o.S 
mm.  in  diameter,  often  occurring  in  the 
diplococcus  form,  and  appears  somewhat 
biscuit-shaped  when  seen  under  a  high 
power. 

These  organisms  are  found  for  the  most 
part  within  the  leucocytes,  in  the  pus  cells 
of  gonorrhea  in  both  male  and  female,  espe- 
cially after  the  discharge  becomes  purulent  ; 
but  when  t lie  secretion  is  glairy,  in  the 
earliest  stage,  a  considerable  number  may 
be  found  adhering  to  the  surface  of  desqua- 
mated epithelial  cells  or  lying  free. 

The  gonococci  gradually  diminish  in  num- 
ber as  the  disease  becomes  more  chronic. 
They  may  be  found  in  Considerable  num- 
bers in  long  standing  cases. 

When  the  process  of  degeneration  begins 
in  the  cocci,  they  have  a  spherical  appear- 
ance, of  various  sizes,  some  being  swollen 
considerably,  lying  singly  or  in  small  groups. 
They  are  found  in  some  cases  in  the  well 
known  "tripper  faden,"  in  the  urine,  which 
is  made  up  mostly  of  pus  cells,  epithelial, 
and  small  amounts  of  fibrin.  Bumm  culti- 
vated pure  cultures  from  gonorrheal  pus, 
and  carried  the  organism  through  twenty 
successive  generations,  and  then  introduced 
it  with  positive  results  in  the  healthy  ure- 
thra of  men. 

After  the  first  few  days  the  discharge 
will  be  most  likely  to  contain  streptococci 
and  staphylococci. 

Bosc  mentions  fourteen  other  organisms 
besides  the  common  staphylococci  which 
occur  in  pus.  And  just  so  long  as  the 
"tripper  faden,"  or  pus  filaments,  are  found 
in  the  urine  it  is  possible  for  the  gonococci 
to  be  present ;  and  the  gleet  that  follows 
often  contains  the  organism.  The  gono- 
coccus is    infective  on    any  mucous  surface, 


THE  CHARLOTTE   MEDICAL  JOURNAL. 


and  has  an  extraordinary  affinity  for  that  of 
the  eye.  When  introduced  into  the  eye, 
unless  treated  within  forty-eight  hours,  it 
may  cause  its  loss,  hence  the  importance  of 
cautioning  the  patient  of  its  danger.  The 
patient  may  spread  contagion  as  long  as  the 
gonococci  persist.  Sometimes  they  are 
latent  in  the  urethra  and  set  up  a  relapse 
when  the  patient  takes  some  irritating  sub- 
stance, such  as  alcohol,  etc. 

The  gonococci  are  hard  to  kill,  taking  60 
deg.  C.  to  destroy  life  ;  and  they  also  with- 
stand drying  fairly  well,  as  was  demonstra- 
ted by  Kratter  when  he  found  them  present 
on  washed  clothing  six  months  after  the 
original  soiling,  and  found  they  still  took 
the  stain  well.  The  cultivation  of  the  gon- 
ococcus  requires  considerable  bacteriologic 
skill,  as  the  suitable  media  and  conditions 
of  growth  are  restricted. 

"Blood  agar,"  solidified  blood  serum, 
urine  agar  and  Wertheim's  medium,  which 
consists  of  one  part  of  fluid  serum,  added 
to  two  parts  of  liquified  agar  at  a  tempera- 
ture of  40  deg.  C,  and  allowed  to  solidify 
by  cooling,  are  the  most  suitable  media. 

The  period  and  active  growth  and  dura- 
tion of  life  are  somewhat  longer  on  the  me- 
dium of  Wertheim. 

Turro  pointed  out  the  fact  that  the  gono- 
coccus  may  be  cultivated  in  acid  urine  and 
gelatine  containing  acid  urine,  where  in  the 
latter  the  gonococci  grow  near  the  surface, 
while  the  pus  cocci  sink  deeper  into  the 
medium.  He  also  asserts,  what  was  ordin- 
arily presumed  not  to  be  true,  and  that  is 
the  communication  of  the  disease  to  ani- 
mals ;  and  this  fact  was  demonstrated  by 
using  gonococci  grown  on  acid  gelatine 
and  readily  communicating  urethritis  to 
dogs  without   any  lesio  continni  necessary. 

To  obtain  cultures,  take  some  pus  on  the 
loop  of  a  platinum  needle  and  inoculate  one 
of  the  media  above  mentioned  by  leaving 
small  quantities  at  different  points  on  the 
surface.  The  young  colonies  are  visible 
often  within  twenty-four  hours  and  almost 
always  within  forty-eight  hours  after  inoc- 
ulation. They  usually  reach  their  maximum 
size  on  the  fourth  or  fifty  day  and  are  usually 
found  dead  on  or  before  the  ninth  day.  It 
is  necessary  to  sub-culture  every  three  days 
or  their  viability  is  lost.  But  growth  may 
be  maintained  indefinitely  by  successive 
sub-cultures  at  short  intervals,  and  the  or- 
ganism gradually  flourishes  more  luxuriant- 
ly. At  the  same  time  their  microscopic 
appearance  will  show  a  marked  tendency 
to  undergo  degeneration.  A  pure  culture 
of  the  gonococcus  assumes  an  appearance 
similar  to  a  mulberry,  and  is  of  a  yellowish 
white  color.  A  watery  solution  of  any  of 
the  basic    analine  dyes  stains  the    organism 


rapidly  and  deeply.  It  is  probably  stained 
best  by  Loeffler's  methylene  blue.  It  is 
easily  decolorized,  and  an  important  point 
in  the  microscopical  examination  is  that  it 
completely  loses  its  stain  by  Gram's  method.  , 
The  organisms  are  generally  found  within 
the  pus  cells  and  this  should  always  be 
sought  for  as  one  of  the  diagnostic  points, 
because  it  has  been  shown  by  some  obser- 
vers that  urethritis  is  sometimes  caused  by 
other  organisms,  such  as  the  bacillus  coli 
communis  and  the  staphylococcus  pyo- 
genese. 

But  position  in  the  cells  is  not  positively 
diagnostic.  Since  cocci  resembling  the 
gonococci  have  been  found  in  the  urethra, 
we  must  have  added  to  shape  and  position 
the  refusal  to  stain  by  Gram's  method  be- 
fore we  can  say  positively  that  the  cocci 
found  in  the  urethral  pus  are  gonococci. 
The  organism  may  be  separated  from  fluids 
which  contain  a  number  of  other  organisms 
by  Wertheim1s  ingenious  method  of  plate 
culture  of  the  gonococcus.  The  medium 
consists  of  a  mixture  of  equal  parts  of  hu- 
man blood  serum  and  agar  (two  per  cent). 
This  is  rendered  sterile  and  put  in  suitable 
quantities  in  two  or  three  test  tubes  and 
brought  to  40  deg.  C.  These  are  then  in- 
oculated in  the  same  manner  as  gelatine 
tubes  for  ordinary  plates.  Now  an  equal 
amount  of  ordinary  agar,  which  has  been 
allowed  to  cool  to  40  deg.  C,  is  added  and 
thoroughly  shaken  up  and  quickly  poured 
out  on  Petri's  dish.  This  is  allowed  to 
solidify  by  cooling  and  then  incubated  at  a 
temperature  of  37  deg.  C. 

At  the  seat  of  all  true  gonorrheal  infec- 
tion and  gonorrheal  discharges  in  the  ure- 
thra the  gonococcus  is  invariably  present. 
This  has  been  repeatedly  demonstrated  both 
by  culture  and  by  the  microscope.  That 
the  disease  is  always  transmitted  directly 
by  contagion  is  a  clinical  fact  borne  out  by 
the  description  of  the  conditions  of  growth 
in  culture,  from  which  it  seems  practically 
impossible  for  its  life  outside  the  body  in 
natural  conditions.  Repeatedly  such  expe- 
rimenters as  Wertheim,  Bumm,  Steinschnei- 
der,  and  others,  have  made  inoculations  of 
pure  cultures  on  the  human  urethra,  both  of 
the  male  and  female,  and  the  disease  result- 
ed with  all  its  characteristic  symptoms. 
Since  the  casual  relationship  has  been  so 
completely  established  by  such  men  as  men- 
tioned above,  it  is  interesting  to  note  how 
the  character  of.  the  natural  disease  agrees 
with  the  conditions  of  growth  and  patho- 
genic effects  of  the  organism.  Wertheim 
found  a  small  amount  of  suppuration  and 
local  peritonitis  after  the  injection  of  pure 
cultures  of  the  gonococcus  in  the  peritoneal 
cavity  of  white  mice,  the   organism    being 


THE  CHARLOTTE  MEDICAL  JOURNAL,. 


found  in  large  numbers  in  the  leucocytes. 
He  found  them  penetrate  the  peritoneal 
lining  and  stop  in  the  sub-endothelial  con- 
nective tissue,  showing  little  or  no  power 
of  proliferation,  soon  disappearing  with- 
out the  inflammatory  condition  spreading. 
Other  experiments,  like  the  injections  of 
pure  cultures  in  the  joints  of  rabbits,  dogs, 
guinea-pigs,  etc.,  show  that  the  gonococci 
rapidly  die  out  after  causing  an  acute  in- 
flammation, which,  however,  soon  subsides. 
These  experiments  all  show  how  little  power 
the  organism  has  of  multiplying  and  spread- 
ing in  the  tissues  even  when  present  in  large 
numbers,  and  that  it  produces  only  a  limited 
amount  of  inflammatory  change  in  these 
animals.  In  the  human  urethra  the  gono- 
cocci penetrate  the  mucous  membrane  be- 
tween the  cells,  and  cause  a  loosening  and 
desquamation  of  many  of  these  epithelial 
cells,  and  at  the  same  time  inflammatory  re- 
action in  the  tissues  below,  attended  by  a 
great  increase  of  secretion. 

The  leucocytes  take  up  a  large  number  of 
the  gonococci.  But  it  must  be  noted  that 
though  there  is  such  an  abundant  phagocy- 
tosis, the  cocci  within  the  leucocytes  are 
usually  quite  healthy  in  appearance,  that 
the  establishment  of  the  phagocytosis  is  not 
followed  by  a  rapid  cure  of  the  disease. 
The  organisms  also  penetrate  the  subjacent 
connective  tissue,  and  are  found  with  ex- 
tensive leucocytic  emigration  around  the 
lacuna*,  when  they  are  contained  in  great 
numbers  in  the  leucocytes  which  constantly 
carry  the  organisms  to  the  surface  and  dis- 
charge them.  But  they  are  able  to  maintain 
their  footing  by  multiplication,  till  such  a 
time  as  the  disease  comes  to  an  end  nat- 
urally. 

At  present  we  have  no  data  for  demon- 
strating whether  the  gonococcus  is  present 
in  the  prostate  and  seminal  vesicles  in  the 
acute  stage,  in  cases  where  there  is  consid- 
erable degree  of  inflammation.  The  same 
can  be  said  of  cystitis  and  orchitis  in  the 
early  stage,  before  other  organisms  appear 
in  the  urethra  during  the  more  chronic  stage. 
Though  it  is  possible  for  the  bacillus  coli 
and  the  various  pyogenic  cocci,  so  often 
present  in  the  urethra,  to  extend  back  or  be 
carried  back  by  means  of  a  catheter  to  the 
bladder  and  set  up  cystitis,  the  bacteriology 
of  these  conditions  and  of  buboes  have  not 
been  fully  demonstrated  yet.  But  we  know 
that  these  conditions  are  sometimes  pro- 
duced by  pyogenic  organisms  and  varieties 
of  diplococci  when  present  in  the  urethra 
in  abnormal  conditions  and  the  gonococcus 
not  present.  The  gonococcus  is  almost  in- 
variably situated  in  the  urethra,  in  the  fe- 
male when  infected  with  this  disease,  and 
next  in  frequency  is  the  cervix  uteri.     The  | 


gonococcus  has  been  found  in  the  Bartho- 
linian  gland,  body  of  the  uterus,  Fallopian 
tubes,  peritoneum,  etc.,  producing  their 
usual  destructive  work.  I  wish  to  empha- 
size especially  the  harm  done  in  the  Fallo- 
pian tubes,  because  it  is  the  most  frequent 
cause  of  pyosalpinx  (Montgomery  and 
Krusen).  The  gonoceccus  has  been  culti- 
vated from  eases  of  arthritis  and  inflamma- 
tion of  tendon  sheaths  following  gonorrhea 
by  such  men  as  Neisser,  Lang,  etc.  The 
gonocoocus  has  been  cultivated  from  a  pleu- 
ritic effusion  along  with  the  arthritis  in  the 
same  individual.  One  case  is  reported  by 
Bordoni-Uffreduzzi  in  which  the  gonococ- 
cus was  cultivated  from  the  affected  joint, 
and  afterwards  produced  gonorrhea  in  the 
human  subject  by  an  inoculation  with  the 
cultures  obtained.  Gonorrheal  endocarditis 
has  not  been  absolutely  proven  by  means  of 
cultures.  Though  organisms  have  been 
found  in  the  vegetations  which,  with  refer- 
ence to  staining,  position  in  the  leucocytes 
andmicroscopical  appearance,  corresponded 
to  the  gonococcus,  Leyden  and  Michealis 
failed  in  their  experiment  to  obtain  a  culture 
on  the  media  used ;  but  from  the  fact  that 
no  organism  was  obtained  on  the  media,  it 
favors  the  view  that  the  organisms  were 
certainly  gonococci. 


I  wish  to  express  thanks  to  Dr.  Randle  C. 
Rosenberger,  Demonstrator  of  Bacteriology  in 
the  Laboratories  of  the  Jefferson  Medical  Col- 
lege Hospital  of  Philadelphia,  for  his  aid  in  the 
study  of  the  microscopical  characters,  cultiva- 
tion and  distribution  in  the  tissues  of  the  gono- 
coccus in  specific  urethritis  by  a  number  of  ex- 
periments in  the  laboratory. 

DISCUSSION. 

By  request  Dr.  E.  C.  Levy,  of  Richmond, 
Virginia,  Professor  of  Bacteriology  in  the 
Medical  College  of  Virginia,  responded  as 
follows  : 

Dr.  Glenn  asked  me  to  say  a  few  words 
on  this  subject.  He  has  put  me  in  a  very 
embarassing  position,  because  in  his  paper 
he  has  fully  covered  the  ground.  There 
remains  scarcely  anything  to  say.  I  do 
wish  to  say,  however,  a  few  words,  which 
I  hope  are  pertinent  enough  to  the  subject 
under  discussion,  I  think,  that  the  diagnosis 
of  gonorrhea  bacteriologically  is  not  always 
easy  and  satisfactory.  Dr.  Glenn  has  fully 
called  attention  to  the  points  we  have  to  go 
on.  They  are,  first,  the  morphology  and 
grouping  of  the  parasite,  second,  its  situa- 
tion in  the  leucocyte,  and  third,  its  peculiar 
staining  properties.  Gramm's  method,  I 
think,  is  universally  admitted  to  be  a  very 
unreliable  thing  unless  we  have    exact  data 

the  length  of  time  in  which  the  specimen 
has  been  subjected  to  the  stain,  to  the  iodine 
solution  and  to  the  alcohol.      Without  that 


600 


THE  CHARLOTTE  MEDICAL-JOURNAL. 


Gramm's  method  is  not  to  be  relied  upon. 
Where  these  organisms  are  abundant  the 
cases  are  in  most  instances  very  clear  clini- 
cally. In  the  difficult  cases,  and,  unfortu- 
nately, those  in  which  it  is  really  important 
that  we  should  have  some  aid,  gonococci 
are  few  in  number.  Those  cases  are  gen- 
erally cases  of  long  standing,  very  mild 
cases,  presenting  a  medico-legal  aspect. 
The  most  difficult  case  I  have  encountered 
was  an  inflammation  of  the  eye  of  a  little 
boy  about  eight  years.  The  child  was  the 
son  of  a  gentlemen  of  high  standing  in 
Richmond,  and  everyone  was  very  loth  in- 
deed to  say  that  this  child  had  gonorrheal 
opthalmia.  Only  after  examining  six  cover- 
slips  was  I  able  to  find  a  single  pair  of  mi- 
crocococci,  whi«h  were  situated  within  a 
leucocyte.  Of  course  I  couldnot  use  Gramm's 
staining.  I  had  to  gave  finally  a  merely 
provisional  diagnosis  that  I  thought  it  very 
probably  gonorrheal. 

There  is  one  point  which  I  have  found 
very  useful  in  diagnosticating  this  trouble 
where  the  secretion  is  scanty,  and  that  is 
by  the  injection  of  a  weak  solution  of  nitrate 
of  silver,  five  grains  to  the  ounce.  Follow- 
ing that  there  is  ordinarily  an  increase  in 
secretion,  and  on  several  occasions  I  have 
been  able  to  demonstrate  the  gonococci  in 
secretion  obtained  in  this  manner  where 
without  this  it  had  been  impossible  to  do 
so.  I  have  forgotten  who  was  the  origina- 
tor of  this  method.  I  have  nothing  further 
to  say  on  this  subject,  because,  as  I  said, 
Dr.  Glenn  has  fully  covered  the  ground. 


Electricity  as  an  Aid  to  the  Physician 
and  Surgeon.* 

By  E.  B.  Goelet,  M.  D.,  Saluda,  N.  C;  Member 

of  the  North  Carolina  Medical-  Society  and 

American  Medical  Association. 

In  presenting  this  paper  on  the  use  of 
electricity  in  the  treatment  of  disease,  I 
wish  to  be  understood,  that  it  is  not  my  de- 
sire to  ignore  the  value  of,  or  set  aside  the 
use  of,  those  time  honored  remedies,  which 
in  the  past  have  rendered  such  valuable  aid 
to  us,  but  to  define  the  uses  of  this  agent  as 
an  adjuvant  to  our  armamentarium. 

To-day  electricity  is  a  science,  when  only 
a  few  years  ago  it  was  an  art ;  we  have 
studied  its  physiological  properties  and  ac- 
tion, harnessed  its  forces  and  placed  a  bridle 
upon  its  currents  ;  the  instruments  now  used 
in  its  application  are  the  result  of  tireless 
study  and  continued  experimental  research 


*Read  before  the  North  Carolina  Medical  So- 
ciety, at  Asheville,  N.  C. 


on  the  part  of  the  greatest  medical  electri- 
cians of  the  age,  both  in  this  country  and 
Europe,  and  its  use  is  no  longer  empyrical. 

The  currents  I  will  briefly  refer  to  in  this 
paper  are  : 

First — The  galvanic  or  constant  current. 

Second — The  faradic  or  interrupted  in- 
duced. 

In  the  galvanic  current,  we  are  mostly 
concerned  in  the  chemical  and  physiologi- 
cal effects,  in  order  to  establish  its  therapeu- 
tical value. 

The  chemical  action  produced  is  known 
as  electrolysis,  which  is  nothing  more  or 
less  than  the  separation  into  its  component 
parts,  of  a  compound  body  in  solution,  bv 
the  constant  current ;  for  instance,  when  a 
current  is  made  to  traverse  a  solution  of 
chlorate  of  potassium,  oxygen  and  chlorine 
are  liberated  at  the  positive  pole,  while 
hydrogen  evolves  from  the  negative,  and 
the  potash  is  seen  to  collect  around  it,  like- 
wise when  the  human  tissues  are  subjected 
to  this  current,  a  decomposition  occurs, 
whereby  the  constituent  elements  are  sepa- 
rated or  altered  in  their  arrangement ;  this 
is  possible  because  the  elements  are  in  a 
fluid  state,  and  certain  effects  are  produced, 
varying  with  the  direction  of  fche  current 
and  differing  at  the  terminal  poles.  These 
effects  are  known  as  electrolytic,  cataphoric, 
catalytic,  electro-tonic  and  thermal. 

Electrolysis  occurs  not  only  at  both  poles, 
but  throughout  the  interpolar  space,  there- 
fore we  have  positive  and  negative  electro- 
lysis, and  that  obscure  process  designated 
catalysis,  which  is  the  indefinable  action 
that  takes  place  in  the  structures  embraced 
in  the  path  of  the  current  from  one  pole  to 
the  other,  just  where  the  effect  of  the  posi- 
tive pole  stops  and  that  of  the  negative 
pole  begins  we  cannot  exactly  define,  but 
the  effect  is  always  more  marked  in  the  im- 
mediate vicinity  of  the  poles,  while  in  the 
intervening  spaces  the  greater  the  distance 
from  the  pole,  the  more  obscure  the  chemi- 
cal process  becomes. 

The  body  subjected  to  the  action  of  the 
current  is  called  the  electrolite,  so  if  the 
electrolite  be  the  human  tissues,  the  chemi- 
cal decomposition  is  somewhat  complex, 
and  there  is  separated  at  the  positive  pole 
not  only  oxygen  and  chlorine,  but  the  min- 
eral acids  also,  the  hydrochloric,  sulphuric, 
nitric  and  phosphoric  ;  while  at  the  nega- 
tive pole  the  alkalies  of  the  tissues  collect 
in  the  form  of  the  hydrates  of  soda,  potash, 
lime  and  ammonia. 

The  cataphoric  action  of  the  current  is 
that  property  which  enables  the  current  to 
carry  with  it  certain  substances  in  solution 
in  its  transit  through  the  tissues  from  the 
positive  to  the  negative  pole ;  this  action  is 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


601 


more  pronounced  at  the  positive  pole  with 
the  majority  of  substances,  though  with 
some  few  we  learn  it  occurs  at  the  negative 
pole — this  is  then  an  electrical  osmosis  and 
its  power  to  reverse  the  normal  osmotic  ac- 
tion can  be  easily  demonstrated.  It  is  this 
combined  action  of  electrolysis  and  cata- 
phoresis,  that  enables  us  to  dispel  tumors, 
to  cause  their  disintegration  and  promote 
their  absorption  by  the  tissues. 

There  are  many  ways  in  which  the  use 
of  the  galvanic  current  may  aid  the  surgeon 
! in  his  work,  and  the  specialist  also  should 
|  be  equally  interested,  for  he  is  often  called 
upon  to  do  much  surgical  work,  and  this 
form  of  electricity  is  most  useful  to  them, 
since  by  means  of  it  a  variety  of  tissue 
changes  can  be  brought  about,  which  may 
>be  turned  to  account  in  the  removal  of  ab- 
normal conditions,  and  those  who  are  not 
acquainted  with  the  electrolytic  effects  of 
this  current  upon  the  living  tissues,  will  be 
surprised  to  learn  how  wide  is  the  range  of 
its  application  as  an  alterative  and  curative 
agent. 

The  elimination  of  oxygen,  chlorine  and 
the  mineral  acids  at  the  positive  pole,  by 
combining  with  t he  albuminoids  in  the  ad- 
jacent tissues,  cause  coagulation,  a  drying 
and  shrinking  of  the  tissues  in  immediate 
contact  with  the  electrode;  hence  we  have 
an  astringent,  denutritive,  sedative  and  he- 
mostatic effect,  with  little  or  no  eschar  when 
the  current  is  applied  mildly  and  of  short 
duration  ;  at  the  negative  pole  on  the  con- 
trary, where  hydrogen  and  the  alkalies  ac- 
cumulate, there  is  a  softening  and  liquify- 
ing effect  upon  the  adjacent  tissues,  and  we 
have  stimulation,  congestion  and  relaxation 
of  the  parts. 

With  the  positive  pole  we  can  cut  off  ex- 
cessive blood  supply  to  abnormal  vascular 
growths,  of  whatever  sort,  be  they  hemor- 
rhoids or  hemorrhagic  mucous  membranes, 
and  in  fact  almost  any  abnormal  growth 
may  be  arrested,  or  removed  by  robbing  it 
of  its  blood  supply,  and  we  have  in  this 
agent  a  simple  and  efficient  means  of  bring- 
ing this  about. 

The  softening  and  liquifying  effect  of 
negative  electrolysis  is  especially  serviceable 
in  the  removal  of  non-vascular,  dense,  horny 
or  warty  growths,  ami  even  cartilaginous 
and  bony  tissue  ;  it  is  equally  effective  in 
the  removal  and  absorption  of  cicatricial 
tissue  resulting  from  burns,  wounds  and  in- 
flammations of  various  kinds,  especially 
when  this  non-elastic,  non-pliable  tissue 
forms  along  the  course  of  a  duct  or  canal, 
which  by  forming  dense  unyielding  bands 
or  patches  at  one  or  more  places,  causes 
strictures  of  these  canals.  But  in  the  re- 
moval of  strictures,  the  surgeon  must  select 


a  suitable  electrode,  and  insulate  it  except 
at  the  point  where  action  is  desired,  which 
is  then  introduced  into  the  canal  until  it 
comes  in  contact  with  the  constricting  band, 
the  anode  (or  positive  pole)  having  pre- 
viously been  applied  by  means  of  a  large 
pad  electrode,  well  moistened,  at  some  con- 
venient place,  as  the  breast,  back,  thigh  or 
abdomen,  and  then  the  current  carefully 
turned  on,  not  to  exceed  five  milliamperes  ; 
soon  the  alkalies  (potash  and  soda)  with 
hydrogen  begin  slowly  to  accumulate,  and 
by  cataphoresis  and  increased  quantity  of 
moisture  is  driven  to  the  spot,  by  which 
combination  of  influences,  the  cicatricial 
band  is  softened,  rendered  lax  and  yielding, 
the  capillaries  and  lymphatics  are  stimu- 
lated to  take  up  the  effusion  and  ultimately 
a  degeneration  of  the  fibrous  tissue  takes 
place  and  there  results  a  complete  removal 
of  the  growth  ;  further  when  properly  done 
there  is  left  no  eschar,  nor  is  there  any  ex- 
cess of  tissue  destruction  beyond  that  which 
is  desired. 

The  most  important  thing  to  be  remem- 
bered is  the  directly  opposite  effects  upon 
the  tissues  caused  by  the  action  of  the  anode 
and  cathode  when  employed  as  the  active 
electrode. 

The  polarity  must  always  be  chosen  with 
due  regard  to  the  work  to  be  done,  and  the 
nature  of  the  tissue  to  be  operated  upon  ; 
tor  a  large  percentage  of  the  failures  of 
those  who  have  attempted  to  use  electroly- 
sis in  surgery,  and  who  have  abandoned 
and  condemned  it,  results  either  from  ignor- 
ance of  its  application  or  neglect  of  the 
physical,  chemical  and  physiological  effects 
of  polarity  in  the  use  of  it. 

There  is  another  physical  effect  of  the 
constant  current,  which  is  capable  of  ren- 
dering much  aid  to  the  surgeon  and  that  is, 
by  this  same  cataphoric  action,  solutions  of 
certain  substances,  such  as  cocaine,  mor- 
phine, iodine,  &c,  placed  upon  the  positive 
electrode,  and  brought  in  contact  with  the 
tissues,  through  the  action  of  this  current 
are  made  to  traverse  the  tissues  to  a  greater 
or  less  extent,  depending  upon  the  electro- 
motive force  and  volume  of  the  current, 
thereby  inducing  local  medication  and  even 
general  medication  if  so  desired  and  the 
drug  introduced  in  sufficient  quantity,  in 
this  way  local  anaesthesia  is  induced  or  the 
parts  prepared  for  surgical  procedures. 

By  this  means,  also,  effusions  into  joints 
and  serous  cavities,  swellings  resulting  from 
bruises,  sprains  and  inflammations  are  made 
to  disappear  and  tumefaction  subside.  It 
is  well  to  observe  the  effect  of  this  current 
also  in  the  treatment  of  ulcers,  lupus,  &c, 
and  here  the  choice  of  polarity  is  most  es- 
sential in    producing  the  desired    result;   if 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


there  is  an  exuberant  granulation,  or  the 
sore  is  of  the  moist  variety,  the  styptic  as- 
tringent effect  of  the  positive  pole  is  indi- 
cated ;  if  on  the  contrary,  there  is  diminish- 
ed nutrition,  and  an  impoverished  condition 
of  the  part,  presenting  a  want  of  sufficient 
fluidity  or  serum,  then  the  stimulating  re- 
laxing effect  of  the  negative  pole  is  indica- 
ted. This  same  process  is  equally  applica- 
ble to  disease  deeply  seated  in  the  tissues, 
as  chronic  inflammatory  conditions  of  the 
bones  and  ligaments,  where  nutrition  is  per- 
verted and  ordinary  treatment  of  no  avail, 
the  stimulating  effect  of  the  negative  pole 
is  sometimes  productive  of  great  benefit. 

Electro-tonic  action  results  when  the  func- 
tional activity  of  the  nerves  is  altered  by 
being  subjected  to  the  action  of  this  current ; 
this  functional  activity,  affecting  the  mus- 
cular system  also,  may  be  increased  or 
diminished,  according  to  the  direction  of 
the  current,  for  instance,  around  the  posi- 
tive pole,  the  excitability  is  diminished,  and 
an  anodyne  sedative  effect  is  produced, 
while  at  the  negative  terminal,  the  oppo- 
site relation  exists,  and  these  effects  are  not 
confined  to  the  immediate  vicinity  of  the 
poles,  but  throughout  the  interpolar  zone. 
To  explain  more  fully,  if  the  current  tra- 
verses a  nerve  in  the  opposite  direction  to 
the  nerve  current,  there  is  a  diminished 
electro-tonic  force,  while  if  a  current  passes 
in  the  same  direction  as  the  nerve  current 
the  excitability  is  increased.  The  thermal 
effects  of  this  current  result  from  its  efforts 
to  overcome  the  resistance  of  the  tissues 
which  sometimes  is  immense,  the  skin  in  its 
dry  state  offers  enormous  resistance,  and  the 
greater  the  resistance,  the  greater  the  heat 
produced,  hence  it  is  necessary  to  reduce 
the  resistance  as  much  as  possible,  in  order 
to  obtain  the  desired  result,  and  make  the 
application  bearable ;  to  do  this  the  skin 
should  be  kept  moistened  and  the  concen- 
trated energy  of  the  current  distributed  over 
a  larger  surface,  by  using  a  large  wire  gauze 
pad,  well  moistened  with  a  saline  solution, 
the  greater  the  surface  area  covered,  the 
more  the  resistance  is  diminished,  and  the 
stronger  the  current  can  be  applied  with  less 
disagreeable  effects.  A  lack  of  knowledge 
of  these  conditions,  or  a  disregard  of  them, 
has  been  the  cause  of  much  unsatisfactory 
work  in  electro-therapy,  on  the  part  of  the 
general  practitioner,  and  has  induced  preju- 
dice by  the  laity  against  its  uses. 

I  will  not  enter  into  the  details  of  its  ap- 
plication, for  it  was  my  intention  only  in 
this  paper,  to  define  its  physiological  action 
and  therapeutical  properties. 

We  come  now  to  speak  of  the  faradic  or 
interrupted  induced  current,  its  physical 
properties    and    therapeucical    virtues.      In 


order  to  understand  its  nature  and  compre- 
hend its  uses,  one  should  have  a  knowledge 
of  magnetism  and  the  laws  governing  it. 
We  are  led  to  believe  "magnetism  to  be  ! 
some  active  condition  of  the  ether,  that  is, 
one  of  the  manifestations  of  energy  in  the 
space  surrounding  the  magnet,  known  as 
the  magnetic  field  ;  this  energy  in  the  mag- 
netic field  is  not  expended,  exerts  no  in- 
fluence and  does  no  work  unless  the  field  is 
disturbed."  It  is  a  well  known  fact  that  a 
magnet  is  a  body  which  has  the  property  of 
attracting  iron,  steel  and  certain  other 
metals,  and  when  a  bar  of  steel  is  rubbed 
by  a  magnet,  it  acquires  magnetic  properties 
and  becomes  endowed  with  polarity ;  so 
when  suspended  in  the  air,  one  end  points 
to  the  north  and  is  called  the  north  pole, 
the  other  end  to  the  south  is  called  the  south 
pole,  now  this  bar  becomes  an  artificial 
magnet  and  has  the  property  of  attracting 
unlike  poles  and  repelling  those  of  like  po- 
larity ;  near  its  center  is  a  point  where  no 
magnetic  force  is  visible,  but  cut  into  two 
or  more  pieces,  each  piece  at  once  displays 
polarity.  Steel  is  much  harder  to  magnetise 
than  iron  and  retains  its  magnetism  longer, 
the  softer  the  iron,  the  more  easily  it  is 
magnetised,  and  consequently  the  more 
easily  demagnetised ;  all  magnets  possess 
what  is  known  as  magnetic  force  or  flux 
lines,  which  are  assumed  to  pass  out  of  the 
north  pole,  describe  a  circuit  in  a  longitu- 
dinal direction  to  the  magnet  and  pass  in 
again  at  the  south  pole.  These  lines  are 
more  numerous  and  hence  the  magnetic  in- 
fluence more  intense  in  close  proximity  to 
the  poles,  and  if  undisturbed  they  exert  no 
energy  except  attraction  and  repulsion,  but 
introduce  a  coil  of  wire  within  the  magnetic 
field  and  at  once  by  intersecting  the  flux 
lines,  energy  is  developed  and  a  current  of 
electricity  is  induced,  though  only  while 
the  coil  is  in  motion  ;  then  again  when  the 
coil  is  removed  from  the  magnetic  field,  a 
current  in  the  opposite  direction  is  induced. 
This  fact  can  be  plainly  demonstrated  by 
placing  a  milliampere  meter  in  the  circuit 
and  the  needle  will  be  seen  to  deviate  in  the 
opposite  direction. 

It  has  been  proven  also  that  if  a  bundle 
of  soft  iron  wire  be  wrapped  and  insulated, 
and  a  coil  of  insulated  wire  be  wound  around 
this  core,  then  a  current  of  electricity  passed 
through  this  coil,  which  is  called  the  pri- 
mary, at  once  the  core  becomes  magnetised, 
is  endowed  with  polarity  and  is,  therefore, 
an  electro-magnet. 

It  was  upon  this  principle  that  the  ordin- 
ary induction  apparatus,  or  faradic  coil  was 
constructed.  By  referring  to  an  apparatus 
of  this  kind,  you  will  see  that  a  vibrating 
spring  rests  upon  the  point  of  a  screw  which 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


projects  from  an  upright  post,  so  when  the 
electric  current  is  established  through  this 
point  of  contact,  it  circulates  in  the  primary 
coil  surrounding  the  core  (or  bundle  of  soft 
iron  wire)  and  magnetises  it ;  this  magnet 
so  formed,  at  once  establishes  a  current  in 
the  opposite  direction  to  the  one  which 
magnetises  it,  it  also  attracts  the  spring  at 
the  same  time  and  breaks  the  current  at  the 
contact  point,  the  current  thus  arrested 
causes  the  core  at  once  to  lose  its  magnetism, 
the  spring  is  released  and  falls  back  upon 
the  contact  point  when  the  current  is  re- 
established. This  automatic  make  and  break 
of  the  current  alternately  magnetises  and 
demagnetises  the  core.  Now  if  this  electro- 
magnet be  introduced  into  the  centre  of  a 
secondary  coil,  it  will  act  the  same  as  a  per- 
manent magnet  and  induce  a  current  in  this 
secondary  coil,  and  the  instant  it  becomes 
demagnetised  another  current  is  induced  in 
the  opposite  direction.  Therefore  this  ap- 
paratus gives  us  an  interrupted  induced  cur- 
rent, because  the  current  in  the  secondary 
coil  is  induced  entirely  by  virture  of  this 
coil  intersecting  the  flux  lines  of  this  core  or 
electro-magnet. 

These  two  currents  thu6  established  are 
of  unequal  strength  and  volume  however ; 
the  make  current,  or  the  one  induced  when 
the  core  becomes  magnetised,  is  very  much 
feebler  than  the  break  current  (or  the  one 
induced  when  the  core  becomes  demagnet- 
ised), the  reason  for  which  we  will  explain  : 
When  the  core  becomes  magnetised  a  cur- 
rent is  induced  in  the  primary  coil  which 
immediately  surrounds  it,  and  there  is  an- 
other current  induced  in  this  coil  in  the  op- 
posite direction  when  the  core  becomes  de- 
magnetised. Now  the  current  induced  in 
this  coil  when  the  core  becomes  magnetised 
is  in  the  opposite  direction  to  the  current 
flowing  through  it  which  produces  magnet- 
ism in  the  core,  hence  it  acts  as  a  counter 
pressure  and  cuts  down  the  force  of  the 
make  current,  or  the  one  produced  when 
contact  is  made  at  the  vibrator,  further  a 
great  part  of  the  force  of  this  make  current 
is  expended  in  magnetising  the  core.  But 
the  current  induced  in  the  primary  coil 
when  contact  is  broken  (or  the  break  cur- 
rent) is  in  the  same  direction  as  the  current 
which  magnetises  the  core  and  has  no  such 
counteracting  force  to  oppose  it,  therefore 
it  is  readily  seen  that  the  two  currents  are 
of  unequal  strength,  this  difference,  how- 
ever, is  not  appreciable  through  the  low  re- 
sistance of  the  galvanometer,  but  when  such 
resistance  as  the  human  body  is  placed  in 
the  current,  it  is  at  once  manifest  and  ap- 
preciable, therefore,  since  we  can  only  con- 
sider that  current  which  produces  an  appre- 
ciable influence,  it  must   be  recognized  as  a 


current  of  one  direction,  and  is  necessarily 
endowed  with  polarity,  since  it  is  always  in 
the  same  direction.  It  is  estimated  that  the 
difference  in  the  force  of  these  two  currents 
(the  make  and  break  as  they  are  termed)  is 
as  i  to  13;  that  is,  the  break  current  when 
the  core  is  rendered  magnetic,  is  13  times 
stronger  than  the  make  current,  or  that  es- 
tablished when  contact  is  made. 

The  strength  of  the  current  in  the  secon- 
dary coil  is  in  proportion  to  the  number  of 
lines  of  wire  which  is  exposed  to  the  mag- 
netic influence  of  the  core  ;  in  other  words, 
if  the  secondary  coil  only  partially  covers 
the  primary,  the  current  induced  is  neces- 
sarily feebler  than  when  it  completely  covers 
it.  In  that  way  we  have  a  means  of  vary- 
ing its  strength. 

We  come  now  to  consider  the  physical 
qualities  of  this  current,  viz.  :  Pressure  and 
volume,  and  the  therapeutical  properties, 
mainly  stimulation  and  sedation. 

The  stimulating  property  is  in  proportion 
to  the  volume  which  may  be  varied  by 
changing  the  length  and  size  of  the  wire  in 
the  secondary  coil.  If  this  coil  is  composed 
of  a  very  long  fine  wire,  there  are,  of  course, 
a  greater  number  of  turns  exposed  to  the 
magnetic  influence  of  the  core,  which  pro- 
duces a  current  of  high  electro-motive  force 
or  pressure,  therefore  the  pressure  depends 
partly  upon  the  number  of  lines  of  magnetic 
force  intersected  and  partly  upon  the  num- 
ber of  cells  producing  the  primary  current, 
but  when  this  long  fine  wire  is  used,  the  re- 
sistance in  the  coil  is  greatly  increased, 
therefore  the  amperage  or  volume  of  the  re- 
sulting current  is  greatly  reduced ;  so  on 
the  contrary,  if  the  coil  is  composed  of  a 
short  coarse  wire,  fewer  lines  of  magnetic 
force  are  intersected,  therefore  the  resistance 
is  greatly  diminished  and  there  results  a 
current  of  lower  electro-motive  force  or 
pressure  and    greater  amperage    or  volume. 

Now  in  dealing  with  the  human  struc- 
tures, where  different  bodies  possess  variable 
resistances,  it  is  exceedingly  important  to 
select  a  current  of  suitable  pressure  to  over- 
come the  encountered  resistance  and  produce 
a  satisfactory  and  beneficial  result. 

Further,  since  these  two  properties  of 
stimulation  and  sedation  depend  upon  the 
qualities  of  pressure  and  volume,  it  is  all 
important  to  possess  an  apparatus  capable 
of  producing  these  varieties  as  desired. 

The  cheap  forms  of  faradic  apparatus  are 
comparatively  worthless,  because  they  are 
not  constructed  so  as  to  make  these  varia- 
tions possible. 

One  of  the  most  important  effects  pro- 
duced by  this  current  is  stimulation  of  in- 
creased tissue  changes,  that  is  increased  ab- 
sorption of  oxygen  and  a  corresponding  in- 


THE  CHARLOTTE  MEDICAL  JOORNAL. 


creased  elimination  of  carbonic  acid,  there- 
fore increased  nutrition.  There  is  also  pro- 
duced a  stimulating  effect  upon  the  capil- 
laries and  lymphatics,  and  it  is  to  this  power 
that  is  attributed  its  ability  to  promote  the 
rapid  absorption  of  inflammatory  exudates. 
Sedation,  perhaps  the  most  important 
effect  of  these'induced  currents,  is  promptly 
brought  about  by  the  current  of  the  long 
fine  wire  coil,  and  with  it  comes  an  anes- 
thesia of  the  terminal  nerve  filaments,  an 
obtunding  of  the  nervous  centres  and  relief 
from  pain,  while  stimulation  is  produced  by 
the  coarse  short  wire  coil ;  therefore  a  thor- 
ough understanding  of  the  subject,  and  a 
knowledge  of  the  different  qualities  and 
effects  of  these  currents,  is  necessary  for  the 
attainment  of  satisfactory  results,  and  unless 
these  points  are  observed  and  the  current 
properly  employed,  success  cannot  be  ex- 
pected. Hence  with  a  proper  appreciation 
of  its  virtues  and  uses,  we  have  in  electric- 
ity an  agent  for  the  cure  of  disease,  which 
is  destined  in  the  future  to  take  a  prominent 
place  in  the  armamentarium  of  many  edu- 
cated and  scientific  physicians   in  the  land. 


Pernicious  Malarial  Fever.* 

By  Dr.  R.  E.  Zachary,  Wilmington,  N.  C. 

Certain  departures  from  the  ordinary 
types  of  malarial  fever  are  termed  pernicious 
because  of  their  great  tendency  to  inflict 
more  than  usual  systemic  danger  and  dam- 
age to  life  upon  those  who  suffer  such  at- 
tacks. 

The  word  pernicious  is  used  in  its  com- 
mon English  sense  of  being  hurtful  or  in- 
jurious. This  disease  is  primarily  due  to 
the  same  poison  which  produces  simple, 
intermittent  attacks. 

The  extreme  danger  of  the  attacks  and 
the  awful  suddenness  with  which  they  often 
occasion  death  form  striking  contrast  with 
the  more  typical  forms  of  malarial  fever 
and  appear  fully  to  justify  the  use  of  the 
qualifying  adjective,  pernicious. 

There  are  several  types  to  be  grouped  un- 
der the  term  pernicious,  which  differ  widely 
in  their  modes  of  inflicting  injury,  and  these 
types  are  classed  by  many  of  the  different 
authors  as  follows  : 

First — Algid  or  congestive  form. 

Second — The  comotose  form. 

Third — The  hemorrhagic  form. 

It  is  not  within  the  scope  of  this  paper 
to  treat  the  subject  of  pernicious  malaria  in 
extenso,  either  as  to  its  history,  causation, 
or  its  different  types. 


*Read  before  the  North  Carolina  Medical  So- 
ciety at  Asheville,  N.  C. 


Having  had  more  experience  with  the 
comotose  form,  I  will    speak  of   that  alone. 

My  object  is  to  try  to  impress  upon  my 
hearers  the  awful  suddenness  with  which 
this  disease  often  causes  death  and  the  great 
necessity  of  immediate  treatment. 

The  term  comotose  is  applied  to  certain 
cases  of  pernicious  malarial  fever,  because 
they  present  coma  as  a  marked  symptom. 
This  disease  is  of  frequent  occurrence  in 
the  intensely  malarious  districts  of  Eastern 
North  Carolina,  in  low,  marshy  localities 
along  the  rivers. 

It  seems  to  be  limited  almost  to  the  labor- 
ing classes,  especially  to  those  working  in 
lumbering  mills  along  the  river  banks,  in 
rice  fields,  and  in  low,  marshy  districts 
generally. 

In  my  experience  a  continuous  residence 
of  from  six  months  to  two  years  in  one  of 
these  intensely  malarious  districts,  with 
frequent  malarial  attacks,  will  produce  the 
condition  in  which  we  have  pernicious  ma- 
laria. Those  drinking  surface  water  seem 
to  be  the  most  liable. 

The  disease  lasts  from  two  to  six  days  and 
if  the  greatest  care  is  not  taken  it  will  end 
fatally. 

Being  connected  for  some  time  with  the 
City  Hospital  of  Wilmington,  a  charitable 
institution,  I  had  ample  means  for  the  study 
of  pernicious  malaria,  in  its  last  stages,  for 
it  is  a  known  fact  that  the  poorer  classes  of 
people  seek  a  hospital  as  a  last  resort,  and 
many  times  the  patient  is  given  up  to  die 
before  being  brought  to  the  hospital,  and  it 
is  in  the  later  stages  that  I  had  some  success 
in  treatment. 

As  the  symptoms  of  this  disease  are 
familiar  to  most  physicians,  especially  to 
those  from  Eastern  Carolina,  only  a  brief 
outline  need  be  given. 

Prodromic  symptoms  are  usually  present, 
the  most  common  are  irregular  chills,  dull 
pains  over  kidneys,  and  aching  of  all  the 
extremities  and  a  general  tired  feeling, 
bowels  constipated,  tongue  badly  coated, 
cold  sensations.  An  attack  may  or  may  not 
be  ushered  in  by  a  chill,  but  in  its  more 
serious  forms  the  chill  is  a  conspicuous  fea- 
ture, being  severe  and  often  rises  to  105 
deg.  or  106  deg.  F.,  then  follows  the  most 
intense  cerebral  disturbance,  a  rapidly  de- 
veloping coma.  The  unconsciousness  may 
persist  for  from  twelve  to  twenty-four  hours 
or  the  patient  may  sink  and  die.  After  re- 
gaining consciousness  a  second  attack  may 
come  on  and  prove  fatal. 

The  following  report  of  a  case  goes  to 
prove  its  fatality  : 

R.  D.,  colored,  male,  age  22.  an  employee 
of  Cape  Fear  Lumber  Co.,  of  Wilmington, 
N.  C,  on  May  2d,  1899,  left  the  mill  sick, 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


605 


was  seized  with  a  chill  shortly  after  reach- 
ing home  and  became  unconscious  with  a 
very  high  fever.  A  physician  was  not 
summoned  until  twenty-four  hours  later, 
when  the  patient  was  sent  to  the  hospital, 
where  he  dies  on  the  morning  of  May  4th. 
This  is  just  the  history  of  many  cases. 

The  doctor  is  usually  sent  for  too  late. 
Out  of  ten  cases  of  the  comotose  type  of 
pernicious  malaria  brought  to  the  Wilming- 
ton City  Hospital  during  the  summer  of 
1898,  only  one  died,  this  one  reached  the 
Hospital  late  one  evening  and  died  early 
next  morning. 

The  following  is  a  report  of  one  of  the 
cases  that  recovered  : 

W.  E.,  colored,  male,  age  42,  was  brought 
to  the  hospital  June  12th,  1898,  He  had 
been  living  in  a  low,  marshy  district,  had 
been  having  irregular  chills  and  drinking 
surface  water.  He  was  stricken  down  with 
a  chill  June  nth,  and  the  next  morning 
was  sent  to  the  hospital,  unconscious,  and 
with  temperature  105  deg.  F.  He  was  In 
a  comotose  condition,  and  by  two  reputable 
physicians  was  pronounced  to  be  in  a  dying 
condition.  Having  diagnosed  the  case  as 
pernicious  malaria,  and  knowing  the  system 
to  be  full  of  malarial  poison,  I  thought  un- 
usually large  doses  of  quinine  would  bring 
the  patient  through,  I  nursed  the  case 
myself,  not  willing  to  trust  him  to  a  nurse. 
At  twelve  m.  he  was  thought  to  be-in  a  dy- 
ing condition.  At  one  o'clock  i>.  m.  I  gave 
him,  per  rectum,  sixty-five  grains  of  quinine 
in  solution.  At  six  v.  m.  three  oz.  of  rye 
whiskey  in  one  pint  of  hot  coffee  per  rec- 
tum, strychnine  sulph.,  gr.  1-50,  every  two 
hours  for  six  hours,  hypodermically.  Every 
hour  the  patient  was  sponged  with  alcohol 
and  an  ice  cap  kept  to  the  head  continually. 
The  bowels  were  constipated,  so  at  ten  p. 
m.  calomel,  gr.  10,  ext.  colycinth  comp., 
gr.  10,  ext.  hyascyamus,  gr.  2,  were  placed 
on  base  of  tongue  and  caused  to  be  swal- 
lowed by  tablespoonful  of  water  trickeled 
over  the  powder. 

At  midnight,  temperature  had  fallen  to 
100  deg.  F.,  and  patient  conscious.  At 
daylight  he  had  a  good  action,  and  at  break- 
fast time  was  able  to  sit  erect  in  bed  and 
drink  a  glass  of  milk.  The  quinine  did  not 
seem  to  effect  the  nerves  of  hearing.  Grs. 
10  of  quinine  was  given  him  three  times  a 
day  for  three  days,  and  on  the  fourth  was 
discharged  well. 

The  other  cases  were  all  treated  in  very 
much  the  same  manner  and  with  the  same 
good  results. 

Patients  suffering  with  pernicious  mala- 
ria in  the  first  stages  were  treated  with  gr. 
10,    doses    of    quinine    every    four    hours, 


giving  the    same  purgative    as  in    the  case 
related  above. 


Juvenile  Criminals.; 

By  Thos.   F.  Costner,  M.  D.,  Lincoln  ton,  N.  C. 

I  desire  to  present  this  subject  to  your 
consideration,  not  because  I  expect  or  can 
hope  to  offer  anything  new,  but  because 
of  its  great  and  ever  increasing  importance, 
both  to  this  Association,  and  to  the  State 
and  society  at  large. 

Our  S^ate  has  taken  on  a  new  life,  and  is 
just  now  developing  its  material  resources 
and  increasing  its  wealth  and  population 
with  wonderful  strides.  So  much  so,  that 
we  are  attracting  the  attention  of  the  hith- 
erto older  and  more  advanced  and  pro- 
gressive States  and  peoples.  Our  civiliza- 
tion should  keep  step  with  our  material 
progress.  And  nothing  more  surely  marks 
the  true  index  of  morality  and  higher  civil- 
ization than  the  attention  paid  by  a  people 
and  by  the  public  authorities  to  their  poor 
and  unfortunates,  and  to  their  criminals, 
those  who  must  be  restrained  or  reformed 
in  order  to  protect  society. 

The  medical  profession  has  during  the 
past  decade  made  the  greatest  advances  in 
its  history,  and  has  kept  its  place  in  the 
very  van  of  the  onward  progress  of  civili- 
zation ;  in  fact,  has  marked  each  step  in 
that  progress  by  some  new  discovery  or 
device  to  alleviate  man's  sufferings  and  to 
prolong  his  days,  or  increase  his  usefulness 
in  lire.  We  may  justly  feel  a  pride  in  the 
fact  that  we  have  almost  invariably  been 
the  pioneers,  who  sounded  the  first  note  of 
warning  and  who  led  the  fight  for  the 
great  reforms  in  the  laws  for  the  benefit  of 
humanity. 

Our  State  has  for  many  years  neglected 
to  properly  look  after  and  care  for  a  large 
class  of  unfortunates,  and  the  duty  has 
again  devolved  on  us  to  call  the  attention 
of  the  people  to  this,  and  to  start  a  crusade, 
which  with  education  and  enlightenment, 
must  eventually  result  in  the  enactment  of 
more  just  and  humane  laws,  for  the  treat- 
ment of  the  young  class  of  criminals. 

It  is  impossible  to  obtain  any  statistics 
regard  to  the  matter  of  criminals  belonging 
to  the  juvenile  class  in  our  own  State,  as 
none  have  been  kept  of  this  particular 
class ;  the  statistics,  like  the  criminals 
themselves,  have  been  jumbled  and  thrown 
together  in  one  bunch.  But  the  informa- 
tion to  be  gathered  from  the  nth  census, 
under  the  report  on  crime,  Pauperism  and 
Benevolence,  and  under  the  subdivision  of 


JRead   before   the    North    Carolina  Medical 
Society,  Asheville,  N.  C. 


THE  CHARLOTTE  MEDICAL  JOURNAL 


Juvenile  Criminals,  as  compared  with  the 
previous,  or  ioth  census,  shows  us  most 
assuredly  that  this  class  of  young  criminals 
is  on  the  increase.  Aside  from  the  census, 
the  very  causes  that  produce  and  concen- 
trate wealth  among  a  few,  increases  the 
number  of  the  poor,  and  the  depths  of 
poverty  ;  and  these  last  two  results  are  in 
their  turn  the  efficient  and  procuring  causes 
of  crime.  If.  the  class  of  criminals  in 
general  are  on  the  increase,  we  may  as- 
sume, that  the  juvenile  shares  in  this  in- 
crease. But  we  have  only  to  look  around 
us  in  our  daily  life  or  step  inside  the  crimi- 
nal Court  room,  to  find  how  crime  has  in- 
fected the  young,  and  how  the  number  of 
this  class  is  constantly  increasing. 

If  we  were  permitted  to  study  and  trace 
the  history  and  ancestry  of  many  of  these 
youthful  criminals,  we  would  probably  find 
that  in  many  instances,  perhaps  the  majority, 
they  themselves  are  not  responsible  morally, 
and  ought  not  to  be  legally,  for  their  first 
crimes. 

Their  crime  is  the  result  of  a  physical  and 
mental  organism  handed  down  to  them 
from  a  criminal  or  defective  ancestry,  per- 
haps accentuated  and  increased  through 
many  generations.  They  are  defects,  were 
so  at  birth,  must  remain  so  through  life, 
and  if  no  proper  method  of  treatment  or 
restraint  is  thrown  around  them,  will  trans- 
mit their  defects  to  their  posterity  in  all 
probability,  with  the  increased  interest 
accumulated  during  a  life  of  vice  and  crime. 
They  are  crippled  in  the  start  of  life's  race, 
unable  to  cope  with  or  resist  the  tempta- 
tions with  which  their  pathway  is  beset, 
and  an  easy  prey  to  the  Evil  One.  It  may 
be  the  parent  or  some  more  remote  ances- 
tor, or  a  long  line  of  ancestry  were  defec- 
tives, either  vicious,  a  drunkard,  an  epilep- 
tic, or  in  some  other  form  a  defect.  Such 
persons  as  these  are  no  more  responsible, 
and  should  no  more,  from  a  moral  stand- 
point, be  held  accountable  for  their  crime 
than  you  and  I.  And  so  far  from  meriting 
the  condemnation  of  the  law,  and  the  felon's 
chains  and  clothes  and  cell ;  they  deserve 
the  pity  and  sympathey  of  all  mankind, 
and  they  should  receive  from  the  better 
class  of  our  people,  that  kind  of  treatment 
which  will  assist  them  to  remedy  the  defects 
of  nature  and  birth,  and  lead  them  towards 
higher  and  better  ideals  in  life. 

Our  criminal  laws,  we  are  told,  are  based 
upon  two  cardinal  ideas,  punishment  of  the 
vicious  law  breakers,  as  an  example  to  de- 
ter others,  and  reformation  of  the  offender. 
I  fear  sometimes,  we  have  almost  entirely 
lost  sight  of  the  latter  element,  and  proceed 
in  the  enactment  of  laws  for  punishment, 
and  in  inflicting  and  carrying  it  out  solely 


on  the  idea  of  making  an  example  of  the 
offender  ;  and  even  at  times  another  element 
seems  to  enter  into  the  execution  of  the 
criminal  laws,  an  element  that  ought  never 
to  be  allowed  to  enter  the  mind  or  heart  of 
a  judge  in  dispensing  punishment  to  the 
unfortunates,  the  idea  of  revenge,  or  a  pun- 
ishment to  recompense,  as  it  were,  the 
State  or  an  individual,  for  the  injury  in- 
flicted by  the  offender. 

To  punish  the  class  of  juvenile  criminals 
above  mentioned  and  referred  to,  for  the 
purpose  of  making  an  example  of  them,  is 
utterly  wrong  in  principle,  is  absolutely  in- 
humane and  cruel,  and  in  its  result  must  " 
necesarily  and  does  end,  not  in  reforming 
the  criminal,  but  in  making  him  worse.  In 
dealing  with  juvenile  offenders,  we  ought 
to  have  the  single  object  in  view  of  reform- 
ing the  offender,  and  in  the  meantime  re- 
straining him  from  doing  injury  to  society. 
He  should  be  taken  charge  of  upon  the 
commission  of  his  first  offense,  placed  in 
the  care  and  custody  of  those  peculiarly  fit- 
ted by  skill  and,  experience  to  study  and 
deal  with  his  defects ;  and  every  endeaver 
made,  which  skill  can  invent,  or  wealth  and 
means  provide,  to  remedy  his  defects,  and 
to  restore  him  to  his  place  in  society  when, 
and  only  when,  it  is  safe  and  prudent  to 
do  so.  The  strongest  moral  influences 
should  surround  him, while  thus  restrained; 
such  a  system  of  merits,  rewards  or  com- 
pensation for  industry,  good  behavior  and 
improvement  should  be  devised,  as  would 
quicken  and  develop  and  stimulate  the  bet- 
ter and  higher  moral  and  intellectual  pow- 
ers;  powers,  even  among  the  criminals,  are 
often  only  dormant,  and  need  to  be  aroused 
and  put  in  action,  in  order  to  engage  the 
attention  of  the  man  or  youth,  and  to  drive 
out  or  tend  to  dispel,  the  vicious  elements 
in  his  make  up.  It  is  unnecessary  to  say  to 
any  who  have  stopped  to  reflect  on  human 
nature,  or  who  have  observed  it  in  their 
every  day  life,  that  there  is  hope  of  reform- 
ing even  the  older  offenders,  and  there  is 
great  hope  of  changing  and  moulding  the 
mind  and  even  the  heart  of  youthful  crimi- 
nals as  to  make  of  them  useful  and  even 
valuable  members  of  society.  A  wide  field 
of  usefulness,  hitherto  u.ioccupied  in  our 
State,  is  open  along  this  line  to  those  who 
wish 

"To  soften  the  weight  of  adversity's  touch 
On  the  faded  cheek  of  their  fellow-man." 

Our  treatment  of  this  class  of  offenders  is 
the  very  reverse  of  what  it  should  be.  Upon 
their  first  offense,  in  some  instances,  yes  in 
many,  when  we  take  into  consideration 
their  surrounding  environments,  their  ante- 
cedents, and  their  capabilities,  when  they 
hardly  have  an  idea  of  society  and  no  con- 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


607 


ception  of  the  law's  demands,  they  are 
taken  and  confined  in  a  jail,  filled  with 
older  and  more  hardened  criminals,  reeking 
with  filth  and  unwholesome  and  repulsive 
surroundings.  In  many  instances  they  re- 
main there  until  the  court  meets  which  will 
try  them,  or  if  they  do  not  remain  during 
this  preliminary  period,  at  the  trial  they  are 
sent  back  there  or  to  the  penitentiary  with 
similar  surroundings.  And  when  this  same 
criminal  in  after  years  is  called  up  before 
the  same  or  some  other  bar  of  justice,  for 
another  or  second  offense,  the  fact  that  it 
is  his  second  offense  is  laid  to  his  charge  ; 
his  punishment  is  increased  because  he  did 
not  reform  ;  when  in  reality  the  State  and 
the  laws  enacted  by  the  governing  powers 
have  placed  in  his  pathway  every  obstacle 
possible  to  his  reformation,  in  the  very 
method  and  manner  of  punishing  him  for 
his  first  offence. 

Certainly  no  cause  is  more  efficient  or 
prolific  source  of  crime  than  evil  associa- 
tions and  companionship  with  the  bad. 
Our  English  cousins  have  long  since  dis- 
covered this  evil,  and  made  provision  to 
remedy  it  to  some  extent  at  least,  by  provi- 
ding a  separate  sleeping  apartment  for  each 
criminal,  old  or  young,  confined  in  their 
prisons  or  penal  institutions.  We  ought  to 
follow  their  example  in  this  matter,  and 
especially  ought  we  to  keep  all  young  off- 
enders, both  during  their  confinement  pre- 
liminary to  their  trial,  and  men  under  final 
sentence  away  from  the  vicious  and  crimi- 
nal elements,  and  surround  him  with  those 
influences  and  associates,  which  make  for 
good,  its  influence  extends  beyond  the  con- 
ception of  man,  if  for  evil  its  blighting  im- 
press is  likewise  immeasurable. 

According  to  the  last  Census  report, 
twenty-five  States  and  the  District  of  Co- 
lumbia had  some  means  for  caring  for  juve- 
nile criminals,  either  such  as  were  provided 
by  law,  or  by  individual  charity.  Perhaps 
the  best  known,  as  it  is  reputed  to  be  the 
best  managed  institution  of  the  kind,  is  the 
New  York  State  Reformatory,  at  Elmira. 
We  are  reliably  informed  that  the  Superin- 
tendent of  the  institution  is  a  man  of  the 
highest  skill  and  qualifications  for  this  kind 
of  business ;  that  the  management  of  the 
institution  is  fortunately  kept  outside  of 
politics  and  its  influence,  which  is  often  so 
destructive  to  the  progress  and  systematic 
development  of  such  and  similar  institu- 
tions. The  criminals  who  are  sent  there, 
are  sent  under  an  indefinite  sentence,  there 
being  simply  an  extreme  limit,  that  is  they 
cannot  be  kept  there  beyond  maximum  time 
which  they  could  be  confined  in  prison, and 
they  may  be  paroled  or  discharged  at  any 
time  the  officers  of  the  institution  under  the 


regulations  thereof  deem  it  proper.  Every 
inmate  of  the  reformatory  is  made  the  sub- 
ject of  the  most  thorough  study,  the  history 
of  his  life  and  of  his  ancestry  as  far  back  as 
can  be  traced  is  gone  into,  all  his  habits,  his 
prejudices  and  his  weaknesses  are  most 
carefully  studied.  He  is  surrounded  with 
the  best  of  influences,  and  his  time  and 
thoughts  are  occupied  with  such  employ- 
ments as  are  deemed  best  suited  to  correct 
the  causes  which  lie  at  the  foundation  of 
his  crime.  A  complete  system  of  merits 
and  of  marking  along  every  line,  with  the 
ultimate  object  in  view  of  paroling  and 
finally  discharging  him  when  he  has  attain- 
ed the  degree  of  perfection  required  by 
their  rules  and  standards,  and  this  hope  and 
the  rewards  attending  each  onward  and  up- 
ward step  are  constantly  before  him  as  an 
inducement  to  progress  and  development. 
When  he  had  attained  the  required  degree 
of  advancement  he  is  first  paroled,  and  a 
place  found  for  him  to  obtain  employment, 
but  he  is  still  under  the  surveillance  and 
oversight  of  the  institution  and  his  history  is 
carefully  followed :  if  he  goes  to  another 
town  or  city,  the  police  are  notified,  and 
are  required  to  keep  trace  of  him  and  re- 
port regularly  and  constantly  his  progress. 
If  he  makes  any,  even  a  slight  lapse,  under 
the  authority  granted  them  by  law,  he  is 
forthwith  sent  back  to  the  Reformatory, 
and  goes  through  a  similar  training.  The 
reports  show  the  most  satisfactory  results, 
and  also  show  that  the  average  time  of  con- 
finement in  this  reformatory  is  considerably 
less  than  for  like  criminals  in  the  ordinary 
prisons. 

Viewed  from  the  point  of  cost,  the  main- 
tainance  of  this  reformatory  may  seem  rath- 
er expensive,  but  we  will  find  it  only  seem- 
ingly so,  when  we  look  to  the  number  of 
inmates.  While  we  may  not  be  able  to  in- 
duce our  law-makers  to  start  on  so  exten- 
sive a  scale,  it  is  time  the  start  was  made. 
It  is  a  duty  every  good  citizen  owes  to  his 
more  unfortunate  fellow-creature ;  it  is  a 
duty  our  law-makers  owe  to  their  constitu- 
ents and  to  the  State  and  society,  to  estab- 
lish in  our  borders  such  a  reformatory. 

One  thought  more  I  desire  to  suggest  for 
the  consideration  of  this  body  on  the  same 
subject,  that  is,  how  best  to  restrict  and  re- 
strain the  marriage  of  defectives  and  crimi- 
nals, and  the  propagation  of  their  defects. 
I  see  one  of  the  Western  States  has  recently 
enacted  a  law  preventing  and  prohibiting 
altogether  the  marriage  of  defectives  and 
criminals.  Such  a  law  is  undoubtedly 
founded  upon  the  highest  wisdom,  and 
will  be  of  inestimable  value  to  society, 
if  it  can  be  carried  out.  How  to  best 
enforce    such     laws,     and    how    to     make 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


them  of  practical  utility,  will  doubtless  re- 
quire great  time  and  patience,  after  such 
laws  are  once  enacted ;  but  before  they  can 
be  enacted  a  great  deal  of  educational  work 
must  be  done. 

Our  situation  and  training  places  us  in  a 
peculiarly  advantageous  position  to  see  the 
needs  of  the  reforms,  which  I  have  briefly 
mentioned  above.  Our  position  and  distri- 
bution throughout  the  whole  country,  and 
our  contact  with  every  class  of  people  places 
us  in  a  position  to  wield  the  greatest  infllu- 
ence,  in  favor  of  those  reforms,  and  in  edu- 
cating the  masses  of  the  people  to  their  ne- 
cessity. It  is  unnecessary  to  add, that  with 
this  peculiar  knowledge  and  opportunity,  a 
Higher  Power  has  coupled  and  placed  upon 
our  profession  the  Duty  of  bending  our  uni- 
ted and  individual  efforts  to  the  accom- 
plishment of  this  great  end. 


An  Interesting  Case  of  Urinary  Calculus. t 

By  M.  Bolton,  M.  D.,   Rich  Square,  N.  C. 

Early  on  the  morning  of  January  16th, 
iSqo,,  I  was  hastily  called  four  miles  in  the 
country  to  see  Mr.  A.  W.,  a  white  man, 
who,  the  messenger  stated,  was  suffering 
with  colic.  I  found  the  patient  suffering 
intensely  with  the  usual  symptoms  of  ne- 
phritic colic — sharp,  lancinating  pains  in 
the  right  side,  running  down  the  course  of 
the  ureter,  retraction  of  the  testicle,  severe 
grating  sensation  in  the  glans  penis,  almost 
constant  desire  to  urinate,  but  voiding  very 
little  high  colored  urine,  occasional  efforts 
at  vomiting,  and  rigid  contraction  of  the 
abdominal  muscles. 

On  inquiry,  I  found  he  had  been  suffer- 
ing in  this  way  since  Sunday  night  (about 
thirty-six  hours),  the  attack  coming  on  ab- 
ruptly. He  had  taken  no  medicine  except 
a  dose  of  patent  purgative  pills  and  a  dose 
of  castor  oil,  which  had  acted  freely. 

His  side  and  abdomen  were  nearly  blis- 
tered with  hot  water,  turpentine  and  vari- 
ous liniments. 

I  proceeded  to  give  morphia,  gr.  £,  and 
atropia,  gr.  1-150,  hypodermically.  In  half 
an  hour  I  gave,  per  orem,  a  tablet  contain- 
acetanilid,  gr.  3^,  soda,  gr.  1,  and  cafhene, 
gr.  \,  with  a  quarter  grain  of  morphia. 
This  had  the  effect  of  quieting  him  tem- 
porarily, but    made  him    slightly  delirious. 

Patient's  age  was  fifty-three  years,  aver- 
age weight  one  hundred  and  fifty  pounds  ; 
married,  family  history  good,  farmer  by 
occupation.  Had  always  been  healthy. 
never    having  been    visited    by  a  physician 


tRead  before  the  North  Carolina  Medical  So- 
ciety at  Asheville,  N.  C. 


professionally. 

He  attributed  his  attack  to  some  heavy 
work  in  which  he  had  been  engaged  during 
the  past  two  or  three  weeks — that  of  haul- 
ing railroad  cross-ties.  He  stated,  how- 
ever, that  he  had  suffered  some  dull,  deep- 
seated  pain  in  that  side,  at  times,  for  a  year 
or  two  and  while  he  had  been  practically 
well  he  had  found  that  he  could  not  carry 
any  heavy  weight  on  the  arm  pressing 
against  that  side.  He  referred  to  it  as  his 
weak  side. 

There  was  no  history  of  any  acute  renal 
or  hepatic  colic. 

I  diagnosed  it  a  case  of  nephritic  colic, 
left  a  few  quarter  grain  morphine  granules 
and  an  equal  number  of  lapactic  pills, 
with  instructions  to  give  one  of  each  as 
necessary  to  control  his  pain,  and  to  report 
to  me  the  next  day  if  he  was  not  relieved 
or  if  he  was  relieved  sufficiently  to  report 
in  person  a  day  or  two  later.  I  did  not 
hear  from  him  until  Saturday  morning, 
January  20th,  when  I  was  again  sent  for  to 
see  him.  I  found  him  suffering  in  the  same 
way,  but  not  so  severely.  He  had  only 
taken  two  or  three  doses  of  the  pills  since 
my  first  visit  (four  days  previously),  his 
wife  giving  as  the  reason  that  they  made 
him  so  crazy  she  could  not  manage  him. 

His  abdomen  was  decidedly  tympanitic, 
and  bowels  constipated,  not  having  acted 
since  my  first  visit.  Temperature  101, 
pulse  full  and  slightly  accelerated,  tongue 
flabby  and  thickly  coated,  slight  nausea, 
but  no  vomiting. 

I  gave  a  two  quart  hot  saline  enema, 
which  brought  away  considerable  gas  and 
fecal  accumulations. 

The  pain  was  more  diffused,  and  the  ab- 
domen was  so  sensative  to  pressure,  I  was 
not  able  to  make  a  very  careful  examination 
of  it.  I  left  eight  tablet  trituates  of  calo- 
mel, I  gr.,soda,  1  gr.,and  ipecac,  i-iogr., 
each,  one  to  be  given  every  hour  and  fol- 
lowed in  two  hours  by  half  an  ounce  of 
epsom  salts.  I  left  also  a  solution  of  mor- 
phia and  hyoscyamus,  which  I  disguised  as 
much  as  possible,  and  ordered  it  given  as 
indicated. 

The  next  day,  Sunday  afternoon,  his 
temperature  was  102,  pulse  90;  still  suffer- 
ing pain,  but  the  character  of  the  pain  had 
gradually  changed.  It  had  lost,  largely, 
its  intermittent  or  paroxysmal  character, 
and  was  general  over  the  side  and  abdomen, 
though  the  tenderness  was  more  marked  in 
the  right  side.  His  bowels  had  been  moved 
several  times  and  were  distended.  He  was 
passing  very  little  urine,  but  the  desire  was 
less  persistent.  I  left  some  three  grain 
Dover's  powder  tablets  to  be  given  to  con- 
trol his  bowels  and    to  quiet    him.     There 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


having  been  a  history  of  malaria  in  his  case 
a  few  weeks  previously,  I  thought  possibly 
that  had  something  to  do  with  keeping  the 
fever,  so  I  prescribed  twenty  grains  of 
quinine  to  be  given  next  morning,  five 
grains  to  be  given  every  two  hours,  begin- 
ning at  6  o'clock. 

Monday  afternoon  his  temperature  was 
102,  pulse  90  to  96  ;  bowels  still  more  dis- 
tended and  acting  every  three  to  four  hours. 
Discharges  consisted  largely  of  bile  and 
mucous,  with  considerable  tenesmus  with 
every  movement ;  the  odor  was  more  or  less 
offensive.  The  pain  was  almost  entirely 
relieved  except  on  pressure.  He  expressed 
himself  as  feeling  a  great  deal  better,  and 
attributed  his  supposed  improvement  to  the 
little  brown  tablets,  of  which  he  had  taken 
only  three  or  four.  He  had  been  quiet 
during  the  past  twenty-four  hours,  but  was 
delirious — talking  and  pulling  at  the  cover 
when  left  to  himself.  There  was  no  nausea, 
but  the  anorexia  which  had  existed  from 
the  first  had  developed  into  a  disgust  for 
every  kind  of  food  ;  patient  losing  flesh  and 
strength  rapidly.  I  prescribed  salol,gr.  5, 
and  strychnine,  gr.  1-60,  every  four  hours, 
and  left  a  few  tablets  of  opium,  camphor, 
rheubarb  and  capsicum  to  be  given  as  neces 
sary  to  restrain  the  movements  of  his 
bowels. 

From  this  date  the  case  ran  on  for  twelve 
or  thirteen  days  with  very  little  variation 
in  the  symptoms  except  progressive  emacia- 
tion. His  temperature  varied  from  100  in 
the  mornings  to  103  in  the  evenings.  Pulse 
90  to  100;  skin  hot  and  dry.  Bowels  con- 
tinued irritable,  acting  several  times  every 
day.  Stools  consisted  of  semi-liquid  bilious 
matter  and  mucous;  general  distension  of 
the  abdomen  ;  no  pain  except  on  pressure. 
I  was  not  able  to  make  out  any  localized 
induration  at  any  time,  but  this  was  ren- 
dered impossible  by  the  extreme  sensitive- 
ness. 

He  gradually  began  to  pass  more  urine 
from  Monday,  the  ninth  day  of  his  illness. 
Th'ere  was  nothing  characteristic  of  it  on 
inspection  until  Tuesday,  the  tenth  day, 
when  I  discovered  a  suspicious  looking  sed- 
iment in  it.  I  took  a  sample  home  with 
me,  and  on  examination  it  proved  to  be 
pus.  I  could,  doubtless,  have  found  it 
earher  had  1  examined  for  it,  which  I  should 
have  done.  From  that  time  there  began  to 
be  a  free  discharge  of  purulent  urine,  though 
the  bladder  was  retentive  and  he  did  not 
have  to  pass  urine  oftener  than  when  well. 

Typhoid  symptoms  continued  unabated. 
Patient  lay  constantly  on  his  back  and  slept 
nearly  all  the  time,  muttering  and  twitch- 
ing frequently.  The  treatment  was  salol, 
gr.  5,  every  four  hours,  and   turpentine.  10 


drops,  every  four  hours,  alternately  One 
of  these  remedies  was  given  forty-eight 
hours  at  a  time  when  it  was  discontinued, 
and  the  other  given.  He  took  20  grains  of 
Royal  Pepsin  Co.,  20  gr.  bismuth  sub-ni- 
trate, and  1-60  gr.  strychnine  four  times 
daily.  Diet  consisted  of  milk,  egg  drams 
and  liquid  peptonoids,  with  a' little  chicken 
broth  occasionally.  I  saw  him  once  every 
day  except  two  or  three  days  when  the 
weather  was  so  inclement  it  was  next  to 
impossible  to  get  there. 

About  the  eighteenth  day  of  his  illness 
he  began  to  have  night  sweats. 

On  Thursday  afternoon  (nineteenth  day) 
I  noticed  an  undue  fullness  in  the  right 
hypochondriac  region,  but  having  no  idea 
that  an  abscess  was  forming  in  that  posi- 
tion, I  was  not  satisfied  as  to  the  nature  of 
it.  On  Friday  afternoon  it  was  more  pro- 
minent, and  I  thought  I  could  make  out 
slight  fluctuation ;  but  the  general  disten- 
sion of  the  abdomen  and  tenderness  on 
pressure,  made  it  impossible  to  make  a  rigid 
examination. 

I  inserted  my  hypodermic  needle  deep 
down  through  the  most  prominent  part  of 
the  enlargement  and  drew  out  a  syringeful 
of  pus.  I  could  not  discover  any  odor  of 
urine  or  appearance  of  bile  in  the  sample  of 
pus.  I  suggested  an  operation,  and  was 
directed  to  exercise  my  judgment  and  do 
whatever  I  thought  best. 

Dr.  Joyner,  of  Woodland,  was  sent  for 
to  meet  me  next  morning  at  10  o'clock. 
We  both  arrived  on  time  and  examined  the 
case  together.  There  was  no  longer  any 
question  as  to  the  presence  of  pus,  but  as 
to  its  cause  and  source  there  was  a  cloud  of 
doubt.  The  site  of  the  abscess  settled  the 
question  as  to  appendicitis  or  nephritic  ab- 
scess— as  we  thought.  While  there  was 
pyuria  it  was  certainly  most  improbable 
that  an  abscess  in  that  region  would  be 
draining  through  the  ureter. 

We  concluded  that  the  symptoms  of  kid- 
ney colic  which  played  such  a  prominent 
part  in  the  early  history  of  the  attack  were 
reflex  or  possibly  there  was  a  coincident 
nephritic  colic. 

We  had  a  most  unpromising  patient  for 
operation — pale,  weak,  emaciated.  It  was 
uncertain  as  to  what  extent  the  operation 
might  have  to  be  carried.  We  decided  to 
do  the  best  we  could  under  the  unfavorable 
circumstances,  and  acting  upon  that  sur- 
gical law  which  is  now  generally  respected 
— to  let  out  pus  wherever  found — we  placed 
the  patient  on  a  table,  disinfected  the  sur- 
face, and  commenced  the  administration  of 
ether.  He  did  not  take  the  ether  well  and 
we  changed  to  chloroform.  Respirations 
and  pulse  became  alarming,  and   both   had 


610 


THE  CHARLOTTE    MEDICAL  JOURNAL. 


to  be  discontinued  before  he  was  thoroughly 
anesthetised.  I  proceeded  to  make  an  in- 
cision about  two  inches  or  more  in  length, 
corresponding  with  the  course  of  the  rectus 
muscle  and  at  the  place  where  I  had  made 
the  exploratory  puncture  with  the  needle  ; 
which  was  in  the  right  hypochondriac  re- 
gion, in  close  proximity  to  the  gall  bladder, 
immediately  beneath  the  cartilage  of  the 
lower  ribs.  Two  pints  or  more  of  ordinary 
pus  escaped.  On  exploration  with  the 
finger  the  pus  was  found  to  be  perfectly 
encysted  and  the  abscess  cavity  contained 
a  calculus  of  considerable  size.  It  was 
rather  an  agglutination  of  four  or  five  dis- 
tinct calculi  projecting  in  different  direc- 
tions and  weighing  about  sixty  grains  when 
first  extirpated. 

The  cavity  was  irrigated  with  a  bichlo- 
ride solution,  i  to  2000,  a  rubber  tube  in- 
serted, and  the  wound  dressed  with  iodo- 
form gauze  and  absorbent  cotton.  Patient 
was  replaced  in  bed,  hot  applications  ap- 
plied and  stimulants  administered. 

It  was  with  great  difficulty  reaction  was 
established.  For  six  or  eight  hours  his 
condition  was  critical.  The  following 
morning  he  had  less  fever,  but  there  was 
no  change  in  the  character  of  his  urine  or 
the  condition  of  his  bowels.  There  was 
undigested  milk  in  the  feces,  but  he  had 
taken  an  excessive  quantity.  The  abscess 
cavity  was  again  irrigated,  but  I  could  not 
wash  it  out  satisfactorily.  He  began  to 
improve  from  that  date — was  clear  of  fever 
in  a  few  days,  tongue  cleaned  off,  appetite 
improved,  tympany  subsided,  and  bowels 
became  regular  or  rather  constipated.  Af- 
ter the  fever  had  gone  off,  I  gave  him  syr. 
hypophosphite  comp.  in  full  doses  three 
times  a  day  before  meals,  and  five  grains  of 
salol  between  meals  and  at  bed  time,  alter- 
nating every  forty-eight  hours  with  turpen- 
tine, ten  drops  at  the  same  hours. 

The  evacuation  of  the  abdominal  abscess 
did  not  seem  to  have  any  effect  on  the  py- 
uria at  the  time  of  operation,  nor  has  the 
amount  discharged  from  it  since,  borne  any 
relation  to  that  from  the  kidney. 

There  was  considerable  pus  in  his  urine 
(though  varying  in  quantity)  until  about 
the  first  of  April,  since  which  date  there 
has  been  only  a  trace.  The  abdominal  ab- 
scess still  continues  to  discharge  freely.  I 
have  experienced  great  difficulty  in  keeping 
it  open. 

He  has  had  a  voracious  appetite  and  per- 
fect digestion,  and  has  about  regained  his 
usual  weight,  though  he  is  still  weak,  and 
while  he  can  do  no  manual  labor,  he  has 
been  able  to  attend  to  his  business  for  about 
two  months.  During  the  past  two  and  a 
half  months   he  has  taken  tonics,    lithiated 


hydrangea,  and  calcium  sulphide  at  different 
times,  leaving  off  all  medicine  for  a  week 
or  more  from  time  to  time. 

Now,  Mr.  President  and  gentlemen,  it 
may  be  that  I  have  consumed  an  unneces- 
sary amount  of  the  valuable  time  of  this 
Convention  in  reporting  this  case,  but  my 
only  excuse  is  that  to  me  it  is  a  most  inter- 
esting and  unique  one.  Dr.  Joyner  and  I 
were  of  the  opinion  that  it  was  a  biliary 
calculus.  To  settle  the  question  as  to  the 
nature  and  source,  I  sent  it  to  the  Editors 
of  the  Charlotte  Medical  Journal  to  be  ex 
amined,  and  it  was  turned  over  to  Dr 
Pressly,  the  Secretary  of  this  Society 
for  analysis.   It  proved  to  be  a  renal  gravel 

I  can  not  understand  how  so  large  a  mul 
tangular  calculus  could  find  its  way  con 
trary  to  the  laws  of  gravity  to  that  position 
in  the  abdominal  cavity. 

There  evidently  existed  in  this  case  a 
suppurating  track  from  the  pelvis  of  the 
kidney  or  upper  dilated  portion  of  the 
ureter  to  and  beyond  the  site  of  the  gravel 
divided  by  inflammatory  adhesions  into  two 
distinct  abscess  cavities ;  one  discharging 
through  the  ureter  and  the  other  through 
the  external  opening.  I  saw  the  patient 
the  day  before  I  left  home,  and  the  dis- 
charge of  pus  from  the  external  opening  is 
greatly  reduced  in  quantity  and  there  exists 
the  slightest  trace  of  it  in  his  urine.  He  is 
much  improved  in  every  way,  and  I  believe 
will  get  well. 


Gun-Shot  Wounds-- With  Report  of  a  Case 
of  Gun-Shot  Wound  of  Stomach* 

By  Dr.   R.    E.   Zachary,    of  Wilmington.  N.  C. 

Being  resident  physician  of  the  Wil- 
mington City  Hospital  at  the  time  of  the 
well-known  race  riot,  in  November,  1898, 
opportunity  was  given  me  for  the  study  of 
gun-shot  wounds  of  most  every  descrip- 
tion. 

Nov.  10,  1898,  fourteen  wounded  men. 
two  whites  and  twelve  colored,  were  admit- 
ted to  the  hospital.  It  may  be  a  singular 
coincidence  that  all  except  the  two  white 
were  shot  in  the  back,  one  of  them  being 
wounded  in  the  bottom  of  the  foot.  All 
recovered  except  two  colored  men,  who  died 
shortly  after  being  admitted.  Of  the  twelve 
who  recovered  only  two  were  seriously  hurt. 
The  lungs  of  these  two  were  pierced,  most 
of  the  rest  were  flesh  wounds,  no  bones 
were  broken. 

Bullets  were  probed  for  and  most  of  them 
extracted,  counter  drainage  formed,  when- 

JRoad  before  the  North   Carolina   Medical    So- 
ciety, Asheville,  N.  C. 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


611 


ever  possible.  The  wounds  all  were  washed 

daily  with  hydiogen  peroxide  and  left  open, 

with  the  exception  of  plain    gauze   dipped 

in  a  bichloride  solution  1-5000  and  applied. 

This  treatment  was  successful    and    twelve 

'  of  the    fourteen    will   perhaps     live  to  tell 

:  their  grandchildren  of  their   experience    in 

.  the  famous     Wilmington    race    riot,     how 

bravely  they  stood  up  and  faced  the  enemy. 

The  following  is  a  report  of  on  accident 

gunshot  wound  of  the  stomach    and    treat 

{  ment  :     G.  F.  White,  age    15,    male,     shot 

himself  accidentally  Jan.  25th,    1899. 

After  eating  an  unusually  hearty    dinner 
he  went    to    his    room   for  the   purpose     of 
'  cleaning  his  pistol,  a  No.   32,    after    which 
,  he  reloaded    it    and    holding  it  directly  in 
front  of  him  about  on  a  level  with  his  chin 
and  attempting  to  close  it,  it  fired,  the  bul- 
let entering  his  body  two  and  one-half    in- 
ches below  and  to  the  left    of  xyphoid  car- 
tilage and  lodged  in    the  muscle    one    inch 
to  the  left  of  spine  and  just  above    crest   of 
ilium.     I    reached    the    patient  about    one 
hour  after  the  accident  occurred  and  found 
'  him    suffering     from     shock,     countenance 
pale,  pulse  rapid  and  weak,  lips  blue.   Mor- 
phia, atropia  and  strychina   were   given    at 
1  once,    hypodermically.     The     patient     had 
i  just  vomited   between  one  quart    and    one- 
half  gallon  of  food  and  blood     mixed.      A 
i  second  time    he  vomited  almost  pure  blood, 
the  third    time    there    was  only  a  trace  of 
blood  and  the  fourth  time  no    blood    at  all. 
Several  physicians  were  called  in    for    con- 
sultation, most  of  whom  were  in    favor  of 
opening    the     abdomen     and      exploring. 
Would  such  a  precedure  have    been    advis- 
ble? 

As  I  stated  before,  the  patient  was  suf- 
fering from  shock  and  had  an  operation 
been  advisable  the  subject  was  too  weak  to 
bear  it.  What  stopped  the  hemorrhage? 
As  stated  in  the  beginning,  the  boy  had 
just  eaten  an  uuusually  large  dinner  and  the 
stomach  was  distended.  After  the  bullet 
had  passed  through  and  the  hemorrhage 
begun,  patient  vomited,  emptying  the 
stomach  of  its  contents,  giving  it  an  op- 
portunity to  contract,  and  it  is  reasonable 
to  suppose  that  after  this  contraction  the 
hemorrhage  ceased. 

In  less  than  three  hours  after  the  accident 
patient  had  passage  without  a  sign  of  blood, 
so  it  is  natural  to  suppose  that  there  was 
'  no  wound  further  along  the  bowels  than 
the  stomach.  Patient  urinated  as  usual, 
so  the  kidneys,  bladder,  ureters  must  have 
been  untouched.  There  was  no  sign  of  in- 
jury to  the  patient  except  that  of  the 
stomach,  and  hemorrhage  from  this  wound 
had  ceased,  but  leaving  patient  in    a    weak 


condition,  and  thinking  an  operation  not 
advisable  the  following  was  the  treatment  : 
The  bullet,  which  was  only  about  two  in- 
ches from  the  surface,  was  extracted,  giv- 
ing excellent  drainage  to  the  wound  at 
both  ends.  Both  wounds  were  left  open 
and  only  a  bichloride  dressing  used.  Now 
there  were  two  wounds  in  the  stomach  and 
in  order  to  prevent  hemorrhage,  nothing 
was  allowed  to  go  into  it.  To  give  the 
wound  a  chance  to  heal  there  must  be  per- 
fect rest  of  stomach  for  at  least  three  weeks 
or  one  month,  so  for  three  long  weeks  not 
one  thing,  not  even  water,  was  allowed  to 
go  down  his  throat.  All  nourishment  and 
medicines  were  given  him  externally  and 
per  rectum.  Knowing  it  to  be  a  very  dif- 
ficult case,  I  did  the  nursing  and  was  with 
him  almost  constantly  the  first  seven  days 
ond  during  this  time  his  temperature 
ranged  between  101  deg.  and  105  deg.  F. 
For  the  first  three  days  he  was  given  an  ice 
bath  every  hour,  after  which  he  was 
sponged  in  alcohol  and  after  this  when  bis 
temperature  exceeded  102  deg.  F.  he  was 
bathed  and  sponged  until  temperature  fell 
below  102  deg.  F.  For  one  month  an  ice 
bag  was  kept  constantly  to  his  abdomen, 
milk,  warm  coffee  and  whiskey  were  given 
per  rectum  every  three  or  four  hours.  He 
would  retain  about  three  pints  of  milk  and 
four  to  eight  oz.  of  whiskey  daily. 

Strychnine  gr.  1-50  was  give"n  hypo- 
dermicaliy,  three  or  four  times  a  day, 
mouth  mopped  thoroughly  every  two  or 
three  hours  with  mixture  of  listerine  gly- 
cerine and  water.  Morphine,  whenever 
required,  was  given  for  pain.  During  the 
period  that  his  temperature  was  so  high  the 
patient  was  unconscious.  On  the  twenty- 
first  day  patient  was  allowed  to  have  one 
table-spoonful  liquid  peptonoids  every  four 
hours  per  mouth  and  at  the  end  of  one 
month  was  given  milk  freely,  but  was  not 
digested,  so  this  was  stopped.  In  a  few 
days  he  was  given  Mellin's  food  and  seemed 
to  thrive  on  it.  Even  the  most  digestible 
food  would  cause  pain  in  the  stomach,  so 
it  was  necessary  to  be  very  careful.  After 
about  the  fourteenth  day  patient  began  to 
improve.  When  the  accident  occurred  he 
weighed  145  pounds,  but  he  got  down  to 
less  than  90  pounds  and  improved  very 
slowly,  was  not  able  to  leave  his  bed  for 
three  months  from  the  time  of  the  injury, 
but  now  he  is  well  and  hearty  and  doing 
good  work. 

The  need  of  a  scientific  test  of  death  has 
suggested  the  use  of  Roentgen  rays,  as  the 
slightest  movement  of  the  heart  blurs  the 
skiagraph,  and  in  Paris  they  have  already 
been  successfully  used  for  this  purpose. 


612 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


Some  Remarks  Upon  Coley's  Treatment 
of  Malignant  Growths. t 

By  Frank  T.  Meriwether,  M.  D.,  U.   S.   A.,    Re- 
tired, Asheville,  N.  C. 

I  wish  to  preface  my  remarks  upon  this 
subject  by  stating  that  I  do  not  in  any  sense 
recommend  this  treatment  in  cases  in  which 
the  tumors  are  operable,  even  though  ope- 
ration requires  total  removal  of  limbs  or 
destruction  of  function  in  all  cases,  when 
operable,  and  when  consent  can  be  obtain- 
ed, do  the  most  radical  operation   possible. 

I  will  confine  my  remarks  more  especial- 
ly to  the  effects  of  this  treatment  upon  Sar- 
coma, for  true  Carcinoma  have  not  given 
very  good  results,  though  in  some  cases 
benefit  has  resulted. 

It  has  long  been  known  that  accidental 
attacks  of  Erysipelas  arrested,  and  in  some 
instances  cured. not  only  malinnant  growths 
but  also  malignant  ulcerations,  Lupus  and 
syphilitic  erosions.  Moullin1  identified  15 
undoubted  cases  of  Sarcoma  ,in  which  Ery- 
sipelas occurred,  9  of  which  were  cured  and 
5  benefitted.  Billroth,  Busch,  Beidert,  Co- 
ley,  Fehleissen,  Wyeth,  Winslow,  Repin,2 
and  others,  also  report  cases  in  which  cures 
or  benefits  have  been  obtained  in  like  man- 
ner. Fehleissen  produced  artificial  Erysipe- 
las in  cases  of  malignant  growths,  and  ob- 
tained a  cure  in  a  case  of  Carcinoma  of  the 
breast, and  benefit  in  two  cases  of  Sarcoma, 
and  two  of  Carcinoma.  I  have  the  personal 
report  of  a  case  of  Sarcoma  of  the  Parotid 
Gland  and  Jaw  treated  by  Drs.  Lewis  and 
Mclntyre,  of  Kansas,  in  which  facial  Ery- 
sipelas caused  the  apparent  cure  of  the 
primary  growth.  A  metastasis  occurred 
afterwards  in  the  Tibia  which  was  treated 
with  success  with  Toxin  injections.  At- 
tempts have  been  made  to  inoculate  cases 
with  the  pure  culture  and  then  with  the 
toxin  products  of  the  germ  alone,  after 
sterilization.  Coley  also  used  the  Bouillon 
cultures  after  sterilization,  but  like  Brieger 
Lossen  and  others,  did  not  accomplish  much 
in  the  way  of  good.  Coley  finally  made 
use  of  the  discovery  of  Roger,  of  Paris, that 
the  addition  of  a  non-pathogenic  micro- 
organism, the  Bacillus  Prodigiosus,  added 
to  the  Streptococci  of  Erysipelas  increased 
materially  their  virulence. 

His  method  of  preparing  the  Toxin  is  as 
follows  ;  Flasks  containing  50  to  100  c.  c. 
of  peptionized  bouillon,  after  proper  steri- 
lization, are  inoculated  with  the  streptococi 


tRead  before  the  North  Carolina  Medical  So- 
ciety at  Asheville,  N.  C. 

lFowler's  article  in  Am.  Journal  Med -Science 
vol.  cxvi,  pages  161  et  al. 

2  Ibid. 


of  Erysipelas,  which  are  allowed  to  grow 
for  three  weeks  at  a  temperature  of  30  to 
35  C-  Tne  flasks  are  then  inoculated  with 
the  bacillus  prodigiosus  and  kept  at  the  room 
temperature  for  ten  or  twelve  days.  Then 
after  being  well  shaken  the  cultures  are 
poured  into  sterilized  half  ounce  bottles  and 
heated  to  a  temperature  of  50  to  60  C.  for 
an  hour,  which  makes  them  perfectly  ste- 
.rile.  After  cooling,  a  small  amount  of 
powdered  Thymol  is  added  and  the  Toxins 
are  then  ready  for  use.  If  they  are  too 
strong  for  use  the  preparation  may  be  dilu- 
ted with  either  distilled  water  or  glycerine. 

To  make  the  bouillon,  soak  a  pound  of 
chopped  lean  meat  over  night  in  water. 
The  next  morning  strain  it  through  a  clothj 
make  it  up  to  1000  c.  c.  and  boil  for  one 
hour.  Then  filter  through  a  cloth,  add 
peptone  and  salt,  neutralize,  and  boil  again 
for  an  hour.  Pass  this  through  filter  paper 
and  put  into  the  flasks.  It  is  not  always 
necessary  to  neutralize  the  bouillon,  as  the 
streptococci  are,  if  anything,  stronger  when 
grown  upon  an  acid  preparation  and  they 
grow  as  readily. 

To  keep  up  the  virulence  of  the  cultures, 
Coley  puts  through  rabbits  as  follows  :  A 
minute  quantity  of  a  bouillon  culture  is  in- 
jected into  a  rabbit's  ear,  which  has  been 
been  cleansed  by  having  the  hair  clipped 
and  the  ear  then  washed  with  a  weak  car- 
bolic solution  and  then  with  sterile  water. 
Forty-eight  hours  afterwards,  after  washing 
the  ear  again,  a  flat  sterile  needle  is  intro- 
duced under  the  skin  near  the  point  of  in- 
oculation and  the  layer  of  skin  cut  off.  An 
agar  tube  is  then  inoculated  with  this  skin 
aud  placed  in  an  incubator.  Twenty-four 
hour  later  the  colonies  may  be  seen  as  min- 
ute white  specks,  and  from  them  a  pure 
culture  may  be  obtained.  If  the  agar  is 
made  with  75%  of  bouillon  and  25%  of 
urine  the  streptococci  will  grow  more 
freely. 

Technique.— The  treatment  should  be 
commenced  with  a  dosage  of  one-half 
a  minim,  repeated  every  two  or  three  days, 
according  to  the  strength  of  the  patient, and 
the  effect  of  the  injections.  In  some  cases 
one-third  of  a  minim  is  not  too  small.  In 
many  cases,  particularly  those  in  which  the 
tumor  is  very  vascular,  even  this  small  dose 
will  produce  a  marked  chill  and  reaction. 
In  a  case  seen  with  Dr.  Weaver,  of  this 
city,  we  never  did  get  above  three-fourths 
of  a  minim,  and  our  usual  dose  was  about 
one-half,  and  yet  this  smlll  dose  produced, 
at  times,  marked  chills  and  depression.  If 
the  patient  does  not  show  the  effects  of  the 
injections,  increase  the  dose  gradually  until 
the  temperature  goes  up  to  102  ar  103  F. 
A  slight  chill    almost    always   accompanies 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


613 


this  temperature,  though  it  should  be  avoid- 
ed if  possible.  Give  enough  to  stop  just 
short  of  the  chill,  and  very  little  depression 
follows  the  subsidence  of  the  temperature. 
The  chill  or  chilly  sensation  usually  comes 
on  within  a  half  to  one  hour  ifter  the  injec- 
tion. Strychnia  or  whiskey  should  be  giv- 
en if  much  depression  or  rigor  follow. 
Usually  within  two  or  three  weeks  the  ef- 
fects of  the  injections  can  be  determined, 
whether  or  not  benefit  will  result.  In  some 
cases  however,  progress  is  slow,  and  re- 
quire a  more  or  less  prolonged  treatment; 
in  one  case  reported  the  treatment  being 
continued  for  two  years  before  the  patient 
could  be  said  to  be  well. 

If  too  much  time  elapses  between  the  in- 
jections the  growth  reiurns  to  its  former 
activity.  The  toxin  does  not  seem  to  have 
a  permanent  effect  upon  the  tumor  mass, for 
after  three  or  four  days  its  inhibitory  and 
destructive  power  disappears  and  the  cells 
commence  again  to  proliferate.  To  obtain 
the  proper  dilution,  use  plain  sterilized 
water. 

If  the  injection  is  given  at  some  distance 
from  the  tumor,  sometimes  as  much  as  ten 
minims  may  be  tolerated,  but  where  possi- 
ble always  inject  into  the  tumor  itself,  for 
the  best  effects  are  and  have  been  obtained 
when  the  injection  has  been  made  into  the 
tumor  mass,  and  a  smaller  dose  can  be  used 
and  its  effect  is  shown  much  more  rapidly, 
and  can  thereby  be  the  better  controlled. 

In  a  case  I  saw,  ten  minims  would  not 
produce  a  chill  when  given  in  the  abdomen 
at  some  distance  from  the  tumor,  it  being  a 
carcinoma  of  the  abdominal  wall,  recurring 
after  the  removal  of  a  large  cyst-adenoma, 
of  the  ovary,  while  two  minims  injected  in- 
to the  mass  itself  would  produce  a  marked 
chill  and  profound  depression  with  cyano- 
sis, pulse  of  140  to  160,  followed  by  a  tem- 
perature of  104  F. 

Mode  of  Action. — The  exact  rationale 
of  the  action  of  the  Toxins  upon  these 
growths  is  as  yet  uncertain.  Coley  seems 
to  think  that  it  depends  upon  a  bactericidal 
action,  but  so  far  the  bacterial  origin  of 
sarcoma  has  not  been  demonstrated.  The 
toxins  seem  to  have  an  elective  affinity  for 
the  cells  of  the  neoplasm,  for  even  if  the 
injection  is  given  at  some  distance  from  the 
growth  the  selective  action  of  the  toxin  is 
manifested.  In  the  cases  where  sloughing 
and  necrosis  occurs,  it  shows  itself  usually 
within  thirty-six  to  forty-eight  hours.  In 
one  case  of  mine,  sloughing  of  the  tumor 
mass  was  frequently  noticed  within  twenty- 
four  hours,  and  the  effect  upon  the  metasta- 
ses was  noticeable  within  almost  as  short  a 
time,  though  at  quite  a  distance  removed 


from  the  primary  tumor.  This  necrosis,  as 
Coley  points  out,  is  not  dependent  upon  the 
action  of  the  toxins  upon  the  tissues  in  a 
manner  similar  to  that  of  an  escharotic,  but 
is  dependent  upon  some  special  selection 
for  the  neoplastic  cells  or  their  cause.  In  a 
case  of  mine,  of  small  round  cell  sarcoma, 
the  sloughing  would  always  occur  at  a  point 
some  distance  removed  from  the  place  of 
injection,  and  in  another  case  in  which  the 
tumor  was  deep  seated,  the  injections  were 
given  under  the  skin  over  the  site  of  the 
tumor,  and  while  the  specific  action  of  the 
toxins  was  shown,  no  local  slough  occurred. 
The  tumor  itself  seemed  to  be  softened,  and 
finally  was  absorbed,  most  probably  a  form 
of  fatty  degeneration. 

Results. — Though  unable  to  explain 
fully  its  favorable  action  upon  malignant 
growths,  and  particularly  upon  spindle  cell- 
ed sarcoma,  the  fact  remains  that  a  good 
percentage  of  cases  treated  have  been  bene- 
fitted or  cured.  I  have  collected  from  vari- 
ous sources  216  cases  of  sarcoma  treated.  I 
do  not  think  that  these  can  represent  all  the 
cases  treated  in  this  country,  for  148  of  them 
are  personal  cases  of  Coley's,  but  I  judge 
that  they  give  a  fair  basis  from  which  to 
form  conclusions.  In  not  all  of  them  was  a 
microscopical  examination  made,  but  the 
clinical  diagnosis,  when  made,  were  con- 
sidered sufficient,  and  were  made  by  able 
men.  Of  these  216  cases  57,  or  26^  per 
cent.,  were  cured;  93,  or 43  per  cent.,  were 
benefitted  to  a  greater  or  less  degree ;  and 
3  died.  Of  the  spindle  celled  sarcoma  diag- 
nosed by  the  microscope,  all  were  benefitted 
and  60  per  cent,  were  cured.  Coley  reports 
a  case  of  epithelioma  cured,  and  I  learn 
from  other  sources  of  two  cases  of  carcino- 
ma, type  unknown,  cured,  and  three  cases 
benefitted.  One  of  my  cases  was  a  malig- 
nant adeno-carcinoma  of  the  ovary,  in 
which  the  patient  was  benefitted,  but  owing 
to  objections  on  her  part,  and  other  obsta- 
cles, the  treatment  could  not  be  carried  out 
as  it  should  have  been.  * 

The  fact  that  in  a  great  many  of  the  cases 
the  treatment  was  commenced  late  in  the 
disease,  when  death  was  imminent,  lessens 
the  favorable  appearance  of  the  statistics. 
By  leaving  out  those  cases  in  which  death 
ensued  within  two  weeks,  the  percentage 
of  cures  is  much  greater.  Undoubtedly 
many  cases  have  been  treated  without  suc- 
cess, which  have  not  been  reported,  but 
even  if  ^7  out  of  a  large  number  have  been 
cured,  the  treatment  should  in  the  proper 
cases  be  considered  to  be  upon  a  firm  basis. 
Of  course  the  only  way  to  arrive  at  positive 
conclusions  is  to  consider  all  cases  whether 
favorable  or  not.  It  would  be  well  if  all 
the  cases,  particularly  the  unsuccessful  ones. 


614 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


were    reported,  from    which  a   comparison 
could  be  made. 

There  have  been  many  objections  made 
to  this  treatment,  one  on  the  ground  that 
mistakes  have  been  made  in  the  diagnosis 
of  those  cases  said  to  have  been  cured.  It 
is  possible  that  error  might  have  occurred 
in  those  cases  in  which  no  microscopical 
examination  was  made,  and  where  the  diag- 
nosis was  made  upon  the  clinical  features 
alone,  but  in  the  greater  percentages  of  the 
cases  benefitted  or  cured,  accurate  micro- 
scopical examination  has  been  made. 

Welch  says  that  "microscopically,  spin- 
dle celled  sarcoma  cannot  be  confounded 
with  anything  else,  though  the  round  celled 
sarcoma  might  be  with  syphilitic  gumma." 
But  it  so  happens  that  it  is  in  the  spindle 
celled  form  that  the  greatest  good  comes. 

In  Battle's1  case, reported  before  the  Med- 
ical Society  of  London,  in  which,  after  this 
treatment,  an  enormous  fibro-sarcoma  of  the 
clavicle  and  shoulder  had  nearly  entirely 
disappeared.  Moullin  stated  that  "he  had 
examined  both  the  tumor  and  the  sections 
made  from  it  and  considered  it  a  sarcoma." 
Another  point  that  has  been  raised  is  that 
frequently  tumors,  some  of  them  said  to  be 
sarcomatous,  have  disappeared  spontaneous- 
ly. Wyeth  and  McCosh2  each  report  a 
case  in  which,  after  pyogenic  infection  and 
suppuration,  the  tumors  disappeared,  but 
Bland  Sutton3,  before  the  Royal  Gynecolo- 
gical Society  of  London,  said  "that  he  did 
not  believe  in  the  spontaneous  disappear- 
ance of  any  connective  tissue  or  cancerous 
growths,  in  no  case  has  the  diagnosis  been 
proven  by  microscopical  examination." 

Another  objection  has  been  to  its  sup- 
posed danger.  In  only  three  cases  so  far 
as  I  can  learn,  has  death  ensued,  due  direct- 
ly to  the  injection-  Two  of  these  occurred 
from  pyogenic  infection,  and  the  other  from 
shock. 

A.  Marmaduke  Shield4  reports  a  case  in 
which  the  growth  showed  shrinkage,  but 
in  which  the  patient  died  from  general 
pyemia,  which  he  thought  due  to  the  injec- 
tion. In  the  secondary  abscesses  found 
post  mortem  staphylococci  aureus.  The 
toxin  being  made  from  the  streptococci 
and  then  sterilized  could  not  have  contained 
the  staphylococci,  but  they  must  have  been 
forced  into  the  circulation  from  the  surface 
of  the  tumor,  which  was  a  sloughing  one, 
or  else  the  injection  was  not  an  aseptic  one. 


Moullin  also  had  a  case  to  die,  in  which  the 
conditions  were  the  same.  In  both  of  the 
cases  the  fluid  was  proven  to  be  sterile,  and 
the  greatest  care  was  said  to  have  been  ex- 
ercised in  preventing  infection. 

Fatalities  may  be  prevented  by  properly 
graduating  the  dose  and  by  care  in  inject- 
ing the  cases,  particularly  the  suppurating 
ones. 

At  all  events,  admitting  that  it  is  dan- 
gerous, and  that  only  a  limited  number  of 
cases  of  true  sarcoma  have  been  cured,  a 
hypothesis  which  I  do  not  believe,  the  mir- 
aculous results  that  have  been  obtained  in 
this  absolutely  fatal  disease,  justifies  any 
measure,  not  in  itself  directly  destructive 
to  life. 


lMedical  News,  12,  24.  1898. 
2 Annals  of  Surgery,  Vol.  XXV.,  page  175-176. 
4Ibid. 

4Am.  Journal  of  Med.  Sciences,   Vol.  CXIII, 
page  726. 


Propagation  of  Typhoid   Fever  and  Other 
Infectious  Diseases.* 

By  G.  A.  Ramsaur,  China  Grove,  N.  C.j 

When  my  friend  Dr.  Costner,  the  chair- 
man of  th's  section,  asked  me  to  write  a 
paper,  I  was  in  a  quandary  what  subject  to 
select,  but  the  one  just  read  has  given  me 
so  much  anxiety  and  thought,  I  at  last  de- 
cided to  make  it  f  he  basis  for  a  few  remarks, 
hoping  thereby  to  provoke  a  lively  discus- 
sion, nevertheless  I  fail  to  give  much  light 
on  the  subject. 

The  propagation  of  infectious  diseases  as 
typhoid  fever,  yellow  fever,  dysentery  and 
malaria  is  of  vital  interest  and  importance 
to  every  practitioner  of  medicine. 

In  the  province  of  prophylaxsis  the  earn- 
est and  skillful  physician  can  save  more 
suffering  and  expenditure  of  money,  and 
confer  greater  boons  upon  afflicted  mankind 
than  in  his  efforts  to  cure  disease. 

When  our  grand  old  science  becomes  so 
enlightened  that  she  knows  just  what  meth- 
ods and  means  to  apply  to  jugulate  the 
dread  infectious  diseases,  she  will  have  con- 
ferred the  greatest  good  upon  man,  and 
should  be  called  blessed. 

It  is  a  fact  too  well  established  to  be  con- 
troverted that  typhoid  fever  and  other  in- 
fectious diseases,  malaria  included,  are  wa- 
ter-borne under  certain  circumstances. 

I  wish  to  premise,  at  this  point,  that 
these  diseases  are  also  fly-borne  in  their 
propagation  under  favorable  circumstances. 

I  wish  to  speak,  more  particularly,  as  to 
the  conveyance  of  infectious  intestinal  dis- 
eases, as  typhoid  fever  and  dysentery,  in 
this  paper. 

Erom  recent  observations  I  have  conclu- 
ded that  typhoid  fever  in  small  towns,  is 
fly-borne. 

*Read  before  the  North  Carolina  Medical  So- 
ciety at  Asheville,  N.  C. 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


615 


The  sewerage  in  cities  with  closed  sinks 
and  closets,  where  the  excrement  is  deposi- 
ted and  at  once  washed  away,  affording 
little  or  no  opportunity  for  access  and  con- 
tact with  flies  is  necessarily  water-borne. 

On  the  contrary  typhoid  fever  in  villages 
with  open  sinks  and  closets  visited  by  my- 
riads of  flies  carrying  away  the  germs  on 
their  feet  to  the  accessible  dining  rooms  and 
kitchens  and  depositing  them  on  the  bread 
and  meat  and  in  the  milk  and  water  is,  un- 
der the  circumstances,  fly-borne. 

Again,  typhoid  fever  prevails  in  cities, at 
any  season  and  from  time  to  time  through- 
out the  year,  provided  the  germs  remain 
active  at  all  temperatures.  While  in  villa- 
ges, its  ravages  are  autumnal  and  most  ex- 
tensive during  the  hotter,  drier  months, 
conditions  most  favorable  to  propagation  by 
flies,  disappearing  when  the  colder  weather 
comes  on,  putting  an  end  to  the  migrations 
of  these  filth  conveyors. 

The  importance  of  flies  in  the  spread  of 
these  diseases,  I  believe  has  been  misunder- 
stood, overlooked  and  unappreciated. 

Contrary  to  views  that  are  held  and  pro- 
mulgated as  the  usual  methods  of  propa- 
gations of  infectious  intestinal  diseases  it  is 
now  clear  to  my  uiind  that  they  are  spread 
in  small  towns  and  rural  districts  almost  ex- 
clusively by  flies,  and  malarial  diseases  by 
water. 

Since  passing  through  the  epidemic  at 
China  Grove  last  summer  and  fall,  I  am 
more  than  ever  convinced  of  this  fact.  I  at 
first  attributed  the  propagation  to  the  sys- 
tem of  the  cotton  mills,  around  which  the 
fever  was  prevalent,  the  method  of  drain- 
age, if  such  it  can  be  termed,  being  cess- 
pools, which  I  fully  believed  had  infected 
the  wells.  If  the  disease  was  water-borne 
from  infected  wells  by  cesspools,  then  the 
whole  hill  was  saturated,  for  there  wa6 
fever  in  every  quarter  and  around  every 
well,  beginnimg  on  the  east  side  of  the  rail 
road  and  ending  on  the  west.  I  do  not 
think  it  possible  these  six  or  eight  wells 
were  all  infected  or  even  probable  that  any 
of  them  were  the  source  of  propagation  in 
this  epidemic,  for  there  are  private  wells  on 
the  grounds  and  no  fever  prevailed  in  any 
of  these  femilies;  and  if  due  to  infected 
wells,  why  did  hoar  frost  curtail  the  epi- 
demic ? 

I  do  not  want  to  leave  the  impressions 
for  a  moment,  I  am  defending  the  system 
of  sewerage,  for  I  regard  it  the  most  dam- 
nable and  unconscionable  method  and 
practises,  and  it  is  only  a  question  of  time 
when  the  hill  will  be  saturated,  and  then 
the  fever  will  be  more  far  reaching  and  last- 
ing than  if  fly-borne. 

A6  I  stated  above,  this  epidemic  began  on 


the  east  side  of  the  rail  road  about  the  first 
of  June,  being  confined  to  one  house  and 
only  one  case.  The  next  cases  were  in  an 
adjacent  house  and  it  spread  from  house  to 
house  until  six  or  seven  families  in  this 
neighborhood  had  fever,  who  drank  water 
from  three  different  wells.  Moreover,  there 
were  fiive  or  six  families  in  this  neighbor- 
hood who  used  the  same  water  and  who 
escaped  infection.  If  water-borne,  then  all 
these  wells  were  certainly  infected, but  how 
can  we  account  for  the  escape  of  the  other 
families  who  drank  the  same  water.  It  is 
not  possible  they  all  had  sufficient  resisting 
power  to  overcome  a  dose  of  germ  from 
day  to  day,  and  is  it  not  more  probable  and 
plausable  that  flies  carried  the  germs  from 
house  to  house  infecting  the  water  and  food, 
and  when  they  ceased  to  be  a  factor  in  the 
cause  or  relation  the  epidemic  suddenly 
ceased?  The  disease  spread  from  the  east 
side  of  railroad  to  the  west  side  and  every 
street  had  its  quoto  of  cases.  The  streets 
all  run  parallel,  the  back  part  of  lots  lying 
adjacent,  rendering  the  kitchens  and  dining 
rooms  of  adjoining  residences  more  exposed 
to  flies  that  inhabit  neighboring  infected 
privies. 

Some  years  ago,  I  remember  a  family 
living  near  by  a  free  school  house  had  tv- 
phoid  fever ;  and  the  nurses,  not  being 
properly  instructed  by  the  doctor,  infected 
the  well  by  rinsing  the  chamber  and  throw- 
ing the  water  about  the  well  to  be  washed 
into  it  with  the  surface  water.  The  school 
drank  from  this  well,  there  being  no  well 
on  school  grounds.  Typhoid  fever  prevail- 
ed in  all  the  families  that  lived  in  this  dis- 
trict and  patronized  the  school.  The  epi- 
demic continued  throughout  the  winter, 
family  after  family  and  member  after  mem 
ber  falling  victims  until  the  school  was  sus" 
pended  because  there  were  no  scholars. 
This  is  a  plain  case  of  water-borne  infec- 
tion. 

The  epidemic  that  has  been  devastating 
Philadelphia,  the  past  winter,  beginning 
during  mid-winter  and  continuing  until  the 
last  of  March,  1899,  ^ve  thousand  had  be- 
come victims  and  five  hundred  had  suc- 
cumbed, is  in  marked  contrast  to  epidemics 
in  small  towns  with  diverse  water  supply. 
"When  flies  are  responsible  there  are  little 
neighborhood  epidemics,  extending  in  short 
leaps,  from  house  to  house  without  refer- 
ence to  water  supply  or  anything  else  in 
common,"  as  in  some  of  the  families  at 
China  Grove  who  are  entirely  isolated  and 
who  did  not  have  their  water  and  so  forth 
in  common  as  was  the  case  in  other  fami- 
lies. But  when  water  supply  is  at  fault,  a6 
it  was  in  Philadelphia,  the  disease  follows 
its  course  and   use  "the  only  limitation   be- 


616 


THE  CHARLOTTE  MEDICAL  JOURNAL 


ingthe  resisting  power  of  individuals  drink- 
ing it  and  such  household  means  as  boiling 
and  the  like  as  tend  to  destroy  disease 
germs." 

Dr.  M.  A.  Veeder,  of  Lyon,  N.  Y.,  who 
has  made  investigations  in  regard  to  con- 
veyance of  germs  by  flies,  says  :  "Epide- 
mics spreads  by  flies  tend  to  follow  the  di- 
rection of  prevailing  warm  winds  as  though 
the  fly,  wandering  out  doors  after  contact 
with  some  source  of 'infection,  had  drifted 
with  the  wind  but  nothing  of  the  sort  is 
perceptible  in  the  case  of  water-borne  dis- 
ease." The  result  of  his  investigations  as 
health  officer  and  physician  during  the  so- 
journ of  our  troops  last  summer  is  summed 
up  thus:  "In  villages  and  camps  where 
shallow  open  closets  are  in  use  giving  access 
to  flies  to  the  chief  sources  of  infection, 
flies  form  the  chief  medium  of  its  convey- 
ance. Hence  in  villages  and  camps  they 
are  usually  fly-borne." 

Dr.  Veeder  states  in  a  paper  read  before 
the  Buffalo  Sanitary  Club  in  December, 
1898,  that  he  cut  short  a  grave  epidemic 
of  dysentery  in  its  height  there  having  been 
forty  cases  and  ten  deaths,  and  rapidly 
spreading  from  house  to  house  without  the 
occurrence  of  a  single  new  case  after  the 
proper  means  of  disinfection  had  been  insti- 
tuted as  would  make  conveyance  by  flies 
impossible.  "In  like  manner  the  past  sum- 
mer a  live  epidemic  of  typhoid  fever  was 
ended  in  a  day  by  means  directed  at  con- 
veyance by  flies;"  so,  too,  he  cites  instan- 
ces, where  malarial  fevers  subs'ded  without 
the  use  of  quinine  by  means  directed  against 
conveyance  by  water. 

Take  for  illustration  a  case  of  typhoid 
fever  in  its  prodrominal  stage  that  is  not 
confined  to  bed,  and,  while  lingering  around 
deposits  the  excrement  in  an  open  closet 
where,  on  a  hot  day,  the  dejections  all  lite- 
rally covered  with  flies  and  the  doors  and 
windows  of  adjacgnt  house,  leading  into 
kitchens,  pantries,  and  dining  rooms,  is  it 
too  much  to  presume  that  a  microscope 
would  reveal  fly  tracks  of  more  or  less  fresh 
excrement  doubtless  containing  the  Colon 
Bacillus  and  Bacillus  of  Eberth  on  meat, 
bread,  sugar,  etc?  Is  it  unreasonable  to 
contend  a  single  case  of  typhoid  fever 
would  start  a  severe  local  epidemic  under 
sucn  circumstances? 

Dr.  Veeder  asserts  that  he  has  made  cul- 
turs  of  bacteria  from  fly  tracks  and,  also, 
from  the  excrement  of  flies  while  acting  as 
health  officer  in  the  army. 

Asepsis  and  Antisepsis  are  the  sheet  an- 
chors in  subjugating  the  forces  of  infec- 
tious diseases.  "Cleanliness  is  next  to 
godliness"  and  with  scrupulousness  in  re- 
gard   to     room,    patient,     linen,    etc.,    and 


through  disinfection  of  the  stools  and  their 
prompt  removal  the  danger  of  a  spread  of 
disease  is  reduced  to  a  minimum. 

The  greatest  difficulty  to  surmount  in 
these  factory  districts  where  laziness  and 
filthiness  is  the  rule,  is  to  enforce  your  in- 
structions in  this  regard.  For  this  reason  I 
was  not  succesiful  in  jugulating  the  epide- 
demic  at  China  Grove  last  summer, but  was 
able  to  limit  its  ravages  in  families  who 
were  faithful  in  performing  their  part  in 
the  work.  It  is  of  paramount  importance 
to  thoroughly  disinfect  the  excreta  before 
they  are  removed  to  closet,  etc. 

I  feel  sure,  if  the  rules  of  Asepsis  and 
Antisepsis  are  rigidly  enforced  in  every 
detail,  the  physician  is  master  of  the  situa- 
tion and  can  curtail  these  diseases  in  small 
towns. 

DISCUSSION. 

Dr.  E.  B.  Glenn. — Dr.  Ramsaur  paper 
was  very  interesting,  and  along  a  line  of 
thought  I  have  been  giving  a  little  study 
for  the  past  few  weeks  in  the  Jefferson 
Hospital  Laboratories  in  Philadelphia,  and 
have  some  very  interesting  plates  showing 
that  the  fly  can  carry  typhoid  fever.  Of 
course  it  is  not  new  that  the  fly  can  carry 
typhoid,  but  I  do  not  know  of  any  one  who 
has  tried  any  experiment  as  to  the  length  of 
time  it  can,  carry  it,  so  1  determined  to 
make  some  experiments,  with  the  aid  of 
Dr.  Rosenberger  of  Philadelphia.  We  found 
it  very  difficult  to  get  any  flies  at  that  season 
of  the  year,  so  I  sent  to  Florida  and  had  a 
lot  of  bed-bugs,  cock-roaches  and  flies  sent 
to  me.  I  took  the  flies  to  the  laboratory  in 
a  mouse  jar.  There  I  cut  the  flies  wings  so 
that  they  could  not  get  away.  The  fly  was 
placed  in  this  jar  after  it  had  been  placed 
on  a  culture  of  the  typhoid  fever  bacilli. 
In  half  an  hour  he  was  allowed  to  walk 
over  an  agar  plate,  and  there  with  his  feet 
inoculate  the  medium  with  typhoid  bacilli. 
Of  course  it  was  a  mixed  infection,  on  ac- 
count of  the  fly  carrying  other  organisms 
naturally  found  on  its  feet.  The  fly  was 
allowed  to  walk  on  the  media  for  half  a 
minute.  Then  he  was  placed  back  in  the 
mouse  jar.  The  next  day  he  was  placed 
on  another  Petri  dish  spread  with  agar. 
Those  where  the  wings  were  pulled  out 
and  those  which  had  a  leg  broken  lived 
but  a  little  while,  but  the  flies  which 
were  well  taken  care  of  lived  commonly  48 
hours.  The  bed-bug  and  the  cock-roach 
lived  much  longer.  I  do  not  know  what 
caused  the  death  of  the  fly,  but  I  was  able 
to  demonstrate  that  the  cock-roach  carried 
the  infection  as  long  as  96  hours,  that  no 
trace  of  typhoid  bacilli  was  found,  but  we 
found  various   other   organisms.      The  bed- 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


617 


bug  smear6  his  culture,  because  he  drags  on 
the  ventral  surface.  The  fly  lifts  himself 
up  and  infects  at  different  points,  while  the 
cock-roach  is  decidedly  more  cleanly  than 
either  in  inoculating  the  media.  You  will 
find  in  one  of  those  plates  that  the  fly  not 
only  carries  the  typhoid  bacillus  on  his  feet 
but  also  on  his  wings.  He  had  one  wing 
left,  and  all  the  time  was  trying  to  fly,  and 
along  with  that  he  left  a  culture  of  typhoid 
fever  bacilli.  I  brought  these  plates,  not  to 
show  that  I  had  found  that  the  fly  does 
carry  the  typhoid  bacillus,  but  how  long 
they  might  carry  it.  This  is  a  very  impor- 
tant point  in  my  opinion,  and  I  think  one 
reason  why  the  prevalence  of  the  disease 
was  so  great  in  the  army  was  because  there 
was  an  abundance  of  flies  about  the  latrines 
which  were  so  close  that  the  flies  flew  from 
place  to  place  in  a  very  short  time,  very 
often  falling  into  milk  and  water,  and  light- 
ing on  uncooked  food  and  cooked  food 
which  was  not  heated  again  before  being 
eaten.  After  the  food  was  eaten  the  men 
would  naturally  be  taken  with  typhoid  fever 
if  their  power  of  resistance  was  not  great 
enough  to  destroy  the  organism.  The  or- 
ganism there  present  on  the  Petri  dishes  are, 
of  course,  various  pus  organisms,  and  some 
of  the  numerous  organisms  carried  by  the 
fly,  and  the  fly  is  not  the  only  thing  that 
carries  infectious  diseases.  I  do  not  know 
that  infection  of  malarial  fever  by  water 
has  ever  been  demonstrated.  It  has  been 
positively  proven  that  malaria  is  carried  by 
the  mosquito,  and  that  it  is  inoculated  by 
his  bite,  and  that  it  is  carried  by  certain 
kinds  of  mosquitoes,  at  different  times  in 
different  parts  of  the  country.  Every  mos- 
quito that  bites  does  not  carry  malaria. 
The  gray  dappled  wing  mosquito  is  one  of 
the  mosquitoes  that  carries  it.  This  theory 
was  claimed  to  be  introduced  by  some  Ital- 
ian observers,  but  the  Philadelphia  Medical 
Journal,  March  nth,  1890,  gives  an  account 
of  an  American  named  Crawford  advancing 
this  theory  in  1807.  Dr.  A.  F.  A.  King 
claimed  that  the  negro  enjoys  a  partial  im- 
munity on  account  of  the  character  of  his 
sudoriparous  secretions  and  dark  skin,  the 
mosquito  not  being  able  to  see  him  quite 
so  well. 

In  some  parts  of  Europe,  which  I  don't 
recall  at  this  moment,  to  prove  that  malarial 
fever  was  carried  by  mosquitoes,  an  obser- 
ver, Dr.  Mason,  if  I  remember  correctly, 
took  some  up  into  the  mountains  to  a  home 
for  the  infirm,  where  some  of  the  inmates 
had  been  for  a  number  of  years.  Malarial 
fever  had  never  been  known  there.  They 
took  these  mosquitoes  and  put  them  into  a 
room  with  three  patients  and  allowed  them 
to  stay  all  night.      In  something  like  a  week 


the  patients  began  to  feel  a  little  chilly  and 
had  a  slight  rise  of  temperature,  but  not  a 
marked  chill,  and  no  plasmodia  was  found 
in  the  blood  at  this  experiment.  A  little 
later  they  recovered  by  doses  of  quinine. 
There  was  only  one  willing  to  undergo  the 
experiment  again.  They  got  other  mos- 
quitoes and  placed  the  patient  in  the  room 
as  before,  and  all  the  characteristic  symp- 
toms of  malaria  occurred  with  the  Plasmo- 
dium in  the  blood,  and  fifteen  grains  of 
quinine  was  given  daily,  hypodermically, 
which  cured  him  of  the  characteristic  chill, 
fever  and  sweat.  Up  to  this  time  I  have 
been  unable  to  find  any  data  which  proves 
any  propagation  of  malarial  fever  by  water 
or  air,  but  it  will  no  doubt  be  attempted  in 
the  near  future. 

In  reference  to  the  importance  of  the 
manner  in  which  infection  is  carried  by  bed- 
bugs and  cock-roaches  in  the  laboratories  is 
that  often  the  excreta  from  patients  are 
thrown  around  the  room  on  soiled  linen, 
and  if  these  parasites  are  there  they  can 
carry  it  into  the  walls  of  the  room  and  after- 
wards bring  it  back  again,  after  fumigation 
has  been  completed.  Therefore  in  such  in- 
stances disinfecting  agents  which  cannot 
reach  or  destroy  the  carrier  and  his  infec- 
tion is  undesirable  and  imperfect.  I  think 
formaldehyde  is  the  best. 

In  reference  to  the  propagation  of  tuber- 
culosis by  bed-bugs,  I  recently  noticed  a 
case  in  the  American  Microscopical  Journal, 
Oct.  22d,  1894,  page  295,  which  Alleger 
was  quoted  by  Craig  as  giving  a  report  by 
Denevre,  in  which  a  case  of  tuberculosis 
was  acquired  in  the  bed  of  a  brother  who 
had  died  of  tuberculosis.  After  the  brother's 
death  it  was  noticed  that  his  body  was  cov- 
ered by  bed-bug  bites,  and  investigation 
showed  the  bed-bugs  present  in  large  num- 
bers, and  60  per  cent,  of  the  bugs  possessed 
the  power  of  infecting  guinea  pigs,  which 
afterwards  died  of  the  disease,  although  the 
room  was  fumigated  before  the  second 
brother  occupied  the  room,  evidently  prov- 
ing that  the  bugs  sought  a  hiding  place 
during  the  process  of  disinfection.  A  re- 
port of  the  work  carried  on  in  the  Jefferson 
Hospital  Laboratories  by  Dr.  Rosenberger 
and  myself  will  appear  in  the  Philadelphia 
Medical  Journal  on  the  5th  of  June,  in  an 
address  read  by  Prof.  W.  L.  M.  Coplin  be- 
fore the  Pennsylvania  State  Medical  So- 
ciety, at  Johnstown,  May  17th.  I  wish  to 
thank  Dr.  Ramsaur  for  his  excellent  paper. 


Foreign  medical  men  are  permitted  to 
practice  among  people  of  their  own  nation- 
ality in  Italy,  but  are  forbidden,  under  pain 
of  prosecution  and  fine,  to  give  first  aid  to 
an  Italian  in  a  street  accident. 


618 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


The  Continued  Fevers  of  North  Carolina. J 

By  Benj.  K.  Hays,  M.  D.,  of  Oxford,  N.  C. 

I  have  no  apology  to  offer  for  bringing 
before  you  to-day  a  subject  with  which  you 
are  already  familiar,  which  you  have  often 
discussed,  and  of  which  no  doubt  you  are 
growing  weary. 

The  frequency  with  which  the  continued 
fevers  of  North  Carolina  recur  ;  the  honest 
doubt  that  often  exists  in  the  mind  of  the 
most  intelligent  clinician  as  to  the  nature 
of  the  fever  with  which  he  has  to  deal ;  and 
the  stern  fact  that  the  responsibility  of 
solving  the  problem  rests  upon  the  practi- 
cal country  doctor,  and  not  upon  some 
theorist  in  a  far  away  German  laboratory, 
makes  it  imperative  that  this  subject  should 
ever  be  kept  fresh  in  our  minds.  I  have  no 
new  theories  to  advance,  but  have  tabulated 
answers  to  fifty  circular  letters  of  inquiry 
in  regard  to  these  fevers, sent  to  representa- 
tive men  in  various  sections  of  the  State. 
In  addition  to  the  answers  sent  to  me  I 
have  drawn  from  similar  reports  made  in 
neighboring  States,  from  the  latest  text 
books,  and  from  current  literature  on  the 
subject. 

Having  made  my  report  I  will  be  fol- 
lowed by  gentlemen  eminently  qualified  to 
discuss  this  broad  subject  in  its  various 
phases. 

i.  How  do  you  classify  the  fevers  seen 
in  your  practice? 

To  this  question  the  answers  were  :  Ma- 
larial, typhoid  and  simple  continued  or 
ephemeral.  Six  answers  included  typho- 
malarial  and  of  these  two  indicated  that 
they  regarded  typho-malaria  as  a  distinct 
disease. 

2.  To  what  extent  do,  they  prevail  and 
what  is  the  mortality  of  each? 

Typhoid  fever  was  reported  with  about 
equal  frequency  in  the  different  sections  of 
the  State  with  an  almost  uniform  mortality 
of  5  per  cent.  Osier  reported  a  mortality 
of  8  per  cent,  in  eight  hundred  cases  treated 
at  Johns  Hopkins.  Malarial  is  much  more 
frequent  than  typhoid  in  the  eastern  and 
central  portions  of  the  State,  rare  in  the 
west.  The  mortality  of  malarial  fever  is 
practically  nil  with  the  exceptions  of  the 
rare  cases  of  pernicious  malarial  seen  in  the 
extreme  east. 

Recent  investigation  has  proved  that  ma- 
laria has  been  diagnosed  in  this  country  far 
more  frequently  than  it  exists.  More 
quinine  was  used  in  1880  than  in  1890  and 
far  more  in  1890  than  to-day.      It    was    the 


JRead  before  the  North  Carolina  Medical  So- 
city  at  Asheville,  N.  C. 


custom  in  former  years,  and  I  regret  to  say 
still  is  with  some  intelligent  practitioners, 
to  regard  almost  all  irregular  forms  of  fever 
as  either  malarial  pure  and  simple,  or  in 
some  way  influenced  by  paludism.  There 
is  no  doubt  that  tuberculosis,  typhoid  fever 
and  many  forms  of  auto-infection  have  been 
repeatedly  diagnosed  and  treated  for  ma- 
laria. When  the  fever  disappeared  with 
the  patient  under  the  influence  of  quinine 
it  was  regarded  as  a  positive  proof  of  the 
accuracy  of  the  diagnosis,  and  when  the 
fever  continued  it  was  maintained  with 
equal  certainty  that  on  a  certain  class  of 
material  favers  quinine  had  no  effect. 

From  1885  to  1890  inclusive,  a  larger 
number  of  deaths  was  reported  from  ma- 
larial than  from  typhoid  fever  in  the  cities 
of  New  York,  Brooklyn  and   Baltimore. 

During  the  past  five  years  deaths  from  ma- 
laria have  been  very  infrequent  in  these 
cities,  while  the  mortality  from  typhoid 
fever  has  increased.  We  would  like  to  be- 
lieve that  this  reduction  in  the  mortality  of 
malaria  has  been  due  to  improvement  in 
treatment  or  sanitation.  Unfortunately  it 
can  be  accounted  for  on  no  other  hypothesis 
than  that  of  an  error  in  diagnosis  in  the 
earlier  reports. 

3.  State  frequency  and  character  of 
eruption? 

To  this  question  only  one  observer  an- 
swered "eruption  in  every  case  of  typhoid." 
Three  or  four  reported  eruption  in  50  per 
cent,  of  cases,  quite  a  number  answered  20 
to  25  percent,  and  others  "seldom  seen," 
"rare  and  indistinct,"  "very  infrequent." 
There  is  no  doubt  that  the  characteristic 
rose  colored  eruption  noted  by  Northern 
writers  is  frequently  absent  in  otherwise 
typical. cases  of  typhoid  fever  seen  in  North 
Carolina,  and  that  in  this  regard  at  least 
our  fevers  differ  from  those  seen  in  the 
Northern  States. 

Loomis  doubted  if  the  rose  spots  were 
ever  absent.  Osier  and  Pepper  agree  that 
they  are  not  always  present,  that  they  are 
more  frequently  absent  in  children,  and  that 
in  some  cases  they  are  found  on  other  parts 
of  the  body  when  absent  from  the  chest 
and  abdomen.  When  present  they  are  re- 
garded as  pathognomonic. 

4.  Do  you  see  typhoid  and  malaria  in 
the  same  patient?  If  so  state  whether  you 
regard  this  as  a  mere  coincidence  or  do  you 
believe  the  two  to  be  combined  in  one  dis- 
ease— typho-malaria  ? 

To  this  question  Dr.  Osier  replied  "There 
may  be  combined  infection — we  have  had 
one  case  only.  This  we  regard  as  a  coin- 
cidence, and  so  far  as  our  experience  goes 
the  malaria  does  not  influence  the  enteric 
fever  in  any  special  way.      A  large  number 


THEJCHARLOTTE  MEDICAL  JOURNAL. 


619 


of  our  typhoid  cases    come  from    very  ma- 
larious districts." 

Dr.  R.  L.  Payne,  of  Norfolk,  wrote : 
"Both  poisons  may  exist  in  the  same  pa- 
tient, modifying  the  usual  symptoms  though 
usually  the  malarial  element  is  eliminated 
early  by  the  use  of  quinine." 

A  reporter  of  recognized  ability  who  has 
devoted  a  great  deal  of  study  to  this  sub- 
ject, confirming  his  diagnosis  by  miscro- 
scopic  examination,  writing  from  a  section 
in  which  both  forms  of  fever  prevail  says  : 
"Never,  I  believe  the  typhoid  germs  are 
killed  by  toxins  from  the  malarial  germs, 
hence  the  two  cannot  exist  in  same  patient 
at  the  same  time." 

A  number  of  reporters,  men  of  expe- 
rience and  recognized  ability,  notable 
among  whom  was  the  Nestor  of  our  socie- 
ty, stated  that  they  had  not  seen  the  two 
forms  of  fever  in  same  patient.  The  ma- 
jority of  reporters  however  recognized  the 
mixed  infection  as  a  rare  coincidence.  Two 
reported  typho-malaria  as  a  separate  disease 
and  four  others  were  in  doubt.  A  number 
of  reporters  objected  to  the  term  typho- 
malaria.  It  was  clearly  shown  that  the 
term  did  not  convey  a  definite  idea,  since 
one  class  of  observers  used  it  to  indicate  one 
condition,  while  others  used  it  with  an  en- 
tirely different  meaning.  Thus,  the  term 
is  employed  to  indicate  the  presence  of  ma- 
laria and  the  specific  poison  of  typhoid 
fever;  by  others,  malaria  of  a  severe  type 
in  which  the  patient  sinks  into  a  typhoid 
state  ;  while  a  third  class  of  observers  use 
the  term  to  designate  a  separate  and  dis- 
tinct disease.  I  have  not  been  able  to  find 
it  so  used  however  by  any  standard  au- 
thority, even  among  the  older  writers.  The 
term  was  introduced  by  J.  J.  Woodward, 
of  U.  S.  A.,  who  wrote  as  follows: 
"Typho-malarial  fever  is  not  a  specific  or 
distinct  type  of  disease,  but  the  term  may 
be  conveniently  applied  to  the  compound 
forms  of  fever  which  result  from  the  com- 
bined influence  of  the  causes  of  the  malari- 
ous fevers  and  of  typhoid  fever."  The  re- 
sults of  Woodward's  investigations  are  too 
well  known  to  be  dwelt  upon.  Among  the 
cases  diagnosed  by  him  typho-malaria  there 
was  a  mortality  of  8  per  cent.  Those  diag- 
nosed typhoid  fever  had  a  mortality  of  35 
per  cent. 

In  our  recent  war  with  Spain  large  num- 
bers of  camp  fevers  received  careful  clini- 
cal study,  aided  by  exact  laboratory  inves- 
tigations, carried  on  both  in  the  camps,  and 
in  Northern  hospitals  where  many  of  them 
were  taken  for  treatment. 

Dr.  Charles  E.  Nammack,  writing  of 
the  camp  fever6  that  he  had  seen  in  Belle- 
vue  Hospital  said  :      "We  found  no  reason 


to  recognize  a  distinct  type  of  continued 
fever  which  is  neither  malaria  nor  typhoid, 
or  one  which  is  a  compound  of  both — the 
so-called  typho-malarial  fever." 

Dr.  Meyer  stated  that  in  thirty  or  forty 
soldiers  treated  at  Mt.  Sinai  Hospital  there 
was  only  one  case  in  which  there  was  any 
approach  to  a  double    infection. 

One  writer  said  that  he  had  made  in- 
quiries at  the  various  hospitals  of  New 
York  City  concerniug  the  double  infection 
and  learned  that  in  all  but  one  hospital  the 
malarial  organisms  had  been  found  in  the 
blood  of  from  one  to  five  per  cent,  of  the 
typhoid  fever  cases. 

Dr.  James  Ewing  has  made  the  follow- 
ing valuable  report,  based  upon  the  study 
of  800  cases  of  fever  at  Camp  Wykoff. 
He  said  :  "A  great  many  cases  which 
were  indistinguishable  from  typhoid  fever 
without  the  most  careful  examination 
proved  to  be  clear  cases  of  infection  with 
the  aestivo-autumnal  organism  of  malaria. 
Over  two  hundred  cases  of  typhoid  fever 
were  studied  and  in  nearly  all  of  these  there 
was  also  malarial  infection.  In  spite  of 
these  favorable  conditions  for  mixed  infec- 
tions in  no  undoubted  fatal  case  of  typhoid 
fever  (in  which  the  diagnosis  was  confirmed 
by  autopsy)  was  the  malarial  organism 
found.  In  five  cases  of  typhoid  fever  the 
Plasmodium  of  malaria  was  found  in  the 
blood  during  the  acute  exacerbations  oc- 
curring during  convalescence  from  the 
typhoid  fever.  From  these  observations 
the  following  conclusions  were  drawn  : 
(1)  Mixed  infection  of  typhoid  fever  and 
malaria  undoubtedly  exist.  (2)  When 
typhoid  develops  in  a  case  of  active  ma- 
laria the  element  nearly  always  becomes 
quiescent,  and  has  little  or  no  effect  on  the 
course  of  the  typhoid  fever.  (3)  Mala- 
rial infection  frequently  outlasts  the  typhoid 
infection  and  make  itself  manifest  during 
convalescence.  5.  Do  you  see  continued 
fever  which  is  neither  typhoid  nor  malari- 
al? If  so  give  clinical  history  of  such  a 
case  ? 

To  this  question  the  majority  of  the  an- 
swers were,  "No."  By  others  a  mild 
form  of  fever  was  described  lasting  in  some 
instances  only  a  few  days,  in  others  three 
or  four  weeks  and  attended  by  headache 
and  foul  tongue,  but  no  epistaxis,  diarrhoea, 
tympany  or  rose  colored  spots.  Those  who 
had  made  miscrocopical  examinations  of 
the  blood  reported  the  malarial  organisms 
absent,  while  nearly  all  agreed  that  this 
fever  was  uninfluenced  in  its  course  by 
quinine.  It  is  evident  that  the  fever  here 
described  as  a  third  form  of  continued  fever 
by  a  limited  number  of  reporters  is  regard- 
ed by  others  as  a  mild  form  of   typhoid. 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


Dr.  James,  in  the  Loomis-Thompson  Sys- 
tem of  Practical  Medicine  the  most  recent 
authority  that  I  have  been  able  to  consult, 
says  of  these  fevers  described  as  simple  con- 
tinued, ephemeral,  catarrahal  and  febricula 
that  they — Are  far  from  uniform  in  their 
manifestations ;  comprise  irregular  cases  of 
many  different  maladies ;  many  are  typhoid 
fever  ;  some  are  due  to  unnoticed  leisions  of 
throat ;  many  are  due  to  fatigue  or  expos- 
ure especially  to  heat. 

6.  To  what  extent  and  with  what  re- 
sult do  you  use  quinine  in  such  fevers? 

Upon  the  mild  form  of  fevers  just  de- 
scribed it  was  generally  conceded  that 
quinine  had  no  effect.  Dr.  Robertson,  of 
Danville,  who  likes  the  name  typho-malarial 
and  whose  opinions  are  certainly  worthy  of 
most  serious  consideration  writes,  "If  ma- 
larial I  give  commandery  doses  of  quinine, 
and  when  the  malarial  element  predomi- 
nates I  obtain  an  abatement  of  temperature 
and  all  symptoms.  I  do  do  not  use  it  in  ty- 
phoid fever  but  often  when  not  tolerated 
in  first  two  weeks  of  typho-malaria  it  does 
good  service  when  the  fever    remits. 

Over  the  names  of  three  men  of  recog- 
nized ability  from  an  eastern  town  was  the 
following:  "In  this  section  we  always  use 
quinine  in  all  fevers  at  first  and  success- 
fully in  a  large  majority  of  cases.  Cases 
not  yielding  to  quinine  in  three  or  four  days 
generally  prove  to  be  continued  malarial, 
typho-malarial  or  tyyhoid  in  order  men- 
tioned." 

A  large  numbeV  of  reporters  stated  that 
they  had  used  quinine  for  the  first  three  or 
four  days  for  diagnostic  purposes.  If  the 
fever  was  malarial  in  origin  it  yielded 
promptly,  otherwise  it  generally  proved  to 
be  typhoid,  in  which  case  quinine  was 
worse  than  useless. 

In  a  private  letter  Dr.  Osier  stated  that, 
"Only  a  careful  blood  examination  enables 
us  to  differentiate  cases  of  the  astivo-au- 
tumnal  malarial  from  typhoid  fever,"  but 
in  their  published  writings  both  Osier  and 
Thayer  positively  affirm  that  any  form  of 
malarial  fever  known  in  this  country  will 
yield  to  quinine  in  three  or  four  days. 

In  a  paper  read  before  this  Society  two 
years  ago  on  this  subject  Dr.  E.  C.  Register 
maintained  that  quinine  was  a  positive  and 
speedy  cure  for  malaria",  and  quoted  numer- 
ous leading  authorities  to  that  effect.  His 
position  was  undisputed  by  those  who  dis- 
cussed the  paper  at  that  time  and  since  then 
has  been  confirmed  by  every  observer  who 
has  based  his  diagnosis  upon  a  microscopi- 
cal examination. 

The  majority  of  doctors  in  North  Caro- 
lina use  quinine  in  the  first  few  days  of 
fever  to  aid  in  determining   the    diagnosis. 


This  has  been  my  own  practice,  but  recent 
investigation  has  convinced  me  that  it  is 
wrong.  Take  three  cases  of  fever  which 
present  when  first  seen,  the  same  clinical 
picture.  One  is  typhoid,  one  malarial  and 
one  due  to  gastric  irritation.  We  give 
quinine  in  all  three.  Upon  the  typhoid  pa- 
tient its  effect  is  to  increase  nervousness, 
produce  nausea  and  perhaps  hemorrhage 
and  death.  The  patient  suffering  from  gas- 
tric fever  is  certainly  made  worse  by  the 
quinine  and  only  the  malarial  patient  cured 
by  it.  Since  it  has  become  possible  to  diag- 
nose malaria  with  certainty  by  the  micro- 
scope, a  method  both  safe  and  simple,  I 
maintain  that  it  is  wrong  to  hazard  the  use 
of    quinine. 

Conclusion. — From  this  symposium  no 
definite  conclusions  can  be  drawn  since  the 
opinions  expressed  have  been  so  varied. 
My  own  conclusions  in  regard  to  the  pres- 
ent status  of  the  continued  fevers  in  North 
Carolina  is  as  follows  : 

I.  Mixed  infection  does  exist,  but  is  ex- 
tremely rare. 

II.  The  term  typho-malaria  is  indefinite, 
misleading  and  should  be  abolished. 

III.  Malarial  fever  is  diagnosed  more 
frequently  than  it  exists. 

IV.  Malaria  invariably  yields  to  quinine 
therefore  there  should  be  no  continued  ma- 
laria fever. 

V.  Typhoid  is  the  only  form  of  con- 
tinued fever  seen  in  North  Carolina. 

VI.  Tuberculosis,  la  grippe,  septic  in- 
toxication, septic  infection  (especially  in 
child  bed)  thermal,  and  other  forms  of 
fever  are  often  mistaken  for  either  typhoid 
or  malaria. 

DISCUSSION. 

Dr.  Reagan. — I  consider  the  paper  a 
very  valuable  one,  but  my  opinion  is  there 
is  a  difference  in  typhoid  fever  in  this 
mountain  country  and  typhoid  fever  in  a 
different  section.  Dr.  Miller,  professor  of 
the  practice  of  medicine  in  one  of  the  col- 
leges of  Atlanta, and  myself  had  a  conversa- 
tion upon  this  point  some  years  ago.  Dr. 
Miller  frequently  visited  the  mountains  in 
this  and  ocher  sections  in  the  summer  time 
and  saw  many  fever  cases  and  he  agreed 
with  me  that  there  is  a  difference  in  the 
typhoid  fever  of  the  mountains  and  the 
typhoid  fever  where  malaria  exists.  Here 
we  have  no  malaria.  There  is  a  iarge  sec- 
tion of  the  country  through  here  where  it 
is  unknown,  and  I  suppose  always  will  be 
unless  it  is  brought  here,  but  there  are  cases 
of  malaria  which  we  have  to  contend  with, 
where  persons  have  the  malaria  in  the  sys- 
tem and  come  here  for  treatment,  and  in 
cases  of  that  kind    the  typhoid  fever    here 


THE  CHARLOTTE  MEDICAL  JOURNAL 


621 


is  very  much  like  the  typhoid  fever  of  other 
sections.  I  am  a  Tarheel,  not  by  birth  or 
education,  but  by  adoption.  I  have  been 
here  fifty  years,  and  I  suppose  that  would 
entitle  me  to  be  called  a  Tarheel  or  North 
Carolinian.  When  I  came  to  this  country 
I  had  a  great  deal  of  malaria  in  my  system. 
It  was  thought  by  physicians  that  I  could 
live  but  a  short  time,  but  I  have  lived, 
while  those  physicians  have  all  gone  before 
me.  I  think  there  ought  to  be  a  distinc- 
tion made  between  the  mountain  typhoid 
fever  and  the  typhoid  fever  of  malarial  sec- 
tions. 

Dr.  Roystkr. — At  Dr.  Hays'  request  I 
have  made  up  my  mind  to  make  a  few 
remarks  on  this  subject.  I  have  already  on 
occasions  before  this  read  two  papers  on 
this  subject  before  the  Society.  In  the  first 
one  of  those  I  took  the  ground  that  there 
was  no  other  continued  fever  in  North 
Carolina  except  typhoid  and  malaria.  In 
the  second  I  pointed  out  by  some  practical 
work  on  the  subject  the  proofs  that  I  had 
brought  to  bear.  I  am  still  of  the  same 
mind  and  want  to  reiterate  the  statements 
I  made  in  both  of  those  papers,  though  I 
have  recently  done  very  little  work  in  that 
direction,  having  been  busy  with  other 
matters.  I  have  not  prepared  anything  for 
this  discussion,  and  therefore  must  go  over 
the  ground  that  I  have  before  done.  In  my 
former  papers,  as  I  said,  1  took  the  ground 
first  that  there  was  no  third  continued  fever 
in  North  Carolina.  I  think  the  burden  of 
proof  rests  upon  some  one  who  believes 
that  there  is,  to  prove  it.  In  sections  where 
we  have  malaria  we  also  have  typhoid.  Dr. 
Reagan  says  there  is  no  malaria  in  Ashe- 
ville  or  the  western  part  of  the  State.  I  do 
not  know  that  any  series  of  blood  examina- 
tions has  been  carried  out  in  sufficient  num- 
bers in  fever  cases  to  absolutely  prove  that 
question.  I  do  not  think  I  am  prepared 
to  believe  that.  I  do  not  know  anything 
about  the  so-called  mountain  fever,  or  why 
it  should  differ  from  typhoid  fever  in  other 
localities.  Secoryd,  I  believe  that  quinine 
is  a  specific  for  malaria.  I  think  sometimes 
that  it  is  administered  in  a  faulty  manner, 
and  I  believe,  as  Dr.  Hays  expressed  in  his 
paper,  the  opinion  of  Dr.  Osier  that  the 
aestivo-autumal  type  yields  reluctantly  to 
quinine.  This  is  a  smaller  organism  than 
the  other  two  varieties,  lives  almost  solely 
in  the  corpuscles,  is  much  harder  for  the 
quinine  to  affect,  and  possibly  more  insidi- 
ous in  its  onset  and  development.  I  have 
seen  cases  of  that  kind  which  yielded  grad- 
ually to  quinine,  but  very  surely.  Some- 
times the  fever  would  last  ten  days,  would 
begin  with  a  chill  and  temperature  of  103, 
and  fall  half  or  one  degree  every  day  until  it 


came  to  normal.  I  do  not  believe  in  the 
term  "typo-malarial  fever,"  and  I  concur 
in  Dr.  Hays'  opinion  that  it  should  be 
abolished.  There  is  no  doubt  that  the  two 
diseases  may  co-exist.  I  suppose  I  have  ex- 
amined the  blood  of  about  150  patients 
with  fever,  ami  I  have  seen  what  I  regard 
as  two  cases  of  mixed  infection.  It  is  my 
rule  in  every  case  of  fever  to  examine  the 
blood  as  soon  as  possible.  If  I  find  the 
Plasmodium  on  the  first  examination  I  give 
quinine.  If  I  do  not  I  examine  again  the 
next  day.  This  question  of  administering 
antipyretics  even  quinine,  just  because  the 
patient  has  fever,  is  pernicious.  It  is  not 
the  fever,  as  we  understand,  that  is  pro- 
ducing harm.  That  is  only  a  surface  symp- 
tom My  opinion  is  that  to  give  quinine 
indiscriminately  does  harm.  It  clouds  the 
diagnosis,  as  much  as  the  continual  use  of 
morphine  in  appendicitis.  I  have  not  had 
experience  with  the  co-existence  of  the  two 
diseases  to  see  which  untimately  predomi- 
nates, or  to  make  any  report  as  to  the  rela- 
tion of  the  one  toward  the  other.  In  running 
over  these  points  hurriedly  I  may  have 
omitted  some  thing,  but  my  opinion  re- 
mains the  same  as  expressed  two  years  ago 
although,  as  I  say,  I  have  made  but  little 
investigation  lately.  I  must  make  the  as- 
sertion again  that  the  burden  of  proof  rests 
upon  somebody  to  study  and  name  the  third 
form  of  fever. 

Dr.  Booth. — The  most  excellent  paper 
just  read  is  very  instructive.  There  are  a 
few  things  in  it  in  which  I  disagree  with  my 
friend  Dr.  Hays.  One  point  that  he  makes, 
however,  might  be  misleading,  and  at  the 
same  time  he  does  not  mean  to  mislead- 
He  means  exactly  what  he  says.  That  is, 
that  the  term  typo-malarial  fever  is  mis- 
leading. That  is  a  fact,  yet  there  is  a  typo- 
malarial  fever  in  North  Carolina.  It  is  not 
like  the  mixture  which  exists  between  the 
horse  and  the  donkey — we  do  not  get  a  mule, 
but  we  have  the  two  diseases  in  the  same 
patient  at  the  same  time.  We  have  a  case 
of  fever  here.  The  fever  is  low  in  the 
morning  and  high  in  the  afternoon.  You 
give  him  a  dose  of  quinine  and  the  fever 
becomes  more  regular  and  becomes  a  case 
of  typhoid  fever.  You  go  ahead  and  treat 
your  case  of  typhoid  fever,  and  in  the  con- 
valescent stage  you  have  a  regular  case  of 
intermittent  fever.  There  are  gentlemen 
here  who  say  there  is  no  form  of  continued 
fever  in  North  Carolina  except  typhoid 
fever.  Now  when  I  commenced  practicing 
32  years  ago  there  was  an  epidemic  of  ty- 
phoid fever  in  the  section  in  which  I  com- 
menced. We  had  the  swelled  abdomen, 
and  tympanitis,  a  havy  coated  brown  or 
thick  red  tongue,  delirium,  with  the  patient 


622 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


sick  from  six  to  eight  weeks.  We  knew 
nothing  about  antiseptics,  yet  we  gave  tur- 
pentine, and  it  certainly  did  the  pa- 
tient good.  I  suppose  it  was  its  antisep- 
tic properties.  We  had  diarrhoea,  some 
times  almost  impossible  to  control.  We 
gave  opium  and  nitrate  of  silver.  We  calked 
the  bowels  if  we  could,  and  we  usually  saved 
the  patient  if  we  did  not  have  perforation. 
As  a  rule  the  patient  got  well.  In  the  last 
10  or  15  years  we  have  in  our  section  a 
continued  fever.  I  do  not  know  what  it 
is.  None  of  them  die,  so  we  cannot  have  any 
post  mortem.  We  have  very  little  tym- 
panitis. They  get  well  in  two  or  three 
weeks.  Quinine  does  not  diminish  the 
fever.  I  don't  know  what  it  is.  A  good 
many  doctors  call  it  typhoid  fever.  It  is  not 
a  febrile  fever.  It  is  too  long  for  that.  It 
is  not  like  the  fevers  we  were  acquainted 
with  a  good  many  years  ago.  As  I  said, 
quinine  does  it  no  good.  I  believe  that 
quinine  does  typhoid  fever  harm.  But  in 
this  fever,  if  you  take  care  of  your  patient 
and  give  him  antiseptics,  even  turpentine 
and  calomel,  he  always  gets  well,  and  they 
do  not  only  get  well  under  my  treatment, 
but  under  everybody  else's  treatment. 
Those  are  the  remarks  I  wish  to  make  for 
the  sake  of  the  older  men.  The  young 
doctor  at  the  present  time  has  a  great  ad- 
vatage  over  the  doctor  when  I  was  a  young 
doctor.  They  teach  them  more,  and  they 
are  much  better  prepared  to  doctor  folks 
than  we  were  then.  They  have  the  mi- 
croscope. I  never  but  once  have  seen  the 
malarial  germ  on  plasmodium.  I  looked 
in  another  man's  microcope.  I  have  a  mi- 
croscope, but  I  am  not  a  microscopist.  But 
for  the  older  members  of  the  profession  I 
make  these  remarks  in  regard  to  typhoid 
fever.  I  think  the  older  men  will  bear  me 
out  as  regards  the  typhoid  fever  of  the  past 
and  the  so-called  typhoid  fever  of  the 
present. 

Dr.  O'Hagan. — Is  there  such  a  thing  as 
typho-malaria?  The  discussion  has  wand- 
ered off  into  several  side  issues.  I  agree, 
though,  with  most  of  the  gentlemen  who 
have  spoken  that  there  is  no  such  thing  as 
typho-malaria  in  this  State, but  I  believe  our 
fever  is  due  to  a  mixed  infection.  Time  and 
time  again  I  have  seen  what  we  call  typhoid 
fever  change  into  the  regular  intermittent 
fever  treated  by  quinine.  I  have  seen 
again  in  the  convalescent  stage  malarial  fe- 
ver express  itself  in  the  usual  way.  Like 
Dr.  Booth,  I  am  an  old  doctor.  I  have  gone 
through  all  manner  of  experience  in  fevers. 
The  old  typhoid  fever  with  the  classic  symp- 
toms has  disappeared  of  late  years.  It  is 
not  in  any  manner  so  pernicious  as  it  was, 
and  I  do   not  know  but   that   the   mortality 


then  was  due  to  overdrugging.  There  is 
one  debt  that  we  owe  today  to  the  homeo- 
pathists — they  have  taught  us  how  to  ac- 
complish much  more  with  much  less  physic. 
Much  harm  has  been  done  with  physic,  and 
more  especially  in  the  treatment  of  typhoid 
fever.  I  remember  one  case  where  the  pa- 
tient in  30  days  took  90  grains  of  quinine 
daily  and  still  survived.  I  will  not  go  into  the 
treatment  of  these  fevers.  You  are  all  as 
familiar  with  them  as  I  am.  I  will  wind 
up  by  thanking  Dr.  Hays  for  the  admirable 
paper  he  has  read  and  the  pains  he  has  taken 
and  the  valuable  information  he  has  given. 

Dr.  J.  H.Williams. — There  is  one  point 
brought  out  of  which  I  wish  to  make  spe- 
cial note,  and  that  is  in  reference  to  the  so- 
called  hybrid  fevers — fevers  of  short  dura- 
tion. They  are  not  fevers  that  depend  upon 
any  disturbance  of  the  prima  via  that 
we  know  of,  they  are  not  malarial.  We 
simply  call  them  typhoid.  They  are  not 
accompanied  by  the  symptoms  that  accom- 
pany our  well  marked  cases.  I  have  obser- 
ved typhoid  fever  in  its  home, Philadelphia, 
and  you  all  know  what  typhoid  fever  is 
there.  I  have  had  an  opportunity  to  observe 
it  here  in  this  mountain  section  of  the  coun- 
try. We  have  here  a  fever  symptom  of 
short  duration,  about  three  weeks,  that  has 
been  called  by  a  great  many  catarrhal  fever 
and  gastric  fever.  A  great  many  names 
have  been  given  to  it,  but  in  almost  every 
instance,  and  especially  of  late  years,  we 
find  that  these  cases  are  reported 
as  malaria.  They  had  this  form 
of  fever,  but  what  is  it?  Under 
the  microscope  it  is  shown  to  be  typhoid. 
It  is  modified  by  the  environment  of  the 
patient.  It  is  modified  by  the  newer  meth- 
ods of  treatment,  local  application  of  water 
and  all  the  methods  by  which  we  today 
control  hyper-pyrexia.  We  do  not  give 
quinine,  because  we  have  no  malaria  here, 
except  in  people  who  come  up  here  with 
their  blood  full  of  it.  I  believe  there  will 
come  a  time  when  typhoid  fever  as  typhoid 
fever  will  almost  disappear  from  the  eastern 
part  of  our  country,  because  that  is  where 
the  germ  best  flourishes,  and  in  such  quan- 
tities that  it  is  bringing  about  a  personal 
immunity  which  by  heredity  will  gradually 
eradicate  the  disease  in  its  well  marked 
form. 

Dr.  Hays. — Permit  me  to  say  in  conclu- 
sion, that  I  have  far  more  respect  for  the 
clinical  experience  of  these  gentlemen  who 
have  spent  years  in  the  sick  room  than  I 
have  for  any  theories,  and  if  my  paper  has 
done  nothing  else  than  bring  out  this  dis- 
cussion, I  think  I  can  congratulate  myself 
upon  having  read  it.  In  reply,  to  Dr.  Rea- 
gan— I  agree  with  him.     There  is  a  differ- 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


623 


ence  in  degree  in  the  fevers  we  see  in  the 
eastern  and  western  parts  of  the  State.       I 
believe  they  are  both  typhoid  fever.      So  far 
as   my  limited    investigations    carry    me,  I 
believe  that  the   literature  of  these  western 
fevers  is  an   unwritten   book,  and  I  there- 
fore    wrote     to     Dr.    J.    Howell    Way.    of 
Waynesville,  for  a   paper  on  these   fevers, 
which  he  is  to  read,  and  I   am  sure  he  will 
tell   us  definitely  what   they  are,  as  he  told 
me  he  had  collected  data  on  several  hundred 
cases  he  had  treated  during  the  last  15  or  26 
years.      In  reply  to  Dr.  Booth,  he  says  he 
likes  the  term  typho-malarial  fever.   I  agree 
with  him  that  we  might  use  it  if  it  convey- 
ed a  definite  meaning.     There  is  no  objec- 
tson  to  it  if  it  conveyed  a  definite  idea,  but 
the  term  is   misleading,  therefore  let  us  eli- 
minate an  equivocal  tarm  and  use  one  in  its 
place  which  is  degnite.      Dr.  Booth   is  still 
in  doubt  as  to  whether  these  mild  continued 
fevers  are   typhoid   or  not.      We    all    have 
known  of  cases  in  which  a  crowd  will  go 
on  a  picnic,  or  drink  milk  from  a   dairy,  or 
do    something    in    which    the     infection 
known  to  be  from  a  single  cause.      A  large 
nnmber  of  cases  will  occur — say  24  cases  of 
fever.      Six  of  then  die  from  typical  typhoid 
fever,   six  have  a  severe  form,  six  have  a 
mild  form,  six  just  feel  badly,  possibly  have 
a   headache  and  diarrhrra.      Are   we  to  be- 
lieve that  this  one  cause  of  infection    gave 
four   different  forms  of  fever,  or  is  it  not 
more  probable  that    the   whole    24   had  the 
same  form    but  owing  to  the  difference  in 
the   resisting    power  and    the    differnce     in 
the  amount  of  poison   taken,  the   fever  had 
a    different    effect.        Dr.  T.  L.  Booth   was 
with  me  in  an  epidemic  of    fevers  of  this 
kind,  in  which  1  saw   over   100  cases.      He 
did  not  what  they  were.      Some  half  dozen 
of  these  were  typical   cases   of  typhoid   fe- 
ver.       The  rest   were  these  mild  continued 
fevers.     I  see  no  reason  on  earth  for  giving 
a  different  diagnosis  for  the  two. 


Meningitis-i 


By  Jno.  E.  S.  Davidson,  M.D.,  Lowesville.  X.C. 

The  most  interesting  and  most  important 
disease  in  early  life  is  that  which  is  now 
designated  meningitis.  The  mortuary  sta- 
tistics that  1  have  gathered  up  show  that  it 
is  the  cause  of  death  in  from  one  in  twenty- 
five  to  one  in  fifty  of  the  entire  number  of 
deaths  in  childhood,  in  different  years  the 
proportion  varying  some.  Such  a  disease 
as  this  should  attract  the  attention  of  all 
physicians  most  earnestly. 


JRead    before   the 
Society,  Asheville,  N. 


North 
C. 


Carolina  Medical 


Cerebral  meningitis  may  affect  the  dura 
mater  or  pia  mater.  In  the  first  case  it 
is  pachy-meningitis,  and  the  second  lepto- 
meningitis. It  may  be  acute  or  chronic. 
Pachy-meningitis  is  rare  in  early  1/fe,  ex- 
cept from  traumatism  or  as  a  lesion  in  some 
specific  disease,  such  as  syphilis,  therefore 
I  will  only  mention  it. 

Lepto-meningitis,  on  the  contrary,  is  very 
frequent  in  childhood.  As  to  its  pathologv 
there  are  two  general  forms — tubercular  and 
non-tubercular.  The  former  usually  affect- 
ing the  base  and  the  latter  the  convexities 
of  the  brain. 

It  is  not  the  purpose  of  this  paper  to  dis- 
cuss cerebro-spinal  meningitis  or  fever  as 
its  cause  is  a  microbe,  and  it  should  be  as- 
sociated with  other  diseases  of  the  infec- 
tious class.  I  will  discuss  only  the  non- 
tubercular  forms  of  cerebral  meningitis. 
This  is  sometimes  called  purulent  meningi- 
tis, but  this  designation  is  not  proper,  for 
some  cases  have  no  pus,  and  on  the  other 
hand  we  sometimes  meet  with  purulent  ex- 
udation in  the  tubercular  form. 

The  term  meningitis  as  used  in  this  paper 
then  will  refer  to  the  non-tubercular  form 
of  lepto-meningitis.  Meningitis  in  its  acute 
form  is  a  disease  which  may  attack  robust 
as  well  as  debilitated  children.  It  may  oc- 
cur at  any  age,  but  is  rare  in  the  first  year 
of  life,  and  most  common  in  the  middle 
period  of  childhood. 

Meningitis  is  generally  secondary.  Some 
rare  cases  have  been  reported  where  the 
disease  was  apparently  primary.  I  myself 
have  never  seen  a  case  of  non-tubercular 
meningitis  which  was  undoubtedly  idio- 
pathic ;  at  any  rate  the  great  majority  of 
cases  are  secondary.  In  my  experience  I 
have  found  meningitis  most  frequently  of 
traumatic  origin,  or  arising  from  some  dis- 
ease in  the  ear  by  the  inflammation  extend- 
ing through  the  petro-squamosal  suture  to 
the  cerebral  meninges.  You  will  find  a 
small  number  of  cases  of  meningitis  caused 
from  the  specific  microbe  of  such  diseases 
as  scarlet  fever,  measles,  erysipelas,  pneu- 
monia, rheumatism,  syphilis,  chicken  pox. 
The  morbid  anatomy  differs  considerably  in 
different  cases. 

The  inflammation  in  a  case  of  acute  men- 
ingitis is  apt  to  extend  downwards  and  to 
involve  the  pia  mater  of  the  cord.  In  mild 
forms  there  is  an  abundant  production  of 
cells  resembling  the  cells  which  coat  the 
surface  of  the  membranes  and  fibres  which 
makeup  the  pia  mater.  The  cell  growth 
is  general,  involving  the  pia  mater  over 
most  of  the  brain  surface.  The  inflamma- 
tion is  one  which  does  not  result  in  the  pro- 
duction of  pus,  or  serum,  or  fibrin,  but  of 
new  connective  tissue  cells.     This  form  of 


THE  CHARLOTTE  MEDICALiJOURNAL. 


meningitis  has  been  called  acute  cellular 
meningitis,  it  is  of  right  frequent  occur- 
rence. It  has  the  ordinary  clinical  symp- 
toms of  acute  meningitis. 

Another  form  of  acute  meningitis  has 
been  termed  by  some  pathologist  the  exu- 
dative, because  it  is  characterized  by  an  ac- 
cumulation of  serum,  fibrin,  and  pus,  chief- 
ly in  the  meshes  of  the  pia  mater  and  along 
the  walls  of  the  blood  vessels.  The  abso- 
lute quantity  of  the  exudation  varies  great- 
ly. In  some  cases  death  may  be  caused 
with  so  slight  a  formation  of  the  exudate 
that  only  by  the  use  of  the  microscope  can 
the  pus  cells  and  fibrin  be  detected;  on  the 
other  hand  the  exudation  may  accumulate 
to  such  a  great  amount  as  to  flatten  the  con- 
volutions of  the  brain.  You  will  generally 
find  the  exudative  form  of  meningitis  fol- 
lowing ear  diseases,  the  portion  of  menin- 
ges nearest  the  ear,  therefore,  being  effected 
most,  the  inflammation  sometimes  also  lead- 
ing to  abscess.  If  the  meningitis  is  caused 
from  exposure  to  the  sun's  rays,  the  inflam- 
mation is  at  the  summit  of  the  brain.  The 
extent  of  the  inflammation  varies  greatly 
in  different  cases,  and  the  results  in  some 
cases  is  strong  adhesions  between  the  dura 
mater  and  the  pia  mater. 

Without  describing  symptoms  and  treat- 
ment in  general,  I  will  mention  three  cases 
that  came  under  my  care. 

The  first  case  that  I  will  report  is  a  little 
boy,  four  years  old,  who  fell  and  struck  the 
back  of  his  head.  He  did  not  complain  of 
much  pain  for  two  days,  when  in  the  even- 
ing I  was  sent  for  and  on  my  arrival  found 
his  face  flushed  and  vomiting  a  great  deal, 
and  was  restless  and  constipated.  On  the 
next  day  the  symptoms  increased  in  sever- 
ity. The  pupils  were  equal  and  re-acted 
very  well  to  light.  He  was  very  restless, 
but  showed  no  evidence  of  pain.  Eyes 
fixed.  Feet  and  hands  cold.  About  the 
third  week  he  began  to  improve  and  con- 
tinued to  do  so. 

Treatment  was  simply  to  keep  him  very 
quiet  in  a  dark  room.  His  diet  was  care- 
fully regulated.  Calomel  given  in  ten  gr. 
doses  until  bowels  moved.  Six  grains  of 
bromide  of  potash  and  chloral  was  given 
several  times  a  day.  The  iodide  of  potash 
was  given  three  times  a  day. 

Recovery  took  place  in  about  two  months. 
My  diagnosis  was  traumatic  non-tubercular 
meningitis. 

Case  2d. — The  next  case  that  I  report  is 
one  of  meningitis,  in  a  child  twelve  years 
old.  He  was  healthy  at  birth,  and  remain- 
ed so,  and  never  had  any  disease  except 
measles.  I  was  called  to  see  him  January 
30th,  and  diagnosed  it  meningitis, 

This  attack,  in  all    probability,  was   pro- 


duced by  a  fall  he  had  at  school  four  days 
before,  in  which  he  struck  the  front  of  his 
head  over  left  eye.  Later,  on  the  day  of 
the  fall,  he  began  to  complain  of  pains  in 
his  head  and  to  vomit.  He  was  very  fret- 
ful, with  heavily  coated  tongue,  and  lay  in 
bed  protecting  his  eyes  from  the  light. 
Pupil  of  left  eye  was  dilated  and  would  not 
contract  to  light ;  afterwards,  both  become 
dilated.  The  bowels  were  constipated  and 
he  did  not  care  for  food.  Temperature  105 
deg.  the  5th  and  6th  day  after  the  fall, 
pulse  85.  Temperature  came  down  shortly 
to  about  100  deg.,  and  remained  about  that 
for  four  weeks.  He  seemed  to  remain  about 
the  same,  except  he  was  loosing  in  weight. 
About  the  fourth  week  he  became  delirious. 
The  delirium  was  sometimes  active,  and 
then  it  would  disappear  and  he  would  re- 
cognize his  parents.  He  was  very  cross  in 
the  intervals  of  the  deliriums,  and  would 
roll  his  head  from  side  to  side.  He  never 
had  convulsions,  but  later  on  had  paralysis 
of  both  upper  and  lower  extremities. 

Treatment  was  to  keep  him  perfectly  quiet 
and  the  room  dark  to  protect  his  eyes.  He 
was  given  the  bromide  of  potash  and  chloral 
to  quiet  him.  Calomel  and  the  iodide  of 
potash  was  also  used.  He  died  about  the 
end  of  the  fifth  week. 

Case  3d. — The  next  case  that  I  will  re- 
port is  a  little  girl,  three  years  old,  whose 
parents  had  always  been  healthy,  and  the 
patient's  health  in  the  past  had  been  good. 
She  was  in  the  habit  of  spending  a  great 
deal  of  her  time  in  the  hot  sunshine.  The 
first  symptoms  noticed  were  that  she  was 
fretful  without  any  apparent  cause,  and 
complained  of  pain  about  the  summit  of 
the  head.  Later  on  temperature  rose  and 
vomiting  came  on.  About  the  third  week 
pupils  became  dilated  and  raged.  She 
got  very  restless  and  dreaded  the  least 
noise  or  light.  Bowels  constipated.  Tongue 
furred  and  heavily  coated. 

Treatment. — Gave  calomel  in  1-10  grain 
doses  to  move  the  bowels.  Used  rubber 
coil  to  lower  temperature.  Bromides  and 
chloral  given  several  times  a  day. 

About  the  sixth  week  she  commenced  to 
improve,  and  about  the  third  month  was 
apparently  over  the  attack. 

My  diagnosis  was  non-tubercular  menin- 
gitis, caused  from  exposure  to  the  sun's 
rays. 

Aconite    Poisoning — The  Diagnosis   and 
Treatment,  with  Report  of  a  Case.* 

By  E.  A.  Moye,  M.  D.,  Greenville,  N.  C. 

Poisoning   by  aconite  is  of   such  rare  oc- 

*Road  before  the  North  Carolina  Medical  So- 
ciety, Asheville,  N.  C. 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


currence  that  I  hope  the  following  case 
which  came  under  my  care  will  prove  inter- 
esting to  this  Society.  In  reporting  the 
case  I  shall  not  review  the  literature  on  the 
subject  or  give  the  symptoms  enumerated 
in  the  various  text-books  of  therapeutics, 
but  I  shall  call  attention  to  two  symptoms 
that  I  have  not  found  reported,  which'  in 
my  case  were  very  important. 

The' history  of  the  case  is  as  follows  : 
VV.  A.  B.,  white,  male,  age  22,  weight 
124  pounds.  About  6  o'clock  in  the  after- 
noon he  visited  a  drug  store  and  asked  the 
clerk  to  give  him  a  dose  of  "sun  cholera 
cure"  to  relieve  a  pain  in  his  stomach.  The 
dose  was  not  measured  accurately,  but  he 
tells  me  that  it  was  a  teaspoonful  or  more. 
Immediately  after  swallowing  the  dose  his 
lips,  tongue  and  throat  began  to  tingle,  and 
he  remarked  to  the  clerk  that  it  did  not  taste 
like  the  medicine  he  had  been  taking.  He 
went  from  the  drug  store  to  supper,  but 
could  not  eat  on  account  of  a  feeling  of  un- 
easiness. Soon  the  muscles  of  his  back  and 
calf  of  his  legs  felt  as  if  pins  were  sticking 
in  them,  and  this  soon  extended  over  the 
whole  body.  He  went  back  to  the  drug 
store  and  told  the  druggist  that  he  had  taken 
the  wrong  medicine,  and  if  something  was 
not  done  for  him  it  would  kill  him.  Both 
the  druggist  and  his  clerk,  who  had  pre- 
pared the  medicine  lor  him,  insisted  that  he 
had  taken  the  medicine  called  for  and  his 
symptoms  were  due  to  the  morphine  con- 
tained in  the  sun  cholera  cure.  He  was  so 
much  alarmed,  however,  that  1  was  called 
to  see  him. 

I  found  him  very  much  excited,  walking 
the  floor  and  declaring  he  was  going  to  die. 
He  could  not  stand  without  support  and 
could  not  walk  without  assistance.  His 
face  was  pale  and  drawn,  eyes  sunken, 
pulse  fairly  good,  full  and  regular.  At  the 
time  I  could  get  absolutely  no  history.  The 
clerk  insisted  that  he  had  taken  sun  cholera 
cure  and  brought  me  the  bottle  to  examine. 
I  suspected  aconite  poisoning  from  the 
burning  and  tingling  of  the  mucous  mem- 
branes with  which  the  drug  had  come  in 
contact.  As  my  office  was  but  a  short  dis- 
tance away  1  had  the  patient  carried  there 
and  at  once  emptied  his  stomach  by  means 
of  the  stomach  pump  and  washed  it  out 
thoroughly  with  hot  water.  Before  doing 
this,  however,  I  had  the  patient  placed  on 
a  couch  with  the  feet  elevated.  Immediate- 
ly after  his  stomach  was  emptied  the  con- 
dition of  the  patient  became  much  more 
serious.  His  pulse  was  imperceptible  at  the 
wrist,  and  the  action  of  his  heart  was  very 
weak.  He  now  complained  of  severe  pain 
in  the  cardiac  region  ;  said  he  felt  as  if  his 
heart  was  in  a  vise.     The  numbness  had  ex- 


tended   over  the   whole  body.     Conscious- 
ness was  not  lost. 

The  treatment  was  that  laid  down  in  all 
text-books.  Nitroglycerine,  strychnine  and 
tincture  digitalis  were  administered  subcu- 
taneously.  Counter  irritation  was  applied 
over  the  heart.  The  patient  was  kept  in 
absolute  rest,  with  head  lowered.  The 
arms,  hands,  legs  and  feet  were  rubbed 
vigorously.  In  two  hours  I  considered  the 
patient  out  of  danger,  but  remained  with 
him  several  hours  and  gave  hypodermic  of 
morphine  to  produce  sleep.  The  following 
morning  he  felt  very  much  better,  but  was 
still  weak,  and  his  feet  and  legs  were  pain- 
ful. The  soreness  of  his  feet  and  legs  1  at- 
tribute to  the  force  used  by  my  zealous  but 
untrained  assistants.  He  was  able  to  re- 
sume his  duties  as  a  clerk  in  two  days,  and 
since  that  time  has  felt  no  bad  effects  from 
his  dangerous  experience. 

The  tingling  and  burning  of  the  mucous 
membranes  with  which  it  comes  in  contact, 
are  very  important  diagnostic  symptoms  of 
poisoning  by  aconite,  and  it  was  upon  these 
that  I  based  my  diagnosis.  The  diagnosis 
was  verified  the  following  day  when  I  visit- 
ed the  drug  store  and  found  that  the  bottle 
containing  tincture  of  aconite  was  similar 
to  the  bottle  containing  sun  cholera  cure  and 
just  below  it. 

The  failure  of  the  heart  following  the 
emptying  of  the  stomach  was  something  I 
was  not  prepared  for  and  very  alarming.  I 
do  not  find  this  symptom  enumerated  among 
the  symptoms  of  aconite  poisoning.  The 
cardiac  pain  was  very  severe  and  gave  the 
patient  more  anxiety  than  any  of  the  other 
symptoms.  This  pain  was  relieved  by  the 
use  of  stimulants  and  counter  irritation  over 
the  heart,  and  was  in  my  opinion  due  to  the 
depressing  action  of  the  drug  on  the  heart, 
muscle. 

Progress  in  Serum  Theraphyt 

By  Chas.    S.  Mangrim,  A.  B.,    M.    D.,    Prof,    of 
Physiology  and   Materia    Medica    Uni- 
versity of  North  Carolina. 

Since  bacteriology  became  a  science  the 
most  earnest  efforts  have  been  put  forth  by 
eminent  medical  men  to  isolate  for  every 
infectious  disease  some  specific  micro- 
organism, thus  leading  to  a  clearer  under- 
standing of  many  phenomena  and  a  more 
rational  treatment  in  numerous  cases.  To 
what  extent  these  efforts  have  succeeded  is 
abundantly  shown  by  the  marvelous  growth 
and  development  of  this  comparatively  re- 
cent science.      Year  by  year    new   and    im- 


iRead  before  the  North  Carolina  Medical  So- 
ciety, Asheville,  N:  C,  May  31st.  1899. 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


portant  discoveries  augment  the  invaluable 
fund  of  knowledge  which  has  already  been 
added  to  the  literature  of  medicine,  until 
we  have  now  reached  a  point  where  it  is 
fair  to  concede  that  the  present  generation 
will  probably  see  every  dreaded  infectious 
disease  accurately  classified  according  to  the 
micro-organism  to  which  it  owes  its  fatali- 
ty. Parallel  with  this  search  for  specific 
eteological  factors  there  has  been  inaug- 
urated during  recent  years  in  the  physiol- 
ogical laboratories  most  comprehensive  re- 
searches into  the  vast  new  field  of  therapu- 
tics  opened  by  the  better  knowledge  of  the 
diversified  activities  and  characteristics  of 
bacteria.  With  the  knowledge  of  toxins 
and  toxalbumens  came  first  the  supposition 
and  later  the  proof  of  the  presence  of  the 
so-called  anti-toxins,  powerful  immunizing 
principles,  of  unknown  chemical  compo- 
sition, but  undoubtedly  possessing  the 
power  either  to  destroy  the  micro-organisms 
themselves  or  neutralize  and  render  harm- 
less the  toxins  elaborated  by  them.  The 
profession  is  more  or  less  familiar  with  the 
surprisingly  successful  results  obtained  by 
serum  therapy,  which  though  still  in  its 
infancy,  has  already  been  conceded  to  be 
one  of  the  greatest  therapeutic  discoveries 
of  the  century,  giving  promise  of  new  life 
to  thousands.  Launched  from  tho  labora- 
tories in  the  early  eighties,  it  at  first  met 
with  most  discouraging  results,  and  for 
years  was  under  a  cloud  of  disapproval, 
and  this  cloud  has  not  yet  been  wholly  re- 
moved. But  its  advocates  persevered  and 
iu  1894  with  the  introduction  of  Behring's 
anti-diptheritic  serum  it  began  a  career 
which  has  lifted  it  steadily  into  favor,  until 
now  the  beneficent  nature  of  the  treatment 
has  been  established,  at  least  in  part,  be- 
yond all  doubt  or  question. 

It  is  readily  apparent  to  one  watching 
the  progress  of  the  year  in  the  treatment 
of  diseased  conditions,  that  the  profession, 
whether  consciously  or  unconsciously,  is 
basing  its  principle  hope  of  material  ad- 
vancement in  therapeutics  upon  the  expe- 
riments now  being  made  with  different 
anti-toxic  serums.  So  great  is  the  interest 
aroused  in  these  new  remedies  that  a  report 
of  progress  in  therapeutics  and  materia 
medica  practically  resolves  itself  into  a  re- 
port of  new  serums  of  real  or  imaginary 
worth.  It  is  evident  that  the  tendency  of 
the  present  time  is  to  depreciate  to  a  great 
extent  those  remedial  measures  by  means 
of  which  we  have  been  wont  heretofore  to 
strengthen  and  aid  the  natural  functions, 
and  hunt  for  a  curative  and  immunizing 
serum  for  every  poison  that  threatens  the 
life  of  man.  As  is  always  the  case  with 
new  theories,  the  claims  of  serum    therapy 


will  doubtless  be  pushed  by  enthusiasts  to 
an  almost  ridiculous  extreme ;  Then  the 
pendulum  will  swing  back  and  anti-toxins 
will  take  their  place  among  other  remedies 
upon  our  lists  according  to  their  proved  ef- 
ficiency. At  this  time  the  data  are  still 
too  incomplete  for  one  to  guage  the  future 
scope  of  this  new  method  of  treating  in- 
fectious diseases,  but  encouraging  progress 
has  been  made  and  for  so  short  a  time  the 
results  have  been  little  short  of  marvelous. 
Whether  serum  therapy  will  broaden  out 
and  develop  as  rapidly  as  did  the  science 
with  which  it  is  so  closely  allied,  or 
whether  it  will  prove  to  be  in  a  large  meas- 
ure a  popular  fad  and  of  only  a  sadly 
limited  sphere  of  usefulness  the  near  future 
will  disclose,  but  the  present  gives  promise 
of  a  future  which  will  practically  revolu- 
tionize our  methods  of  treating  all  those 
diseases  whose  symptoms  are  due  to  the 
presence  in  the  body  of  poisons  of  bacteri- 
logical  origin. 

To  quote  an  eminent  authority  :  "Serum 
therapy  has  merely  entered  the  first  stage 
of  its  development,  and  already  the  results 
are  of  much  value.  The  mortality  of  dip- 
theria  has  been  reduced  from  40  to  8  per 
cent ;  the  mortality  of  hydrophobia  has 
shrunk  at  least  from  16  to  1  per  cent;  the 
prognosis  of  tetanus  has  been  deprived  of 
much  of  its  gloomy  forebodings ;  the  cure 
of  pneumonia,  of  tubercle,  of  erysipelas, 
and  of  septicaemia,  is  seemingly  on  the 
eve  of  being  realized ;  a  complete  dem- 
onstration has  been  obtained  of  the  power 
of  antivenins  to  prevent  the  toxic  and 
lethal  effects  of  venoms;  and  the  experi- 
mental data  are  surely  being  accumulated 
with  a  view  to  the  discovery  of  anti-toxic 
serums  for  the  cure  of  yellow  fever,  the 
bubonic  plague,  Asiatic  cholera,  typhoid 
fever,  cerebro-spinal  meningitis,  and  even 
of  leprosy  and  syphilis.  The  anti-toxic 
treatment  of  diptheria  has  made  the  most 
pronounced  progress  towards  permanent 
establishment,  being  now  almost  universally 
accepted  by  the  medical  world.  The  ex- 
perience of  the  past  year  has  served  to 
place  this  treatment  in  a  position  practi- 
cally unassailable.  The  literature  on  this 
subject  has  grown  to  be  almost  voluminous, 
and  statistics  without  end  have  been 
brought  forward,  showing  such  an  enor- 
mous decrease  in  the  rate  of  mortality  under 
the  new  treatment,  that  by  many  it  would 
be  considered  a  crime  for  any  intelligent 
physician  to  refuse  to  employ  this  means 
of  succor  when  it  is  so  readily  within  his 
reach.  Having  accepted  this  serum  as  a 
remedial  measure  it  is  now  the  aim  of  the 
profession  to  improve  it  and  obviate  any  of 
the   disadvantages    which    may    attend    its 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


627 


use.  The  resulting  joint  pains  and  swel- 
lings and  the  cutaneous  eruptions  have  been 
shown  to  be  due  to  the  use  of  an  hetero- 
geneous serum  and  not  to  the  anti-toxin  as 
at  first  supposed.  It  is  proposed  to  avoid 
these  unpleasant  effects  by  the  use  of  highly 
concentrated  serums,  where  the  number  of 
anti-toxic  units  to  each  cubic  centimeter  of 
serium  is  very  large,  causing  the  volume  of 
serum  necessary  to  a  dose  to  be  small;  and 
by  thoroughly  filtering  this  serum  through 
an  extremly  fine  filter,  thus  getting  rid  of 
all  extraneous  substances.  It  has  been 
clearly  demonstrated  that  the  most  useful 
sphere  of  diptheria  antitoxin  is  to  be  found 
in  the  realm  of  preventive  medicine,  as  a 
prophylactic  and  immunizing  agent.  In 
close  communities,  as  asylums,  hospitals, 
schools,  etc.,  where  the  gravest  danger  is 
to  be  feared  in  the  development  of  secondary 
cases,  the  results  have  been  most  satisfac- 
tory, the  disease,  in  many  instances  re- 
ported, having  been  effectually  stamped  out 
before  it  could  gain  a  foothold.  This  in 
itself  may  be  considered  a  great  triumph. 
To  obtain  the  best  results  from  this  serum 
as  a  curative  measure  it  must  be  adminis- 
tered early  in  the  course  of  the  disease,  be- 
fore the  ravages  of  the  poison  have  become 
too  great  ;  the  initial  dose  must  be  large, 
in  some  cases  even  amounting  to  as  much 
as  3s00  or  4°°°  units  ;  the  dose  to  children 
should  be  relatively  much  greater  than  that 
administered  to  adults,  because  the  most 
virulent  cases  occur  among  children  ;  and 
finally  none  of  the  usual  precautionary 
measures  should  be  neglected  as  aids  to  the 
treatment,  simply  on  the  ground  that  a 
specific  should  be  expected  to  accomplish 
all  things.  The  opportunities  for  testing 
the  value  of  tetanus  antitoxin  have  been 
far  less  numerous  than  in  the  case  of  dip- 
theria, because  of  the  rare  occurrence  of 
this  disease.  The  statistics  are  as  yet 
wholly  inadequate  and  insufficient  in  total 
number,  and  do  not  admit  of  a  positive 
and  definite  report,  though  the  mortality 
of  tetanus  has  undoubtedly  been  reduced 
to  a  marked  degree  since  the  introduction 
of  tin-  antitoxic  treatment.  The  effects  of 
the  serum  are  immediate  in  those  cases 
where  it  is  employed  early,  an  amelioration 
of  all  the  symptoms  being  at  once  apparent. 
It  is  claimed  that  when  injected  subcutane- 
ously  it  only  acts  on  the  bacilli  and  toxins 
actually  present  in  the  blood,  and  does  not 
I  readily  come  in  contact  witli  the  toxins  in 
the  nervous  system.  Hence  the  necessity 
i  for  a  larger  dose  than  that  now  given,  and 
I  an  earlier  administration  of  it,  so  that  the 
poison  may  be  met  in  the  blood  current  and 
conquered  before  it  eludes  the  pursuing 
antitoxin. 


As  the  lethal  effects  of  this  bacillus  are 
chiefly  exerted  upon  the  nerve  elements, 
some  of  the  most  enthusiastic  advocates  of 
the  treatment  have  scorned  all  obstacles 
and  injected  the  antitoxin  directly  into  the 
brain  substance  itself.  They  report  most 
beneficient  results,  but  to  the  general  prac- 
titioner the  intra-cerebral  injection  of  any 
serum,  however  potent,  still  savors  highly 
of  fanaticism,  and  the  statistics  must  neces- 
sarily be  both  more  numerous  and  con- 
vincing than  they  now  are,  ere  he  may  be 
expected  to  accept  this  procedure  as  alto- 
gether the  proper  thing  to  do. 

To  a  much  less  degree  then  the  two  pre- 
ceeding,  though  steadily,  Marmorek's  an- 
tistreptococcus  serum  has  gained  favor 
during  the  past  twelve  months.  As  a 
remedy  against  erysipelas  and  septicemia 
it  has  without  question  done  much  good, 
and  has  yielded  most  favorable  results  in 
many  cases,  though  its  action  seems  to  be 
most  unfortunately  limited  to  strictly  pure 
streptococcus  infections  ;  and  since  we  do 
not  possess  the  privilege  of  selecting  the 
exact  infection  we  would  prefer  in  any 
given  case,  but  must  accept  mixed  infec- 
tions when  they  come,  why,  this  limited  ac- 
tion becomes  a  very  serious  stumbling  block 
to  the  successful  advancement  of  this  new 
remedy.  The  serum  is  still  unstable  and 
unreliable,  as  well  as  often  impure.  Hence 
it  must  be  handled  with  care,  else  it  might 
prove  a  two-edged  weapon  and  cause  a 
double  infection  where  immunity  was 
sought.  It  is  still  too  soon  to  pronounce 
authoritatively  upon  the  value  of  strepto- 
coccus serums,  but  their  use  has  been  so 
productive  of  successively  better  results 
that  it  is  well  to  maintain  an  opimistic 
view,  until  experiments  have  brought  out 
more  satisfactorily  the  details  as  to  methods 
of  preparation,  preservation  and  applica- 
tion. In  December  the  American  Gyne- 
cological Society  appointed  a  committee  to 
investigate  anti-streptococcus  serums  and 
report  in  May.  The  publishing  of  this  re- 
port is  now  awaited  with  much   interest. 

Other  antitoxins  for  the  cure  of  pneu- 
monia, cholera,  the  bubonic  plague,  typhoid 
fever,  yellow  fever,  tuberculosis  and  snake 
venom,  are  passing  through  the  experi- 
mental stage  with  varying  degrees  of  suc- 
cess. But  their  place  is  still  in  the  labora- 
tory and  in  the  hands  of  the  most  careful 
observers,  nor  should  they  be  historically 
thrust  upon  the  general  profession  until  the 
proof  of  their  potency  and  value  as  thera- 
peutic agents  has  been  established  beyond 
all  reasonable  doubt.  They  represent  how- 
ever the  first  steps  taken  in  a  field  of  almost 
boundless  extent,  which  holds  truths  that 
medical  science  will  yet   convert  into  bles- 


THE  CHARLOTTE   MEDICAL  JOURNAL. 


sings  of  priceless  value  to  mankind.  A 
brief  summation  of  the  present  position  of 
serum    therapy    may    be  made  as  follows : 

In  diphtheria  alone  has  it  proved  a  com- 
plete success,  though  it  has  been  very  effi- 
cient in  both  rabes  and  tetanus,  and  to  a 
lesser  degree  in  erysipelas  and  septicaemia. 
The  evidence  is  strongly  in  favor  of  an 
early  demonstration  of  the  power  of  anti- 
toxins to  protect  against  cholera  and  the 
plague,  and  probably  also  against  snake 
venom.  Work  with  all  other  serums  is 
yet  purely  in  an  experimental  stage,  and 
nothing  definite  or  satisfactory  has  so  far 
been  accomplished. 

There  are  two  great  obstacles  to  the  gen- 
eral introduction  and  use  of  antitoxic 
serums.  One  is  the  large  bulk  which  it  is 
necessary  to  inject  in  order  to  obtain  a  suffi- 
cient number  of  antitoxic  units  ;  the  other 
is  the  enormous  expense  of  preparation. 
The  first  is  being  rapidly  removed  by  the 
preparation  of  highly  concentrated  serums 
by  inocculation  with  the  most  virulent  cul- 
tures, the  ideal  aimed  at  being  of  course 
the  isolation  and  complete  separation  of  the 
antitoxic  principle  from  the  serum,  and  its 
subsequent  injection  in  a  sterilized  solution. 
The  expense  of  preparation  is  still  a  most 
serious  problem  and  will  be  likely  to  place 
this  means  of  preserving  life  entirely  out 
of  the  reach  of  many  classes  of  patients  for 
years  to  come.  A  case  is  reported  in  which 
over  one  hundred  dollars'  worth  of  tetanus 
antitoxin  was  used  within  a  fortnight.  The 
treatment  was  a  success,  the  man  recovered 
and  was  no  doubt  considered  a  more  valu- 
able citizen  after  the  experience  than  be- 
fore. 

In  "Science"  of  March  ioth,  1899,  maybe 
found  a  report  of  experiments  now  being 
carried  out  in  Munich  in  connection  with 
enzymes  as  remedies  in  infectious  diseases. 
It  is  well  known  fact  that  the  "bacillus 
pyocyaneus"  when  injected  has  the  power 
to  counteract  the  effects  of  the  bacillus  of 
anthrax.  It  has  been  demonstrated,  as  this 
report  goes  on  to  show,  that  certain  kinds 
of  bacteria  (bacillus  pyocyaneus)  produce 
enzymes  which  not  only  dissolve  these  bac- 
teria themselves,  but  other  microbes  as  well, 
the  claim  is  now  made  that  the  substances 
which  we  have  termed  antitoxins,  and 
which  lead  to  recovery  from  infectious  dis- 
eases, and  produce  immunity  from  them, 
belong  to  the  enzymes.  The  authors  of 
these  experiments  claim  to  have  succeeded 
in  obtaining  enzymes  which,  combined 
with  an  animal  protein,  may  be  transformed 
into  an  immunizing  substance,  which  will 
be  both  durable  and  thoroughly  satisfactory. 
As  yet  the  experiments  are  incomplete,  and 
the  results  have  not  been  published   in   full, 


but  the  "time  seems  near  at  hand  when  the 
the  treatment  with  serum  will  be  replaced 
by  a  cheaper  and  simpler  method." 

DISCUSSION. 

Dr.  Levy. — The  subject  is  one  of  very 
great  interest  to  me.  It  is  not  in  the  line 
of  tuberculosis,  however,  that  I  wish  to 
speak,  but  rather  of  diphtheria,  because  it 
is  in  that  I  have  had  some  little  experience. 
The  improvements  which  Dr.  Mangum  re- 
ferred to  on  yesterday  have  really  not  been 
much  in  dephtheria  toxine.  In  regard  to 
the  use  of  serum  in  diphtheria,  there  is  one 
very  common  error  I  have  seen  in  the  pro- 
fession, namely,  the  comparative  doses  to 
be  used  in  children  and  in  adults.  He  said 
that  the  dose  should  be  relatively  larger  in 
children  than  in  adults.  I,  myself,  hold 
that  it  should  not  only  be  relatively  larger, 
but  should  be  actually,  certainly  as  great, 
and  possibly  absolutely  larger.  We  see  that 
demonstrated  perfectly  in  the  laboratory. 
Here  we  have  two  guinea  pigs,  one  say  of  : 
250  gramms  and  the  other  of  500  gramras. 
Toxine  in  these  cases  is  given  to  the  pigs  in 
ten  times  the  minimum  fatal  dose,  so  that 
the  500  rramm  pig  will  receive  twice  as 
much  as  ,e  other.  On  the  other  hand,  we 
find  that  the  same  dose  of  antitoxine  will 
produce  the  same  result  in  both  pigs. 

Now  if  we  have  two  patients,  one  a  child 
and  the  other  an  adult,  each  one  with  the 
same  infection  and  the  same  germ  as  the 
cause,  the  natural  consequence  is  in  the  or- 
ganism in  each  instance  we  have  an  equiva- 
lent amount  of  toxin  in  the  circulation.  In 
the  child's  system,  the  organism  being 
smaller,  we  have  for  a  given  quantity  of 
blood  a  much  greater  amount  of  toxine  in 
the  circulation.  I  maintain  that  the  child 
should  have  as  large,  and  possibly  a  larger 
dose  of  antitoxine  than  should  the  adult, 
and  antitoxine  of  diphtheria  being  harmless 
it  is  perfectly  safe  to  work  on  that  theory. 
As  yet  there  is  much  room  for  improvement 
in  antitoxine.  I  have  no  doubt  we  will 
soon  obtain  the  dry  product,  which  we  can 
use  in  sterilized  solution,  and  which  will 
possess  many  advantages  and  no  disadvan- 
tages. That  has  been  done  in  tetanus  alrea- 
dy, but  has  not  been  successfully  accom- 
plished in  diphtheria  toxine. 


The  Application   of  Forceps  in   High  Pre- 
sentations.! 

By  D.  A.  Staunton,  M.  D.,  High  Point,  N.  C. 

The  application  of  the  forceps  where  the 
head  is  low  in  the  pelvis  is  extremely    sim- 


JRead  before  the  North  Carolina  Medical  So- 
ciety, Asheville,  N:  C,  May  31st.  1899. 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


pie.  When  in  these  cases  there  is  no  dispro- 
portion between  the  size  of  the  head  and 
pelvis  and  slight  traction  only  is  required 
to  supplement  difficient  expulsive  power, 
the  operation  of  applying  forceps  and  ex- 
pediting the  delivery  is  in  the  hands  of  any 
ordinarily  well  instructed  practitioner, 
perfectly  safe  to  both  mother  and  child.  It 
is  very  different  when  the  head  is  arrested 
at  the  brim,  or  high  in  the  pelvis.  Then 
the  application  of  the  forceps  is  an  opera- 
tion requiring  much  dexterity  for  its  proper 
preformance,  and  must  not  be  undertaken 
without  anxious  and  mature  consideration. 
It  is  because  these  two  classes  of  obstetric 
operation  have  been  confused  that  the  use 
of  the  forceps  is  regarded  by  many  with 
such  unreasonable  dread.  It  should  be 
borne  in  mind  that  most  of  the  bad  results 
following  obstetrical  operations  of  any 
kind,  are  due  to  carelessness  rather  than  to 
ignorance  or  inexpertness  of  the  operator. 
While  most  physicians  feel  that  in  the  prac- 
tice of  surgery  they  must  be  painstaking, 
methodical  and  familiar  with  recent  ad- 
vances in  surgical  knowledge,  yet  in  ob- 
stetrical work  they  are  apt  to  be  careless 
and  indifferent  trusting  that  nature  will 
supplement  all  deticiences  and  somehow 
pull  the  patient  through  safely.  Many  who 
pride  themselves  upon  their  scientific  pre- 
cision as  physicians  or  upon  their  expert- 
ness  and  rigidity  of  technique  as  surgeons 
are  nevertheless  slovenly  and  careless  as 
obstetricians. 

This  anomalous  state  of  affairs  may  be 
due  to  the  wide  diffusion  of  the  erroneous 
idea  that  pregnancy,  being  a  physiological 
process  whose  natural  termination  is  labor, 
there  is  consequently  no  special  care  or 
prevention  necessary.  Obstericians  can 
never  do  good  safe  work  until  they  learn  to 
regard  every  confinement  as  a  surgical  case 
with  many  pathological  possibilities  to  be 
overcome,  rather  than  as  the  natural  ter- 
mination of  a  physiological  process.  This 
may  seem  to  some  an  overdrawn  proposi- 
tion. Nevertheless  it  is  true,  though  some 
may  have  learned  the  force  of  it  after  the 
time  had  passed  for  saving  the  life  of  a 
mother  or  child.  Again,  the  old  half  truth 
that  "Meddlesome  midwifery  is  bad"  has 
done  much  harm  by  detering  obstetricians 
from  acting  promply,  and  thereby  serving 
as  an  ever  ready  excuse  for  procrastination, 
and  at  a  time,  too,  when  two  lives  "tremble 
in  the  balance."  Operative  midwifery  is 
a  department  of  surgery  governed  by  the 
strictest  principles  and  rules  of  general 
surgery.  Operative  precision  cannot  be 
attained  nor  can  mortality  and  morbidity 
be  reduced  to  the  utmost  unless  practice  is 
based  upon  broad  surgical    principles,    and 


the  same  attention  is  paid  to  technique  as 
is  in  operatives  upon  other  parts  of  the 
body.  In  no  department  is  this  more  im- 
portant that  in  operative  obstetrics  and  in 
none  does  disaster  follow  carelessness  and 
neglect  more  rapidly  and  surely.  It  cannot 
therefore  be  too  strongly  impressed  upon 
all  who  practice  the  obstetrical  art  that  a 
rigid  technique  is  essential  and  that  success 
or  failure  will  depend  more  upon  surgical 
cleanliness  than  upon  mere  expertness  in 
operating  and  in  no  obstetric  operation 
should  there  be  a  stricter  observance  of 
these  rules  than  in  the  ones  named  in  the 
heading  of  this  paper. 

Next  in  importance  to  a  careful  techni- 
que stands  the  question  of  when  the  forceps 
should  be  applied.  I  speak  only  of  high 
presentations  as  where  the  head  is  low  the 
indications  for  the  use  of  the  forceps  are 
much  more  readily  determined.  Broadly 
speaking,  I  would  say  that  as  this  proceed- 
ure  deserves  to  be  classed  among  the  major 
operations,  we  should  never  wait  till  the 
mother  is  exhausted,  for  under  the  most 
favorable  circumstances  a  forcep  delivery 
in  high  presentation  is  a  trying  ordeal 
Engagement  often  fails  to  take  place  be- 
cause of  a  faulty  presentation  of  the  head 
or  of  the  body.  Again,  puerperal  convul- 
sions may  necessitate  the  applications  of 
the  forceps  while  the  head  is  still  high,  in 
order  to  bring  the  labor  to  a  speedy  close. 
These  and  other  indications  will  frequently 
lead  the  conscientious  obstetrician  to  resort 
to  the  forceps  before  the  head  descends  into 
the  pelvis. 

The  following  cases  will  be  of  interest 
as  showing  the  ineffectiveness  of  nature 
and  the  difficulty  of  delivery :  Mrs.  W. 
H.  Primipara,  age  22,  was  taken  on  Thurs- 
day morning  at  seven  o'clock.  I  saw  her 
several  times  during  the  day.  Pains  were 
slight  and  dilitation  was  slow,  at  nine  p. 
m.,  gave  1-4  gr.  morphine  hypo,  patient 
rested  fairly  well  during  the  night.  Friday 
morning  the  pains  were  still  feeble  though 
dilitation  had  advanced  to  the  size  of  a 
twenty-five  cent  piece.  The  pains  con- 
tinued all  day  Friday  and  during  the  night 
but  were  too  feeble  to  engage  the  head. 
On  Saturday  the  pains  were  harder  still, 
the  head  would  not  engage.  The  patient 
by  this  time  was  becoming  nervous  and 
showed  signs  of  constitutional  disturbance. 
I  now  called  my  associate,  Dr.  J.  J.  Cox, 
and  were  not  long  in  deciding  that  labor  must 
be  effected  in  some  way.  After  carefully 
studying  all  the  ways  and  means  at  our 
command  we  decided  to  first  try  the  forceps. 
The  head  was  still  al  the  brim  under  com- 
plete anesthesia,  we  succeeded  in  grasp- 
ing the  head  by  having  the    child    steadied 


630 


THE  CHARLOTTE    MEDICAL  JOURNAL. 


by  an  assistant.  Delivery  was  slowly  but 
successfully  effected  without  injury  to  either 
mother  or  child. 

Case  2nd.  Mrs.  L.  J.  Prim  was  first 
seen  on  Friday  June  4th,  '97  at  7  a.  m.  The 
progress  of  this  case  was  almost  parallel 
to  that  of  No.  1,  except  that  the  pains  were 
more  vigorous  from  the  first,  under  the  most 
careful  watching.  By  .Sunday,  the  6th,  she 
was  growing  very  nervous,  fever  had  de- 
veloped to  101,  os.  dilated  to  size  of  a  50 
cent  piece.  At  7  a.  m.,  I  called  my  asso- 
ciate, Dr.  J.  W.  Long.  After  examina- 
tion it  was  decided  to  wait  and  see  if  dili- 
tation  and  engagement  would  not  take 
place.  At  10  a.  m.,  the  patient  was  show- 
ing such  decided  failure  that  we  concluded 
to  attempt  delivery  with  the  forceps  while 
the  head  was  still  at  the  brim,  though 
Dr.  Long  expressed  the  doubt  that  the 
head  could  be  grasped.  After  carefully 
preparing  the  patient,  under  complete  an- 
esthesia we  succeeded  in  delivering  alive 
an  eleven  pound  child  with  no  worse  acci- 
dent than  a  lacerated  perineum  which  was 
repaired  before  we  left  the  house. 

Case  3rd  was  where  the  application  of 
the  forceps  became  necessary  to  expedite 
the  delivery  because  of  puerperal  convul- 
sions. Mrs.  Dr.  G.  Primipara,  aged  33, 
was  taken  with  a  convulsion  at  1 1  p.  m. 
I  reached  her  at  2  a.  m.,  found  her  como- 
tose.  Examination  showed  the  head 
against  the  brim,  only  slightly  dilated. 
The  husband  a  very  competent  physician, 
was  keeping  the  convulsions  under  control 
with  chloroform.  Recognizing  the  gravity 
of  the  case  and  feeling  from  the  circum- 
stances surrounding  the  case  an  unusal  re- 
sponsibility, Dr.  Armfield,  a  man  of  large 
experience,  was  sent  for.  After  a  consul- 
tation we  decided  to  stop  the  chloroform 
and  give  tr.  veratri  viride  to  control  the 
convulsions,  but  the  husband  having  that 
groundless  fear  that  veratri  was  dangerous 
would  not  let  me  give  a  full  dose  (10  drops) 
so  I  gave  only  five  drops  and  the  convul- 
sions was  not  controlled  but  a  few  hours, 
and  we  decided  that  delivery  must  be  ef- 
fected in  some  way  and  the  forceps  was 
selected  ;  the  head  proved  to  be  a  very  large 
one  and  much  time  and  strength  was  spent 
in  effecting  delivery,  but  finally  we  suc- 
ceeded in  bringing  a  live  child  into  the 
world.  There  is  some  difference  of  opin- 
ions as  to  the  application  of  the  blades  in 
high  operation  as  to  which  should  be  con- 
sidered the  head  or  the  sides  of  the  pelvis. 
As  for  my  part  I  pay  no  attention  to  the 
head  but  apply  the  forceps  with  reference 
to  the  sides  of  the  pelvis. 


Typhoid  Fever  as  Met  with  in  Fayetteville 
and  Surrounding  Country.f 

By  J.  F.  Highsmith,  M.  D,.  Fayetteville,  N.  C. 

The  Physicians  in  Fayetteville  and  vicini- 
ty are  accustomed  to  seeing  cases  of  contin- 
ued fever,  which  apparently  come  on  as  a 
malarial  remittent,  but  are  not  controlled  by 
malarial  remedies,  be  they  ever  so  well  tried. 
I  claim  that  this  type  of  fever  is  typhoid, 
such  as  we  have  in  this  locality,  aud  to  il- 
lustrate, I  cite  the  following  case  ;  Mr.  A. 
came  to  my  office  Aug.  1st,  complaining  of 
chilly  sensation,  aching  all  over,  fever  103, 
felt  reasonably  well  until  the  day  before 
consulting  me  though  he  had  been  languid 
with  no  appetite  for  a  week.  Bowels  had 
been  regular,  had  no  headache,  epistaxis, 
general  weakness,  or  any  fever  until  July 
31st,  the  day  before  I  saw  him,  when  he 
thought  he  had  some  fever  but  was  at  his 
work.  From  this  time  on  for  four  weeks 
he  had  continued  fever.  When  I  first  saw 
him  I  gave  him  a  thorough  purgative  of 
calomel  9  grs.,  bi-carbonate  of  soda  2ogrs., 
divided  into  three  doses  given  every  two 
hours,  followed  in  six  hours  by  a  dose  of 
salts.  From  this  purgative  dose  the  bowels 
were  moved  well.  On  the  morning  of  the 
second  day  I  gave  quinine  sulph.  30  grs., 
10  grs.  at  5  a.  m.,  7  a.  m.,  11  a.  m.  In  the 
afternoon  of  the  sama  day  at  4  o'clock,  the 
temperature  being  105,  I  gave  acetanalide 
5  grs.,  with  bi-carbonate  of  soda  5  grs., and 
ordered  it  repeated  in  three  hours  if  the 
fever  was  above  103.  The  second  dose  at 
7  p.m.  reduced  the  fever  to  102.  This  plan 
of  treatment,  well  regulated  diet,  quinine 
sulphate  30  to  40  grs.,  in  the  twenty-four 
hours  with  tepid  baths  of  water  and  vinegar 
was  kept  up  for  seven  days,  fever  fluctua- 
ting from  105  to  100.  On  the  morniug  of 
the  7th,  or  the  seventh  day  of  his  illness,  I 
decided  to  give  no  quinine,  but  simply  give 
nourishment  and  sponge  baths,  first,  if  the 
fever  went  above  103,  if  not  controlled  by 
baths  and  kept  to  103  or  lower,  I  ordered 
acetanalide  as  above  repeated  every  three 
hours  until  the  fever  cooled  to  100  or  101. 
With  this  treatment  the  temperature  was 
held  down,  it  not  being  necessary  to  give 
more  than  two  or  three  doses  in  succession 
to  reduce  temperature  from  105  to  102.  On 
the  fourteenth  day  of  his  illness,  the  fever 
at  its  highest  and  without  any  anti-pyretic, 
at  4  p.m.,  did  not  register  but  102.  I  then 
discontinued  the  anti-pyretics  and  did  not 
repeat  them  in  the  case.  The  bowels  had 
been   slightly  constipated  up  to   this  time. 


fRead  before  the  North  Carolina  Medical  So- 
ciety at  Asheville,  N.  C. 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


631 


I  had  given  several  doses  of  epsom  salts 
with  good  results.  It  would  give  two  or 
three  movements  with  much  relief  to  the 
patient.  The  fourteenth  day,  the  tongue 
being  dry  and  some  tympany  of  the  bowels, 
I  commenced  on  turpentine  5  drops  with 
muiclage  of  acacia,  tablespoonful,  and  gave 
this  off  and  on  for  the  remainder  of  his  ill- 
ness. From  the  fourteenth  to  the  twenty- 
first,  fever  ranged  from  102  to  100;  from 
the  twenty-first  to  the  twenty-eight  day, 
from  100  to  98  F.  I  gave  a  well  regulated 
diet,  liquid  peptenoid,  milk,  chicken  broth, 
beef  juice,  stimulants  as  indicated.  After 
the  twenty-eighth  day  the  patient  made 
rapid  recovery,  no  after  sequel. 

I  report  this  case  not  for  any  peculiar 
symptoms  mauifested  or  special  treatment 
in  the  case,  but  simply  to  illustrate  in  a 
rough  way  the  type  of  continued  fever  as  it 
is  most  common  to  prevail  in  our  section. 
All  cases  are  not  so  mild  as  this,  but  would 
place  this  as  an  average  case.  Now  and 
then  will  have  a  case  come  similar  and  will 
have  either  epistaxis,  bowel  complication, 
petechial  eruption,  but  it  is  seldom  to  meet 
with  these, and  when  we  do  it  means  a  hard 
fight. 

1  will  now  report  the  following  case  to 

illustrate  how   similar   the   diagnosis   was, 

',    and  under  the  same  treatment  how  different 

the  results  of  treatment  were  :      On  August 

1st,  Mr.  B.  came  to   my  office  on  the  same 

i    day  with  Mr.  A.,  and  with  every  symptom 

;    similar    to    Mr.  A.  ;  came    from    the   same 

!    locality,  had  been  drinking  the  same  water, 

I    living  on  the  same  plantation  with  him.      I 

'    gave  him    calomel  followed  by  saline,   then 

,    quinine  30  grains   in   the   morning  for  two 

days,  then    reduced   to    20   grains   per  day, 

and  then    to    10  grains,  dieted  him,  and  on 

the  fifth  day  he  was  out,  no    fever,  slightly 

weak  as  a  result  of  his  illness.    In  the  course 

of  ten  days  he  had  entirely  convalesced. 

It  has  been  my  plan  in  these  fevers  in  this 
locality  to  treat  them  in  most  cases  as  mala- 
rial fever  at  the  beginning,  not  knowing  in 
many  cases  in  the  beginning  whether  I  had 
a  case  of  typhoid  or  malaria,  and  could  ar- 
rive at  a  diagnosis  oidy  by  exclusion,  and 
taking  for  granted  that  typhoid  be  exclu- 
ded; then  sometimes  I  don't  know  what  I 
am  treating  more  than  an  irregular  and  con- 
tinued fever  which  has  to  run  its  course. 
For  many  of  these  cases  do  not  yield  to 
treatment  for  malaria,  yet  I  think  the  grav- 
ity of  the  disease  is  modified  or  made  milder 
by  quinine  in  the  beginning.  While  on  the 
other  hand  many  of  them  do  not  have  a 
typhoid  symptom  more  than  the  tempera- 
ture record  and  that,  you  will  find,  to  be 
typhoid  in  character.  Such  being  the  case 
I  often  feel  that  I  am  abusing  or  needlesslyl 


using  quinine  in  many  cases  and  very  like- 
ly my  patient  would  do  better  and  be  more 
comfortable  without  it.  But  how  are  we 
to  ever  know  the  true  cause  of  the  disease  ? 
Is  it  malaria  or  is  it  typhoid?  Can  we  ar- 
rive at  the  correct  diagnosis  without  the  use 
of  the  microscope  and  an  analysis  of  the 
blood  for  a  malarial  and  typhoid  bacilli, that 
we  may  better  know  how  to  direct  our  treat- 
ment in  the  beginning  of  the  disease  ?  I 
think,  in  most  cases,  by  a  careful  examina- 
tion of  the  patient  we  can  diagnose  typhoid 
as  met  with  in  this  section,  from  the  symp- 
toms which  it  carries,  even  though  we  do 
not  have  the  clinical  symptoms  well  marked 
as  is  taught  in  text-books.  One  among  the 
first  things  I  take  into  consideration  is  the 
age  of  the  patient.  This  disease  is  most 
apt  to  be  met  with  between  the  ages  of  16 
to  35  years.  The  general  expression  of  the 
patient  is  a  wide  awake  nervous  state,  face 
and  lips  red,  cheeks  flushed  and  eyes  bright 
as  if  the  patient  was  in'  the  most  perfect 
health.  The  tongue  appears  contracted 
and  red  around  the  borders,  and  on  extend- 
ing it  will  be  tremulous,  showing  a  nervous 
condition,  may  or  may  not  be  coated,  moist 
and  of  a  fairly  good  color  and  may  remain 
so  throughout  the  disease.  The  skin  is 
usually  dry,  no  moisture  about  it,  as  is  found 
in  malarial  troubles  and  has  not  that  sallow 
and  anasmic  appearance  so  common  in  ma- 
larial cases.  After  fever  has  lasted  for  fif- 
teen or  twenty  days  the  patient  will  have 
periods  of  sweating  which  are^not  copious. 
A  petechial,  or  rose  colored  eruption  is  sel- 
dom found,  and  if  so,  slightly,  and  indi- 
cates bowel  complication.  The  stomach  is 
found  very  irritable  and  has  to  be  watched, 
so  much  so  that  often  I  have  thought  that  I 
was  dealing  with  a  case  of  gastric  fever. 
The  nervous  complications  are  usually  mild 
as  compared  to  the  low  mutterings  or  wild 
delirium  of  typhoid  enteric.  Epistaxis,  a 
most  common  symptom  of  typhoid,  is  sel- 
dom met  with  and  when  it  does  occur  is 
not  grave  within  itself,  but  is  a  signal  in 
the  case,  and  should  warn  the  Physician 
that  he  has  a  stubborn  case  to  treat.  The 
fever  is  the  most  marked  symptom  to  gov- 
ern us  in  the  diagnosis,  and  in  some  cases, 
the  only  thing  upon  which  we  can  base  the 
diagnosis,  in  this  locality.  The  tempera- 
ture record  in  most  cases  is  very  much  like 
that  taught  in  the  text-books  on  enteric 
fever.  Now  and  then  I  have  seen  in  the 
bowels  marked  typhoid  symptoms,  much 
tympany  and  distention  of  bowels,  gurgling 
in  right  iliac,  diarrhoea,  followed  by  hem- 
orrhage, but  this  is  not  common  and  when 
it  does  occur  the  patient  is  apt  to  be  a  new 
comer,  his  first  or  second  summer  in  this 
ocality.     The  assimilation  of  the  bowels  is 


632 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


bad  and  in  them  seems  to  be  located  the 
disease,  and  would  appear  to  be  a  bilious  en- 
teric condition, but  not  such  a  state  as  would 
be  looked  for  in  genuine  typhoid ;  still  I 
believe  that  the  conditions  exist  in  the  bow- 
els as  typhoid,  such  as  we  have  in  this  sec- 
tion. I  am  sorry  that  I  have  never  been 
able  to  make  pathological  investigations  of 
the  true  condition  of  the  bowels.  If  in 
these  cases  it  is  not  typhoid,  why  does  not 
quinine  control  the  disease  ?  We  know 
that  quinine  does  not  arrest  the  disease  ;  but 
as  I  have  said  before  in  some  cases  where 
they  bear  quinine  and  it  is  given  in  good 
dose  in  the  beginning  of  the  disease,  that  it 
appears  to  lessen  the  gravity  of  the  case 
and  makes  it  much  milder,  still,  it  runs  its 
course  from  three  to  five  weeks,  quinine  or 
no  quinine.  The  mortality  rate  I  am  not 
prepared  to*  state,  but  it  is  certainly  much 
less  than  in  typical  typhoid.  As  to  treat- 
ment :  get  a  nurse,  Then,  first,  I  support 
my  patient  by  giving  a  well  regulated  and 
easily  assimilated  diet.  Such  as  peptonoids, 
beef  juice,  chicken  broth,  sweet  milk,  but- 
ter milk,  egg  albumen,  water.  For  the  last 
few  months  I  have  used  less  sweet  milk  as 
nourishment  in  these  cases,  as  many  of  my 
patients  could  not  digest  it.  In  these  cases 
I  have  used  buttermilk,  chicken  broth  and 
beef  tea  instead,  with  much  better  results. 
I  direct  my  patient  to  drink  water  freely  for 
I  believe  it  to  be  a  safeguard  to  the  various 
organs,  and  helps  the  excretory  organs  to 
throw  off  the  poison  of  the  disease  from  the 
system.  Hydrotherapy,  in  the  full  sense,  I 
have  never  used  in  treatment,  but  I  believe 
when  the  surroundings  are  suitable,  it  is 
good  treatment  for  some  cases  but  not  for 
all.  As  to  drugs  in  the  beginning  of  the 
disease  I  usually  give  colomel  S  to  10  grs., 
with  soda  when  first  see  patient,  if  indica- 
ted ;  repeat  the  dose  in  four  or  five  dayst  I 
keep  the  bowels  well  open.  Like  to  have 
from  two  to  four  movements  in  twenty-four 
hours.  I  have  often  found  that  a  dose  of 
salts  when  the  temperature  rises  is  much 
better  than  an  antipyretic.  When  there  is 
no  prostration  from  numerous  actions,  I 
think  it  best  for  the  bowels  to  be  purged  off 
and  on  for  the  first  two  weeks  of  the  disease 
and  even  throughout  the  disease  in  most 
cases  purgatives  may  be  kept  up.  Where 
stomach  is  sensitive  with  torpor  of  the  low- 
er bowel,  enemas  of  warm  water  are  of 
great  service.  I  find  that  colomel  in  small 
dose,  1-16  of  gr.,  with  soda  bi-carb.  1  gr.. 
given  every  hour  or  two,  kept  up  from 
twenty-four  to  thtrty-six  hours  at  a  time,  to 
be  of  much  benefit  by  its  antiseptic  or  al- 
terative effect  bringing  about  better  secre- 
tions of  the  digestive  tract.  I  use  the  calo- 
mel in  this  way  after  the  first  ten  to    four- 


teen days  of  the  disease.  Quinine  I  most 
invariably  use  in  large  dose  in  the  begin- 
ning of  the  disease ;  first  seven  days.  If  it 
has  no  influence  over  the  fever  I  discontinue 
its  use  altogether  save  for  its  tonic  effect  in 
some  cases.  The  "Woodbridge  Treat- 
ment" I  have  never  used,  but  am  favorable 
to  its  modification.  Certainly,  so  far  as  to 
small  dose  of  calomel  and  thorough  purga- 
tion in  the  beginning  of  the  disease.  After 
the  first  few  days,  when  the  fever  has  as- 
sumed its  regular  course,  if  there  be  any 
tympany,  the  tongue  dry  and  indicates  its 
use,  I  give  turpentine  mid  keep  it  up  regu- 
larly throughout  the  disease.  I  also  use 
it  as  stupes  to  the  bowels.  In  some  cases  I 
have  used  salol  with  apparent  good  results, 
while  in  others,  have  used  it  with  no  bene- 
fit. Among  many  other  remedies  I  have 
used  Nitro-muriatic  acid, phosphate  of  soda, 
tincture  of  iodine  and  carbolic  acid  (1  to  2) 
and  many  other  remedies.  But  first,  last, 
all  time  throughout  the  disease,  look  after 
the  lungs,  heart,  stomach,  liver, Jkidney  and 
bowels.  And  see  that  the  proper  food  is 
used  with  as  little  residual  matter  as  possi- 
ble and  that  the  assimilation  be  carefully 
watched  and  the  strength  of  the  patient 
maintained.  This  is  the  most  important, 
as  has  been  my  experience.  And  if  your 
therapeutical  remedies  have  not  this  in  view 
then  they  are  useless.  I  have  found  no  spe- 
cific or  true  remedies  that  never  fail,  but 
each  case  has  to  a  certain  degree  to  be  treat- 
ed as  its  own  peculiarity  demands.  In  con- 
clusions let  me  ask  are  the  cases  of  contine- 
ed  fever,  which  we  have  in  this  locality, 
typhoid  peculiar  to  this  section  ;  are  they 
not  continued  malarial  fevers,  which  has 
to  run  its  course  and  is  not  influenced  by 
cinchona  salts,  or  is  it  typhoid  fever  modi- 
fied by  malarial  infection,  or  the  result  of  a 
combined  infection  ?  It  is  on  this  differen- 
tial diagnosis  I  would  like  to  be  able  to  give 
a  microscopical  examination  of  the  blood  of 
a  number  of  cases,  such  as  we  have  in  this 
locality,  that  it  may  enable  us  to  tell  which 
is  dependent  on  malarial  infection  and  those 
which  are  typhoid,  or  a  combined  infection. 
The  time  has  come  when  every  practicing 
physician  should  be  prepared  to  make  mi- 
croscopical examinations  of  the  blood,  that 
the  diagnosis  in  these  cases  may  be  made 
easy  and  positive. 

DISCUSSION. 

Dr.  O'Hagan. — 1  have  not  heard  a  pa- 
per on  typhoid  fever  in  which  the  advice 
was  more  salutory  and  eminently  fitted  to 
almost  any  variety  of  that  fever  which  we 
generally  meet.  I  think  that  the  ideas  ad- 
vanced by  Dr.  Woodbridge,  which  favor 
elimination,   have  more  or  less  tinged  the 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


63* 


doctor's  paper,  and  I  think  correctly,  for 
notwithstanding  I  think  that  Dr.  Wood- 
bridge's  treatment  is  utterly  impossible  to 
be  carried  out  in  this  country  for  various 
reasons,  nevertheless  the  principle  underly- 
ing it  is  elimination  and  antiseptic.  It 
seems  as  though  the  doctor  might  possibly 
gain  something  by  hydro-therapy,  in  the 
use  of  water  not  only  internally  but  extern- 
ally, accompanied  by  friction.  I  have  en- 
joyed the  doctor's  paper  very  much,  and  I 
think  a  patient  would  be  safe  in  his  hands 
if  he  had  typhoid  fever. 


Report  of  a  Case  of    Encephaloid    Carci- 
noma of  the  Lung  with  Tuberculosis. J 

By  Chas.  L.  Pearson,  M.  D.,  Asheville,  N.  C. 

Mr.  K.,  age  forty-one  years,  male.  Oc- 
cupation, stage  electritian.  Family  his- 
tory, mother  lived  to  an  old  age,  father  was 
killed  in  the  war  of  the  rebellion,  grand- 
mother on  mother's  side  died  of  cancer, two 
sisters  of  his  mother  died  of  cancer. 

The  history  of  the  patient  prior  to  the 
time  he  came  under  my  care  was  as  fol- 
lows :  On  November  5th ,  189S,  patient 
began  to  feel  pain  in  left  side,  pain  con- 
tinued more  or  less  until  December  26th, 
when  he  was  compelled  to  stop  work  for 
about  one  week.  On  January  2nd  he  re- 
sumed his  work  but  was  still  suffering  con- 
siderable pain.  On  January  16th  patient 
took  to  bed  suffering  severe  pain  and  con- 
siderable temperature  as  reported  by  his 
wife.  On  January  25th  patient  was  taken 
to  Maryland  general  hospital,  Baltimore, 
and  on  January  31st  was  apirated  for  sup- 
posed pleuritic  effusion,  result  one-half 
pint  amber-colored  fluid  was  withdrawn. 
On  February  10th  he  left  hospital  and  re- 
sumed his  work  as  stage  electritian,  travel- 
ling from  Baltimore,  Md.,  to  Cleveland, 
Ohio.  He  continued  at  his  work  for  about 
three  weeks  when  the  pain  returned,  also 
having  temperature,  a  dry  cough,  and  night 
sweats.  After  consulting  Dr.  Hamilton 
South,  of  Detroit,  Mich.,  who  diagnosed 
an  existing  tuberculosis  he  was  advised  by 
him  to  come  to  Asheville.  Patient  con- 
sulted me  on  March  17th  and  at  that  time 
his  temperature  was  101,  pulse  115,  respi- 
ration 24.  Patient  complained  of  pain 
over  the  left  lung,  was  suffering  consider- 
ably from  dyspnoea,  also  a  dry  hacking 
cough  and  from  night  sweats. 

On  physicial  examination  I  found  on  per- 
cussion there  was  complete   dullness,     pos- 


JRead  before  the   North. Carolina  Medital  So- 
ciety, Asheville,  N.  C. 


terially  over  the  left  lung  as  far  down  as 
the  seventh  rib,  below  that  region  the  per- 
cussion note  was  perfectly  flat.  Anteriorly 
the  percussion  note  from  the  apex  to  the 
nipple  was  dull  and  from  nipple  to  the 
diaphragm  was  tympanic ;  auscultation  : 
bronchial  respiration  over  apex  anteriorly, 
over  remainder  of  lung  vesicular  murmar 
was  entirely  lost.  Tactile  fremitus  was 
entirely  absent.  The  heart  was  displaced 
3  1-2  inches  to  the  right,  the  apex  beat  to 
the  right  of  the  medium  line  and  in  the 
epigastric  region.  Patient  was  very  little 
emaciated,  had  a  good  appetite,  but  had 
great  difficulty  in  retaining  his  food.  He 
had  a  dry  persistent  cough  except  in  the 
morning  when  he  raised  considerable  prune 
juice  expectoration.  Up  to  this  time  he 
had  had  no  hemorrhage.  His  sputum  ex- 
amination showed  from  four  to  fifteen 
bacilli  to  the  field.  His  condition  remained 
unchanged  until  April  5th  when  I  called 
Dr.  F.  T.  Merriweather  in  consultation 
and  we  decided  upon  an  exploratory  aspi- 
ration. No  ffuid  was  obtained  and  the  re- 
sults were  negative.  On  April  10th  pa- 
tient had  a  severe  coughing  spell  during 
which  he  coughed  up  a  piece  of  necrosed 
lung  about  one  by  one-half  inch.  This 
was  accompanied  by  quite  profuse  hemor- 
rhage. During  his  entire  illness  since 
March  17th  patient  had  profuse  sweats  and 
showed  every  sympton  of  being  septic  and 
while  we  were  not  successful  in  finding  any 
pus  or  fluid  of  any  kind  at  our  first  as- 
piration we  felt  confident  from  his  condi- 
tion and  the  physical  signs  that  there  must 
be  pus  confined  either  in  the  plural  cavi- 
ty or  within  the  lung.  On  April  18th  Dr. 
C.  P.  Ambler  was  also  called  in  to  the  case 
and  on  the  19th  we  decided  upon  another 
exploratory  aspiration,  at  which  time  the 
needle  entered  a  cavity  from  which  we  ob- 
tained several  ounces  of  bloody  fluid,  con- 
sisting of  broken  down  material  which 
under  the  microscope  showed  no  bacilli. 
After  our  first  aspiration,  finding  no  fluid 
of  any  kind,  we  suspected  a  malignant 
growth.  From  April  19th  his  tempera- 
ture decreased,  while  his  pulse  and  respira- 
tion steadily  increased  in  frequency.  His 
dyspnoea  increased  and  about  April  25th  he 
developed  symptom  of  pressure  on  the 
ajsophagos  with  great  difficulty  in  swal- 
lowing and  the  last  few  days  of  his  life 
he  was  practically  unable  to  swallow.  The 
pain  particularly  in  the  region  ot  the  sca- 
pula and  spine  grew  steadily  worse  so  that 
we  were  compiled  to  resort  to  large  doses 
of  morphia.      Patient  died  on   May  2nd. 

AUTOPSY. 

Left  lung    firmly   adherent    to  diaphram 


634 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


and  chest  wall  over  its  whole  extent.  Left 
lung  three  times  the  normal  size  and  per- 
fectly solid  except  a  large  cavity.  The  lung 
itself  was  filled  with  nodules  making  up 
the  tumor  mass.  Right  lung  near  its  root 
was  found  one  small  tumor  about  the  size 
of  a  walnut.  Remainder  presented  a 
healthy  appearance.  No  other  signs  of  a 
malignant  nature  were  found  in  any  other 
organ.  Dr.  F.  T.  Merriweuther  kindly 
mounted  a  speciman  saved  and  after  sub- 
jecting it  to  the  test  of  the  microscope  found 
the  nature  of  the  tumor  to  be  an  encephloid 
carcinoma.  Dr.  Ambler  also  took  a  speci- 
man of  the  contents  found  in  the  cavity 
and  examined  for  and  found  tubercle 
bacilli. 


Annual  Oration— Practice  of  Medicine.  J 

By     Dr.     H.    S.    Lott,     Salem,   N.   C. 

Gentlemen  of  the  N.  C.  Medical  Society: 

I  thank  you  for  this  honor.  The  pleas- 
ure of  it  was  only  equaled  by  the  surprise. 
Ladies  and  gentlemen,  citizens  and  guests 
of  Asheville,  I  thank  you  for  your  presence, 
as  for  the  privilege  of  standing  before  you, 
and  trust  that  you  may  be  in  some  measure 
repaid  for  the  coming.  I  fear  to  attempt 
to  offer  you  anything  new,  lest,  like  the 
clown  in  the  circus,  I  get  kicked  out,  (I 
tried  that  down  at  Charlotte)  ;  I  cannot 
offer  you  anything  original,  "for  there's 
nothing  original  in  me,  except  original 
sin,"  but  the  practice  of  medicine,  like  the 
story  of  love,  is  ever  new,  ever  near  to  our 
hearts,  and  of  equal  interest  to  both  pro- 
fession and  laity  The  work  is  begun  while 
attending  lectures,  for  as  the  adult  is  but 
the  grown-up  child,  so  the  practitioner  of 
medicine  is  but  the  grown-up  student.  The 
college  days  are  the  formative  days ;  all  is 
new,  and  strange,  and  wonderful ;  and  as 
the  infant  brain  gradually  awakens  to  the 
realities  and  the  magnitude  of  life,  and  of 
living,  so  the  student  of  medicine,  as  he 
begins  to  comprehend  the  elementary  and 
fundamental  teachings  of  anatomy,  physi- 
ology and  chemistry,  the  trident  that  forms 
the  base  of,  as  it  points  the  way  to,  the 
complete  structure  in  process  of  erection, 
he  awakens  also  to  the  magnitude  of  his 
task ;  and  lifting  his  eyes  to  the  future,  can 
see  on  its  misty  horizon  the  first  faint  rays 
of  the  dawn  of  a  life  of  usefullness  and  of 
science.  The  life  of  the  student  of  medi- 
cine is,  I  take  it,  much  like  the  life  of  the 
student  in  other  branches  of  education  ;  he 
may  work  much,  or  shirk  much,  as  the  trend 


*Read  before  the  North  Carolina  Medical  So- 
ciety at  Asheville,  ,N.  C. 


of  his  mind  goes ;  and  yet  while  the  per- 
sonality of  the  genius  student  may  be  the 
same,  in  the  studies  there  is  a  difference.  It 
is  not  cold-blooded  theoretical  deductions, 
figured  out  on  blackboards,  which  consti- 
tute the  day's  work  and  the  night's  study 
of  the  student  of  medicine,  but  nature's 
masterpiece,  the  human  organism,  the  won- 
der of  which  never  ceases  and  is  never 
fathomed,  from  its  beginning,  in  infinitesi- 
mal protoplasmic  elements,  to  its  comple- 
tion in  the  anatomically  perfect  human  be- 
ing;  endowed  with  life,  and  intellect,  and 
soul.  During  each  day  of  his  work  the 
student  of  medicine,  if  he  possesses  the. 
qualities  essential  to  the  successful  practi- 
tioner, awakens  more  fully  to  a  realization 
of  the  fact  that  it  is  vital  elements,  flesh 
and  bone,  and  blood  and  nerves  with  which 
his  life-work  has  to  deal.  The  lecture  room 
is  no  longer  tedious,  but  each  hour,  and 
each  lecture  brings  fresh  food  for  thought, 
and  new  problems,  relative  to  health  and 
disease,  for  individual  study  and  solution. 
The  chemical  laboratory,  which  at  first  be- 
wilders with  its  multiplicity  of  uncouth 
implements,  becomes  the  vantage  ground 
on  which  invisible  elements  meet,  to  be 
turned  and  fashioned  by  human  skill  into 
intelligible  shape,  and  applied  to  the 
comfort  and  well  being  of  human  lives. 
The  dissecting  hall,  with  its  ghastly  array 
of  gaunt  cadavers,  entered  at  first  with 
dread  akin  to  loathing,  looses  its  horror, 
which  has  followed  us  even  in  our  dreams, 
and  becomes  possessed  of  a  fascination 
which  can  be  no  more  resisted  than  defined. 
There  is  no  death  there,  and  though  at  work 
among  the  ashes,  each  ember  is  fanned  into 
life  by  imagination's  healthful  glow,  and 
in  seeking  the  source, and  tracing  the  course, 
of  muscle,  artery  and  nerve;  and  in  the 
minute  dissection  of  vital  organs,  the  won- 
der is  that  the  vital  spark  is  gone,  and  our 
subject  no  longer  endowed  with  the  power 
to  think,  and  feel,  and  suffer.  The  clinic 
is  the  student's  rest  time;  when  under  the 
wise  and  kindly  guidance  of  the  teacher, 
tension  of  theoretical  study  is  relaxed,  and  \ 
he  comes  in  touch  with  the  patient,  to  "try 
his  wings"  both  at  fathoming  human  ills 
and  reducing  the  science  of  medicine  to  the 
art  of  healing.  Thu6  the  life  of  the  student 
of  medicine,  while  full  of  work,  is  also  full 
of  pleasure,  that  pleasure  afforded  by  the 
earnest  pursuance  of  an  accepted  life  work  ; 
and  if  the  mettle  of  the  man  rings  true, 
the  day  on  which  he  receives  his  diploma 
will  find  him  well  equiped  to  enter  the 
ranks  of  his  profession.  The  ranks  are 
always  full,  but  they  are  likewise  always 
ready  to  welcome  the  beginner,  and  extend 
to  him  the  right    hand    of  good-fellowship 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


635 


and  I  believe  that  it  is  best  for  the  recent 
graduate  to  go  to  work  in  the  general  practice 
at  least  until  he  has  developed  his  tenden- 
cies. I  remember  the  time  when  I  was  try- 
ing to  decide  between  going  to  work  and 
going  to  seek  further  instruction,  (I  had 
just  about  enough  money  to  buy  a  horse, 
that  is  a  small  horse,)  I  asked  the  advice 
of  my  much  beloved  teacher,  Dr.  Joseph 
A.  Eve,  and  after  having  discussed  vari- 
ous phases  of  the  question,  his  opinion  was 
given  in  these  words,  "Go  to  work  and 
study,  going  to  Europe  has  made  more  doc- 
tors fools  than  it  has  ever  made  fools  doc- 
tors." The  remark,  strengthened  by  the 
purity  of  the  man  who  made  it,  impressed 
me  much  ;  therein  lay  a  distinction  between 
substance  and  shadow.  In  the  practice  at 
the  bedside,  and  furthermore  at  the  bedside 
of  the  patient  who  has  applied  to  us  for 
help,  and  for  whom  we  feel  morally  respon- 
sible, the  best  clinical  teacher  is  obtained. 
When  we  get  a  diploma  we  are  just  fitted  to 
study  intelligently.  The  man  who  feels  that 
when  he  has  graduated  his  need  for  study 
has  passed,  had  better  turn  to  the  plow,  or 
the  woodsaw,  or  indeed  any  other  honest 
calling;  'twere  better  far,  both  for  his  pro- 
fession, his   patient,    and  himself. 

In  selecting  a  location,  he  is  a  very 
fortunate  man  who  finds  a  place  where  he 
will  be  content  to  begin  and  finish  his  life 
work.  The  man  who  is  restless,  and  im- 
patient for  quick  preferment  in  medicine 
or  surgery,  and  moves  from  place  to  place 
to  get  it,  most  often  defeats  his  own  aim, 
and  lessens  his  chances  of  eventual  success. 
The  farmer  who  plows  the  ground,  and 
runs  the  furrow  in  one  field,  and  leaving 
it,  drops  the  grain  in  another,  reaps  a  short 
harvest.  Like  Rome,  professional  charac- 
ter and  reputation  are  not  built  in  a  day ; 
but  they  come,  with  steps  as  sure  as  they 
are  lagging,  to  the  man  who  is  worthy  of 
the  reward.  And  furthermore  they  come 
hand  in  hand,  and  are  both  essential  factors 
to  success.  Professional  reputation  may 
be  gained  through  native  skill  and  mental 
talent,  professional  character  is  only  gained 
by  purity  of  life  and  motive.  Reputation  is 
the  binding,  character  is  the  book;  reputa- 
tion may  bring  the  patients,  character  holds 
them.  The  first  years,  the  waiting  time, 
constitute  the  most  trying  period  of  a  pro- 
fessional career.  They  are  filled  with  trials, 
and  temptations,  and  disappointments.  The 
men  on  whom  fortune  smiles  early,  bring- 
ing to  them  a  living  practice,  without  the 
struggle,  through  either  the  decent  of  a 
father's  mantle  to  their  shoulders,  family 
influence,  or  other  of  her  fickle  freaks,  are 
among  the  favored  few.  To  the  large  ma- 
jority   it    comes    through    years  of  patient 


work  and  patient  waiting.  In  starting  out 
in  practice  the  chafing  against  the  bit  is 
hard  to  overcome.  To  sit  quietly  in  the 
office  waiting  for  calls,  with  very  few  dol- 
lars in  the  pocket,  and  expenses  going  on 
in  spite.  To  see  the  busy  doctors  on  their 
rounds,  doing  the  work,  while  we  sit  idle, 
is  a  trial  well  worth  living  through,  and  if 
bravely  borne,  yields  fruit  well  worth  the 
waiting.  The  time  is  not  wasted  if  prop- 
erly spent,  and  the  discipline  is  just  what 
we  need.  Self  possession,  faith  in  his  calling, 
and  faith  in  his  own  resources,  are  most  es- 
sential to  the  practitioner  of  medicine.  The 
man  who  possesses  them  has  ample  oppor- 
tunities for  their  cultivation  during  this 
period  and  will  be  prepared  to  meet  suc- 
cessfully the  first  emergency  that  arises. 
The  man  who  possesses  them  not  will  be 
found  wanting  in  the  waiting  period,  and 
wanting  in  the  work.  Temptations  come 
from  every  side,  and  are  not  confined  to 
those  which  come  through  a  native  fondness 
for  society  and  its  dissipations;  for  while 
these  are  alluring,  and  may  lead  astray, 
they  are  most  often  refining  and  elevating. 
The  true  physician  is  the  doctor  everywhere 
and  every  when,  always  ready  with  brain 
and  heart  and  hand;  nor  does  his  calling 
debar  him  from  social  recreation.  The 
greatest  temptation  from  that  source,  and 
the  one,  if  yielded  to,  most  damning  and 
destructive  to  the  physician's  moral  char- 
acter and  professional  honor,  seeks  him  in 
the  quiet  of  his  office,  with  gloved  hand 
and  gold-lined  palm,  and  pleading  tear- 
stained  eyes  mayhap,  "just  a  little  medine, 
Doctor!  and  a  little  'treatment,'  and  please 
remember  that  your  fee  is  no  considera- 
tion." Will  he  yield,  and  bear  the  scar  of 
professional  dishonor  throughout  the  bal- 
ance of  his  life?  The  need  is  urgent,  may- 
be, office  rent  is  due,  and  the  money  is  at 
hand  just  for  the  reaching;  and  it  is  so 
simple,  and  really  seems  to  be  an  act  of 
humanity.  Ah,  yes!  I  know  the  tempta- 
tion ;  but  if  he  is  a  true  man,  and  a  true 
physician,  with  the  honor  of  his  profession 
as  dear  to  him  as  his  own,  he  will  say  No  ! 
and  the  "the  fee"  will,  indeed,  be  no  con- 
sideration. Such,  and  lesser  ones,  con- 
stitute the  temptations  from  without. 
Within  the  pale  of  the  profession  there  are 
many,  living  because  countenanced,  and 
equally  ruinous  to  the  physician  ;  if  not  to 
his  honor  to  his  dignity,  and  to  the  scien- 
tific persuance  of  the  practice  of  his  art. 

The  cry  of  the  medicine  vender  is  not 
confined  to  the  streets ;  he  enters  the  phy- 
sician's office  with  much  elegance  and 
suavity ;  appareled  in  the  latest  style  both 
in  person,  in  speech,  and  at  all  ages,  from 
the  beardless  recruit,  who  has  just  shed  his 


636 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


pinafores,  to  the  dignified  veteran,  who  had 
"such  an  extensive  practice"  that  he  must 
needs  leave  it,  forsooth!  and  go  to  travel- 
ing in  the  interest  of  a  "pharmaceutical  es- 
tablishment."     And "my  dear  doctor- 

we  make  the  best,  the  very  best,  the  pro- 
ducts of  no  other  house  can  compare  with 
those  we  offer  you.  We  visit  the  physi- 
cians only,  and  introduce  our  elegant  prepa- 
rations strictly  on  their  merit  and  only 
through  the  medical  profession.  And  this, 
our  special  and  latest  product,  (full  formula 
on  the  label)  is  working  wonders.  Where 
it  is  known  the  profession  simply  cannot 
do  without  it ;  and  it  cures,  always.  These 
samples  I  will  leave  with  you,  and  to  more 
you  are  welcome  just  for  the  asking.  When 
prescribing,  doctor,  there  is  so  much  fraud, 
kindly  specify  our  goods,  and  the  results 
are  certain."  The  recitation  is  well  taught, 
and  beautifully  rendered,  most  pathetic  in 
fact.  And  on  leaving,  "your  full  address, 
doctor,  Ah!  thank  you,  this  will  bring  you, 
each  month,  our  publication  with  exhaus- 
tive reports,  from  the  most  prominent  men, 
on  the  successful  use  of  our  preparations." 
"And  remember  please,  that  we  will  gladly 
furnish  you  with  literature  and  samples  at 
any  time."  And  they  are  furnished,  and 
their  pamphlets  form  the  text  book,  and 
their  nostrums  the  medical  agents  of  num- 
bers of  practitioners.  It  is  so  much  easier 
to  let  some  one  else  do  one's  thinking,  and 
to  use  a  remedy  that  is  known  to  be  the 
right  one,  for  it  says  so  on  the  label.  And 
then  they  are  so  safe  too,  nicely  put  up  in 
little  boxes  ;  and  the  little  pamphlet  tells  you 
just  when  to  give  No.  i,  and  just  when  to 
give  No.  2,  and  all  we  have  to  do  is  to  look 
at  the  numbers,  never  mind  about  the  pa- 
tient, the  little  pamphlet  says  that  hundreds 
and  hundreds  of  cases  have  be  treated  by 
them,  with  never  the  loss  of  one.  Now, 
in  order  to  find  a  very  large  number  of  the 
authors  of  these  valuable  reports,  you  would 
have  to  conduct  your  search  with  a  lantern 
in  the  daytime.  And  the  remedies  lauded, 
most  often  under  mysterious  and  high 
sounding  names,  are  simply  standard  drugs, 
that  are  used  by  all  intelligent  physicians 
each  day  in  their  practice.  Let  the  phar- 
macist devote  his  energies  to  the  securing 
and  preparing  of  pure  and  unadulterated 
drugs,  and  not  assume  the  office  of  clinician 
and  teacher  of  therapeutics ;  the  instru- 
ment maker  to  the  making  of  good  instru- 
ments, and  leave  their  use,  and  the  "post- 
operative sequelae"  to  the  surgeon.  Medical 
literature  offers  a  maze  through  which  the 
young  practitioner  passes  in  bewilderment, 
and  the  only  wonder  is,  that  he  does 
not  stray  further  more  often.  Just  as  un- 
trammeled  freedom  of  the    press    publishes 


crime  and  immorality,  and  sows  broadcast 
their  seed  in  brains  and  hearts  found  fer- 
tile for  the  growing,  so  do  unrepressed  and 
mongrel  medical  journals  teach  and  foster 
unsound  principles  and  practice  of  medi- 
cine. The  ideal  medical  journal,  as  the 
ideal  physician,  should  be  free  from  adver- 
tisements, and  free,  also,  from  solicitations 
for  patronage.  The  want  of  to-day  is  not 
for  literature  on  subjects  medical  and  sur- 
gical, of  that  there  is  an  abundance;  but 
for  the  power  to  discriminate  between  good 
and  bad,  the  ring  of  the  false,  and  the  ring 
of  the  true.  Like  all  human  effort,  a  large 
mass  of  it  sinks  into  restful  oblivion.  Just 
here  and  there,  untarnished  and  untattered 
by  time's  progress,  stand  out  in  bold  relief 
the  work  and  thoughts  of  men  endowed  by 
nature  with  the  power  to  read  her  lines 
correctly,  and  follow  close  their  teaching. 
The  best  literature  that  we  have  to-day, 
most  sound  in  pathology,  accurate  in  diag- 
noses and  helpful  in  treatment,  is  found  in 
the  works  of  the  older  writers,  men  with 
their  working  time  behind  them,  and  a 
goodly  number  of  well  rounded  and  well 
ripened  years  of  experience  and  observa- 
tion from  which  to  draw. 

Systems  of  medicine,  compiled  from  many 
sources  and  many  authors,  and  shaped  into 
a  number  of  immense  volumes,  make  quite 
a  formidable  array  on  the  shelves  of  a  book 
case,  and  are  quite  profitable,  no  doubt,  to 
the  compiler  and  the  publisher;  but  I  ques- 
tion much  their  value  to  either  student  or 
patient. 

Such  works,  together  with  most  enticing 
terms  of  purchase,  are  presented  to  the  phy- 
sicians throughout  the  country  by  the  well 
tutored  representatives  of  lay  publishing 
houses.  Just  think  of  it !  Come  all  the  way 
down  from  the  metropolis,  bearing  all  the 
expense  and  distress  of  travel,  for  no  profit 
— mark  you — but  solely  to  offer  to  benight- 
ed doctors  the  "very  latest  work"  by  some 
embryonic  professor,  that  their  house  is 
"pushing."  Ask  one  of  these  gentlemen 
for  a  standard  work,  by  a  master  in  medi- 
cine or  surgery,  and  his  face  is  a  study  in  its 
blending  of  sympathy  and  pity;  "my  dear 
doctor!  we  don't  carry  that,  it  is  out  of 
date ;  the  works  that  I  offer  you  are  the 
latest.  And  the  engravings,  doctor,  see  the 
number  of  fine  engravings." 

Now  the  surgical  picture  book,  while 
having  a  sphere  of  usefulness,  portrays 
rather  the  financial  resources  of  a  wealthy 
corporation,  than  the  native  skill,  wisdom, 
and  conscience,  the  three  essentials,  of  the 
surgeon.  These  are  best  portrayed  either 
through  personal  contact,  or  in  close  study 
of  the  volumes  which  set  forth  the  spirit  of 
the  man,  in    the  writings  of    the  life  work. 


THE  CHARDOTTE  MEDICAL  JOURNAL 


637 


However  trying  it  may  be  to  the  physi- 
cian's mental  and  moral  fiber,  the  waiting 
time  passes  and  the  calls  begin  to  come. 
The  first  call  marks  a  crisis  which  is  ever 
remembered.  It  is  the  culmination  of  hope 
deferred,  the  beginning  of  the  end.  It  may 
be  to  the  mansion,  but  the  chances  ore  very 
great  that  it  will  be  to  the  humble  cabin, 
and  in  either  case  the  issue  is  of  vital  im- 
port. 

With  the  care  and  precision  which  mark 
the  well  trained  student,  and  guided  by  the 
lights  of  to-day  which  give  a  knowledge 
and  understanding  of  obscure  pathological 
condition,  the  patient  is  examined  and  a 
diagnosis  made  of  appendicitis.  The  trouble 
has  become  quite  the  fashion,  and  'tis  rather 
good  fortune  to  have  been  called  to  a  case, 
if  it  can  be  brought  to  a  happy  termina- 
tion. The  patient  is  suffering,  the  family 
anxious,  and  the  skill,  wisdom,  and  ability 
in  general  of  the  young  attendant  much 
shadowed  by  doubt.  What  course  of  treat- 
ment is  it  best  to  pursue?  The  teaching 
and  literature  of  to-day,  which  have  been 
studied  so  well,  present  a  mottled  and  con- 
flicting mass,  seemingly  at  war  with  itself, 
and  failing  to     guide     straight     and      true. 

At  one  elbow  stands  Prof.  .Salts,  with  a 
string  of  extras  to  his  name  as  long  as  your 
arm  and  shaped  into  a  nice  little  pyramid 
underneath,  who  in  his  latest  writing  says 
that  appendicitis  is  not  a  surgical  disease 
at  all  ;  but  it  is  due  to  a  germ  which  makes 
its  home  in  this  little  intestinal  prolonga- 
tion and  its  immediate  neighborhood ;  and 
if  the  doings  and  feeding  of  the  possessor 
of  its  habitant  incur  its  displeasure  by  de- 
ranging its  medium  of  existence,  mueh 
trouble  ensues,  and  the  culprit  is  in  danger 
of  capital  punishment,  which,  however, 
may  always  be  averted  by  medicinal  treat- 
ment, tending  to  expel  this  ill-conditioned 
and  ill-tempered  inhabitant,  and  create  a 
proper  medium  of  existence  for  its  succes- 
sor. Surgical  interference  is  practically 
criminal,  and  never  indicated.  And  then 
a  long  "series"  of  cases  are  cited  in  which 
the  diagnosis  was  sure,  all  were  treated  with 
salts  and  calomel,  and  all  got  well. 

At  the  other  elbow  stands  Prof.  Lancet, 
with  an  equal  number  of  attachments,  who 
says  that  all  cases  of  appendicitis  are  surgi- 
cal cases ;  delay  is  dangerous,  aye  even 
criminal,  and  should  be  subjected  to  opera- 
tive interference  early.  The  exciting  cause, 
in  most  cases,  is  a  foreign  body,  having 
been  introduced  either  by  way  of  the  stom- 
ach, or  formed  within  the  gut  as  an  enter- 
olith, and  its  removal,  together  with  the 
inflamed  and  often  sloughing  appendix 
through  an  abdominal  incision,  the  only 
safe    or    rational  procedure.      Why?    quite 


recently  there  appeared  in  a  medical  jour- 
nal, an  elaborate  article,  prepared  no  doubt, 
by  a  member  of  the  firm  of  Lancet,  Duck 
Pants  &  Co.,  strongly  urging  the  removal 
of  the  appendix  vermiformis  in  early  infan- 
cy, and  recommending  to  its  securance  the 
establishment  of  a  law  like  that  enforcing 
vaccination. 

Now  in  the  face  of  such  conflicting  testi- 
mony,from  presumably  authoritative  sources 
the  position  of  the  man  who  has  not  years 
of  experience  and  observation  from  which 
to  draw,  may  be  much  embarrassed.  That 
co-workers  in  the  field  are  so  widely  at 
variance  is  most  unfortunate.  The  funda- 
mental laws  underlying  and  governing  med- 
ical and  surgical  science,  are  as  fixed  as 
were  those  of  the  Medes  and  Persians, 
cleaving  close  to  nature's  lines.  Not  wast- 
ing precious  time  in  vague  theories,  but 
striving  to  aid  nature's  efforts  at  throwing 
off  disease,  while  they  also  strive  to  solve 
her  mysteries.  'Tis  the  expounders  of  the 
law  who  vacillate,  and  not  the  law.  That 
"doctors  differ"  is  a  much  favored  saying 
among  the  people,  and  often  reflects  dis- 
credit upon  the  science  of  medicine,  when 
the  real  fault  lies  in  the  want  of  equal 
powers  of  observation,  and  equal  training 
of  its  representatives. 

Finding  himself  thus  at  sea,  between  the 
two  extremes  of  authoritative  opinion, 
which  keep  each  shore  in  restless  tumult 
through  the  splash  of  their  discussion  ;  the 
man  of  resource,  sustained  by  native  skill 
and  native  wisdom,  drops  into  the  strong, 
deep  middle  current,  which  traces  its^source 
to  the  masters  in  medicine  and  surgery, 
and  pursues  its  way  from  century  to 
century,  unswerving  as  unchanging,  and 
bearing  on  its  broad  and  mighty  bosom  the 
fixed  and  faithful  laws  which  contribute  to 
the  prolonging  of  human  life,  and  the  relief 
of  human  suffering. 

Thus  guided  the  man  of  doubt  becomes 
the  man  of  action.  The  first  care  is  for  the 
patient,  whose  vitality  and  environments 
are  taken  into  account,  and  the  course  of 
treatment  advised  which  promises  best. 
Each  case  is  a  law  unto  itself,  and  no  fixed 
rules  can  be  established  or  followed. 

A  simple  catarrhal  appendicitis,  or  as 
correctly  speaking  the  perityphlitis  of  Gross, 
involving  the  appendicular  region,  is  often 
tided  over  by  rest,  salines  and  proper  diet, 
without  the  need  for  alarm.  Or,  on  the 
other  hand,  the  case  presents  the  type  so 
perfectly  pictured  by  Dr.  Hunter  McGuire, 
with  a  probable  foreign  body,  the  formation 
of  pus  abscess,  with  a  likelihood  of  perfor- 
ation ;  then  to  open  the  abdomen  nearest 
the  seat  of  inflammation,  let  out  the  offend- 
ing matter  and  drain  the  cavity,  is  beyond 


638 


THE  CHARLOTTE  MEDICAL  JOURNAL 


question  the  right  course  to  be  pursued  ;  and 

liDo  thy  duty,  that  is  best : 
Leave  unto  thy  God  the  rest." 

Such  issues,  with  such  problems  for  so- 
lution, will  present  constantly  in  the  work, 
and  to  think  and  act  promptly  is  most  apt 
both  to  save  the  patient  and  hold  the  con- 
fidence of  the  people. 

The  case  terminates  favorably,  the  patient 
gets  well,  and  the  diagnostic  skill  and  suc- 
cessful treatment  of  the  physician  are  much 
talked  and  lauded  by  the  family  and  neigh- 
bors. Or,  wait !  the  patient  does  not  get 
well ;  the  life  line  has  been  crossed,  and  the 
case  terminates  fatally.  Now,  the  skill  in 
diagnosis  has  been  equally  great,  the  course 
of  treatment  adopted  has  been  equally  cor- 
rect, and  yet  the  issue  is  most  distressing  to 
all  concerned ;  and  not  least  so  to  the  phy- 
sician. He  has  been  guided  by  his  lights, 
and  done  his  best,  aud  yet  the  shadow  of  a 
failure  rests  upon  him.  Each  step  in  diag- 
nosis and  in  treatment  is  reviewed,  and 
while  found  to  be  abreast  of  the  best  teach- 
ing of  to-day,  and  to  have  just  suited  that 
particular  case,  he  questions  their  wisdom  ; 
and  to  the  disappointment  and  discourage- 
ment are  added  the  pain  of  feeling  that  pos- 
sibly some  other  course  would  have  been 
best  pursued,  and  might  have  saved  the  pa- 
tient. Do  the  people  know  what  the  doc- 
tor suffers  in  the  loss  of  a  patient  ?  They 
are  his  judges,  they  make  or  mar  his  future. 
A  few  will  censure  his  boldness,  many  will 
question  his  skill  and  ability,  but  the  large 
and  ruling  number  will  weigh  the  matter 
justly.  Into  the  balance  with  reputed  zeal 
and  professional  ability  the  character  of  the 
man  is  dropped;  and  if  sound  and  pure, 
the  swing  is  in  his  favor.  Failure,  while 
cruel,  is  ofttimes  a  better  teacher  than  suc- 
cess. The  doubt  of  self,  with  its  question- 
ing and  study,  are  fertile  paths  to  plains  of 
broader  knowledge.  As  to  adverse  criti- 
cisms, the  doctor  gets  his  share  of  them. 
No  matter  how  earnest  his  work,  or  how 
pure  his  motives  ;  and 

•'Let  any  man  once  show  the  world  that  he  feels 
Afraid  of  its  bark;  and  'twill  fly  at  his  heels  ; 
Let  him  fearlessly  face  it,  'twill  leave  him  alone: 
But  'twill  fawn  at  his  feet  if  he  flings  it  a  bone. " 

Thus  to  pursue  and  to  comprehend  the 
practice  of  medicine,  in  all  the  breadth  and 
fullness  of  its  scope,  the  physician  should 
bo  a  man  of  power,  mental,  moral,  and 
physical. 

Mental  ability,  with  quick  conceptions 
and  ready  sympathies,  fits  a  man  to  hold 
postion  in  the  foremost  ranks  of  his  profes- 
sion. The  case  pictured  is  but  a  drop  from 
the  mighty  ocean.  Throughout  the  work- 
ing time,  like  problems,  medical  and  surgi- 


cal, for  individual  solution,  are  coming  up 
each  day  and  hour.  In  every  branch  of  the 
work,  and  the  general  practitioner  must 
have  a  knowledge  of  all ;  theorists  form  a 
large  and  also  a  valuable  school,  in  that 
their  searchings  and  controversies  often 
lead  to  truth.  But  theory  must  be  reduced 
to  science,  the  kernel  must  be  freed  from  its 
shell,  before  it  becomes  the  mighty  oak; 
and  upon  the  general  practitioner,  with 
greater  powers  of  observation  and  a  broader 
field  in  which  to  use  the  power,  mostly  de- 
volves this  task. 

The  advances  of  today  along  all  lines  of 
our  profession,  are  most  wonderful.  The 
microbe  hunter, crying  Germs  !  Germs  !  and 
waving  aloft  as  he  runs  his  barber's  banner, 
fresh  dipped  from  the  many-hued  solutions, 
has  done  a  great  and  lasting  work  ;  he  has 
found  the  germs,  and  can  only  see  his  find; 
but  he  has  taught  us  to  be  clean ;  and  if  to 
our  minds  it  is  still  a  question  whether  the 
germ  is  a  cause  or  a  result  of  its  medium  of 
existence,  having  gained  the  house-top,  we 
should  not  despise  the  ladder  which  has  put 
us  there. 

To  preach  and  practice  cleanliness  be- 
longs equally  to  all  branches  of  our  science, 
and  while  through  its  medium  the  advances 
in  surgery,  and  especially  in  abdominal 
surgery  attract  most  admiration  and  won- 
derment, the  field  for  teaching  and  guidance 
to  the  same  end  is  equally  broad  in  the  gen- 
eral practice. 

Tuberculosis,  Syphilis  and  Cancer, which 
in  their  various  manifestations  constitute 
the  greatest  scourges  to  humanity,  have 
their  origin  in  filth,  either  of  person  or  en- 
vironment; and  whether  the  germ  exists 
before  or  after  the  establishment  of  its  me- 
dium, the  preventive  lies  in  cleanlinesss. 

The  same  principle  underlies  the  latest 
and  most  scientific  treatment  of  all  diseases 
with  which  we  have  to  cope.  In  autointox- 
ication, with  all  that  the  term  implies,  we 
recognize  the  chief  source  of  danger  to  the 
vitality  of  the  patient,  and  in  stimulating 
the  emunctories,  and  keepimg  up  nutrition 
we  also  recognize  the  best  means  of  ridding 
the  system  of  the  accumulating  poisons, and 
of  preserving  the  vital  spark. 

It  is  just  here  that  the  serum  therapist, 
heralding  his  theoretical  antidote,  comes 
into  clash  with  the  true  scientist ;  the  man 
who  does  not  take  to  each  new  path  that 
offers,  because  it  is  bright,  and  easy,  and 
diverting.  Nor  will  he  either,  without 
knowing  well  the  reasons,  inflict  upon  an 
organism  laboring  under  a  self-endangered 
poison,  which  taxes  to  its  fullest  the  resist- 
ing and  eliminating  power,  an  additional 
one  of  even  greater  and  more  deadly  in- 
tensity. 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


639 


The  electrician  subjects  both  himself  and 
a  most  valuable  therapeutic  agent  to  the 
criticism  and  ridicule  of  intelligent  surge- 
ons, by  reporting  a  "long  series"  of  cases 
in  which,  under  the  magic  influence  of  the 
current,  huge  fibroids  have  melted  like 
snow  'neath  the  summer's  sun. 

Such  aberrations,  gentlemen,  are  most  in- 
nocent in  origin,  and  not  intended  to  mis- 
guide ;  but  are  simply  prima  facia  evidence 
of  a  want  of  equal  training,  and  of  equal 
powers  of  observation  in  the  authors  of 
their  being.  And  furthermore,  they  lend 
much  to  establish  the  fact  that  the  true 
sicentist  is  not  the  isolated  and  pedestalled 
myth  that  current  opinion  mostly  holds,  but 
a  living  reality,  in  and  out  among  the  peo- 
ple every  day.  The  man  with  the  eye  to 
see  and  the  wit  to  grasp  nature's  proces- 
ses, bearing  in  mind  the  essential  to  life ; 
and  possessing  the  wisdom  that  tells  him 
when  to  aid,  and  when  to  leave  her  to  her 
doings. 

In  his  moral  character  the  physician 
forges  the  link  that  binds  together  the  pro- 
fession and  the  people.  Strip  the  man  of 
moral  strength  and  moral  purity,  and  though 
he  be  possessed  of  the  highest  degree  of 
skill  and  wisdom,  the  picture  has  lost  its 
glow,  and  becomes  one  from  which  both 
people  and  profession  shrink.  The  duties 
of  the  physician  are  such, and  through  them 
he  is  so  intimately  associated  with  the  most 
sacred  ties  of  heart  and  home,  that  his  per- 
sonality becomes  a  household  factor.  His 
help  and  counsel  are  sought  and  trusted ; 
and  even  in  times  of  health,  or  trilling  ills, 
"what  the  doctor  thinks"  is  an  element  of 
no  small  moment  in  deciding  questions  both 
of  duty  and  of  pleasure. 

Throughout  prolonegd  ordeals  of  trying 
sickness,  when  hearts  and  brains  of  friends 
and  relatives  are  racked  with  pain  and  ap- 
prehension, the  family  physician  becomes 
the  stay  and  guide  of  all.  His  coming  is  ever 
welcome  and  his  presence  gives  strength 
and  hope. 

In  daily  contact  with  patients  the  moral 
fibre  of  the  physician  is  stoutly  tested. 
There  is  a  strong  tendency  on  the  part  of 
some  people,  who  constitute  a  fair  per  cent, 
of  the  doctor's  clientelle,  to  make  a  diag- 
nosis of  their  ailment,  and  even  to  formu- 
late a  line  of  treatment  for  the  same,  and 
then  apply  for  professional  endorsement. 
Now  to  cater  to  their  demands  would  be 
"most  culpable,  while  to  find  and  meet  their 
needs,  both  wisely  and  kindly,  offers  a  prob- 
lem which  is  at  times  most  difficult. 

In  the  ranks  of  '■.he  profession  it  is  not 
science,  but  moral  purity  of  life  and  motive 
that  makes  the  front  invincible.  The  paths 
of  earnest    and   faithful  workers   are    often 


widely  divergent,  and  their  deductions 
widely  at  variance,  but  each  is  striv- 
ing for  the  same  end,  and  from  each 
is  culled  a  grain  of  truth,  which, 
dropped  into  the  store-house  ready  garn- 
ered, adds  to  the  richness  from  which 
all  may  draw,  and  also  adds  a  link  to  the 
ever-lengthening  and  ever-strengthening 
chain  of  professional  love  and  unity. 

In  personal  contact  with  fellow  physi- 
cians, each  man  has  a  moral  influence.  We 
seldom  come  in  touch  with  a  man  from 
whom  we  do  not  learn  something,  either  to 
cultivate  or  avoid.  To  our  seniors  we  look  up 
with  admiration  akin  to  reverence.  They 
have  what  we  want,  the  skill,  the  wisdom, 
and  —  the  practice,  and  it  has  been  my  ex- 
perience to  find  them  ever  ready  to  lend  a 
helping  hand,  and  give  the  word  of  counsel 
and  guidance  of  which  we  often  stand  in 
need.  'Tis  not  so  much  the  patients  that 
they  send  us,  as  the  "word  in  season"  drop- 
ped here  and  there  in  soil  rich  of  their  till- 
ing, that  lets  the  mantle  gently  down  to 
the  shoulders  of  their  successor  as  they  re- 
linquish the  work,  and  brings  with  it  the 
confidence  and  patronage  of  the  people. 

Physical  strength  and  power  of  endurance 
are  to  the  physician  as  paint  and  canvas  to 
the  artist's  dream.  Without  them  the  vis- 
ion lives  in  eye  and  mem'ry  only,  nor 
could  the  world  either  share,  or  be  bettered 
by  its  power  and  beauty.  With  them, from 
tenderest  hue  to  full  and  glowing  color,  the 
canvas'portrays  the  artists  inspiration.  'Tis 
a  life  of  doing,  not  of  saying;  and  in  the 
physical  man  lies  the  foundation  to  the  su- 
perstructure. Strength,  as  of  a  man;  and 
gentleness  like  unto  a  woman,  are  attributes 
peculiarly  essential  to  the  physician.  Each 
fiber  of  nerve  and  muscle  is  trained  and 
adapted  to  its  work  ;  ever  under  control,  at 
command  of  the  brain's  supreme  direction, 
and  always  with  strength  to  spare.  With 
the  gentleness  of  the  woman,  the  new  born 
babe  is  washed  and  dressed,  and  laid  in  its 
mother's  arms.  Or,  as  the  chance  may  be, 
with  the  finest  co-ordination  and  adaptation 
of  muscular  movement,  the  most  trying  sur- 
gical operation  is  done. 

The  loss  of  sleep  (burning  the  candle  at 
both  ends),|the  hurried  meals,  the  long  hard 

drive  through  rain,  and  mud,  and the 

collecting,  all  tax  the  doctor's  physical 
strength  and  powers  of  endurance  to  their 
utmost.  There  is  no  hour  that  he  may  call 
his  own  ;  all  time  and  skill,  all  power  of 
brain,  and  heart  and  hand,  belong  to  his 
profession  and  his  patients. 
"Therefore  though  few  may  praise,  or  helk,  or 
heed  us, 

Let  us  work  on  with  head,  or  heart,  or  hand, 
For  that  we  know  the  future  ages  need  us, 

And  we  must  help  our  time  to  take  its  stand." 


THE  CHARLOTTE  MEDICAL  JOURNAL 


And  the  patients  love  "The  Doctor," 
and  when  the  task  is  done,  and  the  life  is 
spent  from  each  house  comes  the  sorrowing 
sigh  : 

"But  oh  for  the  touch  of  a  vanished  hand 
And  the  sound  of  a  voice  that  is  still." 


Antiseptic  Midwifery,  t 

By  W.  W.  McKenzie,  M.  D„  Salisbury,  N,  C. 

It  has  long  since  been  ascertained  that 
puerperal  septicaemia  is  due  to  a  poison 
which  enters  the  system  through  the  genital 
tract,  as  such  or  is  produced  there  by  a  sub- 
stance coming  in  from  without. 

It  is  also  a  settled  fact  that  in  almost,  if 
not  in  all  cases,  by  the  local  use  of  certain 
measures  and  drugs,  we  can  prevent  puer- 
peral septicaemia.  It  can  furthermore  be 
said  that  the  producers  of  this  poison  are 
certain  microscopical  fungi,  which  have 
been  found  on  the  wounds  of  the  genital 
canal,  in  the  blood  circulating  in  the  veins 
of  the  living  patient  and  after  death,  in 
almost  all  the  great  cavities,  exudations,  &c. 
The  most  dangerous  of  these,  it  is  said  by 
those  who  should  know,  are  the  round  mi- 
crococci in  chain-like  groupes,  but  beside 
them  are  found  single  and  double  round 
micrococci  and  the  common  rod-shaped 
bacteria  of  putrefaction.  Chains  of  micro- 
cocci similar  to  those  of  puerperal  septicae- 
mia are  found  in  erysipelas,  scarlet  fever, 
diphtheria  and  pyemia,  and  so  far  it  has  not 
been  possible  to  differentiate  them  in  these 
clinically  different  diseases. 

The  poison  causing  puerperal  septicaemia 
may  be  derived  from  different  sources,  such 
as  patients  suffering  from  the  same  affec- 
tion ;  patients  suffering  from  suppuration 
or  decomposition  of  tissue  ;  patients  suffer- 
ing from  zymotic  diseases,  and  from  putre- 
fying substances. 

The  contagiousness  of  puerperal  infection 
is  universally  admitted.  The  only  mooted 
point  is  whether  it  is  essential  that  the  mi- 
crobes be  carried  from  one  patient  to  an- 
other on  solid  objects,  or  whether  they  may 
float  through  the  air. 

That  the  source  of  puerperal  infection 
may  be  suppuration  was  pointed  out  by 
Semmelweis  as  early  as  1847.  Students 
who  had  examined  a  patient  with  a  cancer- 
ous ulcer  of  the  uterus  caused  puerperal 
fever  in  and  death  to  fourteen  women,  and 
the  case  of  Dr.  Rutter,  of  Philadelphia,  who 
suffered  from  ozena  and  had  45  cases  of 
puerperal  septicaemia  in  his  own  practice, 
in  one  year  (1843),  is   one  of    the  most  re- 


fRoad  before  the  North   Carolina   Medical    So- 
ciety, Asheville,  N.  C. 


markable  instances  of  this  kind.  It  is  easy 
to  understand  now  how  by  touching  his 
nose  with  his  fingers,  Dr.  Rutter  brought 
staphylococci  and  streptococci  into  the  va- 
gina or  the  uterus  of  his  unfortunate  pa- 
tients. A  French  physician  who  had  de- 
livered eight  hundred  women  without  the 
slightest  infection,  was  seized  with  suppur- 
ative adenitis,  for  which  he  wore  a  drainage 
tube.  Within  three  weeks  he  had  three 
cases  of  puerperal  septicaemia.  A  dentist. 
Dr.  Redley,  called  attention  to  diseased 
teeth  in  doctors  and  nurses  as  a  possible 
source  of  puerperal  infection. 

All  inflammatory  puerperal  diseases  are 
due  to  infection,  such  as  cellulitis,  metritis, 
and  local  peritonitis,  the  proof  of  which  is, 
that  they  almost  disappear  and  entirely 
change  character,  when  the  antiseptic  oc- 
clusion treatment  is  used.  If  no  poison 
from  without  found  its  way  into  the  body 
of  the  pregnant  or  puerperal  woman,  few 
of  them  would  be  sick  after  delivery.  In 
the  vast  majority  of  cases  the  infection  takes 
place  by  absorption  through  the  wounds  of 
the  genital  canal,  but  not  exclusively.  In 
most  cases  the  poison  is  brought  into  direct 
contact  with  the  genitals  by  the  hands  of 
the  doctors,  widwives  or  nurses  ;  by  instru- 
ments, sponges,  rags,  cotton,  oakum,  or 
other  substances,  but  it  can  quite  as  well  be 
suspended  in  the  air  of  the  rooms.  Dupaul 
reported  the  case  of  a  pupil-midwife  who, 
while  washing  the  genitals  of  a  patient  af- 
fected with  puerperal  infection,  felt  an  un- 
pleasant sensation,  was  taken  sick  in  the 
evening,  and  died  on  the  third  day  with  all 
the  symptoms  of  the  most  characteristic 
puerperal  fever.  The  diagnosis  of  puer- 
peral fever  was  confirmed  by  the  autopsy ; 
she  was  found  also  to  be  a  virgin  and  not 
menstruating.  The  natural  inference  is  that 
she  inhaled  through  the  lungs  the  poison 
that  caused  her  death.  vSuch  a  case  may  be 
unique,  but  it  ought,  nevertheless,  to  make 
us  a  little  reserved  in  our  expression  about 
the  way  the  poison  of  the  puerperal  septi- 
caemia enters  the  system. 

The  infection  will,  of  course,  be  most 
likely  to  take  place  during  the  manipulation 
of  delivery,  but  it  may  likewise  occur  before 
and  after.  Thus  we  sometimes,  although 
rarely,  find  fever  before  delivery,  and,  on 
the  other  hand,  septicaemia  may  develop  at 
a  period  when,  as  a  rule,  all  danger  is 
passed. 

The  mortality  from  puerperal  fever  be- 
fore the  use  of  antiseptics  in  midwifery, 
was  simply  enormous,  rate  being  about  10 
per  cent.,  but  now,  since  the  adoption  of 
proper  antiseptic  measures  it  is  only  ^  of  1 
per  cent.  Before  the  introduction  of  anti- 
septic measures  puerperal  septicaemia  used 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


641 


to  reign  in  so-called  epidemics.  With  our 
present  knowledge  we  can,  as  Fritsch  aptly 
puts  it,  "as  little  speaks  of  an  epidemic  of 
puerperal  fever  as  of  an  epidemic  of  gun- 
shot wounds  the  day  after  a  battle." 

I  will  be  brief  in  indicating  the  historical 
developments  of  antiseptic  midwifery.  The 
first  who  understood  the  septic  nature  of 
puerperal  fever,  and  instituted  an  antiseptic 
prophylaxis  (by  means  of  chloride)  was 
Semmelweis,  of  Vienna,  in  1847.  Still  our 
present  highly  developed  antisepsis  is  not 
derived  in  a  direct  line  from  him.  It  was 
first  when  Lister,  budding  on  the  resear- 
ches of  Pasteur,  had  created  antiseptic  sur- 
gery (1866)  that  Stadfeld  (1S70)  tried  to 
adapt  his  treatment  with  carbolic  acid  to 
midwifery,  and  he  was  soon  followed  by 
Bischoff,  of  Basel,  and  Fritsch,  of  Halle. 
From  that  time  the  use  of  carbolic  acid  in 
obstetric  practice  spread  rapidly  over  Europe 
and  America.  But  another  period  was  in- 
augurated when  Tarnier  introduced  bichlo- 
ride of  mercury,  which  he  recommended  in 
a  paper  read  before  the  International  Medi- 
cal Congress  in  London  in  1881,  and  this 
treatment  received  new  impulse  through 
the  experiment  of  Koch  of  Berlin,  and  the 
introduction  of  it  into  surgery  by  Schede  of 
Hamburg. 

The  bichloride  of  mercury,  as  a  preven- 
tive and  curative  agent,  was  then  intro- 
duced (1883)  in  many  lying  in  hospitals. 
In  America  it  was  first  introduced  by  Gar- 
rigues  in  the  New  York  Maternity  Hospital 
on  the  first  day  of  October,  1883. 

This  is  the  chief  drug  used  by  obstetri- 
cians, but  some  still  prefer  carbolic  acid, 
while  others  use  nothing.  The  latter  con- 
sequently are  continually  furnishing  the  un- 
dertakers with  plenty  of  material,  I  know 
of  a  practitioner  who,  during  the  last  six 
months,  lost  five  cases — t*vo  the  same  day 
— from  puerperal  fever.  This  practitioner 
pretended  to  use  antiseptics,  but  he  didn't 
use  them  right.  There  is  a  right  way  and 
a  very  wrong  way  to  do  all  things.  In  this 
case  the  wrong  way  was  the  easiest,  and 
seems  to  have  been  used  to  perfection. 

I  know  of  still  another  physician  who 
lost  four  or  five  cases  in  succession.  I  am 
glad  to  say  that  neither  of  the  physicians 
live  in  my  town. 

Insurance  reports  show  that  all  deaths  in 
women  between  the  ages  of  nineteen  and 
twenty-nine,  more  than  eighteen  per  cent, 
and  between  twenty-nine  and  thirty-nine, 
thirteen  percent  are  due  to  puerperal  causes. 
From  sixty-five  to  seventy  five  per  cent  are 
attributable  to  sepsis.  It  is  fair  to  assume 
that  these  statistics  have  to  do  almost  en- 
tirely with  a  class  who  are  deliveed  out- 
side   of    hospitals.      Thousands    of  invalid 


mothers  to-day  owe  their  impaired  health 
to  the  milder  grade  of  sepsis  in  childbed. 
Now  are  we  going  to  allow  this  to  con- 
tinue when  we  can  prevent  it?  Certainly 
not.  There  are  a  number  of  physicians 
to-day  who,  when  you  mention  antisepsis 
and  asepsis,  turn  their  noses  up  with  dis- 
gust and  say  "nonsense,  there  is  nothing  in 
it."  But  I  am  glad  to  be  able  to  say  that 
the  majority  of  physicians  do  use  antiseptic 
measures,  consequently  we  rarely  hear  of 
a  case  of  puerperal  septicasmia.  Only  one 
of  my  patients  ever  suffered  with  this  ter- 
rible disease,  and  she  was  one  of  the  con- 
trary kind.  There  was  a  slight  laceration 
and  she  would  not  let  me  repair  it,  nor  al- 
low the  antiseptic  douches  to  be  used,  so 
she  died  very  promptly  on  the  ninth' day 
after  confinement. 

Coming  now  to  the  preventive  treatment 
I  will  confine  my  remarks  to  private  prac- 
tice, as  we  of  course  cannot  do  every  thing 
as  neatly,  &c,  as  they  can  in  hospitals  and 
our  patients  have  to  be  treated  at  ther  homes. 
But  we  can  use  the  same  antiseptic  pre- 
caution if  not  as  neatly,  as  in  hospitals.  In 
well-to-do  families  we  should  choose  a  large, 
airy,  sunny  room,  and  as  far  as  possible 
from  the  water  closet.  In  the  dwellings  of 
the  poor  you  will  have  to  do  the  best  you 
can.  Select  the  best  room  in  the  house  and 
have  the  best  ventilation  possible.  In  my 
obstetric  bag  I  always  have  a  jar  of  green 
soap,  bichloride  of  mercury  tablets,  car- 
bolic acid,  a  sterilized  apron  and  Kelly  pad 
(also  previously  sterilized)  nail  brush, foun- 
tain syringe,  forceps,  scissors,  sutures, 
needles,  ergot  and  chloroform.  Upon  ar- 
riving at  my  patient's  house  I  proceed  at 
once  to  scrub  my  hands  and  arms  well, 
having  my  sleeves  rolled  up  above  the  el- 
bow and  then  bath  them  in  bichloride  of 
mercury  1-2000.  I  have  the  nurse  to  do 
the  same.  Next  I  direct  the  nurse  to  give 
her  an  enema,  then  have  her  to  bath  all 
parts  liable  to  be  touched  during  the  de- 
livery with  bichloride  solution.  I  then  give 
her  a  vaginal  douche  whenever  patient  has 
leuchorhea.  I  make  as  few  examinations  as 
possible,  and  always  before  and  after  each 
examination  I  bath  my  hands  in  a  2-2000 
sol.  bichloride  of  mercury  which  I  always 
have  in  a  bowl  or  basin  near  me.  I  have 
the  Kelly  pad  placed  under  patient  after 
the  nurse  has  bathed  her,  as  I  have  before 
mentioned.  Placenta  should  be  expelled 
by  Crede  method  when  possible,  so  as  to 
avoid  introducing  the  hand  into  uterus. 
When  placenta  is  retained  be  careful  to 
thoroughly  disenfect  hand  and  arm  imme- 
diately before  attempting  to  remove  pla- 
centa. Be  sure  to  remove  every  particle 
of    after    birth,    as    in  this   way  puerperal 


642 


THE  CHARLOTTE  MEDICAL  JOCTKNAU 


septicaemia  will  develop  immediately. 
Whenever  summoned  to  case  of  labor  after 
attending  a  case  of  sepsis  such  as  erysipe- 
las, puerperal  fever,  &c,  besides  using  the 
ordary  antiseptic  measures  you  should  use 
the  permanganate  method.  By  it  the  hands, 
it  is  claimed,  may  be  rendered  practically 
sterile  to  culture  tests.  It  is  as  follows : 
First,  the  nails  are  cut  short  and  carefully 
cleaned;  second,  the  hands  and  forearm 
are  scrubbed  for  three  minutes  with  soap 
and  water.  The  brush  before  using  is  steri- 
lized by  steam,  and  the  water,  which  is  as 
hot  as  can  be  borne,  is  frequently  changed. 
The  soap  is  rinsed  off  with  plain  water; 
third,  the  hands  are  next  immersed  into  a 
warm  solution  of  permanganate  of  potas- 
sium and  are  scrubbed  with  a  sterilized 
swab.  Boiled  water  should  be  used  for  the 
solution,  which  should  be  saturated  ;  fourth, 
the  hands  are  next  held  in  a  warm  saturated 
solution  of  oxalic  acid  in  boiled  water  until 
permanganate  stain  is  entirely  removed ; 
fifth,  after  rinsing  in  sterilized  water  the 
hands  are  immersed  for  two  minutes  in  a 
1-500  mencuric  chlor.  sol.  After  this 
method  any  physician  can  safely  attend 
labor  cases.  After  delivery  if  there  is  a 
laceratation  repair  it  immediately,  using 
prepared  silk,  silk  worm  gut  or  silver  wire, 
as  they  are  less  apt  to  cause  suppuration 
along  the  needle  tract.  Use  cat  gut  for 
buried  sutures.  Sutures  should  be  removed 
on  eighth  or  ninth  day.  After  delivery  you 
must  again  thoroughly  disinfect  your  hands 
and  arms,  remove  placenta  and  disinfect 
again  as  before,  then  have  soiled  parts  of 
body  thoroughly  cleaned  at  once  with  anti- 
septic solution ;  her  linen  if  necessary 
should  be  changed  and  all  blood-stained 
articles  removed  from  bed.  Bathe  genitals 
thoroughly  with  antiseptic  solution,  using 
a  piece  of  sterilized  gauze  or  fowling.  Af- 
ter cleansing  fhe  vulva  is  covered  with  an 
antiseptic  dressing.  They  are  not  employ- 
ed as  occlusion  dressing.  Their  object  is 
rather  to  promote  cleanliness  of  the  ex- 
ternal parts,  thus  limiting  the  danger  of 
infecting  the  passage  from  the  proximity 
of  the  decomposing  discharges.  Should 
catherization  be  required  after  labor,  care 
will  obviously  be  needed  to  prevent  infec- 
tion of  the  vaginal  wounds  and  abrasions, 
but  this  is  not  all — cystitis  frequently  re- 
sults from  infectious  materials  being  carried 
into  the  bladder  during  catherization.  Pye- 
litis may  result  by  the  extention  of  the  sep- 
tic process  from  the  vesical  mucosa  through 
the  ureters.  To  prevent  this  the  strictest 
asepsis  must  therefore  be  observed  in  cath- 
erterizing  the  bladder.  Instruments  should 
be  boiled  in  water  for  five  minutes  imme- 
diately before  using, and  this  is  possible  even 


with  soft  rubber  catherters  without  material 
injury  to  the  instrument.  Extreme  care 
must  be  taken  to  prevent  urine  from  trick- 
ling down  over  the  effected  parts.  After 
removing  catheter  disinfect  it  immedia- 
ly,  bathe  the  external  genitals  with  1-4000 
bichloride  mercury  sol.  (I  use  the  glass 
catheter  altogether.  It  has  the  advantage 
that  it  presents  a  perfectly  smooth  surface 
and  corner,  therefore,  a  minimum  amount 
of  urethral  irritation.  Boiling  the  instru- 
ment for  five  minutes  immediately  before 
using  renders  it  aseptic). 

During  the  lying-in  period  I  always  di- 
rect the  nurse  to  use  the  vaginal  douche 
1-4000,  twice  daily,  also  to  change  vulva 
dressing  every  three  or  four  hours,  and  after 
removing  each  dressing  bathe  the  external 
genitals.  All  linen  must  be  changed  every 
day. 

DISCUSSION. 

Dr.  Kent. — "I  listened  with  pleasure 
and  interest  to  the  well  prepared  paper  of 
Dr.  McKenzie.  I  would  be  rather  inclined 
to  criticise  Dr.  McKenzie  adversely,  but  in 
truth  I  find  no  fault  with  him,  and  must 
say  that  I  heartily  approve  of  everything 
that  Dr.  McKenzie  has  said.  I  have  been 
practicing  midwifery  antiseptically  I  think 
ever  since  I  have  been  practising  medicine, 
which  is  quite  a  number  of  years,  but  I  do 
it,  I  think,  in  a  much  simpler  way  than  Dr. 
McKenzie  advocates,  and  I  say  with  pride 
that  so  far  as  I  know  I  have  never  had  a 
case  of  puerperal  septicemia  where  I  deliv- 
ered the  case.  In  consequence  of  the  suc- 
cess I  have  had  along  that  line  I  am  going 
to  give  in  a  few  plain  words  my  manner  of 
managing  the  case  so  as  to  avoid  puerperal 
septicemia.  When  I  am  called  in  I  wash 
my  hands  thoroughly  in  a  simple  carbolized 
solution,  not  very  strong,  but  strong  enough 
as  I  think,  to  cleanse  my  hands  well.  Then 
I  use  carbolized  vaseline.  I  have  never 
taken  the  trouble  Dr.  McKenzie  advocates 
of  having  the  patient  sponged.  That  might 
be  necassary  in  some  cases,  but  I  have  not 
found  it  so,  and  I  am  inclined  to  think  from 
my  experience  that  puerperal  septicaemia  is 
not  a  very  common  disease,  or  I  might  have 
had  some  of  it  in  consequence  of  my  not 
having  been  more  thorough  in  my  treat- 
ment. Oftentimes  in  the  rush  of  human 
affairs  even  in  a  small  village,  you  do  not 
have  time  to  do  everything  that  Dr. McKen- 
zie advocates,  and  then  you  must  do  the 
best  you  can.  After  I  have  delivered  my 
patient,  within  a  few  minutes  I  deliver  the 
placenta.  I  ordinarily  have  her  sponged 
then,  the  bed  linen  changed  at  once,  and 
have  her  washed  once  or  twice  a  day  with 
a  simple  carbolized  solution.  I  instruct 
usually  that  these  washings  should  be  kept 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


643 


up  from  five  to  eight  days,  depending  upon 
the  length  of  the  discharge  or  evidence  of 
any  septic  matter  that  might  be  there. 
Where  I  have  been  called  to  cases  of  puer- 
peral septicemia  I  used  much  the  same  treat- 
ment, and  I  have  been  gratified  with  the 
quick  falling  of  the  temperature  and  the 
rapid  improvement  of  the  patient  after  I 
began  the  washing.  I  believe  that  the  best 
of  all  is  in  cleanliness,  absolute  cleanliness, 
abundance  of  fresh  air,  and  as  much  sun- 
shine as  you  can  conveniently  have. 

Dr.  McMullan. — I  am  disposed  to  agree 
with  Dr.  Kent  in  his  management  of  nor- 
mal labor.  My  record  probably  has  been 
as  good  as  the  every  day  practitioner,  and 
I  have  never  yet  found  it  necessary  to  do 
more  than  exercise  ordinary  cleanliness.  I 
would  like  to  have  one  point  brought  out, 
and  that  is  with  reference  to  the  vaginal 
douches  after  labor.  My  custom  has  been 
not  to  use  them,  and  I  would  like  to  hear 
some  expression  in  reference  to  their  use  in 
ordinary  normal  labor. 

Dr.  O'Hagan. — I  am  opposed  to  vagi- 
nal douches,  and  it  has  been  established 
without  doubt  that  the  discharges  them- 
selves are  the  best  antiseptics  we  have. 
The  difficulty  and  annoyance  of  using  vagi- 
nal douches  does  harm  to  the  patient  in  the 
way  of  disturbing  her,  and  I  think  among 
the  most  advanced  and  enlightened  obste- 
tricians the  method  is  not  approved.  I  do 
not  think  they  are  of  value,  and  should  be 
condemned. 

Dr.  Watson. — I  cannot  agree  with  Dr. 
O'Hagan  about  the  harmfulness  of  vaginal 
douches.  1  think  the  best  time  to  use  them 
is  by  the  vagina  in  the  early  stages.  I  am 
sure  it  makes  the  patient  a  great  deal  more 
comfortable.  I  have  tried  both  methods, 
and  my  patients  invariably  call  for  the 
douches.  In  regard  to  the  rare  occurrence 
of  .sepsis  following  labor,  I  have  not  had 
the  same  experience-  Dr.  Kent  has.  I  feel 
it  my  duty  to  proceed,  as  this  gentleman  in 
his  paper  advocated,  to  deal  cautiously  with 
every  case.  I  think  we  have,  most  of  us, 
met  with  cases  where  there  is  septic  infec- 
tion and  various  other  things  of  that  kind. 
In  regard  to  the  use  of  the  douche  after 
labor  as  an  antiseptic  protection,  I  do  not 
think  that  is  necessary.  I  think  that  vagi- 
nal douches  and  washing  off  with  bichloride 
solution  after  delivery  will  dispense  with 
the  use  of  the  douches.  I  am  opposed  to 
post-partem  douches  unless  they  are  called 
for  especially. 

Dr.  Royster. — The  only  point  about 
which  Dr.  McKenzic  has  overstepped  the 
hounds  is  in  recommending  the  use  of 
douches  in  leucorrhea  cases.  My  practice 
has  been  not  to  use  douches  in  normal  labor. 


I  believe  Dr.  Kent  has  been  very  lucky.  I 
am  sure  if  I  had  omitted  any  link  in  the 
chain  of  my  usual  precautions  I  would  have 
had  a  case  of  puerperal  fever  on  my  hands. 
I  have  no  record  to  speak  from,  because  my 
experience  has  been  too  small,  but  it  seems 
to  me  we  are  called  upon  to  be  just  as  care- 
ful in  our  ordinary  midwifery  as  we  are  in 
surgical  practice.  I  think  that  a  man  should 
use  a  stiff  brush  and  plenty  of  soap  and  wa- 
fer, and  some  chemical  preparation  after- 
wards. I  think  if  that  is  done  the  rest  of 
the  conduct  of  antisepsis  in  keeping  the 
hands  clean  will  be  very  easy.  I  was  much 
interested  in  an  article  by  Dr.  Edgar  some 
time  ago  on  the  practical  management  of 
normal  labor.  He  quoted  statistics  from 
Williams  and  others  to  prove  that  there 
were  no  germs  subsisting  normally  in  the 
lochia.  I  have  seen  a  great  many  articles 
on  the  study  of  practical  asepsis  for  labor, 
but  there  are  very  few  which  tell  the  gen- 
eral practitioner  what  he  wants  to  know  in 
ordinary  practice.  They  talk  about  steril- 
ized sheets  and  sterilized  gowns  and  things 
of  that  kind,  but  they  do  not  talk  about  the 
sterilized  finger.  The  germs  do  not  exist 
normally  in  the  vagina.  My  experience 
has  not  been  large  enough  to  make  any  fur- 
thur  observations,  but  I  think  we  all  learn 
that  most  of  the  trouble  comes  trom  per- 
sonal contact  either  from  the  doctor  or  the 
nurse.      It  is  not  medicine. 

Dr.  Herring, — What  little  we  all  know 
about  medicine  in  my  opinion  we  learn  by 
experience.  We  have  learned  that  a  dose 
of  castor  oil  affects  the  bowels  if  we  take  it. 
We  know  that  it  will  act  in  a  uniform  man- 
ner with  but  few  exceptions.  I  can  only 
reason  from  facts.  I  cannot  manufacture 
theories,  neither  can  I  get  a  theory  from 
anything  but  a  known  fact.  I  wish  simply 
to  relate  a  case.  It  was  the  case  of  a  pau- 
per patient  who  had  miscarried  at  three 
months.  She  miscarried  two  days,  the  foe- 
tus had  discharged  promptly  as  it  usually 
does,  and  left  the  balance  behind.  When 
I  went  to  see  her  she  had  a  temperature  of 
106.  She  had  all  the  cover  in  the  house 
piled  on  her,  and  she  was  shivering.  I 
found  that  the  afterbirth  was  still  adhering 
to  the  uterus.  I  told  her  the  necessity  for 
getting  it  out.  I  went  back  to  get  instru- 
ments, and  told  her  to  have  some  hot  water, 
and  told  her  to  send  for  some  old  woman 
who  would  do  what  I  said  to  do  without 
asking  any  questions.  When  I  got  back 
the  hot  water  was  there  and  the  old  woman 
was  there.  I  put  her  on  a  table,  put  her  on 
her  side  and  tried  to  detach  the  placenta.  I 
could  not  get  it  with  my  finger.  I  never 
have  been  able  to  get  one  with  my  finger 
yet,  but  I  went  in  with  instruments.       The 


THE  CHARLOTTE  MEDICALi JOURNAL. 


placenta  was  absolutely  in  a  state  of  decay. 
I  worked  with  her  for  two  hours.  I  got 
every  particle  out  that  I  could.  I  don't 
know  whether  I  got  any  microbes  or  not. 
I  didn't  see  them.  I  cleansed  her  as  best  I 
could  with  hot  water.  After  I  got  every- 
thing I  could  with  the  instrument  I  took  a 
syringe  and  introduced  the  nozzle  into  the 
uterus,  and  washed  it  clean  and  took  hot 
water  and  pumped  in  there.  I  pumped  in 
about  three  gallons.  I  took  it  out  and  had 
her  washed  outside.  I  put  her  back  to  bed 
and  her  temperature  was  98^.  It  never 
went  above  that  temperature  any  more, and 
she  never  took  a  drop  of  medicine.  I  want 
to  ask  this  question  :  If  the  germs  produced 
all  that  disturbance  in  her  system,  caused  a 
temperature  of  106,  and  she  was  in  a  pro- 
fuse cold — cold  to  the  hand,  but  hot  to  the 
thermometer,  I  want  to  ask  whether  the 
microbes  causing  all  this  disturbance,  and 
which  you  need  a  powerful  microscope  to 
see,  is  it  possible  that  I  took  them  out  with 
a  pair  of  dressing  forceps?  Here  was  a 
woman  having  chill  after  chill,  in  profuse 
perspiration,  with  pure  and  unadulterated 
septicemia,  and  all  I  did  was  to  cleanse  out 
her  womb  with  forceps  and  pump  in  hot 
water  until  I  could  not  get  a  trace  of  color- 
ed matter.  I  ask  this  Society  to  tell  me 
what  caused  that  temperature  and  what 
caused  it  to  go  away. 

Dr.  J.  W.  Long. — If  Dr.  Herring  had 
looked  for  those  microbes  with  a  microscope 
he  probably  would  have  found  them.  I  am 
familiar  to  some  extent  with  Dr.  McKen- 
zie's  obstetrical  work,  and  if  his  method 
may  be  dominated  meddlesome  midwifery 
then  it  gives  good  results,  for  I  know  he 
attains  excellent  results.  I  agree  with  Dr. 
Royster  that  the  same  precautions  should 
be  taken  in  preparing  ones  hands  for  an 
obstetrical  case  as  in  surgical  practice.  If, 
as  most  of  us  believe,  these  little  microbes 
or  bacteria  may  be  destroyed  or  gotten  rid 
of  by  the  use  of  mechanical  measures  and 
antiseptic  drugs,  then  it  seems  to  me  to  be 
rational,  to  be  good  common  sense  treat- 
ment and  a  common  sense  method  to  scrape 
and  wash  and  use  antiseptics  until  we  free 
our  hauds  and  the  genitals  from  bacteria. 
It  has,  I  think,  been  clearly  shown  that  the 
germs  have  their  normal  habitat  in  the  up- 
per part  of  the  vagina  and  even  in  the  ure- 
thral canal.  None  are  found  beyond  the 
os  in  a  normal  healthy  uterus.  I  agree, and 
my  practice  is  when  there  is  no  leucorrhea, 
there  should  not  be  used  any  vaginal  douches 
before  labor.  The  gist  of  Dr.  McDenzie's 
paper  is  that  he  is  striving  to  attain  asepsis 
and  that  he  is  working  to  free  his  hands 
and  the  genitals  from  these  germs,  and  I 
believe  that   that    is  the    basis    of    all  good 


surgery,  and  I  believe  we  ought  to  observe 
an  obstetrical  case  as  a  surgical  case,  and 
treat  it  after  the  same  general  principles. 

Dr.  McBrayer. — In  regard  to  the  vagi- 
nal douches,  I  would  be  willing  to  use  it 
after  every  labor  grovided  I  had  a  trained 
nurse  to  administer  it,  but  in  the  absence  of 
a  trained  nurse  I  think  it  is  not  only  not 
necessary,  but  I  think  it  is  dangerous  to  use 
these  common  syringes  that  lay  around  the 
house  in  the  dirt  and  to  use  the  vaginal 
douch  after  normal  labor.  You  all  down 
east  may  be  fortunate  enough  to  have  a 
trained  nurse  with  every  case  of  obstetrics, 
but  we  up  here  are  not  quite  so  fortunate, 
and  the  younger  members  of  our  profession 
are  so  rushed  that  they  have  not  the  time 
to  administer  the  douche  themselves,  so 
under  those  circumstances  I  am  opposed  to 
giving  the  douche.  Theory  is  a  nice  thing, 
and  I  am  sorry  that  all  our  theories  do  not 
prove  to  be  correct.  I  just  want  to  tell 
you  what  a  young  doctor  said  to  me  one 
day.  The  old  doctor  referred  to  is  a  mem- 
ber of  this  Society,  and  if  I  called  his  name 
you  would  all  revere  and  honor  it.  The 
young  doctor  happened  to  practice  in  the 
same  neighborhood,  and  he  came  to  me  one 
day  and  said  :  "I  cannot  understand  it. 
Here  I  go  to  a  case  of  labor  and  use  all  anti- 
septic precautions,  and  yet  I  have  a  number 
of  cases  of  septicemia  and  my  patients  die, 
while  my  friend  and  colleague  never  washes 
his  hands.  He  even  goes  to  the  stable  and 
hitches  his  own  horse  and  goes  on  and  never 
has  had  a  case  of  septicemia."  I  don't 
know  what  that  proves,  but  I  understand 
it  is  true. 


President's   Address. 

Annual  Meeting  of  N.  C.  Medical  Society, 
As/ieville,  N.  C,  May  30-  June  2,  '99. 

Gentlemen  of  the  N.  C.  Medical  Society' 

I  congratulate  you  upon  this  your  third 
meeting  in  this  delightful  city  of  the  moun- 
tains where  there  is  so  much  to  charm 
the  eye  and  elevate  the  mind.  In  this  in- 
spiring clime  your  faculties  will  doubtless 
appear  at  their  very  best.  Since  the  aband- 
onment on  the  part  of  your  presiding  offi- 
cers of  the  old  time  custom  of  delivering 
an  address  upon  some  medical  subject,  my 
immediate  predecessors  in  office  have  adopt- 
ed a  course  of  discussing  questions  of  pas- 
sing interest  or  of  importance  for  the  better 
government  of  your  body.  I  can  see  no 
reason  why  I  should  not  follow  this  well 
beaten  track.  Much  ground  has  been  gone 
over,  and  in  some  instances  we  have  found 


*Read  before  the  North  Carolina  Medical  So- 
ciety at  Asheville,  N.  C. 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


645 


it  expedient  to  retrace  our  steps.  I  hope 
now  that  we  have  reached  a  position  suffi- 
ciently high  to  almost  adopt  the  motto  of 
"Nulla  vestigia  retrorsum."  I  heartily 
congratulate  you  upon  the  most  distinctive 
and  by  far  real  advancement  you  have  had 
in  many  years.  It  is  a  complete  attain- 
ment of  the  wishes  and  purposes  of  your 
most  advanced  thinkers  for  years.  Many 
eloquent  pleas  have  been  made  for  a  higher 
standard  of  medical  education  in  this  State. 
A  number  of  plans  to  reach  this  end  have 
been  discussed  and  proposed  by  your  former 
presidents.  To  their  constant  repetition 
of,  and  urging  this  question  we  owe  its 
happy  solution  at  least.  "The  Gordion 
Knot"  has  been  severed  at  one  stroke  by 
legislative  enactment.  The  passing  of  the 
act  to  require  applicants  for  license  to  prac- 
tice medicine  in  this  State  to  exhibit  a  dip- 
ploma  from  some  medical  College  having 
clinical  facilities,  and  a  minimum  curricu- 
lum for  three  full  years  of  study  is  a  wise 
one,  and  I  feel  sure  will  meet  with  your 
unqualified  endorsement.  Unstinted  praise 
is  due  to  the  efforts  and  wisdom  of  your 
committee  on  medical  legislatson,  and  par- 
ticularly to  its  chairman  in  securing  the 
passage  of  this  law.  It  was  a  fortunate 
circumstance  that  this  society  had  a  strong 
representation  in  the  Legislature.  It  is  a 
source  of  gratification  that  in  recent  years 
every  Legislature  contains  some  of  your 
formost  members  who  always  guard  your 
interest  with  watchful  care.  This  law 
should  mark  a  new  era  in  the  history  of 
your  progress.  From  this  time  forward  the 
records  of  the  Hoard  of  Medical  Examineers 
will  show  a  greatly  decreased  percentage 
in  its  rejections  and  re-examinations.  The 
duties  of  the  Examining  Board,  instead  of 
being  as  heretofore  trying  and  burdensome 
in  the  extreme,  will  be  light  and  pleasant. 
The  probability  of  any  applicant  for  license 
being  rejected  as  many  as  five  or  six  times 
is  hardly  to  be  considered.  So  that  all  fu- 
ture boards  are  to  be  facilitated  upon  the 
passage  of  this  measure.  All  this  has  been 
accomplished  by  the  passage  of  this  meas- 
ure. All  this  has  been  accomplished  by 
the  sentiment  id'  a  united  profession.  At  the 
first  Inter-State  conference  of  the  Examin- 
ing Board  held  in  Washington  two  years 
since,  Dr.  Rauch,  President  of  the  Illinois 
Medical  Society,  severely  criticised  the 
medical  law  of  North  Carolina,  in  that  it 
admitted  to  examination  all  classes  of  ap- 
plicants without  regard  for  educational 
qualifications.  The  lamented  and  beloved 
Dr.  Thomas  S.  Wood,  joined  with  me  in 
defence  of  our  law,  while  we  were  painfully 
aware  of  its  defects.  To  such  constant  and 
zealous  workers  as  Dr.  Wood    do    we    owe 


the  present  comparative  efficiency  of  our 
medical  law,  after  which  in  the  main  other 
States  have  been  modelled.  You  have  been 
the  pioneer  of  medical  legislation  in  this 
country;  and  if  you  cherish  this  spirit  of 
progress,  as  no  doubt  you  will,  you  will 
always  maintain  a  position  with  the  fore- 
most medical  societies  of  this  country. 
From  your  constant  education  of  the  peo- 
ple you  have  at  last  secured  their  moral 
support,  and  they  are  looking  to  you  to-day 
to  devise  methods  to  stay  or  prevent  the 
march  of  disease.  1  can  very  well  remem- 
ber, and  so  can  many  of  you,  when  it  was 
thought  by  many  of  the  laity  that  the  medi- 
cal society  was  only  organized  to  maintain  a 
standard  of  high  charges  for  services,  and 
expressed  great  surprise  when  told  that  no 
such  thing  had  ever  been  discussed  in  a 
meeting.  Now,  whenever  there  is  a  medi- 
cal convention,  the  newspapers  are  eagerly 
read  to  learn  what  the  doctors  are  doing  to 
prevent  or  cure  disease.  We  are  often 
asked  after  a  return  from  our  conventions, 
after  the  usual  inquiries  as  to  the  personel 
of.  the  new  officers,  if  anything  has  been 
found  out  to  cure  cancer  or  consumption  ; 
they  read  and  ask  about  germs,  too. 

But  a  few  weeks  since  a  distinguished 
United  States  Senator  gravely  informed  me 
that  pneumonia  was,  beyond  controversy, 
caused  by  germs,  and  that  turpentine  would 
certainly  kill  the  germs  and  cure  pneu- 
monia. I  promptly  excused  him  for  sug- 
gesting turpentine  on  the  ground  of  State 
pride  and  loyalty  to  a  North  Carolina  pro- 
duct. This  is  in  strong  contrast  to  the 
preacher,  who  a  few  days  after,  asked  if  I 
believed  vaccination  would  prevent  small 
pox.  It  is  probable  that  he  had  been  read- 
ing the  "London  Anti-Vaccination  Re- 
ports." 

The  utility  of  the  Board  of  Health  is 
recognized  by  the  people  of  the  State.  The 
recent  bi-ennial  report  is  a  credit  to  its  offi- 
cers, and  compares  favorably  with  the  re- 
ports of  any  other  State.  No  water  com- 
pany can  now  set  itself  up  in  business  in 
any  town  in  this  State  without  proper  con- 
sultation with,  and  advice  from  competent 
medical  authority.  It  has  come  to  be  known 
that  no  one  can  jeopardize  the  health  of 
another  or  of  a  community  without  let  or 
hindrance.  In  any  sudden  outbreak  of 
disease  in  the  country,  town  or  city,  the 
help  of  our  health  officers  is  at  once  in- 
voked to  abate  it.  An  apt  illustration  of 
this  is  furnished  by  the  recent  development 
of  small-pox  cases  in  various  sections  of  the 
State,  and  if  any  proofs  are  needed  to  show 
the  efficiency  of  the  work  of  the  State 
Board  of  Health  and  its  Auxiliary  County 
Boards,  they  are  ample.     The  people    now 


646 


THE  CHARLOTTE  MEDICAL  JOURNAL 


look  upon  these  boards  of  health  as  matters 
of  necessity,  and  appeal  to  their  officers 
for  help  in  the  hour  of  danger.  The  State 
Board  of  health  within  the  last  year  has 
held  conferences  with  the  people  upon  in- 
terests pertaining  to  the  public  health  in 
different  towns  in  the  State.  These  con- 
ferences should  be  encouraged,  and  held 
oftener,  as  they  have  proven  useful  object 
lessons  in  helping  to  educate  the  people  to 
a  knowledge  of  hygienic  laws.  They  have 
begotten  a  confidence  on  the  part  of  the 
people  on  all  matters  pertaining  to  the  laws 
of  health.  It  has  taken  many  years,  pa- 
tient zeal  and  work  to  bring  about  these  re- 
lations between  the  people  and  the  profes- 
sion. Many  of  those  who  worked  for  years 
to  accomplish  this  end  have  gone  to  their 
last  reward,  leaving  us  to  continuously 
build  upon  the  foundations  so  wisely    laid. 

I  am  rejoiced  to  say,  in  your  membership, 
there  are  young  men  full  of  ambition,  and 
thoroughly  qualified  by  reason  of  profes- 
sional attainments  to  carry  on  this  work. 
Let  us  encourage  the  ambitions  and  hopes 
of  the  members,  and  teach  them  to  know 
the  society  will  reward  their  allegiance  by 
bestowing  on  them  their  full  share  of  its 
honors. 

Since  our  last  meeting  there  have  been 
two  events  which,  in  their  nature,  as  affect- 
ing the  interest  of  this  society,  demand  our 
attention.  I  refer  to  the  organization  and 
convention  of  the  Seaboard  and  Tri-State 
Medical  Societies,  the  former  consisting  of 
a  membership  of  the  doctors  of  the  Tide 
Water  Section  of  Virginia  and  North  Car- 
olina, and  the  latter  of  members  of  the  Vir- 
ginia, North  and  South  Carolina  Medical 
Societies.  These  matters  you  will  have  to 
consider  and  decide  what  your  attitude  and 
relations  shall  be  toward  these  bodies.  To 
a  certain  extent  they  are  off-shoots  from  this 
Society.  The  question  that  confronts  you 
mainly  is,  will  they,  and  in  what  way,  affect 
your  interest  and  growth.  I  am  fully  satis- 
fied that  they  will  seriously  injure  this  So- 
ciety, and  the  reasons  are  plain  enough. 

They  must  in  a  measure,  depend  upon 
the  profession  for  their  membership  and 
support.  This,  our  Society,  is  largely  made 
up  of  country  doctors.  The  average  doctor 
can  not  pull  away  from  his  business  more 
than  once  in  any  year  to  attend  a  society 
meeting,  even  if  he  could  afford  the  ex- 
pense. If  he  belonged  to  all  of  these  so- 
cieties, he  has  a  divided  interest,  and  the 
chances  are  strong  that  he  would  adhere  the 
closer  to  the  society  that  to  the  greatest  de- 
gree furthered  his  aims  or  gratified  his  am- 
bitions. 

If  there  are  are  to  be  two  or  three  society 
meetings  during  the   year  in  North  Caroli- 


na, it  is  but  natural  that  any  member  of 
either  society,  will  attend  the  most  conve- 
nient. The  exigencies  of  convenience  are 
more  often  followed  than  the  dictates  of 
loyalty.  The  members  that  attend  these 
new  organizations  will  hardly  be  induce'd 
to  attend  the  State  Society.  The  officers 
of  these  new  bodies  will  strive  to  make  their 
meetings  successful.  Recent  converts  are 
almost  always  the  most  zealous.  I  think  we 
will  make  a  grave  error,  and  one  not  easily 
remedied,  to  encourage  any  organizations 
that  must  tend  to  cause  a  division  of  profes- 
sional interests,  and  lessen  that  power  for 
professional  advancement  which  this  socie- 
ty has  so  faithfully  and  earnestly  worked 
for  through  long  years.  A  Society  formed 
of  material  outside  of  North  Carolina  can, 
and  will  not  feel  the  same  pride  and  inter- 
est in  professional  growth,  as  one  belong- 
ing exclusively  to  the  State.  This  Society 
has  the  highest  claims  upon  your  loyalty, 
and  cannot  afford  to  further  any  interests 
to  divide  the  profession. 

Of  the  making  of  Medical  Societies  there 
is  no  end.  If  this  thing  goes  on,  Western 
North  Carolina  might  unite  with  East 
Tennessee  to  form  a  Trans-Mountain  Med- 
ical Society,  and  the  middle  section  of  the 
State  might  also  organize  a  Central  Medi- 
cal Association.  All  of  these  would  leave 
us  with  a  name  only.  I  most  earnestly 
submit  that  there  is  ample  room  in  the  State 
Medical  Society  for  the  entire  profession  of 
the  State.  It  is  only  to  be  regretted  that 
there  are  not  officers  enough  to  go  around 
at  every  meeting. 

If  any  of  you  have  ambitions  beyond  the 
State  limits,  the  arms  of  the  A.  INI.  A.  are 
wide  open  to  receive  you,  and  will  give 
you  every  opportunity  to  gratify  them ; 
and  its  Journal  stands  ready  to  print  and 
disseminate  your  papers,  This  seems  to 
me  encouragement  enough  to  broaden  out 
medically  beyond  the  State  lines,  so  to 
speak.  So  let  us  enter  a  solem  resolution 
here  to  stand  by  the  State  Medical  Society, 
and  encourage  no  others  in  conflict  with 
its  interests.  The  Tri-State  has  incorpor- 
ated in  its  by-laws  a  provision  that  mem- 
bership in  one  of  the  State  Societies  shall 
be  a  pre-requisite  to  membership  in  that 
body.  It  judiciously  halts  there.  If  the 
provision  had  said  that  continuous  member- 
ship it  might  have  been  more  plausible. 

It  has  been  my  intention  for  several  years 
to  bring  to  your  attention  a  matter  which  I 
consider  more  worthy  of  the  most  careful 
consideration.  The  occasion  seems  now 
ripe  for  it,  the  membership  being  sufficient- 
ly large  to  properly  maintain  it.  We  are 
constantly  reminded  of  the  fact  that  doctors 
are     not    business-like     in    their     methods. 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


647 


Their  time  is  taken  up  with  other  thoughts 
than  of  money  getting.  They  lay  up  litsle 
in  this  world,  but  immense  treasures  in 
heaven,  where  they  may  be  of  service  to 
them  in  the  hereafter,  but  can  surely  be  of 
no  earthly  use  to  their  wives  and  children 
who  were  dependent  upon  them  for  food 
and  raiment,  and  also  for  their  social  posi- 
tion in  the  community.  It  is  no  matter  of 
hearsay,  but  of  direct  personal  knowledge 
that  ih  many  instances  in  the  house  of  the 
dead  doctor  there  was  not  enough  ready 
cash  to  give  him  a  decent  burial,  while 
there  was  a  small  fortune  in  unpaid  and 
non-collectable  accounts  on  his  books. 
This  is  a  sad  commentary,  and  if  any  plan 
can  be  devised  by  which  the  families  of  our 
dead  members  can  be  benefitted,  it  is  a  con- 
summation devoutly  to  be  sought  for.  If 
I  can  succeed  in  pointing  out  a  way  I  shall 
feel  that  my  mission  has  not  been  in  vain. 
Whatever  has  been  accomplished  by  other 
Medical  Societies,  surely  you  can  do  also. 
I  learn  from  the  Polyclinic  that  the  New 
York  physicians  Mutual  Aid  Association 
was  organized  thirt)  years  ago.  That  jour- 
nal says;  "The  record  of  success  attained 
by  a  movement  originating  primarily  as 
a  philanthropic  charity  is  most  remarkable. 
When  first  established  in  1868  the  object 
was  to  afford  aid  to  worthy  medical  men  in 
circumstances  of  need,  and  to  assist  finan- 
cially the  widow,  if,  as  is  only  too  often 
the  case,  she  should  be  left  destitute.  From 
such  a  beginning  with  a  membership  of  less 
than  twenty  and  an  insurance  feature  rare- 
ly exceeding  an  amount  sufficient  to  afford 
a  decent  burial,  an  association  has  develop- 
ed numbering  1,450  physicians,  and  paying 
a  fixed  sum  of  $1,000  insurance,  within  a 
maximum  period  of  five  days  after  death, 
the  cost  of  such  insurance  being  less  than 
$18  per  thousand.  This  record  embodies  a 
suggestive  lesson  to  communities.  A 
thousand  dollars  in  cash  is  a  very  desirable 
heritage,  especially  in  country  communities. 
There  is  no  good  reason  why  every  State 
Society  in  the  Union  could  not  either  alone 
or  in  conjunction  with  neighboring  States, 
organize  and  maintain  successfully  such  an 
institution. 

Almost  as  long  ago  as  I  can  remember 
anything  medical,  my  grand  "Old  Master," 
Prof,  (iross,  whose  name  1  always  speak 
with  reverence,  was  trying  to  introduce 
this  feature  in  the  Philadelphia  Medical 
Society.  The  members  of  the  So.  Exp. 
Co.,  and  Brotherhood  of  Locomotive  Engi- 
neers, have  had  this  feature  in  successful 
operation  for  years.  Why  should  we  not 
have?  I  hope  you  can  formulate  and  adopt 
a  plan  to  carry  out  these  suggestions. 

Last    year  at   our  convention   there    was 


some  discussion  as  to  the  propriety  of  es- 
tablishing reciprocal  relation  between  the 
North  Carolina  and  Virginia  examining 
boards.  No  definite  conclusion  was  reach- 
ed as  to  any  method  to  attain  this  end. 
For  many  reasons  I  have  long  thought  there 
should  be  an  interchange  of  licenses  be- 
tween these  boards.  I  now  propose  a  com- 
mittee of  conference  between  the  boards, 
and  let  this  committee  settle  upon  a  modi- 
fied plan  of  examination  for  licentiates  of 
one  board  applying  to  the  other.  North 
Carolina  board  has  discretionary  authority 
as  to  the  method  and  scope  of  examination, 
and  it  is  probable  that  the  Virginia  board 
is  empowered  with  some  latitude. 

There  are  quite  a  number  of  our  members, 
who  in  recent  years,  by  reason  of  their  ap- 
pointments, have  become  interested  in  rail- 
way surgery.  This  branch  of  surgery  seems 
now  as  distinctive  as  any  other,  and  certain 
journals  devote  t©  it  a  considerable  portion 
of  their  space.  I  would  suggest  for  your 
consideration  the  creation  of  a  new  section 
to  be  styled  "The  Section  on  Railway  Sur- 
gery." The  chairman  of  such  a  section  can 
introduce  many  matters  of  interest  in  sur- 
gery as  well  as  in  medical  jurisprudence. 
I  would  also  recommend  the  establishment 
of  a  section  in  Paadiatrics.  "  These  matters 
are  in  keeping  with  the  trend  of  medical 
thought,  and  I  believe  deserve  your  consid- 
eration. 

I  shall  trust,  gentlemen,  to  your  kind 
patience  to  help  me  perform  the  duties  of 
your  presiding  officer. 


Asepsis  and  Antisepsis   in  Surgery. f 

By  Dr.  Goode  Cheatham,   Henderson,  N.  C. 

The  practice  of  asepsis  and  antisepsis  is 
no  longer  a  subject  for  argument  or  contro- 
versy in  the  surgical  world,  Surgery  has 
made  such  rapid  progress  since  the  intro- 
duction of  the  "antiseptic  method"  of  Sir 
Joseph  Lister,  that  nearly  all  opposition  to 
asepsis  and  antisepsis  has  disappeared.  It 
has  become  an  integral  part  of  the  practice 
of  the  majority  of  surgeons  all  over  the 
world  ;  yet  there  are  a  few  surgeons  of  to- 
day who  will  operate  without  any  antisep- 
tic precautions  whatever,  while  others  use 
very  little,  thereby  exposing  their  patients 
to  infections  which  may  prove  fatal.  Among 
some  of  the  advances  made  in  surgery,  due 
te  asepsis  and  antisepsis,  may  be  mentioned 
the  abdominal  surgery  of  to-day.  No  sur- 
geon would  hesitate  to  open  the  abdominal 
cavity  now,  when  only  a  few  years  ago  it 
was  considered  almost  certain  death.      The 


fRead  before  the  North  Carolina  Medical  So- 
ciety at  Asheville,  N.  C. 


THE  CHARLOTTE   MEDICAL  JOURNAL. 


number  of  successful  abdominal  operations 
in  cases  of  gun-shot  wounds  of  the  intes- 
tines is  proof  enough  to  justify  the  employ- 
ment of  every  antiseptic  precaution  in  all 
operations  and  wounds,  for  without  it  we 
are  sure  to  have  suppuration  and,  in  many 
instances,  septicaemia. 

Reports  from  the  last  war  show  that  a 
very  small  percentage  of  wounds  of  Amer- 
ican soldiers  proved  fatal,  which  was  due 
to  the  rigid  antiseptic  methods  employed. 
Each  soldier  was  provided  with  an  emer- 
gency outfit,  consisting  of  a  piece  of  sterile 
gauze,  a  handkerchief  with  illustrations  and 
stamped  instructions  for  bandaging  every 
part  of  the  body.  These  immediate  anti- 
septic precautions,  with  the  care  of  the  sur- 
geons in  the  hospitals,  gives  American  sur- 
gery a  great  triumph.  Compound  fractures 
have  been  considered  among  the  most  dan- 
gerous accidents,  but  now  little  more  than 
simple  ones,  while,  in  amputations,  the 
mortality  rate  is  almost  nothing. 

A  review  of  the  actual  status  of  the  life- 
saving  value  of  antiseptic  method  certainly 
justifies  its  use  under  all  circumstances.  If 
the  only  claim  that  could  be  made  for  the 
antiseptic  method  was  that  it  made  the  pa- 
tient more  comfortable,  hastened  the  heal- 
ing of  wounds,  or  rendered  an  operation 
safer,  it  immediately  becomes  the  impera- 
tive duty  of  every  surgeon  to  adopt  it. 

Since  the  advent  of  Lister's  method  with 
its  elaborately  prepared  dressings,  its  power- 
ful germicides,  and  its  troublesome  appa- 
ratus, there  has  been  slow,  but  sure  tenden- 
cy to  simplify  these  methods.  Simplicity, 
cleanliness  and  the  weaker  antiseptic  solu- 
tions have  gained  predominence  over  the 
above  method.  The  use  of  powerful  ger- 
micides upon  a  wound  surface  is  falling  into 
disuse,  and  rightly  so,  for  it  has  been  proven 
that  a  wound  subjected  to  this  undue  irri- 
tation does  not  heal  as  promptly,  for  this 
solution  destroys  the  resistance  and  antisep- 
tic action  of  the  living  cells,  which  will,  if 
not  interfered  with,  render  the  few  germs 
inactive,  which  may  gain  entrance  during 
an  operation  conducted  in  accordance  with 
the  improved  methods  of  modern  surgery. 
It  will  also  cause  undue  serous  exudation. 
There  is  also  some  danger  of  poisoning  from 
the  use  of  strong  solutions  of  bi-chloride 
and  carbolic  acid,  and  also  from  the  use  of 
iodoform,  but  these  cases  are  very  rare,  in 
fact  too  rare  to  deserve  mention.  The  sim- 
ple methods  of  sterilization,  which  give 
better  results,  are  due  to  the  practical  teach- 
ings given  us  by  the  abdominal  surgeons. 
Now  the  surgeon  uses,  after  his  first  incis- 
ion, weak  bi-chloride  solutions,  simple  boil- 
ed water,  or  boiled    normal    salt   solutions, 


reserving  his  strong  antiseptic  solutions  for 
cleansing  sponges,  tampons,  etc. 

Infection  from  the  germs,  which  enter 
wounds  through  the  medium  of  air,  is  rare, 
but  that  it  may  occur  by  this  means  is  not 
in  the  least  impossible.  The  most  impor- 
tant steps  to  be  taken  to  prevent  infection 
are  the  careful  preparation  of  the  patient, 
the  rendering  aseptic  the  hands  of  the  oper- 
ator and  assistants,  and  also  the  thorough 
sterilization  of  instruments,  sponges,-  liga- 
tures and  dressings.  The  most  approved 
methods  of  asepsis  and  antisepsis  of  to-day 
should  be  familiar  to  every  surgeon.  These 
methods  can  be  found  discussed  in  detail  in 
any  standard  work  on  surgery. 

Recently,  for  disinfection  of  instruments 
and  dressings,  formaldehyde  gas  has  become 
very  popular  with   some  of   the   profession. 

The  following  are  some  of  the  experi- 
ments with  formaldehyde  gas,  as  a  means 
of  disinfecting  instruments  and  dressings. 
The  apparatus  used  contains  about  six  cubic 
feet.  Using  four  pastilles  of  paraform,  it 
was  possible  to  render  the  piece  of  gauze 
that  had  been  dipped  in  a  pure  culture  of 
anthrax,  sterile  in  ten  minutes,  but  if  a 
piece  of  gauze  was  wrapped  in  seven  or 
eight  layers  of  gauze  and  this  bundle  envel- 
oped in  three  thicknesses  of  foolscap  paper, 
twenty  minutes  were  required  for  steriliza- 
tion. The  only  disadvantage  noted  was 
that  on  opening  the  box  the  escaping  gas 
caused  considerable  irritation  of  the  eyes  of 
those  in  the  room.  With  regard  to  the  ef- 
fect on  instruments,  it  was  found  that 
neither  the  gas  nor  the  liquid  formaline  had 
any  influence  whatever  upon  the  sharpness 
of  the  instruments.  For  the  disinfection  of 
small  instruments,  such  as  those  used  by 
ophthalmologists,  otologists,  laryngologists 
and  dentists,  it  is  by  far  the  most  conve- 
nient and  speedy  method.  This  method, 
probably  better  than  any  other  for  the  work 
designed,  carries  out  the  principles  of  dis- 
infection laid  down  by  Koch,  viz.  :  "tbfl 
absolutely  certain  destruction  of  all  patho- 
genic organisms,  in  the  shortest  possible 
time,  at  the  least  expense  and  with  a  mini- 
mum injury  to  the  object  of  disinfection." 
For  practical  purposes  ten  or  fifteen  minutes 
is  a  short  enough  time  for  the  sterilization 
of  instruments,  and  this  can  be  done  with 
five  or  three  grains  of  paraform. 


Chronic  Gastro-Intestestinal  Catarrh. t 

By  Dr.  Win.  J.  McAnally,  High  Point,  N.  C. 

Chronic  Gastro-Intestinal    Catarrh  is  by 
no  means  an  infrequent  disease,  I  realize  its 

fRoad  before  the  North   Carolina   Medical    So- 
ciety, Asheville,  N.  C. 


THE  CHARLOTTE  MEDICAL   JOURNAL. 


649 


importance  and  am  conscious'of'my  inabili- 
ty to  do  justice  to  such  a  broad"  subject  in 
this  paper.  But  if  I  shall  succeed  in  draw- 
ing out  discussion  then  my  labor  is  not  in 
vain.  These  old  dyspeptics  of  whom  I  shall 
speak  have  suffered  a  great  deal  and  have 
been  despondent  and  cross  a  long  time.  To 
relieve  them  is  to  win  their  lasting  friend- 
ship and  make  perhaps  more  than  one  soul 
happy.  This  trouble  may  arise  from  a  va- 
riety of  causes, eating  too  much  and  too  fast, 
use  of  too  many  cold  drinks,  poor  and  im- 
properly cooked  food,  and  of  course  various 
troubles  in  other  parts  of  the  body,  as  Can- 
cer, Cirrhosis  of  the  liver,  Brights'  Disease, 
etc.  But  of  these  later  cases  I  shall  not 
speak,  my  remarks  shall  be  confined  to  those 
cases  in  which  the  cause  may  be  removed. 
During  the  three  years  I  have  been  practi- 
sing many  interesting  cases  of  Chronic 
Gastro-Intestinal  Catarrh  have  come  under 
my  care.  In  the  diagnosis  and  treatment 
of  these  cases  no  Ewald  or  other  test  meals 
have  been  given  and  no  chemical  or  microsco- 
pical examination  of  the  Stools  or  Stomach 
Contents  were  made,  because  I  did  not  have 
the  necessary  apparatus.  But  I  arrived  at 
my  conclusions  as  to  the  cause  and  kind  of 
trouble  in  these  patients  by  observing  their 
habits,  food  they  eat,  what  agreed  with 
them  best,  when  they  were  in  more  distress, 
whether  the  pain  was  continuous  or  not, the 
presence  or  absence  of  hunger,  etc.  What 
I  have  to  say  can  perhaps  be  made  more 
plain  by  citing  cases.  Miss  J.  B.,  a  lady 
sixty,  who  had  for  a  number  of  years  been 
troubled  w.th  her  stomach  and  bowels  had, 
when  I  first  saw  her,  been  confined  to  her 
room  for  four  months  and  could  scarcely 
take  any  food  without  intense  suffering  and 
a  little  over  her  starvation  diet  would  cause 
so  much  pain  and  burning  in  stomach  and 
bowels  begining  about  one-half  hour  after 
eating,  that  she  was  compelled  to  take  mor- 
phine. 

All  this  time  her  bowels  were  moving 
from  four  to  eight  times  a  day,  and  con- 
taining much  mucos,  often  streaked  with 
blood.  She  was  thirsty  and  would  occa- 
sionally have  some  fever.  Tongue  was 
large  and  flabby,  red  at  edges  and  white  in 
the  middle,  all  kinds  of  food,  even  water, 
would  ferment  and  cause  pain.  Diagnosis, 
an  anaciditj.  Caused  by  poor  and  im- 
properly cooked  food  and  the  use  of  whis- 
key and  tobacco.  1  believe  it  was  anacid- 
ity  because  she  never  got  hungry,  and  lean 
meats  hurt  tier  just  as  bad  as  the  farinace- 
ous food  and  the  fermentation  and  pain  be- 
gan too  soon  after  eating  to  be  hyperacidity, 
and  there  was  the  morning  vomiting  of 
mucus.  I  did  not  think  it  was  cancer  or 
ulcer  because  the  pain  was  not  constant  and 


did  not  begin  immediately  after  taking  food 
as  is  the  case  in  cancer  or  ulcer  but  some 
twenty  or  thirty  minutes  thereafter. 

Treatment — Gave  an  ounce  of  epsom 
salts  to  start  with,  stopped  all  food  except 
Valentines  meat  juice,  milk  and  lime  water 
every  two  hours,  and  a  cup  of  hot  water 
every  morning,  ordered  a  capsule  of  bis-sub- 
nit  12  grs.,  and  silver  nitrate  one  quarter 
grain,  to  be  taken  t.  i.  d.  one  hour  after  food 
and  every  night  a  capsule  containing  five 
grains  sulpho  carbolate  of  zinc  and  opii 
one-half  grain,  kept  up  this  treatment  for 
one  week  and  she  got  along  very  well  and 
began  to  be  hvngry.  Then  put  her  on  fif- 
teen drops  HC1  and  ten  drops  tr.  nux. 
vom.  in  water  three  times  a  day  before  eat- 
ing, and  allowed  eggs  and  lean  meats  and 
light  bread  with  the  milk,  discontinued  the 
Valentines  meat  juice,  kept  up  the  bismuth 
and  silver  twice  a  day  two  hours  after  meals. 
In  about  two  weeks  all  the  mucus  had  dis- 
appeared from  the  stools  and  her  bowels 
moved  regular  twice  a  day,  she  could  man- 
age her  food  without  distress,  was  gaining 
weight  and  has  been  getting  along  nicely 
ever  since,  but  has  had  to  continue  the 
HC1.  This  long  continued  use  of  the  acid 
has  brought  no  evil  results. 

She  is  doing  her  house  work  and  eats 
most  anything,  feels  better,  looks  well  and 
weighs  more  than  she  has  in  five  years.  I 
attribute  these  results  to  silver  nitrate  and 
HC1. 

Have  never  gotten  good  from  pepsin  in 
these  cases,  and  begin  to  believe  like  Prof. 
Hemmeter,  of  Johns  Hopkins,  that  pepsin 
has  absolutely  no  place  in  the  treatment  of 
these  cases.  He  says  it  is  a  very  rare  thing 
to  find  pepsinogen  absent  from  the  gastric 
juice.  But  there  will  be  no  pepsin  from 
the  pepsinogen  if  HC1  is  absent.  All 
this  is  needed  to  get  the  necessary  amount 
of  pepsin  is  to  supply  the  HC1.  Really 
I  have  very  little  use  for  the  commercial 
pepsin  at  all,  except  when  it  is  desired  to 
digest  food  outside  of  the  stomach.  If 
HC1  is  absent  there  will  be  hardly  any  di- 
gestion done  in  the  stomach.  Meats  can- 
not be  digested  at  all.  A  short  while  after 
food  i6  taken  fermentation  will  begin  in 
the  stomach  and  even  the  starches  which 
need  no  pepsin  or  acid  for  their  digestion 
will  be  ruined  and  rendered  useless.  The 
organic  acids  formed  by  this  fermentation 
will  irritate  the  mucous  membrane  of  the 
stomach  and  bowels  and  produce  an  un- 
healthy condition  of  the  entire  alimentary 
canal. 

For  this  condition  of  affairs  we  can  read- 
ily see  the  necessity  of  sweeping  out  the  ali- 
mentary canal,  (and  nature  has  been  trying 
to  do  this  for   the   diarrhoea  which  we  find 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


present.)  and  then  give  antiseptics  to  pre- 
vent fermentation,  and  silver  nitrate  to  pro- 
duce a  reaction  and  bring  about  a  healthy 
condition  of  the  mucous  membrane. 

Supply  the  acid  and  give  strychnine  to 
help  the  motor  power  of  the  stomach  and 
the  patient  will  improve  right  along.  The 
vomiting  in  the  case  just  mentioned  was 
only  once  or  twice  a  week,  had  it  been 
worse  I  should  have  used  lavage.  Anacid- 
ity  is  a  disease  which  may  last  for  years, 
even  a  life  time,  and  in  different  patients 
we  see  every  degree  of  severity,  it  is  more 
often  met  with  and  causes  a  great  deal  more 
trouble  than  hyperacidity,  but  some  dis- 
tressing cases  of  the  latter  are  seen.  B.  D., 
male,  aged  42,  came  under  my  care  in  Jan- 
uary, 1898.  Had  for  four  years  been  suf- 
fering with  hyperacidity,  he  was  nearly  al- 
ways hungry,  and  the  hunger  was  accom- 
panied by  burning  and  an  annoying  sensa- 
tion in  the  stomach,  which  was  relieved  by 
taking  food  or  water,  but  would  begin  again 
in  about  an  hour  after  eating,  and  would 
be  worse  than  when  the  stomach  was  empty. 
He  had  been  compelled  to  take  bicarbonate 
of  soda  to  stop  this  pyrosis.  Lean  meats, 
eggs,  and  other  proteids  would  prevent  the 
burning  being  so  severe,  and  a  big  meal  of 
lean  roast  beef  (and  by  the  way  he  could 
eat  the  most  of  any  man  I  ever  saw)  would 
entirely  stop  the  burning  for  five  or  six 
hours,  but  an  ordinary  amount  would  not 
stop  it  entirely  very  long,  though  he  never 
suffered  so  very  much  when  he  got  a  reason- 
able amount  at  each  meal  and  took  his  soda. 
But  when  he  ate  a  lot  of  potatoes  and  beans 
and  only  a  little  meat,  and  took  no  soda 
after  eating,  the  burning  would  be  so  in- 
tense that  he  could  hardly  stand  it,  and  the 
motor  power  of  his  stomach  would  get  so 
strong  from  the  stimulus  the  extra  amout  of 
acid  furnished  that  the  food  would  be  re- 
gurgitated, and  nearly  the  entire  meal  would 
be  spit  up  within  an  hour  and  a  half.  I 
gave  him  calcined  magnesia,  twenty  grains 
after  each  meal,  advised  him  to  eat  largely 
of  lean  meats  and  eggs,  and  to  increase  the 
magnesia  when  eating  vegetables.  Magne- 
sia is  much  better  than  soda  in  these  cases, 
as  there  is  no  gas  formed  by  the  action  of 
the  gastric  juice  upon  it.  He  has  been  get- 
ting along  beautifully,  and  has  had  do  diar- 
rhoea and  no  tenderness  over  his  bowels. 
The  meat  uses  up  the  acid  while  it  is  being 
digested,  and  Prof.  Memmeter  says  this 
kind  of  treatment  will,  after  a  while,  stop 
the  formation  of  so  much  acid  in  the  stom- 
ach, and  he  has  fully  demonstrated  the  fal- 
lacy of  the  old  theory  that  an  alkali  in  the 
stomach  will  increase  the  amount  of  acid 
secreted.  Thus  we  may  have  many  a  dys- 
peptic, and   even  the  old  alcoholic  stomach 


may  be  repaired  and  made  to  do  good  ser- 
vice again,  but  where  there  has  been  much 
destruction  of  mucous  membrane  that  the 
patient's  digestion,  like  the  one  legged 
man's  walk,  will  never  be  perfect  again, 
but  let  us  give  him  his  crutch. 


Report  of    a  Case  of  Tumor  of  the   Brain 
Symtomatically  Relieved  by  an  Explo- 
ratory Operation  Upon  the   Skull.  J 

By  William   Broaddus   Pritchard,    M.    D.,  and 
Jno.   A.  Wyeth,  M.  D.,  of   New  York. 

Tumors  of  the  brain  constitute  a  com- 
paratively small  but  exceedingly  interesting 
and  important  group  among  the  diseases  to 
which  human  flesh  is  heir.  Within  the 
past  ten  years,  a  period  devoted  chiefly  to 
the  observation  and  study  of  affections  of 
the  nervous  system  and  the  mind,  I  have 
personally  seen  only  15  cases  in  which  a 
diagnosis  was  tenable  with  any  certainty, 
and  it  is  quite  possible  that  autopsy  would 
have  failed  to  confirm  such  diagnosis  in 
appreciable  percentage  of  this  total.  In 
eight  of  the  cases,  however,  in  which  either 
of  the  autopsy  or  operation  afforded  oppor- 
tunity for  confirmation  the  tumor  was 
found.  The  interest  attaching  to  the  sub- 
ject, while  entrancing,  is,  unfortunately 
rather  pedagogic  than  practical.  I  do  not 
believe  that  this  is  necessarily  so,  however, 
and  one  object  and  the  chief  one,  in  pre- 
senting the  subject  to  your  attention  is  that 
of  aiding  in  establishing  the  converse  of 
this  proposition.  There  is  no  single  prob- 
lem in  clinical  neurology  so  protean  in  its 
symptomatic  aspects,  so  fascinating  in  its 
attractiveness,  so  uncertain  in  developmen- 
tal possibilities,  and  finally  so  gratifying  to 
the  student  enthusiast  in  its  irrefutable 
demonstration,  as  that  of  tumor  within  the 
cranial  cavity  and  of  the  cerebral  structures. 
The  full  and  intelligent  study  of  this  con- 
dition involves  a  masterly  grasp  of  the  en- 
tire subject  of  cerebral  anatomy,  physiology 
and  localization,  as  well  as  thorough  fami- 
liarity with  the  recorded  facts  of  epirical 
experience.  Even  this  degree  of  knowledge 
is  insufficient  in  the  absence  of  common 
sense  since  the  importance  of  the  personal 
equation  of  the  patient  in  intelligence, 
education,  environment  and  heredity  enters 
largely  as  a  factor  in  diagnosis.  The  im- 
portance of  the  subject  scarcely  need  em- 
phasis. Tumors  of  the  brain  are  essentially 
fatal.  The  vis  medicatrix  natural,  that 
most  potent  ally  of  the  physician  in  or- 
dinary disease  is  as  helpless  here   as    impo- 


JRead  before  the  North  Carolina  Medical  So- 
ciety, Asheville,  N:  C,  May  31st.  1899. 


THE  CHARLOTTE  MEDICAL  JOURNAL 


tence  itself.  The  fate  of  the  victim  of  tu- 
mor of  the  brain,  if  nature  alone  be  de- 
pended upon,  is  no  less  deperate  than  that 
embodied  in  the  inscription  which  marked 
the  portals  of  Dante's  Inferno,  "Leave 
hope  behind  all  ye  who  enter  here."  The 
utmost  attainments  of  medical  art  are  al- 
most equally  futile.  I  have  yet  to  learn  of 
an  authentic  case  of  spontaneous  or  medi- 
cally induced  recovery  from  intracranial  tu- 
mor, except  possibly  cysts.  Gumma  I  ex- 
clude. The  stimulus  to  effort  which  is  em- 
bodied in  this  statement  is,  or  at  least  should 
be,  all  powerful.  To  cope  with  disease 
successfully,  with  the  assistance  of  nature, 
represents  a  degree  of  usefulness  which 
should  not  be  despised.  To  cope  success- 
fully with  disease  unaided,  is  self-evidently 
the  greater  accomplishment  and  represents 
the  highest  possibilities  of  the  art.  The 
ultimate  and  ideal  aim  of  medicine  is  mas- 
tery of  disease  regardless  of  coadjutant 
factors.  For  the  present  he  is  a  fool  who 
disregards  any  source  of  help.  To  aid  in 
saving  life  is  worthy,  to  save  life  should  be 
the  very  acme  of  our  effort.  I  shall  not 
burden  you  with  a  resume  of  the  abstract 
clinical  facts  of  brain  tumor.  To  cover  the 
subject  adequately  would  necessitate  a  pa- 
per far  beyond  the  time  limit  permitted  by 
the  occasion.  The  subject  is  exhaustively 
considered  in  many  standard  text  books, 
and  monographs,  and  is  probably  familiar 
to  mv  audience.  Many  if  not  most  of  the 
clinical  facts  correllated  to  the  subject  are 
illustrated  in  the  case  to  which  I  desire  to 
call  your  attention.  1  beg  your  indulgence 
in  advance  for  a  case  history  which  almost 
necessarily  may  appear   prolix. 

The  patient  P.  L.  B.  was  first  seen  by 
me  November  20th,  1897,  and  his  home  in 
Asheville,  N.  C,  in  consultation  with  my 
friend,  Dr.  H.  B.  Weaver.  The  object  of  the 
consultation  was  to  determine  the  nature  of 
an  epilepsy  from,  which  the  patient  suffered. 
The  following  history  was  obtained  :  P. 
L.  B.,  male,  aged  30,  married,  merchant 
by  occupation,  family  history  negative, 
personal  history  free  from  any  record  of  se- 
rious illness  or  injury  up  to  1882.  During 
the  spring  of  1882  patient  was  suddenly 
attacked  witli  a  fulminant  and  severe  form 
of  cerebro-spinal  meningitis.  His  occupa- 
tion at  that  time  was  that  of  a  farmer  in 
a  mountainous  region  of  Western  North 
Carolina,  a  locality  subject  to  recurring 
epidemics  of  cerebro-spinal  meningitis. 
His  attack  was  of  some  five  or  six  weeks 
duration,  recovery  being  apparently  com- 
plete, the  disease  leaving  no  nervous  se- 
quels. Six  months  later  the  patient  suf- 
fered from  his  first  (so  far  as  known)  epilep- 
tic attack,  which  occurred   at    night,   with- 


out warning  or  assignable  exciting  cause. 
This  convulsion  was  general  in  distribution 
and  of  comparatively  severe  type,  the 
tongue  being  bitten.  Subsequently  other 
attack  followed,  always  at  night  (two  diur- 
nal attacks  only  in  seven  years),  always 
general,  always  without  aura.  His  condi- 
tion remained  practically  the  same  up  to 
1889,  except  that  the  average  number  of 
seizures  increased  from  two  or  three  to  five 
or  six  a  month,  the  paroxysms  preserving 
the  same  characteristics.  In  1889  he  moved 
his  residence  to  Asheville  and  changed  his 
occupation  from  farmer  to  merchant.  For 
three  years  subsequently  and  without  other 
assignable  cause  than  that  of  change  of  resi- 
dence and  occupation,  he  remained  abso- 
lutely free  from  these  attacks,  his  health 
being,  to  quote  his  own  language,  "per- 
fect." In  1892,  without  any  known  cause, 
the  epilepsy  recurred,  but  in  an  entirely 
different  form.  While  an  occasional  noc- 
tural  attack  would  occur,  the  majority  of 
the  seizures  were  diurnal.  Instead  of  be- 
ing general  and  severe  as  formerly  the  at- 
tacks were  lighter  and  often  unilateral  and 
occasionally  without  loss  of  consciousness. 
Very  many  of  these  later  attacks  were  pre- 
ceded by  an  aura  consisting  of  a  strange 
and  indescribable  sensation  in  the  left  side 
(leg  and  arm)  and  with  an  initial  motor 
spasm  or  signal  symptom  in  the  left  foot. 
In  exceptional  instances  this  signal  symp- 
tom was  limited  to  a  tonic  rigidity  of  the 
toes,  chiefly  the  great  toe.  Quite  often  the 
entire  seizure  would  consist  of  the  sudden 
aura  described,  with  a  succeeding  tonic 
rigidity  of  the  foot  muscles.  More  fre- 
quently the  spasm  would  extend  quickly  up 
the  leg,  thence  to  the  arm  of  the  same  side, 
next  to  the  left  face,  ending  in  unconscious- 
ness and  sometimes  generalized  tonic  and 
clonic  movements  of  the  muscles  of  the 
entire  body.  Usually  the  interval  between 
the  aura  and  the  spasm  permitted  sufficient 
preparation  to  prevent  injury  from  a  fall. 
Occasionally  the  upward  extension  of  the 
spasm,  beginning  in  the  foot,  could  be  pre- 
vented by  pressing  the  foot  against  some 
object  or  by  grasping  in  constriction  the 
thigh  of  the  same  side.  These  paroxysms 
varied  considerably  in  frequency.  Eight 
or  ten  or  even  more  might  occur  in  a  day. 
On  the  other  hand,  he  would  sometimes  re- 
main for  several  days  perhaps  free  from  at- 
tacks. During  the  interval  he  suffered 
greatly  from  severe  headaches  associated 
with  vertigo  and  occasional  though  infre- 
quent sudden  vomiting.  The  headaches  at 
times  were  said  to  have  been  agoniz- 
ing. Minor  occasional  changes  in  temper- 
ament and  emotional  stability  were  noted, 
but  intellectual  processes  proper  are  said  to 


652 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


have  remained  unimpaired.  During  the  sum- 
mer of  1S97  the  patient  noticed  a  gradually- 
developing  weakness  of  the  left  leg  and 
arm  which  slowly  but  «teadily  increased. 
At  about  the  same  time  he  began  to  notice 
peculiar  disturbances  of  vision.  He  would 
suddenly  become  blind.  "I  would  have  to 
stand  still  for  a  few  minutes  when  my  sight 
would  just  as  suddenly  return,"  to  quote 
the  patient.  An  extreme  polydipsia  de- 
veloped, as  much  as  two  gallons  of  water 
being  often  consumed  in  a  day.  There  was 
of  course  a  corresponding  polyuria.  There 
were  no  other  subjective  symptoms  except 
numerous  inconstant  and  very  variable  pa- 
resthesia of  the  left  side. 

Physical  Examination. — The  patient 
appeared  a  well-developed  and  fairly  nour- 
ished man  of  about  the  age  given.  Mental- 
ly I  observed  no  variation  from  the  normal. 
Memory,  reason  and  judgment  seemed  un- 
impaired. The  mental  reflexes  were  quite 
normally  active.  I  observed  no  emotional 
instability  whatever.  Motor  and  sensory 
speech  were  normal.  Taking  the  cranial 
nerves  in  numerical  order,  the  sense  of 
smell  was  not  affected.  In  testing  vision  I 
found  a  fair  perception  of  light  with  a  bare 
perception  of  form.  Opthalmos  copically 
the  fundi  showed  well  advanced  double 
optic  neuritis.  The  opthalmoscopic  find- 
ings   were    established     by  Dr.  of 

Asheville,  and  later  by  Dr.  Marple  of  New 
York.  The  extrinsic  muscles  of  the  eye 
(3d,  4th  and  6th)  were  normal  and  the  eye 
was  moved  freely  in  all  directions.  There 
was  no  sensory  impairment  in  the  area  sup- 
plied by  the  fifth.  Innervation  of  the  facial 
muscles  was  about  equal  on  the  two  sides 
and  there  was  no  asymmetry.  The  auditory 
nerve  was  intact  on  both  sides.  There  was 
no  impairment  of  taste.  The  vagus  was 
not  affected.  The  tongue  was  projected 
without  deviation.  Examination  of  the 
upper  extremities  showed  decided  ataxia  of 
the  left  arm  and  hand.  Forced  flexion  and 
extension  of  the  muscles  of  the  arm  and 
forearm  showed  distinct  weakness  of  the 
left  as  compared  with  the  right.  Left  hand 
grasp  by  dynamometer,  28;  Rt.  70,  No 
atrophy.  Slight  tremor  of  right  hand  and 
arm  on  extension.  Tact,  pain  and  temper- 
ature sense,  normal  and  equal  on 
the  two  sides.  Muscular  sense  im- 
paired on  the  left  by  comparison 
with  the  right.  Wrist  and  triceps  re- 
flexes exaggerated  on  the  left.  Lower  ex- 
tremities :  gait  hemiplegia  with  drag  of  left 
foot.  No  contractures,  but  slight  spasticity 
of  left  leg.  Flexors  and  extensors  of  left 
leg,  ankle  and  thigh  distinctly  weaker  than 
right.  No  Romberg  present,  but  was  un- 
able to  stand  on  left  leg  alone.      Left  knee 


jerk  quite  actively  exaggerated  and  clonus 
present  on  left  side.  No  atrophy.  No 
sensory  impairment  was  demonstrated  at 
this  time.  The  tests  employed  were,  how- 
ever, not  at  all  elaborate  or  delicate  in  de- 
tail. There  were  no  rectal  or  vesical  symp- 
toms. A  summary  of  the  facts  related,  ob- 
tained from  the  history  and  a  personal  ex- 
amination, led  promptly  to  the  diagnosis  of 
brain  tumor,  the  symptoms  constituting  an 
almost  classical  group.  It  seemed  equally 
legitimate,  basing  the  conclusion  upon  the 
nearly  always  constant  aura  of  paresthesia 
of  the  left  leg  and  arm,  and  of  a  signal 
symptom  or  initial  motor  spasm  affecting 
the  left  foot  and  leg,  to  assume  that  the 
tumor  was  located  in  the  upper  third  of  the 
Rolandic  region  of  the  right  side.  The  fre- 
quent occurrence  of  spasms  limited  to  the 
foot  alone  and  sometimes  to  the  toes  point- 
ed to  the  post  central  rather  than  the  prae- 
Rolandic  area.  The  sensory  aura  and  the 
disturbance  of  muscular  sense  in  the  upper 
extremity  together  with  the  apparent  non- 
involvement  of  mentality,  at  least  in  its 
higher  spheres,  seemed  consistent  with  and 
indeed  confirmatory  of  this  view.  The  ab- 
sence of  family  or  personal  tuberculosis  or 
syphilis  and  of  cancerous  tendencies  together 
with  the  empirically  known  fact  that  glio- 
matous  growths  are  next  perhaps  in  fre- 
quency, served  as  a  basis  for  a  presumptive 
diagnosis,  from  the  pathological  standpoint, 
of  glioma  or  gliosarcoma.  The  etiological 
relationship  of  the  preceding  cerebro  spinal 
meningitis  offered  many  conjectural  possi- 
bilities, but  nothing  positive  and  little  if 
any  precedent.  The  prognosis  was  neces- 
sarily pessimistic  and  in  extreme  degree, 
with  one  modifying  possibility,  and  one 
alone.  Assuming  the  diagnosis  to  be  cor- 
rect, the  one  chance  for  life  lay  in  the  direc- 
tion of  surgical  interferrence.  Following  a 
time-honored  precedent,  the  value  of  which 
I  have  confirmed  through  personal  expe- 
rience, I  advised  that  the  patient  be  put 
upon  steadily  and  rapidly  increasing  doses 
of  potassium  iodide.  If  after  reaching  a 
daily  dose  of  300  grains,  attainable  in  a 
month  or  six  weeks  by  gradual  increase,  no 
improvement  should  result,  I  advised  that 
the  patient  be  sent  on  to  New  York,  placed 
in  the  Polyclinic  Hospital,  there  to  be  watch- 
ed by  trained  attendants  under  my  supervi- 
sion, and  if  the  symptoms  observed  confirm- 
ed the  diagnosis  already  made,  then  open 
the  brain  and,  if  possible,  remove  the  tu- 
mor. Should  death  occur  from  operation  it 
would  be  only  an  anticipation  by  a  few 
weeks  or  months  of  a  fate  which  was  inevi- 
table, and  the  patient  would  have  the  bene- 
fit of  a  legitimate  euthanasia.  My  advice 
was    followed    to  the    letter.     The    iodides 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


653 


proving  useless  the  patient  came  to  New 
York  accompanied  by  Dr.  Weaver  and  was 
admitted  to  the  Polyclinic  Hospital.  With- 
in less  than  a  week  the  history  as  already 
given  was  confirmed.  The  symptoms  had 
meantime  progressed  markedly.  The  pa- 
tient was  totally  blind.  Beginning  atrophy 
had  succeeded  the  neuritis.  He  was  com- 
pletely helpless,  the  hemiplegia  having  be- 
come almost  absolute.  The  spasms  had  in- 
creased, as  many  as  twenty  or  more  occur- 
ring sometimes  daily.  The  headache  was 
excruciating  and  continuous.  Insomnia  ad- 
ded its  agonies  to  the  picture.  The  patient 
begged  for  death  and  expressed  himself  as 
more  than  willing  to  take  any  risks  involved 
in  surgical  interference.  Preliminary  to  the 
operation  I  made  a  further  and  more  elab- 
orate and  exact  examination  of  the  patient. 
In  addition  to  the  demonstration  of  the 
symptoms  already  mentioned,  which  differed 
from  former  observations  only  in  degree,  I 
noted  the  following  exceedingly  interesting 
sensory  and  other  phenomena.  In  the  lower 
extremity  (the  leg)  there  was  present  de- 
cided defect  of  tactile  sense.  He  was  un- 
able to  distinguish  cotton  or  cloth  from 
wood  or  the  touch  of  the  finger.  When 
touched  at  more  than  one  point  he  was  to- 
tally unable  to  determine  the  number  of 
points  of  contact.  A  peculiar  ataxia  or 
allochiria  of  tactile  perception  was  manifest. 
When  touched  on  the  left  leg  he  would  say 
it  was  the  right.  When  touched  on  the 
left  foot  he  would  refer  the  tactile  impres- 
sion to  the  knee  or  thigh  perhaps.  This 
was  true  also  of  pain  sense.  He  was  unable 
to  differentiate  differences  in  the  degree  of 
pressure  or  weight  upon  the  leg  and  was 
totally  unable  to  duplicate  accurately  with 
the  right  leg  or  foot  the  various  positions 
into  which  I  put  the  left  leg.  At  this  time 
a  very  marked  and  aggravated  degree  of 
tremor  was  noticed  on  the  sound  side  (the 
right)  on  any  muscular  effort  involving  ex- 
tension of  leg  or  arm.  The  scalp  having 
been  shaved  several  observations  were  made 
as  to  differences  in  surface  temperature  upon 
the  two  sides  of  the  skull.  The  results  were 
not  entirely  negative,  but  they  did  not  ad- 
mit of  any  positive  conclusions.  A  distinct 
and  constant  difference  was,  however,  plain- 
ly evident  in  the  percussion  note  over  the 
the  parietal  region  of  the  two  sides,  decided 
and  constant  increase  of  dullness  being  noted 
over  the  right  as  compared  with  the  left. 
This  difference  was  demonstrated  upon  sev- 
eral occasions  and  was  invariably  present. 
These  symptoms  were  construed  as  confirm- 
ing the  localizing  diagnosis  placing  the  tu- 
mor at  or  beneath  the  post-Rolandic  or  post- 
central convolution  on  the  right  side  in  its 
posterior  and    lower    segments  adjacent  to 


and  probably  involving  (from  the  sensory 
symptoms)  the  supra-marginal  and  angular 
gyri.  I  hesitated  in  an  opinion  as  to  a  cor- 
tical or  subcortical  localization  for  obvious 
reasons,  but  leaned  rather  to  the  subcortical 
in  view  of  the  fact  that  purely  mental  pro- 
cesses were  absolutely  intact.  That  the  cor- 
tex was  involved  I  felt  no  doubt,  and  I  also 
believed  that  the  tumor  was  accessible  sur- 
gically and  probably  removable.  On  Jan- 
uary 20th  Dr.  Wyeth  operated. 

REPORT  OF  THE  OPERATION. 

On  the  20th  of  January,  1898,  at  the 
New  York  Polyclinic  Medical  School  and 
Hospital,  the  following  operation  was  per- 
formed on  Mr.  P.,  of  Asheville,  N.  C. 

A  diagnosis  of  a  tumor  near  the  right 
fissure  of  Rolando  at  the  lower  border  of 
the  upper  third  posteriorly,  had  been  made 
by  Dr.  Pritchard  who  had  carefully  studied 
the  case  from  the  standpoint  of  a  neurolog- 
ist. A  large  horseshoe-shaped  incision  was 
made  through  the  scalp  down  to  the  cra- 
nium. The  convexity  of  this  incision  was 
near  the  median  line  of  the  skull  and  ex- 
tended toward  the  temporo-purietal  suture 
about  four  inches,  there  being  about  three 
inches  between  the  sides  of  the  incision. 
The  bone  was  exposed  by  separating  the 
scalp  on  either  side  of  the  line  of  incision 
for  about  a  quarter  of  an  inch,  leaving  it 
as  closely  adherent  to  the  bony  flap  to  be 
elevated  as  was  possible.  With  a  small 
sharp  chisel  the  bone  was  now  furrowed, 
and  with  the  aid  of  the  DeVilbiss  rougeur, 
the  bone  was  entirely  cut  through  in  line 
with  the  primary  incision.  The  comple 
tion  of  the  operation  was  postponed,  as  is 
my  custom,  to  the  following  day.  The 
following  day  this  flap  of  bone  was  fractur- 
ed across  the  point  between  the  ends  of 
the  incision,  and  with  the  adherent  scalp 
was  turned  down  over  the  patient's  ear. 
The  dura  mater  was  incised  in  the  same 
line  as  the  original  flap  and  this  was  also 
turned  down  and  the  brain  exposed.  By 
careful  exploration  with  the  dull  end  of  a 
long  Hagedorn  needle,  the  tumor  could  be 
distinctly  felt,  measuring  more  than  two 
inches  transversely  and  so  deep-seated  and 
so  far  from  the  surface  that  its  removal  was 
deemed  unjustifiable.  It  was  found  im- 
possible to  stitch  the  dural  flap  in  position 
as  the  brain  bulged  through  the  opening 
and  as  this  membrane  had  been  worn  to 
extreme  thinness  by  the  long  continued 
pressure  of  the  brain  the  sutures  did 
not  hold.  The  trap-door  of  bone  and 
adhering  scalp  was  restored  about  to  its  or- 
riginal  position,  leaving  one-half  inch  of 
room  for  relief  of  pressure. 

The  patient   did  well  after  the  operation 


654 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


despite  the  development  of  a  fungus  cere- 
bri. 

Several  interesting  problems  present 
themselves  in  connection  with  this  case. 
I  shall  confine  myself,  less  I  trespass  too 
far  upon  a  tolerance  taxed  I  fear  already  to 
the  limits  of  courteous  endurance,  to  two 
aspects  aloue.  To  what  extent  is  surgical 
interference  indicated  or  permissible  in 
tumor  of  the  brain?  What  is  the  explana- 
tion of  the  symptomatic  relief  obtained  in 
this  case,  in  which  the  tumor  was  not  re- 
moved? The  two  problems  are  correllated 
to  such  a  degree  as  will  permit  of  their 
joint  consideration.  The  facts  of  expe- 
rience, personal  and  impersonal,  justify,  I 
believe,  he  acceptance  of  the  following 
propositions:  Tumor  of  the  brain,  per  se, 
is  essentially  fatal  regardless  of  patholog- 
ical type  or  location.  Possible  and  rare 
exceptions  are  tubercular  and  cystic  neo- 
plasms. Syphilitic  gummata  should  not  be 
considered  a  variety  of  brain  tumor.  Sur- 
gical interference  is  the  only  hope,  and  is 
not  only  indiceted  but  imperatively  de- 
manded. In  a  small  proportion  of  cases, 
depending  upon  location  and  pathological 
type,  surgical  procedure  may  prove  cura- 
tive. Ferrier  states  this  proportion  as  13 
per  cent.,  which  seems  rather  optimistic. 
In  mauy  casys,  Ferrier  says,  more  than  50 
per  cent,  surgical  interference  offers  the 
probability — indeed  a  reasonable  certainty 
— of  symptomatic  relief  and  prolongation 
of  life.  Results  here  also  vary  in  degree, 
though  less  so,  with  the  factors  of  patho- 
genesis and  locality.  In  all  cases,  regard- 
less of  pathological  variety,  localization  or 
multiplicity  of  lesions,  osteoplastic  opera- 
tions upon  the  skull  are  not  only  permissi- 
ble but  indicated  since  they  offer  the  only 
hope  and  under  proper  precautions  and 
technique  exploratory  entrance  of  the  skull 
involves  but  little  danger  to  life  per  se. 
Such  operations  should,  by  the  way,  be  al- 
ways primarily  exploratory. 

With  regard  to  the  second  problem  the- 
ories rather  than  facts,  must  necessarily  en- 
ter into  the  answer.  In  the  case  presented 
the  tumor  was  not  removed  and  yet  the 
patient  (who  I  feel  confident  would  have 
been  dead  long  ago  but  for  the  operation) 
is  not  only  alive,  but  is,  and  has  been,  free 
from  headaches,  epilepsy  and  all  other 
irritative  symptoms  for  more  than  a  year, 
has  recovered  his  general  health  and 
strength  and  is  able  to  make  a  living.  To 
what  does  he  owe  his  improvement? 

The  results  in  this  case  are  not  unique, 
many  similar  instances  having  been  record- 
ed, notably  several  which  were  reported  at 
the  meeting  of  the  British  Medical  Associa- 
tion in  Edinburgh  just  a  year  ago  by  Hors- 


ley,  Waterhouse  and  others,  and  by  Kra- 
mer, of  Cincinatti.  Irritative  symptoms 
may  be  and  often  are  due  in  intracranial 
tumor  to  increased  intracranial  pressure. 
The  relief  of  such  pressure  by  opening  up 
the  skull  suggests  an  explanation.  Gray 
case  Stanford  (3  mos.)  I  cannot  believe 
however,  that  such  relief  would  be  either 
permanent  or  prolonged.  Our  patient, 
eighteen  months  after  the  operation,  is  still 
free  from  irritative  symptoms. 

Another  theory  suggests  itself  :  The  op- 
erative field,  it  will  be  remembered,  was 
subsequently  filled  with  an  enormous  hernia 
cerebri,  The  major  part  of  this  hernia 
eventually  sloughed  off,  aided  by  a  ligature. 
Why  is  it  not  possible,  and  indeed  proable, 
that  the  tumor,  following  the  law  of  all 
neoplasms,  which  is  growth  in  the  direc- 
tion of  least  resistance,  should  have  grown 
out  of  the  cranial  cavity  with  the  hernia 
and  been  sloughed  off  with  it?  I  believe 
this  theory  to  be  additionally  probable  if, 
as  assumed,  the  growth  was  gliomatous. 
There  is  some  precedent  in  support  of  this 
theory.  My  friend,  Dr.  Weiner,  of  New 
York,  in  his  report  of  a  somewhat  similar 
case,  with  enormous  hernia  cerebra  follow- 
ing the  operation,  found  on  microscopical 
examination  of  the  hernia  tissue  that  it  was 
chiefly  composed  of  cancerous  tumor  ele- 
ments. Still  another  theory  has  been  ad- 
vanced to  the  effect  that  surgical  trauma  is 
sometimes  pathologically  alterative,  so  to 
speak,  as  for  example  in  the  effects  from 
scarifying  ulcers.  This  last  hypothesis 
seems  to  me  to  be  least  entitled  to  credence 
and  I  do  not  offer  it  with  any  personal  en- 
dorsement whatever. 

105  W,  73  St..  N.  Y.  City. 


The  American    Electro-Therapeutic  Asso- 
ciation. 

The  ninth  annual  meeting  of  the  Ameri- 
can Electro-Therapeutic  Association  will 
be  held  in  Washington,  D.  C,  on  Septem- 
ber 19th,  20th  and  21st,  1899,  under  the 
presidency  of  Dr.  F.  B.  Bishop,  of  Wash- 
ington. 

Quite  a  number  of  papers  of  great  scien- 
tific value  have  been  promised,  and  the 
Committee  of  Arrangements  insures  the 
members  a  very  entertaining  and  pleasura- 
ble meeting.  Aside  from  the  sessions  of 
the  Association,  the  Committee  has  com- 
pleted arrangements  for  a  trip  to  Mt.  Ver- 
non, one  to  Arlington,  and  several  other 
social  features. 

The  headquarters  of  the  Association  will 
be  at  Willard's  Hotel,  where  special  rates 
will  be  given  to  members  and  their  families 
during  the  meeting. 


THE  CHARLOTTE  MEDICAL    JOURNAL. 


655 


McK.  &  R. 

Compound  Stearates 


Compound  Stearate  of  Zink  (McK.  &R.) 

is  the  most  satisfactory  dusting  powder  for  almost  all  purposes.  It  does 
not  cake,  never  becomes  rancid  nor  "sticky,"  resists  moisture  and  does 
not  soil  the  clothing. 

It  can  be  applied  to  the  nose,  throat  or  other  passages  without  causing 
irritation  or  discomfort. 

Compound  Stearate  of  Zinc  with  Ichthyol  (McK.  &R.) 

Ichthyol  is  of  undoubted  value  in  many  forms  of  skin  disease.  In  some 
cases  it  gives  results  which  no  other  agent  will  produce.  The  objections  to 
its  use  on  account  of  its  odor,  etc.,  are  largely  overcome  in  our  combination 
of  Compound  Stearate  of  Zinc  with  Ichthyol. 


We   shall   be   pleased   to  send   samples  of  this  or  other  combination,  together  with  Pamphlet, 
.  containing:  full  list  of  combinations  and  uses,  on  application, 


McKESSON  &  ROBBINS, 


New  York. 


For  All  External  Dressings 

the  highest  fulfillment  of  modern  aseptic  or  antiseptic  surgery  is 
found  in  Unguentine,  which  satisfies  all  the  requirements;  for  it  is 
Antiseptic,  Permanent,  Non-Irritating  and  Constructive.  It  is  the 
most  economical   and   least  expensive. 

THE  CONTAINER 

is  thoroughly  antiseptic,  clean,  convenient;  can  be  carried  in  pocket; 
always  aV  hand  for  minor  work  ;  or  maybe  thrown  in  satchel  with 
no   risk   of    soiling  anything. 

THE   DRESSER 

is  the  ideal  antiseptic  ;  compounded  of  Ichthyol,  Carbolic  Acid,  and 
Alum,  after  the  modified  formula  of  Sir  Astley  Cooper,  but  with  a 
pure  Petrolatum  base.  The  irritating  effects  of  ordinary  alum  are 
entirely  eleminated,  rendering  a  dressing  of  marvelous  healing  quali- 
ties, i.e.  astringest,  but  non-irritating.  Unguentine  is  used  daily  in 
practice  by  a  majority  of  the  physicians  and  surgeons  of  America  and 
has  been  reviewed  scientifically  by  more  medical  publications  than 
have  all  other  dressings  combined. 

Price,  2  oz.  Tube,  25c.     Per  Doz.  $2.00. 

To  introduce  Unguentine  in  the  Collapsible  Tube  we  will  send  to  yon,  on 

request,  one  tube  free,  prepaid. 

THE  NORWICH  PHARMACAL  CO,  Sole  HanTrs, 
NORWICH,  NEW  YORK. 


656  THE  CHARLOTTE  MEDICAL  JOURNAL. 


Predigested 

JjCCI  is  the  basis  of  ARHOUR'S  NUTRIENT  WINE 
of  BEEF  PEPTONE===a  preparation  which  pre= 
sents  the  entire  digestible  substance  of  prime, 
lean  beef  in  a  form  requiring  no  effort  of  the 
digestive  organs  to  render  it  diffusible. 

Nlltrient  Wilie  is  more  of  a  food  than  a  stim= 
ulant,  and  is  invaluable  in  the  treatment  of 
Typhoid  Fever,  Phthisis,  Cancer,  Ulceration  of  the 
Stomach,  or  any  disease  accompanied  by  faulty  or 
insufficient  nutrtion. 

Put  up  in  pint  bottles  that  retail  at  $1.00. 

ARflOUR  &  COMPANY, 
CHICAGO. 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


657 


THE 


Charlotte  Medical  Journal. 

Editorial  Department. 


E.  C.   REGISTER,   M.  D.  J.  C.   MONTGOMERY,   M.  D. 

Editors  and  Publishers. 

No.  36  South  Tryon  Street,    -    -    -    - 
Charlotte,  N.  C. 


SUBSCRIPTION.  $2-50  PER  YEAR, 


The  place  of  meeting,  being  in  the 
Headquarters  Hotel,  was  a  great  conve- 
nience, especially  to  the  officers  and  com- 
mitteemen. The  attendance  was  large 
and  the  man  who  did  not  enjoy  him- 
self thoroughly  must  have  had  some  catar- 
rhal affection  of  his  bile-ducts.  The  de- 
lightful weather  and  the  ever  present  charm 
of  mountain  scenery  gave  no  rest  to  pleas- 
ure and  delight.  We  would  say  something 
of  the  daughters  of  these  people  but  lan- 
guage fails  and  words  fall  short  of  their 
meaning. 


nEETING  OF  THE  STATE  MEDICAL  SOC1E 
TY  IN  ASHEVILLE. 

The  46th  annual  meeting  of  the  Medical 
Society  of  the  .State  of  North  Carolina, 
was  held  in  Asheville  May  30th  to  June 
1st.  The  local  committee  of  arrangements 
with  Dr.  M.  H.  Fletcher  at  its  head,  de- 
serves much  praise  for  the  admirable  man- 
ner in  which  they  provided  for  the  varied 
wants  and  necessities  of  the  society.  The 
hospitality  of  the  people  of  Asheville  had 
neither  rule  nor  measure,  but  was  given 
with  the  most  liberal  hand,  not  only  to  the 
Society  as  a  whole  but  each  individual 
member  felt  a  personal  interest  in  the  wel- 
come and  an  appointed  place  in  the  enter- 
tainments. The  reception  at  Dr.  Bur- 
roughs, the  drive  over  the  Biltmore  estate, 
the  lunch  at  the  Oakland  Heights  Sanita- 
rium, the  smoker  at  Dr.  Minor's,  the  ele- 
gant supper  at  Dr.  Van  Bergen,  the  ban- 
quet at  the  Battery  Park  Hotel,  will  linger 
in  the  heart  for  many,  many  days  to  come 
like  a  pleasant  dream  to  be  often  recalled 
to  mind.  To  the  younger  members  the 
german,  on  the  evening  of  the  second  day, 
was  by  no  means  the  least  among  the  many 
things  provided  by  the  Asheville  people. 
The  scientific  part  of  the  program  was 
overshadowed  by  the  full  handed  welcome, 
and  some  would  complain  that  not  much 
real  work  was  done.  But  is  it  not  real 
work  to  make  the  overburdened  heart  for- 
get its  worry,  to  deepen  and  broaden  the 
fraternal  spirit  which  is  in  us  all,  to  draw 
men  close  together  in  their  daily  tasks,  to 
make  them  feel  their  common  lot,  their 
common  end,  that  each  is  brother  to  the 
other  in  their  joy  and  pleasure? 

There  is  hardly  greater  work  than  this, 
and  this  work  was  done  in  Asheville.  We 
claim  in  addition  to  all  this  that  the  papers 
were  excellent  denoting  care  and  study  in 
their  preparation.  The  discussion  might 
have  been  more  full  and  general. 


niNUTES  OF    THE  FORTY-SIXTH  ANNUAL 
MEETING  OF  THE  HEDICAL  SOCIETY 
OF  THE  STATE  OF  NORTH  CARO- 
LINA. 

First  day-*— Tuesday  Morning. 

The  46th  annual  meeting  of  the  Medical 
Society  of  the  State  of  North  Carolina  was 
convened  in  the  ball  room  of  the  Battery 
Park  Hotel,  Asheville,  N.  C,  President  L. 
J.  Picot  in  the  chair. 

The  Society  was  called  to  order  by  Dr. 
M.  H.  Fletcher,  of  Asheville,  Chairman  of 
the  Local  Committee  of  Arrangements. 

The  session  was  opened  with  prayer  by 
Rev.  C.  W.  Byrd,  D.  D.,  of  the  Central 
Methodist  Church. 

Hon.  Locke  Craige  then  delivered  the 
following  address  of  welcome  : 

Mr.  Chairman,  Gentlemen  of  the  Medical 
Society,  Ladies  and  Gentlemen: 
When  I  was  asked  to  deliver  this  address 
of  welcome,  Dr.  McBrayer  presented  it  to 
me  in  this  way  :  Did  I  think  that  I  was 
afraid  to  stand  before  four  hundred  doctors, 
and  if  1  had  felt  then  as  I  feel  now  I  would 
have  said  yes,  and  would  not  have  been 
here. 

The  most  cordial  hospitality  that  I  ever 
received  was  in  a  little  pine  cabin  home. 
It  nestled  away  up  under  overhanging 
cliffs,  beneath  the  shadows  of  the  towers 
and  the  domes  of  the  Black  mountains. 
The  address  of  welcome  was  in  these  words  : 
"We  are  poor,  but  we  are  friendly."  There 
was  indeed  a  dearth  of  luxury,  but  there 
was  a  great  abundance  of  good  will,  more 
refreshing  even  than  the  sparkling  waters 
of  the  stream  that  poured  down  fresh  from 
the  granite  of  the  eternal  hills.  It  is  in  this 
same  spirit  of  free,  cordial,  simple  mountain 
city  hospitality  that  I,  in  the  name  of  the 
people  of  our  mountain  city,  greet  the  med- 
ical fraternity  of  North  Carolina,  and  tell 
you  that  the  gates  of  this  city  are  wide  open 
to  you,  that  the  city  ;s  yours,  and  the  full- 
ness thereof.  The  doctor  is  always  wel- 
come— that  is,  in  the  hour  of  necessity.    We 


658 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


never  believe  in  doctors  until  we  need  one, 
and  when  wo  need  one  we  are  like  the  man 
in  Texas  who  wanted  a  pistol,  we  need  him 
bad,  and  we  want  him  now.  When  the 
strong  arm  that  is  the  stay  and  protection 
of  the  family  is  stricken  down  by  affliction 
in  the  dark  hours,  "when  the  dying  night 
lamp  flickers,  and  the  shadows  rise  and 
fall,"  we  welcome  the  one  who  can  give  a 
ray  of  hope  that  this  will  not  be  the  light 
of  the  stern  last  morning.  When  the 
mother  with  streaming  hair  leans  over  the 
dying  infant  whose  parched,  cracked  lips 
only  her  tears  now  moisten,  she  welcomes 
the  one  who  can  stop  the  pain  of  the  last 
death  cry  of  the  little  one  in  the  night. 

Some  one  has  said  that  the  physician  who 
first  discovered  the  efficacy  of  anaesthetics 
conferred  a  greater  service  on  humanity 
than  all  the  authors  and  teachers  of  moral 
dogmas.  This  is,  doubtless,  an  extrava- 
gant statement,  but  it  is  but  just  to  say  that 
there  is  no  calling,  no  profession,  nobler, 
higher,  grander,  with  a  more  divine  mis- 
sion than  that  which  has  for  its  ultimate 
purpose  the  mastery  of  the  science  of  the 
human  body,  and  the  conquest  of  diseases 
and  sufferings  of  our  kind.  While  Alex- 
ander the  Great  was  conquering  the  world, 
while  Caesar  pushing  out  the  borders  of  the 
Republic  and  crushing  his  enemies  with  his 
legions,  while  Napoleon  was  terrifying  Eu- 
rope with  a  conflagration  of  falling  cities 
and  the  tramp  of  embattled  hosts,  Hippo- 
crates and  Galena,  and  Tenner  and  Harvey, 
and  their  fellows,  unnoticed,  unknown,  in 
the  obscure  laboratory,  sometimes  in  the 
prison  of  persecution,  were  battling,  with 
courage  and  a  faith  that  never  faltered, 
against  the  great  enemy  of  mankind,  and 
doing  a  work  that  will  always  bless  all  the 
children  of  all  generations.  There  is  one 
thing  about  the  doctor,  too — he  never  makes 
any  mistakes,  for  dead  men  tell  no  tales. 
But  there  is  this  consolation,  that  the  doc- 
tor can  learn  in  the  school  of  experience. 
Mind  you,  I  do  not  say  it  is  the  only  school 
in  which  he  can  learn,  but  he  does  learn  in 
the  school  of  experience.  They  can  truth- 
fully say  with  the  poet  : 

We  hold  it  truth,  with  him  who  sings 
To  one  clear  harp  in  divers  tones, 

That  we  may  rise  on  stepping  stones, 
Of  our  dead  patic tits  to   higher  things. 

I  have  read  that  it  is  the  contention  of 
some  who  have  studied  the  records  written 
upon  the  rocks  that  there  are  evidences  on 
this  planet  of  a  race  of  men  who  have  been 
exterminated  by  an  incurable  disease,  and 
we  know  that  the  smallpox  would  have  de- 
vastated Europe  had  it  not  been  for  the  dis- 
covery of  Dr.  Jenner.      There  is    now  pre- 


sented to  the  medical  profession  a  problem, 
and  its  solution  is  demanded.  There  is  a 
little  germ,  they  tell  me,  and  I  believe  that 
you  call  him  bacillus  tuberculosis.  He  is 
more  invincible  than  an  army  with  banners, 
he  is  the  greatest  enemy  that  the  human 
family  has  encountered.  He  destroys  not 
in  the  fierce,  fiery  conflict,  he  grapples  not 
his  victim  in  the  fiery  agonies  of  death, 
but  slowly  he  parades  him  before  the  eyes 
of  loved  ones,  and  with  a  cruelty  as  relent- 
less as  the  gates  of  hell  knaws  away  his 
vitals.  Your  profession,  with  all  its  learn- 
ing and  ability,  stands  helpless  in  his  pres- 
ence, powerless  as  the  poor  deluded  priest 
who  walks  out  in  front  of  the  naked  army 
of  Filipinos  and  implores  his  god  to  bring 
consternation  on  the  ranks  of  the  monsters 
who  ire  killing  his  people  with  fire  and 
leaden  hail.  It  is  the  great  enemy  of  hu- 
man kind,  it  is  the  great  problem  for  solu- 
tion of  modern  medicine,  and  I  believe  that 
the  man  now  lives,  an  intellectual  Hercules, 
who  shall  destroy  this  myriad-headed  hy- 
dra, who  will  rescue  and  bless  our  race. 
His  name  will  eclipse  that  of  Harvey  and 
Jenner. 

However  this  may  be,  again  I  say,  in  the 
name  of  all  the  people  of  Asheville,  both 
laymen  and  belonging  to  the  profession,  I 
hope  your  deliberarions  may  be  pleasant 
and  profitable,  that  your  Society  may  con- 
tinue, as  it  always  has  been,  learned  and 
progressive,  the  pride  of  our  people  and  an 
ornament  to  our  State. 

RESPONSE     TO     ADDRESS  OF  WELCOME. 

Dr.  Benj.  K.  Hays,  of  Oxford,  made  the 
following  response  on  behalf  of  the  So- 
ciety : 

To  me,  Mr.  President,  has  been  assigned 
the  pleasing  but  extremely  difficult  task  of 
making  suitable  acknowledgment  of  this 
most  cordial  reception.  Fortunately  it  is 
not  expected  of  an  unknown  country  doc- 
tor to  echo  in  strains  harmonious  the  elo- 
quence of  a  lawyer  and  statesman  whose 
name  is  a  household  word  throughout  North 
Carolina. 

Had  it  been  my  duty  to  prepare  an  ad- 
dress for  this  occasion  and  had  the  speaker 
to  whom  we  have  just  listened  with  so 
much  pleasure,  been  unexpectedly  called 
upon  to  make  reply,  even  then  the  results 
would  have  been  most  unequal.  But,  sir, 
when  it  is  required  of  me  to  make  an  im- 
mediate reply  to  so  finished  an  oration  and 
to  express  the  gratitude  of  this  body  for 
such  words  of  welcome,  I  feel  myself 
wholly  unequal  to  the  task.  And  yet,  Mr. 
President,  this  body  of  physicians  deems  it 
a  peculiar  privilege  to  meet  in  this  city,  and 
while    its    many    attractions     are     known 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


659 


throughout  the  civilized  world,  I  wish  to 
say  that  its  beautiful  scenery,  and  pure  air, 
and  magnificent  hotels  are  less  to  us  than 
the  reception  which  has  been  accorded  us 
here  to-day. 

I  shall  not  undertake  to  enumerate  the 
charms  of  Asheville  ;  they  are  in  evidence 
and  speak  for  themselves,  and  we  must 
read  the  history  of  a  dozen  nations  to  learn 
of  the  blessings  enjoyed  here  by  the  in- 
habitants of  a  single  town.  The  Athenians 
were  a  people  of  culture,  but  could  not  re- 
sist the  armies  of  Philip,  nor  the  Romans. 
The  Roman  soldier  conquered  the  world, 
but  could  not  expel  from  his  city  the  dread 
malaria  that  came  with  each  returning  sum- 
mer claiming  its  victims  by  thousands. 
The  arid  regions  of  Africa  were  free  from 
malaria,  but  who  would  build  his  home  in 
a  desert?  The  mountains  of  Switzerland 
were  truly  beautiful,  but  the  Government 
of  that  country  was  unsettled,  and  the 
mountains  infested  with  robbers. 

But  here,  Mr.  President, .we  find  all  the 
beauties  of  Switzerland  ;  we  find  a  climate 
more  healthful  than  the  arid  regions  of 
Africa,  a  soil  more  fertile  than  the  banks 
of  the  Nile.  We  find  a  people  whose  cul- 
ture is  equal  to  that  of  the  Athenians.  We 
find  the  largest  library  in  the  State,  and 
schools  which  are  equal  to  the  best.  On 
every  side  is  manifest  a  love  for  the  beau- 
tiful and  for  the  artistic.  The  most  casual 
observer  finds  evidence  that  this  people  is 
not  disturbed  by  intestinal  discord,  for 
yonder  magnificent  temples  dedicated  to 
the  worship  of  Him  who  hung  on  Calvary 
are  monuments  of  perpetual  peace.  Nor  is 
there  fear  of  a  foreign  foe,  for  it  is  known 
to  all  that  the  life  and  liberty  and  property 
of  the  humblest  citizen  are  protebted  by  a 
strong  right  arm,  before  which  the  com- 
bined hosts  of  all  the  Cassras  would  be  as 
chaff    before  a  mighty  wind. 

Here,  too,  Mr.  President,  in  our  own 
profession  are  men  whose  ability  is  recog- 
nized in  two  continents.  When  the  future 
historian  of  medicine  shall  tell  how  that 
dread  disease,  tuberculosis,  was  blotted 
from  the  face  of  the  earth,  it  will  be  found 
that  the  labor  and  investigations  of  men 
now  seated  within  the  sound  of  my  voice 
played  no  small  part  in  that  Herculean  un- 
dertaking. But,  sir,  the  most  crucial  test 
that  can  be  applied  to  a  people  is  the  posi- 
tion occupied  by  its  womanhood.  By  savage 
people  woman  is  treated  as  a  slave  ;  a  little 
higher  in  the  social  scale  she  is  still  a  ser- 
vant ;  among  people  of  civilization  she  is 
regarded  as  man's  equal,  while  h^re  in 
Asheville  she  reigns  a   queen. 

Would  you  know  the  fairest  woman 
That  has  lived  within  the    North  State? 


Go  you  then  unto  the  mountains, 
View  the  lovely  Belle  of  Asheville. 
In  her  form  and  in  her  figure, 
Standing  like  a  Grecian  statue— 
In  her  brow  of  speaking  grandeur, 
In  her  eye  of   liquid  azure; 
In  her  lips  of   rose  and  ruby. 
In  her  neck  and  arms  majestic, 
In  her  rich  and  fair  complexion 
She  combines  as  many  graces, 
She  combines  as  much  of  beauty 
As  to  any  earthly  creature. 
By  the  Gods  was  ever  granted. 
In  his  heart  of   heart  blind  Homer 
Never  pictured  fairer  woman, 
In  his  sweetest  strain  did  Horace 
Ne'er  ascribe  to  Roman  beauty 
More  that  forms  a  perfect  beauty, 
More  that  forms  a  majestic  beauty. 
More   that  forms  a  perfect  woman. 

Such,  Mr.  President,  is  the  Queen  citv 
of  North  Carolina  as  she  is  to-day,  arrayed 
in  her  robes  of  verdue,  the  mountains  form- 
ing her  chair  of  State,  while  the  French 
Broad  plays  laughingly  about  her  feet.  Had 
the  little  strip  of  land  on  which  Asheville 
is  located  been  cut  from  North  Carolina  one 
hundred  years  ago,  it  would  have  been 
counted  no  great  loss;  and  yet,  sir.  this 
strip  of  land  has  produced  some  half  dozen 
men,  each  of  whom  has  been  instrumental 
in  shaping  laws,  the  institutions,  the  char- 
acter, the  destiny  of    the  State. 

Need  I  tell  of  David  L.  Swain,  who  left 
the  Governor's  chair  to  become  President 
of  the  University  and  who,  laboring  in 
that  capacity  for  the  third  of  a  century 
made  that  institution  the  pride  of  the  State 
and  the  admiration  of  the  South?  Need  I 
tell  you  of  Thos.  L.  Clingman,  soldier, 
statesman,  jurist,  scientist  and  scholar? 
Need  I  tell  you  of  Augustus  W.  Merrimon, 
whose  energy,  integrity  and  natural  ability 
won  for  him  eminence  as  a  statesman  and 
placed  him  in  the  very  first  rank  as  a  jurist? 
Need  I  tell  you  of  him  whose  firm  hand 
and  mighty  heart,  and  mightier  soul,  guided 
and  directed  our  people  in  the  hour  of 
greatest  extremity?  Who  obtained  cloth- 
ing for  the  naked  soldiers,  release  for  those 
in  prison,  and  in  a  thousand  ways  so  cared 
for  the  interest  of  the  people  as  to  win  for 
himself  the  name  of  the  great  war  Governor 
of  the  South?  Need  I  tell  how  he  alone 
was  able  to  redeem  the  State  from  the  con- 
dition worse  than  war  itself,  and  restore  the 
light  after  fifteen  years  of  night  and  gloom  ; 
and  how  later,  in  the  Senatorial  Chamber 
in  Washington,  at  a  time  when  it  was  diffi- 
cult for  a  Southerner  to  obtain  recognition, 
he  by  his  heroic  defence  of  North  Carolina 
and  the  South  won  the  admiration  and  ap- 
plause of  the  very  men  whom  he  had 
opposed  in  battle?  when  the  prejudice 
of  party  and  hatred  of  sectionalism  threat- 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


ened  to    trample    North    Carolina  into  the 
dust. 

"His  was  the  thunder — His  the  avenging  rod, 
The  wrath — the  delegated  voice  of  God, 
Which  shook  the  nations  through  his  lips,  and 

blazed, 
Till    vanquished      senates    trembled    as    they 

praised." 

Mr.  President,  these  things  are  matters 
of  history  and  there  is  no  occasion  for  me 
to  dwell  upon  them  here.  1  simply  refer 
to  them  in  passing,  that  we  in  our  admira- 
tion for  tbe  many  beauties  and  attractions 
which  surround  us  may  not,  in  the  intoxi- 
cation of  the  present  hour  be  unmindful 
that  Asheville  has  enjoyed  a  glorious  past. 

The  roll  was  called. 

The  President  then  read  his  Message. 

On  motion  of  Dr.  H.  B.  Weaver  of  Ashe- 
ville, seconded  by  Dr.  C.  J.  O'Hagan  of 
Greenville,  a  committee  was  appointed  to 
take  charge  of  the  President's  Message  and 
report  on  the  several  recommendations  con- 
tained therein. 

Dr.  M.  H.  Fletcher  of  Asheville,  Dr.  H. 
A.  Royster  of  Raleigh,  Dr.  C.  M.  Poole  of 
Craven,  were  appointed  a  committee  on 
credentials. 

Dr.  A.  G.  Carr  of  Durham,  Dr.  R.  H. 
Speight  of  Wrendale,  Dr.  T.  S.  McMullan 
of  Hertford,  were  appointed  a  committee 
on  finance. 

Dr.  H.  A.  Royster  of  Raleigh,  made  a 
motion  to  extend  the  courtesy  of  the  floor 
to  visiting  members  of  the  profession,  which 
was  carried. 

The  President  called  up  the  section  on 
Practice  of  Medicine,  and  the  chairman. 
Dr.  Benj.  K.  Hays  of  Oxford,  made  his  re- 
port on  "The  Continued  Fevers  of  North 
Carolina." 

Dr.  Hays'  paper  was  discussed  by  Drs. 
John  Hey  Williams,  J.  A.  Reagan,  H.  A. 
Royster,  S.  D.  Booth  and  C.  J.  O'Hagan. 

On  motion, 'the  paper  was  reerred  to  the 
committee  on  publication. 

The  committee  on  credentials  made  a  par- 
tial report. 

Drs.  E.  C.  Levy  and  John  P.  Davidson 
presented  credentials  as  delegates  from  the 
Medical  Society  of  Virginia. 

Dr.  J.  M.  Baker  of  Tarboro,  announced 
that  Miss  Minerva  Pittman,  the  daughter 
of  the  late  Dr.  N.  J.  Pittman,  for  many 
years  an  honored  member  of  this  Society, 
desired  to  give  a  prize  of  one  hundred  dol- 
lars in  cash  to  be  competed  for  annually  by 
members  of  the  Society,  under  such  rules 
as  it  should  see  proper  to  establish.  She 
desires  to  impose  only  one  condition,  that 
the  award  should  be  made  for  original  work 
or  investigation  upon  any  subject  pertain- 
ing to  medicine,  leaving  all  other  conditions 


to  the  pleasure  of  the  Society.  Miss  Pitt- 
man hoped  the  Society  would  see  fit  to  ac- 
cept this  offer,  so  that  the  award  might  be 
made  at  this  meeting. 

It  was  moved  that  the  offer  be  accepted. 
Dr.  Long  offered  an  amendment  that  a 
committee  of  three  be  appointed  to  have 
this  matter  in  charge,  and  said  that  it  was 
fitting  that  the  Society  should  recognize  this 
generous  offer,  and  very  proper  that  the 
name  of  Dr.  Pittman  should  be  recalled  at 
the  annual  meetings  in  this  way ;  that  it 
was  an  inspiration  to  the  young  men  and  a 
pleasure  to  the  old  men  to  recall  his  useful 
life  and  valuable  services. 

Dr.  O'Hagan  said  that  he  had  had  the 
honor  of  knowing  Dr.  Pittman  well  and 
intimately;  that  what  struck  him  in  the 
offer  was  the  filial  piety  of  the  young  lady, 
and  the  interest  she  took  in  the  advance- 
ment of  the  medical  profession  of  which 
her  father  was  such  a  distinguished  member. 
Motion  seconded  and  carried. 

The  reading  of  the  paper  on  "'Clinical 
History  and  Prognosis  of  Continued  Fever 
as  seen  in  the  Mountain  Section  of  North 
Carolina,"  by  Dr.  J.  Howell  Way,  was 
postponed  on  account  of  the  unavoidable 
absence  of  Dr.  Way. 

Dr.  W.  L.  Robinson  of  Danville,  being 
also  unavoidably  detained,  the  reading  of 
his  paper  on  "Treatment  of  Typhoid  Fever, 
was  postponed. 

On  motion,  the  Seciety  adjourned  until 
3:30  P.  M. 

Afternoon   Session. 

The  Society  was  called  to  order  at  3  130 
p.  m.,  by  the  President. 

The  credential  committee  made  a  partial 
report. 

The  report  of  the  section  on  Practice  of 
Medicine  was  continued  by  a  paper  on 
"Typhoid  Fever  as  met  with  in  Fayetteville 
and  Surrounding  Country,"  read  by  Dr.  J. 
F.  Highsmith  of  Fayetteville.  Discussed 
by  Dr.  O'Hagan. 

On  motion,  Dr.  Highsmith's  paper  was 
referred  to  the  committee  on  publication. 

A  paper  on  "Chronic  Gastro-Intestinal 
Catarrh,"  was  read  by  Dr.  Wm.  J.  Mc- 
Anally  of  High  Point.  Referred  'to  the 
committee  on  publication. 

Dr.  E.  B.  Glenn  of  Asheville,  read  a 
paper  on  "Study  of  the  Bacteriology  of 
Specific  Urethritis."  Discussed  by  Prof. 
E.  C.  Levy  of  Richmond,  Va.  Paper  was 
referred  to  the  committee  on  publication. 

Dr.  Paul  Pacquin  of  Asheville,  discussed 
"Biology  and  Pathology  of  Mixed  Infection 
in  Tuberculosis." 

The  following  committee  was  appointed 
on  the  Pittman  prize  :  Julian  M.  Baker, M. 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


D.,  Geo.  W.  Long,  M.  D.,  J.  P.  Munroe, 
M.  D. 

The  following  committee  was  appointed 
to  report  on  the  President's  address  :  Drs. 
C.  J.  O'Hagan,  R.  H.  Lewis,  Geo.  Gillett 
Thomas. 

It  was  moved  and  seconded  that  the  sten- 
ographer reporting  last  year's  meeting  be 
paid  a  balance  of  $14.65.      Carried. 

The  Treasurer  stated  that,  in  the  regular 
routine  of  his  work,  he  had  sent,  among 
other  bills,  one  to  Dr.  R.  W.  Mills,  to  which 
he  had  received  the  following  reply  : 

Troutmans,  N.  C,  Aug.  2,  '98. 
Dear  Doctor: — Yours  of  recent  date  is  to 
hand,  and  in  reply  will  say  my  condition  is 
such,  from  age  and  infirmities,  also  straiten- 
ed circumstances,  as  stated  to  your  prede- 
cessor, I  am  totally  unable  to  pay  any  dues 
to  the  treasurer  of  the  State  Medical  .Society. 
I  hope  you  will  not  construe  this  as  any 
want  of  generosity,  but  simply  the  want  of 
ability.  I,  as  many  other  medical  practi- 
tioners, have  large  accounts  due  me,  but  un- 
able to  collect  any,  hence  with  no  income 
leaves  me  ill  no  condition  to  pay  any  kind 
of  assessments  as  taxes.  Hoping  tin's  might 
prove  satisfactory — I  am  near  seventy-five 
years  of  age,  eye-sight  almost  gone. 
Fraternally  yours, 

R.  W.  Mills,  M.  D." 

It  was  unanimously  declared  that  Dr. 
Mills  dues  be  remitted,  and  that  lie  be  per- 
mitted to  remain  a  member  of  the  State 
Medical  Society  during  his  life  time  with- 
out further  payment  of  dues. 

The  President  read    the  following  letter: 
State  of  North  Carolina, 
Insurance  Department \ 

Raleigh,    X.  C,  May  15,  '99. 
Dr.  L.  J.  PiCOT,    President, 

Littleton,  X.  C. 
My  Dear  Honor:  I  see  that  your  society 
is  to  meet  in  Asheville  about  the  1st  of 
June,  and  I  take  the  liberty  of  enclosing 
you,  under  separate  cover,  a  copy  of  our 
new  Insurance  Laws,  and  of  calling  your 
attention  to  section  58  of  the  same.  You 
will  find  upon  examination  of  it,  that  no 
life  insurance  company  can  now  issue  a 
policy  in  this  State  without  an  examination 
by  the  registered  medical  practitioner. 
This,  I  take  it,  will  be  of  some  interest  to 
you  and  your  profession,  and  I  would  be 
glad  to  have  you  call  the  attention  of  your 
Society  to  the  same  in  your  annual  address, 
saving  that  I  have  called  it  to  your  atten- 
tion, and  urge  them  to  lend  their  aid  in 
seeing  that  it  is  carried  out.  Xot  only  as 
a  matter  of  personal  interest  to  them  indi- 
vidually, but    as  one    that   will   be  of    great 


advantage  to    the  people  of    the  State,  and 
the  insurance  interest. 
Very  truly  yours, 

J.  R.  Young, 
Insurance  Commissioner. 
On  motion  the  Society  adjourned. 

.Second  Day — Morning  Session. 

The  Society  was  called  to  order  at  10  a. 
m.  by  the  President. 

The  following  committee  on  Nominations 
was  appointed  :  Drs.  H.  B.  Weaver,  II.  H. 
Harris,  J.  M.  Baker,  B.  F.  Halsey,  George 
L.  Kirby. 

The  Finance  Committee  made  the  fol- 
lowing report,  which  was  received  and 
adopted. 

We,  your  Finance  Committee  make  the 
following  report  after  examining  the  books 
and  vouchers  of  the  Secretary  and  Treas- 
urer : 

To  balance  on  hand  June  5,  '98 $561  64 

May  5.  To  ain't  collected  trom  members.     42  00 
Aug.  1.  To  am't  collected  from  members,     34  00 

1899. 
Ap'l  2">.  To  am't  collected  from  members     86  00 
May  29.  To  am't  collected  from  members    29  00 

$752  64 
EXPENSES. 
1898. 
May  5.  Paid  M.  P.  Perry,  Treasurer. . .  .$100  00 

"30.       "     Stenographer 25  00 

"    2.       "    Observer  Printing  House. .       3  75 

••    4.       '•     R.  D.  Jewett 305  86 

July  2.       "     News  and  Observer 2  80 

.1  u  l'v  8.       "    Stationery 3  00 

Sept.  30.    "     Postage 4  16 

1899. 
May  29.     "     Postage 36 

$444  93 
Balance  on  hand  May  31,  1899 $307  71 

We  recommend  the  usual  assessment  of 
$2.00  per  capita.  That  the  salary  of  the 
Secretary  be  $100.00,  and  that  of  the  Treas- 
urer $75.00  for  the  ensuing  year.  We  also 
again  urgently  recommend  that  the  Treas- 
urer notify  each  delinquent  member  of  his 
indebtedness,  and  request  an  early  settle- 
ment of  the  same.  We  would  also  recom- 
mend that  the  stenographer  be  employed 
at  a  maximum  salary  of  $25.00.  We  rec- 
ommend that  the  proposed  resolution  of 
Dr.  J.  P.  Monroe  be  considered  in  connec- 
tion with  this  report. 

Dr.  J.  P.  Monroe  withdrew  his  resolu- 
tion heretofore  introduced,  which  reads  as 
follows  : 

Resolved,  that  Article  in,  Section  2,  be 
amended  by  adding  to  it  the  following : 
But  any  licentiate  who  shall  apply  for 
membership  in  this  society  at  the  current 
meeting  during  which  he  has  been  licensed 
by  the  Board  of  Examiners,  and  be  recom- 
mended by  the  Committee  on  Credentials, 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


shall  be  admitted  without  paying  the  ini- 
tiation fee  of  $5. 

On  motion  the  report  was  received,  and 
the  committee  discharged  in  so  far  as  these 
particular  reports  are  concerned. 

Dr.  C.  S.  Mangum,  of  Chapel  Hill, 
Chairman  on  section  of  Materia  Medica 
and  Therapeutics,  presented  a  paper  on 
"Progress  in  Serum  Therapy,"  which,  on 
motion,  was  referred  to  the  Committee  on 
Publication. 

The  Obituary  Committee  reported  as 
follows  : 

At  the  meeting  of  the  Society  in  Raleigh 
in  1893  the  death  of  Dr.  S.  S.  Satchwell 
was  reported,  and  a  number  of  eulogistic 
speeches  make  by  the  older  members  who 
had  been  associated  with  him  for  years.  So 
highly  was  he  esteemed  by  the  Society,  that 
his  case  was  referred  to  a  special  committee 
to  report  suitable  resolutions  in  regard  to 
his  useful  life,  his  love  for  the  Society,  and 
his  great  interest  in  the  health  of  the  State. 
Owing  to  sickness,  and  the  death  of  one  of 
the  committee,  the  report  has  been  delayed, 
but  is  now  submitted  as  follows  : 

IN  MEMORIAM. 

Solomon  Sampson  Satchwell,  a.m.,m.d. 

Dr.  Satchwell  was  born  in  Beaufort 
County,  N.  C,  October  26th,  1821,  and 
died  at  his  home,  Burgaw,  Pender  County, 
October  9th,  1892,  in  the  seventy-first  (71) 
year  of  his  age. 

He  was  educated  at  Wake  Forest  College, 
studied  medicine  with  Dr.  John  Norcom, 
of  Washington,  N.  C,  and  at  the  Medical 
Department  of  the  University  of  New 
York,  receiving  his  degree  of  Doctor  of 
Medicine  from  that  Institution  in  the 
Spring  of  1850.  He  remained  in  New 
York  for  eighteen  months  studying  medi- 
cine after  receiving  his  degree. 

He  then  returned  to  his  home  in  Beau- 
fort County,  N.  C,  near  Washington,  and 
began  the  practice  of  his  profession,  and 
remained  there  until  1854,  when  he  moved 
to  Long  Creek,  in  Pender  County,  N.  C. 
He  practiced  his  profession  in  this  county 
until  i860,  when  he  went  to  Paris,  France, 
to  pursue  the  study  of  medicine.  He  was 
one  among  the  first  members  of  this  Socie- 
ty, which  he  loved  and  served  faithfully  up 
to  his  death.  It  afforded  him  pleasure  to 
attend  the  meetings  of  the  Society  and  he 
rarely  came  to  one  empty  handed.  He  al- 
tended  the  meetings  of  the  Society  when  it 
was  possible  for  him  to  do  so. 

The  Society  appreciated  his  interest  in 
and  devotion  to  its  welfare  and  conferred 
upon  him  almost  every  honor  within  its 
gift;  electing  him    Secretary  in  1854,  1855 


and  1856,  Co-Editor  of  the  North  Carolina 
Medical  Journal,  with  Dr.  Chas.  E.  John- 
son in  1859,  when  the  Journal  was  pub- 
lished by  the  Society. 

He  was  elected  a  member  of  the  second 
Board  of  Medical  Examiners  for  six  years, 
from  1866  to  1872. 

He  was  elected  President  of  the  Society 
and  presided  at  the  meeting  in  1868. 

He  was  the  first  one  to  make  a  move  for 
the  establishment  of  the  Board  of  Health 
for  this  State. 

Single  handed  and  almost  entirely  alone, 
he  worked  for  and  succeeded  in  securing 
the  establishment  of  the  Board  of  Health, 
by  the  Legislature.  He  was  elected  the 
first  president  of  the  Board,  and  to  him 
the  profession  of  medicine  and  the  public 
are  indebted  for  whatever  good  the  Board 
has  accomplished. 

Dr.  Satchwell  returned  home  from  Paris 
in  the  Spring  of  1861,  upon  the  beginning 
of  the  great  war  and  entered  the  Confeder- 
ate Army  as  the  Surgeon  of  the  25th  North 
Carolina  Regiment,  then  Col.  Clingman's 
regiment.  He  served  with  Clingman's 
command  until  the  Spring  of  1863,  when 
he  was  assigned  to  duty  as  Surgeon  in 
charge  of  the  general  hospital  at  Wilson, 
N.  C,  afterwards  known  as  general  hos- 
pital No.  1,  in  the  general  hospital  dis- 
trict of  North  Carolina.  He  continued  in 
the  faithful  discharge  of  all  his  duties  here 
until  the  end  of  the  war  in  April  1865. 

The  conduct  and  management  of  the 
hospital  reflected  great  credit  and  honor 
upon  him  and  all  his  assistants  under  his 
charge.  This  hospital  was  reported  to  the 
Surgeon  General  of  the  Confederate  States 
in  the  Spring  of  1865  as  one  among  the 
best  general  hospitals  of  the  Confederate 
States,  by  Surgeon  Chopin,  of  New  Or- 
leans, who  was  the  Medical  Inspector  on 
General  Beauregard's  staff,  and  who  said 
that  he  had  inspected  the  general  hospitals 
in  every  district  of  the  Confederate  States. 

At  the  end  of  the  war,  in  April  1865,  he 
returned  to  his  home  at  Burgaw,  in  Pender 
County,  and  devoted  himself  to  the  prac- 
tice of  his  profession  and  the  welfare  of  his 
fellow  citizens,  until  his  death  October  the 
9th,  1892. 

He  died  of  Typhoid  Fever,  while  in  at- 
tendance of  several  patients  with  that  dis- 
ease, whom  he  visited  while  so  sick  himself 
that  he  had  to  be  lifted  into  and  taken  out 
of  his  buggy  when  he  called  upon  them. 

He  was  true,  devoted  and  faithful  to 
every  duty,  through  a  long  and  useful  life, 
even  unto  death. 

He  served  his  patients,  his  State  and  the 
Confederate  States,  truly,  loyally  and  de- 
votedly. 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


663 


Resolved,  that  in  the  death  of  Dr.  Satch 
well,  this  Society  has  lost  one  of  its  oldest 
and  most  devoted  members,  full  of  years 
and  the  honors  of  this  Society,  and  ex 
presses  its  appreciation  of  his  life,  charac 
ter  and  reputation,  and  deplores  its  loss 
caused  by  his  death. 

Resolved,  that  one  or  more  pages  in  the 
records  be  devoted  to  the  memory  of  Dr. 
Batch  well,  and  that  the  Society  extend  its 
sympathy  to  his  family  in  their  great  loss 
and  in  their  bereavement  at  his  death. 

Resolved,  that  the  secretary  be  instructed 
to  send  a  copy  of  this  memoir  and  resolu- 
tions to  the  family  of  Dr.  Satchwell. 

Geo.  W.  Long,  Chm'n, 

J.  A.  Reagan, 

C.  J.  O'Hagan. 

Dr.  Charles  Eugene  Hilliard  was  born 
in  Asheville  August  the  24th,  1864,  was 
educated  up  to  the  times,  in  Asheville, 
graduated  from  Jefferson  Medical  College, 
Philadelphia,  in  the  Class  of  '88,  died  De- 
cember 19th,  1898. 

It  is  thought  by  many  that  a  young  man 
has  a  more  difficult  chance  for  success,  in 
his  profession  at  home  where  he  has  mixed 
with  the  men  of  his  age,  than  among 
strangers,  but  while  this  may  be  the  case 
with  some,  it  was  not  the  case  with  Dr. 
Hilliard.  He  at  once  entered  into  a  fine 
practice,  and  retained  it  with  increasing 
popularity  as  a  man  and  a  physician.  But 
few  men  of  his  age  stood  higher  in  the  pro- 
fession among  the  physicians  and  the  peo- 
ple than  did  Dr.  Hilliard.  His  father  was 
one  of  the  leading  physicians  of  this  sec- 
tion, and  his  son  was  reflecting  honors  on. 
the  name  when  he  was  suddenly  called  to 
leave  all  that  were  dear  to  him.  He  had  been 
visiting  patients,  came  home  and  was  eat- 
ing his  supper  when  he  was  suddenly  taken 
sick  and  died  in  a  few  minutes.  He  was 
loved  and  honored  by  all  who  knew  him. 
].  A.  Reagan, 
C.  J.  O'Hagan, 
Geo.  W.  Long. 

"Whom  the  gods  love  die  young"! 
Dr.  Brown  was  born  in   Pitt    county,    near 

Greeneville.   He  was old  and  decended 

from  one  of  the  oldest  and  most  respected 
families  in  the  county.  His  father  gave 
him  a  splendid  education,  both  academic 
and  collegiate.  At  an  early  age  he  selected 
medicine  as  his  vocation  in  life,  and  after 
two  years  purilage  he  entered  Bellevue 
Medical  College,  from  which  he  graduated 
with  distinction,  after  three  years  study. 
He  became  partner  of  his  preceptor  with 
whom  he  practiced  for  twelve  years  in  the 
discharge  of  his  professional  duties.  He 
was  distinguished     by  zeal,     industry  and 


speedily  secured  confidence  and  respect  of 
his  patients.  He  had  decided  talent  for 
surgery,  and  if  his  life  had  been  spared  he 
would  have  been  distinguised  in  his  favorite 

branch.     He  died universally  loved 

and  respected.  Geo.  W.  Long, 

J.  A.  Reagan, 
C.  J.  O'Hagan. 
Dr.  George  A.  Foote  was  born   in    War- 

renton ,  studied   medicine    with 

Dr.  O.  F.  Manson,  granduated  from 

College — ,  settled   in    War- 


renton  and  practiced  successfully  until  the 
breaking  out  of  the  civil  war,  when  he 
joined  the  Confederate  army  and  served 
throughout  the  entire  war,  distinguishing 
himself  especially  in  the  assault  and  cap- 
ture of  Ft.  Fisher,  where  he  displayed  con- 
spicuous gallantry  in  the  discharge  of  his 
professional  duties  under  the  most  terrific 
fire  known  in  the  annals  of  war.  He  was 
an  active  and  devoted  member  of  the  Medi- 
cal Society  of  the  State  which  rewarded 
him  by  the  bestowal  of  the  highest  honors 
within  its  gift.  As  a  near  and  dear  physi- 
cian he  won  the  honor  and  respect  of  all 
with  whom  he  was  brought  in  contact. 
After  a  lingering  illness  he  died  regretted 
and  mourned  not  only  by  the  community 
in  which  he  lived  and  woiked  so  faithfully 
and  long  but  also  by  this  Society. 

Resolved,  That  a  copy  of  this  report  be 
spread  upon  our  minutes  and  that  the  Sec- 
retary forward  a  copy  to  the  family. 

Geo.    W.    Long,   Ch'm, 

J.  A.  Reagan, 

C.  J.  O'Hagan. 

The  report  of  the  Board  of  Medical  Ex- 
aminers was  then  made  through  their  Sec- 
retary, Dr.  Thos.  E.  Anderson  of  States- 
ville,  as  follows  : 

Air.  President  and  Gentlemen  of  the  North 
Carolina  Medical  Society  : 

The  Board  of  Medical  Examiners,  insti- 
tuted by  yourselves,  having  completed  its 
work,  desires  through  me,  its  Secretary,  to 
submit  the  following  report  : 

The  Board  began  its  work  Thursday  af- 
ternoon, the  25th  inst.,  and  has  been,  with 
the  exception  of  Sunday  intervening,  in 
almost  continuous  session,  having  finished 
this  morning  at  6  130  after  an  all  night  ses- 
sion. Our  roll  shows  that  112  names  have 
been  registered,  the  number  of  applicants 
being  112.  These  applicants  represent  40 
medical  colleges  or  schools.  The  list  shows 
that  the  University  College  of  Medicine  of 
Richmond,  Va.,  leads  all  the  rest  in  num- 
bers, there  being  from  this  Institution  19 
applicants,  only  one  of  which  is  an  under- 
graduate. The  next  in  point  of  numbers  is 
the   University  of  Maryland,  it   furnishing 


664 


THE  CHARLOTTE  MEDICAL-JOURNAL. 


12  applicants,  one  of  whom  is  an  under- 
graduate. The  North  Carolina  Medical 
College  -stands  next  in  order  and  presents 
10  applicants  for  license,  6  of  whom  are 
non-graduates.  The  University  of  Nash- 
ville, Medical  College  of  Virginia  andVan- 
derbilt  University  each  furnish  5,  and  out 
of  the  15  three  are  non-graduates.  The 
Kentucky  School  of  Medicine  furnishes  4, 
three  of  whom  are  non-graduates.  The 
Ohio  Medical  College,  Baltimore  Medical, 
Jefferson  Medical  College  and  Long  Island 
College  Hospital,  all  furnish  three  each, 
and  out 'of  the  12  thus  furnished,  one  only 
is  an  undergraduate.  The  Medical  Depart- 
ment of  the  University  furnishes  two  first 
course  men.  Atlanta  College  of  Physicians 
and  Surgeons,  Leonard  Medical  College, 
Chattanooga  Medical  College,  Baltimore 
University,  Medico-Chirurgical  of  Philadel- 
phia, Pa.,  Medical  College  of  South  Caro- 
lina, Tulane  University  of  Louisiana.,  Phy- 
sicians and  Surgeons  Baltimore,  Bellevue, 
and  University  of  New  York,  each  furnish 
two,  making  18,  all  graduates  in  medicine. 
University  of  Tennessee,  Missouri  Medical, 
Georgetown  University,  University  of  Penn- 
sylvania, Chicago  School  of  Homeopathy, 
Medical  College  of  Alabama,  Columbia 
University  of  Washington,  D.  C,  Univer- 
sity of  Louisville,  Ky.,  Medical  Department 
National  University  of  Georgetown,  D.  C, 
LIniversity  of  Leipsic,  Germany,  St.  Louis 
Medical  College,  Physicians  and  Surgeons 
of  New  York,  Alabama  Medical  College, 
University  of  Virginia,  Southern  Medical 
College  of  Atlanta,  Ga.,  University  of  Geor- 
gia, the  Laura  Memorial  Medical  College  of 
Cincinnati,  Ohio,  and  Medical  College  of 
Maine,  all  furnish  one  each,  all  of  whom 
are  full  graduates  except  one,  making  a  to- 
tal of  112.  Of  this  number  two,  mindful 
that  coming  events  cast  their  shadows  be- 
fore, withdrew.  Of  the  112  applying,  95 
are  graduates,  17  are  non-graduates. 

After  a  careful,  painstaking,  if  not  pain- 
ful, and  deeply  conscientious  consideration 
of  the  papers  presented  by  this  large  and 
unprecedented  number,  we  have,  after  care- 
ful consideration  and  revision  placed  in  the 
hands  of  those  whose  names  appear  below 
our  license  to  practice  medicine  in  the  State, 
with  all  the  immunities,  privileges,  &c, 
appertaining  : 

Among  the  applicants  for  license  before 
the  State  Board  of  Medical  Examiners  this 
year,  the  highest  grade  was  made  by  L.  H. 
Love  of  Wilmington,  with  96  per  cent. 
W.  E.  Miller  of  Burlington  came  next  with 
a  percentage  of  94  5-7  ;  S.  W.  Schell  of 
Lenoir,  92  5-7,  and  Chauncey  Bakestrawof 
Charlotte,  a  near  fourth  with  92.  Thirteen 
others  made  over  90  per  cent. 


The  following  is  the  list  of  the  successful 
applicants  : 

William  P  Isley,  Burlington,  J  M  New- 
bern,  Powells  Point,  Charles  L  Scott,  Me- 
bane,  W  C  Lauderdale,  Asheville,  J  D 
MacRae,  Fayetteville,  J  F  Peavy,  Ashe- 
ville, J  S  Wise,  Chester,  S.C.JW  Slate, 
Quaker,  Paul  Paquin,  Asheville,  G  W 
Hays,  Lancaster,  Ky.,  J  P  Whitehead, 
Rocky  Mount,  B  W  Fassett,  Cross  Roads 
Church,  A  W  Calloway,  Asheville,  J  D 
Heathman,  Woodleaf,  D  G  McKethan, 
Fayetteville,  N  C  Hunter,  Enfield,  \V  G 
Leak,  Francisco,  T  W  Davis,  Louisburg, 
T  W  Shore,  Booneville,  R  F  Yarborough, 
Louisburg,  H  S  Monk,  Newton  Grove,  W 
W  Duson,  Asheville,  W  E  Miller,  Bur- 
lington, C  C  Joyner,  Greenville,  H  G  Hei- 
lig,  Salisbury,  D  W  Griffin,  Reppetoe,  J 
S  Slate,  Mizpah,  A  R  Winston  Franklin, 
O  S  Smith,  Waycross,  J  H  Peeler,  Faith, 
J  E  Nobles,  Greenville,  H  H  Boss,  Rocky 
Mount,  H  R  Moore,  Burlington,  W  M 
White,  Statesville,  C  W  Banner,  Mt.  Airy, 
Geo  H  Ross,  Oakdale,  R  G  Rozier,  Rozier, 
R  T  S  Steele,  Rockingham,  H  M  S  Cason, 
Edenton,  T  C  Quickel,  Lincolnton,  R  D 
Holt,  Smithfield,  F  D  Drewry,  Garysburg, 
H  C  Houston,  Walkups,  F  A  Ward,  Gli- 
den,  T  B  Tyson,  Covington,  D  A  Boyd, 
Plott,  G  W  Cardwell,  Reidsville,  R  M 
Roberson,  Pittsburg,  I  W  Lann,  Siler  City, 
L  A  Walker,  Stone  Creek,  R  E  Hollings- 
worth,  Mt  Airy,  E  J  Widby,  Lenoir,  J  B 
Wright,  Coharie,  S  W  Schell,  Lenoir,  Wm 
Fountain,  Tarboro,  W  O  Nisbet,  Waxhaw, 
J  M  Covington,  Rockingham,  G  M  Van 
Poole,  Craven,  C  S  Maxwell,  Mt  Olive,  J 
T  Smith,  Westfield,  Edmond  Gladmon, 
Southern  Pines,  James  A  Smith,  Raleigh, 
J  R  Thompson,  Colly,  T  L  Brooks,  Black 
Creek,  J  C  Hall,  Star,  O  L  Ray,  Bangor, 
Geo  H  'Kirby,  Raleigh,  J  P  Wimberly, 
Rocky  Mount,  Calvin  M  Case,  Asheville, 
Robert  L  Felts,  Charlotte,  Chauncey  Rake- 
straw,  Charlotte,  W  D  Price.  Charlotre, 
H  McKee  Tucker,  Raleigh,  T  L  Fox, 
Franklinville,  D  L  Fox,  Worthville,  L  H. 
Love,  Wilmington,  T  M  Copple,  Lexing- 
ton, W  J  Meadows,  McAdenville,  WH 
Smith,  Marshville,  A  B  Drafts,  Lexington, 
W  T  Parrott,  Kinston,  I  H  Manning,  Wil- 
mington, Ida  M  Wilson,  Charlotte,  S  H 
von  Ruck,  Asheville,  Louise  Anderson 
Merrimon,  Asheville,  L  Warren  Achorn, 
Boston,  T  O  Joyner,  Seaboard. 

Dr.  Anderson  further  said  :  "The  Board 
exposed  one  of  the  most  infamous  attempts 
to  secure  a  license  that  has  come  to  our 
knowledge,  wherein  a  young  native  of  this 
State  went  to  Baltimore  and  secured  a  young 
man  from  one  of  the  institutions,  which 
place  he  had  secured   by  competitive  exam- 


THE  CHARLOTTE  MEDICAL   JOURNAL. 


665 


ination,  brought  him  here,  registered  in  the 
name  of  this  North  Carolina  young  man, 
Bfitd  was  regularly  proceeding  to  take  our 
examination,  when  a  little  bit  of  data  in 
my  hands  enabled  me  to  get  after  it,  and 
after  questioning  him  and  looking  after  him 
pretty  sharply,  he  found  that  he  was  detect- 
ed and  disclosed  the  whole  scheme.  He 
said  that  he  was  prompted  purely  by  friend- 
ship to  this  young  fellow,  who  had  been  a 
classmate  of  his,  and  who  felt  very  certain 
he  could  not  stand  the  examination,  and  he 
came  here  representing  that  fellow,  but  un- 
fortunately he  had  not  studied  his  part  well. 
He  knew  the  town  he  was  from,  but  did  not 
know  his  county.  He  said  he  had  been  out 
of  the  State  four  or  five  years,  was  the  reason 
he  forgot  his  county.  1  asked  him  about 
some  other  citizens  of  that  county,  and  he 
knew  nothing  whatever,  and  he  saw  he  was 
detected,  and  he  told  the  whole  thing  and 
left  on  the  first  train.  A  very  infamous 
thing  indeed.  He  said  he  would  never  do 
anything  of   that  kind  again. 

I  would  like  to  give  notice  that  we  will 
immediately  issue  licenses  to  the  successful 
gentlemen,  and  that  we  have  some  very 
nice  blanks  on  parchment  which  will  cost 
$1.00.  Anybody  wishing  them  will  please 
notify  me. 

The  Committee  on  Legislation  reported 
as  follows  : 

REPORT  OF  COMMITTEE  <>N   I.KCISLATION. 

Your  committee  respectfully  beg  leave  to 
report  : 

In  [849  the  State  Medical  Society  was 
organized  by  a  handful  of  our  leading  phy- 
sicians. Ten  years  afteawards,  just  forty 
years  ago,  it  was  incorporated  by  the  Gen- 
eral Assembly,  and  in  the  same  bill  were 
embodied  provisions  for  regulating  the 
practice  of  medicine  in  this  State,  requir- 
ing a  license  from  a  Board  of  Examiners 
to  be  elected  by  the  Society.  The  penalty 
was  inability  to  collect  fees  at  law.  Ac- 
cording to  our  recollection,  this  was,  with 
the  exception  of  a  meagre  law  enacted  by 
the  Legislature  of  New  York  early  in  the 
century,  but  which  fell  almost  immediately 
into  ••innocuous  desuetude,"  and  there- 
fore should  not  count— the  first  attempt 
made  in  the  United  States  to  regulate  the 
practice  of  medicine.  For  many  years  ours 
was  the  only  law  of  the  kind  in  the  coun- 
try, and  slow  old  North  Carolina  was  the 
leader  in  this  important  movement. 

In  1885,  chiely  through  the  efforts  of  the 
late  deeply  lamented  Dr.  Thomas  F.  Wood, 
of  Wilmington,  the  law  was  amended  by 
making  it  a  misdemeanor,  punishable  by 
fine  and  imprisonment  to  practice  without 
license. 


In  1889  the  registration  feature  was  add- 
ed— the  act  allowing  all  in  practice  at  the 
time  to  register  whether  licensed  or  not,  but 
closing  the  doors  finally  on  January  1,  1892, 
to  all  except  those  holding  a  license  from 
the  Board  of   Medical   Examiners. 

While  the  Acts  of  1885  and  1889  greatly 
strengthened  the  law,  two  serious  defects 
remained  to  be  cured.  One  was  the  right 
of  any  one,  whether  properly  educated  in 
medicine  or  not,  to  apply  for  license,  and 
the  other  was  the  practical  ability  of  the 
Board,  owing  to  the  fact  that  its  examina- 
tions were  necessarily  theoretical,  to  ascer- 
tain whether  the  applicant  had  received  the 
necessary  clinical  instruction.  To  cure 
these  defect  your  Committee  on  Legisla- 
tion, believing  that  public  opinion  had 
grown  up  to  this  point,  and  that  the  time 
was  ripe  for  making  the  effort,  drew  a  bid 
embodying  these  amendments  and  secured 
its  enactment  by  the  General  Assembly  of 
1899.  It  received  a  unanimously  favorable 
report  from  the  Judiciary  Committees  of 
both  the  Senate  and  House,  and  passed  the 
Senate  unanimously,  but  met  with  active 
opposition  in  the  House,  much  to  our  sur- 
prise, as  no  one  outside  the  Legislature,  or 
in  it,  so  far  as  known,  was  against  it.  The 
argument  against  it  was  directed  chiefly  to 
the  provision  requiring  a  diploma  from  a 
college  requiring  an  attendance  of  three 
years,  the  speakers  holding  that  it  would 
debar  some  ambitious  young  men  of  limit- 
ed means  from  entering  the  profession,  the 
insinuation  being  made  that  the  bill  was  a 
scheme  on  the  part  of  the  physicians  now 
in  practice  to  form  a  •'doctor's  trust,"  and 
reduce  competition.  We  know  that  this 
idea  did  not  enter  the  minds  of  your  com- 
mittee, and  that  we  were  actuated  by  only 
two  motives— the  still  further  elevation  ot 
our  profession  and  the  more  certain  protec- 
tion of  the  people  against  incompetency 
on  the  part  c5f  their  medical  advisers.  In- 
stead of  lessening  competition.  the 
effect  of  the  amendment  will  be  to  in- 
crease it  by  insuring  the  more  thorough 
preparation  of  the  new  men  coming  in 
from  year  to  year,  while  it  will  not  sensibly 
diminish  the  number.  There  is  no  dan- 
ger of  a  failure  in  the  crop  of  doctors.  Ad- 
mitting that  the  requirement  of  a  diploma 
from  a  respectable  college— no   college     re 


quiring 


less  than  three  years  attendance  can 


now  be  called  respectable— will  prevent  a 
few  young  men  from  following  the  profes- 
sion of  medicine  instead  of  some  other  calling 
equally  honorable  and  frequently  more  lu- 
crative it  should  not  even  be  so  much  as 
named  in  comparison  with  the  greater  pro- 
tection to  the  health  and  lives  o  the  peo- 
ple of  the  whole  State.      We  feel  that    the 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


ackwledgments  of  the  Society  and  of  the 
people  of  the  State  are  due  the  gentlemen 
of  the  Legislature  who  supported  the  bill 
by  speech  and  vote.  Among  so  many 
friends  we  would  not  make  any  invidious 
distictions,  but  we  feel  that  it  would  be 
proper  to  mention  particularly  the  Hon. 
M.  H.  Justice,  of  Rutherford,  who  intro- 
duced and  championed  the  bill  in  the 
Senate,  securing  its  passage  without  a  dis- 
senting vote  ;  the  Hon.  B.  E.  Reeves,  M. 
D.,  the  Representative  from  Ashe,  who  led 
the  fight  for  it  in  the  House,  and  the  Hon. 
H.  G.  Connor,  of  Wilson,  Speaker  of  the 
House,  who  becoming  concerned  for  the 
pasasge  of  the  bill,  left  the  Speaker's  chair 
and  advocated  it  on  the  floor  in  a  speech  of 
great  weight,  in  the  course  of  which  he  took 
occasson  to  pay  an  eloquent  tribute  to  the 
physician — the  country  doctor  in  particular. 
Richard  H.  Lewis,  Ch'm, 

for  the  Committee. 

An  Act  to  Amend  Chapter  Thity-four 
of  the  Code  and  Chapter  One  Hun- 
ered  and  elghty-one    of   the    laws 

OF   1889. 

The  General  Assembly  of  North    Carolina 

do  enact  : 

Section  i.  That  chapter  thirty-four  of 
The  Code  be  amended  by  inserting  after 
the  word  "applicants"  in  line  two  of  sec- 
tion three  thousand  one  hundred  and  twen- 
ty-four, the  following  words:  "who  shall 
exhibit  a  diploma,  or  furnish  satisfactory 
proof  of  graduation,  from  a  medical  col- 
lege in  good  standing  requiring  an  attend- 
ance of  not  less  than  three  years  and  sup- 
plying such  facilities  for  clinical  instruc- 
tiot  as  shall  meet  the  approval  of  the  said 
Board'"  ;  and  by  adding  immediately  after 
said  section  three  thousand  one  hundred 
and  twenty-four  the  following  words : 
"Provided,  that  the  requirement  of  three 
years'  attendance  shall  not  apply  to  those 
graduating  prior  to  January  first,  1900.  Pro- 
vided further ,  that  license  or  other  satis- 
factory evidence  of  standing  as  a  legal 
practitioner  in  another  State  shall  be  ac- 
cepted in  lieu  of  a  diploma  and  entitle  to 
examination." 

Sec.  2.  That  section  three  thousand 
one  hundred  and  twenty-five  of  The  Code 
be  amended  by  inserting  after  the  word 
"applicant"  in  line  three,  the  following 
words:  "who  shall  comply  with  the  re- 
quirements as  to  graduation  prescribed  in 
section  three  thousand  one  hundred  and 
twenty-four  as  amended." 

Sec.  3.  That  section  three  thousand 
one  hundred  and  twenty-seven  of  The  Code 
be  amended  by  adding  immediately  after 
said   section  the     following  words  :      Pro- 


vided, That  the  said  Board  may,  in  its  dis- 
cretion, meet  not  more  than  one  week  before 
the  said  society,  but  always  in  the  same 
place ;  and  that  one  additional  meeting  in 
each  year  may  be  held  at  some  suitable  point 
in  the  State  if  deemed  advisable." 

Sec.  4.  That  chapter  one  hundred  and 
eighty-one  of  the  Laws  of  1889  be  amended 
by  striking  out  all  of  section  three  from  the 
word  "words"  in  line  four  down  to  the 
word  "any"  in  line  nine.  the  word 
"likewise"  in  line  eleven  and  the  word 
"such"  in  line  fourteen  ;  by  striking  out  in 
section  four  all  from  the  word  "or"  in  line 
three  to  the  number  "1885"  in  line  six,  in- 
clusive, and  the  words  "on  oath"  in  line 
seven  ;  and  by  striking  out  in  section  seven 
all  after  the  word  "act"  in  line  three. 

Sec.  5.  That  this  act  shall  be  in  force 
from  and  after  January  first,  1900, 

So  that  the  laws,  as  amended  to  date, 
read  as  follows  : 

THE   LAWS   REGULATING    THE  PRACTICE  OF 
MEDICINE   IN  NORTH    CAROLINA. 

{From  The  Code). 
Section  3121.    Medical  Society  of  the 

State,     a    Body      Politic.     Private 

Laws,  i858-'9,  c.  258,  s.  1  : 

The  Association  of  regularly  graduated 
physicians,  calling  themselves  "The  State 
Medical  Society,"  is  hereby  declared  to  be 
a  body  politic  and  corporate,  to  be  known 
and  distinguished  by  the  name  of  "The 
Medical  Society  of  the  State  of  North 
Carolina." 

Sec.  3122.   Who  May  Practice.    i858-'9, 

c.  258,  s.  2  : 

No  person  shall  practice  medicine  or  sur- 
gery, nor  any  of  the  branches  there- 
of, nor  in  any  case  prescribe  for  the  cure  of 
diseases  for  fee  or  reward,  unless  he  shall 
have  been  first  licensed  so  to  do  in  the  man- 
ner hereinafter  provided. 

Sec.  3123.     Board  of   Physicians    to 

Consist    of    Seven.      i858-'9,  c.     258, 

ss.  3,  4: 

In  order  to  the  proper  regulation  of  the 
practice  of  medicine  and  surgery,  there 
shall  be  established  a  Board  of  regularly 
graduated  physicians,  to  be  known  by  the 
title  of  "The  Board  of  Medical  Examiners 
of  the  State  of  North  Carolina,"  which 
shall  consist  of  seven  regularly  graduated 
physicians. 

Sec,  3124.     Duty  of  Board.      i858-'9,  c. 

258,  s.  5  : 

It  shall  be  the  duty  of  the  said  Board  to 
examine  all  applicants  who  shall  exhibit  a 
deploma,  or  furnish  satisfactory  proof  of 
graduation,  from  a  medical  college  in  good 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


fi«7 


standing  requiring  an  attendance  of  not 
less  than  three  years  and  supplying  such 
facilities  for  clinical  instruction  as  shall 
meet  the  approval  of  the  said  Board,  for 
license  to  practice  medicine  or  surgery,  or 
any  of  the  branches  thereof,  on  the  follow- 
ing branches  of  medical  science  :  Anatomy, 
Physiology,  Surgery,  Pathology,  Medical 
Hygiene,  Chemistry,  Pharmacy,  Materia 
Medica,  Therapeutics.  Obstetrics,  and  the 
Practice  of  Medicine,  and  if  on  such  ex- 
amination they  be  found  competent,  to 
grant  to  each  applicant  a  license  or  diplo- 
ma, authorizing  him  to  practice  medicine 
and  surgery,  or  any  of  the  branches  there- 
of Provided,  five  members  of  the  Board 
shall  constitute  a  quorum  and  four  of  those 
present  shall  be  agreed  as  to  the  qualifica- 
tions of  the  applicant  :  Provided,  that  the 
requirement  of  the  years'  attendance  shall 
not  apply  to  those  graduating  prior  to  Jan- 
uary first,  1900.  Provided  further,  that 
license  or  other  satisfactory  evidence  of 
standing  as  a  legal  practitioner  in  another 
State  shall  be  accepted  in  lieu  of  a  diploma 
ami  entitle  to  examination, 

Skc.  3125.  Temporary  License.   iSsS-'o,, 

c.  258,  ss.  7  : 

To  prevent  delay  and  inconvenience,  two 
members  of  the  Board  of  Medical  Examin- 
ers may  grant  a  temporary  license  to  any 
applicant  who  shall  comply  with  the  re- 
quirements as  to  graduation  prescribed  in 
section  three  thousand  one  hundred  and 
twenty-four  as  amended,  and  make  report 
thereof  to  the  next  regular  meeting  of  the 
Board  :  Provided,  such  temporary  license 
shall  not  continue  in  force  longer  than  the 
next  regular  meeting  of  the  Board,  and 
such  temporary  license  shall  in  no  case  be 
granted  after  the  applicant  has  been  re- 
fused a  license  by  the  Board  of  Medical 
Examiners. 

Sec.  3126.     How  Appointed.     i858-'q,  c. 

258,  s.  9: 

The  Medical  Society  shall  have  power  to 
appoint  the  Board  of   Medical    Evaminers. 

Sec.  3127.      Where  and   When    to   As- 
semble.     1870-'!,  c. — ,  s.  11  : 

The  Board  of  Medical  Examiners  shall 
assemble  at  the  same  time  and  place  when 
and  where  the  Medical  Society  assembles, 
which  Society  shall  assemble  at  least  once 
in  every  year  at  such  time  and  place  as  the 
said  Society,  at  its  next  preceding  meeting, 
shall  have  fixed;  and  the  said  Board  shall 
remain  in  session  from  day  to  day  until  all 
applicants  who  may  present  themselves  for 
examination  within  the  first  five  days  after 
its  meeting  shall  have  been  examined  and 
disposed  :    Provided,   That  the  said    Board 


may,  at  its  discretion,  meet  not  more  than 
one  week  before  the  said  Society,  but  al- 
ways in  the  same  place ;  and  that  one  ad- 
ditional meeting  in  each  year  may  be  h,ld 
at  some  suitable  point  in  the  .State  if  deem- 
ed advisable. 

Sec  3128.     Officers,   etc.      i858-'9,  c. 

258,  s.  11. 

The  Board  of  Medical  Examiners  are 
authorized  to  elect  all  such  officers  and  to 
frame  all  such  bylaws  as  may  be  necessary, 
and  in  the  event  of  any  vacancy  by  death, 
resignation  or  otherwise,  of  any  member  of 
said  Board,  the  Board,  or  a  quorum  thereof, 
is  empowered  to  fill  such  vacancy. 
Sec.  3129.     The  Board    of    Examiners' 

to  Keep  a  Record.     i858-'59,  c.  258, 

s.  12. 

The  Board  of  Examiners  shall  keep  a 
regular  record  of  its  proceedings  in  a  book 
kept  for  that  purpose,  which  shall  always 
be  open  for  inspection,  and  shall  cause  to 
be  entered  on  a  book  kept  for  the  purpose 
the  name  of  each  applicant  licensed  to  prac- 
tice medicine  and  surgery,  and  the  time  of 
granting  the  same,  together  with  the  names 
of  the  members  of  the  Board  present,  and 
shall  publish  the  names  of  those  licensed  in 
two  of  the  newspapers  published  in  the 
city  of  Raleigh, within  thirty  days  after  the 
granting  of  the  same. 

Sec.  3130.       License.       i858-'59,  c.  258, 

s.  13. 

The  Board  shall  have  power  to  demand 
of  every  applicant  thus  licensed  the  sum  of 
ten  dollars  before  issuing  a  license  or  diplo- 
ma, and  the  sum  of  five  dollars  for  each 
temporary  license,  to  be  paid  to  the  Secre- 
tary of  the  Board. 

Sec.  3131.  The  Board;  Their  Com- 
pensation. i87o-'7i,  c.  — ,  s.  14. 
The  members  of  the  said  Board  shall  each 
receive  as  a  compensation  for  their  services 
four  dollars  per  day  during  the  time  of 
their  session,  and  in  addition  thereto  their 
traveling  expenses  to  and  from  their  places 
of  meeting  by  the  most  direet  route  from 
their  respective  places  of  residence,  to  be 
paid  by  the  Secretary  of  the  Board  out  of 
any  moneys  in  his  hands,  upon  the  certifi- 
cate of  the  President  of  the  Board  of  Medi- 
cal Examiners. 

Sec    3132.       Practicing    Without    Li- 
cense.    i858-'9,  c  258,  s.  15;   1885,   c 

117  AND  261. 

Any  person  who  shall  practice  medicine 
or  surgery  without  having  first  applied  for 
and  obtained  license  from  the  said  Board  of 
examiners,  shall  not  be  entitled  to  sue  for 
or  recover  before  any  court  any  medical  bill 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


for  services  rendered  in  the  practice  of 
medicine  or  surgery  or  any  of  the  branches 
thereof.  And  any  person  who  shall  begin 
the  practice  of  medicine  or  surgery  in  this 
State  for  fee  or  reward,  after  the  passage 
of  this  act,  [March  7th,  18S5]  without  first 
having  obtained  license  from  said  Board 
of  Examiners,  shall  not  only  not  be  entitled 
to  sue  for  or  recover  before  any  court  any 
medical  bill  for  services  rendered  in  the 
practice  of  medicine  or  surgery,  or  any  of 
the  branches  thereof,  but  shall  also  be  guil- 
ty of  a  misdemeanor,  and  upon  conviction 
thereof  shall  be  fined  not  less  than  twenty- 
five  dollars  nor  more  than  one  hundred 
.  dollars,  or  imprisoned  at  the  discretion  of 
the  court,  for  each  and  every  offence  :  Pro- 
vided, this  act  shall  not  be  construed  to  ap- 
ply to  women  who  pursue  the  vocation  of 
a  midwife  :  And  provided  further,  that 
this  act  shall  not  apply  to  any  reputable 
phycician  or  surgeon  resident  in  a  neighbor- 
ing State  or  coming  into  this  State  for  con- 
sultation with  a  registered  physician  resi- 
dent therein.  But  this  proviso  shall  not  ap- 
ply to  physicians  resident  in  a  neighboring 
State  regularly  practicing  in  this  State : 
Provided,  that  this  section  shall  not  apply 
to  physicians  who  have  a  diploma  from  a 
regular  medical  college,  and  were  practic- 
ing medicine  or  surgery  in  this  State  prior 
to  the  seventh  day  of  March,  one  thousand 
eight  hundred  and  eighty-five. 

Sec.  3133.  May  Rescind  License.   1858- 

'59>  c-  258, s.  16. 

The  said  Board  shall  have  the  power  to 
recind  any  lincense  granted  by  them 
when,  upon  satisfactory  proof,  it  shall  ap- 
pear that  any  physician  thus  licensed  has 
been  guilty  of  grossly  immoral  conduct, 

Sec  3134.     Secretary.      i858-'9,  c.  258, 

s.  17. 

The  Secretary  of  the  Board  of  Medical 
Examiners  shall  give  bond,  with  good  se- 
curity, to  the  President  of  the  Board,  for 
the  safe  keeping  and  proper  payment  of 
all  moneys  that  may  come  into    his   hands. 

Registration.      1889,    c.    181,    ss.  3    (in 

part),  4,  5,  6,  7. 

Sec  3.  That  chapter  thirty-four  of  The 
Code  be  amended  by  striking  from  section 
three  thousand  one  hundred  and  twenty- 
five  the  words  "for  confirmatian,"  and  by 
adding  immediately  after  section  three 
thousand  one  hundred  and  thirty-four  the 
following  words  :  "Any  person  who  shall 
begin  the  practice  of  medicine  or  surgery 
in  this  State  after  the  passage  of  this  act, 
shall  personally  apper  before  the  Clerk  of 
the  Superior  Court  of  the  county  in  which 
he   resides  or  practices  within    thirty    days 


after  obtaining  a  license  from  the  Board  of 
Medical  Examiners  of  the  State,  as  now 
provided  by  law  for  registration." 

Sec  4.  That  any  person  applying  for 
registration  as  herein  provided  shall  pro- 
duce and  exhibit  before  the  Clerk  of  the 
Superior  Court  a  license  obtained  from  the 
Board  of  Medical  Examiners  aforesaid ; 
and  upon  such  exhibit  being  made  as  afore- 
said, the  clerk  shall  register  the  date  of 
registration  with  the  name  and  residence 
of  such  applicant  in  a  book  to  be  kept  for 
this  purpose  in  his  office,  marked  "Regis- 
ter of  Physicians  and  Surgeons,"  and  shall 
issue  to  him  a  certificate  of  such  registra- 
tion under  the  seal  of  the  Superior  Court 
of  the  county  upon  the  form  furnished  him, 
hereinafter  provided,  for  which  the  Clerk 
shall  be  entitled  to  collect  a  fee  of  twenty- 
five  cents.  The  person  obtaining  said  cer- 
tificate shail  be  entitled  to  practice  medi- 
cine or  surgery,  or  both,  in  the  county 
where  the  same  was  obtained,  and  in  any 
other  county  in  this  State  ;  but  if  he  shall 
remove  his  residence  to  another  county  he 
shall  exhibit  the  said  certificate  to  the 
clerk  of  such  other  county  and  be  register, 
ed,  which  registration  shall  be  made  by 
said  clerk  without  fee  or  charge,  Provided, 
that  any  one  having  obtained  a  temporary 
license,  as  provided  in  section  three  thous- 
and one  hundred  and  twenty-five  of  The 
Code,  shall  not  be  entitled  to  register,  but 
may  practice  during  the  time  such  license 
shall  remain  in  force. 

Sec  5.  That  any  person  who  shall  prac- 
tice medicine  or  surgery  in  this  State  with- 
out first  having  registered  and  obtained  the 
certificate  as  aforesaid  shall  be  guilty  of  a 
misdemeanor,  and  upon  conviction  thereof 
shall  be  fined  not  less  than  twenty-five  dol- 
lars, nor  more  than  one  hundred  dollars,  or 
be  imprisoned  at  the  discretion  of  the  court, 
for  each  and  every  offence  :  Provided,  this 
act  shall  not  apply  to  women  pursuing  the 
vocation  of  midwife,  nor  to  reputable  phy- 
sicians or  surgeons  resident  in  a  neighbor- 
ing State  coming  into  the  State  for  consul- 
tation with  a  registered  physician  of  this 
State. 

Sec  6.  That  any  Clerk  of  the  Superior 
Court  who  shall  register  or  issue  a  certifi- 
cate to  any  person  in  any  other  manner 
than  that  prescribed  by  this  act  shall  be 
guilty  of  a  misdemeanor,  and  upon  convic- 
tion thereof  shall  be  fined  not  less  than  two 
hundred  dollars  and  shall  be  removed  from 
office. 

Sec  7.  That  it  shall  be  the  duty  of  the 
Medical  Society  of  the  State  of  North  Car- 
olina to  prescribed  a  proper  form  of  certifi- 
cate required  by  this  act. 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


CONJOINT    MEETING. 

The  hour  having  arrived  for  the  conjoint 
meeting  with  the  N.  C.  State  Board  of 
Health,  Dr.  Geo.  Gillet  Thomas  of  Wil- 
mington, President  of  the  Board,  called  the 
conjoint  meeting  to  order.  The  President 
made  his  address. 

The  Secretary,  Dr.  Richard  H.  Lewis  of 
Raleigh,  then  made  his  report. 

On  motion  of  Dr.  Picot,  a  vote  of  thanks 
was  tendered  Dr.  Lewis,  not  only  for  the 
excellent  report,  but  also  for  his  work  as 
chairman  of  the  Committee  on  Legislation. 
Dr.  Carr  moved  that  the  name  of  Dr.  H.F. 
Long  be  included  in  this  vote  of  thanks  for 
his  very  efficient  work  as  State  Inspector. 
Unanimously  carried. 

Dr.  H.  F.  Long  of  Statesville.  then  made 
his  report  as  State  Small-Pox  Inspector. 
The  report  was  received. 

The  President  announced  that  for  the  en- 
suing two  years  the  following  appointments 
had  heen  made  lor  the  State  Board  of 
Health  : 

Appointments  by  the  Governor  :  Chas. 
J.  O' I  lagan,  M.  1).,  J.  L.  Nicholson,  M. 
D.,  Albert  Anderson'  M.  I).,  Richard  II. 
Lewis,  M.  D.,  and  Col.  A.  \V.  Shaffer, 
Sanitary  Engineer 

The  ballot  of  the  Society  was  then  cast 
for  the  following  four  to  serveon  the  Board  : 
S.  \Y.  Battle,  George  G.  Thomas,  Henry 
W.   Lewis  and  11.  II.  Dodson. 

On  motion,  the  session  was  then  ad- 
journed. 

Afternoon    Session. 

The  Society  was  called  to  order  by  the 
President  at  2  :3c  p.  M. 

The  committee  appointed  to  report  on  the 
President's  address  reported  as  follows  : 

Your  committee,  to  whom  was  committed 
the  admirable  Message  of  the  President  for 
report,  beg  leave  to  say  : 

That  careful  study  of  the  thoughtful  sug- 
gestions of  our  chief  executive  officer  leads 
us  to  offer  you  the  following  resume  and 
endorsement. 

We  heartily  concur  with  the  opinion  that 
it  is  unwise  to  encourage  the  formation  of 
Medical  Societies  in  North  Carolina  that 
will  directly  or  indirectly  detract  from  the 
general  Medical  Association.  Here  is  the 
body  which  has  been  the  source  and  soul  of 
the  advance  movements  that  have  made  the 
record  of  which  we  all  are  so  justly  proud. 
It  cannot  be  too  often  told  that  this  Society 
was  the  pioneer  of  higher  medical  educa- 
tion. It  was  the  wisdom  of  our  grand  So- 
ciety who  shaped  out  the  course  that  has 
brought  us  to  the  safe  haven  in  which  we 
are  resting.  There  are  opportunities  in  its 
ranks  for  the  exercise  of  the  best  intellects, 


and  the  satisfaction  of  the  most  vaulting 
ambitions.  The  elders  of  our  members 
stand  by  the  Society.  Knowing  its  worth, 
and  happy  in  the  realization  of  the  hopes 
of  many  years,  the  conservative  members 
find  in  it  the  chance  to  be  taught  the  newer 
thoughts  and  advancing  ideas,  and  to  the 
reseless  energy  and  watchful  and  ready 
trained  intellects  of  the  younger  men,  it  is 
a  field  forever  ready  for  the  work,  and  to 
them  it  has  always  yielded  an  abundant 
harvest.  Let  us  resolve  now  and  forever 
to  cherish  to  the  utmost  of  our  powers  the 
best  interests  of  this  organization,  depart- 
ing from  the  ways  of  those  whose  hopes  of 
preferment  or  desires  for  the  betterment  of 
business  ventures  or  personal  ambitions 
would  draw  us  from  this  untiring  mother 
with  new,  untried  and  possibly  useless  asso- 
ciation, originating  in  localities  outside  of 
North  Carolina,  and  having  as  a  cause  of 
their  being  the  upbuilding  of  one  or  other 
rival  interests  to  which  our  people  are  to 
be  dragged  in  as  contributors.  There  is  no 
good  ground,  we  take  it,  for  the  two  new 
societies  in  North  Carolina,  and  we  heartily 
agree  with  the  President  in  his  criticism 
and  his  appeals  to  the  members  of  our  own 
body  to  stay  at  home  and  labor  zealously 
for  the  greatest  good  of  the  institution  that 
has  made  the  North  Carolina  doctor,  the 
licentiate  of  the  Board  of  Examiners,  the 
peer  and    leader  in  the    medical  profession. 

Regarding  the  recommendation  of  an  or- 
ganized insurance  to  be  conducted  within 
our  ranks,  we  are  heartily  in  favor  of  some 
such  idea,  if  it  can  be  materialized,  but  it 
needs  most  careful  study  and  preparation, 
including  the  setting  forth  of  plans,  the 
scale  of  rates  chargeable  and  the  basis  of 
assessment.  We  recommend  that  a  com- 
mittee of  three,  to  be  named  by  the  Presi- 
dent, himself  to  be  one  of  it  and  chairman, 
be  appointed  to  take  this  matter  under  ad- 
visement and  report  to  the  next  annual  ses- 
sion of  the  Society. 

We  regret  that  under  the  laws  of  North 
Carolina,  regulating  the  practice  of  medi- 
cine, no  reciprocity  in  the  exchange  of 
licenses  can  be  considered.  No  doubt  the 
time  is  at  hand  when  some  change  neces- 
sary to  enable  one  Board  of  Examiners  to 
accept  the  licenses  of  other  States  having 
the  same  standard  as  our  own,  may  be  con- 
sidered, and  the  matter  could  be  wisely  re- 
ferred to  the  Committee  on  Legislation. 

If  the  Society  deems  it  wise  it  will  add 
interest  to  the  meetings  to  have  a  special 
report  on  Pediatrics,  and  the  organization 
of  the  new  section  will  be  timely,  and  the 
suggestion  of  the  President  for  it  a  most 
thoughtful  one.  To  those  of  our  members 
engaged  in  the    railway  surgical  service,    a 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


section  devoted  to  that  particular  branch 
would  certainly  bring  to  the  annual  meet- 
ihgs  much  material  which  would  interest 
and  instruct  not  only  those  so  especially 
engaged,  but  the  whole  Society  as  well. 

In  conclusion,  we  beg  leave  to  congratu- 
late the  President  upon  his  message,  and 
the  Society  upon  the  selection  of  so  able  a 
leader  for  this  year. 

C.  J.   O'Hagan, 

R.  H.    Lewis, 

Geo.   Gillet  Thomas. 

Referring  to  the  report  of  the  Commit- 
tee in  regard  to  the  formation  of  Medical 
Societies  in  North  Carolina,  Dr.  Cobb 
said:  "The  Tri-State  Medical  Society  was 
intended  for  the  upbuilding  and  uplifting 
of  the  profession  and  for  the  elevation  of 
suffering  mankind.  It  was  not  the  inten- 
tion of  any  of  the  members  who  composed 
that  Society  to  injure  in  any  way  the  Socie- 
ties of  the  three  States  that  compose  it. 
One  of  the  requisites  of  membejship  is  that 
the  applicant  shall  be  a  member  of  the  So- 
ciety of  his  State,  and  why  should  the 
State  of  North  Carolina  so  degrade  itself 
as  to  say  that  one  of  its  members  shall  not 
join  a  Society  outside  of  the  State?  While 
we  have  specialists  and  general  practition- 
ers, I  am  sorry  to  say  that  some  of  them 
are  afraid  to  meet  open  competition  of 
members  from  other  States.  I  think  that 
is  very  uncalled  for,  to  say  the  least  of  it. 

Dr.  Booth  :  I  did  not  hear  all  of  the  re- 
port of  that  Committee,  which  I  regret 
very  deeply,  but  I  move  that  the  report  of 
the  Committee  be  taken  up  and  passed 
upon  seriatum.  Seconded  and  on  vote  re- 
jected. 

It  was  moved  and  seconded  that  the  re- 
port be  accepted  as  presented  by  the  Com- 
mittee.     Carried. 

Nominations  for  officers  for  the  ensuing 
year  being  now  in  order,  Dr.  O'Hagan 
nominated  Dr.  Geo.  W.  Long  for  President 
in  the  following  words  : 

In  accordance  with  a  rule  that  I  have 
followed  for  many  years,  the  results  of 
which  have  been  so  satisfactory  that  I  deem 
that  rule  the  best  one,  and  that  rule  is 
pushing  the  young  men  to  the  front. 
Therefore,  in  accordance  with  that  policy 
I  rise  to  propose  the  name  of  Dr.  Geo-  W. 
Long,  of  Graham.  He  has  been  a  working 
member  of  this  Society  for  many  years. 
He  has  discharged  satisfactorily  every  duty 
imposed  upon  him,  and  I  am  quite  sure 
that  he  will  justify  the  confidence  I  have  in 
him.  I  beg  leave  to  put  in  nomination 
George  W.  Long. 

Dr,  Thomas,  in  seconding  this  nomina- 
tion,  said:    It  gives  me   great    pleasure  to 


second  this  nomination.  A  long  and  very 
intimate  acquaintance  with  Dr.  Long  en- 
courages me  to  say  in  his  favor  all  that  Dr. 
O'Hagan  has  said,  and  as  much  more  as 
the  greatest  imagination  can  picture. 

Dr.  Lewis  moved  that  that  nominations 
be  closed,  the  rules  supended,  and  the  vote 
of  the  Society  be  cast  for  Dr.  Geo.  W. 
Long,  of  Alamance,  for  President.  Unan- 
imously adopted. 

Nomination*  for  Vice-President  being 
now  in  order,  Dr.  Parrott  nominated  Dr. 
McMullin  for  First  Vice-President,  but  on 
request  of  Dr.  McMullin  his  name  was 
withdrawn. 

Dr.  G.  T.  Sikesthen  nominated  for  First 
Vice-President,  Dr.  C.  M.  Poole.  Second- 
ed. 

Dr.  Williams  was  nominated  for  Second 
Vice-President  by  Dr.  Speight.      Seconded. 

Dr.  James  M.  Parrot,  of  Kinston,  was 
nominated  for  Third  Vice-President.  Sec- 
onded. 

For  Fourth  Vice-President  Dr.  VV.  D. 
Hilliard,  of  Asheville,  was  nominated  by 
Dr.  Parker.      Seconded. 

All  unanimously  elected. 

Dr.  Geo.  W.  Pressly,  of  Charlotte,  the 
present  Secretary,  was  nominated  for  Sec- 
retary, and  the  Treasurer  instructed  to  cast 
the  vote  of  the  Society  for  Dr.  Pressly. 

Dr.  G.  T.  Sikes,  the  present  Treasurer, 
was  nominated  to  succeed  himself,  and  the 
Secretary  instructed  to  cast  the  vote  of  the 
Society  for  Dr.  Sikes. 

Dr.  Long,  the  incoming  President,  was 
presented  with  a  boquet  of  flowers  from 
the  citizens  and  physicians  of  Asheville, 
to  which  he  responded  in  a  speech  of 
thanks. 

It  being  moved  that  the  place  of  meeting 
for  1900  be  selected,  the  unanimous  vote  of 
the  Society  was  cast  for  Tarboro,  The 
time  was  left  in  the  hands  of  the  local  com- 
mittee of  arrangements. 

On  motion  the  Society  adjourned. 

Third    Day — Moring  Session. 

The  Society  was  called  to  order  by  the 
President  at  10  A.  M. 

Dr.  J.  M.  Baker,  Chairman  of  the  Com- 
mittee on  the  Pittman  prize,  having  re- 
quested that  his  name  be  withdrawn  on  ac- 
count of  his  connection  with  the  offering 
of  the  prize,  Dr.  Richard  H.  Whitehead, 
of  Chapel  Hill  was  appointed  in   his  place. 

The  discussion  on  Dr.  McKenzie's  paper 
having  been  postponed  on  yesterday,  it  was 
concluded  by  Dr.  McKenzie  as  follows  : 

I  simply  want  to  thank  the  gentlemen 
for  the  discussion,  and  there  are  also  a  few 
things  I  want  to  answer.  One  in  regard 
to  Dr.  Herring's  case.      His  case,    I  think, 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


671 


was  one  of  septicaemia,  and  I  think  the 
hot  water  he  used,  together  with  the  as- 
sistance of  Providence,  saved  his  patient. 
Dr.  McBrayer  opposed  the  use  of  the 
original  douche  after  delivery  because  he 
did  not  think  it  was  the  proper  thing  to 
use  any  old  syringe  lying  around  the  house. 
Of  course  it  is  not.  I  always  require  them 
to  use  the  fountain  syringe,  and  boil  the 
whole  thing  before  using.  You  can  easily 
teach  any  woman  how  to  do  that. 

The  .Secretary  read  a  letter  from  Dr.  W. 
T.  Cheatham,  of  Henderson,  regretting  his 
inability  to  be  present,  and  wishing  the 
Society  a  profitable  session.  Also  from 
Dr.  Joseph  Price,  of  Philadelphia,  who 
was  to  have  read  a  paper  before  the  Socie- 
ty but  was  unable  to  attend. 

Dr.  Goode  Cheatham,  of  Henerson, 
Chairman  of  Section  on  Anatomy  and 
Surgery,  presented  a  paper  on  "Antisepsis 
in  Surgery,"  which  on  motion  was  referred 
to  the  Committee  on  Publication. 

Dr.  F.  T.  Meriwether,  of  Asheville,  pre- 
sented a  paper  on  "Some  Remarks  upon 
Coley's  Treatment  of  Malignant  Growths." 
On  motion  this  paper  was  referred  to  the 
Committee  on  Publication. 

"An  Interesting  case  of  Renal  Calcu- 
lus," presented  by  Dr.  M.  Bolton,  of  Rich 
Square,  was  on  motion  referred  to  the 
Committee   on  Publication. 

Dr.  R.  E.  Zachary,  of  Wilmington,  pre- 
sented a  paper  on  "Gunshot  Wounds  with 
report  of  case,"  which  on  motion  was  re- 
ferred to  the  Committee  on    Publication. 

The  Committee  on  Nominations  make 
the  following  report  : 

For  Orator,  T.  S.  McMullan,  Hertford; 
Essayist,  R.  H.  Whitehead,  Chapel  Hill; 
Leader  of  Debate,  J.  M.  Parrott,  Kinston  ; 
Board  of  Censors,  G.  G.  Thomas,  Wil- 
mington, L.  J.  Picot,  Littleton,  R.  H. 
Speight,  Wrendale,  M.  H.  Fletcher.  Ashe- 
ville ;  CM.  Poole,  Craven. 

Committee  on  Publication  :  Drs.  R.  J. 
Hrevard,  G.  W.  Pressly,  D.  O'Donoghue, 
A.  J.  Crowell,  Charlotte. 

Committee  on  Legislation  :  Drs.  R.  H. 
Lewis,  Raleigh;  G.  T.  Sikes,  Grissom  ;  N. 
P.  Boddie,  Durham,  L.  J.  Picot,  Littleton, 
H.  A.  Royster,  Raleigh. 

Obituary  Committee  :  Drs.  K.  P.  Battle, 
Raleigh  ;  P.  L.  Murphy,  Morganton  ;  G. 
W.  Purefoy,  Asheville. 

Delegates  to  American  Medical  Associa- 
tion :  Drs.  A.  G.  Carr,  Durham;  H.  B. 
Weaver,  Asheville;  S.  D.  Booth,  Oxford ; 
N.  B.  Herring,  Wilson;  C.  P.  Ambler, 
Asheville;  G.  L.  Kirby,  Raleigh;  M. 
Olivia  Nelon-Denison,  Asheville;  J.  P. 
Munroe,  Davidson,  W.  W.  McKenzie, 
Salisbury. 


Delegates  to  South  Carolina  Medical  So- 
ciety :  Drs.  J.  A.  Borroughs,  Asheville; 
Annie  Alexander,  Charlotte  ;  F.  H.  Russell , 
Wilmington  ;  W.  H.  Wakefield,  Charlotte. 

Delegates  to  Virginia  Medical  Society  : 
Drs.  Anna  M.  Gove,  Greensboro;  H.  W. 
Lewis,  Alexander  ;  C.  L.  Minor,  Asheville  ; 
W.  H.  Ward,  Plymouth  ;  B.  L.  Long, 
Hamilton. 

Delegates  to  American  Public  Health 
Association:  Drs.  A.  A.  Kent,  Lenoir; 
Carl  von  Ruck,  Asheville ;  J.  W.  Long, 
Salisbury;  J.  A.  Reagan,  Weaverville  :  S. 
H.  Lyle,  Franklin. 

On  motion,  the  Committee  on  Finance 
was  discharged  for  this  term. 

Dr.  McMullan  then  moved  to  re-consider 
that  part  of  the  Finance  Committee's  re- 
port reducing  the  salary  of  the  Secretary  and 
Treasurer,  and  that  their  salaries  be  placed 
at  the  former  figures  of  $125  for  the  Sec- 
retary, and  $100  for  the  Treasurer,  as  the 
receipts  for  this  session  have  been  in  ex- 
cess of  what  was  expected  by  the  Finance 
Committee.  Seconded  and  carried  unani- 
mously. 

The  following  resolution  was  offered  by 
Dr.  C.  M.  Poole  : 

Resolved,  That  the  Transactions  of  the 
Society  be  hereafter  bound  in  cloth,  price,- 
not  to  exceed  50  cents  per  copy."  Seconded 
and  adopted. 

Dr.  H.  B.  Weaver,  of  Asheville:  A 
very  important  paper,  and  one  which  per- 
tains to  the  living  issues  of  the  day  was 
huriedly  discussed  yesterday.  It  was  on 
Serum  Therapy  by  Dr.  Mangum.  I  have 
here  some  notes  which  I  think  will  elicit 
some  discussion,  and  which  I  would  be 
glad  to  read, 

(Dr.  Weaver's  notes  will  be  found  in 
the  Discussion  of  Dr.  Mangum's  paper.) 

Dr.  J.  E.  S.  Davidson  read  a  paper  on 
"Meningitis"  which  was  referred  to  the 
Committee  on    Publication. 

Dr.  R.  E.  Zachary.  then  read  a  paper 
on  "Pernicious  Malarial  Fever."  which 
was  referred  to  the  Committee  on  Publica- 
tion. 

Society  adjourned. 

Afternoon    Session. 

The  Society  was  called  to  order  at  3  :30 
p.  M. 

The  President  announced  that  Dr.  A.  A. 
Kent  is  appointed  a  member  of  the  commit- 
tee on  the  Pittman  Prize. 

The  papers  of  Drs.  E.  A.  Moye  of  Green- 
ville, on  "Aconite  Poisoning,  its  Diagnosis 
and  Treatment,  with  a  Report  of  a  Case," 
and  Dr.  E.  B.  Goelet  of  Saluda,  on  "Elec- 
tricity as  an  Aid  to  the  Physician  and  Sur- 
geon,"   was,    by    motion,    referred    to  the 


672 


THE  CHARLOTTE    MEDICAL  JOURNAL. 


Committee  on  Publication  without  being 
read,  the  authors  having  been  compelled  to 
leave. 

Dr.  J.  W.  Long  of  Salisbury,  presented 
a  paper  on  "Ectopic  Pregnancy." 

Discussed  by  Drs.  H.  A.  Roysterand  H. 
S.  Lott.  On  motion,  it  was  referred  to  the 
Committee  on  Publication. 

Dr.  Chas.  L.  Pearson  of  Asheville,  pre- 
sented a  "Report  of  a  Case  of  Carcinoma 
of  the  Lung  with  Tuberculosis."  On  mo- 
tion, the  paper  was  referred  to  the  Commit- 
tee on  Publication. 

W.  B.  Pritchard,  M.  D.,  of  New  York 
City,  gave  a  "Report  of  a  Case  of  Brain 
Tumor  Relieved  Symptomatically  by  an 
Exploratory  Operation  upon  the  Skull." 
On  motion,  the  paper  was  referred  to  the 
Committee  on  Publication. 

The  papers  of  Drs.  D.  A.  Staunton  and 
Thos.  F.  Costner  were  referred  to  the  Com- 
mittee on  Publication. 

On  motion,  the  paper  of  Dr.  Robinson  of 
Danville,  on  "Treatment  of  Typhoid  Fever" 
was  referred  to  the  Committee  on  Publica- 
tion, the  author  being  unable  to  be  present 
and  read  it. 

The  committee  on  the  Pittman  Prize  re- 
ported that  two  papers  were  submitted  for 
their  consideration,  but  that  neither  were, 
in  their  opinion,  of  sufficient  merit  to  win 
the  prize  of  $100.00. 

As  a  part  of  the  report,  the  committee 
turned  over  to  the  Treasurer  the  $100.00 
offered,  which  had  been  placed  in  their 
hands  for  disposition. 

The  Society  then  proceeded  to  the  instal- 
lation of  officers.  Dr.  Lewis  and  Dr.  Kent 
were  appointed  to  escort  the  newly  elected 
President  to  the  chair.  After  being  intro- 
duced, he  said  :  Gentlemen  of  the  Medical 
Society  of  North  Carolina  :  I  am  deeply 
touched  and  impressed  at  the  singular  una- 
nimity with  which  you  have  called  me  to 
preside  over  your  deliberations.  I  thank 
you  very  much  for  this  high  mark  of  re- 
spect. This  is  a  responsible  position,  and 
I  promise  you  to  use  my  utmost  endeavors 
to  discharge  the  duties  of  the  place  in  the 
best  interests  of  the  profession.  To  aid  me 
in  that  work  I  ask  your  earnest  co-opera- 
tion.     I  thank  you,  gentlemen. 

The  President  appointed  the  following 
Chairmen  of  Sections  : 

Pathology  and  Microscopy — Dr.  Carl  V. 
Reynolds,  Asheville. 

Anatomy  and  Surgery — Dr.  Arthur  Pen- 
dleton, Warrenton. 

Medical  Jurisprudence  and  State  Medi- 
cine— Dr.   John    McCampbell,   Morganton. 

Obstetrics— Dr.  W.  E.  Russell,  Hickory. 

Gynecology — Dr.  B.  Ray  Browning,  Lit- 
tleton. 


Practice  of  Medicine — Dr.  W.  E.  Spen- 
cer, Yanceyville. 

Materia  Medica  and  Therapeutics — Dr. 
D.  J.  Hill,  Lexington. 

Chemistry  and  Physiology — Dr.  L.  P. 
Aaron,  Mt.  Olive. 

Pediatrics — Dr.    J.  R.  Irwin,  Charlotte. 

Railway  Surgery— Dr.  W.  D.  Hilliard, 
Asheville. 

On  motion  by  Dr.  Lewis,  the  thanks  of 
the  Society  were  extended  to  the  people  of 
Asheville  and  the  Buncombe  County  Medi- 
cal Society,  as  well  as  the  Oakland  Heights 
Sanitorium,  for  the  kind  attention  and  hos- 
pitality shown  them-  Also  to  the  Railway 
Company  for  reduction  of  rates. 

On  motion,  the  Society  then  adjourned 
to  meet  in  Tarboro,  the  date  to  be  fixed 
later. 

L.  J.  Picot,  M.  D.,  President. 

Geo.  W.  Pressly,  M.  D_,  Secretary. 

THE   FULL  REPORT  OF    THE    COMMITTEE    ON 
CREDENTIALS. 

Wm  J  McAnally,  High  Point. 

T  W  Long,  Catawba. 

H  M  S  Cason,  Edenton. 

W  L  Hilliard,  Asheville. 

John  McCampbell,  Morganton. 

John  B  Wright,  Coharie. 

Paul  Pacquin,   Asheville. 

S  H  Crocker,  Moyeton. 

G  J  Ganger,  Tulin. 

Mary  O    Nelon-Denison,    Asheville. 

Norman  C  Hunter,  Enfield. 

John  D  Mac  Rae,  Fayetteville. 

Chas  L  Scott,  Mebane. 

Walter  C  Lauderdale,  Asheville. 

D  G  McKethan,  Fayetteville. 

G  M  Van  Poole,  Craven. 

J  F  Peavy,  Asheville. 

Thomas  Stringfield,  Waynesville. 

J  Warren  Achorn,  Boston,  Mass. 

W  E  Miller,   Burlington. 

Harris  R  Moore,  Burlington. 

A  M  Whisnant,  Caroline. 

R  Hicks,  Henrietta, 

W  H  Smith,  Olive  Branch, 

W  O  Nisbet,  Waxhaw. 

J  H  Russell,  Canton. 

Wm  Fountain,  Leggett. 

T  L  Brooks,  Black  Creek. 

R  T  S  Steele,  Rockingham. 

L  H  Love,  Wilmington. 

J  P  Whitehead,  Rocky  Mount. 

S  H  Lyle,  Franklin. 

Chas  Van  Bergen,  Asheville. 

J  H  Woodcock,  Asheville. 

J  B  Matthews,  Pittsboro. 

J  F  Abel,  Canton. 

Chas  vS  Jordan,  Asheville. 

Chas  L  Pearson,  Asheville. 

A  M  Bennett,  Bryson  City. 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


673 


Earle  Grady,   Tryon. 

Jas  Sawyer,  Asheville. 

H  C  Menzies,  Hickory. 

L  B  McBrayer,  Asheville. 

John  W  Osborne,  Asheville. 

D  E  Sexier,  Asheville. 

J  T  Sevier,  Asheville. 

E  R  Morris,  Asheville. 

A  S  Pendleton,  Warrenton. 

S  L  Russell,  vSpilhnan. 

W  C  Daniel.  Adoniram. 

C  A  Anderson,  Burlington. 

J  A  Morris,  Wilton. 

Thos  P  Cheesborough,  Asheville. 

B  Ray  Browning,  Littleton. 

J  E  Moore,  Sandy  Mush. 

J  E  Smithwick,   Tamesville. 

R  L  Allen,  Waynesville. 

F  G  Wilson,  Gastonia. 

B  R  Graham,  Wallace. 

G  P  Reid,  Old  Fort. 

J  M  Newbern,  Powell's  Point. 

H  McK  Tucker,  Raleigh. 

I)  A  Garrison,  Bessemer  City. 

R  F  Yarborough,  Louisburg. 

Thomas  VV  Davis,  Louisburg. 

11  M  Fletcher,) 
II  A  Royster,  \ 
C  M  Poole,  J 


Com. 


Board  of   North  Carolina   Medical  Exami- 


ne. D.  T.  TAVI.OK,  PRESIDENT  AND  EXAM- 
INER on  surgery,  Washington,  N.  C. 

1.  What  are  the  symptoms  and  treatment 
of  a  fracture  of  the  neck  of  femur  within 
the  capsule? 

2.  What  is  the  treatment  of  each  of  the 
varieties  of  dislocation  of  hip-joint? 

3.  Describe,  in  a  general  way,  the  princi- 
pal methods  of  amputation. 

4.'  Give  the  causes  and  treatment  of  acute 
intestinal  obstruction. 

5.  Give  the  differential  diagnosis  between 
scirrhus  and  non-malignant  breast  tumors. 

6.  Describe  herniotomy. 

7.  What  is  the  difference  between  traumat- 
ic inflammatory  fever,  septicaemia  and 
pyaemia : 

8.  What  is  shock,  its  course  and  treatment? 

9.  In  what  regions  must  abscess  be  opened 
before  fluctuation  is  detected? 

10.  Wha}  is  the  differential  diagnosis  be- 
tween concussion  and  compression  of  the 
brain?  And  what  are  the  indications 
for  trephining? 

Questions  on  Practice  of  Medicine. 
BY  w.  h.  11.  COBB,  m.  D.,   Goldsboro,  N.  C. 

Define  Acute  Ileo-Colitis,  giving  Dietetic 
and  Medicinal  treatment? 


Give  Diagnosis  and  Treatment  of  Typhoid 
Fever? 

Define  Pneumonia  and  give  treatment? 

Give  Symptoms  and  Treatment  of  Insola- 
tion? 

Define  Hodgkin's  Disease,  giving  Morbid 
Anatomy  and  Symptons? 

Give  Causes,  .Symptoms  and  Treatment  of 
Acute  Bright's  Disease? 

Define  Neurasthenia,  giving  Etiology  and 
Symptoms? 

What  is  Asphyxia?  How  is  it  produced? 
What  are  causes  of  death  from  Asphyxia? 

Define  Remittent  Fever,  giving  Treatment  ? 

Give  periods  of  Incubation,  dates  of  Erup- 
tion and  length  of    danger  of    Contagion 

of  the  five  Eruptive  Fevers? 

Materia  Medica. 
By  Dr.  E.  C.  Register,  Charlotte,  N.  C. 

1.  What  are  the  preparations  and  doses 
of  arsenic? 

2.  Name  the  alkaloids  of  opium  and  their 
doses. 

3.  What  are  the  medicinal  uses  of  nitrate 
of  silver? 

4.  Name  the  two  principal  cardiac  seda- 
tives and  compare  them  physiologically. 

5.  What  substances  are  incompatible 
with  the  mercurial   preparations? 

6.  What  are  the  contra-indications  for 
the  use  of  an  anaesthetic? 

7.  Name  and  describe  the  potassium  salts 
that  act  as  cathartics. 

S.  What  is  the  difference  in  the  action  on 
the  heart  between  alcohol,  digitalis,  and 
strychnine? 

9.  What  is  the  difference  between  teta- 
nus, picrotoxin  and  strychnine  spasms? 

10.  What  are  the  two  principal  condi- 
tions with  which  acute  alcoholism  may  be 
confounded?  Give  the  differential  diagno- 
sis of  each. 

Examinations  by  Albert  Anderson, 
Wilson,  N.  C. 

GYNECOLOGY. 

i.  Describe  some  of  the  methods  of  mak- 
ing a  physical  diagnosis. 

2.  Name  the  varieties  of  vaginitis  ;  compli- 
cations, symptoms   and  treatment. 

3.  Classify  endometritis ;  give  causes, 
symptoms,  complications  and  treatment. 

4.  Classify  uterine  displacements  and  give 
etiology. 

5.  Give  principal  disorders  and  treatment 
of  menstruation. 

OBSTETRICS. 

1.  Describe  the  process  of  fecundation  and 
give  brief  description  of  the  elements 
entering  into  it. 

2.  Signs  of  pregnancy. 


674 


THE  CHARLOTTE  MEDICAL  JOURNAL 


9.  Explain  what  is  meant  when  drugs  are 
said  to  be  chemically  incompatible. 

10.  Give  a  test  for  the  purity  of  chloroform. 

Examination   in  Physiology. 

Thos.  E.  Anderson,  M.  D.,  Statesville, 
N.  C. 

1.  Define  Proteids  ;  how  and  where  digest- 
ed ?  Define  Amyloid  foods  ;  name  agents 
employed  in  their  digestion. 

11.  Explain  the  physiological  circuit  essen- 
tial to  a  reflex  action,  and  cite  an  instance. 

III.  Differentiate  voluntary  and  involuntary 
muscles;   illustrate. 

IV.  Explain  Amoeboid  movement ;  in  what 
organism  exhibited? 

(a)  What  is  Diapedesis? 

(b)  What    is   Phagocytosis?  and  to 
what  organ  accredited? 

V.  In  what  glands  of  the  body  is  function 
undetermined? 

VI.  What  is  the  function  of  the  Par  Vagum  ? 

VII.  In  the  function  of  vision,  what  is  un- 
derstood by  "accommodation?"  Name 
structures  employed. 

VIII.  Give  in  cubic  inches  of  air  the  respir- 
atory capacity  of  a  healthy  adult. 

IX.  From  what  part  of  the  Cortex  Cerebri 
do  the  leg,  arm  and  face  receive  their 
motor  impulses. 

X.  Describe  the  circulation  of  the  blood  in 
the  infant  just  before  and  just  afterbirth. 


3.  Give  diameters,  planes  and  axes  of  pel- 
vis. 

4.  Define  puerperal  fever  and  give  its 
causes  and  treatment. 

5.  Give  variety  of  forceps,  their  action  and 
indications  for  their  use. 

PEDIATRICS. 

1.  Give  difference  between  the  clinical  in- 
vestigation of  diseases  in  children  and 
adults. 

2.  Give  a  short  outline  of  the  general  man- 
agement of  children  as  to  feeding,  bathing 
sleep,  clothing  and  exercise. 

3.  Define  and  describe  these  terms  :  Caput 
Succedaneum ;  Cephalhematoma ;  As- 
phyxia ;  Icterus  Neonatorum ;  Ophthal- 
mia Neonatorum. 

4.  Give  the  order  and  age  of  dentition. 

5.  Give  differential  diagnosis  between  va- 
ricella and  variola. 

6.  Give  diagnosis  and  treatment  of  diph- 
theria. 

Examination  in  Anatomy. 

Dr.  J.  Howell  Way,  Waynesville,  N.  C. 

1.  Describe  the  superior  extremity  of  the 
ulna. 

2.  Describe  the  knee  joint. 

3.  Name  the  muscles  which  pass  from  the 
scapula  to  the  upper  limb  and  describe 
the  deltoid. 

4.  Describe  the  coeliac  axis  and  its  branches. 

5.  Describe  the  cephalic  vein. 

6.  Describe  the  fourth  ventricle  of  the  brain. 

7.  Give  the  course  and  distribution  of  the 
posterior  cord  of  the  brachial  plexus. 

8.  Locate  the  heart  and  describe  its  arterial 
ventricle. 

9.  Describe  the  popliteal  space,  naming 
structures  contained  therein  and  their  re- 
lations. 

10.  Locate  the  right  kidney  and  give  its  re- 
lations. 

Chemistry. 

Dr.  K.   P.   Battle.  Jr.,  Raleigh,  N.   C. 

1.  Give  the  rharacteristic  differences  be- 
tween an  acid  and  an  alkali. 

2.  Describe  chlorine;  give  its  physical  pro- 
perties and  its  chemical  action. 

3.  How  would  you  test  for  sugar  in  the 
urine? 

4.  How  would  you  detect  an  excess  of  car- 
bonic acid  in  the  air? 

5.  Describe  the  phenomena  of  electrolysis. 

6.  Describe  nitrogen,  naming  its  oxygen 
compounds  and  its  relation  to  atmospher- 
ic air. 

7.  What  are  the  physical  and  chemical  pro- 
perties of  phosphorus? 

8.  What  is  the  difference  between  chemical 
union  and  mechanical  mixture? 


A  JOURNAL  ON  TUBERCULOSIS. 

The  literature  on  Tuberculosis  is  becom- 
ing very  voluminous  and  hard  to  keep  up 
with,  as  it  is  scattered  throughout  the  va- 
rious journals  and  publications  along  with 
other  subjects.  Every  physician  has  per- 
haps felt  the  need  of  a  journal  devoted  es- 
pecially to  this  important  part  of  medicine. 
"The  Journal  of  Tuberculosis,"  edited  by 
Dr.  Carl  Von  Ruck,  of  Asheville,  N.  C, 
will  supply  this  need.  It  is  a  quarterly 
magazine  devoted  to  the  prevention  and 
cure  of  Tuberculosis.  The  April  number 
is  now  out  and  promises  great  things  for 
this  particular  subject.  The  editorial  mat- 
ter on  "Immunity  in  Tuberculosis,"  and 
"Tuberculosis  Diagnosis,"  is  written  by 
one  who  understands  his  business  and  con- 
tains all  that  is  new  and  up  to  date  on  this 
subject.  The  original  articles  are  by  such 
well  known  men  as  Denison,  of  Denver, 
Taylor,  of  St.  Paul,  Williams  and  Chap- 
man, of  Asheville. 

A  department  is  devoted  to  the  review 
of  current  literature.  A  twenty  page  sup- 
plement is  added  to  the  Journal  which  will 
contain  a  continued  series  of  articles,  writ- 
ten by  Dr.  Von  Ruck.  Articles  already 
in    print  will  be    revised  and  republished, 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


675 


appearing 


and  others  will  be  written    ne 
in  the  following  order  : 

i.  The  cause  of  Tuberculosis  and  the  con- 
ditions which  predispose  to  its  acquire- 
ment. 

2.  The  Prevention  of  Tuberculosis. 

3.  The  clinical  course  of  Pulmonory  Tu- 
berculosis with  reference  to  its  pathology 
and  complications. 

4.  The  Diagnosis  of  Pulmonary  Tuber- 
culosis. 

5.  The  progress  of  Pulmonary  Tubercu- 
losis. 

6.  The  treatment  of  Tuberculosis,  die- 
tetic, hygienic,  and  symptomatic. 

7.  The  Climatic   treatment. 

8.  The  Specific  Treatment. 

9.  Laryngeal  Tuberculosis,  its  diagnosis 
and  treatment. 

10.  Institutions  for  the  treatment  of  Pul- 
monary Tuberculosis. 

The  subscription  price  is  only  $1.00  per 
year  and  is  certainly  to  be  recom- 
mended to  every  physician  inter- 
ested in  this  very  important  subject.  It  is 
published  by  A.  II.  McQuillan,  95  College 
Street,  Asheville,  N.  C,  in  a  very  neat 
and  creditable  manner. 


DR.  PICOT'S  PRESIDENTIAL  ADDRESS 
AT  ASHEVILLE. 

The  eminently  practical  character  of  the 
addresses  of  the  Presidents  for  several  years 
past  was  continued  in  the  message  for  1899. 

Dr.  Picot  took  up  the  relation  of  the  Tri- 
State  and  Seaboard  Medical  Associations  to 
the  .State  Society,  taking  the  position  that 
these  societies  were  hurtful  to  the  best  in- 
terests of  the  State  Society.  Such  position 
is  hardly  tenable,  taking  into  consideration 
all  the  facts  in  the  case.  The  policy  of  this 
Journal  is  most  favorable  to  the  mainten- 
ance and  growth  of  the  Tri-State  Society 
for  many  reasons.  The  Medical  Society  of 
the  State  can  only  claim  one-third  of  the 
regular  practitioners  among  her  members, 
leaving  at  least  1,000  physicians  who  should 
be  members.  This  field  is  wide  and  broad 
enough  for  both  Societies. 

The  Tri-State  will  only  meet  in  North 
Carolina  once  in  three  years,  and  its  meet- 
ings can  not  interfere  with  our  attendance. 
Success  has  attended  the  organization  of 
Tri-State  Societies  in  other  parts  of  the 
country,  as  they  serve  t©  develop  and  deepen 
the  pride  and  interest  in  the  different  State 
associations.  Who  will  show  that  our 
Slate  Society  is  hurtful  to  our  local  and 
county  societies,  is  it  not  rather  the  inspir- 
ation and  help  they  need?  So  that  the 
Tri-State  organization,  instead  of  proving 
hurtful  to    our  society,  will    actually  prove 


of  benefit.  Notice  who  among  our  mem- 
bers belong  to  the  Tri-State — are  they  the 
disgruntled,  the  careless,  the  indifferent? 
Rather  the  very  back-bone  and  main  stay, 
the  leaders  themselves.  Witness  such  men 
as  W.  H.  H.  Cobb,  J.  A.  Burroughs,  J. 
W.  Long,  G.  W.  Long.  We  feel  sure  that 
these  men  will  not  lead  us  wrong.  In  fact 
the  majority  of  our  best  men  are  either  ac- 
tive members  of,  or  in  cordial  sympathy 
with,  the  Tri-State  Society. 

The  suggestion  concerning  insurance 
among  the  members  is  a  good  one,  and  it  is 
to  be  hoped  that  the  committee  will  have  a 
full  and  favorable  report  to  make  concern- 
ing it  at  the  next  annual  meeting.  A  little 
I  ready  cash  would  be  very  welcome  in  the 
j  doctor's  family,  as  he  too  often  leaves  them 
1  only  a  large  bundle  of  poor  accounts.  The 
recommendation  in  regard  to  the  establish- 
ment of  sections  on  Pediatrics  and  Ra-lway 
Surgery  was  promptly  taken  up  and  adopt- 
ed,the  incoming  president  appointing  chair- 
men for  each  of  these  sections. 

Taken  all  together  the  message  was  ex- 
ceedingly good,  showing  in  many  ways  the 
interest,  love  and  sympathy  of  Dr.  Picot 
for  the  Society,  in  fact,  such  a  deliverance 
as  we  would  expect  from  a  man  of  his  abil- 
ity, and  from  one  who  has  been  foremost 
in  every  good  work  of  the  Society  for  many 
years. 

nALTINE   WITH  CREOSOTE. 

The  value  of  creosote,  in  the  treatment 
of  diarrhoea,  either  from  septic  condition  of 
the  alimentary  canal  as  in  turberculosis  or 
from  digestive  disorders  common  at  this 
season  of  the  year,  is  recognized  by  all. 
The  progressive  Maltine  Company  of  New 
York,  have  introduced  upon  the  market 
this  new  and  up  to  date  preparation  mal- 
tine -with  creosote 

The  maltine   which    is  a  very  nutritious 
element,  serves  to  disguise  the  taste   of  the' 
creosote    and    removes    its   tendency  to  ir- 
ritate the  stomach. 

The  cresote  in  this  preparation  is  abso- 
lutely pure,  which  is  the  only  proper  kind 
to  be  used  under  all  circumstances. 

Maltine  with  creosote  contains  four  min- 
ims of  creosote  to  the  ounce  and  the  dose 
can  be  regulated  to  a  nicety. 

The  reputation  of  the  Maltine  Company 
as  the  makers  of  first-olass  scientific  medi- 
cines, has  been  enhanced  by  the  introduc- 
tion of  this   new  preparation. 


Dr.    J.    R.    Reitzel    has  removed   from 

Woodleaf    to    High    Point,  N.  C,    for  the 

practice  of   his  profession.  We  wish   him 
success  in  his  new  field. 


676 


THE  CHARLOTTE  MEDICAL  JOURNAL 


NEW  LAWS  IN  REGARD  TO  WATER 
SUPPLIES. 

The  State  Board  of  Health  of  North  Car- 
olina, is  pushing  forward  its  work  in  the 
interest  of  the  public  health.  The  follow- 
ing act  was  passed  by  the  last  Assembly  : 

AN   ACT  TO  PROTECT  WATER    SUPPLIES. 

The  General  Assembly  of  North  Carolina 

do  enact: 

Section  i.  In  the  interest  of  the  public 
health  every  person  or  company  selling 
water  to  the  public  for  drinking  and  house- 
hold purposes  shall  take  every  reasonable 
precaution  to  protect  from  contamination 
and  assure  the  healthfulness  of  such  water; 
and  any  provisions  in  any  charters  hereto- 
fore granted  to  such  persons  or  companies 
in  conflict  with  the  provisions  of  this  act 
are  hereby  repealed. 

Sec  2.  Those  water  companies  deriving 
their  supply  from  lakes  or  ponds  or  from 
small  streams  not  more  than  fifteen  miles  in 
lengh  shall  have  a  sanitary  inspection  of 
the  entire  watershed  not  less,  under  any 
circumstances,  than  once  in  every  three  cal- 
andar  months,  and  a  sanitary  inspection  of 
any  particular  locality  on  said  watershed  at 
least  once  in  each  calendar  month,  when- 
ever in  the  opinion  of  the  board  of  health 
of  the  city  or  town  to  which  the  water  is 
supplied,  or  when  there  is  no  such  local 
board  of  health  in  the  opinion  of  the  coun- 
ty superintendent  of  health  or  in  the  opin- 
ion of  the  state  board  of  health,  there  is 
reason  to  apprehend  the  infection  of  the 
water  by  that  particular  locality.  Said 
companies  shall  have  made  a  sanitary  in- 
spection of  any  particular  locality  on  said 
watershed  at  least  once  in  each  week  when- 
ever in  the  opinion  of  the  board  of  health 
of  the  city  or  town  to  which  the  water  is 
supplied,  or  when  there  is  no  such  local 
board  of  health  in  the  opinion  of  the  county 
superintendent  of  health,  or  in  the  opinion 
of  the  state  board  of  health,  there  is  special 
reason  to  appehend  the  infection  of  the 
water  from  that  particular  locality  by  the 
germs  of  typhoid  fever  or  cholera. 

The  inspection  of  the  entire  watershed  as 
herein  provided  for  shall  include  a  particu- 
lar examination  of  the  premises  of  every  in- 
habited house  on  the  watershed,  and  in 
passing  from  house  to  house  a  general  in- 
spection for  dead  bodies  of  animals  or  accu- 
mulations of  filth.  It  is  not  intended  that 
the  phrase  "entire  watershed"  shall  include 
uninhabited  fields  and  wooded  tracts  that 
are  free  from  suspicion. 

The  inspection  shall  be  made  by  an  em- 
ployee of  and  at  the  expense  of  the  said 
water  company  in  accordance  with  reason- 
able instruction  as  to  method  to  be  furnish- 


ed by  the  secretary  of  the  state  board  of 
health.  The  said  sanitary  inspector  shall 
give  in  person  to  the  head  of  each  house- 
hold on  said  watershed,  or  in  his  absence  to 
some  member  of  said  household,  the  neces- 
sary directions  for  the  proper  sanitary  care 
of  his  premises.  It  shall  further  be  the 
duty  of  said  inspector  to  deliver  to  each 
family  residing  on  the  watershed  such  liter- 
ature on  pertinent  sanitary  subjects  as  may 
be  supplied  him  by  the  municipal  health 
officer  or  by  the  secretary  of  the  state  board 
of  health. 

Sec  3.  In  case  of  those  companies  ob- 
taining their  supply  of  water  from  rivers  or 
large  creeks  having  a  minimum  flow  of  ten 
million  gallons  the  provisions  of  section  two 
be  applied  to  the  fifteen  miles  of  watershed 
draining  into  the  said  river  or  creek  next 
above  the  intake  of  the  water  works. 

Sec  4.  Failure  on  the  part  of  any  water 
company  to  comply  with  the  requirements 
of  sections  two  and  three  shall  be  punished 
by  a  deduction  from  any  charges  against 
the  city  or  town  supplied  of  twenty-five 
dollars  for  each  and  every  failure  :  Pvoyid- 
ed,  that  in  no  one  year  shall  the  sum  of 
such  forfeitures  exceed  five  hundred  dollars. 
When  the  water  works  are  owned  and  ope- 
rated by  the  city  or  town,  failure  on  the 
part  of  the  municipal  officials,  having  in 
charge  the  management  of  the  water  works 
to  comply  as  above  shall  be  a  misdemeanor 
and  punished  by  a  fine  of  not  less  than  ten 
nor  more  than  twenty-five  dollars  or  by  im- 
prisonment for  not  less  than  ten  nor  more 
than  thirty  days  :  Provided,  the  said  offi- 
cial do  not  prove  to  the  satisfaction  of  the 
court  that  in  spite  of  reasonable  effort  and 
diligence  on  his  part  he  was  prevented  di- 
rectly or  indirectly  by  his  superiors  from 
doing  his  duty  in  this  repect,  in  which  case 
said  superior  officer  or  officers  shall  be 
deemed  guilty  of  a  misdemeanor  and  pun- 
ishable by  a  fine  of  not  less  than  fifty  nor 
more  than  two  hundred  dollars  or  by  im- 
prisonment for  not  less  than  one  nor  more 
than  six  months. 

Sec  5.  Every  city  or  town  having  a  pub- 
lic water  supply  shall,  at  its  own  expense, 
have  made  at  least  once  in  every  three 
months  by  one  of  its  own  officials  a  sanita- 
ry inspection  of  the  entire  watershed  of  its 
water  supply,  and  it  shall  be  the  duty  of 
the  said  official  making  such  inspection  to 
report  to  the  mayor  any  violation  of  this 
act. 

Sec  6.  Every  water  company,  whether 
owned  by  private  individuals  or  corpora- 
tions or  by  the  municipality,  shall  have 
made  not  less  frequently  than  once  in  every 
three  months  at  its  owners  expense,  both  a 
chemical    and    bacteriological    examination 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


677 


of  its  water  drawn  from  a  faucet  used  for 
drinking  purposes,  packed  and  shipped 
in  accordance  with  the  instructions  to  be 
furnished  by  the  secretary  of  the  state  board 
of  health  :  Provided,  that  when  a  supply  is 
from  artesian  wells  the  analysis  shall  be 
made  in  the  discretion  of  the  secretary  of 
the  state  board  of  health,  but  not  oftener 
than  once  in  each  year  at  the  expense  of 
the  water  company. 

Sec.  7.  As  a  check  and  guarantee  of  the 
faithful  performance  of  the  requirements 
laid  down  in  the  preceding  section  of  this 
act  the  state  board  of  health  shall  make  or 
have  made  by  its  authorized  agents  such 
inspections  of  the  watersheds  and  such 
chemical  and  bacteriological  examinations 
of  the  public  water  supplies  of  the  state  as 
may  be  deemed  necessary  to  insure  their 
purity.  Should  such  inspection  or  exami- 
nation show  conditions  dangerous  to  the 
public  health  the  secretary  of  the  state 
board  of  health  shall  notify  the  mayor,  the 
municipal  health  officer  and  the  superin- 
tendent or  manager  of  the  water  works  at 
fault  and  demand  the  immediate  removal 
of  said  dangerous  conditions.  If  at  the 
end  of  thirty  days  after  service  of  said  no- 
tice and  demand  the  said  dangerous  condi- 
tions have  not  been  removed  to  the  extent 
that  due  diligence  could  accomplish  such 
removal,  the  said  secretary  shall  printed  in 
one  or  more  of  the  local  newspapers  a  plain 
statement  of  the  facts  for  the  information 
and  protection  of  the  citizens  using  the 
water. 

.Sec.  8  Each  sanitary  inspector  herein 
provided  for  is  hereby  authorized  and  em- 
powered to  enter  upon  any  premises  and 
into  any  building  upon  his  respective  water- 
shed for  the  purpose  of  making  the  inspec- 
tion herein  required. 

Sec.  9.  This  act  shall  be  in  force  from 
and  after  its  ratification. 

Ratified  the  8th  day  of  March,  A.  D. 
1899  ^^^^ 

Annual     Report    of   the    Secretary    of  the 
North  Carolina  Board  of  Health, 

18U8-1899. 

K.  H.  Lewis,  M.  D.,  Raleigh,  N.  C. 

The  Seventh  Biennial  Report  of  the 
Board  to  the  General  Assembly  through  the 
Governor,  which  gives  a  complete  state- 
ment of  its  work  for  the  two  years  ending 
December  31,  1898,  includes  that  done  be- 
tween the  time  of  our  last  meeting  and 
I  hat  date.  The  report  has  been  published, 
and  as  it  will  be  sent  to  any  one  requesting 
it.  it  would  be  a  work  of  supererogation  to 
repeat  it    here.      Suffice   it    to    say   that  our 


principal  work  since  we  last  met  is  in- 
cluded in  :  An  official  examination  by  Col. 
A.  W.  Shaffer,  the  engineer  of  the  Board, 
of  the  water  sheds  and  works  of  the  public 
water  supplies  of  the  State,  including  both 
chemical  and  bacteriological  examinations 
of  the  same  ;  an  examination  of  the  water 
supply  of  the  State  Hospital  at  Morganton, 
and  of  certain  wells  suspected  of  causing 
typhoid  fever  at  Williardsville  and  at  North 
Wilkesboro,  infection  with  intestinal  bacilli 
being  found  at  both  places;  sanitary  in- 
spections of  the  State  Hospital,  a  particu- 
lar study  being  made  of  a  small  outbreak  of 
typhoid  fever  there,  the  conclusion  reached 
being  that  it  was  caused  by  an  infection  of 
a  part  of  the  milk  supply ;  a  sanitary  in- 
spection of  the  School  for  the  Deaf  and 
Dumb  at  Morganton,  of  the  North  Carolina 
College  of  Agriculture  and  the  Mechanic 
Arts  at  Raleigh,  and  of  the  State  prison  ; 
an  investigation,  by  request  of  the  Superin- 
tendent of  Health  of  Alamance  county  of 
the  conditions  at  Swepsonville,  in  the  hope 
of  ascertaining  the  cause  of  the  very  un- 
usual outbreak  there  of  malarial  diseases  ;  a 
health  conference  with  the  people  of  Wins- 
ton-Salem. 

Smallpox. — .Since  the  period  covered  by 
the  Biennial  Report,  the  work  of  the  Board 
outside  the  regular  routine  work  of  the  sec- 
retary has  been  practically  confined  to  work 
in  relation  to  the  legislation  and  to  the 
management  in  an  advisory  way  of  the  ep- 
idemic of  smallpox  which  has  been  prevail- 
ing throughout  the  State.  Although  a  part 
of  this  has  been  covered  by  the  Biennial 
Report,  it  would  doubtless  be  more  satis- 
factory to  consider  the  matter  as  a  whole 
and  report  the  epidemic  from  the  first  case 
to  May  1,  1899. 

SMALLPOX    IN    NORTH    CAROLINA 

The  first  case  occurred  in  Wilmington  on 
January  12,  1898  in  the  person  of  a  negro 
train  hand  on  the  Atlantic  Coast  Line,  whose 
run  was  into  South  Carolina,  inwhichState 
the  disease  was  prevailing — warning  of 
which  was  given  in  the  Bulletin  for  De- 
cember, 1897.  Prior  to  May,  '98,  it  show- 
ed itself  in  Charlotte,  5  cases,  2  deaths,  all 
colored,  origin  South  Carolina ;  in  Salis- 
bury, 1  case,  colored  mad  agent  running 
between  that  point  and  Knoxville,  origin 
Tennessee;  in  Buncombe,  2  cases,  colored, 
origin  South  Carolina  ;  Alamance,  2  cases, 
colored,  origin  Alabama ;  Clay,  10  cases, 
white,  origin  Georgia.  Since  May  1st  the 
disease  has  occurred  in  all  the  counties 
named  except  Clay,  and  in  32  other  coun- 
ties, making  in  all  38  counties  that  have 
been  visited  by  it,  the  infection  in  most 
outbreaks  coming   from    Norfolk,  Va.,  and 


678 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


vicinity.  The  official  reports  for  the  month 
of  April  show  smallpox  still  present  in  the 
following  counties  :  Anson,  2;  Bertie,  1; 
Chatham,  2  ;  Chowan,  15  ;  Currituck,  1  ; 
Gates,  several ;  Hertford,  2  ;  Iredell,  1  ; 
Martin,  3;  Mecklenburg,  2;  Moore,  4; 
Nash,  7  ;  Union,  8  ;  Wake,  43 — i4counties. 
While  new  outbreaks  have  been  reported 
since  May  1st,  '99,  (5,  Catawba  (Hickory), 
Edgecombe  (Rocky  Mount  (Gates,  Rock- 
ham  (Mayodan),  Burke  (Morgan ton),  the 
last  name  is  the  only  one  which  does  not 
appear  in  tabulated  statement  given  below. 
There  have  been  so  far  14  cases  in  Morgan- 
ton,  with  two  deaths  among  the  whites. 
The  reporter  did  not  separate  the  races. 

The  total  number  of  cases  from  the  intro- 
duction of  the  disease  into  the  State  on  Jan. 
12,  1898,  to  May  1st,  when  the  reports 
closed,  was  616,  with  17  deaths,  or  2.76%. 
Of  this  number  182  were  whites  with  8 
deaths,  4.93%,  and  454  colored  with  9 
deaths,  or  1.97%.  This  death  rate  is  some- 
what larger  than  appears  to  have  been  the 
case  in  some  other  States  whose  records  can 
be  depended  on — Ohio,  for  instance,  where 
of  770  cases, .only  7  died,  or  less  than  1  per 
cent.  Indeed  our  smallpox  death  rate  has 
been  quite  respectable  in  view  of  the  fact 
that  many  wiseacres  have  persisted  in  as- 
serting that  the  disease  was  not  small- 
pox but  "chickenpox,"  Cuban  itch,"  "ele- 
phant itch,  etc."  But  still  the  mortality  was 
very  low  and  that  very  fact  increased  the 
difficulty  of  managing  the  outbreaks,  by 
rendering  the  people  more  indifferent  to  the 
importance  of  vaccination.  Formerly  when 
asked  my  opinion  as  to  the  best  method  of 
getting  the  people  vaccinated,  I  would  say, 
"A  case  of  smallpox."  Now  I  would  say 
a  number  of  cases  with  several  deaths. 

In  view  of  the  rapid  spread  of  the  dis- 
ease during  the  latter  part  of  February  it 
was  thought  advisable  by  the  President  of 
the  Board  to  investigate  the  matter  by  a 
personal  inspection  of  some  of  the  infected 
districts  on  the  part  of  a  committee  from 
the  Board.  This  inspection  of  several  of 
the  Eastern  counties  was  made  by  himself 
and  Dr.  O'Hagan  and  the  conditions  were 
found  to  be  such  that  he  called  a  meeting 
of  the  Board  at  Raleigh  on  March  5th  to 
consider  them.  At  this  meeting  the  report 
of  the  committee  was  received  and  the  sit- 
uation fully  discussed,  the  unanimous  con- 
clusion being  that  the  time  had  arrived  for 
calling  upon  the  Governor  for  authority  to 
expend  a  part  of  the  emergency  fund  ap- 
propriated in  section  29  of  the  act  in  rela- 
tion to  the  Board  of  Health.  In  pursuance 
of  this  decision  the  members  of  the  Board 
present  waited  upon  his  Excellency  and 
laid  the  facts  before  him.      He  showed    his 


intelligent  appreciation  of  the  situation  by 
promptly  giving  the  authority  desired. 
Reassembling,  it  was  decided  to  emplov  a 
competent  physician  who  should,  under  the 
title  of  Smallpox  Inspector,  visit  infected 
points,  decide  doubtful  diagnosis,  interview 
local  health  officers,  explain  to  the  county 
and  municipal  authorities  the  gravity  of  the 
situation  and  the  best  way  of  meeting  it, 
and  impress  upon  the  people  the  overwhelm- 
ing importance  of  vaccination,  Dr.  Henry 
F.  Long,  of  Statesville,  Superintendent  of 
Health  of  Iredell,  in  view  of  his  intelligent 
management  of  a  considerable  outbreak  of 
smallpox  in  his  own  county,  was  selected 
for  the  place.  The  results  have  shown  the 
wisdom  of  the  action  of  the  Board  and  of 
their  selection,  as  the  unanimous  testimony 
from  the  points  he  has  visited  has  been 
that  his  presence  and  advice  have  been  of 
great  assistance.  I  am  satisfied  that  the 
St?te  never  spent  the  same  amount  of 
money  to  better  advantage  than  the  $395.75 
spent  in  this  cause  from  March  13th  to  May 
1st. 

Owing  to  the  blessed  fact  that  epidemics 
of  infectious  diseases  of  any  magnitude 
have  been  extremely  rare  in  our  state  our 
people  are  unaccustomed  to  the  restraints 
and  duties  incident  to  the  proper  manage- 
ment of  them  according  to  the  principles  of 
modern  hygiene  and  this  fact  combined 
with  the  mildness  of  the  disease  engender- 
ing indifference  to  its  dangers — such  indif- 
ference in  some  instances,  at  first,  before 
the  public  were  generally  awakened  to  the 
fact  that  genuine  small-pox  was  among  us, 
that  the  patient  not  feeling  sick  much 
would  not  call  in  a  physician, — increased 
the  difficulties  of  management.  The  ex- 
posures resulting  from  this  were  necessarily 
very  numerous  and  why  so  many  unvac- 
cinated  persons  escaped,  as  they  unques- 
tionably did,  is  a  mystery.  But  strange  as 
it  may  seem  the  greatest  trouble  has 
come  from  our  own  profession.  In  some 
instances  it  arose  from  inexperience  with 
the  disease  and  the  consequent  failure  to 
make  promptly  the  correct  diagnosis  and 
report  the  case  to  the  health  officers.  This 
was  perhaps  in  some  instances  excusable, 
althoguh  it  must  be  said  that  a  knowledge 
of  the  elementary  principles  of  sanitary 
rules  or  a  regard  for  them  would  have  in- 
sured the  taking  of  the  proper  precautions. 
This,  however  was  a  small  matter  compar- 
ed to  obstructions  to  the  proper  control  of 
the  disease  which  arose  in  another  way, 
caused  probably  by  unfortunate  factional 
disagreements  in  the  profession  in  certain 
communities — very  few  I  am  glad  to  say. 
I  refer  to  the  denial  of  the  correctness  of 
the  diagnosis  of   smallpox  by  some  physi- 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


679 


cians,  thereby  furnishing  a  centre  for  the 
intractable  members  of  the  community  to 
rally  around, and  rendering  the  enforcement 
of  the  necessary  regulations  very  much  more 
difficult.  Where  the  dissenting  physician 
saw  the  case  or  cases  in  person  it  was 
doubtless  an  honest  difference  of  opinion, 
but  usually  he  refused  to  visit  the  patient, 
while  he  continued  to  publicly  express  his 
opinions.  With  the  lights  before  me  I  can 
see  no  sufficient  justification  for  this  attitude 
on  the  part  of  a  medical  man.  In  the 
matter  of  disease  the  physician  occupies 
with  the  people  a  position  of  authority  and 
as  a  patriotic  citizen,  to  say  nothing  of  his 
professional  obligations,  the  abuse  of  that 
high  position,  from  whatever  motive,  in  a 
way  calculated  to  increase  the  misfortunes 
of  his  neighbors  is  to  express  it  in  the 
mildest  possible  terms, extremely  indiscreet. 
In  every  instance  where  the  profession  was 
united  no  trouble  was  experienced,  the 
authorities  both  country  and  municipal 
responding   promptly   to  their  suggestions. 

In  addition  to  directing  the  movements 
of  the  Inspector  I  have  written  a  great 
many  letters  to  superitendents  of  health, 
mayors,  county  commissioners,  and  others, 
and  have  prepared  two  circulars — the  first 
in  July  1898,  which  was  sent  with  a  letter 
to  the  editors  of  the  newspapers  of  the 
State  for  publication,  and  the  second,  in 
March  1899,  which  was  printed  in  the  form 
of  a  poster,  a  copy  of  which  is  attached, 
which  was  sent  to  the  superintendents  of 
health  with  a  letter  requesting  them  to  post 
in  conspicuous  places. 

On  the  whole  when  we  take  into  con- 
sideration the  conditions  already  alluded  to, 
and,  in  addition,  the  imperfections  in  our 
sanitary  machinery,  I  think  there  is  good 
ground  for  congratulating  ourselves  and  the 
state  that  the  various  outbreaks  have  been 
generally  so  well  managed  and  that  so  many 
of  the  people  have  been  vaccinated.  While 
there  has  been  a  good  deal  of  opposition  to 
vaccination  it  is  gratifying  to  know  that 
several  enterprising  communities  with  offi- 
cials of  nerve  carried  it  out  under  compul- 
sion, going  so  far  in  more  than  one  instance 
as  to  commit  the  recalcitrant  to  jail,  or  to 
work  upon  the  roads,  until  a  more  enlight- 
ened frame  of  mind  was  reached.  This  is 
fortunate,  for  the  seeds  having  been  widely 
distributed  there  is  reason  to  fear  a  recru- 
descence of  the  disease  next  winter  and 
probably  in  a  severer  form. 

The  following  is  a  tabulated  statement  of 
smallpox  in  the  State  from  January  12th, 
1898,  to  May  1st,  1899,  when  the  last  offi- 
cial report  was  received. 


TABULATED  STATEMENT. 

RECORD  OF  SMALLPOX  IN  NORTH  CAROLI- 
NA FROM  JANUARY  12,  1S98,  TO  MAY  I, 
1899. 


CASES. 

DEATHS 

COUNTIES. 

Alamance 

Anson .    . 

w. 
20 

c. 

2 
5 
2 
12 
11 
13 
18 
21 

"2' 
2 
30 
8 

13 
30 

"9* 

2 
57 

1 
16 

"3' 

7 
6 

14 
3 
9 

35 
.... 

23 

"s 

64 

1 

24 

2 

t'l 

22 

5 

2 
12 
11 
13 
19 
21 
10 

4 

2 
40 

8 
56 
34 

3 

9 

3 
73 

1 
17 
14 

3 

8 

6 
14 

6 

9 
49 

1 

1 
25 

4 

8 
69 

4 
27 

3 

W. 

1 

C. 

T'L 

1 

Beaufort 

Bertie. 

1 
1 

1 
1 

Buncombe 

Catawba 

Chatham 

1 

1 

1 

Clay 

10 
2 

Craven 

Currituck 

10 

1 

1 

Edgecombe 

43 
4 
3 

Gates 

Guilford 

Halifax 

Hertford 

1 
16 

Iredell    

1 
14 

6 

6 

McDowell 

Mecklenburg 

I 

3 

3 

Nash 

New  Hanover 

3 

ii ' 

1 

Northampton 

Pasquotank 

Perquimans 

1 

1 

2 

4 

Tyrrell 

Wake 

5 
3 
3 

1 

1 

1 

1 

1 

8 
4.93 

9 

1.97 

Total  No.  cases. . 
Death  rate  percent 

162 

454 

616 

17 

2.76 

Total  number  of  counties  38. 


LEGISLATION. 


In  the  early  part  of  the  session  of  the  re- 
cent Legislature  I  sent  a  circular  letter  to 
all  superintendents  of  health  asking  for  any 
suggestions  they  might  have  to  make  as  to 
the  amendment  of  our  health  law.  Many 
did  not  reply  at  all  and  most  of  those  who 
did  had  no  amendment  to  suggest.  Among 
those  expressing  an  opinion  one  or  two 
favored  an  increase  in  the  powers  of  the 
Board  for  which  public  sentiment  was  not 
yet  ready,  but  most  confined  themselves  to 
the  method  of  electing  the  county  superin- 
tendent of  health.  They  were  about  equal- 
ly divided  between  retaining  the  present 
plan  of  election  by  the  county  commission- 
ers and  returning  to  the  old  plan  of  election 
by  the  county  board  of  health.     After  very 


680 


tHe  charlotte  Medical  journal. 


careful  consideration  of  the  matter  I  finally 
settled  upon  a  compromisse  method  which, 
in  short,  constituted  a  new  county  board  of 
health,  to  be  composed  of  not  more  than 
three  registered  physicians,  the  county  com- 
missioners, and  the  mayor  of  the  county 
town,  which  board  would  elect  the  super- 
intendent and  fix  his  salary.  This  was  re- 
garded by  those  with  whom  I  discussed  it 
as  a  good  solution  of  the  difficulty,  but 
knowing  from  experience  how  dangerous  a 
discussion  of  any  technical  bill  was  with  no 
one  on  the  floor  thoroughly  understanding 
it,  I  decided,  after  advising  with  some  judi- 
cious friends,  that  the  gain  to  be  obtained 
was  not  sufficient  to  justify  the  risk,  and 
abandoned  it.  I  did,  however,  after  a  good 
deal  of  tribulation,  succeed  in  securing  the 
enactment  of  "An  Act  to  Protect  Water 
Supplies,"  which  is  an  advance  on  the  line 
of  sanitary  progress  in  the  State.  This 
matter  is  fully  set  forth  in  an  editorial 
prepared  for  the  May  bulletin  which  is 
now  in  press. 

But  the  most  important  legislation  bear- 
ing on  the  public  health  for  many  years  was 
the  amendment  of  the  medical  license  laws 
so  as  to  require  of  all  applicants  for  license 
a  diploma  from  a  medical  college  in  good 
standing  requiring  an  attendance  of  not  less 
than  three  years,  and  furnishing  such  facil- 
ities for  clinical  instruction  as  should  meet 
the  approval  of  the  Board  of  Medical  Ex- 
aminers. It  is  unnecessary  to  say  that 
nothing  is  so  important  to  the  preservation 
of  the  public  health  in  a  community  as  the 
thorough  and  practical  education  of  its  phy- 
sicians. Acting  formally  in  another  capaci- 
ty, as  chairman  of  the  Committee  on  Legis- 
lation of  the  State  Medical  Society,  I  had 
the  honor  of  assisting  in  securing  the  enact- 
ment of  the  amendments.  As  the  medical 
license  laws,  as  amended,  were  printed  in 
full  in  the  April  number  of  the  Bulletin,  it 
is  unnecessary  to  discuss  this  matter  fur- 
ther, other  than  to  congratulate  the  Board 
and  the  Society  on  now  having  the  best 
medical  license  law  in  the  country. 

The  annual  health  conference  was  held  in 
Winston-Salem  on  December  7th,  1898.  I 
thoroughly  advertised  it  through  the  local 
newspapers,  which  were  very  kind  in  do- 
ing it,  and  by  means  of  a  circular  letter 
giving  the  programme,  distributed  in  ad- 
vance, but  the  attendance  for  a  town  of  that 
size  was  a  disappointment  to  us — eaused  in 
part,  let  us  hope,  by  the  uncomfortable 
climatic  conditions   prevailing  at   the  time. 

As  per  appointment  I  attended  the  Na- 
tional Conference  of  State  and  Provincial 
Boards  of    Health    of    North    America    for 

1898  at  Detroit  in  August  last,  and  that  for 

1899  at  Richmond  the  23d  and  24th  of  this 


month.  These  meetings  composed  entirely 
of  practical  health  officers  and  members  of 
boards  of  health  have  been  of  value  to  your 
Secretary  in  reviving  his  interest,  stimula- 
ting his  zeal,  and  in  broadening  his  views. 
They  afford  an  excellent  opportunity  in 
private  conversations  and  in  public  discus- 
sions to  compare  the  work  and  methods  of 
the  different  boards,  and  in  conclusion  I 
wish  to  say,  as  the  result  of  such  a  compar- 
ison, that,  especially  in  view  of  the  tremen- 
dous inertia  on  the  part  of  the  people — and 
largely  of  the  profession  too,  I  regret  to  ad- 
mit— and  considering  our  meagre  appro- 
priation, we  have  no  reason  to  be  ashamed 
of  our  work — unsatisfactory  as  it  is.  But 
the  people  have  been  awakened  as  never  be- 
fore in  my  experience  by  the  smallpox  epi- 
demic, and  I  hope  that  it  is  the  beginning 
of  better  things. 


A   NEW   JOURNAL. 

The  first  number  of  the  "Jeffersonian," 
a  medical  journal  published  by  the  under 
graduates  of  the  Jefferson  Medical  College 
of  Philadelphia,  has  been  received.  The 
new  journal  will  be  run  in  the  interest  of 
the  college,  and  it  can  hardly  hope  to  be 
worth  much  for  the  dissemination  of  real 
scientific  literature.  Journals  published  in 
the  interest  of  drug  houses,  hospitals,  sani- 
tariums or  colleges  all  belong  to  the  same 
class  and  it  cannot  be  said  that  they  con- 
stitute any  real  addition  to  our  means  of 
growth  and  development.  To  the  alumni 
of  this  famous  school,  the  local  news  will 
be  of  some  interest,  but  the  deficiency  as  a 
medical    journal  is  very  apparent. 

The  Journal  of  the  American  Medical 
Association  for  June  3rd  is  a  credit  to 
medical  journalism  in  this  country.  It  is  a 
souvenir  number  of  the  50th  Annual  meet- 
ing of  the  American  Medical  Association, 
held  in  Columbus,  Ohio,  June  6-9,  1899. 
The  cover  has  excellent  cuts  of  ten  of  the 
living  ex-Presidents.  Among  them  we 
notice  the  familiar  face  of  Dr.  Hunter  Mc- 
Guire.  The  reading  matter  is  interesting 
as  history  of  the  Association  and  as  show- 
ing the  progress  of  the  different  depart- 
ments of  medicine  in  the  past  50  years. 
Progress  in  Surgery  is  written  by  R.  \V. 
Matas,  in  Medicine  by  Musser,  Gynecology, 
by  Charles  A.  L.  Reed,  Obstetrics  by 
Frank  A  Stahl,  Therapeutics  by  the  Thera- 
peutical Hare,  Physiology  by  G.  W. 
Stewart,  Anatomy  by  Frank  Baker,  with 
several  other  well  written  departments. 

This  number  of  the  Journal  will  be  treas- 
ured by  the  members  of  the  Association 
and  by  every  physician  who  is  really  inter- 
ested in  his  profsssion. 


THE  CHARLOTTE  MEDICAL   JOURNAL. 


Terraline. 

By  Win.  L.  Dickinson,  M.    D.,   Saginaw,    Mich. 

From  the  dawn  of  history  civilized  man 
has  known  of  petroleum,  and  made  use  of 
it  as  a  medicine.  Petroleum  was  used  many 
generations  before  'boring  was  employed  to 
obtain  the  oil,  it  then  being  obtained  where 
it  had  forced  its  way  to  the  surface  of  the 
ground.  We  use  the  word  "petroleum" 
to  designate  those  bitumenous  formations 
of  an  oily  consistence,  that  by  insensible 
gradation  on  the  one  hand  pass  into  the  vo- 
latile and  ethereal  napthas,  while  on  the 
other  hand  into  the  semi-fluid  mathas  or 
mineral  tars.  Herodotus  wrote  of  the 
springs  of  Zacynthus,  while  the  Arabs  and 
Persians  of  the   fountains  of    Hit. 

Pliny  and  Dioscorides  in  their  writings 
describe  the  oil  of  Agrigentum,  which  was 
used  in  lamps,  under  the  name  of  "Sicilian 
oil."  Mention  is  also  made  in  the  ancient 
records  of  China  of  its  petroleum  springs. 
Travelers  from  an  early  date  who  have  gone 
overland  from  Europe  to  I.idia  have  fre- 
quently mentioned  the  abundance  of  petro- 
leum and  the  fire-temple  at  Baku  on  the 
Caspian. 

A  Franciscan  missionary,  Joseph  de  la 
Roche  d'Allion,  in  a  letter  written  in  1629, 
made  metion  of  the  petroleum  found  in 
North  America,  while  Peter  Kalm,  of  Lon- 
don, in  1772,  published  a  book  of  his  travels 
in  North  America,  in  which  he  described 
the  springs  on  Oil  Creek.  In  1814  while 
wells  were  being  bored  for  brine  in  Wash- 
ington county,  Ohio,  petroleum  was  dis- 
covered and  described. 

In  1819  a  well  bored  for  brine  in  Wayne 
county,  Ky.,  yielded  so  great  a  quantity  of 
block  petroleum  that  it    was    abandoned. 

Near  Burksville,  Cumberland  county, 
Ky.,  a  well  was  drilled  for  brine  in  1829, 
and  it  yielded  such  a  flow  of  petroleum  that 
it  was  regarded  as  a  wonderful  natural 
phenomenon.  A  few  barrels  only  of  the 
oil  was  bottled  and  sold  as  a  liniment  in 
the  United  States  and  Europe,  under  the 
name  of   "American  oil." 

Petroleum  in  its  crude  form  was  used  for 
many  years  as  an  external  application  for 
rheumatism,  and  also  taken  internally  as  a 
remedy  for  consumption,  but  on  account  of 
its  disagreeable  odor  and  taste  it  never  was 
a  popular  medicine.  After  a  time  a  taste- 
less and  odorless  preparation  under  the 
name  of  Terraline  was  brought  to  the  no- 
tice of  physicians,  and  the  good  results 
looked  for  from  its  use  have  not  been  want- 
ing. 

Terraline  is  now  used  in  consumption, 
chronic  bronchitis,  throat    and  all   wasting 


diseases.  Terraline,  as  has  been  stated,  is 
a  preparation  of  petroleum  refined  by  dis- 
tilled and  otherwise  purified,  nearly  "color- 
less or  translucent,  odorless  and  tasteless, 
and  free  from  acidity  or  alkalinity,  and 
does  not  undergo  decomposition  or  become 
rancid,  unless  the  bottle  is  left  uncorked 
and  standing  in  a  too  warm  room  for  a  long 
time.  Terraline  has  been  largely  used  for 
internal  administration  as  it  possesses  sooth- 
ing and  healing  properties,  especially  grate- 
ful to  the  bronchial  and  gastro-intestinal 
mucus  membranes. 

There  are  many  cases  of  consumption 
where  Cod  Liver  Oil  in  any  form  can  not 
be  given  on  account  of  its  taste  and  fishy 
smell,  and  in  these  cases  Terraline  can  be 
given  without  any  disturbance  of  the  stom- 
ach. Children  will  take  this  purified  form 
of  petroleum  without  the  least  resistance. 
I  have  found  that  by  giving  the  patient  (an 
adult)  from  ten  to  twenty  grains  of  guaia- 
col  carbonate  four  times  daily,  and  two  tea- 
spoonful  of  Terraline  three  times  daily, 
combining  this  treatment  with  good  hygen- 
ic  surroundings,  proper  food,  warm  tem- 
perature, living  out  of  doors  as  much  as 
possible,  cheerful  and  pleasant  companions, 
and  the  inhalation  of  creosote  liberated  by 
steam  atomization  into  the  air  of  the  sleep- 
ing room  occupied  by  the  patient,  that  the 
cough  soon  commences  to  stop,  the  expec- 
toration becoming  less,  while  the  appetite 
improves,   and   the   patient   takes  on   flesh. 

I  here  report  two  cases  of  consumption 
where  the  diagnosis  was  confirmed  by  the 
finding  in  the  sputum  of  tubercle  bacillus. 
Case  1.  Mrs.  X.  ,aet.  25,  Catarrhal  phthisis, 
breaking  down  of  lung  tissue  in  the  up- 
per porterior  portion  of  lobe  of  right  lung. 
Temperature  had  been  ranging  from  100 
to  ioi£  for  a  period  of  two  months.  There 
had  been  two  slight  and  one  quite  severe 
haemorrhages.  There  was  also  anorexia, 
loss  of  appetite,  impaired  digestion,  and  in- 
ability to  sleep  on  account  of  the  severe  at- 
tacks of  coughing.  The  expectoration  was 
very  profuse,  and  there  was  also  night 
sweats.  The  loss  in  weight  had  been  six- 
teen pounds.  In  two  weeks  time  after  tak- 
ing Terraline  in  two  teaspoonful  doses  and 
the  Guaiacol  Carbonate  in  two  grain  doses, 
each  four  times  daily,  the  patient  had  gain- 
ed three  pounds  in  weight,  the  appetite 
was  much  better,  cough  less,  expectoration 
much  diminished,  and  gaining  in  every 
way.  She  continued  to  improve  steadily 
and  after  eight  months  treatment,  micro- 
scopical examination  of  the  sputum  did  not 
reveal  any  tubercle  bacillus,  and  she  had 
regained  her  former  weight,  and  considered 
herself  as  well  and  strong  as  ever. 

Case  2     Mr.  A.,  aet.  42.      Greatly  einan- 


682 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


ciated,  coughed  almost  constantly  except 
when  given  morphine  to  control  it.  There 
was  a  cavity  under  left  scapula.  The  ex- 
pectoration amounted  to  about  ten  ounces 
in  twenty-four  hours.  Afternoon  temper- 
ature 101  to  102. 

Gave  Creasotal  gtt.  x  in  teaspoonful  Ter- 
raline  four  times  daily,  and  a  capsule  three 
times  daily  of  Protonuclein  gr.  v.,  Quinine 
Sulph.  grain  i. 

In  one  month  had  gained  four  pounds  in 
weight,  while  the  cough  and  expectoration 
was  much  less.  Patient  continued  to  im- 
prove and  in  five  months  had  ceased  to 
cough  and  had  regained  his  usual  weight 
and  an  examination  of  the  sputum  showed 
it  to  be  free  of  turbercle  bacillus.  The 
case  I  now  report  I  do  not  class  as  a  pro- 
nounced case  of  consumption,  but  I  believe 
if  it  had  been  left  alone  it  would  have  be- 
come such.  Mr.  A.,  aet.  35,  had  been 
gradually  growing  weaker  for  several 
months,  had  been  having  vague  pains 
through  the  chest  and  upper  apex  of  right 
lung,  accompanied  by  a  dry  cough.  Had 
lost  in  weight  six  pounds,  and  at  time  of 
examination  had  a  temperature  of  100^. 

Physical  examination  showed  some  dull- 
ness of  upper  porterior  portion  of  right 
lung.  Patient  had  been  trying  to  take  cod 
liver  oil  in  different  forms,  and  on  account 
of  his  repugnance  to  the  oil,  I  prescribed 
Terraline  in  two  teaspoonful  doses,  to  be 
taken  in  half  an  ounce  of  Sherry  wine  im- 
mediately before  meals,  Syrup  Hydriodic 
Acid  teaspoonful  in  water  half  hour  after 
meals.  Two  months  of  this  treatment 
cleared  his  lung  up,  the  temperature  became 
normal,  the  cough  stopped,  and  he  gained 
in  flesh  until  he  weighed  nine  pounds  more 
than  his  usual  weight. 

We  can  say  in  closing  that  the  advan- 
tages of  Terraline  are  its  palatability,  easy 
digestion,  rapid  assimilation,  and  its  seda- 
tive effect  upon  the  mucous  membranes, 
and  that  it  can  be  given  in  cases  where  cod 
liver  oil  cannot. 


Ocular  Evidence  of  Hysteria. 

Dr.  Casey  Wood  (Am.  Journal  Medical 
Sciences)  makes  the  following  statements  : 

Most  cases  of  hysteria  present  well-mark- 
ed, easily  detected  eye-signs  and  symptoms. 

A  few  ocular  symptoms,  such  as  a  rever- 
sal of  the  relation  of  the  colorfields  and  the 
field  for  white,  the  tonic  form  of  blepharo- 
spasm, spasm  of  accommodation  and  con- 
vergence, and  pseudopapalytic,  may  be  re- 
garded as  pathognomonic  of  hysteria. 

Defects  of  vision  (in  the  absence  of  re- 
fractive errors,  accommodative  anomalies, 
and    fundus    lesions)  are,    generally  speak- 


ing, hysterical,  if  accompanied  by  photo- 
phobia and  any  form  of  plepharospasm. 

No  examination  of  a  patient  for  hysteria 
should  be  regarded  as  complete  without 
considering  the  condition  of  his  ocular  ap- 
paratus. 

Where  there  is  no  conclusive  external 
evidence  of  neurosis  present  the  perimeter 
should  be  carefully  used,  the  range  of  ac- 
commodation should  be  noted,  and  the  oph- 
thalmoscope employed. 

It  should  always  be  remembered  that 
ocular  hysteria  is  common  in  children  and 
men. 

Organic  disease  (traumatism  especially) 
of  the  eye  may  accompany  functional  dis- 
turbances of  that  organ. 

The  Treatment  of  Gall-stones. 

W.  L.  Carr,  [New  York  Medical  Jour- 
nal of  April  22,  1899.]  The  predisposi- 
tion to  gout  and  rheumatic  disorders  is 
largely  concerned  in  the  production  of  gall- 
stones. The  possibility  of  the  bacterium 
coli  commune  being  a  cause  of  their  forma- 
tion is  due  to  the  fact  that  it  produces  a 
catarrhal  condition  of  the  intestinal  tract. 
The  treatment  of  biliary  colic  consists  in 
relieving  the  pain  by  morphine  and  atro- 
phine,  to  which  large  draughts  of  water 
may  be  added.  The  preventive  treatment 
or  the  management  during  the  intervals  of 
hepatic  colic  are  dietetic  and  drugs.  For 
diet  the  strict  elimination  of  all  foods  slow 
of  digestion  and  those  which  are  especially 
rich  in  fats  and  sugars.  Chloroform,  ether 
and  turpentine,  which  have  been  held  for 
many  years  as  having  power  to  dissolve 
gall-stones,  have  really  little  action  in  this 
direction.  Sweet  oil  is  a  valuable  adjunct, 
but  in  many  cases  the  saponified  masses  of 
oil  are  mistaken  for  gall-stones.  Among 
the  drugs  which  are  considered  valuable  in 
stimulating  the  flow  of  bile  and  increasing 
its  solvent  properties  are  salicylate  of  so- 
dium, cholate  of  sodium,  succinate  of  so- 
dium, and  the  succinate  of  iron.  Locally 
massage  of  the  abdomen  with  gentle  manip- 
ulation of  the  region  of  the  gall-bladder. 
In  impaction  surgical  means  will  alone 
afford  relief. 


Sanmetto  in  all  Forms  of  Vesical  Disease- 

I  have  found  the  preparation  known  as 
Sanmetto  a  most  excellent  remedy  in  all 
forms  of  vesical  diseases  that  have  come 
under  my  observation,  especially  the  cysti- 
tis attendant  on  the  presence  of  stone  be- 
fore and  after  its  removal,  and  also  the  ves- 
ical tenesmus  from  colds  and  urethral  in- 
flammation, both  specific  and  non-specific. 
Jno.  R.   Papin,  M.  D. 

St.  Louis,  Mo. 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


H 


THE  SANITARIUM, BA 


MICH. 


CHE  largest,  most  thoroughly  equipped  and  one  of  the  most  favorably  located  in  the  United  States. 
It  is  under  strictly  regular  management.  Eight  physicians,  well-trained  and  of  large  experience. 
A  quiet  homelike  place,  where  "trained  nurses,"  "rest-cure,"  "massage,"  "faradization,"  "gal- 
vanization," "static  electrization,"  "Swedish  movements,"  "dieting,"  "baths,"  "  physical  train- 
ing," and  all  that  pertains  to  modern  rational  medical  treatment  can  be  had  iu  perfection  at  reasonable 
prices.  Special  attention  given  to  the  treatmen^of  chr  ! 
iar  to  women 
appliances. 

I.arge  fan  for  winter  and  summer  ventilation.  Absolutely  devoid  of  usual  h 
ful  surroundings.  Lakeside  resort.  Pleasure  grounds,  steamers,  sailboats,  el 
either  sex  furnished  at  reasonable  rates. 

J.  H.  KELLOGG,  1*1.  D.,  Supt.,  Battle  Creek,  Mich 


disorders  of  the  stomach,  and  diseases  pecul- 

pecial  hospital  building  (100  beds)  for  surgical  cases  with  finest  hospital  facilities  and 


Made  from 
sat  of  freel, 
amples  free 


i  the  purest  wheat  gluten  ami  nut  meal.    The  only  food  on  the 
y.  without  danger,     l'reseribed  and  endorsed  hy  the  phj  -i.mic: 
physicians  when  card  ' 


dosed  with  the  request.    Others 


BATTLE  CREEK  SANITARIUM  HEALTH  FOOD  CO.,  Battle  Creek,  Mich. 


A  Therapeutic  Recourse  of 
Wide  Application. 


1 

§ 


HIALIOIV 

A  Laxative  Salt  of  Lithia. 


Prepared  only  for  the  Medical  Profession. 

INDICATIONS.— Gout  and  all  of  those  diseases  arising  from  a  gouty  condition  of  the  sys- 
tem, rheumatism  and  all  of  those  diseases  arising  from  a  general  rheumatic  condition,  chronic 
constipation,  hepatic  torpor  and  obesity.  In  all  cases  where  there  is  a  pronounced  leaning  to 
corpulency,  it  reduces  to  a  minimum  the  always  present  tendency  to  apoplexy.  In  malaria 
because  of  its  wonderful  action  on  the  liver,  increasing  twofold  the  power  of  quinine. 

Inasmuch  as  some  difficulty  is  experienced  by  physicians  in  procuring  Thialion,  we  will,  on 
receipt  of  one  dollar,  send  one  bottle  containing  four  ounces,  sufficient  for  three  weeks  treat- 
ment, prepaid  to  any  address. 


JJ    Literature  on  Appli-.'  //■'.;  m 

2   "  THE  VASS  CHEMICAL  CO.,  2 

*    ,        rL  D ANBURY,  CONN.  £ 


684 


THE  CHARLOTTE    MEDICAL  JOURNAL. 


Cord.  Ol.  Morrhuae  Coinp.  (Hagee). 

A  great  desideratum  in  the  medical  prac- 
tice is  an  ideal  tissue  builder.  The  busy 
practitioner  frequently  finds  himself  at  a 
loss  to  decide  upon  the  most  efficient  remedy 
for  a  given  case,  in  spite  of  the  great  va- 
riety of  drugs  from  which  he  may 
select.  This  is  especially  true  in  cases 
where  tissue  changes  and  waste 
are  continuous  and  where  it  is 
necessary  to  check  the  disintegration  and 
repair  and  restore  the  waste  of  cellular  tis- 
sue, resulting  from  established  cachexias. 
In  these  cases  remedies  are  required  both 
for  their  antidotal  properties  and  their  food 
values.  Under  these  circumstances  that 
remedy,  which  most  nearly  meets  the  re- 
quirements of  the    case,    is  of  most  value. 

I  am  rarely  constrained  to  lend  my  in- 
dorsement to  any  proprietary  remedy, 
though  admitting,  in  a  general  way,  that 
many  of  them  are  excellent  for  the  treat- 
ment of  diseases  which  they  are  recom- 
mended. But  I  have  found  in  the  use  of 
Cord.  Ol.  Morrhuae  Comp.  (Hagee)  such 
marked  benefit,  that  I  feel  justified  in  calling 
the  attention  of  the  profession  to  its  merits, 
both  as  a  medicine  and  tissue  builder.  Its 
elegance  and  excellence  as  a  pharmaceuti- 
cal product,  the  ease  with  .which  it  is  as- 
similated, its  retention  by  the  most  delicate 
stomachs,  all  make  it  desirable  for  exhibi- 
tion incases  where  the  principal  indication 
is  to  guard  the  patient's  stomach.  Used  in 
anaemic  conditions  associated  with  chloro- 
sis, when  the  catamenia  are  slow  in  assert- 
ing themselves  or  dysmenorrhea  exists  on 
account  of  a  defficincy  of  red  blood  cor- 
puscles, or  in  cases  of  menorrhagia  requir- 
ing the  use  of  a  tonic.  I  have  secured  ex- 
cellent results,  and  have  seen  patients  rapid- 
ly relieved  of  untoward  symptoms,  while 
in  debilitated  conditions  following  typhoid 
fever,  when  convalescence  is  slow,  the  ef- 
fects of  the  remedy  are  all  that  can  be  de- 
sired. During  convalence  from  pneumonia, 
when  resolution  is  slow  and  the  normal  re- 
spiratory murmur  is  not  rapidly  established, 
I  know  of  no  better  remedy.  I  have  used 
it  satisfactorily  with  children,  recovering 
from  summer  diarrhoea,  in  connection  with 
milk  or  some  of  the  most  desirable  baby 
foods  upon  the  market. 

In  the  primary  stages  of  phthisis  pul- 
monalis,  I  have  confidence  in  its  curative 
powers,  while  it  has  proved  of  advantage 
in  my  hands  in  all  stages  of  the  disease. 
It  is  particularly  in  these  cases  where  the 
stomach  becomes  so  rebelious  and  so  in- 
tolerant of  medication,  that  I  could  cite 
many  cases  in  which  I  have  used  the  Cor- 
dial, but  will  only  subjoin  one  for  the  con- 
sideration of  the  profession. 


M.  H.,  female,  white,  age  16,  American, 
tall,  slim,  slightly  cachectic,  poorly  de- 
veloped, general  health  below  normal,  suf- 
fers from  amenorrhea,  has  some  cough, 
mammary  glands  undeveloped,  pulse  90, 
elevation  of  temperature  1-2  degree  above 
normal,  no  expectoration  with  cough,  no 
sinking  of  tissues  above  clavicle,  slight  dull- 
ness on  percussion  in  apices  of  both  lungs, 
auscultation  reveals  dry  rales  of  both 
lungs,  slight  hoarseness.  History  shows 
menses  appeared  at  fourteen  and  were  reg- 
ular for  three  or  four  months,  though  scanty 
and  painful,  then  ceased  and  had  not  re- 
appeared up  to  present  date.  Prescribed 
Cord.  Ol.  Morrhuae  Com.  (Hagee),  tea- 
spoonful  4  times  per  day,  tinct.  ferri 
cholorid,  10  drops  3  times  per  day,  and  oc- 
casional hot  hip  baths.  The  menstrual  flow 
was  re-established  in  two  months  and  re- 
covery was  rapid  and  uneventful.  At  this 
time  the  patient  is  in  excellent  health  and 
has  had  no  tendency  to  relapse  to  her  for- 
mer   condition. 

N.  M.  Baskktt,  M.  D., 

Moberly,  Mo. 


Defective    Elimination. 

Defective  elimination  is  without  doubt 
the  cause  of  a  large  number  of  diseases. 

Usually  when  the  kidneys  fail  to  do  their 
work  the  skin  comes  to  the  rescue  and  vice 
versa.  Occasionally  when  both  are  derelict 
the  bowels  may  help,  but  to  a  small  extent 
only.  Again,  all  the  excretory  organs  may 
be  ready,  able  and  willing  to  perform  their 
functions,  but  there  is  an  emunctory  at  fault, 
which  has  become  gorged  and  fails  to  carry 
to  the  "main"  that  waste  product  over 
which  it  exercises  particular  care,  causing 
an  interruption  of  metabolism.  As  a  result 
there  is  an  attack  of  a  rheumatic  or  neural- 
gic character. 

Tongaline,  on  account  of  its  extraordin- 
ary eliminative  properties,  especially  when 
administered  with  copious  draughts  of  pure 
water,  hot  preferred,  flushes  the  emuncto- 
ries,  thoroughly  removes  the  obstructions 
and  promptly  restores  normal  conditions. 


Chemical  Food  is  a  mixture  of  Phosphoric 
Acid  and  Phosphates,  the  value  of  which 
Physicians  seem  to  have  lost  sight  of  to 
some  extent,  in  the  past  few  years.  The 
Robinson-Pettet  Co.,  to  whose  advertise- 
ment (on  page  14)  we  refer  our  readers, 
have  placed  upon  the  market  a  much  im- 
proved form  of  this  compound,  "Robinson's 
Phosphoric  Elixir."  Its  superiority  con- 
sists in  its  uniform  composition  and  high 
degree  of  palatability. 


THE  CHARLOTTE  MEDICAL    JOURNAL. 


NOW  READY 


fflaltine 

@J  ^  WITH 


CREOSOTE. 


A  number  of  years  ago,  when  the  value  of  Creosote  became 
fully  demonstrated,  we  began  the  publication  of  a  formula  for  the 
administration  of  Creosote  in  Maltine.  This  formula  has  been 
employed  successfully  by  thousands  of  physicians,  and  we  have 
been  urged  over  and  over  again  to  place  such  a  combination  upon 
the  market  in  order  that  a  uniform  and  properly  prepared  product 
could  be  had  under  all  circumstances. 


"MALTINE  with  CREOSOTE" 

is  the  most  eligible  and  palatable  form  in  which  Creosote 
can  be  administered.  The  vehicle-Maltine  Plain-is  particularly 
indicated,  by  reason  of  its  great  food  and  digestive  value,  in  all 
conditions  in  which  Creosote  is  so  universally  employed. 


It  will  give  os  pleasure  to  send,  prepaid,  samples  of 

"MALTINE  with  CREOSOTE" 

to  any  physician  in  good  standing  who  wishes  to  satisfy  himself  of  its 
therapeutic  value  and  elegance. 

THE  MALTINE  COMPANY, 

Eighth  Ave,  I8th  »n<J  (9th  Sts..  BROOKLYN,  N.  Y. 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


The  Treatment  of- Carbuncles.* 

There  is  no  affection  falling  to  the  lot  of 
human  suffering  that  is  attended  with  more 
pain  and  suffering  than  carbuncles.  Be- 
sides the  pain  which  they  carry  in  their 
train,  they  are  attended  with  much  danger. 
As  a  cause  of  death,  upon  investigation, 
we  will  find  that  the  mortality  incident 
upon  this  affection  is  by  no  means  contemp- 
tible. In  this  article  I  shall  not  deal  with 
the  symptoms  or  pathology  of  this  affection, 
that  being  easily  obtained  by  reference  to 
the  standard  text-books  on  surgery. 

One  of  the  first  considerations  in  the  treat- 
ment of  a  patient  with  carbuncles  is  to  see 
that  he  is  well  and  thoroughly  nourished. 
The  importance  of  this  is  very  manifest 
when  we  reflect  how  much  debility  is  asso- 
ciated with  the  unfolding  of  a  carbuncle. 
We  should  give  regularly  food  of  a  nourish- 
ing character,  and  we  must  be  satisfied  that 
our  patient  gets  enough  to  sustain  his 
strength.  Liquid  diet  and  easily  digested 
solid  foods  are  to  be  given  as  regularly  as 
we  do  our  drugs.  Milk,  predigested  foods, 
and  everything  which  offers  no  resistance 
along  the  line  of  nourishment  will  be  called 
into  requisition  by  the  wise  physician.  In 
this  connection  I  must  not  omit  to  mention 
the  value  of  stimulants  in  some  cases.  In 
patients  who  are  extremely  weak,  either 
from  the  disease  itself  or  from  a  poorly 
nourished  state  of  the  system  existing  be- 
fore the  supervention  of  the  carbuncles,  it 
is  of  the  greatest  importance  to  give  some 
stimulant  regularly.  Whisky  serves  us  well, 
but  I  generally  allow  the  patient  to  select 
his  own  favorite  liquor.  I  give  stimulants 
often  enough  to  keep  the  volume  of  the 
pulse  good.  There  is  no  rule  better  than 
the  one  Turgensen  lays  down  ;  this,  he  says, 
"is  the  rule  of  consistency."  He  explains 
this  by  saying  that  stimulants  should  be 
given  to  produce  the  effect  we  desire.  We 
must  not  stand  on  quantity  or  dosage,  effect 
on  the  pulse  is  what  we  must  obtain ;  if 
large  doses  are  requisite  and  frequent  dosage 
is  necessary,  we  must  bring  both  to  bear. 

The  old  writers  on  surgery  and  practice 
advocated  the  abstraction  of  blood  and  the 
employment  of  drastic  purgatives.  It  is 
not  worth  serious  argument  to  convince  the 
practitioner  of  the  present  day  that  such 
practice  tends  to  intensify  all  the  serious 
factors  in  the  case. 

I  shall  now  speak  of  the  treatment  of  car- 
buncles by  drugs  and  by  surgical  means. 
Let  me  consider  the  treatment  under  two 
heads  :  First,  the  internal  treatment ;  sec- 
ond, the  treatment  by  local  applications 
and  surgical    procedures.      By  the  internal 


*Dr.  M.  P.  Creel  in  Lancet  Clinic. 


remedies  are  meant  not,  of  course,  foods 
and  stimulants  as  have  already  been  men- 
tioned, but  pure  medication  to  correct  the 
blood  dyscrasia  which  gave  rise  to  the  car- 
buncular  conditions.  Iodides  and  sulphide 
of  calcium  have  been  administered,  but  they 
are  not  now  relied  upon  by  the  profession. 
Both  of  these  agents  have  utterly  failed  to 
modify  in  any  way  the  progress  of  a  car- 
buncle, and  they  have  been  tried  thoroughly. 
Iron  has  also  been  tried,  and  it,  too,  has 
failed,  and  is  not  now  relied  upon  by  the 
profession.  For  some  months  I  have  relied 
upon  ecthol  as  an  internal  medicine.  I 
have  notes  on  fifteen  cases  treated  with  this 
agent.  I  employ  it  in  doses  of  a  teaspoon- 
ful  every  two  hours.  Its  internal  adminis- 
tration is  the  only  drug  which  I  can  say 
has  ever  seemed  to  abbreviate  the  carbuncle. 
It  is  a  corrector  of  blood  dyscrasia,  and  in 
the  best  sense  an  anti-purulent.  In  this 
connection  we  may  say  that  an  anti-puru- 
lent is  just  what  our  therapeutics  has  lacked, 
and  it  is  the  first  need  of  the  practitioner 
when  he  has  a  carbuncle  under  his  charge. 
Ordinarily  I  give  no  other  internal  remedy 
than  ecthol.  This  remedy  I  continue  until 
the  patient  has  been  discharged.  But  as 
improvement  becomes  marked  and  steadfast, 
I  allow  the  interval  between  the  doses  to 
grow  longer.  First,  he  is  given  the  reme- 
dy every  two  hours,  then  every  four  as  he 
gets  along  substantially  well.  This  given 
in  doses  of  a  teaspoonful  acts  very  promptly 
in  giving,  as  it  were,  a  check  to  tissue  dis- 
integration. Of  course,  opiates  are  often 
called  for  to  overcome  the  pain  present,  in 
in  some  cases  to  an  almost  insufferable  ex- 
tent. Papine  is  the  best  way  to  exhibit  this 
agent,  since  it  does  not  produce  interference 
with  the  secretions  as  in  the  case  with  other 
opiates.  I  give  it  in  doses  of  a  teaspoonful 
every  one  or  two  hours  until  the  patient  has 
obtained  relief  from  pain. 

Coming  now  to  the  measures  which  should 
be  employed  locally  and  surgically,  let  me 
say  that  this  part  of  the  treatment  is  as  im- 
portant as  the  giving  of  internal  remedies. 
During  the  time  the  inflammation  is  begin- 
ning and  up  to  the  time  when  there  is  suf- 
ficient pus  in  the  pointing  carbuncle  to 
justify  an  incision,  I  employ  flaxseed  poul- 
tices. These  soothe  and  hasten  the  forma- 
tion of  the  pus.  An  incision  is  now  made, 
and  the  pus  all  emptied;  the  cavity  is 
scraped  and  all  the  dead  inflamed  tissue  is 
removed.  It  is  then  carefully  cleaned  with 
peroxide  of  hydrogen.  Then  absorbent 
cotton  saturated  with  ecthol  is  applied  to 
the  exposed  and  adjacent  surfaces.  This  is 
to  be  reapplied  every  four  or  eight  hours, 
as  the  case  in  hand  seems  to  warrant.  Each 
opening  is  to  be  treated  in  this  manner,  and 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


687 


A  SIMPLE  AND  MOST  EFFECTIVE 


Treatment  of  Chronic  Leg  Ulcers 


Thoroughly  wash  and  irrigate  the  ulcer  and  adjacent  parts; 
after  drying  apply  Antinosine  (pulv.),  distributing  the  powder 
lightly  over  the  entire  surface.  Over  this  place  a  nosophen- 
gauze  dressing,  the  whole  held  in  place  by  a  roller  bandage. 
In  cases  with  hard  infiltrated  borders,  precede  the  above  treat- 
ment by  curetting. 


(the  sodium  salt  of  tetraiodo-phenolphtalein)  has  been  proven 
by  extensive  and  most  severe  clinical  tests  to  be  beyond  ques- 
tion the  most  efficient  of  all  existing  antiseptics  in  the  treat- 
ment of  ulcers  and  abscesses  generally,  infected  wounds  of 
any  nature;  very  useful  in  palliative  treatment  of  cancerous 
ulcerations,  lupus,  etc.  Antinosine  is  absolutely  non-toxic 
non-irritating  and  odorless.  It  is  freely  soluble  in  water,  and 
in  solutions  of  1  to  2+  per  cent,  gives  most  excellent  results  in 
cystitis,  as  an  injection  in  gonorrhoea,  as  an  antiseptic  fluid  in 
ear.  nose  and  throat  practice,  etc. 

Literature  on  request. 

Sole  Agents  for  the  U.  S.  and  Canada: 


STALLMAN  &  FULTON,     10  Gold  St.,  New  York 


$alephen 


The  Safest,  Most  Agreeable  and 
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An  Important  Advance  in  Gonor- 
rhoea Therapeutics. 


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Semarfese 


A  Scientific  Food,  Tonic  and 
Restorative. 


The  Chalybeate  Tonic 
and  Nutrient. 


Ferr©-S«mar©se 


Lycetel 


The 


Uric  Acid  Solvent 
Anti-arthritic. 


and 


Send  for  samples  and  literature  to 

FARBENFABRIKEN   OF  ELBERFELD  CO.,  40  Stone  St.,  New  York. 

Selling  agents  for  the  Bayer  Pharmaceutical  Products : 

Aristol,  Creosote  Carbonate  (Creosotal),  Europhen,  Ferro-Somatose,  Guaiacol  Carbonate  (Duotal).  Hemicranin,  Heroin, 
iodothyrine,  Lacto-Somatose,  Losophan,  Lycetol.  Phenacetin.  Piperazine-Bayer.  D" 
Salicylic  Acid.  Salophen,  Somatose,  Sulfonal,  Tannigen,  Tannopine 


rgol.  Qu 


THE  CHARLOTTE  MEDICAL  JOURNA.L. 


when  we  see  a  case  of  carbuncle  with  sev- 
eral centers  ready  to  open  we  should  remove 
as  much  of  the  diseased  tissue  as  possible. 
Great  freedom  in  the  employment  of  the 
knife  often  greatly  aids  us  in  bringing  about 
a  speedy  termination  of  the  case  in  hand. 
It  is  the  best  thing  we  can  do  for  our  pa- 
tients to  lay  the  carbuncle  open  and  remove 
all  the  diseased  tissue,  and  treat  the  lesion 
then  with  ecthol  locally.  If  we  employ  this 
agent  as  our  internal  remedy,  and  use  it 
also  as  a  local  application,  we  shall  find  that 
our  treatment  will  prove  more  effective  than 
by  methods  employed  formerly. 

I  have  treated  fifteen  cases  of  carbuncles 
in  the  manner  here  outlined,  and  the  dura- 
tion in  each  case  has  been  greatly  shortened, 
and  the  patients  naturally  got  up  with  less 
weakness  than  they  otherwise  would. 

Before  employing  this  agc?it,  a  carbuncle 
meant  a  long  spell  and  death  or  long-contin- 
ued convalcsence.  The  average  duration 
of  my  cases  under  this  treatment  has  been 
ten  days. 

I  now  give  a  brief  account  of  several 
cases  treated  by  the  method  I  have  here  ad- 
vocated : 

S.  C.  T.,  aged  thirty-seven,  a  miner  by 
occupation.  He  had  been  a  sufferer  from 
malarial  fever  for  a  month  or  so,  but  was 
able  to  work.  He  had  a  carbuncle  about 
the  size  of  the  palm  of  the  hand  on  the  neck. 
There  was  a  great  deal  of  pain,  and  fever 
of  101  deg.  F.  was  present.  His  carbuncle 
had  five  heads  or  points,  and  seemed  to  in- 
vite incision,  they  showing  the  presence  of 
pus.  This  was  thoroughly  opened  and  the 
diseased  tissue  was  removed  as  thoroughly 
as  possible.  Peroxide  of  hydrogen  was 
used  to  clean  out  the  diseased  cavity  well, 
and  then  absorbent  cotton  saturated  with 
ecthol  was  applied  constantly  throughout 
the  course  of  the  disease.  Ecthol  in  doses 
of  a  teaspoonful  was  given  every  two  hours. 
This  patient  began  to  improve  at  once,  and 
there  was  no  retrogression.  The  carbuncle 
began  to  take  on  a  healthy  action,  and  this 
patient  was  discharged  nine  days  later. 

Mrs.  B.  K.  Y.,  aged  forty-seven,  had  a 
carbuncle  on  her  face.  This  was  attended 
with  high  fever  and  delirium.  This  car- 
buncle had  three  openings.  It  was  treated 
as  in  the  former  case  as  regards  the  local 
and  surgical  means  employed.  Besides 
these  she  had  to  take  predigested  milk  and 
considerable  quantities  of  wine,  so  weak  was 
she.  She  took  ecthol  internally  also,  in 
doses  of  a  teaspoonful  every  two  hours. 

J.  C.  P.,  aged  fifty-five,  had  a  carbuncle 
on  the  nape  of  the  neck.  He  had  been  a 
sufferer  for  years  with  asthma,  and  was  in 
a  low  state  of  health.  This  patient  I  re- 
garded as  one  who    would  give   me  serious 


trouble,  and  who  would  in  all  probability 
die.  The  carbuncle  was  freely  opened  and 
treated  in  the  same  way  as  the  first  case 
here  recorded  as  regards  the  surgical  and 
local  measures.  He  was  from  the  first  given 
predigested  foods  and  stimulants,  and  ecthol 
was  the  only  internal  medicine  he  received 
except  some  papine  to  relieve  the  pain. 
This  man  went  along  slowly,  but  he  recov- 
ered fully,  and  was  able  to  go  about  his 
work  seventeen  days  from  the  time  I  first 
saw  him. 

These  cases  are  selected  because  they  are 
ones  which  would  test  the  efficacy  of  a 
treatment. 


In  the  warfare  on  microbes  which  of  ne- 
cessity forms  so  important  a  factor  in  mod- 
ern surgery,  too  much  care  cannot  be  de- 
voted to  the  ammunition.  Pus  must  be 
removed  or  destroyed,  its  formation  pre- 
vented. Alcohol,  in  certain  strengths,  is 
well  known  to  be  a  very  good  germicide. 
Camphor  and  menthol  also  have  their  merits 
for  this  purpose.  For  some  time  a  combin- 
ation of  these  with  hydrogen  peroxide  has 
been  in  use  in  the  hospitals  of  Berlin,  and 
has  been  found  to  be  a  superior  antiseptic. 
The  laboratory  tests  show  marked  results 
indicating  that  these  solutions  have  a  ger- 
micidal power  exceeding  what  would  be 
expected  from  the  sum  of  the  ingredients. 
Camphoroxol  and  Menthoxol,  as  these  solu- 
tions have  been  called,  not  only  are  power- 
ful germicides,  but  harmless  as  well.  They 
do  not  irritate,  they  stimulate  the  growth 
of  healthy  granulations,  and  besides  are 
very  stable  solutions  which  retain  an  undi- 
minished activity  for  a  very  long  time. 
Sterile  gauze,  wet  with  a  ten  per  cent,  so- 
lution, forms  a  neat  and  most  efficacious 
dressing  for  any  wound  surface,  and  pos- 
sesses the  merit  of  being  not  only  a  power- 
ful, but  also  a  continuous  antiseptic.  As 
of  minor  importance,  perhaps,  it  may  be 
remarked  that  freely  diluted  with  water 
they  form  a  very  pleasant,  refreshing  and 
efficient  mouth  wash. 


There  are  men  in  the  practice  of  medi- 
cine whose  aversion  to  giving  endorsements 
to  pharmacists  is  so  intense  that  only  qual- 
ities far  out  of  the  common  could  induce 
them  to  utter  a  word  of  commendation.  A 
single  sentence  from  such  a  man  is  more 
significant  than  reams  of  eulogy  from  other 
sources.  Of  such  a  character  is  the  follow- 
iug  from  a  physician  who  enjoys  probably 
the  largest  practice  in  Oakland,  California. 
"I  have  used  Angier's  Petroleum  Emulsion 
for  many  years,  and  have  found  it  of  great 
utility  in  the  treatment  of  debility,  espe- 
cially in  tuberculosis  cases." 


THE  CHARLOTTE   MEDICAL  JOURNAL. 


STANDARD     PREPARATIONS 

Made  for  and   Highly  Endorsed   by   Medical   Men   Everywhere. 

UngUentUIYI       ResinOl.         Antipruritic,    Antiphlogistic, 

i     -  ..  ■     ,  ■ ,  Nutrient  and,   l'ln-otic. 

Elixir    Cascanata.     Alt u'"lm-  '  -  ;    ;     ,  Q 

Antacid  and   Sccernnd. 


ReSinOl      Soap*        Prophylactic. 


Germicidal,    Etc. 

I   prescribe    Unguentum   Resinol  daily  with   entire   satisfaction.— D.  F.  MONASH,  M.  D.,  Lect.  on  Theory  and 
Practice  of  Med.,  Iowa  Col.  of  Phys.  and  Surjrs.,  Des  Moines,  Iowa. 

I  have  requested  our  druggists  to  carry  Unguentum  Resinol  and  Resinol  SoAr.    They  are  all  right.— 

A.  E.  EARLY,  M.D.,  Kingman,  Arizona. 
Resinol   has   given   me   entire    satisfaction.     Its   wide  range  of  usefulness   especially   recommends  it.— 
._        .  LOUIS  A.  BOORING.  M.  D.,  Louisville,  Ky. 

Am  prescribing  I  NGUBNTUM  Resinol  with  great  satisfaction.—,!.  S.  BEAUDRY,  M.  D.,  Chicago,  111. 
Have  used   Resinol   in    many  cases  and   am    exceedingly   pleased   with    its   action.— G.   E.  WILDER,   M.  D., 
Sandusky,  Ohio. 

I   cannot   find   anything  that   can  take   the   place   of   Resinol.— A.  AGEE,  M.  D.,  Holbrook.  Ky. 
I  have  found  Resinol   to   be   a  remarkable  cure   for  almost   any  type  of  Sore.— G.  D.  BOUDOUsyuiE,  M.D. 
Tuscaloosa,  Ala. 

I   have   prescribed    Resinol    in   many   cases   and   am  very  much  pleased  with    it.— SAM'L  G.  SEWALL,  M.  D., 
71  E.  121st  St.,  New  York. 

I  have  prescribed  Unguentum  Resinol  with  great  success  in  Eczema,  Pruritis  Ani  and  Pruritis  Vulvae.— 

WM.  LAMBERT,  M.  D.,  Kansas  City.  Mo. 
I  am  more  than  pleased  with   UNGUENTUM  Resinol.— C.  B.  WALRAD,  M.  D.,  Johnstown    N.  Y. 
All  Leading  Druggists  carry  these  Goods. 

RESINOL    CHEHICAL    COflPANY, 

^Samples  sent  on  request.  BALTIMORE,  MD. 


X-Ray  Work  at  St.  Peter's  Hosoital. 

CHARIvOTTB,  K.  O. 

A  room  has  been  fitted  up  at  ST.  PETER'S  HOSPITAL  with  the  most  improved 
X-Ray  apparatus.  An  eight-plate  thirty-inch  static  machine  is  used  to  generate  its 
current.   This  is  the  largest  machine  made  for  this  kind  of  work  and  it  produces  its  Rays  in 

A   CLEAR  AND  POWERFUL  STREAM. 

The   latest   and    most  expensive    accessories  are    used  in  connection  with  this  machine 
making  it  the  most  powerful  and  complete  outfit  in  the  South  at  the  present  time. 

Prices  for  Complete  and  Thorough   Examinations  will  be  $10.00  to  $25.00. 
Photographs  Furnished  if  Desired, 

For  particulars  address, 

St.  Peter's  Hospital, 

Charlotte,  N.  C. 


THE  CHARLOTTEi MEDICAL  JOURNAL. 


Local  Anesthesia. 

The  International  Journal  of  Surgery, 
comments  as  follows  on  this  subject  : 

It  is  remarkable  how  unimportant  a  place 
local  anesthesia  still  occupies  in  surgery. 
It  is  an  indisputable  fact  that  complete  an- 
esthesia is  still,  and  will  always  remain,  a 
matter  of  dread  to  patients  ;  that  surgeons 
do  not  make  any  very  strenuous  endeavors 
to  avoid  it  when  they  could  possibly  do 
without  it.  The  most  profitable  work  for 
the  surgeon  is  often  connected  with  the 
painless  treatment  of  common  affections, 
such  as  piles,  in  people  who  would  subject 
themselves  to  ordinary  operative  measures 
were  it  not  for  the  fear  of  anesthesia.  In 
chloride  of  ethyl  and  the  subcutaneous  em- 
ployment of  cocaine  and  eucaine  we  have 
means  that  are  really  not  half  studied  out, 
and  which  deserve  more  careful  considera- 
tion than  they  have  yet  obtained.  The 
writer  has  operated  for  piles  and  fistula, 
has  removed  the  breast  and  done  a  partial 
excision  of  the  clavicle  with  Schleich's  in- 
filtration anesthesia  and  chloride  of  ethyl. 
The  use  of  the  latter  prior  to  inserting  the 
hypodermic  needle  is  often  of  advantage, 
as  its  insertion,  in  cases  of  ingrowing  nails 
and  infected  fingers  is  often  almost  as  pain- 
ful as  the  operation  itself.  The  ophthal- 
mologists are  nearly  the  only  ones  who  use 
local  anesthesia  to  the  full  extent  of  its  pos- 
sibilities, and  we  expect  to  see  practitioners 
of  other  branches  of  surgery,  in  the  near 
future,  more  eager  to  extend  the  scope  of 
local  anesthesia,  both  for  the  welfare, 
mental  and  physical,  of  the  patients,  and 
for  the  increased  facility  with  which  they 
will  find  that  patients  will  submit  to  nec- 
essary procedures. 

Prevention   of  Hay  Fever. 

In  the  January  21st,  1899,  number  of 
The  Journal  of  the  American  Medical  As- 
sociation, Dr.  Alexander  Rixa,  of  New 
York,  contributed  a  very  interesting  arti- 
cle on  "Prevention  of  Hay  Fever."  After 
a  highly  interesting  historical  review,  and 
a  brief  survey  of  the  results  achieved  in  the 
past  few  years,  the  writer  resumes  the  re- 
sults of  his  own  investigations. 

His  ingenious  reseaches  for  a  number  of 
years,  regarding  the  etiology  of  hay  fever, 
lead  him  to  admit  that  the  pollen  of  the 
Roman  wormwood,  ragweed  (ambrosia 
artemisjefolia)  is  the  primitive  and  active 
cause  of  this  peculiar  disease.  By  inhaling 
these  pollen  he  produced  the  symptoms  of 
genuine  hay  fever.      He   writes  as  follows  : 

From  the  time  I  found  the  pollen  to  be 
the  exciting  cause  of  the  disease,  I  conclud- 
ed in  a  logical  way  upon  the  proper  treat- 
ment.     I   conceived    the    idea  of  rendering 


the  receptacle  aseptic  by  preparing  the  soil 
for  the  reception  of  the  pollen.  Naturally, 
they  will  find  no  proper  soil  for  a  possible 
generation,  propagation  or  development, 
destroying  their  existence  in  embryo,  so  to 
speak,  and  with  it  the  real  cause  of  hay 
fever.  For  this  purpose  I  decided  on  the 
following  treatment  : 

About  two  weeks  before  the  onset  of  the 
disease  1  commence  to  irrigate  or  sterilize 
the  nasal  cavity  and  the  post-nasal  spaces 
with  a  harmless  antiseptic  solution,  using 
the  douche  and  atomizer.  After  giving  a 
great  number  of  antiseptics  a  fair  trial,  I 
decided  on  Hydrozone  as  the  most  innocu- 
ous and  most  powerful  germicide.  Hydro- 
zone  is  a  30-volume  aqueous  solution  of 
peroxide  of  hydrogen.  At  the  beginning  I 
use  it  for  irrigation  diluted  in  the  propor- 
tion of  one  ounce  of  Hydrozone  to  twelve 
ounces  of  sterilized  water.  Nearing  the 
period  of  the  expected  onset  of  the  disease, 
I  increase  the  dose  to  two  or  three  ounces 
of  Hydrozone,  to  twelve  ounces  of  the  ster- 
ilized water,  according  to  the  severity  of 
the  disease,  using  the  douche,  either  tepid 
or  cold,  four  times  a  day — morning,  noon, 
evening  and  at  bedtime — while  during  the 
intervals  I  use  the  atomizer,  with  a  solution 
of  Hydrozone  and  pure  glycerin,  or  steril- 
ized water,  one  to  three,  thus  keeping  the 
nares  perfectly  aseptic  during  the  entire 
period,  and  preventing  the  outbreak  of  the 
disease  in  consequence  thereof. 

In  most  obstinate  cases,  when  there  is 
still  some  irritation  in  the  nasal  cavity,  I 
give  as  an  adjuvant,  the  following  prescrip- 
tion : 

ft     Acid  boracic,  gr.  xx. 
Menthol,  gr.  iv. 
Glyco-thymoline,  3  ij. 
Sol.  eucain  B.  4  per  cent.,  q.  s.  ad  3  ji. 

Sig.      Use  in  atomizer. 

As  a  rule  this  treatment  was  sufficient  to 
avert  the  disease  and  keep  the  patient  in 
perfect  comfort. 

Chlorin  Water  in  Typhoid  Fever. 

The  chlorin  water  treatment  of  typhoid 
comes  from  India.  The  usual  dose  is  a 
drachm  every  three  hours.  Wilcox,  accord- 
ing to  the  New  York  Medical  News,  makes 
the  following  statements  : 

(1)  Chlorin  can  be  safely  used  till  com- 
plete disinfection  of  the  alimentary  canal  is 
obtained. 

(2)  It  improves  the  appetite  and  diges- 
tion, lessens  the  fever,  and  cleans  the  tongue. 
The  only  odor  to  the  stools  is  that  of  chlorin. 

(3)  It  causes  increase  of  strength  and 
lessens  the  nervous  symptoms. 

(4)  It  shortens  the  duration  of  the  dis- 
ease and  under  its  influence  the  patient  usu- 
ally makes  a  rapid    and  complete  recovery. 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


Some  Fallacies  of  EARLY  Infant  Feeding. 

IT  is  commonly  supposed  that  a  young  infant  may  be  fed  on  any  mixture  of 
cow's  milk  with  07'  without  one  of  the  many  advertised  farinaceous  foods . 
Physiological  research  tells  us  that  not  until  the  child  is  nearly  six  months  old 
is  it  capable  of  digesting  starchy  food,  and  that  during  these  early  months  it 
has  little  power  to  assimilate  the  casein  of  cow's  mtlk.  The  practical  truth  of 
this  statement  is  shown  in  the  terrible  mortality  of  young  infants  from  diar- 
rhoea and  disorders  of  the  alimentary  canal — conditions  due  alone  in  the 
majority  of  instances  to  irritating,  indigestible  food  and  bacterial  contamination. 

IHPROPER  FOODS  in  common  use  during  the  First  Six  Months 


Condensed  Milks 

Which  are  deficient  in  fat  and  soluble  albumen, 
contain  an  excess  of  sugar,  and  that  not  milk- 
sugar.  This  class  of  foods  is  therefore  not  only 
highly  indigestible,  but  also  below  the  normal 
in  fat-forming  constituents. 

Farinaceous    Foods 

Containing  unaltered  Starch,  are  inadmissible, 
as  the  infant  is  given  wort  to  do  which  it  cannot 
perform;  and  the  additional  fact  of  these  neces- 
sarily being  made  wiih  unaltered  cow's  milk 
renders  them  still  more  indigestible. 


Cow's   Milk   and 

Barley-Water   riixture 

Is  perhaps  the  least  harmful,  but  is  not  a 
perfect  food  in  that  it  contains  too  much  casein, 
too  little  fat  and  albumen,  and  generally  swarms 
with  bacteria.  Its  reaction,  moreover,  is  un- 
certain, and,  though  the  presence  of  the  barley- 
water  mitigates  the  formation  of  large  and  in- 
digestible curds,  it  is  itself  by  no  means  suitable 
for  the  infant  economy. 


PROPER  FOODS  to  be  used  during  the  First  Six  Months 

Should  be.  its  nearly  as  possible,  the  physiological  equivalent  of  human  milk.  This 
principle  ALLKN  &  HANBURYS  have  carried  out  in  the  preparation  of  their 
"ALLENBURYS"  No.  1  and  No.  2  MILK  FOODS.  These  not  only  provide  a 
perfect  humanized  food,  bu1  the  addition  in  the  No.  2  Food  of  certain  constituents 
affords  a  proper  progressive  dietary  to  meet  the  developing  functions  of  infant 
digestion 


"Allenburys"  Hilk  Food,  No.  i, 

For  use  from  Birth  to  Three  Months.J 

Is  prepared  in  the  form  of  a  dry  powder,  and  is 
made  from  cow's  milk,  from  which,  after  the 
proximate  composition  has  been  ascertained, 
the  excess  of  casein  is  removed,  and  the  defi- 
ciency in  fat  (cream),  soluble  albumen,  and  milk- 
sugar  corrected.  The  method  of  preparation 
renders  this  Food  sterile,  and  boiled  water  alone 
is  required  in  preparing  it  for  use. 

Infants  reared  by  hand  should  be  brought 
up  on  this  Food  until  they  are  three  months 
old. 


"Allenburys"  Hilk  Food,  No.  2, 

For  use  from  Three  to  Six  Months. 

About  this  period  (three  months)  it  is  found 
that  the  infant  requires,  in  consequence  of  the 
development  of  the  digestive  organs,  a  some- 
what more  sustaining  form  of  nourishment. 
This  is  best  obtained  not  by  increasing  the 
amount  of  indigestible  material,  as  is  usually 
practiced,  but  by  affording  in  addition  to  the 
milk  a  digested  food 

This  Food  contains,  besides  the  constituents 
of  the  No  1  Food,  maltose,  soluble  phosphates, 
and  albuminoids  derived  from  whole  meal. 
There  is,  however,  no  unconverted  starch  left  in 
the  Food,  whicn  at  this  age  the  infant  would  be 
unable  to  digest. 


A  Sample  of  any  or  all  of  the  Foods,  and  full  descriptive  pamphlet,  will  be  sent 
free  to  any   physician   upon  request.       Address   82   Warren   Street,   New  York. 

Please  specify  on  prescription  the  NUMBER  of  the   Food  desired, 


Allen  &  Hanburys  Ltd.,  (London,  Eng.) 

(established  a.  d.,   1715.) 

82  Warren  Street,  New  York. 

Agent  forlCanada:    W.  Lloyd  Wood,  Toronto. 


692 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


Insufficient  Menstruation, 

Dunn  (Am.  Journal  Obstetrics).  They 
appear  to  be  due  to  a  lack  of  proper  func- 
tional activity  of  the  glandular  structure  of 
the  uterus  and  adnexa. 

Anything  that  will  stimulate  the  func- 
tional activity  of  these  glandular  structures 
will  increase  the  menstrual  flow  and  give 
more  or  less  marked  relief. 

Direct  stimulation  of  the  endometrium 
and  muscular  structures  of  the  uterus,  by 
stimulating  the  terminal  nerve  filaments  and 
conveying  an  awakening  impulse  to  the 
ganglia  in  the  uterus  and  adnexa,  is  the 
surest  means  of  relief. 

This  stimulation  should  be  only  such  as 
is  necessary  to  give  relief  to  symptoms. 

Unless  there  be  something  in  the  uterus 
requiring  removal,  a  sharp  curette  should 
never  be  used. 

The  difficulty  of  effecting  a  cure  increases 
in  direct  ratio  with  the  amount  of  injury 
done  to  the  endometrium. 

Judging  from  one  case,  stimulation,  such 
as  described,  will  relieve  symptoms  at  any 
time  between  periods  without  producing  at 
the  same  time  any  flow  of  blood. 

If  this  conclusion  should  prove  true  in  a 
series  of  cases  we  should  be  justified  in  be- 
lieving that  the  amount  of  the  menstrual 
flow  is  in  itself  of  no  particular  moment 
except  in  so  far  as  it  indicates  a  normal  ac- 
tivity of  the  glandular  structures  of  the  re- 
productive organs. 

If  the  symptoms  enumerated  and  the  suf- 
fering endured  by  subjects  of  insufficient 
menstruation  are  due  to  insufficient  func- 
tional activity  of  glandular  structures  rath- 
er than  to  an  insufficient  flow  of  blood,  is 
there  not  at  least  a  strong  probability  that 
they  are  the  result  of  a  form  of  toxemia? 


Ergot  in  Hemorrhage. 

F.  A.  Packard  (Merck's  Bulletin)  points 
out  that  in  hemorrhage  ergot,  of  all  other 
drugs,  is  the  very  one  that  should  not  be 
used,  as  it  is  the  most  active  in  lessening 
arterial  capacity  and  increasing  blood-ten- 
sion. The  object  in  hemorrhage  should  be 
to  increase  the  coagulability  of  the  blood 
so  as  to  favor  the  formation  of  a  clot.  This 
can  be  done  by  local  applications  such  as 
the  topical  use  of  witch-hazel  in  epistaxis, 
the  inhalation  of  turpentine  in  hemoptysis, 
the  administration  of  tannic  acid  in  hemate- 
mesis,  or  of  lead  acetate  in  hemorrhage  of 
the  bowels.  Calcium  chloride  can  be  given 
internally  to  increase  the  coagulability  of 
the  blood.  Mechanical  disturbance  of  the 
clot  can  be  prevented  by  checking  peristal- 
sis and  cough  with  opium,  blood-pressure 
lessened  by  saline  laxatives,  where  permis- 


sible, hot  foot-baths,  ligature  of  extremities, 
and  the  administration  of  veratum  viride, 
or  nitro-glycerin.  R.  W.  Wilcox,  com- 
menting on  the  above, says  that  for  hemopty- 
sis, calcium  chloride  and  tincture  of  aconite 
given  alternately  are  generally  efficient. 
Aconite,  he  says,  is  better  than  veratrum  in 
being  more  easily  managed,  less  irritating 
to  the  stomach,  and  quite  as  efficient. 


Elegance  in  pharmacy  often  will  achieve 
a  success  for  the  physician  which  is  unat- 
tainable by  even  the  greatest  ability  or 
pains — taking  care  on  his  part,  Particular- 
ly is  this  true  in  pediatric  practice.  When 
one  intestinal  astringent  can  be  given  in  a 
pleasant  and  palatable  solution,  whilst  an- 
other also  with  desirable  therapeutic  action 
is  unsightly  and  distasteful,  there  certainly 
is  no  question  as  to  which  should  be  chosen. 
For  these  reasons  a  soluble  form  of  bismuth 
known  as  Bisol  is  a  most  desirable  drug  at 
this  time  of  year,  in  the  treatment  of  the 
numerous  gastro-intestinal  disorders  of  the 
little  ones.  It  is  a  salt,  virtually  harmless, 
which  is  prescribed  in  smaller  doses  than 
the  older  series  of  bismuth  salts  (3-7^  grains) 
and  has  the  additional  advantage  of  form- 
ing a  perfectly  clear  solution  in  water.  It 
has  been  found  highly  efficacious  also  in  the 
diarrhoeas  of  typhoid,  of  dysentery  and  of 
phthisis.  In  gastralgia  and  vomiting  it  is 
of  the  greatest  service.  By  adding  tannin 
to  a  solution  of  Bisol  there  may  be  prepared 
a  moist  tannate,  or  a  salicylate  of  bismuth 
much  stronger  by  far  than  the  usual  forms 
of  these  drugs  in  that  they  contain  more 
tannin  or  more  salicylic  acid  and  besides 
seem  to  possess  a  power  which  may  be  com- 
pared to  that  of  a  substance  in  the  nascent 
state. 


We  wish  to  call  the  attention  of  our 
readers  to  the  superior  merits  of  the  Patent 
Adjustable  Double  Slip  Socket  Artificial 
Leg,  as  manufactured  by  the  Winkley  Com- 
pany of  Minneapolis,  Minnesota,  now  the 
largest  establishment  of  its  kind.  With 
this  leg  a  perfect  fit  can  be  secured  without 
the  patient  leaving  home.  Their  large  1899 
catalogue,  giving  full  information,  will  be 
sent  free  upon  application  by  mentioning 
our  Journal. 

I  have  prescribed  "Maltine  with  Coca 
Wine"  with  great  benefit  as  a  general  tonic 
and  to  counteract  the  prostration  incident 
to  intestinal  hemorrhage  from  severe  inter- 
nal piles.  No  other  preparation  of  many 
used  has  offered  such  relief  as  "Maltine 
with  Coca  Wine." 

Louis  W.   Dunavan,  M.  D. 

Chicago. 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


IT  IS  IMPORTANT 

For  the  dispensing  pharmacist  to  recognize  the  right  of  the  physician 
to  dictate,  not  only  what  remedy  he  shall  use  in  a  given  case,  but  whose 
preparation  he  prefers,  for  the  quality  of  the  medicine  is  often  as  much 
a  factor  in  the  cure  of  disease  as  a  correct  diagnosis. 

Most  druggists  appreciate  this  fact,  some  are  indifferent  to  it, 
A  few  ignore  it,  specification  is  therefore  a  necessity. 

Syrup  Albuminate  of  Iron. 

An  organic  compound  of  Iron,  representing  in  a  purified  and  soluble  form  the  albumin- 
ate and  salts  (phosphates)  present  in  the  blood.  It  contains  0.7  per  cent,  metallic  iron  in  a 
form  readily  absorbed  and  is  very  efficient  in  medicinal  action.  This  combination  of  iron 
approximates  the  natural  forms  in  which  the  metal  is  present  in  the  animal  system,  and 
possesses  a  ma/ked  value  in  anemia  and  chlorotic  neurasthenia  where  prolonged  adminis- 
tration of  iron  is  indicated.  It  is  not  only  free  from  all  tendency  to  cause  digestive  distur- 
bances, but"4*  uf  positive  value  in  these  conditions  during  convalescence.  One  part  of  this 
syrup  represents  about  fifteen  parts  fresh  bullock's  blood. 

Cordial  Pas=Carnata=Merrell. 

DARTMOUTH  PHARMACY,  "BY  ALL  MEANS  TRY  IT." 

Established  1798. 
L.  B.  DOWNING,  Box  444.  Hanover,  N.  H.,  July  17,  1895. 

WM.  S.  MEBBELL  CHEMICAL  CO.  : 

(Jknts  :--  In  June  I  ordered  your  Fl.  Ext.  Passion  Flower,  as  an  experiment,  for  a  son  of  12 
years,  who  has  made  very  rapid  growth,  and  was  at  the  time  very  nervous,  and  several  physicians 
had  tried  in  vain  to  help  him.  one  an  uncle  in  whose  family  he  staid  for  a  month.  My  wife  hap- 
pened to  see  your  circular  on  Pas-Carnata,  and  on  consulting  the  doctors  who  had  treated  him, 
they  said,  "by  all  means  try  it." 

The  result  was  truly  marvelous. 

There  was  a  change  for  the  better  in  four  days.  Facial  and  shoulder  muscles  were  twitching 
when  we  commenced  using  it.  In  a  few  days  they  disappeared,  and  on  15  drop  doses  three  times 
a  day  he  keeps  all  right,  apparently. 

I  shall  speak  a  good  word  for  the  medicine,  as  I  have  already  done.  Will  you  please  send 
me  some  circulars  to  give  to  my  physicians?  Very  truly  yours,  L.  B.  Downing. 

NATURAL===from  oil  of  wintergreen. 

TRUE  SALICYLIC  ACID  in  Crystals==Merrell. 
TRUE  SALICYLATE  SODIUM  !vNNS0T^§Ts»Merrell. 

The  investigations  of  Professor  Latham  (Cambridge,  England),  confirmed  by  Drs.  Char- 
teris  and  MacLennon  (University  of  Glasgow),  warn  the  profession  against  the  use  of  arti- 
ficial acid  of  commerce  and  its  Sodium  salt. 

They  conclude   that     |  are  slow,  but  certain  poisons. 
g-^  •II  produce  symptoms  closely  resembling  delirium  tremens. 

Commercial  patients  become  delirious. 

„     . .         . .  .       .  ,  !  dangerous  to  human  life. 

ISallCyllC    AClCl  J  have  to  be  watched  and  not  to  be  trusted. 

AND  ITS  retard  convalescence 

^      j  •  n  should  not  be  administered  internally,  however  much  they  may 

Sodllim    Salt        [         have  been  dialized  or  purified. 

For  internal  use  the  true  Salicylic  acid  and  its  Sodium  salt  should  only  be  dispensed. 


THE  Wm.  S.  MERRELL  CHEMICAL  CO. 

Cincinnati.  New  York.  San  Francisco, 

MERRELL  products  are  supplied  through  professional  channels  ONLY. 
JOHN  M.  SCOTT  &  CO.,  Charlotte,  N,  C, 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


Toxicodendron  Poison. 

Dr.  M.  Herschel  Wheeler,  of  Butler,  Ky., 
thus  reports  a  very  remarkable  case  of  Toxi- 
codendron poison  following  erysipelas. 

Case  i.  The  patient  a  gentleman,  was 
about  convalescent  of  a  very  severe  case  of 
erysipelas  when  he  came  in  contact  with  a 
poison  oak  vine.  When  I  called  to  see  him 
his  face  was  swollen  nearly  beyond  recog- 
"  nition,  and  he  was  suffering  intensely.  Not 
having  with  me  what  I  called  nearly  a  spe- 
cific in  said  trouble,  but  instead  a  two  ounce 
jar  of  Unguentine,  this  I  applied  freely,  and 
after  a  short  time  he  said  :  "Doctor.  I  feel 
so  much  better.  I  am  very  thankful  to  you. 
What  is  that  preparation  you  are  using?  I 
want  you  to  make  me  a  large  box  of  it." 

Suffice  it  to  say,  the  third  application 
made  a  cure. 

Case  2 — Was'a  case  of  Urticaria  in  an  aged 
lady.  You  know  I  presume  the  agony  one 
endures  with  urticaria,  and  many  times  has 
it  baffled  my  skill  to  check  it.  After  having 
the  patient  sponged  with  an  antiseptic  so- 
lution,Unguentine  was  applied  freely  which 
gave  her  some  relief.  This  treatment  was 
continued  until  the  case  was  cured. 

"I  believe  Unguentine  will  be  the  ideal 
ointment  in  the  near  future  in  both  skin 
diseases  and  as  a  surgical  dressing,  and  I 
cannot  thank  you  too  much  for  your  kind- 
ness in  calling  my  attention  to  your  valua- 
ble preparation." 


Forcible  Straining  of  the  Spine  to  Correct 
the  Deformity  of  Pott's  Disease. 

A.  M.  Phelps  (Post-Graduate  for  Feb- 
ruary, 1899,)  says  the  question  of  forcible 
straightening  of  spinal  curvatures  occurring 
in  tuberculosis  of  the  spine  has  been  recent- 
ly revived  from  an  old  practice,  as  old  al- 
most as  the  history  of  medicine,  revived 
and  practiced  by  Hippocrates  500  years  b. 
c,  and  again  revived  in  the  sixteenth  cen- 
tury by  Pere. 

That  ankylosed  spines  of  old  standing, 
with  a  large  kyphosis,  should  not  be  opera- 
ted upon.  Cases  with  large  abscesses  should 
be  avoided.  Cases  of  osteomyelitis  after 
the  abscess  has  been  evacuated  would  pro- 
mise more  than  tubercular  cases.  The  cases 
in  which  he  would  expect  to  have  good  re- 
sults are  beginning  kyposis,  cases  of  recent 
standing,  cases  unattended  with  abscesses, 
or  cases  in  which  the  abscess  had  already 
discharged,  in  which  a  small  kyphosis  was 
present,  all  cases  of  beginning  paralysis  or 
even  advanced  cases  with  paralysis,  not  due 
to  invasion  of  the  spinal  canal  by  the  dis- 
ease. Cases  of  lumbar  disease  are  more 
favorable  than  dorsal. 

The   indiscriminate  work  which    will  be 


done  in  the  future  by  individuals  incapable 
of  selecting  their  cases  or  actuated  by  other 
motives  will  relegate  the  operation  to  the 
obscurity  in  which  it  has  slept  for  more  than 
twenty-four  hundred  years. 

That  the  operation  is  a  useful  one  and 
will  save  many  a  child  from  a  crippled  life 
and  a  premature  death  the  author  has  not 
the  slightest  doubt,  and  as  time  goes  on  the 
profession  can  speak  from  their  ripe  expe- 
rience and  formulate  rules  which  will  be 
infallible  guides  to  scientific  work.  By  do- 
ing as  has  already  been  done,  and  is  being 
done,  in  some  of  the  diseases  and  deformi- 
ties classified  as  orthopedic,  empiricism  and 
charlatanism  will  be  stamped  with  an  ap- 
propriate brand. 

A  physician  of  extensive  practice  who 
has  devoted  many  years  to  the  study  of  re- 
spiratory troubles  writes  that  he  believes  he 
has  found  the  most  reliable  treatment  yet 
devised  for  obstinate  bronchitis  :  "My  sis- 
ter, Mrs.  M.,  had  been  under  treatment 
during  ten  years  for  chronic  bronchitis 
without  definite  improvement.  She  was 
extremely  weak  and  emaciated  and  had  fre- 
quent paroxysms  of  coughing  with  copious 
opaque  yellowish  expectoration  streaked 
with  blood.  There  was  pronounced  angina 
with  a  sense  of  weight  and  tightness  across 
the  chest.  About  six  weeks  ago  I  begau 
administering  a  Petroleum  Emulsion  made 
by  the  Angier  Chemical  Company  of  Bos- 
ton, in  teaspoonful  doses  mixed  with  two 
ounces  of  milk.  In  three  days  the  cough 
entirely  vanished,  and  the  pulse  became  full 
and  regular.  In  six  weeks  she  has  gained 
eighteen  pounds  and  declares  herself  cured. 
This  is  only  one  case  among  many." 

Local  Application. 

It  may  not  be  generally  known  that  in 
addition  to  its  marked  curative  properties 
when  administered  internally,  Tongaline 
produces  no  less  beneficial  efiects  when  ap- 
plied locally  in  certian  conditions. 

Among  the  indications  which  call  for 
the  topical  use  of  Tongaline  are  the  inflam- 
ed joints  of  rheumatism,  the  enlarged  artic- 
ulations of  gout  and  stiff  and  strained  mus- 
cles from  any  cause  whatever. 

In  fact  the  internal  administration  of 
any  one  of  the  Tongaline  preparations,  as 
indicated,  given  at  short  intervals  with  co- 
pious draughts  of  hot  water,  may  be  sup- 
plemented by  the  local  application  of  Ton- 
galine Liquid.  What  is  very  important  to 
note  is  the  fact  that  the  same  good  results 
are  invariably  secured  and  the  disturbing 
effects  of  internal  medication  upon  an  irri- 
table stomach  and  sensitive  nerves  entirely 
avoided  by  the  external  use  of  Tongaline 
Liquid  alone. 


THE^CHARLOTTE  MEDICAL  JOURNAL. 


HYDROZONE 

(30  volumes  preserved  aquen"s  solution  of  H3Oa) 

JS  THE  MOST   POWERFUL   ANTISEPTIC  AND    PUS  DESTROYER. 
HABMLESS  STIMULI  f  TO  HEALTHY  GRANULATIONS. 

!       GLYCOZONE 

(C.  P.   Glycerine  combined  with  Ozone) 

THE  MOST  POWERFUL  HEALINO 
AGENT  KNOWN. 

These  Remedies  cure  all  Diseases  caused  by  Germs. 

8*ocessfuilf   used   in  the  treatment  of    Diseases  of  the  Nose,, 
Throat  a»c«  ^\est: 

Diphtheria,  Croup,  Scarlet  Fever,  Sore  Throat,  Catarrh  of 

the  Pose,  Ozcena,  Hw  Fever,  LaGrippe,  Bronchitis, 

jLsthma   Laryngitis,  Pharyngitis,  Whooping  Cough,  Etc. 

Vnd  for  f  ee  240-page  book  "Treatment  of  Diseases  caused   by 
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contributors  to  medical  literature. 

Physicia  is  remitting  50  cents  will  receive  one  complimentary 

Sample  of  t*ch,  "Hydrozone"  and  'Glycozone  "  by  express,  charges 

prepaid. 

Hydrozone  is  pat  np  only  in  extra  small, 
Small,  medium  aad  large  size  bottles,  bearing  a  Prhparbd  only  bt 

red  label,  white  /etters,  gold  and  blue  border 
with  my  signature 


GlyCOZOne   is   put  up    only  in  4-0Z., 


.&M^^^^_ 


U^VUAUUC     IS      pui     up      winy     in     ^.-yz..,       Kj-yj/..  ^^K>i 

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mid  black  letters,  r^d  and  blue  border  with  my  — — 

Signature.  <  7,,  mistand  Graduate  o/<*e  "Ecole  Central 

Marchand'8  Eye  Balsam  cures  all  inflar ..  *•  ^  «  Manufactures  de  Pa**"  (Am). 
uatory  and  contagious  diseases  of  the  eyes- 

Charles  Marrhaii(l>  28  Prmco  St.,  New  iork. 

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THE  CHARLOTTE  MEDICAL  JOURNAL 


k^? 


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Show  these  Cardinal  Virt  ues.  As  used 
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tubes  (which  have  the  greatest  power 
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induction  around  the  tube,  thus  en- 
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X-Ray  burns.  The  great  speed  at 
which  they  can  be  run  makes  it  possi- 
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practical  purposes,  with  a  compara- 
tively inexpensive  machine. 

CATALOG     ON     APPLICATION 

R.  V.  WAGNER  &  CO.,  Inc. 

308    DEARBORN    ST.,   CHICAGO 


Treatment  of  Dysentery. 

Dr.  Christopher  C.  Cronkhite  (Medical 
Review,  May  20th,  1899)  gives  an  inter- 
esting account  of  an  epidemic  of  dysentery 
in  which  he  had  an  oportunity  of  treating 
twenty-three  cases.  Owing  to  the  bad  hy- 
gienic conditions  prevailing  it  was  found 
very  diffiult  to  successfully  combat  the  dis- 
ease. The  treatment  consisted  chiefly  in 
the  administration  of  Tannigen  in  doses  of 
5  to  10  gm.  every  three  or  four  hours,  ac- 
cording to  the  age,  in  connection  with  the 
necessary  dietic  regulations.  In  some  cases 
its  use  was  prrceeded  by  small  doses  of 
calomel  given  for  the  purpose  of  cleansing 
the  alimentary  tract.  Under  this  treatment 
the  fatality  in  twenty-three  cases  was  only 
two,  and  these,  the  author  believes,  would 
have  recovered  with  careful  and  intelligent 
nursing.  On  the  ground  of  two  year's  ob- 
servation, he  states  that  in  diarrhea  Tanni- 
gen is  his  first  and  last  remedy,  that  it  will 
cure  ninety-nine  of  every  one  hundred 
cases,  and  that  the  physician  can  use  it 
with  absolute  confidence  in  its  powerful 
curative  properties  in  dysentery  and  diar- 
rhea. 


Analytical  Test. 

I  have  used  Neurosine,  prepared  by  the 
Dios  Chemical  Co.  of  St.  Louis,  Mo.,  in 
my  practice  for  a  number  of  years  in  hun- 
dreds of  cases  where  the  bromides  are  in- 
dicated, with  marked  success.  The  prepar- 
ation has  always  been  uniform,  and  is  in 
my  opinion  the  best  combination  of  bro- 
mides on  the  market.  On  request  I  have 
made  a  chemical  analysis  of  this  prepara- 
tion and  can  state  conscientiously  that  it  is 
entirely  free  of  Opium,  Morphine  and 
Chloral. 

Carl  Orth,  Ph.G.,  M.  D., 

Analytical  Chemist. 

1437  Penrose  St. 


EXPERIENCE. 


MARKS, 
DESICNS, 
COPYRIGHTS    Ac. 

Anyone  sending  a  sketch  and  description  may 
quickly  ascertain,  free,  whether  an  invention  la 
probably  patentable.  Communications  strictly 
confidential.  Oldest  agency  for  securing  patents 
in  America.     We  have   a  Washington  office. 

Patents  taken  through  Munn  &  Co.  recelTO 
special  notice  in  the 

SCIENTIFIC  AMERICAN, 

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any  scientific  Journal,  weekly,  terms  $3.00  ayear; 

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MUNN    &    CO., 
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THE  CHARLOTTE  MEDICAL  JOURNAL. 


LISTERINE 


The  Standard  Antiseptic 


in  the  antisepti 


LISTERINE  is  a  non-toxic,  non-irritating-  and  non-escharotic  antiseptic,  composed  of  ozonifer 

ous  essences,  vegetable  antiseptics  and  benzo-boracic  acid. 
LISTERINE  is  sufficiently  powerful  to  make  and  maintain  surgical  cleanlir 

and  prophylactic  treatment  and  care  of  all  parts  of  the  human  body. 
LISTERINE  has  ever  proven  a  trustworthy  antiseptic  dressing   for  operative  or  accidental 

wounds. 
LISTERINE  is  invaluable  in  obstetrics  and  gynecology  as  a  general   cleansing,   prophylactic- 

or  antiseptic  agent,  and  is  an   effective   remedy  in  the   treatment  of  catarrhal   conditions  of 

every  locality. 
LISTERINE  is  useful  in  the  treatment  of  the  infectious  maladies  which  are  attended  by  inflam 

mation  of  accessible  surfaces — as  diphtheria,  scarlet  fever  and  pertussis. 
LISTERINE  is  especially  applicable  to  the  treatment  of  scarlet  fever,  used   freely  as  a  mouth 

wash,  or  by  means  of  the  spray  apparatus. 
LISTERINE  is  extensively  prescribed  in  typhoid   fever,  both  for  its  antiseptic  effect  and  to  im- 
prove the  condition  of  the  stomach  for  the  reception  of  nourishment. 
LISTERINE  agreeably  diluted,  is  prescribed  with  very  good  results,  in  the  treatment  of  diph- 
theria, both  as  a  prophylactic  and  curative — internal  antiseptic — agent. 
LISTERINE  is  used  extensively  with  good  results  in  the  treatment  of  whooping  cough. 
LISTERINE  diluted  with   water  or  glycerine  speedily  relieves  certain  fermentative   forms  of 

indigestion. 
LISTERINE  is  indispensable  for  the  preservation  of  the  teeth,  and  for  maintaining  the  mucous 

membrane  of  the  mouth  in  a  healthy  condition. 
LISTERINE  employed  in  a  sick  room  by  means  of  a  spray,  or  saturated   cloths   hung  about,  is 

actively  ozonifying  and  imparts  an  agreeable  refreshing  odor  to  the  atmosphere. 
LISTERINE  is  of    accurately   determined    and    uniform    antiseptic    power   and  of   positive  ori 

ginality. 
LISTERINE  is  kept  in  stock  by  the  leading  dealers  in  drugs,  everywhere. 


Lambert's  Lithiated  Hydrangea. 


Close  clinical  observation  has 
caused  Lambert's  Lithiated 
Hydrangea  to  be  regarded  by 
Physicians  generally  as  a  very 
valuable  Renal  Alterative 
and  Antilithic  Agent. 


Albuminuria,  Lithaemia, 

Bright's  Disease,      Nephritis, 
Cystitis,  Rheumatism, 

Diabetes,  Urinary  Calculus, 

Gout,  and  all  forms  of 

Hematuria,  Vesical  Irritation 


For  Descriptive  Literature,  Address 


Lambert  Pharmacal  Co., 


ST.     LOUIS 


THE  CHARLOTTE  MEDICALaOURNAL. 


Colden's 


Alii 


AAAini#u*.f4 


LIQUID     BEEF    TONIC. 


.  .  .  SPECIAL  ATTENTION  .  .  . 

of  the  Medical  Profession  is  directed  to  this  remarkable  Curative 
Preparation,  as  it  has  been  endorsed  by  THOUSANDS  OF  THE 
LEADING  PHYSICIANS  OF  THE  UNITED  STATES,  who  are  using 
it  in  their  daily  practice. 

COLDEN'S  LIQUID  BEEF  TONIC  is  invaluable  in  all  forms  of  Wasting 
Diseases  and  in  cases  of  convalescence  from  severe  illness.  It  can  also  be  de- 
pended upon  with  positive  certainty  of  success  for  the  cure  of  Nervous  Weakness, 
Malarial  Fever,  Incipient  Consumption,  General  Debility,  etc. 

COLDEN'S   LIQUID   BEEF  TONIC 

Is  a  reliable  Food  Hedicine  ;  rapidly  finds  its  way  into  the  circulation  ;  arrests 
Decomposition  of  the  Vital  Tissues,  and  is  agreeable  to  the  most  delicate 
stomach.  To  the  physician,  it  is  of  incalculable  value,  as  it  gives  the  patient  assurance 
of  return  to  perfect  health.      Sold  by  Druggists  generally. 


The  CHARLES  N.  CRITTENTON  CO.,  General  Agents, 
Nos.  115  and  117  Fulton  Street,  NEW  YORK. 


W 


vwm 


THE  WINKLEY  ARTIFICIAL  LIMB  CO. 

Largest  Manufacturers  of  Artificial  Lygs  in  the  World. 

DoMe-si%s socL  AnTIFIllAL  LIMB. 

Warranted  not  to  Chafe  the  Stump. 


PERFECT  FIT  guaranteed 

■      ■■  ■  m.  M     mm  ^m1    ■  ■     ■     ■        From  Casts  and  Measurements. 


Send  for  New  1899  Catalogue  and  Self  Measuring  Sheet. 

(.DepartmentA.)      MINNEAPOLIS,   MINN. 


A  physician  of  the  first  rank  in  Boston 
said  recently  :  "The  main  difficulty  in  feed- 
ing consumptives  is  not  to  find  food  for 
them,  but  to  quiet  the  nerves  racked  by  pain 
and  coughing — to  quiet,  but  not  to  depress, 
them.  This  once  accomplished,  the  forces 
influencing  nutrition  revive  immediately, 
and  only  then  will  nourishment  of  any  kind 
find  its  way  to  the  depleted  tissues.  An- 
gier's  Pretroleum  Emulsion  is  one  of  the 
exceptional  few  agents  upon  which  I  de- 
pend for  this  functional  restoring  process, 
and  the  only  one  in  my  experience  that 
never  caused  any  unpleasant  sensation  after 
swallowing." 


The  anodyne  properties  of  kryofine  are 
so  marked  as  to  render  it  a  drug  of  incal- 
culable value  in  all  conditions  attended  by 
pain.  More  especially  is  it  efficient  in  fe- 
brile disease,  since  it  also  acts  as  a  prompt 
and  safe  antipyretic.  In  addition  it  induces 
a  marked  sense  of  well-being,  of  euphoria. 
Under  its  influence  pain,  delirium,  high  tem- 
perature and  restlessness  disappear  to  give 
place  to  calm,  peaceful  and  recuperative 
sleep.  An  important  feature  also  is  that 
it  can  be  administered  in  an  elegant  and 
palatable  solution  and  combined  with  other 
drugs  that  may  be  desirable  in  the  individual 
case.   The  dosage  is  small.  4  to  7  1-2  grains. 


IIVDE^X    TO    VOIvUMK^    XIV, 


Original  Communications. 
A  case  of  Incontinence  of 
Ui'ine  cured  by  Anterior 
and  Posterior  Colporaphy, 
by  A.Lapthorn  Smith,  B. 
A.,M.D.,  M.R.C.S.,  Eng- 
land      29 

Anaesthesia  and  Anaesthe- 
tics, by  C.C.  Hersman,M. 

D.,  Pittsburgh 31 

Abortion  of  Fevers,  by  T. 
Edwards  Converse,>M.  D.. 
Louisville,  Ky 34 

A  Plea  for  the  Earlier 
Diagnosis  of  Pulmonary 
Consumption,  by>Louis  F. 
High,  M.D.,Danville,Va.  168 

Advisability  of  Bone  Sutu- 
ring in  Treatment  of  Frac- 
tures, by  HughT.  Nelson, 
M.D., Charlottesville, Va.  227 

Accidents  from  Vaccination 
-  How  to  Prevent  Them, 
by  Isadore  Dyer,  Ph.B., 
M.  D.,  New  Orleans 312 

Appendicitis,  by  J.  H.  Van 
Eman,  M.  D.,  Kansas 
City.  Mo 330 

A  Tablets  Soliloquy,  by  A. 
L.  Russell,  M.  D.,  Mid- 
way, N.  Y :  340 

A  Study  in  Metaphysics 
Through  Drugs  and 
Dream  States,  by  F.  Sa- 
vai>  Pearce,  M.D.,  Phil- 
adelphia,   Pa 403 

Abscess  <>l  tin'  Lung  -with 
Reference  to  Its  Surgical 
Treatment,  by  E.  M. 
Dooley,  M-  !>■■  Buffalo, 
\.  y'..  Attending  Sur- 
geon Buffalo  Hospital, 
Sisters  of  <  Iharity,  and 
Knirrg.-nry  IIospital;Sur- 
geon  to  Erie  Railroad 
Company 514 

A  Study  of  the  Bacteriolo- 
gy of  Specific  Urethritis, 
by  Eugene  B.  Glenn,  M. 
D.,  Asheville,  N.   C 597 

An  Interesting  Case  of  Uri- 
nary Calculus,  by  M.  Bol- 
ton, M.  D.,  Rich  Square, 
N.C ' 608 

A  ii  mite  Poisoning — The 
Diagnosis  and  Treatment 
with  Report  of  a  Case,  by 
E  A.  Moye,  M.D., Green- 
ville, N.  C 624 

Annual  Oration— Practice 
of  Medicine,  by  Dr.  H.  S. 
Lott,  Salem,  N.  C 634 

Antiseptic  Midwifery,  by 
W.  W.  McKenzie,  M.  D., 
Salisbury,  N.  C ;-  640 

Asepsis  and  Antisepsis  in 
Surgery,  by  Dr.  Goode 
Cheatham,  Henderson, N. 

Bright's  Disease— Malaria, 


by  J.  A.  Reagan,  M.  D., 
Weaverville,  N.  C 47 

Chronic  Gastritis — Resting 
.a  Plea  for  more  Careful 
Consideration  in  the  Di- 
agnosis and  Treatment  of 
the  Same  by  the  General 
Practitioner,  by  Eugene 
R.  Morris,  M.  D.,  Ashe- 
ville, N.  C 49* 

Clinical  Experience  Show- 
ing the  Physiological  Ac- 
tion of  Mercauro  and  Ar- 
senauro,  by  W.  Ross 
Thompson,  New  York . . .  543 

Chronic  Gastro-Intestinal 
Catarrh,  bv  Dr.  Wm.  J. 
McAnally, '  High  Point, 
N.C 648 

Dystocia,  by  David  A. 
Stanton,  M.  D.,  High 
Point,  N.  C 196 

Drainage  in  Abdominal  Sur- 
gery, by  J.  W.  Long,  M. 
D.,  Salisbury,  N.  C 303 

Diagnosis  and  Treatment  of 
Tubercular  Peritonitis,by 
W.  L.  Robinson,  M.  D., 
Danville,  Va 305 

Drug  Habit,  by  Carl  V. 
Reynolds,  M.  D.,  Ashe- 
ville,  N.  C 314 

Differential  Diagnosis  of 
Diphtheria  from  Mem- 
branous Croup,  by  T.  T. 
Ferree,  M.  D.,  Asheboro, 
N.C 321 

Dressing  in  Minor  Surgery, 
by  Frank  H.  Hancock,M. 
D.,  Port  Norfolk,  Va 407 

Dress  as  a  Factor  in  the 
Causation  of  Catarrhal 
Diseases,  by  C.  P.  Amb- 
ler, M.  D.  Asheville.N.C  530 

Epilepsy;  State  Institutions 
for  Epileptics,  by  William 
Francis  Drewry,  M.  D., 
Petersburg,  Va 220 

Electricity  as  an  aid  to  the 
Physician  and  Surgeon, 
by-E.  B.  Goelet,  Saluda, 
N.C 600 

General  Infection  by  the 
Diplococcus  Intracellula- 
ris  in  an  Infant,  by  John 
Zahorsky,  M.  D 32n 

Gun-Shot  Wounds— With 
Report  of  a  Case  of  Gun- 
shot Wound  of  Stomach, 
by  Dr.  R.  E.  Zachary,  of 
Wilmington,  N.  C 610 

Hemorrhage  in  the  New- 
Born,  by  John  N.Upshur, 
M.D.,  Richmond,  Va 28 

Head  Injuries, by  J.Herbert 
Austin,  M.D..M.R.C.  S., 
England  29 


Hyperaemia  of  Conjunctiva, 
by  Edw.W.  Wright,M.  D., 
Brooklyn,  N.  Y 49 

Headache  —  Ocular  and 
Nasal,  by  Joseph  A. 
White,  A.  M.,  M.  D., 
Richmond,  Va 18b' 

Hemorrhoids,  by  H.  L.  Ap- 
pleton,M.D.,  Cedar  Bluff, 
Alabama 335 

Juvenile  Criminals,  by  T. 
F.  Costner,  M.  D.,  Lin- 
colnton,  N.  C 605 

Lithamiia,  by  John  N.  Up- 
shur, M.  D.,  Richmond, 
Va., 153 

Medical  Examining  Board 
— Especially  those  of  Vir- 
ginia and  North  Carolina, 
by  A.  S.  Priddy,  M.  D., 
Keysville,  Virginia 158 

Modern  Views  of  the  Nature 
and  Treatment  of  Pulmo- 
nary Tuberculosis,  by  H. 
B.  Weaver,  M.  D.,  Ashe- 
ville, N.  C 205 

Malignant  Tumors  of  the 
Breast,  by  Hunter  Mc- 
Guire,  M.  D. ,  LL.  D. ,  Rich- 
mond, Va 289 

Membranous  Croup  (so-call- 
ed) and  Diphtheria,  by  I. 
A.  McSwain,  M.D.,  Paris, 
Tennessee 322 

Medicine,  by  H.  Plummer, 
M.  D.,  Harrodsburg,  Ky.  329 

Meningitis,  by  Jno.  E.  S. 
Davidson,  M.  D.,  Lowes- 
ville,  N.C 623 

Otitis  Media  Chronica,  by 
J.  H.  McCassy,  M.  A.,  M. 
D.,  Dayton,  Ohio 45 

Ovaritis — Acute  and  Chron- 
ic, by  Dr.  L.  G.  Frazier, 
Youngsville,  N.  C 201 

Pernicious  Malarial  Fever 
Complicating  the  Puer- 
peral State — with  Report 
of  a  case,  by  F.  D.  Gray, 
M.D.,  Jersey  City,  N.  J..     37 

Pseudo-Membraneous  En- 
teritis, by  J.  M.  Fladger, 
M.  D.,  Summerton,  S.  C.  183 

Perforating  Ulcer  of  Duode- 
num— Operation — Recov- 
ery, by  Hugh  M.  Taylor, 
M.  D.,  Richmond,  Va. . . .  232 

Puerperal  Insanity,  by  J. 
A.  Reagan,  M.  D. ,  Weaver- 
ville, N.  C 308 

Pneumonia,  by  Dr.  T.  Cat- 
lett  Gibson,  Winton,N.C.  310 

Prophylaxis  of  Ophthalmia 
Neonatorium,  by  Harriet 
E.  Garrison,  M.D.,  Dixon, 
Illinois 323 

Peritonitis— Its   Pathology 


700 


THE  CHARLOTTE  MEDICAL  JOURNAL 


and  Treatment,  by  Hal. 
C.  Wyman,  M.  S.,  M.  D., 
Detroit,  Michigan 400 

Pernicious  Malarial  Fever, 
by  Dr.  R.  E.  Zachary, 
Wilmington,  N.  C 604 

Propagation  of  Typhoid 
Fever  and  Other  Infec- 
tious Diseases,  by  G.  A. 
Ramsaur,  China  Grove, 
N.  C 614 

Progress  in  Serum  Thera- 
py, by  Charles  S.  Man- 
gum,  M.  D.,  University 
of  North  Carolina 625 

President's  Address  at  the 
Annual  Meeting  of  N.  C. 
Medical  Society,  Asho- 
ville,  N.  C 644 

Questions  and  Observations 
on  Pernicious  Malaria,  or 
Hemorrhagic  Malaria, 
Hemorrnagic  Fever,  Yel- 
low Chills,  Yellow  Dis- 
ease, by  E.  T.  Dickinson, 
M.  D.,  Smithfield,  N.  C. .  324 

Report  of  a  Case  of  Appen- 
dicitis, Complicated  with 
Intestinal  Perforation- 
Recovery,  by  George  W. 
Long,  M.  D.  Graham, 
N.  C 185 

Report  of  Two  Successful 
Nephrectomies,  by  Geo. 
Ben  Johnston,  M.D. ,  Rich- 
mond, Va 212 

Report  of  Cases  of  Rupture 
of  Uterus  During  Preg- 
nancy, by  Francis  D.  Ken- 
dall, M.D.,Columbia,S.C.  240 

Report  of  Three  Cases,  by 
R.  H.  Hale,  M.  D.,  York 
Station,  Ala 326 

Rheumatism,  (a)  Etiology, 
(b)  Pathology,  by  A.  A. 
Young,  M.  D. ,  Newark, 
•N.  Y., 327 

Remarkable  Case,  by  F.  O. 
Hawley,  M.D.,  Charlotte, 
N.  C 336 

Report  of  Cases  Treated 
with  Paquin's  Anti-Tu- 
bercle Serum,  by  J.  P. 
Bridges,  M.  D.  Kahoka, 
Mo ' 342 

Relative  Immunity  to  Tu- 
berculosis, the  Altitude 
of  the  Ideal  Climate  and 
Intra-PulmoDary  Medica- 
tion, by  Charles  Denison, 
M.  D.,  Denver,  Colorado,  393 

Random  Sketches,  by  I.  W 
Costen,  M.D.,  Gatesville, 
N.  C 409 

Radical  Cure  of  Writer's 
Cramp  and  Other  Occu- 
pation Palsies,  by  S.  H. 
Monell,  M.  D.,  Brooklyn, 
N.  Y 410 

Report  of  a  Case  of  Enceph- 
aloid  Carcinoma  of  the 
Lung  with  Tuberculosis, 
by  Chas.  L.  Pearson,  M. 
D.,  Asheville,  N.  C 633 

Report  of  a  Case  of  Tumor 
of  the  Brain  Symtomati- 
cally  Relieved  by  an  Ex- 


ploratory Operation  upon 
the  Skull,  by  Wm.  B. 
Pritcbard,  M.D.,  and  Jno. 
A.  Wyeth,  M.  D.,  N.  Y. .  650 

Streptococcus  Infections, 
by  Frederick  C.  Taylor, 
M.D.,  Cleveland,  Ohio. . .     40 

Some  little  things  on  Drugs 
and  Diet,  by  Albert  Bern- 
heim,  A.M.,  M.D.,  Padu- 
cah,  Ky 42 

Syphilitic  Sore  Throat,  by 
John  S.  Moreman,  M.  D., 
Louisville,  Ky 48 

Simultaneous  Blood-wash- 
ing and  Blood-letting  in 
Uraemia,  by  A.  B.  Knowl- 
ton,M.  D., Columbia,  S.C.  178 

Some  Remarks  Upon  Co- 
ley's  Treatment  of  Malig- 
nant Growths,  by  Frank 
T.  Meriwether,  M.  D., 
Asheville,  N.  C 612 

The  Symptoms  and  Diagno- 
sis of  Simple  Glaucoma, 
by  Gaillard  S.  Tennent, 
M.D.,  Asheville,  N.  C...     23 

The  Problem  of  Life,  by 
Wm.  S.  Stoakley,  M.  D., 
Millboro  Springs,  Va 52 

Tubal  Pregnancy,  by  Vir- 
ginius  Harrison,  A.  M.. 
M.  D.,  Richmond,  Va. . . .   160 

Typhoid  Fever,  Diagnosis 
and  Treatment,  by  Rolfe 
E.  Hughes,  M.  D., 
Laurens,    S.   C 166 

The  Practical  Treatment 
of  Carbolic  Acid  Poison- 
ing, by  Dr.  Stephen 
Harnsberger,  Catlett,Va.  170 

The  Medical  Treatment  of 
Appendicitis,  or  Appen- 
dicitis Without  Opera- 
tion, by  Charles  B.  Mc- 
Anally,  Madison,  N.  C. . .   180 

Treatment  of  Urethral  Dis- 
charges, by  Jas.  M.  Par- 
rot, M.  D.,  Kinston,  N.  C.  217 

The  Eye  as  a  Causative 
Factor  in  Functional  Ner- 
vous Disorders,  by  W.  H. 
Wakefield,  M.  D.,  Char- 
lotte, N.  C 235 

Treatment  of  Uterine  Dis- 
eases in  Virgins,  by  Os- 
car S.  Brown,  M.D.,Wild- 
omar,  California ,  341 

Typhoid  Perforation — Op- 
eration— Recovery,  by 
Hugh  M.  Taylor,  M.  D.", 
Richmond,    Va 389 

The  Early  Diagnosis  and 
Treatment  of  Melancho- 
lia, by  E.  O.  Grossman,  M. 
D.,  Markleton.  Pa 397 

Typhoid  (Enteric)  Fever — 
In  the  Past  and  at  the 
Present  Time,  by  Frank- 
lin Staples,  M.  D.,  Wino- 
na, Minn -. 398 

The  Paliative  Treatment  of 
Hemorrhoids,  by  H.  G. 
Thomas,  B.  Sc,  M.  D., 
Kirkman,  Iowa 405 

The  Internal  Use  of  Car- 
bolic Acid,  by  E.  R.  Max- 


son,  M.  D.,A.  M.,LL.D., 
Syracuse,   New  York 493 

Tuberculosis  —  Prevention 
and  Treatment  with  Some 
Personal  Observations  on 
the  Use  of  Anti-Tuber- 
cle Serum,  by  A.  E.  Pow- 
ell, M.  D,  Marion,  Ind.. .  499 

Treatment  of  Eclampsia, 
by  Louis  D.  Barbot,  M.D., 
Charleston,  S.  C 504 

The  Principles  of  Conserv- 
ative Surgery,  by  Irving 
H.Haynes,  Ph.  B.,  M.  D., 
Professor  of  Anatomy  in 
the  Cornell  University 
Medical  College;  Visiting 
Surgeon  of  the  Harlem 
Hospital:  Member  of  the 
New  York  Academy  of 
Medicine,   etc 508 

The  Weak  Heart  in  Pneu- 
monia, by  F.  R.  Millard, 
M.  D.,  San  Diego,  Cal. . .  511 

Treatment  of  Whooping 
Cough,  by  Robert  C.  Ken- 
ner.  A.  M.,  M.  D.,  Louis- 
ville, Ky 513 

The  Philosophy  of  Mater- 
nal Impressions,  by  Wil- 
liam Mathews  Ogle,  Ph.  B., 
M.  S.,  M.  D.,  Delaware 
City,  Del 516 

The  Practical  Advantages 
of  Modern  Standardized 
Preparations,  by  F.  O. 
Hawley,  M.  D., Charlotte, 
N.  C 520 

The  Report  of  Three  Ab- 
dominal Sections  on  the 
Same  Woman  in  5  Years 
The  Second  Being  Caesar- 
ean  Section,  the  Mother 
and  Child  both  Living, 
by  S.  W.  Pryor,  M.  D. , 
Chester,  S.  C 523 

The  Care  of  the  Digestive 
Tract  in  Tuburcular  Pa- 
tients, by  H.  J.  Chap- 
man, M.  D.,  Asheville, 
N.  C 524 

The  Diagnosis  of  Appendi- 
citis, by  Frank  T.  Meri- 
wether, M.  D.,  U.  S.  A., 
Retired,   Asheville,  N.  C  537 

The  Preventive  and  Cura- 
tive Treatment  of  Ec- 
lampsia, by  S.  M.  Davega 
M.  D,  Chester,  S.  C 540 

The  Continued  Fevers  of 
North  Carolina,  by  Benj. 
K.  Hays,  M.  D.,  Oxford, 
N.    C 618 

The  Application  of  Forceps 
in  High  Presentations, by 
D.  A.  Staunton,  M.  D., 
High  Point,  N.  C 628 

Typhoid  Fever  as  Met  with 
in  Fayetteville  and  Sur- 
rouuding  Country,  by  J. 
F.  Highsmith,  M.  D., 
Fayetteville,  N.  C 630 

Use  of  Resinol,  by  Dr.  Hor- 
ace Wardner,  M.  D.,  La 
Porte,  Indiana 311 

Uterine  Tonics,  by  W.  F. 
Milroy,  M.  D.,  Omaha, 
Nebraska 396 


THE  CHARLOTTE  MEDICAL  JOURNAj 


701 


Uricacidsemia  as  the  Cause 
of  Hay  Fever  and  Asthma 
by  Dr.  John  Dunn,  Rich- 
mond,  Va 171 

What  Medicine  Owes  to 
Bacteriology,  by  E.  C. 
L,evy,  M.  D.,  Richmond, 
Va 191 

What  to  Do  with  Strangu- 
lated Hernia,  by  Clinton 
B.  Herrick,  M.  D.,  Troy, 
N.  Y 336 

Editorial 

Animal  Extracts 55 

Abdominal  Pains 56 

Abuse  of  Medical  Charity.     57 

Address  of  Welcome 241 

A  Good  Location  for  a  Phy- 
sician    351 

Antitoxin 416 

A  State  of  Things 418 

Army  Medical  Department  420 
Antitoxin  Patent  Trouble.  422 

Address  of  Welcome 657 

A  Journal  on  Tuberculosis.  674 
Annual  Report  of  the  Sec- 
retary of  the  North  Car- 
olina Board    of    Health, 
1898-1899 677 

Board  of  North  Carolina 
Medical  Examiners 673 

<  Ireasote  vs.  Carbolic  Acid.    53 
( ounter-Prescribing     and 

( Office-Dispensing, 345 

(  Yiminal  Abortions, 347 

( lommercialism  in  Medicine  419 
Cocaine  Habit 421 

Diagnosis  of  Typhoid  Fever  346 
Dr.  (!.  11.  Simmons  editor  of 
the  Journal  of  the  Amer- 
ican Medical  Association,  351 

Diabetes  Mellitus 552 

Dr.  Picot's  Presidential 
Address  at  Asheville 675 

Exercise  and  Physiologic 
Changes, 350 

Fluctuations  in  the  Disease 
Curve 59 

Heredity   or  Association— 

Which? 54 

High  Degrees  of  Myopia. .     57 

Is  there  Something  beyond 
Science? 54 

Inspection  of  the  Cornea  in 
Ophthalmia  Neonatorum    55 

Is  Sexual  Perversion  In- 
creasing?      59 

[eternal  Use  of  Carbolic 
Acid 348 

impetigo 349 

Is  ( remus  a  Form  of  Insanity  550 

"Knowledge     Comes      but 

Wisdom  Lingers" 561 

Keep  the  Baby  Warm 552 

Little  Things  in  Medicine.  350 
Life  Examinations  Again . .  415 

Modern  Surgery  and  the 
Peritoneum 58 


Mental  Expectancy 422 

Medical   Literature 551 

Meeting  of  the  State  Medi- 
cal Society  in  Asheville. .  657 
Minntes  of  the  Forty-Sixth 
Annual  Meeting  of  the 
Medical  Society  of  the 
State  of  North  Carolina.  657 
Maltine  with  Creosote 675 

Nasal  Treatment  as  a  cause 
of  Ear  Disease 58 

North  Carolina  Medical  So- 
ciety    345 

New  Laws  in  Regard  to 
Water  Supplies 676 

New  Journal 680 

Old  Age, 423 

Passing  of  the  Expectorant    57 
President  Cobb's  Address, .  243 
Pyoktanin,  or  C.  P.  Methy- 
lene in  Diseases  of  the  Eye  422 
Pseudo  Neurasthenia 550 

Response  to  the  Address  of 
Welcome 242 

Rectal  Irrigations  in  Dis- 
eases of  Children 417 

Recent  Dispensary  Legisla- 
tion      551 

Response  to  Address  of 
Welcome 658 

Report  of  Finance  Commit- 
tee    661 

Report  of  Obituary  Com- 
mittee   662 

Report  of  the  Board  of  Med- 
ical Examiners 663 

Report  of  Committee  on 
Legislation 665 

Sympathetic  Nervous  Sys- 
tem       59 

Southern  Medical  Journal,  351 

The  Successful  Consultant.     53 
Treatment  of  Scrabismus. .     56 
Tri-State  Medical  Associa- 
tion of  the  Carolinas  and 

Virginia 241 

Transactions  of  the  Asso- 
ciation    244 

The  Curette  in  Suppurative 

Otitis, 418 

The  Title  Doctor 419 

The  Morphine  Habit 549 

Union  of  Medical  Men, 421 

Why  has  Alcohol  been  so 
Popular  in  the  Treatment 
of  Disea&e  in  the  Past?. .  349 

Why  Is  It? 416 

Who  is  Responsible  ? 420 

Literary  Notes- 
Announcement  of  Import- 
ance to  every  Physician .     63 
American  Monthly  Review 
of  Reviews  for  April, 427 

Cosmopolitan  Magazine  . . .  354 

Lippincott's  Magazine  for 
January,  1899 63 

Lippincott's  Magazine  for 
March, 355 

Lippincott's   Magazine 556  | 


Lippincott's  Magazine  for 
April,  1899 427 

Review  of  Reviews 355 

Scribner's  Magazine, 4J.1 

Scribner's  Magazine 557 

The  American  Monthly  Re- 
view of   Reviews 62 

The  Cosmopolitan 62 

The   Living   Age    for    the 

New  Year 63 

The  Forum 63 

The  Forum  for  March,. . . .  354 
The  Living  Age  for  March,  355 

The  February  Forum 427 

The  Living  Age 427 

The    American      Monthly 

Review  of  Reviews 557 

The  Forum 557 

The  Living  Age \  557 

Miscellaneous 

Acute  Hemorrhagic  As- 
cites         64 

Appendicitis  and  Renal 
Colic 70 

Action  of  Mineral  Waters 
and  Drugs  on  the  Bile  . .     71 

A  Speedy  Method  of  Dila- 
ting the  Rigid  Os 76 

Appendicitis  During  Preg- 
nancy       78 

A  Good  Rule  for  the  Coun- 
ty Doctor 79 

Auto-intoxication  in  Epi- 
lepsy      81 

Automatic  Pressure  Re- 
gulator      85 

Allenburys  Throat  Pastilles  100 

Auto-intoxication  and  Al- 
buminuria      83 

A  Valuable  Opportune  Re- 
medy      98 

Allen  &  Hanbm-ys  Ltd., 
London 98 

Alleged  Heredity  of  Con- 
sumption   370 

A  Card 379 

A  Reason  and  a  Relief 382 

Antistreptococcic  Serum..  361 

Appendicitis  or  Epityphlitis  432 

Acute  Cervical  Adenitis  in 
Childhood 433 

A  House  Epidemic  of  Syph- 
ilis   445 

Artificial  Dilatation  of  the 
Mouth  of  the  Uterus  Dur- 
ing Labor 449 

A  Memorial  of  the  Late  Dr. 
Joseph  O'Dwyer 453 

A  Hypnotic  for  Confirmed 
Insomnia 464 

Aseptic  Midwifery, 465 

Animal  and  Vegetable  Fer- 
ment    481 

Acute  Cory za 483 

An  Excellent  Uric  Acid 
Solvent 484 

An  Emulsion 486 

A  Contribution  to  the  Credo 
Silver  Method  of  Wound 
Treatment 572 

A  Case  of  Salpingitis,  Ul- 
cerative Endometritis  and 
Proctitis,  Issuing  in  Ova- 
rian Abscess 576 

Action  of  Diphtheria  Toxin 


702 


THE  CHARLOTTE  MEDICAL  JOURNAL 


on  the  Nervous  System. .  578 
A  Case  of  Nasal  Vertigo, . .  582 
Accidents  in  Laparatomy. .   582 
A  Case  of  Puerperal  Fever 
Treated  with  Unguentum 

Crede 586 

A  Non-Depressing  Anal- 
gesic    588 

Acute  Gonorrheal  Menin- 
gitis,    594 

Allenbury's  Food 590 

Analytical   Test 696 

Bacteriological  Investiga- 
tions of  the  Etiology  of 
Ophthalmia  Neonatorum  359 

Bacterial  Origin  of  Biliary 
Calculi 369 

Board  of  Medical  Exam- 
iners    427 

Balsam  of  Peru  in  Scabies,  445 

Bacillus  of  Syphilis, 454 

Board  of  Medical  Examin- 
ers    557 

Boric-Acid  Intoxication . . .  570 

Cold  Feet 68 

Certain  Points   of  Interest 

in  Phthisis 71 

Christian-Science  Fanatics    73 
Creosote  in  Chronic  Consti- 
pation      74 

Christian  Scientists 85 

Control  of  Diphtheria 92 

Clinical  Experience  Show- 
ing the  Physiological  Ac- 
tion of  Mercauro  and  Ar- 

senauro 372 

Congratulate  You,  Gentle- 
men    378 

Creosote   in   Phthisis  Pul- 

monalis 380 

Clinical  Study  of   Nervous 

Dyspepsia. 431 

Curettement  in   Puerperal 

Fever 434 

Csesarean    Section    in    the 

Philippines 441 

Calomel  in  Typhoid  Fever,  442 
Cause  of  Bright 's  Disease, .  443 
Craze  of  the  Medical  Pro- 
fession to  Affix  Titles  to 

their  Names, 446 

Causes  of  Albuminuria. . . .  451 
Confederate  Veterans'  Re- 
union   455 

Commencement  Exercises.  458 
Caution  in  the  use   of  Pro- 
prietary Remedies 482 

Curious  Pocket  Piece 486 

Cystitis  and  Urine  Infection  574 

Chancre  of  the  Tonsil 578 

Cause  and  Cure  of  Hiccough  579 
Chlorin  Water   in  Typhoid 

Fever 690 

Cord.  Ol.  Morrhuae  Comp. .  684 

Diphtheria  as  it  Occurred 
in  two  Families   in  West 

Texas 64 

Diet  for  Surgical  cases. .. .     84 
Drainage    in    Suppurative 

Appendicitis 85 

Diet  in  Hyperacidity 82 

Dust  and  Disease 90 

Dismenorrhoea 357 

Death  of  R.   W.   Peacock, 

M.  D 357' 

Diet  in  Acne 365 


Don'ts  for  the  Treatment  of 

Pneumonia 360 

Diagnosis  between  Tuber- 
cular Syphilis  of  the 
Tongue  and  Syphilitic 

Glossitis, 369 

Drug  Addiction 370 

Dangers  of  Blisters, 386 

Diphtheria 432 

Diagnosis  of  Mammary  Ab- 
scess      440 

Demonstrating  the  Malari- 
al Parasite  in  tne  Blood .  460 
Drug  and  Food  Diseases. . .  462 

Diuretin 480 

Diagnosis  of  Scarlet  Fe- 
ver   567 

Defective  Elimination 684 

Electricity  as  an  Aid  to 
Diadermie  Medication. . .     72 

Ecthol, 100 

Education  of  the  Ophthal- 
mologist,    360 

Evidence  in  Favor  of  V  ac- 

cination 367 

Entrance  of  Air  into   the 

Uterus  during  Labor 437 

Edema  in  Bright's  Disease  478 

Epileptic  Insanity 483 

Enteralgia  of  Infants 564 

Enlargement  of  the  Lin- 
gual Tonsil    as     to    the 

Cause  of  Cough, 571 

Ergot  in  Hemorrhage 692 

Family  Prevalence  in  Re- 
lation'.to  Inheritance 67 

Fear  Neurosis 83 

Fads     and      Fallacies     of 

Rectal  Surgery 89 

Female  Neurosis 97 

Forced  Examination  of  the 

Larynx  in  Children 447 

Frequency  of  Rickets 449 

Further   Uses  of   Ureteral 

Catheter 474 

Familiar  Clinical  Picture..  580 
Forcible   Straining  of  the 
Spine  to  Correct  the   De- 
formity of  Pott's  Disease  694 

Growing  Pains 70 

Gonorrheal  Ophthalmia  of 

Infants 75 

Gastric  Hypersesthesia 92 

Galvanism  of  the  Neck  in 

Obstinate  Vomiting 92 

Grateful   Testimony 100 

Gray's  Glycerine  Tonic 479 

Grip  and  its  Allies 484 

Heredity   and  Disease 66 

Hypnotism  in  the  Treat- 
ment of  Alcoholics    66 

How  to  Avoid  Tuberculosis    73 
Hot  Water  in   the   Treat- 
ment of  Gonorrhea 93 

Hemorrhage  as  a  Sign   of 

Congenital  Syphilis 357 

High    Temperature    and 

Prognosis  of  Pneumonia,  368 
How  to  Avoid  Tuberculosis  369 

Hypertrichosis 372 

Heating  of  Milk   Used  for 

Feeding  Infants 433 

Hemorrhages  from  Ana- 
tomically Unaltered  Kid- 
neys,    441 

Holocain     in    Ophthalmic 


Surgery;  Its  Superiority 
over  Cocaine;  Its  Thera- 
peutic Value 468 

How  to  Limit  the  Over-pro- 
duction of  Defectives  and 
Criminals 558 

Infectivity  of  the  Urine  in 

Typhoid  Fever 67 

Influenza 102 

Intra-Nasal  Diseases 260 

Internal   Application   of 

Antiseptics 412 

Indications  for    Operation 

in  Renal  Tuberculosis. . .  428 
Indications    for    Hysterec- 
tomy    442 

Intussusception  in  Children  448 

In  Cholera  Infantum 462 

Infection    of    the    Mother 

from  the  Fetus 476 

Is  Eczema  a  Parasitic  Dis- 
ease    480 

Iodia 484 

Injections  of  Carbolic  Acid 
in  the  Treatment  of  Te- 
tanus,     575 

Insufficient  Menstruation. .  692 

Laryngeal  Hemorrhage. . .     84 

Longevity  in  Spain 86 

Lead  as  an  Abortifacient, .  255 
Liquor  Trade  in  America, .  435 
Locomotor    Ataxy     in    Its 

Modern  Aspect 436 

Limits  of  Usefulness  of  the 
X-Rays  for  the  Diagnosis 

of  Fractures, 452 

Lung  Gymnastics 460 

Lactation  During  Preg- 
nancy     570 

Local  Application 694 

Local  Anesthesia 690 

Moles 86 

Modern  Treatment  of  Hem- 
orrhoids,   365 

Massage  of  the  Abdomen . .  368 

Mai-Nutrition 380 

Mississippi   State    Medical 

Assoiation, 386 

Mechanism  of  the  Contrac- 
tion of  the  Peripheral 
Bloodvessels  Under  Hy- 
drotherapeutic  Treat- 
ment    431 

Microbian  Origin  of  Ec- 
lampsia    436 

Medical  Progress 443 

Movable  Kidney  with  Spe- 
cial Reference  to  its  In- 
fluence on    the   Nervous 

System 455 

Malaria  and  Mosquitoes. . .  460 
Massage  of  the  Abdomen . .  462 

Measurements  of  Pain, 471 

Maltine 478 

Malaria 557 

Malarial  Peripheral  Neu- 
ritis   565 

Medical  Society  of  the 
State  of  North  Carolina.   567 

Management  of  Labor, 569 

Medical   Journals  Consoli 

dated 571 

Management  of  Patients  be- 
fore and  afterLaparotomy  582 

Nervous  Dyspepsia 91 

Nasal  Bacteria  in  Health, .  356 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


703 


Nervous  Headache, 366 

North  Carolina  Medical  So- 
ciety   452 

Non-Medicinal  Treatment 
of  Habitual  Constipation.  458 

Nephritis  of  Malarial  Ori- 
gin    461 

North  Carolina  Hoard  of 
Health 577 

On  Ocular  Affections  in 
Puerperal  Eclampsia,...  349 

Operation  for  the  Effects  of 
Gastric  Ulcers 361 

Orthoform  as  a  Local  An- 
asethetic,  Analgestic  and 
Antiseptic 379 

Ocular  Troubles  in  Dia- 
betes   439 

Otitis 457 

Observations  on  the  Treat- 
ment of  Hay  Fever 460 

Operations  on  Syphilitics, .  47 

Ocular  Evidence  of  Hys 
teria 474 

Old  Age  and  Sleep 490 

Ocular  Tubercles  in  Dia- 
betes    484 

Ocular  Evidence  of  Hyste- 
ria   682 

Protective    action    of    the 

Liver  against  Microbes. .  68 
Programme  of  the  first  An- 
nual Session  of  the  Tri- 
State  Medical  Society  of 
the  Carolinas  and  Virgin- 
ia, to  be  held  at  Char- 
lotte, N.  C 69 

Palatable  Throat  Pastilles    88 

Phillips'   Emulsion 100 

Pruritis  Ani 379 

Progress    and    Growth    of 

Our  Oew  Orleans  Branch  387 
Pain  in  the  Fallopian  Tubes  428 

Paris  Exposition 439 

Puerperal  Eclampsia 441 

Points  in  the  Arsenical 
Caustic  Treatment  of  Cu- 
taneous Cancers 450 

Protective    Action  of    the 

Liver  against  Microbes. .  453 
Preparation   Needed  for  a 

Case  of  Labor 454 

Proposed  Change  in  New 
York  State  Medical  Ex- 
aminations   459 

Pathology  of    Diphtherial 

Paralysis 461 

Premature  Baldness, 466 

Picric  Acid   in  Eczema 546 

Postpartum  Douche 574 

Period  of  Isolation  of  School 
Children   for  Contagious 

Diseases, 575 

Picric  Acid  Dressing  of  the 

Umbilical  Cord 578 

Post-Partum   Management 

of  Uterine  Displacements  584 
Prevention  of  Hay  Fever. .  690 


Remarks  on  Exophthalmic 
Goitre 81 

Report  of  the  War  Investi- 
gating Committee 358 

Report  of  Treatment  of 
Secondary  Anemias  with 
Cases 363 

Relation  of  Pelvic  Disorder 
to  Mental  Disease 371 

Rebellious  Constipation 
Cured  by  Massage  of  the 
Gall-Bladder 371 

Reaction  of  Syphilitic  Blood 
to  Mercury 441 

Ringworm  of  the  Scalp 445 

Report  of  78  Cases  of  Pul- 
monary Tuberculosis 
Treated  with  Watery  Ex- 
tract of  Tubercle  Bacilli,  476 

Rheumatic    Tonsillitis 566 

Resinol  as  an  Application 
to  Septic  Wounds, 593 


Quinin  in  Malarial  Fever. 
Quinine  Haemoglobinuria, . 
Quinine  in  Malaria 


77 
258 
570 

Rheumatism  in  Children..     65 
Rontgen   on    the    Rontgen 

I  lays 65 

Removal  Notice 453 


Soil    as   a    Factor    in    the 

Spread  of  Disease. 67 

Syphilis  in  the  Third  Gene- 
ration       75 

Spinal  Meningitis  Com- 
plicating Measles 85 

Subcutaneous   Injection  of 

Iron 93 

Seaboard  Medical  Associa- 
tion    258 

Sanmetto  in -General  Naso- 
pharyngeal and  Bronchial 

Catarrh,  etc.,  etc 258 

Surgery  of  Perforation  in 

Typhoid, 371 

Salt  and  Bright's  Disease.  412 
Systematic  Exercise  in  the 
Treatment  of  Locomotor 

Ataxia 429 

Skin  Eruptions  Caused  by 

Antipyrin 430 

Somatose  in  Syphilis 432 

Senile  Changes  in  the  Fal- 
lopian Tubes 437 

Serum  Diagnosis  of  Diph- 
theria   438 

Some  Conditions  Necessary 
for  the  Spread  of  Tuber- 
culosis    439 

Syphilis  in  Relation  to  Ob- 
stetrics   •  •  456 

Sleep  in  Treatment  of  Dis- 
ease   458 

Syphilis  of  the  Brain   and 

Spinal  Cord 463 

Sanmetto  in  Imitations 478 

Syphilis  of  the  Respiratory 

Passages :   565 

Skin  Diseases 5°° 

Sanmetto  in  all  Forms  of 
Vesical  Disease 681, 


The  Liability  to  Cramp  af- 
ter Sleep 

Tubercular  Peritonitis  in 
Children •■•• 

The  Old-Fashioned  Saddle 
Bags • 

The  Operative  Treatment 
of  Cancer  of  the  Breast. . 

Tuberculosis  and  the  Milk 
Supply 

The  Diagnosis  of  Nephritis 
without  Albuminuria 

Toxi-Alimentary  Dyspnoea 

The  Mortality  of  Cancer.. 


fiS 


73 


74 


78 


The  Value  of  Casts  in  the 
Prognosis  of  Albuminu- 
ria       80 

The  Relative  Importance 
of  Flies  and  the  Water 
Supply  in  Spreading  Dis- 
ease      88 

The  Effects  Produced  by 
Anaesthetics  upon  the 
Kidneys  and  Circulation .     89 

The  Cure  of  Diabetes 90 

The  Contagiousness  of  Tu- 
berculosis      M 

Typhoid  Fever  and  Insanity     91 
Treatment  of  Gout  by  Al- 
kalies     256 

The  Rational  Treatment  of 

Grippe 260 

Treatment  of  LaGrippe  or 

Epidemic  Influenza, 262 

To  the  Members  of  the  Med- 
ical   Society   of    North 

Carolina, 262 

Treatment    of    Pulmonary 

Phthisis, 264 

Tubercular      Cystitis      in 

Children 362 

Tuberculous  Ulcers  of  the 

Rectum 363 

The  Western  Ophthalmo- 
logic   and    Oto-Laryngo- 

logic  Association 363 

The     Male     and      Female 

Skull 363 

Tri-State  Medical  Associa- 
tion of  Mississippi,   Ar- 
kansas and  Tennessee. . .  386 
Treatment  of  Eclampsia . . .  412 
Traumatisms  of   the   Ure- 
thra   428 

Treatment  of  Exophthal- 
mic Goitre 434 

Treatment  of  Pneumonia  in 

Children 437 

Treatment  of  Hjematemesis  440 
Treatment  of  Chronic  Mor- 
phinism    443 

Tuberculosis  of  the  Nose..  445 
Treatment  of  Incontinence 
of  Urine  in  Children  with 

Rhus  Aromatica 446 

Treatment  of  Hip  Disease .   449 
Tumors  of    the   Kidney  in 

Children ,.  •  ■  450 

Thrombosis  and  Embolism 

After  Childbirth 451 

Typhoid  Fever  in  the  Uni- 
ted States 452 

The  Significance  of  Mouth- 
Breathing,  455 

Tubercular  Tonsils  and  Ad- 
enoids as  the  Etiology  of 
Enlarged  Cervical  Lymph 

Glands 456 

Toxa?mic  Factor  in  Diabe- 
tes Mellitus 459 

Treatment  of   Harelip   and 

Cleft  Palate.        464 

Treatment  of  Chronic  Bron- 
chitis,   ;  •  • •  466 

Tri-State  Medical  Society 
of  Iowa,  Illinois  and  Mis- 


souri  

Toxines  in  Dermatology, . .  474 
The      Circulation    of     the 

Blood  while  Sick 546 

Treatment  of   Fibroids    of 

the  Uterus 546 

Treatment  of  Asthma o»» 


THE  CHARLOTTE   MEDICAL  JOURNAL. 


Tuberculosis  in  the  Colored 

Race 579 

Toxic    Effects    of    Boracic 

Acid 580 

Tonsillitis   with   Albumin- 
uria  586 

Tongaline   and    Quinine 

Tabiets, 588 

The  American  Electro  The- 
rapeutic Association ....  654 

To>  icodendron  Poison 694 

Treatment  of  Dysentery . . .  696 
Treatment  of  Gall-stones. .  682 

Terraline 681 

Treatment  of  Carbuncles. .  686 

Utero-Intestinal  Fistula. . .     77 
Use  of  Morphine  in  Cardiac 

Disease    355 

Uterine  Cough 584 


Use  of  Credo's  Silver  Oint- 
ment in  Puerperal  Sepsis  370 

Ultimate  Results  of  Mech- 
anical and  Operative 
Treatment  in  Hip  Dis- 
ease     411 

Use  of  Quinine  in  Topical 
Leucorrhea 451 

Urine  Examinations  in  In- 
sanity   457 

Vaginal  Bacteria  in  Preg- 
nancy       72 

Vitality  of  the  Diphtheria 
Bacillus  93 

Vomiting  of  Pregnancy...     97 

Vague  and  Indefinite  Pains 
due  to  Latent  Rheumatic 
Conditions 98 

Vapor  Massage 486 


Vaccination 429 

Vitality  of  Epithelial  Cells 
and  the  Etiology  of  Can- 
cer    472 

Vin  Mariani  in  Exhaustion  486 

Vin  Mariani, 582 

Vomiting  of  Pregnancy, . . .  590 
Veratrum  Viride  in  Pneu- 
monia      590 

What  to  Inject  in  Gonorrhea  260 
What  Shall  the  Physician 
Say  to  a  Gonorrheal  Pa- 
tient   who   Desires    to 

Marry, 357 

Writers'  Cramp 571 

X-Rays  and  Lupus 89 


book:    rejviej,ws. 


A  Text  Book  of  Obstetrics. 
By  Barton  Cook  Hirst,  M. 
D.,  Philadelphia 60 

A  Primer  of  Psychology 
and  Mental  Disease,  for 
Use  in  Training  Schools 
for  attendants  and  Nurses 
and  in  Medical  classes. 
By  OB.  Burr.M.D., Flint, 
Mich 61 

A  Compend  on  Obstetrics. 
By  Henry  G.  Landis,  A. 
M.,M.D.,  Philadelphia..     61 

A  Pilgrimage;  or  the  Sun- 
shine and  Shadow  of  the 
Physician.  By  Wm.Lane 
Lowder,  B.S.,M.D 62 

American  Year-Boo k  of 
Medicine  and  Surgery,  by 
George  M.  Gould,  M.  D.,  351 

An  American  Text- Book  of 
Diseases  of  the  Eye,  Ear, 
ISose  and  Throat,  edited 
by  G.  E.  DeSchweinitz,  A. 
M.,  M.  D.,  Philadelphia,  352 

An  Experimental  Research 
into  Surgical  Shock,  by 
Geo.  W.  Crile,  A.  M.,  M. 
D.,  Ph.D., 352 

A  Treatise  on  Fractures 
and  Dislocations.  For 
Practitioners  and  S  t  u  - 
dents,  by  Lewis  A.  Stim- 
son,  B.  A.,  M.  D.,  New 
York 353 

A  Text-Book  of  Mechano- 
Therapy,by  Axel  V.  Graf- 
strom,  B.  S.  C,  M.  D....  354 

A  Compend  of  Human  Phy- 
siology, by  Albert  P. 
Brubaker,  A.  M.,  M.  D.,    354 

Annual  and  Analytical  Cy- 
clopaedia of  Practical 
Medicine,  by  Charles  E. 
de  M.  Sajous,  M.D.  Vol- 
ume 1  and  2 423 

A  Text- Book  on  Practical 
Obstetrics,  by  Egbert  H. 
Grandin,  M.  D 425 

An  Essay  on  the  Nature  and 
Consequences  of  Anoma- 
lies of  Refraction,  by  F. 
C.  Donders,  M.  D.,  Phil- 
adelphia   554 


A  Pratical  Hand-Book  on 
the  Muscular  Anomalies 
of  the  Eye,  by  Howard  H. 
Hansell,  A.  M.,  M.  D. . . .  555 

Coca  and  its  Therapeutic 
Application.  By  Angelo 
Mariani,   New  York 62 

Chemistry:  General,  Medi- 
cal and  Pharmaceutical, 
including  the  Chemistry 
of  the  TJ.  S.  Pharmaco- 
poeia, by  John  Attfield, 
F.  R.  6....-— 552 

Diseases  of  the  Skin.  By 
Malcolm  Morris,  M.  D., 
Philadelphia 62 

Diseases  and  Their  Cure. 
By  A.H.  Crondace,  M.D., 
Quincy,  111 62 

Diseases  of  the  Eye.  A 
Handbook  of  Ophthalmic 
Practice  for  Students  and 
Practitioners,  by  G.  E. 
DeSchweinitz,A.M.,M.D.  354 

Diseases  of  the  Ear,  Nose 
and  Throat,  and  their  Ac- 
cessory Cavities,  by  Seth 
Scott  Bishop,  M.  D 426 

David  Harum,  by  Edward 
Noyes  Westcott,  New 
York 555 


Wilson,   A.  M. 


by    J.    C. 
M.  D.... 


354 


Human  Anatomy.  A  com- 
plete Systematic  Treatise 
by  various  authors,  inclu- 
ding a  Special  Section  on 
Surgery  and  Topographi- 
cal Anatomy.  Edited  by 
Henry  Morris,  M.A.,  and 
M.  B.,  London 60 

Medical  News  Pocket  For- 
mulary for  1899.  By  E. 
Quin  Thornton,  M.  D., 
Philadelphia 61 

Maisch's  Materia  Medica,  by 
John  M.  Maisch,  Phar.D.554 

Nervous  and   Mental    Dis- 


by     Archibald 

Church,  M.  D 425 

Nursing:  Its  Principles  and 
Practice,  for  Hospital  and 
Private  Use,  by  Isabel 
Adams  Hampton, 426 

Progressive  Medicine  —  A 
Quarterly  Digest  of  Ad- 
vances, Discoveries,  and 
Improvements  in  the  Med- 
ical and  Surgical  Sciences. 
Edited  by  Hobart  Amory 
Hare,  M.  D 424 

Pathology  and  Treatment 
of  Sexual  Impotence,  by 
Victor  G.  Vecki,  M.  D.. .  425 

Practical  Materia  Medica 
for  Nurses  with  an  Ap- 
pendix, by  Emily  A.  M. 
Strong 555 

Relinoscopy  (or  Shadow 
List)  in  the  Determina- 
tion of  Refraction  at  one 
meter  Distance,  with 
Phone  Mirror,  by  James 
Thorington,  M.  D 555 

Saunders  Medical  Formu- 
lary with  an  Appendix. 
By  William  M.  Powell, 
M.  D 93 

Self-Examination  for  Medi- 
cal Students.  P.  Blakis- 
ton's  Son  &  Co.,  Phila- 
delphia,    353 

Seventh  Biennial  Report  of 
the  North  Carolina  Board 
of  Health.     1897-1898. ...   426 

Saunders'  Medical  Hand- 
Atlases,  by  Prof.  Dr.  O. 
Hoab,  of  Zurich 555 

Surgical  Nursing,  by  Ber- 
tha M.  Voswinkel 556 

The  Sexual  Instinct,  its  use 
and  Dangers  as  Affecting 
Heredity  and  Morals.  By 
James  Foster  Scott,B.A., 
M.D.,C.M 61 

The  Practice  of  Obstetrics, 
by  American  Authors. 
Edited  by  Charles  Jewett, 
M.  D.,  Brooklyn,  N.  Y..  353 


THE  CHARLOTTE  MEDICAL  JOURNAL. 


705 


The  Phonendoscope  and  its 
Pr  ac  t  ic  a  1  Application , 
with  thirty-seven  illus- 
trations, by  Felix  Reg- 
nault,  M.D 

The  Dawn  of  Reason  or 
Mental  Traits  in  the  Low- 
er Animals,  by  James 
Weir.  M.  D 

The  Ready  Reference  Hand- 
book of  Diseases  of  the 
Skin,  by  Geo.  Thos.  Jack- 
son. M.D 424 


61 


:r,4 


Transactions  of  the  New 
Hampshire  Medical  So- 
ciety    425 

Transactions  of  the  Michi- 
gan State  Medical  Society 
for  the  Year  1898 426 

The  International  Medical 
Annual,  1899.  A  Work 
of  Reference  for  Medi- 
cal Practitioners,  E.  B. 
Treat  &  Co..  New  York.  553 

The  Anatomy  of  the  Central 
Nervous  System  in  Gen- 


eral, by  Prof.  Ludwig 
Edinger 553 

The  Principles  of  Bacteri- 
ology, by  A.  C.  Abbott,  M. 
D 554 

Transactions  of  The  Ameri- 
can Pediatric  Society,  by 
Floyd  M.  Cransdall.  M.  D  556 

Transactions  of  the  Ameri- 
can Surgical  Association, 
by  De  Forest  Willard,  A. 
M.,  M.  D.,  Phi 556 


Medical  Schools  of  the  United  States. 

Regular,  128;  homeopathic,  20 ;  eclectic, 
8;   physio-medical,  1;   total,  157. 

Session  open  about  1  O  and  closes  about 
1  My. 

Matriculates,  i8o7-'8,  12,905;  graduates, 
i8q7-'8,  2,720;  matriculates,  i8q8-'9,  7,- 
911.      (These  items  are  partial  results  only. ,) 

Fees:  average  matriculation,  $5.17; 
average  course,  $74.74;  average  additional 
expenses,  $29.19;  total  $109.10. 

Faculty:  professors,  2,506;  lecturers. 
516;  others,  1,907;  total,  4,929.  (Partial 
results  only.) 

There  are  no  uniform  admission  and 
graduation     requirements   for    the    United 


States.  Of  the  55  political  subdivisions  in 
the  United  States  the  relations  of  four  are 
so  recent  that  present  conditions  are  un- 
known and  no  reply  to  statements  based  on 
former  conditions  has  been  received.  Of 
the  remaining  51  political  subdivisions  the 
following  have  no  medical  schools:  viz., 
Alaska,  Arizona,  Delaware,  Florida,  Idaho, 
Indian  territory,  Mississippi,  Montana, 
Nevada,  New  Jersey,  New  Mexico,  North 
Dakota,  Oklahoma,  Rhode  Island  South 
Dakota,  Utah,  Washington,  West  Virginia 
U'G   Wyoming. 

Magnesia  sulphate,  Medical  Summary 
says,  is  a  better  antidote  to  carbolic  acid 
than  vinegar. 


The  Dow  Portable  Electric  Assistant. 


Physicians',  Surgeons'  and  ftentists'  Outfit  Complete. 

The  Dow  Portable-  Electric  Assistant  is  the 
best  portable  electric  outfit  ever  put  on  the  mar- 
ket and  has  been  adopted  by  the  United  States 
Army  and  Navy.  It  illuminates,  as  no  other 
apparatus  can,  the  mouth,  throat,  ear  and  nasal 
passages:  and  for  gynecological  observations  it 
s  unrivaled. 

Gentlemen:  Chicago,  March  22,  1897. 

The  portable  battery,  "Dow's  Physician's 
Electric  Assistant,"  which  I  got  from  you  has 
been  in  constant  use  for  over  three  months.  I 
have  found  it  fully  up  to  your  representations, 
and  fully  satisfactory.  I  have  recommended  it 
to  several  professional  friends,  and  will  take 
pleasure  in  continuing  to  do  so. 
Yours  truly, 
HUGH  BLAKE  WILLIAMS,  M.  D. 

Gentlemen:  Braintree,  March  1,  L398. 

I  believe  it  to  be  the  most  complete,  compact 
and  unique  invention  yet  devised  for  application 
in  awide  range  of  cases,  destined  to  find  a  place 
in  the  office  of  physicians  and  surgeons  alive  to 
the  advancement  of  Scientific  medicane  and 
modern   surgery.  Respectfully  yours, 

HENRY   L.    DEARING,   M.    D., 


Send  for  circiular  and  price  list. 

The  Dow  Portable  Electric  Assistant  Co. 

218  Tremont  St.,  Boston,  Mass.,  U.  S.  A. 


706 


THE  CHARLOTTE  MEDICAL  .JOURNAL. 


Sewer-gas  Poisoning. 

According  to  "Treatment"  cases  of  sewer 
gas  poisoning  can  be  divided,  as  is  well- 
known,  into  two  categories — those  of  sud- 
den onset  due  to  asphpxia  from  sulphuret- 
ted hydrogen  or  deficiency  of  oxygen,  or 
from  both  of  these  causes,  and  those  cases 
of  illness  which,  in  all  probability,  are  due 
to  infection  by  micro-organisms  of  various 
kinds  in  sewage. 

Work  in  sewers  is  not  such  an  unhealthy 
occupation  as  might  at  first  sight  be  sup- 
posed, for  the  air  in  sewers  where  the  sew- 
age is  in  movement  is  not  so  very  impure, 
and  one  knows  clinically  that  it  is  rare  for 
sewer  men — once  they  have  got  used  to  the 
work — to  come  under  medical  observation 
for  any  illness  which  might  in  any  way  be 
attributed  to  the  nature  of  their  employ- 
ment. But  if  sew  age  be  st^gnauX  and,  de- 
composing there>is-an  enormous  production 
of  micro-ovgahisms,  which  may  infect  the 
neighboring  atmosphere  and  be  a  fruitful 
cause  of  disease^ 

Dr.  F.  H.  E-dg^w'ofth  describes  (Bristol 
Med.  Chir.  Jour'.,'  March, '  189*8,)  'Several 
cases  in  men  who,  although  accustomed  to 
work  in  sewers,  were  taken  ill  whilst  ex- 
cavating ground  which  was  soaked  with 
decomposing  sewage  and  gave  off  a  most 
offensive  smell.  Illness  due  to  sewer-gas 
poisoning  may  be  of  various  kinds  and 
severity  ;  general  ill-health  without  any  ob- 
vious lesion,  feverish  attacks,  tonsilitis, 
gastro-intestinal  affections,  and  nephritis 
are  no  doubt  the  commonest.  Mr.  W. 
Gifford  Nash,  F.R.C.S.,  narrates  (British 
Medical  Journal,  January  28,  1899,)  four 
series  of  cases  of  sewer-gas  poisoning  in 
which  streptococci  and  staphylococci  de- 
veloped a  variety  of  symptoms  in  the  per- 
sons attacked. 


has  been  substantiated.  With  in  the  last 
three  months  Dr.  C.  Liebreich,  director  of 
the  Royal  Pharmaceutical  Institute  in  Berlin, 
said,  at  the  instigation  of  Prof.  Virchow  he 
had  carried  on  a  long  series  of  experiments 
with  boracic  acid  and  had  convinced  him- 
self that  it  was  admirably  adapted  as  a  food 
preservative,  and  in  the  quantities  neces- 
sary for  that  purpose  it  was  quite  harmless 
He  added  that  neither  in  actual  practice 
nor  according  to  authoritative  literature 
has  a  case  been  known,  so  far  as  he  was 
aware,  in  which  food  prepared  or  preserved 
with  borax  or  boracic  acid  had  exercised  a 
deleterious  effect  on  the  health  of  any  in- 
dividual. 


Boracic  Acid  in  tne  Preservation  of  Milk. 

Boracic  acid  is  claimed  to  de  an  excellent 
and  harmless  preservative  of  milk,  and  in 
the  quantities  necessary  to  preservation 
It.  e.,  according  to  the  length  of  time  for 
which  it  is  desired  to  preserve  the  milk)  its 
presence  cannot  be  detected,  either  by  the 
sense  of  taste  or  smell.  Five  grains  to  the 
gallon  will  preserve  the  milk  from  one  to 
three  days,  according  to  the  care  exercised 
in  the  cleaning  of  the  containing  vessels, 
the  temrerature,  &.  It  is  somewhat  surpris- 
ing that  this  innocuous  substance  should 
have  acquired  an  evil  reputation  on  the 
public  mind.  It  is  stated  on  good  authority 
that  although  vague  statements  about  it  of 
an  injurious  nature  have  from  time  to  time 
been  spread  by  its  opponents,  not  a  single 
instance  of  injury  to  health  by  boracic  acid 


Sanmetto  in  Cystic  and  Urethral  Irritation 
and  Inflammation,  and  in  Chronic  Pro- 
static   Hyprotrophy    and   Atrophy. 

,  I  have  for  years  prescribed,  as  well  as 
taken  myself,  Sanmetto,  and  have  found  it 
aimost -uniqersallp  satisfactory  in  cystic  and 
urethral  irritation  and  inflammation.  I 
have  also  used  it  with  marked  results  in 
chronic  prostatic  hypertrophy,  and  even  in 
atrophy  of  the  prostate  I  have  found  it  use- 
ful. 

W.  A.  Foster,  M.  D. 
Kansas  City,  Mo. 

Alcohol  and  the  Russian  Death  Rate. 

An  official  inquiry  into  the  comparative- 
ly large  increase  in  the  Tartar  population 
in  the  city  and  government  of  Kazan  has, 
according  to  the  "Kamsko  Volshki  Krai," 
brought  out  some  remarkable  facts  as  to  the 
effect  of  alcoholic  indulgence  on  the  death- 
rate.  The  Kazan  Tartars,  numbering 
about  640,000,  have  a  rate  of  mortality  of 
only  21  in  1,000,  while  the  mortality  among 
the  Russians  is  40  in  1. 000.  The  general 
conditions  among  orthodox  Russians  and 
Mohammedan  Tartars  are  practically  the 
same,  except  in  so  far  as  personal  habits 
are  concerned.  The  medical  investigation 
leaves  no  room  for  doubt  that  the  lesser 
mortality  of  the  Mohammedan  Tartars  is 
directly  due  to  their  abstinence  from  spirit- 
uous liquors,  in  which  the  Russians  indulge 
freely. 

Sanmetto  in  Genito-Urinary  Diseases  and 
as  a  Re-builder. 

I  have  used  Sanmetto  in  a  great  number 
of  genito-urinary  diseases,  also  as  a  re- 
builder  of  strength  throughout  the  genito- 
urinary tract,  always  with  the  happiest  re- 
sults. This  is  the  first  and  only  testimonial 
I  have  ever  given  in  twenty  years  active 
practice  of  medicine. 

C.   H.   Eckert,  M.  D. 

Marion,  Ind.