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Charlotte Medical Journal. 

A MONTHLY JOURNAL OF MEDICINE AND SURGERY. 
;:SiiS'.!- Oiarlotte, N. C, July, J906. pe."*'™um 



7 able of Contents, fage 5S 



DESICCATED THYROIDS U. S. P. 

Each grain represents approximately five grains of raw gland. 




THYROID TABLETS 

Each tablet corxtains tvvo. gridiiis of p9wdered Thyroids U. S. P. 



SUPRARENALIN SOLUTION 

A stable preparation of the active principle of the suprarenal glands. 



SUPRARENALIN OINTMENT 

Permanent, and especially adapted to eye, ear, nose and throat work. 



Armour & Company, Chicago 






for Liquor and 

Drug Using 

A scientific remedy -which has been 
skilfully and successfully administered by 
medical specialists for the past 25 years. 
AT THE FOLLOWING KEELEY INSTITUTES: 



Birmmgnaui, A a. 
IIoi Svrini?», Ark 
S&a S"ncisoo, Cal., 

!li»0 Market St. 
West H»Teri, Conn. 



W»«nlJi^'ton,D. C, 

31! N.Capitol St. 
Dwipht, 111. 
Marion. Ind. 
Flainfteld, luc^. 
Dea MoIdcs, la. 



Portland, Me. 
Lexlngtcu, Mass. 
St. LouIb, Mo., 

2803 Locxist St. 
North Ccnwaj, N. H. 
Bufftio, N. Y. 



Whit* Plains, N. Y. Harrisburg, P*. 

Columbua, O., Pittsburc, P»„ 

1087N.DennisonATe. ■1246 ritthATe. 

PhiladelpUio.Pa. ProTidonce, R. I. 

812 N. Broad, St 3,;^ ^ake City. Utah 



THE PINKS, BlacK Mountain* NortK Carolina. 

A private Sanatorium specially equipped for the treatment of early 
Tuberuclosis. 

Besides the main building also have tents and cottages specially construct- 
ed to insure thorough and constant ventilation. Altitude 2,800 feet. Situ- 
ated in pine grove of twenty acres. 

. . . .Rates on application. 



College of Pfiysiciaix^ and Su^ 

3Sth Annua! Session Begins October 1st. 

New building; modern equipment; unsurpassed laboratories; large and 
independent Lying-in Asylum for practical Obstetrics; department for pre- 
vention of hydrophobia and many hospitals for clinical work present to the 
medical student every advantage. For catalogue and other information 
apply to 

CHARLES F. BEVAN, M. D., DEAN, 

Corner Calvert and Saratoga Sts., - - - _ _ Baltimore, Md. 

TENNESSEE 

CHATTANOOGA MEDICAL COLLEGE 

Medical Deparf»iexit o! Grant University, Session oi 1906-1907. 
Eighteenth Annual Seysion begins in October. 



New bnlldlnirs. Lmtp pat.- 



Kv»r7 fnr.;!itr. VvW reaoli'm 



J. R. RATHAIELL, M. D., Deao 



rps. Laboratories with latest equipment and 

T^'lal. Minimum livlnjr expenses. Reqiiire- 

jtituatlou is a member. Amost desirable 

vim.-ite, faTorablc to effective vitudy. City 

ilit.-iry Parle, National Cemetery, anfl'miles 

■■'> continent. Populalioi) (including 



Ctiattanooga, Tennessee. 



The Charlotte Medical Journal. 



Vol. XXIX CHARLOTTE, N. C, JUNE 1906. No. 1 

The Annual Oration: Nineteenth Century vvas also busv teacliinj? and elucidalino- the 

Progress and Twentieth Century great medical facts, which jjained for him 

Problems.* the title "Father of Medicine." When the 

By Dr. Jas. M. Parrott, Kinston, N. C. echoes of the guns of Marengo thundering 

This is an age of progress. Perhaps dur- Napoleon's victory rose over the mountains 

ing no period of historv has man's perma- ^^ Northern Italy and died away on the 

nent improvement been so marked as during «^""^>' ^^"/^ of Southern Prance the suffer- 

the last decade. This development does "ig world heard with gladness the annunc- 

not belong exclusivelv to anv countrv or ^tions of Bichat in his Researches on Life 

vocation. ^ It is the one theme which is ^''^ ^f^^^'' , ^r Rush and three other 

common to the various pursuits of practi- compatriots left their busy work of curing 

callv all mankind. Standing bv the black- ^^,^ «'^^ ^o participate m the deliberations 



of our first colonial con 



gress. 



When the revolutions incident to the 



smith's door you see it in the flaming forge, 

you hear it in the bellows' roar; it is the ^ ,,■ , ^ r.i j • r ^^ 

song sung by the shrill, quick whistleof the establishmentof the second empire o Prance 

locomotive rushing through our rugged were bathing the streets of Pans with blood, 



mountain gorges, bearing the rich harvest 
from the fertile plains of the east to distant 



the immediate predecessors of Pasteur were 
laying the foundations of modern medicine, 



lands; you hear it in the harsh cry of the and as the star of Napoleon the Third went 



factory whistle, calling the laborers to work; 



down to its gory grave, the apostle of the 



it is the note of harmony which runs Present scientific school of medicine rose m 
through every song of the farmer, and finds resplendent glory. With the burden of the 
a responsive svmphony in the answering f''''^^^ of his people resting heavily on his 



call of every profession 



heart, and while the agonizing cries of 



The march of the nations is toward the Parisian neighbors were yet ringing in his 

permanent upbuilding of the human race, ears, Pasteur indicated the means by which 

1 rejoice in the spirit of progress of the the sick of future ages could be relieved 

twentieth centurv. It heralds the breaking ^"^ Pomted out the way wherein we could 

of another and a brighter dav. I am not f^^^^ '"^^ "^-^7 ^ """ ^^f ^^^"""^ *-^^ ^''■^^^ 

one of those who mourn because they were transcendent blessings of this civilization 

not born yesterdav. I regret that the period ^J^^"^ historical illustrations can be para lel- 

of my existence cannot extend over into, ^^ "^ ^^^^-^ ^•"^- .'^^ ^.^°^^^^ '\ the welfare 

yea, 'even cover, tomorrow. I rejoice that °^ T' P^°f^««>o" identified with that of man 

I live todav. I have no patience with the '^" ^"'*°''-^ practically tells the story of hu- 

conscience lashed, despairing Macbeth, "lan progress. ,,,,,,. . 

when he exclaimed Mankind is under incalculable obligations 

,.^ , , . ^ ' to the medical profession. Within the last 
lSS b°:t'a'w.',SSSa„ow; «"'">■• -^ w'thin the memory of .he liv- 
it is a tale "^8'' the medical man has practically elinii- 
Told by an idiot, full of sound and fury iiated pain, and has brought the methods of 
Signifying nothing." aseptic surgery to a point which well-nigh 
I rather prefer that other sentiment, which approaches perfection. Utilizing recent 
has been an inspiration for years past, and bacteriological discoveries as a foundation 
doubtless will be for ages vet to come— ^^PO" which to build his super-structure, 
"Life is real, life is earnest, ' the surgeon has erected an edifice, the like 
And the grave is not its goal, C)t which can scarcely be found among the 
Dust thou art, to dust returneth, works of man. Within recent years the 
Wasnotspokenof the soul." specialties of medical practice have been 
The medical profession always has kept wonderfully developed; speech has been re- 
step with the march of other vocations, and stored to many mutes, ears once deaf now 
the early years of this century finds it hear with ease the sweet harmonies of na- 
abreast with the most progressive. Dr. ture, and eyes once dim or abandoned to 
Holmes pointed out the fact that a great up- permanent darkness now see the beauties of 
heavel in any sphere of life, whether it be God's handiwork. In the last quarter of 
political or otherwise, will affect every other, the century the surgeon has taken the crutch 
The practice of medicine is not an excep- from the cripple and the lame, ' 'has restor- 
tion. When Plato was teaching the Athen- ed lost functions to organs and glands," has 
ian youths in the market place, Hypocrates ^et in the light of reason to the insane, has 

*r'„o,i u„f„ n, . .• c ., n.T ^. heard and heeded the cry of those on whom 

*i\,ead before the recent meeting of tb^ A- /Cr»^£:*, i n i i c i- .. ^\. \, 
Medical Society at Charlotte, N. C. O i34-0?^ deadly hand of mahgnant growths has 



THE CHARLOTTE MEDICAL JOURNAL. 



been laid, and has restored them to health 
and happiness. M as explored the abdomen 
for penetrating- wounds and infections. He 
has cut away tumors from glands and cavi- 
ties, invaded joints, oresected viscera; he 
has eliminated blood poison, walked almost 
at liljerty through the brain and cord, re- 
duced the mortality of all surgical diseases, 
and has actually entirely removed the death 
rate of many. 

Inter-linked \vith this progress in surgery 
and keeping step with it, we note an equal 
improvement in the strict practice of intern- 
al medicine. Within the century a general 
practitioner, a North Carolinian he was, 
has invented and taught us the use of the 
hypodermic syringe; while another co-labor- 
er, and another North Carolinian, it is said, 
perfected the clinical thermometer — the two 
most useful and necessary instruments ever 
contributed to the science and art of heal- 
ing. Since the beloved blood-stained Stars 
and Bars were furled forever at Appomat- 
tox, the practitioner of medicine has grad- 
ually driven back many of the foes of hu- 
man health, and today typhus fever, scur- 
vey, and a half dozen otlrer diseases, which 
annihilated whole cities in the past, are 
known only to the students of medical his- 
tory. Since the fall of the storm-cradled 
nation the medical forces have been hurled 
daily and vigorously against small-pox, 
scarlet fever, diphtheria, yellow fever, ty- 
phoid fever, tuberculosis, malaria, tetanus; 
in fact, every disease, and the batallions of 
nearly all are wavering, yea, those of most 
of them are in full retreat. Mortality of the 
wounded in the Civil War was fifty per 
cent. So great has been the improvement 
in medical affairs since that period the 
death rate of the wounded in the Japanese 
army, in the recent war with Russia, was 
practically nothing. Within a few years 
the fatality of malaria has been enormously 
reduced, 'i'he mortality from scarlet fever 
has fallen lower and lower, until in one 
Slate, where it formerly raged with great 
severity, it is estimated that over four hun- 
dred lives are now saved annually from it. 
Prior to 1.S94 diphtheria was considered one 
of the greatest curses to which human flesh 
was susceptible. Since Herhing discovered 
antitoxin its fatality has grown less and 
less, and recently when contemplating its 
results Turner, in an ecstasy of delight, de- 
clared ' 'No child ought to die of diphtheria . ' ' 
The frequency of t>-phoid fever within the 
last few years has l)een reduced fifty per 
cent, in Lawrence, sixty in Chicago, and 
literally wiped out in Munich. This is the 
story told of it the world over where the ad- 
vice of the doctor, the sanitarian, is heeded. 
The death rate from tuberculosis in New 
York is now thirty per cent, less than seven 



years ago, and this is an index to conditions 
in the country at large. In the 17th and 
18th centuries the world mortality was fifty 
per one thousand, and sometimes it reached 
in certain centers as high as seventy. In 
London, the largest city in the world, it was 
onlv seventeen in 1902, while the average 
for all civilized countries was perhaps lower 
even than this. Since the close of the eigh- 
teenth century over eleven years have been 
added to the averag-e span of human life; 
later statistics show an increase of seven 
years since 18S0. Wonderful, these, are 
they not! 

Now answer me lawyer, merchant, farm- 
er, manufacturer, to whom are you indebted 
for accomplishing these things? Is it the 
minister? No. Is it the philantrophist? 
No. Is it the capitalist? No. Well, an- 
swer me then, who? I will tell you. It was 
and is the surgeon, the clinician, the micro- 
scopist combined and harmonized in one. — 
that thoughtful, painstaking, humanity- 
loving individual over there, you know 
him, for he held you in his arms when the 
light of day first fell on your face, he sat by 
your bed-side and gently nursed you back 
to health when disease had laid its hand 
upon you, he it was who shed an honest 
tear when your loved one left you for the 
other shore. He is the one who will stand 
by you and comfort you as you fall in your 
long, last sleep. You recognize him now, 
I know you do, for no other fulfills this true, 
real description but this one, and he is — 
your doctor. 

In an hurried manner I have pointed out 
several of the beneficial results of modern 
medical progress. We should strive to do 
at least as much for the profession and hu- 
manity as did those who have preceded us. 
In contemplating the work which lies before 
us, one is almost staggered by the enormity 
of the task. It is not my purpose to discuss 
all the problems which are awaiting our so- 
lution. There is one certain fixed fact in 
medicine, which, in importance, stands pre- 
eminent above all others, and that is that 
the four hundred and fifty-one thousand 
deaths annually in the United States, in- 
cluding the eight thousand eight hundred 
de.aths yearly in North Carolina, from trans- 
missible diseases, can be prevented. Pasteur 
declared some years ago "it is in the power 
of man to make all infectious diseases dis- 
appear from the face of the earth." No 
one well informed denies this, and every 
thoughtful person agrees that it should be 
done. 

There is and has been for some time an 
actual increase in the frequency of renal, 
heart affections, and malignant growths. 
Without question we have failed, utterly 
and disastrously, to make even the slightest 



ORIGINAL COMMUNICATIONS. 3 

impress on pneumonia. Those conditions two hundred thousand deaths means a loss 
deserve our most serious consideration, and of two hundred and thirty million dollars, 
I pass them by because of lack of time to a sum half as great as needed to meet the 
discuss them, and not because I consider enormous annual expense of our National 
them of no consequence. There are three CTOvernment. 1 am sure that the loss en- 
great dangers to public health, which be- tailed liv the sickness of those who recover 
cause of their very great overshadowing will bring the total up to three hundred and 
importance merit special and emphatic dis- twenty-five million annually — think of it, 
cussion. h'or the couijtry at large I would three hundred and twenty-five million dol- 
say thev are pneumonia, tuberculosis and lars, a yearly tribute for our folly and stu- 
alcohol; for our State I would substitute ty- pidity. We lose yearly in North Carolina 
phoid fever for the first mentioned. nearly twenty-five hundred from this mala- 

There are only four or five deaths in North dy. Valuing human life by money, as we 
Carolina from hydrophobia annually. Men, are sometimes wont to do, this mortality 
however, stand in mortal dread of this dis- means an annual loss of nearly three million 
ease, and yet they pass quietly by with dollars. Mind you, this is from the cases 
scarcely a comment when typhoid fever is which prove fatal and does not include 
announced, while as an actual fact there those which recover. I am sure that our 
are in round numbers twelve hundred and State loses every year four million dollars, 
fifty deaths in North Carolina each year at least, because of tuberculosis. If this 
from this affection. This means a great sum were added to the public school fund it 
loss to our State and represents thousands would place a splendidly equipped graded 
of cases of sickness. The mortality alone school in reach of every boy and girl in 
of eenterift ■ fever means a money loss to North Carolina, and have a sum left over 
North Carolina of nearly a million and a sufficiently large to build and equip quarters 
half dollars annually — a greater sum than for every insane person now out of our 
is expended for our public schools each crowded asylums, every orphan not now in 
year. Thanks to our health laws and our an orphanage, every deaf and dumb and 
well established rules of health, the number blind person for whom there is no provision, 
seems to be growing smaller, but the shame All medical authority bears out the state- 
of it is that there should be even a single ment that tuberculosis is a transmissible 
case of this disease in North Carolina at all. disease due to a specific organism, that posi- 
Typhoid fever can be prevented and it tively and unquestionably it is not neces- 
should be. It would be a comparatively sarily hereditary, that over eighty per cent, 
easy matter to wipe it out from our vState of cases are curable in the early stages, and 
entirely. It has been driven from crowded that it can be prevented. It is the duty of 
cities, why not from North Carolina. It is the vState to lend a helping hand inthewar- 
our duty as guardians of public health to fare we are waging against this menace to 
arouse the public mind to a realization of our health. Child labor in the mills for 
so doing. Once the people see their duty, long hours is a very powerful factor in pro- 
and see it clearly, it will be done. ducing tuberculosis and must be prohibited. 

One out of every four deaths in the Unit- Intemperance must be fought, and a vigor- 
ed States is due to some form of tuberculosis, ous crusade inaugurated against everything 
Over two hundred thousand of our citizens which tends to lower the vitality of the hu- 
cross over the River each year from this man economy if we would succeed. This 
disease. Do you grasp the enormity of these is a gigantic struggle, but one which we 
figures? do you really appreciate what they have every assurance of winning if we but 
mean? push our efforts, laboring to this end. Doc- 

The battle of vSharpsburg was one of the tor, reiterate it everywhere that tuberculosis 
bloodiest in the series of the terrible fights causes twenty-five per cent, of our deaths, 
of the Civil War. On that field both armies is curable and can be prevented. In an 
lost over thirty-eight thousand, killed and hour of most intense hatred Hamilcar led 
wounded, h'or three days Lee and Meade Honebal to the altar and there had him 
struggled for the mastery at Gettysburg, swear everlasting hatred to the Roman em- 
and when the gigantic fight was over both pire. Let us go to the altar of our duty and 
armies had lost, killed and wounded, nearly in no uncertain terms, borrowing if need be 
fifty-five thousand, making a total loss in the voice of the Thunders that the world 
both battles of ninety-three thousand. Add may hear, them resolve, that since tubercu- 
to this number all the killed and wounded losis can be, it shall be wiped off the face 
on both sides of the entire Spanish- Ameri- of the earth! 

can war, and the total scarcely exceeds one- Sometime ago a friend of mine asked me 
half as many as die each year in the United why the medical profession opposed patent 
vStates from tuberculosis. LVom a financial medicines. There are .several reasons, but 
standpoint this loss is stupendous. These chief among them is the fact that the pro- 



THE CHARLOTTE MEDICAL JOURNAL. 



loug-ed and iudiscriinate use of those which 
contain stimulants, and most of them do, 
has a tendency to arouse latent desires for 
excitants, thus making: successful resistance 
to after temi)tation much more difficult. 
We know that every year since 1898 doctors 
have used less and less opium and cocain in 
their j^ractice, while the world consumes 
five hundred percent, more opium and three 
hundred per cent, more cocain annually 
than ever before. This enormous increase 
sjjells ruin for hundreds of men, women, 
and even children in our countr>' each year. 
Our annual drink bill amounts to fourteen 
hundred million dollars — a sum greater by 
two hundred and twenty million than the 
total amount spent for bread, meat and edu- 
cation. It is out of my present role to dis- 
cuss the moral and social aspect of the 
question. Let us look at the medical side 
of the case. Broadbent truthfully declared 
that while deficient food, over-work, foul 
atmosphere and alcoholic excesses were the 
principal factors in the progress of tubercu- 
losis, the greatest and most potent is alcohol. 
We all know that this latter clause is true 
of all transmissible diseases. Intemperance 
is more deadly in its effects on the human 
system than tuberculosis. A prominent 
Enjjlish writer, in referring to drinking, 
says, "Not only is it often inherited, but 
organic ailments are by it originated, and 
organic weaknesses crystalized into disease. 
The degenerations of age are anticipated 
and precipitated by alcohol, and the dram- 
drinker is thus sure to have a shortened 
life." My friends, I tell you that the ad- 
ministration of intoxicants, whether it be in 
the shape of milk punch or Peruna, is a 
dangerous thing' and one not to be done 
lightly. It is i)ossible that the seed of a fu- 
ture drunkard may be planted then. It has 
been my unpleasant duty to witness the 
death and burial of a widow's only son and 
lone support." When the light of that poor 
woman's life was extinguished and densest 
winter's darkness crept into her soul, when 
thai innocent voice was hushed forever, and 
those hands which promised to battle for 
the gentle mother in the stern conflicts of 
life were stilled in death, when kind friends 
gently bore the boy to the little burving 
ground on the hill-side over yonder "anil 
lowered his bod\' into its grave to sleep for- 
ever beneath the blue-bells and violets, 
within the call of the song-birds of his youth, 
a feeling of sornnv and sadness swept over 
my soul, unutterably, indescribable. My 
neighbor between his tears declared that it 
was the saddest sight on earth. Not so, 
my friends, not so! Hear me! A scene like 
that is not more distressing to the human 
heart than to see one staggering and reeling 
through life to an early death; Hope gone! 



Faith broken! Ideals forsaken! A soul 
damned and lost forever! I believe, and I 
say it with forethought, that ten gallons of 
liquor would meet all the annual require- 
ments, in a medical way, for the entire 
State of North Carolina. It is absolutely 
unnecessary to prescribe it, except for the 
aged and those previously addicted to its 
use, and then not in every instance. "Ah," 
says one full of pseudo-scientific ideas and 
false hypothoses which he, poor ignorant 
man, thinks are true, "What about alco- 
hol's place in Materia Medica?" Bosh! 
Rot! Alcohol should have no necessary 
place anywhere. I am sick of the discus- 
sion as to the food value of li(iuor. Its 
therapeutic indications are but precious few. 
It certainly has no medical virtue, except 
in the conditions named, which cannot be 
duplicated by other drugs less dangerous in 
tendency. Let us, as medical men, sound 
the tocsin of war against whiskey drinking 
and fight it to the death. 
Olu the gigantic struggle of th# hour, in 
the preparation for the Herculean tasks of 
the future, nothing can afford greater in- 
spiration than the critical study of the lives 
of the "Fathers." The days of the doctor 
of the Old School have passed, sad to relate. 
He had his faults, and great ones, too, of 
course he did, but his virtues were numer- 
ous, and to these we should turn again and 
again until their hallowed precepts are our 
own. The doctor of the Old School pos- 
sessed that potent charm — Sympathy and 
Love. I pity the young doctor who has 
])een denied the privilege of sitting at the 
feet of the typical old-time family physician. 
He was a citizen of high ideals. He taught 
practically the Divine lesson — Brotherhood 
of Man. This he ever held as his "vision 
splendid," and he followed its beckonings 
as steadfastly as the mariner follows the 
north star. He listened to the voice of duty, 
this cry of the soul's ideal, bidding him to 
battle for humanity's sake, and he succeed- 
ed because he barkened unto its call. 

Sometime ago an excursion boat on one 
of the great lakes caught fire. The panic 
stricken pleasure seekers crowded to the 
front of the vesseL Though every possible 
effort was made to stop the progress of the 
flames they spread rapidly; there was only 
one possible way to safety for the passen- 
gers, that by quickly docking the steamer. 
John Maynard, a sturdy seaman, was plac- 
ed at the helm. Both he and the captain 
knew and realized that the lives of the ex- 
cursionists depended on him. b'anned by 
a gale the flames rapidly eat their way into 
the vitals of the ship. Firery tongues began 
to leap from every crack, and great volumes 
of densest smoke rolled around the old sea- 
man; the fire grew rapidly in fierceness and 



ORIGINAL COMMUNICATIONS. 



iiileiisit\-. It swept around and enveloped 
the masts; with an awful crash the rigging 
fell! The captain rushed to the side of the 
ship and cried "John Maynard, art thou 
there?" and the husky-voiced seaman an- 
swered "Aye, aye, sir." A sudden gust of 
wind drove the fire further into the ship, 
the oil tanks were ignited and exploded. 
C'.reat flame-sheets and burning timbers 
were hurled on high, women fainted and 
men grew sick with fear! From the bridge 
the captain again cried, "John Maynard, 
art thou there?" and back over the waters, 
over the din of the conflagration, the voice 
of the old hero was heard still holding out a 
ray of hope to all "Aye, aye, sir," and the 
ship sped on. The wharf is reached, what 
joy to those passengers! Presently some 
one remembers the old seaman. The cry is 
raised, "Where is John Maynard?" The 
captain shouts, "John Maynard, John May- 
nard, John Maynard," but no answer 
comes, for he, who but a few minutes be- 
fore, was holding, with burning hands, the 
vessel to its course, was now wrapped in 
the embrace of death. The medical pro- 
fession in North Carolina has produced 
many John Maynards. 

Hark! what cry is that piercing the mid- 
night air, .striking terror to the strongest of 
human hearts? "Help, help. Oh God help 
me, my baby is dying, the doctor, the doc- 
tor, go for the doctor!" Out in the mid- 
night dashes the messenger, over hills, 
through valleys, on, on he speeds to the dis- 
tant village, down its lonely street, straight 
to the little cottage on the hill-side where 
flickers the mid-night lamp — a beacon light 
to those seeking health. The sound of the 
approaching horseman falls upon the sensi- 
tive ear of the physician. Self is at once 
abnegated and forgotten. He hears the 
human call? He springs from bed; half 
dressed, ill prepared to face the raging storm, 
he begins his perilous journey. Though 
the winter's blasts are raging, he cares not 
for their icy coldness, for is not a life at 
stake? He realizes the necessity of the 
greatest haste. On he rushes, plunging 
swiftly through the darkness, galloping his 
faithful horse here in the opening, rapidly 
picking his way there among the fallen 
l)ranches, through roaring torrents, up steep 
hills, never pausing, onward, onward to his 
patient! Gently, tactfully, and swiftly he 
glides into the sick chamber; He realizes 
in a second the true situation. By the side 
of the little svifferer he drops, without hesi- 
tation, though knowing full well the danger 
of such a procedure, he places his mouth to 
the mucous-plugged tube in the child's 
throat. It is opened, the pure air inflates 
the little lungs again. Artificial respiration 
is begun. All through the lonely night the 



physician labors, and at last when the gray 
dawn of approaching morning breaks in 
gladness over the earth, dispelling the storm 
of the night, joy reigns supreme in that 
home — the baby is safe again. But, sad to 
relate, ten days later this grand, good man, 
the John Maynard of that incident, gave up 
the ghost, a victim to the dreadful disease 
diphtheria, which he contracted from the 
baby on that eventful night. Dr. Wood, 
for the rescuer was none other than he, was 
a hero in the highest .sense, and died a 
hero's death. "Greater love hath no man 
than this that he lay down his life for his 
friend." 

Abou siDoke more low, 

But cheerily still; and said "I pray thee, then 
Write ine as one who loves his fellowmen."' 
The angel wrote and vanished. The next 

night 
It came again with a great awakening light, 
And showed the names whom love of God had 

blest. 
And lo! Ben Adhem's name led all the rest. 

We hear much in this day, of Commercial 
Development, of what men call Hustle, 
Progressiveness, Business Methods in Pro- 
fessional Life. I suppose these are well, 
but ah, how much, how much of life's 
greatest and richest joys are we, who are 
chasing the dollar, missing when we fail to 
follow in the foot-stepsof the world's grand- 
est nobleman, the medical John Maynard? 
Oh, young man, young practitioner, cling 
closer, closer, yea closer to your soul's ideal! 
You cannot afford to break faith with the 
"visions of your better hours" even to save 
your life! As sure as there is a God you 
cannot succeed in the very highest without 
sympathy, without the broadest Christ-like 
love! 

Mankind the world over is undergoing 
great intellectual development. Sentiment 
is rapidly giving way to common sense, the 
arts are heldin higher esteem than in any 
previous age, and science is beginning to 
be estimated by its true value. People 
realize as never before the great importance 
of the medical profession, in its relations to, 
and the role it plays in civilization. Our 
vocation is more alert than in any period 
of its history. While, thank God, it is still 
devoted to its ideals and its altruistic ideas, 
it has caught the progressive spirit of the 
hour, and is rapidly making toward its goal. 
It is wise that we cling to the inspiring 
memories of the past; we must take from it 
those things which are useful for the pres- 
ent and the future; we must prune from the 
products of this day that which is worthless, 
and save for tomorrow that which is perma- 
nent and fadeth not away. Let us hold 
steadfastly with one hand to the elevating 
character traits, the "visions splendid" of 
the fathers, and the many bits of knowledge 



THE CHARLOTTE MEDICAL JOUANAL. 



which have come to us as a rich legacy from 
the glorious past, while with the other let 
us reach out and behold the hustling, pro- 
gressive streiuiosity of the twentieth cen- 
tur>', bring the two together, combine them 
in one striving thus to attain unto an ideal 
of which we have dreamed, but not yet 
realized; hoping, trusting that they may be 
harmonized eventually to the betterment of 
humanity, and to the honor and glory of 
the great profession to which we belong. 

Once on a Time There was a Man.^ 

An Address to the Profession bv T. S. McMullan, 
M. D., Hertford, N. C. 

Mr. President, Me?>ibers of the Medical 
Society of the State of North Carolina, 
Ladies and Gentletnen : 

The theories of human knowledge and of 
human perception have been varied and the 
causes of many and anxious disputations 
since metaphysics became the study of man- 
kind. The evolution of this science has 
been attended by great earnestness and 
marked ability, and its discussion has some- 
times provoked a bitterness almost akin to 
malignity. I'rom the idealism of Plato, 
who taught the doctrine of innate knowl- 
edge supplemented by human reminiscence, 
who believed in the existence of eternal 
forms . and ideas in .some supra-mundane 
si)here, and that these were the arch-types 
of all the senses perceive upon the earth; 
that these types were perfect and unchange- 
able, and that every human soul in its pre- 
natal existence saw these arch-types and 
knew the objects seen on earth by their like- 
ness to the su])ra-hvmian ideas; the phenom- 
ena, appearances and objects of the senses 
being to the early Greeks and Mediaevalists 
not real, but to those who followed this 
teaching as the shadows of eternity upon a 
lighted wall; from the cosmothetic idealism 
of Descartes and Kant, and later, Male- 
branche, who taught the problematical ex- 
istence of things analogous to that attribut- 
ed to tlie perfect and eternal forms, down to 
tlie common sense and sensualism of John 
Locke, whose theories have survived in 
modern intellectualism as the philosophic 
guide, who saw in an idea "Whatever is 
the object of the understanding when a man 
thinks," I say from all these different logics, 
from all these higher speculations and prob- 
lematical beliefs, the scientific world has 
been brought to believe, that while all things 
are material, all phenomena and appear- 
ances are real, all objects can be apprehetid- 
ed by the physical senses, and that all sens- 
ations as joy and grief, and pain and pleas- 
ure are not imagination, but the reflections 

• Delivered before the recent meeting of the 
North Carolina Medical Society at Charlotte. 
MHy 30, 1906. 



on our intellects of physical circumstances 
and environments, yet our thoughts and 
perceptions and ideas do have cast upon 
them the flash-light cf an eternal world, 
and whether this influence be, as Plato 
taught, of a prenatal nature, or whether it 
be the present whisperings of those invisible 
spirits which hover about poor fallen man, 
the belief prevails, though many doubt, that 
in every mind there is a sub-consciousness 
of things immortal, that in each heart there 
is a spirittial ideal, that in each soul there 
is a link binding it to eternity, and that in 
the lives of men ofttimes the gates are lifted 
and there flits across the brain a dim and 
hazy blush that without consciousnessleaves 
behind some vague and subtle impress; 

L,ike blushes of the sky at night. 

When from some unknown, unseen height, 

A fiery meteor falls. 

How often have we known it; how oft in 
trials and vicissitudes an unseen help ap- 
pears; how oft in agony and woe supernal 
strength is given; when perils come and dan- 
gers lurk about, how oft the power comes to 
bear men up beyond their mortal might. 
There is a blending of the ideal and the 
material; the history of the world stamps 
this as truth; experience a witness that it 
is so. We cannot understand these subtle 
communings, neither do we know the mys- 
teries of life; we only believe that in the lives 
of men they come, sometimes to bear them 
up, sometimes to note their doom; sometimes 
to cheer a broken heart, sometimes to mark 
an end. What say you, who deny these 
things, to the evidences before yoti? Do you 
believe the unflinching courage of the early 
martyrs born alone of mortal strength? Do 
you reject the fore-knowledge told and pre- 
served in history of knightly soldiers who 
have felt before the battle the breath from 
an angel's wing? Do ypu discard as of no 
amount the visions that ha\-e come to dy- 
ing saints, and do you think the words of 
Holy Writ mere wild imaginings? Ah, Mr. 
President, these things are true; the embod- 
ied testimony of an enlightened world; the 
recorded truths of men to whom the truth 
was paramount to all. And if hallucina- 
tions, and if illusions as many make believe, 
what are they but the expressions of an in- 
tellect wrought upon by some undefined, 
btit infinite, influence? Yet some reject, and 
.some of us; of our guild who daily see the 
hidden portions of the human body; who 
statid appalled at mysteries not yet disclosed 
to us; who daily see the agonies and the 
strength to bear; who see the pains and 
aches and ills, and ofttimes, too, the light 
that comes at last. Five hundred deaths 
without the light; five hundred scenes where 
death approached unheralded; five hundred 
cots where nature sank to rest alone are 



ORIGINAL COMMUNICATION 



counted as no proof against the rapturous 
glories of the dying Saint Ignatius, and all 
the wisdom and the glittering fame of an 
honored Osier are worth but nought about 
this thing beside the softened whisper of 
some white-faced sufferer that she sees the 
great White Throne, and hears the soft- 
toned singing of the Heavenly Choristers. 

The modern tendency of Medicine, Mr. 
President, is toward materialism; we have 
no more right to deny the influences of the 
unseen, because they are beyond our ken, 
than we have to deny the "Vital Principle" 
in life; we understand neither, but we must 
believe the ample evidences of the existence 
of both. Their union makes up the sum of 
our being, and on both we are dependent. 

Ideals not only exist in men's minds, but 
they inspire their acts; since the world be- 
gan the lives of heroes have led the people; 
the recorded deeds of great men; either real 
or mythical, whether in this world or in the 
spheres to which beliefs attached them, have 
been the signs which mark the paths we 
take; the darkest days of history are lit 
with beacon lights, which beam upon us 
yet, and in the days of myth, in pre-enlight- 
ened times, whether the tales were of physi- 
cal origin or whether they were songs by 
which the wandering bards beguiled the 
weary hours, the old heroes that they sung 
about were to the people jjrototypes of honor 
and of wisdom, and even of iniquity; when 
Jove and Apollo were worshipped as gods, 
and The Fates human destinies spun; when 
the Cestus of \'enus brought passion and 
war, and Valkyries beckoned the heroes 
home in the land of the mid-night sun. Then 
afterward when truth and legend met; when 
to the vices or the virtues of men were add- 
ed the anger or the pleasure of the gods; 
when giant deeds were daily boasts and 
round each mighty life was wove a wreath 
of praise as fragrant now as when its leaves 
were fresh from laurel boughs; the day of 
early light, when visions of the saints made 
men belie\'e in God; when lives revealed to 
us and simple acts of faith inspired the sac- 
rifice and made the blind to see; the day not 
gone afar wdien our art was born; when 
from its myths and from its fallacies great 
men derived a grain of truth, which like a 
seed implanted in the ground has become a 
mighty tree. Through all these times ideals 
have led us; in all the logics and statecrafts; 
amid the good and wiles and wickedness of 
a restless world; some man living his life be- 
fore us, or perhaps being one of us, has been 
the exemplar of that for which we strove; 
or if not one our type may have been a 
composite — the union of many virtues or of 
many vices, each existent in and distinguish- 
ing one life; but whether of one or of many, 
some type we have and some type we will 



follow. 

Man is a creature of imitation, guided by 
the experience of his ancestors, shaped by 
the reminiscences of his own life and mould- 
ed by the records of the world. History is 
replete with deeds worthy of repetition, and 
filled, too, with actions unworthy of the 
memory of the race; these we study, some- 
times choosing the bad, but oftener the 
good; sometimes choosing our arch-types by 
a blending of the seen and of the unseen. 
For all the ages men have been moved by 
the same life forces; have acted from the 
same motives; have suffered and gone to 
death; have lived in joy or gloom because 
of a virtue or a vice pre-existent in some 
one, who, unconsciously to themselves, have 
helped to shape their destinies. 

It is to the credit of us all that the good 
we do lives after us, though the wrong be 
often blotted out, and that the world sets up 
as pillars of fire men of virtue rather than 
of vice. If there be bloody prints upon the 
pages of history, and if evil faces leer at us 
through the dimming haze of centuries that 
have some followers, the shining lights are 
men of truth and grace, and men whose 
glories shine as bright as in their day. One 
single attribute will mark a life sometimes, 
and one heroic act will point the height to 
which we all may climb; so true is this that 
names are synon^'ms of qualities once pos- 
sessed, and this should teach us all what 
pictures of the past to cast our eyes upon, 
what we should study, what we should emu- 
late, and what we should disregard. Un- 
questionably and almost unconsciously we 
associate names and acts; we join special 
vices to special men, and good men involun- 
tarily try to follow the lives of and to ap- 
propriate the characteristics of 'good men; 
to attribute to them without thought the 
graces that they most famously wear, and 
to live by the reflection that is cast upon 
themselves and moulds them. 

If this be true, Mr. President, if we be 
creatures of imitation and emulation; if our 
lives and characters be cast in the mould of 
past events and formed by an investiture of 
ourselves with the properties of our arch- 
types, the conclusion is inevita]:)le that upon 
a proper selection depends our worthiness 
or failure. Do we prefer the blots of history 
rather than its glories? Do we choose to 
study the stories told of courage and human 
kindness, of honor and unselfishness, of 
duty and self-sacrifice, or had we rather 
read the tales of cruelty and envious strife, 
and of the treachery and wickedness that 
stalk the earth? 

The Medical profession stands today the 
most honored profession, save one, among 
the callings of men; to the public it is colos- 
sal in its benefactions, full of charity toward 



8 THE CHARLOTTE MEDICAL JOURNAL. 

hiimaiiity, burdened with a mighty weight of commercialism; the opportunity often af- 
of mortal' sufTerins,^ and woe, and united to forded one doctor to review the work of an- 
a man in all its battlings against schismatic other in consultation, urgent distress, or by 
l)ractices: l>eloved by its votaries, valiant in a reasonable or unreasonable exchange of 
its fightings for the proven truths, unselfish medical attendants, and the too prevalent 
in its' free offerings of discovery, and stand- disposition under such circumstances to let 
ing as one in support of scientific progres- fall a word, to criticise a treatment not our 
sion, with an absolute knowledge of its own, to strengthen our cause even if we dis- 
value to mankind, this great profession, I parage our fellow man. It is to the credit 
say, to the public stands mighty and co- of the doctors that they are given high rank 
hesive in its power; it stands today erect and as social factors, and by this how much 
defiant in its scientific work and utterances more is it discreditable when they, by their 
because it believes it has the right through enmities toward each other, use this high 
the verdict of a glorious history. And yet, influence to set in motion currents of un- 
Ah! yet, Mr. President, between ourselves, friendly comment and vindictive criticism, 
between us who should be united as brother which may sometimes meet and form a so- 
is to brother, there is sometimes a mutual cial maelstrom as greedy to engulf the fames 
dislike, the spirit of a jealousy that may be and good reputes of those who come within 
akin to hate. its grasp, as are the seething waters off 

I wish to ask your pardon, ladies and Lofoten's shore to draw to death the hardy 
gentlemen, for two offences. My duty here mariners. 

tonight assigns me to read an essay; this I Ladies and gentlemen, you who seek our 
am not doing and is my first offence; my aid; you who believe in us and yet each day 
second is that instead of saying sweet and do see our faults; you who trust your lives 
pleasant things about my brethren I shall to us and the lives of those most dear to you; 
attempt to lay bear the darkest stain that who have watched with us full many a 
rests upon the heart of us today; the stain night till gleams of light from out the east 
of professional envy; of professional antag- thrust back our black despair; beside whose 
onisms, even, I am ashamed to say it, of couches we have stood and wrestled hour 
professional jealousy. This is not a pleas- by hour until we brought some loved one 
ant subject; we love to say in public nice back from death's grim clutch, or earned 
things of one another, as others say of us; for you the blessings of more days on earth;. 
we love to think, each one of us, that at O, Woman, Woman, in whose loving heart 
some other door this fault may lie, but not the doctor always has a jilace, whose grate- 
at ours; and yet I know, with the fullest re- ful words he covets, and whose pangs to 
spect to all of you, that this thing touches him, though oft you know it not, are like 
and grinds and tears and rankles in the unto the wails of broken harpsichords; O, 
breast of many here tonight. It is Bete Mothers of our land, whose holy lips caress 
Noir of our craft; the wormwood and the and teach the little ones and pray each 
gall; the oi)probrium of our art; it mars the night that health may cling to them; who 
beauty of our work; lessens the confidence stand with us beside their childish cribs and 
the people have in us, and is neither neces- watch with faith that we can guard your 
sary nor in accordance with the proper ideals own, the feverish flush upon their little 
of the medical spirit. cheeks, who are the guardian spirits of the 

It might be well to seek the causes of this sons of men, and teach us by your sweet- 
condition; why so much dislike between voiced words what noble gifts man hath; 
doctors? Why so many communities em- help us, we ask, to take away this stain, 
bittered and torn apart by the envious dis- this crimson blush upon our blazoned shield; 
putations of its medical men? One reason give us your aid in this, our great distress, 
may he found in that ours is not a yet ex- as we will give you ours; speak no harsh 
act science; our judgments diifer and pro- word of what we do when in the stress of 
duce varied opinions, which each one's ad- circumstance; reflect on us your sweet, for- 
herents gratuitously distribute; as is com- giving ways, and touch us with the spirit of 
mon with all rumors these variances grow your gentleness. Mr. President, there is a 
greater as they run, and when carried back help for every ill, and there is one for this, 
are wider than at first appeared; the falli- Once on a time there was a Man. No 
bility of human judgment in treating disease boast of heraldrv nor pomp of power was 
IS a cause, a superior ability in another or his inheritance; obscure in life, with the 
the ordinary happening of a cure due, per- teachings of a simple father and the bless- 
iai)s, to an altered condition; the thought- ings of a sweet faced-mother he grew to 
less remarks of friends; the proffering of our man's estate, and was a'benefactor to his 
advice when none is sought; the violation of people; with bodv stern and rugged as the 
ethical rules for spite or sake of gain; the native hills whose wooded tops o'erlooked 
strong competition which causes too much his daily walk, with temper sweet as was the 



ORIGINAL COMMUNICATION. 



heather bloom that whitened in the dale, 
bright-hearted and as happy as the larks 
that every early morn brought wakefulness 
from sleep, and laugh so warm and com- 
forting as made all nature smile, this man 
has left on record's page a lesson we may 
learn. No call for help was ever made in 
vain; through storm and calm, through 
shadow and through sunshine, ministering 
to body and to soul, giving ease to suffer- 
ing, cheering the unfortunate, providing for 
the comfortless and lending the benediction 
of a noble charity the errands of mercy did 
not fail. No envy nor bickerings did he 
have, no war of words, no jealous rank- 
lings in his heart; but with a courage that 
did not flinch; with a purpose that did not 
fail; with heart o'erflowed with love for all 
alike this simple man, blessed of his own, 
went on his way; his life serene and joyful, 
and as full of music as King Mennon's sun- 
kissed lyre. 

The picture of this simple man may be 
ideal; it may find its likeness in some of 
you; it may be the creation of some mighty 
intellect touched with the beautiful possi- 
bilities of mankind; it is well-nigh the apo- 
theosis of the lowly servitor of the medical 
art; its type exists and has existed and will 
exist, and presents not a perfection beyond 
our possibilities but an excellence for which 
we all should strive and to which we may 
attain ; it is the story of an humble countn,' 
doctor, whose work lay parallel with ours, 
whose temptings came to him no doubt as 
ours come to us, and who proved himself a 
mighty man because he ruled himself. 

In speaking of our envies and mutual dis- 
trusts I do not wish to even seem to refer to 
the natural right of man to live by his own 
endeavors, nor do I for a moment disparage 
the proper spirit of an honest rivalry; I do 
not counsel a ready acquiescence in the 
habit a brother may have to infract ethical 
rules, nor do I deny the right to resent an 
unjust imputation, though it bring a breach; 
nor can I hold him guilty who, in the stress 
of dangerous circumstance, over-rides to 
save a life, perhaps, the rules that guide our 
conduct; in the lives of all of us there come 
these times when haste is paramount and 
ethics best postponed. But, Sir, I refer to- 
that unreasonable dislike which makes a 
chasm where there should be a link; which 
makes a breach where there should be a 
sympathy; there is no true name to call it 
save its own — ^Jealousy — the crime for which 
an angel fell; which draws the wrath of 
God and fills with ghoulish glee the Prince 
of lowest Hell; which distorts the truth and 
feeds itself on lies; which magnifies the 
trivial and oft attaches wrong in deed to 
those most pure in heart. The same sin — 
call it what you may — that has been the 



mightiest wrecker of the world since Cain 
became a murderer; that has wrecked men, 
wrecked women, wrecked homes, wrecked 
States and hurled from off their honest 
thrones the makers of the epochs; that has 
marred the life of many noble sons, made 
saints almost to sin, and sowed its seed 
among our kind that bring up tares where 
wheat should always spring — Professional 
Jealousy, Mr. President, that darkening 
stain upon our quarterings that repels the 
coming of a new practitioner into our midst; 
which grudges a success to honest rivalry 
and sneers when it begets a confidence; that 
sees no room but for itself, and rates no 
service worthy save its own. It is enjoined 
upon us all to protect our own ; to guard our 
fames and lives and all our natural rights; 
the same high power, who has endowed 
each one of us with talents demands their 
fullest use and holds us to account should 
we hide them in the ground; and yet the 
burden of a brother's part is laid on us and 
no one stands beyond this law. It is as 
much our duty. Sir, and as burdensome up- 
on us to enhance our worldly goods by what 
square means we can, as it is our right to 
live and our right to protect our lives; and 
in just so much as it is our right to do these 
things, it is our duty to give help and not 
make hindrances to those less fortunate than 
ourselves. 

There is no habit. Sir, beyond a reforma- 
tion; no sin beyond redemption; no life so 
black that cannot be made whiter; there is 
a cure for this, our great professional fault; 
the ideals have been set for us to look upon, 
and are no higher than the doctor can at- 
tain; it is not given to the human mind to 
contemplate a higher type than one that can 
be reached; we must fix our standards high, 
and having set them up must diligenth^ pur- 
sue them; we cannot hope, all of us, to 
excel; the talents given to us are not the 
same; the opportunities that come to us are 
different; the circumstances and environ- 
ments of our lives are varied; we must ex- 
pect a divergence in observations, in opin- 
ions, in practices and in successes. Each 
man here tonight has his allotted place, his 
allotted work, and must be the builder of 
his own professional edifice; is one unit, one 
factor in the great work of lowering or of 
raising higher the plane of the inter-life of 
the great medical community. The culti- 
vation of a warm cordiality toward our 
brother doctors must be our constant study; 
a painstaking avoidance of unfriendly com- 
ment on their acts and opinions; a shown 
willingness to act for them when necessary; 
a support of their treatments when in con- 
sultation if possible, and if forced to dis- 
agree do so with the least disparagement 
and not with the intent to gain a client; be 



THE CHARLOTTE MEDICAL JOURNAL. 



intolerant of the hostile criticisms of your 
competitors by your friends, and let not 
rumor use your name in wild extravag^an- 
cies; uphold the work and judj^ment of your 
medical oflficers when not in your opinion 
adverse to the public interests, and always 
keep in mind that there is a guide in life 
which says that you should do to men what 
vou wouid have them do to you. 

It is not pleasant to think, Mr. President, 
that in the time of so many s^lories of the 
medical art; that in the time of its many suc- 
cesses, its many deeds of kindness and of 
charity and of self-abnetjation; that past the 
time of its many gjapples with and triumphs 
over superstitions and churchisms and 
priestcrafts; that past the time of mists and 
murk and dangerous heresies, until now it 
stands revealed in all the splendor of an an- 
cient prophecy, and through the earnestness 
of its myriads is unfolding day by day the 
as yet unseen and beautiful mj'steries of 
human life, slowly emerging into the efful- 
gent light of a still far greater destiny, it is 
not a gracious thought to us that clinging 
to it yet we sometimes see this deadly, 
blighting sin, for like of which, enhanced 
in great degree, have come through all the 
years of earth the fearful social cataclysms 
that with woe unspeakable have rent in 
twain the fabrics of the ages. 

I-'ellow-members, there is room for every 
doctor on this earth today; there is work for 
all to do; some are more favored than the 
others, but each one can have the friendship 
of his brother and the full respect of all his 
fellow men. Our profession was not design- 
ed for riches; its commercialism is behind 
many of its faults, and I fear sometimes 
that its greed is sapping its gentility; for un- 
til we all believe in the usefulness of each 
to the other, in the equal rights of all and 
that our science is a science of brotherhood, 
we will not reach that high estate to which 
we all aspire; and until we know that we 
reflect each other; that we seem high and 
noble and useful, because others of our pro- 
fession are high and noble and useful, we 
will net cast off this cancerous sore, which 
brings us such unrest. The light of one 
good doctor in a community casts its light 
upon them all, and the shadow thrown from 
one bad professional act darkens far bevond 
its fall. Travelers tell us, Mr. President, 
that in the beautiful region of the Lepontine 
Ali)s. near by the Sphlugen Pass, there 
stand two mountain peaks which rear their 
storm-swept heads just side by side. Cover- 
ed with unmeasured widths of snow, girded 
by their glaciers and towering in the clouds 
as thougli to storm the heights of Heaven 
these stntinels stand, the awful monuments 
of a primal cause; no human foot has ever 
scaled their giant cliffs and from their mina- 



rets the light shoots up as if to meet the 
splendors of some glorious majesty; alike 
they stand in form and height and grand 
embattlements, while twixt the two the leap- 
ing cascade roars, formed from the meltings 
of their mighty sides; darkness and the win- 
ter's blasts touch both alike, and in the 
morn the sunbeams sparkle on their gleam- 
ing snows like diamonds on the lily throat 
of Egypt's Queen. Like sentient things, 
who know the dangers of the path we trod, 
they point the safest wa}', and oft amid the 
thunders of the battlings of the clouds from 
out their clefts and yawning crevices there 
come the distant echoes, which do wail and 
groan and crash and rave as if within their 
throbbing hearts were waged again the con- 
flict of the gods and mighty Titans. They 
stand as rivals for the admiration of the 
world, and to each peak a greater grandeur 
is because its mate is grand, and more sub- 
lime are both because on each is cast the 
rugged beauties of its fellow. And so we 
live our lives observed of all the earth, and 
side by side with him who, if he be a man, 
will shed the radiance of a useful life around 
him, but if he live in darkness and in wrong- 
ful i^ractices some gloom will fall on us, 
though our lives be shining as the brilliance 
of the Astriae. 

I ask you, fellow-members, to hear what 
I have said in the spirit I have tried to say 
it; I feel my frailties and know somewhat 
of m}^ imperfections; I have felt the bitter 
stings, and no doubt in my short experience 
have dealt the blow to others; I a.sk no part 
of this for you I do not hope will come to 
me; the public rehearsal of our faults is not 
a pleasant duty, but to me this seemed a 
burning question, and if I have offended the 
pardon lies, I trust, in the intent. The song 
of ages past is music of a sweeter key, and 
rather would we hear summed up the pro- 
phecies now fulfilled; but truth will rise, 
and we must know our faults should we 
correct them. May the knowledge of our 
value to mankind; may the examples of our 
great; may our belief in the conception 
of our science in the wisdom of our Ciod, 
and may the hope for the ultimate perfec- 
tion of our art upon the earth aid us in the 
furtherance of one grand fraternalism. 

Let us forget our spites; let us judge not 
lest we .ourselves be judged, and when we 
feel a wound let's be gentle as we can; let's 
meet unkindness with kindly words and 
kindly acts, for the effort to be friends on 
the part of one has brought within the bond 
of friendship many between whom there 
seemed to be an ever-widening chasm. A 
gentle spirit has healed many a tear, and a 
soft answ^er averted many a wrath. Let us 
appeal in our moments of resentment from 
maturity's stern manhood, to when a little 



ORIGINAL COMMUNICATIONS. 



child we said our prayers at setliii,t>- of the 
sun around our mothers' knees. It is related, 
Mr. President, that when Jenny Lind was 
just beginning- her life of sweetest song-, and 
ATadame Grisi then at the height of her 
o^reat fame was the favored idol of all true 
lovers of her art, there came to be the great- 
est jealousy of the older woman toward the 
younger; it so happened, during the stay of 
both in London, that Oueen Victoria, know- 
ing- already of the fame of Madame Grisi 
and wishing- too to hear the sweet-voiced 
Swedish girl, commanded them to sing at 
one of her assemblages; Grisi sang first, and 
sang most beautifully ; the notes poured forth 
from out her golden throat in richest har- 
mony, and swelled and swelled till all the 
air about seemed bursting into song; and 
then came Jenny Lind, the blushing maid 
just barely sweet sixteen; too timid yet to 
face a royal throng, too shy to know her 
power, she tried to sing and failed; the 
sounds would not come forth, and as em- 
barrassed and wounded in her pride she 
turned away, she met her rival's stare, sneer- 
ing and triumphant and full of hatred; 
stung, and at the same time calmed by 
one quick touch of woman's soul and 
strengthened by some word of sympathy 
she asked the Queen if she might try once 
more; receiving assent, to her own accom- 
paniment she began to sing a childhood's 
pra^'er she learned to sing when by her little 
bed at night she asked to be forgiven. A 
simple song of purest faith and love. Slowly 
and sweetly she began, each note as pure 
and clear and as full of music as the bells 
of Scheppen's chimes, and every word for- 
giving and as full of love as the gentle heart 
from which they flowed; and then, as if she 
sought some help from God, her face lit up 
and from her slender throat there rushed a 
mighty tempest of divinest melody, which 
sobbed and raged and thrilled and awed as 
higher yet her Heavenly voice arose until 
from out the skies above the angels seemed 
to come and join with her in one grand, 
glorious aria; her breath grew soft and low 
again with suppliant murmurings, plaintive 
as the moaning of the distant sea, and then 
at last as if some hovering spirit whispered 
that the day of peace was broke, were heard 
the song of gladsomeness and music jo^^ous 
as the babbling of a summer's brook. She 
rose and from a hush as silent as the stars 
at night there came the victory; the little 
prayer had done what woman's will had set 
at naught, and child-like words in simple 
song had tied the bonds of sweet accord 
^ twixt those who had l^een enemies. Grisi 
* approached and kissed this daughter of the 
North, and with a heart of love where hate 
had seethed she turned away. And this. Sir, 
is the feeling we must show; the gentle 



touches of our early lessons. If we love 
our profession we must strengthen its union, 
and must sacrifice our feelings sometimes as 
freely as its heroes have their lives; we 
must live and work and forgive, and if need 
be, suffer too, for the ultimate good of a great- 
er humanity. The sternest, too, are softened 
by a gentle word, and many a time some 
heart of oak, made harder still by hostile 
attitudes, has grown as soft when tender- 
ness is shown as winter's ice when Notus 
breathes upon it. The giving rightful dues 
for labors well performed, and honors for 
heroic acts, have been and are and will be 
evermore the strongest props of men and 
States and Kingdoms of the earth. 

It is said, Sir, that at the battle of Wa- 
gram the legions of I'rance had been hurled 
back time after time by the terrific onslaughts 
of the Austrian hosts massed in their front; 
with a lightning- eye and with that pre- 
science, which was in the hour of danger 
the very genius of Napoleon, the Emperor 
saw that his only hope lay in dividing the 
army of the Arch-Duke Charles. Summon- 
ing MacDonald, he ordered him to pierce 
the Austrian centre. This General, between 
whom and Napoleon there was at this time 
a feeling of unfriendliness, bowed his assent 
and silently turned away. Putting himself 
at the head of his veteran corps of fifteen 
thousand men, his towering form erect as if 
some gigantic Titan was at war, his eye lit 
up with battle's lurid glare, and his stern 
old heart filled with a soldier's purpose to 
save the Empire or to die, this hero of the 
French began his awful charge, x-lcross 
the plain is heard the measured tread of 
armed men, and from their front and from 
each flank there come the roar and crash 
and shrieks and screams of Austria's mighty 
guns; yet on MacDonald goes; and now 
men fail; the ranks close up and others fall 
to die; the groans go up, the piteous cries 
of pain, the calls to God are mingled with 
the rattle of the musketry; the battle flags 
are torn and rent, and hands that hold them 
up are black with clotted gore; and still 
MacDonald moves. But now we see the 
tired soldier pause and look behind; he sees 
far back a trail of blood and men; he sees 
one stand where ten had stood before; he 
hears a mighty cry go up "Vive le Emper- 
eur," and then he hears, O, God!; far off he 
hears the thundering on the Austrian left of 
Davoust's savage guns; "Forward" breaks 
from MacDonald's iron lips, and through 
the gloom and streams of sulphurous smoke, 
through shouts and din and clash and belch- 
ing tongues of flame, through living walls 
of fire and crimson rivulets he leads his war- 
scarred veterans, straight through the jaws 
of death, right to the mouth of Hell he 
storms and storms and storms until at last 



12 



THE CHARLOTTE MEDICAL JOURNAL. 



with one tremendous shout he broke 
the battle line of Austria's royal Duke, 
and changed defeat into most glorious 
victory. And when the Emporer held 
out his hand and thanked him for his valor 
and his noble services to France, presenting 
him a Marechal's baton, this grand old man 
forgetting all his anger, all his hatred, 
which he thought was just, grasping Na- 
poleon's outstretched hand, while tears 
coursed down his rugged cheeks, said, ' 'Sire, 
I count all that I have done this day, all my 
life as nothing but for the glory of your 
majesty." This, Sir, is the spirit to guide 
us, and this the zeal to urge us on if we 
hope to reap a ripened field, and if we ex- 
pect to gather figs instead of thistles. 

I have said these words, my fellow mem- 
bers, because to me it seems a danger 
lies; if I mistake the words are wholly mine; 
if I'm condemned then let it come — the con- 
demnation's mine; 

I'll feel full paid if from a word 
Of mine some seed may spring 
To blossom, and on every heart 
Their gathered fragrance fling. 

For what too oft has come to me 
May bring to you some mars, 
For both have friends as dear to us 
As Cancer's triple stars. 

And so I'll write and say my say, 
And strive for what I ween, 
Will keep from out your lives and mine 
This fault — and all that's mean. 

This fault touches me, and so I think it 
must touch you; it may be that it is grow- 
ing less, but while it exists upon the earth 
its exorcise must be our constant aim, for 
by this alone can be achieved the climax of 
our work, can come the full respect of every 
one, and can be brought to pass a strong 
cohesiveness. 

Mr. President, philosophers have dreamed 
of universal knowledge; scientists have 
dreamed of the perfection of their sciences; 
statesmen have dreamed of universal em- 
pire; conquerors of never ending victory, 
and poets have sung of a beautiful land 
where flowers loom and brippling streams 
chant glorias to their God; but. Sir, the 
sweetest dream that can come to him who 
loves the art of Medicine; to the student who 
has learned of the days of a nebulous myth, 
who has read of its march triumphant 
through the years until it conquers some- 
times even death itself; T say, Mr. Presi- 
dent, the sweetest dream that can come to 
him is not of tlie plaudits of a thankful 
people, nor of well deserved rewards, but it is 
a dream of peace and concord, of unity and 
freedom from dislikes, of great professional 
cohesion and mutual friendships, which 
make more close the bonds l)etween us all. 

Sir, I am done; the future is not told to 
us save as we gauge the past; the height 



from which the world was made still is and 
guides; the frailties of mankind are burdens 
we must bear, and if w^e bear them down, 
we must look upon ideals that elevate our 
standards, find these where you may, and 
having found them cling more closely to the 
lessons that they teach. The years to come 
will bring to us more cares, more kind- 
nesses, more conquests and defeats. Our 
btiilding stands secure, implanted on a rock 
deep sunk in toils, and battered by an erst- 
while storm of persectitions, but solid, hard, 
as lasting as the cliffs and beetling crags of 
Norway's stormy shore. And he who lives 
will see some day where our structure stands 
a splendid temple rise, each building stone 
the monument of a wearied, useful life; 
across its massive doors are writ the stories 
of our great, and in its halls and stately 
corridors are costly tapestries and pictures 
of the struggles that are past; the epoch 
scenes are vivid on its frescoed walls, and 
from its spires and gorgeous pinnacles there 
hang the emblems of our steady onward- 
ness; no sounds of discord ever dwell there- 
in, but oftentimes there rises on the eventide 
the joyous hallelujahs of the waiting multi- 
tudes; its sculptured columns lift eternal as 
the trtiths on which they stand, and far be- 
yond, beyond the daily restless strife, its 
glittering dome, resplendent in a golden 
sheen, gleams out and sends its rays of 
purest light to gladden burdened men. But 
higher than all this; than all our trophies 
won from occult sciences; than all our tri- 
umphs and our overthrow of heresies; than 
all otir proofs of life's deep-hidden mysteries 
and all the stories of our deeds which make 
a tome of wondrous worth, higher yet than 
all of these there waves above this temple 
we will build the banner of a perfect brother- 
hood, which floats and dips and glistens in 
the early light of day to show the world that 
for their greater good we*'ve fought the fight 
and won, have torn the bitter envies that 
we once possessed from out our hearts, and 
over ourselves have gained the mastery. 



The End Results-Mental, Physical and 
Psychic, Following Ablation ol Cer- 
tain Organs and Structures In the 
Human Body—A Critical Review 
ol 1250 Operations.^ 
By J. Ernest vStokes, M. D., Salisbury, N. C. 
When the Creator spoke and man sprang 
into existence, there stood forth in creation 
a mystery — marvelous, wonderful, sublime, 
in its complex and interwoven structures of 
body, mind, and spirit! A mystery that 
only a God could have created! A mysterj^ 
so great that thousands of years afterwards 
we hear the Psalmist cry fearfully and won- 

*Read before the North Carolina Medical 
Society at Charlotte, N. C. 



ORIGINAL COMMUNICATIONS. 



13 



derfully are we inadel 

C.lorious, indeed, must have been this 
human l^ody as it came forth fresh from the 
hand of the Creator, with all its various tis- 
sues, structures, organs and systems, in per- 
fect condition and relationship. The instru- 
ment of a thousand strings, with each string 
attuned to vil^rate in perfect harmony with 
its fellow! But man sinned and the curse 
fell, and with the curse came the blight. 
The thousand strings no longer vibrated in 
perfect harmony and accord. The delicate, 
wonderful, interwoven structures of organs 
and sN'steuis became the seat of disease, and 
each organ not only suffered injury or death 
to itself, but imparted them to other and dis- 
tant organs, sometimes threatening the death 
of the whole. Then again, in the histor>' 
of the human race, was heard that same 
voice that had called man into existence, 
saying, "If thy right hand oft'end thee, cut 
it off and cast it from thee; if thy right eye 
offend thee, pluck it out and cast it from 
thee!" Hence, just as invention follows 
necessity, so has surgery come into exist- 
ence to meet the diseased conditions of the 
structures and organs of the body, and it 
is brought before us clearly, in all its mani- 
fold responsibilities, demanding and exact- 
ing prevision, acumen and sagacity of de- 
cision, with a quickness of execution on the 
part of all who attempt successfully its 
practice. ' With these demands ever pres- 
ent, the question readily comes before us, 
how can we be best prepared to meet and 
overcome them? o\'ercome them in so direct 
a manner that the amount of work accom- 
plished, and the final results obtained will 
demonstrate that even apart from the medi- 
cal centres, surgical attainments of the very 
highest order can and no exist. . 

To accomplish this, however, will require 
more than a strong head and a ready hand; 
adequate and appropriate training should be 
the stepping-stone. On this point a promi- 
nent surgeon has to say, ' 'Only those should 
practice sur,ger>' who by education in the 
laboratory, in the dissecting room, by. the 
bed-side and at the operating table are quali- 
fied, first, to make reasonably correct de- 
ductions from subjective and objective signs; 
secondly, to give sound advice for or against 
operation; thirdly, to perform operations 
skillfull}^ and quickl}', and foui'thly, to con- 
duct wisely the after treatment." Notwith- 
standing such self-evident facts and in di- 
rect opposition to such necessary and indis- 
putable reciuirements, too often do we see 
solely the conscience of man and the en- 
lightenment of a community decide who is 
qualified in surgery, and even to what 
lengths he is justified in proceeding in the 
practice, irrespective of training or attain- 
ment. 



It is easy to understand that the layman 
may not understand or realize to how great 
extent the gravity of surgical interference 
may vary, or fails to place the proper valua- 
tion on skill attained only by long training 
and broad experience. He is simply gov- 
erned in his choice of a surgical adviser 
through association or preference, even mere 
personal acquaintance. Many times does 
one hear of the patient and family having 
consented to an operation on the condition 
their family physician should perform it, 
even .though that physician may have no 
surgical inclination or aspiration. The laity 
base their selection of a surgical consultant 
often simply on results independent of the 
actual lesion to be contended with. Thus 
a man totally lacking proper training and 
experience may do an amputation, or oper- 
ate for some stray or indefinite pain, which 
results in recovery of the patient, and con- 
sequently stands out in the eyes of the com- 
munity as a far safer and more desirable 
consultant than the surgeon of experience 
and training, who happened to operate next 
door on some acute abdominal emergency, 
or advanced carcinomatous condition, say 
of the uterus, which resulted fatally, lu'en 
though in the first instance the amputation 
might have been avoided and the pain ig- 
nored; while in the latter the surgeon's sole 
duty had been to give the patient, unselfish- 
ly, the benefit of the one and only hope for 
life. 

In addition to the proper education and 
training, personal experience and skill, the 
natural aptitude of a man should be a po- 
tent factor in qualifying him to take up sur- 
gery as a specialty. 

The physician is a minister of great ideas 
requiring proficiency, patience, perception, 
and painstaking efforts in research. The 
surgeon is ever a servant of tyranical duties, 
of arduous achievements, demanding 
strength; decision, even to the point of ob- 
stinancy; foresight and other mental powers 
far beyond mere manual skill. The greatest 
good to the greatest number can only accrue 
through the combined efforts and labors of 
both. Unpuestionably they should labor 
hand in hand, though neither one should 
allow his field of activity to extend beyond 
his specialty, into that of the other. It is 
just as incumbent upon the surgeon to give 
up to the physician his medical practice, as 
it is that the man doing medical practice 
should turn over to the surgeon all cases 
surgical. The work in this way will be 
centralized where environment and sur- 
roundings are better conducive to success, 
and where the good results which can only 
be obtained through training, experience 
and skill may be so grouped and may so 
multiply in number as to stimulate and 



14 THE CHARLOTTE MEDICAL JOURNAL. 

arouse that community at lar-e. The mortality, occurin"- in this series of 
The sphere of surgerv is rapidly expand- cases was 6.4%. It is only fair, however, 
mg and pathologic conditions are becoming to add that the death rate has been made on 
so much earlier recognized in their period the same basis as that used by the Alayo 
of growth and development, that the ability brothers in their gall-bladder records, name- 
and skill to cover the entire field of even the ly, that if a patient entered the hospital 
specialty of surgery itself are vouchsafed to alive, was sul)jected to an operation and 
a very few operators of today. It is true came out dead, the death was accredited to 
that the majority of surgical interventions the operation. Thus in one instance a pa- 
are safe and easy, the mortality, excluding tient succumbed suddenly from a pulmonary 
acute abdominal emergencies and certain embolism, on the fourteenth day, following 
brain lesions, is low. Yet to decide whether a hysterectomy. Though the convalescence 
an operation is justifiable is indeed in .itself had been absolutely uninterrupted; the tem- 
a grave responsibility, and owing to this ex- perature never above normal, and at no time 
pansion of surgery and that pathologic con- up to the moment of her death had there 
ditions are seen much earlier than formerly, been the slightest untoward symptom. An- 
it is becoming daily more and more difficult other death occurred twenty-one days after 
to decide correctly and wisely for or against operation from acute nephritis following re- 
operative interference in many instances, moval of a suppurating appendix. While 
To decide correctly on the one hand wheth- still another patient succumbed to shock 
er surgical intervention is indicated or nee- following operation for ruptured spleen, af- 
essary; or on the other hand whether it may ter having ridden a number of miles in an 
not be contraindicated or unnecessary calls erect position in a buggy. This list also 
for the most careful and conscientious study contains the deaths following "The Opera- 
on the part of every operator. tion of I^ast Resort" in the advanced stage 
The responsibility of the surgeon is indeed of either the delayed or unrecognized cases 
great, not only to his patient but towards of septic peritonitis. In one series alone of 
retaining the confidence of the laity. The fourteen consecutive appendectomies, nine 
failure of an operation, either by incomplete- were drain cases with more or less septic 
ness or death, reaches far beyond the loss of peritonitis. The aim in presenting this list 
a life. For a community understanding an of fatalities is not to indicate in the slightest 
operation to be dangerous, or having been the mortality incident to any special class 
accepted by a patient as a last resort, is gen- of surgical cases, but simply to indicate 
erally lenient when failures occur; but in the gross mortality occurring in the institu- 
those cases where there is reasonable doubt tional work, 
of the justification of the oi)eration, where Mental Rcsnlts. 
the patient appears to the communitv as be- ,,,, , - . p ., 
ing in good health and the operative inter- Though a temporary confusion of ideas, 
vention be followed by failure, then it is ^o ^ varying degree, is. not infrequently 
that the community is obstinately unforgiv- f°^"^ following surgical intervention, the 
ing, and surgerv receives a set-back, which ^^ate of mental aberration or actual insanity 
not only impedes its progress, but discour- occurring as a surgical sequelae always pro- 
ages and turns many an urgent case against ^^^^^^ consternation and .resentment. I^or- 
a justifiable intervention. These are the in- tunately it is an extremely rare occurrence, 
stances which demand that the surgeon "\ comparison to the whole ncmber of oper- 
shall ever maintain in addition to his abilitv ations and still more rare m comparison 
and skill a close studv of his records, an ^^^J^ ^he whole number of insane. Never- 
eternal vigilance, from which springs the *^^^^^^^ ^^^^^ ^^ ^^"^^ occur should make every 
power to grasp the essential features of each operator observant and vigilant towards de- 
individual case, and thus formulate almost tecting any manifestations previous to the 
invariablv a correct decision, for the better- surgical intervention, and thus be able to 
ment of his patient and the advancement of )^'^"^ ^^^^^^ interested m the patient. For it 
surgery ^^ ^ sequela, which niav frustrate the aim of 
The following observaticms of The Ivnd the operation, appall the family and friends 
Results, Mental, Phvsical and Psvchic, fol- ° ,^t' ^f 'T ' "ifi bnng an odium upon 
lowing ablation of certain ()roons and '^^f '>^,^H "^ ^'^'? 'r'^-^'""^^^ 
Structures are based on conclusions person- , /V'' \ T i writer to discuss the 
allv drawn from 1250 operations occurring 'f''^*'"" ^'^^r.?" i^'^'/T ^""^""'^ . 
at the Private Sanatorium, Salisburv, in this ^^^^"^|^"" of the mmd followmg . surgica 
State. These cases cover a i)ost-oi.erative P^^^^dures, save to call attention to several 
period of more than six months, as no case P^^^ly clinical facts. It has been noted by 
has been considered in which tlie post-oper- an eminent writer "That the lower we go in 
ative convalescence has not extended over the animal scale, the more important the 

at least that length of time. ,^^.^^^^1 ;, i *^ i • i ^^ • • 

* visceral impulses seem to be in determining 



ORIGINAL COMMUNICATIONS. 15 

the actions of the individual. Hut in the safety and prol)al)le avoidance of serious 
normal, healthy individual these are kept in trouble later, that the youn.^- dauj^hter should 
the back-ground, whereas durin"' disease the be operated upon; yet she will hesitate to 
organic sensations may ijecome so promi- the point of refusal, wholly from dread that 
nent and insistent as to be important in de- the young girl's remote physical condition 
termining- action." may be impaired or she will show by physi- 

Thus the state of alienation succeeding cal depreciation the operation. It is not an 
an operation may be wrongly attributed to unusual inquiry whether the removal of the 
the surgical interference, when, in reality, appendix does not preclude the possil)ility 
if the actual condition of insanity did not of a long life. These are not ([uestions of 
ante-date the operation, a strong predisposi- jest, but asked in all earnestness, and must 
tion did. be met by physicians and surg-eons. 

The possible causative factors concerned Formerly when surgery was looked upon 
in a case of post-operative insanity are in- and acknowledg:ed to be an art of nece.ssity; 
numerable, the physical condition of the to be taken as a last resort, the remote after 
patient; the neurotic tendencies; the great effects came in for slight consideration. The 
fear and apprehension of the anesthetic; the operation had accomplished its end if the 
nature of the operation at that especial time; patient did not die. Now, however, surgery 
the kind of surgical dressings used, the af- is wisely looked upon, even by the laity, as 
ter treatment, especially with that cruel and a science of election. One to 1)e envoked, 
senseless withholding; of water for hours and not just resorted to. The means of not only 
hours, and finally the drugs administered, saving life, but of improving or removing 

The question of absorption in septic cases, conditions which are not in themselves nec- 
and the toxic influences, in those cases essarily dangerous, so much as undesirable, 
where the area of operation can not be ren- Again the laity is rapidly, very rapidly com- 
dered thoroughly aseptic, as the vagina, ing to the recognition of the immediate ad- 
rectum and genito-urinary tract .should be vantages and benefits obtained l)y early 
borne in mind as. possible factors. Sex does surgical intervention, even in some instances 
not seem to be a potent factor; the statistics abreast with the profession. It is beginning 
varying greatly on this point. to be understood that when the pathologic 

In the series of 1250 operations there were lesions are taken early in their period of 
four occurrences of alienation of the mind, life, how safe surgery is, and how seldom 
Three of these proved to have had mjijjcejd. th.e. dangerous and painful complications, 
predisposition to insanity; whil^'the*fi>urt]j;'3infiie41«.te to former operations, do now 
a septic case, has niadf?. fi '^ ^,rupflet6 re- 'otcur/.\.^o 'if is very natural that the lay- 
covery. v '>^' ' ^.. ... man's m*{n4,.;^eed of these points, should 

Regarding the remote, eiid results,^, frcilti turn to the mof.e Ireliiote end results and ask 
380 cases, of several!, • years back, I find, for assurayce. •'. *, 

from personal comrAunic^tjon^ takern.aUatt- : 'J^hkbpi-i.H to be' established is not what 
dom, the mental oonditioh' a-nH^ecp'i,!'^ /'i^i. kie re^flekfed'afler effect on the human body, 
fact, without exception,' the general reply the removal of an organ or certain struc- 
was unaffected or im])roved. This latter, tures may produce — a most comprehensive 
of course, is attributaljle to improved health study in itself — but simply to show thatt 
and improved condition. taking the body complex as a whole, the 

Physical and Psychic Results. physical and psychic integrity is not de- 

The remote physical condition of a pa- «troyed by surgical intervention, and there- 
tient, as a post-operative sequela may ap- ^^^ remove if not a local prejudice at least 
pear so self-evident to many of the profes- one too prevalent. 

sion as to be thread-bare, and lacking in ^° illustrate this point: In a series of 
value, or interest; but it is not so with^he ''f^ ^^^^^ ^aken at random, the percentage 
laity. It is an inquiry not infrequently of total absence of any unpleasant physical 
made. For, with the increasing recognition or psychical post-operative sequala what- 
that surgical intervention, in this period of ^Y^^ ^^^ '^^^^ • ^^ ^^^ ^P^ff^ ''^f ^- '"""f '"'' 
time, is more often accompanied by success f "°te, one was rupture of the pelvis of the 
than failure; that evil results are due more ^'^."^>^' ^^^^ extravasation of urine into the 
often from omission of an operation than Pfitoneal cavity following the extirpation 
from permitting one, the natural question of the opposite kidney two months previous, 
arises, what will be the final physical con- -I^he kidney was sutured and a large hydro- 
dition? Will it be possible to take up the f^^P"^^ and fibroid ovary removed, followed 
former lines of duty, on passing from the ^y recovery Even at advanced age exten- 
surgeon's hand? This is not an infrequent «^^^ surgical interventions may be resorted 
inquiry regarding the operations on the ap- ^o without untoward effect. Thus were two 
pendix during the interval. Or a mother cases of large, adherent, abdominal tumors 
may fully realize that from a standpoint of in patients aged 79 and 76 years respective" 



16 



THE CHARLOTTE MEDICAL JOURNAL. 



ly, removed by abdominal section, followed 
l)y an uninterrupted convalescence and com- 
l^iete restoration to health: while in another 
patient, asjed 87 years, a high amputation 
of cervix, with two extensive plastic opera- 
tions on the vagina for complete prolapsus 
utri, was likewise followed by complete^ re- 
cover^^ This patient is alive today, having 
experienced no unpleasant post-operative 
sequelae in the slightest degree. Finally, 
two cases of interest illustrating that even 
extensive manipulation of structures and 
organs may be followed by complete recov- 
er}' and the restoration of the human body 
to a normal state, not showing in the slight- 
est degree the extent of the trouble, nor the 
extensiveuess of the operation. I mention 
a cystectomy for a large, densely and uni- 
versally adherent cyst of the ovary, weigh- 
ing sixty-nine pounds. The recovery was 
uninterrupted after a perfectly normal con- 
valescence, (^ne splenectomy, for a large 
movable spleen, extending into the pelvis, 
weighing nineteen pounds. This case was 
operated upon four years ago. She has en- 
joyed excellent health, and has passed 
through two perfectly normal pregnancies. 
Id concluding, in order not to be misun- 
derstood, I repeat that in the critical review 
of these 1250 operations, the immediate 
complications or more remote particular re- 
sults, which do or may follow any special 
operation have Iseen purposely avoi-ded. TJie 
one object has been to show, in a broad.Wiiy, 
that out of the large number of operations 
the gross result is highly •satijjf&.ctory, and 
unless the i)athologic lesioa-ei'ther by delay, 
nature or extension as to- prechtde it, that 
the human body resumes its nonn'ai. st^te 
mentally, physically and psycliickily-'even 
after the most extensive surgical interven- 
tion. 



Some Points in Clinical Psychiatry of 
Interest to the General Practitioner.* 

By Isaac M. Taylor, M. D , Sui)erinUTident and 
Resident Physician Broadoaks Sanatorium, 
Moi'ganton, North Carolina. 

The family physician, in whose i)ractice oc- 
curs a case of illness accom])anied by mental 
symptoms, which develoi) independently of 
acute disease, or persist after the sul)sidence 
of fever, and well into the period of conva- 
lescence, has presented to him directly by 
the friends of his patient or by his own 
tliought several cjuestions which require, for 
an approximately correct atiswer, the expe- 
rience and the study of the alienist. 

1st. Is the symjitom complex in this case 
such that it should be termed "insanity"? 

Insanity is a term not possible to define, 

*rresentod at the Fifty-third Annual Meeting 
of Ihe Medical Society of the State of North 
Carolina, at Charlotte, N, C, May 29. 190(5. 



it is more of a legal than a medical term, it 
is relative, and what is denominated insani- 
ty by one set of people is not so called by 
another. 

To the alienist any prolonged departure 
from the normal mental processes not ac- 
companying the acute diseases and inde- 
pendent of the use of intoxicating drugs, is 
termed insanity. 

Under the common law and in countries 
where the development of the law has not 
recognized the disease conditions underly- 
ing deviations from normal mental states, 
there must be as a test of the lack of men- 
tal integrity, an inability to distinguish 
right from wrong, and an inability to con- 
trol the actions and emotions. 

The ordinary layman looks upon mania 
and dementia as the only insanities, and 
classes the equally insane paranoiac as a 
crank or criminal, according to the degree 
in which his acts are offensive to the com- 
munity, and thinks the melancholiac lacks 
only action to remove his depression. 

Taking a conservative position we may 
consider a person insane, who, independent- 
ly of acute disease and drugs, shows a 
marked degree of mental alienation, a wide 
departure from normal habits of thought 
and action, or who has become offensive to 
those with whom he has come in contact by- 
reason of his mental state. Symptoms which 
point.to a tendency to violence, homicide or 
Soici'Xie, should especially influence the fam- 
ily physician, to, a declared diagnosis which 
is alv^ays shoekiii^f, and often offensive, to 
the friends of the patient. 

2nd. Has the tim6 arrived for separation 
ff6m ,ho:me and treatmeirt in an institution 
espQcfially Jieyoted to tliese classes of in- 
valids? ■■■■'■'■- - 

The modern idea of the treatment of all 
diseases calls for the equipment of a hospi- 
tal, nurses trained for the especial work, 
construction of buildings adapted to the 
peculiar needs, and physicians in ready call 
for emergencies. The Psychopathic hospi- 
tal is as much needed for the treatment of 
recent cases of alienation as are the Surgi- 
cal hospitals for the treatment of surgical 
diseases and emergencies. It is true that 
with care some cases may be carried to a 
successful ending in the home. Hroadly 
speaking cases of Melancholia, of Dementia 
Praecox of the hebephrenic type, and mild 
cases of Maniacal-Depressive insanity in 
the depressed stage may, with sufficient 
nursing force, remain at home, always re- 
membering that melancholia means a strong 
tendency to suicide, that the precocious de- 
ment is subject without warning to do a 
violent act, and that maniacal depressive 
insanity may with little notice pass from the 
depressed stage to the maniacal. 



ORIGINAL COMMUNICATIONS. 



17 



We should be very watchful too for uu- 
suspected delusious and tendencies, the per- 
verted sexual instincts, the sudden impulse 
to burn or do other mischief. 

The paranoiac is usually unbearable at 
home, but may be trusted there until his de- 
lusions render him violent or show hiui to 
be dangerous. The maniacal state of 
maniacal-depressive insanity shouldbe treat- 
ed only in a hospital. Without exception 
all cases of Paresis, the general paralysis of 
the insane, should in the beginning of the 
disease be removed from the environment of 
home, and all cases where in any form of 
insanity there is a marked homicidal or sui- 
cidal tendency. The demented states of all 
forms of insanity can be cared for by those 
anywhere who have the willingness to take 
the trouble, the patience to persuade to eat 
and the skill to feed by force when food is 
refused. 

3rd. Is the mental disease in this case, in 
the class of those which will recover? 

It is impossible for any one, however 
skilled or experienced, to say which case 
will recover; it is possible with reasonable 
certainty to pick out some which will not 
get well, but these sometimes will deceive 
us. 

It is, however, possible by close analysis 
to place a case in a class and reason from 
experience what chance it has for recovery, 
youth is a favorable factor in the prognosis, 
a small per cent, of the cases of dementia 
praecox will recover. 

There will be apparent recovery in about 
half the cases of maniacal-depressive in- 
sanity occurring in persons under forty 
years of age. Melancholia, usually occur- 
ring as it does in elderly persons, whose 
condition is one of degeneration with a 
marked lowering of vitality and usually as- 
sociated with organic disease of heart, liver 
or kidneys and atheroma of arteries, points 
to an unfavorable prognosis. 

Insanity associated with epilepsy we may 
regard as chronic, and while between times 
the patient may be quite well showing no 
symptoms beyond an impaired mentality, 
we may be sure of another outbreak. 

The paretic will not get well, and alco- 
holic dementia, though running its course 
to a fatal ending much more slowly, gives 
no promise of other change than gradual 
and positive decline in mind and body. As 
a rule a case of insanity with distinct audi- 
tory hallucinations is to be regarded as 
chronic. Insanities occurring in markedly 
hysterical subjects give promise of possible 
and often astonishing recoveries. Insanities 
the result of toxis, septicaemia, auto-infec- 
tion, or the acute diseases, may be expected 
to recover with the removal of the cause. 
The factor of heredity must be considered 



in every case and has a very great bearing 
on the prognosis. 

The cases of paranoia are hopeless from 
the beginning, and cases of dementia iirae- 
cox, which have developed paranoiac symp- 
toms, are most unfavorable. We may con- 
clude that a mistake in diagnosis has been 
made when a case called paranoia gets 
well. 

4th. In the event of recovery may we ex- 
pect full recovery or will there be permanent 
impairment? 

The cases of insanity resulting from toxis, 
auto-intoxication and the acute diseases 
may result in perfect and complete recovery. 
Some cases of dementia praecox may end 
in recovery so nearly perfect that we can 
point to no evidence of mental impairment. 
The maniacal-depressive forms of mental 
disease furnish the greatest number of ap- 
parent recoveries. The epileptic insanities 
are followed by a continuance of the recur- 
ring epileptic seizures and eventually by a 
permanent l)lunting of the mental faculties. 

Sth. May we expect a return of the men- 
tal disease in after years? 

The occurrence of mental disease demon- 
strates a constitutional lack of nervous bal- 
ance. Almost always a search will show 
hereditary causes, and these being present, 
under similar stress the mind may again 
give way and insanity develop. 

The cases of maniacal-depressive insanity 
which recover will, in many cases, in after 
years again develop the prominent symp- 
toms which we call insanity. 

Cases which follow acute disease, recov- 
ery being complete and those cases caused 
by toxis, give the best promise of permanent 
recovery. 

As civilization advances we find more 
and more the mental deterioration which 
the struggle for life brings, the effect of the 
use of alcohol to excess by forebears, the 
presence of syphilitic taint from personal 
infection or as an inheritance is more and 
more in each succeeding generation, as we 
seek for the etiology of the cases, brought to 
our attention. 

In conclusion, there are no diseases to 
which such careful study must be given be- 
fore a diagnosis is made, as those of mind, 
and we may not pronounce any person in- 
sane before there is thorough study of the 
body functions and a complete release from 
commanding drugs, especially the more 
potent so-called hypnotics. A diagnosis 
having been made, there is no greater in- 
justice to the patient and the family of the 
patient than, from fear of offending, to keep 
up the hope that the case will go on to re- 
covery while continuing it in the conditions 
which must be most unfavorable for such a 
result. The hospital is not always indicated, 



18 



THE CHARLOTTE MEDICAL JOURNAL. 



l)ut the hospital comes always l^efore con- 
tinued seclusion, the continued solicitude of 
injudicious friends and neio:hbors, and es- 
pecially before the continued use of sedative 
and sleep-conimandinc;- drugs. 

When The Baby Comes.* 

By Dr. Cyrus Thomp.son, Jacksonville, N. C. 

There is no other time in a woman's life 
like the hour when the baby comes. You 
saw her "like a red, red rose that's newly 
sprung- in June" when, just bloomed into 
ripe womanhood, she bent down one day 
and kissed her neighbor's new-born baby, 
and said extravagant things to it, things 
which you and I could never have thought 
of. Moved by her two strongest instincts 
of maternity and protection, the protecting 
arm of the man who for love should choose 
her from among a thousand, she was dream- 
ing of the time when, in her husband's 
house, she should kiss and clasp to her 
breast a bairn born of her own body. Not 
consciously, it may be; but so dreaming, 
none the less. And now the hour is come, 
and it is a time of trouble. It is her supreme 
hour. In other hours of trouble, she may 
comfort herself with friends, or find solace 
in fair recollections of long ago she may 
hope that time, moving slowly, will smoothe 
the bitter angles of a deep regret, or dull the 
keen edge of a lasting sorrow: some balm of 
drug, or touch of hand, or kiss of love, may 
ease her pain, or quiet her fear, or give her 
rest. But this is the hour of fruitage; the 
rose-petals are all blown with the winds; it 
is the hour of fact and not of dreaming 
fancy. It is the inevitable crisis which 
must be met in the path of her love in ful- 
fillment of her highest destiny; and the wo- 
man must be in travail alone. Ciod pity 
every woman that conies to bed with child, 
and give her that sweetest of all a woman's 
joys, to know that a man, or a woman, is 
safely born into her house! Have you never 
heard one say "Oh, Doctor! I am so thank- 
ful it is all over, and that the baby is all 
right?" I have sometimes thought that no 
man ever felt a joy comparable to that. 

Do you say that you will relieve her pain 
with chloroform, or ether, or morpliine and 
scopolamine? Take away all her pain — I 
have seen an eclamptic unconscious of it — 
make labor as painless as the kiss of love, 
the hour when the baby comes is by no 
means thereby delivered of its pregnancy. 
The accidents that may befall her then and 
the c()nse<iuences that may follow long after- 
ward, anaesthetics do not relieve these. A 
painless labor will not prevent a laceration, 
or a hemorrhage, or an infection. It may 
or ma\- n ot leave the woman in apparently 

*Read before the North Carolina Medical Socie- 
ty, Charlotte, N. C. 



better condition upon the termination of the 
process. Go ask the general practitioner 
how many of the ailments of mothers date 
from the birth of the baby; ask the gyne- 
cologist how far a better practice of obstet- 
rics would diminish his clientele; and ask 
the husband what time the roses began to 
fade from her cheeks and the daily weari- 
ness to come on, and the zest of love and of 
life began to wane. Their answer will but 
emphasize the mother's need of the profes- 
sion's best care when the baby comes. 

True it is that the healthiest, helpfulest, 
happiest women, I ever knew were mothers 
— mothers of many children, women that 
were well cared for in their confinements. 
One such I met only a few days ago at a 
house whither she was come to inquire after 
a neighbor's sick baby. A plain farmer's 
wife she is; she does her house work and 
kitchen work without servants. "l have 
seven children," she said. On my drives 
that way I see her children, robust and 
happy. The color and spirit of June days 
has not left her face and mien; her eyes are 
not dimmed, nor her natural force abated. 
This woman knows nothing of headaches 
and backaches and dragging sensations, 
and pains about her heart and lumps in her 
throat, and miseries in her side and in her 
pelvis. Her husband is full of industry, 
and his face is without worry. In the na- 
ture of things, to be sure, this woman will 
pass 

"Thi-ough years of toil and soil and care, 
From gio^sy tress to thin gray hair;" 

But none the less true it is, that 

"The morning dew that dries so soon 
With others, glistens at her noon.'' 

But this type of mother is not the rule, 
unfortunately: it is the exception which 
proves what the rule ou-ght to be. With 
better attendance for women when the baby 
comes and for a little while afterward, this 
small company of normal mothers could be 
largely increased. In what other way could 
the sum total of human happiness be so 
greatly augmented? A strong and happy 
woman in the house is the surest founda- 
tion for a prosperous and happy household. 

It is well that tliis Society twenty-odd 
years ago took a stand for the protection of 
the public, and secured the passage of the 
act regulating the practice of medicine in 
North Carolina. A member of the Legisla- 
ture at the time, I well remember how this 
innovation upon old custom, this "infringe- 
ment of human rights, " was opposed. Law- 
yers opposed it, although they might gener- 
ously have considered it an effort of medical 
men to get legally on an equal footing with 
them. Even medical men in the Assembly 
opposed the measure, we need not stop to 



ORIGINAL COMMUNICATIONS. 



19 



inquire why. Its best friends, perhaps, 
were thou<ilitful farmers and ])usiness men. 
The bill liecame law, however.^ — weak as a 
child to begin with; but through lapse of 
years, now grown well-nigh to manhood, it 
is firmly fixed in popular favor. This act 
protects the i^ul^lic against gross ignorance 
in the practice of medicine, — except in the 
one important field of obstetrics. Anybody 
may practice midwifery in the proud com- 
monwealth of North Carolina who has 
knowledge that, when the baby comes, it is 
followed by an afterbirth, which must not 
be left permanently attached to the child. 

If there be a remedy for this public and 
professional disregard of the w^elfare of 
women, it is cruel not to find and apply it. 
The mothers directly, and their families in- 
directly, are entitled to the benefit of it. 
We have laws for the protection of the pub- 
lic against acute contagious diseases, dis- 
eases dangerous to the public health we say; 
not one of which, nay, not all of which are 
so destructive of health and happiness as 
the ignorant, careless, and uncleanly prac- 
tice of midwifery. 

I have sometimes wished that pregnancy 
might be included in the list of contagious 
diseases, and that parturient women and 
their attendants were quarantined and dis- 
infected before the labor begins. One ac- 
quaintance I have who does, indeed, so re- 
gard it. lie rang my bell early one morn- 
ing, and my wife, being near the door, an- 
swered. Lying in bed, I heard the young- 
man say that "Mr. Blank's wife is mighty 
bad off, and he wants the Doctor to go and 
see her just as quick as he can." My wife, 
who is always afraid that I will bring home 
smallpox, diphtheria, or the like, to our 
children, asked what was the matter; and 
added, "She has'nt any catching disease, 
has she?" I heard the fellow stammer, 
"Ye — yes'm! She's in the family way!" 
I got out of bed at once, and went to the 
door to relieve the faltering speech; from 
which I had gained knowledge. Labor is 
the limit of a germ disorder that affects, or 
is liable to affect, about one-half of the 
population; and previous attacks confer no 
immunity upon the subject of the malady. 
I went with due haste, and took with me the 
usual disinfectants. 

It is said that the saddest commentary on 
the boasting of modern medicine is the con- 
tinued presence of puerperal infection. In 
other fields of surgery, the danger of infec- 
tion is practically nothing: nobody expects 
infection in a laparotomy. And while ob- 
stetricians were the earliest advocates of 
asepsis, it is declared by as high authority 
as the President of the Obstetrical Society 
of London, that the mortality from puer- 
peral fever has rather increased than de- 



creased in the last 20 years. DeLee of 
Chicago, holding similar opinion, says that 
it is a very conservative statement to say 
that 6000 women in the Ihiited States die 
every year from puerperal fever, to say 
nothing of the vastly greater multitude who 
suffer infection and recover. And what is 
true in this particular of the United States 
and Great Britain, is none the less true on 
the continent, also: Bumm says that 4000 
to 5000 women die annually from puerperal 
fever in Prussia. The record was no worse 
in pre-antiseptic days. But we are told that 
in large cities the showing is better than in 
the country districts; and that in Maternity 
Hospitals, mortality and even morbidity 
from puerperal infection have been reduced 
to almost nothing. So, then, we are con- 
fronted and staggered by the ugly fact, that 
in private practice puerperal infection is at 
least as frequent now as it was in the days 
when we knew nothing of asepsis. 

This difference admits of but one explan- 
ation: if the Maternity Hospitals have put 
obstetrics abreast of surgery in other fields, 
it is only because they consider every case 
of labor a case of surgery; and in every 
confinement, therefore, they attempt the 
same aseptic precautions that surgeons ex- 
ercise elsewhere; and, if private practitioners 
of obstetrics, whether physicians or mid- 
wives, are followed more frequently than 
the maternities by puerperal infection, it is 
mainly because they do not view labor in 
this reasonable light; and do not, therefore, 
whether from carelessness or ignorance, 
take the same aseptic caution in the conduct 
of it. 

It is admitted that when the baby comes 
in private homes, the conditions surround- 
ng its coming are, on the average, not so- 
iavorable for clean work as the circum- 
fstances of a modern hospital. But the con 
ditions in private houses are certainly no 
worse, and are probably better, than they 
were twenty years ago. And may it not be 
said, moreover, that the physician is meas- 
urably the maker of the environment? liven 
in the houses of the poor, would not the en- 
vironment in any case be bettered upon the 
word of the professional attendant? Noth- 
ing but a clear denial of the value of asepsis 
can charge the bad showing of private prac- 
tice to faulty surroundings. 

If the physician would get it fixed in his 
mind that all obstetrics is surgery, requiring 
scrupulous surgical care, he would teach 
the public lessons in cleanliness which even 
the poorest would heed. For the physician, 
if he will be, is an authoritative teacher, 
authoritative certainly among the poor. As 
it is within his power, therefore, it is the 
physician's province to educate the public 
to cleaner and better conditions about the 



THE CHARLOTTE MEDICAL JOURNAL. 



parturient and puerperal woman. 

But the oeneral practitioner, it must be 
confessed, is sometimes a careless obstetric- 
ian. It may be that circumstances tend to 
make him so. Reaching a case belated af- 
ter a hard drive, he may find the waters 
l)roken, the head upon the perineum, or, it 
may l)e, already born, — conditions so urg- 
ent among anxious friends as seeming to 
excuse his lack of preparation. The woman 
in dire distress may have fallen into the 
hands of a midwife, or of some superannu- 
ated female friend whose fear, sympathy, 
and ignorance stand in perfect equation. 
In such circumstances, what time has the 
physician for thorough cleansing, and what 
will such cleansing now avail? If he would 
infect the woman, she is infected already: 
so he may persuade himself as he throws off 
his coat, rinses his hands with a little soap 
and water, and dries them on a towel which 
has been doing multiple service. In God's 
providence, this woman does well: he may 
recall others of like good fortune. Gradu- 
ally asepsis becomes tiresome and seems 
unnecessary to our professional man. One 
day it occurs to him that Adam and Cain 
must have been their own obstetricians. 
What did Adam know of sterile water, or 
bichloride solutions, or rubber gloves? He 
didn't even have soap. Adam knew noth- 
ing of these things, and no more knew Cain, 
his son, in the land of Nod. So he settles 
down dreamily into the foul ooze of the 
midwife. 

But the ])liysician should always remem- 
ber that in midwifery he is a surgeon. 
If a perineum tears, he can afterward repair 
it. It were better so than prevented with 
infectious hands. And the hands of the 
midwife may be nearer sterile than his own: 
he may Ining with him contamination from 
some focus which she has not known. 

The infection of a puerperal woman, — 
child-l^ed fever they call it and remember 
who died of it — is a matter of the gravest 
solicitude to the mother herself, to her hus- 
l)and whose life centers in his wife, and to 
her friends who are helpless about her: the 
children who play in the yard, they alone 
keep happy with the thought that "a pretty 
little l)al)y" is come. Their only worry is 
their wonder where it came from. And 
what if the infection through your fault 
proves fatal? Tlie woman makes no accus- 
ation: she has found "rest from all bitter 
thoughts and things." The husband does 
not ])lame you: while he is struggling to 
reconcile himself to "God's will," his ignor- 
ance covers your crime. But when you 
look into the sad faces of motherless chil- 
dren, what will you say to them? And 
when their father sits by his fireside alone, 
musing 



"How strange it seems, with so much gone 
Of life and love, to still live onl" 

what cheer has your conscience for him? 

Like every oUier surgeon, the obstetrician 
must take time to make reasonable prepara- 
tion for his work. It is a prime maxim in 
all practice to do no harm. To make haste 
slowly is better for his patient, and it is best 
for him. P^or while sepsis is not always 
fatal, it is always distressing and it may 
entail conditions and suffering which the 
woman will bear about in her body through 
the long-drawn days of a wretched life. 

When labor begins, the contents of the 
uterus are aseptic. Rarely, if ever, at this 
time are septic organisms found in the 
vagina; and the vaginal secretions are pro- 
tective against such organisms if present. 
But the external genitalia are always septic, 
and the unsterilized hand of the accoucheur 
is always septic. Ninety-nine per cent, of 
all cases of puerperal infection results from 
vaginal examinations and manipulations. 
As a source of infection, unclean apart- 
ments, bed-clothes and garments are not 
comparable with unclean hands and unclean 
genitals. If the woman is infected, there- 
fore, the fault lies with the accoucheur who 
fails to put unclean fabrics out of his way, 
and to disinfect himself and his patient. 

But when the physician has ample time 
at his disposal, does he always have due re- 
gard for obstetric asepsis? No man should 
examine a parturient or puerperal woman 
until he has thoroughly disinfected his 
hands and his arms above the elbows. We 
are told to trim and clean the nails, and to 
scrub with brush and soap and warm water 
for five minutes, changing the water two or 
three times, and then to scrub for the same 
length of time with a 1:1000 bichloride so- 
lution, or a solution of lysol 1:150, or the 
like. So little as this is not always done. 
If done, it may be insufficient. Such cleans- 
ing might do for hands not specially con- 
taminated, and so cleansed every day. But 
the delivery of babies is not an every-day 
business with the general practitioner; and, 
besides, the general practitioner attends all 
sorts of cases. He may be dressing an 
erysipelas or a suppurating wound today 
and attending a labor tonight. No scrub- 
bing for five minutes will sterilize his hands, 
and no brief contact of a solution harmless 
to the skin will destroy all the pathogenic 
bacteria that flourish thereon. Let it be 
realized that no antiseptic in reasonable 
strength has power in reasonable time to 
take the place of prolonged use of brush 
and soap and frequent changes of warm 
sterile water. This process alone, indeed, 
continued industriously for thirty minutes 
will render the hands practically aseptic. 



ORIGINAL COMMUNICATIONS. 



It is immensely better than the i)erfunctory 
use of a o-ermicide: if it kills no bacteria, it 
does as well by removiiis' them. And when 
this is followed by the prescribed antiseptic 
solution, left to dry upon the hands, it may 
be deemed a reasonable disinfection. If, 
in addition to this, the obstetrician will use 
rubber gloves sterilized by boiling-, — and es- 
pecially so if he has been about some septic 
case, — he may then trust that, for himself, 
he has clean hands and a good conscience, 
a conscience which in any outcome will not 
cower his eye or startle his heart. 

But having removed from himself the 
probability of becoming a source of danger 
to the woman, he must, before making any 
examination, take like care to render the 
woman harmless to herself. To be aseptic 
with himself and septic with the mother is 
criminal absurdity. He should clip at least 
the vulvar covering, infectious in the be- 
ginning and a constant menace by retention 
of coagula and discharges afterward. Does 
she object to exposure? Upon explanation, 
she consents readily to whatever exposure 
you deem necessary for her safety. No 
fiu'the rexposure in any case should be made 
than is necessary for the right performance 
of your duty: not to make this much in 
every case is wanton disregard of your pa- 
tient's welfare. Carefully separating every 
fold, you should wash the vulva and all the 
region around about for fifteen minutes with 
soap and water and pledgets of clean cotton, 
and afterwards bathe the parts with a 1 :2000 
bichloride solution, and irrigate the vulvar 
region from above with the solution from a 
sterile bag. Making the external genitalia 
aseptic, you remove from the woman the 
second of the two sources of her danger. 
For, while there lis a possibility of auto-in- 
fection by means of bacteria lodged in the 
vagina by coitus or by self-examination, 
this source of infection is so rare as to be 
practically inconsiderable. 

If the case has been in the hands of a 
midwife or other unclean attendant, infec- 
tion from this source must be assumed as a 
fact already ;and, in addition to the external 
disinfection, the vagina should be copiously 
douched with the bichloride solution ( 1 :2000) 
followed by sterile water. 

During the progress of the labor, the parts 
should be kept covered with an aseptic nap- 
kin, and cleansed by antiseptic sponging 
before examination. Examinations should 
be as infrequent as certainty of conditions 
will admit; and the fingers should never be 
passed into the vagina again until they 
have first been re-sterilized. Let it bear 
hard upon your conscience that the source 
of infection lies outside the vagina; and that 
rigid asepsis prevents infection. The ma- 
ternities have made their brilliant and 



beneficent record and ])ul to sliame llie ])ri- 
vate practice of midwifery only l)y right 
appreciation of these simple facts. 

When the baby is come, — when the labor 
is over and the mother would rest from her 
travail, your duties are not yet done. Re- 
sides guarding her against the accident of 
hemorrhage, the physician himself should 
wash the external parts with the same 
scrupulous regard for asepsis tliat has char- 
acterized him in the progress of the case. 
This is a part of your work. Ihiless, as 
seldom happens, you have at hand a com- 
petent nurse, who has been made as clean 
as yourself, you must not relegate it to an- 
other. With your own hand and e>e, you 
must carefully examine for jjelvic-floor lac- 
erations. You may have endeavored judici- 
ously to prevent this accident of labor, and 
you may have failed in your endeavor. It 
is an accident which, to considerable extent, 
notwithstanding the use of every known 
method of supporting the perineum, occurs 
in more than 20 per cent, of all first labors, 
and in nearly five per cent, of all others. 
You may have attempted to prepare the 
vaginal outlet by careful and continued 
backward and outward massage-pressure; 
but the rigidity may have resisted your ef- 
forts. You may have tried to delay the ex- 
pulsion of the head and to deliver it between 
pains. Fierce and prolonged contractions, 
or relative disproportion between presenting 
part and parturient outlet, may have ren- 
dered all your efforts vain. Or if the head 
is safely through, the damage may be done 
in the birth of the shoulders. It sometimes 
happens that the expulsive effort is so in- 
tense and continuous that you are unable, 
in the delivery of the shoulders, to give the 
perineum the advantage of the cervico- 
acromial over the bis-acromial diameter. 
Laceration may occur in consequence of 
your inability to deliver the posterior shoul- 
der first. And unavoidable lacerations may 
have occurred in other ways. But it is the 
phj'sician's business to know if they have 
occurred; and, if they exist, he must repair 
them as soon as the mother takes a little 
rest and the oozing from the torn surfaces 
is visibly checked. 

If lacerations of the cervix have taken 
place, of these you will attempt to find out 
nothing, except in cases of 7)rofuse hemor- 
rhage, which may come from a cervical lac- 
eration extensive enough to involve the 
circular artery. Only such accident would 
necessitate or justify immediate inspection 
and repair of the cervix. For besides the 
added danger of infection, lacerations of 
the cervix have a fine tendency to take care 
of themselves. 

Your work so far complete, you should 
cover the vulva with gauze wrung out of a 



22 



THE CHARLOTTE MEDICAL JOURNAL. 



1:10,000 bichloride solution; and over this 
should be apth^ placed absorbent cotton or 
a clean napkin. Let this dressing be chang- 
ed, a strong boric acid solution being sub- 
stituted for the bichloride, and re-applied as 
often as it becomes saturated; and, for sev- 
eral days, the parts at each change shovxld 
be cleansed with an antiseptic wash; or, 
rather, irrigated from above with sterile 
water. Disinfectants should be left for the 
use of the attendant, and she should be well 
instructed as to the method and the neces- 
sity of cleansing her hands before touching 
the puerperal woman. 

If the mother will use a bed pan for ten 
days, the vulva will be less an open wound 
than if she assumes the sitting posture, — a 
point worthy of insistence if any sort of 
vulvar covering against infection is worth 
the using. 

In ordinary labors, the ph3'sician should 
remain at the house for two hours after the 
birth of the baby; and before leaving, when 
the condition of the mother is good, he 
should prescribe for her, by way of further 
prophylaxis, 5 grains of quinine three times 
a day for three or four days, and ergot and 
hydrastis with nux vomica for two weeks; 
and he should enjoin upon her the reason- 
able necessity of remaining recumbent in 
bed for three weeks, — 1 had rather advise 
four. And this is advised in deference to 
the following facts: the upright or sitting 
posture is in no wise essential for proper 
drainage or the woman's comfort; after 
labor the womb requires six weeks or more 
for its perfect involution; the heavy puer- 
peral uterus is easy of displacement and 
consequent subinvolution, when the woman 
leaves her bed for any purpose; and "smart- 
ness" in the early weeks of confinement is 
the one fruitful cause of malposition and 
subinvolution with their numerous evil 
brood. 

As a further aid to early involution, the 
physician may safely advise after the twelfth 
day postpartum copious hot vaginal douches 
once or twice a day. They will give a sense 
of cleanliness and a feeling of comfort; and 
their effect, both local and systemic, is every 
way desirable. 

Unless there be some special indication, 
as we have seen, for vaginal disinfection, 
no douche .should be given antepartum; 
and, short of the twelfth day postpartum, 
none should be given, except after ojoera- 
tions and instrumental deliveries, or for the 
arrest of postpartum hemorrhage, or for the 
prevention of further se])tic absorption when 
this is thought already to have begun. In 
the latter instances the douche should be 
first vaginal and then intra-uterine through 
a Fritsch-Bozeman tube. 

And yet I have no doubt that the comfort 



of every woman just delivered would be en- 
hanced by an immediate postpartum vagi- 
nal douche of hot sterile water as a part of 
her cleansing. Nothing but the fear of in- 
fection by this procedure forbids its routine 
use. It would tone a tired and relaxed 
uterus; it would soothe bruised and wound- 
ed tissues; it would wash away clots and 
possibly shreds which, easily infected, might 
become a prolific source of infection. If 
this immediate hot sterile douche were fol- 
lowed three times a day for a week post- 
partum by a copious warm douche of boric 
acid, one or two drams to the pint of sterile 
water, it would be conducive to comfort and 
beneficial in fact, — provided it were given 
under rigid aseptic conditions. But in 
questionable hands it is omitted: so the wo- 
man is safer from sepsis if the vagina is left 
to care for itself when the labor is ended. 

If it had been written in the Holy Scrip- 
tures that Jonah swallowed the whale, and 
not that the whale swallowed Jonah, this 
statement, notwithstanding the disparity be- 
tween mouth and morsel, would have found 
easy credence among the faithful, because 
the faithful would see that all things are 
possible with Omnipotence. That the whale 
swallowed Jonah is easy of belief for both 
mechanical and anatomical reasons. And 
for valid analogies, indeed, it should not be 
hard to believe any of the miracles of Scrip- 
ture, if we consider a moment the wonder- 
ful things round about us. That charming 
old French essayist, M. Montaigne, declar- 
ed that he accepted them all for the reason 
that he discovered in his own body greater 
miracles than Jewish historian or Christian 
evangelist anywhere records. Physicians 
may be careless obstetricians sometimes; 
but, in labors in homes, medical men deliver 
but a meagre portion of the incoming popu- 
lation. The inevitable tide of domestic im- 
migration flows towards* the midwives. The 
private practice of obstetrics is mainly their 
work. When one inquires into the charac- 
ter and qualifications of the average mid- 
wife, it is little short of miraculous that so 
many children live and so few women die 
when the baby comes. 

But some one has said that God always 
takes care of children, fools, and the United 
States. The birth and splendid growth of 
our nation declare the Divine blessing at- 
tendant upon it; the multitude and fair 
fortune of fools show that they are loved 
and held by some mighty hand; and the 
deep eyes and joyous laughter of children 
bespeak their easy citizenship in the King- 
dom of Heaven. But the mothers of the 
children, these highest organisms following 
their highest instinct and fulfilling their 
highest destiny, who cares for them? God 
takes care of the mothers also. The makers 



ORIGINAL COMMUNICATIONS. 



23 



of the prayer book recognized this fact and in the wood and i)ick(-d u]^ dniv rhips from 
the need of it, when they tanght us to pray the wood-pile to keep the room uurni and 
for all women in the perils of childbirth, comfortable; and then she warmed her 
Oh! it is wonderful, God's care of mothers hands and washed the lochia from the.'^'-eni- 
from Mary until now! tals. No service was too menial for"" her 

But I am not sure that the Lord is well willin.-r hands to do. And so she did what 
pleased that you and I and the people of she could: she cast in her mite. 
North Carolina only pray for the mothers This hard problem would be solved by 
in their travail, leaving them in their su- the transfer of parturients to Maternities for 
prenie hour, when most of all they should childbirth in i:.lace of allowing confinement 
be the recipients of high-born kindness and at home. But this solution is impracticable, 
the highest benefits of skill and science, to Limitation of the practice of midwifery to 
suffer in the hands of superannuation, super- medical men would approach a solution, 
stition, blind stupidity, and contented ig- But this, also, is impracticable for sundry 
norance; in the hands of midwives, careless and evident reasons. In most sections, the 
and unclean, dull or over-wise in their own midwife is a necessity, a necessary evil, 
conceit, pestilential examples of dismal in- But the profoundlv ignorant, or criminally 
competence and inefficiency. wise, and unclean midwife is not a neces- 

You have seen their work and the wretch- sary evil anywhere, 
ed fruitage of it. Not long ago I delivered In the face of conditions like these, the 
a placenta and checked a hemorrhage and public plods on, demanding no ameliora- 
contended four hours with the powers of tion. 'Such things be, and overcome us 
darkness to re-balance a mother who was like a summer cloud, without our special 
sinking away from her children in the sym- wonder. ' So men go undisturbed amid the 
pathetic presence of stolid helplessness, blood and carnage of the battle-field: it is 
And twice these few months I have fought seen so often; it seems so unavoidable; as it 
sep.sis following the service of the most ex- is now, it always has been; it is necessary, 
perienced and knowing midwife in my com- So the public wears without protest the 
munity. In January, I drove twelve miles old clothes of crooked custom. The public 
one bitter night to see a mother with babe is too ignorant to demand amelioration, 
five days old. She had a chill that morn- The public needs to be taught. It is the 
ing, I was told, and the babe was having peculiar province of this Society to teach 
spasms. I found her with sharp tempera- the public. It always waits to be taught 
ture, perspiring freely, face anxious, intel- and it is always responsive to your teach- 
lect clear, teeth clinched, and head drawn ing. Let the profession teach 'the public 
back into her pillow. The child lay on a the importance of a mother's confinement, 
pillow in a chair near the fire, — cyanotic, Already you have taught the public that 
generally spasmodic, and spasmodically anybody is not good enough to treat a fever: 
dyspnoeic, — a pitiable picture. This mother teach it now that anybody is not good 
and her babe died within thirty hours after enough to attend a labor; teach it more, — 
the onset of tetanus communicated to both that only the best obtainable is good enough 
by the dirty hands of a kind-hearted old at a time so full of eager solicitude, so 
negro midwife; who could accurately fore- pregnant of immediate possibilities and far- 
tell the number of subsequent pregnancies reaching consequences. If you would bet- 
by counting the lumps on the cord; and ter the public health, here opens the most 
would not for anything wash the baby until fertile field for your efforts. 



the afterbirth was come; and would not dis- 
pose of the afterbirth without first sprinkling 



If this Society would consider the feasi- 



it with salt; and would not sweep under the ^^^^^^ .°^ ^°"^^ legislation looking to the in 



bed during the lying-in period; lest, for 
sooth, some dire mishap should surely be- 
fall mother or child. To be sure, this stupid 
midwife is unconscious of her crime; the 
public takes no account of it; the husband 
paid her fee and speaks of her kindness to 
his wife; and the little children know onlv 



struction of midwives, even if that instruc- 
tion went no further than the teaching and 
enforcement of asepsis, it would confer a 
signal and lasting benefit upon women, and 
entitle itself to the State's amplest gratitude. 
There must be some' balm in Gilead. Surely 



that their mother was buried when there something better can be done for the aver- 
was snow on the ground. age mother when the baby comes; something 

And why should not the husband, all r r . ^.i, i i .1 • 

crushed as he was, pav the midwife and °'' «^fer stronger motherhood; something 
thank her, too? He was poor and she was ^^^ more hopeful and helpful companionship 
industrious. She washed the baby and all of women with men; something for the bet- 
its belongings; she washed the soiled bed- ferment of the race in the bearing of strong- 
clothes and garments of the wife ;she brought er babes on the breasts of sounder mothers. 



THE CHARLOTTE MEDICAL JOURNAL. 



Tho Effects of X Ray* Upon the Blood. 

Liuser and Helber (Deutche Arch, fur 
Klin. Medizin.) have experimentally in- 
vestigated the changes produced in the 
blood of rabbits as the results of exposure 
to the X ray. They find that the Rontgen 
rays exercise a direct influence upon the 
white corpuscles; the destruction of leuco- 
cytes — among which the lymphocytes are 
the least resistant — is most marked in the 
circulating blood. This destruction of 
leucocytes, whether in the blood or in the 
tissues, produces a secondary change in the 
blood serum ; it enriches it in leucotoxin. 
The sera derived from rabbits after raying 
has a destructive effect upon the leucocytes 
of other animals into which it has been in- 
jected : it also can pass from mother to 
fcBtus via the placental circulation. The 
formative changes that occur in such sera 
after exposure to the X rays produce an 
immunizing body, whose action is opposed 
to that of tlie ieucotoxir ; this body is ren- 
dered inert by txposure to heat between 
55 ^^K ^'^ 60 deg C. Apart fr'^m the 
dirtci influence of tlie rays upon the kidney, 
lu-phrilides occur. Tlie effect of tiie Rnnt- 
gen rays upon tlie red sell';, biixni plates, 
and haemoglobin, is sliglit. Tlie coagula- 
tion of the biood is not affected by the leu- 
cocytic disintegratif.m set up by the X rays. 
No specific relation would be established 
between tlie action of rad'um and ultra 
violet light and the blood cliar.ges. 
Membranous Colitis. 

White (Guy's Hospital G:tzette.) in a 
clinical lecture on this interesting subject, 
states that the disease is irost common 
among those who have had indigestion and 
are constipated. It is commoner among 
the middle and upper classes than among 
hospital patients. This is quite a definite 
disease, characterized by considerable ab- 
dominal pain, and the passage by the bowel 
of huge casts of coagulated mucus, which 
from on the interior of the intestine. They 
may be a foot or more long. These casts 
are quite struciureless when viewed under 
tlie microscope, and adhering to them are 
a few epithelial cells, which have been drag- 
ged off from the intestinal mucous mem- 
brane. The best nomenclature for this 
disease is muco-membranous entero-colitis. 
It is very doubtful whether any inflamma- 
tion is present in this disease, which is pro- 
bably a disorder of secretion, as a result of 
which excess of mucus is passed. It is much 
more common in women than in men. It 
mostly affects young adults or those in early 
middle life, and it is far more common about 
the age of thirty than at any other period. 
When elderly subjects suffer from thisdisease 
it is generally associated with some unusual 
condition. The prognosis is favourable, 
and it rarely causes death. When this 



condition is present it becomes the duty of 
the physician to see that malignant disease 
of the bowel does not exist. In this disease 
the sigmoid is often found thickened, 
These patients are distinctly neurotic, and 
some of them suffer from enteroptosis. It is 
sometimes associated with appendicitis. 
Successful treatment consists in keeping 
the large bowel empty. This may be 
achieved by giving castor oil. If this can- 
not be taken, then sulphate of magnesium, 
sulphate of sodium, or phosphate of sodium, 
may be tried. Again, calomel may be given 
instead. Washing out the bowel with water 
at 100 deg. F. is valuable. Operation may 
be tried when medical measures fail. 
Milky Ascites. 

Volpe (Giornale Medico del Ro. Eser- 
cito.) describes the case of a recruit, aged 
twenty-one, who, when fourteen years old, 
had typhoid fever with malaria, and had 
since occasionally suffered gastro-entsritis 
and indefinite abdominal pains. 

In August ascites appeared so rapidly 
that in two days the trousers could not be 
buttoned; in a week intermittent pulse had 
developed, with cedema of the legs and 
dimiimlion of urine. On September 8, 15 
litres of straw-coloured ascitic fluid was 
withdrawn. On tho 24th, 12 litres of milky 
fluid was obtained. The left pleura, as 
high as the angle of the scapula, contained 
fluid; the liver, spleen, and heart were 
normal. T.iere wis slight reise of temper- 
ature at nigiit, and sweating in the morn- 
ing. There was no cough or expectoration. 
In the groins there were small, slightly 
hard, movable glands. On October 4, 12 
litres of milky fluid were withdrawn, and 
on the 14th fifteen litres tfat were white in 
colour wi;h a yellow tint. The fluid had 
a specific gravity of (,oii, was alkaline in 
reaction, and did not coiit tin sugar. On 
standing, the uppe'r part under the 
microscope shewed abundant granular mat 
ter of a faltynature ; the lower part contain- 
ed numerous leucocytes. 

After the last tapping the general health 
improved, the temperature was normal, the 
fluid disappeared from the pleura. In Jan 
uary the glands in the right groin became 
larger than those in the left. On deep 
palpation, a lump was felt in the right side 
of the abdomen above Pou part's ligament. 
Treatment with iodide of potash and gener- 
ous diet, adopted because the trouble was 
looked on as tubercular in origin, resulted 
in the patient being discharged in April. 

iVlilky, pseudochylous, or chylifonn 
ascites may be due to cancer, cirrhosis or 
or syphilis of the liver, or to chronic 
nephritis. But tubercular peritonitis was 
the cause of most rscorded cases, some of 
which were treated by puncture, others by 
laparotomy. 



EDITORIAL. 



25 



Charlotte Medical Journal 

EDWARD C. REGISTER, M. D., Editor. 
No. 36 South Tkyon Stkeet. - - - - 
Charlotte, N. C 



TI1B ROBERT BRUOB MEMORIAL, MOS- 
PITri\L. OF KINSTON, N. C. 

The formal opening of this recently erect- 
ed institution in Kinston, N. C, with the 
laving of the corner stone of the Elizabeth 



this excellent publication, a long and care- 
fully prepared article entitled Pipe-Dreams 
vs. Facts, in which he takes up a siiecific 
list of thirty-two cases, published by Col- 
lier's Weekly as authentic instances of 
deaths or serious illnesses from head- ache 
powders. 

In December a list of thirty-two supposed 
cases of death or illness from the same cause, 
was given to its readers, which an investi- 
gation by the Proprietary Association of 
America proved either to be untrue, or, as 
Mark Twain cabled in regard to the report 



Parrott Memori al Wards by the Grand Lodge , . ^^^^^^^ exa'ggerated. ' ' After 

of Masons of North Carolina, ni the pres- ' ' "^ - 

ence of the CTOvernor of the State and many 
other distinguished citizens, may well be 
noted as marking an important epoch in the 
progress of medicine in Eastern Carolina. 
The hospital, which in its various depart- 
ments will be one of the most complete in 
the State, is located on a beautiful and ex- 
tensive park, generously donated for the 
purpose by Mr. and Mrs. J. A. MeDaniel, 
of Kinston', in memory of their son Robert 
Bruce. The Charity Annex, or the Eliza- 
beth Parrott Memorial Wards, is physically 
connected with the private hospital recently 
opened for general medical and surgical 



the publication of these denial-explanationj 
Collier's Weekly excused itself by stating 
that the information was published on the 
authority of reputable newspapers. Thus a 
partially good cause is weakened in the 
house of its friends. When direct charges 
are made, and names and dates given, it is, 
comparatively, an easy matter to find out 
the truth, or non-truth, of any incident, and 
a magazine of repute can not be excused 
for not making a personal and thorough in- 
vestigation of its so-called facts. 

Out of the list of thirty-two cases, men- 
tioned above, twenty-one are shown to be 
false, while the remainder have a saving 



work by Drs. J. M. and W. P. Parrott, of ^^^^^^^^ ^f ^^^i,^^ the benefit of which any 
Kinston, N. C, and is their muiiiticent ^io-ht-minded court would allow to the ac- 
memorial to their deceased mother, the late ^^^^^ ^^T^t so, the editor of Collier's 
Mrs. Elizabeth Parrott. Weeklv' There is apt to be a ludicrous ex- 

While there has not been the lavish waste- j-e'of ignorance (a quality that has a 

ful expenditure of moneys so often seen in ^^_^^.^ ^^ making itself known, ) when a man 
the exterior construction of modern hospital ^^^^^^gj-takestoreformortoadvocatethatabout 
buildings, no expense has been spared to ^yi^j^h he knows nothing. But ignorance has 
render the institution complete in its every 
important detail for the comfort, conveni- 
ence, and proper medical and surgical care 
of suffering humanity. 

Being fullv conversant with the high order 
of professional ability of the Drs. Parrott 

we can but feel that our congratulations are ^^^^^^ ^ ^ 

due the people and the profession of that g'f 'evidence give'" 
section of the State naturally tributary to r^^^ article referred to 
Kinston, in having located in their midst an 
institution of high grade character and 
officered and managed by such accomplish- 
ed gentlemen of the profession. Again are 
we reminded of the manifestly growing dis- 
position on the part of our Southern doctors 
to provide near the homes of our people 



no place as an extenuator when libelous mat- 
ter is published. 

The undoing of "The Great American 
Fraud" is being undertaken by arguments 
that are easilv disproved and clumsily manu- 
factured—and we use the word manufac- 
tured advisedly, after going over the array 

well worth a 
thoughtful reading, and it will prove an 
antidote to undue credulity. 

ORGANOTMBRAPY. 

Organotherapv has made ver\' consider- 
able advance during the last decade, being 
a revival of ancient theories and supersti- 
hospital facilities where skill and service are tions based, however, on scientific theor>^ 
the equal of the best, and as good as anv and phvsiologic experiment. Plinius states 
to be had on the face of the earth, can be that the Ckeeks and Romans used the tes- 
provided at an' equivalent or even lessened tides of asses and the semen for impotence, 
expense, and without the discomforts and in Albania- these organs are used tor tne 
dangers incident to the transporting of in- same purpose today, as well as for amenorr- 
valids by long railwav journevs to the great hea. Paracelsus recommends the spleen tor 
cities of the East. " " the latter disease. Among barbarous and 

semi-civilized peoples, as well as among tlie 

THE MBTNODS OF GObLiER'S WBEKEY. gj^yaiitry in all countries, these customs 

The editor of The St. Louis Medical and exist. The Chinese physician prescribes 

Surgical Journal has, in the April issue of dried mouse and lizard; the native African 



26 



THE CHARLOTTE MEDICAL JOURNAL. 



uses the liver of snakes, both internally and 
externally, as an antidote for snake bite, 
sho\vin.<>- the empirical application of an 
antitoxin; the warrior eats the heart of the 
lion to give him courage. In southern 
France raw snails are used for indigestion, 
as well as a luxury' when cooked; in Corn- 
wall and Devonshire earthworms are given 
for the same purjiose, and are probably ef- 
fective, as they contain a very powerful di- 
gestive ferment. In the materia medica 
pepsin, pancreatin, ingluvin, codliver oil 
and Pels Bovis are official, all of which are 
animal extracts connected with the digestive 
functions, so that to the use of other secret- 
ing organs, or their extracts, is but a short 
step, and today the thyroid and suprarenal 
glands have obtained a permanent place in 
therapy, while the use of other organs is 
still subjudice. 

Theoretically, the administration of the 
active principle of any gland should be a 
specific for any pathologic condition, the 
result of a glandular insufficiency, and 
eliminating the effects of complications, this 
is true. The thyroid is a specific in myx- 
edema and cretinism, provided there is no 
involvement of other organs, and that the 
drug is absorbed into the system in an active 
condition, the latter being a point often 
overlooked in treating these diseases. It 
should be remembered that thyroiodin, the 
active principle of the gland, is precipitated 
by acids, but is soluble in alkaline solutions 
and in solutions of neutral salts; in many 
cases of tlie diseases under consideration, 
the intestinal tract is acid through its whole 
length, owing to constipation and faulty di- 
gestion. Pepsin and hydrochloric acid will 
digest protein bodies in the test tube as well 
as in the stomach, and if administered prop- 
erly and continuously, are a specific for ab- 
sence of these two substances from the suc- 
cus stomachi. The hydrochloric acid has a 
further and more important function; upon 
its entrance into the duodenum it stimulates 
the secretion of secretin, the ferment which 
is absorbed into the general circulation and 
serves to stimulate the pancreas to secretion; 
further, the hydrochloric acid stimulates the 
secretion of enterokinase the ferment which 
converts trypsinogen into active trypsin; it 
is probable that it also stimulates the secre- 
tion of erepsin, a ferment which, though 
occurring in every organ of the body, is 
found by far the largest quantity in the in- 
testine and in the kidney having a peptone 
splitting power. If hydrochloric acid or 
pepsin be absent or decreased in quantity 
in the succus stomachi it is probable, and 
analyses have proven, that rennin and in- 
vertin are also deficient. Recently Pawlaw% 
of St. Petersburg, and his school have en- 
deavored to prove that rennin and pepsin 



were the same ferment, a view contradicted 
by Dr. Hemmeter, of the University of 
Maryland; be that as it may, there is no 
doubt that rennin has other functions to 
perform besides sim])ly clotting milk, the 
very fact of its presence in the succus 
stomachi from infancy to old age goes to 
show that it is necessary to digestion, and 
further, it exists in the stomachs of both 
birds and fishes, neither of whom at any 
period of their lives are on a milk diet. 
Definite experiments on the presence of cane 
sugar in the stomach contents under pathol- 
ogic conditions are lacking, but there are 
many patients in whom cane sugar produces 
marked indigestion, due to its not being in- 
verted. Theoretically and practically we 
have a specific remedy for ach^lia, if we 
administer a sufficient quantity and at fre- 
quent intervals during digestion an artificial 
succus stomachi containing hydrochloric 
acid, pepsin, rennin, calcium chlorid, and 
invertin, the failure of hydrochloric acid 
alone, or with pepsin, to relieve cases of 
achylia is due to the absence of the other 
ingredients of normal succus stomachi and 
to imperfect methods of administration. 

The administration of Pels Bovis has 
fallen into disrepute, probably from the in- 
ability of the patient to take a sufficient 
quantity. Theoretically, if the bile contains 
a sufficiency of sodium glycocholate and 
taurocholate the cholesterine and bilirubi- 
nate of calcium, precipitation of which 
either in the hepatic bile ducts or in the gall 
bladder is the cause of gall stone, will be 
held in solution, consequently no stones 
will be formed; further, if an excess of the 
bile acids be present in the bile, stones al- 
ready formed will be dissolved, therefore 
sodium glycocholate mass should be a speci- 
fic for gall stones, which is borne out by 
clinical experience. 

Pancreatin does not give very satisfactory 
clinical results, the reason probably being 
that it is effected in its passage through the 
stomach, and that the cause of the pancre- 
atic insufficiency may lie in the absence of 
secretin or enterokinase, in which case its 
administration could not possibly do any 
good. 

Suprarenal extract' has not found much 
of a field in internal medicine; in Addison's 
disease where it should theoretically be a 
specific it has given practically no results. 
Its use in Basedow's disease, owing to its 
physiologic action being directly opposed to 
that of the thyroid, has given some results. 
Prom its power of contracting the blood ves- 
sels, and thus arresting hemorrhage, it is 
much used in minor surgery, some good re- 
sults having also been obtained in hemate- 
mesis and hemoptysis. 

There can be no doubt that the testicles 



EDITORIAL. 



27 



and ovaries have a distinct function other 
than the secretion of the substances neces- 
sary for procreation. The effect of castra- 
tion on the mental and physical condition 
is well known, especially in the arrest of 
puberty. The Russian chemist Phoel ob- 
tained certain results by the injection of 
'spermin' extracted from testicles which he 
claimed was the active principle, but they 
have not been confirmed by other experi- 
menters. Overian extract has been used 
during- the menopause, in chlorosis and 
dysmenorrhea. 

The thymus has recently been shown to 
have some connection with the organs of 
generation, and has been given in Basedow's 
disease. Bone marrow has also its advo- 
cates in anemia, but the clinical results are 
conflicting. Desiccated brain and cord have 
been used by h^'podermic injection in loco- 
motor ataxia and good results claimed. The 
parotid gland is. claimed to have some con- 
nection with menstruation, and has been 
given in dysmenorrhea. Extracts of the 
spleen and prostate have also been tried in 
various diseases, but without apparent 
benefit. 

The antitoxins are a form of organothera- 
py and have given some very brilliant re- 
sults, and our hopes of successfully combat- 
ing those diseases which up to the present 
have resisted medical science are placed 
upon the development of this form of 
•therapy. 

MOUSE OF DELBG/\TES. 

Minutes of the Third Annual Session 

(PIfty-thircl of the Society) held in 

Charlotte, M. C, May 29, 30 and 31, 

1906. 

The third regular annual session of the 
House of Delegates of the Medical Society 
of the State 'of North Carolina convened in 
the Criminal Court Room, County Court 
House, in the City of Charlotte, N. C, on 
May 29, 1906, at 3:15 o'clock, p. m. 

Called to order by the President, Dr. 
Edward C. Register, of Charlotte, N. C. 

Roll-call by the Secretary, Dr. J. Howell 
Way, of Waynesville, N. C, denoted the 
presence of the following Members of the 
House of Delegates: 

President: Dr. E. C. Register, of Char- 
lotte. 

Vice-Presidents: Drs. L. B. McBrayer, 
of Asheville, and W. O. Spencer, of Wins- 
ton, present. 

Vice-President: Dr. W. H. II. Cobb, Jr., 
of Goldsboro, absent. 

Secretary: Dr. J. Howell Way, Waynes- 
ville. 

Treasurer: Dr. G. T. Sikes, Grissom. 

COUNCILLOR.S. 

First District — Dr. Oscar McMullan, 



l':iizal)etli City. 

vSecond District — Dr. James M. Parrott, 
Kinston. 

■ Third District— Dr. I'rank II. Russell, 
Wilmington. 

Fourth District — Dr. Albert Anderson, 
Wilson. 

Sixth District— Dr. Hubert A. Royster, 
Raleigh. 

Seventh District — Dr. E. C. Register, 
Charlotte. 

Eighth District — Dr. David A. Stanton, 
High Point. 

Ninth District — Dr. Thos. E. Anderson, 
Statesville. 

Tenth District — Dr. James A. Burroughs, 
Asheville. 

Dr. J. I<\ Highsmith, Councillor for the 
Fifth District noted absent in luirope. 

Delegates from the county societies noted 
as follows: 

J^lrsi District. 

Currituck : 

Pasquotank-Camden-Dare: Dr. Oscar 
McMullan. 

Perquimans: Dr. T. S. McMullan. 

Gates: Dr. W. O. P. Lee. 

Chowan: Not organized. 

Washington: Dr. W. H. Ward. 

Tyrrell: Not organized. 

Hyde: Not organized. 

Second District. 

Hertford: Dr. J. R. Parker. ■ 
. Martin: Dr. W. E. Warren. 

Pitt: Dr. J. E. Nobles. 

Bertie: Dr. W. J. Harrill. 

Beaufort: Dr. Jno. C. Rodman. 

Lenoir: Dr. R. A. Whittaker. 

Jones: — : 

Craven: Dr. R. vS. Primrose. 

Pamlico: Dr. G. S. Atmore. 

Carteret: Dr. L. C. Adams. 
Third District. 

New Hanover: Dr. G. G. Thomas. 

Pender: 

Onslow: Dr. Cyrus Thompson . 

Duplin: Dr. J. L. Lane. 

Bladen: Dr. R. Sam'l. Cromartie. 

Sampson: Dr. G. L. Sikes. 

Columbus: 

Brunswick : 

FourtJi District. 

Northampton: Dr. Mahlon Bolton. 

Halifax: 

Nash: 



Edgecombe : 

Johnston: Dr. G. J. Robinson. 
Wilson: Dr. W. S. Anderson. 
Wavne: Dr. M. E. Robinson. 
Greene: Dr. W. W. Whittington. 

Fifth District. 
Cumberland: Dr. A. S. Rose. 



THE CHARLOTTE MEDICAL JOURNAL. 



Robeson: Dr. J. D. Croom. 
Scotland: Dr. K. A. Blue. 
Richmond: Dr. E. C. McEachern. 
Montgomery: Dr. C. Daligny. 
Moore: Dr. G. McLeod. 
Harnett: Dr. J. W. Hal ford. 
Sixth District. 

Chatham: : 

Wake: Dr. W. H. Boone, Dr. Z. M 
Cavincss. 

Franklin: Dr. R. F. Yarlwrough. 

Warren: 

Vance: Dr. 1'. R. Harris. 

(rranville: Dr. Ben. K. Hays. 

Person: 

Caswell: Dr. M. H. McBryde. 

Alamance: Dr. G. W. Long. 

Orange: 

Durham: Dr. T. A. Mann. 
ScvcJith District. 

Anson: 

Fnion: Dr. R. Armfield. 

Stanly: Dr. T. A. Hathcock. 

Mecklenburg-: Dr. I. W. Faison, Dr. R, 
E. Mason. 

Cabarrus: Dr. J. E. Smoot. 

Lincoln: Dr. R. W. Petrie. 
Gaston: Dr. D. A. Garrison. 
Cleveland: Dr. W. F. Mitchell. 
Rutherford: Dr. E. B. Harris. 
Eighth District. 

Rockingham: Dr. W. P. McGehee. 
Ckiilford: Dr. J. W. Long, Dr. C. W. 
Banner. 

Randolph: 

Forsyth: Dr. IL S. Lott. 

Stokes: 

Surrv: Dr. J. B. Smith. 
Yadkin: Dr. M. L. Matthews. 

Alleghany: 

Wilkes: Dr. J. L. Myers. 

Ashe: ^ 

Ninth District. 
Davidson: Dr. C. A. Julian. 
Davie: Dr. J. W. Rodvvell. 
Rowan: Dr. C. M. Poole. 
Tredell-Alexander: Dr. H. V. Long. 

Catawba: 

Caldwell: Dr. A. A. Kent. 
Watauga- Mitchell: 



Graham: 



Burke: Dr. L M. Taylor. 
7c7ith District. 

Buncombe: Dr. M. H. Fletcher. 
Yancey: Dr. A\'. P. Whittington. 
McDowell: Dr. M. F. Morphew. 

Madison: 

Polk- Henderson: Dr. L. P. Russell. 
Haywood: Dr. F. M. Davis. 
Transylvania: Dr. Goode Cheatham. 
Jack.son: Dr. C. Z. Candler. 
Swain: Dr. D. R. Brj'son. 
Mason-Clav: ..,. ^ 



Cherokee; Dr. S. C. Highway. 

After the calling- of .the roll the accredited 
list of Delegates as reported by the Secretary 
was declared the official roster for the 
session . 

The annual address of the President de- 
livered at the morning session of the general 
meeting before the larg-est membership in 
attendance upon any previous of the fifty- 
two sessions of the State Society was called 
up and referred to the House of Delegates. 
After cordially commending the address to 
the thoughtful consideration of the profes- 
sion, it was on motion referred to a com- 
mittee composed of Drs. Albert Anderson, 
James M. Parrott, J. Howell Way. 

Dr. J. Howell Way presented the report 
of the Secretary as follows: 

Charlotte, N. C, May 29, 1906. 
7o the Officers and Members of the House 

of Delegates of the Medical Society of the 

State of North Carolina: 

GenelEMEn: I shall not consume the 
time of this body with a lengthy report of 
the various matters which have occupied 
much of m3^ time and attention during the 
past year. Suffice it to sa}' the general af- 
fairs of the Society continue in excellent 
condition, and the condition of our organi- 
zation units, the county societies, is all of 
the time improving. With the continued 
growth of the interest in the local societies, 
there is an inevitable increase in the interest 
felt in the State society, evidence of which 
we see in the very extensive program pre- 
sented for this meeting. 

At the present date there are eig-hty-four 
chartered county societies, with an enrolled 
membership of a little more than 1200. 
This includes within our sphere of influence 
a little more than four-fi.fths of the active 
practitioners of medicine in the State. In 
many of these societies most excellent work 
is being done, and local professional stand- 
ai'ds are being- raised hig:her, and a growing 
better feeling- existing between the different 
members of the profession. In the more 
sparsely poi)ulated counties there are g-reat 
difficulties in the way of making- the socie- 
ties as successful as' in the larger counties, 
but I have everywhere encouraged the few 
to stand together, realizing that where there 
were only a few practitioners it was especi- 
ally necessary that there should be soine 
local tie to bind them together for their own 
interests, for the good of their clientele, and 
for the betterment of society in general. 

Some of these local societies are officered 
by zealous, active men, who see in them 
great powers for g^ood, and consequently 
they are all of the time working and striving 
for better things. With this type of a so- 
ciety, your vSecretary has no difficulty in 



EDITORIAL. 



29 



securing- reports, or other local information to this have been review copies and copies 
desired' There are others who are not real- sent other State or.oanizations. i he publi- 
Iv "interested in the work of the local society cation of the annnal volume is as in former 
or of the State oroanization, and their re- years, delayed very largely by the tardiness 
ports are not so readily forthcoming- or so of the gentlemen reading papers at our an- 
favorable. The gentlemen will pardon the nual meeting^ m sending them m to the 
suo-o-estion of the Secretary that a re- Secretary While the 1905 volume was n 
quest for information relative to the press 1 had the forms opened twice to admit 
local afTairs of the profession is always to publication papers read at Ureensboro 
based on some proposition useful and the May previous, and the order for the 
beneficial to the interests of the society, and binding covers was changed by telegram m 
shouldreceive immediate attention. County December to permit tue admission of an- 
societies are also kindly advised to see to it other paper from one of our distinguished 
„ ,„i,^ „.;i"i attf.i,r1 to business members. I submit gentlemen, m all fair- 
ness, that this is an imposition on the socie- 
ty, and that our members should comil/ 
with the rules which require the papers read 
at the annual meetings to be turned over to 
the society at the time of presentation before 
the body at the annual s2.^s"ons. Weeths 
rule adhered to, it would be possible to pub- 
lish the volume months before its appear- 
ance as it now is. 

The "insurance resolutions" adopted by 
the State society at the 19.)5 session have 



that only men who will attend to business memb 
are honored with official position. Notwith- 
standing the unnecessary effort your Secre- 
tary has been compelled to make to secure 
the annual reports of the county societies in 
advance of this meeting, there are yet sev- 
eral of the county organizations which have 
not sent in their official reports, though pro- 
vided with blanks the third time, and in no 
case less than five gentle recjuests for their 
return. A dilatory spirit like this naturally 
sueo'ests why some members of our profes- - 

sion do not succeed in a business way, and been the subject of much comment consid- 
brings the sober reflection that after all we eration and correspondence during the year, 
really each of us probably get just about In addition to securmg their publication m 
wtat\e deserve from our patrons, for it is various journals I sent to each of our mem- 
neiitable that a lack of business methods bers a printed copy. The county societies 
a lono- one line is likely to be manifested in have had much discussion along liese lines, 
■^ - and the insurance companies have also 

h to say in this connection, taken a pretty active hand in the matter, 
that at this date 1 have in hand a larger The action of the county societies has m 
number of the annual reports of the county most instances, where action has been taken, 
societies than 1 have ever been able to se- been m accord with the spirit of the resolu- 
cure pr or to any previous meeting of the tions recommended to the r consideration 
State Lciety, nearll four-fifths of thecoun- by the State society at the Greensboro mee- 
Ty societies having filed their reports with mg, -"^ fi--'>;^f;r^V Jrntmb'r of 
the Secretary to date. And in allprobabili- sition on the part of the leading members of 

ybeSre the close of the year all will have f^^^^'^'^'^rr '^^^^^''::mrZ 

reported. I mention this matter because it ly by the resolutions that there will hy an 

win explain to a few o-entlemen present why inevitable acceptance by the co.npaaies of 

Ur y h^^^e not receTved copies of the pre- the five dollar fee for al -^^lar old-line 

liminary program of this meeting. It is to examinations for life insurance. Tnis mat- 



others as well. 
However, I w 



b^iSm^rSX; llle i=Sri;;rth; ^r has assumed nation^ P^^^^-^^^ 
State society is the membership of the com- much attention has been g^ven t in other 
ponent county societies, and unless your States, as well as m our own, and it is ex- 
Secretary receives regu ar reports from the pected to come up for consideration and ex- 
S branches of this society he cannot be pression of opinion by the American Medi- 
expected to know who the local members 



cal Association at its forthcoming meeting 
in Boston next week. In this State with 
few exceptions the societies which were well 
organized promptly adopted the suggestion 
of this body. In others the suggestions 
were modified so as to permit the examining 
of applicants where no urinalysis was re- 
1200 copies of the Transactions of 1905 quired for a fee of .$..00. In some nothing 
were published and almost all have been was done. 

rent out A few copies yet remain on hand. It was very interesting to note the activi- 
astheTnvariabTe rue has been followed of ty of some of the insurance companies m 
ZtZn^^XeXLe to ^ny members.^- this matter here in this State. Some of 
ceptlhose^eporU as having paid their them kept pace of what the county societies 
dues to the Treasurer. The only exceptions were doing, and very kindly, wherever there 



are. The volume of the necessary corres 
pondence of the Secretary's office has great- 
ly increased over former years, and is ac- 
counted for in the greater amount of interest 
manifested in the work of the society over 
the State 



THE CHARLOTTE MEDICAL JOURNAL. 



appeared any seulimeiit favorable to work- 
ing cheaply for the insurance people, kept 
the other counties advised of such action. 
This certainly showed a disposition to stand 
for what nii,o:ht be termed their business in- 
terests on the part of the companies, which 
is to be commended to the members of our 
profession who unsuspectin.oly agreed to 
what the astute mana.oers of the companies 
suo-oested would be for "real interests of 
the profession!" Several times it was sug- 
gested to me that certain of the companies 
wished to send lobbyists here to this meet- 
ing of the State Society to present their 
wishes in the premises. I have not approv- 
ed of or advised any motion of this charac- 
ter, feeling that this matter of insurance 
examination fees, like other medical fees, 
is a matter about which the State Society 
may, and properly should, express an opin- 
ion to the county societies, and then permit 
them to regulate their own fees to suit them- 
selves. It is very evident, to one who has 
followed the efforts of the companies in 
times of unparalleled general prosperity in 
the country at large, to reduce the fees of 
physicians which were already really too 
small, considering the value of the services 
they rendered the companies; I repeat, it is 
very evident that the profession all over the 
nation is aroused in this matter, and with 
firmness on our part there can be no doubt 
that less than one-third of the different com- 
i:)anies who are in this reducing-fee proposal, 
will be compelled to do one of two things: 
Pay a proper fee, or accept the services of 
an undergrade class of men who, with low 
standards of professional ethical principles, 
are willing to admit the inferior value of 
their own professional service and to under- 
bid their fellow-practitioners. To a man 
who thinks critically it is highly probable 
the former will be the action of the com- 
panies. The jiresent duty of the profession 
would appear to be simply to stand ffrmly 
for a reasonal)le compensation. 

There has, during the year past, been an 
unusual amount of attention paid the social 
features of the doctor's life in the fact that 
more than thirty of the county societies of 
the State have had annual dinners or more 
formal bancjuets at which the membership 
were entertained, and thus a more fraternal 
sentiment promoted among the members of 
the medical guild. 

In conclusion, I would remind the mem- 
bers of this society that the future of our 
work as a society lies with the individual 
membership, and our success will depend 
wholly upon the amount of interest the in- 
dividual member may have in the work of 
his profession as advanced by medical or- 
ganization, and not upon constitutions or 
laws, or constructions of the same. To reach 



the individual member is our duty. While 
with the growth of the society and the de- 
velopment of the various questions which 
come up for solution in a body so large as 
ours is now, the entire time of the Secretary 
could well and profitably be given to his 
duties, yet we all know this is an impossi- 
bility, and any man who fills the duties of 
the position in even the imperfect way of 
your present incumbent will hardly fail to 
have done some things which he ought not 
to have done and assuredly to have left un- 
done many things he should have done. I 
congratulate you on our continued pros- 
perous condition, on the growing influence 
and prestige our most noble profession, 
and bespeak your kindly condoning of the 
shortcomings as an official of your secretary. 
I'raternally submitted, 

J. HowELi. Way, Secretary. 

( )n motion the report of the Secretary was 
received and its recommendations adopted 
by unanimous vote. 

Reports of the Councillors being called 
for, verbal reports were submitted froni Drs. 
Oscar McMullan, Parrott, Russell, Stanton, 
Royster, T. E. Anderson, A. Anderson, and 
Burroughs, each of whom spoke hopefully 
of organization conditions in his district, 
commended the work of the local county 
societies, and advised that efforts be made 
to continue all measures calculated to pro- 
mote an active local interest in the affairs 
of the profession, believing the increased in- 
terest growing out of the county societies 
operating greatly to the advancement of the 
profession's best interests throughout the' 
State. 

Some remarks relative to the practical 
workings of the county societies were made. 

It being in order the President announced 
that the delegations from each Councillor's 
District should select their member of the 
Committee on Nominations and report. 

Dr. Whittaker asked the President for a 
ruling as to who was eligible to serve on the 
Committee on Nominations. 

Discussion ensued. 

The President ruled in answer to Dr. 
Whittaker that any member of the House 
of Delegates, be he Councillor or delegate 
from a county society or other member of 
the body of the House of Delegates, selected 
by a majority of the members present from 
a Councillor's District, was eligible to serve 
on the Nominating Committee. 

Dr. Whittaker insisted that under his view 
of the laws no one except a delegate from a 
county society was eligible to serve as a 
member of the Committee on Nominations 
and discussed the question at length, advo- 
cating that only delegates elected as such 
by county societies should serve on the Com- 
mittee on Nominations. 



EDITORIAL. 



31 



Dr. Mason moved that no one be selected 
to serve as a member of the Nominating- 
Committee except a delegate from a county 
society. 

Dr. Fletcher asked for a ruling- of the 
chair on the ]ioint of the legality of any one 
to serve except a delegate from a county 
society. 

The chair ruled the matter was wholly in 
the hands of the members from the separate 
districts, who covild exercise their own 
loleasure in selecting their representative on 
the committee. 

Dr. Faison urged that no one except dele 
gates from county societies were el 



Sixth District— Dr. l!en. K. Hays. 

Seventh District — Dr. 1. \V. I'aison. 

Eighth District— Dr. J. W. Long. 

Ninth District— Dr. C. M. Toole. 

Tenth District— Dr. W. P. Whittington. 

On motion the reports were approved and 
the designations as made were ai)proved by 
the House. 

Dr. Thos. S. McMuUan presented the fol- 
lowing resolutions and moved their adop- 
tion: 

Whereas, a resolution advising a regula- 
tion of fees for life insurance examinations 
was passed by the Medical .Society of the 
ble to State of North Carolina in 1905, and, where- 



3, the developments of the past year has 
shown that for its greater usefulness and 
surer practice some modification is advis- 
able. 

Resolved, that tlie Ilou^e of Delegates 
recommend to the Society, now in session, 
that as amendatory to aforesaid resolution, 
the county societies be advised that a reduc- 
tion of the fee from $5.00 to not less than 
deiegatesl^e'placed on Nominating $3.00 where no urinalyss 14 required will 



serve on the Nominating- Committee, and 
contended that no one except delegates 
elected from county societies is entitled to a 
seat in this body. 

Dr. Fletcher raised the point of order as 
to the right of any one except delegates 
from county societies to serve on the Nomi- 
nating Committee. 

Dr. Oscar McMullan moved that no one 
except 

Committee and urged, an appeal from the 
ruling of the chair to ithe effect that Coun- 
cillors were eligible to serve on the Nomi- 
nating Committee. 

The President then put the question as to 
sustaining the decision of the chair that 
Councillors were entitled to sit with the 
members of the delegates from their respec- 
tive districts and to participate with them in 
the selection of the members of the Nomi- 
nating Committee. 

The chair was not sustained. 
Dr. J. M. Parrott rose to a question of 
personal privilege and asked if it was now 
definitely decided that a Councillor could 
not participate in the selection of the mem- 
ber from his own district. 

He was advised that under the recent de- 
cision of the House a Councillor could not. 
General discussion ensued as to the rights 
of Councillors to sit in the House of Dele- 
gates or to participate in any of its proceed- 
ings, it being strongly contended by some 
of" the delegates that the "ex-officio mem- 
bership" conferred on others in the consti 
tution than elected delegates from the conn 



not be construed as subversive of the intent 
and spirit of the resolutions originally pass- 
ed in 1905. 

Considerable discussion ensued, partici- 
pated in by Drs. Whittington, T. S. Mc- 
Mullan, Oscar McMullan, Faison, Arm- 
field, Whittaker, R. DuVal Jones, T. A. 
Mann, Yarborough, Halford, Z. M. Cavi- 
ness, K. A. Blue, A. S. Rose, Hill, M. E. 
Robinson, Cyrus Thompson, and others. 

A motion to lay the resolutions on table 
was seconded and announced as carried. 
Questions as to vote raised and division 
called for. The resolutions were read by 
request again. 

A vote was again taken and the resolu- 
tions of Dr. McMullan declared lost b/ more 
than three-fourths present voting against 
their passage. 

At 6 p. m. a recess was on motion order- 
ed until Wednesday morning. 

WEDNESDAY MORNING, MAY 30, 1906. 

The -House of Delegates was called to or- 
der at 10 o'clock, a. m. President Register 
in the chair. 

Dr. M. II. Fletcher asked to be excused 
ty societies only carried with it the privilege from further attendance and desiied the 
of attending the meetings of the House of seating in his place of the alternate dele- 
Delegates, but without voice or vote in the oate, Dr. W. L. Dunn. Agreed to. 
deliberations of the body. ' Dr. Albert Anderson of the Committee on 

The delegates from the various Districts President's essay asked for further time to 
consulted together and designated the fol- complete the report. Granted. 



lowing gentlemen to compose the Committee 
on Nominations for the session: 

Inrst District— Dr. W. li. Ward. 

Second District — Dr. Jno. C. Rodman. 

Third District — Dr. Cyrus Thompson. 

Fourth District — Dr. M. E. Robinson. 

Fifth District — Dr. K. A. Blue. 



Dr. Poole for the Rowan county Medical 
Society asked that the time of holding the 
annual meeting of the State Society be 
changed from the spring to early autumn. 
Discussion by Drs. 0.scar McMullan and 
others. Motion lost on being put to \'ote. 

Dr. Lott moved the advisability of the 



32 



THE CHARLOTTE MEDICAL JOURNAL. 



Stale Society meeting' in sections as does the 
American Medical Association. Opposed by 
Drs. O. McMullan and Mason. 

Dr. Thos. S. McMullan urged the advis- 
ability of the same, and insisted the large 
attendance made it highly necessary in or- 
der to facilitate the work of the organization 
and called for the question on his motion to 
refer the matter to a committee of three to 
report thereon. Seconded. Carried. Drs. 
Thos. S. McMullan, Cyrus Thompson and 

C. A. Julian were designated the committee. 
Dr. Cyrus Thompson for the Committee 

on Nominations presented the following as 
the choice of the committee for the various 
officers and committees for the ensuing 
vear: 

President— Dr. S. I). Booth, Oxford. 

First Vice-President — Dr. C. M. Strong, 
Charlotte. 

Second Vice-I*resident — Dr. J. li. Mc- 
Laughlin, States ville. 

Third Vice-President— Dr. W. F. Har- 
grove, Kinston. 

Secretary — Dr. D. A. Stanton, High 
Point. ■ 

Treasurer— Dr. H. McKee Tucker, Ral- 
eigh. 

Orator — Dr. L. B. McBrayer, Asheville. 

Essayist — Dr. E. T. Dickenson, Wilson. 

Leader of Debate— Dr. C. W. Mosely, 
North Wilkesboro. 

Councillor Fvighth District — Dr. J. B. 
Smithy Pilot Mountain. 

Members House of Delegates Aiuerican 
Medical Association — Drs. W.J. Lumsden, 
Elizabeth City; James AL Templeton, Cary. 

Committee on Pulilic Policy and Legisla- 
tion — Drs. R. H. Lewis, Raleigh; David T. 
Tayloe, Washington; J. E. Brooks, Greens- 
boro; (ex-officio) vSam. D. Booth, Oxford, 

D. A. Stanton, High Point. 

Committee on Publication — Drs. I). A. 
vStanton. High Point, (Ex-oflficio); T. AL 
Jordan, Raleigh; Wm. A. Graham, Durham. 

Committee on Scientific Work — Drs. Wm. 
Dei',. MacNider, Chapel Hill; H. S. Mun- 
roe, Davidson; ( I'^x-ofificio ) D. A. Stanton, 
High Point. 

Committee on iMuance — Drs. J. T.J. Bat- 
tle, (ireenslK)ro; 1-Yank Duffy, New Bern; 
J. 11. Marsh, l<^ayetteville. 

Committee on Obituaries — Drs. R. D. 
Jewett, Winston; A. S. Pendleton, Hender- 
son; F. H. Holmes, Clinton. 

Delegates to Mississippi Valley Medical 
Association — Drs. J. Howell Way, Waynes- 
ville; J. !<:. vStokes, Salisbury; R. S. Young, 
Concord; D. A. vStanton, High Point; W. A. 
Munroe, Sanford; W. C. Steel, Mount Olive. 

Delegates to Virginia Medical vSociety — 
Drs. Albert Anderson, Wilson; H. A. Roys- 
ter, Raleigh, H. H. Dodson, Greensboro; 
H. F. Long, Statesville; L M. Taylor, Mor- 



ganton. 

Delegates to South Carolina Medical As- 
sociation — Drs. E. C. Register, Charlotte; 
D. M. Prince, Laurinburg; R. B. Hunter, 
Kings Mountain; J. M. F^aison, Mount 
Olive; D. W. Bullock, Wilmington. 

Members State Board of F^xaminers for 
Nurses — Drs. Jno. G. P>lount, Washington.; 
J. E. Ashcraft, Monroe. 

Place of meeting in 1907: 

Morehead City. 

Chairman of Local Committee Arrange- 
ments, Meeting 1907: 

Dr. W. E. Headen, Morehead City. 

Dr. T. S. McMullan moved to amend the 
report of the Committeee on Nominations so 
as to include as an additional meml^er of 
the committee on Public Policy and Legis- 
lation, Dr. Geo. G. Thomas. 

Dr. Cyrus Thompson agreed that Dr. 
Thomas would be a most valuable addition 
to the committee. Dr. Whittaker also stat- 
ed that he favored the addition of Dr. 
Thomas. On motion the report was so 
amended. 

(^n motion the report of the Committee on 
Nominations was adopted unanimouslv. 

Dr. Oscar McMullan moved a vote of 
thanks to Dr. J. Howell Way for his mark- 
edly efficient service to the Society as its 
Secretary for the past four years, and to 
Dr. Sikes for his equally excellent work as 
Treasurer. 

Dr. M. Eugene Street seconded the mo- 
tion, and did so, he said, with great pleas- 
ure, as the retiring Secretary had been one 
of the most efficient officers he had ever 
known. 

Dr. Albert Anderson seconded the motion 
and briefly expressed his regret at the retir- 
ing of the Secretary from a post he had filled 
with great credit to himself and honor to the 
Society. 

^^ Dr. J. W. Long stated that it afforded him 
'unusual pleasure to second the motion, as 
he had alwavs held Dr. Way in the highest 
esteem, and unhesitatingly stated his opin- 
ion that he had been the most efficient Sec- 
retary the State Society had ever had." 

Dr. Whittaker also stated his pleasure in 
seconding the motion, both as to Dr. Way 
and Dr. Sikes. 

Motion adopted unanimously. 

Dr. James M. Parrott tendered his resig- 
nation as Councillor for the vSecond District, 
and stated that he felt he could retire at this 
time leaving the affairs of the District in 
good shape. 

■ The House declined to accept the resig- 
nation. 

The Secretary of the State Board of Medi- 
cal lixaminers presented the following, 
which was received with thanks and order- 
ed printed in the Transactions and the at- 



EDITORIAL. 



33 



teiilion of llie county Societies invited there- 
to as bein.a: the correct and proper position 
for the State Board of Medical Examiners 
to take in this important matter affectin.<>- 
both the welfare of the ,<^eneral public aiid 
the honor of the medical profession. The 
resolution of the Board of Medical F.xamin- 
ers is as follows: 

The Board of Medical Examiners of the 
State of North Carolina, being in forty- 
fourth regular annual session, unanimously 
pass the following-: 

Resolved, That the vSecretary of the Medi- 
cal Society of the State of North Carolina 
l)e and is hereby requested to communicate 
to the various county Medical Societies of 
the State of North Carolina that the Board 
of Medical Examiners believe it to be their 
duty, . and that they will on presentation of 
sufficient evidence rescind the license of any 
physician who is in any way grossly im- 
moral, or who is a drug or alcohol habitue 
to a degree which may cause him to be a 
menace to the welfare of his community. 

The regular annual report of the State 
Board of Medical Examiners, exhibiting in 
detail the work of the Board during the re- 
cent session, was also presented and ordered 
printed in the annual volume of Transac- 
tions. 

The President announced that in compli- 
ance with suggestions made at the 1905 ses- 
sion of the Society he had during the year 
appointed as special committee on State 
Society for the Prevention of Tuberculosis 
the following gentlemen of the Societv: 
Drs. M. L. Stevens, Asheville; R. H. Lewis, 
Raleigh; Jas. M. Parrott, Kinston; C. M. 
Strong, Charlotte; J. Howell Wav, Wavnes- 
ville; W. H. H. Cobb, Goldsboro; Albert 
Anderson, Wilsofl; Ben. K. Hays, Oxford; 
Geo. G. Thomas, Wilmington; James A. 
Burroughs, Asheville; Chas. A. Julian, 
Thomasville; Watson S. Rankin, Wake 
I'orest; and stated that a meeting of the 
Committee with others interested would be 
held during the session of the Society. 

Dr. Cyrus Thompson presented the follow- 
ing: 
Petition from the Onslow county Medical 

Society to the House of Delegates of the 

N. C. State Medical Society: 

1st. Amend Section 1, Article \HIT, of 
the Constitution of the North Carolina State 
Medical Society as follows: 

After the word "Secretary" insert the 
words "Reading Clerk." 

2nd. Amend Section 2, Article VHI, of 
the Constitution, etc., as follows: 

After the word "Secretary" insert the 
words "Reading Clerk." 

1st. Amend the By-laws of the North 
Carolina State JNIedical Society as follows, 
by adding at the close of Chapter I\': 



"Sec. 5. It shall be the duty of the Read- 
ing Clerk to attend the sessions of the So- 
ciety, and to read any i)apers presented only 
upon request of the member presenting the 
paper." 

Amend the By-laws of the North Carolina 
State Medical vSociety, Chapter X, Section 1, 
by adding at the end of said section the fol- 
lowing: 

"And the chairman of each of the fore- 
going sections shall be privileged during the 
reading and consideration of papers in his 
section to occupy a seat by the President, 
and with him have joint control of the 
program. 

Dr. Thompson then moved the amend- 
ment of the By-laws of the Society to con- 
form to the suggestion contained in the pe- 
tition from Onslow county Society, and 
discussed the very great advantages to be 
derived from having a "reading clerk" for 
the Society. 

Dr. Ivey discussed the proposed measure 
also, and suggested it be referred to a special 
committee. This was agreed to and the 
matter was so referred. 

The proposition to enlarge the functions 
of the Chairmen of Sections contained in 
the resolutions was also approved and re- 
ferred for the consideration of the same com- 
mittee to be appointed later by the Presi- 
dent : 

The following compose the committee to 
consider the matier: 

Drs. T. S. McMullan, Geo. G. Thomas, 
I. M. Taylor. 

Dr. W. P. Whittington presented the fol- 
lowing from the Buncombe county Medical 
Society, and moved that the State Society 
approve the same: 
Committee Report and Resolutions 

Adopted by the Buncombe County 

Medical Society, May 21st, 1906. 

Whereas, It is the duty of every physician 
to guard the public health and to instruct 
the public in matters of hygiene and sanita- 
tion; 

Whereas, The unrestricted manufacture 
and sale of patented and proprietary medi- 
cines, with their fraudulent claims, and the 
devices used in advertising the same are a 
menace to the pul^lic health: 

Whereas, The American Medical Asso- 
ciation, through its Committee on Pharmacy 
and Chemistry, is making a heroic fight 
against the indecent, unscrupulous and 
avaricious system of prescribing, advertising 
and selling nostrums; therefore, be it 

Resolved, That the Buncombe County 
Medical Society heartily approve of the 
work being done by the Committee on Phar- 
macy and Chemistry of the A. M. A., and 
the great educational campaign being car- 
ried on by the Ladies' Home Journal, Col- 



THE CHARLOTTE MEDICA JOURNAL 



lier's Weekly, lvveryl)ody's Maj^aziiie, the 
Drugsisls' Circular, the P'arm Journal and 
other lay publications, in their fig-ht against 
the fraud and deception practiced in the 
manufacture and sale of secret remedies. 

Resolved, That it condemn the slovenly, 
unscientific and stultifying practice of ph>'- 
siciaus prescribing or sanctioning the use of 
medicinal agents of whose fonnulce and 
composition they are ignorant. 

Resolved, That it deeply deplores and 
heartily condemns the methods employed by 
certain druggists in advertising, both in 
public places and in the press, secret reme- 
dies, for which unscientific and fraudulent 
claims are made, and who thus necessarily 
tend to encourage ignorance and deception, 
and that the Society request them to co- 
operate with the medical profession in their 
fight against the nostrum evil. 

Resolved, That the Society, in the inter- 
ests of public health and common decency, 
recommend to the Board of Alderman of the 
City of Asheville, the passage of such ordi- 
nances as will iffohibit the indecent and 
fraudulent advertising of secret remedies on 
bill-boards and in other public places; and 
also prohibit the distribution of free samples 
of secret and possibly poisonous prepara- 
tions. 

Resolved, That the proposed act to regu- 
late the manufacture and sale of patent and 
proprietary medicines,- as published in the 
Journal of the A. M. A., of Veh. 3, 1906, 
p. 374, meet with the hearty approval of this 
Society, and the delegates of this Society to 
the N. C. State Medical Society are hereby 
instructed to have these resolutions read be- 
fore that body, with the request that the 
Committee on Legislation make every effort 
to secure the passage of this, or some simi- 
lar bill, by the vState Legislature. 

Resolved, That a special committee be 
appointed to continue in the interest of these 
resolutions, and report to this Society, from 
lime to time, as occasion may require. 

Resolved, That a copy of these resolu- 
tions be sent to each member of this Society; 
to each County Society of this State; to the 
Journal of the A. M. A., and the above 
named lay periodicals; to each of the drug- 
gists of ihinconibe county, N. C, and to 
the Hoard of Alderman of the Citv of Ashe- 
ville, N. C. 

n. IL HRIGCxS, 
LAllRHNCEli. HOLMES, 
J. II. W1LLL\MS. 
C.AILLARI) S. TENNENT, 

Secretary. 

Dr. Mason seconded Dr. Whittington's 
motion relative to the Buncom]:)e County 
Medical Society resolutions, and urged that 
the Society place itself on record as desiring 
our legislators, Iwtli State and national, to 



use every possible legitimate means to place 
on the statute books laws covering complete- 
ly the various needs suggested in the Bun- 
combe County Society communication. 

Dr. Faison thought we had already urged 
our congressmen to support "pure food leg- 
islation," but thought the motion was along 
proper lines. 

Dr. W. P. Whittington discussed "nos- 
trum legislation" and urged adoption of the 
resolutions pre.sented. 

Dr. Cyrus Thompson favored the resolu- 
tions and related a humorous incident rela- 
tive to the sick wife who took "three bottles 
of a certain medicine, &c." 

Dr. Mason's amendment was adopted, 
after which the resolutions as presented by 
Dr. Whittington were approved by the 
House. 

Dr. Mason urged the members of the So- 
ciety to exercise care and study closely the 
remedies they prescribed that we might 
eliminate the too prevalent tendency to care- 
lessly prescribe remedies, the composition 
of which was not known to the profession. 

It was reported to the House of Delegates 
that the committee on the State Society for 
the Prevention of Tuberculosis appointed 
by the President had met during the session 
and effected the organization of Tiie North 
Carolina Society for the Prevention of 
Tuberculosis, which would hold annual 
meetings at the same time and place as the 
State Medical Society. 

On motion a recess was ordered until 
Thursday a. m. subject to the call of the 
President. 

THURSDAY MORNING, MAY 31, 1906. 

The House of Delegates met on the call 
of the President at 11 o'clock, a. m. 

A communication from the Board of 
Medical lixaminers wag presented advising 
the Society of the resignation from the 
Board of Dr. Geo. W. Pressly,. on account 
of his having accepted a call to one of the 
chairs in the North Carolina Medical Col- 
lege, and not deeming it in harmony with 
the established sentiment of the profession 
in this State to remain a member of the Ex- 
amining Board while engaged in medical 
teaching. The H®use was also advised of 
the election to fill the vacancy caused by 
the resignation of Dr. Pressly, by the re- 
maining members of the Board, of Dr. G. 
T. Sikes, of Grissom, the late efficient 
Treasurer of the State Society, and his as- 
signment to the former duties of Dr. Pressly 
as Examiner in Chemistry and Pharmacy 
and Secretary to the Board of Examiners. 

The action of the Board of Examiners 
was approved. 

Dr. Oscar McMullan called attention to 
the fact that the House of Delegates at the 
session of the day previous had, in adopt- 



EDITORIAL. 



35 



ins Ae report of the Nominatiiii; Committee, 
elected two members of the House of Dele- 
.q:ates of the American Medical Association, 
when in fact it appeared that at the nieeting- 
of the Society in 19()n the two members 
elected were elected for two years, the regu- 
lar term of service in the position, and sug- 
gested that the House rescind its action in 
electing these gentlemen. 

Discussion followed. 

Dr. Way suggested the easiest way to ad- 
just the matter was for the members elected 
in 1905 for two years to resign, which would 
more readily enable the Mouse to arrange 
the representation in accord with the ex- 
pressed wishes of the Committee, and in ac- 
cordance with his suggestion the resigna- 
tions of Drs. J. Howell Way and James A. 
Burroughs as Members of the House of 
Delegates of the American Medical Associ- 
ation for the terms ending May, 1907, were 
tendered the House. 

After some discussion, on motion of Dr. 
McMullan the resignations were accepted. 

Proceeding to fill the vacancies created 
thereby, Drs. J. Howell Way and W. J. 
Lumsden were nominated for the positions. 
Dr. Way insisted on his willingness to serve 
the Society in any capacity where he could 
promote the good of the profession, but urg- 
ed that his name be withdrawn from con- 
sideration in this connection. 

A vote being' taken the nominees were 
elected unanimously. Later, acting on a 
suggestion made by him during the sitting 
of the House, Dr. Way's resignation was 
tendered to the President, and the choice of 
the Committee on Nominations for Member 
of the House of Delegates of the A. M. A. 
was approved by President Booth in ap- 
pointing Dr. J. M. Templeton, of Car}^ as 
Member for the year 1906. 

Report of Committee on President's 
Address to the PIouse of Delegates. 

Your Committee believe the suggestions 
as to the importance of further legislative 
enactments to our Medical laws, making a 
minimum standard of all applicants to 
know sufficient Ivnglish to speak and write 
correctly, are timely, and if carried out into 
legal requirements would relieve many ap- 
plicants and our Board of Medical Exam- 
iners of an annual recurrent embarrassment 
and keep out of the medical ranks a num- 
ber of defective members, who stand in dan- 
.ger of chronic "mental dyspepsia," that 
only a good literary education could have 
prevented. As sug.gested by the President 
and urged by the Board of Medical Exam- 
iners at Cxreensboro in 190.S North Carolina 
should not wait for outside States to take 
the initiative, but be a pioneer in this as she 
has in other medical legislation. We should 



recognixe that it takes a broader and stnmg- 
er mental .grasp at i^resent for the successful 
practice of medicine and surgery commen- 
surate with their broader scope in the various 
sciences, and this ability must come from 
literary or school training. 

■ We, therefore, recommend that an ad- 
junct committee be appointed to co-operate 
with the regular committee for the purpose of 
enacting a law in this State requiring a mini- 
mum standard of a literary education ]:)efore 
commencing the study of medicine and that 
our President, with three others of his selec- 
tion, shall constitute this committee. 

Albert Anderson, 
J. M. Parrott, 
J. Howell Way. 

The President appointed to be associated 
with him and the legislative committee, in 
this work, Drs. Albert Anderson, of Wilson, 
J. Plowell Way, of Waynesville, and James 
M. Parrott, of Kinston. 

A committee was appointed by the Presi- 
dent to escort Dr. S. D. Booth, the President- 
elect, to the Cieneral Meeting of the Society 
and introduce him. 

The following appointments as Chairmen 
of Sections for the ensuing year was an- 
nounced: 

Anatomy and Surgery — Dr. L. A. Crowell, 
Lincolnton. 

Materia Medica and Therapeutics — Dr. 
C. G. McManaway, Charlotte. 

Practiceof Medicine — Dr. J. B. II. Knight, 
Williamston. 

Physiology and Chemistry — Dr. J. E. 
Nobles, Greenville. 

Obstetrics — Dr. R. Duval Jones, New 
Bern. 

Civnaecolo.gy — Dr. J. R. Browning, Lit- 
tleton. 

Medical Jurisprudence and State Medi- 
cine — Dr. (Toode Cheatham, Brevard. 

Pathology and Microscopy — Dr. E. W. 
Phifer, Morganton. 

Railway Surgery — Dr. W. E. I leaden, 
Morehead City. . 

Paediatrics — Dr. O. W. Hollowav, North 
Side. 

There being no further business, the House 
adjourned sine die. 

Minutes of the North Carolina State Med- 
ical Society, FItty-thIrd Annual 
Session, 1906. 

GENERAL MEETING. 



The Fifty-third Annual Session of the 
North Carolina State Medical Society was 
called to order in the county court house at 
Charlotte, N. C, on the morning of May 
29th, with Dr. R. L. Gibbon, Chairman of 
the Committee of Arrangements, presiding, 
who made the following address: 



THE CHARLOTTE MEDICAL JOUANAL. 



' ' It gives me a great deal of pleasure, as 
Chairman of the Committee of Arrange- 
meiils, to call this meeting^ to order, and I 
will introduce to you Dr. J. R. Howerton, 
of the First Presbyterian Church of this city, 
who will lead us in prayer." 

Prayer by Dr. Howerton. 

Dr. (iibbon announced that, owing to the 
unavoidable absence of the mayor, the Hon. 
T. C. Ciuthrie, of the Charlotte bar, would 
deliver the address of welcome. Mr. Guthrie 
spoke in his usual happy style and made an 
able address on behalf of the city. 

Dr. Wm. A. Graham, of Durham, who 
was on the program for the response to the 
address of welcome, was unavoidablv ab- 
sent, but Dr. Ben. K. Hays, of Oxford, 
delivered a most entertaining and enjoyable 
address, and was heartily applauded by 
those present. 

Dr. Gibbon: 

Cientlemen, I next introduce to you your 
President, Dr. F,. C. Register, who will de- 
liver his annual address. ( Applause"). 

(Address by the President). 

Dr. Albert Anderson made the following 
motion : 

]\Ir. Chairman: 

I move a committee be appointed to re- 
port on the recommendations of the Presi- 
dent's address, and in making this motion 
I should like to add ^hat in my opinion we 
have never had a more scholarly and timely 
address from any President in the history of 
the North Carolina Medical Society. Its 
notice of progress along scientific, legisla- 
tive and organization lines is encouraging 
to those who have been eng^aged in the 
battle for the bringing to pass these things. 
While we have much to encourage us in his 
address, yet our President is faithful in 
pointing to our defects that we may elimi- 
nate them and build upon a surer founda- 
tion, -and thereby reach higher standards. 

Dr. GiI)bon: 

I want to make a few announcements, 
gentlemen. One is: I want to urge upon 
you to register as promptly as possible. 
When you register you will receive an en- 
velope containing a ticket to the various 
clubs of the city, a ticket to the banquet 
and a ticket to the reception to be given at 
the Colonial Club tonight at ten o'clock. 

The first paper is by Dr. P. F. Murphv, 
of Morganton, — "Colony Treatment of the 
Insane and other Defectives." 

Dr. jos. (kaham, of Charlotte, here made 
a motion that the registration l)e done in the 
hall on account of the confusion. The mo- 
tion was carried. 

Dr. Murphy's paper discussed bv Drs. 

Peacock, Thompson, Robertson and Svkes. 

"Some Points in Clinical Psychiatry of 

interest to the (xeneral Practitioner." — Dr. 



I. M. Taylor, of Morganton. 

Discussed by Drs. Geo. Thomas, Albert 
Anderson, R. IF Fewis, Dr. Burroughs, Dr. 
Booth, Dr. S. M. Crowell. 

"Incidental Observations on Hydropho- 
bia." — Dr. Davis Furman, Greenville, S. C. 

Discussed by Dr. Kent, and Dr. IF O. 
Alexander. 

"Acute Articular Rheumatism." — Dr. E. 
C. Boyette, Mt. Holly. 

Discussed by Dr. P'aison, Charlotte, N. C. 

"The Treatment of (Toitre." — Dr. Annie 
F. Alexander, Charlotte, N. C. 

The President: 

The House of Deleg^ates will meet in the 
Flail opposite at 3:15. The general meeting 
will be here this afternoon at three 'o'clock. 

The Society took a recess until three p. m. 



TUESDAY AFTERNOON. 

Convention re-assembled at three p. m. 
with Dr. F. B. McBrayer, First Vice-Presi- 
dent, in the Chair. 

"Therapeutic Nihilism and Pneumonia." 
— Dr. N. P. Coppedge, Margarets ville, N. C. 

Discussed by Dr. S. D. Booth. 

' ' The Treatment of Typhoid Fever. ' ' — Dr. 
J. M. Matthews, Mount Pleasant, N. C. 

"Malaria as seen in (Taston county." — 
Dr. T. C. Quickel, Stanley Creek, N. C. 

Discussed by Drs. Wharton, Marsh, Rod- 
man, and Matthews. 

Dr. Parrott: 

Here presents to the President the report 
of the Board of Medical Examiners and 
resolution attached. 

Chairman: 

Refers same to House of Delegates with- 
out action. 

' ' Broncho-Pneumonia Complicating 
Measles." — Dr. J. G. Busby, Spencer, N. C. 

"The Relations Existing Between the 
Upper Air Passages and the Fungs." — Dr. 
R. V. Brawley, Salisbury, N. C. 

Discussed by Dr. Marsh. 

A recess was taken by the Society until 
8:15 p. m. 

Note: — It is ordered that by general con- 
sent, those having- papers to read, and who 
are not present shall have them read by 
title. 

TUESDAY EVENING, MAY 30TIT. 

Convention called to order at 8:15 p. m. 
with the President presiding. 

"Tuberculosis." — Dr. K. M. Ferguson, 
Southern Pines. 

Note: — It was decided on account of the 
general symposium of tuberculosis, that all 
papers of like nature, upon the same sub- 
ject be discussed to.gether. 

"Skin Tuberculosis and other Derma- 
toses," (Illustrated) — Dr. Paul Paquin, 
Asheville, N. C. 



EDITORIAL. 



37 



"Tuberculosis, Prevention and Cure." — 
Dr. C. A. Juliaii, Thomasville, N. C. 

"Unjustifiable Negligence in the Dias- 
nosisof Pulmonary Tuberculosis." — Dr. \V. 
M. Jones, High Point, N. C. 

"The Prognosis of Pulmonar}' 'J'ubercu- 
losis." — Dr. James Sawyer, Asheville, N. C. 

The Vice-President here tenders a motion 
that the Convention adjourn until 9 a. m. 
the following morning ( Wednesday ) in or- 
der that the Convention might attend the 
reception at the Colonial Club, which recep- 
tion was tendered by the ladies of the City 
of Charlotte, N. C. 

The motion was unanimously carried and 
the meeting adjourned until 9 o'clock Wed- 
nesday morning. 

WEDNESDAY BIORNING, MAY 30TH. 

The Convention met at 9 o'clock with the 
President in the Chair. The program of 
Tuesday evening, "The Symposium on 
Tuberculosis," which had not been finished 
was taken up and completed. Dr. Arthur R. 
Guerard, of Flat Rock, N. C, reading first 
paper, "Treatment of Tuberculosis." 

"The Rational Treatment of Tubercu- 
losis." — Dr. W. R. Kirk, Hendersonville, 
N. C. 

"The Physician and his Relation to Tu- 
berculosis as a Social Problem." — Dr. T. A. 
Mann, Durham, N. C. 

"The use of Cotton Seed Oil in treatment 
of Pulmonary Tuberculosis." — Dr. C. D. 
Thompson, Lowesville, N. C. 

Discussed bv Dr. W. S. Anderson, of 
Wilson, N. C. 

"The Infection Dangers in Pulmonary 
Tuberculosis," by Dr. J. Howell Way, of 
Waynesville, N. C, read by title and re- 
ferred. 

The program of the morning was then 
begun, Dr. J. H. Marsh, of P^ayetteville, 
N. C, reading the first paper, "Are we do- 
ing our duty in preventing the spread of 
Venereal Disease?" 

"The Results of Cxonorrhoeal Infection in 
Females." — Dr. II. B. Weaver, of Ashe- 
ville, N. C. 

Dr. Weaver's and Dr. Marsh's papers 
were discussed together. 

Discu.ssion: Drs. Templeton, Burroughs, 
Coppedge . 

"The Imperfect Development of Certain 
Organs a Factor in the Special Diseases of 
Women." — Dr. B. S. Moore, of Charlotte, 
N. C. 

Discussion: Drs. Weaver, Ro3'ster. 

"Extrauterine Pregnancy, Fourteen Suc- 
cessful Operations. — Dr. J. W. Long, 
Greensboro, N. C. 

Discussed by Dr. Ilunner, Dr. Royster, 
Dr. Moore, of Wilson, N. C. 

"Post Operative Leucorrhoea." — Dr. C. 



M. Strong, of Charlotte. 

Discussed ))y Dr. IIuniRT. 

The Convention and the State Hoard <jf 
Health met in conjoint session at 12 o'clock, 
noon, with Dr. Geo. Thomas, President, of 
Wilmington, N. C, presiding. 

The organization of a State Society for 
the prevention of tuberculosis was discussed. 

Dr. Hayes here read the constitution. 
^Membership cards were then circulated. 

Dr. R. H. Lewis, Secretary of the State 
Board of Health, here submitted his report. 

The discussion of various features of the 
Secretary's report was here participated in 
by Drs. Julian, Templeton, Mason, I'ergu- 
son. Weaver, liaison, Anderson, Mann, 
Haves, Kirk. 

The Secretary's report was accepted. 

The President here ordered that Dr. 
Stevens would take what measures he saw 
fit to expedite the organization of the So- 
ciety for the Prevention of Tuberculosis, 
and extended a cordial welcome to all help- 
ful influences on sanitary lines. 

The conjoint session then adjourned. 

The convention adjourned until .3 p. m. 
WEDNESDAY AFTERNOON. 

vSociety re-assembled at three o'clock with 
Dr. McBrayer, Vice-President, presiding. 

Program of the morning resumed. Dr. 
M. A. Royall, of Yadkinville, read the first 
paper, "Curettment of the Uterus." 

"Vesical Calculi in the b'emale." Dr. A. 
M. Caveness, of Wakefield. 

Discussion: Dr. L. li. Holmes, Dr. 
M on cure. 

"Serum Therapy." — Dr. T. G. Hamrick, 
Caroleen. 

Discussion: Dr. M. E. Robinson, Golds- 
boro; Faison, A. S. Rose, Coppedge. 

Dr. Poole here read the report of the 
Obituary Committee. 

Discussed by Dr. Sykes, Dr. Coppedge, 
Mason. 

"Immediate and Remote Influences of 
County Medical Organizations." — Dr. J. C. 
Grady, of Kenly. 

Afternoon program taken uj) at the con- 
clusion of the morning program. 

"Arthritis Deformans." — Dr. L. E. 
Holmes, Biltmore, N. C. 

"A Plea for More I'requent Autopsies in 
Private Practice." — Dr. J. P. INIunroe, 
Davidson, N. C. 

Discussed by Dr. Crowell. 

"Where the Tides Meet."— Dr. II. S. 
Lott, Winston, N. C. 

Discussed by Dr. McBrayer. 

The Society adjourned until 8:15 p. m. 

WEDNESDAY EVENING, MAY 30th. 

Convention called to order at 8:15 p. m. 
by the President. 

Dr. James M. Parrott, of Kinston, N. C, 



e8 



THE CHARLOTTE MEDICAL JOURNAL. 



delivered the annual oration. 

Dr. Thos. S. McMullan, of Hertford, N. 
C, delivered the annual essay. 

Regular prog-ram here taken up, Dr. 
Royster, of Raleigh, N. C, reading first 
paper, "Washing the Hands." 

"The end results — mental, physical, psy- 
chical after oblation of certain structures and 
organs of the human body." — Dr. J. Ernest 
Stokes, of Salisbury, N. C. 

Discussed by Dr. Geo. W. Long. 

The Convention here adjourned until nine 
o'clock Thursday morning to attend the 
banquet given by the Mecklenburg Medical 
Society. 

Thursday morning the Society re-assem- 
bled with the President in the Chair. 

The program of Wednesday was con- 
tinued. 

Dr. Henry F. Long, of Statesville, N. C, 
read the first paper, "Gall Stones." 

Discussed by Drs. Tenipleton, Faison, 
Carr of Johns ilopkins, Hargrave, Mason. 

Dr. Way: Mr. President, I desire to in- 
troduce to this Society Drs. Davis Furman, 
of Greenville, S. C, and C. B. Earle, of 
Cjreenville, S. C, and move that we extend 
to them the privileges of the floor and debate. 
Motion carried. 

"Present Status of the Treatment of the 
Cancer." — Dr. L. B. McBrayer, of Ashe- 
ville, N. C. 

Discussed by Drs. Whittington, vSwann, 
Annie L. Alexander, Brooks, Carr, Mc- 
Brayer and Witherbee. 

"X-Ray Treatment as a Preventive of 
Recurrence following Extirpation of Malig- 
nant Growths." — Dr. W. D. Witherbee, of 
Charlotte, N. C. 

Note: — This j^aper was discussed in con- 
nection with the above paper of Dr. Mc- 
Brayer. 

"Trei^hining with ;Modern Instruments." 
—Dr. H. M. Wilder, Charlotte, N. C. 

"Chorea Graviadrum." — Dr. Tenipleton, 
of Carey, N. C. 

"Carcinoma of Penis." — Dr. Chas. M. 
Green, Wilmington. 

"Placenta Praevia."— Dr. C. II. C. Mills, 
Charlotte. 

"When the I^aby Comes." — Dr. Cyrus 
Thompson, Jacksonville. Read by Dr. 
Laughinghouse. 

Convention took a recess until 3 o'clock. 

TIUIRSDAY AFTKRNOON, MAY 31. 

Convention re-assembled at three o'clock, 
with the Vice-President in the chair. 

The members of the State Nurses Asso- 
ciation, in convention in the city, attended 
the convention in a body at this afternoon 
session, and added much to the interest of 
the occasion. Their presence was comment- 
ed on by the Vice-President in happy style. 



and he gave them a cordial welcome, on 
behalf of the Society. 

"Puerperal liclampsia." — Dr. M. R. 
Adams, of Statesville. 

"P^clampsia." — Dr. J. W. McGhee,Keids- 
ville. 

"Notes on Puerperal Eclampsia." — Dr. 
Raymond Pollock, Dover. 

Dr. Way, the vSecretary, presented a re- 
port from the House of Delegates of the 
officers elected for the ensuing vear. 

Dr. Ben. K. Hays and Dr. C^,eo. W. 
Long here introduced the President-elect, 
Dr. S. D. Booth. 

The Vice-President, in a brief, happy 
speech, introduced to the members of the 
Society the President-elect for the coming 
year— Dr. S. D. Booth, of Oxford. Dr. 
Booth responded in similar vein. 

Dr. McMullan asked that a resolution of 
thanks of the North Carolina Medical So- 
ciety be returned to the good people of 
Charlotte for their generous, beautiful hos- 
pitality during the meeting. The motion 
was unanimously carried, amid much ap- 
plause. 

The President then read the names of the 
Chairmen of the various sections for the en- 
suing year. 

Motion made and carried by Dr. Mason 
that discussion of the papers be dispensed 
with. 

"I'orceps in Labor." — Dr. L. D. Whar- 
ton, Smithfield. 

"Clinical Reports, two Caesarian Sec- 
tions, one Umbilical Fistula." — Dr. W. II. 
Dixon, PMward, N. C. 

"Imperforate Hymen at Full Term." — 
Dr. H. S. Lott, of Winston. 

"Marasmus." — Dr. E. II. Brooks, Reids- 
ville, N, C. 

"State Medicine as now enforced, and 
how it should be." — Dr. V/. P\ Hargrove, 
Kinston. 

Vice-President adjourned the Convention, 
sine die, to meet next vear at Morehead 
City. 

Delegates to the International Congress 
on Tuberculosis to be held in New Vork, 
Nov. 14, 15, IG, 1906, appointed by Presi- 
dent Booth: 

R. H. Lewis, Raleigh, N. C. 

Ben. K. Hays, Oxford. 

Chas. J. OH. Laughinghouse, Greenville. 

A. W. Knox, Raleigh. 

J. Howell Way, Waynesville. 

J as. A. Burroughs, Asheville. 

J. Roy Williams, Greensboro. 

Chas. A. Julian; Thomasville. 

W. M. Jones, High Point. 

A. A. Kent, Lenoir. 

COUNCIL ON MEDICAL EDUCATION OF AMER- 
ICAN MEDICAL ASSOCIATION IN NORTH 
CAROLINA. 



EDITORIAL. 



39 



Drs. Thos. S. McMullaii, Hertford, N. C' 
T. L. Booth, Oxford, N. C, Clias. Rober- 
son, C^reensboro, N. C. 

Editorial Notes 



THE PEOPbE VS. TMB PACKERS. 

It will be, as Lowell says, a sorry day for 
this Kepul)lic when there are no protestants 
to protest, and wdien the 8O,O(M),U00 of 
American people become awake to condi- 
tions that have (according to the govern- 
mental report of Messrs. Neill and Reynolds, 
made after a two weeks' inspection,) exist- 
ed in the Chicago stock yards, the court of 
Public Opinion will give a verdict in favor 
of decency . The people are not infallible or 
always fair, but with them lies the final ap- 
peal. "Given" says Upton Sinclair, "an 
enlightened public opinion, everything else 
will come." That the maker must, in the 
long run, keep faith with the buyer, is the 
underlying principle of barter and commerce. 

As to the detail of the report itself, it is 
as revolting as Mr. Roosevelt describes it; 
in this case, at least, the muck-raker seems 
to be a needed citizen. There is a con- 
glomeration of filth, human and animal, in 
the canning departments of the Chicago 
meat plants that seems incredible. Condi- 
tions are unsanitary, floors rotting and slimy, 
ventilation wretched, the air germ-laden, 
and the conveniences for the workmen are 
vile. A paragraph from the Neill- Reynolds 
rejjorts, says: 

''The neglect on the part of their employ- 
ers to recognize or provide for the require- 
ments of cleanliness and decency of the 
employees must have an influence that can- 
not be exaggerated in lowering the morals 
and discouraging cleanliness on the part of 
the workers employed in the packing-houses. 
The whole situation as we saw it in these 
huge establishments tends necessarily and 
inevitably to the moral degradation of 
thousands of workers, who are forced to 
spend their working hours under conditions 
that are entirely unnecessary and unpardon- 
able, and which are a constant menace not 
only to their own health, but to the health 
of those who use the food products prepared 
by them." 

In reply to the indictments, the eight 
largest i>acking li,ouses have issued a joint 
statement, but they do not make specific 
denial of the charges; in the interim, they 
have been cleaning up their places, and 
certain reforms that will be helpful have 
been set in motion. A pertinent question 
before the legislators is whether or not the 
government should pay for the drastic in- 
spection that will be needed in the future; 
those who call for this seem to overlook the 
responsibility that lies on any individual or 



any corporation seeking public i)atr()nage 
to make its wares safe for i)ublic u.se. A 
grewsonie exhibit of rotten and treated beef 
was provided for the recent meeting of the 
American Medical x\ssociation, wliich re- 
sulted in a resolution supporting the Presi- 
dent in his inspection crusade. 

It is stated that the demand for potted 
products has fallen off to the extent of J2(),- 
000,000, and that 60% of the workers are 
idle; certainly the public appetite for canned 
meat is not normal and those factories that 
do follow after cleanliness have suffered in 
consequence of the Augean disclosures at 
Chicago. A little more discrimination — the 
calling of guilty names, for instance — would 
have been more just to manufacturers as a 
class. Reports from Eurojae indicate a de- 
termination to exercise a rigid oversight of 
all food supplies coming from America. 

THE MBDIGAl, PROFESSIOIN AND THE 
ISSUES WHICH GOINrROMT IT. 

At the opening of the fifty-seventh annual 
meeting of the American Medical Associa- 
tion, at Boston, June 5th-Sth, President 
Mayo, of Rochester, Minn., made a most 
notable address on the above broad subject. 

lie referred, as introducing his theme, to 
the organization which has been attained, 
with a note of warning that we are as yet 
but on the threshold of a perfected organi- 
zation, that can appeal to the country as 
sanitative authority, an "organization that 
will encourage right thinking and good us- 
age among ourselves, help to secure needed 
medical reforms, compel redress of griev- 
ances and promote and encourage the high- 
est interests of its individual members." 
To accomplish this, self must be merged 
into service, looking to the greatest good to 
the greatest number. We have been over- 
whelmed by the new truths that are daily 
opening to our visions, and it is impossible 
to expect the lay mind to keep pace. There 
is need for infinite tact and infinite jjatience 
in educating the public in the grave im- 
portance of measures to prevent and control 
tuberculosis, yellow and typhoid fever, ma- 
laria, cancer, smallpox, etc. 

Appreciative reference was made to the 
crusade against patent nostrums by the 
Ladies' Home Journal and Colliers' Weekly, 
and to the work done by the Public Health 
and Marine Hospital service. 

In speaking of the life-study the jM'ofes- 
sion involves, and the need of careful and 
broad preparation, he stated: 

"We can not rid ourselves of dogmas and 
pathys until we can secure a universal pri- 
mary law as to the minimum amount of 
knowledge on fundamental branches. To 
accomplish this the American Medical As- 
sociation must co-operate with and encour- 
age medical colleges to do better work. The 



40 



THE CHARLOTTE MEDICAL JOURNAL. 



profession owes it to itself to investigate in 
some manner what the schools are actually 
doing and to make it known whether or not 
they fulfill their obligations to the student. 
No well-conducted college could object to 
such reasonable supervision." 

The address was closed with an appeal 
for the individual following out of the aims 
and ideals of those who have blazed the 
way, and for united effort towards further- 
ing the great movements of the day. 

BINGUISM EMPIRICISM. 

\\'hen it comes to the question of nos- 
trums and quacks, it may help us to bear 
with more professional equanimity the trou- 
bles of our own land, when we realize that 
America has not cornered the crank market. 
It would seem to be too late, in the progress 
of the suns, for the anti-vaccinationists to 
be pandered to by a body like the British 
House of Commons; and yet so exalted a 
personage as the Minister of liducation has 
stated that he would insert in the regula- 
tions "a provision to exempt intending 
teachers who objected to be vaccinated, 
leaving local authorities to decide in each 
case whether they would employ such a 
teacher." When asked if such a gap as he 
was letting down was allowed in other civi- 
lized countries he made the undignified, 
evasive reply, that he was not a judge of- 
civilization, he was Minister of I^ducation! 

THE PRBB AUGOHOL, BIL.L.. 

The free alcohol bill, reported to thevSen- 
ate on May 23, was passed the next day, to 
become effective January 1st, 1907. This 
will give the internal revenue department 
time to adjust itself, and the manufacturers 
of wood alcohol a chance to dispose of sur- 
plus stock. The bill provides that after it 
becomes a law domestic alcohol of such de- 
gree of ])roof as may be prescribed by the 
commissioner of internal revenue may be 
withdrawn from bond without payment of 
internal revenue tax, for use in the arts and 
industries and for fuel, light, and power, 
provided said alcohol shall have been mixed 
in the i^resence and under the direction of 
an authorized Government officer, with 
denaturizing material, which destroys its 
character as a beverage and renders it unfit 
for medicinal purposes." 

DBFIINITIOIN OF PR'\GTIGB OP MBDIGINB 

The New York Court of Record's decision 
as to the meaning of Practice of Medicine 
is worthy of publication: "The practice of 
medicine is the exercise or performance of 
any act, by or through the use of anything 
or matter, or by things done, given, or ap- 
plied, whether with or without the use of 
drugs or medicine, and whether with or 
without fee therefor, by a person holding 



himself or herself out as al)le to cure disease, 
with a view to relieve, heal, or cure, and 
having for its object the prevention, heal- 
ing, remedying, cure, or alleviation of 
disease." 

TUBERCUUOSIS ll> GBRMAiNY. 

The National Tuberculosis Congress, in 
recent session in Berlin, has published a 
gratifi^ng statement that shows a decrease 
of 38 per cent, in the number of deaths from 
tuberculosis since 1875. Of the patients 
treated 34 per cent, have been restored to 
health. In 1905, 15,161 persons were ex- 
amined at Berlin; 8,200 apartments were so 
arranged that infected cases could be iso- 
lated. 

The insurance companies of that pro- 
gressive country have made an outlay of 
i' 1,900, 000 within four years, for the pur- 
pose of staying the disease; this included 
the establishment of thirty-six sanatoria, 
with 2652 beds, for women and children; 
during 1905, 26,621 persons were treated at 
these institutions. 

Tlie friends of Drs. E. R. Russell and A. 
J. Crowell, of Charlotte, N. C, will be 
pleased to know that they are now in Eu- 
rope, where they are studying in their re- 
spective, special lines. 

STATE MEDIGAb SOCIETY OP MORTM 
CAROLiMA. 

We are indebted to Dr. J. Howell Way, 
of Waynesville, N. C, Secretary of the 
Society, for a handsomely bound copy of 
' 'Transactions of Fifty-second Annual fleet- 
ing of the Medical Society of the State of 
North Carolina." The Society of North 
Carolina is one of the few State Societies 
which adheres to the plan of an annual 
volume of transactions which can be pre- 
served in good form for reference. 

This volume indicates that the vSociety of 
North Carolina is doing the work which 
falls to a State Society in a very able man- 
ner, indeed, and that the Society is in a 
most flourishing condition. We understand 
that the membership of this Society has of 
late been very largely increased, and that 
this condition is largely due to the untiring 
efforts of its secretary. Dr. Way. It is dif- 
ficult to estimate the value of a competent 
secretary to a Society, and when one is 
found who is all right his services should be 
retained as long as he can afford to make 
the sacrifice of time which is always neces- 
sary to make t][ie work of the office, a suc- 
cess. 

The above appeared as an editorial in a 
recent issue of The International Journal of 
Surgery, of New York. Dr. McDonald's 
last paragraph indicates that he knows that 
every bright, successful physician cannot 
make a good Secretary of a Medical Society. 



EDITORIAL NOTFS. 



41 



THE BOSTON MEETING. 

The fifty-seveiilli annual meetin<j of the 
American Medical Association, after an in- 
terval of forty-one years, met in Boston, 
June 5th. Nothing was spared by the city 
in the way of money or human effort, to 
make the meetintj a delightful one. The 
handsome group of marble buildings, which 
the Harvard Medical School will dedicate 
next fall, was used with satisfactory effect 
for both social and professional ends, and 
the many hospitals and medical schools 
furnished opportunity for clinics, the study 
of individual cases, etc. 

The scientific work of the meeting was 
above the average; papers wei'e presented 
by experts to the various sections, to hear 
which fully repaid long journeyings; in fact 
the number of these papers has become so 
great as to make it imi:)ossible for them to 
be assimilated and calmly discussed. How 
to curtail the continually gTowing program 
and at the same time utilize the thought of 
the organization is one of the problems that 
lie before it. 

Whispers, in official circles, of a proposed 
change in the administrative affairs of the 
Association gave additional interest to this 
meeting. The feeling of dissatisfaction with 
the work of the secretary-editor. Dr. George 
H. Simmons, has become so general that a 
change would have doubtless resulted had 
the question come before the body, instead 
of the House of Delegates, the members of 
which are appointed each year by the State 
Societies, and not directly by the ilssocia- 
tion. Dr. Walker, of Detroit, presented a 
resolution, asking for an investigating com- 
mittee; introducing the same, he stated that 
the majority of the members do not under- 
stand the workings of the Association and 
that an investigation would clear the officers 
of suspicion. The fact that this resolution 
was tabled will have a far from quieting 
effect; it will feed the feeling that things 
have been done that will not bear the light, 
and only postpones what must come before 
confidence will be restored. The Charlotte 
Medical Journal feels, and feels strongly, 
that Dr. Simmons is not the man for the 
place he occupies as editor of the official 
organ of the Association, which goes, each 
week, to 43,000 doctors and should be the 
leading professional magazine in the world. 

We give, in another column, a resume of 
the address of the President, Dr'. William J. 
Mayo, of Rochester, Minnesota, who, in 
connection with his brother, has built up a 
hospital to which eminent men in the pro- 
fession go, both for treatment and observa- 
tion. 

The next meeting will be held at Atlantic 
City, which as a convention city is coming 
to be a rival to Washington and where the 



tired worker from the interior will find, next 
June, a tonic in the sea air and accommo- 
dations that will be ample for all needs. 

TtlE AMERICAN MEDIGAE BDITOKS" AS- 
SOCIATION. 

In connection with the meeting of the 
American Medical Association the above 
named body met in Boston, June 4th, in its 
thirty-eighth annual meeting, with Dr. 
Henry Waldo Coe, of Portland, Oregon, in 
the chair. 

Interesting jjapers were read by Drs. 
James li. Pilcher, William J. Robinson, T. 
I). Brothers, John Punton, Charles Wood 
Fassett, W. C. Abbott and Frank P. Foster. 

Among the questions considered, that 
deal with practical journalism, and which 
are constantly arising in all medical editor- 
ial offices, was the matter of advertising 
proprietary medicines, and the advisability 
of printing, simultaneously, the same article 
in a number of different journals. Dr. l<"os- 
ter made a strong plea for united action to 
prevent the latter, and Dr. Abbott, of Chi- 
cago, and Dr. K. W. Millican, of St. Louis, 
dealt with the former question, insisting on 
fairness to the worthy advertiser, and ex- 
posure, so far as in us lies, to the frauds. 

The following officers were elected : Presi- 
dent, Dr. James Evelyn Pilcher, of Carlisle, 
Pa.; First Vice-President, Dr. Fraiik P. 
Foster, of New York ; Second Vice-President, 
Dr. Charles F. Taylor, of Philadelphia: 
Secretary and Treasurer, Dr. Joseph Mac- 
Donald, Jr., of New York. 

The busy physician will find a real com- 
fort in the ledger manufactured by M. S. & 
D. A. Byck, of Savannah, Ga., advertised 
in this issue of the Journal. He can make 
certain memoranda which are very valuable 
to him for future reference; for instance: 
sometimes in the successful treating of a 
case — a physician desires to record any par- 
ticular method of treatment — so that at any 
future time having a similar case to attend 
might wish to treat in like manner, he can 
easily refer to the party's page in Ledger 
and find all the requisite memoranda at 
once. Whereas, as a general thing the 
physician not having such a Ledger, quite 
often makes his notes or memoranda — places 
same on various files, and in time the ac- 
cumulation of papers on said files, &c., be- 
comes so much that the doctor cannot find 
it when wanted — and often one particular 
note when wanted, to refer to, is worth to 
the doctor the price of the entire book itself. 
This space on every page. 



THE CHARLOTTE MEDICAL JOURNAL. 



Book Notices. 



Lady Baltimore. By Owen Wister. With 
illustrations by Vernon Howe Bailey and 
Lester Ralph. The Macmillan Co., 66 
Fifth Avenue, New York. Price $1.50. 
Owen Wister needs no introduction to 
our readers, for the simple statement. Author 
of The Virj^inian, is sufficient explanation. 
He has entered fully into the traditions of 
Kingsport, which is Charleston, thinly 
veiled, where he went to find a link in the 
past, but found, instead, a new link to the 
charming i)re!-ent. The story is unique and 
quaint, and the author's epigrammatic vein 
makes many happy side-shots at some of 
the absurdities of life. We are indebted to 
him for two expressions that express some- 
thing, and will live: "The yellow rich" 
and "The Replacers." Their satellites are 
drawn with a master hand. 

Little by little the details of the plot are 
put together. An inexperienced youiig^ fel- 
low, fascinated by a woman, with little but 
her beauty to attract, awakens to find that 
there is nothing save his sense of honor 
binding him in the promise of marriage; 
then he finds the girl who has what his 
fiancee lacked, and the inevitable takes 
place. A tame little story? There is a deli- 
cate flavor, and a delightful aroma, there is 
old-time picturesqueness, there is the secret 
of the old order, there is a keen sense of 
personal honor and the aristocracy of blood, 
there is loyalty in which money does not 
count, there is simplicity, there is a note of 
patriotism, there is true friendship and quiet 
fun — all making a whimsical and sympa- 
thetic and wholesome story. 

As to the title of the book you must read 
it yourself to find out what it means. 



The Holy Grail. By James A. B. Scherer, 
LL. D. J. B. Lippincott Company. Phila- 
delphia and London. $1.25 net. 
Dr. Scherer is the capable President of 
Newberry College in South Carolina, and is 
well-known among thousands of readers by 
his popular books on Japan — "japan To- 
Day" and "Young Japan" — and by his 
unique story of the Church, entitled "Four 
Princes." He is equally well known as a 
speaker, having been heard on many plat- 
forms, especially in the South. The present 
volume is offered in respone to a wide-spread 
demand for the preservation of a selection 
of his literary addresses and essays in per- 
manent form. 

He is a graceful, appreciative writer, and 
a student of literature and of life. The con- 
tents of this interesting volume are: 

The Holy Grail— A Tribute and an Ap- 
peal. 

Henry Timrod— A Carolina Poet. 



Sidney Lanier^Minstrel and Man. 

The Crusaders — A Study of the Trans- 
formed Cross. 

Liberty and Law — The Foundations of 
Patriotism. 

Tire Century in Literature — A Review and 
a Forecast. 

The book ought to be in every Southern 
library. 

The Mecklenburg Declaration of Indepen- 
dence, May 20, 1775, and Lives of its 
Signers. By George W. Graham, M. D. 
Cloth, 205 pages. Price, $1.50. The 
Neale Publishing Company, Washington, 
D. C. ' ' 

This book, in a more condensed form, 
was read before the Scotch-Irish Society of 
America, at its meeting in Lexington, Vir- 
ginia, in 1S95, and is included in the trans- 
actions of that Association. As a demand 
for information in regard to long mooted 
questions was evidenced, the original essay 
was enlarged and published in book form. 
The 20th of May, 1906, was so elaborately 
and so worthily celebrated in the city of 
Charlotte, where the Mecklenburg Declara- 
tion was made and which is the home of Dr. 
Graham, that a new impetus has been given 
to perpetuating the date on which it is con- 
tended that the several militia companies of 
the county met and resolved to be free from 
the mother-country. 

We have not room here to go into the 
merits of the chain of evidence presented, 
but the author has made an interesting con- 
tribution to the history of the period, and 
there is no more interesting period in our 
Nation-history, than that of the decade in 
which we came into being. 

Some Neglected History of North Carolina, 
by William Edward Fitch, M. D., in- 
cluding the Battle of Alamance, the First 
Battle of the American Revolution, 8vo. 
pp. 308; illustrated; price, $2. Publishers: 
The Neale Publishing Company, Fifth 
Avenue and Twenty-third Street, New 
York. 

Dedicated 
to 
Hon. Joseph M. Morehead 
In acknowledgement of his consummate 
wisdom as a statesman, his valor as a 
soldier, his incorruptible integrity, and 
his researches in the history and causes 
of the Revolution of the Regulators, un- 
surpassed by any writer; and 
To 
General Julian Shakespeare Carr 
Because of his love for the 'Old North 
State, ' his veneration for her heroes who 
bled at Alamance, his success as a model 
man, his philanthrophy and loftiness of 



BOOK NOTICES. 



character." 

Dr. Fitch is a Georj^ia physician, who has 
given much careful study to the early his- 
tory of North Carolina, and this contribu- 
tion to the limited literature of that period 
is an interesting and valuable one. 

Of course the "Regulators" are the star 
actors, and Dr. Fitch contends bravely for 
giving them and the battle of Alamance the 
place they deserve in the Revolution series. 
Of them he writes: 

"The war of the Regulators was a revo- 
lution and the beginning of, and the Revo- 
lutionary War the ending of, one and the 
same war against oppression by the British 
government." 

There are biographical sketches of Gover- 
nors Arthur Dobb and William Tryon, 
Colonels Edmund Fanning and Hugh Wad- 
dell, and Judges Henderson, Moore and 
Howard; the Regulator leaders, Col. Thomas 
Person, James Hunter, James Pugh, Har- 
mon Husband, Dr. David Caldwell and 
others. 

The loyal spirit, and its real merit, will 
hold your attention to the end, while the 
mechanical make-up of the book shows the 
estimate that the publishers place upon it. 
The student of North Carolina history — and 
may his tribe increase — can not afford to 
over-look this book, which was published 
early in 1903. 



The Diagnostics of Internal Medicine. A 
Clinical Treatise upon the Recognized 
Principles of Medical Diagnosis Prepared 
for the use of Students and Practitioners 
of Medicine. By Glentworth Reeve But- 
ler, A. M., M. D., Chief of the Second 
Medical Division, Methodist Episcopal 
Hospital; Attending Physician to the 
Brooklyn Hospital; Consulting Physician 
to the Bushwick Central Flospital; form- 
erly Associate Physician, Departments of 
Diseases of the Chest and Diseases of 
Children, St. Mary's Hospital, Brooklyn, 
N. Y.; Fellow of the New York Academy 
of Medicine; Member of the Medical So- 
ciety of the County of Kings, etc. 8vo. 
1061 pages. 224 Illustrations. Prices: 
Cloth, $6.00; sheep, $7.00. D. Appleton 
and Company, 72 Fifth Avenue, New 
York. 

The Diagnostics of Internal Medicine is 
the work of a practical clinician, written in 
a clear, fresh, and fascinating style that 
will be appreciated by the student and prac- 
titioner of medicine who wishes to become 
familiar with the foundations -of the art of 
medicine. Dr. Butler has covered a wider 
range than is usual in works of this class; 
and this book is probably without a rival in 
its chosen field of Medical Diagnosis. 

Part I deals with the evidences of Disease 



(in 44 sections), comprising a brief consid- 
eration of the clinical anatomy and physi- 
ology of certain- organs and systems; a de- 
scription of the approved methods of exami- 
nation; a careful consideration of the many 
signs and symptoms encountered in the 
practice of internal medicine; and a state- 
ment of the diagnostic significance of each 
sign and symptom. 

Part, II, Diagnosis, Direct and Differential 
(11 sections), comprises succinct descrip- 
tions of recognized diseases and their symp- 
toms, with special reference to the diagnosis, 
direct and differential, of each disease. 

A Manual for the Eclectic Treatment of 
.Disease. Finley I{llingvvood, M. D., 
Professor of ^Materia Medica and Thera- 
peutics, Bennett Medical College, Chicago. 
Editor Chicago Medical Times. Two 
Volumes. Volume I. Chicago Medical 
Times Publishing Company, 100 State 
Street, Chicago, 111. 

The author, in writing this work on the 
treatment of disease, has embodied the prin- 
ciples which he presented in his former 
works on Materia Medica and Therapeutics. 
It is a companion volume to the former 
works, and can best be used in connection 
with those, where will be found, in many 
instances, an exhaustive consideration of 
the remedies suggested. In the arrange- 
ment of the different topics a strictly scien- 
tific grouping has been sacrificed in order 
to make a more practical working arrange- 
ment. 

i\.s the successful treatment of disease is 
the objective point of every student in medi- 
cine, this book will doubtless have a wide 
sale among physicians who are not satisfied 
with their attainments in this direction, who 
are continually searching for knowledge of 
the most direct action of drugs, as applied 
to specific conditions of disease. 

The Dawn of a Tomorrow. By Frances 

Hodgson Burnett. Charles Scribner's 

Sons, N. Y. $1.00. 

The present tense of this book is a story 
of a British Baronet of great power and ac- 
cumulated wealth, who became satiated 
with life, and disguising himself in old, 
cheap clothing, he went down into the slums 
to die by his own hand; in the fog he came 
in touch with a slum-child, from Apple 
Blossom Court — a born optimist; he went 
home with her to find so much wretchedness 
that he and his money could help that he 
was won from hts wish to die, and life took 
on a new meaning; that is the tomorrow of 
the title. 

Mrs. Burnett writes with deep spiritual 
feeling and the story is a new testimony to 
the fact that the world-weary reaching out 



THE CHARLOTTE MEDICAL JOURNAL. 



after CtOcI, may find him in service. The 
child-like, responsive faith of the Court is 
shown in the prayer of the simple woman; 
"Speak Lord, for thy servant 'eareth," and 
her satisfied statement: "The answer will 
be save me soon . " 

The Phantom of the Poles. William Reed's 
arguments to prove that the earth is hol- 
low. Walter S. Rockey Company, Pub- 
lishers, 259 Fifth Avenue, New York. 
Illustrated. 

The narrative is founded upon the theory 
that the earth is hollow, with openin<j;s at 
♦the northern and southern extremities. 

The author declares that "when Lieuten- 
ant Greeley was beholding- the mock sun at 
120 deg. L., he was looking: into our sister- 
world; and when Nansen saw the square 
sun lined with horizontal bars he was gaz- 
ing on what may be the future home of his 
daughter, then but two years old. 

The old complaint of the unsatisfying ex- 
planation of books is also expressed by the 
author. "School-books teach that the earth 
is round, and flattened at the poles," but 
do not tell us why. He opens our eyes with 
this belief: that the earth is hollow and that 
the opening causes the appearance of flat- 
ness. Again, "when Nansen was going 
into the interior of the earth, he was under 
the impression that he was going north." 
Of course, as the author says, "travelers 
must go north wdien they go into the in- 
terior, until they reach the farthest point, 
but long before they do, they will have sunk 
a long way into the earth." 



unknown in America, but this translation 
will do much to introduce her to our people. 



Balzac; A Critical Story. By llippolyte 

Adolphe Taine, with an Appreciation of 

Tainebythetranslator,LorenzoO'Rourke. 

The Funk & Wagnalls Company, New 

York City. Priced $1.50. 

Emerson says there is no history, only 

biography, so a biographical study of one 

of the greatest of novelists, by one of the 

greatest literary critics can hardly fail to 

find an appreciative audience. Balzac and 

Taine are household words among English 

speaking i^eoples, but to comprehend them 

it is needful to be acquainted with them as 

men, in addition to knowing them through 

their writings. Balzac has been called the 

greatest storehouse of documents on human 

nature that we possess. 



The Mystery of The Lost Dauphin. By 

Emilia Pardo Bazan. Translated from 

the Spanish by Annabel Ilord' Seeger. 

Pp. 337. New York: Funk & Wagnalls. 

Price, $1.50. 

The Mystery of the lost Dauphin, Louis 
XVII, of France, takes its place along with 
the Man in the Iron Mask, and the disap- 
pearance of the Little Princes' in mysterious- 
ness and jiiti fulness. However, this version 
of the story might have happened, and it 
makes, as Horace Greely said, mighty in- 
teresting reading. 

The author founds the tale on the assump- 
tion that Maundorf, the Prussian watch- 
maker, was the dauphin; Maundorf tells the 
story of his capture, imprisonments, escapes, 
and subsequent trials and disai)pointments. 
His appeal to Maria Therese would touch 
any heart. The plot of the story is grouped 
about this narrative of Maundorf's, as a 
great deal of time and money was spent to 
discover the Mss. in order that it might be 
destroyed. 

Madame Bazan is among the great women 
novelists of her time; h^r w^ork is almost 



The Life of William Pepper, M. D., LL. D. 

Francis Newton Thorpe. The J. B. Lip- 

pincott Compau}^, Philadelphia, Penna. 

$3.75, postpaid. 

This book is the life-storv of a man of 
mark, who has not only influenced thous- 
ands of students who sat at his feet, but his 
services to Philadelphia, in Art, Science 
and Industry will endear his name to pos- 
terity. It is a story of the philanthropic 
growth of the city. 

Future generations may appreciate even 
more than the present, the work of William 
Pepper. Looking at the work he did and 
the plans he wrought, we see that he strove 
to establish in his own city a system of 
schools and museums that will make his 
name fragrant for all time to come. 

He was, first of all, a healer of disease; 
his power of diagnosis was inborn. When 
but thirty-three years old, he was appointed 
Medical Director of th^e Philadelphia Cen- 
tennial, and he received personal recognition 
from the English Government for his care 
of its Commission, and had been made 
Knight Commander of the order of St. Olaf . 

In 1885 he finished his five- volume work, 
The American System of Medicine, which 
has become popularly known as the Pepper 
System; during this year he was jjresident 
of the American Climatological Association, 
and was the father of the Association of 
American Physicians. 

During General vSheridan's last illness Dr. 
Pepper spent the nights in Washington by 
his bedside, and his days in Philadelphia, 
where his duties as Provost of the Univer- 
sity of Pennsylvania, or his profession were 
not neglected. 

At fifty-five years he droojjed under his 
burden. No man could carry so much and 
live. As an enduring monument, he left 
The LTniversity Hospital, The Commercial 



BOOK NOTICES. 



45 



Museum, The Philadelphia I'ree Library, 
and the rniversily of Peuusylvauia reor- 
.o-anized. The educational ideals of the city 
had been changed. To do these thintis 
$10,(M)().000 has been secured through his 
solicitation; of the amount he save nearly a 
half-million out of his own pocket. It is an 
inspiring^ story, and the face of the man is 
an inspirino- face. Tvvery physician should 
have the book in his library. 



Polk's Medical Register and Directory of 

North America, V)0(i. Ninth revised 

edition has been received. 

This volume contains 3166 pages of con- 
centrated information that is useful to the 
profession . The Directory j^roper is arrang- 
ed by location, giving postoffice address, in 
alphabetic order, first, and then the indi- 
vidual names, so arranged. 

The publishers are R. L. Polk & Company, 
Detroit, Michigan. 



Modern Physio-Therapy. A System of 
Drugless Therapeutic Methods, Including 
a Chapter on X-ray Diagnosis. By Otto 
Juettner, A. M., Sc. M.,' M. D., M. E., 
Ph. D., Professor of Practice at the Cin- 
cinnati Post Graduate School of Physi- 
ological Therapeutics, Associate Ivditor 
Journal of Physical Therapy and Inter- 
national Journal of Therapy, Member 
Roentg-en Society, London, Eng., etc., 
etc. Harvey Publishing Co., Cincinnati, 
Ohio. Price, cloth, $6.00 net. 
This book is divided into twro sections, 
Part I treating of the Principle of Physiolo- 
g-ical Therapeutics, and Part II is a Thera- 
peutic Index, in which the writer has ar- 
ranged diseases and their treatment in an 
alphabetic manner. 

The work has grown out of a large ex- 
perience, and its magnitude necessarily 
cramps one in attempting to present it in 
one volume. The chapter on X-ray diag- 
nosis is an especially valuable one, and it 
will prove of great interest to those who wish 
to investigate this art. 

Many physicians will doubtless take is.sue 
with him in that he does not iind the uses 
of electricity and the X-ray to be on the 
same plane of s'cientific exactness as photo- 
theraphy, mechanotherapy and hydrother- 
apy. Theoretically, the book covers the 
entire field of clinical medicine, and a thor- 
ough study of the first four chapters will be 
extremely helpful to any student of Physio- 
therapy . 

We are glad to note that there has been a 
great demand for this publication and it has 
brought wide recognition to its talented 
author. A Spanish edition is being pre- 
pared by a Professor at the University of 
Mexico. 



The Medical Diseases of Infancy and Child 
hood, with points on the Anatomy, Physi- 
ology and Hygiene peculiar to the De- 
veloping Period. By Alfred Cleveland 
Cotten, A. M., M. D., Professor of Pedi- 
atrics Rush Medical College, University 
of Chicago; Attending Physician for Dis- 
eases of Children Presbyterian Hospital; 
Consultant to the Central ['"ire Dispens- 
ary, etc., etc. Formerly physician in 
charge of the Chicago Isolation Hospital 
and of the Infectious Disease Wards of 
the County Hospital. Meml^er of the 
XIII International Medical Congress, 
Moscow. Honorary Member of the So- 
ciete d'Hygiene, Paris, etc. Philadelphia 
and London. J. B. Lippincott Company. 
1906. 

The Journal has already referred to this 
most excellent and reliable text-book. It is 
what it claims to be — a treatise on Pedi- 
atrics, growing out of extensive preparation, 
in which the author has devoted large space 
to the subjects connected with the develop- 
ing period. The matter of infant feeding is 
broadly treated, as is also the action of 
medicines and hygiene. 

The type is good and there is a sense of 
comfort surrounding the book that makes 
its very appearance a joy to the book-lover. 
It is aptly and extensively illustrated, and 
the book will receive a warm welcome from 
the profession. It is one of a new medical 
series that is being brought out by the J. B. 
Lippincott Company, a firm that gives to 
the internal as well as to the mechanical 
make-up of its books the most scrupulous 
over-sight. 

Abstracts of the Leading Articles of 

the Month. 

PROLAPSE OF THE RECTUM--PATHO- 
GENESIS AND TREATMENT n of m a n n 

(Centralblatt fur Chirurgie) says that the 
rectum is supported by the muscles of the 
perineum, especially the levator and sphinc- 
ter ani, and not by internal attachments. 
Treatment should, therefore, be directed to 
the strengthening and support of the peri- 
neal floor, and lie proposes the following 
operation to effect this purpose: 

An Il-shaped incision is made in the 
perineum, embracing the rectum in the an- 
terior part of the II and the tip of the coccyx 
in the posterior. The rectum is separated 
from the structures behind it to a depth of 
two inches, and the cavity thus produced is 
elongated anteroposteriorly by drawing the 
rectum and anus forward and closed from 
the bottom, so as to make a straight wound 
running anteroposteriorly from the coccyx 
to the rectum. In this way the transverse 
muscles supporting the rectal floor are short- 



46 



THE CHARLOTTE MEDICAL JOURNAL. 



eiied without any sacrifice of tissue. Rest 
in bed for three weeks after operation is 
advisable. 

The method has been used in several cases 
with good results. 

A NEW SIGN OF ORGANIC PARALYSIS 

OF THE LOWER EXTREMITY (.rassett 

and Ciaussel (Univ. de Montpellier) men- 
tion a new sign of organic paralysis of the 
lower extremity, consisting in the possibility 
of raising the paralyzed limb separately, 
with impossibility of raising both lower ex- 
tremities simultaneously. 

This sign, according to these observers, 
is to be considered as a proof of insufficiency 
of pelvic fixation in the act of raising the 
lower limbs, and is freciuently observed in 
the organic palsies of the lower extremity, 
more especially in hemiplegia. This phe- 
nomenon does not agree with our knowledge 
of the greater facility of associated move- 
ments in hemiplegia, and may be interpreted 
as due to paralysis of pelvic fixation in the 
flexor movements of the thigh on the pelvis. 
The symptom, which has also been noticed 
to occur in paraplegia, should be looked for 
along with the signs of Babinski and Pierre 
Marie, in testing motion in hemiplegia. It 
would certainly seem serviceable in the dif- 
ficult differentiation between organic paraly- 
sis and the neuroses. In hysteria the para- 
lyzed limb is either not raised at all, be it 
alone or together with the other one; or it is 
raised equally well in both cases, fixation 
being an automatic phenomenon distinct 
from voluntary actions. In hemiplegia the 
new sign is not invariably present, for the 
paralysis must be incomplete in order to ad- 
mit of raising the paralyzed limb at all, and 
yet sufficiently marked in certain muscles 
to prevent normal raising of the limb. 

Four observations made on individuals 
having hemiplegia are given in illustration 
of the author's argument. 

ALBUMINURIA AND THE INDUCTION 
OF LABOR.— Veit (British (gynecological 
Journal ) believes that neither albuminuria 
in itself nor the kidneys of pregnancy con- 
stitutes an indication for the induction of 
premature labor, though the first signs of 
the transition into nephritis do. Ascites, 
hypertrophy of the left ventricle, and still 
more albuminuric changes in the retina, 
demand the induction of labor. If the preg- 
nant woman already has nephritis, he does 
not induce labor until there is some further 
disturbance of equilibrium in the patient's 
condition, such, for instance, as the onset 
of dyspnoea, or of irregularity in the pulse. 

THE ENLARGED PROSTATE: ITS NA= 
TURE, SYMPTOMS AND TREATMENT. 

— Wallace (The London Practitioner) says: 



(l) That it may be a sphincter of the blad- 
der; (2) that it may be a secondary sexual 
gland. The latter theory is proved by well 
known facts. The theories as to the cause 
of its enlargement are: (1) That it is a 
senile fil)rotic change; (2) that it is produc- 
ed by sexual excess; (3) that it is due to 
ungratified sexual desire; (4) that it is 
secondary to sexual degeneration of the 
bladder; (5) that it is due to perverted testi- 
cular secretions; (6) that it is a change 
normal to advancing years; (7) that it is 
dug" to a chronic inflammatory process; (8) 
that it is an inflammatory catarrhal process; 
(9) that it is a new growth of an adenoma- 
tous nature. 

As to the appearance of enlarged prostates: 
(1 ) The changes do not occur before mid- 
dle life; (2) there are white, opaque areas 
of gland tissue in the normal spongy tissue; 
(3) these areas often form encapsulated 
tumors; (4) these tumors contain more 
filjrous than muscular tissue; (5) there are 
areas of round-celled infiltration in the or- 
gan; (6) the alveoli contain desquamated 
epithelium cells, polymorphonuclear leuco- 
cytes, and amyloid bodies. 

The author believes the enlarged prostate 
is a new growth. The noteworthy clinical 
symptom is either frequency of micturition 
or retention. The forces which act in fre- 
quent micturition are: (1) Increased ten- 
sion of the urethra; (2) pressure on the outer 
side of the intravesical cone; (3) forcing of 
a large lobe against its smaller fellow. The 
cause of residual urine is not clear; several 
factors are adduced. Palliative treatment 
consists in properly regulated catheterization 
and rest in bed. Operative treatment is in- 
dicated: (1) When the catheter cannot be 
passed; (2) when it causes pain or hemorr- 
hage; (3) when there is complete retention. 
Operation may consist of castration, vasec- 
tomy, or prostatectomy. The last of these 
is usually to be preferred, but not when the 
patient is suffering from acute retention or 
exhaustion from sepsis. The ultimate re- 
sults of the operation are usually most satis- 
factory . 

THE TREATMENT OF BRADYCARDIA. 

— Gibson (The iMinburgh Medical Journal) 
discusses this subject as follows: 

The treatment of cases manifesting this 
symptom must of necessity be based upon 
the nature of the underlying lesion. In the 
instances of organic nerve disease, the op- 
portunities of relief always depend upon the 
possibility of removing the nervous lesion. 
In those dependent upon reflex causes, treat- 
ment directed to the disturbing factor must 
be adopted, while in those produced by 
functional disorders the aim will be to re- 
store the whole nervous system to a more 
healthy condition. 



ABSTRACTS. 



47 



In cases induced by toxic influences, 
elimination of the poison is necessary. As 
regards the metallic and chemical poisons, 
the proper remedy for each must be em- 
ployed, and the element of time is necessary. 
In the cases produced l^y microbic poisons 
there is usually a natural period to the 
symptoms induced by their noxious in- 
fluence, and it suffices to support the patient 
during the interval which nrust elapse be- 
fore the jjoison has l)een thrown off. For 
most of these poisons strychnine is more or 
less an antidote, and it acts most beneficial- 
ly when given subcutaneously. For the 
cases in wliich arterial spasm is responsible, 
the nitrites must be employed, while in those 
produced by arterial and cardiac degenera- 
tion hydriodic acid and the iodides are of 
paramount importance. In many of these 
cases the iodine compound may be emj)loy- 
ed most usefully along with digitalis or 
strophantluis. 'fliis apjjears to be in itself 
somewhat paradoxical, but it is probable 
that these two last-mentioned drugs operate 
by increasing the nutrition of the cardiac 
muscle. One interesting i)oint deserves 
mention. Atropine has been suggested as 
a means of reducing the heart rate, and 
when the change of rate is due to nerve in- 
fluences acting through the sinus, it is use- 
ful. I'Manger points out that the auricular 
beat is under the influence of atropine, 
while the ventricular is not. This accords 
with our knowledge that in cases of heart 
block atropine is useless. It also falls well 
in with the experience of Dehio, who found 
atropine very useful in the infrec|uent heart 
rate of sinus thrombosis, but of no avail in 
that of convalescence from acute disease. 

In every form of reduced heart rate the 
diet must be such as to give the least dis- 
turbance to the digestive system. A sufiic- 
iency of rest must be allowed for the purpose 
of aiding nature in restoring cardiac energy, 
while enough of exercise must be obtained 
to keep up tissue change. It is in this way 
that massage is of so much importance. If 
the patient is not in a condition to indulge 
in sufficient active exercise, massage will 
come to his aid. The assisted exercises of 
the Swedish school are most helpful, and 
particularly those forms which induce deep 
respiration. 

A CASE OF ACUTE SEPTIC PEMPHI= 
QUS. — Crary (Journal Cutaneous Diseases) 
reports the case of an infant born after pro- 
longed labor. The third day after birth the 
temperature of the infant rose to 104 deg. 
and then fell below normal. The physical 
signs were normal and the skin normal. 
Two days later an erui)tion of vesicles ap- 
peared over the cheek and about the angles 
of the mouth. As there had been a case of 
impetigo in the same ward, this trouble was 



thought to be of that nature, but did not 
improve under treatment. The eruption of 
the vesicles extended over the face, neck 
and chest, and became larger. Some of the 
buUte were very large and broke, leaving 
denuded areas. Death took place on the 
twenty-third day of the child's life, twenty 
days after the rise in temperature and eigh- 
teen days after the appearance of the erup- 
tion. The temperature throughout the sick- 
ness was irregular. Autopsy showed small 
areas of bronchopneumonia in both lungs, 
heart normal, lymph nodes and peritoneum 
normal, spleen congested, fatty infiltration 
of the liver cells, kidneys large, soft and 
red, with degeneration in the cortical tubes; 
suprarenals were normal, umbilicus normal, 
but in a fusiform dilation of the partially 
obliterated left hypogastric artery was dis- 
covered a circumscribed collection of pus to 
the amount of about half a dram. Cultures 
from the blood in the vessels of the general 
circulation gave the staphylococcus pyo- 
genes aureus; from the liver and from the 
spleen, the staphylococcus aureus and albus; 
and from the little abscess, the staphylococ- 
cus albus and aureus. 

CONTRIBUTIONS TO THE STUDY OF 
URTICARIA PIGMENTOSA.— Little (Brit 
ish Journal of Dermatology) believes it 
justifiable to draw the inference that there 
is a general tendency, probably congenital, 
to over-production of mass cells in the skin 
of patients suffering from urticaria pigmen- 
tosa, and that the local excessive accumu- 
lations of these cells can be caused by 
various accidental phenomena. The man- 
ner of the infiltration of the mass cells sug- 
gests a close relation with blood changes 
and certain examinations in these cases 
brings them somewhat into line with the re- 
sults obtained in the class of blood diseases 
including hemophilia, pernicious anemia 
and lymphadenomata. 

A CASE OF MYASTHENIC PARALYSIS. 

— Bolt (Monat. Psychiatric u. Neurologie) 
reports a case of myasthenia gravis with 
autopsy findings. Such cases are so rare 
that each one is worthy of careful attention. 
This case is that of a man aged thirty years. 
At the time of the first examination the 
symptoms which were most prominent were 
weakness, difficulty in swallowing and in 
speaking, on account of the great muscular 
fatigue. As the case progressed the typical 
symptoms developed in the way of attacks 
of dysponoea, inability to swallow food, etc., 
and g-reat weakness. The patient died in 
an attack of choking. At the autopsy there 
was an absolutely normal finding in regard 
to the internal organs. The nervous system 
showed nothing abnormal except a quantity 
of minute haemorrhages scattered through- 



48 



THE CHARLOTTE MEDICAL JOURNAL. 



out some of the nuclei of the cranial nerves. 
The author is inclined to agree with Oppen- 
heiui, who interprets these as the result of 
the frequent attacks of choking; and are 
mechanically produced. In the muscles 
were found in places the cell infiltration of 
which Wigert among others has written 
about. He does not attempt to explain the 
process from the meager post-mortem find- 
ings. This case can be set down as a very 
tj'pical case of myasthenia gravis. 

CONCERNING THE BLOOD PRESSURE 
OF HEALTHY CHILDREN.— (jppenheimer 
and Bauchwitz (Archiv. f. Kinderheilk) 
used the three sphygmomanometers most 
commonly employed at present; the instru- 
ments of Basch, Ciaertner and Riva Rocci. 
They conclude that the Riva Rocci instru- 
ment is by far the best, that the percentage 
of error with this instrument is far less than 
with the others mentioned. They find that 
Sahli's modification of this instrument may 
be used both for children and infants. The 
results obtained while infants are screaming- 
are, however, not trustworthy. 

The blood pressure, increases with age in 
childhood. After the ingestion of food, 
particularly after considerable quantities 
have been taken, there is an appreciable 
rise in blood pressure. In infants, the phe- 
nomenon is not always noted. The inges- 
tion of large quantities of fluid also raises 
the pressure. Physical exercise in moderate 
amount raises the pressure, though in some 
of the experiments there was no change. 
Psychical excitement always _ raises the 
pressure. 

They mention the fact that their experi- 
ments, and the observationsof most writers, 
concern only the maximum or systolic pres- 
sure. Observations on the diastolic pressure 
are as yet not available, in any great num- 
ber. It would appear, however, that by 
the method of Strassburger (the details of 
which may be found in the original article, 
in the Zeitschr. f. klin. Med. Vol. 54) the 
diastolic pressure may also be recorded, at 
least in older children, though probably not 
in infants. 

At the last meeting of the C^.erman Pedi- 
atric vSociety at Meran, Trumpp reported 
the results of his studies of the blood pres- 
sure in infants in health and disease. He 
used the (iaertner tonometer, and as the re- 
sult of 1300 measurements reached the fol- 
lowing conclusions (Archiv. f. Kinderheilk. 
Vol. 42, p. 456): In the waking infant, 
and in the infant while screaming, the pres- 
sure is higher than during sleep. A rise in 
pressure follows the taking of food. Change 
of food, particularly the change from breast 
to bottle, causes a rise in pressure. The 
normal pressure in infancy is about 80 mm. 



In bronchitis and pneumonia there is a rise 
in pressure, comparable to the severit>- of 
the lesion. In convalescence the pressure 
falls. Pus retention increases the pressure. 
In acute cases, with great loss of the body 
fluids and of the body weig^ht, there is a fall 
in pressure. In chronic disturbances of 
nutrition the blood pressure varies with the 
condition. Loss of weight usually causes a 
fall. 

Increase in pressure or constancy in the 
reading, offers an important index, as to 
whether a gain in weight is due to retention 
of fluids, or to actual growth. 

ABOUT RESORPTION AND PHENOM= 

ENA OF IMMUNITY. — Loewenstein's 
(Arch. f. Ilyg. u. Infect. Ur.) very inter-- 
esting and perhaps important suggestions 
are derived from experiments, in all of 
which he inoculated rabbits with the same 
quantities either of tubercle or typhoid 
bacilli. In some, the site of injection was 
the anterior chamber of the eye; in others 
the subcutaneous or intravenous way was 
used. The eye inoculation remained local, 
while the other methods lead to death from 
tuberculosis. The serum of these animals 
was examined for their agglutinating 
quality. The eye animals showed no ag- 
glutination, while the others exhibited a 
high agglutinating capacity. It is shown, 
thus, that tubercle-bacilli and dead typhoid 
bacilli injected subcutaneously or intraven- 
ously, cause pronounced production of ag- 
glutinins, while the same quantities injected 
into the anterior chamber have lost this 
quality, and that therefore a purely local 
infection does not lead to agglutinin forma- 
tion. It appears that in immunity the same 
conditions obtain, general infections in most 
diseases leading mostly to immunization, 
local infections not (goxiorrhea, erysipelas, 
etc.). Chronic infections are generally 
local infections, and therefore in them im- 
munity does not appear. After the healing 
of one focus, another one forms in its neigh- 
borhood. 

This could lead to attempts to alterate the 
slow, uniform course of a chronic infectious 
disease by imitating artificially the course 
of the acute infections in establishing im- 
munity. i\s experiments have demonstrated 
that local infections have no general effect 
on account of the lack of resorption, the 
specific causative agents of the chronic in- 
fections must be made amenable to resorp- 
tion, so that an active immunization during 
the course of such a disease becomes possi- 
ble. As lately the extent of specificity has 
been extended even to individual strains of 
pathogenic microbes, in each case the speci- 
fic bacillus ought to be utilized. Besides 
tuberculosis, lepra, actinomycosis, trachoma, 
suggest themselves as accessible to this 



ABSTRACTS. 



49 



method. The author even thinks that a 
treatment of lepers by the injection of an 
emulsion of leprous lesions of the same pa- 
tient is within the rano^e of success. 

Altliou.oh at the first olance the author's 
ideas appear somewhat phantastic, they are 
certainly based upon exact experiments, 
made also by others, leading^ to the same 
result, the demonstration of a local immuni- 
zation. Wassermann has made interesting- 
reports about this condition in typhoid. In 
this condition, the gall bladder has become 
known lately as the main focus for local 
immunity in animals and man. A^er\' in- 
teresting also is the local immunity for 
vaccinia, limited in the cornea of rabbits 
(Prowaczek) and rats (reviewer) to the area 
of the extent of the inoculation surface. 
His results may be very important for learn- 
ing to understand the action of tuberculin 
and its derivatives, together with that of the 
bacillary substances used for immunization 
and treatment, down to Behring:'s latest 
T. C. 

PAQET'S DISEASE, CONCERNING ITS 
PROBABLE SYPHILITIC ORIGIN.— Auf 

fret ( Revue d'( )rtliopedie ) reports a case of 
a man of forty-five >'ears, who presented 
deformities absolutely typical of Paget's 
disease. A careful study of the man's past 
history and of his hereditary historv in- 
clines the author to the o]nnion that there is 
certainly reason to suppose that hereditary 
syphilis, or acquired syj^hilis, were present 
and were influential in the production of 
the deformities in this case. The writer re- 
fers to the opinion ex]:)ressedby Lannelong-ue 
in 1903, that Paget's Disease may be seri- 
ously reg:arded as one of the para-syphilitic 
affections. Fournier also agrees in this 
opinion, and says that to his mind Pag-et's 
disease will undoubtedly one day be classed 
with tabes, general paralysis, and other late 
manifestations of syphilis. He has reported 
two cases, where there was no doubt of an 
association between Paget's disease and 
hereditary syphilis. The author suggests 
that in each new case of Paget's disease, 
minute research be made in order to discover 
the ])rol)able yiresence of syphilis in the 
antecedents of the person affected. 

CONTRIBUTION TO THE QUESTION 
OF TUBERCULOSIS ON THE BASIS OF 
EXPERIMENTS ON ANTHROPOID APES. 

— Dungern ( Aluench. Med. W'och. ) states 
that to understand the relation of man to 
both types of tubercle-bacilli, the human 
and the bovine, two methods are at our dis- 
posal. The one followed so far, especially 
in the splendid work of Kossel and his as- 
s )ciates, starts out with the cultivation of 
bacilli from human lesions and the investi- 
gations of the racial characters of the culti- 



vated bacilli. The decisive points are main- 
ly the higher virulence for cattle and some 
cultural differences. In this way the greater 
majority of cultivated forms were found to 
be of human character, while, in a few, 
mainly derived from intestinal and mesen- 
terial lesions showed the characteristics of 
the bovine bacillus. The conclusion that 
these observations reveal the true nature of 
the behavior of the two forms of bacilli 
would only be justified if we with certainty 
knew that the bovine-bacillus does not 
undergo in the human organism a change 
of its pathogenicity. Experiments to alter 
the virulence of any of the two forms for 
different animals have given very contra- 
dictory results; altogether, it appears im- 
probable that a change can be brought 
about in this way. Theoretically, therefore, 
we have no right, without experimentation 
on human beings to priorily assume that the 
bovine-bacillus is less virulent for man and 
not, perhaps, more virulent than the human 
form. The other method is the experimen- 
tation on animals nearly related to man, 
that in their biologic-reactions can hardly 
he differentiated from man ( precipitin reac- 
tion, etc.). The writer used, during his 
stay in Sumatra, anthropoids, of which two 
species of Gibbons (hylobates syndactylus 
and agilis) were at his disposition. The 
animals were inoculated subcutaneously 
with equal doses of living bacilli, the one 
series receiving the bovine, the "Other the 
human culture. All of the animals that did 
not die of intercurrent diseases died of tuber- 
culosis, which in all cases showed a general 
dissemination over the body. A difference 
in the effect in the infection with bovine or 
human bacilli could in no way be establish- 
ed. Two other series of three animals each 
were infected by feeding the bacilli. Two 
of each series died; those infected with 
bovine-bacilli with a typical intestinal tuber- 
culosis, while the two killed b}^ human 
bacilli showed the oldest lesions in the lower 
lobes of the lungs. V. Dungern declares 
that for the last ones the infection by a 
passage of the bacilli through the intestinal 
mucosa and in addition through the mesen- 
terial glands without leaving marks of their 
presence is to the highest de.gree improbable. 
He is rather inclined to believe in a direct 
infection by way of the bronchial tract. 
The analogy of these findings with human 
experiences suggests to the author that bo- 
vine bacilli in some way prefer the intestine 
as a port of entrance, the human the bron- 
chial passages. Van Dungern's work is 
exceedingly important, as it calls to our 
mind a factor that seems to have escaped 
the mind of most observers. Whether the 
material accumulated by him is sufficient to 
allow further conclusions is not certain. 



50 



THE CHARLOTTE MEDICAL JOURNAL. 



Bui it has shown the way in which, more 
directly than up to now the importance or 
harmlessness of the bovine bacillus can be 
determined. The author insists on its dan- 
ijerous qualities, an opinion that must have 
suoo:ested itself necessarily from the results 
of his experiments. 

RHINOSCLEROMA AND ITS TREAT= 

MENT.— H. Von Schratter (The London 
Medical Lancet) exhibited at a recent meet- 
ing of the Vienna Medical Society several 
maps showing' the countries of central Eu- 
rope where rhinoscleroma prevails. One 
focus of infection is situated in the Polish 
provinces, with branches going off to Prussia 
and Moravia, and another is in the Russian 
frontier districts. Up to the present time 
about 700 cases have been recorded. The 
disease is infectious, and consists in a growth 
of granulating tissues in the larger respira- 
tory canals (nose, pharynx, larynx, and 
trachea, down to the bronchi of the second 
order). It has no tendency to ulcerate, but 
it generally cicatrizes, and might obliterate 
the lumen of canals. The disease is due to 
a micro-organism similar to the bacillus of 
In-iedlander. As several persons are known 
to have acquired the disease without leav- 
ing X'ienna, it must be presumed that it also 
exists in that city. 

In former times such cases were often 
mistaken for carcinoma or acne rosacea, 
especially, if the localization was in the alse 
nasi. Several patients lived for fifteen or 
twenty years, and died of other diseases. 

URETEROURETERAL ANASTOMOSIS. 

— Bemasconi and Coloml^ino (Annales des 
Maladies des organes genito-urinaries ) made 
a series of experiments to determine whether 
anastomosis between the ureters could not 
be performed in those cases in which it was 
necessary to cut a ureter at a point too high 
to allow anastomosis into the bladder. 

A series of experiments on dogs and on 
the human cadaver convinced them that the 
operation was practicable, and they devel- 
oped the following technique: 

The abdomen is generally opened for 
some other purpose, e.g., the removal of a 
tumor which involves the lower part of one 
ureter. The operation being completed the 
posterior abdominal wall is exposed by 
drawing the descending colon to the left 
and the other viscera to the right, and an 
incision is made in the posterior parietal 
peritoneum in the middle line. The peri- 
toneum is then separated from the abdomi- 
nal wall in both directions until the ureters 
are reached. The wounded ureter is then 
freed from all adhesions, which may present 
some difficulty, but does not interfere with 
its nutrition, and is drawn obliquelv across 
the middle line and placed parallel to the 



other ureter. The lower end has of course 
been previously severed and ligated. The 
ureters are closed above by hemostats pro- 
tected with rubber, and are stitched together 
by a single suture above and below the 
point of anastomosis, which should be lateral 
and about half an inch long. The anterior 
wall of each ureter is then incised complete- 
ly for a distance of half an inch, and a con- 
tinuous catgut suture involving the mucous 
membrane and muscularis is begun at the 
lower end and carried to the upper corner 
and back along the other edge, uniting the 
edges of the two incisions firmly to one an- 
other. It only remains to repair the perito- 
neum with catgut whenever necessary, and 
to remove the hemostats. Drainage is not 
required. 

THE TREATMENT OF INDUSTRIAL MER- 
CURIAL POISONING Walker, in The Lon- 
don Medical Lancet, recommends prophy- 
lactic as well as active. Only healthy and 
temperate men with sound teeth should be 
employed in the work, which should ])e car- 
ried on in a well-ventilated room, illuminat- 
ed by daylight. Only eight hours' work a 
day should be allowed, no man being per- 
mitted to work overtime. Water, soap, 
towels, and nail-brushes should be provided, 
and the men advised to wash before leaving 
work. A good plan is to let the men off 
five minutes earlier. Nails and hair should 
be kept short, and any cuts or sores on 
body, hands, or limbs should be immediate- 
ly covered up. Overalls and caps should 
be worn, and where possible gloves. Out- 
door coats should be kept in another room. 
No meals should be eaten in the workroom. 
In the winter when the men are working 
wnth closed windows it is a good plan to 
have doors and windows opened during the 
dinner hour. Iwery man should wash his 
teeth night and morning with a tooth-brush. 
Due attention to the teeth the author thinks 
is most important, as he has never seen a 
case of mercurial poisoning unless the teeth 
were decayed or dirty. The author gives a 
mouth-wash of five grains of alum, five 
grains of chlorate of potash, half a drachm 
of glycerin, and water to one ounce, to be 
used two or three times a day when the 
gums are soft and inflamed. For general 
condition the patient should stop work in 
mercury, get as much fresh air as possible, 
and never fatigue himself bodily or mentally. 
By this treatment the nervous system is 
greatly benefited. Light and nourishing 
diet is essential for the patient's gastric dis- 
turbance. The bowels should be kept open 
by cascara sagrada, licorice, aloes, etc. 
Potassium iodide is said to be a specific, 
but so far the author has had very indiffer- 
ent results with it. The author has found 
patients benefited by five grains of bromide 



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INDEX FOR JULY. 

TABLE OF CONTENTS FOR 



Original Coiiiiiiiiiiications. 

Once on a Time 'I'here was 
a Man. An Address to the 
Profession by T. S. Mc- 
MuUan, M. D., Hertford, 
N.C 6 

Some Points in Clinical Fh}- 
cliiati-y of Interest to tiie 
General Practitioner, by 
Isaac M. Taylor, M. I)., 16 

The Annual Oration: Nine- 
teenth Century Prof^ress 
and Twentieth Centur'y 
Problems, by Dr. Jas. M. 
Parrott, Kinstoii, N. C , 1 

The End Results- Mental, 
Physical and Psychic, 
Following'- Ablation of 
Certain (^r^rans aid Struc- 
tures in the Human Body 
— A ( ritical Review of 
1250 Operations, by J Kr- 
nesi Stoltes, M. D., Salis- 
bury, N C 12 

When The Haby Comes, by 
Dr. Cvrus Thomj)son, 
Jacksonville, N. C 18 

Editorial. 

House of Delegates— Min- 
utes of the Tliird Annual 
Session { Fifty-third of the 
Society)held in Charlotte, 
N. C. May 29, ;{U and 31, 
190(i 27 

< )r}4anotherapy, 25 

The IvobertHruce Memoria. 
Hosi)iialof Kiuston, N.C, 25 

The Methods of Collier's 

Weekly, 25 

Editorial Notes. 

Minutes of the N. (J. State 
Medical Society. Fifty- 
third annual session, IDUti, 35 

Definition of Practice of 



Medicine,. 40 

English Empiricism 40 

State Medical Society of 

North Carolina, 40 

The People vs. The Packers 39 
The Medical Profession and 
the issues which confront 

it, 39 

The Free Icohol Bill, 40 

T'uberculosis in Germany, 40 
The lioston Meeting-, ...' . 41 
The American Medical Ed- 
itor's Association, 41 

The I^usy Physician, 4J 

Book Notices. 

A Manual for the Eclectic 
Treatment of Disease. By 
Finiey Ellingwood, M. I). 43 

Balzac: A Critical Story. 
liy Hippolyte Adolphe 
Taine 44 

Lady Baltimore. By Owen 
Wister 42 

Modern Physio-Therapy. 
Hy Otto Ju.ttner '. . 45 

Polk's Medical Register and 
Directory of North Amer- 
ica, 45 

Some Neglected History of 
North Carolina. By Wil- 
liam EdwardRitch, M. D., 42 

The Diagnostics of Internal 
Medicine. By Glentworth 
Lleeves Butler, A. M. M.D 43 

The Holy Grail. By James 
A. B. Scherer, LI. D.,. . 42 

The Mei'klenburg Declara- 
tion of Ind<'poiidence. By 
George W. Graham, M 
D., 42 

The Dawn of a Tomorrow. 
By Frances Hodgson Bur- 
nett 43 

The Phantom of the Poles. 
By William Reed, 44 



53 

JULY, 1906. 

The Myslfi-y of th^) Lost 
Oauphin. By Annabel 
Hold Seeger, 44 

The Life of William Pep- 
per, M. I)., LL. I). By 
Francis Nawton Tliorjie, 44 

The Medical Diseases of In- 
fancy and ChUdhood. By 
Alfred Cleveland Gotten, 45 
Abstracts. 

A New Sign of Organic Pa- 
ralysis of th_ Lower Ex- 
tremity, 4B 

Albuminuria and the Indi- 
cation of Labor, 46 

A Case of acute Septic Pem- 
phigus, 47 

A Case of Myasthenic Pa- 
raly^is, 47 

About Uesorption and Phe- 
nomena of Immunity, .... 48 

Contributions to the Study 
of Urticuria Pigmentosa, 47 

Concerning the Hlood Pres- 
sureof HealthyChildren, 48 

Contribution to the question 
of Tuberculosis on the 
Basis of Experiments on 
Anthropoid A[)hs 49 

Fagot's Disease,(;()iiCHrning 
its Probable Svi)liilitic 
Origin ." 49 

Pii>laj)se of the R'^ctum--- 
Pathogenesis and Treat- 
ment, 45 

Rhinoscleroma and its treat- 
ment 50 

The Enlarged Prostate: Its 
Natuie, Symptoms and 
Treatment," 46 

The Treatment of Bardy- 
cadia, 46 

The Treatmentof Industrial 
Mercurial Poisoning,. . . . 50 

Ureteroureteral Anasto- 
mosis, 50 



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of i)olassiuni,i five minims of^ tincture of 
di.uilalis, three minims of solution of strych- 
nine, with water to one ounce; one ounce 
of this mixtiu'e is to be taken three times a 
day. 

REMOVAL OF A LARGE PIN FROM THE 
LOWER LOBE OF THE LUNG BY TRANS- 
PLEURAL PNEUMOTOMY k u s s e 11 and 



Fox, in The London Medical Lancet, pre 
sent the report of a unique operation for re- 
moval of a foreign body from the lung. 
The patient, aged twelve years, was admit- 
ted to the hospital in September, 1903. Five 
weeks previously a large, black-headed 
shawl-pin had accidentally slipped down 
the trachea. A week later cough, and later 



THE CHARLOTTE MEDICAL JOURNAL. 



still bloody expectoration, set in. Fox 
found b3' the radioscope that the pin was in 
the left bronchus two and one-half inches 
below the bifurcation; subsequently it was 
found to have miji^rated further down. The 
symptoms were slight, and auscultation re- 
vealed nothing. 

After some experiments upon the cadaver 
by way of preparation the operation was 
undertaken. The patient was placed upon 
the right side and a flap raised. A portion 
of the left eighth rib six inches long was re- 
moved from the posterolateral aspect of the 
chest, and air was allowed to enter the 
pleural cavity through a small puncture. 
The pleura was then opened the full length 
of the wound. The fingers of the left hand 
were then passed between the lung and the 
diaphragm, the lower lobe grasped near its 
root and drawn toward the opening. The 
position of the pin was ascertained by gentle 
palpation with the right hand. A small in- 
cision was made in the lung over the pin's 
head; a small forceps, unopened, was jjush- 
ed in until the pin was felt, and by hitching 
the in.strument under the neck cf the pin the 
head was easily lifted out of the wound and 
the pin withdrawn. There was no hemor- 
rhage, but an abscess had begun to form 
around the head of the pin. No suture was 
put into the lung. The flap of skin was re- 
placed and sutured except about two inches 
in the middle, over which portion oiled silk 
dressings were applied and a dressing put 
on. In this way free escape of air from the 
pleura was insured while entrance of air 
was discouraged. Some pneumo:iic consoli- 
dation took place, as did some suppuration 
around the incision, but no suppuration took 
place in the pleura. In twelve days the 
patient was able to leave the hospital per- 
fectly well. 

STASIS HYPEREMIA IN ACUTE SUP- 
PURATIVE PROCESSES.— I lerold ( Mun- 
chener medicinische Wochenschrift, ) has 
employed it in 2.5 cases, of which 14 were 
felons, 5 suppurative tenosynovitis, 15 fu- 
runcles, and one a cellulitis of the thigh. 

The boils were treated by covering them 
with a glass dome from which the air was 
exausted. In the remaining cases circular 
constriction of the extremity was applied 
above the seat of the lesion . To prevent 
the formation of l)lebs and vesicles when 
employing circular constriction the .skin 
should be protected from the rubber band 
by a few turns of a primary muslin ban- 
dage. 

The amount of constriction must be kept 
under control for at least the first ten min- 
utes. It should be sufficiently great to 
abolish the pain and yet not cause blueness 
and coldness of the extremity. If properly 
applied the skin is somewhat warmer and 



redder than normal, and there is no numb- 
ness of the digits. The amount of the con- 
striction should be regulated again in the 
afternoon. 

The felons were opened by a small in- 
cision as soon as a focus of pus manifested 
itself beneath the skin, and the congestion 
was continued. No drainage nor packing 
was used in the wound, but a moist dress- 
ing was applied to the surface. The pa- 
tients stated that pain subsided as soon as 
the congestion was instituted. On the fol- 
lowing day if pus had not already been 
manifest it was found in a small drop at 
the tip of the finger. This was evacuated, 
and within two or three days more the cen- 
tral slough was so softened that gentle pres- 
sure caused it to be exuded, whereupon 
there was left a simple granulating wound. 

In treating boils mild suction was em- 
pioyed for fifteen to twenty minutes, twice 
daily. Boils in which pus had not yet 
formed rapidly disappeared. In cases in 
which pus was present the overlying skin 
was first incised, and then suction during 
the following days aspirated pus and blood, 
and boils were cured without futher treat- 
ment. With large furuncular abscesses an 
incision at least one centimeter long was 
necessary to secure the desired results. The 
painful packing of these wounds is render- 
ed unnecessary by this method. The boil 
is protected simply by placing over it a 
small piece of perforated gauze which is 
held in place by two small strips of adhe- 
sive plaster. 

In two of the 14 cases of felon stasis 
congestion caused an increase of pain and 
increase of pain and inflammatory signs, so 
that this treatment was discontinued; in 
one the patient was cured without suppur- 
ation; and the remaining 11 pursued a very 
favorable course. The average duration 
of treatment in the twelve cases was eleven 
days. 

In one of the 15 cases of furunculosis, 
stasis treatment was discontinued in favor 
of local applications because of widespread 
outbreak of boils. The remaining 14 cases 
were cured after an average of 9.2 days of 
treatment. 

Of the five cases, of suppurative tenosy- 
novitis of the hand, treatment was ineffec- 
ual in one because of the great extent of 
the effection ; in a second improvement dur- 
ing the first two days was followed by an 
increase in the severity of the symptoms; 
in the third case a preexisting extensive 
lymphangitis became worse at the site of 
constriction and the patient showed marked 
febrile reaction ; in only two cases was 
treatment pursued till patients were cured, 
on the fourteenth and twenty-eighth days 
respectively. 



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The cellulitis of the thigh which devel- 
oped secondary to a kick subsided within 
twenty- four hours after applying constric- 
tion, leaving only the lacerated wound for 
further treatment. 

CYSTOSCOPY BY AIR.— Catheline ( An- 
nales des maladies des organes genito-uri- 
naires) says that the advantage of the 
instrument lies in the fact that vision is di- 
rect and not by means of a reflector or mir- 
ror, and that the distortion resulting from 
looking through water is avoided, as well 
as the obscurity from cystitis or hemorrhage 
clouding the water. The straight cysto- 
scopes have various disadvantages, espe- 
cially in the male. 

The instrument consists of a metal ca- 
theter curved to a right angle at the tip, 
below which is placed a minute incandes- 
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56 THE CHARLOTTE MEDICAL JOURNAL. 

RELAXATION OF THE UTERUS DURING been described in other joints. Treatment 
CURETTAGE — c.ussenhn.ck ( Centrall)latt consists in massage, and if this fails to give 
fur Gynakologicj slates that usually relief, in operative removal of the fibrous 
the uterus relaxes at the beginnino- of masses, 
curettement, althoug^h he is not sure wheth- 

er this is due to dilatation of the cervix or -rff'^'^SSS'^nSSSfa ^'^ ^^ ™^ ^^**'^- 
to the curettement itself. The soft feelin- '^^ BONE-REPAIR._e,ray and Archi- 
vvhich was supposed to be due to mucous '^^^^^ (Montreal Medical Journal) report 
membrane is due to this relaxation, and the ^, ^'^^^ of extensive syphilitic necrosis of 
hard, orating sensation, formerly thought the frontal bone m a woman thirty-two 
to show that the musculature ha^ been >'^a''« "^ ^^^re. The necrotic process follow- 
reached, is due to the subsequent contrac- ^^^ ^" i"J"^>' to the forehead, and for a time 



tion of the uterine vessels. In some cases 



the character of the necrosis was obscured. 



the ralaxation is so extreme that the dis- but finally it was decided that it was due to 
tance to which the curette sinks suggests svphilis. Operation was performed on Jan- 
perforation, and the author reports several ^^ry 1, 1905, about six months after the 
such cases, in. one of which the ^und , . n , ,■ ■, ,t^-, 
entered to a depth of 15 centimeters. The ^^"'°" ^^« ^'^^ "°^^'^^^- ^^'^ ^^^^P ^^« ^^- 
author warns against mistaking this condi- Aected by a crucial incision and all the dead 
tion for perforation and interrupting opera- bone removed, laying bare the dura over an 
tions unnecessarily-, and against the danger extent 3 inches transversely and 2 1-2 in- 
of making a perforation in the relaxed wall, ^j^^, vertically. The wound progressed 
which will harden m a few minutes if the ^ j i ,- , , r , 
operator pauses. toward healmg, but two months after the 

CONTRACTED MUSCLES OF INFANTILE ^^^^ operation it was necessary to remove 

PARALYSIS. — Insher says ill The London more bone which had become necrotic. In 

Medical Lancet the early state of infantile x\pril the wound was granulating, and the 

paralysis, when it is seen that one set of effect was repaired by means of a flap rais- 

muscles is in better condition than the op- ed over the anterior surface of the left fore- 
ponents, much may be done to prevent the ^. , . ^ ■, r, 

former from becoming intractile. Such ^^^- Withm ten days the flap was united 

movements of the foot upon the leg as will sufficiently to allow the pedicle to be cut. 

bring the stronger muscles to a full degree The resultant scar, though prominent, was 

of normal relaxation should be practiced concealed bv an arrangement of false hair, 
regularlv. Passive exercises" are valu- 

less, a due use of the muscles is imperative, ^ SECOND CASE OF PNEUMOCOCCUS 
and with very young children it requires ENDOCARDITIS TREATED BY ANTIPNEU- 
some. little ingenuity to get what is wanted MOCOCCUS SERUM.— d^he London Medi- 
iii this respect. Should some intractility of cal Lancet, ) Ilorder and Scofield report the 
the fibres be already established and the case of a boy aged ten vears, who had en- 
full degree of relaxation not be ol)tainable, ^^ ' ^ ^^.^jig ^n,! ^ .^^i-^t .^re throat. A 
exercises are again to be employed, but no . " . , i i i i 
forcible extension of the fibres must be at- ^^^ ^^^^" ^^^^' ^'^ developed an acute 
tempted. Gentle handling is ver>' necessa- rheumatism, with a mrtral systolic murmur, 
rj'; violent measures will be met by obstin- The joint pains passed off under salicylates, 
acy. v\ well contrived appliance can be the temperature being normal onthe eleventh 
obtained which will offer resistance to the ^^,. ^n the thirteenth dav he had pleuri- 
pull of anv one muscle. \\ hen such reme- ' ., , ,., •' , • ■, 
dial measures fail to prevent the develop- ^>^' ^^^h lung consolidation on the right 
inent of intractility or overcome the defect, ^i^e. This passed off by lysis, but left an 
then tenotomy must be resorted to. empyema, for which a rib was resected. 

TRAUMATIC ARTHRITIS OF THE KNEE. The' irregular temperature continued and a 

—I-Ioffa (Berliner klinischeWochenschrift) left-sided empyema was opened. The fe- 

'eH," f'"'"lf°\''-' ^^-^^^It^'therfroma ^er persisted, 102 deg.-103 deg. F. The mi- 
series of small contusions or from a severe i > » » 

blow or wrench. It begins as a fibrous hyper- tral murmur was still present. Pulse 140. 
trophy of the mass of fat underlying the pa- The blood showed leukocytes 11,000 and 
tellar ligament, accompanied bv pain and gave a good pneumococcus culture. On 
stiffness of the joint The edges of the syno- ihree consecutive days 2 c.c. of Pane's se- 
vial membrane mav be involved in the inflam- xt -, • ' i i .• „ 

mation and likewise undergo fibrous hvper- '^'^^^- ^^^re given hyperdermatically, 
trophy, and even give rise ]:)y being broken repeated two days later. Nephritis set in 
off to free bodies in the joint. vSimilar con- hi two days and the i)atieiit died on the 
ditions following trauma have recently sixty-sixth day of his illness. 



ADVERTISEMENTS. 



UNIVERSITY of NASHVILLE 



MEDICAL DEPARTMENT 



Established 1850. 



Graduates 4630. 



JMiltVi 



EX-GOV. JAS. D. PORTER, A. M., LL D., Chancellor. 

WILLIAM G. EWING. Ph. G., M. D., Dean. 

M. C. McCANNON, C. H. M. U. Secretary. 



W. G. EwiNG, Ph.G., M. D., Professor of Mate- 
ria Medica, Therapeutics, and Clinical Medicine. 

S. S. Crockett. M. D. Professor of Obstetrics. 

M.C. McGANNON, C. M., M. D., Professor of Dis- 
eases of Women and Abdominal Surgery, 

I,. B. GR.\nDY, M. D., Professor of Diseases of 
Eye, Ear, Nose and Throat . 

jAS. M. King, B. vS.; M. D., Professor of Chemistry 
and Clinical Dermatology. 



Larkin vSmiTh, M. D., Professor of Pathology 
and Bacteriology. 

Charles Brower, M. D., Professor of vSur- 

gery. 

Edwin G. Wood, C. M., M. D. Professor of Prac- 
tice of Medicine and Clinical Medicine. 

Alberto Hudson, M. D., Professor of Anatomy. 

Jos. P. Kellor, A. B., M. D., Professor of Physi 
ology. 



Double Session. - • Students may begin the Medical Course either in (Ictober or January. 

The course of study covers completely the entire field of modern Medicine and Surgery and in- 
cludes twenty five lecture courses each followed by a through review quiz; seven laboratory courses and 
three hours daily of clinical work; bedside clinics after special Laboratory training for same. The 
facilities for study are the same in the two sessions. Four courses of lectures of 26 weeks each are 
required for graduation 

Tuition and Living Expenses Moderate. 

Write for catalogue giving full information. Address, 

DR W. G. EWING, Dean. 

638.640 Secoad Ave, South. (Market St). NASHVILLE. TENN. 



TKe Baltimore Medical College 

PRELIMINARY FALL COURSE BEGINS SEPTEMBER i. 

REGULAR WINTER COURSE BEGINS SEPTEMBER 20, 

Liberal Teaching Facilities; Modern College Buildings; Comfortable Lecture Hall and 

Amphitheaters; Large and Completely Equipped Laboratories; Capacious Hospitals and 

Dispensary; Lyingin Department for Teaching Clinical Obstetrics; Large Clinics, 

Send for Catalogue, and address DAVID STREE VT, M. D., Dean, 

712 Park Ave., Baltimore. Md. 



• As to training nurses with an elaborate curri- 
culum. Dr. Thompson says: "It would be much 
better to graduate all suitable pupils after two years 
of training, and give an additional certificate to 
such as desire to proloug their course for a year or 
more by post-graduate work, thereby constituting 
a second group trained in particular methods and 
having larger experience, from which could be 
drawn superintendents of new schools, district 
nurses, nurses for sanatoria and for other special 
services. By this means credit would be given for 
proficiency where it was due, and those who are 
compelled to follow the work of ordinary private 
nursing would be free to do so at an earlier period." 



Tbese trade-mttrk crlsi 

Glut 

BARLE 

Perfect Breakfasi 
PANSY FLOUR 
Unlike all 0^1 er 
For b6ok 
FARWELL & RKIN 



The Treatment of Infantile Diarrhea. 

I have found the following to be the most satis- 
factory method of treatment for the summer diar- 
rheas of infants. Firstly, administer a purge con- 
sisting of castor oil, rhubarb, calomel or saline. In 
my experience the last two are the most efficacious, 
one-tenth of a grain of calomel being administered 
every half hour for at least four doses, and some- 
times until the motions assume a bilious hue. The 
saline is given in this manner: dissolve two tea- 
spoonfuls of sulphate of magnesium in a teacupful 
of warm water, flavor with a little lemon, and then 




every package. 



IHD 



its 



STALS, 

Health Cereals, 
ke and Biscuit. 

Ask Grocers, 
write 
ertown.N.Y.. U.S.A. 



©"""IS 






i 



Does not Oi-ipe 



The most Active 



SURE AND SAFE UAXATIVE 

FOR BOTH CMIUDREN AND ADULTS 

AFrORDS PERMANENT RELIEF IN 

CHRONIC CONSTIPATION 



THE CHARLOTTE MEDICAL JOUANAL. 



give two teaspoonfuls of this mixture every 20 
minutes until the bowels are well cleared. Where 
the motion is of a dysenteric character the colon 
must be flushed out with some weak antiseptic so- 
lution. 

So far as medicinal medication is concerned I 
have had the most brilliant results with copper 
arsenite given in doses of i-iooo grain to i-ioo 
grain every ten minutes for from four to six doses, 
and then every two hours. A most useful method 
for removing the horrid foetor of these cases is to 
give the sulphocarbolates of zinc, soda and lime, of 
each i grain; if given in combination with bismuth 
the bismuth will no longer blacken the motions, 
but the sulphocarbolates must be of the purest de- 
scription or they will produce vomiting and other 
undesired effects. I find the subgallate or salicy- 
late of bismuth acts better than the subcarbonate or 
subnitrate. 

The other drugs which I most frequently use are 
cotoine, emetine, and hydrastine. In extreme 
algid cases I find the most useful aids in a good hot 
bath, and a hypodermic injection of atropine sul- 
phate 1-500 grain to 1-250 grain, or glonoin 1-250 
grain. Atropine sulphate has been recommended 
for the extreme thirst in doses of 1-5000 grain to 
1-1500 grain every half hour. Opium I never use, 
but give codeine sulphate 1-25 grain to 1-12 grain; 
or Gregory's salt 1-67 grain to effect. I have al- 
ways thought that the better way of judging the 
dosage of narcotics for children was not so much 
the age as the weight and status proesens of the in- 
dividual case. The best pain relievers I have found 
to be hyoscyamine i-iooo grain, and strychnine 
arsenate 1-134 grain, every ten minutes to effect. 
The diet should be albumin water, oat meal water, 
or plain ordinary water, flavored with lemon; if 
possible all milk should be stopped for at least 48 
hours. The beef teas and extracts are of use as the 
easiest way of making broths without any grease. 
The high fever of these cases is best treated by 
small doses of aconitine or good hot baths. 

William Ayres, B. A., M. D., Dub. 

Brierley Hill, Staff, May 28, 1906. 

The Lancet June 2, 1906. 



sections: 

Medicine — Chairman, Dr. Thomas H. Coleman, 
of Augusta, Ga. ; Secretary, Dr. Joseph L. Miller, 
of Chicago; Delegate, Dr. Nathaniel B. Potter, of 
New York. 

Obstetrics and Diseases of Women — Chairman, 
Dr. J. Wesley Bovee, of Washington, D. C; Vice- 
Chairman, Dr. Edward Reynolds, of Boston; Secre- 
tary, Dr. W. P. Manton, of Detroit; Delegate, Dr. 
Walter B. Dorsett, of St. Louis. 

Hygiene and Sanitary Science — Chairman, Dr. 
Prince A. Morrow, of New York City; Secretary, 
Dr. Elmer E. Hegg, of vSeattle, Wash.; Delegate, 
Dr. W. Lewis, of Chicago. 

Diseases of Children — Chairman, Dr. J. Ross 
Snyder, of Birmingham, Ala. ; Secretary, Dr. George 
Wentworth, of Chicago; Delegate, Dr. T. W. South- 
worth, of New York. 

Pathology and Physiology — Chairman, Dr. W. 
L. Bierring, of Iowa City, Iowa; Secretary, Dr. W. 
B. Cannon, of Boston; Delegate, Dr. W. S. Hall, of 
Chicago. 

Laryngology and Otology — Chairman, Dr. S. M. 
Snow, of Philadelphia; Vice-Chairman, Dr. Philip 
Hammond, of Boston; Secretary, Dr. W. Sohier 
Bryant, of New York; Delegate, Dr. Otto F. Frier, 
of Chicago. 

Ophthalmology — Chairman, Dr. G. C. Savage, of 
Nashville, Tenn.; Vice-Chairman, Dr. A. A. Hub- 
bell, of Bufifalo; Secretary, Dr. A. E. Bulson, Jr., of 
Fort Wayne, Ind.; Delegate, Dr. vS. D. Pisley, of 
Philadelphia. 



From treating a great many patients with diabetes 
mellitus with papine I have the experience that I 
have yet to see a patient that could not stop taking 
the papine at any time I so directed him. It does 
not seem to cause the least desire for its continu- 
ance, or to create the least disposition to the forma- 
tion of a drug habit. This has proven itself to me 
on several occasions when I have had occasion to 
administer the drug for six or more consecutive 
months and the patient to be able to stop at the end 
of that time with no bad effects or symptoms, which 
would surely have occurred had I prescribed opium 
or any of its preparations commonly in use today. 
With that reputation at its back I use it more and 
more promiscuously today than ever before, and am 
always pleased with its results.— Extract from an 
article on "Treatment of diabetes mellitus" by Dr. 
J. W. Pearce, of North Carolina, in Medical Brief. 



vSt. James Place, Goshen, N. Y., June 4, 1906. 
Lane Chemical Co. 

Enclosed please find 75 cents in postage stamps, 
for which I desire a bottle ot Sulpho-Lytliin. 

I regard the product indispensable to my com- 
fort. I am afflicted with a gastric trouble, and use 
a full teaspoonful of the medicament, dissolved in 
about a quarter of a glass of hot water, before 
breakfast every morning. The effect of it is to 
cleanse and sweeten the mouth and stomach, and 
give me a comfortable send-off for the first day 
meal. I am retired from practice, so I cannot abet 
the merits of your product as it deserves. 
Sincerely yours, 

(Signed) John H. Thompson, M. D. 



An Abuse of the Malls, 

Our attention is called to the offer made by the 
publishers of the Journal of the American Medical 
Association to send it free to all who pay five dol- 
lars for membership in the Association. This is 
manifestly an abuse of the mails, and contrary to 
the postal laws. With its free journal, its prize 
badge buttons, and its many drummers abroad 
over the land business should be brisk! — Southern 
Clinic. 



Battle & Co., vSt. Louis, Mo., have just issued the 
loth of the series of twelve illustrations of the In- 
testinal Parasites. They will send them free to 
physicians on application. 



American Medical Association; Officers 
of Sections. 

The following officers were elected in thevaripns 



The Journal of the A. M. A. , by reasons of its 
wealth, its wide circulation, is in a position to do a 
vast amount of original, pure, and abstract scien- 
tific work that would be of untold value to humani- 
ty and the medical profession, but the indications 
are that these powers will be used by the manage- 
ment to further their personal and financial schemes, 
and to crush already established legitimate enter- 
prises, and independent, private and unincorporat- 
ed medical journals. 

The characteristic and predominating impulses 
of a people are manifested in their deeds, and the 
signs which they display to the world. 

The lusts that ruled the peoples of ancient days 
was shown in their Phallic emblems, their worship 
at the shrine of an Aphrodite, and their tribute to 
the court of Phryne, and from signs not hard to 
see, it may be that the Journal of the A. M. A. in 
its lust for undisputed power may become the bar- 



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other advertisement that will pay the price.— F. M. 
McIntosh, M. D.— Atlanta Journal-Record of 
Medicine. 



The Davidson (N. C.) Medical College, hereto- 
fore an adjunct of the Davidson College, is to be 
moved to Charlotte, N. C, and established as an in- 
dependent institution. The trustees of the college 
have purchased a large lot in the center of the city, 
and work will .shortly begin on the erection of a 
three-story building, in which the college will be 
domiciled. It is expected that the building will be 
ready for the opening of the college as an indepen- 
dent institution, next autumn. The trustees have 
not revealed theirplans for the future beyon4 what 



SAL^HEPATICA 

^^ The original efferves- 
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fortified by addition of Lithium 
and Sodium Phosphates. It 
stimulates liver, tones intes- 
tinal glands, purifies alimen- 
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Especially valuable in rheu- 
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Write for free samples. 
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THE CHARLOTTE MEDICAL JOURNAL. 



is stated. The announcement is considered im- will pay expressage. Address 

portant, as it will be the State's first independent THE ANTI-URIC COMPANY, 

medical college. —Atlanta Journal Record of Medi- Peoria, 111. 



Th« Proper Strength of Adrenalin Solu- 
tions In the Treatment of May Fever. 

In the treatment of hay fever with Adrenalin 
Chloride it has been suggested that weak solutions, 
frequently applied, are apt to yield better results 
than the occasional application of a strong solution. 
One of the pathological features of this peculiar 
malady is a turgescence of the turbinal tissues, due 
to excessive dilatation of the capillaries. That this 
is the result of a neurosis involving more or less 
pronounced local vasomotor paralysis is pretty gen- 
erally conceded. Overstimulation, by reaction, is 
very sure to result in a complete paralysis of the 
vasomotor supply in the region affected. On the 
other hand, gentle stimulation with weak solutions 
is not so likely to be followed by a reaction. 

These views are in harmony with the published 
observations of Dr. Crile, of Cleveland Ohio, who 
found that in a decapitated animal the heart's ac- 
tion was better sustained by the continuous admin- 
istration of a weak solution of Adrenalin Chloride. 
Furthermore, this is probably nature's method of 
supplying this vital principle to the healthy human 
body through the agency of the suprarenal gland, 
its constant presence in the blood in minute amount 
being suiBcient to maintain vasomotor equilibrium. 



Physicians who prefer to encourage the process 
of digestion rather than to resort to artificial aid, 
claim that Seng gives most satisfactory results. 
Seng acts purely as a secernant to the secretory 
glands of the alimentary canal; and panax ginseng, 
the root from which it derives its phj'siological ac- 
tion, has been used for centuries by the Chinese for 
stomach and all other troubles. Of course, many 
claims made for it by the Chinese are ridiculous, 
but that it has a specific stimulating action on the 
secretory glands is generally conceded. 



Through considerable experience with Chiona 
this remedy has convinced me of its sterling merit 
in the treatment of biliousness and all other hepatic 
derangements, functional and organic. I have 
come to regard it as an ideal hepatic stimulant, 
with perhaps a wider range of therapeutic adapt- 
ability than any cholagogue medicine I am ac- 
quainted with. Perhaps its greatest advantage is 
the fact that its use is not followed by any reaction 
tending to induce a sluggish condition of the stom- 
ach and bowels, such as follows the use of many 
other remedies. It is a pharmaceutical triumph. — 
D. S. Maddox, M. D. 



One Method of Substitution. 

We are creditably informed that representatives 
of certain eastern chemical houses are trying to in- 
troduce a mixture claiming that it contains the 
same ingredients as Neurosine. 

We have worked up a large demand for Neuro- 
sine exclusively with the Medical Profession; it is 
evident they are trying to reap where they have not 
sown. Physicians will readily recognize that the 
intention of the parties referred to is to encourage 
substitution, therefore, we deem it only necessary 
to mention this fact to doctors, as we believe they 
would not knowingly allow their prescription to be 
filled except with the identical drug prescribed. It 
is for the profession to determine the efficient re- 
sults they have obtained in the use of Neurosine, 
and not to be induced to try that which is claimed 
to be "just as good." Talk is cheap. 

The satisfactory results doctors have obtained 
with Neurosine in cases where indicated will not, 
we think, warrant them changing to an untried 
mixture, or substitute, more especially when they 
only claim the same formula as Neurosine. 

Doctors can rely on Neurosine, Dioviburnia and 
Germiletum, which we manufacture exclusively for 
physicians to prescribe, being always kept up to 
the high standard of efficiency. 

DIOS CHEMICAI. CO. 



Treatment of May Fever. 

There is abundant clinical evidence to establish 
the claim that Uric-Antagon controls the progress 
of this disease and gives relief where its administra- 
tion is continued throughout the season. Uric- 
Antagon is a purely vegetable pharmaceutical prep- 
aration combining the alterative properties of 
Phytolacca Decandra, Serenaea.Serrulata, Stillingia 
Sylvatica, Cimicifuga Racemosa, Aconitum Napel- 
lus, a trace not sufficient to unduly depress heart 
action. It contains no salicylate, opium, colchicum 
or potassium. 

Favorable reports on the use of Uric-Antagon in 
hay fever have come from .so many responsible phy- 
sicians that a trial of this carefully compounded 
preparation should be given in all of these cases 
A full size bottle will be sent to any physician who 



As to Proprietary IMedlclnes. 

The bitter and selfish fight being made by the 
Journal of the American Medical Associalion, 
some of its satellites, and a few lay papers, on 
pharmaceutical preparations, has degenerated 
to a point, where misrei)resentation and positive 
mendacity have become their chief stock in 
trade. While an honest and upright fight was 
being made for what was supposed by some to 
be a principle of medical ethic, we were willing 
to let the matter run its course, knowing and 
believing that right would in the end prevail. 
But when misrepresentation and other unfair 
means are used to intlame and mislead the pi'o- 
fession and the public, we think it time for us 
to say something about the matter and place 
ourselves on record, by setting forth the truth 
regarding these attacks, in so far as it appears 
to us. 

For instance, Collier's Weekly published a 
list of 22 cases of poisoning "from headache 
remedies" and this was referred to gloatingly 
by the Journal of the American Medical Asso- 
ciation and othei- medical journals. Yet not 
one of them all had the grace, fairness, or hon- 
esty to later publish the fact, that a careful in- 
vestigation of these 22 cases by the Western 
Druggist and the National Druggist disclosed 
that only four cases were bona fide, the remain- 
ing 18 cases of death from morphin, strychnin, 
arsenic, Bright's disease, and other diseases, 
not in the remotest way 'connected with head- 
ache remedies. One of these trumped-up cases 
was even found to have been caused by a gun- 
shot wound. 

From time to time, apparently inspired re- 
ports of deaths or serious illness from the coal- 
tar relievers appear in the daily press, and in- 
vestigations of these reports almost invariably 
show them to be absolutely without a basis of 
fact, or to have so little truth behind them as 
to prove beyond peradventure of a doubt, that 
they are inspired oy some one whose purpose it 
is to mislead, regarding the safety of these 
remedies, if properly usod. 

The very evident purpose of these reports is 
to create alarm, regardless of the facts, touch- 
ing the coal-tar preparations, so that when the 



ADVERTISEMENTS. 



XXXVII 



liste:rine 



THe original antiseptic compound 



Listerine is an efficient and very effective means of convey- 
ing to the innermost recesses and folds of the mucous mem- 
branes that mild and efficient mineral antiseptic, boracic acid, 
which it holds in perfect solution; and whilst there is no possi- 
bility of poisonous effect through the absorption of Listerine, its 
power to neutralize the products of putrefaction (thus prevent- 
ing septic absorption) has been most satisfactorily determined. 

LISTERINE 

DERMATIC SOAP 

A. saponaceous determent for ttse 

in the antiseptic treatment 

of aiseases of tHe skin 

Listerine Dermatic Soap contains the essential antiseptic 
constituents of eucalyptus (1%), mentha, gauUheria and thyme 
(each /^%), which enter into the composition of the well- 
known antiseptic preparation Listerine, while the quality of 
excellence of the soap-stock employed as the vehicle for this 
medication, will be readily apparent when used upon the most 
delicate skin, and upon the scalp. Listerine Dermatic Soap 
contains no animal fats, and none but the very best vegetable 
oils; before it is "milled" and pressed into cakes it is super- 
fatted by the addition of an emoUient oil, and the smooth, elastic 
condition of the skin secured by using Listerine Dermatic 
Soap is largely due to the presence of this ingredient. Unusual 
care is exercised in the preparation of Listerine Dermatic 
Soap, and as the antiseptic constituents of Listerine are added 
to the soap after it has received its surplus of unsaponified 
emollient oil, they retain their peculiar antiseptic virtues 
and fragrance. 

A sample of Listerine Dermatic Soap may be had upon 
application to the manufacturers— 

I^ambert PSiarmacal Company 
ST. LOUIS, u. s. A. 



Bronze Medal (Highest Award) Exposition Universelle de 1900, Paris 



XXXVIII 



THE CHARLOTTE MEDICAL JOURNAL. 



State Legislatures are ia session next winter, 
the Ladies' Home Journal bill and other similar 
bills, classing the coal-tar preparations as pois- 
ons, will pass the various legislatures. We are 
pleased to say that this scheme to create a fear 
of coal-tar preparations by false reports, will 
fail, because statistics are being carefully com- 
piled, showing the number of such cases falsely 
reported or greatly exaggerated. These statis- 
tics, presented to the various State legislatures 
whei'e such bills are under consideration, ex- 
pose the under-handed methods being used, and 
will act as a decided boomerang to those who 
consider it honorable to use disreputable means 
to accomplish their ends. 

The ( oal-tui- derivatives appear to be the par- 
ticular butt of attack by those who are creating 
the present epidemic of hysteria regarding 
these remedies and the most ridiculous and pre- 
viously unheard-of statements are made coc- 
cerning them. Already bills have been intro- 
duced in several State legislatures classing all 
coal-tar derivatives as poisons, yet Collier's, 
assisted by the .lournal of the American Medi- 
cal Association was, as stated above, able to 
find only four bona tide cases of untoward effect 
resulting from over-doses of all the various coal- 
tar preparations aold in the United States and 
Canada. Yet there have been recorded over 
100 cases of quiuin blindness, numberless cases 
of quinin deafness, thousands of cases of skin 
lesions and other untoward results from small 
doses of quinin, not to say anything of the num- 
erous deaths caused by it. And quinin is con- 
sidered a safe remedy, and is not mentioned in 
the Schedule of Poisons referred to in the above- 
mentioned bills. 

The <'oal-tar preparations are not poisons, as 
that term is usually understood, and every per- 
son familiar with medical literature knows — 
though all may not publicly adoiit it — that thi're 
are more cases of poisoning by almost every 
potent drug, than by all the various coal-tar 
preparations combined. This, in spite of the 
fact that there are probably more doses of the 
coal-tar pain relievers taiien every day, than 
are taken of any other five drugs. 

Some of these pi-eparations we have be mi us- 
ing for a number of years and with every degree 
of satisfaction and mo-tt gratifying results One 
of which in particular, known as ^ntikamnia, 
has been on the market for over fifteen years, 
and during all that time, not one well authenti- 
cated case of untoward effect has ever been re- 
ported where the proper and advised dose was 
taken. To call a preparation "Poison" which 
never acts even unpleasantly, unless taken in 
greatly excessive doses, is ridiculous, to say the 
least. Salt in excessive doses is a poison, and 
has often produced death. Al food contains 
the most powerful poisons in minute quantities; 
foi- instance, prussic acid in fruits, other poison- 
ous substances in meat, fish, eggs, milk, bread, 
beer, many vegetables, mineral wat^^rs, etc. 
Therefore, these artic es of food and drink could 
more justly be called "poison" than to call a 
medicine a poison simply because it contains 
such dru(,s or a coal-tar preparation. It is es- 
sential that a certain prescribed quantity be ex- 
ceeded to convert any substance into a poison. 
However, all drugs which are poisonous when 
given to htman beings in doses ol a single grain 
or less, arc commonly called "poisons" and these 
drugs are the substances that people think of 
when poison is mentioned. To call other drugs 
'■poisons" is misleading, unjust, and is evidence 
of pure malice. 

Of all dishonorable and unprincipled means 
to injure an article of trade, be it medicine or 
other substance, the worst is that which libels 



its character. Numbers of pounds of the coal- 
tar preparations have been administered in the 
past twenty years, with injurious results from 
over-doses so rare as to be the marvel of medi- 
cal history: The New York Quinine & Chemi- 
cal Company alone sells over 100 tons of aceta- 
nilid a year. No other potent drug is as safe as 
these remedies, and those who are attempting, 
from ulterior motives, to create the impression 
that they are poisons, are doing an act for which 
all right-mided people ought to, and will con-, 
demn them. 

"What is a Poison?" is the title of a very able 
article by Dr. R. G. Eccles, published in Ameri- 
can Medicine on December 9 and 16, 1905. Every 
medical man and especially every editor of a 
medical journal should read the said article, 
now that the attempt is being made to classify 
the coal-tar preparations as poisons, and he will 
see the utter absurdity and the plainly dishonest 
motive behind the work being done to misrep- 
resent these safe and efficacious remedies. If 
the coal-tar preparations are poisons, then 
quinin, mur. ammonia, chlorate of potash, calo- 
mel, sodium bicarb., santonin, and the bromides 
are poisons as well, as are many other drugs 
which are now considered safe remedies, and 
which are never referred to as poisoi s, in the 
common acceptation of that term. 

We have used quite freely Antikamnia in our 
remarks, for the reason of its great popularity 
and the universally good results that have been 
obtained by its judicious and proper use. But 
there are others that have been unjustly decried 
and the effort has been made to put under the 
ban anything and everything, no matter what, 
just so that it is a "Proprietary." Our medical 
education was obtained at the feet of a Gamaliel 
in the profession, one of the most ethical of the 
ethical. Dr. Wm. K. Bowling, aided by personal 
instruction from his colleagues, Drs. Paul F. 
Eve and Wm. T, Briggs, all of this city, and all 
of them at one time presidents of the American 
Medical Association. We were taught by them 
that it was a duty to use anything under the 
heavens above, on the earth beneath, or under 
the latter and in the waters thereon, yes, any- 
thing that in our opinion or belief would relieve 
pain and suffering and stay the hand of death. 
Regular medicine has no bounds to the domai s 
from which it is jusoifiable in procuring mate- 
rials to aid the injured, the sick, and the suffer- 
ing. It is absolutely unlimited in the fields 
from which it may obtain remedial measui-es or 
substances for the "relief of any of the ills that 
flesh IS heir to." 

Briefly and cursorily I will mention other 
"Proprietaries" concerning which, having had 
.satisfactory information, I was justified in mak- 
ing trial, and found them by personal observa- 
tion to be thoroughly reliable and satisfactory; 
and consequently shall continue to use them, 
notwithstanding they are decried by a few 
extremists following in the lead of one who is so 
very extra ethical for the same reason that a 
thief will often be the first one to raise the cry 
of "stop, thief" to ward off suspicion from him- 
self. But of this more anon. 

Now. there is "Fellow's Ilypophosjihites." 
which I use and have used for years, from the 
fact that it is far easier to write than it is to put 
down in detail the various ingredients in the 
old formula of Churchill; and then, again, I am 
confident that by doing so there is far less lia- 
bility of getting inefficient ingred'ents than I 
would if I had wi-itten the formula and sent it to 
many of even the leading prescription pharma- 
cies in any city. And not only is it of definite 
strength as to all its component jiarts. all of 
which I can depend on as being carefully select- 



ADVERTISEMENTS. 



JOHANNHOFF'S MALT AND IRON 



(PEPTONATE OF MANGANESE AND IRON.) 



Is an ideal preparation to build tip 

BLOOD AND BODY 

(Each wint^slassrul ceiitains 1 gramme of Pcptonate of Manganfse and Iron.) 

It is a Nutrient Oxygen Carrying Agent 



1 

m 

M 

M 

Contains only a minimum amount of alcohol (less than 3%); is more M\ 
readily absorbed into the circulating fluid than the iron preparation by M 

itself. _ M 

Tohann Hoff's Malt and Iron is of marked and certain value in all m 

forms of Anaemia, Chlorosis and general debility. ^ 

EISNER & MENDELSON CO. of New York, i 

SOLE AGENTS. M 

m 



ed, but it will always cost my patients less. The 
same may be said if I prefer to write "Robin- 
son's Hypophosphites." 

I use Tongaline beoause [ know that it con- 
tains the salicylic acid from the oil of winter- 
green and never the synthetic preparation. 
Furthermore, I know from repeated trial that 
it is a most excellent remedy in neuralgic coa- 
ditions in which I want the benefit of this acid 
together with colchicum, etc. 

Battle's Bromidia contains in each fluidounce 
a definite quantity of chemically pure bromides, 
chloral, and cannabis indica, enabling me to 
give a suitable and sutticient dose in ateaspoon- 
ful, which I have never been able to accomplish 
in the best retail pharmacies in this or any 
other city. I have also found Battle's lodia, 
Papine, and Ecthol most excellent and thorough- 
ly reliable preparations— just as much so as 
'•McMunn's Elixir," or any of the '"official prep- 
arations" of the U. S. P. 

More than twenty years ago, in a consultation 
with Dr. .John H. Gallender of this cit.y, then 
Superintendent of the Hospital for the Insane 
in the middle division of this State, he suggest- 
ed, taking a copy of the pre-^cription from his 
memorandum book written by the late Dr. Jno. 
P. Gray, then Superintendent of the Utica Asy- 
lum of New York, a tonic combination that is 
now put up under the "copyrighted" name of 
"Gray's Glycerine Tonic, " and which I use very 
often, finding it more uniform in its definite 
strength and' more reasonable in price than I 
ever did during the years I used it and had it 
compounded by the best retail prescription 
houses in this city. 

Hayden's Viburnum Compound, Wayne's 
Elixir, etc., are but the well tried and definite- 
ly proven working prescriptions ol able and ac- 



tive regular practitioners of medicine, far bet- 
ter prepared and more reasonable in price than 
if one should write out and depend on any pre- 
scription druggist for compounding the original 
formula. 

Antiphlogistine has relieved my patients and 
their friends from the many annoyanct-s of the 
old-time poultice, giving better results. Listcr- 
ine is so well established as a "definite and 
standard" combination, as is Giyco-Heioin 
(Smith), Glyco-Thymoline, Cystogen. and otheis 
that ihey will long withstand the attacks that 
have been made on "proprietary medicines." 

But why this "hue and cry" that has recently 
been raised as to "copyrighted" or "proprietary" 
medicin.-sy The enterprising managers of Col- 
lier's VV^eekly and the Ladies' Home Journal, 
in order to get the advantage in a purely busi- 
ne.ss point of view of other periodicals of like 
character, commenced a crusade against patent 
and proprietary medicines. Regardless as to 
whethei- they were good, bad, or indifferent, 
they made a wholesale attack. They simply 
struck out on new lines, expecting to find "pay 
dirt." It was strictly a matter of exploiting in 
a new field, expecting to realize thereon in a 
purely financial way. Well, that is their privi- 
lege, provided that they do not resort to libel. 

Now, as to the Journal of the American Medi- 
cal Association. In 1857 we had the honor of 
being present at a meeting of the American 
Medical Association held in this city, being then 
in our novitiate; and in 1876 became a member 
of the Association at its Louisville meeting, 
serving as a delegate to the Association at the 
meeting in 1877 in Chicago, and a member of the 
Nominating Committee that year and in several 
subsequent years. For ten years we missed at- 
tendance on but few meetings of the Association. 



Xh 



THE CHARLOTTE MEDICAL JOURNAL. 



A little over a quartei- of a century ago, the 
Journal of the American Medical Association 
was established, and I have in my possession 
several letters from the ''Father of the Associa- 
tion" in his own handwriting acknowledging- 
my humble efforts in this movemnnt. Of lute I 
have not been present at many of the meetings 
of the Association, but have had the pleasure of 
"keeping in touch" with it, although for the 
most part, being but a "looker-on in "Venice," 
yet my interest therein has been continuous and 
sincere. The Journal under the management 
of its able, efficient, and "ethical" editors. Dr. 
N S. Davis, J. C. Culbertson, Jno. HoUister, 
and Jno. H. Hamilton grew apace and became 
"a power in the land." 

Yet, in the years and under the editorial man- 
agement of these "regular members of the 
medical profession," it accepted the advertise- 
ments of all the proprietary preparations men- 
tioned previously and some others. These "re- 
dacteurs en chef, " l)eing "like Cfesar's wife," 
were not afraid to admit to its advertising space 
preparations that had proved of benefit to many 
in the land. But at a later day, one who had 
received his diploma from a Homeopathic 
school, who had "claimed a special designation 
and traded on the same," one who had been 
practicing sectarian medicine, was placed on 
the editorial tripod of the then greatest medical 
journal in America, and at once, although plac- 
ed in this hign and responsible position by the 
"Board of Trustees," began his control of them. 
Yes, it was and is a case of "the tail wagging 
the dog." And, "out-Heroding Herod," under 
the inspiration of Collier's and the Ladies' Home 
Journal, as has before been done by the gtiilty 
thief, he raises the cry of "STOP, THIEPl" 

Under his management he would strike down 
reputable manufacturers who had been recog- 
nized as honest and reputable by his able pre- 
decessors in so responsible a position, and where- 
foreV Has he become uneasy as to his tenure of 
office? Is he uneasy lest some one dig the 
ground from under "his feet? Is it for love, af 
fectioQ for, and sincere devotion to "Regular 
Medicine?" There is a motive in all things that 
inspire men to action. What is his? He is 
shrewd, he is sharp, but his antecedents did not 
justify his being placed in the editorial chair of 
the official organ of the regular profession. 
Will he be sustained in the days that are com- 
ing? 

We know full well that the charge will be 
made that this editorial article is inspired by 
the financial consideration of the advertising 
pages of this .Joui-nal. To this we will say, tha't 
in all the years that have passed since the es- 
tablishmentof the Journal of the American As- 
sociation we have held as our criterion of the 
proprietary preparations the Journal of the As- 
sociation. If an advertisement ajjpeared in its 
pages, we could feel that we were doing no 
wrong in admitting it to ours. And, as before 
stated, when we know that any article or com- 
bination of chemicals and drugs will prove bene 
ficial to the sick and suffering, we will not hesi- 
tate to use them, and also to advocate their use 
by others, notwithstanding what has been said 
or may be said by some very small per-SIM- 
MONS.— Editorial in May Number of The 
Southern Practitioner, Nashville, Tenn. 



the U83 of wood alcohol in any preparation 
whatsoever, is forbidden under a penalty of $2,- 

000.00 Many unprincipled manufacturers 

use wood alcohol, some rely on formaldehyde, 
while again others use a combination of these 
with grain alcohol. — Practical Druggist. 



Wood alcohol exerts its toxic eft'ect only less 
readily when used externally than when taken 
into the stomach. Its use in the inanufature of 
liniments and other external preparations is no 
more to be cons^idered than its employment in 
the manufacture of essences and similar articles 
meant for internal consumption. — Bulletin of 
Pharmacy. 

"All aqueous witchhazel distillates shipped 
inland contain added formaldehyde to preserve 
it until it reaches its destination, where it is 
then fortified by the addition of alcohol." — T. 
D. Wetterstrcom, National Food Commissions' 
Assn., Portland, Ore., July, 1905.— The addi- 
tion of formaldehyde should no more be " toler- 
ated" here than in other substances used as 
food, or in m<^dicines, for the obvious reason 
that it is an irritant poison, the powers of which 
are probably not fully known. Its vapor may 
have some effect on the eyes which we have 
not yet learned to distinguish. — Editor, The 
Druggist' circular. 



It is reported that the majority of several 
hundred samples collected of aistilled extracts 
of wichhazel sold in Chicago drug stores have 
been found to contain wood alcohol, instead of 

grain alcohol, and even formaldehyde 

The spirit of intolerance aga'nst the sale of 
preparations containing wood alcohol, whether 
for internal or extenal use, is constantly grow- 
ing, and it may be expected that the practice 
will meet with more severe punishment in the 
future. — Bulletin of Pharmacy. 



The poison perils of t le common commercial 
and unidentified witchhazels of the market, 
adulterated with Wood Alcohol and Formalde- 
hyde, may be entirely avoided by presciibin^f 
and dispensing only Pond's Extract of Hama- 
melis Virginica. Pond's Extract has been the 
standard of purity, quality and strength among 
di^tillates of hamamelis for more than half-a- 
century and its many medicinal and recognized 
virtues have doubtless contributed materially to 
secure recognition for Aqua Himamelidis by 
the Committee of Revision of the U. S. Phar- 
macopoeia, 1900, and its inclusion in the latter 
as " offiicial. " 



The Perils of Wood Alcohol and Formal- 
dehyde. 

Every package of witchhazel should be care- 
fully tested for wood alcohol and formaldehyde. 
These ingredients are very dangerous, even 
when used externally, and in New York State 



The American Medical Association and 
Independent Medical Journalism. 

We understand that in the House of Dele- 
gates of the American Medical Association, at 
Boston, the committee took occasion to deny 
that there was any pXirpose on the part of the 
national association or of the State societies to 
injure independent medical journals, many of 
which, it was admitted, serve a valuable pur- 
pose. We are glad to have this disclaimer from 
the national association, but as regards the 
State societies, we think they must speak for 
themselves; for so-ne of them, through their 
official organs have explicitly expressed a de- 
sire for the suppression of the independent 
medical journal. — Medical Review. 



We call the attention of our readers to the 
advertisement of the Robinson-Pettet Co.., 
Louisville, Ky., which will be found on another 



ADVERTISEMENTS. 







i 

m 






p (Inflammation's Antidote) .^. 

m 
M 

m 
M 
m 



Apply hot 

and 

Thick 




jLiia 



Entero-Colitis, Cholera Infantum, | 

I Peritonitis. I 

^■) '© 

M TN acute inflammatory conditions of the intestinal tract An- <^> 

m tiphlogistine" will be found of great value. It will not take f0 

0) the place of proper diet and internal medication, but by relieving (^) 

'0^ the local congestion and soothing the nervous system, it will be M 

found to be an inestimable adjuvant. W 

H THE DENVER CHEMICAL MT^a OO. 



NEW YORK 



CHICAGO DENVER 
SAN FRANCISCO 



LONDON SYDNEY 
MONTREAL 



'0:Q.QGQ-&(^M§MMMMi 




XLII 



THE CHARLOTTE MEDICAL JOURNAL. 



page of this issue. This house was established 
fifty years ago, and enjoys a widespread repu- 
tation as manufacturers of high character. We 
do not hesitate to endorse their pi-eparations as 
being all they claim for them. 



Campho-Phenique. It has been on the market 
for the past twenty-five years and there are 
very few physicians of any prominence today 
who have not used this remarkable preparation. 



Dysenteric conditions all present certain 
physical signs which are in common, such as 
the frequent stools, great exhaustion and weak- 
ened heart action dependent upon the virulence 
of the poison. Recognizing this toxic manifes- 
tation and the constantly increasing danger of 
autoinfection, our indicated treatment is one 
which will assist the effort natui-e is making to 
render the tract aseptic by ri ding itself of the 
contents of the bowel which has been a fertile 
field for disease producing germs, to correct 
the existing fermentation and restore burface 
circulation which has been seriously interfered 
with. For this purpose a high colon flush of 
Glyco-Thymoline in a 10 per cent, solution at 
105 degrees should be used at least twice daily. 
This solution exerts a marked inhibitory effect 
upon the growth of putrefactive and pathogenic 
bacteria, depleting the membrane of its pro- 
ducts of inflammation ana restoring normal 
glandular secretion. 



GY8togen-L.lthla Tablet. 

An effervescing tablet of Lithium Tartrate 3 
grains and Cystogen 3 grains, has recently 
been placed on the market. Insomuch, as the 
idea of this combination was given us by ob- 
serving the large number of physicians using 
Cystogen with Lithia, in Gouty and allied affec- 
tions, we bespeak for this tablet an extensive 
use. Put up in packges of three tubes contain- 
ing three dozen effervescent tablets. Samples 
and literature on request. 

Cystogen Chemical Company, 
St. Louis, Mo. 



Shall we Walt for the Serum? 

For years we have contended that very de- 
cided relief followed the complete emptying and 
disinfecting of the alimentary canal, in many 
forms of disease; and that this in itself showed 
that the portion of the symptoms thus remova- 
ble must therefore be due to the presence of this 
matter in the alimentary canal. But it seemed 
that the professional ear was so absorbingly 
trained toward (Germany that nothing uttered 
on this side of the ocean could penetrate the 
tympana of our brethren. Whenever we did 
succeed in inducing someone to listen to us, we 
were impatiently informed that that theory 
had been duly considered and had been aban- 
doned long since. The non-mechanic therape- 
utics of the i)revalent cliques seemed to be 
comprised in the four words -Wait for the 
serum! Meanwhile the Held of practice was 
to be abandoned to the surgeon and the quack 
—American .Journal of clinical Medicine. 



The medical ])rofession has not only made 
It^ advances in the line of appliances in the 
treatmentof diseases, but it is equally as well 
represented with the improvements that have 
been made on the line of a general antiseptic 
There are so few antiseptics ottered to the 
medical profession that can be relied upon in 
all cases where an antiseptic is indicated that 
when one is offered to the profession it is not 
surprising that it received such a reception. 
One of the best antiseptics that is now ottered 
to the medical profession and one that can be 
used with success in the treatment of minor 
and major surgery goes under the name of 



An&ina Pectoris and an Arterial Reflex 
of Abdominal Orlftln. 

Russell (British Medical Journal) records 
his observations regarding an arterial reflex 
having its origin in the abdomen, the impor- 
tance of which he thinks has not been fully 
appreciated. While the active processes of 
digestion are going on, there is an influx of 
blood into the splanchnic area. This drain- 
age into the aodominal vessels is balanced in 
the general circulation by a systemic arterial 
contracdon, evidently a reflex phenomenon 
originating in the splanchnic system, passing 
to the vasomotor center in the medulla, and 
then transmitted to the systemic arteries. 
The changes in the systemic arteries are a 
reduction in size and an apparent thickening 
of the arterial wall. The degree of these 
changes depends on the kind of meal which has 
been taken. In the big eater and the wine- 
drinker the arterial contraction is associated 
with a rise of blood-pressure and a true increase 
of arterial tension. This reflex varies in deli- 
cacy in ditt'ei-ent persons. It exists in all. He 
believes that there is a relation between this 
phenomenon and angina pectoris, and cites 
several instances in support of his contention. 
The author says that this hypersensitiveness 
of the vasomotor center, even in grave anyina 
pjccoris, can be reduced, controlled, or even 
removed by dietetic measures, with the result 
that the anginous seizures are removed or 
greatly modified. In cases where the arterial 
spasm is associated with great anatomic change, 
either in the myocardium or in the coronary 
vessels, absolute cure can hardly be looked for; 
but in all cas is the symptoms of angina pecto- 
ris may be much ameliorated by conducting 
the treatment in accordance with what they 
indic.ite. Owing to the varying degree of in- 
tensity of the symptoms, tlie writer suggests 
that in classifying the cases, the simplest dis- 
tinction miffht be found in the terms angina 
pectoris major and angina pectoris minor, the 
former being con'ined to those cases in which 
th M-o s believed to be permanent anatomic 
change in the heart or its vessels. 



Advantages of the 'Strontium Salts. 

F. S. Mason, ( La Tribune Medicale, ) says 
the stiontium salts are preferred by progres- 
sive physicians because they do not depress 
patients as do the potassium or ammonium salts. 

Sodium chloride is so liberally absorbed with 
food that a great toleration of all sodium salts 
is established, hence larger molecular doses of 
bromide and iodide ai'e required than of stron- 
tium or potassium salts. 

Strontium salts ana to a great extent intesti- 
nal antiseptics, preventing secondary fermen- 
tation and insuring better assimilation of nour- 
ishment. This is especially marked in the case 
of the iodide where largo doses are required for 
antisyphilitic treatment during a long period. 

In card ia'! troubles, and where small doses of 
the iodides are indicated, the strontium salt is 
well tolerated, and is almost tasteless, especial- 
ly when exhibited with syrup of orange peel. 

It is certainly to be preferred to the potassium 
iodide for syphilitics, since instead of depress- 
mg the patient, it stimulates the appetite and 
nutrition, which is so essential to this class of 
patients. 

Smaller doses are required of bromide of 



ADVERTISEMENTS. 



CATARRH ! 



CERMILETUM is Really a Specific in CATARRH 



That which has proven to be the ideal solvent 
and stimulating- alkaline antiseptic is GERMI- 
LETUM, its persistent use twice or thrice daily, 
full strength, or diluted when the mucous mem- 
brane is sensitive, will effectually cure the worst 
advanced case of chronic nasal catarrh. 

Dr. A. W. Latimer, late Physician to the St. 
Louis City and Female Hospital. 

I have used GERMILETUM in many cases of 
catarrh. I consider it a most efficient remedy 
and really a specific in catarrhal affections. 

Dr, A. U. Williams, Hot Springs, Arlc. 

I have used GERMILETUM in many cases of 
rhinitis with most excellent results. It is also 



the most efficient remedy in catarrhal affections. 
Dr. E. W. Watkins, Washington, D. C. 

I have used GERMILETUM in the most ag- 
gravated cases of catarrh and have cured some 
of the worst cases. I consider it as near a spe- 
cific in catarrhal affections as can be. 

Dr. A. Jordan, Nashland, Tex. 

Nasal catarrh, which has long been an odium 
of medicine, may now be successfully combated 
by the alkaline antiseptic— GERMILETUM. 

Dr. A. 11. Ohman-Dumesnil, Professor of 
Dermatology in the College of Physicians and 
Surgeons. 



ECZEMA 



GERMILEIUM is also unexcelled 

Literature Mailed on Application. 
FREE— Buchanan's Book "Antisepsis" and "Antiseptics," 352 pp. 
Pull Size Bottle of GERMILETUM Free to Physicians, they Paying Express Charges. 



DIOS CHEMICAL CO., 



St. Louis, IVIo. 



PiL. SUMBUL COMP. 

(WM. R. WARNER & CO.) 
F^OR PHYSICIANS PRESCRIBlISa. 



PiL Sumbul Comp. is especially recommended for "nervous and 
hysterical women who need building up." This pill was largely 
used by the late Dr. Goodell ; in fact he originated the formula. 



FORMUI.A : 
Ext. Sumbulis, gr. i. 

AsafcEtidae, grs. ii. 

Ferri Sulph. Exs., gr. i. 

Ac. Arsenosi, gr. i-40- 

Dose, I or 2, three times a day. 



This pill is serviceable in neurasthenic conditions, loss of sleep, 
headache or fatigue. 

If you would always have uniform results from Pil. Sumbul Comp., 
specify "Wm. R. Warner & Co." 

Pure drugs in the hands of our experienced chemists result in 
producing a pill that is permanent, potent, soluble and reliable. 
SAMPLE TO DOCTORS OIN REQUEST- 



WM. R. WARNER (S. CO., 

MANUFACTURING PHARMACEUTISTS. 
Philadelphia, New Yorh, Chicago. New Orleans, 



XLIV 



THE CHARLOTTE MEDICA JOURNAL 

Officers of the North Carolina Medical Society. 



President. EtUvard C Reg^isl:,r, Charlotte. 
1st Vice-President, L. B. M cBrayer. Asheville. 
2nd Vi<-e-Presi(lent, \V. H. H. Cobb, Jr., Goldsboro. 
3rd Vice-President, Dr. VV. O. .spencer, Winston. 
Secretary, J. Howe 1 Wa.v, Wa.ynesville. 



I.LOnS (3 YEARS TERM). 



, Oscar McMi 

.J. M. P;urot 



8th 
9th 
lOlh 



;ui. Elizabeth City. 

Kinston. 
Frauli H. Russell. Wilmington. 
Albert .-Niulersou, Wilson. 
J. F. Hitrhsinith, Fai etteville. 
Herbert .\. Royster, Raleigh. 
E. C. Retrister, Charlotte. 
D. a'. Stanton. High Point. 
Thomas E. .\ndersoii, Statesville 
James A. Burroughs, Asheville. 



Orator, James M. Parrott, Kinston. 

Essayist, Thomas S. McMullan, Hertford. 

Leader of Debate, Sam'l D. Booth. Oxford. 

Commilttfe on Puljlic Policy and Legislation, R. H. Lewis, 
Raleigh ; George G. Thomas? Wilmington; P. L. Mur- 
phy, Morgant n, and Ex-officio Edward C. Register 
Charlotte: J. Howell Way, Waynesville. 

Committee on Finance, D. A. Stanton, High Point; C.J.I 
Siwyer, Windsor; S. P. J. Lee. Dunn. 

Committee on Publication, J. Howell Way, WavnesviUe 
(ex-officio); Geo. W. Pressly, Charlotte; h". McKee 
Tucker, Raleigh. 

Committee on Scientific Work, R. H. Whitehead, Chape 
Hill;0. C. Daniels, Oriental; J. Howell Way Waynes 
ville(exofflcio). 

Committee on Obituaries, C. M. Poole, Craven; H. H. 
Harris, Wake Forest; Kemp P. Battle, Jr., Raleiga. 



Officers of Hie County Medical Societies of North Carolina. 



Alamance. 
Anson 

Ashe 

Beaufort. . 
Bladen .... 



Cabarrui 
Caldwell 
Caswell , 



Davidson 
Duplin .. 
Durham . 
Edgeoom 

Forsvthe 
Franklin 
Gates ... 
Gaston.. 
Gr;ihani 



PRESIDENT 



Greene 

Guilford 

Halifax 

Harnet 

Haywood 

Henderson-Po 

Hertford 

Iredell-Alexan 

Jackson 

Johnson 

Lenoir 

Lincnlu 



Madi: 



Mecklenburg.... 

Montgomery 

Moore 

Nash 

^ew Hanover 

Northampton.... 

Onslow 

Orange 

P.amlico 

Pender 

Person 

Perfjuinians 

Pitt 

Pas'iank-C'amder 

Randolph 

Richmond 

Kobe.son 

Kookingham 

Rowan 

Rutherford 



Sampson . 
Scotland , 
Stanly ... 
Stokes ... 



Transylvanli 

Union 

Vance 

Wake 



Dr. G. W. Long 

Dr. J. M. Dunlap 

Dr. J. W. Colvard.... 
Dr. T. J. Nicholson... 
Dr. W. H. G. Lucas . . . 



E. G. Goodman 

Thos. P. cheesboroufi 

George H. Moran 

W. H. Lilly 

J. B. Wright 

M. H. McBrvde 

Geo. H. AVest 



. . . Jetferson 

Booth 

.White Hall 



\shK 



F. M. 



1)1-, s. M. Witln-r> 
Dr. Cli,-i,s. Dnttv. 
Dr. T. D. Haigh. 
llriirv M. .Sliaw. 
Dr. VV. D Kimbn 
Dr. H. W. Dorset! 
Dr. John M. Falsi 
Dr. A. Cheatham 
Dr. R. L. Savage . 
Dr. H. S. Lott .. 
Dr. J. E. Malone. 
Geo. D. Williams 
Dr. J. M. Sloan . . 
Dr. M.T. Maxwell 
Dr. S. D. Booth . . . 
Dr. Albert West.. 
Dr. M. T. Fi>x.... 
Dr. Jolm A, lolih 



He 
....Morganton 

Concord 

.Granite Falls 

Milton 

Newton 

Beaufort 

Murphy 

iiig's Mountain 

.'.'.'. cii'adiionrn 



SBCRETABT 



Dr. T. A. Allen 

Dr. S. S. Daniels 

Dr. E. E. Klutz 

Dr. A. A. Nichols .... 

Dr. J. B. Person 

Dr. J. M. Hodges... . 

Dr. R. B. Killian 

Dr. B. A. Cheek 

Dr. S. H. Lvle.... 

Dr. J. C. Tilsou 

R. J. Nelson 

Dr. Lestar Hunter 

Dr. F. E. Asbury 

Dr. W.A. Monroe 

Dr. J.T Strickland, 
Dr W. J.H. Bellamy. 

Dr. A. J. Ellis 

Dr. W. J. Montford . 
Dr. I. H. Manning... 

<T. S. Attmore 

W. J. Lamsden 

Dr. A. C.rBovles 

Dr C. (i. Nicii,,ls . . 

W. M. Iti.Mi.-k 

Dr. Osrar .M .■:\l n I hin . 

Dr. S. A HtMilev 

Dr. W. H. Steele 

Dr. R. M. Norment, . 



....Robbinaville 

O.^ford 

Speight's Bridge 
Hull ford College 

Enfield 

...Buie's Creek 
....Waynesville 
. Hendersonville 

..Winton 

Troutman 

Painter 

helma 



rr. J. S. Brown 

Dr. Remee Hicks 

Dr J. B. Smith 

Dr. Jno. A. Stevens, 

Dr. D. M. Prince 

Dr. Tiios. A. Hathcoi-k, 

Dr. L. H. Hill 

Dr. D. R. Bryson, 

Dr. E. S. English 

Dr. R. Armfield 

Dr. F. R. Harris 

Dr. L. P. Sorrell 



W iison . . 
Yadklu . 
Yancey . 



Dr 


D. W. H. Hardison 


Creswell 


Di- 


J. W.Jones, 




Dr 


M. E. Robinson 


li.ildsboro 


Dr 


C. W. Mosrly N. 


rth Wilkesboro 




C. E. Moore 


Wilson 


Dr 


W. G. Leak, 


East Bend 


Dr 


J. L.Ray 


BurnsviUe 



Dr. J. W. McPerson Haw River 

Dr. J. M. Covington, Jr., Wadesboro 

Dr. J. L. Ballon Crumpler 

Dr. Ira M. Hardy Washington 

Dr, Newton Robinson Elizaliethtou 

E. H. II... Ion Aulander 

1)1 . ,1. .V l)..slifr Soulhport 

Di-. (laiil.ii-.l .s. Ten nan t Asheville 

1)1-. I. M. 'I'.iylor Morganoln 

Dr. F. O. Rogers Concord 

Dr. W. P. Ivey, Lenoir 

Dr. S. A. Malloy Yanevvllle 

Dr. J. H. Shuford Hickory 

Dr. D. S. George Marshallburg 

Dr. S. C. Higlnvay Murphy 

Dr. L. V. Lee, Lattimore 

Dr. H. T. Chapin, Pittsboro 

Dr. T. C. Johnson Vineland 

Dr. R. D. Jones, Newbern 

Dr. John D. MeRae Fayetleville 

Stuart W. Mann Moyock 

Dr. W. C. Martin, Mocksville 

Dr. D. J. Hill Lexington 

Dr. Ben. R. Graham Wallace 

Dr. W. A. Graham Durham 

Dr. S. N. Harrell, Tarboro 

Dr. R. D. Jewett, Winston 

Dr. S. P. Burt Louisburg 

G. C. Brooks Sunbury 

Dr. H. P. Glenn Gastonia 

Dr. R. J. Orr Robbinsville 

Dr. Ben . K. Hays Oxford 

Dr. G. C. Edwards Hookerton 

Dr. W. J. Richard.son, Greensboro 

Dr. A. S. Harrison Enfield 

Dr. Chas. Highsmith Dunn 

Dr. J. Howell Way Waynesville 

Dr. J. G. Waldrop Hendersonville 

Dr. J. Rainey Parker, Union 

Dr. J. E. McLaughlin State.ville 

Dr. Deles D Hooper Svlva 

Dr. T. Hooks Smithdeld 

W.F.Hargrove Kinston 

Dr. L. .-v. I rowill Lincolnton 

Dr. G S. Kirbv Marion 

Dr. W. A. Rngtns Franklin 

Dr. W. F. Robinson Mars Hill 

Dr. W. E. Warren Williamston 

Dr. Parks M. King Charlotte 

Dr. C. Dalighy Troy 

Dr. Gilbert McLeod Carthage 

Dr. J. P. Whitehead, Rocky Mount 

Dr. S. E. Koouee, Wilmington 

Dr. R. P. Morehead, Lasker 

Dr. E. L Cox Jacksonville 

Dr. C. D. Jones Hill.sboro 

H. P. Underhill Bay bore 

Dr. R. H. Bradford Burgaw 

Dr. W. A. Brailslier Ro.tboro 

R. W. Smith Hertford 

Dr. Jos. E. Nobles Greenville 

Dr. Claude B. Willis Elizabeth City 

Dr. C. C. pubbard orthviUe 

Rockingham 

Lumberton 

ReidsviUe 

Salisbury 

Rutlierfordton 

rth Mt. Airy 

Clinton 

Laurinburg 

Norwood 

Walnut Cove 

Bryson City 

!e (. heatiiam ..Brevard 

Dr. J. P. Monroe, ". .Monroe 

Dr H. H. Bass, Henderson' 

Dr. W. C. Horton Raleigh 

B.Ray Browning Littleton 

Dr. J. L. Hassell Creswell 

Dr. McD. Little Horlon 

Dr. W. K. Lane (ioldsb,.ro 

Dr. C. tJ. Bryant Ituaring River 

Dr. J. W. Lamm, Lucama 

Dr. M L Matthews, East Bend 

BurnsviUe ) J. B. Gibbs BurnsviUe 



I''ranklin 

rshriil, R. F. I). 

.Robersonville 

Sard is 

.\sbury 

San ford 

Nashville 

....Wilmington 

Garysburg 

...Ward's Mills 
....Chapel Hill 

Stonewall 

.Elizabeth City 

Mt. Tirzah 

Roxboro 

Hertford 

Kli/.ibeth City 

.-Vsheboro 

. . Rockingham 

Lumberton 



.Salisbury 

, Henrietta 

.Pilot Mountain 

Clinton 

Laurinburg 

Norwood 

Germanton 

Bryson City 

Brevard 

Marsh ville 

Henderson 



.Fli 



Dr 


L 


D 


kcPll 


I r 


N 


A 


Thorn 


J. W. 


\I< 


Gehec 


Dr 


1 


H 


Foust, 


Dr 


E 


H 


H.irri^ 


Dr 


Ed. M. HoU 


Dr 


G 


M 


GH.lie 


Dr 


A 


\V 


H.iin. 


Dr 


.1 


M 


Liilv, 


Dr 


K 


la- 


Fulp, 


Dr 


A 


M 


Beunt 



Dr. G( 



ADVERTISEMENTS. 



XLV 




(C3H6O4 + C3H3O3) 

Indorsed and Successfully used by leading Physicians in the 
treatment of 

DYSPEPSIA, GASTRITIS, GASTRIC ULCER 

and CONTAGIOUS DISEASES of the STOMACH and INTESTINES. 

In order to prove the efficiency of GLYCOZONE, I will 
send a ^X.OO laottxe. f jro«3 

to Physicians accompanying their request with 25c. to pay 
forwarding charges. 

A copy of the i8th edition of my book of 2A0 pages, on 
the " Rational Treatment of Diseases Characterized by the 
Presence of Pathogenic Germs," containing reprints of 210 
unsolicited clinical reports, by leading contributors to Medical Chemist and Graduate of the " Ecole Centraie des 
Literature, will be mailed free of charge to Physicians Ans et Manufactures de Paris" (Prance) 
mentioning this Journal. 57-59 prince Street, NEW TOKK. 



Prepared only by 




1765 University of Pennsylvania \m 

DEPARTMENT OF MEDICINE 

Undergraduate Department. The Oue Hvindi-Pd and Forty-fii-st Session will befjii 
which covers a period of four years, of eight and one-lialf months each, is 
irraded beprinuing with laboratory iustruetiou in the fundamental sutjjei'ts, a 
sive system of clinical instruction, terminating- in the Fourth Year with the i 
clerks in the Hospital. 



September r28, 19015. The course 
eminently practical, and properly 
nd concludinpT with a comprehen- 
issignment of students as clinical 

; positions as Resident Physicians 



A large proportion (at least 80 per cent.) of the graduating classes 

in Hospitals. 

imer School for Qraduates. The clinics and laboratories of this Department are open throughout the year for 
the benefit of those who wish to eng.ige in graduate work. For those whose time is m ire limited, a compre- 
hensive course is given, beginning this year May 7, and continuing for a period of six weeks. This course is 
designed to meet the needs of the practitioner. 

For further information, apply to the Dean of the Medical Dcepartment, University of Pennsylvania, Phila. 



OF PHILADKLPIUA 

Founded 1825 A Chartered University since 1838 

Kew |[(»s|)itiil, IVow l)o!leg« Building and i\ew Laboratories 

-ill begin September -^M 1006, and continue eight months. 
ut extT-a fees. 1. Prartical manual training in ten differ- 



For four annual sessions the c 
ent labor.-itories recently tiltfl u| 
demoiisti-,-ili..ns in the c-oiiiiiiod ioi 
Hospital ; besides the cliiiirs ;^ivri 
and Municipal H..spiials; 5. Lyin^ 
$1. 200.000. with unrivaled facilitie 



:•-.■ .Maternity. THE NKW 
)g will be open this year. 



J. W. HOLLAND, Dean. 



strontium than of bromide of sodium, as owing 
to the tolerance establishtd by habitual use of 
chloride of sodium in food, all the sodium salts 
show less marked physiological effects on the 
economy 

There are many objections to ammonium bro- 
mide, and it is little used. 

It is hardly necessary to recapitulate diseases 
in which the strontium iodide and bromide may 
be used, for they are suitable for all cases where 



iodides and bromides are indicated. 

Clinical data show a marked improvement in 
cases of albiminuria when the solution of lactate 
of strontium is prescribed. This applies to the 
albuminuria of pregnancy, post-scarlatinal ne- 
phritis, the early stages of Bright's disease, and 
in some cases of hepatic glycosuria. In the 
albuminuria of pregnancy it has been found ad- 
visable to combine the solution of lactate of 
strontium with some preparation of iron, pre- 



XLVI 



THE CHARLOTTE MEDICAL JOURNAL. 



ferably the tincture of chloride, or Basham's 
mixture, and the same combination is recom- 
mended in the nephritis following scarlatina. 

hike many other therapeutic agents, the ra- 
tionale of the action of lactate of strontium is 
imperfectly understood, but a plausible theory 
is that it exerts a profound influence on the 
processes of nutrition and reduces the forma- 
tion of alimentary toxines to a minimum. 

Some physicians are of opinion that appen- 
dicitis is sometimes indirectly caused by chron- 
ic constipation from accumulation in the intes- 
tines of micro-organisms and ptomaines. It 
will be found advisable in such cases of consti- 
pation to give a saline laxative every morning 
(sulphate or phosphate of soda ) and a table- 
spoonful of solution of lactate of strontium (P. 
J ) before each meal. 

Combined with bromide of strontium ( P. J. ) 
the lactate is most successful in diabetes, owing 
to the sedative action of the bromide on the 
nervous system, thereby greatly reducing the 
amount of sugar, as well as assuring better as- 
similation of food 



etiology and Treatment of Infantile Con- 
vulsions. 

Grant McDonald in The Leucocyte, considers 
the common causes and the treatment of con- 
vulsions in infants and children. Holt says 
"the principal predisposing causes are infancy, 
con litions affecting the nutrition of the brain, 
and hereditary influence. Of all these factors, 
the most important one is the instability of the 
nerve center which is characteristic of infancy 
and is associated with the non-development of 
the voluntary centers of the cortex." 

nickels is a very common cause of convul- 
sions, which are often one of the earliest symp- 
toms of that disease, arid should always be 
looked for when there are convulsions without 
evident cause! In such cases a distinct im- 
provement of the rickets under treatment is 
accompanied usually by a cess ition of the 
convulsive tendency. 

An inherited nervous constitution is another 
impori ant cause, and may bo seen in several 
members of tie same family; a fit will arise 
from a slight elevation of the temperature or 
from a trivial peripheral source of irritation 
which would do no harm to less excitable indi- 
viduals. 

Among other predisposing causes may be 
mentioned anc mia, malnutrition, syphilis, dis- 
turbance of nutrition, or debility from any acute 
disease. 

In almost every case of serious organic dis- 
ease of the brain there may be convulsions at 
some stage. I'hus we meet with them in cases 
of tumor, abscess, concussion, hemorrhage, tu- 
bercular and non-tubercular meningitis, mi- 
crocephalus, and all other numerous develop- 
mental and inflammatory brain lesions which 
produce idiocy. Also wheie the cerebral cir- 
culation becomes engorged from any cause, as 
in whooping-(v»ugh, and in some forms of con- 
genital heart disease. They may also occur in 
cerebral anemia, such as accompanies severe 
diarrhea and general hemorrhage. 

A sudden rise in temperature is very apt to 
be followed by convulsion in many children, as, 
in the begiuing of pneumonia, scarlet-fever, 
measles, er-ysipelas, malaria, influenza, and in 
some instances in chicken-pox, typhoid fever, 
and diphtheria. Uremia may also be mention- 
ed as not, an uncommon cause. 

An exciting cause is, very frequently, the 
presence in the stomach or intestines of undi- 
gested food, known as auto-toxemia. Acute 
and chi'onic indigestion are to be ranked among 



the most frequent causes of convulsion, both in 
infants and older children. 

We also have what we call peripheral irrita- 
tion of nerves, which cause convulsions, espe- 
cially in those who are suffering from rickets, 
such as difficult detention, middle-ear inflama- 
tion, or foreign body in the ear, phimosis, 
burns, fractures, renal oi- intestinal colic, re- 
tention of urine or intestinal strangulation, and 
a large number of poisons, metallic and vegeta- 
ble, give rise to convulsions. 

Having outlined the main types of causes, we 
may now pi-oceed to make a diagnosis, by elim- 
ination ; to do this we must examine the patient 
thoroughly and draw any inference we can 
from his temperature, from the rate and char- 
acter of pulse and respiration, also from state 
of nutrition and strength. 

There can rarely be any difficulty in recog- 
nizing an attack of convulsions. The difficulty 
consists in determining which one of the many 
causes is to blame for the fit. Therefoi-e, we 
must consider carefully the real cause before 
we begin the general treatment. One of our 
first guides is the patient's age. When con- 
vulsions occur in a new-born babe, we natural- 
ly suspect them to be due to some injury receiv- 
ed during birth. In many cases of difficult 
birth, as breech presentation, forceps delivery, 
protracted labors, there is intracranial hemor- 
rhage, and if situated about tjie base and in 
large amount, it is generally fata', but if over 
the vertex it may be very large without caus- 
ing death, in these cases fits generally occur 
before the end of the first fortnight. The his- 
tory of such a case will usually aid us in our 
diagnosis. The next condition in which age is 
considered is epilepsy. In infancy epilepsy is 
certainly the least probable diagnosis; here 
also we must rely on history of previous attacks, 
the outset baing very sudden with a cry or fall, 
biting the tongue, a tonic spasm before the 
clonic, etc. Perhaps before these questions 
have risen in our minds we have noticed the 
patient has a very high temperature, and we 
proceed to take its temperature per rectum ( let 
me say right here a baby's temperatui-e should 
always be taken per rectum to procure a cor- 
rect report), or wo may have noticed a distend- 
ed abdomen; these together with history of 
overfeeding or injudicious feeding may lead us 
to make a diagnosis of auto- toxemia, or the on- 
set of pneumonia, scarlet-fever, malaria, or 
some other acute disease, which can only be 
determined by carefully watching the patient's 
symptoms for twenty-four or thirty-six hours. 
Examination of the urine should never be omit- 
ted in cases of doubtful origin. Dentition and 
worms should be considered among the least 
probable, never as the most probable of reflex 
irritation. In obscure cases rickets should al- 
ways be suspected as an underlying cause, and 
the child should be examined lor other evi- 
dences of that disea'se. 

Convulsions occurring in brain disease, except 
in acute meningitis, are not as a rule accompa- 
nied by any marked rise in temperature. If 
there are convulsive movements without loss 
of consciousness there is probably a cortical 
lesion present. Should the fit be followed by 
prolonged stupor, this points to organic disease 
of the brain or membranes. If the seizure con- 
sists of a very slight passing loss of conscious- 
ness — a sort of petit mal — this in childi*en as 
well as in adults often indicates serious organic 
disease of the brain. 

Prognosis depends upon the age of the pa- 
tient, its endurance, and the cause of the con- 
vulsions. In idiopathic and reflex cases it is 
generally good, unless the child is very young 



ADVERTISEMENTS. 



XLVII 



SUMMER THERAPY 

is largely synonymous with the treatment of stomach and intestinal 
disorders. 

ELIXIR MALTOPEPSINE 

(OTilclerx's) 

represents the most potent combination of digestants, forming a 
powerful remedy for the treatment of every form of indigestion as 
well as an elegant vehicle for any drug indicated in these disorders. 

RESPIRAZONE 

(oriicieix's) 

is another prescription to which we invite the especial attention of 
the medical profession at this time, as ASTHMA and HAY FEVER 
are also troubles which the advent of spring and summer carry in 
their wake more than any other season. RESPIRAZONE has proven 
itself the most reliable remedy for these conditions and for all ca- 
tarrhal and spasmodic respiratory disorders, such as acute bronchitis, 
laryngitis, whooping cough, spasmodic and catarrhal croup. 

Samples and literature to the profession on application 



THe Tilden Company, 



New Lebanon, N. Y. 



Manufacturing Pharmacists. 



St. Louis. Mo. 



17 UNION SQUARE. 



Menu* trw/Xu , 



i-t-t-i-^i-i-i- 



Uf>e 



t Elastic >^ 



'Master"^""'""""" 

Like roots. 



StocKiriRs ^ 



Garter StockUig. A to E, 
Carter Lesgrlng. C to E. 
Knee Stocking, AtoO, 
KneeLegBlng. C to 0* 
Knee Caps and Anklets. 

On receipt of price \ 



I deliver the goods by road. 



Pomeroy Compan} 




XLVIII 



THE CHARLOTTE MEDICAL JOURNAL. 



The temperance question 
will be solved when pure, 
light wines become a part 
of our daily food. 

It will not only satisfactorily supply the 
natural craving for a nerve food, which now 
too often results in over-indulgence in strong 
drink, but it will diminish the consumption of 
tea, coffee and other nerve wrecking beverages, 
not to mention unwholesome starches and fats. 

There's but one proviso — the wine must 
be pure. 

The label of Garrett A Company insures 
you against all forms of adulteration. It is a 
guarantee that you are drinking only the 
simple, unadulterated juices of tlie famous 
Scuppernong, the Queen Grape of 
America, well ripened and tlioi- 
oughly matured. Ask your grocer 
or wine merchant for Garrett's 

Virginia Dare 
JVine 



or rickety, then we musi be somowhat. guarded, 
as those iufants are usually ^^ery feeble, and 
may, after recovery from the fits, die from 
some mild intercurrent disease. If there is 
reason to suspect intracranial hemorrhag^e, the 
prognosis must be extremely guarded. Uremic 
convulsions, while always grave, yet if recog- 
nized early, do not necessarily prove fatal. 
Convulsions from pertussis and asphyxia are 
especially fatal. But the attack at the outset 
of the exanthemata, pneumonia or auto-toxe- 
mia are not often grave and seldom fatal. 

Having administered our emergency treat- 
ment and given ourselves ample time to make a 
diagnosis, with a favorable or guarded progno- 
sis, we turn our efforts to the e-eneral treatment 
of the case. Our first endeavor, as has already 
been stated, is to control the convulsions, and 
the drugs mentioned are perhaps the most effi- 
cacious; having accomplisned this, the colon 
should be thoroughly irrigated, with warm 
norman saline solution, by passing u soft rubber 
catheter well up into the bowel. If there is 
reason to suspect intestinal disturbance, a free 
purgative should lie administered. If there is 
a high temperature, then a cold sponge should 
be given. Further treatment should be ad- 
ministered according to our diagnosis of the 
case. 



one of the finest of 
the Scuppernong 
products. It is a 
white wine, moder- 
ately sweet, with an 
aroma and bouquet 
approached only by 

the rare and costly Tokay wines from Hungary. 
Learn all about this important subject in 
our handsome booklet — sent free — 




''''The Art of Serving Wine' 

If possible, give us your wine 



erchanfs name. 



The l)ook tells wlien, where and how to correctly serveNvines; 
gives valuable recipes for many delicious beverages; describes 
Garrett's "Virginia Pare," " Minnelialia," "Pocahontas" and 
other pure, wholesome wines, and cites high authorities to prove 
their great food value. It is a book worth having. If your 
dealer will not supply you with Garrett's wines, we will and pay 
delivery charges. 

We insist upon refunding your money if you are not satisfied, 
whether you buy from us or your dealer. Write to-day. 

GARRETT &^ CO. , 5-^ Berkley Av. Norfolk, Va. 

Pioneer American Wine Growers. 
St. Louis, Mo. EST.\BLISHED 1835 S»n Francisco, Cal. 



The Association of Surgeons of the South- 
ern Railway held its eleventh annual con- 
vention on the 24th of May, electing the 
following officers: President, Dr. R. S. 
Toombs, of Greenville, Miss.; First Vice- 
President, Dr. M. F. Coomes, of Louisville, 
Ky.; Second Vice-President, Dr. B. B. 
Simmes, of Talladegra, Ala.; Secretary and 
Treasurer, Dr. J. U. Ray, of Woodstock, 
Ala. The next meeting of this important 
body will be held at Washington. 



state Medical Association of Texas. 

We are glad to note that the recent meet- 
ing at Fort Worth, held April 24-26, was 
the largest in its thirty-eight years of exist- 
ence; it is estimated that there were from 600 
to 800 members present. 

The papers read before the body were of 
exceptional merit and the entertainment 
was delightful; in lieu of the usual banquet, 
which the Texas Medical Journal calls 
burdensome and useless, the members, ladies 
and visitors, were given a barbecue, under 
the trees, at Handley. 

A committee of five was appointed to con- 
fer with like cbmmittees from Missouri, 
Kansas, Indian Territory, Oklahoma, and 
Arkansas, looking to the organization of a 
South-western Medical Association. 

The report of the Councillors shows a 
total membership of 2850. 

Officers-elect: President, Dr. G. B. Fes- 
cue, Waco; Vice-Presidents, Dr. Felix 
Miller, El Paso, Dr. B. S. Weir, Beaumont, 
and Dr. A. B. Small, Waxahachie. The 
Secretary and Treasurer was re-elected. 

The next meeting will be held at Mineral 
Wells the first Tuesday-Thursday in May, 
1907. 



ADVERTISEMENTS. 



XVII 



LITHIA 
WATER 



Buffalo 

IN ALBUMINURIA of PREGNANCY and BRIGHT'S 
DISEASE 

Dr. Alired L/. LtOOVniS, professor of Pathology and Practical Medicine in the Medical 
Dcpartnunt of the University of New York, wrote; "For the past four years I have used BUFFALO 
LITHA WATER in the treatment of Chronic Bright's Disease occurring in Gouty and Rheumatic- 
subjects ,with marked benefits." 

DT. J. Jr^age MaSSie, ti. A., Professor of Obstetrics in the MaJical CoU(ge of Virqinia 
liiduiiond, F«, ; "I have used quite extensively and with excellent results, BUFFALO LITHA WATER 
in the Albuminuria of Pregnancy and in all other conditions incident to pregnancy, in which the Kid- 
neys fail to do their duty in eliminating the products of metabolism. A liberal use of the water will prev- 
ent the accumulation of urea and other poisonous products in the system, and in this way ura;mia and 
puerperal convulsions can be avoided." 

Dr. George Ben Johnston, Richmond. Va, Ex President Southern Surgical and 
Gynecological Association, Ex-President Medical Societt, of Virginia, Professor of Gynecology and Ahd- 
ominal Surgery, Medic<d College of the University of Virginia: "It is an agent of great vriue in the treat- 
ment of the Albuminuria of Pregnancy." 

Dr. J. Allison Hodges, Richmond, Va., President University College of Medicine, and 
Professor of Nervous and Menial Diseases: "In Albuminuria of Pregnancy, this water is one of the very 
best alkaline dieuretics, and ,with milk diet, is one of my sheet anchors." 

Additional Testimony Upon Request to the 

Proprietor, Buffalo Lithia Springs, VIRGINIA. 



ANCIENT 




PeniLilIum ligneum hydropicis utile 
From Nicolai Tnlpii's Observationcs Medicae 



Treatment of Dropsy 



•MODERN 



ANASARCIN 

{Oxydendron Arboreum, Sambucus Canadensis, 
and Urginea Scilla Compound) 

Relieves dropsy, whether caused by 
heart, liver or kidney disease 

Reports from thousands of conservative physicians 
establish that Anasarcin restores the natural balance 
between the arterial and venous systems, stimulates 
the heart, equalizes the circulation, promotes absorp- 
tion of effused serum without increasing the debility of 
the patient or interfering with nutrition by producing 
loss of appetite. 

Literature and Samples on request 

THE ANASARCIN CHEMICAL CO. 
Winchester, Tenn., U. S. A. 

Messrs. Thos. Christy & Co., London, Agents 



ADVERTISEMENTS. 

Elegant 
Pharmaceutical vSpecialties 

Attention is called to the 

EXCELLENCE and THERAPEUTIC PROPERTIES 

of these Preparations. 



ROBINSON'S LIME JUICE & PEPSIN 

Tiire ('onr*nl lilted Tepsiii ffliiiltined nitli 
Pure Lime Juice 

An e.\cee(liiifjly valuable combination in cases of 
Dyspepsia Indlprestion, Biliouness, Heartburn and 
Mai. Assimilation. 

APERIENT AND CHOLAGOGUE. 

Impaired Digestion is the consequence of a seilen- 
tarv life, coupled with nervous and mental strain. 

RELIABL' TEPSIN is one of the best i>i<iEsTiVE 
auenis known. PURE LIME .lUKE with its .\i>Elt- 
lent and ciiolaoooiik characteristics, with the Pei)sin 
furnishes a conipatili'e ami most efficient combin- 
ation as aremeil.v for the disorders named. 

ROBINSON'S LIME .ITU E and PEPSIN is talat- 
ABLKand GRATEFUi. to the taste. 

DOSE— Adult, dessertspoonful to tablespoonfiil, 
after eating. Children one-half to one teaspoonful, 
according to age. 

Price, « -oz Bottles, 50 cents. 
16-oz. Bottles, $1.00. 



ROBINSONS' ELIXIR PARALDEHYD. 

10 PER CENT 

lIVrXOTli;, SEDATIVE \\m\U DIIKETIC. 

Irttiir-aiinnc • Sleeplessness, Irritability, Ner 
lllUlCdllUlia . vousness, Headache, tolic. Etc. 

I N doses of -15 grains, it calms restlessness and 
■ insomnia, and produces unbroken sleep' of from 
four to seven hours' duration, leaving behind 
neither languor, natisea, nor digestive disorders. 
It is proposed as possessing the good without the 
evil qualities of Chloral. 

Our Eli.xir contains 45 grains of the Paraldehjd 
in each tluidounce, dissolved in an aromatic men- 
struum whereby the objectionable taste of the 
chemical is to a great extent disguised, and the 
preparation rendered palatable. 

DOSE— 10 per cent. 2 to 8 fluidrachms. 

Pint Bottles, $1 50. 

Price, per pint, $2.oo. 

N. B.— We also make 25 per cent, strength. 



Please specify ROBINSON'S OriginalRottles. For vSale by Druggists. 



Founded --- 181^2 
Incorporated 1890 



nANLFACTURINQ 
PHARHACiSTS, 



ROBINSON-PETTET CO., 

Louisvifle Kentucky, 



I^PAMPHLETS GRATIS to Practitioners by mail upon request. 



THE BEST RESULTS are assured in 
Bromide Treatment >vhen you specify 

PEACOCK'S BROMIDES 



DOSE 
One to three teaspoon- 
fiils, according to the 
amount of Bromides re- 
quired 

Half-pound bottles only 



AND THE GENUINE IS 
DISPENSED 



Neurologists and General Practition- 
ers prefer it because of its superior 
qualities over the commercial salts. 



HEPATIC STIMULATION 




. FORMULA 

E.ich fluid draoiim represents 

1,5 (Trains of the combined C. P. 

BromidesofPotaisium, Sodium, 

Calcium, Ammonium and Litli- 



For Physicians' Prescriptions 



For clinical trial we will send full size 
bottle of either or both preparations to 
any physician who will pay exp. charges 



WITHOUT CATHARSIS 



G H I O N I A 



Onct 



I day. 



DOSE. 
1 two teaspoonfulB three tii 
rOUMULA. 
Prepared from Chionauthus Virginica, from 
ating features of the 



■bue 






Re-establishes portal circulation 

without producing congestion. 

Invaluable in all ailments due to 

hepatic torpor. 



PEACOCK CHEMICAL CO., ST. LOUIS, MO.. U. S. A. 



ADVERTISEMENTS. XIX 



A diminution in the number of red blood cells and a retrogade 
alteration in their structural integrity. Such are the morpho- 
logical changes in the blood made manifest by the microscope 
in cases of ANAEMIA from whatever cause. 

During its administration the microscope evidences a progressive increase in the number, 
and a constant improvement in the structural character of the corpuscular elements. This 
palatable and quickly assimilable combination of Organic Iron and Manganese is a 
true "blood feeder " and corpuscle contributor in cases of 

Anaemia, Chlorosis, AmenorrhcBa, Bright's Disease, Cliorea, DysmenorrlicBa, etc. 

Prescribe Pepto-Mangan "Gude" in original I xi bottles. It's Never Sold In Bulk, 
M.J. BREITENBACH COMPANY, 

Laboratorv, 

LEIPZIG. GERMANY. ^jg^V YORK. 



BACTERIOLOGICAL WALL CHART FOR THE PHYSICIAN'S OFFICE. 
One of our .scientific, Jind ai-tistically proiluced bactei-iolosioal oliai'ts In color-*, e.thibiting 60 dif- 
ferent pathojreiiic mici-o-ortiaiiisms, will be maileil free to any regular medical practitioner, upon request 
mentionintf lliis journal. 

TO THE DOCTOR:' 

If we have not had the honor of your endorsement for HARRIS LITHIA WATER, 
we feel surest is because you have never had occasion to prescribe it and note the re- 
sults upon the patient. We would, therefore, esteem it a great favor if you would ex- 
amine the analysis of this water as presented by Dr. R. O. Doremus, of New York. 

It is to the medical profession that this water owes its prominence in materia medica 
today. Hundreds of physicians who'have g^iven it an honest trial in their practice rec- 
oo^nize and proclaim its efficacy in all diseases where Lithia is indicated as advantage- 
ous. It is to the credit of HARRIS LITHIA WATER that it has no adverse critics with- 
in the profession, and that those who prescril^e it have given it unstinted praise. 

"We do not claim to have the only valuable Lithia Water on the market, but we do 
claim to have a very much better Lithia Water than very many waters more widely ad- 
vertised, and, furthermore, that none of the best are better than HARRIS LITHIA. 
HARRIS LITHIA WATER is no experiment— no new discovery courting the imagina- 
tion of the ignorant. We appeal to your scientific opinion solely and we shall be con- 
tent to rest upon the results of its use in your practice. 

We invite the closest in.spection of our improved bottling equipment at the Springs, 
with a view of demonstrating the care and cleanliness exercised in placing this water on 
the market in perfect condition. The still water is shipped in 12-gallon carboys, 5-gal- 
lon glass demijohns and cases of one dozen half-gallon bottles. The carbonated water 
is put up in puarts, pints and half-pints; quarts, 50 bottles to case; pints and half-pints, 
100 bottles to case. We call especial attention to our GINGER ALE, made from the 
purest ingredients and HARRIS LITHIA WATER. For the sick room, there is nothing 
to compare to our ale. 

HARRIS LITHIA SPRINGS COMPANY. 

HARRIS SPRINGS, S. C. 



THE CHARLOTTE MEDICAL JOURNAL. 



Irregularities of the menSlrual flow are, as a rule, the fiiit manifeSation of 
^uctural or other impairments of the reprodudtive organs. Those agents which 
reflore the monthly visitations to normal limits, will, if properly proportioned and 
timely administered, exercise a curative influence upon the entire reprodu<ftivc syftem. 

DYSMENORRHEA 



whether neuralgic, membranous, conge^ve, inflammatory, ovarian 
or obstrudlive in charader, yields readily to the pain-relieving and 
flow-augmenting acftion of 


Ergo^pi© 


I (S 


mith) 


if one to two capsules are admini^ered three 
and during the menilrual period. 


times daily before 



AMENORRHEA 

when due to sudden exposure to cold, mental shock, change of 
climate, etc., may be promptly relieved by the admifiiitration of 

E.rg©^pioI (SMiitli) 

in doses of two capsules th»ee or four times daily for a few days 
in advance of the visitation, then giving one capsule three times a 
day until menstruation has ceased. 

MENORRHAGIA 



whatever may be the exciting cause, excessive menstruation may be 
controlled, and the uterus invigorated and toned by the admin- 
istration of 

Ergoapiol (Ssaitli) 

in doses of one capsule once daily for a few days in advance of 
the visitation, then increasing the dose to one capsule four times 
daily throughout the period. 

This product is supplied in metal boxes containing twenty capsules. It is obtain- 
able of all prescriptioniils. Samples and literature will be sent, post paid, to 
physicians upon requeft. 

Martin H. Smitk Company, 

NEW YORK. U. S. A. * 



ADVERTISEMENTS. 




©o^d t© El: 




•^ I 



EGG-O-SEE 



EXTRACT FROM EDIJOPIAL 

NEWYuP< MEDICAL 'JOURNAL 

J UN E q. 1906. 




/ has a plentiful supply of smack — 
' it is a most welcome addition to 
,/ the sick room dietary — it 'HasteS 

j good.'' 

I Made only hom selected California 

white wheat, it is steam-cooked until 

the starch granules burst their cellulose 

walls, and flaked; these flakes are then 

scientifically toasted to a crisp and delicate brown 

by being baked at high temperature. 




,V^><5;^, «^. 



retains all of the elements of whole wheat — the carbohy- 
drates, protein, fat and natural salts as well as a portion of 
the fibrous material so essential to normal peristaltic activity. 
It is a valuable reconstructive food for convalescents and for 
growing children, and should be made an essential part of a 
healthful diet for all healthy people. 

During the hot weather a diet consisting largely of fruit, 

eggs, fresh vegetables and EGG-O-SEE will best supply 

the energy needed for both mental and physical effort. 

EGG-O-SEE retains all the protein of whole wheat— 

at all times a better form of protein than is furnished 

by red meat. 

Trial quantity sent on request. 

THE EGG-O-SEE CEREAL CO. 
Quincy, Illinois, and 




c-'-'lIi;^ 




XXII 



THE CHARLOTTE MEDICAL JOURNAL. 




HERE is style, safety, comfort and convenience in the stately, 
highly-efficient, ^^^^^^^a^^ Stanhope, price ^1,400. 

The electric is now recognized as the real aristocrat of motor 
cars and the one indispensable car that is an absolute necessity 
as the general utility car of the family. 

Its freedom from all dirt, oil and water; its silent easy riding 
qualities; the simplicity of its operation make it the general favor- 
ite of all the family all the year around. It is "always ready." 
Simply throw forward the controller handle and steer. 

We make Runabouts, Stanhopes, Chelseas, Coupes, 
Surreys, Physician's Road, Station and Delivery Wagons. 
Trucks on specifications. 

WRITE FOR CATALOGUE. 

POPE MOTOR CAR CO.. 

INDIANAPOLIS. IND. 

BOSTON. MASS., 223 Columbus Ave. 
NEW YORK CITY. 1733 Broadway; 

WASHINGTON. D. C, 819 Mth St., N. W. 





tfflat!?^SSSr3SaS£..-_-£i..si':^ 



ADVERTISEMENTS. 



HAYFEVER 

Many responsible physicians report Hay Fever is relieved 
and controlled by the administration of 

Uric-Antagdn 

in the early stages of the disease and the continuation of its use throughout the season. 

Uric-Antagon is a purely vegetable pharmaceutical preparation. It is an efficient 

eliminative agent in RHEUMATISM, GOUT and SCIATICA, and many favorable 

reports are received of its action in 

ECZEMA, ASTHMA 

and 

TONSILLITIS. 



COMPOSITION 
Active principles of 
Phytolacca Decandra 
Serenaea Serrulata 
StillingiaSylvatica 
Cimicituga Racemosa 
Aconitum Napellus.-/ (r, 

I yuffici.nl ,0 unduly 



Manufactured Only for 
Prescription Purposes 




send full size 
any physician 
,ol tried Uric- 
Anlagon, on receipt of 25c 
to pay express charges, or 
the physician may pay the 
charges on delivery. 



ANTIUBICCa 

PEORIA, ILLS, J 



iProtessional Furniture 



=1 



Everything for the Doctors 
office and home in Furniture, 
Carpets, Pianos, Pianolas, and 
Pianola Pianos. We guarantee 
to furnish the Best at Lowest 
Prices. Special sale of Leather 
Furniture this Spring. Write for 
sur late Catalogue. We send 
oamples of Carpets and Curtains. 



PARKER GARDNER CO 

Charlotte. .¥. C, 




THE CHARLOTTE MEDICAL JOURNAL. 



The Winkley Artificial Limb Co. 



f Incorporated under the Laws of the State o{ Iklinnesota) 
JEPSON BROS., Sole Owners. 

LARGEST MANUFACTORY OF ARTIFICIAL LEGS IN THE WORLD. 

MANUFACTURERS OF THE 

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With SPONGE RUBBER, 

Mexican Felt or English Willow 



FOOT. 



PERFECT FIT GUARANTEED 

Prom Casts and Measurements WITHOUT Leaving Home 



Send for our New Illustrated Catalogue. 
MINNEAPOLIS, MINN. . U. S. A. 




Cystogen-cGithia 

An effervescent tablet of Cystogen (c, hij N4) 
3 grains and Lithium Tartrate 3 grains. 

Uric acid solvent and alkaline urinary 
antiseptic. 

DOSE- One or two tablets in a glass of water, 
three or four times daily. 

The idea of this combination was given us by observ- 
ing the large number of physicians using CYSTOGEN 
with LITHIA in gouty and allied affections. 




Should be dispensed in tubes 
preserve effervescent quality. 



Where Cystogen is indicated, Lithia is of advantage ; 
Where Lithia is prescribed, Cystogen is indicated. 

INDICATIONS— Rheumatism, gout, urinary deposits, calculus, cystitis, prostatitis and 
gonorrhea. A good urinary antiseptic during convalescence from typhoid and scarlet fever. 



Cystogen — Crystalline Powder. 
Cystogen— 5 grain Tablets. 

Samples on request. 



CYSTOGEN PREPARATIONS: 



Cystogen-Lithia (Effervescent Tablets). 
Cystogen-Aperient (Granular Effervescent Salt 
with Sodium Phosphate). 

CYSTOGEN CHEMICAL CO., St. Louis, U. S. A". 



The Charlotte Medical Journal. 



Vol. XXIX 



CHARLOTTE, N. C, 



AUCtUST 1906. 



No. 2 



Address of Welcome. 

By Hon. T C. Guthrie, Charlotte, N. C. 
Mr. Prc-iidoit and (le/i/leincu of the Medi- 
cal Socictv oft/ic S/aic of North Carolina. 

This g-atlieriii": of the leading men of 
your noble profession is an event of import- 
ance. In the marvelous pro.^ress and de- 
velopment of our country, its resources and 
its people, the medical profession has more 
than kept up with the procession. The 
old-time saddle-baj^ doctor, with his lancet 
and his leeches, his blue pills and his 
blisters, has been superseded by the thor- 
oui>hly educated, highly trained scientific 
physician of today. 

Among the influences which have contri- 
buted to the advancement of your profession 
and its elevation from empiricism to a 
science your society deserves a high place. 
Our law-makers, recognizing that you are 
best fitted for these duties, have delegated 
to you the examination and licensing of 
doctors and the control of their professional 
behavior. The wisdom of this legislative 
action has been well demonstrated by its 
test for nearly a half century. There never 
has been a time in the history of our State 
when the standards of the profession have 
been so high as they are today or when the 
individual doctor was so well prepared and 
so competent. It has come to pass that a 
license issued by the Board of Medical Ex- 
aminers, appointed by your body, is a pass- 
port to. public confidence and a proof of 
professional efficiency. 

The tendency of the present time in all 
branches of human endeavor is to specialize. 
The all-round man of all work, who can do 
a little of everything, is a gentleman out of 
a job. His place has been taken by the 
man who can do one thing or a few things 
excellently well. The medical profession 
is no exception to this tendency. It stands 
to reason that the surgeon, who has per- 
formed some particular operation or class 
of operations hundreds of times, has gained 
skill from his experience and can do better 
work than a doctor who has had little sur- 
gical work to do. So by a process of evolu- 
tion, specialists in various branches of sur- 
gery and classes of disease are attracting to 
themselves particular lines of practice. The 
time is coming, if it has not already come, 
when you will all be specialists. This re- 
sult may be counted a distinct gain to 
humanity and the doctors. There are more 
people to be sick and more doctors to treat 

*Reafl before the North Carolina Medical 
Society at Charlotte, N. C. 



them. One patient may be passed around 
among, and contribute of his substance to, 
several specialists and be cured in the satis- 
f>'ing knowledge that he has had the top- 
notch of medical science in return for his 
money. Thus the afflicted are better served 
and more doctors make a living. 

When a great discovery or invention is 
made in machinery or mechanics that will 
benefit mankind the first thing the inventor 
goes after is a patent. By means of the 
monopol\' created by law the inventor seeks 
to reap the money reward of his brain and 
talents. No matter of what necessity or 
importance to the comfort or happiness of 
humanity the invention or discovery may 
be, it is bra:ided with the dollar mark and 
protected by law and tribute levied for the 
enjoyment of it. These things are mentioned 
not for the purpose of saying it is wrong for 
a man to get money returns for his ideas, 
but for the purpose of emphasizing the 
abounding generosity and vmselfishness of 
the medical profession. When a doctor, by 
means of his study, research and labor, 
discovers some remedy that will cure or 
prevent disease, or some surgical process or 
instrument that will benefit humanity, he 
freely and gladly gives it to the world — not 
for his own glorification, but as a mere 
matter of course. 

I asked a medical friend to tell me some- 
tking to tglk to you about that you would 
like to hear. He said "tell them how to 
make some money." This struck me as 
very practical, but it occurs to me that you 
do not need any such advice, even if I were 
qualified to give it. Our Charlotte doctors 
certainly do not need it, with their automo- 
biles and other evidences of prosperity. 
The medical profession has discovered that 
the secret of making money is not to try to 
make money at all. 

Some years ago there died in a North 
Carolina town a doctor "who through long 
days of labor and nights devoid of ease" 
for forty years had ministered to the sick 
and afflicted. It was not his lot to command 
"the applau.se of listening Senates." His 
tent was not spread "on fame's eternal 
camping ground. ' ' He lived the simple life. 
Rockefeller's millions did not cause him to 
lose any sleep. He devoted his life to his 
profession. He did not stop to bother about 
the patient's ability to pay. He only knew 
that some one was suffering, and he was 
willing to do what he could to relieve the 
sufferer. He never pressed anybody. Yet 
he had a comfortable home — drove good 
stock — lived well — educated his children — 



58 



THE CHARLOTTE MEDICAL JOURNAL. 



and left his family in comfortable circum- 
stances. The church and church-yard would 
not hold the people who came to his funeral. 
They were his friends among- whom he lived 
and labored and who loved him. His g^rave 
was strewn with their flowers and watered 
by their tears. Who would not rather live 
the life and die the death of this noble man, 
this devoted physician, than be a millionaire 
with a colossal fortune built up, perhaps, 
by .cjeed and graft and treachery? 

While this sketch refers to a personality, 
it is also a type of the successful North 
Carolina doctor of today. The all-embrac- 
in.q: charity of the physician whose feet are 
guided by the g;rand ideals of your noble 
profession does not degenerate into burnt 
incense offered at the alter of the g^olden 
calf. Devotion to professional duty brings 
its rewards in money and fame, and the 
doctor is one man to whom both money and 
fame come more abundantly without being 
sought. 

Among matters of vital interest to your 
society may be mentioned hospitals and 
medical schools. The time is very recent 
since any surgical operation of importance 
meant the worry and expense of a trip to 
New York, Philadelphia or Baltimore. Now 
it is different. Almost every important 
town in our State has its hospital and able 
surgeons. Our afflicted ones can be looked 
after right here at home to the mutual ad- 
vantage of both themselves and the doctors. 

There is no more reason why our boys 
should be sent out of the State to get a 
medical education than there «!s that our 
sick ones should be sent abroad for treat- 
ment. You are not mere theorists, but you 
have behind you experience and the prestige 
of success and achievement. There ought 
to be and can be built up under your 
auspices, and with your co-operation and 
support splendid medical schools where first- 
class instruction can be given in all branches 
of medical science. I am not unmindful of 
the work that has been done in this direc- 
tion, and I am not minimizing or depreciat- 
ing that. But there is a field for much 
larger work. 

The doctors examined in our courts qualify 
themselves as experts by saying they are 
.graduates of this or that celebrated Northern 
Medical College. I want to hear them say 
with becoming pride that they are graduates 
of this or that celebrated North Carolina 
Institution. Year after year our boys are 
going away from home spending North 
Carolina money to help build up big medi- 
cal schools and big doctors who teach in 
them. We might just as well keep the boys 
and the money at home and build up great 
medical schools of our own and greater repu- 
ations for our own doctors. Thank God, 



North Carolina is no longer a good State to 
move out of, but she is a good State to stay 
in and to move to, and she is getting bigger 
and better. She is no longer chiefly noted 
for tar, pitch and turpentine, and for filling 
all the census blanks relating to raw ma- 
terial. We are becoming a great manufac- 
turing State, and the wonderful progress for 
the past twenty-five years is not a marker 
to what the next twenty-five years will 
show. What we have done is but an earnest 
of what we will do. And it is not to be 
doubted that the doctors will do their 
share in this great work of developing and 
building up our State. 

I have been selected to perform the agree- 
able function of bidding you welcome to 
Charlotte. Our city is honored in having 
so many distinguished members of your 
profession within her gates. We are glad 
you decided to meet here. We extend to 
you our heartiest welcome and hope your 
pleasure during your stay will be as great as 
ours' in having you. 



Response to the Address ol Welcome. 

By Dr. B. K Hays, Oxford, N. C. 
LaJies and GerJicmcn: 

In the name of the medical profession of 
North Carolina permit me to thank you, the 
people of Charlotte, for the cordial recep- 
tion which has been extended us here to- 
day. 

It is a pleasure to visit Charlotte. It is 
centrally located; easy of access, and des- 
tined to become the metropolis of the State. 
The energy and business activity here mani- 
fest on every side is contagious, and, while 
we have left business care and worry be- 
hind, yet we catch the spirit of enthusiasm, 
and even while we rest from labor, resolve 
to do better and more efficient work when 
we return to our homes. 

It is said by those who have visited Paris 
that there is a feeling of absolute freedom 
from care which comes over one as soon as 
he enters the city. This may be due to the 
splendid architecture which adorns her 
streets, or reverence for places fraught with 
historic interest. It may be her galleries of 
art that charm the eye, or music that lulls 
the ear; but more than these, it seems to me, 
is the presence of men and women who, 
while active in all the potentialities of life, 
have yet time to admire the beautiful, and 
to extend to each other and to strangers 
those delicate courtesies which warm the 
heart and bring contentment to the inner 
man. 

It is this spirit which pervades the very 
atmosphere of Charlotte, and this is why the 
sons of the old North State delight to meet 
within her gates. 



ORIGINAL COMMUNICATIONS. 



59 



But we, geiitleineii of the medical profes- 
sion, must not forget that we have duties to 
perform while here assembled. We are the 
custodians of the health of the people of 
North Carolina. It is a serious thing to be 
a doctor; to combat disease; to assume re- 
sponsibility when a man is in the very 
throes of death; and seriously must we dis- 
cuss the problems of disease at this meeting. 

While I am yet a young man — too young, 
perhaps, to sound a note like this — yet, as 
I look into your faces I perceive that many 
of you are still younger than myself. The 
grand old men whose white hairs gave dig- 
nity to this body ten years ago, and whose 
experience gave wisdom, are gone. From 
every section they came, and in every sec- 
tion they have fallen — not by the way — but 
at their journey's end. In my own county 
of Granville but a few weeks ago Dr. W. 
W. Cozart laid down his burden. Some 
years have passed since the scholarly Jno. 
W. Booth was called away, and in the 
neighboring county of Vance both Chatham 
and Tucker are gone. Each of you recall 
the name of some man in your county who, 
ten years ago, was laboring as you and I 
labor, Init who will be seen at this society 
no more. 

"For them no inoi-e the bluzini;- hearth shall 

burn. 
Or busy hoiisHwif'j ]ily her evening care; 
No children run to lisp their sire's return, 
Nor climb his knee the envied kiss to shai'e." 

And yet we cannot say that these men are 
dead. Is Martin vSims dead? Is Hunter 
McGuire dead? Is O'llagan dead? In the 
language of another let me ask, "Is any 
man who was ever fit to live dead? No. 
The influence of these men will echo down 
the corridors of time, and when your bodies 
and mine have returned to dust the good 
which they did while in the flesh will still 
have influence among the sons of men. 

' In the name of our fathers let us here re- 
solve to dedicate ourselves to their unfinish- 
ed labors, and determine that through the 
influence of their example the family phy- 
sician may continue to l)e a blessing wher- 
ever his influence is felt. 



Puerperal Eclampsia.^ 

By M. R. Adams, M. D., 8tatesville, N. 0. 

The term eclampsia is applied to convul- 
sions tonic and clonic in character, which 
may occur in the pregnant, parturient or 
puerperal woman, during which there is a 
loss of consciousness, followed by coma. 

Clinical History — As a rule eclampsia 
does not occur very often, probably one 
time in three hundred, and the disease us- 

*Ivead before the recent meeting of the N. C. 
Medical Society at Charlotte, N. C. 



ually occurs during the second half of preg- 
nancy, but cases are on record as occurring 
as early as the fifth month of pregnancy. 
A large per cent, of all the cases that have 
come under my observation occur in primi- 
parous women, and it is stated that it is 
much more frequent in twin than in single 
pregnancies, though I am not able to cor- 
roborate this statement. Sometimes the con- 
vulsions come on without any premonition 
whatever in women that are in apparently 
good health, but in a large majority of the 
cases that I have observed the attack is 
preceded by well defined premonitory symp- . 
toms, indicative of the toxaemia incident to 
pregnancy, among the more prominent be- 
ing headache, disturbance of vision, epi- 
gastric pain, restlessness, and often m^reor 
less edema, with a diminished quantity of 
urine. 

When the attack comes on among the 
first symptoms observed is a fixed expression 
of the ej'es, which soon commence to roll 
from side to side, the mouth begins to twitch 
and is in some cases drawn to one side, the 
face becomes distorted and then the entire 
body becomes more or less involved. 

The patient often foams at the mouth, 
bites her tongue, the breathing is labored 
and stertorous and the face congested. The 
convulsions may last from a few seconds to 
two or three minutes, the patient being un- 
conscious and then passing into a profound 
coma. 

I have seen one convulsion occur during 
the latter part of labor and recovery ensue 
without any recurrence of convulsions, but 
oftener the first is but a forerunner of other 
convulsions, which may vary from one to 
fifty or more in fatal cases. When the con- 
vulsions do not occur often the woman us- 
ually recovers consciousness after each at- 
tack, while in some cases the coma persists 
from one attack to another, and death may 
occur without awakening from it. 

Death in rare instances occurs after one 
convulsion, though as a rule death does not 
occur until after several attacks. In a small 
number of cases I have seen the tempera- 
ture run very high, and it is always consid- 
ered a dangerous omen. There is some 
discrepancy of opinion among authors as to 
the cause of the high temperature, some 
claim that the poison that gives rise to the 
eclampsia also stimulates the thermal cen- 
ters, while others claim that the fever is of 
an infectious origin. 

As the eclampsia first appears, before or 
during labor or soon after delivery, it is 
designated, ante-partum, intra-partum and 
post-partum eclampsia, the last, or post- 
partum, is the least common, only two cases 
having occurred in my practice. When 
ante-partum eclampsia occurs labor usually 



60 



THE CHARLOTTE MEDICAL lOURNAL. 



sets ill and a premature child is born spon- 
taneously or the vvoml:) is emptied b\' opera- 
tive measures. 

In a small number of cases labor does not 
supervene, and if the woman survives the 
attack she may give birth to a dead foetus, 
and occasionally the patient may recover 
from the attack and give birth to a living 
child at term. 

In post-partum eclampsia all the cases 
that have come under my observation with 
one exception, there was but one convulsion. 
I have observed in a siuall number of cases 
a jaundiced condition soon after the con- 
vulsive seizure. This symptom is of rather 
grave prognostic significance and indicates 
hepatic lesions. 

During the eclamptic attack the urine is 
diminished in quantity, while occasionally 
the secretion is suppressed and a chemical 
analysis nearly always reveals the presence 
of albumen. In a large majority of cases 
the urine rapidly becomes normal and in a 
short time gives no evidence of the previous 
pathological condition. 

/'a/ho/oi^y—l am candid to admit I know 
very little about the pathology of eclampsia, 
and it is not the purpose of this brief and 
imperfect paper to enter the maize of theories 
about the pathology of this disease. 

After the presence of albumen in the 
urine of women suffering with this disorder, 
it was generally believed that the diseased 
condition was of nephritic origin and to be 
dentical with uraemia, when it was found 
hat a small proportion of the women suffer- 
ng with chronic nephritis this view was 
gradually abandoned. 

In looking over the different authorities 
on the subject, the evidence at hand would 
seem to indicate that the renal changes, 
while frequently present are not as a rule 
sufficiently marked to justify one in consid- 
ering them as the characteristic lesion of 
eclampsia, which must, therefore, be looked 
for some other organ. 

Some French observers believe that the 
hepatic changes are so characteristic and 
constant that the primary lesion of the dis- 
ease is due to the impairment of the hepatic 
function, while others have made statements 
concerning the pathalogical findings of the 
brain, edema, thrombosis, ai^ojjlexy being 
described as the main lesions; it is, there- 
fore, apparent that the main lesions in 
eclampsia are found in the kidneys, liver 
and brain, but in view of the marked dis- 
crepancy in the statements of the various 
authors concerning their relative frequency 
and importance, it would seem that the 
anatomical changes are not constant, al- 
though those of the liver are probably the 
most characteristic. 

Etiology— \ number of theories have 



been advanced as to the cause of eclampsia, 
but as yet the exact nature of the poison is 
not known. Certain conditions are known 
to predispose toward developing the malady 
such as renal insufficiency, imperfect func- 
tion of the bowels, skin, and multiple preg- 
nancy. 

The generally accepted theory is that the 
disease is due to the circulation of some 
toxic agent in the blood; as to the exact 
nature of the offending- substance we are 
yet ignorant. 

In concluding my remarks on the etiology 
of this disease I desire to quote an American 
author, who says: "It appears that the evi- 
dence thus far adduced by the various 
authors in favor of the auto-infectious theory, 
though not conclusive, is sufficiently sug- 
gestive to warrant its tentative acceptance, 
at least until some better explanation is 
produced." 

/yiagnosis — There is usually not much 
difficulty in arriving at a correct diagnosis, 
if the woman has been under observation 
during the latter months of pregnancy. 

It becomes necessary to differentiate be- 
tween epilepsy, uraemia and hysterical con- 
vulsions. 

/'roonosis—T]iQ mortality of eclampsia 
depends in a large measure on the prompt- 
ness and thoroughness of the treatment in- 
stituted. It is considered one of the most 
dangerous conditions the ol^stetrician has to 
deal with. The mortality varies under dif- 
ferent circumstances, the maternal mortality 
is about 30 per cent, and that of the foetus 
much larger. 

My experience is the prognosis is more 
unfavorable when the convulsions come on 
before or during labor, whereas the post- 
partum eclampsia is less dangerous. 

There is considerable discrepancy of 
opinion concerning the relative prognosis of 
primiparous and multiparous women. In 
all probability the prognosis depends more 
on the severity of the attack than upon the 
number of children the woman has borne. 
When coma comes on after each seizure 
and the convulsions follow in rapid succes- 
sion the prognosis is more unfavorable, a 
weak, rapid pulse with a high temperature 
indicates an unfavorable termination, where- 
as a full and firm pulse with low tempera- 
ture indicates a favorable prognosis. 

Treatment— 'S:\iQ prophylactic treatment 
is always impoi*aiit. There is often renal 
inadequacy, and it is important to make 
frequent examinations of the urine during 
the latter months of pregnancy and note the 
quantity passed daily. 

Adopt a suitable line of diet such as milk, 
fruit, bread and poultry, avoiding the 
heavier and less digestible meats, tea, coffee, 
and all stimulants should be strictly for- 



T'HE CHARLOTTE MEDICAL JOURNAL. 



61 



bidden. Always keep liver, kidneys, and 
skin in an active condition. When convul- 
sions come on chloroform is by far the most 
prompt and valuable agent we possess. 
Chloral hydrate, the bromides, opium and 
morphine hypodermically in large doses are 
all valuable remedies. Veratrum viride I 
have used with gratifying results. When 
used judiciously it is an agent of great 
power and usefulness. 

As to the treatment of toxaemia, secure 
prompt and vigorous elimination by cathar- 
sis, diuresis and diaphoresis. 

In my opinion croton oil and calomel 
stand first in the line of cathartics; salts, 
jalap, and other remedies of the same class 
are used. 

To arouse the action of the skin, apply 
blankets wrung out of hot water to the body 
and then put a dry cover or blanket over 
the entire body of the patient. 

The kidneys are stimulated by giving 
liberal quantities of water, if patient can 
swallow. 

The normal saline solution by giving it 
under the skin or into the bowels. 

Venesection should be classed among the 
eliminative measures, though at present. I 
believe it is somewhat in disfavor. I have 
time and again used it with very decided 
benefit, more especially in large plethoric 
women . 

The average woman possesses approxi- 
mately eight pounds of blood, and about 
one-eighth of its total bulk can be drawn off 
and replaced by salt solution, thus in a 
measure diluting the poison and thereby 
aiding nature. 

If the convulsions once occur the preg- 
nancy or labor, as the case may be, should 
be terminated as soon as consistent with the 
safety of the patient. 

Some advocate the administration of mor- 
phine in large doses and not interfering 
until the cervix is completely dilated and 
then employing forceps or version, while on 
the other hand some advocate the idea of 
emptying the uterus at an earlier period if 
it can be done without injury to the mother. 
After one convulsion I am always uneasy 
as to my patient's safety until the womb is 
emptied. 

During the earlier period of my profes- 
sional career I was inclined to the opinion 
that palliative, rather than active treatment, 
was the most judicious course to pursue, 
but my views have changed, and now my 
opinion and experience is that prompt de- 
livery is indicated whenever it can be ac- 
complished in a conservative manner, and 
I believe the statistics confirm this opinion. 
In looking over some recent statistics bear- 
ing on this point it is stated that there is a 
cessation of seizures immediately or soon 



after delivery, the report showing a mor- 
tality of 2S per cent, under expectant, and 
11 per cent, under active treatment. 

7o Summarize — P'irst. That the exact 
nature of the pathology and etiology of this 
disease is yet unknown. We believe that 
there is a toxic agent circulating in the 
blood which needs to be eliminated. 

Second. That chloroform, chloral, hy- 
drate, the bromides, opium, Veratrum, viride 
are remedies which have been extolled from 
time to time as useful in this disease, and 
they are simply remedies which will hold 
the seizures in abeyance until elimination 
can be accomplished. 

Third. By elimination I mean catharsis, 
diuresis, diaphoresis, and emptying the 
womb. 



An Imperforate and Obstructive Hymen 
at Full Term.* 

By H. S. Lott, M. D., Winston-Salem, N. C. 

This case was seen at the request of my 
friend. Dr. A. Y. Linville, of Waughtown. 
The patient was about twenty-four years of 
age, and reported that her menstrual periods, 
prior to conception, had been regular and 
without unusual symptoms. Her pregnancy 
was now at about full term, this being the 
first one occurring in three years of married 
life. 

Labor pains had set in during the previous 
night, and at the time of my visit, about 10 
o'clock in the morning, were recurring at 
regular intervals. The phenomena charac- 
teristic of the onset of labor were well 
marked; the recurrent pains, of an expulsive 
character, and some nausea, indicating dila- 
tation of the OS. The point of most interest 
in watching the woman have her pains, was 
that they seemed to be futile in their efforts. 

Upon making an examination the fingers 
could only be introduced into the vagina to 
about one-half their length. Here they 
were met by an obstructive wall, the cush- 
ioned feeling of which indicated it to be of 
considerable thickness. Rotating the fingers 
over the entire surface of this wall of mem- 
brane, and around the walls of the vagina 
in every direction, no cleft of possible inlet 
could be found; in fact, none existed. The 
sensation was a most discouraging one, as 
the symptoms warranted the finding of a 
dilating os. Biding my time, even at the 
risk of incurring the displeasure of the pa- 
tient, who failed to realize her interesting 
condition, the fingers, having become some- 
what accustomed to their surroundings, 
made a second, and very deliberate explora- 
tion of this blind pouch, with its obstructive 
wall; and after feeling almost discouraged 

»Read before the North Carolina Medical 
Society at Charlotte. 



62 



THE CHARLOTTE MEDICAL JOURNAL. 



again, it seemed to me that through its sub- 
stance, and at an equal distance from the 
top, the bottom, and the sides, could be felt 
a circle, about like that of a small sized 
teething ring. While this sensation was 
cushioned and- obscure, it was almost un- 
mistakable, and, when upon firm pressure 
at the most central point, a hard, round 
body could be distinguished, the case as- 
sumed to me a much more promising aspect. 

Believing it to have been originally either 
a cribriform hymen, or one with a very 
small cleft below, at the posterior wall of 
the vagina, and that this opening had been 
closed by some vaginal inflammation subse- 
quent to conception, I advised that it be 
incised, thus converting the vagina into a 
normal one, and permitting labor to take its 
course. 

Therefore, with the patient under chloro- 
form, the hymen, which was found to be 
about the thickness of the little finger, was 
divided from side to side of the vagina: the 
incision being made in this direction in order 
to avoid important structures, urethra in 
front, and bowel wall behind; and also to 
invite any unavoidable tear which might 
occur in the process of delivery, in this 
lateral direction, rather than into these 
structures. As soon as the incision was 
made, the child's head could be plainh' felt, 
coming down; and the encircling fibres of 
the OS beginning to yield; which indicated 
very plainly that the constriction caused by 
the hymen about the cervix had been ob- 
structive to labor as well. 

By blunt stretching with the fingers the 
incision was enlarged, and the hymen ob- 
literated as nearly as was consistent with 
tlie safety of the surrounding structures. 
No further interference was necessary, as 
from this time labor progressed normally, 
and promptly; and in about four hours I 
received a message that labor had been ac- 
complished. The doctor reported that there 
was some injury to the perinaeum and pos- 
terior wall, but as it was not extreme in de ■ 
gree, and because of the cicatrical character 
of the tissues involved, I advised against its 
repair; rather deeming the enlargement of 
the outlet from this one favorable to the 
accomplishment of future confinements. 



Obstructions to the Upper Respiratory 
Tract.* 

By H. II. Bi-iggs, M. D.. Ashoville, N. G. 

The functions of the nose and naso- 
pharynx are to filter, moisten and modify the 
temperature of the insi)ired air. The air of 
the frozen north and of the torrid desert is 
tempered by the same mucous membrane to 

*Read before the Nortb Carolina Medical So- 
ciety at Charlotte. 



nearly the body temperature. It is impor- 
tant that this change of temperature take 
place in the ujjper respiratory tract rather 
than in the bronchi and air vesicles, which 
latter necessarily' occurs when there is nasal 
or naso-pharyngeal obstruction, with the 
resulting mouth-breathing. 

The vibrissae at the vestibule act as a 
filter, removing from the air particles of dust 
and bacteria, and the greater number of 
foreign substances which pass these senti- 
nels are caught on the undulatory surface 
of the moist Schneiderian membrane, against 
which the whirling current of air carries 
them. In mouth-breathing this sifting and 
filtering process is but feebly carried on, 
and the sputa of such unfortunates are daily 
impregnated with black deposits of foreign 
matter. 

About sixteen ounces of fluid is secreted 
from the nasal mucous membrane in twenty- 
four hours, and utilized in respiration. 
Saturating the inspired air with this aqueous 
vapor is not so much a necessar\^ x^repara- 
tion of the air for osmotic purposes, per se, 
as perhaps an economic factor; for the in- 
creased temperature which necessarily re- 
sults renders the inspired air more hygro- 
scopic, and the saturation which is not 
effected in the upper respiratory tract is 
furnished in the lower respiratory tract, 
which is poorly supplied with secretory 
glands. This accounts for the dry catarrhal 
condition of the trachea and bronchi of 
mouth-1)reathers. 

Aside from the foregoing effect upon the 
physical properties of the inspired air there 
is another, and perhaps more important, 
and one which has never, so far as I know, 
been thoroughly investigated, viz., the 
change in the atmospheric pressure of the 
inspired and expired air in those who with 
difficulty breathe through a stenosed upper 
respiratory tract. This stenosed nasal breath- 
ing occurs in most cases of obstruction un- 
less of too great degree. Children, as a 
rule, practice mouth-breathing with an 
amount of obstruction with which an adult 
would attempt nasal breathing, or at least 
alternate between the two. This is due to 
the fact that the latter keeps the secretions 
which accompany most obstructions cleared 
away, while the former do not, and the 
mucous augments the obstruction. 

There is normally a slight variation of the -j 
air pressure on inhalation and exhalation, j 
in the lower respiratory tract, due to the re- 
sistance of the air passages and to the nar- 
rowness of the same, through which the 
tidal air must pass in so short an interval 
of time. This amounts to about 1 m.m. of 
Hg. negative pressure, on inhalation, and 
about twice as much positive pressure on 
exhalation; the difference due principally 



ORIGINAL COMMUNICATIONS. 



63 



to the elasticity of the lung aiding the ex- 
piration. Aron found in a case of tracheal 
fistula, a negative pressure of two to six mm, 
and from 0.7 to 7 mm of positive pressure. 
If forced respiration be practiced with the 
mouth and one nostril closed, the negative 
pressure may be as great as from 36 to 74 
mm, and as much as 82 to 100 mm. positive 
pressure. In nasal and naso-pharyngeal 
stenosis from hypertrophies, deflections, 
spurs, adenoid growths and tonsillar en- 
largements, nasal breathing is carried on by 
a special effort, resulting in varying degrees 
of pressure, positive and negative, on ex- 
halation and inhalation respectively, in 
proportion to the extent of the stenosis and 
to the respiratory eifort produced. The at- 
mospheric pressure within the bronchi varies, 
instead of 3 mm. as in normal breathing 
through a normal tract, anywhere from 3 
mm. up to 144 mm., owing to the respira- 
tory effort. This great difference in pressure 
in the alveoli and air cells, producing, as it 
were, pressure or suction alternatelj' on the 
delicate endothelial lining and capillaries, 
seems sufficient to effect pathological changes 
which might interfere with the normal ex- 
change of gases. Rallenger, in '96, con- 
fined guinea pigs in an atmosphere laden 
with AgN03 and starch, and found in a 
short time that the endothelial lining of the 
air cells had increased from one to five or 
seven layers, caused no doubt by the alter- 
nate increase and diminution of the pneu- 
matic pressure within the cell, resulting 
from the nasal stenosis induced by the 
starch. May it not be possible that there is 
an hypertrophy of the lining membrane of 
air cells in subjects affected by stenosis of 
the nose or naso-pharynx, modifying the 
osmosis, and hindering the elimination of 
carbon dioxide? The above seems the more 
tenable if we consider the hypertrophic 
changes in the eustachian tube and middle 
ear, resulting from nasal and naso-pharyn- 
geal obstruction. 

Another evil result of upper respiratory 
obstruction is that there is an insufficient 
amoimt of air respired. It may be argued 
that if the patient can not get enough air 
through the nostrils he will resort to mouth- 
breathing, which he will, substituting one 
evil for another, but as above stated, the 
adult especially, breathes through the nose 
when possible, even if he must occasionally 
augment the latter with a long breath through 
the mouth. Normal respiration must take 
place at certain intervals and any decided 
increase in the number of respirations per 
minute, or of the respiratory effort, entails 
fatigue. In case of obstruction the subject 
must increase either the rate of respiration 
or the effort, or both; or receive a limited 
quantity of air. The compromise is usually 



at the expense of the oxygen, which is as 
important to the economy as is food. 

The effect of nasal stenosis, adenoids and 
tonsillar enlargement on the middle ear and 
eustachian tu])e is often overlooked. Seventy 
per cent, of aural diseases are due to patho- 
logical conditions in the nose and naso- 
pharynx, and in my opinion, seventy-five 
per cent, of these result directly from ob- 
structions. An eminent aurist has said that 
if the rhinologists would do their duty and 
attend to the nose and naso-pharynx of the 
children of today, the aurists would have 
nothing to do in the next generation. 

It is due to an hyp'ertrophied turbinate, a 
deflected septum, or adenoids, that infected 
mucous lying in the naso-pharynx is blown 
into the middle ear or perhai^s into the mas- 
toid antrum, by an attempt to blow the 
nose. The indiscriminate use of the Politzer 
bag in patients having a muco-purulent dis- 
charge from adenoids is the cause of many 
cases of middle ear and mastoid infection. 
In a similar way the other accessory sinuses 
frequently become empyemic. It is impos- 
sible to perceptibly improve the hearing in 
cases of catarrhal deafness until the nose 
and naso-pharynx are rendered perfectly 
patent. This alone constitutes the greater 
part of the effective treattnent. 

In children post-nasal adenoids are the 
most common cause of obstruction in the 
upper respiratory tract. There is no benign 
pathological growth more dangerous to the 
patient than this. Next in order of relative 
danger are the tonsils, and lastly, in adults, 
the nasal obstructions. 

The vacant stare, listlessness, nervousness, 
open mouth, nasal voice and pigeon chest 
combine in a characteristic clinical picture 
familiar to all. That this condition usually 
accompanies the backward child in our 
public schools, the feeble-minded and the 
idiot, can not be denied, and it is a foregone 
conclusion that these obstructive growths, 
by pressure and accompanying secretions, 
are often a cause of auto-intoxication. 
Schwalbe and Retzius were able to inject 
the lymphatics of the nasal mucous mem- 
brane through the arachnoid space. An 
intimate relationship exists between the 
venous spaces of the nose and the interior 
of the skull. General toxaemia often fol- 
lows the cauterization of the nasal mucous 
membrane. Diphtheria, tonsillitis and scar- 
let fever afford excellent opportunities of 
observing the rapid toxicity to the general 
system tlirough the lymphatics of these 
parts. Chronic cervical adenitis often 
complicates adenoids and enlarged tonsils. 
The defective drainage of the nose, naso 
and oro-pharynx, and pressure causing 
swelling and stasis in the venous and lym- 
phatic channels, with the consequent large 



64 



THE CHARLOTTE MEDICAL JOURNAL. 



percentage of carbonic oxide in the blood 
and the products of auto-intoxication are 
amply sufficient to affect the brain fujictions. 

At one time it was the custom in Provi- 
dence, R. I., to place the backward children 
of the city in a special school. On examina- 
tion of these children, 70 per cent, had either 
obstruction to the upper respiratory tract or 
error of refraction, and the majority of these 
were able to return to the regular schools 
after treatment. 

Enlargement of tonsils and adenoids — in 
fact of the lymphoid tissue forming the 
tonsillar ring — affords a pathological condi- 
tion which offers an easy entrance for infec- 
tion. It is probable that the specific germs 
of several diseases, notably acute rheuma- 
tism, scarlet fever, diphtheria and tubercu- 
losis gain entrance through these tissues. 
Tubercle bacilli are often found in tonsils 
where no tuberculosis can be found else- 
where in the body. Dieulafoy inoculated 
60 guinea pigs with tonsillar tissue, and 1,5 
per cent, died of tuberculosis, and of 3.S 
inoculated with adenoid tissue 20 per cent, 
died of the same. No tuberculosis was found 
in any of those from whom the tissue was 
taken. These results were confirmed by 
Lermoyez, Brindle and Gottstein, and lead 
to the inference that these tissues, enlarged, 
are often the port of entry of the tubercle 
bacillus. 

In the treatment of pulmonary tubercu- 
losis and other wasting diseases, where 
oxygenation of the blood and elimination of 
products of decomposition are of x^rime im- 
portance, the first and essential considera- 
tion is an upper respiratory tract ample in 
patency and free from obstructions and 
catarrhal secretions. 

73 Havwood St. 



Test Diet in Intestinal Diseases.* 

By Dr. W. O. Nisbit, Charlotte, N. C. 

Internal medicine of today is concerned 
largely with the functional diagnosis of 
disease. Functional diagnostic methods as 
applied to disease of the stomach have been 
reduced to a practical working basis within 
the past decade. In evolving these methods 
a definite rule has been followed of first 
finding the variations in function of the 
normal stomach under a selected test; hav- 
ing once discovered the normal we have a 
guage by which to measure the pathological. 
Applying these methods the pathological 
variations in the three chief functions of the 
stomach, namely, secretion, absorption, and 
motility in their various refinements have 
been worked out. 



*Read before the N. C. Medical Society at 
Charlotte, N. C. 



J^utictional Diag>iosis of Intestinal Dis- 
eases. 

Functional methods as applied to diseases 
of the intestines have not kept pace with 
similar methods applied to diseases of the 
stomach. In fact, only within the past five 
years have we seen an occasional allusion 
in medical literature to an intestinal test 
diet. Recently there have been published 
by several observers the results of investiga- 
tions in this field, and the foundation has 
been laid upon which may be reared a 
finished structure. These observers seeing 
the value of the test meal in examining the 
stomach function it was reasoned that a test 
diet should be established for the study of 
the functions of the intestines. This test 
diet was first given to a series of healthy 
subjects, and their stools examined chemi- 
cally, microscopically and macroscopically; 
thereby establishing a standard. Later the 
diet was exhibited to a series of individuals 
with intestinal derangement, and the patho- 
logical variations in feces noted. It may 
be well to state that at first a chemical esti- 
mate was made of the fats, carbohydrates 
and the nitrogen output in the feces. This 
course was found impractical, owing to the 
great amount of time required to make the 
analysis. Adolf Schmidt and vStrassberger, 
who were the leading investigators, and 
others abandoned this chemic method, and 
after much labor have given out the plan of 
examination of the feces of which it is the 
purpose of this paper to speak. In taking 
up the work it was agreed by these observers 
that a suitable diet should fulfill the follow- 
ing requirements: 

1 . The test diet must be so selected that 
it should be taken by healthy persons as 
well as by those suffering with intestinal 
disorders. 

2. That the diet inust be largely free from 
waste matter, but still contain enough to 
give the stimulus of ordinary food. 

3. That the diet must be callable of sup- 
plying the minimum, at least, of nutrition 
(in calories) reciuired by the body at rest. 

4. That the diet must contain the three 
groups of food stuffs in proportionate rela- 
tion to each other. 

.5. That the diet must be of simple com- 
position, easily made and uniformly pre- 
pared. 

Schmidt' s Intestinal lest Diet , 

The diet as given b}^ Schmidt in each 
twenty-four hours is as follows: 

In the a. m. 0.5 litre (01) of raw milk 
and 50 grms. (2 oz.) of Zweiback bread 
(ordinary bread will suffice). If milk will 
not agree give instead 0.5 litre (01) of 
cocoa, made from 20 grms. (5 drams) of 
cocoa powder, 10 grms. (2^ drams) milk 



ORIGINAL COMMUNICATIONS. 65 



su-ar- 400 -nns. (12 oz.) of water and 100 feces, excepting the sublimate and fermen- 

sugar, ^uu -r™^- v ^^^.^^^ ^^^^^^ ^^^ ^^ ^^^^^ ^^^ ^^ minutes; my 

grms Cooz. otmilk. experience is that it takes at least 30 niin- 

In forenoon. ^-^^ i^^'^^,.^^. ^"''11°^^^ utes. In preparation for examination the 

meal S^n.l rn.detc^m^^m.^ ^ ^^JJ^ thoroughly stirred with a 

oat meal, 10 ^^^ms. -. dramsJ ot bu^ ^^^^^^ ^ ^^^^ ^ ^^^^^ ^^^^^^^ ^^^^^^ 

wlrreig"' StriinLirafbS:;r; using, the size of a walnut is placed in a glass 

water, i ^^8- -' ., x chopped beef mortar. In this it is ground up as fine as 

Atnoon_ 125grms.(4ozJch^^^^ with the addition at first of a few 
(raw weight), broiled rare wi^n -^' f^^=_ ^^ ^^^ gradually more distilled water 
(5 drams) ^;;;|-; J^Jf^^^f rpl^)^:f undlilisol fluidcJnsistency). The grind- 
main raw; o this add 250 grms.U ing up must be done carefully, so that no 
potato broth, made from 1 ;0 grams. (G oz J g I ^^^^^^^^^^ ^^^.^^^^ ^^^^^.^^ .^^^ 
of mashed potatoes, 00 grms.l.o^^^^^^ ground up specimen of feces is then spread 
mi k with 1,-, grms^ (6 drams) of butter. g^^^ ^ fl^^.black plate or a large glass vessel 

In p. m., as "\"^°"""f . ^^^^„ in as thin a layer as possible, and account 

oz.ofbutter,4oz. ofleef r oz.ot potato, ^^^^ ^^^^^^ ^^ ^^^^^.^^ .^ ^^^^^^^^ 

and 2 pints of oat meal gruel .p^vps- this latter method is only of value 

This test is generally give^ 
sometimes onger; ^"^^ at any rate "^^ti stool ^^ ^^.^^^ ^j^^ ^^^„^^^1 ,^^1 ^Uen spread 

is obtained, which comes w th certainty detailed above should be smooth and 

from the diet. With normal evacuao ^^^^^^^ a few brown points, which are 

power this occurs with the second defecation ^^^^ oiily^ a j ^^^ ^^^ ^ P ^ ^^^^^^ p^^^^^_ 

after beginning the diet. logicallv we will find mucous in large and 

The patient, as a rule, does not need to ^ remains of connective tissue 

ine of the test diet feces, administer at the This serves for the most part to complete 
beginning and ending of the test diet a the examination by the "^^e^, J^^' ^hree 
wafer or capsule of .S grains powdered car- preparations are made on a glass slide of the 
mine which passes the canal unchanged feces as origmally stirred up-if it is too 
Sd'-ives its characteristic red color to the hard a little water is added; we next place 
correS ondi t feces. It is not claimed that ^ small portion respect vely on either end 
?ll represen^^ the onlv conceivable or only and the middle of a slide. Withou adding 
OSS Me form of diet for functional exami- anything to it the first portion is crushed mo 
ation of the intestines, but it is maintained a very fine layer with the coyer glass^ The 
that^ has proven the most applicable one second is stirred with a small drop of a ^0 
nthe h^iKls of these observers. per cent, solution o-etic acid and heated 

Ohiections for a moment over the flames (,unt 1 it oe 

Objections. „i„s to boil) and then covered with the cover 

Some make the criticism that tins aiet is » ^^^ ^^^ ^^.^.^ ^^.^^ j^ rubbed up with a 
too difficult of preparation to be earned out s - • ^^ ^^^ solution of lodo Potas- 

except in hospital practice. It is answered ^.^^^^ ^^^^^^ ^ ^ ^ ^^ 2^ H20 50). Normal 
that ijractically such is not the case, as ^^^g^ g^^^^iiied in this way under the micro- 
patients generally appreciate a carefully ^^ ^.^^ .^^ ^^^ ^^^^ specimen show a 
ordered diet. Some criticise that it contains ^^^^^^^ detritus consisting of the smallest 
too much milk. In reply we would say ^^^^^^g globules, bacteria, isolated frag- 
that only one pint of raw milk is given, and s^^^^^^ of' muscle fibre, isolated potato cells, 
that the remaining two parts are given in ^^^^^.^^^ ^f ^^t meal gruel, 
combination with the food. Better diets j^^ ^.^e second, or acetic acid preparation, 
may follow, still this is the most adaptable ^^^.^^^ ^^^^^^ ^^ ^^1^ ^y^ fat remains tem- 
one thus far. porarily and thus to furnish a view of the 
The Examination of the lest Diet Feces, entire fat contents, there is seen after cool- 
The next question in mind is how to pro- ing small flakes of fatty ^^^--^^^^^^^^^ 
ceed with tli2 examination of the feces It the entire V^^^^^^l ver^rTam^s 
is claimed by the originators of his test diet - ^-X^^^^X microscope while still hot 
plan that the proper examination of the and piaceu uimci 



66 



THE CHARLOTTE MEDICAL JOURNAL. 



the small flakes of fatty acid are melted into 
drops, which congeal again as the prepara- 
tion cools. Pathologically we will find in 
the unstained preparation fragments of 
muscle fibre in larger number of good state 
of preparation, needles of fatty acids, and 
soaps and numerous groups of potato cells, 
and may be parasite eggs. In the acetic 
acid preparation pathologically we find 
massive fatty acid flakes. In the Iodine 
preparation iilue colored remains of starch 
granules from the potato cells, blue or violet 
fungus spores and thread like bacilli. Yeast 
cells which are colored by the iodine. 
Chemical Examination of lest Diet Stools. 

In the chemical examination we need 
only consider the reaction test, sublimate 
test, and fermentation test. 

Reaction lest. 

For this only a strip of red and blue litmus 
is placed on (not in) the fecal matter, which 
has been ground up with distilled water. 
Normally the reaction is netral, or at least 
feebly acid or feebly alkaline. 
Sublimate lest. 

This test consists in placing some of the 
prejiared feces in a glass filled with concen- 
trated watery solution of HGC.2, stirring it 
and letting it stand until next day. The 
normal feces is colored red by this ( Hydro- 
bilrubin) and the more intensely red the 
fresher the stool. Particles colored green 
even if microscopically small are pathologi- 
cal and show the presence of unchanged 
bile pigment (Bilirubin). 

1 he fermentation lest. 

This test has been very essentially simpli- 
fied as compared with the old fermentation 
test. For this from the first feces, which 
has been stirred up, a small aniout about 
the size of a small walnut is taken with one 
of the wooden spatulas and put in the lower 
vessel of Strasburger's fermentation tube. 
In hard stools less is taken; in soft stools, 
more; in liquid, the lower vessel is filled 
entirely. In this vessel the feces are stirred 
up with water and the rubber stopper is put 
on, care being taken to exclude air bubbles. 
The rubber stopper is taken from the tube 
"b" and the tube filled with water; this 
tube is then closed by putting on the stop- 
per with the vessels connected with it — a 
(filled) c (empty); c has an opening on top 
and acts as an ascension pipe (steigrohr). 
Note is taken of how far the connecting 
tubes enter into the lumen of these vessels. 
When the apparatus is put together it is 
placed for twenty-four hours in an incubator 
heated to 37 degrees C. If gas is developed 
from specimen within this time this collects 
within tube "a", and a corresponding 
amount of water is forced into the ascension 



tube "c". The height of the water in the 
ascension tube is noted, the vessel "a" is 
opened and the reaction of it is tested with 
litmus paper and compared with the reac- 
tion before the test was instituted. 

Normally only a very little gas is formed 
in the incubator test and the original litmus 
reaction of the feces undergoes no important 
change. If gas is developed to such an 
amount that one-third or more of the ascen- 
sion pipe is filled with water then pathologi- 
cal conditions are involved, and, if at the 
same time, the reaction has become more 
distinctly acid carbohydrate fermentation 
(the positive result of fermentation test) 
has occurred; if it has become distinctly 
more alkaline albumen putrefaction has oc- 
curred. Albumen putrefaction gives putre- 
factive odor. Carbohydrate fermentation 
gives Butyric acid or ranced butter odor. 



Report oi a Case Trephined for Epilepsy."^ 

By W. A. Graham, M. D., Durham, N. C. 

Inasmuch as epilepsy in its various forms 
offers so little hope of permanent improve- 
ment, except in those cases which are 
amenable to surgical treatment, and, even 
traumatic cases are often disapi^ointing in 
their post-operative history, I wish to report 
the following case: 

J. P., colored, forty years old. Father 
died at seventy of "old age," mother is liv- 
ing, no brothers or sisters. Has been strong 
and healthy with no serious illness except 
malarial fever fifteen years ago. No syphilis, 
gonorrhoea fifteen years ago. In June, 1900, 
was struck with 3x3 scantling on left side 
of head, followed by unconsciousness and 
stupor for a period of four weeks, no frac- 
ture being discovered at the time of injury. 
When he recovered, he found a depression 
on line one inch above ear, beginning two 
inches behind ear and running back two 
inches, being about one inch wide. He 
went to work two months after injury, and 
three and one-half months after injury had a 
convulsion. Second convulsion two months 
later. The frequency increased during the 
next eighteen months, convulsions occurring 
as often as once in two weeks when I first 
saw him in May, 1902. The convulsion 
began by twitching in the right eye; he 
"would see a moon-shaped light;" right 
hand became numb, jerked and twitched, 
gradually extending up the arm and over 
the whole body, patient becoming uncon- 
scious, whole onset often taking ten to 
fifteen minutes and unconsciousness lasting 
from one to seven hours. 

In June, 1902, the skull was trephined in 
center of depressed area, remainder being 
removed with Rongeur forceps. Dura was 

*Read before the recent meeting of the North 
Carolina Medical Society at Charlotte, N. C 



ORIGINAL COMMUNICATIONS. 



67 



non-adherent; was opened and brain in- 
spected; no abnormal appearance present. 
Dura was stitched and skin closed with cat- 
j^ut drain. Patient made a good recovery 
and in the four years since operation has 
had three convulsions, December, 1902, 
June, 1903, December, 1904; none in eigh- 
teen months. He is at present well enough 
to work regularly; has gradually lost sexual 
power and desire; complains of slight full- 
ness of head. There is evidently some ad- 
hesion between the scalp and dura, which 
may account for the full feeling. 

Epilepsy following cranial injury arises 
from scars in soft coverings, a peripheral 
nerve being the starting point, from injuries 
of bone or dura, and actual brain injuries. 
Apparently the cause was due to bone de- 
pression with little cortical change and his 
recovery to the removal of the depressed 
bone before the permanent establishment of 
the epileptic habit. Although four years 
have lapsed since operation, it is not certain 
that he is cured, but at least there has been 
a great improvement. The loss of sexual 
power is probably not due to the brain in- 
jury but to previous abuse. 



The Present Status of the Treatment of 
Cancer—with Report of Cases.* 

By Dr. L. B McBi-ayor, Ashoville, N. C, First 
Vice-President Norih Carolina State Medical 
Society; Surgeon to the Miirsion Hospital, 
Ashevilie. N. C. : Ex-President Buncombe 
County Medical Society; Member American 
Medical Association; Mississippi Valley As- 
sociation; American Electro-Therapeutic As- 
sociation; Ex-President Board of Pension Ex- 
amining Surgeons; Ex-Member of Board of 
Health City of Ashevilie, etc., etc. 

This paper is intended to be intensely 
practical, and the writer hopes to be of help 
to the general practitioner, as well as the 
specialist, and thereby benefit the people. 
If we succeed we shall feel amply repaid for 
the time spent in its preparation. Hence 
there will be no place for theorizing, neither 
will we draw fine distinctions as to kind, 
but use the term cancer in its broadest sense. 

The present status of the treatment of 
cancer resolves itself into Prophylaxis, Abla- 
tion by Surgical Procedure, by plasters, 
and treatment by light; or a combination of 
two of these. 

Prophylaxis. 

Ever since we first became interested in 
the study of cancer, it has been a matter of 
great surprise to us that this matter of 
prophylaxis should be entirely ignored by 
writers both in journal and text-book. Lac- 
eration of the cervix is a very frequent cause 
of cancer in this organ, in fact, cancer of the 
cervix or body of the uterus is so rare in the 

*Read l)efore the North Carolina Medical Socie- 
ty, Charlotte, N. C, 



virgin uterus that it is claimed by many that 
it does not occur. So far as my experience 
goes it agrees fully with this statement. 
Such being the case, if laceration of the 
cervix produces no other disease except 
cancer, which is not the case by any man- 
ner of means, it is the duty of every phy- 
sician to see to it that every woman under 
his care, having a lacerated cervix, has it 
repaired. In fact, I believe it to be good 
routine practice to examine the cervix of 
every parturient patient at the end of two 
months, and if any lacerations are found 
have them repaired. 

The tendency for all tumors of the breast 
to become malignant has become such an 
accepted fact that I need hardly refer to it, 
and will only say that any tumor of the 
breast, however small, should be removed 
as soon as discovered. I have^only seen one 
benign tumor of the breast, and am not sure 
that it would have remained so, had it not 
been removed. Patients having moles, 
naevi, birthmarks, etc., should be warned 
that these are often the starting point for 
cancer, and if they show any sign of growth 
or irritation, should be removed, preferably 
by electrolysis. The people shotild be edu- 
cated out of the idea that the removal of 
these blemishes may start cancer, and be 
educated up to the truth of the fact that the 
opposite is true, if let alone they frequently 
cause cancer, and if removed never do. 
This prophylactic treatment must be looked 
after and insisted upon by the general prac- 
titioner, and it is high time that we were 
waking up to a sense of our duty along this 
line. 




Figure 1. 

IK'W (I carcinoma of the right hreust. Treatment wa.s 
heciun five yearn after the timior first appeared. 
Breast was entirely destroyed. Any other treatmerU 
th'in by the X-ray was not to he thought of. 
Early Diagnosis. 
I want to here and now make the state- 
ment that «^^ cases of cancer can be cured. 



68. 



THE CHARLOTTE MEDICAL, JOURNAL. 



This statement is based, however, on an 
early diagnosis and prompt and proper treat- 
ment. I repeat, it will bear repeating many 
times, all cases of cancer if diagnosed early 
and treated promptly can be cured. If you 
find a patient with a tumor of the breast, 
call it a cancer and remove it, or have it 
done, I mean remove the tumor not the 
breast — and 99 times out of 100 you will be 
correct in your diagnosis, and the same 
number of times you will save a human life. 
If you find a woman who has passed the 
menopause, who has passed blood from the 
uterus, be it ever so small, you have a case 
of cancer, and the time to do a hysterectomy 
is inside of 24 hours. All 3'our patients will 
get well with this treatment; all of them will 
die if you temporize and wait. If you have 
a patient past the menopause with a foul- 
smelling leucorrhoea, do not wait for the 
microscope, you do not need it, take out the 
uterus and save your patient's life. I had 
a patient from Tennessee referred to me for 
cancer of the uterus that had been seen six 
months previous by a physician and at that 
time had a pretty severe hemorrhage from 
the uterus. If he suspected cancer he never 
gave the patient any intimation of it. She 
rightly fell into another doctor's hands and 
was referred by him. The case was entirely 
beyond the pale of surgery. She has since 
died. I had another physician send me a 
patient with cancer of the cervix for opera- 
tion, after he had been treating her with 
glycerine tampons for six months. At the 
time T saw her she had the cachexia. I 
summed up her chances as best I could, she 
wisely took the only chance she had, that 
of operation, and I think she would have 
recovered had she not been attacked with 
hiccough on the 5th day, which ended her 
life on the 12th day. But her power of re- 
sistance had been greatly lessened by the 
delay, and had she recovered the chances of 
return were very much greater than if oper- 
ation had been done several months earlier. 
Two weeks ago I had a case of cancer of 
the uterus referred to me for hysterectomy. 
The doctor had been treating the case for 
three months, and at this time there were 
numerous inguinal glands infected. She 
also had the cancerous cachexia and had 
lost considerable flesh. The chances for an 
operation to cure her were practically nil; 
and when told of her condition as plainly 
and truthfully as I knew how, she decided 
to go home and die. We had a case referred 
by a physician, who, when consulted by 
the patient about the condition, assured the 
patient that he had no cause for alarm, and 
that if the cancer began to eat to come to 
him and he would cure it, and that it was 
impracticable to treat his case with the 
X-ray, as it would ruin his eyes. The pa- 



tient was persistent, however, and the doc- 
tor later referred him to us. In these cases 
the doctor is guilty of gross criminal negli- 
gence, and I only mention them to impress 
upon you the importance of an early diag- 
nosis and prompt treatment in all cases of 
cancer. -ljy\ 

One year ago we had a patient consult us 
in regard to superficial cancer of the nose. 
We advised him that it could be cured and 
named a fee that he was amply able to pay. 
He decided, however, to rely on nostrums 
of more or less value, advertised by quacks 
and applied without any scientific knowl- 
edge. Last week two men helped him into 
our office, with his nose and right eye en- 
tirely destroyed, and he off'ered to pay us 
every dollar he had in this world if we 
would cure him. We advised him to go 
home, give his money to his family, make 
his peace with his God and die. He acted 
on our advice in the first and last items, to- 
wit: to go home and die, whether he did on 
the other items we are not informed. This 
leads me to say that there will come a day 
in every case of cancer, if let alone, i:)rovid- 
ed the patient does not meet his end by some 
intercurrent affection, when it can not be 
cured by any means and will produce death. 
It also leads me to say that the doctor is 
wholly responsible for the quacks who cure 
cancer. I use the term cure advisedly, for 
they do cure many cases, be it said to the 
shame of the doctor. And if the doctors of 
this State will awaken to a sense of their 
duty along this line, and diagnose their 
cases of cancer early and treat them prop- 
erly, or if they have not the inclination to 
do it, refer them to a physician who will, 
the quacks who treat cancer in this State 
will cease to exist; and we owe it to our- 
selves and our people to do ths. And allow 
me to say that in my opinion there is no 
lack of ability on the part of the profession 
of this State, but the most of mistakes made 
are due to failure to make a careful and 
painstaking examination. I am sure such 
has been the cause of most of my mistakes. 

Let us speak more specifically of the treat- 
ment — Surgical Ablation of the part. When 
practical, this should always be resorted to, 
especially in cancer of the uterus, no matter 
how early diagnosis is made. Cancer of the 
breast and cancer of an extremity when far 
advanced — this ablation should always be 
followed by X-radiation. It is our opinion 
that we will never have a treatment for 
cancer that will leave surgery entirely out 
of the question. 

Ablatio?i by Means of Plasters. 

All cases of epithelioma of the skin, if 
treated early, can be cured by plasters or 
paste, especially if no care is had for the 



ORIGINAL COMMUNICATIONS. 



69 



cicatrix that will always result from its use. 
Hence, in men who can not lose time to take 
the longer treatment by X-ray, and who do 
not care for the cosmetic effect to be gotten 
by the ray, we can use plasters or paste to 
great advantage. But in women who are 
always sensitive over a scar, whether on the 
face or other parts of the body, we would 
always use the ray. It is surprising, even 
to those who use the ray, what unsightly 
cancers can be cured by the ray without 
leaving a visible scar. 




Figure 2. 
( Cured hy five months, treatment with the 
X ray .and remains ctired after IS months. ) 

I might say the treatment by light, as 
sunlight properly applied, the Finsen light 
and radium would probably all produce the 
same result, l)ut we are not yet sufficiently 
familiar, and may never be, with the method 
of using sunlight, to make it practicable. 
The Finsen light is too tedious, and radium 
too expensive, to ever admit of either of 
them being used extensively, so the treat- 
ment by light narrows itself down to the 
treatment by X-radiation, and there is now 
no objection since we know enough about it 
to prevent the burns that were once so 
troublesome. All cases of superficial cancer 
can be cured by the ray. Will mention two 
cases where there was complete destruction 
of the breast by the cancerous process, and 
any other treatment than by X-radiation 
was not to be thought of. The first remains 
well today after IS months, the second was 
seen one year Ijefore treatment was begun, 
and at that time surgical ablation of the 
breast was advised to be followed by X-radi- 
ation. This was refused, and when she 
presented herself about S months ago, left 
breast was entirely destroyed, with involve- 
ment of axillary and supra-clavicular glands, 
and also involvement of the left breast and 
scalp. The treatment was used more as an 



experiment than as a cure, yet the ulcera- 
tion in right breast healed and remained so, 
while the other breast seemed to be cured 
also, but patient died a few days ago with 
cancer of the right lung. In cancer of 
uterus and other internal organs irradiation 
cannot be depended upon for a cure, yet 
even in advanced cases that are too far gone 
to admit of surgical procedure, it relieves 
the pain and offensive discharge and pro- 
longs life. 

Dr. Whittington and the writer have dis- 
charged sixty cases of cancer in the last two 
years from our X-ray laboratory. Ten have 
been refused treatment on account of the 
advanced condition of the disease. All of 
them have died except case mentioned 
above, seen two weeks ago, and she will be 
beneath the sod before the frosts of autumn 
ayjpear. Two were treated as a dernier 
resort . One of these mentioned above show- 
ed marked improvement, but died with 
cancer of lung. The other was cancer of 
the right cheek, and had been treated with 
paste by a quack. This showed marked 
improvement, patient died of entero-colitis, 
sui)erinduced by inability to masticate food, 
and a ravenous appetite. We have treated 
fovir other cases of cancer of the breast; one 
by X-ray alone, no other treatment being 
applicable on account of its far advance- 
ment; remains cured. Second by surgical 
al)lation, followed by irradiation, remains 
cured; third far advanced, by surgical abla- 
tion, followed in two months by irradiation, 
breast cured, died of cancer of lung. Fourth, 
treated by X-ray alone, because she refused 
surgical ablation, remains cured. Two 
others treated by surgical ablation, followed 
by irradiation, remain cured. One interest- 
ing case — M. aet. 72. Very feeble, cancer 
of chest over sternum, starting in a mole, 
treated first by a quack, because he could 
find no doctor who would treat it, or tell 
him where he could get it treated scientifi- 
cally. When seen by us had cancer size of 
palm of hand on sternum, gland in left side 
of neck much larger than goose &%^ — right 
side of neck as large as hen 0^%% — gland in 
right axilla size of a walnut, gland in left 
axilla large as pint cup — fluctuating. Fluc- 
tuation was so marked that we incised it in 
office and emptied one pint of broken down 
cancerous tissue with much bleeding; pack- 
ed cavity with iodoform gauze and began 
X-radiation. Edges of incision became in- 
volved and was extending rapidly at end of 
four days. Sent patient to hospital and 
removed glands of both axillae, making 
careful dissection of brachial plexus and 
arteries and veins in left axilla; in doing so 
tore a hole in axillary vein; the vein Avas 
picked up with haemostatic forceps, and 
tied with good result and no untoward 



70 



THE CHARLOTTE MEDICAL lOURNAL. 




Figure 3. 

{Epithelioma, of the left lotver eye-lid in- 

yolving the tarsal cartilage. 

effects; operation lasted 30 minutes. At the 
end of five days patient was able to go to 
office, and at this time the cancerous process 
had attacked all the stitch holes and one 
and one-half inches of incision, although 
incision was healed. With irradiation the 
cancerous process was arrested and cured, 
also cancer over sternum. Gland in right 
side of neck disappeared, and in left side 
was reduced to one-third its former size. 
Patient gained 18 lbs. and went home after 
four months' treatment comparatively well 
and perfectly happy; patient died three 
months later with dysentery. Another case 
was cancer of the neck, beginning in a mole. 
This was treated by surgical ablation, fol- 
lowed by irradiation. She remains well to- 
day. Two cases treated by surgical ablation 
alone — both remain well. Twenty cases 
have been treated by pastes alone — all of 
them remain well. The remainder have 
been treated by X-ray alone. All of them 
remain well but one who showed marked, 
very marked improvement, but treatment 
had to be abandoned on account of a stroke 
of apoplexy. Patient had a second stroke 
about two weeks ago, but is still alive. 
The record of our treatment then, not count- 
ing the two cases treated as a dernier resort, 
is as follows: 



Figure J/.. 

(^7 reatment by the X Ray. Remain cured 

after six tnonths.) 

By plaster 20 remain cured 30 

By surgrical procedure 2 '' " 2 

By surprical procedure and X-ray 6 " " 4 

(died cancer of lung 1) 

(died dystenerj 1) 

By X-radiation 20 " " ....19 



Out of 48 cases treated, 45 were cured, 1 
died of cancer, 1 died of dysentery, and 1 
improved, but treatment abandoned on ac- 
count of apoplexy. A record to be proud 
of, I am sure. Finally, let me say once 
again — all cases of cancer can be cured if 
diagnosed early and treated promptly and 
properly. All cases will die if let alone. 

P. S. The week following the reading of 
the above paper before the North Carolina 
State Medical Society, Dr. William H. 
Mayo, President of the American Medical 
Association, in his Presidential Address to 
that Association at its meeting in Boston, 
Mass., said. "Society must be taught the 
early symptoms of cancer, the greatest foe 
of humanity, that its early manifestations 
may be recognized while in the curable 
stage." The New York Medical Journal, 
commenting on this portion of Dr. Mayo's 
address said he was a "little optimistic." 
But it is not so. He is simply a leader of 
thought. 



ORIGINAL COMMUNICATION. 



71 



Cholelithiasis.* 

By Dr. Heni-y F. Long-, Statesville, N. C. 
]\Ir. President and Gentlemen: 

My own experience lias demonstrated that 
it is not the specialist alone who is con- 
fronted with g:rave problems. Within the 
space of a few months I have been called 
upon to deal with a series of ten cases, a 
fact which is significant of the prevalence 
of cholelithiasis under circumstances which 
must be met by that individual from whom 
the public demands so much, the general 
practitioner. To these, my fellow practi- 
tioners, I trust that a brief study of these 
cases may not be without interest. 

The modern era of gall bladder surgery 
dates back less than fifteen years. During 
this period improvements in technique, a 
more definite fixing of the time to operate, 
and a more enlightened management of 
cases have contributed to a progressive re- 
duction of the mortality until it compares 
1 favorably with that of any other abdomina 
operation. As a result of this, from being 
considered a subject for medical treatment, 
cholelithiasis has been completely trans- 
ferred to the province of surgery. 

As to etiology, Naunyn laid down the 
rule that the formation of gall stones de- 
pended upon two factors — stagnation of bile 
and infection. The recent researches of 
Beer, however, seem to imply that these 
conditions alone are not sufficient, but that 
in addition a deranged hepatic metabolism 
— in other words, a diathesis — is a pre- 
requisite for the development of the disease. 
This theory of the etiology is borne out by 
the following cases: 

Case I. — Mrs. P., 50 years of age. She 
was the mother of thirteen children, and up 
to about a year ago had always been healthy, 
except for a severe attack of typhoid fever 
ten years previous. A year ago she was 
seized with pain, first in the right shoulder, 
then in the stomach, and alternating be- 
tween the two for two weeks. Similar at- 
tacks followed at intervals of two months 
until two weeks before the operation. In 
each attack there was a decided jaundice 
which cleared uy) after the attack subsided. 
On each occasion she was given the usual 
remedies, morphine, sodium, phosphate, 
olive oil, etc. The patient was in good 
condition for operation. Tenderness was 
present at the point of the ninth rib; on deep 
pressure tumor could be made out, but not 
distinctly. The area of liver dullness was 
increased. Incision was made, beginning 
near the ninth costal cartilage of the right 
side and running vertically downward 



*Read before the N. C. Medical Society at 
Charlotte, N. C. 



through the outer border of the rectus 
muscle. The gall bladder was easily found 
and brought into the wound. As there was 
no fluid in it, it was at once incised, and 
106 hard facetted gall stones removed. 
Besides these, three soft stones which were 
crowded into the cystic duct were removed. 
I had no difficulty in working them back 
into the gall bladder, and removed them 
much crushed. The 106 others 1 have here 
in this bottle, which I shall be glad to have 
you examine. The gall bladder was next 
sutured to the peritoneum, a drainage tube 
pushed to the bottom and the gall bladder 
left in the sack four days. Bile discharged 
for eight days and then ceased. The woman 
left the hospital on the twenty-first day, 
and has since been in good health. 

Case II. — Mrs. , 40 years of age. 

She was the mother of seven children, the 
youngest being five months old. She had 
suffered for eleven years from indigestion 
following a long attack of typhoid fever, 
and had taken much medicine for the relief 
of this condition, even beginning the use of 
morphine tablets on her own account when- 
ever she felt the approach of the attacks, 
which were frequent and severe. The last 
one, occurring December 12, 1905, was so 
prolonged and painful that the family doc- 
tor was called. Examination discovered a 
tumor in the upper abdomen. I saw her 
that night at twelve o'clock. At this time 
her whole upper right side was rigid and 
tender. Her pulse was 160, temperature 
104, respiration short and quick, facial ex- 
pression anxious. I advised the usual treat- 
ment in acute intra-abdominal troubles. 
She improved, and on December 14 was 
brought to my hospital. She stood the trip 
well, and when brought in had a tempera- 
ture of 100 and a pulse of 96. Operation 
was delayed for 4 days, at which time her 
pulse and temperature were normal. The 
usual incision was made, and a dense tangle 
of adhesions encountered. They were separ- 
ated, and the gall bladder well exposed and 
pulled up, gauze strips being well packed 
around and below it to prevent the soilino 
of the peritoneum. A trocar was pushed 
into the gall bladder and about three ounces 
of fluid was aspirated. The fluid was viscid 
mucous, dark, fluctuant bile, and serum. 
The gall bladder was then opened and three 
large stones, which I have here in this bot- 
tle, were removed. The gall bladder was 
black and gangrenous, its walls much thick- 
ened and the whole viscus much enlarged. 
It was cut away from below upward until 
the cystic duct was reached and ligated, 
thus finishing its entire removal. A drain- 
age tube was anchored at the stump of the 
cystic duct, another, a long tube of split 
rubber with gauze running through it, was 



72 



THE CHARLOTTE MEDICAL JOURNAL. 



dropped into the subhepatic space, and both 
left ill. The wound was closed in the usual 
way, and on the fifth day the drains were 
removed. The patient made a g^ood re- 
covery. It is noticeable that althoug-h this 
was a much more serious case than No. 1, 
the gall bladder being found in a much 
worse condition and the patient having suf- 
fered for eleven years, yet there was not, at 
any time, the slightest jaundice. 

Case III. — A woman fifty years of age. 
She had always l)eeii healthy except for a 
very severe attack of measles, followed by 
bilious trouble. Her condition on exami- 
nation was found to be practically normal. 
She had suffered for five or six years with 
bilious colic, "bad liver," as she expressed 
it. She had never been badly jaundiced, 
but said that her skin would turn yellow 
when she had an attack. Eight months 
before, the colic became of daily occurrence. 
The pain was always located in the right 
shoulder. In this case the abdominal walls 
were very thin, and the gall bladder could 
be felt as a hard mass at the end of the ninth 
costal cartilage. The usual incision was 
made and the gall bladder at once presented. 
It was pulled up, opened, and 235 stones 
removed. It contained no fluid whatever. 
Further search discovered a stone in the 
common duct, which w-as opened, the stone 
removed and a small fish-tail drainage tube 
anchored in the incision in the duct. An- 
other drainage tube was anchored in the 
gall bladder, and still another split tube 
carrying gauze was passed to the bottom of 
the sub-hepatic space and brought out with 
the two others at the upper angle of the in- 
cision. Gauze was packed around all and 
the wound closed to the gauze. In twenty- 
four hours bile began to discharge freely, 
and continued to do so for a week, at the 
end of which time the tubes were taken out. 
All discharge ceased on the fourteenth day, 
and the patient went home, much pleased 
with the relief ol)taiiied. 

Case IV. — A woman, 65 years of age. 
She had had typhoid fever twenty -five years 
ago, and for twenty years had suffered from 
frequent attacks of colic. For three months 
nhe had not been free from pain in the up- 
per right side, except when under the in- 
fluence of laudanum. The patient was 
much jaundiced, and examination revealed 
a tumor in the upper right quadrant. The 
usual incision was made and the gall blad- 
der presented, with no adhesions about it. 
It contained no fluid; 13 large stones were 
removed. The gall bladder was then stitched 
to the peritoneum, the usual drainage em- 
ployed and the incision closed in the usual 
way. The patient left the hospital on the 
twenty-first day and has been in good health 
since. 



Case V. — Mrs. , 26 years of age. The 

patient was the mother of four children. 
She had had the usual diseases of child- 
hood, also typhoid fever when about full 
grown. The first attack of colic occurred 
two years ago and lasted seven hours. Since 
then she had had attacks every few weeks, 
and the interim between attacks was marked 
by indigestion, distention, etc. Her stools 
remained natural in color, l)ut constipation 
was constant. At no time was there any 
evidence of jaundice. Of late the attacks 
had become so severe that her physician 
sent her to me for operation. The usual in- 
cision was made, the gall bladder brought 
up and opened. At the distal end a walled- 
off abscess was found, which contained 
about one ounce of pus. In the gall bladder 
proper was a large stone, not colored like 
the others, perfectly round and presenting 
no facet. I have it here in this bottle. The 
gall bladder was stitched to the peritoneum 
and the usual drainage employed. The 
drainage ceased on the tenth day and the 
woman left the hospital on the fifteenth. 

Case VI. — Mrs. , 58 years of age. 

She was the mother of two children, the 
youngest 24 years old. She gave a history 
of colic and indigestion for ten years. She 
had had typhoid fever when young. Her 
whole body was decidedly saffron colored. 
The usual incision was made, and the gall 
bladder found to be so thickened that its 
cavity was entirely obliterated. I began 
and dissected it out at once. I could feel a 
large stone in the common duct, near the 
ampula of Vater. I attempted to push this 
along, but it mashed like putty under pres- 
sure. I enlarged my incision upward and 
inward until I could easily palpate and in- 
spect the common duct. I then opened the 
duct and began with a scoop to clear it out. 
In this I encountered some difficulty, as it 
was packed with putty-like stuff and soft 
stones. When I thought I had it clear, I 
inserted a fish-tail tube in the opening in 
the duct and anchored it there, anchored 
another split tube at the stump of the gall 
bladder, and dropped still another in the 
sub-hepatic space. The patient did not do 
well until the third day, when normal bile 
began to flow and she improved. Quantities 
of gravel bile sand discharged for two 
weeks. The patient's health is improved, 
but she still has a biliary fistula which dis- 
charges intermittently. 

Case VII. — Mrs. , 32 years of age. 

The patient was the mother of two children. 
Five years ago she had an attack of measles, 
followed by peritonitis and diarrhoea. For 
four years she had suffered from dyspepsia, 
gastralgia, etc. Two years ago she was 
examined by a surgeon who discovered a 
loose kidney, which he anchored, also re- 



ORIGINAL COMMUNICATION. 



73 



moving the appendix. For two months 
improvement was noticed, but after that 
her colic returned. I saw her three months 
ago, and believing' that her distress came 
from the gall bladder advised operation, to 
which she consented. The usual incision 
was made and the gall bladder easily found. 
It was soft and distended with black fluid, 
resembling tar, too thick to aspirate. The 
gall bladder was therefore opened and clear- 
ed out with gauze sponges, stitched to the 
peritoneum and drained in the usual man- 
ner. The patient made a good recovery, 
has been able to eat liberally of any diet she 
likes, and has had no intimation of colic 
since the operation. 

Case VIII. — A man, 23 years of age. He 
had suffered with pain in the abdomen near 
McBurney's point, and with "stomach 
cramps" for five years. For six days before 
being brought in he had been suffering in- 
tense abdominal pain, and although there 
was no acute pain at this time, he was com- 
fortable only when under the influence of 
morphine. The usual incision was made, 
discovering many firm adhesions, from 
which the gall bladder had to be dug out. 
The appendix was pulled up into the in- 
cision, and as it was found looped upon it- 
self, was removed. The gall bladder was 
very much inflamed and diseased, and con- 
tained several ounces of black, tar-like 
fluid. Owing to the adhesions and to the 
fact that the liver was slightly movable, I 
could not attach the gall bladder to the 
peritoneum. I therefore anchored a tube in 
the gall bladder and let it drop back, plac- 
ing gauze tucks all around the tube and 
closing the incision up to the gauze. In 
twenty-four hours bile was being discharged, 
and the patient improved steadily to re- 
covery. 

Case IX. — Mrs. , .^2 years of age. 

The patient was the mother of three children. 
She gave a history of typhoid fever, colic 
beginning a year after the fever and extend- 
ing over a period of eight years. Attacks 
became more and more frequent until she 
sought relief in operation. Cholecystostomy 
was performed and eight gall stones remov- 
ed. The fistula which followed discharged 
for four months. Since that time the patient 
has been in good health. 

Case X. — Mrs. , 4S years of age. 

The patient was the mother of nine children. 
For two years she had been having severe 
stomach cramps, pain in the right hypo- 
chondrium passing to the right shoulder. 
I ler attending physician made a diagnosis 
of gall stone disease, and she was sent to 
me for operation. The usual incision was 
made. There were no adhesions and no 
fluid in the gall bladder, which was filled, 
however, with small stones, 97 in number. 



which I show you here. Bile began to flow 
before the patient was taken off the table, 
and continued for three days. After the 
effects of the anesthetic were gone the pa- 
tient showed decided delirium which in- 
creased until it became wild and maniacal, 
and continued until she died on the third 
day. 

I'rom the above cases it will be seen: 
( 1 ) That there was present in every case 
a history of intestinal infection of some de- 
scription, and that the infected gall bladder 
dated back to this infection. 

(2) That the degree of pain experienced 
has no relation to the number of stones 
present. (As shown by cases III and V.) 

(3) That a colecystitis in which no .stones 
exist, but in which the gall bladder con- 
tains a viscid fluid too thick to be forced 
through the duct will occasion as much 
pain and as much toxemia as though the 
gall bladder was full of stones. 

(4) That among the intestinal infections 
previously alluded to chronic appendicitis 
is particularly liable to be associated with 
infection of the gall bladder, appendicitis, 
loose kidney and diseases gall bladder fre- 
quently co-existing. 

(.S) That cholecystectomy should not be 
done unless there is evidence that the gall 
bladder is itself diseased. 

(6) That there is a large percentage of 
cases in which jaundice does not occur even 
though the stone be present in the common 
duct. 

( 7 ) That the surgeon who waits for the 
graver "classic" symptoms such as jaun- 
dice, clay-colored stools, enlarged liver, etc., 
which may never appear, makes a serious 
mistake and will miss the opportunity of 
relieving many patients who suffer from 
disease of the gall bladder. 

(5) That all cases, unless indications for 
immediate operative interference are present, 
should be tided over and brought to an in- 
terim operation. 



Results of Gonorrhoea! Infection in the 
Female.* 

By H. B. Weaver, M. D., Asheville, N. C. 

The census of 1900 shows that there are 
in the United States twenty-five millions of 
men over fifteen years of age, and about the 
same number of females. The ablest au- 
thorities, and the most conservative, on 
venereal diseases estimate that of this vast 
male population, 80 per cent, have been in- 
fected with the gonococcus. Then, if 80 per 
cent, of males have suffered and do suffer 
from specific gonorrhoea! infection, how 
many, oh! how many females are subjects 



*liead before the North Carolina Medic 
Society at Charlotte, N. C. 



74 



THE CHARLOTTE MEDICAL JOURNAL- 



of this baleful disease with its everlasting;, 
perilous results? 

The lait_v and a large minority of the 
medical profession have small conception 
of the insidious nature, the difficulty of 
cure, and the serious consequences of 
o^onorrhoea. It is only in the last few years 
that the o;ravity of this disease has been 
fully realized in the manifest inflammatory 
results which follow in the wake of infec- 
tion of the female pelvic organs. 

The dictum, that it is a trivial affection; 
that it is not more "than a bad cold;" and 
can be cured in a week, and allowing; those 
thus afflicted to marry is responsible, in a 
great measure, for its prevalency and far- 
reaching results. After admitting the preva- 
lency of gonorrhoea, it is astonishing with 
what stolid indifference the medical pro- 
fession still views this disease — the greatest 
destroyer of health and homes. A majority, 
doubtless, of the medical profession still 
insists that of the serious and lasting effects 
of the two diseases, — gonorrhoea and syphi- 
lis, the latter far out-weighs the former. 
But facts and figures do not warrant this 
conclusion. Old Ricord said, "A clap be- 
gins and God only knows when and where 
it will end." 

It is maintained by many prominent 
writers that gonorrhoea is practically incur- 
able. Lapthorne Smith thinks "that none 
are absolutely curable." Noble says he 
"regards it as a matter of great difficulty to 
positively eradicate gonorrhoea in the fe- 
male. ' ' Frederick says, ' ' I have never seen 
one whom I felt sure was absolutely cured. ' ' 

When we view these statements of men 
from different portions of the globe, whose 
experience and character render them en- 
tirely trustworthy, should we not begin at 
once to inquire, both from a medical and 
civic standpoint, what we shall do to miti- 
g"te, at least, the ravages of this disease? 

One of the most fertile sources which ac- 
counts for the prevalence of gonorrhoea, is 
its latency in the female organs. W. R. 
Pryor, writing on latent gonorrhoea in 
women, says, "Of 197 prostitutes, the micro- 
scope being used, gonococci were found in 
3.3i per cent, in the cervix uteri: 120 women 
showed gonococci in the urethra: and after 
five months' observation of 53 gonorrhoeic 
women, gonococci were found in the cervix 
of 75 per cent." Noeggerath long ago 
called attention to the pernicious influence 
of latent gonorrhoea, when it was known 
often to produce vaginitis, endometritis, 
and salpingitis, soon after marriage, when 
the cause of the trouble was not suspected 
either by husband or wife. Hence, in ob- 
serving the gonococcus from a bacteriologic 
viewpoint, we find that one of its most 
marked characteristics is its pedatory and 



invasive nature, extending by continuity, 
as it does, along the mucous membranes 
from one organ to another, which nature 
the traumatic and other non-specific inflam- 
mations do not possess. Not only does the 
gonococcus possess the faculty of attacking 
the leucocytes, and with other pus organisms 
produce a local infection, but, as is proven 
by Winn, there occurs general gonococcal 
injection, whose symptoms and lesions de- 
pend on absorption of a toxin ^ as well as 
direct infection of the gonococci itself. 

Gonococcal infection has no special clini- 
cal features by which we may differentiate 
it from other pyemias, and the only positive 
diagnosis that can be made is by bacteri- 
ological examination of the blood. Hence, 
it is proven by microscopic findings that the 
gonococcus penetrates almost every tissue 
of the body, and as Peterson aptly remarks, 
"The closer we study the diseases of wo- 
men" under the new light of bacteriology, 
the higher percentage of complications shall 
we find, which are the direct results of 
specific infection. 

Now what are some of the results of specific 
infection in the female? The gynecologist, 
perhaps, sees more of the serious and last- 
ing effects of gonorrhoea than the general 
practitioner. And I undertake to say that, 
from my experience, I believe the ravages 
of gonorrhoea in women are more severe 
and fatal than those of syphilis. 

When we consider that the gonococcus is 
responsible for 80 per cent, of all inflamma- 
tory diseases of the female pelvic organs; 
for practically all the pus tubes, for a large 
portion of local peritonitis; 40 per cent, of 
all blindness; 50 per cent, of sterility; for 
the despoilment of homes and happiness, 
then is it any wonder that we should assert 
that the sequels of gonorrhoea are far more 
serious and fatal than syphilis? 

Warren, in his latest work, (1902), says: 
"The chief complication and danger in 
gonorrhoea in the female is the infection of 
the uterus and the uterine appendages. 
Gonorrhoea is the chief source of salpingitis 
and pelvic peritonitis, and may cause gen- 
eral peritonitis." Byford says, "A ma- 
jority," Mann and Wathen believe "nearly 
all cases" of pelvic Inflammations are trace- 
able to gonococcal infection. Joseph Price 
declares "that in over 1,000 sections for 
pelvic suppuration, 90 per cent, were trace- 
able to gonorrhoeal infections, and that 90 
per cent, of these histories are reliable and 
clear." Coming, as it does, from such 
eminent authority, this is a remarkable 
statement, and speaks a volume in a word, 
and should claim our most serious attention. 

Endometritis as a sequel is the most com- 
mon and difficult disease to cure. And as 
Warren well says, "Patients often recover 



ORIGINAL COMMUNICATIONS. 



7S 



without known reason; bnt after apparent 
cure, the disease will often recur." And 
why? Because the gonococci have buried 
themselves deep into the sub-mucous tissues 
beyond the reach of antiseptic o^ermicidal 
medicines, where they hatch, as it were, 
new colonies, and reinfect by continuity, 
new tissue; and so the process is repeated 
until, many times, the infection reaches the 
Fallopean tubes and appenda.fjes, and no 
amount of treatment, by curretage, local 
applications or otherwise, will avail in the 
cure. A woman may have endometritis, 
with purulent leukorrhea as a symptom, for 
many years, and yet in other respects be in 
perfect health, until the mixed infection 
reaches the tubes and she then has a pro- 
nounced salpingitis. Now salpingitis is 
practically a chronic disease, and as we 
have said is almost always of gonorrhoeal 
origin. The march of gonorrhoeal salpin- 
gitis is slow, and is preceded or accompa- 
nied by closure of the abdominal ostium, 
brought about by coaptation of the walls of 
the tubes and fimlmae. Later on, the 
uterine end of the tube becomes closed by 
the exudate, pus accumulates in the tubes 
producing a tumor — by distention — and we 
have a classical fyosalpinx. This condi- 
tion, of course, can be relieved only by 
surgical interference. Notwithstanding the 
mutilation which necessarily follows the use 
of the knife, it is the only hope and means 
of a cure. 

We could multiply cases illustrative of 
the pathology and treatment of these results, 
but the details of the same are found in our 
text-books; but the point I wish to stress 
'\^\\\Q^ duty of the hour \ the manifest duty 
of the family physician in this crisis. He 
is the man behind the gun in this combat 
against the greatest scourge; and it is 
through him and by him that relief must 
come. Prophylaxis is the watchword. It 
is a campaigii of education. The people 
need instruction along these lines. They 
should be tavight the means of prevention; 
we should impress both men and women 
with the gravity of the disease, and the su- 
preme importance of permanent cure before 
contracting the marriage state; for too many 
men are permitted to marry with a latent 
gonorrhoea, and in a short time infect a 
poor, innocent wife. 

In view of these facts, it is no small won- 
der that the American Medical Association, 
at a recent session,' thought it of sufficient 
importance to appoint a committee to in- 
quire whether and when a gonorrhoeic may 
be permitted to marry, and whether the 
matter is a proper one for regulation by 
statute. 

In closing, considering the fact that 
twenty millions of men suffer from gonorr- 



hoea in the United States alone; that 80 per 
cent, of inflammatory diseases of women; 
that 40 per cent, of blindness; and 50 per 
cent, of sterility are due primarily to gon- 
orrheal infection; I say, is it asking too 
much of our committee on legislation to in- 
quire into the feasibility of legislative enact- 
ment for the prevention of gonorrhoea? 



Intestinal Indigestion: Its Dietetic and 
Rational Treatment.* 

By .T. R. Ashcraft, M. D., Monroe, N. C. 

This subject has 1)een chosen because 
there is very little attention paid to the dis- 
cussion and treatment of intestinal indiges- 
tion in our modern works upon medicine, 
and also for the reason that the malnutrition 
consequent upon intestinal indigestion is 
largely responsible for almost every disease 
that occurs in the human organism. To 
perfectly understand intestinal indigestion 
necessitates a clear conception of the chemi- 
cal composition of the common food stuffs, 
and the transmutation process that they 
must undergo before they can be absorbed 
and assimilated. This accomplished, the 
abnormal is quickly and accurately detected. 
Briefly stated, all food stuffs when minutely 
studied chemically are foutid to be composed 
of three distinct classes of compounds. 

First, the inorganic substances, or those 
which enter the system under their own 
form, pass through unchanged, and come 
out in the same shape that they entered. 
They assist the economy physically rather 
than by chemical activity. 

Second, the carbohydrate and hydrocar- 
bon compounds, such as the starches, sugars, 
and fats. All of this group act primarily 
through chemical action, being oxidized in- 
to carbon dioxide and water with the pro- 
duction of heat. 

Third, the proteids, of which there are 
two grand classes: the vegetable proteids or 
those existing in a polymeric state, and the 
animal proteids, which are in the form of 
single malecules. 

The chief causes of intestinal indigestion 
are of two kinds. First, the presence of 
micro-organisms, and the fermentative 
changes produced in the food stuffs in the 
alimentary canal by their presence. Second, 
the taking of considerably more food than 
can be digested and perfectly oxidized, and 
also the taking of food of faulty composi- 
tion. To these may be added, not as direct 
causes, but as conditions which influence 
perceptibly the perfection of digestion and 
assimilation, the kind of work which the 
individual has to perform, the lack of exer- 
cise, the peculiar conditions of the nervous 



*Read before the recent meeting of the N. C. 
Medical Society at Charlotte. 



76 



THE CHARLOTTE MEDICAL JOURNAL. 



coini)osilioii, the mental state, climatic in- 
fluence, etc., all of which play their part in 
influencing the digestive phenomena. 

The micro-organisms are apt to excite the 
more pronounced lesions of the alimentary 
canal, such as true inflammatory conditions. 
Still, it must be admitted that most of the 
abnormal fermentative processes that occur 
in the food stuffs in the alimentary canal 
have their origin in some form of micro- 
organisms. While micro-organisms are al- 
ways present in the alimentary canal, the 
normal secretions and digestive processes 
appear to be sufficient to prevent any de- 
leterious influence from their presence, or 
an}^ disturbance in the normal digestive 
phenomena. 

The most important fact, then, in the pro- 
duction of intestinal indgestion, is the mis- 
take of too much food, and especially that 
which is faulty in composition, (as the sub- 
stituting of cow's milk for human milk in 
infant feeding), or the use of vegetable or 
starchy foods in young children before the 
full development of the digestive organs. 

Tlie milk-sugar, the fat, and the proteids 
contained in the milk of the mother are in 
that condition in which the digestive appa- 
ratus of the infant can most easily transmute 
them into an absorbable state, while the 
chemical composition and proportions of the 
sugar, fat, and the proteid in cows' milk 
are differently arranged, consequently not 
available in its natural state for perfect re- 
sults in infant feeding. Consequently, the 
use of cows' milk alone is prone to produce 
digestive disturbances and malnutrition. 
When properly diluted and modified by the 
addition of other sulxstances, such as eggs 
and barley water, cows' milk can be made 
available for infant feeding. The mother's 
milk, when of perfect composition, yields 
tlie highest degree of nutrition with the 
least tax upon the digestive powers of the 
child. All deviations from this fixed plan 
of nature tends to lower the nutritive vitality 
and ultimately excites intestinal indigestion. 

In the adult, over-indulgence in food may 
be sufficient to cause intestinal indigestion. 
Ikit when this is coupled with faulty com- 
position a decided disturbance in the diges- 
tive process must follow sooner or later, 
dei>ending upon the inherent chemical ac- 
tivity of the organism. 

From a careful study of the normal pro- 
cess of digestion, it becomes apparent that a 
well-regulated mixed diet is the most desir- 
able at all times, except in early infancy, 
old age, and in some diseased conditions, 
when a purely milk diet is the most desir- 
able. A well-regulated mixed diet is one 
that contains the mineral ingredients com- 
mon to the animal organism, the starches or 
sugars, the fats, and the proteids all so pro- 



portioned that the requisite amount of heat 
will be produced by the carbohydrates along 
the line of the entero-hepatic system and by 
the fats in the lungs, and the full amount of 
constructive material supplied. 

The animal and vegetable kingdoms both 
contain these three classes of substances. 
No one of them is perfectly adjusted, how- 
ever, for the best results, although milk, so 
far as composition is concerned, comes very 
close to perfection. But milk, like every 
other single article of food, has its defects. 
Therefore, to secure the most perfect results 
the animal and vegetable compounds in 
some form should be blended together in 
outlining a well-regulated mixed diet. 

The vegetables, taken alone, contain an 
excess of the starches and sugars, and com- 
paratively little fat. Their contained pro- 
teids, which often exceeds in percentage 
that found in the animal kingdom, is less 
available for assimilation than the latter, 
because owing to its highly polymeric struc- 
ture it is less readily split up to meet the re- 
quirements of the organism and is much 
more difficult to convert into a peptone. In 
fact, the task is so great that from 1,S to 60 
per cent, passes through the alimentary 
tract without being so transformed, while 
with the animal proteids the loss is only 
from 2 to 10 per cent. 

Therefore, when living upon an exclusive 
vegetable diet a large bulk of unavailable 
material must he taken into the alimentary 
canal to secure the absorption of the requi- 
site amount of proteid substance. With 
this there is also an excessive amount of 
starch and sugar, and a deficient quantity 
of fat. If the individual has been blessed 
with a strong digestive apparatus, and can 
lead a comparatively leisurely and out-of- 
door life, many years may pass without 
material damage to the economy upon a 
purely vegetable diet. If, on the other 
hand, adverse conditions are imposed, as 
they frequently are with such a diet, intes- 
tinal indigestion and various forms of mal- 
nutrition will speedily follow. 

The liberal use of fruits is another very 
potent factor in exciting abnormal fermen- 
tation of the food stuffs in the alimentary 
tract. It is the irritation that arises from 
this disturbed action in the transmutations 
of the food stuffs that makes them laxative 
in their nature. Many of the fruits in the 
market are plucked before they have had an 
opportunity to fully ripen; in their raw state 
they are often laden with micro-organisms, 
and at best are in a state of partial decom- 
position when they are introduced into the 
alimentary canal. Therefore, they should 
be avoided as laxative agents. 

A meat diet alone is defective in that it 
does not contain any glucose compound; 



ORIGINAI, COMMUNICATIONS. 77 

but when the term "animal diet" is used in may cause an intense pain located at the 
its true meanino, it includes milk, eggs, pit of the stomach, or the pain may be more 
butter, cheese, and all the products that are or less diffused throughout the abdomen, 
obtainable from an animal source. Under In other instances, the distention simply 
these conditions, all the three classes of causes a sensation of intense discomfort. In 
chemical compounds are fully represented either case the distress continues until the 
in an animal diet, and can be secured easily gases are absorbed or discharged from the 
in the required i^roportion. alimentary canal by being passed through 

OOn the other hand, when the term vege- the rectum and anus, or by being regurgi- 
table diet is used accurately, it excludes the tated into the stomach, from which they are 
use of butter, lard, eggs, and milk, and belched up and discharged per os. This 
every animal |oroduct, even in the process localized pain and belching of gas often 
of cooking. When this is done it is found cause the false impression that the stomach 
to be absolutely impossible to construct an is at fault. The distention of the abdominal 
exclusive vegetable diet in which the three cavity often crowds up the diaphragm, 
classes of chemical compounds are properly which, together with the reflex disturbance 
proportioned. A near approach to perfec- in the nervous system, causes embarrassed 
tion in composition, even if such were pos- respiratory action, and a rapid and irregular 
sible, would still necessitate the introduction heart action. 

and transmission through the alimentary At the same time that the gas is formed, 
canal of a large amount of waste and irritat- or even without much gas formation, toxic 
ing material, owing to the great indigesti- products, or ptomaines, are produced in the 
bility of the vegetable proteids. Conse- alimentary canal. These, when absorbed 
quently, sooner or later, the system must into the circulation, together with the peri- 
suffer. It is for these reasons that the ex- pheral irritation of the nerves distributed to 
cessive use of the vegetable compounds and the alimentary canal, cause marked consti- 
fruits is so prone to excite intestinal indi- tutional symptoms and reflex nerve phe- 
gestion. In a similar manner an animal nomena. The individual may have severe 
diet may result in intestinal indigestion, not head, heart, and back-ache, and a sensation 
so much from faulty composition as by the throughout the whole system as if he were 
too liberal use of the animal food stuffs. under the influence of some toxic agent. 

O These, then, are the essential conditions There may be rise in temperature and a 
or factors that tend to, and do actually, scanty elimination of urine. All these 
cause the innumerable cases of intestinal symptoms will rapidly disappear after free 
indigestion which are constantly presenting action of the bowels, obtained through a 
themselves for treatment. mercurial; and what simulated strongly the 

The clinical feature presented in connec- beginning of an acute infectious disease 
tion with intestinal indigestion is an exceed- will prove to be simply a case of intestinal 
ingly complex and varied one. The symp- indigestion, the normal state rapidly taking 
toms may be acute or chronic in their nature, the place of the previously abnormal con- 
It is the chronic class, however, that is the dition. 

most important and the most varied in I" the chronic cases it is much more diffi- 
symptomatology. cult to exclude the stomach. In fact, in 

In the purely acute intestinal indigestion many instances it is impossible, because the 
there are so manv primary gastric svmptoms. long continued imperfect intestinal indiges- 
The food taken has passed through the tion has caused defective action on the part 
stomach without exciting gastric irritation, of the liver, pancreas, and all the organs 
When the food stuffs reach the intestinal which are concerned in digestion. A state 
tract, some two or three hours after the last of general malnutrition has been established, 
meal, or even at a still later period, an ab- and the stomach has become weak and irri- 
normal fermentation is developed. Instead table in consequence. In other instances a 
of the normal transmutation products of primary gastric disturbance will lead to in- 
digestion, which give rise to no perceptible testinal indigestion. 

symiJtoms, abnormal products are develop- A careful study into the history usually 
ed, some of which are of a gaseous nature shows that the stomach is not primarily at 
and cause considerable distention of the in- fault. The meals cause no primary dis- 
testine, thus expanding the intraperitoneal turbance or discomfort. There is no pain 
cavity, and in some instances giving rise to or vomiting upon taking food, the individual 
actual and severe pain. This is especially affected often declaring that he can eat 
true when the transverse colon becomes dis- everything, and that nothnig disagrees with 
tended and crowded upward behind the him. Yet these same mdividuals will com- 
stomach and in front of the vertebral column, plain of great discomfort m the abdomen. 
When this is the case, undue pressure is coming at varying times after taking a 
brought to bear upon the solar plexus, which meal. The intestines become greatly dis- 



78 



THE CHARLOTTE MEDICAL JOURNAL. 



tended with gas, and the victims often ex- 
perience intense attacks of pain, relief com- 
ing, after an hour or two of acute distress, 
by the regurgitation of the gas back into the 
stomach, from which it is finally belched up 
and discharged per os. Observing such 
cases closely, the tongue is found to be soft 
and flabby, often showing the deep imprints 
of the teeth along its margins. The dorsal 
aspect is more or less heavily coated with a 
dirty brown fur. The conjunctivae and 
mucous membranes in general are pale, and 
show a decidedly anemic state of the blood. 
Instead of the clear and ruddy complexion 
indicative of perfect nutrition, the skin has 
a dull, muddy appearance — one hard to ex- 
press in words, but quickly appreciated by 
the well-trained eye. The sclera and con- 
junctivae are more or less tinged yellow, 
showing that the function of the liver is 
imperfectly performed. Depending upon 
the character of the faulty action of the liver 
there will be defective bile secretion of two 
kinds. The bile may be decreased both as 
regards quantity and quality. When this 
is the case, obstinate constipation is the 
rule. When the quality of the bile is altered 
rather than the quantity diminished, it is 
often unduly irritating to the intestinal mu- 
cous membrane. This, together with the 
irritating products resulting from the ab- 
normal fermentation of the food stuffs con- 
tained in the alimentary tract, will, as a 
rule, produce a diarrhea. The diarrheal 
discharges often contain more or less mu- 
cous, without any inflammatory action in 
the intestinal canal. These discharges are 
also very irritating, and often produce con- 
siderable pain and tenesmus in the lower 
bowel and anus. The urine is apt to be 
scanty, high colored, and superacid. The 
elimination of urine is decreased, and the 
output of uric acid is abnormally large. 
The bile salts and pigments are usually 
found in such samples. Oxalic and lactic 
acids, albumin, and glucose may be found 
in some of the more aggravated cases. This 
superacid condition of the urine, together 
with the consequent malnutrition dependent 
upon the long continued intestinal indiges- 
tion, cau.ses an unhealthy condition of the 
mucous membrane lining the genito-urinary 
tract, with a hyperesthetic condition of the 
nerves which are distributed to this canal. 
The over-acid urine now acts as a constant 
irritant to this supersensitive membrane, 
thus causing considerable vesical irritation, 
painful and spasmodic action on the part of 
the bladder similar to what occurs in con- 
nection with a true cystitis. There is fre- 
quent and painful micturition. It is often 
for these symptoms that the physician is 
first consulted, and the poor victim is vigor- 
ously treated for the local condition, while 



the true cause of all the trouble passes un" 
recognized and untreated. This continued 
absorption of toxic compounds from the 
alimentary tract, together with the reflex 
nervous irritation, keeps the liver continu- 
ally over-taxed. The central nervous system 
is poorly nourished and unduly irritated. 
As a necessary sequence, we have a large 
and varied train of nervous manifestations. 
There may be: intense headache, continuous 
or intermittent in character; mild or severe 
neuralgic attacks confined to single nervous 
trunks, or multiple in distribution, simulat- 
ing in some instances a rheumatic attack. 
There may be insomnia, or a strong ten- 
dency to suicidal mania. There may be 
the opposite, or a stupid, .sleepy condition, 
almost reaching semi-coma. In other in- 
stances all the symptoms common to the 
most aggravated neurasthenia are directly 
traceable to the prolonged intestinal indi- 
gestion, abnormal fermentation, and toxic 
infection. 

All the non-parasitic skin affections are, 
in a large measure, only the s>'mptoms of 
intestinal indigestion, and not independent 
disease. Thus we find the phenomena of 
intestinal indigestion presented in one 
great complex of symptoms, which are of- 
ten misleading, and, by their local inten- 
sity at one point or another, often lead to 
absolute errors in diagnosis, followed by 
unsatisfactory results from the best efforts 
in the line of treatment. Accuracy in diag- 
nosis in these cases can only be secured by 
a full comprehension of the physiological 
laws which govern the processes of digestion 
and assimilation by a careful study of the 
patient's habits, and of the method of the 
develojjment of the symptoms, so that effects 
are not mistaken for causes. 

The prognosis in these cases is good if 
they are recognized early and carefully 
treated upon a physiological and rational 
dietetic and therapeutic basis. The prog- 
nosis is less favorable when they have l^een 
allowed to go on for years, until some of the 
secondary effects become in themselves al- 
most diseased processes. Then it becomes, 
in some instances, almost impossible to ef- 
fect a cure. 

The chief line of treatment to be employ- 
ed in combating intestinal indigestion con- 
sists in regulating the diet in accordance 
with the well-known physiological laws that 
govern animal life. The physician must be 
thoroughly conversant with the chemical 
composition and possibilities of the various 
food stuffs. A careful study must be made 
of each case separately and every idiosyn- 
crasy for or against all food products accu- 
rately noted. The urine must be carefully 
examined, not so much for albumin and 
glucose, as to determine the comparative 



ORIGINAL COMMUNICATIONS. 



output of urea and uric acid, and also to 
ascertain what other forms of incomplete 
katabolins may be present in the renal secre- 
tion. This accomplished, the diet must be 
regulated absolutely both as regards quantity 
and composition. The particular kind of 
food must be prescribed with just as much 
precision as the medicaments that are used. 
At the same time the urine must be exam- 
ined frequently and the exact modifications 
in the elimination of the katabolic products 
carefully noted. When this is done system- 
atically the exact changes in the system 
can be determined accurately from day to 
day. 

In prescribing a special diet one principle 
should always be kept in mind, which is 
that a well-adjusted mixed diet, when it can 
be perfectly digested, is the height of per- 
fection. It will secure the most complete 
transmutation of the food stuffs, and in con- 
sequence absorption and assimilation will 
reach the highest standard, and perfect 
health will be established. 

In almost every instance of intestinal in- 
digestion the mixing of the various kinds of 
food stuffs, as is commonly done, will not 
be tolerated by the enfeebled and already 
defective digestive apparatus. So long as 
this plan is pursued the case will not im- 
prove. In all cases of intestinal indigestion, 
from the mildest to the most intense type, 
it is absolutely necessary to limit the diet to 
a greater or less extent, both as regards 
quantity and the kind of food stuffs taken. 
In many instances it may be necessary to 
limit the diet to a few articles of food, as 
milk, barley-gruel, or broths; very limited 
amounts, so much so that, at times, the 
patient may even loose flesh, while the de- 
fective digestive function is being slowly 
but surely re-established. The fancy of the 
patient must not be considered, but that 
form of diet must be chosen which will be 
most effectually digested and yield the 
largest amount of nutrition. It may be wise 
at times to take out in a large measure the 
fat or the sugar from milk. This can be 
accomplished by ordering an exclusive 
skimmed-milk or butter-milk diet, or, on 
the other hand, a diet of kumyss or matzoon, 
the former taking out the fat and the latter 
the sugar. When any one of these limited 
plans of dieting is resorted to, the heat pro- 
duction necessary to keep the nervous 
mechanism fully in action falls to too low 
an ebb. When this is the case a little alco- 
hol must be added, as it can be oxidized 
and produce heat without expending any 
digestive energy, thus making up in a 
measure for the defective heat production. 
In other instances the plain milk diet will 
accomplish the best results. This is espec- 
ially so when the milk is taken warm, or 



with a little lime-water, ])arley-\vater, or 
egg-water added. Other cases will do better 
by excluding milk in any form, and limit- 
ing the diet to broths, gruels, eggs, etc. 

An important point, which must be kept 
always in mind when a patient is placed 
vipon an exclusive animal diet of any kind, 
is the well known chemical fact that all 
animal food stuffs contain a very low per- 
centage of the nucleo-albumin — not enough 
to produce the hemoglobin and lecithin as 
rapidly as they are decomposed in the ani- 
mal economy. This being the case, even if 
the subject is not already anemic, there is a 
tendency for him to become so upon an 
exclusive animal diet. Consequently, some 
hemoglobin -forming compound must be con- 
tinuously administered to supply the de- 
ficiency. 

As a vegetable class of food stuffs contain 
a large jiercentage of the nucleo-allniinin, it 
should be our aim to introduce .some form 
of vegetable compound in limited amount 
as speedily as the digestive system will 
tolerate their presence without exciting un- 
due fermentation. By so doing we supply 
most effectually the natural and only com- 
pound so far known to physiological chem- 
istry out of which the physiological economy 
can easily and rapidly increase the hemo- 
globin and overcome the anemia. Many of 
the succulent fruits and green vegetables 
contain the largest percentage of this nucleo- 
albumin. When they can be tolerated, they 
are valuable for this purpose; but, as a rule, 
they tend to excite so much abnormal fer- 
mentation of the food stuffs in the alimen- 
tary canal that they must be excluded ab- 
solutely. The vegetable substances that 
furnish a full supply of nucleo-albumin 
without abnormal fermentation are barley, 
rice, wheat, and rye; barley and rye being 
especially valuable on account of the high 
percentage of the nucleo-albumin. 

The mixed diet which most effectually 
meets the foregoing demands, as soon as it 
can be tolerated, is one composed of milk, 
eggs, meat, and toast, or stale bread and 
butter. Under the heading of meat is in- 
cluded fish of all kinds, game and poultry. 
Beef and mutton are taken, however, as the 
standard from which all the other forms of 
meat are calculated. If one particular form 
of meat cannot be tolerated, another kind 
must be substituted. In like manner, if 
milk and eggs cannot be utilized, some 
other form of food stuffs must be substituted. 
The same rule holds true in the selection of 
the vegetable substances. When these de- 
tails are all observed carefully, a well- 
regulated mixed diet can usually be .secured 
— one that will furnish the requisite amount 
of all the chemical substances that are re- 
quired to sustain the animal economy and 



80 



THE CHARLOTTE MEDICAL JOURNAL. 



Still keep well within the limits of the taring industries over a considerable of a 
oxygenerating capacity. great State's surface; the digging of exten- 

The medical treatment of intestinal indi- sive tunnels under towering mountains, be- 
gestion consists in the use of a little dilute neath great cities and below the road-beds 
hyd.ochloric acid, either alone or in combi- of huge rivers in order to gain time and 
nation with some pepsin, preferably alone, distance in transportation problems; the 
to augment the transmuting or peptonization turning to practical value of all the discov- 
of the proteids of the stomach. This accom- eries in science to the conservation of energy 
plished, the amount of work imposed upon and the i^roduction of force in new forms — 
the intestinal digestive function is reduced these are peculiarly enterprises characteristic 
to the minimum. Transmutation of the of the age in which we live, 
food stuffs in the intestines can be greatly Medicine, like other branches of science, 
augmented by the use of a few grains of has not stood still, but rather by great leaps 
inspissated ox-gall and pancreatic extract and bounds it has gone rapidly forward in 
three times daily before eating. The undue the past few decades until today its votaries 
fermentation is also checked in part by these rank first among the educated and cultured 
substances. To this may be added animal men of every intelligent community, 
charcoal, resorcin, -salicylic acid,naphthalin. And yet while our art has been immeasur- 
phenacetine, or any one of the numerous ably improved and perfected, it is to be re- 
intestinal antiseptics, so-called, that may membered that the very constantly increas- 
suit the fancy of the prescriber. None of ing complexity of modern life is daily pre- 
them will produce any profound and start- senting for solution new problems in the 
ling results, but they assist in a measure to manifestations of and the therapy of disease, 
subdue the abnormal fermentation. When and in what is more vital import we now 



the liver is performing its function abnor- 
mally, and the tissues are stained with bile 
pigment, a mercurial of some form is in 
order, and is always followed by an improve- 
ment in the general and local condition. 

When constipation is a prominent symp- 
tom, it must be overcome by some laxative 
agent, which acts upon the normal plan of 
nature. 



believe, in its prophylaxis. Most prominent 
among the problems for medical men and 
sanitary inventors of the future to solve will 
be the perfection of details to render practi- 
cal and useful to the race certain technical 
principles which we now well understand. 
The science of medicine is, in many of its 
administrative details, as yet wholh' an ex- 
perimental one. In many things the pure 



Caffeine and strychnine are valuable science has advanced to points where as 

agents in intensifying nerve innervation, working, not theorizing men, we have been 

They also augment the intestinal circula- unable to place in practical operation some 

tion, and cause a more rapid and equable of our most valued theories. In no depart- 

distribution of the blood throughout the ment of activity is this proposition more 

body. true than in the varied sanitary pro]:)lems 

. ♦ with which modern society in the infinite 

Remarks on Railway Sanitation, with variety of its conditions is daily confronted. 



Special Reference to the Dangers of 
Present Methods of Disposing of 
Huntan Excreta, and Sugges- 
tions for Improvement.* 



By J. Howell Way, M. D., Waynesville, N. C. 
Surgeon Southern llailwa.\ :' Member North 
State Board of H'-a 



Comparatively recently when more than 

ninety per cent, of the American people 

lived most literally the simple life in rural 

districts, with ample grounds about them, 

the problems of sanitation which now so 

perplex and complicate the situation the 

Carolina State Board of H'-alth; Secretary urban builder must overcome, were not even 

?P^. mL^w?^ As8oci;ition (Va N. C. and thought of. Likewise when the first simple 

b. L.); Member Araerican Medical Association: -i j • a • -.i • r 

American Public Health Agsociation, &c., &c! '^adway appeared m America withm a few 

, miles of the historic ground we stand upon 

in the multitanous avenues of human in this our eleventh annual session, with iw 

activity the modern trend of both human modestly constructed cars, there were fets 

thouglit and endeavor IS constantly forward or no sanitarv felitures essential for consid- 

ancl upward. The thousands of acres of eration and elucidation; but with the enor- 

tertile soil which has only recently been mous growth of the railwav svstems of the 

wrested from extreme aridity and trans- countrv and their constantly increasing 

formed into sources for the cultivation of elaborateness of construction shown in every 

vitality sustaining products; the harnessing detail of the splendidlv conceived modern 

o he mighty cataract of Niagara and its cars, there have arisen numerous sanitarv 

utilization 111 varied and sundry manufac- problems, all of which as yet have not been 

*Kead at the eleventh annual session of the ^^olly satisfactorily solved in practical de- 

Ass-ociatiou of Surgfeons of the Southern Rail- t^^^' though theoretically we are advised of 

way held in Charleston, S. C, May 22-24, 1906. the deficiencies and the points needing fur- 



ORIGINAL COMMUNICATIONS. 



tlier development. 

Without discussing^ the various ethical 
propositions involved, all aj^ree the domi- 
nant spirit of the times demands that rail- 
way corporations shall at all times and 
under all possible circumstances provide for 
the convenience and comfort, as well as the 
safe and quick transit of its patrons; meet- 
ing each of these requirements with the ver\^ 
hij^hest grade of equipment which modern 
science and skill has developed. Among 
the necessary reciuirements demanded, and 
most properly so, is that railway systems 
shall so construct, equip and manage their 
stations, cars and road-beds in such manner 
as will be most conducive to the health of 
their passengers, and with ample regard to 
putting into practical operation the more 
advanced theories of sanitary science.! 

Among the first things which impress the 
traveler as a defect, the elimination of which 
would be contributive to the comfort of the 
traveling public, is the wasteful consump- 
tion of fuel, which instead of a completed 
combustion turns loose to float backwards 
into the eyes, ears, noses and throats of pas- 
sengers large quantities of imperfectly oxi- 
dized gases, laden with smaller particles of 
unburnt fuel, irritating to an intense degree 
all exposed mucous surfaces, and financially 
wasteful from the transportation company's 
view-point. Much inventive genius has 
l)een exercised in efforts to remedy this de- 
fect, but as yet it remains, despite the 
numerous inventions claimed as adjusting 
it, one of the unsolved ])rol)lems of practical 
railway operation. 

With the constantly increasing care and 
attention to sti'ict cleanliness in all its de- 
partments, which I believe the modern home 
receives, it is but natural that the public 
should demand a relatively high degree of 
cleanliness in the care of stations and cars. 
The offices and waiting rooms of the better 
hotels are always, as a rule, cleanly kept, 
and it is done by constant unremitting care. 
Cars and rooms in stations accessible to the 
general public can be continually under- 
going the cleansing process, and the fact 
that the companies are constantly working 
to keep things neatly is an influential factor 
in promoting care in the passengers to per- 
sonally co-operate in the work. In the 
larger city stations I do not believe there is 
very frequent cause for just complaint of 
the sanitary attention paid to stations and 
trains, but in the smaller cities and on cars 
frequented by purely local travel, there is too 
often seen a lack of proper effort to keep 
them clean and the sanitary conveniences 
fit for use by individuals of decent personal 
habits. Now as a matter of fact the charge 
for transportation is quite as much on local 
lines, and a proper consideration of the 



rights of the traveling public should induce 
the corporations to extend the system of 
cleaning cars and stations to local trains 
and rural communities instead of as at pres- 
ent neglecting these and bestowing all this 
attention in the way of thorough cleansing 
and disinfection to the through trains and 
the cars used more exclusively in and about 
the larger cities of the country. The ten- 
dency to construction of cars as regards 
their interiors along plain, simple lines, 
with few panels and insterstices in the decor- 
ations to catch and retain dirt is an indica- 
tion of the fact that railway people are con- 
stantly on the alert to the betterment of all 
possible details of the operating service, 
either for the benefit of the patrons or the 
improvement of the service. In connection 
with this matter of interior finish, it is of 
interest to remark that up to the present 
time there does not appear to have been de- 
vised any material as well adapted for seats 
as the rather old-fashioned plush which we 
have been condemning for the.se ten years 
past, largely because it was the custom to 
abuse it. Metal or hardwood seats, ideal 
for street cars and possibly other cars mak- 
ing only short runs, assuredly are not com- 
fortable for through trains or long distances. 
Leather is likewise objectionable and it ap- 
pears that plush will likely continue, at least 
for a time, to be used, and with the freciuent 
cleansings which the coaches on the better 
lines now receive, plush is really not so ob- 
jectionable as it was considered some years 
ago. With the formaldehyde and com- 
pressed air treatment daily applied to remov- 
able seats and backs there is apparently no 
good reason why plush seats can not be 
kept free from infection. As indicating that 
plush is not necessarily a greater carrier of 
possible infection than smoother surfaces I 
noted with much interest some experiments 
reported a few months past at the meeting 
of the surgeons of the Erie system. Briefly 
si^eaking, such experimental investigations 
showed that smears of microbial infection 
placed on different materials like glass, 
smooth wood, leather, and other substances, 
along with plush, the disinfection under 
both formaldehye and air-blast to have been 
more complete and prompt in the case of 
plush than in either of the other materials 
subjected to the test. In this connection a 
suggestion to the traveling public may be 
pardoned. It is this: People who travel 
have a duty to the railways in the matter of 
cleanliness in cars and stations in avoiding 
tlie making of unnecessarv litter, in not 
placing shoes which they would never think 
of putting on the chairs in their own or their 
friends homes on the car seats, and remem- 
bering the air space on all cars is essentially 
a limited one, to avoid coughing and sneez- 



82 



THE CHARLOTTE MEDICAL JOURNAL. 



iiig without covering the face. 

The ventilation problem of railway cars 
is a most serious one and well "worthy of all 
the careful attention it has received in past 
years, though despite the existence of more 
than two score of patents, which I am ad- 
vised are contained in the offices at Wash- 
ington, is yet in an unsatisfactory state. A 
brief reference to certain primary conditions 
reveals why this should be so. An average 
passenger car contains about four thousand 
and three hundred cubical feet. Now with 
its full complement of sixty-four passengers 
aboard, each, for the purposes of perfect 
ventilation requiring thirty feet of fresh air 
each minute, it follows there should be taken 
from and replaced every minute in round 
numbers two thousand feet of air — almost 
one-half of the entire cubical capacity of the 
caf. Considered for a moment it is seen 
this is a relatively rapid air-change, and 
when we add to it due regard for the fact 
that the coach will a part of the time be 
standing still, while at others it is moving 
at rates of rapidity varying from nothing to 
sixty miles an hour, we can better appreciate 
tlie complexity of the problems involved. 
To accomplish perfect ventilation necessi- 
tates a rapidity of air movement which is so 
active as to be noticable, and this means 
sitting continuously in a draft which is out 
of the question. To not receive sufficient 
pure air and to breathe the dust and com- 
bustion gas-laden air means the tens of 
thousands of minor coughs, colds, and 
bronchial irritations with innumerable piieu- 
moiae, which are contracted annually in 
traveling as an immediate result, besides 
the possibility of often j^reparing the pul- 
monary mucosa for tubercular infection. 

The Dudley method, devised by Dr. Dud- 
ley, Chemist of the Pennsylvania system, 
and which is being quite generally installed 
in their new coaches, is perhaps one of the 
most practical methods yet invented for day 
and parlor cars, but on account of diminish- 
ed space is not applicable to Pullman or 
trolley cars. In this system the air is taken 
from the roof of the car through covered 
downspouts and communicating with chan- 
nels running the whole length^ of the car 
and covering the heating pipes is distributed 
from beneath the seats into the aisle. The 
outlets for bad air are the familiar screened 
deck openings. Dr. Ilurty, the efficient 
vSecretary of the Indiana State Board of 
Health, has suggested a modification of the 
Dudley system which he claims will permit 
the closing of the deck openings, thus elimi- 
nating the great sources of discomfort aris- 
ing from the entrance of smoke and dust 
from that quarter. In his arrangement the 
essential changes of the Dudley system, in 
addition to closing the deck openings, is to 



provide for the elimination of the foul air 
through the exit openings which are placed 
near the floor within the closets and wash 
rooms. 

The newer type of Pullmans with their 
comi^arativeh^ smooth interiors, the use of 
linoleum instead of carpets in the closets 
and lavatories, the abolition of the feather- 
duster and its replacement with dampened 
towels to remove the dust, the careful atten- 
tion paid the linen, the covering of the 
blankets with fresh sheets, and the frequent 
airing and sunning now claimed to be given 
the blankets in addition to their regular 
treatment with formaldehyde, these efforts 
coupled with the regular systematic fumi- 
gating of the cars, all attest the disposition 
of the managers of this branch of the service 
to promote a relatively high standard of 
railway sanitation and a commendable re- 
gard for the health rights of their patrons. 
The ventilation of the ordinary passenger 
coach is even more acutely so than that of the 
sleeping car with its lessened air space, and 
remains yet to be satisfactorily solved. 

But these various matters upon which I 
have briefly and in a way incidentally 
touched are sanitary considerations about 
which there is, and has been for a number 
of years, much interest taken, and in the 
correct solution of which many minds are 
even now actively engaged. Hence it is 
not an unreason al^le expectation to indulge 
that the near future will reveal practical 
methods of combating the discomforts and 
dangers of combustion gases, of dust, and 
that the ventilation problem will likewise 
respond to the inventive genius of men 
thoroughly alive to the demands in that line. 
However, there is to my mind another and 
a hitherto practically neglected source of 
danger to the traveling public, to which I 
desire to more especially invite your atten- 
tion. I refer to the con.'?tant daily, hourly 
pollution of the road-beds of railways with 
human faeces and urine. Aside from a 
notably valuable and highly instructive 
paper published some three years since by 
Dr. Paul Barringer, formerly of North Caro- 
lina but now of the teaching faculty at the 
University of Virginia, I am npt aware that 
the profession has specifically had its atten- 
tion directed to this probable source of in- 
fective danger. Dr. Barringer's article did 
not at the time of its publication elicit the 
amount of professional consideration so im- 
portant a matter should have received, and 
though some three years have passed since 
its publication, I am not aware that there 
has been any specific attention given this 
matter in so far as evidenced by the develop- 
ment of any literature upon the subject 
other than the careful investigations recent- 
ly uudertakeia by Dr. Ilurty, of the Indiana 



ORIGINAL COMMUNICATIONS. 



83 



State Board of Health. From the writings 
of each of these gentlemen I shall not hesi- 
tate to quote freely. Dr. Barringer's atten- 
tion was first directed to this subject on 
having the experience of being called to at- 
tend on the train a patient whom he diag- 
nosed as having a well-marked case of 
typhoid fever, in which "the diarrhoea and 
the straining was so constant that in the 
language of the ])atient himself, he 'had 
been upon the stool one hundred and fifty 
miles' "! On casual view one might think 
this an almost isolated or an unusual in- 
stance of a patient's traveling about the 
country with typhoid fever, but when we 
think for a moment and recall the fact that 
thousands of people travel all over the 
country every year who almost immediately 
on arriving at their destinations, or very 
shortly afterwards, consult a jjliysician who 
finds them at the end of the first, or at the 
beginning of the second week of typhoid 
fever, and that other thousands suffering an 
attack of fever away from home are removed 
to their homes or to other climes to conva- 
lesce during the post-febrile period — a time 
now well known when the urine is often 
laden with the specific bacillus and hence 
highly infective. The probabilities of pollu- 
tion of railway road-beds with typhoid fever 
infection can more fully be appreciated in 
recalling that in the year 1905 there were 
used in the United States in round numbers 
about seven hundred million railway tickets 
in traveling approximately two billions of 
miles over the little more than two hundred 
thousand miles of railway in this country. 
The average distance traversed by each pas- 
senger was slightly less than thirty miles. 
At this rate something like seven thousand 
persons would traverse each mile of railway 
one time, but with seven hundred million 
passengers traveling during the year, it is 
evident that each mile of road-bed was 
covered on an average by about ninety 
thousand persons. "How long would a 
road-bed receiving the discharges of this 
number of persons be likely to escape infec- 
tion?" (Barringer). 

Additional emphasis is given to these facts 
studied in connection with the average an- 
nual death-rate from typhoid fever in the 
country at large, which is shown to be 46.2 
per hundred thousand of population. With 
a well-known average mortality rate of ap- 
proximately ten per cent, in all cases of 
enteric fever, this indicates an average an- 
nual occurrence of fully four hundred and 
sixty cases of typhoid fever for each hundred 
thovxsand population. Now there can be no 
legitimate question that the number of ty- 
phoid infected people who travel are very 
great. People taken ill away from home 
voluntarily and instinctively turn both 



thoughts and feet homeward, contract doc- 
tors in the employ of mining and other cor- 
porations the diagnosis being made or even 
suspected, eycourage patients to go home 
when possible. The same is true of prac- 
titioners in many hotels of resort as well as 
other places: in fact the patient is always as 
a rule only too willing to accept such advice 
if only coupled with the suggestion of a 
possibly continued illness. Again we know 
that the years of greatest susceptibility to 
the contracting of typhoid fever are the 
years of vigorous youth and younger man- 
hood and womanhood when the "lust of 
travel burns most freely in the blood, ' ' hence 
it is easy enough to see why ,so many typhoid 
fever patients are found traveling. Now if 
the proportion of sick to well among the 
passengers of our railways is equal to the 
above mentioned proportion of sick and 
well, that is four hundred and sixty-two to 
each one hundred thousand of the popula- 
tion at large (audit is unquestionably larger 
rather than less!), then with more than 
ninety thousand passengers to each mile, 
annually, we would have approximately 
four hundred patients with typhoid fever 
infection in their bodies traveling annually 
over each mile of railway in the United 
States! Would not a continuance of this 
for even a very few years result in the com- 
plete infection of a road-bed? And if so, 
what is the condition as regards danger of 
typhoid fever infection from the older road- 
beds of the country, which have been in 
constant daily or hourly use for a generation 
or more? Have we reason to hope they are 
by any possibility free of permanent infec- 
tion? The use of the word permanent infec- 
tion is advisedly, l^ecause despite the expos- 
ed position of the faecal deposits on the 
road-beds and the (beneficently for us) de- 
structive influences exerted upon any con- 
tained germ life by the all-powerful influ- 
ences of direct sunlight, and the free, open 
circulation of air in mitigating or destroying 
the viability of the typhoid infection, the 
practical fact must remain that the cool, 
moist soil underneath the cross-ties and bal- 
last of the railway road-bed, covered in part 
daily year in and year out with the albumi- 
nous fluids of human excrement, affords a 
fine natural culture medium for the bacillus 
typhosus once planted and revitalized con- 
stantly by reinfection. Taking this view of 
the subject there is ample ground for the 
belief that the older road-beds of the coun- 
try are in all probability for the most part 
of their entire length permanently infected, 
and unless some radically different method 
of disposing of human excrement on our 
railways is adopted, the country will natur- 
ally eventually be traversed in all directions 
with narrow lines of permanent infection 



S4 



THE CHARL,OTTE MEDICAL JOURNAL. 



constitutin.e: an ever present menace to the 
public health. The practical application of 
this statement, as well as its reasonableness, 
is apparent to all, for the popvUation of this 
countrj^ each year travel more and more. 

Recently compiled statistics by the In- 
diana State Board of Health (not yet pub- 
lished) shows there is a considerably greater 
degree of prevalence of typhoid fever in 
railroad towns and in farm houses contigu- 
ous to lines of railway than in other places, 
and it is also believed that a further study 
of these statistics will show the families 
living near the railways suffer more fre- 
quently than those remoter situated. Cer- 
tainly I believe there is excellent ground for 
the generally growing impression that track- 
hands show a larger percentage of cases of 
typhoid fever than the public at large. 

The acceptance of this theory of typhoid 
fever pollution of the railway road-beds by 
human faeces and urine being discharged 
thereon from the sanitary closets of moving 
cars adds another to the methods of ration- 
ally accounting at times for the apparently 
obscure origin enshrouding the genesis of 
cases of typhoid fever, and other enteric 
irritations as well. Certainly all of us as 
practitioners attend cases of typhoid fever 
where so far as we were enabled to learn 
there had apparently been no other probable 
source of infection. It enables us to satis- 
factorily account for the development of 
certain cases otherwise unaccounted for. 
Incidentally, I might mention the fact that 
it tends to relieve some health resorts of the 
odious suggestion made at times by practi- 
tioners remote from them who upon seeing 
a patient ill with typhoid fever, who had at 
any time comparatively recently visited a 
resort town (even though the town is gener- 
ally known to be quite free of typhoid cases) 
promptly advises his patient that he had 
contracted his disease while at the health 
resort. How often do our confreres in their 
efforts to specificall}^ localize a source of in- 
fection for the benefit of the patient's peace 
of mind unjustly asperse the fair reputation 
of places known to enjoy a remarkable de- 
gree of health fulness. 

Again admitting the force of the sugges- 
tions herein made as to the dangers of soil 
pollution of road-beds, the important ques- 
tion becomes, what shall we do about it? 
Tlie answer is evident. Stop the pollution! 
How? The details must be worked out by 
tlie expert car-builders; suffice it to say 
some form of retention closet which can be 
emptied at suitable distances and places 
without offense to the senses or dangers of 
local contamination. A retention closet with 
an appropriately constructed hoiiper, with 
arrangements for flushing the closet imme- 
diately after use with a covering of dry earth 



or similar material, with possibly the addi- 
tion of a chemical disinfectant, would meet 
the indications. Cremation in the engine 
furnace would solve the. problem as to 
methods of disposal in an ideal way; how- 
ever, the manifest mechanical difficulties in 
the way of putting this idea into practical 
operation would be yery great, possibly in- 
superable without much expense. 

There is one other suggestion I wish to 
make in this connection: It is the desira- 
bility of thorough and complete laboratory 
studies, with proper control experiments be- 
ing made in various sections of the country 
with the soil from road-beds of our older 
railways, with the view of positively de- 
termining the possible extent of the dangers 
suggested in this paper. I suggest that here 
is a most inviting field for laboratory work- 
ers, and one in which I believe the results 
will prove as fruitful a source of beneficent 
results as did the study some years ago of 
the soil of city streets and common dirt 
about stables in relation to the question of 
tetanus infection. If the preparation of this 
paper, imperfect and incomplete as it is, 
incites to effort along this line of scientific 
investigation, I shall be amply repaid for 
my effort, firmly convinced as I am that the 
continuation of the present methods of dis- 
posal of human faeces and urine by the 
common carriers of the country is practically 
as palpable a violation of all modern sani- 
tary principles as would be the publicly 
emptying of night-soil upon the public 
streets of the cities, as was commonly prac- 
ticed by our forefathers in the davs of Henry 
the Eighth. 

The Colony Treatment of the Insane and 
other Defectives." 

By Dr. P. L. Murphy, Morganton, N. C. 

The subject of this paper might be called 
employment as a means of treating and car- 
ing for the insane and other defectives, the 
colony being the means of finding agreeable 
and profitable work for the inmates. 

To many of you a description of what is 
meant by the "colony treatment" is needed 
to fully understand the subject. 

As the expression is used in this paper, 
and as it is generally understood, it means 
the erection of buildings some distance from 
the central hospital plant and placing farm 
working patients there, to be under the con- 
trol and management of the hospital officers. 

Without discussing the origin of the idea, 
and with no reference to Gheel, it is suffic- 
ient to say it was begun in Germany in the 
sixties, and that it has slowly found its way 
into other countries. 



*R'3ad before the North Carolina Medical So- 
ciety, Charlotte, N. C. 



ORIGINAL COMMUNICATION. 



85 




FIRST BUILDING AT THp: COI^ONV. 



Such a colony was estal)lislied in connec- 
tion with the Morganton Hospital three 
years ago, or rather it was ready for occu- 
pancy about that time. It took several 
years of talk to get the idea adopted, and as 
many more to get the colony built. The 
plan of conducting it l)y the Hospital au- 
thorities was largely expertimental, and was 
made to suit the people of western North 
Carolina, but it is after all a modification of 
the original German conception. 

The first building- was for 30 men with 
rooms for a man and his family, the man to 
have general supervision of the place and 
the wife to cook and do the general house- 
hold work. Afterwards a small cottage 
was built for the manager and his family, 
and his rooms were used for patients, and 
later still another building was erected, so 
that now 7.5 patients can be accommodated. 
It would have been much better to have 
limited the numl)er to 30 as first intended. 
No single colony plant for the insane should 
much exceed thai number. As many colo- 
nies as are needed may be had if land is 
sufficient, the number depending on the size 
of the hospitals, as only a certain proportion 
of patients, about 25 per cent., can be thus 
cared for, at the outside 40 per cent. 

The colony buildings, out-houses and 
surroundings at the Morganton colony, were 
made as near as possible like the farm 
houses in this section of the State. This 
was done to give it a home-like appearance. 



and the management has been to make each 
one of the patients feel at home; they are 
free to sit on the porches and the lawn in 
the summer, in the sitting room before open 
fires in the winter. They smoke, have 
games, read or do what pleases them during 
these hours of recreation. They have their 
own garden, orchard, vineyard, berry 
patches, poultry, pigs and cows, which they 
attend to. Every effort is to make each one 
feel that these things are his own, he can 
gather berries and pull the fruit when he 
wants it or as he pleases. Every one is ex- 
pected to do something if no more than pick 
up chips for the cook. The first party of 
patients sent to the colony — about 15 — were 
quiet, industrious men, who were expected 
to be the nucleus of the organization. After 
these became accustomed to their new sur- 
roundings, others who were quiet and who 
had some remnant of mind left, but who did 
little or no work, were tried. These readily 
dropped into the ways of those who had pre- 
ceded them, and who had set the pace. 
Further experiment was made by sending 
those who seemed incurably demented, in- 
capable by reason of their weakened minds 
of doing any kind of work. Most of the 
last mentioned had been residents of the 
Hospital for years and years, i«i whom the 
last vestige of hope for any improvement 
had long vanished. Strange as it may seem 
to you, as it did to us, acquainted with these 
men and their disease, they immediately 



86 



THE CHARLOTTK MEDICAL JOURNAL 




TWO COTTONY BUILDINGS. 



went to work and are today profitably em- 
ployed. They have gained in health and 
self-confidence; they are happier l)ecause 
they feel there is yet something in life for 
them. 

It may occur to some to ask why these 
men had not been sent out to work before 
and given an opportunity. It has been the 
invarialjle custom since the Hospital opened 
to try to induce every one to engage in some 
kind of employment, and it had been tried 
repeatedly with these very men with com- 
plete failure. To conjecture why they were 
willing to work in one place and not in an- 
other might be profitless, it is sufficient to 
know it is true. 

After the work was well under way it was 
strange to see the development of the differ- 
ent fancies of the different men. Each one 
was allowed, as far as possible, to follow 
his own inclination and to select his own 
work. One fancied painting and white 
washing and building fires under the heat- 
ing apparatus. He studied economy in the 
use of fuel as much as the average head of 
a family, and is as intelligent in his work 
as could be expected of any ordinary man. 
Another patient has l^ecome greatly inter- 
ested in poultry, and shows more than ordi- 
nary intelligence in following his bent. He 
reads journals on poultry, and not only 
builds coops, box nests, &c., but has actual- 
ly invented several useful contrivances. 
Another hauls wood to the kitchen in a little 



wagon he made himself, and so on almost 
indefinitely. 

A l)rief report of two cases will partly il- 
lustrate what has been done. The follow- 
ing is quoted from a report to the Board last 
December, and is the case of a boy "who at 
\^ years of age came to the Hospital, in 
June, 1895. He had a form of insanity 
( Dementia praecox), which rarely improves, 
indeed, its course is generally to deteriorate. 
This boy was no exception to the rule, and 
he grew worse and worse until hope for any 
improvement had been_ given up. Three 
months ago he was sent to the colony, bvit 
it was considered a desperate chance. To 
the astonishment of every one he immediately 
began to improve, and this has steadily 
gone on until today he is a strong, vigorous 
young fellow of 23, full of hope and energy, 
whereas when he went there he was dull, 
indifferent and listless; he never inquired of 
his home or home>people, and seemed to 
care for nothing. Recently he has written 
home telling of his marvelous improvement 
and of his joy in life. He testified as 'one risen 
from the dead', after ten years of mental 
darkness. It is not certain that the im- 
i:)rovement will continue, in fact, it is not 
expected, but even if he improves no more, 
great good has been accomplished in reliev- 
ing this young fellow of such suffering as 
we shudder to think of." Six months after 
this report was written, this young man had 
gained but little, and it is probable he is as 



ORIGINAL COMMUNICATIONS. 



.S7 




GKNERAL VIKW 



well as he will ever be. He enjoys life as 
much as the averasje man, taking part and 
interest in base-ball and other amusements 
we are able to furnish our people. 

The second case is of a man who was 
committed to the Hospital in November, 
1899, this being- his second admission. He 
complained of great discomfort in his head, 
which he described as being unbearable, so 
much so that he begged to be killed. His 
appetite was poor, he was anaemic and 
greatly run down in health, and evidently 
was a great sufferer. Every effort to relieve 
him failed. We were sure if he could be 
induced to exercise he would improve, but 
nothing we could do would cause him to 
take the slightest interest in anything. He 
was finally forced to go out with the work- 
ing party, but he would lie on the ground 
complaining of his head. He was a few 
months ago sent to the colony with nine 
other men almost as bad as he. To the 
amazement of us all the man went to work, 
his health improved, the pain and discom- 
fort disappeared, his face is ruddy, and he 
gives every evidence of health and vigor. 
He works cheerfully, seems perfectly satis- 
fied, never complaining of any bad feeling, 
and is as comfortable as he can be. 

These two cases are only two of many as 
unpromising who have been greatly relieved 
and some few cured by the "colony treat- 
ment." 

All this seems so simple, and is so obvi- 



viously the right course that we wonder why 
it had not long ago been tried. 

Two ideas are prominent in this system, 
the first to find agreeable, healthful employ- 
ment for the patients and to give them a 
home. 

The working class, while too defective to 
take up the burden of life, are yet appreci- 
ative of their surroundings and of most 
things that make life happy to the people in 
the outside world. They require the mini- 
mum amount of care and discipline, and 
with this given they conduct themselves as 
well, indeed, better than the same number 
of sane men. Some under this treatment 
recover that otherwise would not, l^ut the 
majority must remain, this being their refuge 
and their home. How much need, there- 
fore, that every effort should be put forth to 
make it pleasant to these affiictedmen. 

In general hospitals and institutions for 
children in reformatories we have a different 
class to deal with. A large number under 
one roof is not so objectionable, but these 
cases of chronic insanity are not children in 
whom the desire for a home is small, nor 
are they malefactors in prison for punish- 
ment. 

You will pardon a little digression, which 
after all leads to this subject from another 
and a practical standpoint. 

In North Carolina there are not less than 
4000 white insane, of this number 1 500 are 
in the two hospitals, leaving 2500 uncared 



88 



THE CHARLOTTE MEDICAL JOURNAL- 




PKACH ORCHARD VXD tVARDKN. 

for l)y the State. To properly house all on the tax-payers may be lightened. With- 

these people means the expenditure of a out discussing the question of the increase 

million dollars, and the annual cost of main- of insanity, there can be no doubt that there 

taining them will be $.S()0,0()0. It is well is an increased demand to |have these per- 

then to consider carefully how this burden sons cared for and properly so. All insane 




PATIiCNT.S WOKKI 



A.SriilCKRIKS 



ORIGINAL COMMUNICATION. 



S9 




CUiynVATING STK.' 



persons are danj^erous in some degree to 
their nei.ia:hbors, more so to themselves. In- 
sanity is the cause of many suicides, while 
sexual crimes, arson, assaults and impos- 
tures are often committed by those mentally 
deranoed. 

Too often families are ruined by some in- 
sane memljer, the bread winner having to 
devote his whole time to the control of wife 
or child, or a crime is committed and every 
energy and the savings of a life time must 
be devoted to the cost of courts. Whole 
communities are frequently terrorized by an 
insane person, and the lives of the women 
and children made miseral)le. 

Only a few recover at once or die. The}" 
live on for years not only imbecile and 
helpless themselves, but a burden on the 
family and community, a severe drain which 
must tend to weaken the general welfare of 
the State. 

These are sufficient reasons for you as 
physicians, men of standing in your re- 
spective communities, not only to make 
yourselves familiar with this disease in order 
that you may x^rescribe intelligently for 
those suffering from it, but to use your in- 
fluence, which is great, to see that proper 
provision is made for them by the jiublic. 

Much insanity is caused by alcohol and 
drugs. This touches you more closely, for 
you are largely responsible for these habits. 
You may do something l:)y preventing un- 
wise marriages of those whose heredity is 
not good. 

It should be your special province to 
recognize dangerous symptoms in time, and 
by prompt action prevent suicides and acci- 
dents, and to send to the hospitals at once 



these patients who have infinitely more 
chances to recover when placed under the 
care of competent alienists. 

The conclusions we reach are that 2.S00 
white insane people in North Carolina are 
uncared for, that a great outlay of money 
will be required to build for this number and 
after that the nev^er ending expense of main- 
taining them begins. If it can be demon- 
strated that the colony system is the best and 
the cheapest, it chould be adopted. 

There is an end to the willingness and 
even the ability of the tax payers to provide 
for the defectives in expensive hospitals and 
asvlums, and it is clearly the duty of those 
who have these matters in hand to use 
proper economy. What is done by the Leg- 
islature will depend on the demand of the 
people and the wisdom of the Legislators. 
It will require great deliljeration and the 
wisest action to solve this question. 

In North Carolina no more hospitals 
ought to be built at present, those now in 
existence ought to be enlarged if possible. 

Unfortunately, at ]\Iorganton no more 
land can be purchased and that institution 
cannot, with advantage, be greatly increas- 
ed in size. The last opportunity to buy 
land there has been allowed to pass. This 
s to l)e deplored, for the plan there has been 
so successful, and it is so well understood 
that much was hoped for in the judicious 
extension of these colonies. 

Much more might be said on the general 
sul\iect of caring for the insane, but time 
forl)ids. Perhaps at some future time this 
will be taken up and discussed. 

Hospitals for the insane cannot properly 
care for epileptics or idiots. I used the term 



90 



THE CHARLOTTE MEDICAL JOURNAL. 




'LAYING BASEBALL. 



idiot in the sense in which it is defined bv 
the North Carolina Statutes, "a person born 
deficient or who became deficient ]:)efore the 
completion of the twelfth year of age." 
OMany of these defectives are capable of 
doing common labor, and can be made very 
nearly self-sustaining if properly managed 
in such a colony for the insane as has been 
described. In many of the States where 
this is tried, it has been successful. In 
North Carolina, where we have such good 
climate and where land can be purchased 
cheaply, more can l^e done than in other 
less fortunate communities. I believe in 
the cotton and truck section of the State 
such a colony could be nearly self-sustain- 
ing; but leaving that out of the question, 
there can be no doubt it is best for these 
people to live out door lives with proper em- 
ployment. I would like also to enlarge on 
this feature of my paper, but time will not 
permit. 

I trust, gentlemen, that you will become 
enough interested in these subjects to give 
them your hearty support. If you do, then 
the labors of those of us who are immedi- 
ately responsible will be greatly lightened, 
and these afflicted fellow-citizens will be 
happier and your State will be a better 
State. 



The Moist Surgical Dressing.* 

By B. R. Graham, M. D., Wallace, N. C. 

In considering the advantages of the 
moist surgical dressing, it may be stated in 
the outset that in the treatment of compara- 
tively small and simple wounds, such as the 
ligation of arteries in continuity, in hernio- 
tomy, or in the extirpation of small tumors; 
wounds which we can reasonably assume 
are sterile, we may hermetically close by 
dry dressings with the almost universal as- 
surance of primary union. But in the treat- 
ment of the vast majority of wounds pre- 
sented to the surgeon we find the conditions 
very different. The wound is either already 
suppurating, or if of recent origin is covered 
with dirt, coal dust, or oil, and sometimes 
with various materials for the control of 
hemorrhage. It is in this class of wounds 
that the moist dressing finds its special 
adaption. 

Of the various materials used for dress- 
ings, gauze or cheese cloth first selected by 
Lister himself has remained the most highly 
prized and most universally used. 

To answer the requirements of modern 
surgery, dressing materials must possess the 
following qualities. 

(1) They must be absorbent to a high 
degree. 



*Ivea(l before the recent meeting of the North 
Carolina Medical Society at Charlotte, N. G. 



ORIGINAL COMMUNICATIONS. 



91 



(2) They must be protective and iioii- 
irritative. 

(3) They must l^e antiseptic. 

(4) They must possess the equality of re- 
maining; asejitic, even if saturated with dis- 
charges. 

(.5J Facility of application and of re- 
moval. 

In the light of these requirements let us 
briefly consider the relative merits of the 
two forms of dressings; the moist and dry. 

We were formerly taught that we should 
exclude moisture from our dressings chiefly 
because moistvire was thought to furnish 
more favorable conditions for the develop- 
ment of the germs of inflammation. But 
experience has taught that these strenuous 
organisms are not so easily conquered, and 
further that one of the most efficient means 
of combating their invasion is by free 
drainage. 

Drainage from the earliest days of .surgery 
has been insisted upon as one of the chief 
factors of controlling inflammatory and sup- 
purative processes, and naturally those 
dressings which promote free drainage are 
manifestly superior to those which more or 
less retard it. We have all seen the dry 
dressings become clogged with blood and 
other exudate and no longer afford drainage, 
allowing the wound to be bathed in pus 
which cannot easily escape. 

When we have to deal with suppurating 
wounds of this character, with secretions 
which are thick and viscid and often con- 
taining considerable masses of decomposing 
detritus and slough, it is evident that evap- 
oration and inspissation become a drawback. 
As soon as evaporation leads to crusting, 
the discharges liecome sealed, and retention 
with all of its harmful consequences results. 
This condition is manifestly impossible with 
the moist dressing. 

In considering the next ([uality which the 
ideal dressing should possess, that of non- 
irritability, we find the moist dressing far 
superior to the dry. A dressing which is at 
all times soft and jjliant and capable of 
adapting itself to the contour of the tender 
structures without friction and one which 
never affords mechanical irritation b}^ dried 
and hardened discharges is much to be pre- 
ferred to one not possessing these qualities. 

Granting that all dressings are aseptic 
we are chiefly concerned with the best 
method of maintaining this asepsis, even 
when saturated with discharges. Itis clearly 
evident that an asejjtic dressing saturated 
with an efficient antiseptic theoretically and 
practically fulfills this reciuirement. 

In the matter of removal we find the moist 
dressing again sui)erior to the dry. The 
dry dressing of iodoform gauze becomes 
tightly adherent and almost impervious to 



water, and it is with difficulty softened and 
removed. These conditions are entirely ob- 
viated by the moist dressing. 

The antiseptic solutions used to moisten 
the dressings may be varied to meet the 
fancies of the surgeon. For all practical 
purposes a saturated solution of boric acid 
in sterile water, or a solution containing 
eciual parts of above and grain alcohol are 
as eff'ective as any and are to be recommend- 
ed in question of economy. The dressing 
may be protected and evaporation prevented 
by oil silk, or equally as well and more 
cheaply by oil paper. 

In the treatment of the majority of wounds 
the application of the moist dressing, pre- 
vention of evaporation by impervious cover- 
ings, the frequent change of dressings, 
accompanied by a thorough cleansing of the 
wound, represents the order to be followed. 



Malaria as Seen in Gaston County.* 

Ry Dr. T. C. Quicknl, Stanley, N. C. 

Malarial manifestations are very preva- 
lent in some localities in Gaston county, 
and in these localities only a minority of the 
population escape infection. While it is 
not very fatal, it incapacitates more adults 
during the summer months than any other 
disease that prevails in our county. It is 
manifested in the remittent and less often 
in the intermittent t>'pe, and very rarely, if 
at all, in the pernicious form. A true case 
of hemorrhagic fever is an unusual occur- 
rence in Gaston county. During my six 
years of practice in a section where malaria 
is quite prevalent I have not encountered a 
single case of pernicious malaria. That it 
should be so uncommon in Gaston county 
has led me to believe that there is some fac- 
tor in its etiology which we do not compre- 
hend, and which is unable to develop in our 
highest altitude or different soil as contrast- 
ed with the more alluvial and marshy re- 
gions of our State. That hemorrhagic fever 
is due to the same form of malarial Plas- 
modium as the remittent and intermittent 
types, without any additional factor, I am 
unable to believe. If this is the true 
cause and there is nothing specific in its 
etiology, why should it be a very rare dis- 
ease in Gaston county? 

As I have already stated malaria in its 
less malignant form is our most common 
disease. Our people have hard chills, high 
fever, and profuse perspiration, which indi- 
cate that they are heavily loaded with ma- 
larial poison. We have some of those wise 
and stingy souls, who either believe that 
they can cure themselves or wear out the 



*Read before the North Carolina Medical 
Society at Charlotte, N. C. 



THE CHARLOTTE MEDICAL JOURNAL. 



disease without seeking professional instruc- 
tion, who go on for weeks and months with- 
out the germs or their poisons being elimi- 
nated from their blood. They show by their 
general appearance a saturated condition. 
W'e see evidences of great destruction of the 
haemoglobin of the blood, and other evi- 
dences of the destructive work of malarial 
poisoning. We have undrained swamps 
and acres of marsh lands, with quantities 
of decaying trees and vegetable matter in 
them, that produce a host of mosquitoes; 
we have villages and thickly settled com- 
munities near these; every condition favor- 
ing the production of malaria in its most 
sevei^e form, if there is no other factor in its 
etiology other than an unusually heavy in- 
vasion of the malarial organisms with which 
we are at the present familiar. There must 
be some specific factor in its cavisation. If 
this is not the case I do not see why we 
should not have malignant malaria in Gas- 
ton county in the same proportion as they 
do in the more alluvial portions of our State. 
Evidently there is something specific which 
has not been recognized in its causation, 
and whatever it may be, whether it is a dis- 
tinct form or a special host for its transmis- 
sion, or some peculiar climatic condition, 
it does not invade the higher altitudes of 
our Piedmont regions. 

That there is no systematic effort being 
directed towards the prevention of malaria 
in this part of our State is to be deplored, 
and especially so because of the ease with 
which it could be curtailed. At least half 
of the breeding places of the Anopheles 
could be destroyed by a small amount of 
work on the part of our land owners. We 
often find small ponds of stagnant water 
near the homes of our rural people that 
could be drained by only a small amount of 
work. Small pools near where the stock 
are watered, old cans, old buckets, and tubs 
are allowed to remain about the premises, 
and are filled with water after each rain; 
various other small quantities of water which 
seem insignificant, but still large enough to 
send forth colony after colony of malaria 
carrying mosquitoes. Often times these 
small ((uantities of water are the only places 
where the>' are propagated near the homes 
of our malarial patients; and with a little 
care all could be easily destroyed. 

The laity needs to be instructed regarding 
the importance of carefully supervising the 
destruction of these various breeding places 
of the inoculating agent, and 1 am encour- 
aged to believe that they would do a great 
deal of effective work in the prevention of 
this very prevalent disease. 
7 rcatfucnt. 
That quinine is a specific in the remittent 
type of malaria I have found to be correct. 



And l.S grains given in divided doses dur- 
ing the five hours just preceding the time 
for the expected chill is usually sufficient to 
prevent its occurrence. When we have pre- 
vented the chill and subsec[uent fev^er I 
direct a tonic of iron and arsenic. I also 
direct that 15 grains of quinine be taken 
every seventh day for four weeks, after 
which if there has been no recurrence I con- 
sider it safe to allow its discontinuance. In 
giving quinine I wish to emphasize the im- 
portance of having it in a form easily disin- 
tegrated, so that the stomach may have a 
fair chance to dissolve and absorb it. To 
give it in solution is the most certain, and 
when I am anxious to secure rapid and cer- 
tain action I employ it, but under ordinary 
conditions the powder or freshly made pills 
will dissolve and be satisfactory. Stock 
pills and capsules where there is a deficiency 
of the secretions will often prove a disap- 
pointment. The intermittent type does not 
yield so readily to cjuinine after the first 
week, hence the importance of pushing this 
remedy during this time. 



Tile Diagnostic Value of the Leucocyte 
Formula in Pcrlussis.-churchill (Journal 
American IMedical Association) mentions 
the importance of an early diagnosis of per- 
tussis, both because of the serious character 
of the disease and because of its dissemina- 
tion in the early stages. The writer has 
collected 100 cases of whooping cough in 
which differential blood counts had been 
made, with the view of determining the 
diagnostic value of such a count. Me be- 
lieves that a general leucocytosis is present 
in almost all cases of whooping cough; that 
a lymphocytotis is found in about S.5 per 
cent, of cases at some time during the course 
of the disease; that a lymphocytosis is found 
even more certainly during the early or 
catarrhal stage, over 90 per cent, showing 
the phenomenon at this time. The presence, 
therefore, of a lymphocytosis in a child 
with a hard, persistent cough is a factor of 
great diagnostic value. It is also of prophy- 
lactic importance, iiiasmuch as it can be 
used to prevent the spread of the disease by 
leading to the prompt isolation of the pa- 
tient. The age ofvthe child must be taken 
into consideration in estimating the import- 
ance of the leucocyte count. 

(ras from cocoanut oil, says the Medical 
Times, has been adopted by the Philippine 
officials, owing to the (Oriental coals being 
expensive and deficient in gas-producing 
qualities. The oil is fed slowly into strong 
cast iron retorts after the latter are brought 
to a red heat. This produces a high quality 
of illuminating gas quite free from smoke 
and tar. 



EDITORIAL. 



93 



Charlotte Medical Journal 

EDWARD C. REGISTER, M. D., Editor. 

No. .'^6 South Tkyon Stkeet. - - - - 

ClIAKLOTTE. N. C. 



SOURCES or ERROR IIMJKIMARY«IN)!\L.Y- 
SIS PROM DRUGS. 

Ill recent years testing the urine for albu- 
min, sus:ar, phosphates, chlorides, sulphates, 
urea, etc., has become a routine practice 
with most physicians, but little attention is 
given to the errors that may arise from the 
patient taking medicines which are elimi- 
nated by the urine in a modified form, giv- 
ing reactions which simulate those of other 
pathologic or normal constituents. The 
effect of drugs, vegetable, mineral and syn- 
thetic, on the urine of those to whom they 
have been administered is a matter of great 
importance to the diagnostician and may be 
the source of grave errors, especially in the 
examination for life insurance. The com- 
Ijlexity of the synthetic derivatives as they 
are formed from a comparatively small num- 
ber of primary groups is very complex, and 
their decomposition products combining 
with organic secretions are eliminated in the 
urine in combination with the bases and 
acids found in health and disease; others 
are eliminated unchanged or combined with 
normal constituents. The wide spread use 
of hypnotic and headache powders by the 
laity render the liability of error from their 
presence in the urine very great, some of 
them reducing h^ehlings solution, others be- 
ing i^recipitated by nitric acid, which would 
mislead the examining physician to a serious 
extent. 

Certain drugs as alkaloids, essential oils, 
and resins produce a reaction with nitric 
picric, acetic acids, Tanret's solution, etc., 
almost identical with that given by traces 
of all)uniin; the phenol compounds and 
synthetic alkaloids will, if taken in svifEci- 
eut quantity and over a period of time, 
produce an albuminuria which disappears 
on stopping the drug. Of the alkaloids 
cinchona, caffein, morphine, piperidine and 
piperazenine are the only ones likely to be 
taken in sufficient doses to produce a reac- 
tion in the urine. 

The fallacies that may occur in the test- 
ing for sugar are more numerous, and great 
care should be exercised in making a diag- 
nosis of diabetes when the quantity of sugar 
eliminated is small. There are more than 
fifty synthetic drugs that will reduce copper 
solutions if taken in large enough do.ses. 
liesides these a concentrated urine, or one 
containing a high percentage of uric acid or 
creatinin, will reduce I'ehlings to a marked 
degree; it is probable that the most reliable 



test for sugar is fermentation. Thirty grains 
of the commonly used synthetics of the 
acetanilid and phenetidin group will pro- 
duce a marked reduction of copper in the 
morning urine. Salol, thenapthols, benzoic 
compounds and some of the phenols and 
cresols will impart reducing properties to 
urine after a few days use, the amyl deriva- 
tives, antipyrin, chloral compounds, anti- 
pyrin derivatives all drugs having an active 
deoxidizing nucleus, which will often cause 
a reduction of both copper and bismuth a 
few hours after administration. Chloral 
and its compounds, aldehydes, pheuylhy- 
drazine derivatives, affect the polariscope 
tests for sugar, as well as causing reduction 
of both copper and bismuth. After anes- 
thesia the urine often reduces b'^ehling, es- 
pecially if chloroform has been used as an 
anesthetic. 

Rhubarb, cascara, senna and santonin 
cause a deep yellow coloration of the urine, 
which may be mistaken for bile pigment. 
The guiacum test for blood is valueless if 
the patient has been taking iodin in any 
form. 

It is evident from the above that before 
placing confidence in the ordinary chemic 
tests used iti urinary analysis it is of im- 
portance that the patient should not have 
taken any medication for at least 24 hours 
before the test is made, and that careful in- 
quiry should be made as to diet. 

THE URINE IPS MBP^TIG DISEASE. 

The hourly variation in the elimination 
of urine, of urea and of pigments depend 
largely upon the diet, and in health is regu- 
lar, but in diseases of the liver there are 
many variations which are of diagnostic 
value. Under normal conditions the urine 
excreted during the day is larger in quan- 
tity than during the night, especially is it 
increased in the hours following a meal, 
but should there be increased tension in the 
portal system the absorption of water from 
the intestine is interfered with and the 
normal increased elimination does not take 
place. At the same time the night urine 
may be much increased at the expense of 
the day excretion ; with this inversion of the 
normal rhythm of quantity there is also an 
inversion of pigment elimination, the night 
urine being of a lighter color than that ex- 
creted during the day. The post prandium 
urine is usually lighter in color, but -in 
hepatic insufficiency the urine passed after 
meals is often deeply colored, showing that 
the stimulating effect of digestion upon the 
biliary secretion has caused more pigment 
to pass into the circulation. 

This inversion of the secretion and color- 
ation occurs in other diseases, especially 
those of the heart and kidneys. In the liver 



94 



THE CHARLOTTE MEDICAL JOURNAL. 



it siijuifies a cliroiiic condition, such as cirr- 
hosis or a functional troul^le of the biliary 
function, catarrhal or lithaic icterus, or 
icterus due to hepatic congestion of cardiac 
orio^in. In hepatic insufficiency there is 
usually a decreased elimination of uitros'en 
due often to a decreased diet; the urea nitro- 
gen may fall to 70 per cent. (40 per cent, is 
on record in a case of phosphorous poison- 
ing) of the total nitrogen while the propor- 
tion of ammonia nitrogen may be much 
increased. Indican is present in excess, as 
is also urobilin; the latter's presence in the 
urine in appreciable quantities being proof 
positive of hepatic insufficiency. The total 
carbon in its relation to total nitrogen is re- 
duced, while bile pigment may be present 
in traces. In hepatic congestion the urhie 
is diminished in quantity, the sp. gr. is in- 
creased, the color varies with the amount of 
bile pigment and urobilin present hypoazo- 
turia is the rule; urid acid is increased, also 
the chlorids and phosphates, the latter hav- 
ing been reported as being eight times the 
normal in one case; albuminuria is not un- 
common. Alcoholic hypertrophic cirrhosis 
shows the inversion of the rliythm of the 
elimination pointing to portal hypertension; 
the urine is hyperacid, highly colored, the 
urea diminished, uric acid and ammonia 
increased, ])hosphates and chlorids dimin- 
ished, carbon increased, tyrosin, leucin, 
albumin, peptone, glucose may be present. 
The toxicity of the urine is much increased, 
in alcoholic atrophic cirrhosis the same 
conditions are found, but to a more marked 
degree. 

In icterus the urine is diminished in quan- 
tity to 250-500 ccm., highly colored from 
the presence of bile pigments and acids; the 
urea elimination is reduced with a general 
retention of waste products of metabolism, 
wliich are freely eliminated as soon as con- 
valescence begins, the bile pigment and 
acids disappearing also, but the amount of 
urobilin remains very large for sometime. 

From the condition of the urine in hepatic 
disease it is evident that a sufficient excre- 
tion of normal bile is of the utmost import- 
ance; to ol)tain which the administration of 
sodium glycocholate mass is specially indi- 
cated, the salt being the natural solvent for 
the various substances to be eliminated, and 
at the same time being the only true chola- 
gogue that we have at our disposal. 

THB TRAINSPI.AINTATIOIN Of=ORQAINS AS 
A SURGICAL. POSSIBILITY. 

That transplantation of vital organs from 
one animal to another of a different species 
is possible, has l)een recognized for some 
time. 

That the procedure might l)e used in sur- 
gery and that by its means diseases now 
considered of necessity fatal, might be ren- 



dered amenable to surgical treatment, has 
been the thought of a long line of investi- 
gators. 

The work done in this direction, though 
small in amount, has been productive of 
some results that, taken as a whole, seem to 
point to the certain development of homo 
and hetero transplantation of organs as regu- 
larly recognized surgical measures. 

The most complete set of experiments are 
those carried out by Carrel and Guthrie, 
and now being continued by the same in- 
vestigators. Their first work was the trans- 
plantation of the thyroid gland of the dog, 
l)y uniting the principal artery and vein of 
that gland with the carotid and external 
jugular respectively. 

The attempt was a failure owing to errors 
in asepsis. About the same time they trans- 
planted the kidney of a dog into the neck 
of the same animal. The extirpated kidney 
with its vessels and ureter was introduced 
into a cervical wound; the renal artery 
joined to the carotid and the renal vein to 
the jugular, by end-to-end anastamosis. 
The distal end of the ureter was united to a 
small opening in the skin, located a little 
above the sternum, the circulation was re- 
established and seemed to be normal. After 
a few hours a clear fluid began flowing 
from the ureter, but sepsis also prevented 
the further observation of this experiment. 

Recently the same observers have reported 
marked success in the surgical and physi- 
ological results of their endeavors. I'rom a 
critical standpoint it is difficult to under- 
stand how such procedures can ever become 
of direct clinical value, in the light of our 
present knowledge of embolus and thrombus 
formation. 

The comparatively large number of deaths 
resulting from pulmonary and c ardiac em- 
bolism which follow ordinary operations in- 
volving large and impoTtant blood vessels, 
would naturally lead to the supposition that 
deliberate anastamosis of veins and arteries 
of different calibre and from different ani- 
mals, must be followed by the production 
of thrombi at the point of anastamosis, even 
should complete stasis and coagulation be 
avoided. 

The intima of ai;teries is of so delicate and 
fragile a character that the slightest trauma 
here is usually followed by unfavorable 
complications. Thrombosis in general may 
be caused by one or more of the following 
factors; alteration of the blood current, 
change in the vessel walls, or alteration of 
the blood itself. Following an arterial anas- 
tamosis, then, we have at least two of these 
factors active, and the result seems obvious. 

The above difficulties all apply to auto or 
homo-transplantation. Now, when hetero 
transplantation is considered, many more 



EDITORIAL. 



95 



complications are to be encountered. For 
surgical purposes hetero-transplantation 
would, for obvious reasons, be the only- 
available method. 

It is, of course, true that in many, indeed, 
in the vast majority of cases, the blood 
serum of animals of a given species is hemo- 
lytic and toxic to animals of another species. 
It is also well authenticated that blood 
serum under similar conditions is capable 
of producing a distinct coagulation ferment 
with the resulting intra-arterial clotting. If, 
in addition to these two deterrant agents, 
the actual physical difficulty of performing 
such operations upon the human being be 
taken into account, with the tremendous 
amount of room for errors in asepsis, to- 
gether with the extreme and hitherto abso- 
lutely unsatisfactory technique of anasta- 
niosis of large blood vessels, it is to be feared 
that while it remains a desideratum to be 
hoped for, hetero-transplantation of organs 
seems a far distant boon to humanity. 

NIXED INFBCTIOINS WITH TYPHOID AND 
PARATYPHOID BAGIL,L.I. 

The frequent reports which we see of a 
mixed infection of the Bac. Typhosus and 
one or the other of the paratyphoid bacilli 
are probably due to the fact that these or- 
ganisms will mutually interact with refer- 
ence to anti-sera. Only a very few cases of 
true mixed infection are on record, while 
there are many authentic reports of typhoid 
fever blood reacting to paratyphoid bacilli 
as well as to the true typhoid organism. 
The reverse is also known. That mixed 
infections can occur is possible, of course, 
but the probability is remote. One infection 
may be engrafted upon another, and Brion 
and Kayser ( Deutsches Archiv. f. klinische 
Medizin, 1906, LXXXV, p. 52.S ) report a 
true 'A' paratyphoid infection followed by 
a typhoid bacillus infection. The blood of 
the patient during the first part of the illness 
agglutinated only the 'A' organism, while 
later in the attack when the Bac. Typhosus 
was the causative factor, this blood clumped 
both the typhoid bacillus and the 'B' para- 
typhoid. This coagglutination was not mis- 
taken for a mixed infection since it l\as 
been shown by many authors that the Bac. 
Typhosus and the Bac. Paratyphosus 'B' 
will often react to the same typhoid blood, 
albeit the latter in somewhat lower dilutions. 
Therefore, should a blood react alone to the 
'A' paratyphoid organism it is suggestive of 
such an infection: The 'B' paratyphoid 
reaction often occurring in typhoid blood is 
only suspicious when it persists in higher 
dilutions than the reaction with the Bac. 
Typhosus. If a blood agglutinate the ty- 
plioid bacillus persistently at a dilution of 
1-100 and the paratyphoid bacillus in per- 
sistently lower strengths, the diagnosis 



usually rests with the former. It is some- 
times important to establish this diagnosis 
since infections by the Bac. Paratyphosus 
'B' are more acute and have a slightly 
higher mortality than typhoid cases, prob- 
ably because this 'B' organism is nearer to 
the meat-]5oisons biologically. 

MEDIGIINAL. TREATMENT OF OAL,E- 
STONE8. 

The theories of the formation of gall- 
stones are still exercising the pathologists, 
while the problem of their solution in situ 
remains unsolved by the clinician, who is 
turning his cases over to the surgeon. 

Cholesterine gall-stones appear to be the 
result of an infection, producing an inflam- 
mation of the walls of the gall-bladder, and 
a reduction in the total solids of the bile, 
especially of the bile acids, with an increase 
of cholesterine. 

Ilerter and Wakeman have found that 
they produced the same results by injecting 
mercuric chloride into the gall-bladder of 
starving dogs, showing that bacterial infec- 
tion is not necessary to produce a condition 
of bile favorable to the formation of gall- 
stones. 

The questions arise, why should an in- 
flammatory condition of the gall-bladder 
reduce the quantity of bile acids, and in 
what part of the organism are the bile acids 
formed? Crofton has produced both bili- 
rubin and glycocholic acid by the action of 
hemoglobin in the presence of glycogen or 
glucose and trypsin; he has also shown that 
the bile acids exist normally in the blood in 
very small quantities. It seems improbable 
that the bile acids should be formed in the 
gall-bladder, it being more likely that they 
are formed in the liver or in the blood in 
very snrall quantities. As they are reab- 
sorbed from the intestinal tract a very small 
amount is required to keep up the quantity 
necessary under normal conditions to hold 
the chole.sterine and bile pigments in solu- 
tion. 

The liver contains the bile acids, at least 
that quantity which is reabsorbed from the 
intestine, and it is possible that the newly 
formed acids are excreted into the gall- 
bladder from its mucous membrane, so that 
any inflammation of that membrane pre- 
vents their excretion. If this is so, inflam- 
mation of the gall-bladder would gradually 
reduce the ciuantity of bile acids in the bile, 
only that which was reabsorbed from the 
intestine being available, which would grad- 
ually decrease in quantity. 

Whatever may be the method by which 
the bile acids are reduced in quantity in 
gall-stone, the fact is patent that if there is 
a sufficient ciuantity of glycocholate in the 
bile, the cholesterine will be held in solution 
and gall-stones will not be formed. Austin 



96 



THE CHARLOTTE MEDICAL JOURNAL. 



(Journal of Medical Research, 1902) ana- 
lyzed the bile from fistulas, the result of 
operations for g^all-stones when there was 
complete occlusion of the duct. In three 
analyses he obtained the following results: 

Total Cholalic Choles- 

solids. Mucin. Water, add. terine. Lecithin. 

"A" 1^28 1.66 984.7 0.061 0.378 0.710 

"B" 14.19 ... 985.8 0.093 0.243 0.736 

"C" 10.68 1.32 986.3 0.048 0.323 Trace. 

Showing that cholalic acid is from one- 
third to one-eighth of the cholesterine, while 
according to Ilammersten and others, nor- 
mal bile contains twelve to thirteen times as 
much cholalic acid as cholesterine. It is 
also worthy of note that the mucin is only 
one-fourth the normal amount, showing that 
the gall-bladder was affected. The above 
analyses of Austin seem to prove conclus- 
ively that cholesterine gall-stones are the 
result of a deficiency of glycocholic acid. 

It naturally suggests itself that the prophy- 
laxis of gall-stones is the administration of 
glycocholate of soda by the mouth, since it 
will then be absorbed from the intestine, 
entering the gall-bladder from the liver, and 
hold the cholesterine in solution . The ques- 
tion as to the possibility of dissolving gall- 
stones in situ has recently been investigated 
by Vaughan Harley and Wakelin Barratt 
(Journal of Physiology, 1903). They in- 
serted large gall-stones into the gall-bladders 
of healthy dogs with antiseptic i^recautions, 
and found that in ]jeriods from six months 
to one year the gall-stones had entirely dis- 
appeared, showing that the healthy bile of 
the dog is capable of dissolving cholesterine 
stones. They also inserted gall-stones into 
the gall-bladder, and at the same time pro- 
duced cholecystitis, with the result that the 
gall-stones remained unaltered. Unfortun- 
ately no analysis of the bile was made in 
these cases, but from the work of Herter 
and Wakeman and the analyses of Austin 
it seems certain that in the cases where 
cholecystitis was produced there was a de- 
ficiency of bile acids, as in no other way is 
it possible to explain the solution of the 
stones in the normal bladder and their re- 
maining undissolved when cholecystitis was 
present. 

From the above experiments it is evident 
that by the administration of glycocholate 
of soda it must be possible to dissolve gall- 
stones in the bladder, and even when chole- 
cystitis is present glycocholate of soda is 
indicated not only as a prophylactic but as 
a solvent for stones already present, and that 
in those cases only in which there is occlu- 
sion of the gall-duct is surgical interference 
permissible. 

CONGKESSMAIN E. Y. WEBB'S "PATENT 
MEDIGIINE BlbE" NOW A EAW. 

One of the final acts of the houses of Con- 
gress was the enactment into law of the now 
famous Pure Food Bill, and while shorn in 



Committee and the perils of protracted de- 
bate of some of its most beneficent provis- 
ions, it still remains a wise a.iid timely piece 
of national legislation and a substantial 
victory for the medical men of the country, 
who have for some years past in medical 
journal articles, in society discussions, and 
last, but by no means least, in the physic- 
ian's way of influencing and developing 
public sentiment, in the daily walk and 
conversation of some thousands of practi- 
tioners throughout the length and breadth 
of the United vStates. 

Congressman E. Yates Webb, of the 
Ninth N. C. District, early in the session 
introduced and waged valiant warfare to 
secure the enactment of a measure compell- 
ing the manufacturers of secret medicines 
to publish their formulae on the package so 
that all could be advised of the character of 
the preparations too often containing alco- 
hol and other narcotics in dangerous quan- 
tities and masquerading as simple, harmless 
"blood purifiers," "liver medicines," or 
"nerve tonics." This bill immediately be- 
came the subject of most vigorous attack 
from the representatives of the various pro- 
prietary interests and their active lobby at 
the Capitol. On the other hand active 
medical men from all parts of the country 
expended their energies in its support. 
Among the latter was the efficient Secretary 
of the North Carolina State Medical Society, 
whose Remarks before the Committee of 
Congress was ireproduced in these columns 
in our June issue, and were also made a 
part of Mr. Webb's printed speech in ad- 
vocacy of the bill. Finally Mr. Webb suc- 
ceeded in having his measure incorporated 
as a section of the Pure Food Bill, thus 
securing added strength for its enactment. 

In the vissicitudes of debate and enact- 
ment in the two Houses of Congress the 
Webb Bill was shorn df many of its most 
vital provisions, by way of elimination and 
amendment. For instance "sufficient alco- 
hol for preservative purposes' ' was i^ermitted 
without any recognition of the same in the 
published formulae, and similar shrewdly 
pl\rased passages inserted in the bill at the 
option of the "patent medicine lobby. ' ' Mr. 
Webb watchfully looked after the measure 
closely, and in the final conference had the 
pleasure the day before adjournment of see- 
ing each of the vital points of his measure, 
for which he had so vigorously contended, 
re-inserted in the bill just before it became 
a law a few hours prior to the final adjourn- 
ment of Congress. Under the provisions of 
the law, as finally enacted, alcohol, mor- 
phine, cocaine, and all other "habit-forming 
drugs" are, when sold in medical com- 
pounds, necessarily compelled to have their 
presence and quantity announced in the 



EDITORIAL. 



printed formula on the label of the container, but at the same time cunningly bindinj,^ the 
This special measure of Mr. Webb's was doctor hand and foot to examine at the 
declared in the final debate upon the Pure company's reduced rates, and in exchang^e 
Food Bill, by the distinguished Illinois tendering his professional vanity the showy 
member, who had the final passage of the tinsel of "chief examiner," which is not 
bill in charge, to "be the most important worth to the physician the paper it is written 
provision in this whole bill." upon. That the recent legislative enact- 
All honor to Congressman K. Yates Webb, ments in New York, following quickly on 



of the Ninth N. C. District, a faithful, 
earnest worker, and a man whom the medi- 
cal profession will remember for his persist- 



the heels of the colossal insurance frauds, 
have gone to an absurd extreme in the limi- 
tations imi:)osed on companies writing new 



INSURANCE FEES AGAIN. 



ent and successful work in this particular business in that vState as regards the amount 
instance. It is a great pleasure to note his of the first year's premiums, which may 
unanimous re-nomination in his District legally be spent by the company in securing 
convention. new business, all who give study to this 

question will admit. On the other hand 
students of the questions at issue will insist 
It would seem that after all that has been that if the New York legislature has trimmed 
said in the past two years by both doctors the companies a trifle close in this particular 
and insurance agents on this topic that the on new policies written in that State, that it 
subject would be almost thread-bare, and it ill-becomes the companies to attempt to 
does not appear that the end of the conten- recoup their losses at the expense of care- 
tion is quite reached yet. The State Society ful, scrutinizing medical examinations of 
of North Carolina has now for two sue- all applicants for insurance protection. And 
cessive sessions em])hasized its opinion that despite claims to the contrary, cutting the 
all physicians should receive $.S.OO for all fee to le&s than $5.00 means a corresponding 
old-line insurance examinations, and recom- reduction in the value of the examinations 



mended to the competent county societies 
that they so enact. A very large number 
of them have done so, more are doing so; 
and it is ver\^ apparent to one who keeps in 
touch with the professional pulse that the 
insurance people will come to the $5.00 fee 
— always provided the profession remain 
firm in their determination not to accept convulsions which leave adhesions, tumors. 



made. Again we contend that the profession 
stand square and firm for their rights and 
the honor of the profession, confident of 
winning in the end. 

TRAUMATIC BPIL,BPSY. 

Injury to the head may lead to recurring 



less! 

This we believe the doctors of North 
Carolina will do. We remind them not to 
be misled by the suggestion being made by 
many agents to the effect that it is purely a 
"local fight in the Carolinas." It is em- 
phatically an affair of national importance, 
and in the past two years has received at- 
tention in the meetings of almost every 



compressed areas or anything that may act 
as a foreign body in the cranial cavity, and 
is undoubtedly a cause of epileptic spasm. 
In these cases the foreign body occupying 
the space of a vascular area, destroying 
more or less the function of a certain portion 
of the brain, obliterates the veins and capil- 
liaries; the local cerebral tension will then 
be equal to that of the arteries which nor- 



State Medical Societv in the nation, and the mally feed the affected area. In the oblit 
recent session of the American Medical As- erated area there will be a complete stasis of 
sociation took the matter under careful con- the blood. In the border areas the capilli- 
sideration, and a committee will report at aries and veins will be more or less com- 
the next session. pressed in proportion as the increased local 

Doctors will not allow themselves to be cerebral tension is transmitted to the brain 
duped bv statements to the effect that "we substance. In consequence of this com- 
now have the signatures of over 200 North pression the blood pressure will be raised m 
Carolina doctors who will agree to examine these capilliaries and veins and the blood 
for $2.00 and $3.00 just as soon as matters flow lessened. In the more and more distant 
can be so arranged in the county medical areas of the brain the circulation will ap 
societies that they will not be ostracised 
professionally." Nor will intelligent phy- 
sicians who think permit themselves to be 
hood-winked into signing a promise to ex- 
amine for less than five dollars with the 
presentation to them of a certificate "signed 
and sealed" at the home office of the com- 
pany in the Hast setting forth the fact that 



proach more and more to normal and the 
blood flow may even be increased, the blood 
taking the channels of least resistance; this 
may produce a congestive oedema which 
will act as a further foreign body in the 
cranial cavity. Supposing there is a com- 
pression or thickening of the dura or any- 
thing acting as a foreign body in the cranial 



the doctor is "chief examiner" for his town, cavity. 



there will be a compressed area of 



9S 



THK CHARLOTTE MEDICAL JOURNAL. 



brain in which the circulation has ceased or 
in which it only continues with difficulty. 
If arterial pressure now arises there is no 
room in the cranium for further expansion 
of arteries. Around the compressed area 
there lie a number of arterioles in which the 
full static pressure exists for the outlet from 
these vessels is locked. The effect of in- 
creased arterial pressure will be felt in the 
arteries and arterioles of the area in which 
static pressure exists and will be greatly in- 
creased in the brain, therefore any increase 
in the arterial tension so far as it is trans- 
mitted directly through the brain substance 
increases the capillian,' venous area of in- 
creased pressure. In physiologic conditions 
the arterial extension of one vascular area 
is no greater than in another; on the other 
hand in the pathologic conditions of com- 
pression the arterial tension of one vascular 
area has become greater than the rest. It 
follows that in a case of compression of a 
foreign body in the cranial cavity an in- 
crease of arterial pressure will more readil}^ 
produce the hyperaemia and the concomi- 
tant anaemia then in a healthy brain'. The 
venous oedema is possibly the cause of ad- 
hesions of the dura and pia so often found 
post mortem in epileptics and paretics, and 
are not the cause but the result of the disease. 

DR. R. J. BREVARD. 

Dr. Robert Joseph Brevard died at his 
home in Charlotte on the 11th of August, 
after a long illness in which the mettle of 
the man was supremely tested. 

He was born at Tallahassee, Fla., De- 
cember 15, 1848. After receiving an ele- 
mentary education he attended Davidson 
College, North Carolina. Later he went to 
the University of the City of New York as 
a student in the medical department. He 
graduated in 1872 and was valedictorian of 
his class, his being the first valedictory de- 
livered by a Southerner at a Northern insti- 
tution after the civil war. Among his class- 
mates were Drs. II. M. Wilder and II. J. 
Walker, of Charlotte; the late Dr. T. George 
Walton, of Morganton, and Dr. Robert Mc- 
Lean, of Lincoln county. He was a brilli- 
ant student and exceedingly popular among 
his fellow-students. 

Dr. Brevard's first medical work was done 
in Shelby, N. C, moving from there to 
Lincolnton, and, in 1882, to Charlotte. He 
was a man of striking personality, a keen 
observer and possessed the instincts that 
came to him from an ancestry of gentle 
folk. Strong, lovable, courteous, wonder- 
fully successful in a business way, he soon 
became a prominent member of the body 
politic of his chosen city, which twice hon- 
ored him by electing him mayor, in which 
capacity he served with rare wisdom and 
courage. 



A few years ago his business interests be- 
came so exacting that the active practice of 
medicine was laid aside, though he retained 
his position as surgeon for the Seaboard 
Air Line Railway and ministered to his per- 
sonal friends with his old-time skill. 

The Mecklenburg County Medical Socie- 
ty, of which he was a prominent member, 
attended the funeral in a body. Thus closed 
a life in which the elements were so mixed 
that it became beautiful and beloved. 

The Pitt county (N. C.) Medical Society 
has recently taken a positive stand in the 
enactment of a By-law providing that no 
member will make old-line insurance exami- 
nations for less than $.5.00. Recalling the 
old phrase relative to "the good that men do 
lives after them," we can almost see the 
spirit of the great Charles J. O'Hagan 
brooding over the profession of the county, 
where for so many years he stood a living 
exemplar of the best and noblest in a medi- 
cal man's life, ever exercising an influence 
for higher standards in all things profes- 
sional. 

Editorial Notes 

The disparity between the amount, $800, 
appropriated by the American Medical As- 
sociation, for scientific research and the 
$10,000 paid as salary to its secretary editor, 
is a straw that is significance itself. 

It was stated on the floor of the House of 
Delegates at Boston, that the services ren- 
dered by Dr. Simmons warranted this ex- 
penditure of salary, and the further extrava- 
gant statement was made, that if the inter- 
ests of the association, and its multiplicity 
of commercial departments, are promoted 
within the next five years, in the same ratio 
as within the past five, a. salary of $20,000 
could well be afforded. 

The American Medical Journalist figures 
in this wise: "It appears that the new 
names added to the membership roll of the 
Association for the eleven months ending 
May 1, 1906, numbered, in the gross, 5,559. 
Deducting a gross loss of 1,208 members — 
171 of whom were lost by death and 619 by 
resignation — we have a net addition of 4,351 
members from all sources. Deducting there- 
from, however, the membership of 3,757 ac- 
cruing from the New York amalgamation 
(this number being merely transferred from 
the sul)scription list of the J. A. M. A. to 
the membership roll of the A. M. A., with- 
out any increase in revenue to the Associa- 
tion), we find only an actual net increase, 
from the country at large, of same 594 new 
members for the eleven months ending May 
1, 1906, or less than one-half the loss 
throughout the same period ! 



EDITORIAL NOTES. 



99 



As, therefore, it has cost the Association 
at the rate of some $20 per head to secure 
these five or six hundred new members — 
McCormack's salary beinj>: $5,000 and his 
"expenses" in the neig-hborhood of $7,00(^ 
per annum (more or less), not to speak of 
the expenses of cultivation in other quar- 
ters and directions — it is obvious that Sec- 
Ed. Simmons' proi>Tess towards the $20,000 
per annum so freely promised by a mem- 
ber of the Board of Trustees in the 
event of certain contingencies being met, 
or results shown, must be through some 
other department." 

Leaving out the wisdom or unwisdom of 
paying $10,000 to the Secretary the fact re- 
mains that in the minds of the Board of 
Trustees the ratio of commercial to scientific 
interests, is as 25 ,to 2 — the body of men, 
to whom, above all others, we should look 
for original scientific work. i\Ien and breth- 
ren, these things ought not to be, and when 
the 19,285 physicians who compose the 
American Medical .:\.ssociation, wake up to 
the situation as it is, the Chicago machine 
will be wiped out of existence. 

SBii\BOARD i^lR UINB RAIbWAY SUR- 
OEOINS. 

The fourth annual session of the Seaboard 
-^ir Line Railway Surgeons was held in the 
I^eSoto Hotel, Savannah, Ga., July 13-14, 
I906. The following interesting program 
was carried out: 

/'7r.s/ Day, Friday. July 13, 1006. 
Morning Session — 10 o'clock. 
Meeting called to order by President G. 
A. Neuffer, Abbeville, S. C. 

Prayer by Rev. John D. Jordan, Savan- 
nah, Ga. 

Address of welcome in behalf of the city; 
Hon. J. H. Estill, Savannah. 

Address of welcome in behalf of profes- 
sion of city. Dr. Ralston Lattimore, Sa- 
vannah. 

Response to address of welcome by Sur- 
geon G. G. Holladay, Portsmouth, Va. 

Address by President G. A. Neuffer, Ab- 
beville. S. C. 

Report of Committee on Arrangements. 
Report of Secretary and Treasurer. 

Papers. 
1 "The Treatment of Fracture of the 
Skull, Trephining and Results" by 
Surgeon W. E. Norton > Savannah. 
.2 "Traumatic Pneumonia from Railway 
Accidents, "by Surgeon John PI. Mil- 
ler, Cross Hill', S. C. 

3 "Practical Surgery," by Surgeon J. E- 
Malone, Louisburg. N. C. 

4 " The Broad View of Therapeutics in 
Medicine and Surgery" by Surgeon 
Cary P. Rogers, Jacksonville, Fla. 

5 "Subject to be announced," by Oculist 
A. W. Calhoun, Atlanta, Ga. 



G "Adhesive Inflammation," by Surgeon 
J. G. Wallace, Dade City, Fla. 

7 "Fractures of the Leg," by Surgeon 
W. A. Monroe, Sanford, N. C. 

8 "Treatment of Fractures," by Surgeon 
Wm. Weston, Columbia, S. C. 

9 "Fatty Degeneration of Scrotum and 
Report of Railroad Accident Case," by 
Surgeon J. G. Dean, Dawson, Ga. 

10 "The Capable Railway Surgeon and 
His Responsibilities, " by Surgeon K. 
M. Ferguson, Southern Pines, N. C. 

Afternoon Session — S o'clock. 

11 "lirichson's So-Called Railroad Spine, 
with report of case illustrating how 
often the ablest doctors have been de- 
ceived b}' this malad3%" by Surgeon 
E. H. Richardson, Atlanta, Ga. 

12 "Malingers and Malingering, " by In- 
vited Guest, Surgeon Geo. R. White, 
Savannah, Ga. 

13 "Some Common Diseases of the Eye 
and Their Treatment, " by Oculist D. 
D. Wilcox, Petersburg, Va. 

14 "Eye Wounds and Their Treatment," 
by Invited Guest, Oculist J. Lawton 
Hiers, Savannah, Ga. 

15 "Subject to be Announced, '' by Invited 
Guest, Surgeon Le Grand Guerry, Co- 
lumbia, S. C. 

16 "Subject to be Announced, ' ' by Invited 
Guest, Surgeon Geo. Ben. Johnston, 
Richmond, Va. 

17 "The Recognition and Management of 
Dislocation of the Shoulder Joint Com- 
plicated by Fracture of the Neck of the 
Humerus," by Invited Guest, Surgeon 
H. A. Royster, Raleigh, N. C. 

18 "A Report of Some Railway Cases," 
by Surgeon G. G. Holladay, Ports- 
mouth, Va. 

19 "The Importance of Selecting a Suit- 
able Line for Operating" by Surgeon 
J. D. Love, Jacksonville, Fla. 

20 "Differential Diagnosis of Lesions in 
the Upper iVbdominal Zone," by Sur- 
geon]. N. Baker, Montgomery, Ala. 

21 "Subject to be Announced," by Sur- 
geon Southgate Leigh, Norfolk, Va. 
Second Day, Saturday, July IJ^th. 

Morning- Session — 9 o'clock. 

22 "Heroin Hypodermically, " by Surgeon 
L. S. Oppenheimer, Tampa, Fla. 

23 "The Railroad Surgeon's Duty When 
Another Doctor Gets the Railroad 
Case," by Surgeon J. W. Palmer, 
Alley, Ga. 

24 Address, by Chief Surgeon Jos. M. 
Burke, Petersburg, Va. 

25 "Injury to Hip in Old Person — was it 
a Fracture?" by Surgeon John W. Cor- 
bett, Camden, S. C. 

26 "Injuries Received by Jumping From 



1 ( lO 



Tine CHARLOTTE MEDICAL JOURNAL. 



FreijT^ht Cars," b)' Surgeon Samuel C. 
Benedict, Athens, Ga. 

27 "Subject to be Announced," by Sur- 
geon J. C. Knight, Plant City, Fla. 

28 "Subject to be Announced," by Sur- 
geon M. T. Johnson, Lawrenceville, 
Ga. 

29 "Subject Unannounced," by Surgeon 
D. W. Prince, Laurinburg, N. C. 

30 "Subject to be Announced," by Sur- 
geon Henry E. Palmer, Tallahassee, 
Fla. 

Afternoon Session — 2 o' clock. 
New Business 

Report of Special Committee 
Report of Executive Committee 
Election of Officers 
Installation of New Officers 

The De Soto is one of the most elegant 
hotels in the South and is an ideal conven- 
tion home. The Seaboard Air Line, ever 
mindful of the comfort and pleasure of its 
faithful surgeons, provided a trip to Tybee 
and an elegant fish supper for the Associa- 
tion, and tendered them its steamer, Bluf- 
ton, for a delightful trip down the river. 

The officers for the next year are as 
mamed: 

President — W. A. Monroe, of Sanford, 
N. C. - 

•Vice President — First Surgeon J. G. Wal- 
lace, Dade City, Fla. 

Second vSurgeon — H. M. Wilder, Char- 
lotte, N. C. 

Third Surgeon — E. H. Richardson, At- 
lanta, Ga. 

Secretary and Treasurer — ^J. W. Palmer, 
of Ailey, Ga. 

Member Executive Committee — ^J. H. 
Miller, Cross Flill, S. C. 

Resolutions were adopted thanking the 
retiring president. Dr. G. A. Neuffer, of 
Abbeville, S. C, for his able administra- 
tion, and upon effective work of the secre- 
tary and treasurer. Dr. J. W. Palmer; in re- 
turn for courtesies extended by the DeSoto 
Hotel, the Savannah Press and the Morn- 
ing News; and the local professions for 
many kindnesses and attentions. 

The next meeting will be held at Nor- 
folk, during the Jame.stown I{xposition. 

COMBINATION OF MEDICAU JOURNALS 
IN L.OS ANGELrBS. 

It is announced that the California Medi- 
cal and Surgical Reporter has bought the 
Los Angeles Medical Journal and the two 
will be ini]:)lished as one. 

SOLITM CAROLINA AND GEORGIA. 

It is stated that the reciprocal relation 
which forinerly existed between these two 
States has been broken. South Carolina 
holding that the Georgia standard is not up 
to hers. The G^eorgia Board has been noti- 
fied that it will be necessary for them to 



raise their standard before former relations 
can be restored. 

NBW QUARANTINE STATION rOR TUB 
SOUTH. 

In order that vessels might enter New 
Orleans with the usual period of detention, 
Surgeon-General Wyman has olitained per- 
mission for the U. S. Public Health and 
Marine Hospital Service to establish quar- 
antine and disinfecting .stations at St. Lucia 
and Barbadoes. 



The annual meeting was held at Wel)- 
sters Springs, on the 22nd of June, when the 
following officers were chosen for the year: 
President, Dr. William W. CTolden, F:ikins: 
First Vice-President, Dr. N. T. Churchman, 
Charleston; Second Vice-President, Dr. M. 
F. Wright, Burlington; Third Vice-Presi- 
dent, Dr. C. T. Smith, Tunnelton; Secre- 
tary, Dr. T. W. Moore, Huntington; Treas- 
urer, Dr. T. D. Barber, Charleston; Coun- 
cillors: First District, Dr. II. P. Linsz, 
Wheeling; Second District, Dr. R. H. 
Powell, Grafton; Third District, Dr. P. A. 
Haley, Charleston; Fourth District, Dr. W. 
S. Link, Parkersburg; Fifth District, Dr. C. 
R. luislow, Huntington, and Dr. J. W. 
Preston, Keystone. 

MISSISSIPPI MBDICAU COUBBGE. 

The Sessions for 1906-1907 will open in 
October, occupying the handsome new 
building which is now in construction being 
rapidly pushed to completion. The officers 
elected are as follows: President, Dr. W. 
W. Hamilton; Vice-President, Dr. T. A. 
Barber; Secretary, Mr. O. W. Bethea; 
Treasurer, Dr. T. J. Houston; Dean, Dr. 
N. L. Clarke. 

TUB tllGHSMITM HOSPITAB, FAYBTTE- 
VIBBB, N. G. 

We are pleased to note the completion of 
a handsome new operating room, at a cost 
of $15,000, $10,000 of this amount being 
given to the hospital, by Mrs. W. P. Coch- 
ran, of Yonkers, N. Y. 

Of this new department, the I'ayetteville 
Observer says: "Nothing like it of the 
kind can be found in North Carolina, either 
in its elegant exterior architecture, or in its 
interior surgical appliances. The operating 
room proper, lighted from above, is flanked 
on one side by the anaesthetic room for pa- 
tients preparatory to operation, and on the 
other by the sterilizing room, fully equipped 
with all the appliances in burnished copper. 
On the other side of the corridor is the su- 
perintendent's private room, furnished for 
his etiuipment for the operating room, and 
his return thetice, with lavatories and hot 
and cold shower and other baths. Next is 
the electrical room, with the latest instru- 
ments, connected with the motors and the 



REVIEW OF SOUTHERN MEDICAL EITERATI'RE. 



city water pressure, and adjoining is the Revicw of Sout hern Medical Literature. 

septic room for patients of that class. Last 



is the heating- room, which adjoins the Otis 
hydraulic elevator, running up to all the 
floors of the main building. The floors of 
the operating annex are of hexagonal mo- 
saic blocks, the walls of wood-fibre, exquis- 



7hc Texas Medical News, May, 1900. 

The Uterus and Ovary of Neurasthenia. 

— Dr. R. T^. Dickinson gives the following 
conclusions after a study of the history of 



itelv tinted'and finished, the wainscoting of ^^^ hundred cases of the more chronic and 

aggravated t3''pe or neurasthenia: 

1. The associated lesions in cases of this 



pure white enamel tiling, and all the basins, 
lavatories, etc., of solid white porcelain. It 
is furnished throughout with electric lights, 
electric bells, and telephone system belong- 
ing exclusively to the hospital. Attached 

to the operating room is a room for visiting , . . ■ -^ r i 

physicians, where all the conveniences of ^^^ ^^^1 P^^^^^^t m the majority of cases, and 
the institution will be at their command. A 



degree as indicated by this series would he 
as follows: a. In the ovary chronic ovaritis 
chiefly microscopic was found in nearly all. 
b. In the uterus endometritis usuallv cervi- 



drive way is being arranged, by which pa- 
tients may be conveyed into the hospital by 
the rear entrance, thus obviating publicity. 



was seldom accompanied with thickening 
of the endometrium, c. A high degree of 
sclerosis of the vessels of the uterine walls 
and of those of the endometrium was some- 
times discovered in cases of long standing 
Dr. Daniel F. Ellis, memberof the faculty and the venous enlargements were many, 
and college physician of the Randolph- c^- About the vulva certain hypertrophies 
Macon College at Ashland, Va., was drown- ^vere noted in the majority of cases, e. In 
ed in Stagg creek, Aug. 13th, while on his the i)ladder congestion of the trigone was 
way to pay a charity visit to an old negro frequent, f. In the rectum catarrhal conges- 
patient. High water swept his buggy down tion and atony were persistent m a large 
the stream. The doctor's .S-year-old son number. 

2. In this class of cases pelvic symptoms 
are prominent and lumbar pain constant. 

^. In almost all of these cases the pelvic 
disorder is coincident, not causative. 

4. Correction of abnormalities of struc- 
ture and function by prolonged local treat- 
ment or by operation lessens pelvic pain 
very little and betters the general condition 



was with him, but was saved by his father 
placing him in an overhanging tree. 

In our last issue we expressed our pleas- 
ure in the completion of the Robert Bruce 
Memorial Hospital, at Kinston, N. C, 
and in the fact that there is manifestly a 
growing inclination on the part of the South- 
ern physicians, to provide the best that can not at all. Treatment should be directed 
be oljtained for the use of our suffering ones, almost entirely to the general condition. 
That it will be a profitable, as well 
beneficent work, we have no doubt. 



Au}'^ young physician, or medical student 
who wishes a change of work for a few 
weeks, will learn something of interest if he 
communicates with Messrs. M. S. & D. A. 
Byck, of Savannah, Ga. 

The many friends of Dr. George Ben 
Johnson will be interested in knowing that 
he has withdrawn from the professorship of 
surgery at the University of Virginia, and 
is continuing his surgical practice in Rich- 
mond, Virginia. 



(Operation on pronounced pelvic lesions 
is warrantable in a few selected cases, such 
as persistent and exhausting hemorrhages 
and the larger tumors, and if thorough- 
going brings about a cure, revolutionizing 
the general condition in a very small per- 
centage of cases. 

6. Anatomic cure frequently fails to bring 
symptomatic cure. 

Jcxas State Journal of Medicine, May, 
1906. 

This issue contains the President's iVn- 
nual Address, the Annual Oration and State 
Transactions. 

Nczu Orleans Medical and Surgical Jour- 
nal, May, 1900. 

Third Stage of Labor — Dr. E. L. Mat 
thews believes that the practice sometimes 
followed by practitioners in these cases of 
inertia uteri or apparent inertia when the 
placenta is not delivered within the first 
twenty minutes following the second stage 
is to wash the hands, lubricate the right 
hand and forearm, place tlie left hand over 



Says a recent medical writer in regard to 
bathing: 

"Do whatever agrees best with your indi- 
vidual constitution and circumstances. If 
you find that a cold bath, with a brisk rub 
down, gives a fine reaction of blood to the 
surface, with a splendid glow and vigor, 
well and good; there is no better way to be- 
gin the day. But if you have a feeble reac- 
tion, and get 'sticks in your throat' as a the fundus uteri, and with the cord as 
result, don't do it if you value your life. So guide follow into the uterus and manually 
for all other kinds of exposure." detach or remove it if already detached. 



lOj 



THE CHARLOTTE .MEDICAL JOURNAL 



This practice has the highest condemna- 
tion of the best authorities. Williams, Pro- 
fessor of Obstetrics at Johns Hopkins, saj^s 
in his latest work "The procedure is more 
serious than the performance of version or 
the application of forceps." The hand is 
rarely sterile — it is introcluced into the uter- 
ine cavity carrying with it bacteria of many 
varieties, and there comes in direct contact 
with a freshly wounded placental site, 
through which are scattered numerous bleed- 
ing and thrombosed vessels which afford 
them an excellent culture medium. Manual 
removal of the placenta should only be 
imdertaken when the condition of the pa- 
tient is serious or there be free hemorrhage. 
The Texas Medical Journal, May, 1906. 
Mosquito Extermination and its Bear- 
ing on Yellow Fever and Modem Quaran- 
tines — i3r. C. W. Truehart regards the 
stegom^ia fasciata as a thoroughh^ domes- 
tic insect— as much a domestic insect as 
barn-yard chickens are domestic fowls. It 
does not breed in marshes, but almost ex- 
clusively in proximity to human habitations, 
and as a rule only in clean, fresh water. 
Cutting any species of mosquito off from 
water to drink as well as to breeding and a 
resort to fumigation of the houses will effec- 
tually rid any place of the insects. 

Formaldehyde gas I have found to be the 
least obnoxious and by far the most effect- 
ive agent as an insecticide and germicide. 
But the secret in securing the fullest measure 
of effectiveness from formaldehyde gas de- 
pends upon the generation of the gas with 
such rapidity and in such large volume and 
concentrated strength as to overwhelm and 
destroy insect and germ life. One hour of 
such fumigation suffices to kill all insects 
and disease germs. 

The rich and growing commerce of Cuba 
and other West India islands, Mexico, Cen- 
tral and South America would naturally 
seek our Texan and other gulf ports if only 
our people would wake up to the fact that 
with the yellow fever-spreading mosquito 
exterminated this valuable trade could be 
handled without danger to the health and 
lives of our citizens. The antiquated quar- 
antine methods that have heretofore prevail- 
ed in gulf ports have driven this commerce 
to their North Atlantic rivals and to Europe. 
Let us stop this cutting our own throats. 
Nashville Journal of Medicine and Sur- 
gery, May, 1906. 
Tinea Versicolor — Dr. John V. Shoe- 
maker gives the following under diagnosis 
in a clinical lecture: The diagnosis of 
tinea versicolor is comparatively easy from 
its characteristic fawn color usually present, 
the slight elevation of the affected skin and 
he furfuraceous desquamation. The fur- 
turous disquamation especially should form 



the salient feature for diagnostic purposes, 
and if combined by the microscopic exami- 
nation will leave little doubt as to the char- 
acter of the disease. The disease might 
possibly be mistaken for an chloasma, 
vitiligo, lentigo and macular syphilis, but 
on close examination and inquiry into the 
history will readily reveal the true nature of 
the affection. 

Atlanta Journal Record of Aledicine, 
May, 1906. 
Treatment of Constipation — y)x. T. Tor- 
pel under the section of Olive Oil Injections 
says that this is a very satisfactory measure 
and is highly recommended by Kussmaul. 
Inject from three to ten ounces of warm 
olive oil in the rectum at bedtime. This is 
retained during the night and usually re- 
sults in an evacuation after breakfast on 
the following day. If the oil is introduced 
slowly at a low pressure by the force of 
gravity the patient should have no difficulty 
in retaining it for the night. Dr. Ilerschels 
method and apparatus is as follows: 

A glass funnel of a large relative capacity 
to its height provided with a loop by which 
it can be suspended at a convenient height 
above the patient is fitted with 28 inches of 
rubber tubing, § inch caliber, and terminat- 
ing a nozzle. Colon tube may answer same 
purpose. The injection can be made by the 
patient without assistance. The oil is first 
heated by placing the bottle containing it in 
a basin of hot water. The funnel is hung 
on a nail above the bed. The patient lies 
on his back with his hips on the pillow, in- 
troduces the tube and waits till the funnel 
is empty. It is best to commence with five 
or six ounces and to reduce the dose daily 
until the smallest amount which will pro- 
duce an action of the bowels is found. In 
a few days it will probably be found that, a 
few ounces of oil at bedtime will produce a 
daily evacuation. The effect may then be 
tried by using the oil on alternating nights, 
and as the case progresses the action of the 
oil will extend over a longer period and 
will be followed by several daily stools. 
When this period arrives the injection should 
be ordered to be taken only on the evening 
of the day on which the action has not 
taken place. 

7 he Virginia Medical Semi - Monthly , 
May, 1906. 
Acute Lymphatic Leukaemia. — jjj- jj 
S. Ilolloway says in arriving at a correct 
diagnosis many simulating conditions must 
be excluded. 

First. Pernicious anemia. Here the blood 
picture is entirely different, although in 
some cases of pernicious anemia the blood 
findings are entirely negative, and the diag- 
nosis must rest upon the clinical evidence. 



RKVIKW OF SOUTHERN MEDICAL LITERATURE. 



lo.- 



The majority of these cases show an enor- 
mous increase of normoblasts and consider- 
able number of mei^alol^lasts, a color index 
of 1 to 1 plus, marked poikilocytosis and a 
hyperleucocytosis. 

Second. Hod.ifkin's Disease. This affec- 
tion runs a more chronic course. The blood 
picture shows only a secondary anemia. 
Upon removing- one of the nodes and exam- 
ining it microscopically the characteristic 
changes are noted. 

Third. Banti's Disease. Here the spleen 
is usually very much enlarged and there is 
a profound anemia and the leucocytes are 
not increased. 

Fourth. Malignancy. Especially that 
form of malignancy affecting the spleen 
primarily. The blood shows nothing char- 
acteri.stic except a secondary anemia. 

Fifth. Simple adenitis. A history of some 
local disease about the skin or mucous mem- 
brane usually sufBces to clear up the diag- 
nosis. 

Sixth. Chronic Malaria. Here again the 
presence of ovoids or crescents in the blood 
or a rapid clearing up of the symptoms un- 
der the administration of quinine should 
suffice to remove all doubt in the mind of 
the clinician as to the exact nature of the 
malady. 

Seventh. Anchylostomiasis. The persist- 
ence of worms or their eggs in the stool 
should immediately make clear the diag- 
nosis. In many cases of anchylostomiasis 
the blood shows a large percentage of 
eosinophiles and frequently in examining 
the blood of individuals with profound 
anemia this feature is the first to direct the 
attention of the examiner to the bowel as 
the original seat of the trouble. 

Eighth. Acute Yellow Atrophy. Marked 
jaundice, delirium, vomiting and a rapidly 
fatal course characterize this malady. 
1 he American Practitioner and JVexvs, 
May. 190G. 
Puerperal Infection. — Dr. A. S. Priddy 
after discussing the subject in general points 
out the following important points concern- 
ing the use of the curette in these cases: 

The curette is such a useful instrument 
in scraping out the contents of the sapremic 
womb and such good has resulted from it 
properly used in sapremia that it has led to 
its indiscriminate use in supposed and real 
cases of puerperal sepsis as to become from 
improper use an instrument of greater harm 
than good. In most cases of puerperal in- 
fection an examination of the endometrial 
surface reveals a perfectly smooth condition. 
Therefore, unless the uterus is enlarged and 
boggy, and the discharge foul smelling be- 
fore deciding to curette the finger well dis- 
infected should be introduced into the cavity 
and swept over the endometrium, and unless 



there are some irregularities or masses felt 
which cannot be peeled off with the finger 
the use of the curette on such an endome- 
trium, aside from the danger of puncturing 
the thinned and softened wall of the uterus 
and infecting the general cavity, the curette 
would most likely increase the danger by 
scraping away the zone of cellular infiltra- 
tion which nature has provided as a barrier 
against the deeper extension of infection. 
GaillarcPs Southern Aledicine, May, 
190G. 
A Case of Hodgkin's Disease. — Dr. w. 
H. Atkinson advises the following treat- 
ment: Medicines thus far seem to have 
accomplished nothing in a curative way. 
Arsenic has long been looked upon as our 
anchor-sheet, although no cures are to its 
credit. The varied symptoms arising from 
the pressure upon the different organs each 
demand its specific treatment as they make 
their appearance during the progress of the 
disease. Relief of pain is of course im- 
portant. 

Conclusions from the observations in my 
case would make me advise the X-Ray 
treatment at the first suspicion of Ilodgkins' 
Disease. The exposure should l)e long and 
as frequent as patient can endure, and the 
continuance of such treatment should not 
cease for months or even years should the 
patient show any improvement by its ad- 
ministration. 

Many cases that have shown much im- 
provement under the X-Ray treatment had 
a rapid return of symptoms when the expos- 
ures were discontinued even for a short 
time. Subsequent exposures did not give 
as good or as effectual results as the first 
ones. The inhalation of oxygen three or 
four times a day from the onset of the dis- 
ease might add much to a cure and surely 
could do no harm. 
Maryland Medical Journal, May, 1900. 

Dr. R. H. Johnson says that those of us 
who have studied the anatomy of the acces- 
sory cavities — their thin walls, their near- 
ness to the vital centers — cannot but be im- 
pressed with the fact that pus confined in 
them without proper drainage must consti- 
tute an element of danger, both as regards 
health and life. In looking over the statis- 
tics of death from empyema, which are far 
from complete, I have found that in nearly 
every case headache, more or less intense, 
preceded the fatal issue. The inference to 
l)e drawn from this is that headache consti- 
tutes a symptom of danger, and if after 
drainage has been established through the 
nose it persists, better drainage with an ex- 
amination of the walls must be secured by 
an external operation. Hajek has collected 
a number of deaths from accessory-cavity 



THE CHARLOTTE MEDICAL JOURNAL. 



disease, and his list is not complete. In his 
article on brain complications he makes the 
significant statement that in meningitis and 
abscess of the brain only exceptionally has 
a careful section of the nose been made and 
that often striking macroscopic changes are 
wanting at the base of the brain or skull 
which would lead to the origin of the disease. 
From the facts he concludes that cerebral 
disease of nasal origin is much more com- 
mon than statistics show. 
1 he Mobile Medical and Surgical yournal, 
May\ V.XHi. 
Some Points on Pulmonary Surgery.— 
Dr. W. R. Jackson draws up the following 
conclusions: 

1. Always use chloroform as an anes- 
thetic. 

2. Immobilize the chest walls in all in- 
juries of the pleura or lung. 

3. Avoid attempting primary disinfection 
of penetrating accidental wounds of the 
lung and pleura. Disinfection of the ex- 
ternal wounds and antiseptic occlusive 
dressing (without suture) usually suffice. 

4. Never probe gunshot wounds of the 
thorax to ascertain the direction or location 
of the ball. 

5. Make sure of adhesions to the parietal 
pleura before exploring the lung for abscess, 
gangxene, bronchiectasis, or tubercle. 

6 . Avoid producing douljle pneumothorax 
even if empyema is present on both sides. 
Operate on one side at a time and wait until 
well, then attack the other side. 

Surgical Treatment of Talipes Para- 
lytica.— Dr. W. T. Berry believes that no 
operation requires stricter asepsis than the 
one of tendon anastomosis if good and satis- 
factory results be gotten. The incision 
should be large enough to expose to view 
all tendons to be grafted, and the operation 
be done under an Esmarch bandage. Para- 
lyzed tendons are easily recognizable by 
their dull, ashy color, while the healthier 
ones are a glistening white. The tendons 
utilized should be scarified and sutured 
firmly to the periosteum with silk sutures. 
The foot is put up in a plaster dressing in 
an over connected dressing and so main- 
tained for from five to eight weeks. The 
patient may be allowed to walk about with 
auxiliary crutches in two or three days after 
the operation, and in another week he is 
able to use the member. 

Virginia Medical Semi-Monthly, May 
25th, 1900. 
Acute Nepliritis--with Special Reference 
to Diagnosis and Treatment —Dr. O. C. 
Albright under the section on treatment he 
says contrary to the advice of good men I 
have used morphine with good results after 
all other drugs have failed. I know I am 
on dangerous ground when I advocate 



opiates in this condition, and I am not go- 
ing to advise anybody to use it who doubts 
its efficacy. In every case of puerperal 
convulsions I ever treated at the beginning 
I tried to follow the text-books, but always 
failed to relieve any patient until I used 
large doses of morphine. I do not advise 
its pernicious use, but in properly selected 
cases when used with discretion and its ac- 
tion guarded with other remedies it has al- 
ways acted well for me and never badly. 

Of other useful drugs in acute nephritis 
may be mentioned strychnine, digitalis, 
nitroglycerine, etc., according to symptoms 
and condition of patient. Iron is always 
indicated in nephritis. Most authors advise 
against its use during the active sta.ge of the 
disease. Of the preparations of iron used I 
prefer a combination of the tincture of the 
chloride with Spts. Mindererus. It is more 
readily assimilated than the pure tincture, 
better borne by the stomach, and can be 
given in smaller doses with beiiefit, even in 
the acute stage of the disease. 

The diet in the beginning of acute ne- 
phritis should consist chiefly of skimmed 
milk. As convalescence is established a 
gradual return to a mixed diet is advised. 
If kept on strictly a milk diet too long nutri- 
tion suffers and thereby retards recovery of 
patient. 
Gaillard'' s Southern Medicine, yuiie, 1006. 

Extra-Uterine Pregnancy with Report 
of twelve Case-s — Dr. J. W. Long, after 
discussing the subject and reporting the 
cases, touches on another phase of this sub- 
ject relative to the cause and sequelae of 
ectopic gestation. 

The biology that we were all taught said 
that the impregnated ovum fell among the 
uterine follicles, which rapidly became hy- 
pertrophic and enveloped it in their arms. 
Peters describes the earliest known human 
ovum, which was secured from a woman 
who suicided three days after missing her 
period. He shows clearly that the ovum is 
the active agent, and that it evades or de- 
stroys the tissues of the mucosa, making for 
itself a cavity or bed into which it sinks. 
Prof. Minot, of Harvard Medical School, 
has proven by experiments on embryo in 
the lower animals that certain chorion cells 
have the property of destroying tissues, and 
t is believed that the same is true of the 
human ovum. Minot says the ectodemic 
cells of the chorion becomes hypertrophied 
and are known by their large size. These 
cells he calls the trophodernis and possess 
he destructive power just described. The 
production of a cavity in the uterine mucosa 
by the digestive properties of the tropho- 
dernis and the lodgement of the ovum in the 
mucosa is styled by emtyologists "implant- 
ation." In other words the ovum is the 



RFVIEW OF SOUTHERN MEDICAL LITERATURE. 



active agent in the process of implantation 
and its activity depends largely on the de- 
structive properties of the trophodermic cells 
of the chorion. 

Suppose for any reason the impregnated 
ovum finds lodgement in the tube tropho- 
dermis quickly get in their work, and in the 
thin walled tube makes a hole entirely 
through or cause the ovum to be implanted 
so close to the surface as to easily cause 
rupture by blood pressure. 

Goffe in discussing this matter cites a case 
in point. At operation he found abundant 
blood clots and only a pin hole opening 
filled with a blood-clot opening in the tube. 
An examination of the interior of the tube 
after removal "gave no indication of the 
development of a placenta or chorion cells. 
The ovum at a very early stage must have 
evaded its way through the tube and hemorr- 
hages must have been quite frequent if not 
continuous." 
Memphis Medical Monthly, June, 1906. 

Some Common Forms of Meningitis. — 
Dr. B. F. Turner ])elieves that the majority 
of inflammations of the coverings of the 
brain and spinal cord are attended with 
permanent defects, and, therefore, this class 
of cases is not inspiring to the therapeutist. 
Thickening of the cerebral or spinal cover- 
ings, invasion of the brain or cord substance, 
distension of the brain by accumulation of 
fluid are almost always accompanied by 
results which are permanent, hence paraly- 
sis disorders of vision, imbecility, or any 
grade of mental impairment is very likely 
to be the ultimate result, even though the 
unfortunate subject does not succumb im- 
mediately to the attack. Indeed it is a sort 
of case that the doctor hopes will not re- 
cover. Furthermore, the pernicious results 
of the pathological processes in the cover- 
ings of the brain and spinal cord may not 
be immediately apparent, especially if it be 
true that an apparent perfect recovery fol- 
lows. The rectum is liable years hence to 
develop epilepsy or mental feebleness, ec- 
centricities, intellectual obliquity, and re- 
cover only to be a crippled member of society 
and a possible care to his friends. Treat- 
ment should be conducted on empirical lines 
inasmuch as we find that it is in the ma- 
jority of cases secondary to some other affec- 
tion and treatment can only be addressed to 
the primary cause and to the symptoms as 
they arise. 

The Mobile Medical and Surgical Journal, 
June, 1906. 

Local Anesthesia is Surgery.— i^r, W. T. 
Henderson thus describes the operation for 
inguinal hernia with local anesthesia. The 
line of incision is marked out and beginning 
at the upper end the skin is picked up and 



a few minums of the one-fourth of one per 
cent, cocaine solution is injected into the 
skin and not under it. As soon as this in- 
jection is made, if done properly, there will 
be an area of anemia produced about the 
size of a twenty-five cent piece. This spot 
is anesthetized. A succession of these spots 
is produced along the line of the intended 
incision, the hypodermic needle being rein- 
serted just in the edge of the anemic area 
on the opposite side from which it was last 
removed. The syringe is now filled with 
the one-eighth per cent, solution and at in- 
tervals of one inch along the line of the in- 
tended incision the needle is inserted straight 
down into the subcutaneous tissue and about 
five minums of the solution injected. This 
is continued along the entire anesthetized 
area, and when done there will l)e a ridge 
and along the summit of this ridge the cut 
is made. The surgeon now dissects down 
through the various tissues until the canal 
is reached where he should find the ilio- 
inguinal nerve which is picked up and in- 
jected with about ten minums of the one- 
eighth per cent, solution. This injection 
should be at the upper angle of the wound, 
as its purpose is to destroy all sensation be- 
low the insertion of the needle. After the 
nerve is successfully treated there need be 
no more fear of hurting the patient. The 
sac is dissected out, opened, transfixed and 
cut off or the operation selected which the 
surgeon may prefer. 

Before the cutaneous stitches are tied, 
and for these I prefer interrupted sutures of 
silk-worm gut, a small piece of gauze is laid 
in the lower angle of the wound to draw off 
the serum which will collect between the 
cut surfaces. In twenty-four hours this is 
removed by gently lifting up the bandage 
and pulling on the lower end of the gauze. 

Texas Medical Journal, June, 1906. 

A Note on the Improper Management 
of Epileptics.— ])r. M. R. Hughes says this 
disease is one that should be handled in the 
most careful manner. One reason why it is 
so widely classed as an incurable disease is 
the fact that the treatment has been over- 
done at the wrong time, or not carried far 
enough at the proper time. The use of 
electricity has been greatly abused, likewise 
the bromides. The bromides are not drugs 
to be given together. Results are much 
Ijetter when given separately. 

It is not possible to effect ^ cure by the 
use of bromides alone, but many think so. 
The patient in the first place in many in- 
stances is not carefully examined, is placed 
upon bromide and electric treatment at once, 
as soon as the diagnosis is made without 
respect or regard to the exact mental phe- 
nomena that are taking place within the 
structure of the brain at that particular time 



106 



THE CHARLOTTE MEDICAL JOURNAL- 



or without knowiii.<f or understanding- why 
that condition is present. Naturally enough 
the results are negative, and that is the first 
reason why it is considered incurable. The 
second reason is because pains are not taken 
in the first and subsequent examinations to 
ascertain what mental phenomena are tak- 
ing place within the cortex and giving rise 
to that particular stage of the disease at 
that time and what is likely to follow. The 
third reason is that most practitioners be- 
lieve the treatment of all epileptics to be 
directed alike, therefore the examinations 
are shallow and the patient does not recover. 
The American Practitioner and News, 
June, 1906. 
A Simple Method of Expanding tlie Lung 
after Operation for Empyema.— j)j- j j^ 

Maddox thus describes this method which 
he used on a case two weeks after the in- 
cision and drain had been put in. The dis- 
charge at this time was serious and no evi- 
dence of re-expansion of the lung. A No. 
26 French rectal tube was used for drainage 
and suction. Over this tube was slipped a 
hard rubber plate 2x3 inches with a hole in 
the center. Before introducing the tul^e into 
the cavity the plate was dipped in hot water 
and curved to fit the chest wall. The tube 
was drawn through the hole just sufficient 
to protrude into the pleural cavity. Over 
this was drawn a circular piece of dentists' 
ruliber done outside the plate, but so as to 
fit snug:ly against it. Over all was placed 
neatly a firm dressing of adhesive strips 
overlapping each other and working from 
tlie center outward and placed perpendicular 
or at right angles to the ribs, and were eight 
to ten inches long. Over this in turn was 
placed another layer of adhesive strips at 
right angles to the first layer. 

This being accomplished a piece of com- 
mon white tubing was joined to the distal 
end of the rectal tube. The other end of 
tlie white tubing was now fitted tightly into 
one of the nipples protruding above the 
rubber stopper of an exhaust bottle belong- 
ing to Black's aspirator and cuppiiig appa- 
ratus. The stopper was then fitted to the 
bottle and the bottle connected to the air 
pump of the apparatus. After testing the 
apparatus the pump was handed to the 
patient and he soon learned that about every 
thirty minutes he should give the pump 
three or four strokes. The niu'se carrying 
it out when pgtient was asleep. Within two 
days the vesicular murmur could be heard 
nearly down to the wound. The fifth day 
the cavity was full of lung, the chest wall 
having noticeably receded. The adhesive 
dressings had to be removed nearly every 
day. At the end of the fifth day the whoe 
dressing and apparatus were discarded; their 
work having been accomplished. Kight 



weeks from the time the apparatus was in- 
stalled and just ten weeks from the date of 
operation the wound is closed and the pa- 
tient is the picture of robust health. 

Book Notices. 



OFF THE ROCKvS. vStoriesof the Deep-vSea 

Fisherfolk of Labrador. I5y Wilfred T. 

Grenfell. W^ith an Introduction by Henry 

van Dyke. Philadelphia: The Sunday 

vSchool Times Co. $1.00 net. 

Dr. van Dyke's introductory closes with: 
"You who love Nature, not trimmed and 
embroidered, but in the largeness and mys- 
tery of her wild charm; you who love hu- 
manity, not disguised and trained for the 
stage, but frankly living its own life and 
expressing its primitive feelings, you who 
know a man when you see him, and like 
him best when he does things; you who feel 
that religion is just as real as Nature, just 
as real as humanity, and that brave adven- 
tures may be achieved in the name of Christ 
— this book is for you. Tliis is the real 
thing." 

Dr. Grenfell has won a warm place in the 
American heart: he is an English mission- 
ary who is giving his life to the rude fisher- 
folk of the Labrador coast, and his floating 
hospital work appeals especially to his 
fellow-craftsmen in the healing art. 

These thirteen stories are from life and 
are written in Dr. Orenfell's inimitable style 
and picture the hardships and pathos of the 
life in that far-away region. 

SONGS MERRY AND SAD. John Charles 
McNeill. The Stone & Barringer Com- 
pany, Charlotte, N. C. $1.00. 
This little volume of poems, issued a few 
doors from the Journal ofiice, finds a warm 
welcome, for they are spngs from the heart 
of a poet. Simple they are, with no strain- 
ing after effect. Mr. McNeill received, last 
Autumn, the loving cup offered by Mrs. 
Lindsay Patterson, for the best original 
work done in the State during the previous 
year, and worthily was this honor bestowed. 
The little poem. Sundown, will take rank 
with the verses that will live, this being the 
finest that the gifted young author has yet 
written. 

We expect him to do even better things 
in the future, for he has it in him to accom- 
plish much in his chosen line. 



AHHOTT'S ALKALOIDAL DIGEST. A 
Brief Therapeutics with Clinical Applica- 
tions. W. C. Abbott, M. D., Editor The 
American Journal of Clinical Medicine. 
The doctrines herein advocated are: The 
use of a single remedy for a single indica- 
tion. Giving the remedy in small and oft- 



ADVERTISEMENTS. 



The one distinctive feature of 

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It improves the appetite, creates dige^ive 
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Gray's Tonic has become the standard 
remedy for anaemia, malnutrition and ner- 
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THE PURDUE FREDERICK CO., 298 Broadway. N. Y. 



ThigenOl Roche 

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A New York specialist in skin diseases (name 
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has the same good effects as ichthyol : in some 
instances, its soothing, antipruritic qualities seem to 
be greater than those of ichthyol." 

Thigenol is employed chiefly in skin 
diseases and gynecological affections. 



ThiOCOl Roche 

Potassium Guaiiicol-Snlphonate. 

A Soluble Form of Quaiacol. 

Odorless; non-irritating; readily assimilated. 

Clinical reports, published during the past 
seven years, indicate the value of Thiocol in 
incipient tuberculosis, bronchitis, winter 
coughs, typhoid fever, pneumonia, malaria. 

Procurable in three forms : Powder ; B-grn. 
Tablets; Syr. Thiocol Roche. 



Digalen 

Digitoxinum Soluliile Cloetta. 

A Distinct Advance in Digitalis 
Medication. 

The most active glucoside of digitalis is 
now procurable in soluble form. Digalen 
may be employed per os, per enema, and by 
intravenous and subcutaneous injection. 
May be used wherever digitalis is indicated. 
Marketed only in solution, because of infinitesimal 
dosage, in K-oz. vials. 



Airol Roche 

Bismuth ttsyiodogallate- 

Odorless Wound Antiseptic. 

"I have had marvellous results with 
Airol, and shall continue to use it 
preference to iodoform," writes a physician 
of Holland, Indiana. 



For samples and literature:— Mark the name of the medicanient of which you desire a sample; cut out this 
and mail it to us with your address. 

THE HOFFMANN=LaROCHE CHEMICAL WORKS, SI=S3 Maiden Lane. New York. 



THE CHARLOTTE MEDICAL JOURNAL. 



Scott's Emulsion 



Hope, fresh air, rest and Scott's 
Emulsion are the greatest rem- 
edies for consumption, Scott's 
Emulsion will always bring 
comfort and relief — often cure. 



SCOTT & BOWNE, Chemists, 409 Pearl St., New York. 



The ^^ Wider" Clinical Syringe 



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THE WIDER vSYRINGE possesses many points of superiority 
over the ordinary fountain syringe. It is open at the top 
the full size of the bag giving access to the contents for u.se 
of therinonieter or mixing of solution, and making it easy to 
clean and sterilize. It has a hroad, flat base and will stand 
alone when filled, and the nozzle and tubing can be coiled 
neatly through the loop when not in use. When empty it can be 
folded flat, the gradation marks show accurately the ciiiaiitity of contents, and by removing the 
ho.se from the outlet and substituting the small rubber cap it can be converted to a variety of sick-room 
uses: a pitcher, — a basin — a measure, — a male urinal, — the flexible chain serving as a haud'e. A 
strong, durable, useful article of real worth. Made in 2 qt. and 4 qt. sizes only. 





The Davidson Rubber Company 

Sole Manufacturers. 



Boston, Mass. 



INDEX FOR AUGUST. 



109 



TABLE OF CONTENTS FOR AUGUST, 1906. 



Original Communications. 

Atldi'oss of Welcome, by 
lion. T. C Guthrie, Char- 
lotte, N. C, 57 

All Imperforate and Ob- 
structive Hymen at Full 
Term, by H S. Lot,t, M. 
D., Winston Salem, N. C, 61 

Cholelithiasis. by Dr. Henry 
F. Long, Siatesville, N. C. 71 

Intestinal Indigestion: Its 
Dietetic and Rational 
Treatment, by J. E. Ash- 
eraft, M. 1)., Monroe, N. 
C.,.. 75 

Malaria as Seen in Gaston 
county, by Dr. T. C. 
Quickol, Stanley, N. C, !)1 

Obstructions to the Upper 
Re8|)iratory Tract, bv II. 
II. Bngo-s, M. D.. Ashe- 
vil.e, N. C, G2 

Puerperal Eclampsia, by M. 
11. Adams, M. D., States- 
ville, N. C, 59 

Response to the Address of 
Welcome, by Di'. B. K. 
Hays, O.Kford, N. C, 58 

Heport of a Case Trephined 
for Epilepsy, by W. A. 
Graham, M. D., Durham, 
N. C, 66 

Results of Gonorihoeal In- 
fection in the Female, by 
H. U. Weaver, M.. D., 
Asheville, N. C 73 

Remarks on Railway Sani- 
tation, with Si)ecial Refer- 
ence to the Dangers of 
Present Methods of Dis- 
posing of Human Excreta, 
and Suggestions for Im- 



provement, by J. Howell 
Way. M. D.,Waynesville, 
N. C, 80 

Test Diet in Intestinal Dis- 
eases, by Dr. W. O. Nis- 
bit, Charlotte. N. C. .... 64 

The Present Status of the 
Treatment of Cancer — 
with Report of Cases, by 
Dr. L. H. McBrayer, Ashe- 
ville, N.C., 67 

The Colony Treatment of 
the Insane and other De- 
fectives, by Dr. P. L. 
Murphy, Morganton, N. 
C, 84 

The Moist Surgical Dre.ss- 
ing, by B. R. Graham, M. 

D., Wallace, N. C 90 

Editorial. 

Congressman E. Y. Webb's 
"Patent Medicine Bill" 
now a Law, 96 

Dr. R. .1. Brevard, 98 

Insurance Fees Again, 97 

Medicinal Treatment of 
Gail-Stones, 95 

Mixed Infections with 'I'y 
phoid and Paratyphoid 
Bacilli, 95 

Sources of Error in Urinary 
Analysis from Drugs. .... 93 

The Urine in Hepatic Dis- 

Tease 93 

he Transplantation of Or- 
gans as a Surgical Possi- 
bility, 94 

Traumatic Epilepsy, 97 

Editorial Notes. 

Any Young Physician, etc., 101 

Dr. Daniel F.Ellis 101 

Misftissippi Medical College 100 



New Quarantine Station for 
the South,. 100 

Robert Bruce Memorial 
Hospital, 101 

Seaboard Air Line Railway 
Surgeons, 99 

The Highsmith Hospital, . . 100 

The American Medical 
Journal I^'igures, 98 

West Virginia State Medi- 
cal Society, 100 

Review of Southern Medical 

Literature loi 

Book Notices. 

Abbott's Alkaloidal Digest, 
by W. C. Abbott, M. 1^., 106 

Diseases of the Nose, Thi-oat 
and Ear, by KentO. Foltz, 
M. D., 110 

International Clinics, by 
Leading Members of the 
Medical Profession 110 

Otf the Rocks, by Wilfred 
T Grenfell, 106 

Practical Dietetics,by Alida 
Prances Pattee 110 

Songs Merry and Sad, by 
John Charles McNeill, 
Charlotte, N. C, 106 

Transactions of the Amei-i- 
can Electro-Therapeutic 
Association, 109 

Transactions of the Royal 
Academy of Medicine in 
Ireland, Dr. Jas. Craig, 
Editor, JIO 

Transactions of the Ameri- 
can Laryngological,Rhin- 
ological and Otological 
Society. Published by 
the Society in St. Louis, 

Mo., no 



Su 



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repeated doses until the desired effect is TRANSACTIONS OI- THIi AMERICAN 



secured. Reiuedies for conditions rather 
than for the names of diseases. These im- 
ply previous knowledj.;e as to the action of 
druys, and careful study of cases, before 
prescribiui; and afterward. 



KLKCTRO-THICRAPEUTIC ASSOCIA- 
TION, Fourteenth Annual Meeting^ at St. 
Louis, Mo., vSeptember 12th-15th, 1904. 
A. L. Chatterton & Co., New York City. 
We are somewhat behind in receiving 



THE CHARLOTTR MKDICAL JOURNAL. 



this Record, but it is a valuable book to 
have for reference in the physician's library. 
The addresses ,cfiven cover such a wide 
rans^e that it is impossible to enumerate them 
all in this limited space. The Society shows 
its good judtjment in thus preserving these 
carefulh' prepared papers, for future use. 
The mechanical make-up of the book is 
most excellent. 



DISEASES OF THE NOSE, THROAT 
AND EAR By Kent O. Foltz, M. D., 
Professor of Ophthalmology, Otology, 
Rhinology and Laryngology, in the Ivc- 
lectic Medical Institute; Consulting Phy- 
sician to the Seton Hospital; Assistant 
Editor the Eclectic Medical Journal; 
Author of a Manual on Diseases of the 
Eye. 117 illustrations, 12 mo., 643 pp., 
cloth, $3.50. The Scudder Brothers Co., 
Publishers, 1009 Plum Sireet, Cincinnati, 
Ohio. 

The writer assumes that in the majority 
of inflammatory conditions of the upper re- 
spiratory tract and the ears, if proper sys- 
temic measures are taken during the second 
stage, a cure will result; that proper consti- 
tutional measures will give more or less 
permanent relief in i^ractically all but malig- 
nant cases. He advocates the use of drugs 
in preference to local treatment only. The 
subject is clearly- stated. A good case is 
made out. Cireat emphasis is given to the 
importance of diagnosis and the prescribing 
of proper remedies. A careful study of this 
valuable treatise is well worth while. 



PRACTICAL DIETETICS, with reference 
to diet in Disease: Alida I'rances Pattee 
(Graduate Boston Normal School of 
Household Arts, Late Instructor in Diet- 
etics, Bellevue Training School for Nurses, 
Bellevue Hospital, New York City; Special 
Lecturer at Bellevue, MountSinai, Hahne- 
maun, and the hlower Hospital Training 
Schools for Nurses, New York City; St. 
Vincent de Paul Hospital, Brockville, 
Ontario, Canada.) 300 pages. Price, 
by mail, $1.10. A. F. Pattee, Publisher, 
52 West 39th Street, New York. 
This text-book has been in such demand 
that three large editions have been publish- 
ed since July, 1903; it has been included in 
the syllabus for the Nurses' Training 
Schools, published by the State of New 
York lulucational Dept., added to the au- 
thorized text-book list of the New York 
public schools, listed No. 3807, adopted by 
the I'nited States Government, Medical 
Department of the Army, and adopted by 
the Canadian C^iovernment, Permanent 
Schools of Instruction for the Canadian 
Militia. 

It is a general guide for proper diet in 



disease, for the preparation of proper food 
for the sick and convalescent, giving in de- 
tail the method of preparing and administer- 
ing liquid, semi-liquid and solid food. It 
contains the diet lists and what to avoid in 
various diseases; also the proper diet for 
infants and children as advised by leading 
physicians and hospitals of New York and 
Boston, all of which speaks for itself. It is 
a most valuable book on an important sub- 
ject. 

INTERNATIONAL CLINICS.. A Quar- 
terly of Illustrated Clinical Lectures and 
especially Prepared Original Articles, bv 
Leading Members of the Medical Profes- 
sion, throughout the world. Edited by 
Dr. A. O. J. Kelly, with a strong corps 
of collaborators. Volume II. Sixteenth 
Series, 1906. Price, cloth, $2.00 net. 
The J. B. Lippincott Company, Philadel- 
phia, Penn. 

The Charlotte Medical Journal has so 
often referred to this valuable series of books 
that its readers must be perfectly familiar 
with its merits. This last edition exceeds 
all the former ones in the variety of subjects 
covered, and in the excellence of the trea- 
tises. The illustrations are extremely good,- 
and the physician who is so fortunate as to 
have a complete file of the International 
Clinics in his library has a most valuble 
reference feature that he must frequently 
consult. 

The publishers have, as they always do, 
given careful thought to the mechanical 
make-up of this series. 

TRANSACTIONS OF THE ROYAL 
ACADEMY OF MEDICINE, IN IRE- 
LAND. Dr. Jas. Craig, Editor. John 
Falconer, Publisher, 53 Upper Sackville 
vStreet, Dublin. 1906. Volume XXIV. 
Illusrrated. 

One of the treasured possessions in the 
library of the Charlotte Medical Journal is 
an unbroken file of the Transactions of the 
Royal Acadetuy, since 1893. There is a 
great diversity in the subject matter discuss- 
ed in this book and marked excellence in 
the treatment of the various themes. 

The mechanical make-up of the volume 
is all that could be wished; showing that 
old-world painstaking that is so delightful 
to the book-lover. 



TRANSACTIONS OF THE AMERICAN 
LARYNGOLOGICAL, RHINOLOGI- 
CAL AND OTOLOGICAL SOCIETY. 
1905. Published by the Societv, in St. 
Louis, Mo., Dr. Wendell C. Phillips, 
vSecretary. 40 West 47 Street, New York 
City. 
This 1905 meeting was the 11th in the 

history of the Society; it is composed of four 



ADVERTISEMENTS. 



We Have Always 
Published Our Formulas 

Ever since the medicines of this Company were first placed upon the market, physicians 
and pharmacists have been given the formulas. Indeed, we have published these formulas 
time and time again, in all the leading medical and pharmaceutical journals the world over. 
In doing this, however, we have only carried out the plan inaugurated by the founder of this 
business. Dr. James C. Ayer. In the first edition of Ayer's Almanac, printed in 1853, 
Dr. Ayer most forcefully called attention to this question of publishing the formulas. He not 
only gave these formulas to the Medical Profession, but he even advised patients to consult 
their family physician with respect to the use of these medicines; advice which we most 
urgently give at the present day. The following is the extract to which we refer: 

"The substances of which Ayer's Cherry Pectoral is composed are those known to be 
most relied on by medical men for the treatment of pulmonary diseases. They, and their 
proportions, are accurately given in the Formula, which has been published in all the principal 
medical journals of the civilized world, and also submitted to the personal inspection of a large 
part of the Medical Profession of the United States and British America. 

"As a consequence of this course, intelligent practitioners everywhere are familiar with 
its composition, nature, and effects, and we would respectfully suggest to patients suffering 
under affections of the lungs, that they should consult their physician respecting the more 
minute directions for its use in their particular cases. Thus may be secured the best effects 
of the medicine, aided by the practical wisdom of those deeply learned in the science of the 
Healing Art." j. C. AYER COMPANY, Lowell, Mass. 



Tke Keystone of Healtk is a Normally Active Liver 

SULPHO-LYTHIN 

(GRANULAR AND NON-EFFERVESCENT) 

Is a truly reliable HEPATIC STIMULANT, 
INTESTINAL ANTIZYMOTIC and TOX- 
INE ELIMINANT that REPLACES CAL- 
OMEL and is free from injurious effect 
under continuous administration. 

SAMPLE AND LITERATURE FREE TO PHYSICIANS ONLY ON REQUEST 

LAINE CHEMICAL CO., Manfg. Chemists, 81-83 FULTON ST., NEW YORK 





sections, which meet in February, and then 
meet as a whole in June. Its Transactions 
fill 570 pages; the book is finely illustrated 
and well bound. The painstakino- work of 
the Secretary, in editing the volume, is 
evident, from cover to cover. 



Anemia oi Infancy.— Petrone (Gazetta 
Med. di Roma) states that anemia is fre- 
quent in infancy on account of the numer- 
ous conditions that may produce it which 
exist in the baby, and the lack of resistance 
of the corpuscles and the hematopoietic or- 
gans to morbific agents. No rational classi- 
fication of anemic conditions in the child is 
possible except with reference to the hema- 
tology. Starting with the conception that 



the essential symptom of anemia is oligoch- 
romemia dependent upon lowering of the 
globular resistance, and that at times there 
is oligocythemia, he divides the anemias 
into two groups: pure anemia and compli- 
cated anemia. Of uncomplicated anemias 
there are three types, chlorotic, simple and 
pernicious. In the chlorotic type the oli- 
gochromemia is produced by diminution of 
the globular resistance without the number 
of the red globules being lovv^ered. There 
is an insufficiency of the amount of iron 
necessary for the formation of hemoglobin. 
This insuflBciency may be congenital, de- 
pending on the scarcity of the reserve iron 
which the infantile organism takes from the 
mother, which may arise from any of the 



112 



THE CHARLOTTE MEDICAL JOURNAL 



' A Guarantee Agaifist 
Adulterated Wines 

A great authority, writing for the New 
International EncyclopEedia, says: "Certain 
it is that a very large percentage of the wine 
imported into the United States is fraudulently 
labeled, and low grade Bordeaux wines are 
commonly sold here under the names of 
famous brands." 

Garrett's 

Virginia Dare 
JVine 

is made from the famous Amci i- 
can Scuppernotig grape, which as 
a wine grape recognizes no rv 
anywhere, at home 
or abroad. f""""^-.. ' 

Every process 
from the gathering 
of the grape to the 
bottling is accom- 
plished by the latest 
and most approved 
methods, all under most careful supervision. 

The result is a wine which for purity, 
wholesomeness, delicious flavor and fine bou- 
quet is unmatched by the rarest vintages of 
France and Italy. 

Garrett's American Wines are to be classed 
with the slaple articles of food for the home 
table. If your wine merchant or grocer does 
not sell them, we will supply you direct, 
carriage charges prepaid. 

Write for our handsome book — sent free 

*''The Art of Serving Wine'^ 

If possible, give us your zaiiie merchant's name. 

The book tells when, where and how to correctly serve wines; 
Ki'ves valuable recipes for many delicious beverages ; describes 
Garrett's •'Virginia Dare," "Minnehaha," "Pocahontas" and 
other pure, wholesome wines, a;id cites high autliorities to prove 
their great food value. It is a book worth having. If your 
dealer will not supply you with Garrett's wines, ive will and pay 
delivery cliarges. 

We insist upon refundiii - vour money if you are not satisfied, 
whether you buy from us or your dealer. Write to-day. 

GARRETT &- CO. , ■- - Berkley Av. Norfolk, Va. 

Pioneer American Wine Growers. 
St. Louis, Mo. Established 1835 San Francisco. Cal. 




causes vi^hich lessen nutrition in the mother, 
such as poor feeding, or they may be a pre- 
mature exhaustion of the reserve, or the 
exaggeration of hemolysis in the few days 
after birth. Simple anemia shows an oli- 
gochromemia produced either by oligocy- 
themia or diminution of the number of red 
corpuscles with lessened globular resistance 
at the same time. In babies, more than in 
adults, there is polycliromatophilia and 
anisocytosis, with appearance of normo- 
blasts in the circulation. There are many 
causes of simple anemia which act by con- 
sumption of the blood, with diminution of 
production. The most frequent are disturb- 
ances of the digestive tube, deficient and 
improper feeding, poor hygiene, hereditary 
syphilis, tuberculosis, intestinal worms, 
sepsis, exanthemata, etc. Pernicious anemia 
is characterized by oligocythemia of high 
degree, oligochromemia, increased globular 
resistance, presence of megaloblasts in the 
circulation, nucleated hematite, anisocytosis, 
poikilocytosis, and marked polychromato- 
phylia. All the ordinary causes of anemia 
when acting in a marked degree may pro- 
duce the pernicious variety. Causes aside 
from these are bothriocephalus latus, anky- 
lostomum duodenale, hemorrhage, malig- 
nant tumors, malaria, syphilis, sepsis, and 
intestinal autointoxication. The compli- 
cated anemias are characterized by various 
types of hematology according to their 
etiology. The most important are mixed 
IJseudoleukemia, and the myelogenous form, 
splenomegaly with leucopenia, and spleno- 
megaly with lymphocytosis. 



University College of 

m^A\ • RICHMOND 

Medicine, Virginia. 

Stuart McGuire, M. D., President. 

DEPARTMENT OF MEDICINE 

Member of the Association 

of 

AMERICAN MEDICAL COLLEGES 

Standards 

of 

Admission, Instruction and graduation 

Entitle 

degrees to recognition 

in 

Every State in the Union. 

Address William R. Miller, Proctor. 



ADVERTISEMENTS. 



St. Luke's Hospital 

RICHMOND, VA. 



O. LUKE'S HOSPITAL is 
^ personally conducted by 
Dr. Stuart Mcguirk for the 
exclusive use of his private 
patients. It is located on the 
corner of Grace & Harrison 
Streets, in an elevated and 
healthy section, and is of con- 
venient access to all parts of 
the city by means of the street 
car service. The building was 
erected in 1900 and enlarged 
in 1905. It represents the best 
efforts of architectural skill to 
meet the demands of a modern 
sanatorium and now has a ca- 
pacity for 62 patients. The 
rooms are furnished with every 
comfort consistent with perfect 
sanitati on. Some of them have 
private baths. The wards are 
large, light and airy. The 
service'^and cuisine are the 
same throughont the building, but the cost of a bed, board, and general nursing varies from 
lio.oo to $25.00 per week according to location. No contagious diseases, cases of insanity 
or colored patients are received. 

For further information address, 

Stuart McGuire. M. D., 

vSurgeon in Charge, or 

W. Lowndes Peple, M. D., 

Associate. 




BROADOAKS SANATORIUM, 

Morganton, North Carolina. 

A Private Hospital for the Treatment of Nervous 

and Mental Diseases, Inebriety and Drug Habits. 

ISAAC M. TAYLOR. M. D, 

The recent enlargement, and consequent increase in number of patients, 
has made necessary the employment of an Assistant Resident Physician, who 
has entered upon his service. We purpose paying especial attention to the 
treatment of Drug Habits, and the permanent care of patients of both sexes, 
with chronic mental diseases of mild type. Other improvements are in pros- 
pect which will be announced when our plans are matured. 



St. Peter's Hospital, charlotte, 



N. C. 



Specially Equipped for the Treatment 
of Gynecological and Surgical Cases, 



GEO. W. PRESSLY, M. D., 

Surgeon. 



EDW'D C. REGISTER, M. D., 

Physician. 



For further information address the Superintendent, St. Peter's Hospital. 



THE CHARLOTTE MEDICAL JOURNAL- 



Miscellaneous. 



Interesting Case of Ovarian Combined 
with Intra-Uterlne Pregnancy. 

The possibility of ovarian pregnancy has always 
been granted by German Writers, but denied up to 
recent years by English authorities, only six cases 
having' been reported in England during the past 
hundred years. In this country up to 1902 only 
one case has proven authentic. This is probably 
due to the lack of proper criteria (Williams), but 
the case I report fulfills the conditions formulated 
by vSpeigelberg, and should therefore leave no 
doubt as to its presence. The conditions formu- 
lated are ( i ) the tube on affected side must be in- 
tact; (2) the foetal sac must occupy the position of 
the ovary; (3) it must be connected with the uterus 
by the ovarian ligament; and (4) definite ovarian 
tissue must be found in the sac wall. 

This case is not only interesting on account of the 
rarity of ovarian pregnancies, but on account of its 
multiplicity, having a pregnant uterus in addition 
to the ovarian. Parry states in his monograph that 
22 out of 500 extra-uterine pregnancies collected by 
him were complicated by co-existing intra-uterine 
pregnancy. 

Report of Case.— Sallie W., colored, was referred 
to me for operation by Dr. vSamuel Lindsay, of 
W^innsboro, vS. C, March 25th. He was called to 
see her the preceding day and found her much dis- 
tended, with symptoms of general peritonitis with 
obstruction of bowels. Operation was advised, and 
upon her consent she was at once sent to the Mag- 
daline Hospital. On opening the abdomen the 
diagnosis of general peritonitis was substantiated, 
and I found a considerable amount of clotted blood, 
which suggested extra-uterine pregnancy. Upon 
further investigation this surmise was shown to be 
correct, and I passed my finger around the tumor 
and discovered an opening large enough to admit 
one finger. This opening was then enlarged suf- 
ficiently to remove the foetus, and judging from its 
size, I would say that pregnancy was of at least five 
months duration. 

The tube was entirely intact, and the sac showed 
distinct evidences of ovarian tissue in its walls. 
The placenta was partially attached to the perito- 
neum, well down into the pelvis. 

The other point of interest was the pregnant 
uterus. I decided to leave the uterus untouched 
with a hope of its going on to term, but abortion 
took place the next morning, pregnancy appearing 
to have been of three months duration. 

The patient died in three days of general perito- 
nitis.— S. W. Pryor, M. D., Chester, S. C. 



Mot Weather Diet. 

In hot weather the average person takes too 
much food, and particularly an excess of meat. The 
digestive organs are kept at hard labor assimilating 
a heavy diet, and forcing every organ in the body 
to do an unnecessar}' amount of work. The diges- 
tive apparatus faithfully performs its function until 
insulted nature rebels and enforces a period of rest 
for the exhausted organs. Another danger from 
eating too much meat in summer is that of ptoniain 
poisoning following the ingestion of tainted meats. 

During the hot months the question of diet is 
largely one of the class of food material best adapt- 
ed to sustain mental and physical energy without 
unduly increasing the production of heat. 

A diet of milk, eggs, fruit and Egg-O-See ismost 
suitable for the summer months. Egg-O-See with 
cold cream makes a delightful basis for every meal, 
as it offers the full food value of whole-wheat. 

The Egg-O-See Cereal Co., of (Juincy, 111., will 
send on request a full-size package pf Egg-O-See to 
any physician. 



The Role of Iron In the Mutrltlve Process 

It is an established custom of physicians to ad- 
minister iron whenever a patient with pale, waxy, 
or sallow complexion complains of extreme exhaus- 
tion, muscular feebleness, easily accelerated pulse, 
aphasia, anorexia and the several symptoms which 
constitute the characteristic issues of a qualitative 
or quantitative reduction of the corpuscular elements 
of the blood. 

Such symptoms are unerring indications of 
anemia, and iron is beyond dispute a cure for that 
disorder. But while the chief therapeutic property 
of iron is that of an anti-anemic, the subordinate, 
or collateral, effects of the drug are manifold, and 
are worthy of far more consideration than they 
usually receive. 

As a hemoglobin-contributor and multiplier of 
red blood corpuscles, iron will doubtless forever 
stand supreme, but its utility is by no means re- 
stricted to anennc conditions, for one of the chief 
effects of iron — one quite often lost sight of — is its 
influence upon nutrition. 

The primary effect of iron is a stimulation of the 
blood supply. This results from invigoration of the 
blood vessels. As a consequence of a more active 
blood stream, the digestive capacity is increased 
and the nutritive processes are correspondingly 
improved. vSubsequentlj', iron increases the amount 
of hemoglobin contained in the red corpuscles. 
This imported hemoglobin converts the systemic 
oxygen into ozone, and thus wise oxidation, upon 
which nutrition directly depends, is restored to its 
proper standard. 

It is impossible to emphasize the fact too strongly 
that it is necessary to do more than increase the 
appetite to correct nutritive disturbances. A vo- 
racious appetite does not necessarily imply an ex- 
tensive appropriation of nutriment. On the con- 
trary, it is commonly observed that individuals 
who eat ravenously suffer, the while, a progressive 
loss in physical weight and strength, even in the 
absence of all exertions that might account for such 
losses. And while it is obviously needful to relieve 
the existing anorexia in order to arrest a loss of 
weight, it is likewise essential that the capacity to 
properly digest food be fully restored before the 
nutritive processes can proceed in befitting order. 

The manner in which iron begets an increase in 
appetite has only recently been perfectly under- 
stood. The earlier observers entertained the belief 
that an increase in appetite resulted from the me- 
chanical effect of iron, and that this mechanical 
effect never manifested itself unless the drug was 
administered in some acid form. Later investi- 
gators advanced the theory that this mechanical 
effect could be secured by rendering the drug either 
strongly acid or alkaline. Recent observations 
have completely disproved the accuracy of both of 
those theories by inviting our attention to the in- 
disputable fact that a neutral preparation of iron 
will relieve anorexia with greater celerity than will 
either an acid or an alkaline one. From the infor- 
mation gained from these observations, we are im- 
pelled to admit that thfe increase in appetite attend- 
ing the employment of iron is due solely to the in- 
creased oxidation induced by its entrance into the 
blood stream. Accepting this as being true, we 
can readily understand the manner in which iron 
e.xerts its happy effect upon the nutritive processes. 

The aforesaid facts compel the admission that 
that preparation of iron which enters most rapidly 
into the blood stream is the one capable of produc- 
ing the best results in all disturbances of nutrition. 
Acid preparations of iron diminish the alkalinity of 
the blood, thus depressing the distribution of nutri- 
ment, and alkaline preparations of the drug offend 
the mucous lining of the alimentary tract. For 
these reasons it is consistent with logic to extend 
preferment to that preparation of iron which is 
neutral in reaction. That preparation is the Pepto- 



ADVERTISEMENTS. 



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new standard of typewriter work 



The New 



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supplv a demand for SWIFTER, EASIER. 
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Tlie new Remington Mcxiels have a bran new 
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Remington supremacy is emphasized. 

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706 E. MAIN STREET, 
Richmond, Va. 
91 PLUME STREET, 
Norfolk, Va. 
1209 PLAIN STREET, 
Columbia, S. C- 
59 Broad Street, 
Charleston, S, C. 
33 N. TRYON STREET, 
Charlotte, N. C. 



Mangan (Glide). 

Pepto-Manj^an (Gude) is unquestionably the 
form of iron most closely resembling that which is 
native to the economy, and the striking affinity for 
it displayed by the circulating fluid causes us to 
concede that it possesses desirable attributes not 
connnon to any other preparation of the drug. 
Whence we take it that it is the precise form in 
which to administer iron when a correction of nutri- 
tive deficiencies is the end to be achieved. 

In those conditions of weakened digestive power 
where the function is unable properly to take care 
of the food supply; when to administer the ordinary 
forms of iron would be but to increase the digestive 
disturbance, Pepto-Maiigan (Gude) may be pre- 
scribed without apprehension, as the preparation is 
tolerated by the weakest stomach. Being practi- ' 
cally predigested, Pepto-Mangan is immediately 
absorbed by the mucous membrane and taken up 
by the blood without the necessity of the weakened 
function being called upon to prepare it for assimi- 
lation, and therefore the entire system, including 
the digestive function, is strengthened and recon- 
structed. As a nutrient tonic in digestive disorders 
Pepto-Mangan (Gude) has no equal. 



r 



GLYCO- 
THYMOUNE 

FOR 

SUMMER COMPLAINTS 



PROPHY LAXIS— The very natui 
cial foods and cow's milk prei 
their rapid decomposition. U •«« «r» 
of Glyco-Thymolincadded to each feeding 
-% acidity and prevenU disoi 



TREATMENT— As an adjunct t 

immer complaints, Glyco- 

I internally and by ene 

ects hyper-acid conditions, stops ex- 

; fermentation and '"'— 

- n. it is soothing— alkaline— 



KRESS « OWEM COMPANY, 

•210 Pulton Street, New York. 



Imitation or Substitution 



bocal Treatment for Vaginal Disorders. 

The use of suppositories, either of cacao butter or 
gelatin base, is open to certain objections which are 
well recognized by physicians. The oily nature of 
the one interferes very materially with the ready 
absorption of the medication, and the difficulties 
attending their preparation often result in faulty 
incorporation and imperfect distribution of some of a physician in spealcing: of Glyco-Tliymoline imitations, re 
the iJigredients. Bot^i are unstable in very hot --^f.^^^^e^/rh^eriwt UoTsi^ble ?o'1'eT^7tt;;"-- ^''"'' 
weather and require great care in keeping. '."imitations are at best poor substitutes and I never use them 

One of the most satisfactory devices which the I want tlie results that inrariably follow the use of Glyco-Thy 
physician can use is a .soluble disintegrating tablet, moli.ie-senuine." Sole Agents for Great Br.'ain, 
These are permanent and uniform in composition. Thos. Christy & Company lo and .2 Old Swan Lane, 

not affected by climate nor melted in the heat of ^°"'^°"' ^- ^^ ^"gi^"'^- 



XXVIII 



THE CHARLOTTE MEDICAL JOURNAL. 



PHILADELPHIA POLYCLINIC 

And College for Graduates in Medicine 

Excellent opportunities are afforded throughout the summer months 
for post-graduate work in all clinical departments of Medicine and Surgery. 
The regular roster remains in force and students may matriculate at any 
time. Individual instruction in the dispensaries and wards of the Hospi- 
tal b}^ thoroughl}" competent teachers. Reduced summer rates. 

For announcements, rosters and special information write to 

R. MAX GOEPP, M. D.. Dean. 
Lombard Street, above Eighteenth, _ - . = PHILADELPHIA, Pa. 




PRIVATE HOSPITAL 

elegantly situated in the center 
of the city, with every appoint- 
ment and appliance for the treat- 
ment of Diseases of the Eye, 
Ear, Nose and Throat, Trained 
nurses in attendance. 

For information address 
A. M. WHISNANT, M. a, 

South Tryon Street :: Charlotte, N. C. 
Phone J97. 



summer. They are applied locally by coating 
slightly with vaseline and inserting well up into 
the vagina, where in the presence of moisture they 
slowly disintegrate, bringing the medicinal agents 
into prolonged contact with the mucous surface of 
the vaginal tract. After inserting, a napkin or 
bandage should be applied and the use of the tablet 
should be followed after some hours by a douche of 
warm water either plain or containing an antiseptic. 
According to conditions a disintegrating tablet may 
be used once or twice a day or every alternate night 
at bed-time. While these tablets are primarily in- 
tended for local application in substance they are 
suitable for use in injection. As an injection they 
should be applied as follows: Drop two or three 
tablets into a cupful of lultewarm water, and allow 
them to soften. This will not require more than 
two or three minutes; then stir until all particles 
are thoroughly disintegrated, and add sufficient hot 
water to make one pint of solution of the proper 
temperature. Should there be any coarse particles 
allow them to subside before filling into syringe. 

Eli Lilly & Company offer twelve standard 
formulas prepared in this way, ready and conveni- 
ent for use in the local treatment of vaginal dis- 
orders. Any physician having a case demanding 
local vaginal medication should write for their de- 
scriptive pamphlet and samples. 



winter. This is more than a pleasant stomach 
tonic, it is something the wise doctor does not neg- 
lect. — American Journal of Clinical Medicine. 



Buffalo Lithia Water is one of the safest and best 
tonics known. 

Dr. Alexander B. Mott says: "I have made suf- 
ficient use of Buffalo Lithia Water to be satisfied 
that it possesses very valuable therapeutic proper- 
ties. In the gouty diathesis, chronic inflammation 
of the bladder, and other diseases affecting the uri- 
nary organs it may be relied on to give the most 
satisfactory results." 

Dr. Robert Battey writes: "I have been using 
Buffalo Lithia Water in my practice three years 
past, in cases of chronic inflammation of the blad- 
der, whether induced by stone, by enlarged prostate 
in the aged, or by neglected gonorrhoea, and have 
secured excellent results, which encourage me to 
prescribe it for the future." 



One of the things we have often said but that is 
well worth repetition is, that the treatment of the 
phthisical in summer is of the utmost importance; 
and that Hagee's Cordial of Cod Liver Oil is the 
hot season's representative of the fatty oil of the 



X-Ray Burns. 

At the 337th regular meeting of the New York 
Dennatological Society held Nov. 28, 1905, the sub- 
ject of X-ray burns was taken up, and Dr. Henry 
G. Piffard, P^meritus Professor of Dermatology in 
New York University said, according to the Journal 
of Cutaneous Diseases, "that he had obtained the 
most benefit in treating these conditions from Anti- 
phlogistine, chloride of zinc, high frequency cur- 
rent and ultra violet rays. ' ' 



ADVERTISEMENTS. 



XXIX 



mil 


, _ 


^^___ 








■■ 



The Sarah Leigh Hospital. 

NORFOLK, VIRGINIA. 

A private Hospital designed and constructed with every modern convenience and equip- 
ment. Pleasant and quiet surroundings. Rooms single or en suite. Private baths. 

Intended especially for Surgical, Gynecological, Obstetrical and Rest Cure cases. 

For inform ition address one of the following: 

Dr. Southgate Leigh, Surgeon in Charge, Dr. Stanley H. Graves, Associate, 

Miss M. A. NewtoD, Superintendent. 



(INCORPORATED.) 




Centrally located on Greene street. Modern appliances through- 
out, giving unsurpassed facilities for the most difficult medical 
and surgical cases. 

Nurses Home and Training School attached ; also, 
Cochran annex, complete in furnishing and equipment, with en- 
dowed beds for both races. 

For further information address 

J. F. HIGHSMITH, M. D., FayetteviUe, N. C 



XXX 



THE CHARLOTTE MEDICAL JOURNAL. 



L>lquid Medicines vs. Pills, Tablets and 
Granules. 

Despite the ]x-rnici()us activit}- of manufacturers 
of really made jiill'^ ami taMets in Hooding the mar- 
ket with all iio>>iMe Milistitutes for tinctures, fluid 
extracts and solutions, it has been amply demon- 
strated that these solid forms of medicine cannot 
compare in efficiency or in usefulness with the 
equivalent preparations given in hquid form. — 
Journal of the American Medical Association, June 
23, 19.16. 



"Manna" From Harvard. 

"Out of the eater came forth meat, and out of the 
strong came fortli sweetness." 

Di. hVeckrick C. .Shattuck is I'nifessor of Clinical 
Medicine in Harxard I 'niversity, and his address on 
the Value of Drugs in Therapeutics is notable in 
several respects. It is notable first for its healthy 
anti-nihilistic appreciation of drugs in the treatment 
of disease. While we believe that Professor Shat- 
tuck puts rather too narrow limitations on the 
value of drugs, still coming from a Harvard ])ro- 
fessor, we must be satisfied with small favors. The 
address is notable in the second instance for its 
having been delivered before a homeopathic body 
— The Boston Homeopathic Medical Society — thus 
offering us turther proof that the chasm between 
the various medical "schools" is being bridged 
over, the bonds of union l)ecoming closer and more 
numerous. And thirdly and more important, the 
address is notable for teaching just exacth' what we 
have been teaching these many years. Let us hear 
what Dr. vShattuck says: "It seems to me, he says, 
that the leading therapeutic principles can be stated 
somewhat as follows: 

"First. Do no harm. This principal seems to be 
well met by the homeopathist who uses the in- 
finitesimal dose. He does not harm save in so far 
as he may miss doing good. And it is still better 
met by our teaching — to start with small, not in- 
finitesimal — doses of the best procurable drug, aiid 
give it until results are seen. 

".Second. Try to see as clearly as possible just 
why you give a drug, your purpose in giving it, 
whether as a specific, curative, palliative, or as a 
placebo." 

Exactly what we have been teaching for years — 
give each drug only for a definite indication. 

"Third. As far as you can, give a drug uncom- 
bined. I'liis is a general rule subject to many ex- 
ceptions. Rules, however, are made to break. They 
are our servants, though we too often allow them 
to be our masters. Hut in breaking rules we must 
use our brains, and exercise that which most of us 
avoid so far as we can." 

Another therapeutic truth which we have been 
teaching for many years, and which we could not 
express in a better manner if we tried. We have 
always taught and asked the profession to adminis- 
ter drugs snigly whenever possible, but not being 
faddists, not being wedded to one itlea, we recog- 
nized that there are instances in which a combina- 
tion of drugs acts better than any one single drug 
can, and in such cases we advocated a combination 
of drugs. We know that one drug may act syner- 
gistically with another, or it can modify its action, 
diminishing its undesirable by-effects, render it mild- 
er in one respect and stronger in another — in all such 
cases we never hesitated to advise a combination of 
drugs. 

But in this paragraph (three) Dr. ,Shattuck really 
saj's more than he perhaps meant to say. "As far 
as you can, give a drug uncombined." Why does 
he say that? Because he wants a clear-cut action. 
And this is a direct plea for active principle therapy. 
For opium is not an uncombined drug; to adminis- 
ter opium with its twenty-odd alkaloids is almost as 
irrational as it is to combine twenty isolated alka- 



loids and administer them in one dose. Jaborandi 
or pilocarpus with its antagonistic alkaloids is not 
an uncombined drug. And when we want clear- 
cut, positive, definite action, we must administer 
the active principles. 

"Fourth (and last). In using an efficient drug, 
be as sure as you can of a good preparation, and 
then give it until something happens — either the 
desired effect or evidence appears that the limit of 
toleration has been reached, what is called the 
physiological, but what I should prefer to call the 
toxic effect. Disregaril of this law is, I believe, 
resjjousible for many therapeutic failures." 

This sounds very much as if it had been taken 
fr<iin soiie ibsue of the .-Vinerican Journal of Clinical 
Medicine. Small do-^cs frequently repeated until 
effect — doesn't this sound familiar to you? 

We will conclude with the closing paragraph 
from I)r. Shattuck's addre.ss, which might be well 
heeded by some of our ultra-scientific physicians: 
".Scientific medicine" says he, "is open to the dan- 
ger of .going to the extreme of therapeutic nihilism, 
of disregarding the imlividual, of forgetting that 
while our knowledge is imperfect and the big thing 
is to hud out the true nature and cause of disease, 
the present day sufferer demands, and has a right 
to demaiul, all the aid that our knowledge, imper- 
fect as it is, permits." 

In other words this means that while we are hunt- 
ing about for the ultimate cause of disease, we 
must not permit our present patient to die, but 
must give him all the aid, no matter from what 
source obtained, all the help that our present day 
knowledge — scientific or empiric — affords. — From 
the American Journal of Clinical Medicine. 



.As it is about time for the annual crop of hay 
fever, physicians will, of course, be thinking over 
the list of remedies that give relief. F'irst comes 
suprarenalin, the most convenient form of which is 
suprarenalin solution, a stable and non-irritating 
preparation of the active principle of the suprarenal 
substance. This is applied locally on pledgets of 
cotton or by spraying into the eyes and nose in 
strengths varying from 1:10,000 to 1:1,000, and is 
also given internally in ro to 20 drop doses three or 
four times per day. There is also suprarenalin 
ointment, 1:1,000 which is especially adapted to 
eye, nose, and throat work, as it is very bland, and 
its effects are more lasting than those of anything 
of the kind. 

Taking all things into consideration, suprarenalin 
is the most satisfactory remedy for hay fever. 

.Suprarenalin is one of the Armour Laboratory 
products, and full literature may be obtained from 
Armour & Company. 

to do their work thoroughly and without bias, viz.: 
Drs. Lydston and Graham, of Chicago; F^ve, of 
Nashville; Cordier, of Kansas City, and Wiggin, of 
New York. — Louisville Medical Journal. 



"INIorenci, Mich., April 10, 1906. 
The .\nti-Uric Co., 

Peoria, 111. 
Gentlemen: — The S-oz> sample of Uric-Antagon 
came promptly to hand. I made a personal use of 
it. The composition of it first secured my attention. 
I took it, watched its effects carefully. In a few 
days I noticed a marked difference in my feelings. 
I was more than pleased with its effects. You are 
at liberty to use this statement as you wish. 

Yours respectfully, 
(Signed) SAMUKL vSTf:VF:NSON, M. D." 



The Finances of the A. M. A. 

In many respects the recent meeting of the 
American Medical Association in Boston was 



ADVERTISEMENTS. xxxl 

SYR. HYPOPHOS. CO., FELLOWS 

Contains the Essential Elements of the Animal Organization-Potash and 

Lime ; 
The Oxidising Agents — Iron and Manganese ; 
The Tonics— Quini"e and Strychnine; (each fluid drachm contains the equivalent 

of i-64th grain of pure Strychnine). 
And the Vitalizing ConStituent -Pl^Q^pho^"^; the whole combined in the form 

of a Syrup with a Sli ghtly 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 Chronic 

Bronchitis, and other affections of the respiratory organs. It has also been em- 
ployed with much success in various nervous and debilitating diseases. 

Its Curative Power is largely attributable to its stimulant, tonic, and nutritive 
properties, by means of which the energy of the system is recruited. 

Its Action is Prompt ; it stimulates the appetite and the digestion, it promotes 
assimilation, 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 tr eatment of mental and nerv- 
ous affections. From the fact, also, that it exerts a tonic influence, and induces a 
healihy flow of the secretions, its use is indicated in a wide range of diseases. 



NOTICE-CAUTION. 

The success of Fellows' Syrup of Hypophosphites has tempted certain persons to 
offer nnitations 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 susceptibfl.ty ^o the effects of 
oxygen when exposed to light or heat, in the property of retam.ng the strychnine .n 
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 prescnb.ng the Syrup, 
to write "Syr. Hyphophos. FellOWS." 

As a further precaution, it is advisable that the Syrup should be ordered in the 
original bottles ; the distinguishing marks which the bottles (and the wrappers surround- 
ing them) bear, can then be examined, and the genuineness-or otherw.se-of the con- 
tents thereby proved. 



This preparation can be procured at all chemists and druggists, everywhere. 



XXXII 



THE CHARLOTTE MEDICAL JOURNAL. 




HILL CREST ^SANITARIUM 



(INCORPORATED) 
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of alcohol and drug- addictions. Full therapeutic equipment. 

Physician in charge Dr. O C. BRUNK, 

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REFERENCES: 
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Dr. J. S. DeJARNETTE, Western State Hospital, Virginia. 
Dr. P. L. MURPHY, Western State Hospital, North Carolina. 
ADDRESS: 



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the most remarkable in the history of this body 
—remarkable not only in size (over 4,500 regis- 
tered members were present), but also in the 
perfection of the local organization (due to the 
remarkable executive ability of Dr. Burrell and 
his efficient aids on the Committee of Arrange- 
ments), in the enthusiasm felt and expressed by 
all present, and, finally, in the bitter condem- 
nation by some of the most prominent men in 
the Association of the arbitrary methods of the 
Secretary Editor. Never has the Association 
been so prosperous as it is today; it has a mem- 
bership of over 20.000— one-sixth of the estimat- 
ed number of physicians in the country; it has a 
surplus of over a quarter of a million dollars, 
and this surplus is increasing at the rate of 
more than $25,000 a year. Ai loyal members of 
the Association, ([uorumjxirssunm^, must rejoice 
in those signs of prosperity and must g^ive due 
credit for the same to the Secretary-Editor, to 
whose genius for organization this "increase is 
largely owing. Since he assumed control of the 
Association, the membership has increased, in 
round numbers, from 8,000 to 20,000 and the out- 
side subscribers to the .Journal from 2,500 to 
17,500. which should have brought an increase 
of $140,000 per annum to the treasury of the As- 
sociation. Credit must also be g-iven to the 
Treasurer of the Association, a practical finan- 
cier and a bank director as well as a jjopular 
physician, whose wise investments of the surplus 
funds have apparently addpd not a little to the 
balance in the treasury. To the salaried organ- 
izer of the AssociatioD, sometimes dubbed the 
"walking delegate" by the disaffected, praise is 



also due from those who approve of the present 
system of organization of the American Medical 
Association. It is true the methods which he 
has thought wise, or has temperamentally been 
compelled, to adopt have made many bitter 
enemies of himself and of the body which he is 
assumed to represent; yet the fact remains that 
he has succeeded in the creation of many county 
societies and has thereby increased the potential 
membership in the Association. 

So far, so good. The American Medical As- 
sociation today is larger and richer and (juoad 
hoc more powerful than ever before. But is it 
stronger in itself, and assured of continued 
progress? "Let him who standeth take heed 
lest he fall." This saying applies to organiza- 
tions as well as to those who rule the organiza- 
tions. Less than two years ago there were three 
enormously rich and, powerful life insurance 
companies in the United States; their surpluses 
were in the neighborhood of $100,000,000; the 
men in control of ihem were among the financial 
magnates of the country, i-espected and envied, 
and anyone who had ventured the suogestion 
that there was danger to the companies in this 
prosperity would have been scouted. Today 
these same companies are putting forth every 
effort to regain the confidence of the public by 
instituting investigations, suing their former 
chiefs to enforce restitution, and reducing sal- 
aries (including those of the medical examiners), 
and the pitiable condition of those who brought 
them to this state of seeming prosperity by their 
deceitful methods is known to all. The cause of 
the spectacular debacle is also known. The fall 



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W. G. EwiNG, Ph.G., M. D., Professor of Mate- 
ria Medica, Therapeutics, and Clinical Medicine. 

S. vS. Crockett. M. D. Professor of Obstetrics. 

M.C. McGANNON.C. M., M.D., Prof essor of Dis- 
eases of Women and Abdominal Surgery, 

L. B. Graddy, M. D., Professor of Diseases of 
Eye, Ear, Nose and Throat . 

J AS. M. King, B. vS.; M. D., Professor of Chemistry 
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and Bacteriology. 
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Edwin G. Wood, C. M., M. D. Professor of Prac- 
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was the logical and inevitable consequence of 
the policy of concealment so long followed by 
those in conti-ol. The published reports dealt 
in aeneralities and studiously avoided details. 
The members of the mutual companies, who 
were tlieoretically part owners with a right to 
know how their money was being: spent, were 
kept in ignorance of the facts and '"jollied" by 
the magniticent totals into believing that they 
were coining money by living and would make 
more by dying. 

The ilnancial reports of the American Medi- 
cal Association are disquietingly analogous to 
those of the insurance corporations. They deal 
in glittering generalities— and the surplus in- 
creases at the rate of $25,000 annually. But 
what are the items of expenditure? In the re- 
port for 1905 the expenses of ''organization" are 
set down as $7,797.04; organization of what'? The 
sum given away in salaries and wages was $78,- 
874.79; whose salaries? For "medical legisla- 
tion" there was spent $1.2H4.90. Under the item 
"Association" we find $10,0(52.30 expended. The 
average circulation of the Journal was 38,000, 
and the income therefrom should have been in 
the neighborhood of $192,000: but the total 
amount received from dues and subscriptions 
was only $147,651 01, leaving over $44,000 unac- 
counted for. And s^o on. What the members 
of the Association want is frank publicity in the 
financial reports—not indefinite items which 
defy analysis. Herein lies danger to the Asso- 
ciation. Such a report as that published in the 
Journal of June 10 is worthless and worse — it is 
not frank. What the members have a right to 
know is what "organization" means, what 
"salaries and pay roll" means, what "associa- 
tion" means, why more than 23 per cent, of 
wnat should have been received in dues and 



subscriptions remains unaccounted for, and so 
on. Every member of the Association is the 
owner of an undivided fraction of the property 
of the Association, and he should be told how 
this property is being managed; he wants some- 
thing more than the assurance of a retiring 
president, in virtue of his ( ifice a mere figure- 
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XXXIV 



THE CHARLOTTE MEDICAL JOl^RNAL. 



the terms, but there is want of frankness on the 
part of those who control the Association which 
is disquieting and tends in these days of "graft" 
to arouse grave suspicions. These may be, and 
we believe are, unjust. They are, however, 
bound to grow so long as those.who have charge 
of the money of the Association make unsatis- 
factory I'eports which suggest a desire for con- 
cealment. The only way for them to purge 
themselves of suspicion is to take all the mem- 
bers into their confidence and to publish a clear 
and definite itemized report of receipts and ex- 
penditures, and then have the report audited by 
a committee of members, not by a local firm of 
expert accountants.— Medical Record. 

Carcinoma of the Bronchus and Uiver fKe- 
sooiated with Glycosuria In a Youth. 

Hall and Tribe (The London Lancet) mention 
the case of a boy of seventeen years who was 
admitted to the University College Hospital, 
with cough, shortness of breath and loss of 
weight. The past and family histories were 
negative. Pie first noticed the cough about three 
months before admission and expectorated large 
amounts of bloody sputum. A month before he 
was admitted he began to complain of itching 
and developed an unnaturally great appetite 
and thirst. Ihen the amounts of his urine in- 
creased. A few days before admission his hands 
and legs began to swell. On admission he was 
pale, thin and cyauotic. Temperature 100.6 de- 
grees F. Both legs were covered with gan- 
grenous purpu)'ic spots. There were several 
edematous swellings on the trunk. The liver 
was enlarged. There was marked bronchial 
breathing. He had diarrhea. The urine was 
loaded with sugar and gave a faint reaction for 
diacetic acid. He died suddenly the day after 
admission. The bronchus of the lower lobe of 
the left lung was the seat of a columnar colled 
carcinoma. There were smaller areas in the 
upper lobe. The liver showed many large no- 
dules with softened summits. There were small 
deposits in the retro-peritoneal glands and the 
posterior cervical glands. 

Some Obscure Gases of Urinary Disorder. 

C. Elsworth, in The London Practitioner, dis- 
cusses urinary disorders, reciting ten cases oc- 
curring in his own practice. He concludes that 
cystitis lasting for long periods, due to primary 
lesion of the bladder, and accompanied through- 
out its entire course by acid urine, is much more 
common than is generally supposed. The oc- 
currence of urinary disorder with acid pyuria, 
and fi-equency of micturition, does not mean 
that a bladder lesion is excluded, and that the 
lesion is necessarily in the kidney. It is possi- 
ble to have extensive disease of the Kidney with- 
out any urinary symptoms whatsoever, and that, 
too, with normal urine. There may be urinary 
symptoms consisting of pain, frequency of mic- 
turition, and acid pyuria, without disease of 
eithei' kidney or bladder, the symptoms being 
due to a lesion in the ureter. The various or- 
gans are so intimately connected that the symp- 
toms produced by disease of one may be common 
to all. The difi'erentiation 4s only possible by 
physical examination, in which the cystoscope 
gives valuable aid. In certain limited numbers 
of cases, the administration of a pigment, such 
*as an aniline dye, facilitates the recognition of 
a partially or completely blocked ureter. 

Serum Therapy by the Mouth. 

Paton (British Medical Journal). For eight 
years Dr. Paton has used serums by the mouth. 
Thus used their action is neither antitoxic nor 



antibacterial. But the theory which best ex- 
plains their action is that of tissue resistance. 
The oral use of normal plasma of the horse, 
sheep, and ox in drachm doses four times a day 
restores lowered nutrition. The reaction lead- 
ing to restored function is obtained in the pres- 
ence of infections to which the animal itself is 
refractory. Tho serum of the horse and sheep 
is of great service in tuberculosis, but is value- 
less in influenza. Ox plasma is of the greatest 
service in influenza, as the animal is extremely 
resistant to that infection. The antidiphtherial 
serum is re-enforced by the oral administration 
after it has been given beneath the skin. In 
such cases it materially assists the recuperative 
powers. 



i3uttermllii in the Gastro-lntestinal Dis- 
orders of Infancy. 

Stoess (Corr.-Bl. f. Schweizer Arzte) has em- 
ployed buttermilk in certain gastro-intestinal 
disorders of infancy. As a food for infants it has 
recently been recommended by de Jager and 
Teixeira de Mattos. It contains 2.5 to 2 7 per 
cent, of albumen, 0.5 to 1 per cent, of fat, and 3 
to .'3.5 per cent, of sugar. Teixeira de Mattos 
gives the following directions: A level table- 
spoonful (10 to 12 grams) of fine rice or wheaten 
flour is stirred in a litre of buttermilk, which is 
placed on the stove and constantly stirred until 
it has thrice been on the point of boiling over 
(for about 25 minutes). Two or three heaped 
tablespoonfuls (70 to 90 grams) of cane or beet 
sugar are then added. As buttermilk is acid 
the utensils should not be of any metal which is 
soluble in acids. He follows Heubner's recom- 
mendation and adds slightly less sugar (50 grams 
of cane sugar). The food is then poured into 
Soxhlet's flasks and boiled for a further three 
minutes. Unless it is poured into several flasks 
(one for each feed) an upper watery layer forms 
on standing. 

Case 1. — A male child of prosperous parents 
weighed at birth 3,640 grams. At first it throve 
on cow's milk and water, but afterwards became 
constipated, and, in spite of change of diet and 
the additionof various infants' foods, emaciated. 
At four months the weight was only 3,215 grams. 
Six feeds, each of 100 grams, and later of 120 
grams, of buttermilk, were given daily. The 
bowels at once acted normally. This diet v/as 
continued (except during ten days, when there 
was diarrhea) until June 23, when ordinary cow's 
milk (vas gradually substituted. On that date 
the weight v.'as 5,410 grams, and on July 15, 
6,500 grams. Thus in the first four months 
weight was lost, but in the second four months 
it was doubled. 

Case 2. — A female child at nine months weigh- 
ed 3,640 grams. At nine weeks there was an 
attack of diarrhea and vomiting, and the weight 
fell from 4,000 to 3,500 grams. Since then, in 
spite of numerous phanges of wet nurses and of 
foods, she did not thrive. There were constant 
constipation and vomitings, which were unin- 
fluenced by gastric irrigations and enemata. At 
the ninth month the weight was practically the 
same as at the third. Buttermilk (120 grams 
for each feed) was, on .June 3, gradually substi- 
tuted for the infants' food which was previously 
given. The stools rapidly became normal, and 
on July 20 the weight had increased to 5,050 
grams. Cow's milk was then substituted and 
was digested perfectly. 

Case 3. — A child, aged two years and two 
months, weighed only 4,275 grams. It had al- 
ways been fed artificially and with a variety of 
miiks (including goat's) and foods. It was of 
about the size of a six-months-old baby, and 



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THE CHARLOTTE MEDICAL JOURNAL 



Bnterospasm Simulating Appendicitis. 

Hawkins (British Medical Journal) while ad- 
vocating prompt operation in most cases of ap- 
pendicitis, believes, nevertheless, that at pres- 
ent the appendix is often removed unnecessarily. 
There is a tendency to look upon every pain in 
the ileocoecal region as appendicitis and to 
operate. Often, the attacks of pain remain un- 
influenced by the oiieration for the reason that 
they were not produced in the region of the ap- 
pendix ar, all. Intestinal neuroses, simulating 
append! ;itis, occur, though rarely, and mucous 
colitis is not infrequently mistaken for the same 
disease. The greatest of these sources of error, 
however, is entercspasm. This condition may 
alfect any portion of the gut, but occurs most 
often in the coecal region and in the descending 
colon. It is found most frequently in neuras- 
thenics and may present a very various picture. 
It may produce definite attacks of acute pain, 
but more often appears as a dull, more or less 
vtigue, pain, sometimes lasting for months and 
usually referred to the left or right iliac fossa. 
In the latter case it is apt to lead to a false diag- 
nosis of chronic appendicitis; in the former to 
one of disea.se of the sipmoid flexure. He re- 
ports a number of such cases, wrongly diagnosed, 
in some of which the spastic stenoses of the gut 
could be observed during the operation. 

Tuberculosis In Infancy and Childhood. 

Matthews (Brit. Jour. Child. Dls.) believes 
that the majority of tuberculous infants appear 
to be infected from tuberculous relatives, not 
from the milk of tuberculous cows, even in cases 
where the infection may appear to have been 
through the alimentary system. In 25 succes- 
sive autopsies upon tuberculous patients in 
the Newcastle Sick Children's Hospital, which 
he has studied, the lungs showed tuberculosis 
in 23 cases, only two of these entirely miliary. 
The bronchial lymph nodes showed macroscopic 
changes in 19 cases, the mesenteric in 20. The 
intestinal mucosa showed changes in 15 cases, in 
all of which there was advanced pulmonary 
tuberculosis. In this series the bronchial and 
mesenteric lymph nodes were affected with al- 
most equal frequency. In only four cases were 
the mesenteric nodes involved without the bron- 
chial, and three had tuberculosis of the bron- 
chial but not of the mesenteric nodes. Accord- 
ing to the writer the histories furnish no means 
of foretelling whether the bronchial or mesen- 
teric nodes have been primarily affected, nor 
does an autopsy afford a more certain clue in the 
majority of cases. Of the cases in which the 
mesenteric nodes were affected there was a his- 
tory of constant association with another tuber- 
culous individual in 50 per cent., while they 
were involved in 66 per cent, of cases which 
were fed entii'ely at the breast or on proprietary 
foods until after the onset of symptoms. From 
these facts the writer argues that it is fallacious 
to compute the frequency of milk infection from 
the proportion of cases of involvement of the 
mesenteric nodes without attention to the his- 
tory of feeding and of association with cases of 
tuberculosis. 

Treatment of Warts by Internal Remedies. 

Hall (British Journal of Dermatology) reports 
the case of a girl suffering from multiple warts, 
one hand and wrist containing as many as 367. 
No local applications were made, but a mixture 
of magnesium sulphate with sulphur was given 
three times a ddy for three weeks. Later the 
treatment was changed to a confection of sul- 
phur and confection of senna, to be later follow- 
ed by aloin and tincture of nux vomica. Under 
the latter treatment, which was continued for 



about one month, it was noted that the warts 
began to diminish in size and later nearly dis- 
appeared, a few remaining on the fingers. 



The Boston Session of the f\. M. f\. 

The session of the American Medical Association 
at Boston, from all accounts, was a remarkable one, 
from the point of attendance, scientific work done, 
sensational rumors of what was to be done to cer- 
tain officers of the Association, candidates for re- 
election, and parliamentary disposition of certain 
resolutions calling for the investigation of the affairs 
of the Association. 

The latter matter was the most unfortunate oc- 
currence that could possibly have happened. A 
resolution introduced by Dr. H. O. Walker, of 
Detroit, contained the following preamble: "Be- 
cause of these facts, there has arisen the sentiment 
which bids fair to be disagreeably large, unless the 
cause upon which it feeds be removed, viz: "Ig- 
norance of the real truth." We are astonished, as 
are so many members of the Association with whom 
we have talked, that the friends of those most 
vitally interested should have allowed this resolu- 
tion to be tabled. This course can have but one 
result, that of causing more talk of corruption and 
mismanagement, and they should realize that an 
investigation will come, and come soon. It has 
been postponed one )'ear, it pos.sibly may be stayed 
at the next meeting, but it is inevitable. A mere 
hint at mismanagement, a suspicion of distrust on 
the part of a single member of the Association 
should have been the cue for a searching investiga- 
tion to have been demanded by the Secretary-Editor 
and Treasurer and the Board of Trustees. 

As stated in a previous editorial, the Association 
is fast becoming a gigantic trust, with enormous 
funds at the disposal of a few who manage to per- 
petuate themselves in office. The twenty thousand 
or more members of the Association for their an- 
nual dues receive only the official organ of the As- 
sociation, are to be charged seven dollars for a 
Medical Directory, issued by a press which belongs 
entirely to them, and compiled through their assist- 
ance to a great extent. 

We do not see of what use this fortune, being 
amassed by the Association, can be to the prof ession 
at large, supporting, as it does, but a few who are 
on the inside, and those on the outside can't learn 
what sum is being paid them. We fail to see why 
the Association should be such a money-maker, so 
largely at the expense of the members and they get 
so little benefit from it. If the members of the pro- 
fession who are not members of the Association are 
to be boycotted, as was stated by one on the "in- 
side" not long ago, it is time we called a halt, and 
began such an investigation as Dr. Walker's resolu- 
tion called for. The investigating Counnittee named 
in the resolution could certainly have been trusted 
to do their work thoroughly and without bias, viz. : 
Drs. Lydston and Graham, of Chicago; Eve, of 
Nashville; Cordier, df Kansas City, and Wiggin, of 
New York. — Louisville Medical Journal. 



The Boston Meeting. 

The resources of the Association have also increas- 
ed correspondingly, for we find that at this time 
there is a surplus in the treasury of over 1236,000, 
and the annual surplus over all running expenses is 
$25,000. It can be seen from these figures that this 
Association is possessed of great power for good or 
evil as it is managed, and the hope is that it may be 
so directed in the future as to advance the cause of 
liberal medicine and journalism rather than become 
a great trust engineered for the purpose of suppress- 
ing healthy competition and personal independence 
in medical practice, medical journalism, and phar- 
maceutical progress, as it has unquestionably at- 



ADVERTISEMENTS. 



XXXVII 



LISTERINE 



The orig'inal antiseptic compound 



Listerine is an efficient and very effective means of convey- 
ing to the innermost recesses and folds of the mucous mem- 
branes that mild and efficient mineral antiseptic, boracic acid, 
which it holds in perfect solution; and whilst there is no possi- 
bility of poisonous effect through the absorption of Listerine, its 
power to neutralize the products of putrefaction (thus prevent- 
ing septic absorption) has been most satisfactorily determined. 

LISTERINE 
DERMATIC SOAP 



A saponaceous detergent for use 

in tHe antiseptic treatment 

of diseases of tHe sKin 

Listerine Dermatic Soap contains the essential antiseptic 
constituents of eucalyptus (1%), mentha, gaultheria and thyme 
(each /4%), which enter into the composition of the well- 
known antiseptic preparation Listerine, while the quality of 
excellence of the soap-stock employed as the vehicle for this 
medication, will be readily apparent when used upon the most 
delicate skin, and upon the scalp. Listerine Dermatic Soap 
contains no animal fats, and none but the very best vegetable 
oils; before it is "milled" and pressed into cakes it is super- 
fatted by the addition of an emollient oil, and the smooth, elastic 
condition of the skin secured by using Listerine Dermatic 
Soap is largely due to the presence of this ingredient. Unusual 
care is exercised in the preparation of Listerine Dermatic 
Soap, and as the antiseptic constituents of Listerine are added 
to the soap after it has received its surplus of unsaponified 
emollient oil, they retain their peculiar antiseptic virtues 
and fragrance. 

A sample of Listerine Dermatic Soap may be had upon 
application to the manufacturers— 

Lambert PHarmacal Company 
ST. LOUIS, u. s. A. 



Bronze Medal (Hiehe.t Award) Exposition Universelle de 1900, Paris 



XXXVIII 



THE CHARLOTTE MEDICAL lOURNAL 



tempted to do in the past in a high-handed man- 
ner. 

We note as a healthy sign, however, that the 
wave of revolt and general indignation on the part 
of the independent medical press of the country has 
been felt by the Association, possibly in time to 
save it from the consequences that must certainly 
follow with disaster and ruin if it continues its past 
policy towards the independent element in the pro- 
fessionsof medicine, journalism, and pharmaceutical 
manufactures. As a sort of placebo to the offended 
journals we find that the Connnittee "disclaimed 
any intention on the part of the National Associa- 
tion or on that of the vState Societies to injure the 
independent medical journals owned or edited by 
physicians. These had in the past done excellent 
work for the development of medicine and the dif- 
fusion of the knowledge of medical advances. 
Many of them still continued to accomplish this 
valuable purpose. The House of Delegates then 
was asked to recommend to the support and patron- 
age of the members of the American Medical Asso- 
ciation such medical journals as did not receive un- 
ethical advertisements." 

Thus by the permission of the great Octopus at 
least a portion of the journals ' 'owned by physicians' ' 
will be spared a little longer, and if perchance they 
can come up to the standard of cleanliness from the 
viewpoint of the advertising critic they may be 
recommended to the members of the Association. 
Well, we venture to say that with the greater illumi- 
nation which the independent medical press will 
throw OH the workings of this Association and its 
money-making schemes it will be at least as con- 
siderate and maybe a little more respectful at its 
next meeting. 

The Handwriting Is on the Wall: Imperial 
Methods In Medical Politics. 

It was Daniel who interpreted mene, mene, tekel 
upharsin. I paraphrase it: "Octopus, you have 
been weighed in the balance and found wanting" 
to boss things and run the "mersheen," and you 
are up against it. 

By reference to another part of this issue it will 
be seen that a resolution introduced in the House of 
Delegates by H. O. Walker, of Detroit, at the re- 
cent Boston meeting, asking for an investigation of 
the financial management of the Octopus was laid 
upon the table! Such is the autocratic power be- 
hind the House of Delegates. The House controls 
the Association; the Trustees the House, and the 
Secretary-Editor the Trustees. Witness a resolution 
adopted empowering the Trustees to change the 
place of meeting elected by the House of Delegates 
— if it didn't suit 'em. (Coe had a close call. They 
would gladly have cut out Portland had this come 
earlier). Thus the power of nullifying the action 
of the House is put into the hands of the Trustees, 
which means the Secretary-Editor — The Czar! The 
fact that an investigation was shut off gives ground 
for suspicion that there is something — what is it? — 
that will not bear investigation. The 23,000 mem- 
bers and the 100,000 physicians not members have 
a right to know what is done with the 1275,000 an- 
nual revenue and the $25,000 annual profit on the 
Journal. But they are denied this right, and are 
told to "shut up." That is about what McCurdy 
and McCall, and Perkins at first told the policy 
holders. They lose their heads. That is about 
what Louis XVI told the rabble when they asked 
for bread. That is about what Charles I. told Par- 
liament. That is about what poor, weak little 
Nicholas has told the Douma. Charles lost his 
head, Louis lost his, and the Czar will lose his. The 
handwriting foretold the fall of Babylon. It fore- 
tells that of the Czar of all the medical profession. 

In Texas we have a splendid organization with 
an enrolled membership close to 3000. Let it throw 
off the yoke, assert itself, and oil will be thrown on 



the troubled waters. Raise the Lone Star flag once 
more. Be we men and submit to be bossed and out- 
raged? Already members are leaving the Octopus 
at the rate of one hundred a month. See Secretary's 
report elsewhere. "1208 were dropped during the 
year; 171 deaths, 619 resignations" (fifty a month 
every month) and the balance (presumably) for 
non-payment of dues — same as resignations. True, 
there was a net gain of 4300. This was largely ac- ' 
cessions from New York State, whose "new code" 
State Association has been whipped back or coaxed 
back. They bring in several thousand. This was 
a master stroke(?) of "the benevolent assimilation" 
polic}', the homeopathic leveling process now go- 
ing on, — "unifying the profession." 

It will be remembered that in 1884 certain lead- 
ing New York delegates favored consulting with 
homeopaths, and, in consequence, were refused ad- 
mittance to the A. M. A. at the Milwaukee meet- 
ing, I think it was (in 1884). They split off and 
organized a separate State association, and were 
known as the "new code men." They were never 
afterwards represented in the A. M. A. They come 
back now and bring their tails behind them, — and 
all is lovely. And so goes on the leveling process, 
the loaf having been leavened with homeopathic 
leaven under the skillful manipulations of the re- 
doubtable disciple of Hahneman, the Secretary- 
Editor of the Octopus. 

But this big addition to the ranks was exceptional 
and can not occur again. In future the falling off 
will exceed the gains, and when the big Western 
State Medical Association now being organized by 
Jabez Jackson is inaugurated, the Western men will 
secede in a body. Then comes the seceding South- 
ern States and the downfall of this modern Babel, 
where "medicine," homeopathy, faith-healing, 
osteopathy and voodoo are all represented and 
spoken. — Texas Medical Journal. 



Editor Ch.\rIvOTTE Medicai. Journal:— 

Ainhum is described by Dunglison as a spontan- 
eous amputation of the little toes, occurring only 
among negroes of pure African blood. Though 
this trouble is extremely rare, it is thought to occur 
more frequently in South America than in this 
country. The poverty of the literature on this sub- 
ject induces me to offer for record two cases of some 
interest; these occurred in mother and daughter, — 
rather suggestive of heredity; one was of the little 
toe, the other of the little finger, showing that it 
does not always affect the toes, unless, resorting to 
the questionable method of delving into evolution, 
we should say that the 'coon' lost a toe off the front 
foot. 

This trouble is painful, but as it is usually thought 
by the patient to be a small matter until an advanc- 
ed stage has been reached, the surgeon rarely sees 
them until naught but the clippers offers relief. 

W. E. JiNKINS. 



The American Medical Association. 

We heard many expressions of dissatisfaction on 
account of the manner in which the Association 
affairs are conducted— especially that in connection 
with the Journal of the American Medical Associa- 
tion. 

The impression has gone forth that the secretary- 
editor receives five thousand dollars annually, while 
we understand from a reliable source that he draws 
double this amount. 

It is also said that another physician who travels 
under the direction of the secretary-editor is paid 
out of the Society's funds five thousand dollars 
annually. 

We fail to see why these items and many others 
do not appear in the financial reports. 

The feeling among the members is growing so 
strong that ere long some changes will come. — The 
Medical Recorder, Shreveport, La. 



ADVERTISEMENTS. 



JOHANN HOFF'S MALT and IRON 

(PEPTONATE OF MANGANESE AND IRON.) 

Is sku ideal preparation to build up 

BLOOD AND BODY 

(Each wiiiej^liissfiil caitaiiis 1 gramme of Peptoiiate of Manganese and Iron.) 

It is a Nutrient Oxygen Carrying Agent 

Contains only a minimnm amount of alcohol (less than 3%); is more 
readily absorbed into the circulating fluid than the iron preparation by 

itself. 

Johann HofT's Malt and Iron is of marked and certain value in all 

forms of Ansemia, Chlorosis and general debility. 

EISNER & MENDELSON CO. of New York, 

SOLE AGENTS. 



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The Ownership of Papers Read Before 
Scientific Societies. 

The most serious inroads that official organs are 
making into the domain of the independent medi- 
cal press has been the restriction of publication of 
papers read before scientific societies to the official 
organ. A few years ago there were no medical 
journals that were owned by medical societies. 
The American Medical Association published its 
papers in the form of transactions which were is- 
sued as annual volumes, and it did not preclude the 
members from publishing their papers in medical 
journals. With the establishment of the Journal 
of the American Medical Association it was required 
that those who read papers before the various sec- 
tions should submit a full abstract or the original 
paper for publication in the journal of the associa- 
tion. vSo far as we are aware the Journal of the 
American Medical Association has never assumed 
that the title of the paper resided wholly in the 
Journal, but it has refused to publish papers which 
were printed elsewhere prior to the time that they 
could appear in the Journal. The tendency of the 
vState journals is to establish a fare more rigid rule, 
and to assume that ownership of the paper passes to 
the State society organ when it is read at one of the 
meetings. 

This same question has been raised regarding the 
Toronto meeting of the British Medical Association. 
According to the rules adopted "all papers read are 
the property of the British Medical As.sociation, and 
may not be published elsewhere than in the British 
Medical Journal without special permission." The 
Montreal Medical Journal in commenting upon this 
says there is no statement as to who is authorized 
to give the permission, but that it proposed to be 
guided by the authority of the reader. It further 
states that it is excellent journalism to endeavor to 
secure so large a body of material for exclusive pub- 



lication at No. 2 Agar Street, and if that is the in- 
tention it is the opinion of the Montreal Medical 
Journal that it should have been specifically stated, 
and that it should be the right of the reader of the 
paper to choose the medium through which he will 
seek publication. It believes that the prestige of 
the British Medical Journal is .so immense that it 
can well afford to adopt this sound principle of free- 
dom, allowing to each reader and each journal en- 
tire liberty of action. That this is sound doctrine 
no one will question, and is quite as applicable to 
the various State society organs as it is to national 
publications, both in this country and in England. 
If the other rule is adopted and strictly adhered to, 
that all papers read before medical societies must 
appear solely in the official organs, it will do much 
to eliminate independent medical journalism.— 
Pxlitorial in "Medicine." 



Variability of Di&ltalls Preppratlens. 

Attention has been called to this subject once 
more by a paper in the British Medical Journal of 
September i6, 1905, by Dr. Hardman. The author 
states that in his experience some specimens of 
digitalis are very deficient in active principle and 
practically inert. He also adds that digitalin, which 
is a term rather loosely applied to a complex sub- 
stance, does not always exercise the effects which 
are desired. As an illustration of the lack of reli- 
ability of this product, he tells us that he recently 
ordered from a first-rate wholesale house a number 
of pills containing one-fiftieth of a grain each of 
digitalin. The first night he took one, the next 
two, the next four, and the next five; in other 
words, the equivalent of one-tenth of a grain of 
digitalin in the last dose, without any effect what- 
ever being produced. He then proceeded to take 
seven in one night, and the next night ten. This 
last dose contained one-fifth of a grain of digitalin. 



XL 



THE CHARLOTTE MEDICAL JOI^RNAL 



The only result of a dose of ten pills was some gas- 
tric discomfort, but not the least effect on the circu- 
lation. 

In view of these remarks concerning the uncer- 
tainties in digitalis therapy, it seems especially 
apropos to cite an opinion regarding a new digitalis 
derivative. This substance is known as Digalen — 
Digitoxinum Soluble Cloetta. 

In Therap. Monat. Dec. 1905, Dr. R. Freund dis- 
cusses various preparations of digitalis. Incident- 
ally he strongly recommends digalen. He states 
that, in his experience digalen has no cumulative 
action, does not give rise to vomiting, and is the 
only derivative of digitalis which can be injected 
into the veins. Such an injection is painless and 
only needs to be repeated every 24 hours; its effect 
is evident in from two to five minutes in a rise of 
blood pressure of about 24 hours' duration. The 
author has employed digalen in one case of cardiac 
weakness after chloroform narcosis, in two of mitral 
insufficiency with dropsy, and in one of pleurisy 
complicated by cardiac weakness. The preparation 
was well borne by the patients, and in each case 
gave good results. Dr. F. finds digalen to be the 
most satisfactory preparation of digitals at present 
in our possession. 

Combines Efficacy with Safety. 

In the practitioner's daily life there is ever an op- 
portunity to exhibit an antipyretic and pain re- 
liever, which combines efficiency with absolute 
safety, for the benefit of his patients and credit to 
himself. Prior to five years ago, I had used the 
various antipyretics and analgesics with fear and 
trembling, feeling that for the decline of every de- 
gree of fever the heart suffered in proportion. How- 
ever, since I have used Antikamnia Tablets I suffer 
from no fears on the above score. 

A brief outline of a few clinical cases, wherein 
this remedy was used with unvarying success, will 
doubtless be of interest. 

Case I — H. S. aet. 19 was taken with a prolonged 
and severe chill, and rise of temperature, followed 
by swelling of both ankle joints, exquisitely painful. 
Diagnosis: Acute inflammatory rheumatism; sali- 
cylate of soda in large doses ordered with very little 
result, in fact with no appreciable effect. Anti- 
kamnia Tablets were ordered, one every three hours. 
After the first few doses the patient was much more 
comfortable, in fact, comparatively free from pain. 
The joints were continuously enveloped in cold 
packs and a tablet of Antikamnia ordered to be 
taken every four hours. The young man made a 
perfect recovery in six days and at no time during 
his illness were any heart symptoms noticed. 

Case 2 — Miss B. was subject to the most excruci- 
ating pain before and during her monthly periods. 
An examination revealed no organic trouble. She 
always spent several days of the month in bed. 
Several medical men had prescribed for this lady 
with only a modicum of relief. Antikamnia & 
Codeine Tablets were prescribed with marked ameli- 
oration of the pain before and during the flow. She 
still continues to take these tablets and suffers little 
or no pain while menstruating. 

Case 3 — Mr. Wm. W., a young man of 22 years, 
consulted me regarding his condition. He had 
been subject to headaches for nearly a year, from 
no apparent cause. The pain was so severe that he 
was often totally incapacitated for business. I gave 
him Laxative Antikamnia & Quinine Tablets, in- 
structing him to take one every two hours. The 
result was entirely satisfactory and he always finds 
prompt relief by the use of these tablets. 

Case 4 — Mr. J., a clergyman, thoroughly conva- 
lescent after a severe attack of pneumonia, was 
troubled with a short hacking cough which annoy- 
ed him exceedingly. Antikamnia & Codeine Tab- 



lets given as required, entirely relieved his condi- 
tion. 

In conclusion, when a prompt and safe antipy- 
retic and analgesic is indicated, I shall continue to 
prescribe Antikamnia Tablets alone, or in some of 
the various combinations, feeling that I shall, in no 
measure, be disappointed in their immediate results. 
— R. Graham Hereford, M. D., July 10, 1906. 

Researches Into the Origin and Structure 

of Moles and their Relation to 

Malignancy. 

Fox (Brit. Journal of Dermat ). The .seven- 
teen specimens which formed the nucleus of this 
articlfa were embedded in paraffin and cut and 
stained by various methods. They were obtain- 
ed from the following sources which the author 
divides into groups for the purpose of histologi- 
cal convenience: 

Group A were taken from young infants show- 
ing the development of the mole. Group B were 
moles taken from adults, (rfoup C were hard 
ntevi. Group D were those becoming- malignant. 

From extensive study of these preparations 
the following conclusions are given: 1. That in 
those moles which show typical columns of cells 
the cells are epidermal in origin. 2. That there 
is a rare variety of soft moles which show no 
typical nsevus-cell arrangement, and whose 
origin is uncertain, possibly mesoblastic. 3. 
That in the majority of cases na^vo-melanoma 
are nffivo-carcin'oma. 4. That melanomata do 
arise in the skin entirely apart from moles. 5. 
That Cohnheim's view of the origin of malig- 
nant growths is not borne out by the foregoing 
observations of the histology of na?vo-melanoma. 
6. That the pigment appears to be closely con- 
nected with the prime cause by reason of which 
moles become malignant, whatever that cause 
may be. 

Angina Pectoris. 

Russell (British Medical Journal), has pre- 
sented a new theory. He attributes the act to 
an exaggeration of the normal abdominal reflex 
which sets up peripheral vasomotor spasm. In 
digestion this vasomotor spasm is normally 
present, but is increased by alcohol or by excess 
of proteid, and in certain individuals there is an 
abnormal sensitiveness by which it may be 
readily exoited to an excessive degree. This 
abnormal sensitiveness may be induced by to- 
bacco, alcohol, or by constant excess of proteid 
food, and in those persons in whom it is jireseut 
the spasm may be excited by slight strain, such 
as going upstairs or uphill, by emotion, or in 
some cases by simple palpation of epigastrium. 
The cardiac embarrassment may be due to de- 
bility of the heart muscle from anatomical 
changes, or to a temporary deficiency of the 
blood supply, he says that the common factor in 
all cases is the hypersensitiveness of the vaso- 
motor center. The .author says that tobacco, 
alcohol, and proteid food — excessive proteid 
food— ai'e in a large degree responsible for the 
latter condition. 

The writer has thus opened up a wide and im- 
portant field for investigation. The dietetic 
principle becomes a very important factor in the 
prevention and treatment of angina pectoris. 



Referring to Dr. Simmons The Texas Medical 
Journal says the independent Press should hold a 
convention and protest against the Medical Journal 
Trust. In union only is there strength. We can 
not effectively fight the combination in detail. But 
one thing is certain: the Czar is bound to go. He 
is marked for slaughter. A juster, more conserva- 
tive, more popular and less presumptuous man 
should be put in his place. 



ADVERTISEMENTS. 



XLI 




i 

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(Inflammation's Antidote) m 



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Apply hot 

and 

Thick 




Entero-Colitis, Cholera Infantum, 
Peritonitis. 



TN acute inflammatory conditions of the intestinal tract An- g 
M tiphlogistine" will be found of great value. It will not take ^j 
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Pi the local congestion and soothing the nervous system, it will be ^ 
^' found to be an inestimable adjuvant. S 

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:©,^©;©/©,^©A©^©A©;©'®'©l©.©',©(©^©,'©.' 



g THE DENVER CHEMICAL M'F'G. CO. 

NEW YORK 



I 



CHICAGO DENVER 
SAN FRANCISCO 



LONDON SYDNEY 
MONTREAL 



XLIV THE CHARLOTTE MEDICAL JOURNAL 

Officers of the North Carolina Medical Society. 



President, S D. Booth, JOxford. 

1st Vioe-President, C M. Stron>r, Charlotte. 

■iiul Vice-President, J. E. McLaiigrhlin. Statesville. 

3rd Vice-President, W. G. Hargrove, Kinslou. 

Secretary, D A. StaDton, High Poiut. 

Treasurer, H. McKee Tucker, Raleigh. 

COUNCILLORS (3 TEAKS TKRM). 
1st District, Oscar McMullau, Klizabeth City. 
o\n\ " J M. Parrott, Kinston. 
3rd " Frank H. Russell, Wilmington. 

5t,ii " Albert Anderson, Wilson. 

4th " J. F. Highsmith, Favetteville. 

fith '• Herbert A. Royster, Raleigh. 

7th " E, C. R:.gister, Charlotte. 

Hth " J. B. Smith, Pilot Mountain. 
9th '• Thomas E. Anderson, Statesville. 
lOth " James A. Burroughs, Asheville. 



Orator, L. B. McBrayer, Asheyille. 

Essayist, E. T. Dickenson, Wilson. 

Leader of Debate, C. W. Moseley, North Wilkesboro. 

Committee on Public Policy and Legislation, R. H. Lewis, 

Raleigh: David T. Tayloe, Washington; J. E.Brooks, 

Greensboro; (Ex-Officio) Sam. D. B oth, O.xford; D. A. 

Stanton, High Point: 
Committee on Publication, D. A. Stanton, High Point, 

(ex-officio); T. M. Jordan, Raleigh; Wm. A. Ciraham, 

Durham. 
Committee on Scientific Work, Wm DeB. MacNider, 

Chapel Hill; H. S. Mnnroe, Charlotte; (ex-ofticio) D. A. 

Stanton. High Point, 
Committee on Finance, J. T. J. Battle, Greensboro; 

Frank Dulfy, New Bern; J. H. Marsh, FayettevlUe. 
Committee on Obituaries, R. D. Jewett, Winston; A. S. 

Pendleton, Heudersonville; F. H. Holmes, Clinton. 



Officers of the County Medical Societies of North Carolina. 



COUNTY 

Alamance 

Anson 

Ashe 

Beau fort 

Bladen 

Bertie.. 

Brunswick 

Buncombe 

Burke 

Cabarrus 

Caldwell 

Caswell 

Catawba 

Carteret 

Cherokee 

CICV.I.UMI 

cli'mi>!'riaiia y.;;;;;;;;; 

Currituck 

Davie 

Davidson 

Duplin 

Durham 

Edgecombe 

Forsythe 

Franklin 

Gates 

Gaston 

Graham 

Granville 

Greene 

Guilford 

Halifax 

Harnet 

Haywood 

Henderson-Polk 

Hertford 

Iredell-Alexander 

Jackson 

Johnson 

Lenoir 

Lincoln 

McDowell 

Macon-Clay 

Madison 

Martin 

Mecklenburg 

Montgomery 

Moore 

Nash 

New Hanover 

Northampton 

Onslow 

Orange 

Pamlico 

Pender 

Person 

Perquimans 

Pitt 

P.-mManli-Caniden-Dari 
i;.-iiul..l|ili 

h'i<'lllll..|Hl 

Uol.cs,.ii 

Rockingham 

Rowan 

Rutherford 

Surry 

Sampson 

Scotland 

Stanly 

Stokes 

Swain 

Transylvania 

Union 

Vance 

Wake 

Warren 

Washington 

Watauga-Mitchell 

Wayne 

Wilkes 

Wilson 

Yadkin 

YanceT 



PRESIDENT 



Dr. G. W. Long 

Dr. J. M. Dunlap 

Dr. J. W. Colvard... 
Dr. T. J. Nicholson. 
Dr. W. H. G. Lucas . 



Ciraha 

..■insonvi 
. . . Jeflferson 

Booth 

.White Hall 



Dr. E. G. Goodman Elpaso 

Dr. Tlios. P. Clieesborough .Asheville 

Dr. George H. Moran Morgantou 

Dr. W. H. Lilly Concord 

Dr. J. B. Wright Granite Falls 

Dr. M. H. McBryde Milton 

Dr. Geo. H. West Newton 

Dr. F. M. Clarke Beaufort 

Dr. J. F. Abernathy Murphy 

Dr. J. L. McKay King's Mountain 

Dr.' S.' U. Withers .' ] .'.".'.' .'.'.'.' .'.'.'.'.". Chadbouru 

Dr. Chas. Duffy Newbern 

Dr. T. D. Haigh Favetteville 

Henry M. Shaw Shawsbnro 

Dr. W. D. Kimbrough Mocksville 

Dr. H. W. Dorsett Bethany 

Dr. John M. Faison Faisons 

Dr. A. Cheatham Durham 

Dr. R. L. Savage Conetoe 

Dr. H. S. Lott Winston 

Dr. J. E. Malone Louisburg 

Geo. D. Williams Gatesville 

Dr. J. M.Sloan Gastonia 

Dr.M.T. Maxwell Robbinsville 

Dr. S. D. Booth O.xford 

Dr. Albert West Speight's Bridge 

Dr. M. T. Fox Gnilford College 

Dr. John A, Collins Enfield 

Dr. J. F. McKay Buie's Creek 

Dr. Thos. Stringfleld Waynesville 

Dr. T. A. Allen Hendersonville 

Dr. S. S. Daniels WHnton 

Dr. E. E. Klutz Troutman 

Dr. A. A. Nichols Painter 

Dr. J. B. Person, Selma 

Dr . J. M. Hodges LaGrange 

Dr. R. B. Killian Lincolnton 

Dr. B. A. Cheek Marion 

Dr. S. H. L.vle.... Franklin 

Dr. J. C. Tilson .Marshall, R. F. D. 

R. J. Nelson Robersunville 

Dr. Lestar Hunter Sardis 

Dr. F. E. Asbury, Asbury 

Dr. W. A. Monroe, Sanford 

Dr. J.T. Strickland, Nashville 

Dr W. J. H. Bellamy Wilmington 

Dr. A. J. Ellis Garysburg 

Dr. W. J. Montford I Ward's Mills 

Dr. I. H. Manning Chapel Hill 

G S. Attmore Stonewall 

W. J. Lamsden Elizabeth City 

Dr. A. C.nBoyles Ml. Tirzah 

Dr C. G. Nichols Roxboro 

W. M. Riddick Hertford 

Dr. Oscar McMullan Elizabeth City 

Dr. S. A. Henley Asheboro 

Dr. W. H. Steele, Rockingham 

Dr. R. M. Norment, ; Lumberton 



1M-. 



Salisbury 



.Lanrinburg 

Norwood 

..Germanton 
.Bryson City 

Brevard 

..Marshville 
..Henderson 
Flint 

iJr. T>. W. H. Harciison .'.'.' Creswell 

Dr. J. W. Jones Boone 

Dr. M. E. Robinson, Goldsboro 

Dr. C. W. Mosely North Wilkesboro 

Dr. C. E. Moore Wilson 

Dr W. G. Leak, East Bend 

Dr. J. L. Ray Burnsville 



S. Brown 

Dr. Remee Hicks 

Dr. J. B. Smith 

Dr. Jno. A. Stevens, 

Dr. D. M. Prince, 

Dr. Thos. A. Hath'cock, 

Dr. L. H. Hill 

Dr. D. R. Bryson, 

Dr. E. S. English 

Dr. R. Armfield, 

Dr. F. R. Harris 

Dr. L. P. Sorrell 



SECRETARY 

Dr. J. W. McPerson 

Dr. J. M. Covington, Jr., 

Dr. J. L. Ballon 

Dr. Ira M. Hardy, 

Dr, Newton Robinson 

E. H. Horton 

Dr. J. A. Dosher, 

Dr. GaillardS. Tennant 

Dr. I. M. Taylor 

Dr. F. O. Rogers 

Dr. W. P. Ivey, 

Dr. S. A. Malloy 

Dr. J. H. Shuford 

Dr. D. S. George 

Dr. S. C. Highway 

Dr. L. V. Lee, 

Dr. H. T. Chapin 

Dr. T. C. Johnson 

Dr. R. D. Jones 

Dr. John D. McRae 

Stuart W. Mann 

Dr. W. C. Martin 

Dr. D. J. Hill 

Dr. Ben. R. Graham, 

Dr. W. A. Graham 

Dr. S. N. Harrell 

Dr. R. D. Jewett 

Dr. S. P. Burt 

G. C. Brooks 

Dr. H. F. Glenn 

Dr. R. J. Orr 

Dr. Ben. K. Hays, 

Dr. G. C. Edwards 

Dr. W. J. Richardson, 

Dr. A. S. Harrison, 

Dr. Chas. Highsmith 

Dr. J. Howell Way, 

Dr. J. G. Waldrop 

Dr. J. Rainey Parker, 

Dr. J. E. McLaughlin, 

Dr. Deles D. Hooper 

Dr. T. Hooks, 

W. F. Hargrove 

Dr. L. A. Crowell 

Dr. G. S. Kirby 

Dr. W. A. Rogers 

Dr. W. F. Robinson 

Dr. W. E. Warren 

Dr. Parks M. King, 

Dr. C. Dalighy 

Dr. Gilbert McLeod, 

Dr. J. P. Whitehead, 

Dr. S. E. Koonce 

Dr. R. P. Morebead, 

Dr. E. L. Cox, 

Dr. C. D. .Tones, 

H. P. Underbill 

Dr. R. H. Bradford 

Dr. W. A. Bradsher 

R. W. Smith .? 

Dr. Jos. E. Nobles 

Dr. Claude B. Willis 

Dr. C. C. Hubbard, 

Dr. L. D. McPhail 

llr. N.A.Thompson, 

J. W. McGehee, 

Dr. I. H. Foust, 

Dr. E. B. Harris 

Dr. Ed. M. Hollingsworth, 

Dr. G. M. Cooper, 

Dr. A. W. Hamer, 

Dr. J. M. Lilly 

Dr. Elias Fnlp, 

Dr. A. M. Bennett 

Dr . Goode Cheatham 

Dr. J. P. Monroe, 

Dr H. H. Bass, 

Dr. W. C. Horton 

B. Ray Browning, 

Dr. J. L. Hassell 

Dr. McD. Little, 

Dr. W. K. Lane, 

Dr. C. <;. Bryant 

Dr. J. W. Lamm, 

Dr. M L Matthews, 

I. B. Gibbs, 



Asheville 

Morgauoln 

Concord 

Lenoir 

. ...Yancvvllle 

Hickory 

. Marshallburg 

Murphy 

Lattimore 

....Pittsboro 

VineUnd 

Newbern 



.. ..Sunbury 

Gastonia 

.Robbinsville 

Oxford 

.. .Hookerton 
..Greensboro 
Enfield 



W; 



mithtteld 
.Kinston 
ncolnton 
..Marion 



.Ch; 



itte 



Troy 

Carthage 

..Rocky Mount 

Wilmington 

Lasker 

...Jacksonville 

Hillsboro 

Bayboro 

Bu'rgaw 

Roxl.oro 

Hertford 

Greenville 

.Elizabeth City 

orthville 

..Rockingham 

. Lumberton 

....Reidsville 

Salisbury 

.Ruthertordton 

Mt. Airy 

Clinton 

! ...Lanrinburg 

Norwood 

. . . Walnut Cove 
....Bryson City 

Brevard 

.Monroe 

. ...Henderson 

Raleigh 

. .Littleton 
"■ ....Creswell 

Horton 

Goldsboro 

Roaring River 

Lucama 

East Bend 

•nsville 



ADVERTISEMENTS. 



XLV 




H3O2 90/0 
Destroys Pus and any Morbid Element with which it comes in contact, leaving the 
tissues beneath in a healthy condition. 

Indorsed and successfully used by leading Physicians 
treatment oi 

Diseases of the Nose, Throat and Chest. — Open 
Sores. — Skin Diseases. — Inflammatory and Purulent Diseases of the 
Ear, — Diseases of the Genito Urinary Organs. — Inflammatory 
and Contagious Diseases of the Eyes, etc. 

In order to prove the efficiency of HYDROZONE, I will 
send a sSo. i3t>tti«3 f r*©© 

to any Physician upon receipt of loc. to pay forwarding 
charges. 

Note. — A copy of the i8th edition of my book of 340 
pages, on the " Rational Treatment of Diseases Character- 
ized by the Presence of Pathogenic Germs," containing re- 
prints of 210 unsolicited clinical reports, by leading con- 
tributors to Medical Literature, will be sent free to Physicians 
mentioning this journal. 



Prepared only by 



I J^^ MMOJi(Kiii> 



of the ' ' Ecole Centrale des 
sde Paris" (France). 

57-59 Prince Street, NEW XOBK. 



history of peritonitis. The diagnosis is only 
certain after puncture, and the treatment is 
complete extirpation. The prognosis is favor- 
able if the viscera are not involved. 



Treatment and Prophylaxis of Scarlatina. 

Campe-Schnarsleben (Berl. klin. Woch.) calls 
attention to the attempts made to produce a serum 
that would antagonize the poison of scarlet fever as 
antitoxin does that of diphtheria. This was diffi- 
cult in the absence of positive knowledge of the 
germ of scarlet fever, but an attempt was made to 
obtain the germ in pure culture. The best tissues 
from which to obtain the culture seemed to be the 
blood and the skin, next the kidneys, while the 
tonsils probably contain more of the complicating 
streptococci. He says that the streptococcus is not 
the cause of scarlet fever, but that the presence of 
this germ prepares the soil for the growth of the 
true causative germ. Scarlet fever is a comparative- 
ly simple disease when streptococcus septicemia 
does not complicate it, and the serious complica- 
tions are due to the streptococcus. After obtaining 
an extract of the tissues mentioned, animals were 
inoculated with it, in order to obtain a powerful 
scarlet fever antitoxin. This serum was prepared 
at the laboratory of Marpmann, in Leipzig, and has 
been tested by various practitioners. Up to Sep- 
tember, 1905, 67 cases of true scarlet fever were 
treated, of which 62 recovered and 5 died. Of the 
deaths, 2 cases in scrofulous children were compli- 
cated with typhoid, and the serum was given on the 
third day of the disease and had no effect. The 
third case was complicated by nephritis and bron- 
chitis, and the serum was given when there were 
dyspnea and much albuminuria. Another had the 
eruption much delayed in appearance. The fifth 
was a young girl, who had the serum on the sixth 
day, and died of heart failure. The first three cases 
died as a result of complications, not from the use 



of the serum. The serum should be used only in 
pure, uncomplicated cases of scarlet fever, as it has 
no effect on the complicating streptococcus infec- 
tion. In 13 of the cured cases the disease was se- 
vere, sometimes complicated by diphtheritic symp- 
toms; 1 8 had albuminuria. When the serum was 
given at the very beginning of the disease the course 
of the latter was short, and the complications were 
few. The effect of the serum was shown in a short 
time after administration: the patients became less 
restless, headache was less, and head symptoms 
disappeared, temperature became lowered, and the 
pulse slower. In most cases convalescence was 
established after a few days. Pure scarlet fever is 
not more harmful than measles or rotheln. It is 
most important to use the serum as soon after diag- 
nosis as possible, and in uncomplicated cases only. 
The question comes up whether this serum has a 
prophylactic value in persons exposed to the dis- 
ease. While this is an exceedingly contagious dis- 
ease, there are in all families persons who do not 
take it, and this complicates the experiment of im- 
munization. The serum has been injected in about 
two hundred cases as a prophylactic. In a number 
of these instances it was noticeable that immunized 
children did not contract the disease, while others 
equally exposed and uninjected succumbed to it. 
This was especially so in a large tenement, in 
which the immunized families escaped and the 
others contracted the disease. In some cases there 
was a sort of abortive attack of fever ending in a 
few hours. In only two cases was true scarlet 
fever developed after injection with the serum. 
The serum was given by the mouth with the same 

results. 

The Functional Importance of Leucocytes. 
Grawitz (Med. Press & Cir. ) says that attempt 
is being made to draw important conclusions as re- 
garded proposed surgical measures from their in- 



XLVI 



THE CHARLOTTE MEDICAL JOURNAL. 



crease or diminution. Many surgeons consider the 
counting of the leucocyte to be as important as 
taking the temperature and the pulse. From this 
point of view the question of the function of the 
leucocytes was important. 

The question of their origin was not yet answered 
with certaint}'. The sharp distinctions of the vari- 
ous liiuds of leucocytes could not justly be main- 
tained at the present day. Their morphology had 
been elaborated under the tegis of Erhlich, and his 
dried, colored preparations. But theclinicist, after 
the example of Virchow, should first examine the 
blood in its native state, and this should be done 
with every patient. 

It was agreeable to chronicle a step in advance. 
After we have come to our limit as regarded refined 
microscopical technique, but using the ultra-violet 
rays of decomposed white light, i.e., the short 
waved rays, we get a clearing up of structure twice 
as sharp as before. As these rays do not pass 
through glass, a quartz object-carrier was required. 
They also allowed conclusions as to the chemical 
composition of the preparations. Probably they 
were metallic substance that refracted light. 

We must ask what these cells signified. The 
nucleus of the cell must have a special function, 
and especially when the nucleus formed the chief 
mass of the cell. Where the protoplasm was further 
developed, the function of the nucleus became less 
important. In the embryo there were but few 
leucocytes in the blood. Lively development and 
activity of nuclei first came into play at birth. This 
was probably connected with the function of diges- 
tion. There were from 5 to 10,000 leucocytes in the 
cubic millimetre. Up to recently, it was taught 
that leucocytes were protective organs against the 
entrance of foreign material. But their function 
must be looked upon as having a much wider 
range. The following might be regarded as cer- 
tainly among their properties: i, phenomena of 
movement, wandering of leucocytes; 2, phagocy- 
tisni; 3, oxydizing properties; 4, reducing powers; 
5, absorbent properties in regard to material in 
solution (iron, iodine, lead, atropine, etc.); 6, as- 
similation; the leucocytes not only took up the 
bodies, but assimilated them; 7, fermentative action 
on break up of leucocytes; 8, absorption of albumen, 
the phenomenon of digestive leucocytosis; 9, trans- 
portation of the glycogen; 10, transportation of 
material also outside the tissues; 11, plastic activity 
of leucocytes, no repair of tissues; 12, antitoxic 
powers as regarded clinical results. We must, for 
the future, go to work a little more cautiously in 
our judgments. 

The Therapeutics of rSeuralgla. 

Spitzmuller (Wiener Med. Wchschrft) describes 
the case of a patient, a woman thirty-two years of 
age, who had suffered for several years from trige- 
minus neuralgia of all three branches, on the right 
and left side alternately. The pain recurred every 
year in repeated attacks, which lasted for weeks 
and then gradually subsided. The patient was 
rarely entirely free from pain. The attacks per- 
sisted day and night, sometimes becoming so severe 
that the patient cried out and refused all nourish- 
ment. She rapidly lost strength, due to the con- 
stant insomnia. All the remedies employed by the 
author proved absolutely negative. The injection 
of morphine in large doses produced the phenomena 
of intoxication, instead of rest. The pain radiated 
from the left trigeminus to the occipital nerve, 
which likewise presented painful points on pressure. 
The situation becoming positively critical one even- 
ing, the author tried an injection of cocain-muriat. 
0.30, Aqua destill. 20.0, Suprarenin gtt. vi. Half a 
Pravatz syringeful of this solution being thrown in- 
to the nerve at the point of origin of the left supra- 
orbital. The idea was the production of local 
anaesthesia of the affected nerve, and the effect was 
startling and instantaneous. The writer then pro- 



ceeded to other injections at the point of exit of the 
infra-orbital and mental as well as the occipital 
nerve. The pain was gone entirely, a characteristic 
dull sensation in the area supplied by the nerve be- 
ing the only remaining trace of the trouble. The 
patient was able to partake of food, for the first 
time in days, and then sank into a refreshing sleep. 
About twelve hours later, neuralgic pains appeared 
in the right supra- and infra-orbital nerves; but 
these were readily controlled by the injection of 
half a syringeful into each nerve, respectively. 
Nine further injections had to be given at a later 
date, all of which had a prompt effect. The patient 
has remained free from neuralgia for the last six 
and one-half months. 

The Operative Treatment of Suppurative 
Meningitis. 

Kummell (British Medical Journal) is of the 
opinion that the progress recently made by the 
operative treatment of suppurative and tuberculous 
peritonitis is such as to favor the supposition that 
active surgical intervention might improve the very 
serious prognosis in cases of diffused inflammation 
of the meninges of the brain and cord. Lumbar 
puncture, it is stated, has been followed by very 
good results in cases of cerebrospinal meningitis, 
and circumscribed suppurative meningitis set up by 
middle-ear disease and by compound fracture of the 
skull has been successfully treated by free removal 
of cranial bone and drainage. The prospects of 
operative treatment are generally regarded as much 
less favorable in diffused suppurative leptomenin- 
gitis, and according to Macewen such treatment is 
quite hopeless when the inflammatory mischief has 
extended from the base of the cranium to the cauda 
equina. He reports a case in which intense and ex- 
tensive meningitis following a fracture of the base, 
clearly indicated by the presence of pus in the fluid 
removed by lumbar puncture, was successfully 
treated by making two large openings into the pos- 
terior cranial fossa and excising the exposed por- 
tions of dura mater. Another case is referred to in 
which flee exposure of the spinal canal in the lum- 
bar region relieved to a considerable extent the 
more serious symptoms of fatal diffused cerebro- 
spinal meningitis following removal of a tumor 
from the sacrum. 



f\ Case of Acromegaly with Destruction 
of the Hypophysis by Haemorrhage. 

Bleibtreu (Munch. Med. Wchschrft) mentions 
the case of a young man seventeen years of age who 
presented the characteristics of simple giant growth, 
his body measuring 1.96 m. The nose, lips and 
forehead were disproportionately enlarged. Death 
occurred at the age of twenty-one of galloping con- 
sumption. The post-mortem examination of the 
cranial cavity showed the presence of a coarse and 
dense yellow tissue in the sella turcica, in place of 
the totally absent hypophysis. Microscopically, 
this was seen to consist of fibrous connective tissue 
interspersed with blood pigment. Only some very 
scanty remnants of hypophysis tissue could be 
demonstrated. These findings teach that acrome- 
galy cannot be the result of increased function of 
the hypophysis, but that it must be interpreted as a 
negative phenomenon subsequent to destruction of 
the hypophysis. 

Pepsin is undoubtedly one of the most valuable 
digestive agents of our Materia Jledica, provided a 
good article is used. Robinson's Lime Juice and 
Pepsin, (see page XVIII this number) we can 
recommend as possessing merit of high order. 

The fact that the manufacturers of this palatable 
preparation use the purest and best Pepsin, and 
that every lot made by them is carefully tested, be- 
fore offering for sale, is a guarantee to the physician 
that he will certainly obtain the good results he ex- 
pects from Pepsin. 



The Charlotte Medical Journal. 



Vol. XXIX 



CHARLOTTE, N. C, SEPTEMBER 1906. 



No. ,3 



Treatment of Teething.* 

By J. Steven Brown, M. D , Greystone Retreat, 
Hendeisonville. N. 

Mindful of the fact that some still consider 
dentition strictly a physioloiiical process 
and therefore not amenable to treatment, I 
venture the opinion that teethiufj; often 
needs treatment and that dentition, com- 
parable to parturition, is best accomplished 
under the supervision of a physician. Dur- 
ing this vulnerable transition period, the 
pediatrist need not be meddlesome, but he 
should exercise the same "watchful expect- 
ancy" so necessary in the obstetrician. 

As in parturition, as in puberty, as in the 
menopause, so in dentition, the patient 
would usually pass safely over the trying- 
period without professional assistance; but 
we are confident that intelligent supervision 
in each class is a great life-saver and health- 
giver, h'or the sake of abnormal cases all 
cases should be watched. 

What is the pathology of dentition? It is 
chiefly and briefly this: a congestion of 
mucous membrane, an over-stimulation of 
certain glands, and an irritation of the ex- 
quisitely sensitive fifth pair of nerves by 
continuous pressure on the terminals. You 
may readily see how such congestion may 
at least predispose to stomatitis and how 
such over-stimulation will give rise to an 
excessive secretion of saliva, usually follow- 
ed by and probably causative of more or 
less alimentary disturbance. 

Odontalgia in an infant, due largely to 
pressure in the matrix, may distract its 
speechless, helpless victim just as a jumping- 
toothache completely unnerves an adult. 
Let this condition continue for days and 
weeks, and L for one, will not deny the 
possibility of its causing convulsions. 

How shall we treat dentition? Bring; the 
baby to that period in the pink of condition. 
See that its food and drink are right, its 
habits right, its surnmndings right, and 
keep them right. The proper food during 
the first year is mother's milk. Somewhere 
from birth to the ninth month, depending 
on quality and quantity of mother's milk 
and condition of child, mixed feeding should 
be begun, (iradually artificial feeding- 
should be increased in accordance with the 
child's needs. Tlie best artificial food is 
fresh, clean cow's milk. Properly modified, 
it is the only artificial food needed up to the 
sixth month, though in many cases, pre- 
pared rice, barley, oats or wheat acts well 
as a modifier. 



Every case must be individualized. Study 
each patient and treat each case on its own 
merits. Teach the child regular habits in 
eating, sleeping and evacuating, and so 
prevent much trouble; preserve the mother's 
health and with her health, the baby's food 
supply, and so rear a happy, restful child, 
instead of a fretful bundle of nerves. Even 
with the best of nourishment and model 
habits, an atmosphere laden with dust in 
which abound tubercle l^acilli or other dis- 
ease germs, or exposure to mosquitoes, flies, 
or other germ carriers may prove a serious 
obstacle to the child's reaching the teething 
period in good shape. After all proper pre- 
cautions have been observed in order to 
bring the child to and through this period 
safe, sane and sound, it sometimes suffers 
from stomatitis, indigestion and diarrhoea, 
becomes peevish and loses weight. The 
proximate treatment here, of course, is as 
previously indicated. Let the child con- 
tinue to have proper food, drink, habits and 
surroundings. The immediate treatment 
depends on the nature of the disorder. For 
stomatitis, a bland antiseptic mouth wash 
may fill the bill. Accomx^anying this sore 
mouth may be indigestion with or without 
diarrhoea. Here the mild chloride, castor 
oil, a period of perfect rest for the digestive 
system, and more careful regulation of the 
diet usually suffice. Partially pre-digested 
food may be needed. Bismuth and sulpho- 
carbolates are sometimes indicated. Enem- 
ata of normal salt solution are often ad- 
vantageous. 

In some cases the bracing sea breeze, or 
the cool, invigorating mountain air seems 
essential to baby's health. Nervous symp- 
toms may be ameliorated by bromides or 
other sedatives. When the pressure is great, 
grave symptoms are often promptly dissi- 
pated, most marked and gratifying relief is 
afforded, and the restless little sufferer se- 
cures sweet sleep and refreshing rest after 
the ancient operation of lancing the gums. 

This brief paper is not meant to be ex- 
haustive — only a peg on which to hang a 
profitable discussion. 



Asphyxia Neanatorum.4^ 

By Dr. Chas. J. Sawyer, Salisbury, N. O. 

Every obstetrician has to deal with as- 
phyxia of the new born, and the condition 
is not of infrequent occurrence. It is a 
state of suspended respiration, due to any 
interference of the oxygenation of the foetal 



*Read before the recent meeting of T,he North 
Carolina Medical Society. 



*llead before the recent meeting of the N. C. 
Medical Society at Charlotte, N. C. 



114 



THE CHARLOTTE MEDICAL JOURNAL. 



blood. The child in utero is in a state of 
apnea, and it derives its oxyoen through 
the placental circulation, hence it has no 
need for air and therefore does not attempt 
to breathe. Anythino- interfering- with this 
placental circulation cuts off the supply of 
oxygen and the child attempts to breathe 
with no air to inspire, with resultant suspend- 
ed animation or asphyxia. 

I shall not here go into a description of 
the foetal circulation, suffice it to say, how- 
ever, that an intimate knowledge of this 
process is needed to fully appreciate the 
causes leading up to asphyxia of the new 
born. 

As before stated anything interfering 
with the aeration of the foetal blood will 
produce asphyxia. Among the chief causes 
we find: pressure upon cord or placental 
vessels as probably occupying the first place; 
prolonged pressure on the foetal head, caus- 
ed by a contracted pelvis or the fact that 
the child is of unusual size, resulting- in a 
long, tedious labor. The pneumogastric 
nerve is probably irritated by this prolonged 
pressure on the head, which results in de- 
pression of foetal heart action, hence its 
inability to propel sufficient aerated blood 
to the tissues. Premature detachment of 
the placenta from the uterine wall is another 
source of asphyxia. We find this condition, 
however, more in placenta praevia than in 
the normally attached placenta. As soon 
as the placenta is torn away the continuity 
of the placental circulation is interrupted. 
The child hungers for its supply of oxygen 
which has been so suddenly cut off, there- 
fore respiration is reflexly set up, with the 
result that the child inspires not air but 
amniotic fluid and other secretions of the 
uterus. If ihis reflex respiration is at all 
prolonged we may have an inspiration pneu- 
monia to develop after birth of child, even 
if we are successful in relieving the asphyxia. 
Eclampsia and sudden death of mother are 
contributing causes of asphyxia. In eclamp- 
sia, respiration of the mother being tempor- 
arily arrested during: the convulsive seizure, 
she is in a state of asphyxia,, hence the 
foetal circulation is deficient in oxygen, 
effete matter is pumped into the tissues and 
we have the child born either dead or in a 
state of suspended animation. In the sud- 
den death of mother the conditions bearing 
upon the child in utero are analagous to 
those ju.st stated, viz.: I'rom its supply of 
sustenance having been suddenly cut off 
the child is born dead or asphyxiated, the 
latter of course if delivery is delayed. 

We find there are two stages of this con- 
dition: Asphyxia Livida and Asphyxia 
Pallida. In the former or first stage the 
skin of the child when born is of a blueish 
color, the face is swollen, the muscles are 



tense, the heart action is slow but forcible, 
and the respiratory effort is feeble or absent. 
In this condition the prognosis is usually 
good, for with suitable procedure at resusci- 
tation the child is soon made to cry out, in- 
dicating- the establishment of normal respir- 
ation. In the more advanced stage the skin 
has a deathly pallor, the lips are cyanosed, 
the muscles have lost their tone, the limbs 
hang limp, the head rolls about when the 
child is handled, the heart action is very 
feeble or not detected at all and all reflexes 
are absent. Kv^en with this picture the 
child may yet be saved if treatment along 
the proper lines for resuscitation is institut- 
ed at once. Prognosis is of course grave, 
for with every known means of artificial 
respiration having been practiced the child 
often dies. 

Ireatmcit: In the simple forms of as- 
phyxia very little treatment is required other 
than clearing the mouth of mucous with the 
finger of the obstetrician and holding the 
infant suspended by ankles with one hand, 
while with the other a few sharp, quick 
strokes are given the nates. In addition, 
if the child still does not breathe, immersion 
in a hot and cold bath alternately usually 
suffices to bring the little one around. 
When these simpler measures do not cause 
the child to respond, it should be placed on 
a table on its back, with its head hanging 
a little over the edge of the table, and a 
little lower than its body. With a soft cloth 
or piece of absorbent cotton wrapped around 
the finger, the mucous is generally wiped 
out of the child's mouth, and if the child 
should have inspired mucous the trachea 
should be cleansed by grasping chest with 
one hand and with finger of other hand 
gently stroking the trachea a few times 
from below upwards, then let finger press 
firmly at the top of trachea, the other hand 
still grasping the chest wall, blow into 
child's mouth when the inspired mucous 
will be forced out through the nostrils. Or, 
the mucous may be aspirated by introduc- 
ing a No. 7 French catheter to the rima 
glottidis and the mucous sucked out by 
mouth of operator. If a short glass tube, 
containing a small piece of absorbant cot- 
ton, is inserted ijito catheter there will be 
no danger of sucking mucous into operator's 
mouth, nor will there be danger of infect- 
ing child by getting saliva from operator's 
mouth into trachea of infant. After the 
mucous is cleared out artificial respiration 
siKHild be resorted to. 

The two principal methods of inducing 
artificial respiration are those of Sylvester 
and of Schultz. It is not necessary here to 
go into a description of these methods, be- 
cause they are both given in detail in most 
text-books on Obstetrics as well as Pedi- 



ORIGINAL COMMUNICATIONS. 



lis 



atrics. Althoutfh I have had "Tatifyins 
results in suitable cases with Schultz' 
method, yet it is not applicable in those 
extreme cases of Asphyxia Pallida when 
the muscles have lost their tone and the 
heart action is weak. In these cases the 
fauces and air passaj^es should be cleansed 
and the child wrapped warmh', and with 
restoration of color and muscular ri.o-idity, 
Sylvester's method should at first be tried, 
and then that of Schultz. 

I think one of the difficulties with most 
of us is that we s^ive up too soon. I have 
butrecenth^ had a case of Asphyxia Pallida 
with which I worked for one and a half 
hours before I noticed any attempt at respir- 
ation, when finally the well known cry was 
heard and normal respiration was estab- 
lished. In these extreme cases, when finally 
respiration has been established, there is 
great danger of relapse, and therefore the 
child should be watched, and sometimes 
cardiac stimulants may be indicated for the 
first twenty- four hours. In .some of these 
extreme cases it may be necessary to prac- 
tice direct insufflation by means of the soft 
rubber catheter, after removing mucous 
from fauces and air passages. Great care 
must, however, be exercised lest by blowing 
into the trachea too hard the air vessicles 
may be ruptured and the consequent em- 
y)hysema ensue. In the event of the air 
passages not being thoroughly cleansed the 
child may die later of Atelectasis, though 
artificial means of resuscitation may have 
been successful. 

There are some diagnostic signs that the 
obstetrician may detect of approaching 
intra-uterine asphyxia, such as convulsive 
efforts on the part of the child, a .slowing of 
the feeble heart, and in head and transverse 
presentations, a discharge of meconium is 
symptomatic of a beginning asphyxia. By 
hastening delivery in these cases much may 
be done to lessen the degree of asphyxia. 

Mr. President, this may appear to be a 
common place or trivial subject, but as I 
view it there is great responsibility for the 
physician in dealing with this condition. 
Let us, therefore, not desist from our efforts 
of resuscitation too soon. It is right and 
proper, of cour.se, that we look after the 
mother well, but let us not forget the little 
one lying there .so still who may yet awake 
to be the light and joy of the home. 

Recent experiments have proved that most 
nuts have a large food value. They are 
rich in starch, proteid and fat. In com- 
parison with the potato, the chestnut con- 
tains more starch, proteid and fat, but less 
mineral matter. Moreover, the chestnut 
seems to be the most digestil)le of all the 
nuts, especially after it has been roasted or 
boiled. 



Forceps in Labor."" 

By Dr. L. 1) Wharton. Sniitlifield, N. C. 

It would appear from the title of this 
paper that the whole ground for the use of 
the obstetrical forceps is intended to be 
covered. That, however, is not my inten- 
tion as it would necessarily consume more 
time than is allotted to one paper. My 
purpose, the rather, is to discuss some fea- 
tures, coupled with a few practical observa- 
tions, for the use of forceps in labor, there- 
by limiting greatly the scope of this paper. 

In the first place I desire to call the atten- 
tion of the vSociety to the utmost practic- 
ability of this subject to every general prac- 
titioner. I believe it can be safely said that 
there is no one thing in medicine that is 
more pregnant, both with good and bad, to 
our patients and corresponding credit or dis- 
credit to ourselves than this. Good, because 
it presages a lessening of the throes and suf- 
ferings of child-birth and, yea more, a 
diminution of many possible evils both to 
mother and child. Bad, because an unin- 
telligent use of the forceps is productive of 
all manner of harm. I deem it needless to 
enumerate the many avenues of danger, 
they are too well known to the medical man. 
A word in behalf of a more thorough tech- 
nical preparation for the practice of this 
branch of our ijrofession, I conceive, would 
not be amiss here. Doubtless there is more 
attention given the subject in our medical 
institutions of today than when I graduated 
some thirteen years ago. In most cases, I 
dare say, the first time we used the forceps 
in actual labor was after a few weeks or 
months, perhaps, of active practice. We 
have a patient suffering from prolonged, 
tedious labor; we are becoming uneasy; we 
imagine we have an impossible delivery; 
we see our patient, in our anxiety, growing 
weaker and weaker and the pains losing 
their expulsive force; in great perturbation 
and uncertainty we seize our forceps and 
with a vague idea of the necessities of the 
case we proceed to apply them, and after a 
successful "pull" we hasten to assure the 
attendants that delivery of a living child 
and, in fact any delivery whatever without 
its use, was an utter impossibility. I refrain 
from detailing the injuries the mother has 
received, as likewise the child. The opera- 
tion may or may not have been performed 
intelligently, and I wish to say that I do 
not by any means desire to disparage it, 
and yet this is the manner of beginning 
with most practitioners of my age. It is to 
be hoped that a great change has been ef- 
fected in later years. 

Now, briefly, I desire to call attention to 



*riead beforo the North Carolina Medical 
Society at Charlotte, N. C, May 31, 1906. 



itr, 



TIIR CHARLOTTE MEDICAL JOURNAL 



a few indications for the use of the forceps 
in la])or. Those more often seen, with a 
few practical snggestions that appear perti- 
nent. 

1st. Deficient uterine contractions. While 
I have mentioned this first my experience 
has not taught me that it is most common. 
It occurs undoubtedly occasionally, but not 
so frequenth^ as some would have you be- 
lieve, indeed I believe it is rare. The con- 
tractions may weaken, and at times cease 
entirely, only, as it were, to get a hold and 
recur with redoubled vigor. I understand 
this indication to obtain only in conjunction 
with a weakened constitution generally, 
and therefore includes what is usually 
classed by itself, viz.: Danger to mother. 

2nd. We are often confronted with dan- 
ger to the foetus. This is most common in 
protracted labors, and I shall confine my- 
self to this phase alone. It is not as gener- 
ally considered as it should be as a cause of 
early infantile deaths. Prolonged pressure 
of from forty to eighty pounds upon the 
child's head impacted firmly within the 
pelvic cavity, it seems to me, is abundant 
cause for the many deaths that occur dur- 
ing the first few days after Inrth. This we 
pass off in a general way as "internal in- 
jury." True, but should we be satisfied 
with that? I think I may state without fear 
of successful contradiction that the far 
larger number of deaths occurring within 
the first few days are thus caused, and in 
support of this contention I merely ask you 
to call to your mind, in your experience, 
the number that have died after prolonged 
labor. Therefore, use the forceps here, 
other things being equal. This brings me 
to the only other indication I shall mention. 

,ird. Mother's Suffering. Some, yea many, 
perhaps a large majority, will take issue with 
me on this proposition. Indeed, only a few 
vears ago I not only did, but went on 
record. Perhaps I should be loath to let 
this stand unnjodified, and in this manner 
that the indication should obtain only in 
experienced hands. 

In an article written bearing upon this 
subject and read before the last meeting of 
this Society that met at Durham, N. C, I 
said, "I am free to say that when labor is 
natural and no danger is threatened or an- 
ticipated one would not be justified in ap- 
plying the forceps. Quoting Sajou's Annual 
and Analytical Cyclopedia of Practical 
Medicine as claiming that the forceps should 
never be used unless there were positive in- 
dications for its employment." I contend- 
ed that suffering was not a positive indica- 
tion. Of course admitting that suffering 
should not be permitted to continue to the 
detriment of my patient; Now I hold that 
suffering should be considered as an indica- 



tion and with a thoroughly dilated os, the 
head well down on the perineum or wedged 
under the pubic arch with a possibility of 
an hour or hours suffering, the woman 
should be relieved. My attention was called 
to an article a few months ago in, which the 
author claimed to wait two hours after the 
OS was thoroughly dilated, then invariably 
took the child. It is not at all necessary, 
indeed, it is not best to assist the head en- 
tirely clear of the mother, but to exert trac- 
tion gently and firmly, o/ivoys within the 
line of the palvic axis at the point of opera 
tion^ until the head is loosened and one or 
two pains, after the withdrawal of the for- 
ceps, will give birth to the child. By re- 
moving the forceps you lessen the risk of 
lacerating the perineum. It is not best, 
likewise, to put the mother too fully under 
the anaesthetic, as in so doing you may 
have to wait too long for the renewal of 
pains, and in case you have delivered the 
head the danger of asphyxia is eminent. 



Tuberculosis ol tl|c Hip Joint.* 

lU- K. C. M(;l<:acheni, M. D., Cordova, N. G. 

This occurs mostly in children, but may 
arise in adults, and occasionally in those of 
advanced years; 6 per cent, of cases arise 
in children under ten years; S par cent, of 
cases occur before the twentieth year. 

The primary lesion may be in the synovial 
membrane, but is more often in the bone. 
It may begin in either the femur or acetabu- 
lum. If it begins in the femur it usually 
arises on the distal side of the epiphyseal 
cartilage. When the synovial membrane 
becomes involved it spreads rapidly through 
the joint. Traumatism and cold are predis- 
posing causes. 

Diagnosis is easy in advanced cases, but 
difficult in incipient cases. It may be con- 
founded with caries of spine in which an 
abscess has formed, with sarcroiliac disease, 
with infantile paralysis, with lordosis due 
to rickets, and with gluteal abscess. In 
caries of spine there is no altered position 
of the limb, and in sacroiliac disease move- 
ments of the hip joint are unlimited and 
cause no x^ain. In infantile paralysis there 
is no pain, but paralysis and a great and 
rapid waste of muscles. In lordosis from 
rickets there is no pain on movement. 
Olu gluteal abscess the symptoms do not 
remit as in early hip joint disease, and pain 
is felt in back of hip and knee. Fluctua- 
tion also can be detected. 

Symptoms — Some divide the disease into 
three stages; first, the stage of deposition 
and multiplication; second, the stage of 
caseation; others contend such division un- 

*Read before the North Carolina Medical So- 
ciety at Charlotte, N. C 



ORIGINAL COMMUNICATIONS. 



117 



desirable from both a clinical and patha- 
logical point of view. Wilson says, "Tuber- 
cular bone and joint disease should be con- 
sidered as the primary invasion and all 
other symptoms should be rej^^arded as re- 
sults and not a necessary part of the trouble. ' ' 

The symptoms are slij^ht and may be 
overlooked. They occur in the following 
order: Limited motion when child first 
arises in the morning^, ni.n^ht terrors, a slig^ht 
limp and some pain may occur in the hip 
on tapping^ the sole of the foot while patient 
is recumbent with leg extended. As the 
disease progresses the child limps, the ad- 
ductor muscles are rigid, the hip is broad- 
ened and fluctuation may be detected. The 
thigh muscles atrophy and there is deformity 
with apparent lengthening or real shorten- 
ing. The pelvis tilts forward, which is due 
to the pelvis moving the femur as if anky- 
losed. This disappears on flexing the 
limb. 

The gluteal muscles begin to waste and 
pain in the knee is noted. Changes occur 
in the gluteal fold and there is heat and 
swelling. If a cure follows an advanced 
coxalgia ankylosis occurs. Death may be 
due to septicaemia, tuberculosis of viscera, 
exhaustion of liver and kidney. 

Prognosis: If disease is seen early the 
chances of cure are excellent in children. 
The longer the duration and older the pa- 
tient the more unfavorable the prognosis. 

Hip joint disease may recur years after 
an apparent cure. 

Treatment: The incipient .stage demands 
rest, sunlight, fresh air and good food. 
Direct exj^osure to rays of sun is beneficial. 
Tent life in open pine fore.st can be success- 
fully employed in summer. The concen- 
tration of the sun's rays by lenses as sug- 
gested by Butler, Finsen and others, is of 
great benefit. The Roentgen rays have an 
inhibitory power on tubercle bacilli also. 
In cases where abscesses are present they 
should be evacuated immediately. If the 
head of the bone is sei:)arated from the neck 
it should be removed. The acetabulum, if 
diseased, should be thoroughly curetted and 
washed out with some antiseptic solution. 
The joint should be filled with an emulsion 
of glycerine and iodoform 10 per cent. 

The patient should then be put to bed on 
a hard mattress with extension in the line 
of deformity and traction above knee; in 
children under ten years of age amounting 
to three to five pounds. In children ten to 
twenty years of age use a weight of from 
five to eight pounds. Always use a cradle 
to hold up the bed-clothes from the limb. 

Day by day the limb should be lowered 
until deformity is overcome. If symptoms 
recur the weight is re-applied. If they do 
not, apply a traction splint, put a high- 



heeled shoe on the sound limb and sendtlie 
patient out on crutches. The Thomas splint 
mav be used or Wyeths apparatus, which is 
a favorite with x\merican surgeons. If the 
limb is in good position by weight exten- 
sion, plaster of Paris is a useful dressing. 
It is put on from the toes up and includes 
the entire extremity, and also the pelvis. 

"No case of hip joint disease," says 
Phelps, "need recover with angular de- 
formity, ' ' and to attain this end steps should 
be taken at the beginning of treatment to 
place the limbs exactly jiarallel. In lordosis 
from thigh flexion raise the limb until the 
iliac spine is straight. If the spine is de- 
pressed on the affected side abduct the 
limb. If the spine is elevated abduct the 
limb until the spines are horizontal. l{x- 
tension will remove flexion in two weeks in 
a recent case, and in course of some months 
in an older case. Abduction demands no 
special treatment. In a movable case it 
will disappear, and in an ankylosed joint it 
is an advantage, compensating by apparent 
lengthening for shortening due to bone ab- 
sorption or to stunted growth of the limb. 
Adduction requires an addition of several 
pounds to the extension weight, the use of 
the long splint on the sound limb, and the 
drawing up of the sound limb by a rope and 
pulley towards the head of the bed. 

In old cases where the weight will not 
bring about the extension anesthetize the 
patient, gently straighten the limb a little 
and re- apply the weight. lixtension in a 
mild case should be continued for three 
months after symptoms have disappeared, 
and in a severe case the period must be at 
least six months. In cases where abscess 
appears externally a free incision should be 
made and cavity curetted and closed up. 
Unless all the diseased tissue can be re- 
moved there is no need of curetting. Punc- 
ture, wash out and drain. 

If it is found on cutting down to a joint 
that it is extensively diseased excision may 
be necessary. After excision or after the 
abscess has been thoroughly curetted the 
joint should be injected with pure carbolic 
acid, which is allowed to remain two or 
three minutes, after which the acid is washed 
out with pure alcohol. 

A drainage tube as large as the wound 
will take is inserted into bottom of wound 
and packing is done through it. It holds 
soft parts away from bone and allows it to 
granulate up until the tube is pushed out, 
when a smaller one can be used. Abscesse:, 
pointing in Scarpa's triangle should never 
be opened at that point. An incision should 
l:)e made along the femur, just below the 
great trochanter. This gives surgeons better 
opportunity for digital 'exploration and there 
is better drainage on account of child lying 



lis 



THE CHARLOTTE MEDICAL JOl'RNAl 



on its back twelve out of twenty-four hours. 
Excision is to be performed when the 
head of femur is detached; when profuse 
suppuration continues for a lon.q- time and 
when amyloid disease bejjins. When ex- 
cision fails to check the disease and when 
patient has not recuperative power to stand 
the long siege following excision Mash says, 
"Amputate." This has become a success- 
ful procedure. 

A Difficult Craniotomy.* 

I5y Di-. L. C. Ki.'eians, flharlotte, N. C. 

In reporting the following case it is not 
my intention to enter into a recital of the 
various steps in the technique of the opera- 
tion of craniotomy, but to present it as 
briefly as possible, its several complications, 
andtiie adverse circumstances under which 
delivery was accomplished. 

The patient was a multipara, who two 
years previously had been delivered, after 
considerable difficulty, of a premature child. 
At that time she had been warned that an- 
other pregnancy would be attended by a 
repetition of operative procedures more se- 
vere than the first, if not by fatal result, as 
her pelvic deformity was so marked as to 
render delivery by ordinary means, such as 
forceps, impracticable. That the injunction 
was not heeded is only too obvious. 

Labor began early in the afternoon of 
November 21st, 1905, and progressed until 
full dilatation of the os was completed. A 
vertex presentation was diagnosed, although 
the head had not become engaged. About 
two o'clock the next morning, after recog-' 
nizing the obstacle to normal delivery, the 
attending physicians applied forceps. 

Their efforts were rewarded by the slip- 
ping of the blades, which were repeatedly 
re-adjusted and traction again made to meet 
with the same result, the descent of the 
head and the engagement not having been 
influenced in the lea.st. 

Having apparently exhausted their re- 
sources, as well as themselves, in their 
many unsuccessful attempts to terminate 
the labor, I was called in consultation. 

When the call came I was out and did 
not reach the house until U) o'clock. Upon 
vaginal examination I found the pelvis con- 
tracted anteroposteriorly, the conjugata vera 
measuring 7.4 cm. (or about o inches); 
also, in addition to this, was an exaggerat- 
ed sacral promontory, on the right lateral 
aspect of which was what seemed to be a 
slight projection, the exact nature of which 
I was unable to determine, jjrobably an 
exostosis. 

During the night fetal life had become 

*Rf'ad before tho TMorth ( ai olina Medical So- 
ciety, ChaiioUo, N. C. 



extinct. I applied the Neale's axis traction 
forceps, but on making traction they prompt- 
ly slipped off, the head not presenting the 
proper dia:neter for application and reten- 
tion of the blades. Had I secured this, as 
I afterwards found, I could not have accom- 
Ijlished a delivery, so after a second unsuc- 
cessful trial I abandoned the procedure. 

As ergot had been given previous to my 
arrival I found the uterus tetanic, and to 
have accomplished delivery by version 
would have been an utter impossibility; any 
attemiit to turn the fetus under such condi- 
tions would have been accompanied by im- 
mediate danger of rupture of the uterus, 
the lower segment of which had become 
appreciably thinned. If version had have 
been successful, the after coming head 
would have recjuired crushing or craniotomy, 
or both, which would have been somewhat 
difficult, and comparatively undesirable to 
craniotomy' in a vertex presentation. Obvi- 
ously, the conditions under which the oper- 
ation was undertaken and delivery effected, 
i.e., pelvic contraction, progressing mater- 
nal exhaustion, and a dead fetus, rendered 
craniotomy not only justifiable, but im- 
perative. 

In perforating I used the Smellie scissors, 
entering the points just anterior to the pos- 
terior fontanelle. When securing a suffici- 
ent opening I removed the brain and applied 
the ordinary forceps to compress the head, 
but the disproportion between it and the 
pelvis was so great that efforts at extraction 
by this method proved futile. As I did not 
have craniotomy forceps I used my fingers 
to break up both parietal and part of the 
occipital bone piece-meal, at the same time 
protecting the maternal parts from contact 
with fragments of bones. 

To prevent laceration of the vagina dur- 
ing descent I bent back the frontal bone 
over the sharp projecting edges of the base 
of the skull. I then inserted a blunt hook 
under the mental symphsis, and with the 
assistance of supra-pubic pressure, made 
traction, bringing the remains of the head 
just to the vaginal orifice, when another 
obstacle was encountered, and on examina- 
tion I found that the shoulders had not en- 
tered the superior straight. 1 then made an 
effort to pull them down into the pelvis with 
a blunt hook under the shoulders, but with- 
out avail. The remains of the head were 
removed in the vagina, and the shoulders 
pushed back from the pelvic brim, and then 
turned the fetus and thus effected delivery. 

Just before delivery the patient showed 
signs of collapse, but after necessary stimu- 
lation rallied sufficiently to permit a con- 
tinuance of the operation. The uterus was 
douched with 1-6000 solution bichloride of 



ORIGINAL COMMUNICATION. 



19 



mercury. Erj^otole 2i) miliums was given 
hypodermically. 

The amount of hemorrha.ije, both aiite- 
aud post-partum, was comparatively small. 
The patient emerged from the anaesthesia 
in fair condition, her cheeks maintaining 
their former rosy color. A few days later I 
was informed by her attending physician 
that she died twelve hours after the opera- 
tion; however, not before all efforts to revive 
her had been exhausted. It is probable 
that while her death may have been partly 
due to shock, it was more directly the result 
of the prolonged anaesthesia, the patient 
having been more or less under chloroform 
for about four and one-half hours previous 
to my arrival, and then for three hours re- 
quired for the operation. 

In making a few comments regarding 
such cases it is not my purpose to refer to 
the different forms of contracted pelvis, nor 
to the special indications for operations, but 
rather to urge the necessity of examination, 
i:)revious to labor, of all pelves, especially 
])rimiparous. Where pelvic deformity is 
either suggested or apparent,, as in Rachitis, 
Scoliosis, Lordosis, Kyphosis, etc., it is to 
])e presumed that special attention would at 
once be directed. 

No conscientious obstetrician fails to 
make a thorough urinary analysis in every 
case of pregnancy under his care, so that in 
the event of the discovery of albumen or 
casts, or both, he may institute ])roper 
prophylactic measures to avert the occur- 
rence of eclampsia. It is one of his first 
duties to the mother as well as to the un- 
born child, failure in the performance of 
which renders him guilty of culpable 
neglect. 

While eclamjisia is not so freciuently as- 
sociated with contracted pelvis, still his ob- 
ligations demand careful observation, and 
])elvic examinations, and the obstetrician 
or general practitioner has not discharged 
his preliminary responsibilities until such 
have been accomplished. In the case of a 
multipara who has given birth to one full- 
term chile, either normally or with forceps, 
such ])reliminary pelvimetry would be un- 
necessary. It is, however, to primaparae 
generally, whether physical deformity be 
evident or not, that the above precaution 
applies. 

The case just cited is one in point, in 
that external appearances indicated a nor- 
mal pelvis. This is especially true in sym- 
metrically or generally contracted pelves. 
With reference to the time at which such 
examination shovild be made ( I refer now 
especially to those cases where there is no 
indication of deformity), it would be well 
to note that the uterus ascends in the ab- 
dominal cavity until about the thirty-eighth 



week (the second week 1)efore the coiniile- 
tion of the pregnancy), at which time it 
begins to descend and sink into the ])elvis, 
thus undergoing what is commonly termed 
"lightening." 

Simultaneously with this jirocess, the 
fetal head, in vertex presentations, assumes 
certain relations to the pelvis; thus in case 
of a multipara, by reason of the relaxed 
abdominal wall, the fetal axis is not coinci- 
dent with, but forms an angle with the axis 
of the superior straight, which position is 
maintained until labor occurs, hence there 
is no engagement until that time; however, 
on the other hand, in the primipara when 
the uterus descends, the abdominal walls 
being very tense, operate to place the fetal 
axis in coincidence with the' axis of the 
superior straight, thus, under normal con- 
ditions, causing the head to enter and grad- 
ually become engaged in the pelvis. 

If such engagement fails to take place in 
the primaparous it might be attributable to 
such cases as ( 1 ) abnormality of the fetus, 
e.g., monstrosity, hydrocephalus (2) hy- 
dramnion (3) contracted pelvis, etc. Vagi- 
nal examination in a multipara is not neces- 
sarily called for, but in primipara, when 
this is omitted, should you on palpation at 
the time just indicated find non-engagement 
of the head, or again, when digital exami- 
nation of the vagina, uterus, etc., in the 
early months has enabled you to detect 
pelvic contraction, it becomes imperative to 
adopt such measures as will enable you to 
estimate the dimensions externally, the 
conjugate diameters, the importance of ex- 
ostosis, etc., as constituting further obstacles 
to delivery. 

Thus only can intelligent treatment be 
instituted to meet the conditions of any par- 
ticular case. Again, if on palpation you 
should diagnose a presentation of the breech, 
lateral plane, etc., the same precautions 
should be observed. 

Regarding operative interference, it must 
vary according to the nature of contraction, 
briefly in a pelvis flattened aiitero-posteriorly 
with a true conjugate of (S.l to 9 cm. (3i 
to 3? inches) and a fetal head of ordinary 
dimensions, delivery can be accomplished 
by forceps or probably by version; or again, 
where the true conjugate measures 6.5 to 
7.5 cm. (2.5 to 3 inches) it is a pelvis 
through which the average head will not 
pass, and therefore, should the child be liv- 
ing, symphysiotomy is indicated or, in the 
event of its death, craniotomy. 

In those forms of contracted pelvis where 
the true conjugate is less than 6.5 cm. 
(2i inches), either with or without osseous 
encroachment, or again where the true con- 
jugate is sufficient for passage of the head 
under the symphysis and yet complicated 



120 



THE CHARLOTTE MEDICAL JOURNAL. 



b^'^ an exostosis, or further, when the pelvis 
is so distorted as to render symphysiotomy 
inellig^ible, Caesarian section is demanded. 

I have purposely omitted mention of the 
induction of premature labor in the treat- 
ment of these cases, as it is to a great ex- 
tent being superseded by symphysiotomy. 
As to the advantages of either operation, 
without going into a comparative analysis, 
I would refer you to the statistics, which 
show as the results of the induction of pre- 
mature labor, a fetal mortality of a little 
more than 60 per cent., which of course in- 
cludes those deaths occurring during deliv- 
ery and those occurring afterward, due to 
prematurity. On the other hand, symphysi- 
otomy holds out a much greater chance to 
the child, as under the operation the fetal 
mortality is very small, ranging from 5 to 
10 per cent., which estimate is based on the 
results of operations performed both in this 
country and Europe. Regarding maternal 
mortality, the results are about equal, the 
percentage being comparatively small under 
either. Hence, as the operation is done 
largely, if not entirely, in the interest of the 
child, symphysiotomy will undoubtedly 
take precedence over tlie induction of pre- 
mature labor. 

In conclusion, while craniotomy on the 
dead fetus is repulsive, it is not only more 
so on the living, but rarely ever justifiable, 
even though the case is seen in an emer- 
gency, and for the first time, unless the 
conditions are such that the mothers life 
depends on the sacrifice of the fetus. 

Therefore, on the whole, if pelvic exami- 
nation be made at the proper time, we can, 
by the exercise of such means as are at our 
command, avert many unhappy conse- 
quences and secure a successful termination 
in the salvation of both the mother and 
child, a thing which is plainly our duty. 

Where The Tides Meet.* 

By H. S. Lott, M. I)., Winston-Salem, N. C. 

We live in the age of advanced knowl- 
edge along all lines of our profession. These 
lines are chiefly, two, — Medical and Surgi- 
cal. Running as they do, .so closely para- 
lell, they should never be strongly at 
variance, and, converging harmoniously, 
their blend attains the nearest approach to 
perfection which is attainable in the practice 
of our science. 

Today, we recognize actual conditions, 
stripped of mystery, and, in a very large 
number of cases, stripped of uncertainty as 
well: and we have learned to apply actual 
remedies, both medical and surgical, for 
the relief of symptoms and to avert disaster. 

Every practitioner of medicine is possess- 

*Read before the North Carolina Medical 
Society at Charlotte. 



ed of some surgical wisdom. It is this wis- 
dom which guides the patient safely through 
the days of doubt; days in which the symp- 
toms tell us nothing to a certainty, but keep 
us ever on the watch for one of many possi- 
ble conditions; and help us finally, by ex- 
clusion, as a rule, to recognize either a 
general systemic infection, or a primary 
and tangiljle point for attack. 

As our knowledge grows, and with it our 
diagnostic skill and conception of future 
possibilities, we recognize a time and a place 
for surgical intervention in man}' conditions 
known to have been confined to the realm 
of medicine. Notable, among such condi- 
tions, are appendicitis, (the classical peri- 
typhilitis of Gross ) gall stones, gastric ulcer, 
typhoid fever, cervical tears, no longer 
treated with swab and cautery, ectopic ges- 
tation, with rupture, which is never recog- 
nized at all, and the woman dies under 
some ominous title ascribed by ignorance: 
and many others, including every region of 
anatomy, and every branch of surgery. 

By the lights of today we recognize in 
these, t\\e/ocus,oi pain, the focus of infec- 
tion, and the/ocus of possible disaster, such 
as rupture, perforation, or malignant growth. 
Such foci needing, not always, perhaps, the 
surgeon's knife, but always surely, the 
surgical wisdom, and the surgical conscience 
to best conserve the vitality of the patient, 
and guide to the safest issue. 

The "time to operate" for appendicitis is 
when the patient has it. Therefore,, the 
want is for greater skill in early and accu- 
rate diagnosis; and more earnest conviction 
as to the best mode of treatment. The wait- 
ing plan, with its placebos and plasters, 
has cost our country more valuable lives, 
and given us more cripples, than the recent 
wars, or an epidemic of small pox. 

In the hands of its originator, and advo- 
cate, who knows just when and how to 
wait, it may be comparatively safe; but as 
teaching to the world, and the masses of 
practitioners, it bears much danger to the 
patient. 

Typhoid fever, the clinical picture of 
which is familiar to us all, is becoming 
each year more distinctly a surgical condi- 
tion. During the days of onset, which are 
also the days of uncertainty, treatment is 
mostly tentative, and our attitude is one of 
watchfulness; but with the diagnosis once 
established, we picture the surgical condi- 
tion that conf;onts us, and also realize the 
delicate structures with which we have to 
deal. A bowel at many points studded 
with inflamed glands, these glands embed- 
ded in the bowel wall, and each one pursu- 
ing the three separate stages of congestion, 
necrosis, and ulceration; which jirocess may 
be accomplished either with'or without suf- 



ORIGINAL COMMUNICATIONS. 



1_M 



ficient slou,<>-liiiiff of tissue to cause a per- 
foration of the ti'ut, or the opening- of a 
blood vessel. 

Now, this condition once established and 
recognized, our surgical conscience tells us 
that the more quiet this bowel is kept, and 
the less it is disturbed by the irritant con- 
tact of foreign bodies passing through its 
lumen, until these weakened points have 
regained their normal tone, the less danger 
there is of fatal accident from perforation 
or hemorrhage. 

Equally as many, if not more fatalities in 
typhoid fever, occur from one or the other 
of these surgical accidents, as from auto- 
intoxication; and the treatment, so com- 
monly in vogue, of giving hard pills and 
capsules, and of disturbing by purgatives a 
bowel which should be kept quiet, and 
emptied, if need be, from below, by a simple 
saline enema, is largelv to blame for the 
fact. 

Treatment, therefore, in typhoid fever, 
the diagnosis once established, may be 
simplified into that of the after care of pa- 
tients who have had abdominal sections; 
and especially of those in which bowel 
lesions previously existed, or when the bowel 
wall is opened by the surgeon, as in the re- 
moval of the appendix, to remove some 
existing condition. This means physical 
rest for the patient — complete, — with the 
avoidance of all foods or medicines taken 
into the stomach that will form lumps to 
be passed through the bowel, or awaken 
peristalsis. 

Accidents occurring, such as perforation 
or haemorrhage, demand especial consider- 
ation. From the former many patients are 
rescued by operation, with repair of the 
lesion, and irrigation of the abdominal 
cavity: and, when haemorrhage occurs, 
seemingly without perforation, the "opium 
splint," with an ice bag, and restriction of 
food and stimulants to the minimum essen- 
tial to life, for a while, gives the sloughing 
ulcer, with its bleeding vessel, the best con- 
ditions under which to be restored to normal 
tone and tissue. 

Abortion is a surgical accident. Con- 
fronting us almost daily it is of prime im- 
portance, because of its danger to the pa- 
tient. The chief dangers from this accident 
are two, haemorrhage and sepsis; both of 
which are best avoided by surgical means. 
In the beginning, when it is only a threat, 
and there is still a chance of tiding the 
patient over, complete physical rest, and 
full doses of opium, to check muscular 
spasm, allay physical pain, and also relieve 
mental anxiety, promise best for the accom- 
plishment of our end; but when the flow is 
once established, showing that the placental 
attachment has been freed, and that the 



abortion is inevitable, the sooner the uterus 
is emptied the better it is for the patient. 

An empty uterus does not bleed, and a 
clean uterus is not so likely to become a 
source of septic infection. Now, in a large 
number of cases the uterus will empty itself 
within twenty-four or forty-eight hours, and 
sometimes during this process an asejitic 
packing of the vagina will lessen the loss of 
blood, and favor the expulsion of the pro- 
duct of conception ; after which a full purg- 
ative and an occasional irrigation of the 
vagina with normal saline solution, if it 
can be properly given, will bring the acci- 
dent to a very happy termination. But 
there are cases in wjiich the natural forces 
are not so prompt and thorough in their 
work; the foetus may be expelled, and per- 
haps a part of the placenta, but there is 
something left behind, and we have at once, 
and beyond a doubt, the three foci in one, 
(viz., of pain, of infection, and of possible 
disaster, through haemorrhage), which 
should awaken the surgical instinct in us 
all. 

To let a woman lie and rot from sepsis 
may seem to those who do not know better 
a very conservative measure; but to me, in 
looking back and reviewing their long and 
tedious convalescence, with perhaps but a 
partial restoration to health after all, it 
seems also a very cowardly one. Therefore, 
after twenty-four hours if the uterus has iiot 
been emptied nature should have some help 
in the matter. This may be safely given in 
many cases without an anaesthetic, using a 
dull curette, and, starting at a given point, 
going carefully over the entire intra-uterine 
surface, and removing all detachable por- 
tions of placental tissue; this to be done, of 
course, with every aseptic precaution, both 
of toilet and of technique; and followed at 
once by an irrigation of the uterine cavity 
with a gallon of normal saline solution, as 
hot as it can be borne, and a full purgative 
on the following day. Waiting longer than 
twenty-four hours offers two sources of re- 
newed danger. First, from continued 
haemorrhage and primary infection of re- 
tained placental tissue, and our aim should 
be to remove this tissue before such infection 
has occurred. And, second, supposing the 
contents of the uterine cavity to have be- 
come septic, each hour of further delay, 
which favors the softening from infiltration 
of the uterine walls, increases the danger to 
their structure in its removal. 

The conditions cited are such as confront 
us daily, but the list may be lengthened in- 
definitely ; and the better able we become to 
bring our cases from out the shades of ob- 
scurity and doubt, and recognize the actual 
state of affairs, the longer it will be. 

Many cases, for instance, of tubercular 



122 



THE CHARLOTTE MEDICAL JOURNAL 



peritonitis are treated throughout weary 
weeks under the ominous title of ' ' fever, ' ' 
whereas, by a timely recognition of the real 
trouble, the patient might be spared much 
useless medication, and also offered the 
hope of checking the tubercular process by 
opening the abdomen and washing out its 
cavity with normal saline solution. Just 
how this helps the matter we do not know; 
both trauma and exposure, no doubt, play 
their part; but that the condition, with its 
distressing symptoms, is bettered is beyond 
a doubt, and the patient is much more com- 
fortable afterwards. 

To my mind, surgery means much more 
than the surgeon's knife; and, to liave at- 
tained perfection, or even its nearest ap- 
proach, the surgeon must be possessed not 
only of the mechanical skill, but also of the 
wisdom and the conscience, which are 
equally essential to the successful and life- 
saving practice of his art. 

There are times when it is a much harder 
task to advise against an operation than it 
would be to urge it. But all men do not 
see things just alike; if they did there would 
be little need for consultations at all; and 
when the inner consciousness tells us that 
the patient will live just as long, maybe 
longer, and be just as comfortable without 
this trying ordeal, the duty becomes a very 
plain one, and in its performance we not 
only best serve the interests of our patient, 
but also sustain the honor and dignity of 
our profession. 

For instance, operations that exchange 
normal for abnormal positions of important 
organs. Innocent fibroids, with no pressure 
symptoms; when the risk of the operation is 
greater to the patient than the risk of retain- 
ing the growth. Cancerous uteri, which 
have gone beyond the life line, ca.ses of 
tender ovaries, in young women, where the 
appendix is removed for a cure. Dilatation 
of the cervix in virgins, for the relief of 
menstrual pain; whereas, the menstrual 
wave and the menstrual pain, like all of the 
functions of woman's pro-creative organs, 
are accomplished in cycles. Just what 
governs the wave, we do not know; and just 
what causes the pain, we do not know; but 
the very frequent failure of the dilatation of 
the cervix to relieve the symptom shows us 
that the real focus is not here. And many 
others might be cited, which are swept into 
the cvirrent, in the present day perfection of 
toilet and technique, with its comparative 
safety; and the promise it gives of rapid 
advancement along most attractive lines. 

The exploratory incision is one of the 
greatest evils of improved technique; and 
also the greatest menace to refinement of 
surgical wisdom. "We'll just make a hole 
and peep in," by which resolution the 



faculties are blunted, and the essential and 
life-saving diagnostic skill is never attained. 
"Make your diagnosis, and then cut!" 
should be the motto of all surgeons. 

Therefore, just where the tides meet in 
medicine and surgery will always be a 
problem, largely for individual solution. 
Each case is a law unto itself. But the man 
who makes best the diagnosis, clearly and 
correctly, recognizing a prime cause, with 
its localized focus for attack, will also be 
best able to foresee accident, and to guide 
his patient with safety. 

134 South Cherry street. 



Are We Doing Our Duty in Trying to Pre- 
vent the Spread of Venereal Disease ? t 

r.y Dr. J. H. Mai'sh, Fayetteville, N. C. 
Mr. President^ and Gentlemen of the 

North Carolina Medical Society : 

With the discovery of vaccination by 
Edward Jenner, small pox was robbed of 
its terrors, and the human race was the re- 
cipient of the blessings of the first great vic- 
tory of preventive medicine. Later, Pasteur, 
through long years of toil and scientific re- 
search, finally established the preventive 
treatment of hydrophobia on a firm basis, 
and a disease with a mortality of one hun- 
dred percent has been reduced to less than 
two percent, if the treatment is administered 
at the proper time. And another of the 
arch enemies of mankind has been robbed 
of its power to destroy. 

Diphtheria, which had a mortality of from 
seventy-iive to eighty percent under the best 
of treatmenti has been reduced to from ten 
to fifteen percent, under the proper use of 
antitoxin, and another of the enemies of 
our race has been robbed of its power to de- 
stroy to a very great extent. 

With the same object in view, but along 
different lines of investigation, Walter Reed 
and his associates discovered that certain 
mosquitoes were the carriers of the yellow 
fever germ, and in their effort to prove their 
theory and establish on a scientific basis 
their discovery, the lives of some of the 
noblest men in our profession wxre sacri- 
ficed that humanity might be relieved of 
one of its most deadly enemies of disease, 
and with that discovery and the proper sani- 
tary regulations, we all know how Cuba 
and our Southern country has been freed 
practically from one of the most fatal 
plagues that they were heir to. 

Likewise the plasmodia of malaria was 
also demonstrated and for the first time this 
disease was attacked on its own soil, and 
will, no doubt in the near future be robbed 
of many of its terrors. 

t Head befoi-e the North Carolina 8 ate Medi- 
cal Society at Charlotte, N. C. 



ORIGINAL COI\ri\irNICATIONS. 



Along- different lines investigators are ac- skill in medicine and surgery, seen the pa- 
tively at work the world over in the effort tients finally devoured by the poison, 
of trying to find out the germs that produced Gentlemen, there is no use for me to try 
the different diseases and the antidote or to describe the horrors of such a life. We all 
prevention of these diseases, and no doubt have seen the ravages of this monster enemy 
the near future has rich rewards for us in in all its forms, — too often for our own 
our efforts to relieve and prevent suffering, peace of conscience. Should we hesitate in 

When the discovery of antiseptics was taking up this subject on account of its 
made known to the profession b}' Sir Joseph delicate nature, which we all admit, and 
Lister, surgery entered upon a new era, and let our patients go on in ignorance till it is 
bacteriology and pathology began to receive too late, and finally end a miserable life, 
the attention which they deserve. The conscious of the sin which we have allowed 
germs of the different diseases were isolated them to ignorantly commit? Has the time 
and surgery became a science as well as an not arrived when we must act ? Mil- 
art, and this most important branch of our lions of dollars are spent each year on pat- 
science to-day has advanced to the point ent medicines, the only claim for which is 
that our laboratory is our most important that they cure veneral diseases. A friend 
guide and the question is no longer asked of mine told me some days ago that he saw 
what we do tbink, but what do we find to in the show window of one of the principal 
be the diseased condition. drug stores at Hot Springs a half dozen 

With the many advances among all lines buckets of mercurial ointment and potas- 
of medicine and surgery, it seems that we slum iodide crystals labelled "Society' 
have been slow to attempt to try to prevent Salve," — "The Mud that Made Hot Springs 
the spread of the veneral diseases. Is it Famous." I only desire to call attention 
not time that we take up this class of dis- to a few points on this subject, with the 
eases and in some way try to prevent the hope that every member of the profession 
promiscuous spread of a class of diseases will awake to the importance of educating 
which, in all probability causes more suffer- his unfortunate patients in this matter, and 
ing and misery and saps the human family that a campaign will in the near future be 
of more vitality than all of the other dis- waged against the habitues of the pest 
eases combined ? houses of these diseases throughout our land, 

It is stated on good authority that one- and we will not sit idly down and allow our 
half of the blindness of the country has legislators in Congress to enact laws to ex- 
been caused from infection. In a recent pose the frauds of the patent medicine men 
issue of the Journal of the American Medi- who are reaping a harvest at the expense of 
cal Association, Dr. J. Parks Lewis, of Buf- the unfortunate victims, but rush to our 
falo, says: "The Ophthalmia of infancy is duty and demonstrate to the world that 
an infectious germ disease," and advises when duty calls the entire profession is on 
the instillation of a solution of silver salt the alert and not one drone is to be found 
into the eyes of the new born, and in that who is willing to benefit by the labor and 
way prevent one-fourth of the blindness 
in the United States. Would it not be far 
better to prevent the cause of that blind- 



sacrifice of another in this great work, but 
each member is willing and ready to sub- 
ordinate his personality and make any sac- 



ness? A prominent physician who attends rifice for the bettering of the conditions of 
the students of one of our large universities the whole people, 
said a few years ago that the first prescrip- 



tion he wrote at the beginning of the college 
year and the last one he wrote at the end of 
the year were for veneral diseases. How 
often have we treated unfortunate young 
men, who had contracted the disease, in a 
careless way and never explained the dan 



The Physician and His Relation to 
Tuberculosis as a Social Problem.* 

By Dr. T. A. Mann. Durham, N. C. 



I shall not attempt to give any new ideas 

garding the physician's relation to this 

v.ciicn_o.-> v\ £iv ciii<^ ii<_4v_i ._,v^^icim^v^ Liiv. u.ci*i niost imoortaut problem which rests for its 

gers and far reaching consequences of not mosi impuiLd^iiL y,^ j ^ 



being properly treated, not only to them- 
selves, but to the innocent wives thev will 



solution on the co-operation of the public, 
the profession and the health authorities. 



one dav marrv. How often have we" been I shall speak for the most part of the phy- 
called upon to treat those innocent victims sician's relation to this problem, with a 
for those same diseases, and how many pus- 



strict understanding that without the work 
of the layman in adapting himself to the 
plans and principles laid down by the medi- 
cal profession, the physician's work will be 
much hampered. Dr. Anders, of Philadel- 
"^nRead before the North Carolina Medical So- 
\nd, after exhausting all of our ciety at Charlotte, N. C. 



tubes, ovaries and uteri have we removed 
as a consequence of these unfortunate 
unions. We have attended abortions, de- 
livered still-born infants, treated infants 
born with infection and often followed them 
to death 



124 



THE CHARLOTTE MEDICAL JOURNAL. 



phia, in speaking along this line says that 
"although the anti-tiiberculosis fight began 
on a medical basis, naturally, victory will 
be a very doubtful and at the best very re- 
mote result without the larger work of the 
laymen. This is truly a fundamental 
principle of the strategy indeed, and there 
must be adaption on the part of the general 
public as well as medical profession to a 
rational knowledge of and habitual atten- 
tion to the means of prevention and limita- 
tion." "Physicians, " he says, "have drawn 
and laid down the plans and specifications 
for the bridge that is to carry the populace 
safely over the dark gulley of disease, des- 
pair and death, but the building must be 
done and the bridge used in the main by 
those who would be saved thereby." 

In working out a solution to this problem, 
however, the physician has a sacred duty 
to perform. Dr. Osier well says that "in 
the warfare against tuberculosis the man 
behind the gun is the general practitioner; 
the battle cannot be won unless he takes an 
active, aggressive and accurate part." The 
time has not yet come when the physician 
is employed as prophylactiker. Let us hope 
that this time is not far in the future, for 
none can deny that it is better to save lives 
by the prevention of disease than by much 
drugging after its ouset. I{specially is this 
so in tuberculosis, for success in combatting 
it depends wholly on preventive measures 
and the earliest possible diagnosis when it 
has set in. 

Dr. S. A. Knoph, of New York, said that 
"The municipality which will inaugurate 
such true and practical philanthrophy as to 
assign a competent physician as family 
practitioner to a number of families not able 
to pay for one will be the ideal municipality 
of the future." I believe in having well 
organized health departments, both State 
and municipal, but when it comes to free 
medical advice in general sickness I must 
dissent. This touches on a social i)robleni 
which, if not handled properly, will break 
up the very foundation of our Governfnent. 
I will say in passing that the downfall of 
the Roman Empire was marked by free din- 
ners and free corn for the poor. Dr. Knoph, 
who perhaps has done as much work in 
tuberculosis as any man in the country 
says, however, that after careful study he 
has found out that the tuberculosis problem 
will and never can be solved without the 
help of the general practitioner, and-that 
consumption as a disease of the masses will 
never be successfully combatted until the 
day in which every family has its family 
physician. No matter how strict the sani- 
tary regulations which boards of health 
may issue, no matter how many sanatoria 
and special hospitals for consumptive poor 



we may have, we must look to the family 
physician for the bulk of the work in fight- 
ing "the great white plague." It is to the 
physician that we must look for the discov- 
ery of the early curable cases. The stoop- 
ing shoulders, the badly developed and de- 
formed chest, the pale appearance, the 
slightly hacking cough (sometimes no 
cough), a marked irritability, a loss in 
weight, a lack of appetite, a glistening eye, 
pasty skin, the bright color of the cheeks, 
a frequent rise of temperature in the after- 
noon, a dislike to pleasure and to duties 
which were formerly easy to perform, should 
put the family physician on his guard and 
indicate that the individual having these 
attributes, signs and symptoms is a subject 
for a most careful examination." 

The medical profession in North Carolina 
is altogether too slow in taking up this work 
against tuberculosis. Physicians are either 
not aware of their duty and responsibilities 
or they are almost inexcusably careless. 
Until a specific antitoxin is found it is plain 
that we must fight an invisible foe by fumi- 
gation and such measures as have proven 
valuable. That we have been careless is 
shown by the fact that from one-fifth to 
one-tenth of the deaths are due to this 
trouble. In some countries of Europe it is 
said that one-third of the working classes 
between fifteen and sixty die of consump- 
tion. Think of what a fearful loss to society 
this is. Dr. Langston has tabulated the 
figures regarding a hundred and seventy- 
seven wage-earning males who died in 
Maryland in 1903. The data for these fig- 
ures were acquired without regard to the 
social standing of the individual, hence it 
may be assumed that they fairly represent 
the average condition. The average indi- 
vidual loss was $741.64. The average po- 
tential loss to the cojumunity of a wage- 
earner was $8512. You can readily see the 
great annual loss society sustains. Besides 
this loss in dollars and cents think what 
hardships are brought to bear on families 
and indirectly on communities. All of us 
have seen whole families brought to poverty 
by the loss of the father in the prime of life. 
Children have been sent to the factories to 
earn food for the widowed mother and her 
nursing babe. Young pupils have been 
taken from the school-room and caused to 
grow up in ignorance in order to keep the 
wolf from the door. All of these things 
have a tendency to lower the standard of 
education and morals of our country. 

One of the first duties of a physician in 
his relation to tuberculosis is co-operation 
with the public and with health boards — 
active and aggressive co-operation. In the 
l)ast physicians have been too apathetic. 
Some one has said that "by far the most 



ORIGINAL COMMUNICATION. 



12.S 



dangerous foe we have to fight is apathy, 
indifference, from whatever cause, not from 
a lack of knowledge, but from a careless- 
ness, from absorption in other pursuits, from 
a contempt born of self-satisfaction. Fully 
25 per cent, of the deaths in a community 
are due to this accursed apathy, fostering a 
human insufficiency, and which goes far to 
counterbalance the extraordinary achieve- 
ments of the past century'. Why should we 
take pride in the wonderful railway system 
which enterprise and energy have traversed 
the land when the supreme law, the public 
health, is neglected; what comfort in the 
thought of a people enjoying great material 
prosperity when we know that the primary 
element of life is denied them? What con- 
solation does the little red school-house 
afford when we know that a Lethean apathy 
allows toll to be taken of every class, from 
the little tots to the youths and maidens?" 
The various health boards should add 
tuberculosis to the list of reportable diseases 
and physicians should do all in their power 
to report promptly. Instead of making false 
diagnoses they should endeavor to clear up 
doul^tful ones. Another duty of the phy- 
sician is care in examination of his patient. 
Many. have been treated and are now being 
treated by reputable physicians for indiges- 
tion and general debility when the real 
trou])le is tuberculosis. No wonder many 
people try jiatent medicines and the druggist 
when if they consult their physician he asks 
them a question or two and then prescribes 
a tonic. Tonics in tuberculosis do very 
little good unless accompanied by advice as 
to the proper mode of living. The lack of 
drugs did not cause the disease and a sup- 
\)\y of drugs cannot remove the cause. The 
physician, too, should be able to detect 
slight changes in the lungs. If not able to 
do so he should consult some other physician 
to help him. If a person objects to consul- 
tation the physician should explain the 
necessity of an early diagnosis, and that the 
expenditure of a few dollars for good medi- 
cal advice at a time when the possibility of 
recovery is good may mean the saving not 
only of many dollars in the future but pos- 
sibly happiness and an unbroken family. 
When a diagnosis is made a full and truth- 
ful statement, should be made to the patient. 
The day of keeping a consumptive ignorant 
of his trouble has passed. It is contrary to 
all scientific teaching. How can a person 
jirotect himself or- his family if he goes on 
frcnn day to day spreading his germs broad- 
cast? Successful treatment depends on a 
knowledge of the specific source of the 
disease. No physician is justified in allow- 
ing his patient to go to a slow but certain 
death when a free and an honest confession 
may give him a chance for recovery and 



will give him an opportunity for preventing 
the spread of the disease to others in his 
family. 

In relation to tuberculosis the physician 
must be a teacher, a hygienist, and prophy- 
lactiker. He must teach the family of a 
tubercular home the nature of "the great 
white plague," and tell them of its dangers. 
He should allay false fears. He should 
teach them the laws of hygiene and be on 
the alert to detect carelessness in carrying 
out instructions. He should not only l)e a ' 
physician but a friend to his unfortunate 
patient, and hold himself in such relation 
that he can freely give advice regarding 
the use of patent medicines and cures. 
This may be due to the fact that the i)hy- 
sician condemns them without explanation. 

I'Mnally, brethren, let us all think serious- 
ly over this subject and take into considera- 
tion its true character. Remember that now 
and then epidemics of smallpox, scarlet 
fever, and diphtheria are as nothing com- 
pared to this grim monster which is always 
creeping into our homes and slowly sapping 
the life from our fairest flowers. 



An Unusual Case of Ectopic Gestation.f 

By Charles Z. Candler, M. D , Dillsboro, N. C. 

My object in reporting this case is not so 
much to add anything new to the subject of 
ectopic pregnancy, but more on account of 
its comparative infrequency . In looking up 
the literature on the subject I have been ' 
unable to find anything that applies to the 
rupture of the sack into the bowel and es- 
cape of its contents by that route. I shall 
enter into the symptomatology of the con- 
dition only in so far as it applies to this par- 
ticular case, as it is taken for granted that 
every one who does any amount of ol^stet- 
rical work is familiar with all the manifes- 
tations of such a condition. 

Mrs. B., age 45 years, mother of eleven 
children, all living, the youngest of which 
is four years of age. Nothing in past his- 
tory of any importance except a miscarriage 
nine years ago. For past two years menses 
have been fairly regular and accompanied 
with slight i^ain at times. Two months 
prior to present illness the"menses suddenly 
ceased, and, as she expressed it, thought 
she had been "caught up." Flaving occa- 
sion to leave home for a distance of about 
ten miles, she took advantage of a wagon 
in which to make the trip. The road being 
very rough and rocky she was considerably 
shaken up, and on returning home in the 
evening she complained of slight pain in 
lower abdomen, but thought nothing of it 
as she was accustomed to such attacks. 



tRead before the recent meetinpf of the North 
Carolina Medical Society at Charlotte, N. C. 



126 



THE CHARLOTTE MEDICAL JOURNAL. 



During the night she became unwell, and 
by the following morning was suffering in- 
tensely, the pain becoming of a spasmodic 
character. She grew steadily worse and I 
saw her in the afternoon of the same day. 
At this time she was in extreme pain, which 
radiated over entire abdominal surface, 
frequent vomiting, which was not preceded 
by nausea (projectile type) pulse 120, tem- 
perature 97, and marked depression. In 
fact, the picture was that of extreme shock. 

On bimanual examination of the pelvic 
organs there was found a profuse bloody 
discharge which contained considerable 
shreds and pieces of membrane (decidua), 
resembling more than anything to which I 
can compare it the lining of an egg shell. 
The uterus was found to be enlarged and 
very sensitive. High up to the left and be- 
hind the cervix, which was widely dilated, 
could be outlined a distinct, pulsating mass 
about the size of an ordinary cocoanut. As 
a result of the extreme sensitiveness of all 
the pelvic organs the tubes and ovaries 
could not be found. 

I made a diagnosis of ectopic pregnancy 
with rupture of the sack into the peritoneal 
cavity and advised an immediate laparo- 
tomy. My friend, Doctor Colby, was called 
in consultation who concurred in my opinion 
and we immediately began to make prepar- 
ations to open the abdomen, but on account 
of th^ extreme shock she was in at the time 
we decided to postpone the operation until 
the following morning, it then being very 
late in the evening. But our main object 
in waiting was the hope that she might rally 
from the shock, thereby better enabling her 
to go through the operation more success- 
fully. Accordingly we administered gr. i 
morphia and gr. 1-00 atrophia hypodermic- 
ally which gave her some relief from the 
great pain. This was followed by the ad- 
ministration of strychnine, 1-30 gr. every 
three hours. vShe rested and was fairly 
comfortable for two or three hours when the 
pain returned with all its severity. She 
was again given the opiate, but with very 
little result. About' four o'clock in the 
morning the pains became more violent and 
cramp-like in character, the interval between 
them being so short that they appeared to 
be almost continuous. At this time she 
acted more like a woman in the last efforts 
to expel the foetal head through the peri- 
neum. There was a sudden cessation of 
the bearing down pain as if she had suc- 
ceeded in her task; at the same time there 
came a gush of liquid — not from the vagina 
— but from the bowel. What had happen- 
ed God only knew, for we didn't. The 
amount of this liquid I am unable to esti- 
mate, for there must have been a consider- 
able quantity lost in the mattress. A bed- 



pan was placed under her, into which she 
passed about one pint of bloody looking 
liquid which resembled nothing other than 
amniotic fluid. Mixed with this were shreds 
of membrane and blood clots in abundance. 
In the course of an hour she again passed 
about the same quantity of fluid in which 
we found unmistakable portions of placenta, 
together with what we took to be the re- 
mains of a six-weeks' foetus. 

During the week following she passed a 
small quantity of sanguineous fluid per 
rectum which gradually decreased until, at 
the end of ten days, it completely disap- 
peared. From that date on her recovery 
was uninterrupted, and at ihe present writ- 
ing she is enjoying excellent health. 

The bibliography of ectopic gestation, to 
which I have access, is limited to standard 
works on gynecology. Encyclopedia of prac- 
tice and the medical journals. In none of 
these, containing articles on this subject, 
am I able to find reported a case in which 
the rupture took place into the rectum. 
Such an early rupture, too, seems to be of 
rare occurrence. These, gentlemen, are my 
reasons for presenting a report on this case. 



Notes on Puerperal Eclampsia.* 

By [)r. W. C. Folder, Dobson, N. C. 

It has been said that "familiarity breeds 
contempt," and while I am reasonably 
familiar with eclampsia I deny the con- 
tempt. In days gone by, when I was young 
in the business, I regarded eclampsia rather 
lightly, but larger experience has changed 
all this. I now regard it as one of the most 
formidable accidents to which the pregnant 
woman is liable. 

There have been many definitions of 
eclampsia, all of which, with which I am 
familiar, are faulty, in that they fail to say 
that it is dependent up'on pregnancy for its 
cause. I think a good definition would be: 
convulsions occurring before, during, or 
after labor and due to pregnancy. 

We are told that eclampsia occurs once 
in about two hundred and fifty to three 
hundred cases of pregnancy, but I am satis- 
fied this is far too small a percentage, as in 
my experience it has occurred in about one 
per cent, of all pregnancies. 

As to the cause: Many writers have ad- 
vanced many theories, all with more or less 
plausibility, and possibly, all with some 
truth in them. That the active cause is a 
poison circulating in the blood there can be 
little doubt. Whatever the specific poison 
may be the presence of the foetus in the 
body of the patient, and in active connec- 
tion with her, is the cause of all the trouble. 

* Read before the North Cai-olinti State Medi- 
cal Society, Charlotte, N. C. 



ORIGINAL COMMUNICATION."?. 



127 



This seems to be clearly proven by the fact 
that eclampsia never occurs till sometime 
after the formation of the placenta, and al- 
most invariably ceases with the birth or 
death of the child. 

For fear that I become tedious and weary 
your patience 1 will pass from theories, 
which are of little value to us, to the treat- 
ment. The treatment of eclampsia is two- 
fold: that directed to the prevention and 
that directed a.^ainst the attack. While I 
would not decry the preventive treatment, 
still, 1 think that directed ag^ainst the attack 
is of more importance to the country prac- 
titioner for the reason that he is seldom 
called to the patient till she is in convulsions. 
I do not think it at all likely that you will 
make a mistake in diagiiosis, certainly not 
if you see the patient have a convulsion. 
The first thing- to do in the attack, if you 
happen to be young in the cause, is to go 
out and cool off, and while you are out 
think over the ca.se and get your treatment 
outlined in your head. Then carry your 
treatment out and do not let the importuni- 
ties of her husband or the suggestions of 
friends hurry you in the least. The treat- 
ment which I have found best is briefly 
stated: Veratrum, morphine, blood letting 
and purgatives. 

These are named in the order of their em- 
ployment: First, gtt. X of Norwood Tr. 
veratrum alternated with one- fourth of a 
grain morphine sulphate hypodermatically, 
followed bv the taking- of 16 to 24 oz. of 
blood from the arm. The veratrum and 
morphine are repeated in 20 to 30 minutes, 
and kept up at this interval till the pulse 
comes down to 60. When this has been 
accomplished you may feel reasonably safe, 
as it is extremely unlikely that your patient 
will have a convulsion with the pulse down 
to 60. If the pulse should go to 40 do not 
become alarmed, as it is only that much 
]:)etter for your patient. I have seen several 
with the pulse at 40 and they have all re- 
covered. 

At this stage, if it is possible without do- 
ing too much violence to the parts, the child 
should be delivered. But I do not think it 
ever justifiable, leastwise in country prac- 
tice where asepsis is unreliable, to slit up 
the cervix in order to deliver. Keep the 
pulse down and wait, and while you wait 
give a large dose of salts. Usually in from 
four to eight hours labor will come on and 
the child will be born without any more 
convulsions. 

Now in regard to preventive treatment: 
You will usually have abundance of time 
to look this up in your text-books. The 
line of treatment I follow is briefly : Calomel, 
epsom salts, citrate or acetate of potassium 
with digitalis, and the milk diet. I think 



all medication is secondary to the milk 
diet. 

As illustrating all phases of eclampsia 
and its treatment, 1 wish to report this case. 

liarly on the morning of January 11, 
190,1, I was called to attend Mrs. P — in her 
first confinement at full term. The labor 
dragged slowly along and about noon she 
complained of headache and I gave her 
gr. xxxx chloral hydrate in two do.ses. 
About 2 o'clock she lay down and in a few 
moments exclaimed "I am falling-" and 
immediately went into convulsions. I gave 
her a hypodermic of Norwood Tr. veratrum 
gtt. X and mori)hine sulphate i gr., both of 
which were repeated in half hour. I also 
bled her 16 oz. Convulsions ceased after 
the second injection, pulse reduced to 40. 
Child delivered (dead) in about six hours. 
iNIother made a good recovery. 

In the fall of the same year she was found 
to be pregnant again, and upon the appear- 
ance of edema of the face and feet, with 
other symptoms of toxemia, she was placed 
upon the preventive treatment I have out- 
lined above, and on 20th of January, 1904, 
I delivered her of a healthy child at full 
term. No convulsions and mother made a 
good recovery. April 24th, 1905, she being 
again pregnant, and edema of the face and 
feet coming on she was put upon the same 
treatment she had been before, which was 
kept up till August 30th, when I delivered 
her of an apparently healthy child at full 
term. Five hours later she went into con- 
vulsions, which were treated as before. 
Result: She died that night, having had no 
convulsions in several hours. Child died 
in convulsions in about ten days. 

And now in closing this rather scattering 
article, those lines by Burns come vividly 
to mind: 

"The best laid plans o' mice and men, 
Gang- aft aglee." 



Personal Experiences in tlie Treatment 
of Pulmonary Tuberculosis.* 

By Edwin Gladmon, M. D., Southecn Pines, N. C. 

The subject of pulmonary tuberculosis is 
the old one of seed and soil: the soil must 
be suitable or the seed will not grow. In 
my humble way I have preached for years 
the doctrine that instead of hunting for 
something to kill the seed we should en- 
deavor to make the soil so sterile the seed 
cannot thrive. 

In the human organism it is not possible 
safely to introduce any germicide that is the 
equal of healthy blood. It is nature's own 
germ killer. But normal blood is only pos- 
sible where there is normal digestion, and 



*Read before the North Carolina Medical Socie- 
ty, Charlotte, N. C. 



128 



THE CHARLOTTE MEDICAL JOTtrnAL. 



as this latter falls below par, so in equal 
ratio does the blood loose its germicidal 
properties, and leaves the body an easy prey 
for infection. Faulty digestion throws in- 
toxicating substances in the blood and it 
then has troubles of its own. 

I believe tuberculosis to be a disease of 
malnutrition; that means non-assimilation, 
and that means further that the food is not 
suited to the stomach, or the stomach is not 
suited to the food. (3r it may be both. 

The food does not suit the stomach when 
it is improper in character, imperfectly pre- 
pared, impure or adulterated. Or it may 
be imperfectly masticated, or too hastily 
eaten. The stomach may not be in a con- 
dition to receive the food because of dis- 
orders of secretion, motor insufficiency, 
neuroses, or other pathological changes. 
The cavise may possibly be found entirely 
outside of the stomach. Whatever the cause 
the final condition is the formation of nox- 
ious substances, which are absorbed and 
produce a condition which is broadly cov- 
ered by the term "auto-intoxication." 

The power of the blood as a germicide is 
therefore lowered in proportion as it is pois- 
oned from within. It is like a warfare be- 
tween nations where one has to fight a revo- 
lution at home. 

What foods are suitable and what are not 
is too large a subject to be treated in the 
brief compass of this paper. But generally 
speaking I am opposed to any rigid, unvary- 
ing form of diet. . The line of success is the 
line of least resistance, and that means a 
diet that accords as fully as possible with 
the patient's desires. The psychic element 
is an important one in digestion, and other 
things being equal more perfect digestion 
results from a diet pleasing to the patient 
than one forced on him by arbitrary rules. 
In the absence of diarrhoea a mixed diet 
meets this indication better than one con- 
fined strictly to nitrogenous foods. It is 
not what a patient eats but what he digests 
that gives results. Nor should the meals 
be given too often. Modern methods of 
forced feeding agree with some, but with 
the large majority of patients I believe it to 
be a positive injury. Increase in weight in 
forced feeding is not an absolute sign of iin- 
provement in all cases. 

There are but few cases of tuberculosis in 
which the stomach does not need treatment. 
Lavage, electricity, and massage are my 
stand-bys. Lavage may be needed every 
day and it may be needed but once a month, 
but it is a duty we owe our patients to keep 
their stomachs as free from slime, mucous 
and bile as possible, and to see that the 
gastric juice has always the requisite amount 
of hydrochloric acid with which to work. 

Cleanliness of the intestinal tract is just 



as important as of the stomach and calls 
for colonic flushings and antiseptics. While 
the sulphocarbolates have no influence in 
tubercular diarrhoea, they are equal to any 
of the new synthetic compounds in controll- 
ing fermentation. Even in the last stages 
of phthisis the movements may be kept al- 
most free from odor. 

Lavage of the stomach I use in its broad 
sense and by it include the drinking of 
medicated waters. 

I give one or two teaspoonfuls of listerine 
or l)orolyptol in water an hour before meals. 
This in many cases obviates the use of the 
stomach tube. I should observe that the 
statements in this paper have reference only 
to cases with fever: with at least a maxi- 
mum of one degree. Just so long as this 
much fever persists just so long will the 
digestive tract need watching along the lines 
here stated. 

The importance of cleanliness of the in- 
testinal tract was especially noted in a pa- 
tient now under treatment who last month 
had several attacks of urticaria, and each 
attack was accompanied with hemoptysis. 
The old fashioned remedy of sulphur, salts, 
creamof tartar with listerine finally stopped 
both the hives and spitting of blood. 

Where flushings have to be supplemented 
by medicine, mercury comliiued with a 
sulphocarbolate is a favorite remedy with 
me. Minute doses of bismuth and ipecac 
add to its effectiveness. 

When fermenting masses are to be remov- 
ed it is best to avoid the use if possible of 
salines. While in time they clean the in- 
testinal tract, by their liquifying action, 
they make absorption of the poisons more 
easy. But when such a medicine has to l)e 
given phosphate of soda in a saturated solu- 
tion gives me the best results. These reme- 
dies are especially indicated when patients 
come with a malarial history. It is hardly 
necessary now to argue against the use of 
creosote and cod liver oil in tul^ercular cases 
with weak digestion. They are both contra- 
indicated, and I believe are now passing 
out of use except in selected cases. 

From the use of these and a multitude of 
other digestive disturbers some physicians 
have gone to the qther extreme, and are as- 
serting that all that is necessary in this 
disease is to live and sleep out of doors. 

Somewhere I have read that a shanty 
which sheltered a pig burned down, and the 
taste of the roasted pig was so delicious that 
in a short time the hill sides were aglow 
with burning shanties. One day some one 
discovered that a pig could be roasted with- 
out burning a house. Some day some one 
will discover that a tubercular patient can 
obtain rest without putting him in a tent, 
for to my mind almost the entire value of 



ORIGINAL COIMMUNICATIONS. 



129 



the so-called open air treatment is the ele- 
ment of rest. 

A man cannot put any more water in his 
stomach if he drinks from a river than if he 
drinks from a glass: and a man cannot get 
any more or any better air in his lungs 
breathing in the open air than he could in 
a properly ventilated room. And to me the 
vaunted claims for the so-called open air 
cure of tuberculosis is the most extraordi- 
nary exhibition of therapeutic nihilism of 
modern times. 

Just think of it after twenty centuries of 
study and research, for members of the 
medical profession to say that the best way 
to fight the greatest plague that afflicts the 
human race is just to keep the patient out 
of doors. What an absurd confession of 
futility. But I know all members of the 
profession do not believe this, and it will 
have less and less followers as the years go 
by. We can understand the marvelous im- 
provement that follows when tubercular 
patients are taken out of slums, hovels and 
tenements, and given a chancy to breathe; 
but all tubercular patients do not live in 
tenements, and if impure air is tlie cause in 
all cases then architects ought to go out of 
business and hide their heads in shame. If 
impure air is not the cause in all cases why 
place all patients out of doors? Besides 
tuberculosis prevails in countries wdiere 
doors and windows are forever open. 

The claim that life in the open air is all 
that is necessary to cure consumption is 
made today by men who a few years ago 
were going to eliminate tuberculosis from 
the list of luan's ailments by the use of 
tuberculin and its congeners. They failed. 
Patients persisted in dying contrary to all 
their laws why they should not die; and 
they have gone to the other extreme, and 
are now advocating a therapeutic iconoclasm 
abhorrent to the teachings of medicine, 
science, and of humanity. 

Have faith in God, take milk and eggs, 
and keep out of doors. Faugh! What is 
this but a grand larceny of Christian science 
humbugery? 

Mr. President, pulmonary tuberculosis is 
a disease protean in its forms and varied in 
its manifestations, and demands unceasing 
vigilance and unwearied care. We cannot 
treat tubercular patients automatically like 
machines: we cannot give them a number 
and have them follow inflexible rules. We 
must individualize, and each tubercular 
patient offers a separate and distinct problem 
for solution. 

No two patients are exactly alike in 
cough, sleep, appetite, pain, digestion, pulse 
rate, or hemorrhage. l{ach indication must 
he met as it arises. Kach patient must be 
treated without regard to the rules laid down 



for another, ever bearing in mind that the 
disease is one of the general system, and 
the lungs merely a local manifestation of it. 

I agree with the most enthusiastic open 
air advocate as to the importance of fresh 
air in this disease; no one disputes that. 
But I emphatically take issue with the state- 
ment that this is all that is needed. In the 
hands of experienced specialists the open 
air cure will be prescribed only in cases 
where it is indicated, and the proper auxil- 
iary treatment given. But its tremendous 
danger lies in the fact that it will be used 
without discrimination, and will surely be 
taken up by the laity as a self cure. We 
have in our town a so-called osteopath, 
without medical experience, who extensive- 
ly advertises his open air cures. I have 
read of more than one death from pneu- 
monia by this system, and in my own town 
I have seen during the past two years pa- 
tients placed in shacks and tents die within 
one, two, and three .weeks after their arrival 
here. 

I believe it the solemn duty of teachers of 
phthisio therapy to emphasize the import- 
ance of discrimination in selecting cases for 
out door treatment. Air, like water, is 
simple, but water can be used in this dis- 
ease with dire and fatal results. 

The fact that patients get well without 
other treatment than living and sleeping 
out of doors does not prove it the most valu- 
able. I have seen visitors here, some with 
hemorrhages, take no treatment, fill up on 
corn whiskey, play cards half the night, 
and still recover. 

Nutrition and rest — therein lies success. 

Rest for the mind, rest for the body, rest 
for lungs and heart. Rest for the mind 
means that the physician should be coun- 
selor and friend as well; minimizing causes 
for worry and discouragement. Rest for 
the body means rest in doors or out, in a 
bed or in a hammock, as occasion may re- 
quire. It means too, abstinence from ex- 
hausting tub and shower baths. Massage 
takes the place of exercise, and is an abso- 
lute necessity; hand baths of different kinds 
keeps the skin functionating, and that too 
is a necessity. No patient with a hide 
bound skin ever recovered. Rest is espec- 
ially important in hemorrhage. Ergot is 
not only useless but positively harmful. 

Rest for the heart means to have one beat 
do the work of two. All the resources at 
our command should be used to bring the 
pulse rate near to normal: for the prognosis 
good or bad may in most cases be judged 
from the pulse rate alone. Strychnine is an 
ideal tonic, but cannot be given to all pa- 
tients. It is contraindicated in tachycardia 
and these people form the most troul)lesome 
class of patients. For them digitalis and 



130 



THE CHARLOTTE MEDICAL JOURNAL. 



bromides give best results. Aconite, vera- 
truin, and gelseminuni should be more 
widely used; I generally give them in con- 
junction with digitalis. Nitroglycerine, 
strophantus and caffeine all have indications 
in particular cases, and the question of 
heart tonics or heart sedatives is a most im- 
portant one and should be carefully studied. 
Rest for the lungs means rest from unneces- 
sary cough. This must be controlled at all 
hazards. It requires also the abatement of 
pleurisy and neuralgic pains, because these 
cause accelerated breathing. 

I do not hesitate to give opium or some 
similar drug to full effect when a patient 
first comes under treatment. It will not 
long be needed if the throat be cared for. 
The large majority of what I call unneces- 
sary coughs are caused by abnormal condi- 
tions in the throat. Even where no growths, 
or elongated u vulvas are found a patient 
with a hacking, continous cough, will have 
a mucous membrane congested. Here is 
where a local astringent yields marvelous 
results. I have tried many drugs, but the 
old-fashioned glycerite of tannin is as good 
as any. Swabbing with a probang is of no 
effect. I use a medium length polypus for- 
ceps which holds firmly a cotton mop, and 
this is rubbed in with some force over ton- 
sils, pharynx, and posterior nares. In the 
latter place especially is often found the 
cause of cough, as a string of phleghm 
hangs from it causing constant irritation. 
Albolene with menthol, chloretone and other 
drugs I use constantly. 

A coarse sprav, especially if used with 
force, will increase the irritation, but a fine 
spray gently applied coats the membrane 
with oil and the cough and irritation ceases. 
It is routine practice in our institution to 
oil a patient's throat as often as necessary 
to control cough, and when this is done 
very little medication is needed. Even in 
the last stages when anaemia takes the place 
of congestion the oil spray is still grateful 
and soothing. With a little manipulation 
the spray can be thrown in the trachea and 
is thus indicated in some cases. 

Seller's tablets, Dobell's solution and like 
preparations should not be used in these 
cases. In fact, I do not think they are in- 
dicated in any kind of case, because we 
can do with oil all we can do with water, 
and there is no comparison as to results. 

I will add, however, that local applica- 
tions will not cure a throat unless the stom- 
ach is kept clean. This I have demonstrated 
over and over again. If results do not come 
then, look out for uric acid, and treat ac- 
cordingly. 

Pains in the pleural region generally yield 
readily to the static breeze or spark: if that 
is not at hand positive galvanism gives 



equally good results. If neither can be used 
small blisters about one inch square will 
give relief. Canthos is very effective and 
is besides convenient to use. 

Finally, I repeat we must look at the body 
as a whole, from the nares to the anus. We 
may find ulcerated teeth, a dilated stomach, 
a congested liver or spleen, or a contracted 
and spasmodic anal sphincter. 

The nearer we approach to personal super- 
vision of details the nearer we come to the 
ideal treatment. 

Supervision of food, drink, clothing and 
exercise: supervision of the whole physical, 
mental and moral life of the patient. This 
would naturally limit the number of patients 
that could be treated by one physician, and 
that is precisely as it should be. 



Treatment of Typhoid Fever.* 

By Dr. .J. M. Matthews, Mt Pleasant, N. C. 

This subject is so common, and has been 
before the Medical Society so often, that I 
feel a delicacy in attempting to write a 
paper. But perhaps it will be of some in- 
terest to some of us to discuss it again. 

When called to a typhoid patient I usual- 
ly give a dose of calomel to open the bowels. 
In ten or twelve hours after there has been 
a good action of the bowels I give ten 
minims of aromatic sulphuric acid or dilut- 
ed hydrocloric acid every four hours. I 
also give ten minims of oil of turpentine 
three or four times a day, unless the patient 
has trouble passing his water. I give liquid 
diet from first to last, or till his fever has 
been broken about two weeks, and no 
tympanites. If the digestion is good I think 
milk diet is the best. If sweet milk curdles 
I use pepsin, or soda or lime water after the 
milk . Sometimes buttermilk is relished and 
agrees with the patient better than sweet 
milk. If the patient cannot take the milk 
I often use a teaspoon ful of brandy to a 
glass of milk. Some people take the milk 
well to get the brandy. 

To reduce the temperature nothing is bet- 
ter than cold water, if the patient can bear 
it well, if not use warm instead. I think 
the plunge bath is all right when it can be 
conveniently used and the patient can bear 
it. I usually prefer sprinkling or pouring 
as the most convenient mode, when the 
patient is weak. If the fever is hard to 
control I use an oil cloth under the patient, 
raise it on each side so the water will run 
off into a tub at the foot of the bed. This 
method bathes the back, and has a tendency 
to prevent bed-sores. 

I had a patient some years ago who had 
been drinking a large amount of new 



*Read before the North CaroUna Medical So- 
ciety, Charlotte, N. C. 



ORIGINAL COMMUNICATIONS. 



lot 



brandy. His temperature rose to one hun- 
dred and five, and his pulse so weak and 
fast I could not count them. 1 put him in 
a wet sheet, poured two buckets of ice water 
on him, kept him there for twenty-five 
minutes, repeated the l^ath in twenty-four 
hours; patient rested well after each bath, 
and made a good recovery. While bathing- 
it is well to keep up friction by rubbing the 
patient with a rough cloth, thereby produc- 
ing good capillary circulation. Always 
bathe if there are no contraindications when 
the temperature is above one hundred and 
two degrees. It is sometimes necessary to 
bathe even when the temperature is below 
one himdred and two. 

Medical 1 real merit — Keep the secretions 
as nearly normal as possible. For a dry 
tongue you have no better remedy than 
turpentine, as it acts on the secretions. I 
give oil of turpentine from the first to keep 
the tongue moist. Keep the kidnej^s acting 
with sweet spirits of niter, or some mild 
diuretic. For constipation I use the injec- 
tion of warm water, or give cascara evacu- 
ant or castor oil. I do not hesitate to give 
minute doses of calomel when I think it 
necessary, because in this disease the liver 
is always sluggish. This draws the bile 
from the gall bladder and flushes the ali- 
mentary canal with natures best antiseptic. 
For intestinal antiseptics I use salol and 
sometimes sulpho carbolate of zinc. For 
typanites I use oil of turpentine internally 
and externally over the bowels. If the 
digestion is not good I give pepsin after the 
milk. If the bowels move too often I give 
sub-nitrate of bismuth, or some form of 
opium. For hemorrhage of the bowels I 
use an opiate to check the peristalic action 
of the bowels, and put ice, or cloths wet in 
cold water over the abdomen. When the 
hemorrhage is great it is sometimes neces- 
sary to use bottles of hot water about the 
patient to keep up capillary circulation. A 
normal saline solution is sometimes useful. 
For stimulation I use brandy and strych- 
nine. I also use tincture of digitalis if the 
fever is broken and the pulse is very fast 
and weak. 

When the bowels are perforated give an 
opiate to quiet the patient, and turn him 
over to the surgeon. But if I were to 
attempt to give a treatment in full for 
all complications and symptoms it would 
make this paper entirely too long. You 
must treat the symptoms as they arise, 
exercising your good common sense. 

Dr. M. L. Matthews and I had fifty-five 
cases of typhoid fever in 1903. Four of them 
had hemorrhage of the bowels. One died of 
hemorrhage, and one of intussusception of 
the descending colon. Only two out of the 
fifty-five died after having received the 



treatment I have given you today. This is 
the treatment I have used for several years 
with marked success. 



The Open Gauze Method of Adminisler- 
ing Anaesthetics. 

By William Moncuro, M. I)., HO? 8 Tucker 
Building, Raleigh, N. C. 

We have all often heard the old adage, 
there is nothing new except that which has 
been forgotten. The subject of this short 
paper comes within the province of neither, 
as it is not exactly forgotten nor entirely 
new. This manner of administering an an- 
aesthetic is increasing in popularity every 
day, as is demonstrated by the numljer of 
surgical clinics adopting it and also its 
efficiency has been proven by its continued 
use in some of the largest and best regulated 
clinics in this country. 

It is not my purpose here to tire you with 
statistics or bibliographical references; but 
I will be content to repeat only one .state- 
ment, made recently by the anaesthetist to 
Dr. Joseph Price's clinic in Philadelphia, 
viz: that, in three thousand anaesthetiza- 
tions by the gauze method in said clinic, 
not once had the operatron been interrupted 
on account of the condition of the patient. 

The continuous drop has been used for a 
long time and various mechanical droppers 
have been devised, but it is the purpose of 
this paper to describe a drop method with 
plain gauze for an inhaler and free from all 
mechanical incumbrances. 

The method is applicable to any of the 
general anaesthetics, chloroform, ethyl chlo- 
ride and ether. 

When chloroform and ethyl chloride are 
used, much wider mesh and fewer layers of 
gauze are essential, because they require 
considerably less of the anaesthetic and a 
larger proportion of admixed atmosphere 
(not oxygen alone). 

The method is as follows: The gauze is 
folded into layers, from six to ten in thick- 
ness according to the mesh. It is often 
overlooked to fold the gauze so that the 
edges are entirely free from ravels, which 
cause considerable trouble and delay when 
allowed to enter the respiratory passages. 
The size of the gauze-pad should be about 
four by six inches. Ether should be dis- 
pensed in four-ounce bottles. I find the 
thick, round bottle is most convenient. The 
patient's lips and nares are anointed with 
vaseline. 

The gauze pad, beginning with six to 
eight layers, is placed over the patient's 
mouth and nose, the centre of the gauze 



Itead before the Noi'th Carolina Stato Medi- 
cal Society, Charlotte, N. C. 



132 



THE CHARLOTTE MEDICAL JOURNAL. 



raised in the manner of a tent and held in 
this position with the thunil) and index fin- 
ger of the left hand. The patient is now 
instructed to breathe through the gauze sev- 
eral times in a natural way before the ether 
is added, in order to quiet his mind and to 
forcibly demonstrate to him the fact that the 
gauze will in no way interfere with the free 
access of air. 

It is of considerable value in quieting the 
invariable nervousness of patients about to 
enter the anaesthetic state, to put them en- 
tirely at their ease as far as it is within the 
power of the anaesthetizer to accomplish, 
by giving them every assurance he possibly 
can of their safety from the anaesthetic. 
Caution them to keep their eyes closed, to 
breathe quietly and naturally and state to 
them that the ether will be given slowly at 
first; and that, by breathing naturally and 
quietly, choking sensations will be avoided 
in a large measure. Words to this effect 
certainly go a long way in producing a 
quiet and unexcited first stage: and it is 
well to add, in this connection, that a simple 
piece of gauze over one's face is certainly 
more conducive to a quiet mind than the 
formidable mechanical apparatus or the 
cone sometimes used for anaesthesia. More 
especially is this so, when the patient is the 
last of a series of anaesthesias and the res- 
piratory waste-products of his more fortun- 
ate predecessors are still tenaciously cling- 
ing to the inhaler. 

After the patient has been assured of the 
simplicity of the gauze and how easy it is 
to breathe through its mesh, the ether is 
dropped, one minim at a time, on the high- 
est point of the gauze. Some prefer a me- 
chanical dropper, but there is no better 
instrument constructed for regulating the 
size and frequency of the drop thaii one's 
index finger. It has often been asked: 
"Does this not chill and benumb the finger 
to such a degree that it l)econies useless as 
a dropper?" The answer is, to try it only 
once and you will soon find that the finger 
reacts from the primary numbness and be- 
comes unusually warm, though not uncom- 
fortably so. 

The drops are gradually increased in 
frequency, never falling in the same spot 
twice in succession, but in rotation over the 
surface of the gauze directly above the 
mouth and nares. 

It is preferable to hold the gauze over the 
face in a way to i:)revent air from entering 
beneath the layers, thus forcing it to pene- 
trate the mesh. This facilitates the evapor- 
ation of the ether and insures its thorough 
admixture with air. So the patient breathes 
with ease the ether-va])or diluted with air, 
and does so without the usual coughing and 
struggling so often seen when he receives it 



in gulps, as it is indifferently poured into 
the various cones. 

Many patients have a very marked in- 
crease in the flow of saliva; but this is easily 
taken care of so long as they are able to 
swallow. As soon as they get well under 
and swallow with difficulty, the saliva and 
secretions of the naso-pharynx trickle back 
into the larynx; and this is a frequent cause 
of the so-called "mucous in the throat." 
In this class of patients, as they are nearing 
complete anaesthesia, I have found it ad- 
vantageous to insert well back into the 
mouth two strips of gauze, free of ravels, to 
absorb the excess of saliva and bring it out 
of the mouth by capillary action. 

When the patient reaches the stage of 
excitement the frequency of the drop is in- 
creased, but never to the point of saturat- 
ing the gauze with ether — but rather, with 
ether-^ '/''"', because the saturation of the 
gauze with any '''^''^'"'iM'events the penetra- 
tion of air through the mesh and also 
hinders the ether's complete evaporation. 
For this reason, when the gauze becomes 
wet with the water of evaporation and the 
secretions from the mouth, time is saved by 
replacing the wet gauze with a fresh, dry 
piece. 

After the stage of excitement has passed, 
and the patient has become fully anaesthet- 
ized, the frequency and size of the drop are 
decreased. For the remainder of the anaes- 
thesia, ether is dropped as needed; and this 
takes much less for the same length of time 
than during the induction of anaesthesia. 

The gauze is easily held in place, always 
with the left hand — the little finger behind 
the ramus of the jaw constantly holding this 
forward; the ring-finger on the facial artery; 
the index, middle finger and thumb holding 
tne gauze-pad in position, while the pa- 
tient's head is always turned to the right. 
The right hand holds the ether bottle and 
the index-finger over the mouth of the 
bottle regulates the drop. While the right 
hand is not engaged in administering the 
ether it is free to elicit the reflexes and 
pulse. vShould one find that he is unable to 
use the finger as a dropper, a cork, with a 
groove cut on either side, will allow the en- 
trance of air and the^gradual escape of ether 
from the bottle. The gauze can at all times 
be easily and conveniently lifted to expose 
the eye for the reflexes, to observe the facial 
expression and the condition of the capillary 
circulation — especially of the face and ears. 

Whenever it is necessary to operate on a 
patient in any of the iwsitions other than 
flat of the back, the gauze can be held in 
place with greater ease than a cone or 
cumlDersome apparatus. Thus, with all the 
reflexes — circulatory, respiratory, secretory 
and vaso-motor systems — always conveu- 



ORIGINAL COMMUNICATION. 



1 .5.1 



iently before the eye, daii.i^erous symptoms 
can, in the majority of cases, be antici- 
pated. 

All stimulating drugs, when pushed be- 
yond a certain point, become dejiressants; 
and this is true of ether. But the open- 
gauze method affords a free admixture of 
oxygen and the regulated drop insures the 
sustained stimulant effect of the ether and 
a better tolerance of it by the patient — two 
very important factors in diminishing the 
after-nausea and vomiting. 

The anaesthesia, also, in the vast majori- 
ty of cases, runs a smooth and even course, 
without the interruptions so annoying to the 
operator, and the ].^atient at no time receives 
enough ether to be depressed by its excess, 
because he is constantly getting small quan- 
tities of nascent ether-vajjor at frequent and 
regular intervals, which is not the case with 
other forms of inhalers. For this reason, 
the method has been aptly described as "the 
minimum amount in the minimum fashion. ' ' 

The method has to recommend if, and 
certainly of no little importance, cleanliness, 
cheapness, and the fact that it is ever at 
hand on a moment's notice. 

Dr. Lawrence E. Holmes alluded to the 
method before this Society on a former oc- 
casion in connection with post-operative 
nausea and vomiting, and whatever there 
may be of repetition here only lends em- 
phasis to a very efficient, convenient, cleanly 
and useful method at the hands of all and 
at all times. 



Treatment ©1 Pneumonia. t 

By Lloyd P. Russell, Fletcher, N. C. 

The harvest of this fatal disease has 
just past. Hence, I have chosen this sub- 
ject. I shall not try to offer anything new 
in the treatment of Pneumonia, but only to 
point out the agents at our command that 
are most likely to carry us safely through. 
There is no specific as yet. The antitoxin 
is yet in the experimental stage, and we 
miM be contented with the remedies that 
are within our grasp. Vet we hope in the 
near future, that the laboratories will pro- 
duce an antitoxin that will control pneu- 
monia as we now do diphtheria: Such a 
remedy would be a Godsend, as pneumonia 
is one of the most fatal diseases that we 
have to contend with, and the death rate is 
on the increase. 

When called .to see a patient, suffering 
with pneumonia, the first thing I order is to 
have all the wearing apparel removed and 
a light gown put on which should be open 
in front, this enables me to make my ex- 
aminations without unnecessarily disturb- 



t lleiid before' the North Carolina vStiite Medi- 
cal Society, Charlotte, N. C. 



ing the patient. The patient should be in a 
light, well ventilated room. Preferably an 
up-stairs room. The bed should be smooth 
and no more cover used than is necessary; 
for too much bed clothing is a nuisance. 
The patient should be kept absolutely quiet. 
Not more than one or two persons in the 
room at one time. 

1 am a strong believer in elimination in 
the beginning of an attack of pneumonia. 
Get the. bowels, kidneys and skin acting 
well, and you have certainly got your pa- 
tient in a more comfortable condition. I 
usually give my patient from three to ten 
grains of calomel combined with one-fourth 
to one grain of podophyllin, being governed 
by the age- and strength of the patient, as 
to dosage. This is followed by a table- 
spoonful of 'sulphate of magnesia.' If I 
do not get the desired effect, I repeat in 
twenty-four hours. By this time we hope 
to have all the eliminative organs acting 
well. The congestion is relieved and the 
patient is feeling more comfortable, and is 
better prepared to fight the battle which is 
now on him. The pain in the side is best 
relieved by hypodermic injection of one- 
fourth grain of morphia. 

Then I order antiphlogistine applied hot, 
well over the affected area; both in front 
and behind; and I am sure that I have had 
some good results from antiphlogistine. It 
relieves the congestion of the lungs and 
enables our patient to breathe better through 
the affected parts. The antiphlogistine 
should be renewed in twelve or twenty- four 
hours. 

Next we must keep the temperature with- 
in the proper bounds, and our most trust- 
worthy agent is hydrotherapy. I think the 
patient should have a tepid sponge bath 
every day. It keeps the pores of the skin 
open, lowers the temperature, and if given 
at night, will have a tendency to produce 
sleep, which is very necessary to our pa- 
tient. 

If the temperature reaches 104 or 10.5, we 
should resort to the ice-cap, one should be 
applied to the head, and another to the 
stomach or affected side: Sometimes the 
cold pack to the affected side acts admirably 
well in relieving the pain. 

I do not believe in the extreme cold bath, 
as it is quite an ordeal for our patient to 
stand; it unnecessarily worries our patient, 
taking the energy from him, that we need 
to carry us over the crisis. And, it has been 
my experience that after having used tho,se 
extreme measures, the temperature will run 
higher when it returns than if we were to 
use a happy medium of hydrotherapy. Ex- 
ample the ice-cap. 

The patient's mouth and teeth should be 
cared for, as the sordes will soon decompose 



134 



THE CHARLOTTE MEDICAL JOURNAL. 



and give the patient a very foul smelling 
breath and bad taste, and cause him to re- 
ject nourishment. Listerine, one-half 
strength, or carbolized water are both ex- 
cellent mouth washes. 

What shall we use for expectorants? Aro- 
matic spirits of ammonia, and syrup senega, 
aa. parts given in teaspoonful doses even,' 
four hours, has acted well with me. 

To relieve the cough and produce rest, 
Dovers Powders given in five-grain doses 
act very well. Unfortunately it is apt to 
disturb the stomach, and opium checks the 
secretion of the body. So we should be 
very cautious in the treatment of pneu- 
monia. 

If the patient is extremely nervous I think 
it by far better to use the bromide of soda, 
given in five grain doses as indications re- 
quire. The bromide should be given in the 
elixir lactopeptine, as it is much less liable 
to disturb the stomach in this way. 

The digestive tract must be looked after, 
for this salol and elixir lactopeptine keeps 
it in excellent condition. I usually give 
two grains of salol in a teaspoonful of elixir 
lactopeptine every four hours. If the tongue 
is dry and heavily coated, oil of turpentine 
acts quite well given in six or eight drop 
doses every six hours. The diet should 
consist of liquids. Milk being the best — 
sweet or butter milk. The animal broths 
are all right, but I find as a general rule, 
that patients do not take them very well. 
Eggnog, or, egg-albumin are usually borne 
very well. 

We should allow our patients plenty of 
water, lemonade or the carbonated waters 
are very useful, as they help to loosen the 
mucous that accumulates in the bronchi 
and makes it more easily expelled. 

The next and most important is the heart, 
and this is, as you all know, our great 
danger in pneumonia. Strychnine is our 
best heart tonic. I usually start early in 
the disease with a one- fortieth grain given 
every four hours and increase the dose to 
one-thirtieth or even one-twentieth of a 
grain. I do not believe in too much alco- 
hol, as the secondary effects are depressing, 
though I think an ounce or two of good 
brandy or whiskey is beneficial, given every 
four hours, alternating the time of strych- 
nine by giving brandy between the strych- 
nine. Its depressing effects are overcome 
by the strychnine. 

If the pulse is very feeble, one or two 
pints of normal salt solution injected into 
the rectum acts very well. 

Summing up the whole; first eliminate 
your patient, get all the poisonous material 
in his system out. Keep your temperature 
within the bounds; nourish your patient; 
keep him absolutely quiet and sustain your 



heart until the crisis has passed, and you 
have won the victory. 

I shall not speak of the complications, as 
they are comparatively few, compared with 
the other diseases. 

Gentlemen, I thank you all for the op- 
portunity you have given me to read this 
paper. 

Mitral Insufficiency: Symptoms and 
Treatment.* 

By Dr. O. L. Ray, Raleigh, N. C, R. F. D. 

yl/r. President and Meinbc7-s (if the jSoriJi 
Carolina Aledical Society: 

In attempting to find a subject for a paper 
to present to you it occurred to me that 
while I had nothing original to offer we 
might study the subject of my brief paper, 
"Mitral Insufficiency: Its Symptoms and 
Treatment' ' with interest and perhaps profit, 
as it has fallen to my lot during my short 
professional experience (7 years) to have 
under my care several patients suffering 
from it, the most common of all the cardiac 
insufficiencies. 

Before entering upon'a discussion of the 
subject it might not be out of place to con- 
sider the morbid physiology of the heart in 
this trouble. 

In mitral insufficiency the blood flows in 
two directions during systole of left ventricle. 
The greater amount escapes into aorta, as 
in health. The smaller quantity' regurgi- 
tates through the imperfectly guarded left 
auriculo-ventricular orifice into left auricle 
during diastole, and this with the blood re- 
ceived from pulmonary veins causes dis- 
tension of auricle, and if the regurgitation 
progresses gradually hypertrophy results, 
which enables the auricle during systole to 
completely empty itself, and delivers an 
over- amount of blood to left ventricle and 
this causes dilatation, ' and to expel this 
extra amount of blood the Ventricle must 
hypertrophy (to furnish needed amount of 
blood to the general system and to make up 
for lost blood due to regurgitation into 
auricle). The engorgement of left auricle 
renders it difficult for the pulmonary veins 
to effectually empty themselves into left 
auricle and therefore the lungs become en- 
gorged, and here the right ventricle finds 
difficulty in pumping blood through the 
lungs and demands greater force on part of 
right ventricle and hypertrophy results and 
finally dilatation takes place from over-work 
and produces insufficiency of the tricuspid 
valves, the right auricle undergoes dilata- 
tion and hypertrophy, but the hypertrophied 
auricle fails to empty itself and we have en- 
gorgement of venous circulation. 

*Iiead beforo the North Carolina Medical 
Society at Charlotte, N. C. 



ORIGINAL CO-WWUNICATIONS. 



SyJiiptoiiis — In a good many cases the 
disease in its beginning has no symptoms for 
years after lesion is established, which 
causes patient to seek medical advice, ow- 
ing to compensation keeping in pace with 
the development of the disease. It is upon 
extra exertion that symptoms of cardiac 
embarrassment ensue, such as dyspnoea and 
palpitation, and these symptoms are usually 
attributed to some digestive disturbance by 
patient. 

If no disease or hard work causes weak- 
ening of the cardiac muscles the patient 
will pass with comfort to old age, when 
symptoms of cardiac failure will develop, 
due to changes in cardiac muscles incident 
to old age, also the heart's work is increased, 
as it takes a greater amount of force to send 
the blood to all parts of the body. 

Usually about the first symptoms the pa- 
tient complains of is shortness of breath on 
slightest exertion, usually accompanied by 
a "fluttering" or palpitation of the heart 
and indigestion. 

Pain and tenderness over the heart and 
an oppressed feeling: of the chest. Dizziness 
on stooping- over and rising suddenly, and 
often pain extending down left arm. Patient 
is unable to rest lying down owing to the 
engorged lungs, d>'spnoea becomes perma- 
nent due to failing compensation. Cyanosis 
of lips and fingers due to impaired capillary 
circulation, repeated attacks of bronchitis 
from congestion of the lungs are experienc- 
ed, and in coughing the sputum is some- 
times blood-stained and the dyspnoea be- 
comes worse. In advanced cases where we 
have congestion of the stomach and kidneys, 
we have a disturbance of these organs, as 
indigestion, gastritis, albuminuria, and 
these complications or secondary affected 
organs have symptoms of their own, and 
these, with the alread^^ existing trouble, 
sometimes make it hard to tell which is the 
primary trouble unless we have had the 
patient constantly under our care. 

The urine upon examination is scanty 
and highly colored and of high sp. gr. and 
we find large quantities of albumen. The 
liver becomes congested, enlarged and ten- 
der upon pressure, and when the tricuspid 
valves give way we have a pulsating liver 
and jugular pulse and this is pathog-nomonic 
of tricuspid insufficiency. Cieneral effusion 
into the serous and plural cavities result. 

Physical Signs.. — (Inspection). We will 
find the apex beat out of normal position, 
which is one and one-half inches below and 
within the nipple line and between the fifth 
and sixth ribs. The beat is more forcible 
and is displaced to the left. The position 
of apex beat depends upon the amount of 
dilatation of the ventricles. Sometimes we 



find impulse in the second interspace to the 
left. 

Palpation simply verifies inspection and 
determines more accurately the apex beat. 

The pulse at first is unaffected when com- 
pensation is complete, although the volume 
is lacking, but later, when compensation 
fails, it becomes frequent, irregular, weak, 
and intermits. 

Percussion. — The area of dullness is 
greatly enlarged from dilatation of the heart 
cavities. 

The enlargement is usually transverse or 
lateral, and may extend to right edge of 
sternum due to dilatation of right ventricle 
and as far as left of nipple from dilatation 
and hypertrophy of left ventricle. 

Auscultation. — You find a systolic mur- 
mur which is soft and loud in the mitral 
area, which is located at the apex beat, and 
the murmur is conducted into left axilla 
und'er the angle of the left scapula, and if 
very loud may be heard in any part of the 
chest, but best at apex beat (this being a 
very distinctive feature of the disease). 

As the right side of the heart becomes 
affected we have accentuation of the second 
sound of the heart which is heard in the 
second interspace to the left of the sternum. 
When the tricuspid valves fail we have a 
systolic murmur in the tricuspid area which 
is heard best at the fifth costal cartilage to 
right of sternum. 

Treatment - The first treatment we should 
consider in this disease, as in all diseases, 
is the preventive treatment, and this should 
be borne in mind when treating a patient 
with a disease where the heart is likely to 
become affected, secondarily, such diseases 
as acute rheumatism, diphtheria, Bright's 
disease and acute infectious fevers. We 
should be on our guard so that we may be 
able to cope with the condition if it should 
present itself and the treatment should de- 
pend upon the severity of the involvement 
of the heart. 

The giving of heart tonics to patients in 
this trouble before signs of cardiac failure 
present themselves often does harm instead 
of good, because the natural compensation 
may be disturbed and the patient will show 
symptoms of cardiac failure for the first 
time, neither does the presence of valvular 
lesion indicate direct treatment of the heart 
until it begins to show symptoms of failure, 
then we can resort to cardiac tonics. 

During the quiescent period we should 
look after the patient's general health, and 
see that every organ is performing its func- 
tion properly. 

The medicinal treatment in the beginning 
of failure of compensation and before should 
be iron in some form, and in my opinion 
the Peptonate of Iron is the best form in 



136 



THE CHARLOTTE MEDICAL JOURNAL. 



which to administer it, as it takes additional 
work off the digestive organs, and is ready 
for absorption and assimilation when taken 
into the stomach. 

By giving iron, the oxygen-carrying agent 
to the blood and tissues, we overcome the 
imperfect oxygenation of the blood to a cer- 
tain extent, caused by impaired pulmonary 
circulation, and we have good, rich blood 
reaching the heart muscles through the 
coronary arteries and this combined with 
prolonged rest brings about a permanent 
compensation in some cases where cardiac 
stimulants fail. 

Rest is a very important factor when com- 
pensation is failing, both of body and mind. 
Although the heart is an organ which can- 
not have complete rest at any time, its work 
can be diminished from 15 to 20 per cent, 
by a prolonged rest in bed from six to eight 
weeks. 

Shocks of all kind are to be avofded. 
Exercise in the beginning before symptoms 
of cardiac failure appear should be moder- 
ate and never excessive and taken in open 
air. 

Sleeping apartments should be well venti- 
lated, some preferring the patient to sleep 
out of doors- When cardiac failure is great 
enough to prevent out-door exercise, then 
massage, regulated according to strength of 
patient, is good. 

Closely related to the relief of all unneces- 
sary work of the heart is the management 
of the diet. It should be light and nutritious 
and mostly of proteids, and of such a nature 
as not to cause fermentation in stomach or 
intestines, as this will aggravate the trouble. 
Should any disturbance of the stomach or 
intestines arise digestants should be given 
to aid the stomach, while looking after the 
primary trouble. Meals should be given 
often and in small quantities. The selec- 
tion of the ideal dietary in each individual 
case must be the result of an intimate ac- 
quaintance with the patient's digestive 
ability and tastes and a thorough knowledge 
of the nutritive value of food stuffs. Sub- 
stances which are bulky and of small nutri- 
tive value should be cut out. 

In advanced cases where there is an ac- 
cumulation of dropsical effusion the diet 
should be entirely liquid and reduced to as 
small amount as possible. 

When compensation has failed the patient 
should be warned of his condition, so he 
may avoid any severe effort of any kind, as 
this may cause sudden death, or if not, do 
irreparable damage. 

Digitalis is the best cardiac stimulant, its 
action upon the heart increases the force of 
the systole and by prolonging the diastole 
it improves the nutrition of the cardiac 
muscles. 



While much benefit may be derived from 
the use of this drug, we should bear in mind 
the fact that it should not be administered 
in too large doses, as is often the case, some 
giving 10 to 20 minims three times a day, 
with the result that in a few days the heart 
is over-stimulated and instead of doing good 
it may do serious harm, and if persisted in 
for a considerable length of time may result 
in sudden death of patient. 

Digitalis in over doses produces a marked 
irregularity of force in the heart. The urine 
is decreased instead of increased as it should 
be. 

It has been my experience that small doses 
combined with the "rest cure" give satisfac- 
tory results. 

The only conditions in which I use large 
doses are when patient's condition demands 
immediate stimulation, or when from some 
cause the heart does not respond to smaller 
doses. 

When patient's condition is so critical 
that immediate stimulation is necessary, it 
is better to give more rapidly acting stimu- 
lants until digitalis has time to act, but 
while we have in mind the fact that digitalis 
is a drug that produces its effects slowly, 
we should also remember its effects are 
maintained for sometime after its use has 
been stopped. I have always found it satis- 
factory after having given it in large doses, 
to decrease the quantity to about one-half 
or less the original dose in a few days. 

The infusion of digitalis has been given 
by some where dropsy is present, but as it 
is very apt to disorder the stomach I think 
that it aggravates the existing trouble, there- 
by causing more harm than the slight in- 
crease in diuretic power does good. 

Where the arterial tension is higher than 
normal nitroglycerine should be given, as 
this reduces the tension. It is often given 
with digitalis to counteract the arterial effect 
of that drug. 

Strophanthus possesses the advantage of 
not raising the arterial pressure as does digi- 
talis, though a much less powerful stimu- 
lant. 

Where. there is a great amount of effusion 
in the pleural and abdominal cavities and 
digitalis fails to remove this effectually, 
then one of the salines in concentrated solu- 
tion should be given every morning. 

Periodical doses of calomel or blue mass 
does good, and especially where the liver is 
congested. 

Usually digitalis acts better after the ad- 
ministration of calomel or blue mass. 

I have also used apocynum cannabinum 
effectually in some cases, but this in large 
doses is apt to cause vomiting and diarrhoea. 

A combination of powdered squills, digi- 
talis and calomel, equal parts, is good to 



ORIGINAL COMMUNICAUIONS. 



^^7 



remove the effusion, l:)ut an occasional dose 
of saline is necessary to clear the calomel 
away. In cases where this fails to relieve 
tapping of the pleural and abdominal cavi- 
ties are resorted to, also puncture of the leg. 
Bleeding has been known to give relief in 
desperate cases, where there is distention of 
the right side of the heart with pulmonary 
congestion. 

Insomnia that accompanies this disease 
is usually relieved by the use of codeine. If 
this fails then give morphine, which, how- 
ever, cannot be given hypodermically if 
dropsy is present. These drugs are also 
used to relieve the dyspnoea, and in severe 
cases the administration of oxygen has 
proven beneficial for the dyspnoea. 

The palpitation and irregularity of the 
heart is often relieved by combining bella- 
donna with digitalis, sometimes a belladonna 
plaster over the heart gives relief. 



The Use of the Microscope in General 
Practice.* 

By Everett A. Lockett, M. D., Winston-Salem, 
N. C. 

All through the history of medicine from 
time to time instruments have been given 
us as a means of diagnosis, but there is 
none, perhaps, of more inestimable value 
than the microscope. 

In order to successfully treat our patients 
it is essential that a diagnosis be made as 
soon as possible; it is not only due to the 
patient who trusts his health and perhaps 
life in our hands, but also gives the physi- 
cian himself a better stand in the com- 
munity when it becomes known that he 
makes his diagnoses at the beginning or 
or early in the course of the disease; rather 
than late or after the patient has gotten 
well. 

The complaint has often been made that 
a physician is too busy to fool with a micro- 
scope — that only those who have nothing 
to do are always looking through micro- 
scopes. The busier a physician is the more 
occasion he has for using a microscope, for 
no one has a right to assume the responsi- 
bility of a case unless he be competent of 
treating it intelligently; and how can he do 
this without making a diagnosis, and in 
such a large percentage of cases, how can 
this be done without having recourse to mi- 
croscopy. 

That the microscope has a legitimate use 
in general practice none can gainsay. Ev- 
erything cannot be told by the microscope, 
— the microscope will not diagnose rheuma- 
tism for us, neither does it help us in many 
of the nervous diseases, but there are com- 



* Read before the North Carolina State Medi- 
cal Society at Charlotte, N. C. 



paratively few cases in which it will not 
help to clear up the diagnosis, and in all 
obscure cases, its use appears to me, to be 
indispensable, especially in cases where 
diagnosis is made by exclusion, 

At this late date there are scarcely any 
infectious diseases the germs of which the 
bacteriologists have not taught us how to 
find, this in general practice we can find by 
examining the blood and excreta. Having 
done this early in the disease, the diagnosis 
being established we can give direction as 
to the proper care and sanitation of the pa- 
tient, and, at the same time, protect the rest 
of the community from a similar infection. 

To prepare to examine the blood and ex- 
creta does not require a very great expen- 
diture of money, and an elaborate labora- 
tory. Presupposing a previous training in 
bacteriology and urinalysis, the entire space 
required for a general practitioner's labora- 
tory would not be greater than the top of an 
ordinary office desk, which may be placed 
in any convenient well-lighted corner of the 
office. This to contain any good micro- 
scope, with a two-thirds and a one-sixth 
objective; and if he can afford it, a twelfth 
oil immersion lens, a few test tubes, red and 
blue litmus, a bottle of pure nitric acid, 
Fehling's solution freshly prepared, a urino- 
meter, a bottle of acetic acid, a bottle of 
triple stain, a bottle of methylene blue, a 
a bottle of carbol fuschiu four per cent, 
solution of sulphuric acid, cover glasses and 
slides. With the above equipment any 
general practitioner is prepared to do the 
requisite amount of microscopic work and 
at the same time to do his patient the most 
good, to say nothing of the personal satis- 
faction to be derived from the consciousness 
of having made an early scientific diag- 
nosis. 

The physician who does this, has merely 
done his duty and deserves no praise; but 
is certainly not to receive censure and ridi- 
cule of his colleagues who don't feel able to 
go off and familiarize themselves w^ith this 
work, or else are too lazy to do so. 

There is scarce'y a day in general prac- 
tice that one does not have use for his micro- 
scope, in both medical and surgical cases. 
Just a few illustrations as to its practical 
value: It is very amusing at times, how 
many cases of malarial fever which ulti- 
mately turn into typhoid, a community has, 
which would not be the case were intelli- 
gent recourse had to the microscope. 

"Malaria" is unquestionably used as a 
substitute when no diagnosis is made. In 
all cases of fever extending over three or 
four days, it is very desirable to examiiie 
the blood for malaria plasmadium, which 
can be readily found either with or without 
staining after a little experience and more 



138 



THE CHARLOTTE MEDICAL JOURNAL 



or less perseverance at times, if they are 
there. Failing to find the malarial germs a 
leukocytic count is next made, and if no 
leukocytosis or a diminution in leukocytes 
is found typhoid fever is strongly to be sus- 
pected, the diagnosis of which in 98 per 
cent, of the cases is determined by means of 
the Widal test. Thus by the end of the 
eighth or ninth day of the fever the diag- 
nosis made by the symptoms is confirmed 
by the microscope. 

Again a differential diagnosis between 
acute, general military tuberculosis and ty- 
phoid fever is to be made early by means of 
the Widal test. 

In cases of appendicitis and other acute 
abdominal conditions, pus formation is pre- 
ceded by a leucocytosis which is detected 
by means of a microscopic examination of 
the blood. 

A differential diagnosis and prognosis of 
the essential enemias can only be made by 
the microscopic examination of the blood. 

In all cases of headaches the blood should 
be examined for malaria, after all renal 
complications are eliminated. Personally, 
if I may be pardoned for alluding to it, I 
recall one or two cases of headaches with- 
out any degree of periodicity and accom- 
panied by a slight rise of temperature where 
the diagnosis of malaria was made and the 
patients entirely recovered after anti-malaria 
treatment. 

Any case of cough extending over a few 
weeks the sputum should be examined for 
tubercle bacili. It sometimes being neces- 
sary to administer several doses of stimulat- 
ing expectorants before the bacilli are found! 
Thus a diagnosis of tuberculosis, to my 
own certain knowledge has been made in 
several cases before the family ever sus- 
pected the real cause of the trouble. The 
patient being at this stage favorable for the 
arrest of the process. 

Any suspicious secretions from the mu- 
cus surfaces should be carefully examined, 
especially in unsuspecting individuals, and 
Neisser's bacillus found before the patient 
is subjected to the humiliation if needs be, 
to be informed as to the true cause of his 
trouble. 

An examination of the spinal fluid to my 
personal knowledge will aid in the progno- 
sis of meningitis. 

The diagnosis of hook worm can only be 
made positively after often repeated exam- 
inations of the feces. 

In all cases of Bright's disease the urine 
should be examined for casts so as to deter- 
mine the form of nephritis and be able to 
intelligently treat and prognosticate. 

No cases of suspected itch can be posi- 
tively diagnosed unless the mite is found. 

Suspicious deposits in the throat should 



be immediately subjected to a microscopic 
examination as unquestionably cases of 
diphtheria are diagnosed very' much earlier 
than otherwise, by waiting for the culture 
process; the antitoxine being administered 
several hours earlier than would otherwise 
have been the case. 

Thus, in brief, I have outlined a few of 
the many invaluable uses to which the gen- 
eral practitioner can put his microscope. 



Some Views on Curettement of the 
Utcrus.t 

By Dr. M. A. Koyall, Yadkinville, N. C. 

In this paper I make no pretensions to 
discuss all the conditions that indicate a 
curettement of the uterus as a means of 
treatment, nor the minute pathology of the 
different forms of disease in which it is com- 
monly used. If anything I say suggests an 
agreement or disagreement I ask for a can- 
did discussion, not onh"^ from the specialist 
but from the general practitioner also. I 
aim to give a very brief summary of the 
practical points from the standpoint of a 
general practitioner whose practice is remote 
from hospital centers. While in Philadel- 
phia I heard a noted specialist say that 
while the general practitioner, who in most 
cases is not capable of making even a gyne- 
cological diagnosis, is apt to put in a pes- 
sary or scrape out the womb, often with the 
result of starting a pelvic inflammation that 
may end in death. We general practitioners 
see our patients going to the specialists, 
who are numerous in villages and cities. 
The specialist in gynecology is among the 
most active. When we look over the statis- 
tics of hospitals we find currettement by far 
the most numerous among operations and 
wonder if it is really so necessary. I think 
it would be instructive to follow these cases, 
and, if possible, take -an internal view of 
the uterus and its surroundings and de- 
termine the conditions of the patient, physi- 
cally and mentally. I think I might com- 
pare the results of the general practitioner's 
work with the results of the over-zealous 
operator, with credit to the former. But we 
bless the honest, conscientious specialist, to 
whom we are ever glad to turn in times of 
great responsibilities. The operator should 
have a definite knowledge of the conditions 
he is to relieve, based on pathological and 
bacteriological data and on clinical experi- 
ence. The recent graduate is skilled in 
pathology and bacteriology, and is impress- 
ed with the idea that his diagnosis will be 
accurately made from this high standard. 
He will examine specimens for pathological 
lesions and bacteria, make blood counts, «S:c. 



fKead before the North Carolina Medical 
Society at Charlotte, N. C. 



ORIGINAL COMMUNICATIONS. 



139 



That is ri.ijht, but he will depend on these 
means of diagnosis more at first than later, 
when he will be g^uided largely by experi- 
ence. We are instructed that all scrapings 
from the uterus should be examined under 
the microscope. In the city the surgeon 
has but to direct the pathologist to make the 
diagnosis and report. We hope the time 
will soon come when there will be an expert 
microscopist within reach of all general 
practitioners. The graduate of some years 
ago is not so familiar with bacteriology and 
pathology as the recent graduate, and con- 
sequently must depend upon practical ex- 
perience. I shall very briefly discuss 
curettement in three conditions, viz.: 

1st. For the removal of the remaining 
portions of an incomplete abortion. 

2nd. For removal of septic matter after 
delivery. 

3rd. For the removal of the superficial 
portions of the uterine mucosa in endome- 
tritis. 

The physician spends many anxious hours 
waiting for the successful end of an abor- 
tion. We are advised by the extremist that 
if abortion is sure the patient should be 
given an anaesthetic, the cervix dilated, the 
uterus scraped with a sharp curette and the 
decidua removed, whether there is sepsis or 
not. In the light of my past experience, I 
am not yet convinced that such a vigorous 
procedure is necessary. I do not think we 
are justified in putting a patient under an 
anaesthetic until we are sure it is necessary, 
for I fear it may have remote effect which 
we never take into consideration. I think 
the abortion may be so managed and nature 
so assisted that the use of the curette will 
be seldom needed. In the first years of my 
practice I used the method of carefully and 
tightly tamponing the vagina, gave a seda- 
tive if necessary, and waited for the pains 
to do the work. In a few hours I removed 
the tampon and usually found the abortion 
complete. Sometimes it was found in the 
cervix and easily removed. In cases of 
early abortion if a bad odor developed I 
dilated gently with finger or dilator, remov- 
ed what was left with the finger or dull 
curette, used an antiseptic intra-uterine 
douch and drained. I never packed the 
uterus for the purpose of drainage. I had 
to dilate two or three times in some cases, 
but seldom more. I swabbed the uterus 
with Churchill's tincture iodine when there 
were symptoms of sepsis. At that time I 
thought hemorrhage was a dangerous factor; 
but later I thought less of it and left off 
tamponing and dilated with the finger, if 
possible, and removed the contents of the 
uterus with the fingers. If I could not do 
this and hemorrhage continued I used the 
tampon with gratifying results. Afterward 



I tried the more vigorous treatment with the 
curette and did not give nature a chance, 
and following this I had the worst cases of 
sepsis I ever had. It may have been due 
to the improper use of the curette and lack 
of thorough operation, but I returned to the 
tampon method and when the abortion is 
progressing favorably I do not curette. 
When all else fails and septic symptoms 
appear, and flowing is severe and frequent, 
I curette with care, using the antiseptic pre- 
cautions of a major operation. 

After the second to the sixth month I use 
the tampon if the hemorrhage is severe. If 
the placenta does not come away, and it is 
adherent in its entirety, I watch the patient 
for hemorrhage till they do appear. In 
cases where the placenta is partly adherent 
and partly non-adherent hemorrhage is quite 
severe and sepsis more probable the tampon 
method will remove it quite as well as the 
curette. In one case of abortion at four 
months the placenta was firmly adherent. 
I kept patient under close observation and 
at the end of three weeks it came away with 
very little trouble. If hemorrhage continues 
dilate and curette with the precautions be- 
fore mentioned, and drain by keeping the os 
open, but do not pack the uterus. I often 
apply Churchill's tincture of iodine and 
glycerine to the uterine membrane. We 
are taught to examine the placenta after 
labor to determine if any of it is left in the 
uterus. I do not think we can always tell; 
even then small pieces may be left. I think 
we are all agreed that there is more danger 
in curetteing in these cases than after early 
abortion. If all the septic material is not 
removed absorption takes place very much 
more readily because the glandular protec- 
tive zone is gone. If after labor septic 
symptoms occur I dilate if necessary, and 
use antiseptic douches, and possibly iodine 
or ichthyol or a similar preparation. If 
symptoms continue I determine with the 
finger if any of the placenta is present and 
remove it with the finger or dull curette or 
forceps. Use hot antiseptic douches, sup- 
plemented with ichthyol and glycerine appli- 
cations. If the sepsis still continues shall 
we curette? If we remove all the septic 
material we may have no further trouble, 
but if it is not thoroughly done it would be 
better not to interfere at all. I shall not 
consider the different classifications of en- 
dometritis, for after some study I am per- 
suaded that it is a very indefinite disease, 
and it is not as prevalent as is supposed. 
Two varieties of endometritis will cover the 
essential symptoms of all: 

1st. Interstitial; 2nd. Glandular. In both 
the principal symptom is menorrhagia. In 
the interstitial we have a purulent and a 
muco-purulent discharge. In the glandular 



140 



THE CHARLOTTE MEDICAL JOURNAL- 



we have leucorrhea and hemorrhag-e. The 
catarrhal conditions observed in young: un- 
married women are due to vitiated blood, 
exposure, improper care at the menstrual 
period, uterine displacements, etc., and are 
not true endometritis. The married women 
we may treat locally as conditions indicate,- 
repairing the perineum and cervix and cor- 
recting flexions. I do not think a curette- 
ment is indicated unless there are repeated 
severe hemorrhages or excessive flowing. 
1 have had very little experience with en- 
dometritis due to the gonococci. I think 
even greater caution should be shown here 
because of the probable adhesions and dis- 
ease of the tubes. 

Some of the unpleasant consequences of 
curettement are: Sepsis from incomplete 
operations, perforation, atresia, peritonitis 
if the operation is too vigorous, and the 
immediate and remote dangers of the anaes- 
thetic. In order to avoid the use of the 
curette, first tampon; second, dilate and 
drain; third, use antiseptics intelligently; 
fourth, use proper local and systemic treat- 
ment. As a rule curette only wdien hemor- 
rhage is frequent and profuse, and then 
with the antiseptic precautions of a major 
operation. 

Writer acknowledges his indebtedness to 
Howard Kelly, of Baltimore, W. A. B. 
Sellman, Baltimore, and E. D. Gardner, 
Hancock, Michigan. 



Perineal Lacerations — Prevention and 
Treatment.! 

My W. F. Mitchell, M. D., Shelby, N. C. 

In a brief discussion of this subject I do 
not deem it necessary to enter into the 
anatomy of the perineum, and will only 
speak of this accident as it occurs in normal 
labor. 

Of the many pathological conditions oc- 
casioned by labor, that of perineal lacera- 
tion is one of the most frequent. It has 
always been difficult to give a correct esti- 
mate of what per cent, of women are lacer- 
ated during labor, as authorities differ as to 
what constitutes a laceration. German 
midwives are compelled by the Government 
to call a physician to close a laceration from 
one-half to two-thirds of an inch, including 
mucous membrane. 

According to the classification adopted 
by Prof. Edward P. Davis, of Philadelphia, 
three-fourths of all primiparous and one- 
half of all multiparous patients sustain 
lacerations justifying suture. Another au- 
thority estimates that thirty-five per cent, 
of primiparae and about fifteen per cent, of 
multiparae are ruptured. Tlius we see that 

tRead before the North Carolina Medical 
Society at Charlotte, N. C. 



no matter whose classification we accept 
the frequency of this accident is admitted 
by all. Yet, notwithstanding these facts, 
there are physicians who claim that they 
never meet with a laceration, and I can best 
answer such statements by quoting a well 
known obstetric authority who says: "The 
practitioner who claims that in an extensive 
practice he has never seen a lacerated peri- 
neum has become today a rara avis in the 
light of the recorded experience from hos- 
pitals, which certify to the necessarily fre- 
quent occurrence of this accident in the 
hands of the most expert." 

When the many ills that naturally follow 
from this accident are considered it becomes 
the duty of the physician to use every means 
at his command to prevent the occurrence. 
Indeed, there is no accident of labor that is 
followed by so many complications as that 
of laceration of the pelvic floor. Rectocele, 
prolapse, and various forms of uterine dis- 
placements are the direct results of this 
accident. 

I wish briefly to discuss Some of the l:)est 
ways to prevent this accident, as I believe 
it should be the aim of the physician to 
prevent its occurrence, even though we were 
always able to repair the lesion. 

A proper understanding of the manner in 
which the delivery of the head is accom- 
plished will go a long way to prevent rup- 
ture, as it is at this stage of labor that it 
most frequently occurs. It is vers^ important 
for the physician to have a thorough kno.wl- 
edge of the mechanism at this stage, and 
unless he masters it his conduct of labor 
will be but little superior to that of a mid- 
wife. 

In order to effect safe delivery and pre- 
serve the integrity of the perineum the fol- 
lowing cardinal rules should be observed: 
The shortest diameter of the head should be 
constantly kept in relation to the antero- 
posterior diameter of the outlet, and this is 
best accomplished by keeping the chin 
flexed upon the sternum until the occiput 
engages under the pubic arch, extension 
then slowly takes place, counter pressure 
being made against the head to retard the 
progress of labor until the perineum is fully 
relaxed, as extension proceeds the head is 
supiwrted and pressed against the pubic 
bones as it sweeps over the perineum. 

The older obstetric writers laid much 
stress upon what they called perineal sup- 
port; but experience has proven that this 
was not only erroneous, but positively dan- 
gerous. Much misunderstanding and con- 
fusion has been the outcome of this teach- 
ing, for the profession has never entirely 
gotten rid of the idea that the perineum 
must be supported. It is the head beyond 
question that needs to be supported, and 



ORIGINAL COMMUNICATIONS. 141 

any direct pressure of the perineum against the sloughing- of the pelvic floor, and the 
the presenting part might cause the ver_v in- physician should apply the forceps before 
jury that we wish to avert. the parts have become oedematous and the 

In my experience, chloroform is a most patient is exhausted. I am persuaded that 
valuable agent for the relaxation of a rigid we are disposed to rely too much on nature 
perineum, and should be classed among the in our obstetrical work, and believe many 
preventive measures. The profession has injuries could be averted, and even lives 
])een too chary of the use of anaesthetics in saved if we were not so timid and hesitating 
labor, and to my mind, without any good in coming to the relief of nature, 
reason, for it is a noteworthy fact that acci- Our modern civilization has evolved a 
dents from their use in obstetrical practice class of nervous women who bear the shock 
have been exceedingly rare. When there and pain of labor with much less fortitude 
is api)rehension of injury to the perineum than did their mothers and grandmothers, 
chloroform should be given intermittently Every physician who has been in active 
during the second stage of labor, and as the practice for any length of time will bear 
head passes over the perineum it should be testimony to the fact that it is necessary to 
pushed almost to the surgical degree, and use the forceps, or resort to other means, to 
immediately withdrawn as soon as the head effect delivery with much greater frequency 
is delivered. When given in this manner than formerly. There is a growing senti- 
it has little or no tendency to abate uterine ment among the profession in favor of a 
contractions, nor have I ever had a hemor- more general use of chloroform and a more 
rhage from its use. Many physicians are frequent resort to the forceps, not only as a 
prejudiced against chloroform for fear of means of preventing injury to the maternal 
hemorrhage; but there is little or no danger soft parts, but to relieve the suffering of the 
from this source unless anaesthesia is pro- parturient woman. 

longed. There are few cases of primiparae Laceration will sometimes occur after all 
in which 1 do not resort to chloroform, and the skill and resources of the physician have 
in many instances it has been the means of been taxed to the utmost. It is estimated 
preventing laceration when other means that about 15 per cent, of the lacerations 
would have failed. The longer I practice are unavoidable. After the delivery has 
obstetrics the more freciuently I resort to been completed the physician should per- 
chloroform anaesthesia, not only to prevent sonally examine for this accident, as there 
injuries but to relieve the intense suffering may be deep laceration of the pelvic floor 
incident to parturition. without any external evidence. When lacer- 

In the forceps we have a quick and effic- ation has occurred it should be immediately 
lent means of terminating prolonged labors, repaired, unless contraindicated from ex- 
thus saving the patient unnecessary suffer- treme exhaustion of the patient. It is easy 
ing and preventing injury to the pelvic for the tired physician to persuade himself 
floor. The forceps have a wide range of that these injuries will heal without suture, 
usefulness in obstetrical practice; but I wish and it is wonderful how well nature repairs 
to call especial attention to the following small lacerations; but the doctor has not 
class of cases in which they are not only fully performed his duty when he leaves his 
indicated, but the physician who fails to patient with an unrepaired laceration. The 
applv them is derelict in his duty. operation is usually not difficult, and the 

After the first stage of labor is completed results are good when proper cleanliness is 
the head is forced down upon the pelvic observed. It is true that it sometimes fails; 
floor, and although the uterine contractions but this in no way interferes with a subse- 
may continue they are insufficient for the quent operation. The immediate danger 
delivery of the child. The vagina becomes from an unrepaired laceration is infection, 
hot and dry, the soft parts swell, the head and if the patient is so fortunate as to escape 
ceases to recede after each contraction, and this her convalescence is usually retarded, 
the condition of the patient becomes one of and ultimately she has to run the risk of 
great distress with the ultimate result of rectocele, prolapse, or some uterine displace- 
deep injury to the pelvic floor if not quickly ment, which are direct complications of this 
relieved. injury. 

The application of the forceps in these A visit to the clinics of our leading gyne- 
cases will not only relieve the patient from cologists will reveal the fact that a large per 
an agonizing condition, but will be the cent, of their operative work would have 
means of preventing serious injury to the been rendered unnecessary had the obstet- 
soft parts. The physician who sits idly by rici an not been negligent of his duty. Hun- 
awaiting nature to effect delivery in these dreds and thousands of women annually 
cases reflects no honor upon his profession, submit to operations, which might have 
and fails to do his duty to his patient. A been averted by sewing up a lacerated peri- 
prolonging of this condition will result in neum. These are facts that cannot be de- 



142 



THE CHARLOTTE MEDICAL JOURNAL. 



nied, and they are a constant reflection 
upon the work of the general practitioner. 
In concluding- this imperfect presentation 
of this subject I wish to make an urgent 
plea for better obstetrical work, and if every 
physician would make it a rule to repair 
these injuries as they occur it would prove 
an inestimable blessing to the parturient 
woman, and our hospitals would no longer 
be filled by them seeking relief from the 
gynecologist. 



Chorea Gravidarum, with Report of a 
Case.* 

By Dr. J. M. Templeton, Gary, N. C. 

Diseases that are commonest and those 
that are very rare are alike of interest to the 
physician; to the latter class belong cases of 
chorea complicating pregnancy, a condition 
that may confront the general practitioner 
at any time. This affection during preg- 
nancy is characterized by the same symp- 
toms that are presented in true chorea and 
the diagnosis may be as readily made. 

It is seen oftenest in primipara, and those 
who have suffered from chorea in childhood 
are prone to have it return when they be- 
come pregnant, and the younger they are 
when pregnancy occurs the greater is the 
probability of their developing the disease. 
Except in pregnancy chorea rarely ever de- 
velops in the adult. The etiology of this 
disease is not clear, some authorities attrib- 
ute it to rheumatism, or a rheumatic taint; 
others, and I think correctly, claim that its 
resemblance to eclampsia points to some 
underlying cause that produces puerperal 
convulsions and the pernicious vomiting of 
pregnancy. Postmortem examination show 
the motor cortex, intellectual centers and 
spinal cord to be affected. Chorea usually 
begins about the time foetal movements are 
felt, and this may be the exciting cause 
that so frequently produces it at this stage 
of child-bearing, though fright, emotion, 
lowered vitality and toxemia from any cause 
predispose to it. It is sometimes unilateral 
throughout an attack, but oftener begins on 
one side, extends, and becomes general. 
Gower reports 11 out of 64 cases on the 
right side, and 13 out of 64 on the left side. 
Severe cases are marked by violent move- 
ment, insomnia, interference with degluti- 
tion, involuntary passage of feces and urine 
and sometimes acute mania and paralysis. 
Lesions of the heart or other organs in- 
crease the gravit}' of cases and make even 
light attacks dangerous. The disease with 
which it is most likely to be confounded is 
hysteria, and as it occurs mostly in neurotic 
subjects prone to nervous manifestations it 



*Read before the North Carolina Medical So- 
ciety, Charlotte, N. C. 



may require some care to differentiate them. 
In true chorea the movements are irregular 
and spasmodic, increased by motion and 
voluntary effort, while hysterical movements 
are sudden, isolated, and often rhythmical. 
Pregnancy is interrupted in proba])ly one 
half the cases and the death rate to mothers 
is high. 

As to treatment, emptying the uterus may 
be necessary in intractable cases. Rest in 
bed, as movement intensifies the disease, is 
desirable. Diet, hygiene and sanitation 
should of course be looked after, and the 
elimination of the patient receive marked 
attention. (Jf drugs there are in this, as in 
most other diseases, no specifics. Bromide, 
the coal-tar derivatives, opium and other 
narcotics and sedatives are indicated to 
control the symptoms. Arsenic, iron, qui- 
nine, strychnia and other tonics and alter- 
atives are useful in the management of such 
cases. The only case that has come under 
my care was treated some three years ago. 

She was 23 years old and in the second 
month of her second pregnancy. Up to the 
time chorea developed she had been in fair 
health, though she came of a neurotic 
family, her mother's mind being weak, one 
brother an idiot, a sister an epileptic, while 
a cousin had "spells" that were probably 
epileptic, and a maternal uncle had died in 
the asylum for insane. 

When I saw her, some five hours after 
the attack began, the choreic movements 
were general, involving both sides of the 
whole body, and I was impressed with the 
marked severity in the abdominal muscles. 
She was complaining of severe pain in the 
head and back and much soreness of the 
muscles, her temperature was elevated about 
one degree. I had her put to bed, gave her 
l.'i grains of bromide of potash and a hypo- 
dermic of morphia. This had a quieting 
effect and I directed tlie bromide to be re- 
peated every hour until bedtime, when she 
was to have ten grains each of calomel and 
Dovers powder, to be followed by a saline 
next morning. Next morning the chorea 
returned, but was controlled by morphia 
until evening, when she had another attack 
relieved in the same way. I put her on 
arsenic, increasing rapidly to intolerance, 
and also small doses of quinine, the sedative 
and narcotics to be used as sparingly as 
possible and the emunctories stimulated 
highly. At the end of a week she was 
much improved, but not entirely free from 
the trouble. Continuing the tonics and 
eliminants I then put her on Exalgine, 30 
grains per day, which reinforced by an oc- 
casional dose of bromide enal)led me to dis- 
charge her about one month after the disease 
appeared. I directed her to take her tonic 
at intervals, keep her secretions in good 



ORIGINAL COMMUNICATIONS. 



143 



condition, and as she was still very nervous 
use the sedatives occasionally. She did 
well until Sept. 2nd, when the chorea re- 
turned as severe as at the bes:inning. Treat- 
ment was only partially successful, and 
about ten days after the trouble returned I 
dilated the os and a few hours later deliver- 
ed her of a boy. The disease disappeared 
almost at once, and she has since borne a 
child with no return of the chorea. 



Management of the First Stage of Labor.* 

13y H. McKee Tucker, M. D , Pi-ofeSHor of Ob- 
isteti-ics in the Meilicul Department of the 
University of North Carolina and Gynecology 
in the Leonard Medical School. 

If a doctor is called to see a case of labor 
for the first time and finds a woman in the 
first stage, there five things he should do. 

(1) Get her history, particularly with 
reference to rickets in childhood, and if 
multipara with the reference also to past 
labors, etc. 

(2) Ascertain by external pelvimetry the 
probability of contracted pelvis, to be con- 
firmed later by internal examination if sus- 
pected. At this time also determine the 
probable position and presentation by in- 
spection, palpation and auscultation. 

(3) See that bladder and rectum are 
emptied, the latter by enema, as the disten- 
tion of either predisposes to uterine inertia. 
And a distended rectum narrows the pelvic 
canal as well as predisposing to infection. 

(4) Direct the patient to be given a gen- 
eral bath followed by a disinfectant, the 
external genitalia and surrounding area 
with bi. chloride solution. 

(.S) Make internal examination with 
sterilized hands, separating lal^ia with the 
fingers of the other hand, at the same time 
looking at the parts so as to introduce the 
examining finger directly into the vagina, 
and thereby avoid possible contamination 
from contact with the external genitals; 
trying to find the vaginal orifice without 
looking at the parts is false modesty and an 
inexcusable break in the technique. 

The objects of this internal examination 
are: first and most important to determine 
the position, presentation and degree of 
engagement of the presenting part; the 
position of the perineum; size and dilability 
of the vagina; the presence of exostosis and 
tumors; the condition of the cervix, whether 
soft or rigid, thin or edematous; and last 
the movability of the child. After this, if 
everything is normal, pains regular and 
effectual in action is the course for the 
obstetrician, other than allowing his patient 
to walk or sit as she desires, as moving 
around hastens dilatation and makes her 

*Read before the North Carolina Medical So- 
ciety at Cliarlotle. 



more content to go to bed when she has to. 
Do not allow her to continue erect posture 
after the cervix has dilated to the size of a 
dollar, as it predisposes to danger, both 
mother and child. After this time, by no 
means allow her to use commode or water 
closet, as she will often request, for it is 
possible for child to be born thus, suddenly 
into sewer or closet. 

How many times should she be examined? 
As few times as possible, ascertaining all 
the foregoing facts at one examination, 
which can only be done by a careful and 
always methodical examination. So much 
for the normal case. Here let me say these 
really need no ph^'sician; the only need for 
him is to detect, and detect early, any com- 
plications or abnormalities which may be 
present, and treat these at the proper time 
a.\\d h\ X\\& proper way. If this is always 
done, the maternal and foetal mortality 
would be practically nil, as it is these com- 
plications are often not ascertained until it 
is too late to correct them, and in this way 
countless mothers and children have been 
sacrificed. The importance of the early 
recognition of complications which prolong 
labor and make it difficult or which, if left 
unrecognized, threatens the life of either 
mother or child, or possibly both, can not 
])e over-estimated. For instance, take a 
posterior face case. If this be recognized 
early, it may be converted into an anterior 
vertex, the most favorable position and 
presentation by external version, or if this 
fails it is possible to push the chin forward 
or perform an easy podalic version. While 
if unrecognized and allowed to go on for 
some time it may become impacted, which 
will necessitate a destructive operation, as 
well as endanger the mother's life by ex- 
haustion, threatened rupture of the uterus, 
and increase risk of infection. In case of 
contracted pelvis, carcinoma of the cervix 
or rectum or anything which makes it im- 
possible for delivery by the natural pass- 
ages, the danger to mother and infant de- 
pends largely upon its early recognition 
during the first stage of labor if not before. 
If breech cases were always recognized dur- 
ing the first stage and converted into vertex 
cases by external version, you would have 
a foetal mortality of less than 5 per cent, 
instead of 30 per cent, as is the case in 
breech presentation. In short th^ treatment 
of all complications is to recognize them 
during the first stage of labor, if not before, 
and institute treatment before it is too late 
to save the life of infant, or before the 
mother's life is too far endangered. In 
cases of adynamic fevers or advanced disease 
of the heart, it is well to apply the forceps 
through a partly dilated cervix, and in this 
way facilitate its early dilatation and there- 



144 



THE CHARLOTTE MEDICAL JOURNAL. 



by save the woman the nervous strain and 
exhaustion of a prolong^ed first stage. 

In this connection, let me emphasize the 
fact that no woman with advanced organic 
disease of the heart, especially if she has 
renal insufficiency as well, should be allow- 
ed to carry her child beyond the eighth and 
one-half or the ninth lunar month. At this 
time, premature labor should be induced, 
and if properly performed may be done 
without danger, insuring a verv' much easier 
and consequently a less dangerous labor. 

Some may term this meddlesome mid- 
wifery, but, nevertheless, meddlesome or 
otherwise, it is the correct method. 

The one thing that most often recjuires 
treatment is the prevention of a too pro- 
longed first stage. In the large majority of 
these there is no real obstruction in the 
cervix, but is due almost always to deficient 
expulsive powers, uterine inertia, therefore 
we should direct our attention to the differ- 
ent means of stimulating the expulsive 
forces of the first stage of labor. These 
methods are applied both without and with- 
in the passages. All of our resources which 
are used without the passages, should be 
applied. If the patient is more or less tired 
out from a long continuation of feeble and 
ineffectual pains, the rational thing is to 
give her a sedative which will produce sleep 
and restore her nervous tone. The best is 
probably chloral or morphia. On awaken- 
ing, the cervix will probably have softened, 
the pains will be strong and regular and 
the first stage proceed satisfactorily. If 
after administering the drugs, or if from the 
beginning they are ineffectual we should 
administer uterine and nervous stimulants. 
Quinine in a glass of sherry is often all that 
is needed. If the stomach is irritable, the 
bisulphate should be given by the rectum 
in twenty to thirty grain doses in the form 
of a suppository. Walking, as stated be- 
fore, will often increase the contractions by 
reflex excitation. Hot and cold applica- 
tions applied alternately to thehypogastrium 
will often be of benefit. Strychnine given 
hypodermically in one-sixtieth of a grain 
doses every fifteen minutes for three or four 
doses is often of benefit, especially in mul- 
tipera with more or less flabby uteri. A 
better plan is probably to give one-thirtieth 
of a grain three times a day for the last four 
weeks before confinement. Ergot should 
never be given during the first or second 
stages of labor, except in delivery of the 
second child, in case of twins, or in those 
cases where you fear post partal hemorrhage 
and are prepared to empty the uterus at 
once. Any one who would give ergot, as 
is sometimes done to stimulate pains of the 
first stage, must certainly be ignorant of its 
mechanism and does not realize that while 



he is increasing the expulsive forces, he at 
the same time may be blocking up the gate- 
way, the ergot sometimes acting on the 
circular fibres of the cervix, thereby caus- 
ing its contraction. Occasionally we observe 
a tetanoid contraction, and when it exists 
oxytoxics are positively contra-indicated. 
Here you should administer a few drops of 
ether or chloroform, and if necessary hasten 
delivery by manual dilatation and extrac- 
tion, as a prolonged and powerful tetanoid 
contraction may result in the death of the 
infant. 

So much for the methods of accelerating 
the first stage of labor applied outside the 
passages. 

Now just a few words in regard to the 
means of shortening the first stage of labor 
applied within the i^assages. As a general 
rule, we should avoid recourse to these as 
far as possible, as all are predisposed to 
some degree to sepsis, but there are times 
when it is necessary and we should recog- 
nize these and know how to deal with them. 
For instance, in case of placenta previa, 
premature separation of abnormally situated 
placenta, rigidity and cicatrical contraction 
of the cervix, eclampsia, imminent danger 
of the death of the mother and any condi- 
tion which renders immediate emptying of 
the uterus necessary. The os may be dilated 
by Barnes' bags, by graduated bougies, by 
the fingers, by forceps or pulling on foot or 
leg in breech cases, by multiple incisions or 
by metal dilators. 

In regard to the hydrostatic dilators of 
Barnes and Champetier de Ribes, they not 
only excite uterine contractions but also 
hasten dilatation of the os. 

The objections to them are: they predis- 
pose to sepsis, mal positions and presenta- 
tions, as well as being difficult to place. 
Although it is considered by some to be mal 
practice to assist ordinary dilatation with 
the fingers, yet when the cervix is soft and 
low down it is perfectly justifiable. 

Incisions and instrumental dilatations are 
seldom indicated except where there are in- 
dications to extract the child at once. 
Sometimes you examine and find although 
the cervix is partly dilated, yet during a 
pain, the bag of waters does not protrude 
into or through the cervix. In this instance 
it is due to adhesions between the mem- 
branes and uterine wall, which should be 
separated by introducing the finger through 
the OS and sweeping the first and two joints 
around the lower uterine segment. 

The bag of waters should never be rup- 
tured in primipara until it presents at the 
vulva, and in multipara until the cervix is 
fully dilated, then the rupture will shorten 
the labor. 



ORIGINAL COMMUNICATIONS. 



145 



Chairman's Report— State Medicine as 
Now Enforced and How it Should be.« 

By Di-. W. F. Hargrove, Kiiihton, N. C. 
il/r. President . Officers and i\lc)nbers of 
the Society: 

About last February I received the tran- 
sactions of the last meeting, and on exam- 
ining them, found, to my surprise, that I 
was Chairman of a Section. I am sure that 
you, after hearing my paper, will be sorry 
that I found it out. When I am called to 
a case, I endeavor to make a diagnosis, if 
possible evade a prognosis, and for treat- 
ment try to correct the errors and give 
nature a chance to cure. 

So in presenting my subject I have tried 
to state facts — so you can make a diagnosis. 
I have left out the prognosis. The treat- 
ment, after a few suggestions, is left with 
you and the State. The State to represent 
nature in this case. 

Our State, through the officers and mem- 
bers of the State Medical Society and the 
Board of Health, has attempted to stamp 
out disease, and prevent imposition upon its 
citizens by the making of laws. 

Now the State's duty can be briefly stated 
as follovv's: 

1st. To prevent disease. 
2nd. Care for its sick. 
3rd. Prevent fraud. 
4th. Pay the doctors. 

Under the above divisions I will endeavor 
to show, in a brief way, how the State is 
looking after its people, and how it should 
do it; what I will say may sound harsh, but 
truth is never careful of how it upsets 
theories or on whose corns it treads. 

My idea of what a doctor should be is ex- 
pressed in ' ' Beside the Bonny Brier bush, ' ' 
and the following verses from "Medical 
Rhymes": 

In every phase of human life 
From earliest breath to latt-st sigh. 
'Mid hours of peaco and sotnes of strife, 
When men are born, and when they die, 
In cittage, palace, hovel, hall. 
On silken couch, or stony ground, 
Where sickness, pain, or death may call, 
''The State's best citizen, the doctor's' found. 

When othei's flee contagion's breath, 
Foi-gelting earth's most sacred ties, 
And safety seek from march of death, 
'Mid healthier climes, 'neuth coo er skies — 
When others shrink from sight of woes. 
And shut with horror fi'om tlieir gaze 
The sights which only mi^er-y knows, 
"The State's best citizen, the doctot ," stays. 

With open heart and cultured mind 

In church or State, in field or mart. 

In all fjood works his hand doth hnd, 

He shrinks not from an active part. 

With all who seek by word or deed 

To help a brother man to rise. 

Of every nation, every creed, 

''The State's best citizen, the doctor," vies. 

*llead before the Norlh Carolina Medical 
Society at Charlotte, N. C. 



The State, through its health officers, 
endeavors to enforce certain laws to prevent 
acute, infectious, and contagious diseases 
from becoming epidemic. It should go 
further and instruct the people on the evils 
of immorality, and the baneful effect of filth 
on the health. Lvspecially the carrying of 
diseases by flies, mosquitoes, dust, polluted 
water. Hook Worms, etc. For example, 
there is no good reason known to me why 
my neighbor should make an incubator of 
his stables, to raise flies to contaminate my 
food with feces from near-by privies, into 
which has been dtimped the excrements of 
typhoid patients. 

I believe it has been pretty well settled 
that impure water and flies are the great 
carriers of typhoid, and both of these are 
within the power of the State to correct, but 
only through public opinion. 

Our schools should teach the common 
laws of health, thereby raising the stand- 
ard of living, then all will become pro- 
ducers. By the sweat of your brow shall 
you earn the right to live, but to properly 
sweat you must have health. 

iMiormous amounts are spent each year 
by people in search of that priceless gem, 
as is evidenced by the cure-alls that are ex- 
ploited and swallowed by the gullible public 
without ever knowing the contents of the 
bottle, so the label says "it is harmless, " 
and our State raises not a finger to stop this 
"wholesale slaughter of the innocent." 

Springs and climate are lauded to the 
skies without much regard for truth. What 
can the poor sick man do? He probably is 
reaping wild oats sowed in his youth, or 
what was sowed for him by his parents. 
He wants help and here is where the State 
can do its best work, not for him, but for 
the children who will be his successors. 

Teach them that there should not be a 
double standard of morality, as there now 
is, one for men and one for women; and 
that will settle the social evil. That cleanli- 
ness is Ciodliness and that drones or para- 
sites have no place in North Carolina. That 
purity in its broadest sense, combined with 
work, is the greatest producer of health 
known. 

An idle person is the devil's emissary. 
The sick, the lame and the blind will al- 
ways be with us, until we have evoluted 
into the millennium, when health and happi- 
ness will be the heritage of all; and it is up 
to us to hasten that day through the medium 
of public opinion. 

A sick man with a real or imaginary- 
trouble will, like a drowning man, grab at 
a straw, and that straw is usually the sug- 
gestion of some friend or a newspaper patent 
medicine advertisement. Spend his money 
and his health and when bankrupt of purse 



146 



THE CHARLOTTE MEDICAL JOURNAL- 



and a physical wi;eck, send for the doctor; 
should the doctor attend him he must ex- 
pect his reward in the next world, but the 
unfortunate part of that kind of pay is that 
the doctor's creditors will not accept a check 
on that bank in payment for groceries. 
They want the coin. 

A well man is or should be a producer, 
and that is the kind our State should foster 
and care for; prevent him, if possible, from 
getting sick. Our State provides for the 
demented, deaf, dumb and blind, as a rule 
non -producers; how much more should it be 
interested in establishing hospitals for the 
sick and other non -producers. The doctor 
should not be required to "bear this cross 
alone." It is the vState's duty to provide 
for the health of its people, and when sick- 
ness enters a home, be it a palace or a hovel, 
to see that proper care is taken of the un- 
fortunate, in a well equipped hospital, in 
order to quickly restore him to the produc- 
tive class, and prevent the further spread of 
thecauseof his sickness; thereby protecting 
the well in caring for the sick, without 
money and without price. 

As matters now stand, for a price our 
State says to a recent graduate, if you pass 
the gauntlet of the State medical examiners, 
I will license 3'ou, and for the further fee of 
$5.00 per year I will allow you to work out 
the State's salvation from disease without 
pay; make out death certificates to bury 
your mistakes, blow your own horn, or get 
some one to do it for you. 

That you shall not be required any more 
to study the science of healing, and that 
moss may grow upon your back until you 
awake in the great beyond and there face 
your accusers for their untimely demise. 
As the poor are always with us, you shall 
not be required to attend them; send them 
to a doctor that has not a paying practice, 
or give nature a chance to cure them. You 
are now a regular. In testimony whereof 
the Medical examiners attach their great 
seal and sign their names to the license in 
behalf of the State. Without any restric- 
tion. 
■ The ethics of our Society says to them, 
"Sirs, unless patients are cured our way, it 
is rank heresy. It is unprofessional to teach 
people how to prevent diseases, for by their 
infirmities we have our wealth . " " Great is 
Diana of the Ephesians." "Liberty, how 
many crimes are committed in thy name," 
and our State raises not one protest. 

I am sorry to say that some of the breth- 
ren take the above literally, and after at- 
tending one or more meetings of the Medical 
Society, and that usually at extreme ends of 
the State, go home, hang out their shingle, 
and boast of their rapidly growing practice. 
When wiih drugs they well have swilled him, 



Tell his friend.s the fever killed him; 
All that could be doue was done; 
The worst case they evnr saw, but one; 
And this is a mighty consolation, 
In such an avvfu: visitation. 

To better illustrate what I mean I will 
give a few examples. 

( 1 ) Shortly after having studied anatomy 
I was commenting on the, to me, unfairness 
of an anatomy examination, to one ques- 
tion. Describe the cuboid. A doctor said I 
was very much mistaken, as it was a very 
important bone, that recently he attended a 
patient whose hand was caught in a gin 
and his cuboid cut to pieces, and he came 
very near losing his arm. 

(2) Was in a physician's office when a 
patient came in to be treated for epithelioma. 
The Static machine was started, a Crooks 
tube excited and patient properly placed 
and Ray applied. In a few minutes I re- 
marked that he did not protect the patient 
from the Ray. The doctor replied, "That 
is so," and taking a piece of blotting paper 
from his desk, cut a hole in it, and placed 
the paper on the patient, leaving the epi- 
thelioma exposed. 

(.i) In speaking to a doctor about a 
chronic relapsing pustular skin infection, 
on an exposed surface, he insisted that it 
was psoriasis. 

(4) Another physician in speaking of the 
therapeutics of the ultra violet ray in skin 
affections, showed me his ultra violet outfit, 
which was an ordinary 16 candle-power 
lamp with a blue or violet colored globe 
with a reflector. 

( .S ) Another physician when consulted as 
to the advisability of giving immunizing 
doses of diphtheria antitoxin to some chil- 
dren that had been exposed to diphtheria, 
advised against it, saying there was more 
danger in the antitoxin than in diphtheria. 

Now these doctors are among the leading 
men in medicine in their respective com- 
munities and have large and remunerative 
practices. I know them to be men of sterl- 
ing worth, and above the average if their 
respective patrons is any testimony. 

To say these men are fakes would be do- 
ing an injustice. They are not required 
and have not studied the subjects. As thei'e 
is no way for the public to know or judge 
such matters we have as a result the various 
kinds of healers, pathies and patent medi- 
cines. 

Our Medical Jovirnals, and I am sorry to 
say the one edited by our Honorable Presi- 
dent is no exception (be it to the shame of 
the doctors) and secular press, are full of 
glaring medical advertisements in which 
truth would be a foreign body. Because it 
pays. 

These nostrums would not be so extens- 



ORIGINAL COMMUNICATION. 



147 



ively advertised if they did not find pur- 
chasers. Read one of the advertisements in 
your local paper; you will see that in the 
majority of the cases your local druggist 
permits his name to be used as a guarantee 
of its worth. Now the druggist is an honor- 
able man, perhaps an alderman or pillar in 
the church, or at least a good business man. 
He pushed them becau.se it pays. When 
the poor in health asks him for help he de- 
livers a bottle of cure-all for so much cash. 
None of his business if it is a poison, and 
he holds a license from his State to do it. 

When a traveler is relieved of his purse 
by a highwayman, the people are up in 
arms and ready to punish without court or 
jury. How different is the sitiiation when 
those who look after public health by ex- 
posing the frauds that rob the credulous 
sick! They have to fight the battle alone. 

The public is prone to assume, without 
investigation, that the medical boards are 
prompted by professional spite and jealousy 
in such exposures. Nostrum venders and 
quacks "live principally by the murder of 
the innocents" through the medium of the 
press, and are continually advising the 
dear people about their liver and kidneys, 
etc. 

Just how much lower in the scale of hu- 
manity a man can go than to prey on the 
fears of the people for a few dollars, I do 
not know. There may be something more 
despisable, but what is it? 

Now to me, the State's dut}^ is plain. 
Let no medicine be sold, or offered for sale, 
that does not give the amount of each in- 
gredient in the bottle in plain luiglish, and 
if one or more of them is an accepted nar- 
cotic or poison, then label it poison. Should 
the advertisement state things about the 
properties that are untrue confiscate and 
destroy the whole supply. Stop all fake 
advertisements and scare-heads sent out in 
various ways for the public to read. 

As to the treatment of the doctors, they 
should be required to keep up with the ad- 
vancements in medicine, and every few 
years be made to stand an examination on 
preventive medicine, diagnosis, prognosis, 
and treatment of disease found within our 
State. 

This would reciuire a graded system, and 
should doctors fail to keep up let the public 
know who they are, so they can protect 
themselves from these incompetents, or at 
least know that which they have the right 
to know, who are the low grade or incom- 
petent men. 

This can best be accomplished by making 

them State officials and salaried men, with 

proper authority to enforce hygienic laws. 

With one incentive only — prevent sickness. 

As it now stands a doctor is virtually a 



parasite, makes his living by taxing the 
people for their infirmities. 

A sick man is a non-producer and an ex- 
pense to his family; and on top of this comes 
the doctor's bill at the very time he is least 
able to pay. 

So long as the doctors have to collect 
money for services rendered duriug sickness, 
will the incentive to make money warp 
their judgment and will give best attention 
where pay is best. 

Health being the heritage of all, the 
State's duty can be summarized as follows: 

First. Prevent disease by teaching jjeople 
the cause of disease, how spread and how 
prevented. 

vSecond. Care for the sick by having prop- 
erly equipped hospitals free to all. 

Third. Prevent fraud by stopping fake 
advertisements, properly labeling all medi- 
cines, and hold the druggist responsible for 
all medicine sold by him. 

b'ourth. Pay the doctors. Have them 
examined and graded every few years, and 
this published for the benefit of the people. 

Carcinoma of the Penis.* 

By Thos. M. Green, M. I). 

Carcinoma of the penis occurs, according 
to the various authorities, from one to three 
per cent, of all carcinoma in the male, and 
is the form of neoplasm most frequently met 
with in that organ. It is usually encoun- 
tered after the fortieth year, most frequently 
between the fiftieth and seventieth years, 
although Freyer' reports a case in a youth 
of seventeen years. Kaufman' gives six 
per cent, in the third decade. 

Etiology — Like carcinoma elsewhere, it 
is frequently associated with chronic irrita- 
tion, whether it be a scar at the side of an 
old ulcer, specific or otherwise, or long- 
standing phimosis, with accumulation of 
smegma and resulting balano-posthitis, or 
a traumatic scar. Of all the etiological 
factors, phymosis and venereal warts seem 
to be the most prolific. Kauffman""* gives 
twenty-nine out of thirty-three cases associ- 
ated with warts. Dermarguay'* reports 
forty-two cases out of fifty-nine occurring 
from phimosis, and Keys claims that the 
circumcised Jew is exempt. 

Pathology. — Kuttner describes three 
forms : 

1st Form. — Papillary cauliflower; most 
frequently seen in the presence of phimosis. 
Beginning on the glands, or inner layer of 
the pepuce, growing rapidly and involving 
scrotum, pubic coverings and entire penile 
structure. 

2nd Form. — Carcinomatous ulcer; less 



♦Read before the North Carolina Medical 
Society at Charlotte. 



THE CHARLOTTE MEDICAL JOURNAL. 



frequent, beginning- on the glands or coronal 
sulcus, growing slowly at the local point, 
but manifest remotely, out of all proportion 
to the extent of local involvement. 

3rd Form. — Non-papillary; rarest of all. 
Has no papillary arrangement, but rather 
resembles carcinoma of the breast. Very 
malignant. 

The growth may invade all the penile 
structures, scrotum, pubic coverings, pros- 
tate, rectum, bladder and seminal vesicles, 
by direct invasion, although Kuttner has 
demonstrated that in the corpus cavernosum 
metastatic nodules may be found remote 
from the diseased area, with healthy tissue 
intervening, simulating metastasis of sar- 
coma. The corpora cavernosa seem to en- 
joy a great deal of resistance to direct in- 
vasion, while the corpus spongiosum and 
urethra are even more so. Metastatic ex- 
tension is by the lymphatics, except in the 
corpora cavernosa, superficial penile lym- 
phatics to the inguinal and femoral lym- 
phatics: and deep penile lymphatics to the 
retro-peritoneal glands. The time of invasion 
varies; in some cases, early, and again, de- 
layed out of all proportion to the extent of 
the local growth. The glandular extension 
shows often a tendency to be arrested at the 
inguinal and femoral lymphatics for some- 
time before extending to the retro-peritoneal 
glands. Early lymphatic involvement is 
generally the rule. Secondary pyogenic 
glandular infection may be seen late. 

Symptoms. — Little or no pain is experi- 
enced until toward the end, when itcliing 
niay or ma}^ not be present. Bleeding on 
manipulation and sloughing with charac- 
teristic epitheliomatous discharge is the rule. 
Death is due to exhaustion, whether it be 
from septicaemia, constant hemorrhage or 
cachexia. 

Diagnosis. — Becoming manifest usually 
in the last decade of life, when the sexual 
life is practically spent, one would naturally 
suppose the recognition of it to be compara- 
tively easy, and yet such is not always the 
case. It is to be recognized from venereal 
warts, chancroids, chancre or tuberculous 
ulcer. Careful attention to the history and 
examination will eliminate all of these ex- 
cept chancre. Here, except in doubtful 
cases, specific treatment should always be 
tried. In fact, it seems to me that the pa- 
tient should be given the l)enefit of this 
doubt in all cases. 

Prognosis. — Depends upon the extent of 
the lesion. Most authorities give a rather 
gloomy prognosis, especially when the lym- 
phatics are involved. Some go so far as to 
discourage operation when there are extens- 
ive inguinal enlargements. Judging from 
the results recently demonstrated in Kelly's 
Clinic, where it was shown that about fifteen 



per cent, of uterine carcinoma with retro- 
peritoneal involvement were saved after 
careful removal of the pelvic lymphatics, 
together with the growth, it would seem to 
me that these patients should have an 
equally fair chance with a similar treatment, 
better of course, the earlier seen. The fact, 
too, that the metastasis by the lymphatics is 
often arrested for sometime at the inguinal 
and femoral glands, before extending into 
the abdomen, seems to add further hope. 
At best, however, any expression of prog- 
nosis should be guarded, certainly until one 
has seen the extent of the metastasis. 

1 reatment. — In the early stages, where 
no metastasis has taken place, treatment 
may be limited to thorough curettage or 
exposure to the X-ray. These growths, 
however, are seldom seen or recognized 
until there is lymphatic involvement. The 
question of how much of the organ should 
be amputated is often a difficult one to 
decide. Partial amputation should never 
be undertaken if the corpora cavernosa 
have been extensively invaded, since, as 
Kuttner has shown, nodules of cancerous 
tissue may be left in the stumps of these 
bodies, with certainty of local recurrence, 
as well as further mestastasis from these 
points. We are most usually confronted 
with the problem of complete extirpation, 
extensive dissection of both groins, and 
laparatomy, with removal of the retro-peri- 
toneal glands. Most authorities advise 
leaving the testes when svire of no invasion, 
while others advise complete emasculation, 
chief among whom is Pantolini, " who claims 
better psychological results with total emas- 
culation. 

Report of Case — ^J. D., white, male, age 
4f), widower, bar-keeper, presented himself 
on January 2nd, 1906, with the following 
history: Family history, negative; past 
history, negative. Has always enjoyed 
good health, except from time to time has 
had attacks of malaria. Never had venereal 
warts or phimosis. Had gonorrhoea in 
1895; cured. In 1896 had a chancre: was 
never thoroughly treated: followed by sec- 
ondary symptoms, which were mild. Six- 
teen months ago he noticed a small nodule 
appearing on the site of the chancre, just 
behind the sulcus, which grew slowly and 
without discomfort. At the end of six 
months it had attained the size of a small 
marble, when it became ulcerated. Four 
months later he noticed slight inguinal en- 
largement. That was six months before he 
presented himself to me for treatment. From 
then until I saw him the growth increased 
in size rapidly, assuming more and more 
the characteristics of an epithelioma, with 
concomitant increase in the growth and ex- 
tent of lymphatic involvement. 



ORIGINAL COMMUNICATION. 



149 



Physical Examination — Medium statue; 
fairly well developed; somewhat emaciated 
and cachectic; reflexes normal; chest and 
upper extremities negative; abdomen, ague- 
cake spleen, 5 cm below costal margin. 
Situated on the dorsum of the penis was a 
cauliflower growth, 10 cm in circumference, 
4i cm in diameter, involving the skin, 
pepuce, posterior half of the glands, coronal 
sulcus and corpora cavernosa to some ex- 
tent. The corpus spongiosum and urethra 
were not involved, nor did careful palpita- 
tion of the testes, ex)idydimi and vas deferens, 
as far into the inguinal canal as the finger 
could reach, elicit any nodulations. The 
corpora cavernosa proximal to the growth 
were apparently free. The growth bled 
freely upon manii^ulation and emitted a 
foul-smelling discharge. The glands were 
enlarged in both groins, especially the right; 
freely movable; hard and not painful. The 
enlargements were confined chiefly to the 
inguinal chain, but clustered about the 
femoral opening; one very large gland on 
the left was situated at, and adherent to, 
the saphenous opening. Rectal examina- 
tion, negative. Blood showed slight haemo- 
globinaemia: urine, negative. 

Treatment. — Three weeks of vigorous 
treatment with mercury and iodides, pre- 
vious to my seeing him: without effect. 
Refused to allow removal of portion of 
growth for microscopic examination. Oper- 
ation under ether; time, three hours. Con- 
sisted of free removal of inguinal and 
femoral glands on both sides, with splitting 
of the external oblique tendon, in order 
that the cord could be followed to the in- 
ternal ring. The penis was then extirpated 
by Gould's method, consisting of complete 
extirpation of corpora cavernosa and im- 
plantation of the urethra in the perineum at 
the lower angle of the wound. The stump 
of the corpus spongiosm was not dissected 
from the urethra, but the latter was left a 
little longer and split up, in order to prevent 
as much as possible a subsequent stricture 
at the muco-cutaneous junction. Great 
difficulty was experienced in dissecting the 
corpora cavernosa from the rami of the 
pubes and ischii, a procedure accompanied 
by free bleeding. A permanent catheter 
was used for five days. Testes were not 
removed. 

It was my intention to further safe-guard 
the patient, by opening the abdomen and 
removing, if necessary, the retro-peritoneal 
glands at a second operation. He, how- 
ever, refused further operative procedure. 

Convalescence was uneventful. At the 
present time — about five months since the 
operation, he seems to be in perfect health, 
having gained fifteen pounds, and has re- 
turned to work. He seems perfectly con- 



tented with his condition; has no sexual 
desire, but has felt, at times, an itching 
sensation in the glans penis. So far I am 
unable to demonstrate an}^ recurrence of the 
growth. I believe, however, that had he 
permitted me to carry out the entire plan of 
procedure I could offer him a more than fair 
hope of cure. The act of urinating is ac- 
complished in a sitting posture, without 
difficulty. 

Microscopically, the growth was carci- 
nomatous, with papillary arrangement. The 
lymphatic glands from both groins showed 
metastases, as well as secondary iiyogenic 
infection. No nodules of growth found in 
the cavenous body. 

It occurred to me that the objectionable 
feature of hemorrhage during complete ex- 
tirpation of the penis might be eliminated 
by ligating the internal pudic artery beneath 
the superficial layer of the triangular liga- 
ment, before attempting to dissect the crura 
of the penis from the rami of the pubes and 
ischii. One can scarcely avoid wounding 
these bodies in the usual procedure, an acci- 
dent which will prove very annoying, and 
in some cases of serious import. In order 
to accomplish this the preliminary incision 
through the raphe of the scrotum down to 
the penile structures is performed as in the 
(touM method, with an extension of the in- 
cision above to encircle the penis, cutting 
through, at the same time, the suspensory 
ligament, and then ligating its dorsal vein. 
The incision below is continued down into 
the perineum to a point about on a level 
with the bulb of the corpus spongiosum — 
dividing the overlying tissues to clearly ex- 
pose this structure. The two halves of the 
scrotum are now retracted and the super- 
ficial perineal coverings pushed away from 
the median line, so as to expose the crura 
of the penis on each side, resting on the 
rami of the pubes and ischii. The floor of 
the triangular space thus exposed is formed 
by the anterior layer of the triangular liga- 
ment, the base of the triangle by the lower 
edge of the triangular ligament with the 
crura of the penis forming its sides and 
converging above to form the apex. An 
incision through the triangular ligament at 
a point marked "X" in the diagram on a 
level with the bulb and just to the inner 
edge of the crura on either side will expose 
the internal pubic vessels at a point where 
they divide into their branches to supply 
the various elements of the penis. If one 
contemplates implanting the stump of the 
corpus spongiosum, surrounding the urethra 
in the lower angle of the wound, only such 
branches as supply the cavernous bodies 
and dorsal artery of the penis should be 
ligated, leaving intact the branch to the 
corpus spongiosum or artery of the bulb. 



150 



THE CHARLOTTE MEDICAL JOURNAL. 



If the entire bulb is to be removed from 
about the urethra, then the vessel should be 
ligated before it splits up into its various 
branches. The remainder of the procedure 
is similar to Gould's method. 

This method would render the procedure 
practically bloodless and would oreatly fa- 
cilitate a clean and thorough dissection. 

Bibliography : 

1 British Medical Journal May 30, 1891. 

2 Keys Genito-Urinary Diseases. 

3 Keys " " " 

4 Keys " " " 

5 Arch. Prov. de Chir. 1,S98. 



Resection of the Ovaries. — Zacharias 
(Zentbl. fur Cxynak, ) says that in three 
cases of benign tumors of the ovary the neo- 
plasm was circumcised at its pedicle in such 
a manner that the tumor could be shelled 
out, leaving the outer covering in the pedi- 
cle. This thin shell of tissue was then 
sewed over in such a manner that the re- 
maining stump (not having been ligated) 
had its circulation undisturbed. hVom sec- 
tions of the same thinness removed from the 
exsected tumor it was found under the 
microscope that the shell thickness did not 
exceed 1 mm. It consisted of the germinal 
epithelium of the albuguinea and connec- 
tive tissue stroma rich in cells. Follicles 
were not present, but occasionally the pres- 
ence of small corpora albicantia was deter- 
mined, which proved that the stump was 
the remains of the ovarian stroma. 

The observations extended over a period 
varying between several months and a year. 
In all three patients there were few or no 
evidences of the artificial climacteric, and 
in all menstruation continued undisturbed. 

Although the view prevails that menstru- 
ation without ovulation cannot occur, the 
writer thinks that our opinions on this sub- 
ject may be erroneous. He thinks it quite 
possible that menstruation may depend on 
the presence of the germinal epithelium, as 
there was no possibility of the presence of 
Graafian follicles in the three cases reported. 
As there seemed to be an increase in the size 
of the stump in the course of time, he fur- 
ther ventures the opinion that possibly there 
was a regeneration of ovarian tissue going 
on. He thinks that if pregnancy does not 
set in at some future time in his cases, the 
theory of menstruation being dependent 
solely on the germinal epithelium will be 
quite plausible. 

The Sfgnliicance of Streptococci in 

***'**-~Heinemann's (The Jour, of Infect. 
Dis.) general conclusions are, shortly, as 
follows: The ordinary bacteria producing 
lactic acid fermentation are bacillus aero- 
genes var. lacticus and streptococcus lacti- 



cus. The latter agrees in morphologic, cul- 
tural and coagulative properties with patho- 
genic, fecal and sewage streptococci. It 
can be found in cow feces, on the external 
surface of cows and in milk of all stages of 
subsequent handling. Souring of milk is 
caused by the co-operation of both groups 
of bacteria and is, perhaps, favored by pep- 
tonized bacteria always present in market 
milk. Gas is produced by the aerogenes, 
but its development is checked by the 
growth of the streptococcus. Both of them 
produce acid; the aerogenes is more sensi- 
tive to a high acidity and is regularly over- 
grown by the streptococcus. Sterile milk 
can be made to produce acid fermentation 
by inoculation with streptococcus. The 
constant presence of streptococcus therefore 
in market milk and milk collected with 
special precautions will be a stimulus for 
further investigation in sanitary work. 

Carcinoma of tlic Uterus.— Jessett (Med. 
Press) has operated on o\'er 200 cases for 
carcinoma of the uterus with a mortality 
from operation of 10 deaths, but in the 73 
cases only one patient died. Of 180 of 
these, which were performed over two years 
ago, very many have been lost sight of. Of 
the remainder 17 are still alive and w^ell at 
periods varying from 12 years to three years, 
while 20 per cent, lived and kept free from 
recurrence for periods varying from two to 
five years. 

When the case is one of uterine cancer 
he regards vaginal hysterectomy as the bet- 
ter operation, for the reason that shock to 
the system is not nearly so severe and pa- 
tients make a much readier convalescence. 
Vaginal hysterectomy is also the better op- 
eration, for those cases in which the dis- 
ease is limited to the os and vaginal portion 
of the uterus. When the disease has ex- 
tended up the cervical canal, infiltrating 
the cervix and possibly infecting the cellu- 
lar tissue, then the abdominal route or per- 
haps the combined abdomino-vaginal op- 
eration would be the wiser if not the only 
operation which would hold out any hope 
of success. 

With the uterus fixed and the ureters and 
bladder possibly ^implicated the author is 
convinced that tliey are better left rigidly 
alone. 



An Ivnglish insurance company issues' 
policies, protecting against financial losses 
due to appendicitis, at the rate of $1.25 a 
year for every $500. This policy guarantees 
to pay for medical and surgical treatment 
and nursing up to the face of the policy in 
force at the time of treatment. 



EDITORIAL. 



151 



Charlotte Medical Journal 

EDWARD C. REGISTER, M. D., Editor. 
No. 36 South Tkyon Street. - - - 

CnAKI.OTTE. N. C. 

THE ETIOLOGY OP TABES. 

It is remarkable with what tenacity the 
profession holds to the syphilitic origin of 
tabes, it being rare to read an article in 
which it is not given as the principal etiol- 
ogic factor of the disease. In the recent 
Lumleian lectures, David I'errier -presents 
the evolution of our knowledge of tabes, its 
nature and causes, in a very able manner, 
pointing out that the essential character of 
the tabetic process is a progressive dystrophy 
or demyelinisation and ultimate destruction 
of the nerve fibres, with secondary prolifer- 
ation of the neuroglia, he classifies the three 
leading views regarding its pathogenesis 
( 1 ) the primary ganglionic origin (2) the 
peripheral origin (v. Leyden and Gold- 
schneider) (3) the meningetic origin (Na- 
geotte, Redlich and Obersteiner) and con- 
cludes that "there is not one which is not 
open to several more or less serious objec- 
tions" and considers that "the most prob- 
able pathogeny of the tabetic degeneration 
is the result of a toxin generated or con- 
ditioned by the syphilitic virus," basing 
his conclusions on the statistics of Erb and 
Hirschl, in his opinion "little room for 
doubt that tabes and general paralysis are 
in all cases of syphilitic origin, and that 
tabes /c se is as much a proof of syphilis 
as gumma of the skin." Such a dogmatic 
statement in the face of the recent work of 
Ford Robertson on the diphtheroid bacillus 
which he has isolated from many cases of 
paresis, and which on inoculation into 
animals has produced x:)aretic symptoms, 
work which has recently been confirmed by 
Dr. Saunders, of Cincinnati, seems to be 
based on insufficient grounds. The argu- 
ments against the syphilitic origin of the 
disease are in part (1) that the disease re- 
fuses to 34eld to syphilitic treatment (2) 
that many cases are on record in which no 
luetic infection could be shown (3) that 
such a ver\^ small proportion of syphilitics 
have tabes (4) the long interval between 
the date of the syphilitic infection and the 
development of tabetic symptoms (5) that 
the tabetic process, once begun, is essential- 
ly of a progressive character and postulates 
a more or less continuous generation of the 
poison (6) the lympliocytosis of the cerebro- 
spinal fluid, which has also been found in 
meningitis, as well as in Landrys paralysis 
and herpes zoster. 

Against the above six points the only one 
which has any force in favor of the luetic 



origin of tabes is the large percentage of 
cases which have a syphilitic history, this 
is in part accounted for by the bias of the 
statician, if only those cases were counted 
who gave a distinct history of an initial 
chancre the number would be very materi- 
ally decreased, but when we read the state- 
ment that the patient "denies infection but 
admits exposure" we know at once that 
every effort lias been made by the statician 
to prove his views, further in the incipient 
stages of both paresis and tabes both the 
sexual capacity and desire are very much 
increased, it being not uncommon to receive 
a history of remarkable excesses in venery 
over long periods before the development of 
any symptoms, increasing the liability to 
luetic infection. That tabes is the result of 
an elective poison is more than probable, 
similar degeneration having been produced 
by ergot, pellagra, lathyrism, the toxins of 
diphtheria and beri-beri and by certain 
cachectic conditions, e.g. diabetes, pernic- 
ious anaemia, etc. The selective action of 
infections under certain conditions upon 
the cord are seen in anterior poliomyelitis, 
which always occurs as a sequel to a period 
of high fever of shorter or longer duration, 
other neurosis are produced in the same 
manner, some of which are transient, some 
slowly progressive, others stationary and 
some remittent, consequently it seems prob- 
able that many of the diseases caused by 
nerve degeneration will ultimately prove to 
be the result of infection of the part either 
by a specific bacillus or by any localized 
infection: in some cases of epilepsy it has 
been suggested that the attacks are due to 
infection by a parasite which produces 
periodic attacks in the same manner as the 
Plasmodia malariae. 

DR. JAMES MoKBB. 

In a recent issue of one of the most promi- 
nent state papers, there was an attack 
made on Dr. J as. McKee, Superintendent 
of the Central Insane Hospital, Raleigh, 
N. C, in which definite and hurtful charges 
were made. 

Having confidence in Dr. McKee, in the 
executive committee in charge of the insti- 
tution, and in Governor Glenn, the Charlotte 
Medical Journal awaited with expectant 
interest a complete exoneration of the man- 
agement when the real facts were brought 
to light. And we did not have to wait long. 
The charges related to the mistreatment of 
one of the patients, and through him, of his 
relatives. They were: 

First, of discourtesy to the relatives on 
the part of the management of the hospital; 
second, of misrepresentation, in that the 
relatives were informed that George E. 
Billings was in the institution and doing 



152 



THE CHARLOTTE MEDICAL JOURNAL. 



well, whereas, as a matter of fact, he had 
escaped prior to that time; third, that the 
family were not notified of his escape; 
fourth, that his family were not notified of 
his death. 

To these allegations, Mr. R. C. Lawrence, 
of Lumberton, makes direct denial, after a 
thoroug-h investigation of the case. The 
charge of discourtesy was utterly without 
foundation, as the corresponde''nce on file 
clearly shows. The second failed to be 
substantiated, though the mother of the 
unfortunate man was invited to come to the 
hospital and point out the employe that had 
made the alleged statement to her. As to 
the third, it has been the custom of the in- 
stitution not to notify relatives of the escape 
of inmates, thus sparing them the anxiety 
of this knowledge, while every effort is be- 
ing made for locating them. This rule. 
Governor Glenn advised to be abolished 
and, in future, relatives will be notified, 
though the experience of the management 
has shown it to be unwise. 

In regard to the last, it seems that it was 
assumed that a murdered man found in his 
home county was the missing lunatic, when 
the evidence failed absolutely to justify this 
assumption. 

Here the matter stands. The situation is 
a most delicate one, for the friends of those 
unfortunates who have to be protected by 
their commonwealth have a burden of sor- 
row in their condition, and are naturally 
sensitive and vitally interested in everything 
pertaining to their welfare; on the other 
hand, the men at the helms of the hospitals 
for the insane are men to be trusted; they 
are men to whom the State looks for the 
care of its most sorely afflicted children, and 
they are worthy of this confidence. Dr. 
Jas. McKee is a physician in the high, 
ethical sense of that word. lie is gentle 
and symphathetic, with a clear brain, a 
kind heart and a steady hand — eminently 
fitted for the exceedingly difficult position 
he so worthily and faithfully fills. 

GOMPUUSOKY EMASCUbATIOIN. 

It has been recognized from the earliest 
times that the testicles are connected with 
the normal development l)oth mental and 
physical and that their absence whether 
congenital, by operation or by atrophy was 
followed by a definite perversion of develop- 
ment of the type known as feminism, they 
have ever been considered as the attribute 
and evidence of virility and their absence 
a disgrace, in some cases debarring the un- 
fortunate from religious rights. As there is 
at present an agitation in favor of the emas- 
culation of habitual criminals, epileptics, 
the insane and the feeble-minded, as a pre- 
ventive to their transmitting their infirmi- 



ties to future generations and thus to im- 
prove the general standard of the race, it 
is interesting to review our knowledge of 
the function of the testicle and to carry to 
its logical conclusions the doctrine advo- 
cated. 

Such wholesale emasculation as would 
have to be practiced in order to carry out 
the elimination of the possibility of any per- 
sons affected with a disease which is con- 
sidered to be traiismissible by inheritance 
or to have pernicious effects upon the off- 
spring renders the scheme impracticable, at 
least under present social conditions. In 
the first place the parents of every afflicted 
child would have to be operated upon in 
order to prevent their producing others, to 
which they would not unnaturally object. 
As one man in eight is said to have syph- 
ilis, one in five hundred epilepsy, one in 
two thousand mentally afflicted, as well as 
cases of alcoholism, tuberculosis and chronic 
diseases generally, all of which affect the 
offspring, it is possible that at least 25 per 
cent, of the population would come under 
the knife of the surgeon. If nature's laws 
for the survival of the fittest have to be in- 
terfered with in any such wholesale fashion 
it would be better to only allow a certain 
number of picked persons to propagate the 
race and to emasculate the remainder. It 
has to be remembered that all our efforts in 
sanitation and hygiene have tended to the 
survival of the unfit and it may be that 
some deterioration of the race standard has 
resulted. 

Nature has no means of artificial selec- 
tion she makes no selection of individuals 
or type, for about these she cares nothing_ 
"Are God and nature then at strife? 
That nature lends such evil dreams 
So careful of the tj-pe she seems 
So careless of the single life: 
vSo careful of the type ? but no 
From scarped cliff and quarried stone 
She cries, 'A thousand types are gone, 
I care for nothing, all shall go'." 

Nature as a rule tries to make up in quan- 
tity when she fails in quality and the in- 
ferior quality soon cease to propagate and 
are rapidly eliminated in the struggle for 
existence. 

There is also the question of the rights 
of the individual' even if he be afflicted, 
atid a menace to the public good, how far 
the right of the majority to dictate to the 
minority extends it is impossible to define, 
but compulsory mutilation is going very far; 
it is but a short step from advocating that 
persons should be forcibly operated upon 
for the benefit of the majority to arguing 
that they should be put to death to save the 
community the cost of the maintenance. 

Since the theory of the continuity of the 
germ cell has become recognized our views 



EDITORIAL. 



153 



on heritance have become very modified, 
environment bein<>- the factor producing de- 
viations from the normal type and conse- 
quently many diseases which have hereto- 
fore been looked upon as the result of a 
morphologic change in the germ cell from 
its somatic origin must now be regarded as 
due to environment. The average individ- 
ual has about twentv ancestors whose medi- 
cal history the advocates of inheritance take 
into consideration, viz: parents, grandpa- 
rents, uncles, aunts, greatuncles and great- 
aunts, and it must ])e rare indeed to find a 
family in which syphilis, tuberculosis, alco- 
holism, epilepsy, insanity, feeble-minded- 
ness or a neurosis does not exist, conse- 
quently statistics showing the number of 
normal persons with the so-called hereditary 
taint would be of great interest. Too much 
stress has been laid upon inheritance in the 
past as a factor in disease and has resulted 
in children being relegated to the incurable 
class without even an effort to aid them 
medicinally. 

SOME rURTHBR STUDIES OPS TMB LYM- 
PHATIC SYSTEM AND TUBERCULOSIS, 

During the past year more work concern- 
ing the method of infection, and the latenc}' 
of tuberculosis has been published, in 
many ways corroborating the previous work 
of von Behring, Maragliano and Ravenel. 
Weichselbaum and Bartel (Weiner klin- 
ische Wochenschrift, 100.5, several articles) 
showed that general lymphatic tuberculosis 
resulted when the bacilli were dropped into 
the mouth of animals, and that when the 
organisms were mixed with the food, mesen- 
teric lymphatic tuberculosis was easily pro- 
duced, the mucous membranes in neither 
case having been affected. That the lymph 
nodes contained tubercle bacilli, even in the 
absence of specific lesions, could be proven 
by injection into animals. This could be 
done on the 104th day after a single intro- 
duction of bacilli into the intestines. It 
seems that the latent xjeriod of this disease 
may be quite protracted. 

In autopsy material from children, these 
authors were able to demonstrate the pres- 
ence of living organisms in the abdominal 
lymphatics in the absence of specific histo- 
logic change. It therefore seems improba- 
ble that the infection atrium can always be 
fixed upon with certainty, since the bacilli 
could easily be transferred to another site, 
at which i^oint the true histologic pathology 
might begin. For example, they have been 
found in the lymphatic tissue of the respi- 
ratory tract two weeks after they were inten- 
tionally introduced into the digestive tract. 

It further appears from the work of the 
above named observers that the tubercle 
bacillus undergoes a loss of virulence while 



on its way to the lymphatic tissues, but that 
while there an increase in the i^atho- 
genic energy can be discovered experiment- 
ally; why they should remain latent when 
more virulent, does not seem clear; this la- 
tent period may be quite long. 

One point which may lead to the detec- 
tion of the infection atrium in tuberculosis 
is that the prominent feature of early lym- 
phatic invasion presents itself as a stage of 
small round cell hyperplasia. This may be 
contemporaneous with typical tubercles in 
neighboring glands but usually indicates a 
primary invasion. The glands and the 
small round cells seem to play the part of a 
filter less than we formerly thought, since 
by injecting an animal having an artificial 
lymphocytosis with tubercule bacilli, the in- 
fection was delayed in appearance and de- 
creased in severity. In the test-tube as 
well, the longevity of the organism was af- 
fected more by the lymphocytes than by the 
polymorphonuclears. 

That the lymphatics of sucklings can be 
infected from the milk without injury to the 
mucous membranes, was proven by the find- 
ing of tuberculosis in the lymphatics of the 
intestinal tract, the wall itself being per- 
fectly normal. The mother had been in- 
jected, not fed, after the birth of the young. 

This work is extremely interesting and 
adds one more link to the chain of evidence 
in favor of an intestinal infection as against 
a respiratory infection. When one consid- 
ers how much more easily a particle adher- 
ing to the oral, buccal, gingival or pharyn- 
geal mucous membrane can be swallowed 
than inspired, even as far as the trachea, 
the former route seems certainly more prob- 
able. Undoubtedly, infection by one or' 
other of the direct routes to the lung has 
occurred. 

THE DRAINAGE Or THE TAUCIAL AND 
PHARYNGEAL TONSILS. 

The interpretation of swellings in the 
neck resulting from infection in the nasal, 
pharyngeal or buccal cavities has always 
been one of the greatest importance. The 
value in knowing which gland is first in- 
volved as a result of the drainage of an in- 
fected area, lies in the fact that then we 
know how many barriers the infection has 
yet to pass to reach the general lymphatic 
system, by a direct route, or, in other words, 
how far it has spread. 

The deep set of the cervical lymph glands, 
lying beneath the sternocleidomastoid mus- 
cle, — receives the greater part of the affer- 
ent lymph from the head and neck; that of 
the back of the head and pharynx drains 
into the posterior chain of these deep glands. 

Therefore the involvement of this deep 
anterior set would indicate a centripetal 



154 



THE CHARLOTTE MEDICAL JOURNAL. 



movement of an infection from anywhere 
but the back of the head or the pharynx. 

The late works of Wood (Am. Jour. Med. 
So. Aug. '05, and April, '06) have shown 
ver}' conclusively that the drainage of the 
faucial tonsil is not as usually supposed, 
into the posterior gland of the submaxillary 
group, but into one of the deep anterior set. 
This gland is located beneath the sterno- 
cleidomastoid where this muscle is crossed 
by the posterior belly of the digastric, lying 
in a pad of fat, easily movable backwards, 
and connected with the other deep anterior 
glands by a rich efferent anastomosis. Topo- 
graphically this node is behind the angle of 
the jaw, whereas the submaxillary gland 
above mentioned is below the angle and 
cannot be moved backwards freely. 

The pharyngeal tonsil according to Wood, 
drains into one of the upper glands of the 
posterior deep set, which set forms a long 
freely anastomosing chain along the poste- 
rior margin of the sternocleidomastoid 
finally terminating in the set above the 
clavicle. 

This is also an improvement in our 
knowledge for we previously thought that 
the nasopharynx drained into the anterior 
set. 

Since the anastomosis is greater between 
the radicals of each set than between the 
two sets as a whole it is reasonable to as- 
sume that an infection will spread along the 
chain to which the gland into which the in- 
fected lymph flow first came belongs. There- 
fore a chain of enlarged glands along the 
anterior margin of the posterior triangle of 
the neck would suggest the origin of the in- 
fection high in the pharynx or in the naso- 
pharynx, while a faucial infection would 
affect the anterior chain first. 



"Please don't ask for back numbers of 
the Journal, for there are none. Please 
don't ask for copies of the Constitution and 
By-Laws, or for back numbers of the Regis- 
ter of Physicians, or for programs, for there 
are none. In writing, please do not refer 
to any correspondence sent or received prior 
to April 18th, for all our correspondence is 
gone. If you wish to refer to anything in 
the way of correspondence prior to that 
date, please quote the letter or letters to 
which you refer. Please don't ask for sample 
copies until we have had time to dust off 
some of the ashes and find out just where 
we are. If you have written to us and do 
not get an answer by return mail, do not 
become enraged; be patient; about four 
sacks of mail accumulated before we had 
time to even begin to read the written word. 
Just a little thought along these lines will 
help us and will be appreciated. We ask 
the medical journals that receive this, please 
to publish a paragraph stating that we are 
trying to re-establish our mailing list and 
requesting all journals that formerly receiv- 
ed our journal or should wish to exchange 
with us, please to indicate that fact by writ- 
ing to us at 2210 Jackson Street, San 
Francisco." 



DR. H. W. L.IUL.Y. 

After a long and painful illness Dr. H. W. 
Lilly, of Concord, N. C, died on the morn- 
ing of the 12th inst. Dr. Lilly had reached 
the ripened age of 70 years and was a phy- 
sician of the old-school. Concord had no 
finer citizen; he was beloved by all its peo- 
ple, and will be greatly missed. Patience 
and gentleness marked the long months of 
suffering that were met with a spirit that 
was brave and noble. 



Few of us realize the pricking difficulties 
that follow in the track of a great disaster 
like that of the San Francisco earthquake- 
fire; leaving out thought of the money loss 
that came to all those engaged in the differ- 
ent lines of business, just the matter of 
getting adjusted, and getting the wheels 
oiled again, is a serious question. 

Of the difficulties of journalism under the 
present conditions. The California State 
Journal of Medicine has this to say: 



The action of Denver, Colorado, in ap- 
pointing a cleaning day is one that might 
be followed by all cities to their benefit from 
the stand-point of health and beauty. 

Some of the hints in the Mayor's procla- 
mation were as follows: 

"If your store front, residence, or fence 
is dingy, order it repainted." 

"If your awning is old, torn or faded, get 
a new one." 

"Resolve never to throw papers in the 
street." 

"Ask your milkmen, grocerymen and ex- 
pressmen to have theil: wagons painted." 

And the people responded by cleaning all 
the streets and alleys, painting all poles, 
placing refuse cans at all crossings and 
collecting rubbish and garbage from vacant 
lots; if all bill-boards can be done away 
with, (they can not be considered from an 
artistic standpoint), and each vacant lot 
made a temporary park, by sodding it and 
planting quick-growing vines and shrubs, 
much of the ugliness that wears the nerves 
of the working thousands could be changed 
into restfulness and beauty. 

The friends of Dr. H. Q. Alexander will 
regret to hear of his continued and joainful 
illness at his home in Mecklenburg county, 
N. C. ^__^_ 

Dr. T. R. W. Brown has opened an office 
in Asheville, N. C, for practice that is 
limited to surgery and gynaecology. 



REVIEW OF SOUTHERN MEDICAL LITERATURE. 



155 



The city of Darmstadt, Germany, has pre- 
pared a museum devoted entirely to tubercu- 
losis which is intended to be carried to all 
the centers of population; during its exhibi- 
tion a series of explanatory lectures will be 
given and it is hoped, in this way, to induce 
the public to pay more attention to sanita- 
tion and hygiene. By pictures the symp- 
toms of tuberculosis will be shown in every 
form and also the means adopted by modern 
medical science to check the disease. 



_ Dr. D. C. Mclntyre, of Tabor, N. C, 
died on the 6th inst., of typhoid fever. Dr. 
Mclntyre graduated in medicine two years 
ago; he was twenty-five years of age, and 
the future held much of promise for him in 
his chosen work. 

Review of Southern Medical Literature. 



Atlanta yoiirnal Record of Aledicine, 
7tine, 1906. 

An Unusual Complication following 
Typhoid Fever, Report of Case.— Dr, j_ 

E. Sommerfield reports a case which seems 
to have been apparently of a mild type. On 
the twentieth day of treatment the tempera- 
ture returned to the normal and remained 
so for six days when a relapse occurred 
which lasted two weeks. Just about this 
time he complained of a dull pain in the 
region of the liver, but a careful examina- 
tion showed no enlargement. In the course 
of four or five days the pain became more 
intense, the temperature was normal each 
morning, but rose to 10,5 degrees F. each 
night, followed by a profuse perspiration. 
Gradually an enlargement of the liver was 
noticed, with bulging of the intercostal 
spaces. Abscess of the liver was diagnosed. 
On aspiration pus was found. The pus was 
examined microscopically with negative 
results. Immediate operation was advised 
and on the following day an incision was 
made in the ninth intercostal space and a 
large quantity of pus evacuated. The cavity 
was not irrigated, but large drainage tubes 
inserted. For several days the patient was 
in a critical condition, then rallied and in a 
short time made a complete recovery. 



The Georgia Practician, 'jfune, 1906. 
MeiHcal Ethics.-Dr. M. A. Clark under 
the title of specialists in this paper says. 
In all cases where there is a question of 
special treatment being indicated the patient 
should be encouraged to consult the family 
physician as to whether or not special treat- 
ment is needed and by whom it should be 
given. In the large majority of such cases 
the family physician's opinion will be of no 
little value to the specialist in his manage- 
ment of the case. Greater good will re- 



bound to the patient if the specialist and 
physician work together. 

In those cases where an operation is indi- 
cated the regular physician should be ad- 
vised before an opinion is given to the pa- 
tient, and only in very grave conditions 
should an operation be performed without 
advising with the family physician. 

Because the physician is a specialist he is 
none the less excused from the same rules 
that apply to other physicians' prescribing 
for or taking charge of the patient of others 
and he should be equally as careful in the 
observance of these principles. 

Virginia Medical Semi-Monthly, 'yu?ie 
20th, 1906 
Symptoms and Treatment of Urticaria. 

— Dr. T. W. Murrells says for convenience* 
of treatment I divide urticaria into four 
classes, viz.: Acute reflex, acute toxic, 
chronic reflex, and chi'onic toxic. 

Acute reflex. Here there is a sudden 
outbreak of urticaria without systemic dis- 
turbance. The patient seems in perfect 
health and may or may not give a history of 
previous attacks. Look at patient's tongue 
and other means of diagnosis and all is as 
should be. On questioning closely he may 
say that he chewed a piece of orange peel; 
swallowed a grape skin or something of 
that sort; and here is the source of the 
trouble. Acting as a mechanical irritant it 
causes reflexly an urticaria. This case 
should not be vomited, as it will set up 
further irritation, but prescribe something 
soothing to the gastric mucous membrane. 
Hydrocyanic acid diluted and later a saline 
to wash out the offending material. The 
acute toxic form is most often seen after the 
crab supper and ice cream festival and pre- 
sents all the symptoms of an acute urticaria. 

Chronic reflex. — This is the urticaria that 
accompanies Col. R. E. Morse and helps to 
pave the downward road after the Christ- 
mas holidays. There is no toxic absorption 
but a gastritis and the ordinary foods of life 
act as irritants. Treatment same as for 
gastritis. 

Chronic toxic is that form sometimes 
called urticaria of autointoxication. In this 
class of cases we have to supervise the pa- 
tient's life and diet in our effort to eliminate 
the poison and prevent its reformation. 
Always examine the stomach contents and 
look for dilitation. Cases of this sort have 
occurred in connection with hydatids of the 
liver. In these two latter conditions the 
surgeon's knife is the only remedy. The 
external treatment of urticaria is simple. 
The evaporating and astringent lotions will 
be found more serviceable than dusting 
powders. Carbolic acid as a lotion in va- 
rious strengths is perhaps the most useful 
remedy. 



156 



THE CHARLOTTE MEDICAL JOURNAL. 



Ncxv Orleans Medical and Surgical your- 
nal, }zine, 1906. 

The Early Diagnosis of Malignant Tum- 
ors with Special Reference to Cancers of 
the Breast, Uterus and Stomach. — pj- ^/^ 

A. Laiidey gives the following clinical points 
in relation to cancer of the breast and all 
external tumors: 

Rapid growth is one of the main clinical 
features of malignancy and should of itself 
enable one to make a positive diagnosis. 
The rapidly enlarging nodule in the breast, 
the small papilloma of the lip which sud- 
denly takes on a proliferating and ulcerat- 
ing aspect, the bone tumor showing undue 
activity should all be viewed with suspicion, 
regardless of other signs and symptoms. It 
,is true, however, that some types of epi- 
thelial carcinomas are at some stage of de- 
velopment of extremely slow growth. Ten- 
derness, very marked inflammatory swelling 
and absent in malignant tumors is an im- 
portant feature in differentiating the two 
affections. 

The tendenc}', too, of malignant tumors 
to invade surrounding tissues and to recur 
after removal is another characteristic. 

Pain is not characteristic of early cancer. 
It may be present and it may not. It is at 
times absent even in advanced cases. Be- 
sides pain may be severe in benign tumors. 
Adenoma of the breast is often much more 
painful than early cancer. Retraction of 
the nipple so often referred to as typical of 
cancer of the breast should not be looked 
on as a very important sign. It may or 
may not be present. 

Redness, oedema of the skin, the develop- 
ment of nodules which run together produc- 
ing a hard elevated patch eventually ul- 
cerating, the involvement of lymphatic 
glands and the development of the charac- 
teristic cachexea are all late symptoms 
which should not be waited for before hav- 
ing recourse to radical treatment. 



most usually putting the patient into a pro- 
found sleep of some hours duration. There 
will be none of the nausea of prolonged 
ether or chloroform norcoses, no increased 
danger of past partum hemorrhage (as after 
chloroform) and no necessity for a skilled 
assistant to give the anesthesia. This is 
practically the same as the greatly lauded 
'morphine-scopolamine anesthesia" but the 
author desires to be safer. 

The author uses this method in major op- 
erations such as vaginal hysto-rectomies. 
He says it must not be used in cases with 
serious heart lesion or in cases of albumi- 
nuria. The patient's hands must be tied 
above the head, lest a sudden movement 
contaminate the field of operation. 



The Medical Recorder, ]u?ie, 1906. 

Painless Labor Surgical Operations With- 
out Ether or Chloroform. — Dj- j7 Laup- 
hear says when labor has progressed to the 
stage when os uteri is well dilated and the 
pains are becoming distressingly severe a 
hypodermic injection of one quarter grain 
of morphine and one hundredth of a grain 
of the hypobromate of Hyocene may be 
given ; in one hour the forceps may be ap- 
plied and labor completed without any pain 
whatsoever even though the perineum be 
lacerated and sewed up. 

There need be no hurry — perfect an»- 
algesia will last for hours. If the patient is 
not asleep at the expiration of the hour 
after injection a few drops of chloroform 
may be given by inhalation — a draw at 



7/ie Southern Practitioner, ]une, 1906. 
Hemorrhages in and around Nerve Tis- 

s"e.— Dr. H. Padgett gives three classes of 
causes of hemorrhage in these cases as 
follows: 

1. Some force acting from without upon 
a healthy vessel thus causing rupture, and 
it is interesting to note how easily blood 
vessels break when a force is applied to the 
head externally and no fracture, and while 
we know we have concussion of nerve mat- 
ter, yet the author believes that in many 
such cases classed as pure concussion that 
minute hemorrhages do not exist, but 
through his clinical experience and post 
mortem nerve work he is convinced that 
minute hemorrhages often exist in cases 
classed purely as concussion. 

2. Arterial pressure acting upon a blood 
vessel that has undergone some histologic 
change and this condition is most common. 

3. Those blood changes in infectious and 
other diseases in which the vessel allows the 
blood to pass through this is very common 
in leukemia and purpura. 

The result of hemorrhages in nerve mat- 
ter is one of breaking up, tearing, interfer- 
ing with local nutrition and softening and 
formation of scars and cysts. If the patient 
survives the blood undergoes a chemical 
and physical change, restoration of tissue 
and function in many cases, and the only 
evidence of a past hemorrhage may be a 
little pigment. The spinal cord and verte- 
bral canal are subject to the same kind of 
influences as the brain mass, possibly with 
the exception that in those infectious dis- 
eases and blood conditions that often give 
hemorrhages in the brain and retina not 
quite as common in the cord. 



Maryland Medical Jouriial, Jztne, 1906. 
The Production of Clean Milk as a Prac- 
tical Proposition —Dr. S. C. Prescott after 
giving a complete outline of this subject 
says that he believes that a satisfactory 



REVIEW OF SOUTHERN MEDICAL LITERATURE. 157 

clean milk supply is possible and practic- 2. Paralysis from diphtheria, delirium, 

able if the following; suo;gestions can be put coma or conditions of the insane in which 

in force. refusal to take food is persistent. 

1. An intellij^ent, sympathetic, but rigid 3. Gastritis, g-astric ulcers, cancer or any 
insi^ection or supervision of the farms, ex- kind of obstruction at the cardiac or pyloric 
eluding milk from all those sources where ends of the stomach or along- the alimentary 
the farmer is not inclined to do what he can canal above the rectum. 

to fulfill cleanly conditions. 4. Reflex vomiting- when unduly pro- 

2. Dissemination of information to the longed, such as from sea-sickness or preg- 
farmer of needful points as to the care and nancy. 

handling of the milk at the farm, and in 5. Conditions of exhaustion from wasting 
fact to all those who have to do with the diseases where defective absorption and ex- 
handling of the milk before it reaches the treme anorexia are persistent as supple- 
hands of the consumer. mental to stomach feeding. 

3. Proper regulations and inspection of 6. Any surgical operations u])on the 
the handling, transportation, etc., with per- stomach and upper alimentary tract. After 
haps an ordinance as in force in Boston discussing the kinds and the manner of 
setting up a bacteriological standard for preparation of the nutritive enema he em- 
saleable milk. • phasizes the fact that whatever enema is 

4. A higher selling price to the farmers given it should be placed into or above the 
in return for the extra care in the production sigmoid flexure. Physiologists teach that 
of clean milk. the absorbents are more active in that por- 

tion of the bowel, and besides the nutri- 

Nashville Journal of Medicine and Stir- ment material is conveyed direct to the liver 

gery, June, 1906. through the portal circulation, whereas the 

Synovitis. Dx. J. W. Brandan believes hemorrhoidal veins empty into the vena 

that the constitutional symptoms of dry cava, the less desirable of the two routes. 



synovitis are usually more marked, though 

they are not in proportion to the local in- 7/^c Alabama Medical and Surgical Jour- 

flammation and pain — the latter being the ^''''A June, 1.900. 

most important symptom. Care should be Retro-displacement ol the Uterus with 

taken in examination, as the point is in- Report of Operative Cases.— By Dr. E. 
tensely sensitive to pressure. The general m. Prince, Birmingham, Ala. 

health, as a rule, suffers but little. There 

is more or less thickening of the tissues 7/ie Virginia Medical Send - Monthly , 
around the point. The swelling being hard, ]unc Sth, 1906. 

elastic, and leathery, but not fluctuating, Early Diagnosis and Maiiasenient of 
as there is little or no effusion into the joint. Pulmonary ruberciilo.sis.— Dr. R. J. Kline 
The edge of this thickening is abrupt, a gays the pulse is a most valuable aid in the 
more or less elevated ridge being felt as the early diagnosis of this disease. • It is alwavs 
hand is passed up and down the limit. accelerated and very frequently lowered in 

If after a few days or weeks the tempera- tension. While there are other and numer- 
ture suddenly rises to 102 or 103 degrees, ous causes that result in the elevation of 
especially if the rise be preceded by a rigor, temperature, still a certain kind of tempera- 
it is probable that suppuration within the ture continous in character more marked in 
joint has taken place. evenings and remittent — to say the least it 

The muscles of the thigh quickly atrophy is very suspicious. Percussion. Slight dull- 
in this form of synovitis, and when suppur'- ness detected either above or below the 
ation occurs very rapid destruction of the clavicle should cause suspicion, especially 
joint may result. if certain clinical symptoms are associated 

In the treatment of this affection the gen- with it, but may have dullness over thick- 
eral condition of the patient, hereditary and ened pleura or a recent pneumonia. The 
acquired tendencies should be carefully supra spinous and intra scapular regions 
studied and such constitutional treatment should be carefully percussed and even 
given as needed. slight dullness is often significant. Auscul- 

tation, if there is any change in the rythm 

7 he Texas Medical N'eivs, June, 1900 between inspiration and expiration or if 

Rectal Feeding —Dr. T.J. Bennett gives inspiration is short and jerky — cog-wheel — 
the following as the indications for rectal and the expiratory sound is prolonged and 
feeding: high-pitched at the same time there is some- 

1 . Anv temporary obstruction to. the en- thing vitally wrong which demands immedi- 
trance of food into the stomach, such as ate attention. Aslight spitting of blood may 
swellings about the throat, growths, foreign not always be a forerunner of tuberculosis, 
bodies, etc. yet it occurs often enough to be of value as 



158 



THE CHARLOTTE MEDICAL JOURNAL- 



indicative of the disease. The tuberculin 
test if employed will show the character of 
the trouble, even before the bacillus has 
made its appearance in the sputum. This 
is followed by a very interesting account of 
the management of tuberculosis. 



Southern Medicine and Surgery, June, 
1906. 

Cystoscopy.— Dr. P. Bromberg says that 
he scarcely deems it necessary to mention 
the advantages of cystoscopic catheteriza- 
tion of the ureters over other methods, such 
as segregation, compression of the ureters, 
etc., quotes Dr. Van Der Poel, who says: 

"1. The cystoscope is more easy of intro- 
duction than are the seperators or segre- 
gators,, is less painful during the bladder 
manipulations, and much less so during the 
collection of urines. 

2. With urethral catheterism we can col- 
lect the urine during as long a time as may 
be thought necessary, the patient not re- 
quiring any supervision. 

3. A cystoscopic examination of the blad- 
der can be made at the same time, which in 
some cases is useful, in others indispensible. 

4. We are much more certain of the exact 
results, especially when the two urines are 
of similar character, whether clear, bloody 
or purulent. 

5. It is the only method by which we are 
fairly certain that there is no bladder con- 
tamination." 

It is contraindicated in acute cystitis, 
unless the patient be anaesthetised. Pre- 
liminary treatment will soon enable one to 
use the instrument if indicated. 

The unskillful use of the instrument i\\ 
tubercular cystitis often aggravates the con- 
dition. Large non-operative tumors are 
only made to bleed, and no advantages are 
derived from its use. It can be of no ad- 
vantage in cases of cancer of the prostate. 



1 . Examination of the gonorrhoeal shreds 
found in the morning and afternoon urine, 
immediately after voiding same in the office, 
for pus cells and gonococci. 

2. Urethroscopic examination of the an- 
terior and posterior urethra. 

o. Dilitation of the urethral canal; intro- 
duction of a bougie, a boule and irritation 
of the urethra with a strong solution of 
nitrate of silver. Examination of the ob- 
tained discharge under the microscope. 

4. Microscopic examination of the semen 
for pus cells and gonococci. 

If no leucocytes and gonococci are found 
the entire procedure is repeated in five days, 
a negative result of which repeated exami- 
nation justifies the author in offering no 
objection to marriage with the caution, 
however, of warning the patient that infec- 
tion may occur, and to at once consult a 
competent surgeon should symptoms point- 
ing to an infection occur. 

Specialists resort to further test of attempt- 
ing to cultivate the gonococci in suitable 
media. 



Gaillard's Sonthern Medicine, July, 1906. 
Gonorrhoea and Marriage. — Qi- q_ m 

Blech believes that the answer to the ques- 
tion as to when a gonorrhoeic may marry 
without fear of infecting his partner is a 
serious one and not easily answered. The 
greatest authorities on genito-urinary sur- 
gery have different views. It is sad indeed 
to note that after a patient had had his 
urine, artificially produced urethral dis- 
charge and semen examined with the micro- 
scope with negative results — and this even 
repeatedly — he can at best be declared only 
probably safe. W^e have in the literature 
records of cases in which the most minute 
examination gave negative results and yet 
infection of a hitherto healthy wife took 
place. The following method of examina- 
tion is routine with the writer. 



Atlanta yournal Record of Medicine, 
]uly, 1906. 

Diagnosis and Treatment of Pulmo- 
nary Tuberculosis.— Dr. n. F. Harris says 
under the section on treatment that treat- 
ment of tuberculosis on modern lines is 
marvelously simple; briefly stated it consists 
in putting the patient practically out of 
doors night and day in rest as long as the 
disease is active, and supplying a sufficient 
quantity of good wholesome food. When 
treated in this way patients improve in an 
incredible degree in a very short period of 
time, and where the disease is truly incipi- 
ent six months to a year suffices for com- 
plete cure in a large number of instances. 

In a recent visit made to the great sana- 
toria of the North he was astounded to see 
the wonderful effects produced by this treat- 
ment. That we have in Georgia a large 
number of places where tuberculosis can be 
successfully treated there can be no ques- 
tion. For the majority of patients an alti- 
tude of from 1500 to 2500 feet is to be pre- 
ferred, and fortunately we have a number 
of such places within our State which are 
easily accessible. At the instance of Dr. 
L. Ct. Hardman the legislature at its last 
session passed an act ordering an investiga- 
tion as to the feasibility of erecting a State 
sanitorium for the treatment of tuberculosis. 
This, the author feels certain, will be heartily 
endorsed by the members of the vState asso- 
ciation. 



7 he Sonthern Clinic, July, 1906. 
A New Consumption Blotter. — J3y Dr. G. 

B. H. Swayze. 



REVIEW OF SOUTHERN MEDICAL LITERATURE. 



159 



Virginia Medical Semi Monthly, ]uly 12, 

1006. 

Principles of Surgery— Lecture XX— 

Syphilis.— Dr. Stewart McGuire says for a 
loiio- time it was thought that every product 
eliminatino- from an infected person, such 
as tears, sweat, saliva, and even the breath 
was capable of transmitting syphilis. It is 
now known that the disease is transmissable 
only through the products of the primary 
and secondary lesions and the circulating 
blood. The presence of the spirocheta pal- 
lida in only these lesions and in the blood 
in only these stages strengthens the belief 
of its specific relation to the disease. The 
physiological secretions from the special 
glands, such as the salivary, milk and sweat 
glands, the normal kidney and testicle, un- 
less contaminated by admixture with a dis- 
charge from a primary or secondary lesion 
or by blood or lymph, will not convey the 
disease, even during the mostactive stage 
of the disease. This is easily accounted for 
when it is borne in mind that the special 
products from these glands are the result of 
elaboration within their epithelial elements 
and that these cells select from the blood 
the proxinrate principles necessary for their 
work. The essential cause of syphilis does 
not penetrate intact epithelium. 

Sparmatozoa and ova are not products of 
secretion, but active, living, organic struc- 
ture. Each of these elements is capable, 
therefore, of grafting disease on the other. 



7 he Southern Practitioner, ^uly, 1090. 
The Proper Care of Pregnancy.— j^r. I. 

C. Smith regards the therapeutic nihilism 
now so widely prevalent, even in many 
places of high pretensions — and which is 
founded in ignorance — we are often dog- 
matically informed that owing to the fact 
that pregnancy being a physiological pro- 
cess that drug remedies can be of no special 
benefit to improve the disturbances of health 
resulting from the conditions of pregnancy. 
The main reason why the health of preg- 
nant women has been so long and so widely 
and lirutally neglected was because woman 
as a sex for countless ages existed in a state 
of ignorant slavery. The time, labor and 
expense involved in improving the health 
of the pregnant woman will find an abund- 
ant reward in the greatly improved mental 
and physical condition and vital stamina of 
the human race. Hereby the best features 
of an upward evolution will be greatly pro- 
moted, for the physical powers being im- 
proved and strengthened the mental endow- 
ments are increased and elevated, and thus 
the coming race becomes superior to their 
predecessors and the world of mankind is 
thereby greatly improved. 



7 he Medical /Recorder. ]?ily, lUOd. 

The Static and Constant Currents Ra- 
tional Therapeutic Agents.— j^j- s. C. Bar- 
row believes that neurasthenia of cerebral, 
spinal, gastric, or any organ yields prompt- 
ly when the function of these organs is re- 
stored, and as a regulator of function there 
is no remedy which eciuals the static cur- 
rent. In tabes when applied in the early 
stages the pathological changes in the cord 
are checked and the distressing train of 
symptoms which usually follow are not 
seen. In the paralysis following the acute 
myelitis of children nothing restores the af- 
fected muscles to normal more constantly 
than the static current. 

The functional forms of insanity are 
benefited by the static current when the 
treatment is directed at the cause, which is 
usually located in some organ doing defect- 
ive work. In organic torpor due to a local 
stasis constipation, impotency, and other 
like conditions in which the muscular tissue 
in the organs is in an atonic state the static 
current is of rational use. In the constitu- 
tional diseases due to faulty metabolism, 
such as rheumatism, gout, etc., static elec- 
tricity is our best aid. Applied to an acute- 
ly congested or inflamed organ we see stasis 
overcome pain, and swelling disappear, 
muscular tone developed and :iornial func- 
tion resulting, whether it be an acute pros- 
tatitis, a vesiculitis, a gleety urethritis, a 
tonsilitis, or an acute non-specific inflam- 
mation at any site. In the painful neuroses, 
such as sciatica and neuralgia the static 
current in conjunction with the constant or 
induced is most effective. The brush and 
vacuum tube discharges, through their anti- 
septic and mechanical properties, are especi- 
ally serviceable in dermatology. 



7 he Virginia Medical Semi Montlily, ]uly 

27th, moo. 

Salt Action and Salt Solution.— j)j-. A. 

L. Muirhead points out clearly the thera- 
peutic indication and action of salt solution 
and concludes by saying that these salts 
perform most important functions, main- 
taining normal osmotic conditions and con- 
trolling the flow of water to and from the 
tissues. They also constitute an essential 
part of the composition of living matter, 
being in some way bound up in the struc- 
ture of living molecules and necessary to 
their normal action. In any disease with 
high temperature the loss of the body's 
chief salt — sodium chloride (which amounts 
to about one-half ounce in twenty-four 
hours) — is not replaced, owing to loss of 
appetite, restricted diet, and many other 
factors, and the time soon comes when the 
cells are hampered in their vital functions 
and gradually fail to secrete their protective 



160 



THE CHARLOTTE MEDICAL JOURNAL. 



anti-bodies, thus .fjiving^ free sway to patho- 
genic substances. 

Nature, wise in all her acts, tries to pre- 
vent this, and at a certain point the excre- 
tion of sodium chloride by the urine ceases. 
This niav avail, or in spite of nature's ef- 
forts the patient gradually sinks, the vital 
functions being more and more hampered 
until life ceases. To avoid this we are ad- 
vised to use saline solutions, not when the 
case has reached the danger limit, but from 
the beginning. Keep the body in febrile 
cases well supplied with its necessary salts, 
the greatest of which is sodium chloride. 



Book Notices. 



Texas Medical Journal, July, l."0<>. 

The Importance of Some Symptoms of 
Uterine Fibroids with Report ol Cases. 

— Dr. F. L. Barnes desir.es to call attention 
to the apparent disproportion which we 
sometimes find between the size of the 
tumors and the severity of the symptoms, 
and also to emphasize the fact that these 
symptoms are probably more often due to 
adhesion than to the tumor per se. After 
giving an account of cases which illustrate 
these points he says he is impressed with 
the idea that these cases of small fibroids 
would probably not have given any trouble 
for a long time had there been no surround- 
ing adhesions, and that the time when they 
cause the most trouble is just at the time 
when they are about to be converted from 
pelvic into pel vo- abdominal tumors. If 
they are not bound down by adhesions or 
blocked by irregular formatians at this time 
they will come up into the abdomen like a 
normally pregnant uterus and the patient 
will experience considerable relief from 
pelvic pressure and pain. On the contrary 
if they can not make a smooth entry into 
the abdomen the patient will suffer exacer- 
bation of all symptoms and probably some 
new complications. 



Nashville yournal of Medicine and Sjir 
gcry, July, 1906. 
A Plea for Plastic Surgery in Gynae- 
cology.— ]^v Dr. C. A. Robertson, Nash- 
ville, Tenn. 



JVew Orleans Medical and Surgical Jour- 
nal, July, 100(). 

Mechanical Treatment of Fracture of 
the Patella.- ]}y Dj-. j. ]). Bloom, New 
Orleans. 



From the South comes this veracious 
story, as told by a writer in the Atlanta 
Record of Medicine: 

"Did you hear about Isaacs? lie vas 
bad sick, and they took his appendix away 
from him." 

"Vy didn't he put it in his vife's name?" 



WALTER RF:ED AND YELLOW FEVER. 
By Howard H. Kelly, Professor of Gynae- 
cology, Johns Hopkins University. Two 
hundred and ninety pages. New York. 
McClure, Phillips & Co. 1906. 
This interesting book is a memorial from 
a great physician to a great physician. 

"When nature has work to be done she 
creates a genius to do it." 

Major Reed was born in Virginia, gradu- 
ating at its University, and at Bellevue 
Hospital Medical School. 

In 1S90 he was sent to Baltimore, as at- 
tending surgeon and examiner of recruits; 
while there he made a specialty of bacteri- 
ology and pathology, fitting himself for the 
work that will be associated with his name 
forever, — the conquering of the yellow 
plague. 

Chapter IV treats of the history of yellow 
fever; chapter V of insects and diseases; 
chapters VI and VII of the work of the 
United States Army Commission; VIII of 
the application of the mosquito theory and 
IX of the value of Major Reed's work to 
the world. 

On the monument that marks his grave 
in Arlington is the simple sentence; 

"He gave to man control over that dread- 
ful scourge. Yellow Fever." 

A COMPEND OF MATERIA MEDICA, 
THERAPEUTICS AND PRESCRIP- 
TION WRITING. Samue-1 O. L. Potter, 
M. D., M. R. C. P., London. 
The text of this the seventh edition has 
been thoroughly revised and brought into 
conformity with the eighth revision of the 
U. S. Pharmacopoeia. Twelve new articles 
and forty-three new paragraphs on impor- 
tant drugs have been inserted, and sixteen 
articles have been re-written. Material con- 
sidered obsolete, or comparatively unimpor- 
tant, has been removed; but the insertion of 
so much new matter, and the adoption of a 
wider-faced type, have added thirty-seven 
pages to the book. 

The new articles are those on Animal 
Extracts, Boric Acid, Ethyl Chloride, 
Formaldehyde, Methylene Blue, Musk, 
Oxygen, Senega, Sera, Sumbul, Uric Acid 
Eliminants, and Urinary Sedatives. The 
new paragraphs include those on Acetozone, 
Argyrol, Aspirin, Chloretone, Citarin,Cotar- 
nine, Dionin, Diuretin, Ergone, liucaine, 
Euchinin, Gambir, Glycerin, Heroin, Hexa- 
methylenamine, Lactophenin, Orexin, Pe- 
ronin, Piperidin, Protargol, Sabal, Scopola, 
Stovaine, Theocin, Th^^mol Iodide, Veronal, 
and seventeen others. 



CLINICAL DIAGNOSIS. Charles Phillips 
Emmerson, A. B., M. D., Resident Phy- 



BOOK NOTICES. 



161 



sician the- Johns Hopkins Hospital and the author has not had personal experience 
Associate in Medicine at Johns Hopkins and in these chapters he has compiled from 
University. The J. B. Lippincott Com- the most reliable sources, 
pany. Philadelphia and London. The treatment of internal disease is an 

This book, which is dedicated to Dr. Wm. art, and cannot be reduced to exact science; 
Osier, is based on the author's experience all advance is marked by relief from human 
at the Johns Hopkins institutions in Balti- suffering and the saving- of human life. 

more and the clinical records of the same ' 

during the past seventeen years. Large IF YOUTH BUT KNEW. By Agnes and 
space is given to examinations of the sputum, Rgerton Castle. The Macmillan Com- 



tlie urine, the stomach contents, the intesti 
nal contents, the blood and various body 
fluids. 

The book is meant especially for young 
practitioners, who will find a small labora- 
orv their most valuable stock-in-trade. 



pany. New York City. Cloth, $1.50. 
A genuine love story of the Napoleonic 
period, centering in the rule of Jerome in 
Westphalia; "through the mazes of this 
carnival, unique in the lenten gravity of 
nations, wander the footsteps of the singer 
of youth." 

It is a tale of love and of wanderlust, 

woven out of a keen insight of human 

nature, and there is not a dull page in it. 

etc. Postpaid, $1.10. Frederick A. Stokes It is a delightful book for the eveninglamp 

Company, New York. or the autumn vacation. In it we hear the 

The author of this book comes to her sub- music of young love; we see the beauty of 

ject with an authority based on wide and the world and taste the fragrance of adven- 

thoughtful experience. As the founder ture. 



CHILDHOOD; Mrs. Theodore W. Birney 
with an introduction by G. Stanley Hall 
Ph. D., LL. D., author of "Adolescence,' 



and promoter of the National Congress of 
Mothers, and for many years its president, 
she has wielded an influence second to none 
in that" important organization. 

Her dominant impulse is to bring parents 
and children into closer and more sympa- 



CONISTON. By Winston Churchill. Cloth, 
543 pp. Price, $1.50. The Macmillan 
Company, New York. 
The story is laid in New Hampshire and 

the chief character is a well-remembered 



thetic relations. She believes that discord political figure in the State's history. The 
in the home is in most cases due to a lack interest in the novel as a political treatise is 
of comprehension of child nature and its heightened by the fact that the author has, 
needs. since its completion, entered into active poli- 

She claims there is abundant parental, tics as a candidate for office. It is a novel 
self-sacrificing love, but that it must be with an earnest and worthy purpose, through 
supplemented by real knowledge of the which a tender love story runs like the red 
child's mental, moral, and physical nature, thread through English cordage. The peo- 
Through simple practical illustrations of pie are real because their creator is a master, 
every-day occurrences the author endeavors He shows that the need of the political 
to make clear to parents the importance of hour is that each American citizen make 
being able to grasp the boy's or the girl's good to the world those principles upon 
point of view, for only by so doing can which his government was built and "regain 
they hope to gain the confidence of children the true axis established for us by the 



and to guide them wisely. 

The illustrative cases are such as can be 
applied with great advantage to the trying 
conditions existing in many households. 



founders of the republic." 



THE PROPHYLAXIS AND TREAT- 
MENT OF INTERNAL DISEASES: 
F. Forchheimer, Professor of Theory and 
Practice of Medicine, Medical College of 
Ohio, Department of Medicine, the Uni- 
versity of Cincinnati, etc. D. Appleton 
and Company, New York. 
The methods advocated are such as can 
be carried out in private practice. Much 
space is devoted to hydrotherapy, gymnas- 
tics, exercises and diet, while surgical 
methods are treated from the point of view 



"THE BATTLES OF LABOR: Being the 
William Levi Bull Lectures for the Year 
1906." By Carroll D. Wright, Ph.D., 
LL.D., Former United States Commis- 
sioner of Labor, President of Clark Col- 
lege and author of "Industrial Evolution 
of the United States," "Outline of Prac- 
tical Sociologv," etc. $1.00 net. Oeorge 
W. Jacobs & Co., Philadelphia. 
Here are four lectures delivered before 
the Philadelphia Divinity School. Dr. 
Wright goes back to the exodus which he 
calls the first great strike having an eco- 
nomic origin. 

Then he outlines labor troubles in the 



of the physician, leaving out largely the early and mediaeval days, coming up to the 
technique' of diseases. In tropical diseases great modern battles between labor and 



162 



THE CHARLOTTE MEDICAL JOURNAL. 



capital. The cure that he points out is in- 
creasing intelligence and the application of 
the spirit of Christ to business methods. 
Men should meet men in a simple, moral 
Christian way; then a new political economy 
will come into existence that looks to the 
"care and culture of men." 



A NARRx\TlYE OF MEDICINE IN 
AMERICA. James Gregory Mumford, 
M. D., Surgeon to the out patients at the 
Massachusetts General Hospital, and a 
teacher in the Harvard Medical School. 
Cloth, $3.00. 4S8 pages. The J. B. 
Lippincott Company, Philadelphia. 
This book is a narrative of medicine and 
conspicuous American physicians of each 
era, telling the story of their lives and their 
doings, showing to laymen as well as phy- 
sicians something of the meaning of medi- 
cine and the life of its votaries. 

Of the doctors and their story, few know 
or seem to care. Even the professioiral off- 
spring of the physician tell you it is only 
the science of today which counts, as though 
we could divorce ourselves from the past, 
as though we could understand truly our 
present or make progress without the knowl- 
edge of that past. In the development of 
the theme it has seemed best for reasons 
that must appear sufficiently obvious, not 
to bring the narrative down to the present 
time. It stops practically at 1860, or about 
the middle of the last century, certain fugi- 
tive chapters being added on Ether, the 
American Medical Association, and some 
Modern Tendencies. 

CONTENTS. 
The Seventeenth Century. — Colonial Medi- 
cine. 
The liighteenth Century. — Colonial Medi- 
cine. 
The liighteenth Century. — Colonial Medi- 
cine. 

(Continued). 
The Eighteenth Century. — Colonial Medi- 
cine. 

Introduction to Chapter V. 

The Eighteenth Century. — The Revolution. 

The Eighteenth Century. — Henjamin Rush. 

The Eighteenth Century. — l{lihu Hubbard 
Smith. 

The Eighteenth Century. — After the Revo- 
lution. 

The Nineteenth Centurv. — Ivarl}^ Surgeons 
(Physick, McDowell"). 

The Nineteenth Centurv. — liarlv Surgeons 
(Mott, J. C. Warren,' Dudley). 

The Nineteenth Century. — Some I^arly Phy- 
sicians and their Problems (Hosack, 
Smith, J. Bigelow). 

The Nineteenth Century. — Chapman, Fran- 
cis, Gibson, Jackson. 



The Nineteenth Century. — Daniel Drake 

and the Western Schools. 
The Nineteenth Century. — Ether, 1846. 
The Nineteenth Century. — Founding of the 

American Medical Association, 1847. 
The Nineteenth Century. — Notable Names 

of Fifty Years. 
The Nineteenth Century. — Some Tendencies 

in Modern Medicine. 

A NON-SURGICAL TREATISE ON DIS- 
EASES OF THE PROSTATE GLAND 
AND ADNEXA. Bv George WTiitfield 
Overall, A. B., M. D., Chicago. The 
Rowe Publishing Co. 

This book is now in its third edition and 
it is intended to aid the general practitioner 
in the treatment of chronic diseases of the 
urethra, and the reckless use of the knife is 
deplored. It has grown out of the careful 
observations of a quarter of a century. The 
little treatise is worthy of careful study and 
application of its teachings. 



Messrs. W. B. Saunders Company an- 
nounce for publication in the early fall the 
following practical works: 

Keen's Surgery: Its Principles and Prac- 
tice (Volume I); Sobotta and McMurrich's 
Human Anatomy (Volume III); Webster's 
Text-Book of Gynecology; Hill's Histology 
and Organography; McConnell's Pathology; 
Morrow's Immediate Care of the Injured; 
Stevenson's Photoscopy (Retinoscopy and 
Skiascopy); Preiswerk and Warren's Atlas 
of Dentistry; Goepp's State Board Questions 
and Answers; Lusk's P^lements of Nutrition. 

The most notable announcement is the 
new work on Surgery, edited by Dr. W. W. 
Keen, complete in five octavo volumes, and 
containing over 1.500 original illustrations. 
The entire work is written by the leaders of 
modern surgery — men whose names are in- 
separably associated with the subjects upon 
which they have written. Without ques- 
tion. Keen's Surgery will represent the best 
surgical practice of today. 

Abstracts of the Leading Articles of 
the Month. 

Torticollis— Wry-Neck.— Tubby ( British 
Medical Journal) 'says that there are two 
chief varieties, the true and the false. The 
true form is of two types, the fixed, — the 
wry-neck of childhood, or the congenital 
form, — and the reflex, the spasmodic and 
the acute forms. The author states that 
acute wry-neck is an acute rheumatism of 
the neck, which is amenable in most cases 
to medicinal treatment, but in a minority 
may be the beginning of the spasmodic 
form. The spasmodic form may be reflex, 
due to irritation. The usual cases have en- 
larged glands, from carious teeth or other 



ADVERTISEMENTS. 



163 



The usual combination of 
impoverished blood, nervous 
exhaustion, lack of digestive 
vigor yields most quickly to 



Grays Glycerine Tonic Comp, 



It restores, nourishes, reconstructs; 
besides this, it is especially 
efficient in diseases of the 
Chest and Throat 

THE PURDUE FREDERICK CO., 

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ThigenOl Roche 

Sodium salt of the sulphonic acid of a synthetic snlpho oil. 

The one Soluble Sulphur Compound 
that is odorless on use. 

A New York specialist in skin diseases (name 
omitted by request) writes :— "Thigeno! apparently 
has the same good effects as ichthyol : in some 
instances, its soothing, antipruritic qualities seem to 
be greater than those of ichthyol." 

Thigenol is employed chiefly in skin 
diseases and gynecological affections. 



ThiOCOl Roche 

Potassium Guaiacol-Sulphonate. 

A Soluble Form of Guaiacol. 

Odorless; non-irritating: readily assimilated. 

Clinical reports, published during the past 
seven years, indicate the value of Thiocol in 
incipient tuberculosis, bronchitis, winter 
coughs, typhoid fever, pneumonia, malaria. 

Procurable in three forms : Powder ; 5.grn. 
Tablets; Syr. Thiocol Roche. 



Digalen 

Dieritoxinum Solubile Cloetta. 

A Distinct Advance in Digitalis 
Medication. 

The most active glucoside of digitalis is 
now procurable in soluble form. Digalen 
may be employed per os, per enema, and by 
intravenous and subcutaneous injection. 
May be used wherever digitalis is indicated. 
Marketed only in solution, because of infinitesimal 
dosage, in 'A-oz. vials. 



Airol Roche 

Bismuth Oxyiodogallate. 

Odorless Wound Antiseptic. 

"I 

Airol, 



have had marvellous results with 
and shall continue to use it in 

preference to iodoform," writes a physician 

of Holland, Indiana. 



For samples and literature :-Mark the name of the medicament of which you desire a sample; cut out this ad. 
and mail it to us with your address. 

THE HOFFMANN=LaROCHE CHEMICAL WORKS, 5I=53 Maiden Lane, New York. 



' 



164 



THE CHARLOTTE MEDICAL JOURNAL. 



Scott's Emulsion 



The bone-forming and nerve- 
strengthening hypophosphites in 
Scott's Emulsion make it espe- 
cially useful for young children. 
Scott's Emulsion contains nothing 
that children should not have 
and everything that they should. 



SCOTT & BOWNE, Chemists, 409 Pearl St, New YorK. 



MORRISON SURGICAL PADS 



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little more than the regular style of surgical pads over which 
they possess many advantages. The inflatable air cushion is at- 
tached in such a manner that there is no .sp;ice or crevict; he- 
tweeii the cushiuii and the body part of the pad. This is a 
very important improvement as the cushion lies flat when deflated, 
and can be easily sterilized and thoroughly cleaned. 

The body of the pad is attached to the centre of the air space 
(see cut) instead of the bottom, and because of this the ciiihioii can 

be used on either side, which is a 

^ ^.. ^^' '"^^^ great advantage, as the wear is uni- 

^i. " ^ '^^^Sk. form on both sides. This tends to 

^ ^Sk^ make the pad last longer than one 

Tnade as they were formely. The feature of the 
new, and permits more thorough cleaning 
than could be done with the sleeve per 
manently attached to the pad. 
Made in fj>c nizcs. 

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SOLE MANUFACTURERS. 



INDEX FOR SEPTEMBER. 



165 



TABLE OF CONTENTS FOR SEPTEMBER, 1906 



Original Coniiminications. 

A Difficult Cranioomy, by 
Dr. L. C. Keerans, Char- 
lotte, N. C, 118 

Asphyxia Neanatorum, by 
Dr.'Cha.s. J. Sawyer, Salis- 
bury, N.C. 113 

Are we Doin^ our Duty in 
Trying- to Prevent the 
Spread of Venereal Dis- 
ease, by Dr. J. H. Marsh, 

Fayetteville, N. C, 122 

An Unusual Case of Ectopic 
Gestation, by Charles Z. 
Candler, M. D., Dillsboro, 

N.C 125 

Carcinoma of the Penis, by 

Thos. M. Green, M. D.,. . 147 
Chairman's Report — State 
Medicine as now Enforced 
and how it Should be, by 
Dr. W. F. Hargrove, 

Kinston, N. C., 145 

Chorea Gravidarum, with 
Report of a Case, by Dr. 
J. M. Templeton, Cary, 

N.C 142 

Forceps in Labor, by Dr. L. 
D. Wharton, Smithfleld, 

N.C, 115 

Management of the First 
Stage of Labor, by H. 
McKee Tucker, M. D., 143 
Mitral Insufficiency: Symp- 
toms and Treatment, by 
Dr. O. L. Ray, Raleigh, 

N. C, II. F. D., 134 

Notes on Puerperal Eclamp- 
sia, by Dr. W. C. Folger, 

Dobson, N. C, 126 

Personal Experiences in the 
Treatment of Pulmonary 
Tubei'culosis, by Edwin 
Gladmon, M.D., Southern 

Pines, N.C, 127 

Perineal Lacerations—Pre- 
vention and Treatment, 



by W. F. Mitchell, M. D., 
Shelby, N. C, 140 

Some Viewi4 on Curettment 
of the Uterus, by Dr. M. 
A. Royall, Yadkinville, 
N. C 138 

The Physician and His Re- 
lation to Tuberculosis as 
a Social Problem, by Dr. 
T. A. Mann, Durham, N. 
C 123 

Treatment of Typhoid Fe- 
ver, by Dr. J. M Mat- 
thews, Mt. Pleasant, N. 
C, 130 

The Open Gauze Method of 
Administering Anaes- 
thetics, by William Mou- 
cure, M. D., 507-8 Tucker 
Building, Raleigh, N. C, 131 

Treatment of Pneumonia, 
by Lloyd P. Russell, 
Fletcher, N. C 133 

The Use of the Microscope 
in General Practice, by 
Everett A. Lockett, M.D., 
Winston-Salem, N. 137 

Treatment of Teething, by 
J. Steven Brown, M. D., 
Greystone Retreat, Hen- 
dersonville. N. C, 113 

Tuberculosis of the Hip 
Joint, by E. C. McEach- 
ern, M. D.. ( ordova, N. C 116 

Where The Tides Meet, by 
H. S. Lott, M. D.. Wins- 
ton-Salem, N. C, 120 

Editorial 

Compulsory Emasculation, 152 

Dr. James Mclvee, 151 

Dr. H W.Lilly 154 

The Etiology of Tabes, .... 151 
Some Further Studies on 
the Lymphatic System 

and Tuberculosis 153 

The Drainage of t he Faucial 
and Pharyngeal Tonsils . 153 



Review of Soutlierii Medical 
Literature 155 

Booli Notices. 

A Compend of Materia 
Medica, Therapeutics and 
Prescription Writing, by 
Samuel O L. Potter, iVl . 
D. M R. C. P 160 

A Narrative in Medicine in 
America, by James Gre- 
gory Mum ford, M. D....162 

A Non-Surgical Treatise on 
Diseases of the Prostate 
Gland and Adnexa, by 
George Whitfield Overall, 
A.B.. M. D 162 

Clinical Diagnosis by Chas. 
Phillips Emmersoc, J^. 
M., M. D 160 

Childhood; Mrs. Theodore 
W. Birney 161 

Coniston, by Winston 
Churchill 161 

If Youth but Knew, by Ag- 
nes and Edgerton Castle . 161 

The Battles of Labor: Wil- 
liam Levi Bull Lectures 
for 1906 161 

The Prophylaxis and Treat- 
ment of Internal Diseases: 
F. Forchheimer 161 

Walter Reed and Yellow 
Fever, by Howard H. 

Kelly 160 

Abstracts. 

Carcinoma of the Uterus.. 150 
Dietary Control of Base- 
dow's Disease 166 

Etiology and Treatment of 

Diabetes 167 

Resection rf the Ovaries, 150 
The Significance of Strepto- 
cocci in Milk 150 

Torticollis Wry-Neck 162 



NEW ORLEANS POLYCLINIC 

THE TWENTIEII ANNUAL SESSION OPENS NOVEMBER 5. 1906. and CLOSES 

MAY 18, 1907 

I is intended for practitioners only. All in,,truction aims to be CLINICAL and PRACTICAL ^nd to 
■ill be made of the vast facilities offered at the great Charity Hospital, at the Eje, Eai, Nose anti 
the Special Clinics to be held at the Polyclinic, ■ ^ , ,, , ;.,, f,„iiif!e... iviu 

j/nvsicians in tne interior, who. by reason of their isolation, have been deprived of ^'^ l'°«P t^^^^'^f '''^f/. V" 
will find the POLYCLINIC an e.vcellent means for posting themselves upon the Status of the science of medicine 

^"VhoTeTe "irons of ^^rfecting themselves in any special department or of becoming familiar with the use of any 
of the allied branches, such as Electricity or Microscopy, will be afforded every faeiUtj , , ^ , 

For information address NEW ORLEANS POLYCLINIC, P O. Box, 797 N. O , La. 



This school is intended for practitioners only, 
this end 
Throat Hospital, and at the Special Clin 



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PRELIMINARY FALL COURSE BEGINS SEPTEMBER i. 
REGULAR WINTER COURSE BEGINS SEPTEMBER 20, 

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Send for Catalogue, and address DAVID STREE TT, M. D. Dean, 

^ ' 712 Park Ave., Baltimore. Md. 



166 



THE CHARLOTTE MEDICAL JOURNAL. 



irritation. It disappears as soon as the 
cause of the spasm is removed. The fixed 
form is due primarily to a chanoe in the 
sterno-mastoid, and then to secondary con- 
traction in the trapezius and other muscles 
of the neck and deep facia, and lastly there 
are distinct alterations in the shape of the 
cervical spine. The patholog^y shows that 
there is always a fibroid nature, the muscle- 
fibre being replaced by dense cicatrical 
tissue. 

As to the as3'mmetry of the face, the au- 
thor is of the opinion that it is due to the 
pressure on the carotid vessels which pres- 
sure allows less blood to go to the affected 
side. This may be proven by placing a 
delicate surface thermometer on the con- 
tracted side of the face where it is found 
that the temperature is less than on the un- 
contracted side. The author points out that 
there are three curves in the spine: one 
cervical, which is primary; second, a long 
compensatory curve in the dorsal region; 
and, third, a corresponding compensatory 
curve in the lumbar region. The treatment 
of this form is operative, and may be done 
in one of two ways: one, which is unsafe 
and unwise and unsatisfactory, viz.: sub- 
cutaneous tenotomy; and the other, which 
is perfectly safe and overcomes the deformi- 
ty, that is, open operation and thorough 
division of the contracted muscle. 

As to the spasmodic form of torticollis 
there is evidence accumulating to show that 
it is due to some form of cerebral lesion, 
probably due to sclerotic changes in the 
vessel. Many of these cases have some his- 
tory of mental aberration in their family. 
They go through a large amount of treat- 
ment, all of the remedies proving of no 
value whatever. Up to the year 1888 the 
best form of treatment for these cases was 
the stretching or cutting of the spinal ac- 
cessory nerve. To Professor Keen and Dr. 
Gardner, however, is due the credit jointly 
for devising a radical operation, which con- 
sists in cutting down on the posterior prim- 
ary branches of the cervical nerve and re- 
moving a portion of them. By this opera- 
tion you deprive the back part of the head 
of sensation, and also the skin of the neck, 
and you break the vicious reflex circle 
which runs through the sensory nerves. At 
the same time you cut out the motor supply 
to the posterior cervical muscles and so stop 
the vicious movements. 

False torticollis is associated with spinal 
caries and follows cicatrices of burns and 
wounds in the neck. The neck is twisted 
in some cases in a way similar to that seen 
in true wry-neck. 



Dietary Control of Basedow's Disease. 

— Alt (Muench. Med. Wochschr.) has con- 
ducted experiments in the meta]:)olism of 
patients afflicted with exophthalmic goitre, 
and found that the pathological changes in 
function consist of sodium chloride reten- 
tion, diminution in tolerance for carbohy- 
drates (as appears from the presence of 
sugar in the urine after relatively small 
quantities of carbohydrates), and a much 
exaggerated excretion of phosphoric acid. 
In addition to this a greatly increased nutri- 
tional value is required by these patients to 
meet the active katabolic changes, in some 
cases as much as 100 calories per kilo of 
weight. 

On ttie basis of these observations he 
places these patients on a milk diet, in 
quantity not containing more than 4 g. of 
sodium chloride in the 24 hours. This 
small quantity of salt is continued indefi- 
nitely; meanwhile the salt retention is re- 
lieved- and a greater tolerance for salt is 
gradually developed. Carbohydrates (salt 
free ) are added to the diet in 3 or 4 da^-s 
and gradually increased until the limit of 
tolerance (indicated by the appearance of 
sugar in the urine) is reached. The weight 
usually falls until sufficient caloric- values 
have been reached. This is usually accom- 
plished after the tolerance for carbohydrates 
has been reached by the addition of fats, — 
antithyreoidin during periods varying from 
four to eight wxeks at intervals of two or 
three weeks. 

5. Cases without marked goiter, with 
slight exopthalmic, tremor, and the Graeffe 
symptom, have yielded most readily to the 
antithyreoidin treatment. The enlarged 
thyroid has become perceptibly small, but 
has not returned to the normal size. 

6. ICxophthalmos, in our experience, con- 
tinues to be the most -rebellious symptom, 
never yielding entirely to antithyreoidin 
treatment. 

7. Nervous symptoms usually yield as the 
heart becomes slower. The many fears 
which take possession of these patients are 
also relieved at the same time. 

8. The majority of our patients have in- 
creased in weight. .Patients who have taken 
antithyreoidin during a long period feel 
when the serum is discontinued as if they 
had been robbed of a food to which they are 
entitled. 

9. In no case have Ave had occasion to 
regret the trial of antithyreoidin. It has 
always proved itself harmless. It may be 
given during pregnancy without fear of in- 
juring the mother or fcetus. Hypertrophied 
and dilated hearts offer no counter-indication 
to its administration. 



ADVERTISEMENTS. 



We Have Nothing to Hide 

Our formulas as published are complete in every way, giving the exact 
quantity of each ingredient (including alcohol, if it be present), printed in 
plain English, and forming a part of the label. 

Honesty and frankness, with intrinsic merit, recently elected a man to the 
Presidency of these United States; and honesty and frankness will elect into 
popular and continued favor any genuine, worthy medicine. If all Proprie- 
tary Medicine houses would only engage in such an endeavor, we could wipe 
out forever a great lot of miserable, useless, and even dangerous compounds 
that are now causing, directly or indirectly, the annual loss of thousands and 
thousands of lives, to say nothing of the millions of dollars stolen from our 
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If we know our product is good, if we know it contains merit, genuine 
merit, then we can safely place our case before the very best jury in the 
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and thereby creating in him an ever-increasing confidence. 

J. C. AYER COMPANY, Lowell, Mass. 



Etiology and Treatment of Diabetes.- toms of diabetes. Psychical disturbances, 
Burwinkel (Der Arzt als lirziclier) says as fright, etc., and changes in the pancreas, 
that in 400 cases by French, 206 occurred People of the upper class seem to be predis- 
between 40 and 60, 5 between 1 and 10, 42 posed. The author mentions a very inter- 
between 30 and 40, 70 between 40 and 50, esting case of a hysterical woman who in- 
2 between 60 and 70, 29 between 18 and 20, jected sugar into her bladder in order to 
and 5 after 70. It has been present at .seven stimulate this disease. Among the atypical 
months and at 81 years. Males to females symptoms, weakness, malaise and loss of 
is 3-1. Females in younger ages, especially physical energy may be the only complaint 
during the menopause. The author believes for a long time. Contrary to the rule, de- 
that diabetes should be classified as a dis- creased appetite, distension of the abdomen, 
ease of metabolism or a constitutional dis- vomiting and irregular bowel movements 
ease; that no localized cause (?) has yet are sometimes early symptoms. Patients 
been established; that the normal urine often complain of tape worm symptoms, or 
contains a trace of sugar and blood; that if rheumatism and constant pruritis. Diabetic 
from 50 to 200 gms. of glucose is introduced rhinitis sometimes causes the most disturb- 
into an empty stomach the urine contains ing symptoms and in children incontinence 
sugar without the presence of organic dis- of urine. The author states that it is not 
ease. It is also normal in pregnancy and a uncommon to have a diabetes cause nephritis 
few days after birth. That it is present in and also have sugar in the urine in a case 
poorly nourished people (Hopp-Schiller); of contracted kidney; that angina pectoris 
that shock and anxiety (Von Noorden), and phthisis occur as complications of severe 
intoxications, carbondioxide, morphine, forms of diabetes. As to the course Seegen 
amylnitrite, alcohol and blue saure produce observed no cures in 400 cases treated by 
glycosuria. Etiological factors are heredity Karlebab. Naunya and Wientric considered 
(gout, adiposes, uric acid diathesis and the prognosis as to cure unfavorable. Cantim 
neurosis), alcoholism, sailors and people reported 50 entirely cured in 218 cases, 
whose diet is composed mostly of sweets Young persons are specially liable to short, 
and carbohydrate; infections of the pons rapid course. Slow progression is a favor- 
and fourth ventricle and cranium (tumors, able sign. Excessive exercise and mental 
hemorrhages, softening, epilepsy and apo- exertion frequently cause death by coma, 
plexy). The affections are also frequently Death is sometimes caused by secondary 
accompanied by emaciation and other symp- conditions. As to prophylaxis and treat- 



168 



THE CHARLOTTE MEDICAL JOURNAL 



We will be a happier, healthier race when light, pure 
wines become part of our daily food." 

— Hauerbach, 




nient, he considers diet as most important. 
Laro:e amounts of water are harmful; fresh 
air and a general h^^o^ienic condition of the 
skin are necessary. Mental control is abso- 
lutely indicated. Constant medical observa- 
tion is necessary. Climate and environment 
are especially helpful in this disease. 



Pure Wine 



IS a 



Food 



*|[ It is pronounced so by the greatest med- 
ical authorities and physiologists. 
\ It is easily assimilated and takes the 
place of indigestible starches and unwhole- 
some fats. 

\ Besides these qualities, which make it the 
first among nerve foods, it contains many 
ingredients such as the fruit acids, phos- 
phates and nitrogenous matters which act 
as natural correctives for all stomach 
troubles and disorders of the blood. 
When you buy Garrett's 

Virginia Dare 
IVine 

you get the pure, untainted juice of the 
famous American Scuppernong grape, thor- 
oughly ripened and matured by the most 
approved processes known to the wine 
industry. 

1 The Garrett label is your protection, for 
it makes us responsible. 

Write for our beautiful book — 

^'The Art of Servi?tg Wines'' 

Sent free in exchange for your -u<ine vierchant' s name. 

Tells when, where and how to correctly serve wines ; gives 
valuable recipes for many delicious beverages ; describes Garrett's 
"Virginia Dare," "Minnehaha," " Pocaliontas" and other pure, 
wholesome wines, and cites high autliorities to prove their great 
food value. It is a book worth having. If your dealer will not 
supply you with Garrett's wines.wf 7(^7/ and pay delivery cliarges. 

We insist upon refunding your money if you are not satisfied, 
whether you buy from us or your dealer. Write to-day. 



Antedating the organization of the Red 
Cross work in other countries, Japan had 
instituted a system by which all the wound- 
ed in war received impartial treatment. 
Anticipating the present war Japan got her 
army medical service in working order, and 
as early as last January had fourteen chief 
surgeons, two hundred and seventy-seven 
ordinary surgeons, forty-five pharmacists, 
nearly two thousand trained nurses, about 
five hundred nurses on probation, besides a 
corps of stretcher bearers and male attend- 
ants. 



Jury trials, says Judge W. W. Goodrich 
in an article in the Brooklyn Medical Jour- 
nal, were first introduced in luigland by 
Henry II, in 11. S4, succeeding that hated 
and burdensome Norman importation, the 
duel or trial by battle, and that curious form 
of trial, than which nothing is older and 
which is ever^^where found among barbar- 
ous people, to-wit, the ordeal, wherein the 
defendant is subjected to certain so-called 
divine tests, of the balance, fire, water, 
poison and sacred libation. 



GARRETT L 



■ CC. -28 Berkley Av. Norfolk, Va. 



University College of 

,, ,. . RICHMOND 

Medicine, Virginia. 

Stuart McGuire, M. D., President. 

DEPARTMENT OF MEDICINE 

Member of the Association 

of 

AMERICAN MEDICAL COLLEGES 

Standards, 

of 

Admission, instruction and graduation 

Entitle 

degrees to recognition 

in 

Every State in the Union. 

Addreit William R. Miller, Proctor. 



ADVERTISEMENTS. 



St. Luke's Hospital 

RICHMOND, VA. 



VJt. LUKE'vS HOvSPITAIv is 
^ personally conducted by 
Dr. Stuart Mcguirk for the 
exclusive use of his private 
patients. It is located on the 
corner of Grace & Harrison 
Streets, in an elevated and 
healthy section, and is of con- 
venient access to all parts of 
the city by means of the street 
car service. The building was 
erected in 1900 and enlarged 
in 1905. It represents the best 
efforts of architectural skill to 
meet the demands of a modern 
sanatorium and now has a ca- 
pacity for 62 patients. The 
rooms are furnished with every 
comfort consistent with perfect 
sanitati on. Some of them have 
private baths. The wards are 
large, light and airy The 
service and cuisine are the 
same throughont the building, but the cost of a bed, board, and general nursing varies from 
fio.oo to $25. 00 per week according to location. No contagious diseases, cases of insanity 
or colored patients are received. 

For further information address, 

Stuart McGuire, M. D., 

Surgeon in Charge, or 

W. Lowndes Peple, M. D., 

Associate. 




BROADOAKS SANATORIUM, 

Morganton, North Carolina* 

A Private Hospital for the Treatment of Nervous 

and Mental Diseases, Inebriety and Drug Habits. 

ISAAC M. TAYLOR. M. D, 

The recent enlargement, and consequent increase in number of patients, 
has made necessary the employment of an Assistant Resident Physician, who 
has entered upon his service. We purpose paying especial attention to the 
treatment of Drug Habits, and the permanent care of patients of both sexes, 
with chronic mental diseases of mild type. Other improvements are in pros- 
pect which will be announced when our plans are matured. 



St. Peter's Hospital, charlotte, n. c. 

Specially Equipped for the Treatment 
of Gynecological and Surgical Cases. 



GEO. W. PRESSLY, M. D., 

Surgeon. 



EDW'D C. REGISTER, M. D., 

Physician. 



For further information address the Superintendent, St. Peter's Hospital 



THE CHARLOTTE MEDICAL JOURNAL. 



Miscellaneous. 



The Modern Management of Malarial 
Anemia. 

One of the most obstinate forms of anemia with 
which the physician has to contend is that which 
succeeds malarial infection, This particular form 
of anemia is, unquestionably, due directly to the 
structural changes induced by the protozoon para- 
site. 

While a mild form of anemia is a common, if not 
invariable, consequence of malarial infection, there 
is a severe type, termed malarial anemia, which not 
infrequently occurs. This latter variety usually 
responds slowly to curative measures; and, since its 
existence renders the individual a fit subject for 
recurring malarial manifestations upon the slightest 
exposure, the importance of its cure cannot be too 
strongly emphasized. 

The doctrine of the latency of malarial poisoning 
in the human body is rapidly gaining in popularity. 
Some authorities even go so far as to claim that a 
person who has once been inoculated with the ma- 
larial protozoa never completely recovers. 

Whether this be true or not, it is certain that the 
protozoon parasite does exert an influence which 
tends, for a great length of time, to lower vitality 
and render feeble the powers of resistance to re- 
newed attacks. This is especially true in the case 
of women, children and persons of advanced age. 

Recent investigators unite in ascribing the cause 
of malarial anemia to the liberation of hemoglobin 
from the red corpuscles in the blood vessels. The 
pigmentation resulting from this liberation of 
hemoglobin is one of the characteristics of malarial 
infection. And while the coloring matter may re- 
main in the blood stream, it usually infiltrates into 
the cells and neighboring tissues. The deposit of 
pigment is especially great throughout the tissue of 
the liver and spleen. 

The thickening and softening of the mucous 
membrane of the stomach which always attends 
malarial infection, seems likely to contribute, at 
least to some extent, to the development of anemia. 

In every instance the degree of the anemia is in 
direct ratio to the amount of the hemoglobin liber- 
ated from the red corpuscles. And this fact ex- 
plains the philosophy of effecting repair by the ad- 
ministration of iron, the hemoglobin-contributor. 

Whether or not the protozoon parasite is ever 
completely eliminated from the economy remains 
an unanswered question. But it is now universally 
conceded that the protracted administration of iron 
does render the individual partly, if not completely, 
exempt from a return of malarial manifestations of 
an aggravated type. Far more so, in fact, than 
does quinine. Indeed, we have good cause to be- 
lieve that iron does exert a destructive influence 
upon the malarial protozoa and increases the im- 
munity of the individual. 

While it is the chief aim of the physician to make 
up the deficiency of the hemoglobin in these sub- 
jects by the administration of iron, it is distinctly 
important, coincidently, to increase the appetite 
and augment the capacity to appropriate the food 
ingested